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MNJ31-001

images/MNJ-P-OSCE 31. Nephrology_page_0_Picture_8.jpeg

  1. Name the investigation.
  2. What 1s the diagnosis?
  3. What are the further inveshigatons this child need?

Answer

  1. MCU (Micturating cystourethrogram)

MNJ31-002
See the image and answer the following questions.

Tar |

images/MNJ-P-OSCE 31. Nephrology_page_1_Picture_5.jpeg

  1. Give the diagnosis of this condition
  2. Give four important components
  3. State the most important prognostic factors.

Answer

  1. Prune-belly syndrome

Long-term complication

MNJ31-003

  1. How do you determine GFR using serum creatinine with Schwartz formula?
  2. Whats stage II chromic kidney disease (CKD) in terms of GFR?
  3. State True / False

Answer

  1. GFR (ml/min/1.73 m2)

=K×Height (cm)serum creatinine (mg/dl)

where K is

Table 31.1: Genet Standardized terminology for stage of chronic kidney disease
Stage Description GFR (ml/min/1.73 m)
Stage 1 Kidney damage with normal or increased GFR >90
Stage 2 Kidney damage with mid decrease in GFR 60-89
Stage 3 Moderate decrease in GFR 30-59
Stage 4 Severe decrease in GFR 5-29
Stage 5 Kidney failure GFR <15 or on dialysis

MNJ31-004
A 6-year-old boy Rajeev presented with periorbital puffiness, red color urine. He had history of URTI 12 days back and now on examination he had tachycardia, tachypnea and his BP 142/80 mm Hg:

  1. Whats the most likely diagnosis of this clinical scerurio?
  2. What investigations will you do to confirm the diagnosis?
  3. What 1s the drug of choice for hypertension?

Answer

  1. Acute glomerulonephritis

MNJ31-005
A 12-year-old boy Vivek presents with 2 episodes of gross hematuria. He also has hearing impairment. All other clinical examination is normal:

  1. Whats the likely diagnosis?
  2. Which are the other extra renal manifestations present in this condition?
  3. What are the patterns of inheritance?

Answer

  1. Alport syndrome

Nephrology 439

MNJ31-006
A 14-year-old male child Bhanu presented with complaints of severe failure to thrive, history of recurrent vomiting, polyuria. On examination he is moderately dehydrated with

Nephrology 433 |

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  1. What 1s the most likely diagnosis?
  2. What are the various types of this disorder?
  3. Give three secondary causes of this condition.
  4. How will you manage this child?

Answer

  1. Distal RTA

MNJ31-007
A6-year-old girl Megha is referred with an abdominal mass found by her mother as she was undressing her. She has had no significant problems in the past. On examination, you note a mass arising from the right renal angle extending medially almost to the midline and inferiorly 10 cm. Her BP is noted to be 160/110. Investigations of plasma urea, creatinine, and electrolytes are normal, urine microscopy—haematuria +++, culture—no growth:

  1. What are the 2 most likely diagnosis?
  2. Explain why the BP 1s raised in these 2 condibons.
  3. For each diagnosis give one site where further lesions might be commonly found.

Answer

  1. Wilms' and neuroblastoma

Neuroblastoma-increased catecholamine secretion

  1. Wilms'-lung

Neuroblastoma-long bones

MNJ31-008
A 4-day-old newborn male baby of Anita with history of oligohydramnios in the antenatal period in the mother underwent MCU (Micturating cystourethrogram):

images/MNJ-P-OSCE 31. Nephrology_page_2_Picture_16.jpeg

  1. Describe the MCU image.
  2. What 1s the absolute indication for MCU in newborn?
  3. What antenatal intervention would have helped this child?
  4. What are the chances of CKD in adolescence in this child?
  5. What are the surgical procedures possible?

Answer

  1. MCU showing narrow anterior urethral stream, dilated posterior urethra, dilated and trabeculated bladder with diverticulae and secondary VUR

MNJ31-009
2-year-old male Rahul with acute gastroenteritis develops anuria. His Hb is 8.5, platelet count: 80,000 and PT: 24/20, PTT: 28/30:

Answer

  1. Microangiopathy—hemolytic anemia with helmet cells, burn cells, He—RBCs

MNJ31-010
An 8-year-old boy Bhushan brought from his native place with history of fever and hematuria for last three days. He was apparently alright 3 months back. He had epistaxis from right and then from both nostrils. Also noted to have red eyes without discharge. 1 month back developed cough and had hemoptysis. He was noted to have breathlessness since 1 week. His voice has changed significantly as per his mother:

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  1. Clinical diagnosis.
  2. Name the confirmatory lab test for this disease.
  3. Write (any 2) treatment options.
  4. Name (any 2) other diseases with similar pathogenesis

Answer

  1. Granulomatosis with polyangiitis (GPA)—Wegener

MNJ31-011
An infant born to diabetic mother presented with hematuria/anuria with bi-enlarged kidneys on USG and CBC showed Hb: 22.5, HCT: 72%, TLC: 9100, platelet: 70,000:

  1. Clinical diagnosis of this condition.
  2. Differential diagnosis of this condition.
  3. Diagnostic modality for this condition.
  4. Treatment principles.
  5. Long-term complications.

Answer

  1. Renal vein thrombosis

MNJ31-012
A child Monu presents with muscle cramps since last 7 days. The serum magnesium is 1.2 mg/dL, K is 1.6 mg/dl and HCO3 is 42 mg/dl. There is no sign of dehydration:

  1. What electrolyte in urine will you estimate?
  2. Why?
  3. The level of the urinary electrolyte estimated is high—BP is normal. List 3 possible diagnosis.
  4. There is no history of drug ingestion or failure to thrive, hypertension. What is the diagnosis?
  5. 3 drugs for treatment
  6. What will be level of renin and aldosterone in serum?
  7. What will be the urinary calcium level?

Answer

  1. Calcium

MNJ31-013
With regard to the renal radioimaging, identify the following images and mention the name of the imaging:

Nephrology 435 |

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images/MNJ-P-OSCE 31. Nephrology_page_4_Picture_2.jpeg
images/MNJ-P-OSCE 31. Nephrology_page_4_Picture_3.jpeg
images/MNJ-P-OSCE 31. Nephrology_page_4_Picture_4.jpeg

Answer

A. PUJ obstruction—excretory urogram

MNJ31-014
A 13-year-old girl Radha, history of recurrent muscle cramps, ABG-pH: 7.65, pO,: 98, HCO,: 37, pCO,: 46, SaQ,: 98:

  1. Interpret the ABG.
  2. Is it compensated? What is the formula for compensation?
  3. What is the probable diagnosis?
  4. Whats the basic defect?
  5. Mention 3 associated metabolic abnormalities in this condition.

Answer

  1. Metabolic alkalosis.

MNJ31-015
A 7-month-old male child Sanju admitted with complaints of tubercular meningitis. He is unimmunized till date. His serum sodium 124, S.K: 4.1:

  1. What cause of this low sodium you will suspect in this case?
  2. How will you correct this hyponatremia?
  3. What investigation you advise to confirm you the diagnosis of this low sodium?

Answer

  1. Cereberal self wasting

MNJ31-016
Match the investigation of choice with given renal conditions: Each option may be use once, more than once or not at all.

  1. Abdominal X-ray in. Pylonephritis
  2. IVU (intravenous urography) v. VUR
  3. DMSA i Horse shoe kidney
  4. MCUG 11. Detection of obstructive renal disease
  5. USG iv. Diagnosis of renal artery stenosis
  6. MAG 3 scan vi. Calcium stone in ureter

Answer

  1. E, 2. A, 3. F, 4 F, 5. C, 6. B

**Calcium stone are radio opaque so we can see them in X-ray but oxalate, uric acid and xanthine stones are radiolucent so visible only on USG. For any anatomical defect like horse shoe kidney, duplication of renal system IVU is good investigation. Hydronephrosis because of obstruction or without obstruction is best diagnosed by MAG-3 scan. Vascular pathology like renal artery and venous stenosis are best diagnosed by MAG-3 scan. For scarring due to reflux or pylonephritis DMSA scan is best. MCUG is best investigation for reflux.

MNJ31-017
A 9-month-old child came to you as a follow up case of UTI. Renal USG showed unilateral dilated pelvis. Your consultant order an important investigation. You called to give Inj Lasix given at 20 min of procedure.

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  1. Whats this investigation?
  2. What are its uses?
  3. What are its phases?
  4. What abnormality 1s this scan showing 1n this child?

Answer

  1. This is T99 -mercapto-acetyl triglycine (MAG3) scan. This is also called dynamic renogram.

images/MNJ-P-OSCE 31. Nephrology_page_9_Figure_26.jpeg

Normal MAG-3 scan

Nephrology 444 ]

Ans. 18. 1.1,2.iv,3 un

MNJ31-018
Choose right diagnosis from given scenarios

  1. A6 years old boy with history of UTI present with a few hours history of severe scrotal pain. His urine R/M 1s normal and no history of fever is present. You examine the child and found swollen and tender left testis.
  2. A3 years old boy came in emergency for rash and painful right scrotal swelling. His urine examination showed presence of blood and he 1s also afebrile.
  3. A 13 years old boy Rajan admitted with complaints of 2 days history of scrotal pam. His urine R/M showed positive for leucocyte and protein. On examination, his ght tests is tender on posterolateral surface. He has straddle injury a few days back.
  4. Testicular torsion
    v. Testicular trauma.

Answer

No model answer in source material.

MNJ31-019
Nephrology 437

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  1. Identify the following test.
  2. Whats possible diagnosis according to this film
  3. How much Time needed between injection and imaging?
  4. Write down Four indications of this investigation.

Answer

  1. Identify-Technetium99m DMSA (Di mercapto succinic acid) scan

MNJ31-020

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  1. Identify the following test.
  2. What information we get with this investigation?
  3. How much time needed between injection and imaging?
  4. Write down four indications of this investigation.

Answer

  1. DTPA (99 mTc-diethylene triamine pentaacetic acid) scan