DE LA SALLE HEALTH SCIENCES INSTITUTE

COLLEGE OF MEDICINE
DEPARTMENT OF PEDIATRICS

PEDIATRICS II
ELEVENTH EVALUATION
PEDIATRIC NEPHROLOGY &
ADOLESCENT HEALTH MODULE
April 3, 2018

ANSWER KEY
NAME: ____________________________________________ STUDENT NO. __________

GENERAL DIRECTIONS: Choose the best answer. (60 items)

1. Karen a 9 month old female infant was brought to the clinic because of fever. No focus of
fever can be identified. Which of the following is a risk factor for the possible diagnosis of the
patient?
A. Loose bowel movement
B. Loose clothing or underwear
C. Female gender
D. Hygiene

2. Karen could be at risk for kidney damage by which of the following factor?
A. Toilet training
B. Constipation
C. Age <1 year old
D. Bacteria with P-fimbriae

3. A 2 year old male was brought to the ER because of high grade fever. Urinalysis showed
RBC = 1-5/HPF, WBC = 2030/HPF, protein trace. Which of the following urine collection
method is the most appropriate for the patient’s urine CS collection?
A. Sterile urine bag
B. Urethral catheterization
C. Suprapubic aspiration
D. Midstream urine clear catch

4. Marco, a 6 year old male was brought for consult because of high grade fever, abdominal
pain and dysuria. Physical examination revealed tender abdomen, positive kidney punch
test. Which laboratory test is considered the gold standard to confirm the diagnosis?
A. KUB ultrasound
B. Blood culture
C. Urine culture
D. Urinalysis

5. Marco is highly febrile, clinically ill with vomiting and moderate dehydration. Which of the
following treatment modalities should be done?
A. Observe and encourage increase oral fluid intake
B. Hospitalize and start parenteral antibiotic
C. Chemophrophylaxis
D. Send home and start empiric oral antibiotics

6. Marisa, a 15 year old female was referred because of a positive urine culture result. She is
afebrile and asymptomatic. BP 110/70mmHg, CR: 80/bpm, RR=22/min. Which of the
following is true regarding her case?
A. Her condition is more common in boys
B. The urinary tract is colonized by uropathogens which can cause urinary
symptoms
C. Does not cause renal injury
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 D. Need immediate antimicrobial treatment for acute pyelonephritis
7. Julia, an 8-year-old female consulted because of dysuria and hypogastric pain. BP =
90/60mmHg T°=36.9°C, CR=81/bpm, RR = 21/min. She also had urinary frequency,
urgency and foul-smelling urine. Which of the following is the most probable diagnosis?
A. Cystitis
B. Chronic pyelonephritis
C. Acute pyelonephritis
D. Asymptomatic bacteriuria

8. What is the most common etiologic agent that can cause the manifestation of Julia?
A. Staphylococcus
B. E. coli
C. Enterobacter
D. Streptococcus

9. Joshua, 6 year old male consulted because of fever, abdominal pain and vomiting.
Urinalysis showed RBC = 35/hpf WBC = 10-20/hpf, protein trace. Urine culture showed
negative results. Which of the following could explain the culture result?
A. Dehydration
B. No prior antibiotic intake
C. Increase dietary fiber intake
D. Recent bladder emptying

10. Eradication of infection, and assessment of any anatomic and/or functional abnormalities
are the aims of treatment of urinary tract infection in order to prevent which long term
complication?
A. Voiding dysfunction
B. Obstructive uropathy
C. Renal insufficiency
D. Aterial hypotension

11. A newborn male infant was referred because of multiple congenital anomalies. Upon
physical examination a cardiac murmur and a single umbilical artery were noted. What
diagnostic test should be requested to determine if there is renal or urinary tract anomaly?
A. Urinalysis
B. KUB ultrasound
C. Abdominal CT scan
D. Renal function test

12. What is the common cause of postrenal renal failure?

A. Obstructive uropathy
B. Infantile polycystic kidney disease
C. Renal hypoplasia
D. Medullary dysplasia

13. Romulo, a 3 month old male infant was referred because of bilateral renal mass. There was
associated hepatic fibrosis and both parents have normal renal ultrasound. What is the most
probable diagnosis?
A. Autosomal dominant PKD
B. Autosomal recessive PKD
C. Oligomeganephronia
D. Multicystic dysplastic kidney

14. What is the clinical feature suggesting autosomal dominant PKD rather than autosomal
recessive PKD?
A. Hepatosplenomegaly
B. Positive family history
C. Bacterial cholangitis
D. Esophageal varices

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15. A newborn male infant was referred because of multiple congenital anomalies. PE showed
low set malformed ears, limb anomalies, broad flat nose, widely separated eyes. What
pertinent maternal information should be elicited?
A. Family history of renal disease
B. Polyhydramnios
C. Olighydramnios
D. Maternal age

16. Toni, 8 year old boy was brought to the ER because of vomiting and diarrhea. He has no
urine output for the last 8 hours. BP = 90/60mmHg, CR = 105/min, RR = 25/min. Which
clinical hallmark of early renal failure does the patient have?
A. Oliguria
B. Tachycardia
C. Hypotension
D. Uremia

17. Which stage/category of AKI does Toni belong to?

A. Acute tubular necrosis
B. Prerenal
C. Intrinsic
D. Postrenal

18. What causative factor could be responsible for the condition of Toni?
A. Obstructive uropathy
B. Renal ischemia
C. Impaired renal perfusion
D. Renal parenchymal disease

19. Six year old Ruben was brought for consult because of 2 days duration of edema, dark
colored urine and decreased urine output. BP = 140/90mmHg, CR = 92/min RR = 28/min.
Renal function tests results revealed slightly elevated serum creatinine and blood urea
nitrogen. What main pathogenetic mechanism is responsible for the development of acute
kidney injury?
A. Decrease renal perfusion
B. Decrease renal cortical blood flow
C. Renal vessel thrombosis
D. intravascular volume

20. A 3 day old newborn female was referred because of elevated renal function tests results.
Patient has good urine output but blood culture revealed Klebsiella pneumoniae. Which of
the following is the most probable cause of the AKI?
A. Sepsis
B. Urinary infection
C. Posterior urethral valve
D. Glomerulonephritis

21. Wilma 12 year old female was brought for consult because of on and off pallor and edema
of 9 months duration. Calculated GFR = 20ml/min/m2. To which category does the patient
belong?
A. CKD stage 3
B. CKD stage 4
C. pRIFLE: Injury
D. pRIFLE: Failure

22. Physical examination of Wilma showed BP = 150/100mmHg, CR = 100/min, PR = 25/min.

What is the pathophysiologic mechanism of her blood pressure?
A. Hypovolemia
B. Anemia
C. Electrolyte imbalance
D. Volume overload

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23. Work up of Wilma revealed Hemoglobin = 70, WBC = 9,000, Platelet count = 200,000 with
small kidneys on renal sonogram. Her anemia is due to:
A. Defective granulocyte function
B. Defective platelet function
C. Folic acid deficiency
D. Hemodilution

24. Helen, 6 years old girl has been diagnosed with chronic kidney disease secondary to
chronic GN. She is on dialysis for the last 6 months. However, there is noted persistent
hypocalcemia despite normal serum sodium, potassium, chloride, and phosphorus. What is
the appropriate treatment plan?
A. Vitamin D supplementation
B. Calcium supplementation only
C. Aluminum containing antacid
D. Low phosphate formula

25. Which of the following can result to chronic kidney disease in children less than 5 years old?
A. Acute glomerulonephritis
B. Congenital anatomic malformation
C. Hemolytic uremic syndrome
D. Alports syndrome

26. Which of the following glomerular diseases is due to increased glomerular capillary wall
permeability?
A. Membranoproliferative GN
B. IgA nephropathy
C. Nephrotic syndrome
D. Acute glomerulonephritis

27. Which of the following indicate the immunologic mechanism of acute glomerulonephritis?
A. Hematuria
B. Presence of hypertension
C. Latent period between infection and the development of nephritis
D. Hypercomplementenemia during the acute stage

28. Flora, a 6 year old female patient was brought to the ER because of seizures. She was
noted to be edematous, tachycardic, tachypneic with a BP = 150/100mmHg. Which of the
following should be initially given
A. Anticonvulsant
B. Diuretics and antihypertensive
C. Dialysis
D. Digitalis

29. Renato, 2 year old boy was brought to the clinic because of on and off generalized edema
accompanied by cough and abdominal pain of 3 months duration. BP = 90/50mmHg, CR =
98/min, RR= 35/min, afebrile. What pertinent laboratory tests should be done to arrive at the
diagnosis?
A. Urinalysis, ASO titer, serum C3
B. Abdominal ultrasound
C. Urinalysis, TPAG, serum cholesterol, urine protein determination
D. CBC, Urinalysis, chest x-ray

30. Laboratory tests results of Renato showed anemia, proteinuria, pyuria, hypoalbuminemia,
hyperchlolesterolemia and normal serum C3. Which of the following is the drug of choice?
A. Prednisone
B. Penicillin
C. Furosemide
D. Antihypertensive

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31. Robbie, 9 year old boy consulted the clinic because of oliguria and cola colored urine. He
had history of fever and cough 2 weeks prior which was treated with amoxicillin. BP =
160/100, CR = 110/min PR = 28/min, afebrile. What treatment modality should be done
A. Encourage ambulation
B. Anticonvulsant
C. Dialysis
D. Fluid and salt restriction

32. Which of the following is suggestive of chronic glomerulonephritis?

A. Gross hematuria at 2 weeks
B. Microscopic hematuria at 6 months
C. Persistent Hypocomplementenemia
D. Proteinuria at 4 months

33. Nephrotic syndrome (NS) has several morphologic forms. Which of the following is
suggestive of minimal change disease NS?
A. 20% responds to steroid therapy
B. Normal glomeruli
C. 50-60% are steroid responsive
D. Segmental scarring

34. Adelle, 3 year old girl consulted because of on and off edema of 3 months duration.
Antihistamine, and several antibiotics were given with minimal response. BP = 90/60, CR =
90/min, RR = 25/min, afebrile. Urinalysis RBC = 0-3/hpf, WBC = 5-10/hpf, protein +3. Which
of the following pathophysiologic mechanisms could explain the findings?
A. Hypocomplementenemia
B. Protein selectivity and alteration in the glomerular capillary membrane
C. Circulating immune complex formation
D. Decreased glomerular filtration rate

35. Ten year old girl, Happy, was brought to the ER because of headache, vomiting and visual
loss. She was noted to have facial edema 2 days prior. BP = 160/100, CR = 110/min, RR =
30/min. Which of the following could cause the cerebral symptoms?
A. Decreased GFR
B. Direct toxic effect of bacterial antigens in the CNS
C. Anemia
D. Fluid retention

36. Happy was noted to be tachypneic, tachycardic, with chest pain and palpitation. Chest
examination showed retractions and crackles. Which of the following mechanism is
responsible?
A. Encephalopathy
B. Hypervolemia
C. Oligoanuria
D. Related to BP

37. Jason a 3 year old boy diagnosed with nephrotic syndrome was brought to the ER because
of abdominal pain and loose bowel movement. BP = 90/50, CR = 82/min, RR = 22/min, T° =
38.5°C. Abdomen was tense, tender with hypoactive bowel sounds. Which of the following
should be considered?
A. Acute gastroenteritis
B. Peritonitis
C. Acute gastritis
D. Urinary tract infection

38. Urinalysis of Jason showed RBC = 1-3/hpf, WBC = 3-5/hpf, protein +2. What medication
should be given?
A. Penicillin
B. Metronidazole
C. Omeprazole
D. Broad aspiration cephalosporin

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39. Seven year old Angel consulted the clinic with urinalysis result of RBC = 10-15/hpf, WBC =
1-5/hpf, protein +1. She was diagnosed with PSAGN 2 months prior to consult and is
presently asymptomatic. What should be done to the patient?
A. Give antibiotics
B. Observe and do regular urinalysis monitoring
C. Start prednisone
D. Admit and treat as UTI

40. Billy, 5 year old boy with history of cough and colds 2 weeks ago consulted because of dark
colored urine. 3 days ago facial and periorbital edema was noted. Which of the following
provide strong evidence that the patient has an immune-complex mediated diseas?
A. Proteinuria
B. Hematuria
C. Hypocomplementenemia
D. Increase ASO titer

For numbers 41 to 45:

You were called to the Emergency Room to attend to two teenagers involved in a vehicular
accident. Vincent, a sixteen year old, disclosed that he had never used illegal drugs and that his
last intake of alcohol, described as a few sips of beer, was during his father’s birthday a year
ago. His friend, Rob, a seventeen year old, admitted that he took a few puffs of weed and
consumed four bottles of beer prior to the accident.

41. When using the CRAFFT screening tool, which of the following questions will be your priority
for Vincent?
A. Do you ever forget things while using alcohol?
B. Do you ever use alcohol to relax?
C. Have you ever gotten into trouble while you were using alcohol?
D. Have you ever ridden a car driven by someone who had been using alcohol or
drugs?

42. If Vincent is a non-smoker but is exposed to second-hand smoke, what needs to be included
in your plan of management as stated in the Toolkit for Brief Tobacco Interventions in
Primary Care?
A. Ask, advise, assess, admit, arrange
B. Ask, assess, admit, assist, arrange
C. Ask, assume, assess, assist, arrange
D. Ask, advise, assess, assist, arrange

43. Upon further probing, Rob divulged that this was his second time to drive while high on
drugs and that he had used marijuana by himself once. Which of the following questions will
you ask next, as stated in the CRAFFT screening tool?
A. Has he been physically abused?
B. Has he been attracted to other males?
C. Has he engaged in unprotected sexual intercourse?
D. Has he encountered problems with the law?

44. Which of the following is considered a risk factor associated with Rob’s risk behaviors?
A. Strict religious affiliation
B. Lack of access to sexual health services
C. Estranged relationship with parents
D. Poor class ranking

45. Which of the following is considered a protective factor associated with Rob’s risk
behaviors?
A. High hopes from parents
B. Low incidence of smoking among school mates
C. Apparent consciousness of being healthy
D. Deep spiritual attachment

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For numbers 46 to 53:

Joanna is an eighteen year female brought by her mother for consult because of poor appetite.
Fifteen days prior to consult, her parents noted that Joanna preferred staying in her room rather
than being with her family & friends. She complained of being easily exhausted. This was
associated with occasional psychomotor retardation causing her to be late for class. One day
prior to consult, Joanna refused to eat prompting consult.

46. Based on the Patient Health Questionnaire Scoring, what is the recommended treatment for
Joanna?
A. Support, watchful waiting, antidepressant
B. Support, educate, follow-up after 1 month
C. Antidepressant and psychotherapy
D. Antidepressant or psychotherapy

47. If she has a PHQ 9 score of 15, this is interpreted as _______.

A. Minor depression with dysthymia
B. Major depression, mild
C. Major depression, moderately severe
D. Major depression, severe

48. Which of the following responses warrants active treatment?

A. Feeling guilty for fourteen days over the past month
B. Thinking of hurting one’s self for several days over the past two weeks
C. Feeling melancholic most of the time in the past two years
D. Having trouble sleeping for several days over the past three months

49. If Joanna performs her house chores based on what is expected of her as a female, you
would identify this as her ______.
A. Gender role
B. Gender identity
C. Sexual orientation
D. Biologic sex

50. If she has a height of 150 cm and a weight of 40 kilograms, her Body Mass Index (BMI) for
age is inferred as _________.
A. Normal
B. Underweight
C. Overweight
D. Obese

51. What BMI value in the past year would merit a cause for alarm?
A. 17
B. 18
C. 19
D. 20

52. What Sexual Maturity Rating do you expect Joanna to have?

A. II
B. III
C. IV
D. V

53. When is a pelvic exam warranted?

A. Joanna has a BMI of 15.
B. Joanna has a foul-smelling vaginal discharge.
C. Joanna has a hemoglobin of 8 grams/dl.
D. Joanna has a chronic illness.

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For numbers 54 to 59:

Alex is an eighteen year old male who is seeking consult because of brown to black
hyperpigmentation on the nape area. He has a blood pressure of 140/80 mmHg, a height of 180
centimeters and a weight of 77 kilograms.

54. Given the above information, what part of the psychosocial screening tool will you
investigate further?
A. Recreation
B. Sexual orientation
C. Threats and violence
D. Education

55. What BMI value in the past year would warrant a deeper inquiry?
A. 22
B. 23
C. 24
D. 25

56. If Alex discloses that he smokes 5 sticks/day, what laboratory examination should be
requested initially?
A. Serum triglycerides
B. Fasting blood sugar
C. Complete blood count
D. Serum cholesterol

57. If Alex has an unremarkable medical history, what Sexual Maturity Rating do you expect
Alex to have?
A. II
B. III
C. IV
D. V

58. What risk factor deserves a lipoprotein analysis?

A. Alex’ sister had Gestational Diabetes
B. Alex’ father is a smoker
C. Alex’ mother has Mitral Valve Prolapse
D. Alex’ grandfather had a coronary bypass surgery five years ago

59. If Alex cannot recall any of the vaccines given to him twelve years ago, what vaccine may
be given during this consult?
A. 2 doses of Hepatitis B vaccine
B. 1 dose of oral Polio
C. 2 doses of Flu vaccine
D. 1 dose of Tetanus-Diphtheria-Acellular Pertussis (Tdap)

60. This statement is TRUE of the World Health Organization 2014 report.
A. HIV is the primary cause of death among girls 15 – 19 years of age.
B. Suicide is the leading cause of death among late adolescents.
C. Unintentional injuries is the top cause of disability among adolescents.
D. Adolescents in developing countries are now mostly overweight.

***************************** END OF PEDIATRICS II EVALUATION 11 *****************************

Note: All answers based in Moodle.

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