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Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? | What gene contributes to the majority of ADPKD cases? a) PKD1 b) PKD2 c) PKD3 d) CYS1 e) CYS2 | a |
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? | What is the average age of ICA rupture in those with ADPKD? a) 12 years b) 20 years c) 34 years d) 40 years e) 52 years | d |
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? | What is the true prevalence of ICA in the ADPKD paediatric population? a) 0.1% b) 1% c) 2% d) 5% e) unknown | e |
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? | What is the imaging tool of choice for investigations for an ICA in children? a) CT b) X-ray c) TOF MRA d) Cranial ultrasound e) PET scan | c |
Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? | Which of the following statistical measures are affected by the prevalence of a disorder? (2 correct) a) Sensitivity b) Specificity c) Positive predictive value d) Negative predictive value | c and d |
Serum osmolality and hyperosmolar states | 1. A 5-year-old female patient was admitted to the pediatric emergency room with complaints of irritability, nausea, vomiting, and abdominal pain. Blood gas analysis showed pH 7.28, HCO3 18 mmol/dL; serum biochemistry revealed sodium 143 mEq/L, potassium 4.3 mEq/L, chloride 102 mEq/L, glucose 96 mg/dL, blood urea nitrogen 26 mg/dL, and creatinine 0.8 mg/dL. Fractional excretion of sodium was 0.8%. Serum osmolality was measured as 305 mOsm/kg with osmolal gap 22 mOsm/kg. What is the most probable diagnosis?\na. Renal tubular acidosis\nb. Hypernatremic dehydration\nc. Ethylene glycol poisoning\nd. Acute tubular necrosis\ne. Septic shock | c |
Serum osmolality and hyperosmolar states | 2. Which of the below conditions is not associated with an increased osmolal gap? a) Radiocontrast medium use b) Methanol intoxication c) Mannitol treatment d) Severe hyperproteinemia e) Sodium chloride administration | e |
Serum osmolality and hyperosmolar states | 3. Please select the false statement. a) Serum tonicity increases in cases of diabetic ketoacidosis. b) Serum tonicity increases in cases of acute hyperkalemia due to crush injury. c) An increase in serum tonicity is responded to by arginine vasopressin release and stimulation of thirst. d) Organic osmolytes are slowly removed during restoring serum osmolality. e) Rapid hemodialysis in the initiation of kidney replacement treatment can cause brain edema due to water shift into the brain cells with relatively higher urea concentrations. | b |
Serum osmolality and hyperosmolar states | 4. Which of the substances given below is not considered an organic osmolyte? a) Glutamate b) Aspartate c) Taurine d) Oxalate e) Glycine | d |
Sociodemographic determinants of chronic kidney disease in Indigenous children | Which of the following is the most important risk factor for CKD in Indigenous children? a) Genetic predisposition. b) Post-infectious glomerulonephritis. c) Type 1 diabetes. d) Impacts of colonization including sociodemographic disadvantage. | d |
Sociodemographic determinants of chronic kidney disease in Indigenous children | Which of the following statements about the developmental origins of health is most accurate? a) In utero exposures are only relevant to kidney development in the 1st and 2nd trimesters of pregnancy. b) Prenatal exposure to diabetes in pregnancy increases the risk of diabetes and kidney disease in offspring. c) Prenatal exposure to CKD in pregnancy increases the risk of diabetes and kidney disease in offspring. d) Indigenous individuals have glomeruli that are smaller than non-Indigenous individuals. | b |
Sociodemographic determinants of chronic kidney disease in Indigenous children | What prevention strategies would best address the high rates of CKD in Indigenous peoples? a) Exercise-based interventions. b) Multifaceted interventions that include screening for early risk factors, intensive follow-up and care that is culturally appropriate. c) Dialysis education. d) Prenatal vitamins. | b |
Sociodemographic determinants of chronic kidney disease in Indigenous children | What standard work-up should be considered for an asymptomatic Indigenous adolescent in the primary care setting? a) None—screening tests are not useful. b) BMI assessment only. c) Thyroid studies. d) Blood pressure, BMI assessment, creatinine for eGFR, HbA1c, and urine for assessment of albuminuria. | d |
Sociodemographic determinants of chronic kidney disease in Indigenous children | What is the best argument for screening Indigenous children for metabolic and kidney disease? a) Early metabolic disease and CKD risk factors are modifiable with treatment. b) Screening for CKD is cost effective in children. c) There are none—screening is irrelevant in children. d) There are none—diabetes and CKD usually are associated with symptoms in children. | a |
Monogenic forms of low-renin hypertension: clinical and molecular insights | 1. Monogenic hypertension can be excluded in a patient if: a) Patient’s mother has hypertension diagnosed at 40 years of age b) Blood pressure in a 15-year-old girl does not exceed 140/80, and there is no target organ damage c) Plasma aldosterone concentration is normal d) Blood potassium and acid–base balance is normal e) None of the above | e |
Monogenic forms of low-renin hypertension: clinical and molecular insights | 2. Which of the following abnormalities is NOT inherited as autosomal dominant: a) Intronic WNK1 mutation in pseudohypoaldosteronism type 2 b) Chimeric CYP11B1/CYP11B2 c) Deficiency of 11β-hydroxysteroid dehydrogenase-2 d) p.Ser810Leu mutation in NR3C2 e) SCNN1B defect in Liddle syndrome | c |
Monogenic forms of low-renin hypertension: clinical and molecular insights | 3. Match the disorders with appropriate primary treatment: 1. Apparent mineralocorticoid excess A. Amiloride 2. Pseudohypoaldosteronism type 2 B. Low-dose dexamethasone 3. Liddle syndrome C. Hydrocortisone replacement 4. 17α-Hydroxylase deficiency D. Spironolactone E. Thiazide a) 1-A, 2-E, 3-D, 4-C b) 1-D, 2-E, 3-A, 4-C c) 1-E, 2-C, 3-D, 4-B d) 1-D, 2-B, 3-A, 4-C e) 1-D, 2-E, 3-A, 4-B | b |
Monogenic forms of low-renin hypertension: clinical and molecular insights | 4. A 12-year-old boy presented with short stature (height −2.5 standard deviation) and blood pressure of 150/100. Father had hypertension diagnosed at 30 years of age and died following an intracranial bleed. Cardiac and abdominal examinations were unremarkable. Investigations showed Na 143 mEq/L, K 6.2 mEq/L, HCO3 18 mEq/L, and creatinine 0.48 mg/dl. The gene implicated for this condition most likely is: a) KCNJ5 b) HSD11B2 c) KCNJ1 d) CUL3 e) SCNN1G | d |
Monogenic forms of low-renin hypertension: clinical and molecular insights | 5. A 3-year-old girl presented with poor weight gain, polyuria, and polydipsia since infancy. She was born at term weighing 2.1 kg. Family history was unremarkable. Blood pressure was 140/90 mmHg. Investigations were creatinine of 0.6 mg/dL, sodium of 144 mEq/L, potassium of 2.4 mEq/L, and bicarbonate 25 mEq/L. Ultrasound showed normal sized kidneys with medullary nephrocalcinosis, and Doppler showed normal renal vasculature. Plasma renin activity was 0.3 ng/mL/h (normal for age 3.0–9.0 ng/mL/h). Which is the next best approach for diagnosis? a) Urinary free cortisol:cortisone and sequencing of HSD11B2 b) Long PCR technique for CYP11B1/CYP11B2 c) Thiazide trial d) Overnight dexamethasone suppression test e) Plasma metanephrines and MIBG scan | a |
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program | 1. In which situations might an extracorporeal KST be preferable over PD? a) Infants with congenital kidney failure b) Infants with extreme prematurity and low birthweight c) Infants with inborn errors of metabolism, e.g., hyperammonemia d) Infants with hemodynamic instability e) None of the above | c |
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program | 2. All of the following are advantages of newer KST modalities (CVVH with Aquadex, CARPDIEM™) compared to traditional CKST (Prismaflex, NxStage), except a) Designed or adopted for the needs of smaller neonates and infants b) Do not require central venous access c) Smaller ECV which minimizes hemodynamic instability during treatment d) Precise control of clearance and ultrafiltration e) Fewer complications at initiation of therapy | b |
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program | 3. Which of the following are essential members of the multidisciplinary team that cares for a neonate or infant with complicated AKI or CKF requiring KST: a) Nursing: bedside, dialysis, KST-trained b) Providers: nephrologists, advanced practitioners, neonatologists, and pharmacists c) Maternal fetal medicine, ethics, and palliative care d) Surgeons, interventional radiologists, hospital administrators and data team e) All of the above | e |
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program | 4. When choosing the best KST modality for a particular infant: a) PD is always preferred over other KST modalities b) Newer KST platforms (CVVH with Aquadex, CARPEDIEM™) are preferred over PD c) The ideal modality varies depending on patient characteristics, indication, goals of therapy and local resources d) Extracorporeal KST cannot be performed in neonates and small infants e) None of the above | c |
Kidney support for babies: building a comprehensive and integrated neonatal kidney support therapy program | 5. Which of the following are effective approaches to KST team education? Choose all that apply. a) High-fidelity simulation b) Bedside clinical coaching and just-in-time teaching c) Didactics and online modules only d) Multidisciplinary neonatal KST educational programs e) None of the above | a, b, d |
Kidney disease and thyroid dysfunction: the chicken or egg problem | 1. Which of the following statements is true? a) Hypothyroidism is found less frequently in CKD patients than in the general population. b) Low T3 syndrome is rarely observed in DD-CKD patients. c) The prevalence of hyperthyroidism does not seem to be associated with CKD. d) The prevalence of hypothyroidism seems to decrease with CKD progression. e) The prevalence of thyroid disorders in NDD-CKD and DD-CKD patients has not been assessed so far. | c |
Kidney disease and thyroid dysfunction: the chicken or egg problem | 2. Which of the following statements is false? a) Hypothyroidism results in increased tubuloglomerular feedback with a sequential reduction in eGFR. b) The effects of hypothyroidism on glomerular filtration have only been shown indirectly using creatinine-based equations. c) Hypothyroidism affects the renin–angiotensin–aldosterone system which results in reduced autoregulation of the kidneys. d) Hypothyroidism reduces myocardial contractility. e) Hypothyroidism causes reduced expression of renal vasodilators such as nitric oxide. | b |
Kidney disease and thyroid dysfunction: the chicken or egg problem | 3. Which of the following statements is false? a) Uraemia is a frequent trigger of Graves’ disease. b) Children with congenital nephrotic syndrome often develop primary hypothyroidism. c) DD-CKD and its associated metabolic changes may be a cause of non-thyroidal illness. d) Metabolic acidosis seems to affect thyroid hormone and TSH levels. e) Nephrotic syndrome may result in depletion of thyroid hormones. | a |
Kidney disease and thyroid dysfunction: the chicken or egg problem | 4. Which of the following statements is true? a) Hypothyroidism leads to decreased serum creatinine levels. b) Assessment of thyroid function should not be taken into account when evaluating serial serum creatinine measurement in individual patients over time. c) Reduced activity of deiodinating enzymes has not been established as a potential cause of low T3 syndrome in DD-CKD patients. d) Hypothyroidism results in decreased serum cystatin C levels. e) Hyperthyroidism appears to result in an increase in serum creatinine levels. | d |
Kidney disease and thyroid dysfunction: the chicken or egg problem | 5. Which of the following statements is false? a) Hypothyroidism has been associated with an increased mortality in DD-CKD patients. b) Thyroid replacement therapy in NDD-CKD patients with subclinical hypothyroidism may attenuate the decline of kidney function. c) Low T3 syndrome has been associated with an increased mortality in DD-CKD patients. d) The optimal TSH range in NDD-CKD and DD-CKD patients remains to be established. e) The effect of hypothyroidism on the mortality of NDD-CKD and DD-CKD patients has not been assessed so far. | e |
Pediatric Onco-Nephrology Time to Spread the Word-Part II | 1. All the following post kidney transplant malignancies could be attributed to viral infections except: a) PTLD b) Anorectal cancer c) Lung cancer d) Skin cancer | c |
Pediatric Onco-Nephrology Time to Spread the Word-Part II | 2. Which of the following group of children are at highest risk of developing deterioration of kidney function on follow-up: a) Children with ALL b) Children with unilateral Wilms tumor who had partial nephrectomy and chemotherapy c) Children with unilateral Wilms tumor who had unilateral total nephrectomy and chemotherapy d) Children with unilateral Wilms tumor who had unilateral total nephrectomy and radiation therapy | d |
Pediatric Onco-Nephrology Time to Spread the Word-Part II | 3. In children with PTLD, select one correct answer: a) Most cases diagnosed during the first year can be attributed to CMV infection. b) Most cases after the first post-transplant year are due to EBV infection in EBV-naïve children. c) Valganciclovir has proven activity against EBV in vivo. d) Chronic, low-grade EBV viremia in transplant recipients without development of PTLD is not uncommon. | d |
Pediatric Onco-Nephrology Time to Spread the Word-Part II | 4. You are taking care of a 4-year-old boy with stage 5 CKD. He has a history of Wilms tumor. He completed therapy when he was 3.5 years old. The earliest he can receive kidney transplant is when he is: a) 5 years old b) 6 years old c) 7 years old d) 8.5 years old e) 11 years old | d |
Use of extracorporeal therapies to treat life-threatening intoxications | Which of the following is not a property of an ideally hemodialyzable drug? a) Small molecule size b) Small volume of distribution c) Lipophilic and non-polarity nature d) Low protein binding | c |
Use of extracorporeal therapies to treat life-threatening intoxications | A 10-kg child is admitted to your ICU with a salicylate overdose (VD = 0.2 l/kg, molecular weight = 180 Da, 30% protein bound in overdose setting). The salicylate level is 136 mg/dl, and the patient has developed respiratory failure requiring intubation. Which of the following is the next best step, following initial medical therapy with alkalinization? a) Perform pheresis with a 1.5 plasma volume exchange b) CKST with standard (20–30 cc/kg or 2000 cc/m2) clearance c) Continue medical therapy and recheck level in 4 h d) Hemodialysis with blood flow of 75 ml/min and dialysate flow of 500 ml/min for 3 h | d |
Use of extracorporeal therapies to treat life-threatening intoxications | True or false: Diffusive clearance on CKST can achieve removal of larger “middle” molecules/toxins (15–30 kDa)? True False | False |
Use of extracorporeal therapies to treat life-threatening intoxications | You are called regarding a patient who accidentally received 10 times the intended dose of IV rituximab (144 kDa, volume of distribution < 0.2 l/kg, protein binding: negligible). Extracorporeal therapeutic removal is desired. Which is the best option? a) High-dose CKST with 4–5 times standard clearance b) Plasma exchange c) Hemofiltration using convective mode d) Standard hemodialysis | b |
Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d | 1. Which of the following statements is true? a) Dialysis patients are at risk for micronutrient deficiency but not excess due to the increased loss from dialytic clearance. b) Pediatric dialysis patients lose significant amounts of vitamin B12 in dialysate. c) Human body storage of thiamine is large and can last for several months despite deficient intake. d) Children with CKD might not meet the RDA intake for several water-soluble vitamins, but those who depend on enteral nutrition with formula often meet the RDA for water-soluble vitamins. | d |
Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d | 2. Which of the following statements is true? a) Pediatric dialysis patients are spared from vitamin C toxicity due to their inadequate vitamin C intake and the dialyzability of vitamin C. b) Zinc toxicity manifests as copper deficiency as their levels are inversely related. c) Riboflavin toxicity can present as peripheral sensory neuropathy. d) Niacin is considered safe without toxicity even if consumed in large dosage. | b |
Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d | 3. Which of the following statements is true? a) There is a plethora of research on micronutrient disorders among children with CKD stage 5d. b) Patients who are on HD vs. PD are at similar risk for micronutrient deficiencies. c) Underlying CKD diagnosis (such as congenital nephrotic syndrome), residual urine output, diet/feeding, and other comorbidities (such as oncologic diagnoses or bowel surgeries) can all affect pediatric dialysis patients’ micronutrient status. d) Water-soluble multivitamin should be prescribed to all pediatric dialysis patients regardless of their diet. | c |
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know | Which of the following is untrue regarding proactive management of neurogenic bladder? a) CIC initiated at birth b) Urodynamics delayed until potty training age c) Anticholinergic medication initiated with findings of poor bladder compliance without hydronephrosis d) Kidney function studies (i.e. Creatinine, Cystatin- C) are regularly performed | b |
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know | The management of recurrent UTIs in children who perform CIC includes all of the following, except: a) Intravesical antibiotic administration b) Prophylactic oral antibiotics c) Optimization of bladder dynamics d) Retrograde colonic irrigation | d |
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know | Several medications can be used to treat poor compliant, high-pressure bladders, except: a) Oxybutynin b) Mirabegron c) Solifenacin d) Tamsulosin | d |
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know | Intravesical injections of Botulinum toxin-A are effective to manage: a) High post void residual b) UTIs c) High pressure bladder d) Detrusor sphincter dyssynergia | c |
The urological evaluation and management of neurogenic bladder in children and adolescents—what every pediatric nephrologist needs to know | The following are true regarding urological surgeries for neurogenic bladder except: a) Mitrofanoff is a continent catheterizable channel that facilitates CIC b) Urinary diversions should be done for all infants with high grade VUR c) Bladder augmentation comes with significant short- and long-term risks including stones, cancer, metabolic changes, UTIs, and mucus production d) VUR due to neurogenic bladder is usually secondary and management should be focused on improving bladder dynamics | b |
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review | 1. Which of the following statements is correct? a) TDM is useful in the monitoring of drugs with wide therapeutic window. b) Patients with nephrotic syndrome who received rituximab should have regular checks of serum drug levels to predict response. c) Equations validated in similar patient populations should be used to estimate drug AUC. d) Free drug level is often used to monitor treatment effectiveness in clinical practice. e) Pharmacodynamic monitoring is a cost-effective tool to aid dose titration. | c |
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review | 2. Which of the following factors does not contribute to the variability in drug levels in nephrotic syndrome? a) Hypoalbuminemia b) Nephrotic-range proteinuria c) Hypercholesterolemia d) Change in prednisolone dose e) Capillary refill time | e |
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review | 3. Which of the following scenarios is most indicated for pharmacokinetic TDM? a) A 4-year-old girl who received prednisolone at 60 mg/m2/day for newly diagnosed nephrotic syndrome b) A 10-year-old boy who received rituximab 2 weeks ago c) A 5-year-old boy who was started on MMF 1 week ago and is currently in disease remission d) A 5-year-old boy who was started on MMF 2 weeks ago and is admitted to the hospital due to a disease relapse e) A 4-year-old girl who is receiving tacrolimus on a stable dose. Her last blood level check was 2 weeks ago. | c |
Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review | 4. Which of the following statements regarding mycophenolate-based therapy is incorrect? a) The use of a proton pump inhibitor may reduce the efficacy of MMF. b) TDM is not recommended during therapy of MMF or EC-MPS. c) A higher range of MPA AUC is recommended in NS as compared to kidney transplantation. d) The measured total MPA level is reduced during the time of NS relapse with a serum albumin level of 10 g/dl. e) A low trough MPA level is associated with a higher risk of NS relapse. | b |
The impact of rural status on pediatric chronic kidney disease | 1. What is the universal definition of rurality? a) Living outside of a city b) There is no universal definition of rurality c) Residing more than 30 km from a town d) Areas with less than 10,000 people per square mile | b |
The impact of rural status on pediatric chronic kidney disease | 2. Which of the following domains of care from Levesque et al.’s model of access to care would best encompass issues with having very few pediatric nephrologists in a rural state? a) Acceptability b) Appropriateness c) Availability and accommodation d) Affordability | c |
The impact of rural status on pediatric chronic kidney disease | 3. How is the current pediatric care capacity in the United States changing? a) Fewer hospitals that provide pediatric inpatient care b) Rural hospitals are admitting more pediatric patients c) Creation of regionalized tiered systems of pediatric inpatient care based on acuity d) Development of long-term telemedicine programs to deliver pediatric inpatient care in rural hospitals | a |
The impact of rural status on pediatric chronic kidney disease | 4. What was unique about the screening programs presented in Guatemala and Canada? a) Use of a novel technique to measure blood pressure and estimate GFR b) Implementation of population-based screening programs in high-risk rural communities c) Employing telehealth strategies to connect with rural populations from existing medical centers d) Integration of CKD care into a primary care clinic visit | b |
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services | 1. Which of the following statements is true regarding the transition period for AYA and young adults with chronic health conditions? <br> a) It is associated with improved adherence to medications. <br> b) The added responsibility of navigating the health care system is good for development. <br> c) It is associated with poor health outcomes and increased hospital visits. <br> d) Risk of graft loss is the same regardless of the type of support received during transition. | c |
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services | 2. Select the true statement regarding the primary care medical home model. <br> a) The specialist serves as the hub to coordinate patient care. <br> b) Coordinates care and communication for smooth transitions. <br> c) Relies on the caregiver and families to coordinate care and transition. <br> d) Does not focus on prevention and wellness. | b |
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services | 3. Barriers to maintaining continuity of care include all of the following except: <br> a) Lack of clearly defined roles and responsibilities of primary care providers. <br> b) Inadequate education and training of primary care providers around complex care and coordination of care. <br> c) Lack of communication between primary care providers and specialists. <br> d) Guidelines and frameworks to allow effective and smooth transition. | d |
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services | 4. Adolescents and young adults with chronic kidney disease will benefit from multidisciplinary care and special transition of care services. All of the below responses are true except: <br> a) They may have developmental and cognitive delays. <br> b) They frequently take multiple medications. <br> c) There is an increased risk of kidney failure and kidney transplant graft loss during transition. <br> d) Specialized transition care services can replace primary care services. | d |
Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services | 5. Continuity of care has a critical role in transitioning from pediatric to adult care. Which of the following statements is true? <br> a) Management continuation involves the use of information and past events to make decisions. <br> b) Relational continuity is an ongoing therapeutic relationship between the patient and health care provider(s). <br> c) Informational continuity is a cohesive management approach to caring for a patient’s changing needs. <br> d) Continuity of care is illness-specific and does not exceed beyond that illness period. | b |
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury | 1. What is the safe threshold of priming volume for an extracorporeal dialysis treatment (as a percentage of the patient’s blood volume)? <br> a) 3% <br> b) 5% <br> c) 10% <br> d) 20% | c |
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury | 2. What is one of the greatest technical innovations of the CARPEDIEM dialysis machine? <br> a) the three-roller pump, which allows for controlled flows even in small-sized catheters <br> b) the ability to perform CVVHD <br> c) the possibility of using the device with catheters of different sizes <br> d) the possibility to use three different filters | a |
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury | 3. What makes a device, specifically designed for neonatal dialysis, safe and reliable? <br> a) the small size of the hardware <br> b) the accuracy of the scales and alarms <br> c) the ability to perform multiple types of extracorporeal treatments <br> d) the possibility of performing blood priming | b |
New perspectives in pediatric dialysis technologies: the case for neonates and infants with acute kidney injury | 4. What is one of the biggest challenges of neonatal CKRT when performed with adult dialysis machines? <br> a) the patient’s lack of compliance <br> b) the requested size of the vascular access and the need for circuit priming <br> c) the inadequate warming system for dialysis fluids <br> d) the absence of a dedicated fluid management monitoring tool | b |
Hypertension in diabetes | 1. Which of the following statements regarding hypertension and diabetes in the adult population is false?<br>a. Hypertension is approximately twice as prevalent in those with diabetes compared to the general population.<br>b. There is a two-fold higher risk of hypertension in prediabetic patients compared to those with normoglycemia.<br>c. In the US adult population, hypertension affects 30% of patients with type 2 diabetes and up to 80% of patients with T1D.<br>d. In the setting of diabetes, hypertension often requires several anti-hypertensive medications to achieve BP targets.<br>e. In the setting of diabetes, hypertension serves to accelerate the rate of adverse macrovascular and microvascular outcomes. | c |
Hypertension in diabetes | 2. Which of the following regarding the epidemiology of hypertension and diabetes in the paediatric population is false?<br>a. Studies suggest poor self-awareness of hypertension in youths with T1D and T2D.<br>b. Hypertension is often over-diagnosed and over-treated in paediatric patients with diabetes.<br>c. In children with T1D, hypertension has a prevalence of 6%.<br>d. In adolescents with T2D, hypertension may occur with a prevalence of 12–31%.<br>e. Appropriate management of hypertension in adolescent patients with evidence of target organ damage can lead to reversal of these findings. | b |
Hypertension in diabetes | 3. Which of the following is true regarding the interplay of hyperglycemia, inflammation, and hypertension?<br>a. Hyperglycemia is associated with increased ROS production, which can uncouple eNOS from NO production.<br>b. Hyperglycemia induces increased plasma concentrations of inflammatory cytokines when the effect of insulin is blocked by octreotide, and this effect is potentiated in those with hypertension.<br>c. Hyperglycemia accelerates the formation of AGEs, which lead to vascular inflammation and cross-linking of elastin, collagen, and other ECM components, resulting in decreased arterial wall elasticity.<br>d. Sympathetic kidney denervation has been demonstrated to improve fasting glucose levels and glucose tolerance in humans subjects with treatment-resistant hypertension.<br>e. All are true. | e |
Hypertension in diabetes | 4. With respect to the renin–angiotensin–aldosterone system (RAAS) in diabetes, the following statements are correct except for?<br>a. In vitro and animal studies suggest that hyperglycemia can trigger RAAS activation.<br>b. ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) have also been shown to improve insulin sensitivity and reduce diabetic complications in animal models.<br>c. Angiotensin II (AngII) increases sodium retention by increasing activity of the Na–H exchanger in the proximal convoluted tubule and by directly stimulating the release of aldosterone from the adrenal medulla, which in turn increases the expression of the epithelial Na channel in the principal cell of the distal convoluted tubule.<br>d. AngII can decrease systemic vascular resistance by mediating systemic arteriolar vasodilation by increasing endothelin-1 and the production of reactive oxygen species.<br>e. AngII may contribute to insulin resistance in T2D as evidenced by rodent studies. | d |
Hypertension in diabetes | 5. Which of the following regarding the use of RAAS blockers in the setting of diabetes is false?<br>a. RAAS blockers are thought to have a particular therapeutic advantage in the setting of diabetes due to improving the hemodynamics in the glomerulus and protecting against maladaptive processes.<br>b. Several studies have demonstrated a clinically significant role for RAAS blockers in delaying the onset and progression of albuminuria and diabetic nephropathy.<br>c. RAAS blockers are recommended in most guidelines as first-line therapy in the treatment of hypertension in the setting of diabetes.<br>d. When compared to other antihypertensive medications, RAAS blockers consistently have been demonstrated to improve all cardiovascular and kidney outcomes.<br>e. C and D. | d |
Hypertension in diabetes | 6. Regarding the differences in defining and managing hypertension and diabetes between adult and paediatric populations, which of the following is true?<br>a. Blood pressure targets in adults are based on normative distributions in healthy individuals.<br>b. Blood pressure targets in children are based on outcome data regarding BP limits above which there is a higher risk of morbidity and mortality.<br>c. Anti-hypertensive medications are generally as easily accessible for paediatric patients as they are for adult patients.<br>d. More paediatric-specific studies of hypertension and diabetes are needed, and the inclusion of paediatric patients in future trials is important. | d |
Hypertension in diabetes | 7. Regarding the third generation mineralocorticoid receptor antagonist finerenone, which of the following statements is true?<br>a. Finerenone has a higher affinity for the mineralocorticoid receptor than spironolactone.<br>b. Finerenone is approved in North America for use in adult patients with chronic kidney disease and T2D.<br>c. The main adverse event experienced by the participants of the FiGARO and FIDELIO trials in adults was hyperkalemia.<br>d. All of the above.<br>e. None of the above. | d |
Holistic care and symptom management for pediatric kidney transplant recipients | Symptom management includes which three domains? a) Social work, psychology, nephrology b) Therapy, medications, exercise c) Personal, environmental, and health and illness factors d) Mental, emotional, physical | c |
Holistic care and symptom management for pediatric kidney transplant recipients | The USPSTF recommends that all children what age and older be routinely screened for anxiety? a) 8 years b) 10 years c) 12 years d) 13 years | a |
Holistic care and symptom management for pediatric kidney transplant recipients | Which of the following factors have been shown to have an association with non-adherence? a) Poor body image b) Depression c) Increased experience of side effects d) All of the above | d |
Fluid management in children with volume depletion | 1. Which of the following statements reflects the relationship between change of serum osmolality and release of AVP?<br>a. Decreased serum osmolality detected by osmoreceptors in proximal nephron results in release of AVP.<br>b. Decreased serum osmolality detected by osmoreceptors in hypothalamus results in release of AVP.<br>c. Increased serum osmolality detected by osmoreceptors in proximal nephron results in release of AVP.<br>d. Increased serum osmolality detected by osmoreceptors in hypothalamus results in release of AVP. | d |
Fluid management in children with volume depletion | 2. Which of the following statements is true?<br>a. Oral or enteral rehydration therapy is only used in mildly dehydrated children.<br>b. Enteral rehydration is associated with fewer major adverse events and shorter hospital stay in children compared to parenteral therapy.<br>c. Children with hyponatremic dehydration should always receive hypertonic saline to prevent development of cerebral edema.<br>d. The optimal correction rate of serum sodium in children with hyponatremic encephalopathy is 10–15 meq/l increase over 24 h. | b |
Fluid management in children with volume depletion | 3. A 20-kg boy presents with vomiting and diarrhea and a 10% volume loss. On admission he is somnolent, with blood pressure of 70/30 mm Hg and has clinical signs of dehydration. His plasma sodium is 144 mmol/l and creatinine is 32 µmol/l (0.36 mg/dl). His total body water is 0.6 × 20 kg = 12 l. His water maintenance requirements are 1500 ml/day. His fluid deficit is 10% of 12 l = 1.2 l. Of the following treatment courses, which would be the most preferable?<br>a. 0.9% NaCl 20 ml/kg (400 ml/h) should be administered initially and repeated as necessary after reassessment of the child to cover the fluid deficit followed by 0.9% NaCl solution at 70 ml/h. The rate of the infusion should be decreased when oral fluid intake is restored.<br>b. 0.45% NaCl 20 ml/kg (400 ml/h) for 4 h should be administered initially to cover the fluid deficit followed by a 5% glucose solution 70 ml/h.<br>c. 3% NaCl 2 ml/kg for 10-min infusion should be administered initially to prevent the development of brain edema followed by a 0.45% NaCl solution 70 ml/h.<br>d. 5% glucose 20 ml/kg (400 ml/h) for 3 h should be administered initially to replace the fluid deficit followed by 0.9% NaCl solution 70 ml/h. The infusion rate should be decreased when oral fluid intake is restored. | a |
Fluid management in children with volume depletion | 4. A 10-kg girl presents with generalized convulsions. She has a history of 3 days of severe diarrhea. The parents noticed her reduced urine output over the last 2 days. She lost approximately 1 kg of weight. She was able to drink tea and water despite the weight loss. Her physical examination is consistent with severe dehydration. Her blood pressure is 80/40 mm Hg. Laboratory examination shows plasma osmolality of 240 mmol/l, plasma sodium 115 mmol/l, plasma potassium 5 mmol/l, and plasma creatinine 60 µmol/l (0.68 mg/dl). Her FENa is 0.3%. Her total body water is 0.6 × 10 kg = 6 l. Her water maintenance requirements are 1000 ml/day. Her fluid deficit is 10% of 6 l = 600 ml. Her sodium deficit is 0.6 × 6 l × (125 − 115) = 36 mmol. Of the following treatment courses, which would be the most preferable?<br>a. 0.9% NaCl 20 ml/kg (400 ml/h) for 4 h should be administered initially to cover the fluid deficit followed by a 5% glucose solution 70 ml/h.<br>b. 0.45% NaCl 20 ml/kg (400 ml/h) for 4 h should be administered initially to cover the fluid deficit followed by a 5% glucose solution 70 ml/h.<br>c. Administration of 3% NaCl is indicated (2 ml/kg) over 10 minutes. It may be repeated until symptoms resolve.<br>d. Administration of 3% NaCl is indicated (10 ml/kg) over 15 minutes. It may be repeated until symptoms resolve. | c |
Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families | By what week is fetal urine the major contributor to amniotic fluid?a) 8 weeks b) 14 weeks c) 20 weeks d) 24 weeks | e |
Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families | What is the 50th centile for renal pelvis size at term? a) 4 mm b) 7 mm c) 12 mm d) 15 mm | b |
Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families | Variants in HNF1β have been associated with which of the following prenatal phenotypes? a) Bilateral multicystic dysplastic kidneys b) Bilateral hyperechogenic kidneys c) Unilateral kidney hypoplasia d) Isolated upper urinary tract dilation e) All of the above | b |
Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families | True or false: prenatal diagnosis of a congenital anomaly can be considered a traumatic experience. a) True b) False | e |
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding | 1. Which statement is correct: a) The process of bone formation, resorption and remodelling is known as bone turnover b) Cortical bone is more metabolically active than trabecular bone c) The trabecular compartment is the mineral rich, dense bone compartment d) There are only 2 cell types in the bone; osteoblasts and osteoclasts e) The predominant driving force in bone in adults is bone formation | a |
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding | 2. Clinical manifestation of mineral bone disease includes: a) Bone pain b) Limb deformities c) Fractures d) Slipped epiphyses e) All of the above | e |
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding | 3. Calcium balance is: a) Positive until around 30 years of age b) Positive until around 15 years of age c) Positive until around 50 years of age d) Negative after 60 years of age e) Neutral throughout life | a |
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding | 4. The predominant abnormality found in bone biopsies of children with CKD is: a) Low bone turnover b) High bone turnover c) Abnormal mineralization d) Osteitis fibrosa e) Aluminium staining | c |
Chronic kidney disease mineral bone disorder in childhood and young adulthood: a ‘growing’ understanding | 5. Which statement is correct: a) Vascular calcification is associated with an increased morbidity and mortality in people with CKD b) Coronary artery calcification is only seen in older adults with CKD c) Dialysis attenuates the progression of vascular calcification d) Vascular calcification involves dumping of excess calcium and phosphate from calcium-containing medications in blood vessels | a |
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities | What is the spontaneous process of activation of the alternative pathway (AP) of complement called? a) Tickover b) Autocleavage c) Hydrosilation d) Dehydration | a |
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities | What are the components of complement called "anaphylatoxins"? a) C1q, C2a b) C3b, C5b c) C3a, C5a d) C5B-9 | c |
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities | Which of the following complement inhibitors act on the LP? a) Iptacopan b) Danicopan c) Narsoplimab d) Pegcetacoplan | c |
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities | Which bioengineering innovations prolong the half-life of ravulizumab compared to eculizumab? a) Complete humanization of the molecule b) Amino acid substitutions c) Pegylation of the molecule d) Greater dissociative capacity from C5 | b |
Complement inhibitors in pediatric kidney diseases: new therapeutic opportunities | What is currently the only complement inhibitor indicated for AAV? a) Pegcetacoplan b) Eculizumab c) Narsoplimab d) Avacopan | d |
Kidney manifestations of pediatric Sjögren’s syndrome | Which of the following statements is true about pediatric Sjögren’s syndrome? A) Sicca syndrome is the most significant feature. B) Kidney involvement is not relevant in affected patients. C) Kidney failure has been observed due to severe kidney involvement. D) Current classification criteria are accurate enough for the pediatric population. | C |
Kidney manifestations of pediatric Sjögren’s syndrome | What percentage of children with Sjögren’s syndrome has kidney manifestations? A) 5–20.5% B) 1–5% C) 45–70% D) 0.5–2% | A |
Kidney manifestations of pediatric Sjögren’s syndrome | Which of the following manifestations of tubulointerstitial nephritis is the most feared in children? A) Macroscopic hematuria B) Mild impaired urinary concentrating ability C) Periodic hypokalemic paralysis D) Severe proteinuria | C |
Kidney manifestations of pediatric Sjögren’s syndrome | What is the most serious long-term complication in pediatric Sjögren’s syndrome with kidney involvement? A) Recurrent nephrolithiasis B) Persistent proteinuria C) Diabetes insipidus D) Extranodal marginal zone lymphomas | D |
Kidney manifestations of pediatric Sjögren’s syndrome | Which of the following classification criteria for Sjögren’s syndrome includes kidney manifestation? A) The 2016 ACR/EULAR criteria for all patients with Sjögren’s syndrome B) The 1999 criteria for children and adolescents with Sjögren’s syndrome C) The 2002 AECG criteria for all patients with Sjögren’s syndrome D) None of these | B |