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Anemia in nephrotic syndrome: approach to evaluation and treatment | 2. Hepcidin regulates systemic iron homeostasis by which of the following processes? a) Binding of iron in plasma and excretion through the kidneys b) Inhibition of ferritin formation c) Inhibition of iron entry into the bone marrow d) Internalization and degradation of ferroportin e) Prevention of iron storage in macrophages | d |
Anemia in nephrotic syndrome: approach to evaluation and treatment | 3. Which of the following is a pathophysiologic mechanism of anemia in nephrotic syndrome include: a) Increased urinary losses of transferrin and iron b) Decreased production of transferrin c) Downregulation of the soluble transferrin receptor d) Increased urinary losses of free hemoglobin e) Erythropoietin resistance | a |
Anemia in nephrotic syndrome: approach to evaluation and treatment | 4. Which of the following is true of the role of drugs and metals in the etiology of anemia in nephrotic syndrome? a) Copper deficiency is not associated with any morphological changes in erythropoietic cells b) Copper deficiency is difficult to treat in patients with nephrotic syndrome c) The use of ACEIs is not associated with anemia in patients with kidney disease d) The effect of ACEIs on erythropoiesis is unknown e) ACEIs may cause anemia by lowering circulating levels of erythropoietin and inhibiting erythropoiesis in the process | e |
Anemia in nephrotic syndrome: approach to evaluation and treatment | 5. Of anemia in nephrotic syndrome, which of the following statements is correct? a) Anemia is always corrected by iron and erythropoietin supplementation b) Patients with steroid-sensitive nephrotic syndrome are more likely to develop iron deficiency anemia c) Anemia does not occur in patients with nephrotic syndrome and normal kidney function d) The use of erythropoietin should be considered only when plasma erythropoietin levels are low e) The pathophysiologic mechanisms are likely multifactorial and incompletely understood | e |
C3 Glomerulopathy | 1. The final diagnosis of C3G is established based on: a) Clinical symptoms alone b) Light microscopy alone c) Immunohistochemistry and electron microscopy d) Combination of clinical symptoms and light microscopy e) Low C3 levels alone | c |
C3 Glomerulopathy | 2. Common clinical and laboratory features of C3G do not include: a) Proteinuria b) Nephrotic syndrome c) Nephritic syndrome d) Low C3 levels e) Low C4 levels | e |
C3 Glomerulopathy | 3. Complement mutations and autoantibodies found in C3G patients affect mainly: a) C5b-9 formation b) Decay of C3 convertase c) C3a formation d) C1q inhibition e) Endothelial surface regulation | b |
C3 Glomerulopathy | 4. Treatment options commonly NOT used in C3G include: a) ACE inhibitors b) MMF c) Eculizumab d) AT2 antagonists e) Steroids | d |
C3 Glomerulopathy | 5. PIGN patients which might represent C3G patients show: a) Humps in kidney biopsy b) Persistently low C3 levels and continuous proteinuria and/or hematuria c) Streptococcal infections d) Predominant IgG staining in kidney biopsy e) Hematuria | b |
Cognitive remediation in pediatric chronic kidney disease | 1. In children and adolescents, neurocognitive deficits and dysfunctions: a) Only occur in those with ESKD. b) Occur in those with ESKD, but can be seen in mild to moderate chronic kidney disease c) Only occur in the presence of documented brain injury d) All the above | b |
Cognitive remediation in pediatric chronic kidney disease | 2. The effects of CKD on neurocognitive functioning during childhood may be different from those observed in adults owing to brain elasticity and neurodevelopmental growth. a) True b) False | a |
Cognitive remediation in pediatric chronic kidney disease | 3. Attention deficit/hyperactivity disorder (ADHD) has been reported in pediatric-onset CKD/ESKD in: a) 10–20% of patients b) 20–30% of patients c) 30–40% of patients d) 40–50% of patients e) >50% of patients | b |
Cognitive remediation in pediatric chronic kidney disease | 4. There are well known and robust cognitive interventions for children and adolescents with CKD. a) True b) False | b |
Cognitive remediation in pediatric chronic kidney disease | 5. Cognitive remediation programs: a) Have been tested and designed only for adult use. b) Have been tested and designed for children with CKD/ESKD. c) Have been tested and designed for children and adolescents, and hold promise for children with CKD/ESKD. d) Have no inherent value for children and adolescents with CKD/ESRD. | c |
Current status of pediatric renal transplant pathology | 1. Which statement regarding the Banff Classification is incorrect? a) The most common type of acute T-cell-mediated rejection today is Banff Borderline. b) Arteritis without tubulointerstitial infiltrates qualifies as acute T-cell-mediated rejection. c) The Banff classification is updated biannually. d) It has been thoroughly validated for AB0-incompatible renal transplants. e) Currently only transplant vasculopathy is recognized as being chronic T-cell mediated rejection. | d |
Current status of pediatric renal transplant pathology | 2. Which statement regarding antibody-mediated rejection (ABMR) is correct? a) According to the current Banff Classification set of rules it is impossible to diagnose ABMR without C4d positivity. b) C4d staining of peritubular capillaries has high sensitivity but low specificity for ABMR. c) Arteritis has recently been added to the Banff Classification set of rules as an indicator of acute ABMR. d) The presence of any immune complexes on electron microscopy rules out a diagnosis of ABMR. e) Chronic ABMR is the second most common cause for chronic transplant loss after chronic calcineurin-inhibitor (CNI) toxicity. | c |
Current status of pediatric renal transplant pathology | 3. Which statement regarding thrombotic microangiopathy (TMA) in renal transplants is correct? a) TMA is most frequently caused by CNI toxicity. b) Recurrent TMA should be ruled out in all cases. c) TMA due to ABMR can be clearly distinguished from recurrent TMA by the presence of glomerulitis and peritubular capillaritis in the former. d) Chronic glomerular TMA can show subepithelial immune complexes. e) Chronic arterial changes in recurrent TMA can be clearly distinguished histologically from transplant vasculopathy. | b |
Current status of pediatric renal transplant pathology | 4. Which statement regarding recurrent glomerular diseases is incorrect? a) Primary focal and segmental glomerulosclerosis (FSGS) almost always recurs as the collapsing type, regardless of the primary histological pattern in the native kidney. b) Immunoglobulin A glomerulonephritis is one of the most common primary diseases to recur in renal transplants. c) In children recurrent disease accounts for less transplant losses than in adults. d) Dense deposit disease can recur in renal transplants as thrombotic microangiopathy. e) The most likely cause for nephrotic range proteinuria in a renal transplant starting just after implantation is recurrent FSGS. | a |
Current status of pediatric renal transplant pathology | 5. Which statement about polyomavirus nephropathy is incorrect? a) The infection causing polyomavirus nephritis almost always stems from the kidney transplant. b) The most frequent type to cause polyomavirus nephropathy is BK virus. c) Polyomavirus spreads from the urothelium up into the tubular system but it can only infect the parietal epithelial cell of a glomerulus, not the visceral epithelial cells (podocytes). d) Only replicative infection with polyomavirus gives positive staining on immunohistochemistry with antibodies against SV-40. e) The renal biopsy is far less sensitive than blood or urine tests for polyomavirus nephropathy. | c |
Delayed graft function and its management in children | 1. What is the most common current definition of DGF? a) Complete anuria during 7 days after renal transplantation b) No decrease of serum creatinine after 3 days post-transplant c) Increase of the baseline post-transplant serum creatinine by 30% at the 3rd day post-transplant d) Requirement for dialysis during the first 7 days post-transplant e) Inadequate diuresis during the first 2 days post-transplant | d |
Delayed graft function and its management in children | 2. The incidence of delayed graft function (DGF): a) Is higher in children than in adult kidney recipients due to technical difficulties with paediatric renal transplantation b) Depends mostly from the use or non use of steroids after transplantation c) Is zero in living-related transplantation d) Is lower in children than in adult kidney recipients due to the allocation policy addressing younger deceased donors to children and frequent use of living-related donors e) Depends mostly on the dose and blood concentration of tacrolimus at day 3 post-transplant | d |
Delayed graft function and its management in children | 3. Ischaemia/reperfusion injury: a) Is recipient age-dependent b) Never occurs in living-related procurement and transplantation c) Is a two-step clinical event related to prolonged renal ischaemia and harmful reperfusion, involving several metabolic and immunological mechanisms d) May be completely prevented by infusion of erythropoietin to the renal graft e) Is not reversible in cardiac-death deceased donation | c |
Delayed graft function and its management in children | 4. Direct pre-transplant haemodialysis: a) Should be avoided as it increases the risk of DGF b) Should be performed at least 1 day before transplantation as performed later it increases the risk of DGF c) Should always be performed with the most biocompatible dialyzer membrane d) Should be of low clearance e) Should be performed at any time once necessary, however with no excessive ultrafiltration | e |
Delayed graft function and its management in children | 5. Patients with DGF: a) Present 50% of acute rejection within first 3 months after transplantation b) Present very low 5-year graft survival c) Should never be given tacrolimus d) Should always be given thymoglobuline e) Are at minor risk of acute rejection | e |
Drug-associated acute kidney injury: who’s at risk? | 1. Why is serum creatinine a poor biomarker for renal function? a. It only rises when >0 % of glomerular function is lost b. Volume expansion can lower serum creatinine values c. Creatinine production is dependent on muscle mass and may also be affected by muscle perfusion d. All of the above | d |
Drug-associated acute kidney injury: who’s at risk? | 2. There is a standardized method to assess nephrotoxicity of medications? a. True b. False | b |
Drug-associated acute kidney injury: who’s at risk? | 3. Which of the following is NOT a typical phenotype of drug-associated kidney disease? a. AKI b. Glomerular disorder c. Nephrolithiasis d. Tubular dysfunction e. Oliguria | e |
Drug-associated acute kidney injury: who’s at risk? | 4. Which of the following is a cell-cycle arrest biomarker? a. NGAL b. L-FABP c. TIMP-2 d. Cystatin-C | c |
Endemic bladder calculi in children | 1. The most common urinary risk factors in children with endemic bladder calculi are: a) Hyperphosphaturia and hyperoxaluria b) Hypocitraturia and hypovolemia c) Hyperuricosuria and hypercalciuria d) Hyperammonuria and hyperuricosuria | b |
Endemic bladder calculi in children | 2. Endemic bladder calculi are mostly composed of: a) Calcium oxalate and phosphates b) Ammonium acid urate and struvite c) Ammonium acid urate or mixture with calcium oxalate d) Uric acid and calcium oxalate | c |
Endemic bladder calculi in children | 3. The most common risk factor for endemic ammonium acid urate bladder calculi is: a) Vitamin A deficiency b) Diarrhea c) Oxalate-rich diet d) Diet poor in animal protein | d |
Endemic bladder calculi in children | 4. Pneumatic lithoclast disintegrates stone using the energy source: a) Compressed air b) Electro-hydraulics c) Laser light d) Ultrasound energy | a |
Endemic bladder calculi in children | 5. Endemic bladder calculi are: a) Frequent and commonly recur shortly after removal b) Usually solitary, but frequently recur after removal c) Usually solitary and rarely recur once removed d) Commonly multiple, but never recur after removal | c |
Endemic bladder calculi in children | 6. Endemic bladder stones are common in the following countries except: a) Sudan b) Thailand c) Turkey d) Ukraine | d |
Enhancing dialyser clearance—from target to development | 1. Which dialyser characteristic reduces small solute clearance? a) High flux membrane b) Hydrophilic dialyser membrane c) High-porosity dialyser membrane d) High adsorptive membrane structure. | d |
Enhancing dialyser clearance—from target to development | 2. Which statement about superflux dialysers is correct? a) Membrane pore size allows similar permeability to the glomerulus b) Some middle molecular weight solutes and protein-bound toxin clearances are increased c) Studies have reported clinical benefits d) There is no increase in albumin loss. | b |
Enhancing dialyser clearance—from target to development | 3. Which advantage(s) do microfluidic dialyser designs potentially offer? a) Reduced priming and extracorporeal volume b) Reduced complement, platelet and leukocyte activation c) More effective convective clearance than high-flux capillary dialysers d) All of above. | d |
Enhancing dialyser clearance—from target to development | 4. Which approach does not significantly increase protein-bound toxin clearance? a) More frequent dialysis b) Infusing hypertonic saline infusion to the dialyser blood inlet c) Switching from hydrophilic to hydrophobic dialyser membranes d) Including mesoporous activated carbon in the extracorporeal circuit. | a |
Enhancing dialyser clearance—from target to development | 5. How can the bio-incompatibility of activated carbon be reduced, but retaining absorptive capacity? a) Coating external surface of the carbon particles b) Adding activated carbon to the dialysate c) Using microporous activated carbon dialysers d) Using dual layer composite dialyser designs | d |
Extrarenal effects of FGF23 | 1. Which is NOT true? Stimulators of FGF23 serum levels in CKD are: a. Phosphate load b. Treatment with active vitamin D c. Secondary hyperparathyroidism d. Treatment with calcimimetics e. Klotho deficiency | d |
Extrarenal effects of FGF23 | 2. Which of the following statements regarding the actions of FGF23 on the heart is NOT true? a. FGF23 activates the calcineurin/NFAT signaling pathway b. FGF23 induces left ventricular hypertrophy c. FGF23 binds to its co-receptor Klotho d. FGF23 activates FGF receptor 4 e. FGF23 is locally produced in cardiac myocytes | c |
Extrarenal effects of FGF23 | 3. Which of the following statements regarding vascular comorbidity in CKD patients is NOT true? a. FGF23 serum levels are associated with arterial stiffness and vascular calcification in CKD patients b. FGF23 promotes vascular calcification ex vivo in the presence of normal and increased phosphate levels c. The negative association between elevated FGF23 levels and endothelial function in human studies may be partly explained by concomitant Klotho deficiency d. Renal transplantation results in a rapid normalization of FGF23 levels together with other alterations in mineral metabolism correlating with improved endothelial function e. Endothelial dysfunction is characterized by an imbalance between NO bioavailability and upregulation of NADPH oxidase and reactive oxygen species | b |
Extrarenal effects of FGF23 | 4. Which is NOT true? a. FGF23 and Klotho are not expressed in the brain b. FGF23 serum levels are associated with cognitive dysfunction in CKD patients c. FGF23 impacts on neuronal morphology and synaptic density in hippocampal cells d. FGF23 and Klotho are present in cerebrospinal fluid in humans and mainly originate from the brain e. FGF23 overexpression in rodents results in cognitive dysfunction and impaired spatial learning | a |
Extrarenal effects of FGF23 | 5. Which is NOT true? Promising therapeutic measures to reduce FGF23 serum levels in CKD patients are: a. Calcimimetics b. Nicotinamid c. Restoration of Klotho levels by use of ACE inhibitors d. Dietary phosphate restriction e. Calcium-containing phosphate binders | e |
HLA epitope matching in pediatric renal transplantation | 1. Which of the following statements about HLA epitopes is incorrect: a) The same epitope present on two different HLA antigens can explain the cross-reactivity of an antibody that binds both antigens. b) Each HLA antigen contains multiple epitopes that can potentially bind anti-HLA antibody c) All members of an HLA serotype (e.g., HLA-A2) have the same amino acid sequence and therefore identical epitopes. d) HLA epitopes are defined as the region of the HLA antigen that binds to the paratope of an anti-HLA antibody e) The cluster of amino acid residues that plays a key role in determining antibody binding specificity is sometimes referred to as the ‘functional epitope’ region | c |
HLA epitope matching in pediatric renal transplantation | 2. Which of the following statements concerning HLA eplets is true? a) Eplets are defined as linear sequences of three amino acids on the surface of HLA molecules b) Eplets are clusters of amino acids that theoretically define the functional epitopes that determine HLA antibody binding specificity c) Eplets have been determined by antibody absorption/elution studies of serum containing anti-HLA antibodies d) Eplets are composed of 15–25 amino acid residues that bind to the paratope of an antibody e) Eplets typically cover an area of 650–900 Å2 | b |
HLA epitope matching in pediatric renal transplantation | 3. Which one of the following has not been shown in clinical studies addressing the role of eplet mismatches in transplantation? a) The number of locus-specific class II eplet mismatches is predictive of HLA-DR and HLA-DQ de novo DSA development post renal transplant b) HLA-DQ eplet mismatch of less than 17 is associated with low risk of locus-specific de novo DSA formation c) Class II eplet mismatch is associated with the development of transplant glomerulopathy d) Class I eplet mismatch > 10 in pediatric heart transplantation is associated with increased risk of graft failure compared with class I eplet mismatch < 10 e) Class I eplet mismatch (highest vs. lowest quartile) in lung transplantation is associated with increased risk of chronic lung allograft dysfunction (CLAD). | e |
HLA epitope matching in pediatric renal transplantation | 4. Which of the following statements concerning pediatric renal transplantation is true? a) Eplet mismatch has been shown to be superior in predicting clinical outcomes compared to traditional HLA mismatch for pediatric patients receiving kidney transplants b) HLA matching in pediatric transplantation is not important as the developing immune system rapidly develops tolerance to foreign HLA c) Many children will require multiple transplants during their lives and therefore strategies to prevent HLA sensitization are important d) Deceased donor allocation policies that give priority to pediatric transplant recipients result in better histocompatibility matching for these patients e) Children with related potential donors should not enter paired kidney exchange programs, as this will result in poorer histocompatibility matching from unrelated paired donors | c |
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease | 1. How can qualitative research complement quantitative studies? a) Explain findings from a quality of life survey b) Evaluate patient satisfaction with new transition program c) Inform the design of a new intervention to improve adherence d) All of the above | d |
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease | 2. Which of the following is not a principle of data collection in qualitative research? a) Data or theoretical saturation b) Constructivist—i.e. meaning is built by the interaction between the researcher and participants c) Systematic and scientific d) Fixed and controlled experimental setting | d |
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease | 3. If you were planning to conduct a qualitative study to understand adolescents’ perspectives on medicine-taking in kidney transplantation, what would be the best sampling strategy to capture a range of experiences? a) Purposive b) Snowballing c) Random d) Convenience | a |
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease | 4. What is member-checking? a) Ascertaining the reasons for non-participation b) Cross-checking participant responses against medical records c) Comparing participants views with findings from other studies conducted in different settings d) Obtaining and integrating feedback from participants on the preliminary findings | d |
In their own words: the value of qualitative research to improve the care of children with chronic kidney disease | 5. Which of the following principles reflects strategies to demonstrate that the findings may be relevant to other settings and populations? a) Credibility b) Confirmability c) Transferability d) Dependability | c |
Inflammation in IgA nephropathy | 1. Which statement on IgAN pathogenesis is correct? a. Galactosylation of the IgA1 light chains is strongly increased in IgAN patients b. Galactose-deficient IgA1 molecules appear as monomers in the serum c. Sera from IgAN patients contain elevated levels of autoantibodies against undergalactosylated IgA1 d. Podocytes are not involved in IgAN pathogenesis | c |
Inflammation in IgA nephropathy | 2. According to the most recent GWAS analyses in IgAN patients, which compartment might play a central role in IgAN development? a. T lymphocytes b. Resident renal dendritic cells c. Pararenal lymph nodes d. Waldeyer’ ring e. The intestinal immunity | e |
Inflammation in IgA nephropathy | 3. The 2012 KDIGO guidelines suggest: a. Tonsillectomy in all IgAN patients b. A 6-month corticosteroid course in IgAN patients who are still proteinuric at >1 g/day and have preserved renal function (i.e., GFR > 50ml/min/1.73 m2) c. MMF in Asian IgAN patients d. Calcineurin inhibitors in IgAN patients with crescentic IgAN variants e. To stop supportive measures when these had been ineffective over 3–6 months | b |
Inflammation in IgA nephropathy | 4. Supportive measures in IgAN patients do not include: a. Antihypertensive treatment primarily with dihydropyridine calcium-channel blockers b. ACE inhibitors or ARBs as first-choice antihypertensive drugs c. Smoking cessation d. Control of lipid levels e. Restriction of NaCl intake | a |
Inflammation in IgA nephropathy | 5. Which statement about the recent STOP-IgAN trial is correct? a. During the 6-month run-in phase ACE inhibitor or ARB treatment was stopped in all participants. b. All randomized patients received immunosuppressants according to their renal function c. Numbers of patients who developed a reduction of eGFR of ≥15 ml/min during the 3-year trial phase were comparable in both treatment groups, i.e., between those on supportive and those on additional immunosuppressive therapy d. Adverse events occurred with comparable frequencies in patients under supportive and those under additional immunosuppressive treatment | c |
Life expectancy with chronic kidney disease: an educational review | 1. Proteinuria predicts progressive renal failure if greater than: a) 50 mg/mmol creatinine (0.5 g/d) b) 100 mg/mmol creatinine (1.0 g/d) c) 150 mg/mmol creatinine d) 200 mg/mmol creatinine | a |
Life expectancy with chronic kidney disease: an educational review | 2. Life expectancy is reduced when eGFR falls below: a) 60 ml/min b) 50 ml/min c) 50 ml/min d) 30 ml/min | a |
Life expectancy with chronic kidney disease: an educational review | 3. Life expectancy on dialysis in USA has stopped increasing a) Since 2000 b) Since 2005 c) Since 2010 d) Is still increasing | d |
Life expectancy with chronic kidney disease: an educational review | 4. The increased relative risk of dying in young patients with CKD is: a) Cardiovascular b) Cancer c) Infection d) None of these | a |
Lower urinary tract obstruction: fetal intervention based on prenatal staging | 1. What is the best indication for fetal vesicoamniotic shunting? a) Presence of enlarged bladder, bilateral hydronephrosis, normal amount of amniotic fluid and favorable amount of amniotic fluid for urinary biochemistry after 18 weeks of gestation. b) Presence of enlarged bladder, bilateral hydronephrosis, reduced/absent amount of amniotic fluid, and favorable urinary biochemistry after 18 weeks of gestation. c) Presence of enlarged bladder, bilateral hydronephrosis with renal cortical cysts, reduced/absent amount of amniotic fluid, and nonfavorable urinary analysis after 18 weeks of gestation. d) Presence of mildly distended bladder, bilateral hydronephrosis with renal cortical cysts, and absence of corticomedullar differentiation associated with reduced or absent amniotic fluid and nonfavorable urinary analysis after 18 weeks of gestation. e) There is no indication. | b |
Lower urinary tract obstruction: fetal intervention based on prenatal staging | 2. What are the main characteristics of stage I LUTO? a) Presence of enlarged bladder, bilateral hydronephrosis, normal amount of amniotic fluid, and favorable amount of amniotic fluid for urinary biochemistry after 18 weeks of gestation. b) Presence of enlarged bladder, bilateral hydronephrosis, reduced or absent amniotic fluid, and favorable urinary biochemistry after 18 weeks of gestation. c) Presence of enlarged bladder, bilateral hydronephrosis with renal cortical cysts, reduced or absent amniotic fluid, and nonfavorable urinary analysis after 18 weeks of gestation. d) Presence of mildly distended bladder, bilateral hydronephrosis with renal cortical cysts and absence of corticomedullar differentiation associated with anhydramnios, and nonfavorable urinary analysis after 18 weeks of gestation. e) Presence of normal fetal bladder, bilateral mild hydronephrosis, and normal amount of amniotic fluid after 18 weeks of gestation. | a |
Lower urinary tract obstruction: fetal intervention based on prenatal staging | 3. What are the main characteristics of stage IV LUTO–intrauterine fetal renal failure? a) Presence of enlarged bladder, bilateral hydronephrosis, normal amount of amniotic fluid, and favorable amount of amniotic fluid for urinary biochemistry after 18 weeks of gestation. b) Presence of enlarged bladder, bilateral hydronephrosis, reduced or absent amniotic fluid, and favorable urinary biochemistry after 18 weeks of gestation. c) Presence of enlarged bladder, bilateral hydronephrosis with renal cortical cysts, reduced or absent amniotic fluid, and nonfavorable urinary analysis after 18 weeks of gestation. d) Presence of mildly distended bladder, bilateral hydronephrosis with renal cortical cysts and absence of corticomedullar differentiation associated with anhydramnios, and nonfavorable urinary analysis after 18 weeks of gestation. e) Presence of normal fetal bladder, bilateral mild hydronephrosis, and normal amount of amniotic fluid after 18 weeks of gestation. | d |
Lower urinary tract obstruction: fetal intervention based on prenatal staging | 4. What is the best perinatal management of fetuses with stage I LUTO at 28 weeks of gestation? a) Delivery and postnatal care. b) Fetal vesicoamniotic shunting. c) Fetal cystoscopy to identify the cause of the obstruction and to treat it specifically. d) Expectant prenatal management with weekly fetal US follow-up and delivery at term. e) Open fetal vesicostomy. | d |
Lower urinary tract obstruction: fetal intervention based on prenatal staging | 5. What is the best perinatal management of fetuses with stage IV LUTO at 28 weeks of gestation? a) Delivery now and postnatal care. b) Fetal vesicocamniotic shunting. c) Fetal cystoscopy to identify the cause of the obstruction and then treat it specifically. d) Expectant prenatal management with weekly fetal US follow-up and delivery after 34 weeks, preferentially close to term. e) Open fetal vesicostomy. | d |
Measuring and estimating glomerular filtration rate in children | 1. Normal GFR for children is above a. 60 mL/min/1.73 m2 b. 75 mL/min/1.73 m2 c. 90 mL/min/1.73 m2 d. 120 mL/min/1.73 m2 | c |
Measuring and estimating glomerular filtration rate in children | 2. The gold standard for direct GFR measurement is a. Renal clearance of inulin b. Plasma clearance of iohexol c. Renal clearance of iothalamate d. Plasma clearance of inulin | a |
Measuring and estimating glomerular filtration rate in children | 3. When the reduced plasma clearance protocol with only late blood samples is used, then a. The AUC is overestimated and can be corrected with the Bröchner-Mortensen formula b. The AUC is underestimated and can be corrected with the Bröchner-Mortensen formula c. The GFR is overestimated and can be corrected with the Bröchner-Mortensen formula d. The GFR is underestimated and can be corrected with the Bröchner-Mortensen formula | c |
Measuring and estimating glomerular filtration rate in children | 4. The updated bedside Schwartz equation is a. eGFR=0.368 L/Scr b. eGFR=0.413 L/Scr c. eGFR=107.3/[Scr/Q] d. eGFR=0.413 L/CysC | b |
Measuring and estimating glomerular filtration rate in children | 5. Scr-based equations should be avoided a. For adolescents b. For healthy children c. For children with CKD d. For children with reduced muscle mass | d |
Nutritional management in the critically ill child with acute kidney injury: a review | 1. All of the following are metabolic derangements in AKI except: a. increased secretion of catabolic hormones b. decreased secretion of anabolic hormones c. reduced peripheral lipoprotein lipase d. increased hepatic triglyceride levels. | d |
Nutritional management in the critically ill child with acute kidney injury: a review | 2. Which of the following statements about markers of nutritional status in AKI is false? a. anthropometric variables may be interfered with by the fluid status of the critically ill child b. laboratory markers such as albumin and transferrin are negative markers of inflammation c. body composition parameters are always helpful in the clinical setting of AKI d. limited data are available on growth hormone/insulin-like growth factor axis changes in critically ill patients in the ICU to be used in clinical practice. | c |
Nutritional management in the critically ill child with acute kidney injury: a review | 3. Which of the following statements is true about energy needs in critically ill children? a. the gold standard to quantify energy needs in children and in adults is the measurement of actual energy consumption by indirect calorimetry b. resting energy expenditure calculations in patients receiving continuous RRT are always reliable c. the Schofield equation should not be used in children as it has no correlation with indirect calorimetry d. The Schofield equation can be calculated from the weight, mid-arm circumference, and age. | a |
Nutritional management in the critically ill child with acute kidney injury: a review | 4. Which of the following statements is true about protein losses in dialysis? a. in a pediatric study, glutamine losses during CRRT accounted for 25 % of all amino acid losses b. during RRT, there is no need to account for protein losses in the dialysate c. clearance of amino acids in children on CRRT is in the range of 60–100 ml/min/1.73 m2 d. AKI is a state of low protein turnover. | a |
Nutritional management in the critically ill child with acute kidney injury: a review | 5. Which of the following statement is not true? a. for children receiving CRRT for prolonged periods, serum levels of water soluble vitamins should be monitored, and additional supplementation may be required b. additional folate supplementation is needed in children who are receiving CRRT for prolonged periods c. for children on acute PD and HD, 100 % of the recommended nutrient intake of micronutrients can be considered the target d. there is evidence to prove that all patients on CRRT should receive glutamine supplements. | d |
Peritoneal dialysis for the management of pediatric patients with acute kidney injury | 1. Which of the following statement is true: a) Peritoneal surface area in infants is lower than that in adults (per unit weight) b) To perform PD, an ICU environment is not always necessary c) PD is not safe in patients with bleeding diathesis d) Controlled and precise fluid balance can be obtained with acute intermittent PD | b |
Peritoneal dialysis for the management of pediatric patients with acute kidney injury | 2. The maximum dwell volume in PD is: a) 800 ml/m2 b) 1000 ml/m2 c) 1200 ml/m2 d) 1400 ml/m2 | d |
Peritoneal dialysis for the management of pediatric patients with acute kidney injury | 3. All of the following are true with reference to composition of standard 1.7 % peritoneal dialysis fluid with the exception of: a) Osmolarity of 355 mOsm/l b) Sodium of 130 mmol/l c) Potassium of 2 mmol/l d) Dextrose of 1.7 g/dl | c |
Peritoneal dialysis for the management of pediatric patients with acute kidney injury | 4. Which of the following regimens of PD has highest small solute clearance as compared to standard PD: a) Tidal PD b) Continuous flow PD c) High-volume PD d) All have similar solute clearances | b |
Potassium regulation in the neonate | 1. Potassium regulation by the feedforward mechanism: a) Is mediated by aldosterone b) Is activated 6 h after a glucose-containing meal c) Is activated 6 h after ingesting a potassium-containing meal d) Is triggered by elevated [K+] in gastrointestinal tract e) Is triggered by elevated [K+] in plasma. | d |
Potassium regulation in the neonate | 2. The neonatal kidney is programmed to preserve potassium. A potential mechanism involves the following: a) Increased activity of Na+/K+-ATPase b) Increased activity of apical ROMK c) Increased expression of H+/K+-ATPase d) Increased expression of Maxi-K channels e) Increased expression of NKCC2. | c |
Potassium regulation in the neonate | 3. Which following statement is TRUE, regarding NOH of the newborn: a) Is a benign condition b) Is more frequent in late pre-term infants c) Is the result of impaired feedforward mechanism d) Is the result of impaired transcellular potassium shift e) Should be treated if plasma [K+] exceeds 6 meq/L. | d |
Potassium regulation in the neonate | 4. A 4-day-old premature infant developed a plasma [K+] = 2.3 meq/L, [HCO3−] = 26 meq/L. The ECG is normal. Of the following, the BEST therapeutic approach is: a) Add 40 meq/L of KCl to 0.45 saline solution with 5% dextrose water b) Add 40 meq/L of KCl to 0.45 saline solution without dextrose c) Add 60 meq/L of KCl to 0.45 saline solution without dextrose d) Administer KCl at a dose of 1 mEq/kg in 0.9 normal salts intravenously in 1 h e) Administer potassium citrate at a dose of 1–2 meq/kg/day by oral route | b |
Potassium regulation in the neonate | 5. You get a laboratory report of [K+] = 7 meq/L in a 2-day-old infant, born at 29 weeks of postmenstrual age. The ECG is normal. You should: a) Administer sodium polysterene resin 1 g/kg as enema b) Administer NaHCO3 1meq/kg intravenously over 1 h c) Administer calcium gluconate 10% 1 ml/kg intravenously over 15 min d) Administer albuterol by nebulizer continuously until [K+] <6 meq/L e) Repeat blood sample. | e |
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies | 1. Which statement is true regarding proteinuria and CKD: a) Proteinuria is an indicator of glomerular dysfunction b) Proteinuria is an indicator of tubular dysfunction c) Proteinuria induces interstitial inflammation and apoptosis of proximal tubular cells d) RAAS plays an important role on proteinuria-induced fibrosis e) All of the above | e |
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies | 2. In the Italian Pediatric registry of chronic renal failure: a) All predialysis patients aged <18 years with a GFR of <75 ml/min/1.73 m2 in Italy are included b) The GFR was estimated from serum Cr using the Schwartz equation and proteinuria was based on baseline 24-h urine measurements c) By multivariate analysis the baseline Up/c correlated with a faster decline in eGFR irrespective of the baseline GFR d) In patients with renal hypodysplasia ACEi did delay the progression of CKD | c |
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies | 3. In the randomized control trial of low protein diet on progression of CKD: a) Both low-protein diet as well as proteinuria were associated with CKD progression b) The design is a randomized multicenter study in children aged 2–18 years c) GFR was estimated and the proteinuria was assessed using 24-h urine measurements d) Proteinuria >40 mg/kg/day was a predictor of progression | b |
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies | 4. In the ESCAPE trial: a) 30–40 % of the patients had hypodysplasia as the primary cause of CKD b) Greater degree of proteinuria was associated with an overall risk of reaching ESKD or 50 % reduction in GFR with a HR of 1.46 c) GFR was estimated and the proteinuria was assessed using mostly random Up/c d) The patients were followed over a period of 4 years | b |
Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies | 5. In the CKiD study: a) Children 1–16 years of age with GFR 15–90 ml/min/1.73 m2 have been followed for >10 years b) GFR is measured using plasma iohexol disappearance curves and the proteinuria is assessed using 24-h urine collection c) Nephrotic-range proteinuria was one of the predictors of progression for patients with a glomerular but not nonglomerular cause of CKD. d) Among the nonglomerular cases of CKD; CKD progressed faster in the presence of elevated Up/c, elevated BP or both. | d |
Pubertal development in children with chronic kidney disease | 1. Which is NOT true? Impairment of pubertal height gain in children with CKD is associated with: a. Exposure to glucocorticoids b. An earlier era for the start of renal replacement therapy c. Age at renal transplantation d. Growth hormone treatment e. Duration of dialysis | d |
Pubertal development in children with chronic kidney disease | 2. Which of the following statements regarding skeletal maturation in CKD patients is NOT true? a. The severity of the relative growth retardation at the time of puberty correlates positively with the delay in bone maturation b. Linear growth and bone maturation are dissociated during puberty c. Final height prediction models are reliable d. GH treatment does not accelerate bone maturation e. Treatment with sex steroids is associated with accelerated bone maturation | c |
Pubertal development in children with chronic kidney disease | 3. Which of the following does NOT occur in adolescents with end-stage CKD? a. LH and FSH levels may be increased b. Gonadal hormone levels may be decreased c. Pituitary GH secretion may be decreased d. IGF binding capacity is usually normal e. A state of hypergonadotropic hypogonadism is frequently observed in patients with long-standing dialysis | d |
Pubertal development in children with chronic kidney disease | 4. Which is NOT true? a. Pubertal delay is rarely seen nowadays in patients with end-stage CKD b. GH treatment may result in precocious puberty in CKD patients c. GH treatment does not increase total pubertal height gain d. GH treatment results in catch-up growth during the prepubertal age e. Withdrawal of glucocorticoids within the first 6 months after transplantation results in normal pubertal growth and adult height in the majority of patients | b |
Pubertal development in children with chronic kidney disease | 5. Which is NOT true? Renal transplantation with use of daily steroids: a. Is associated with obesity b. Has been shown to increase total pubertal height gain compared with healthy children c. May require GH treatment in the case of persistent growth failure d. Is associated with reduced pituitary GH secretion e. Is associated with low plasma IGF-1 levels | b |
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume? | 1. All statements below regarding small pores are true except one: a) Are less abundant than large pores b) Are 1/10,000-fold less abundant than AQP1 c) Allow dialytic solute removal d) Permit diffusive and convective transport | a |
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume? | 2. All statements below regarding sodium sieving are true except one: a) Occurs during the early phase of exchange b) Is a parameter of AQP1 channels function c) Is correlated to UF d) Is independent of peritoneal membrane solute permeability | d |
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume? | 3. All statements below regarding osmotic conductance are true except one: a) Can be expressed in milliliters of UF per gram of glucose absorbed b) Is more accurately estimated applying 3.86 % glucose dialysate than applying 1.36 % glucose dialysate c) Is not impacted by peritoneal surface area recruitment d) Is an evaluation of the functional relation between the small pores and the AQP1 channels | c |
Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume? | 4. All statements below regarding DSR are true except two: a) Is essentially realized by diffusive transport in conventional PD b) Peritoneal sodium absorption is usually negligible c) Can be estimated from UF volume in CAPD d) May be improved by modifying dwell volume and dwell time within one session e) Should be measured in automated PD | a, b |