[
{
"question": "A 5-year-old boy presents with progressive periorbital swelling for 4 days followed by pedal edema and abdominal distension. Blood pressure is normal. Urinalysis shows 4+ protein with no RBCs. Serum albumin is 1.6 g/dL and cholesterol is elevated. Which mechanism best explains the edema in this child?",
"options": [
"Reduced plasma oncotic pressure leading to fluid shift into interstitial space",
"Increased capillary hydrostatic pressure due to hypertension",
"Primary renal sodium loss",
"Excess erythropoietin production"
],
"correct": 0,
"explanation": "In nephrotic syndrome, massive albumin loss lowers plasma oncotic pressure causing fluid to shift into the interstitial space leading to edema."
},
{
"question": "A 6-year-old child with nephrotic syndrome develops sudden severe abdominal pain, fever, and guarding. Ascitic fluid shows neutrophils and gram positive cocci. Which organism is most commonly responsible?",
"options": [
"Streptococcus pneumoniae",
"Escherichia coli",
"Mycobacterium tuberculosis",
"Pseudomonas aeruginosa"
],
"correct": 0,
"explanation": "Spontaneous bacterial peritonitis in nephrotic syndrome is most commonly caused by Streptococcus pneumoniae due to loss of immunoglobulins."
},
{
"question": "A 7-year-old child develops cola-colored urine, facial edema, and hypertension two weeks after streptococcal pharyngitis. Complement C3 levels are low. What is the most likely diagnosis?",
"options": [
"Minimal change disease",
"Post-streptococcal glomerulonephritis",
"IgA nephropathy",
"Membranous nephropathy"
],
"correct": 1,
"explanation": "Post-streptococcal glomerulonephritis presents with nephritic syndrome 1–3 weeks after streptococcal infection and is associated with low complement levels."
},
{
"question": "A child with nephrotic syndrome develops sudden flank pain and gross hematuria. Doppler ultrasound reveals absence of flow in the renal vein. What is the most likely cause?",
"options": [
"Renal artery stenosis",
"Renal vein thrombosis",
"Ureteric obstruction",
"Acute pyelonephritis"
],
"correct": 1,
"explanation": "Hypercoagulability due to urinary loss of antithrombin III predisposes nephrotic children to renal vein thrombosis."
},
{
"question": "A 4-year-old boy with nephrotic syndrome has persistent heavy proteinuria after 8 weeks of adequate steroid therapy. What is the most appropriate next step?",
"options": [
"Increase steroid dose indefinitely",
"Renal biopsy to evaluate steroid-resistant nephrotic syndrome",
"Stop all treatment",
"Start antibiotics"
],
"correct": 1,
"explanation": "Failure to achieve remission after adequate steroid therapy suggests steroid-resistant nephrotic syndrome requiring renal biopsy."
},
{
"question": "A 10-year-old boy has recurrent episodes of hematuria occurring within 24 hours of upper respiratory infections. Which disease is most likely?",
"options": [
"IgA nephropathy",
"Minimal change disease",
"Membranous nephropathy",
"Post-streptococcal GN"
],
"correct": 0,
"explanation": "IgA nephropathy typically causes recurrent hematuria occurring concurrently with respiratory infections."
},
{
"question": "A child with nephritic syndrome presents with severe headache, vomiting, and seizures. Blood pressure is 180/110 mmHg. What is the most likely cause of neurological symptoms?",
"options": [
"Hypertensive encephalopathy",
"Hypoglycemia",
"Meningitis",
"Septic shock"
],
"correct": 0,
"explanation": "Severe hypertension in nephritic syndrome can cause hypertensive encephalopathy presenting with seizures."
},
{
"question": "A 5-year-old boy with nephrotic syndrome develops tachypnea and sudden pleuritic chest pain. Which life-threatening complication should be suspected first?",
"options": [
"Pulmonary embolism",
"Pleural effusion",
"Bronchial asthma",
"Pneumonia"
],
"correct": 0,
"explanation": "Nephrotic syndrome causes hypercoagulability due to loss of anticoagulant proteins leading to pulmonary embolism."
},
{
"question": "A child with nephritic syndrome has persistent low complement levels for more than 8 weeks. Which diagnosis should be considered?",
"options": [
"Membranoproliferative glomerulonephritis",
"Minimal change disease",
"Focal segmental glomerulosclerosis",
"Diabetic nephropathy"
],
"correct": 0,
"explanation": "Persistent hypocomplementemia beyond 8 weeks suggests MPGN rather than post streptococcal GN."
},
{
"question": "A 6-year-old child with nephrotic syndrome presents with severe edema and respiratory distress. Chest examination reveals decreased breath sounds bilaterally. What is the most likely diagnosis?",
"options": [
"Pleural effusion",
"Pulmonary fibrosis",
"Bronchitis",
"Atelectasis"
],
"correct": 0,
"explanation": "Severe hypoalbuminemia leads to fluid accumulation including pleural effusion."
},
{
"question": "A 7-year-old boy presents with hematuria, proteinuria, and sensorineural hearing loss with a positive family history of kidney disease. What condition is most likely?",
"options": [
"Alport syndrome",
"Minimal change disease",
"IgA nephropathy",
"Post-streptococcal GN"
],
"correct": 0,
"explanation": "Alport syndrome is characterized by hereditary nephritis with hearing loss and progressive renal failure."
},
{
"question": "A child with nephrotic syndrome develops fever and erythema over the leg with tenderness and swelling. What infection is most likely?",
"options": [
"Cellulitis",
"Osteomyelitis",
"Septic arthritis",
"Tuberculosis"
],
"correct": 0,
"explanation": "Children with nephrotic syndrome are prone to bacterial infections including cellulitis due to immune protein loss."
},
{
"question": "A 5-year-old boy presents with massive proteinuria but normal blood pressure and normal complement levels. Electron microscopy would most likely reveal which finding?",
"options": [
"Podocyte foot process effacement",
"Subendothelial immune deposits",
"Mesangial IgA deposition",
"Crescent formation"
],
"correct": 0,
"explanation": "Minimal change disease shows diffuse effacement of podocyte foot processes on electron microscopy."
},
{
"question": "A child with nephritic syndrome presents with oliguria, pulmonary edema, and rising serum creatinine. What is the immediate management priority?",
"options": [
"Fluid restriction and diuretics",
"High protein diet",
"Immediate corticosteroids",
"Insulin infusion"
],
"correct": 0,
"explanation": "Fluid restriction and diuretics are necessary to manage fluid overload and pulmonary edema."
},
{
"question": "A 4-year-old boy with nephrotic syndrome develops frequent relapses whenever steroids are tapered. Which medication is commonly used as a steroid-sparing agent?",
"options": [
"Cyclophosphamide",
"Metformin",
"Atenolol",
"Amoxicillin"
],
"correct": 0,
"explanation": "Cyclophosphamide is used for frequently relapsing or steroid dependent nephrotic syndrome."
}
]
