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NS MCQs

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Eke Eghosasere Paul
Eke Eghosasere Paul

Nephrotic syndrome is characterized by massive proteinuria, low serum albumin levels, and generally elevated cholesterol. It is most common in children and the male to female ratio is approximately 2:1. Focal segmental glomerulosclerosis can develop from minimal change nephrotic syndrome or present separately, and mutations in podocyte proteins have been implicated in its pathophysiology. Steroid dependent nephrotic syndrome involves relapsing while tapering steroids or within 4 weeks of stopping them.

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NEPHROTIC SYNDROME MCQs
1. Concerning Nephrotic Syndrome: A. There is massive proteinuria of > 40mg/m2/day or 3+ or 4+ on albustix B. Serum albumin levels are usually > 2.5g/dL C. The male:female ratio is about 2:1 D. It is the second most common chronic renal disease of childhood E. Cholesterol levels are generally raised > 250mg/dL
2. Concerning Focal Segmental Glomerulosclerosis: A. Response to steroids may be up to 40% of cases B. Hypocomplementaemia is characteristic C. It may develop from minimal change nephrotic syndrome or present as a separate entity D. Less than 1/3 of cases will progress to renal failure E. Mutations in podocyte proteins podocin and α- actinin 4, and MYH9 gene have been implicated in the pathophysiology
3. The following statements are correct with respect to outcome of Nephrotic Syndrome therapy, except: A. Steroid dependent: relapse while on alternate day steroid therapy, or within 28 days of completing therapy B. Steroid resistant: proteinuria (2+ or greater) after 8 weeks of steroid therapy C. Frequent relapsers: respond well to prednisone therapy but relapse > 6 times in a 12 month period D. Relapse: 3-4+ proteinuria plus oedema for 3 consecutive days E. Remission: diuresis, urine trace or negative for protein for 3 consecutive days
4. On pathology of Nephrotic Syndrome: A. Complex disturbances in T-Cell mediated immunity have been observed in primary nephrotic syndrome B. Effacement of the podocytes leads to a loss in the positive charge of the glomerular basement membrane C. There is increase in blood levels of lipoprotein lipase D. Reduced plasma oncotic pressure leads to fluid shift from the interstitium to the intravascular space E. Mutation in NPHS2 gene is implicated in steroid resistant Nephrotic syndrome
5. Concerning the clinical features of Nephrotic Syndrome: A. There is usually weight gain in spite of reduced appetite B. Gross haematuria is a typical feature C. Urine output may be normal or reduced D. Blood pressure is typically raised in the early stages E. Patient may present with features of infection like UTI or pneumonia
6. Identify the true statements concerning nephrotic syndrome: A. Renal biopsy may not be indicated in an 11 month old infant presenting for the 1st time B. A patient with 1st episode of nephrotic syndrome with tense scrotal oedema may be managed as an outpatient C. A 4year old child having 1st episode of nephrotic syndrome with mild oedema may be commenced on prednisone therapy D. Hypocomplementaemia is an indication for renal biopsy E. Frequent relapsers who respond to prednisone therapy may not require renal biopsy
7. Concerning investigations for Nephrotic syndrome: A. Microscopic haematuria is seen in most cases B. Spot Creatinine : Protein > 2 is diagnostic C. Stool microscopy may show ova of Schistosoma mansoni in some cases D. HBV may be positive in secondary nephrotic syndrome E. Hypocomplementaemia may be a pointer to membranous nephropathy
8. Concerning treatment of Nephrotic Syndrome A. Cautious administration of intravenous albumin over 1-2 hours may be used to treat all cases of oedema B. Patients on long term prednisone therapy may develop hypotension as a side effect C. Haemorrhagic cystitis is a potential side effect of cyclophosphamide therapy D. Levamisole, an immune modulator, may be used to treat frequent relapsers E. Persistent hypertension usually responds to ACE inhibitor therapy

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NS MCQs

  • 2. 1. Concerning Nephrotic Syndrome: A. There is massive proteinuria of > 40mg/m2/day or 3+ or 4+ on albustix B. Serum albumin levels are usually > 2.5g/dL C. The male:female ratio is about 2:1 D. It is the second most common chronic renal disease of childhood E. Cholesterol levels are generally raised > 250mg/dL
  • 3. 2. Concerning Focal Segmental Glomerulosclerosis: A. Response to steroids may be up to 40% of cases B. Hypocomplementaemia is characteristic C. It may develop from minimal change nephrotic syndrome or present as a separate entity D. Less than 1/3 of cases will progress to renal failure E. Mutations in podocyte proteins podocin and α- actinin 4, and MYH9 gene have been implicated in the pathophysiology
  • 4. 3. The following statements are correct with respect to outcome of Nephrotic Syndrome therapy, except: A. Steroid dependent: relapse while on alternate day steroid therapy, or within 28 days of completing therapy B. Steroid resistant: proteinuria (2+ or greater) after 8 weeks of steroid therapy C. Frequent relapsers: respond well to prednisone therapy but relapse > 6 times in a 12 month period D. Relapse: 3-4+ proteinuria plus oedema for 3 consecutive days E. Remission: diuresis, urine trace or negative for protein for 3 consecutive days
  • 5. 4. On pathology of Nephrotic Syndrome: A. Complex disturbances in T-Cell mediated immunity have been observed in primary nephrotic syndrome B. Effacement of the podocytes leads to a loss in the positive charge of the glomerular basement membrane C. There is increase in blood levels of lipoprotein lipase D. Reduced plasma oncotic pressure leads to fluid shift from the interstitium to the intravascular space E. Mutation in NPHS2 gene is implicated in steroid resistant Nephrotic syndrome
  • 6. 5. Concerning the clinical features of Nephrotic Syndrome: A. There is usually weight gain in spite of reduced appetite B. Gross haematuria is a typical feature C. Urine output may be normal or reduced D. Blood pressure is typically raised in the early stages E. Patient may present with features of infection like UTI or pneumonia
  • 7. 6. Identify the true statements concerning nephrotic syndrome: A. Renal biopsy may not be indicated in an 11 month old infant presenting for the 1st time B. A patient with 1st episode of nephrotic syndrome with tense scrotal oedema may be managed as an outpatient C. A 4year old child having 1st episode of nephrotic syndrome with mild oedema may be commenced on prednisone therapy D. Hypocomplementaemia is an indication for renal biopsy E. Frequent relapsers who respond to prednisone therapy may not require renal biopsy
  • 8. 7. Concerning investigations for Nephrotic syndrome: A. Microscopic haematuria is seen in most cases B. Spot Creatinine : Protein > 2 is diagnostic C. Stool microscopy may show ova of Schistosoma mansoni in some cases D. HBV may be positive in secondary nephrotic syndrome E. Hypocomplementaemia may be a pointer to membranous nephropathy
  • 9. 8. Concerning treatment of Nephrotic Syndrome A. Cautious administration of intravenous albumin over 1-2 hours may be used to treat all cases of oedema B. Patients on long term prednisone therapy may develop hypotension as a side effect C. Haemorrhagic cystitis is a potential side effect of cyclophosphamide therapy D. Levamisole, an immune modulator, may be used to treat frequent relapsers E. Persistent hypertension usually responds to ACE inhibitor therapy

Editor's Notes

  1. A. F (> 40mg/m2/hour) B. F (< 2.5g/dL) C. T D. F (commonest) E. T
  2. A. F (15-20%) B. F (MPGN) C. T D. F (>1/3) E. T
  3. A. F B. F C. T (> 4 times in 12 months) D. F E. F
  4. A. T B. F (negative charge) C. F (decrease) D. F (intravascular to interstitium) E. T
  5. A. T B. F C. T D. F E. T
  6. A. F (biopsy indicated in <1 or >8yrs) B. F C. T D. T E. F (frequent relapsers= indication for biopsy)
  7. A. F (20%) B. F (protein : creatinine > 2) C. T D. T E. F (MPGN)
  8. A. F (severe oedema) B. F (hypertension) C. T D. T E. T