This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'A child comes with steroid-resistant nephrotic syndrome secondary to FSGS, not responsive to methylprednisolone. What next should be given – \nSelect and explain. \nA. Oral cyclophosphamide, B. Oral cyclosporine, C. Oral mycophenolate, D. IV cyclophosphamide', 'role': 'user'}, {'content': 'Answer: B \nExplanation: The treatment options for steroid-resistant nephrotic syndrome are:\n\n\nCalcineurin inhibitors (cyclosporine, Tacrolinzus)\nIV or oral cyclophosphamide\n\tLevamisol\n\n\nMycophenolate\nPulse corticosteroid\n\n\nAll above immunosuppressants are used along with corticosteroids (Prednisolone or methylprednisolone).\nCyclosporine and cyclophosphamide are most commonly used.\nDespite these options, there is a lack of consensus on first line appropriate therapy for steroid-resistant nephrotic syndrome.\nAccording to Indian Journal of pediatric (vol. 46, Jan 17, 2009) the efficacy of these drugs are (in decreasing order): Tacrolimus + Prednisolone > cyclosporine + Prednisolone > IV cyclophosphamide + Prednisolone > Pulse Corticosteroids (IV dexamethasone + oral cyclophosphamide + Prednisolne) > oral cyclophosphamide + Predniso-lone.\nSo, amongst the given options, best answer is cyclosporine.', 'role': 'assistant'}]