Nephrology Prometric Style Questions – 50 Cases with Answers

What this deck covers

Nephrology Prometric Style Questions, Set 1 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Three febrile infections and a small kidney
2. Flank pain in a nephrotic child
3. Anuric five days after bloody diarrhoea
4. Oedema from the first week of life
5. Polyuria with a low potassium and high calcium
6. Alkalosis in a baby who is not vomiting
7. Wet at night, dry all day, aged five
8. Protein that will not go away in IgA disease
9. Purpura, tummy pain and a swollen scrotum
10. Four hours of testicular pain at thirteen
11. Fever and a positive stick in a bag
12. Five weeks old, febrile, and unwell
13. Doughy skin after three days of diarrhoea
14. Tea coloured urine at seven
15. Wet, soiling, and a tuft of hair
16. Bone pain in a boy with kidney disease
17. Bow legs with a normal calcium
18. Acidosis with an alkaline urine
19. Bicarbonate leaking into the urine
20. Acidosis with a high potassium
21. Grit in the urine and loin pain
22. Pressure still high after the diuretic
23. Breathless at the end of the infusion
24. Tense ascites and cold hands
25. Eight weeks of steroid and still leaking
26. A creatinine of 320 at first presentation
27. Breakthrough infections on prophylaxis
28. After a first febrile infection
29. Choosing the maintenance fluid
30. Dry for two years, wet again at seven
31. Salt craving and a low potassium
32. Pale and petechial after bloody diarrhoea
33. A flank mass in a dehydrated newborn
34. Fever and loin pain on day four
35. The one that raises the potassium
36. Dark urine with no red cells
37. A gas with a high chloride
38. How tubular acidosis shows itself
39. Fewer wet nappies in a constipated toddler
40. Small patches, more than once a night
41. The alarm did not work
42. A blue dot at the upper pole
43. The quiet one that takes the kidney
44. A seizure on day three after surgery
45. Dry for three years until the move
46. Relapsing every time the dose comes down
47. Which antibiotic to give at night
48. Leucocytes but no nitrite
49. When to scan the antenatal dilatation
50. A lump found at bath time

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: DMSA scan, Albumin infusions and diuretics until he outgrows it, Start desmopressin at night, Radioisotope scanning of the scrotum, Over 48 hours, checking the sodium regularly, Nutritional vitamin D deficiency rickets, Medullary nephrocalcinosis on ultrasound, An angiotensin converting enzyme inhibitor, Renal biopsy and a calcineurin inhibitor, Renal ultrasound, Gitelman syndrome, The nephritis has become rapidly progressive, Diabetic ketoacidosis, Reduced functional bladder capacity at night.

Clinical pearls from this deck

• Ultrasound tells you the size and the plumbing; only DMSA tells you how much working cortex is left.
• Nephrotic syndrome clots. Flank pain plus visible blood plus falling output is the renal vein until proven otherwise.
• In haemolytic uraemic syndrome the treatment is the dialysis machine and time; nothing else changes the outcome.
• Nephrotic syndrome in the first three months of life is genetic until proven otherwise, and steroids have no part in it.
• Hypokalaemic alkalosis with a normal blood pressure is a tubule, not an adrenal gland; the urinary calcium then tells you which tubule.
• Alkalosis with diarrhoea rather than vomiting should make you think of congenital chloride diarrhoea, and the urinary chloride starts the sorting.

This deck is open to everyone with no sign-in. Work through it once for recognition, then again a week later to test yourself.

More from this system: all nephrology case decks · pediatric reference values.