Q.1 Which of the following is the most common cause of nephrotic syndrome in children?
Focal segmental glomerulosclerosis
Minimal change disease
Membranous nephropathy
IgA nephropathy
Explanation - Minimal change disease is the most common cause of nephrotic syndrome in children, often responsive to corticosteroid therapy.
Correct answer is: Minimal change disease
Q.2 What is the hallmark laboratory finding in nephrotic syndrome?
Hematuria
Proteinuria >3.5 g/day
Hypokalemia
Leukocyturia
Explanation - Nephrotic syndrome is characterized by heavy proteinuria (>3.5 g/day), hypoalbuminemia, hyperlipidemia, and edema.
Correct answer is: Proteinuria >3.5 g/day
Q.3 A child with post-streptococcal glomerulonephritis typically presents with which feature?
Edema and hypertension
Polyuria
Nephrotic-range proteinuria
Hypotension
Explanation - Post-streptococcal glomerulonephritis presents with hematuria, edema, and hypertension due to glomerular inflammation.
Correct answer is: Edema and hypertension
Q.4 Which complement component is typically low in post-streptococcal glomerulonephritis?
C3
C4
CH50
Factor B
Explanation - C3 is usually decreased in post-streptococcal glomerulonephritis due to activation of the alternative complement pathway.
Correct answer is: C3
Q.5 The most common renal malignancy in children is:
Wilms tumor
Renal cell carcinoma
Mesoblastic nephroma
Clear cell sarcoma
Explanation - Wilms tumor (nephroblastoma) is the most common renal malignancy in children, typically presenting before age 5.
Correct answer is: Wilms tumor
Q.6 Which of the following is NOT a typical feature of nephrotic syndrome?
Edema
Hypoalbuminemia
Hyperlipidemia
Hyperkalemia
Explanation - Hyperkalemia is not a feature of nephrotic syndrome. The syndrome is defined by proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
Correct answer is: Hyperkalemia
Q.7 Hemolytic uremic syndrome in children is commonly associated with infection by:
Streptococcus pyogenes
Shiga toxin-producing E. coli
Pseudomonas aeruginosa
Staphylococcus aureus
Explanation - Typical HUS in children follows gastrointestinal infection with Shiga toxin-producing E. coli (e.g., O157:H7).
Correct answer is: Shiga toxin-producing E. coli
Q.8 Which of the following is a common complication of nephrotic syndrome in children?
Thrombosis
Diabetes mellitus
Peptic ulcer disease
Asthma
Explanation - Children with nephrotic syndrome are at risk of thrombotic events due to urinary loss of anticoagulant proteins such as antithrombin III.
Correct answer is: Thrombosis
Q.9 In Wilms tumor, which congenital anomaly is commonly associated?
Beckwith-Wiedemann syndrome
Turner syndrome
Down syndrome
Marfan syndrome
Explanation - Wilms tumor is associated with Beckwith-Wiedemann syndrome, an overgrowth syndrome with macroglossia, organomegaly, and hemihypertrophy.
Correct answer is: Beckwith-Wiedemann syndrome
Q.10 Which finding is most typical of minimal change disease on renal biopsy?
Focal segmental sclerosis
Subepithelial deposits
Effacement of podocyte foot processes
Mesangial hypercellularity
Explanation - Minimal change disease shows normal glomeruli under light microscopy, but electron microscopy reveals podocyte foot process effacement.
Correct answer is: Effacement of podocyte foot processes
Q.11 What is the first-line treatment for minimal change nephrotic syndrome in children?
Cyclophosphamide
Prednisone
Cyclosporine
Rituximab
Explanation - Prednisone is the first-line treatment for minimal change nephrotic syndrome, to which most children respond.
Correct answer is: Prednisone
Q.12 The triad of acute renal failure, hemolytic anemia, and thrombocytopenia is characteristic of:
Acute glomerulonephritis
Nephrotic syndrome
Hemolytic uremic syndrome
Renal vein thrombosis
Explanation - HUS is defined by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury.
Correct answer is: Hemolytic uremic syndrome
Q.13 Which electrolyte disturbance is most concerning in acute kidney injury?
Hyperkalemia
Hyponatremia
Hypocalcemia
Hypermagnesemia
Explanation - Hyperkalemia in AKI can cause life-threatening cardiac arrhythmias and must be addressed urgently.
Correct answer is: Hyperkalemia
Q.14 Which urinary finding is most characteristic of post-streptococcal glomerulonephritis?
Red cell casts
Oval fat bodies
White cell casts
Hyaline casts
Explanation - Red cell casts are a hallmark of glomerulonephritis, indicating glomerular bleeding.
Correct answer is: Red cell casts
Q.15 The most common presenting symptom of Wilms tumor is:
Gross hematuria
Palpable abdominal mass
Abdominal pain
Hypertension
Explanation - Wilms tumor most commonly presents as a painless palpable abdominal mass in children.
Correct answer is: Palpable abdominal mass
Q.16 Which of the following is the earliest sign of nephrotic syndrome in children?
Ascites
Periorbital edema
Pleural effusion
Ankle swelling
Explanation - Periorbital edema is usually the earliest and most recognizable sign of nephrotic syndrome in children.
Correct answer is: Periorbital edema
Q.17 The drug most commonly used to reduce proteinuria in children with chronic kidney disease is:
ACE inhibitors
Diuretics
Beta-blockers
Calcium channel blockers
Explanation - ACE inhibitors decrease intraglomerular pressure and reduce proteinuria, slowing CKD progression.
Correct answer is: ACE inhibitors
Q.18 Which of the following syndromes includes renal anomalies as part of its diagnostic criteria?
VACTERL association
Pierre Robin sequence
Marfan syndrome
Noonan syndrome
Explanation - VACTERL includes Vertebral, Anal, Cardiac, Tracheoesophageal, Renal, and Limb anomalies.
Correct answer is: VACTERL association
Q.19 Children with nephrotic syndrome are particularly at risk for infections due to loss of:
IgA
IgG
IgM
IgE
Explanation - Urinary loss of IgG and complement factors increases susceptibility to infections in nephrotic syndrome.
Correct answer is: IgG
Q.20 Renal vein thrombosis in children with nephrotic syndrome typically presents with:
Abdominal mass and hematuria
Polyuria and polydipsia
Severe hypotension
Fever and dysuria
Explanation - Renal vein thrombosis may present with flank or abdominal mass, hematuria, and worsening renal function.
Correct answer is: Abdominal mass and hematuria
Q.21 Which antihypertensive agent is avoided in bilateral renal artery stenosis?
ACE inhibitors
Calcium channel blockers
Beta-blockers
Diuretics
Explanation - ACE inhibitors can cause acute renal failure in bilateral renal artery stenosis due to reduced glomerular perfusion.
Correct answer is: ACE inhibitors
Q.22 The best screening test for proteinuria in children is:
Random urine dipstick
24-hour urine protein
Spot urine protein/creatinine ratio
Serum albumin
Explanation - Spot urine protein/creatinine ratio is reliable and easier than 24-hour collection, making it ideal for children.
Correct answer is: Spot urine protein/creatinine ratio
Q.23 A 6-year-old with edema, proteinuria, and hypoalbuminemia but normal renal function most likely has:
Minimal change disease
Membranoproliferative GN
FSGS
Post-streptococcal GN
Explanation - The typical presentation in a 6-year-old with nephrotic syndrome and preserved renal function suggests minimal change disease.
Correct answer is: Minimal change disease
Q.24 Which is the gold standard for diagnosing vesicoureteral reflux in children?
Ultrasound
Voiding cystourethrogram
DMSA scan
MRI
Explanation - Voiding cystourethrogram (VCUG) is the gold standard for diagnosing vesicoureteral reflux.
Correct answer is: Voiding cystourethrogram
Q.25 A child with nephrotic syndrome is started on steroids. Lack of remission after 8 weeks suggests:
Steroid-resistant nephrotic syndrome
Steroid-dependent nephrotic syndrome
Steroid-sensitive nephrotic syndrome
Relapsing nephrotic syndrome
Explanation - Failure to achieve remission after 8 weeks of corticosteroids defines steroid-resistant nephrotic syndrome.
Correct answer is: Steroid-resistant nephrotic syndrome