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 .

36 - Nephrotic Syndrome Mcqs with answers part 1

1q: Nephrotic syndrome is how many times more common in children than adults ?
a. 5 times
b. 10 times
c. 15 times
d. 20 times

answer c . 15 times

2q: what is the incidence of nephrotic syndrome ?
a. 2-3/100000 children per year
b. 20-30/100000 children per year
c. 200-300/100000 children per year
d. 2000-3000/100000 children per year

answer a. 2-3 / 100000 children per year

3q: The characteristic features of nephrotic syndrome are ?
a. Heavy proteinuria ( greater than 3.5 g/24 hr in adults or 40 mg/sq.m/hr in children )
b. Hypoalbunemia ( less than 2.5 g/dL )
c. Edema
d. Hyperlipidemia
e. All the above

answer e. all the above

4q: Which of the following statements about nephrotic syndrome are true ?
a. Most children ( 90 % ) with nephrotic syndrome have a form of idiopathic nephrotic syndrome
b. Minimal change disease ( 85 % ) is the most common cause of idiopathic nephrotic syndrome
c. Focal segmental glomerulo sclerosis ( 10 % ) and mesangial proliferation ( 5 % ) are the next common causes of idiopathic nephrotic syndrome
d. The remaining 10 % who do not have idiopathic NS have secondary NS related to systemic or glomerular diseases such as membranous nephropathy or membranoproliferative glomerulonephritis
 e. All the above statements are true

answer e. all the above

5q: Which of the following causes nephrotic syndrome which is steroid responsive ?
a. Minimal change nephrotic syndrome
b. FSGS
c. Denys-drash syndrome with diffuse mesangial sclerosis
d. Nail-patella syndrome
e. Finnish type of congenital NS

answer a. MCNS , rest of them are steroid resistant .

6q: All of the following are true about nephrin except ?
a. It is a product of the gene NPHS1
b. Location of the gene is on 1q25
c. The inheritance is of recessive type
d. A defect in the production of nephrin causes finnish type of congenital nephrotic syndrome
e. The NS produced by nephrin defect is steroid resistant

answer b. the location of the NPHS1 gene is on 19q13.1 NPHS2 is located on 1q25 which produces Podocin.

7q: Alpha actinin-4 is a product of which gene ?
a. NPHS1
b. NPHS2
c. FSGS1
d. FSGS2
e. WT1

answer c. FSGS1 .

8q: All of the following are true about podocin except ?
a. It is product of the gene LMX1B
b. Inheritance is of recessive type
c. A defect in podocin production is associated with FSGS
d. Gene location is on chromosome 1q25

answer a. it is product of NPHS2 gene and not LMX1B.

9q: gene for alpha-actinin-4 ( FSGS1 ) is located on which chromosome ?
a. 19q13
b. 1q25
c. 2q35
d. 9q34

answer a. 19q13

10q: What is the renal disease causing steroid resistant nephrotic syndrome associated with the defect in gene LMX1B which produces the protein LIM-homeodomain ?
a. Denys-Drash syndrome with diffuse mesangial sclerosis
b. Nail patella syndrome
c. FSGS
d. MCNS

answer b. Nail patella syndrome .

11q: In the nephrotic state , serum lipid levels ( cholesterol, triglycerides ) are elevated for the following reason ?
a. Hypoalbuminemia stimulates generalized hepatic protein synthesis, including synthesis of lipoproteins
b. Lipid catabolism is diminished, as a result of reduced plasma levels of lipoprotein lipase, related to increased urinary losses of this enzyme
c. Both a and b
d. None

answer c. both a and b

12q: How much percentage of children with Minimal Change Nephrotic Syndrome respond to corticosteroid therapy ?
a. 95 %
b. 50 %
c. 20 %
d. 5 %

answer a. 95 %

13q: Electron microscopy of a patient with FSGS shows segmental scarring of the glomerular tuft with obliteration of the glomerular capillary lumen . A similar lesion may be seen with ?
a. HIV infection
b. Vesicoureteric reflux
c. Intravenous heroin abuse
d. All the above

answer d. all the above

14q: All of the following are true about FSGS associated nephrotic syndrome except ?
a. FSGS involves 85 % of all the cases presenting with idiopathic NS
b. 20 % of these cases respond to prednisone
c. Immunofluorence microscopy shows IgM and C3 staining in areas of segmental sclerosis
d. Electron microscopy shows segmental scarring of the glomerula tuft with obliteration of the glomerular capillary lumen
e. FSGS is frequently progressive, ultimately involving all glomeruli , and leads to end-stage renal disease in most patients

answer a is false because FSGS involves only 10 % of cases presenting with idiopathic NS

15q: Which of the following are uncommon findings in a patient with idiopathic nephrotic syndrome ?
a. Abdominal pain
b. Diarrhea
c. Anorexia and Irritability
d. Hypertension
e. Gross hematuria

answer d and e are uncommon . hypertension and gross hematuria .

16q: what is the differential diagnosis of a child with marked edema ?
a. Protein-losing enteropathy
b. Hepatic failure
c. Congestive heart failure
d. Acute or chronic glomerulonephritis
e. Protein malnutrition
f. All the above

answer f. all the above

17q: All of the following are true about idiopathic nephrotic syndrome except ?
a. More common in females than in males ( 2:1 )
b. Most commonly appears between the ages of 2 and 6 years
c. MCNS is present in 85-90 % of patients of less than 6 years of age
d. FSGS develops in older children
e. 20 -30 % of adolescents have MCNS

answer a is false because males are more commonly affected than females at a ratio of 2:1 .

MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes