Professional Documents
Culture Documents
Question 1:
A 10-yr-old girl (body surface area of 1.0 m2) with chronic renal insufficiency is seen in your
clinic and undergoes a 24-hr urine collection for measurement of creatinine clearance. The
results are as follows: urine creatinine 144 mg/dL (12672 mcmol/l) ; serum creatinine 1.7
mg/dL (150 mcmol/l); urine volume 700 mL. Based on these measurements, this patient's
standard creatinine clearance (mL/min/1.73 m2) is:
35 mL/min/1.73 m2
60 mL/min/1.73 m2
40 mL/min/1.73 m2
70 mL/min/1.73 m2
25 mL/min/1.73 m2
Question 2:
A 3-yr-old boy presents to your office with sudden onset of cola-colored urine, progressive
facial swelling over the past 3 days, and decreased urine volume over the past day. His
examination is notable for blood pressure 130/80 mm Hg, periorbital edema, bibasilar rales,
and ankle swelling. His urinalysis is remarkable for 3+ hematuria, 1+ proteinuria, 100 red
blood cells per high-power field, and red blood cell casts. His serum electrolytes are normal
and the serum albumin is 3.2 g/liter. This clinical presentation is most consistent with:
Acute pyelonephritis
Nephrotic syndrome
Acute glomerulonephritis
Question 3:
In the case described in Question 2, which of the following laboratory studies would be the
most helpful in determining the cause of this patient's hematuria and proteinuria?
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Complement C3 and C4,
Question 4:
Question 5:
A 15-yr-old boy with a 12-yr history of microscopic hematuria is noted to have bilateral high-
frequency sensorineural hearing loss, blood pressure of 140/90 mm Hg, serum creatinine of
1.5 mg/dl (132 mcmol/l), and urinary protein of 2,000 mg/24 hr. This patient's mother also has
microscopic hematuria. The most likely mode of inheritance for this child's glomerular disease
is:
X-linked dominant
Autosomal recessive
X-linked recessive
Autosomal dominant
Question 6:
A 5-yr-old girl presents with cola-colored urine, oliguria, and body edema 2 wk after being
treated for group A-hemolytic streptococcal pharyngitis. Her complement C3 is noted to be
very low at 15 mg/dL (0.15 g/l). When should this patient's complement C3 level be repeated
in order to confirm your suspected diagnosis?
In 1 week
In 2 weeks
In 3 weeks
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In 4 weeks
In 8 weeks
Question 7:
The most common clinical presentation for membranous nephropathy in children is:
Nephrotic syndrome
Question 8:
Question 9:
A 14-yr-old girl presents to your clinic with a 1-mo history of fatigue. Over the past week, she
has developed low-grade fevers with temperatures to 38 oC, bilateral knee pain, and chest
pain with deep inspiration. On examination, she is seen to be a tired-appearing adolescent in
no acute distress. Blood pressure is 130/80 mm Hg. Breath sounds are diminished over the
right lung base. Cardiac examination findings are normal. Abdominal auscultation/palpation
reveals no abnormalities. A urinalysis reveals 3+ hematuria and 3+ proteinuria. Which of the
following laboratory studies is the most appropriate next step in confirming this patient's
diagnosis?
Sedimentation rate
Rheumatoid factor
Antinuclear antibody
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Anti-neutrophil cytoplasmic antibody
Kidney biopsy
Question 10:
The most appropriate initial treatment for the patient described in Question 9 is:
Oral chorambucil
Oral prednisone
Plasmapheresis
Question 11:
A 3-yr-old boy presents to an urgent care clinic with a 3-day history of abdominal pain and
difficulty walking. Abnormal findings include blood pressure of 120/80 mm Hg, diffuse
abdominal tenderness, purpuric rash of the hands and ankles, and diffuse periarticular
tenderness and swelling of the ankles. The most likely diagnosis is:
Henoch-Schoenlein purpura
Stevens-Johnson syndrome
Question 12:
All of the following glomerular diseases often manifest with rapidly progressive
glomerulonephritis except:
Wegener's granulomatosis
Membranoproliferative glomerulonephritis
Goodpasture syndrome
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Focal segmental glomerulosclerosis
Question 13:
A 3-yr-old girl presents to your office with acute onset of lethargy and pallor. The child's
mother reports that the child had bloody diarrhea for 5 days that cleared one day prior to
presenting to your office. She also notes acute onset of cola-colored urine. On examination,
the patient is pale and lethargic. Blood pressure is 120/80 mm Hg. The most appropriate next
step in diagnosis would be:
Urinalysis
Urine culture
Prothrombin time
Question 14:
A 3-yr-old girl develops bloody diarrhea and pallor of acute onset. A stool culture reveals E.
coli O157:H7. Laboratory values include Na+ 130 mg/dL, K+ 5.5 mEq/L, Cl-90 mg/dL, total
CO2 18 mEq/L, BUN 100 mg/dL (urea 35 mmol/l), and creatinine 4.0 mg/dL (352 mcmol/l). All
of the following are accepted treatments for this patient except:
Aggressive nutrition
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Question 15:
A full-term male newborn is noted to have gross hematuria of acute onset associated with
new bilateral abdominal flank masses at 24 hr of life. All of the following may be contributing
factors in this clinical scenario except:
Dehydration
Perinatal asphyxia
Hypertension
Sepsis
Maternal diabetes
Question 16:
An 8-yr-old girl presents with dysuria, abdominal pain, and intermittent red urine. A urinalysis
reveals specific gravity of 1.020, pH of 6.0, 2+ blood, no protein, and Excess red blood cells
per high-power field. A 24-hr urine specimen reveals 8 mg/kg body weight (0.2 mmol/kg) of
calcium. Which of the following is an acceptable treatment for this patient's problem?
Hydrochlorthiazide
Vitamin D supplementation
Vitamin C supplementation
Question 17:
A full-term newborn male is noted to have bilateral flank masses, hepatomegaly, and blood
pressure of 120/80 mm Hg. A renal ultrasound study reveals enlarged hyperechoic kidneys
bilaterally and an echogenic liver. Which of the following is correct regarding this patient's
diagnosis?
Hypertension is uncommon
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Question 18:
A 15-yr-old boy is noted to have enlarged kidneys with macrocysts seen bilaterally on a renal
ultrasound study after developing gross hematuria while playing hockey. His mother is 40 yr
of age and demonstrates similar findings on renal ultrasound examination. What is the most
appropriate next step in this patient's management?
Question 19:
A 15-yr-old boy is seen in your office for dysuria and is noted to have 4+ hematuria and >100
red blood cells per high-power field on urinalysis. All of the following organisms may cause
infection leading to these symptoms except:
Ureaplasma
Chlamydia
E. Coli
Adenovirus
Enterovirus
Question 20:
The plasma filtered through the glomerular capillary walls is cell free but contains all
the substances in the plasma
After birth, the glomerular filtration (GF) increases until kidney growth ceases toward
the end of the second decade of life
Serum creatinine level does not rise above normal until the GF rate falls by 30-40%
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Question 21:
Hematuria is defined as the presence of at least 5 red blood cells (RBCs) in HPF (or 10
RBCs/ul)
Question 22:
IgA nephropathy commonly manifests with gross hematuria 1-2 days after the onset of
an apparent viral upper respiratory tract infection
Gross hematuria does not occur in patients with thin glomerular basement membrane
disease
Question 23:
Microscopic hematuria may persist for 1-2 yr following the initial presentation of PSGN
The best single antibody titer to document cutaneous streptococcal infection is the
deoxyribonuclease (DNase) B antigen
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Question 24:
All of the following statements about hemolytic-uremic syndrome (HUS) are true except:
HUS is the most common cause of acute renal failure in young children
Verotoxin elaborated by Escherichia coli O157:H7 initiates endothelial cell injury in HUS
Question 25:
All of the following statements regarding autosomal recessive and autosomal dominant
polycystic kidney disease (ARPKD and ADPKD) are true except:
In about 85% of patients with ADPKD, the trait maps to the PKD1 gene on the short arm
of chromosome 16
Question 26:
A 16-yr-old boy with focal segmental glomerulosclerosis has a serum creatinine of 1.9 mg/dL
(167 mcmol/l) and a 24-hr urinary protein excretion of 1800 mg. All of the following strategies
may theoretically help to slow the progression of chronic renal failure except:
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Question 27:
A 12-yr-old boy presents with a long-standing history of polyuria and polydipsia, progressive
fatigue, decreased appetite, morning nausea and emesis, weight loss, and impaired growth
velocity. In addition, he has had no response to a 6-mo course of iron therapy for treatment of
anemia. Initial laboratory evaluation reveals BUN of 125 mg/dL (43 mmol/l) and serum
creatinine of 8.7 mg/dL (765 mcmol/l). Other expected laboratory features include all of the
following except:
Hypocalcemia
Question 28:
A 4-mo-old boy is noted to have poor growth at a routine well child visit. Results of laboratory
studies include serum sodium 140 mmol/L, potassium 3.5 mmol/L, chloride 116 mmol/L, and
bicarbonate 13 mmol/L. All of the following should be considered in the differential diagnosis
except:
Chronic diarrhea
Lactic acidosis
Question 29:
A 15-yr-old-girl is admitted with a 5-day history of worsening fever, left flank pain, and
vomiting. Physical examination reveals an ill-appearing, dehydrated adolescent. Pulse rate is
110/min; temperature is 40°C. Left costovertebral angle tenderness is present. Serum sodium
is 131 mmol/L, potassium 6.7 mmol/L, chloride 108 mmol/L, and bicarbonate 15 mmol/L. The
most likely diagnosis is:
Acute pyelonephritis
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Congenital adrenal hyperplasia
Question 30:
A patient develops renal Fanconi syndrome after receiving ifosfamide for treatment of Wilms
tumor. All of the following are features of this condition except:
Phosphaturia
Metabolic alkalosis
Rickets
Polyuria
Growth retardation
Question 31:
A 9-mo-old male infant is noted to have failure to thrive. At birth, his height and weight were
at the 25th percentile, but by 9 mo of age, height and weight are at less than the 5th
percentile. Laboratory tests reveal a non-anion gap metabolic acidosis, with a serum
potassium of 3.5 mmol/L. Serum creatinine is 0.3 mg/dL (26 mcmol/l). Urinalysis shows a
urine pH of 8.0, with no abnormalities. A diagnosis of distal renal tubular acidosis is made.
Renal ultrasonography is most likely to show:
Polycystic kidneys
Nephrocalcinosis
Enlarged kidneys
Question 32:
A 1-wk-old full-term male infant presents with irritability and low-grade fever. His parents
report that his urine output has been very high, despite a decrease in oral intake. Physical
examination reveals a moderately to severely dehydrated infant. Serum sodium is 170
mmol/L. Serum osmolarity is 340 mmol/kg. Urinalysis reveals a specific gravity of 1.000, with
no protein, blood, or leukocytes. Urine osmolarity is 240 mmol/kg. The patient is given
intravenous fluids. Massive polyuria is noted. Vasopressin is administered, but no change in
urine output or urine osmolarity is seen. The genetic defects that cause this congenital
condition result in:
Question 33:
A 16-yr-old girl has a 3-yr history of bipolar disorder and seizures. In the last several months
she has noted new onset of polyuria and excessive thirst. Her current medications include
lithium and valproic acid. Findings on physical examination are unremarkable. All of the
following are potential causes of her recent symptoms except:
Psychogenic polydipsia
Lithium toxicity
Diabetes mellitus
Question 34:
A 1-mo-old infant presents with lethargy. Physical examination reveals a mildly to moderately
dehydrated infant. Results of laboratory tests include serum sodium 137 mmol/L, potassium
3.2 mmol/L, chloride 90 mmol/L, and bicarbonate 38 mmol/L. All of the following are potential
causes of this patient's laboratory findings except:
Pyloric stenosis
Chronic diarrhea
Bartter syndrome
Question 35:
A 13-yr-old girl develops a sore throat and low-grade fever. A throat culture is positive for
group A streptococcal infection, for which she is given oral penicillin. Seven days later, she
develops a rash and fever. Urine output is normal. Her pulse is 90/min; blood pressure is
110/60 mm Hg. Serum creatinine is 2.4 mg/dL (211 mcmol/l). WBC count is 12,000 per mm3
with 60% neutrophils, 25% lymphocytes, and 15% eosinophils. C3 level is normal. Urinalysis
demonstrates specific gravity of 1.010, small amount of blood, no protein, 5-10 WBCs per
high-power field, 5-10 RBCs per high-power field, and no RBC casts. The most likely diagnosis
is:
Question 36:
A 12-yr-old boy presents with a 1-yr history of worsening polyuria and a 2-to 3-wk history of
nausea, fatigue, and malaise. Serum creatinine is 4.0 mg/dL (352 mcmol/l); bicarbonate is 15
mg/dL. Urinalysis shows specific gravity of 1.004, trace leukocytes, trace blood, and no
protein, with 3-5 WBCs per high-power field, 3-5 RBCs per high-power field, and no RBC casts.
Which of the following is the most likely diagnosis?
Question 37:
A 4-yr-old boy with chronic kidney disease is seen in your clinic. His lab shows a serum
creatinine 2.2 mg/dL (194 mcmol/l). His body length is 100 cm. What is the estimated GFR
according to Schwartz formula?
25 mL/min/1.73 m2
40 mL/min/1.73 m2
60 mL/min/1.73 m2
70 mL/min/1.73 m2
80 mL/min/1.73 m2
Question 38:
A 2-yr-old girl has an acute afebrile diarrheal syndrome characterized by abdominal pain,
vomiting, and grossly bloody stools. A stool culture suggests E. coli O157:H7; a fecal toxin
electroimmunoassay suggests that a Shiga toxin is present. Appropriate care includes:
Loperamide
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A parenteral antibiotic (choice based on susceptibility of the Shiga toxin-producing E.
coli)
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Question 39:
Shigella fIexneri
Shigella sonnei
Question 40:
Urine dipstick testing of a specimen obtained from a febrile 4yr-old child with acute viral
gastroenteritis shows specific gravity 1.030, pH 5.0, 2+ proteinuria, and no blood cells. The
most likely cause of the patient's proteinuria is:
Transient proteinuria
Nephrotic syndrome
Orthostatic proteinuria
Acute glomerulonephritis
Chronic glomerulonephritis
Question 41:
A newborn boy is delivered by emergency cesarean section for severe fetal distress and
placental abruption. Resuscitation is required in the delivery room. The infant develops gross
hematuria and oliguric acute renal failure with a peak serum creatinine level of 8.0 mg/dL
(704 mcmol/l) at 8 days of age. The most likely cause of the infant's acute renal failure is:
Renal dysplasia
Cortical necrosis
Obstructive uropathy
Acute glomerulonephritis
Prerenal azotemia
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