37 - Nephrotic Syndrome Mcqs with answers part 2

18q: In a patient presenting with features of NS , diagnosis other than MCNS should be considered in the presence of ?
a. Age less than 1 year
b. A family history
c. Extrarenal findings ( arthritis, rash and anemia )
d. Hypertension
e. Pulmonary edema
f. Acute or chronic renal insufficiency
g. Hematuria

answer a, b, c, d, e, f, g, . all are true .

19q: all of the following are true regarding the lab findings of idiopathic nephrotic syndrome except ?
a. Microscopic hematuria may be present in 20 % of children
b. Urinalysis reveals 3+ or 4+ proteinuria
c. Spot urine protein/ creatinine ratio exceeds 2.0
d. Urinary protein excretion exceeds 3.5 gm/24 hr in adults and 40 mg/sq.m/hr in children
e. Serum creatinine value is decreased

answer e. serum creatinine value is usually normal , but it may be increased because of diminished renal perfusion resulting from contraction of the intravascular volume .

20q: all of the following are true regarding the lab findings of idiopathic nephrotic syndrome except ?
a. Serum albumin level is generally less than 2.5 g/dL
b. Serum cholesterol and triglyceride levels are elevated
c. C3 and C4 are elevated
d. Renal biopsy is not required for diagnosis in most children

answer c. C3 and C4 are normal and not elevated .

21q: What is the most frequent type of infection which occurs as a complication of Nephrotic syndrome?
a. Pneumonia
b. Spontaneous bacterial peritonitis
c. Cellulitis
d. Urinary tract infections

answer b. spontaneous bacterial peritonitis .

22q: Which is the most common organism causing peritonitis in a nephrotic syndrome patient?
a. E.Coli
b. Streptococcus pneumoniae
c. Staphylococcus
d. Mycoplasma

answer b. streptococcus pneumoniae

23q: All of the following are true about nephrotic syndrome except ?
a. All children with nephrotic syndrome should receive polyvalent pneumococcal vaccine
b. Influenza vaccine should be given on a yearly basis
c. Children with NS are at increased risk for thromboembolic events
d. Prophylactic anticoagulation is recommended in all children with NS

answer d. prophylactic anticoagulation is recommended only in children with nephrotic syndrome who had a previous thromboembolic episode .

24q: Example of a malignancy in which the renal pathology most often resembles Minimal change nephrotic syndrome ( MCNS ) ?
a. Lung carcinoma
b. Hodgkin lymphoma
c. Non-hodgkin lymphoma
d. GIT cancers

answer b. Hodgkin’s lymphoma .

25q: Drugs which cause nephrotic syndrome with a histological picture of MCNS are ?
a. Probenecid
b. Ethosuximide
c. Methimazole
d. Lithium

answer a, b, c, d . all are true .

26q: Drugs which cause nephrotic syndrome with a histological picture of membranous glomerulopathy are all except ?
a. Pencillamine
b. Captopril
c. Gold
d. NSAIDs
e. Mercury compounds
f. procainamide

answer f. procainamide . this drug causes NS with a proliferative glomerulonephritis histological picture.

27q: Drugs which cause nephrotic syndrome with a histological picture of proliferative glomerulonephritis are
a. procainamide
b. chlorpropamide
c. phenytoin
d. trimethadone
e. paramethadione

answer a, b, c, d, e . all are true .

28q: Infants who develop nephrotic syndrome within the first ----- months of life are considered to have congenital nephrotic syndrome ?
a. first 3 months
b. first 6 months
c. first 9 months
d. first 12 months

answer a. first 3 months .

29q: what is the most common cause of congenital nephrotic syndrome ?
a. Denys-Drash syndrome
b. Finnish type of congenital NS
c. Nail patella syndrome
d. Frasier’s syndrome

answer b. Finnish type of Congenital nephrotic syndrome .

30q: Major features of the finnish type of congenital nephrotic syndrome are all except ?
a. Dilatation of the proximal tubules
b. Dilatation of the distal tubules
c. Mesangial hypercellularity
d. Glomerular sclerosis

answer b. dilatation of distal tubules is not a feature of finnish type of NS .

31q: All of the following are true about finnish type of congenital NS except ?
a. Infants present with large placenta and marked edema
b. Prematurity and respiratory distress are seen in these infants
c. Separation of cranial sutures and massive proteinuria is seen in these infants
d. Corticosteroids are very helpful in the treatment

answer d. corticosteroids and immunosuppressive agents are not useful in the treatment .

32q: All of the following are true about finnish type of congenital NS except ?
a. Progressive renal failure with death by the age of 5 years
b. This disease is detectable in utero by increased alpha fetoprotein levels
c. Inheritance is autosomal dominant type
d. Most common in populations of Scandinavian descent ( 1: 8000 incidence )
e. Mutation in the NPHS1 gene which produces nephrin

answer c. inheritance is of autosomal recessive type not AD .

33q: all of the following are true about Denys-Drash syndrome except ?

a. Mutation in WT1 gene
b. Wilm’s tumor is a feature of it
c. Male pseudohermaphroditism is seen in it
d. Diffuse mesangial sclerosis is characteristic
e. WT1 gene is located on chromosome 13

answer e. WT1 gene is located on 11th chromosome not 13th.

34q: Which of the following drugs are used in the treatment of Idiopathic nephrotic syndrome ?
a. Prednisone
b. Cyclophosphamide
c. Methylprednisolone
d. Cyclosporine
e. Tacrolimus
f. Mycophenolate

answer a, b, c, d, e, f . all are true . ACE inhibitors and angiotensin II blockers may also be helpful as adjunct therapy to reduce proteinuria in steroid-resistant patients .

35q: In the presence of which of the following features do u suspect the presence of secondary nephrotic syndrome ?
a. Age greater than 8 years
b. Hypertension and hematuria
c. Renal dysfunction
d. Extrarenal symptomatology ( rash, arthralgias, fever )
e. Raised serum complement levels

answer a,b,c,d only . depressed serum complement levels suggest secondary Nephrotic Syndrome and not raised levels complement levels .

36q: Drugs causing nephrotic syndrome are ?
a. Gold
b. Pamidronate
c. Interferon
d. Heroin

answer a, b, c , d. all of them cause nephrotic syndrome .

37q: Steps taken to ameliorate nephrotic state in a patient with congenital nephrotic syndrome are all except ?
a. ACE inhibitors
b. Indomethacin
c. Unilateral nephrectomy
d. Corticosteroids

answer d. corticosteroids . they are of no use here .