IPNA Online | Archive

Surgical management of vesicoureteral reflux in children

Wed, May 16, 2012

What is the success rate of endoscopic injection for treatment of VUR

a. 30-40%
b. 50-60%
c. 70-80%
d. 90-95%

What is the risk of renal scarring following first UTI

a. 5%
b. 10%
c. 15%
d. 25%

All of the following are recommendations based on the 2010 AUA guidelines for the treatment of VUR, except:

a. A VCUG should be performed following a febrile UTI in a child with prior successful endoscopic treatment
b. Surgical correction is recommended for patients on antibiotic prophylaxis with febrile break-through UTI
c. Either endoscopic or open repair of VUR are acceptable options for surgical correction
d. Endoscopic injection is effective for the treatment of grade 5 VUR

The only factor which has been demonstrated to significantly influence DHA injection success rate is:

a. Surgeon experience
b. Pre-operative VUR grade
c. Injection volume
d. Conflict of interest

Which of the following is not true of endoscopic treatment of reflux:

a. Entails injection of a bulking agent, allowing coaptation of the ureteral orifice
b. Sub-ureteral and intraureteral injection techniques have been described
c. Presence of bladder and bowel dysfunction does not affect the cure rate
d. Benefits include outpatient surgery and decreased patient morbidity

Renal involvement in mitochondrial cytopathies

Wed, May 16, 2012

Uncategorized

Which of these statements is correct in respect to mtDNA:

a. As opposed to nuclear DNA, mtDNA is single stranded
b. Contains the nuclear information of all mitochondrial proteins
c. Mutations are always evenly distributed in cells
d. It forms a circular string that varies in length among individuals
e. None of the above is correct

Which of the following organic acids is highly evocative of a renal mitochondrial cytopathy when found in excess in urine:

a. 3 OH-butyrate
b. Succinate
c. Fumarate
d. Phenyl acetone
e. None of the above

The most frequent renal disease in mitochondrial cytopathies is:

a. Renal vascular disease
b. Chronic interstitial nephritis
c. Proximal tubulopathy
d. Glomerulopathy
e. None of the above

Which of the following statements is correct:

a. Clinical or subclinical renal involvement is always present in mitochondrial cytopathies
b. All patients with mitochondrial cytopathies have neuromuscular symptoms
c. Patients generally become symptomatic after the age of 5 years
d. FSGS lesions in patients with a maternal history of diabetes and deafness is evocative of a mutation of the tyrosine tRNA gene
e. None of the above

Which of the following statements is correct:

a. Mitochondrial coenzyme Q10 derives primarily from de novo synthesis
b. Coenzyme Q10 is present in the normal diet
c. Mutations in genes involved in the biosynthesis of coenzyme Q10 may cause NS
d. Symptoms related to coenzyme Q10 defects may be prevented by oral ubiquinone supplements
e. All of the above

Surveillance biopsies in children post-kidney transplant

Wed, May 16, 2012

Uncategorized

The following statements about subclinical acute cellular rejection (SCR) are true except:

a. The incidence of SCR is dependent on the amount and potency of immunosuppression
b. In adult renal transplant recipients, the incidence of SCR is decreasing
c. In pediatric renal transplant recipients, the incidence of SCR is decreasing
d. SCR is defined as Banff histology showing acute rejection in patients with stable allograft function

True or False: Acute subclinical rejection (A-SCR) is defined as acute rejection by Banff criteria (≥i2t2) with a concomitant increase in the serum creatinine.

a. True
b. False

True or False: Borderline subclinical rejection (B-SCR) is defined as acute rejection which does not meet Banff criteria (i0-i1 and/or t1-t3) without a concomitant increase in the serum creatinine.

a. True
b. False

The following are complications of surveillance biopsies except:

a. Macroscopic hematuria
b. Arteriovenous fistula
c. Death
d. Bowel perforation

All of the following increase the risk of post-biopsy hemorrhage except:

a. Acute rejection with vascular involvement
b. Adult-sized kidney (ASK)
c. Penetration of the renal medulla
d. Use of a 16-gauge needle

Which of the following lesions have been observed in surveillance biopsies?

a. Acute cellular rejection
b. Interstitial fibrosis and tubular atrophy (IF/TA)
c. Transplant glomerulopathy (TG)
d. All of the above

Hypertensive crisis in children

Wed, May 16, 2012

Uncategorized

The pathogenesis of hypertension in hypertensive crisis is all of the following except:

a. Increased activity of the renin angiotensin system
b. Increased nitric oxide activity
c. Increased sympathetic activity
d. Endothelial dysfunction
e. Decreased kininogen activity

A 45-day-old premature infant who weighed 700 g at birth is being weaned from oxygen to room air. An ophthalmologist performed an eye exam. The infant was noted to have an acute increase in blood pressure from a baseline of 70/40 mmHg to 130/70 mmHg with tachycardia. The most likely etiology is:

a. History of umbilical artery catheterization
b. Development of broncho-pulmonary dysplasia
c. Phenylephrine eye drops
d. Renal parenchymal disease
e. Coarctation of aorta

A 5-year-old female had a living donor kidney transplant. Seven days after the transplant she had a seizure. Her blood pressure was 170/120 mmHg, and her serum creatinine was 0.8 mg/dl. Calcineurin inhibitors were started on the third post-transplant day, and she was also started on mycophenolate mofetil. She is polyuric. What would you most likely expect to find upon investigation.

a. Posterior reversible encephalopathy
b. Acute vascular rejection
c. Fluid overload
d. Increased intracranial pressure
e. High mycophenolate mofetil levels

An 8-year-old male has ESRD and is on hemodialysis. He had severe hypertension which improved with aggressive fluid removal and re-adjustment of his dry weight. His hypertension was managed with β blockers, clonidine and a calcium channel blocker. Blood pressures are now generally 110/80 mmHg. Which of the following would you consider as the next step.

a. Wean clonidine
b. Stop calcium channel blocker
c. Increase β blocker
d. Increase dry weight
e. All of the above

Posterior reversible encephalopathy syndrome in children with kidney diseases

Tue, May 15, 2012

Uncategorized

Symptoms of PRES include:

a. Seizures
b. Headache
c. Visual disturbance
d. Altered consciousness
e. All the of the above

Which of the following agents is used for management of PRES?

a. Steroid
b. Antihypertensive agents
c. Immunoglobulin
d. Antibiotics
e. All of the above

The most sensitive modality for the diagnosis of PRES is:

a. Cranial CT
b. Cranial MRI
c. Electroencephalography
d. Funduscopic examination
e. Cerebrospinal fluid study

PRES can develop in children with:

a. Hemolytic uremic syndrome
b. Nephrotic syndrome
c. Kidney transplant
d. Acute poststreptococcal glomerulonephritis
e. All of the above

The chief pathophysiological component of PRES is:

a. Cytotoxic edema
b. Hemorrhage
c. Vasogenic edema
d. Infection
e. Degeneration of neurons

Epidemiology of chronic kidney disease in children

Tue, May 15, 2012

Uncategorized

Which of the following statements regarding CKD is false?

a. The KDOQI guidelines define CKD as a GFR < 50 ml/min/1.73 m2
b. GFR increases from birth and reaches adult values by 2 years of age
c. CAKUT is the major cause of CKD worldwide, although the proportion of glomerulonephritis in developing countries is higher due to infectious causes
d. There are few population-based studies in the early stages of CKD as it is often asymptomatic

Which of the following statements regarding screening in children is true?

a. Screening is currently recommended in children in the USA by the American Academy of Pediatrics
b. Screening has been proven to reduce the development of ESRD
c. Screening mainly employs dipsticks in children, as opposed to calculating GFR in adults
d. Urine dipstick testing is a cost-effective strategy for detecting CKD

Which of the following statements regarding ESRD is false?

a. Prevalence of ESRD is increasing owing to better overall survival and increased uptake of younger children and infants into RRT programs
b. The prevalence of RRT in 2008 in Australia, Canada, and western Europe (except Finland) is around 65 pmarp
c. Access to ESRD programs is highly dependent on socio-economic factors and as such, is limited in poorly developed countries
d. Incidence of ESRD varies depending on age and ethnic group
e. The majority of children are transplanted pre-emptively

Which of the following regarding mortality and morbidity is false?

a. The mortality rate has remained relatively unchanged in the last 15 years and is about 30 times higher than in healthy peers
b. Children on dialysis have a higher mortality rate compared with transplanted patients
c. Rejection is the main cause of admission in transplanted children
d. 20–40% of deaths in RRT are cardiovascular-related

Which of the following statements regarding CKD progression is not true?

a. Hypertension is a major risk factor for CKD progression
b. Hyperphosphatemia is an independent risk factor for CKD progression, as has been shown in prospective studies
c. There is evidence that the progression of CKD can be slowed by pharmacological intervention
d. The rate of CKD progression is inversely proportional to baseline GFR
e. Children with congenital disorders experience a slower progression of CKD than those with glomerulonephritis

Dyslipidemia in children with CKD: should we treat with statins?

Tue, May 15, 2012

Uncategorized

Which of the risk factors for the development of CVD listed below are possible to treat in children with CKD?

a. Disturbed calcium phosphate metabolism
b. Dyslipidemia
c. Hypertension
d. Obesity
e. All of the above

Treatment with a statin has convincingly been shown to improve mortality from CVDs in adult patients

a. In CKD stage 2
b. On haemodialysis
c. On peritoneal dialysis
d. After a kidney transplant
e. All of the above

The American Academy of Pediatrics recently recommended:

a. Lipid screening in all children
b. Lipid screening in all children with one or more of defined risk factors for CVD
c. Treatment with a statin to be considered in all children older than 8 years with a confirmed LDL cholesterol level >4.9 mmol/L
d. Treatment with a statin to be considered in all children older than 8 years who have one of defined risk factors and a confirmed LDL cholesterol level >4.1 mmol/L
e. b, c and d.

Which of the below statements is not true regarding a child with CKD?

a. Has an increased risk to develop CVD
b. Should always have good blood pressure control
c. In many cases show increased levels of total and LDL cholesterol
d. Should have calcium phosphate balance carefully managed
e. Should routinely be treated with a statin if LDL cholesterol levels are increased

Treatment data from adult patients with CKD are difficult to extrapolate to children, as:

a. The diagnosis causing CKD in adults and children are very different
b. The child is growing and developing
c. There is a lack of long-term safety data in children
d. CVD normally becomes clinically overt when the child has grown up and been transferred to adult care
e. All of the above