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1)         10 years old boy brought to the emergency room in  coma state, the child was apparently well, his father is hypertensive with persistent microscopic hematuria, physical examination showed bilateral flank masses.  Abdominal ultrasound showed multiple cysts in both kidneys.


            The most likely diagnosis is:


A.                 Multicystic dysplastic kidney disease

B.                 Autosomal recessive polycystic kidney disease

C.                 Autosomal dominant polycystic kidney disease

D.                 Bilateral pelviuretric junction obstruction

E.                  Bilateral vesicouretric refluxes



2)         Physical examination of a newborn boy reveals malformed left ear with preauricular pits. 


The most appropriate next study is:


A.                 Computed tomographic scan of the skull

B.                 Bronchoscopy

C.                 Abdominal ultrasound

D.                 Echocardiogram

E.                  Nuclear scanning of the kidneys



3)         7 years old mentally retarded with history of recurrent convulsions, his routine urinalysis showed microscopic hematuria, ultrasound of kidneys showed multiple small rounded echogenic foci throughout the parenchyma.


            The most likely diagnosis of this patient is:


A.                 Autosomal dominant polycystic kidney disease

B.                 Medullary sponge kidney

C.                 Multilocular cystic Wilm’s tumour

D.                 Tuberose sclerosis

E.                  T.B. pyelonephritis



4)         2 years old boy present with edema, pallor, irritability and oliguria, there was history of fever, vomiting and bloody diarrhea.


To achieve better prognosis in this case, the best management of this patient is:


A.                 Start intravenous high dose of steroids

B.                 Start IV fluid double maintenance with loop diuretics

C.                 Start loop diuretics alone

D.                 Start peritoneal dialysis as soon as possible

E.                  Transfuse platelets



5)         13 years old girl admitted through ER because of tetany, the serum magnesium was 0.4 mmol/L.


            The causes of hypomagnesemia includes the following except:


A.                 Gitelman syndrome

B.                 Post-obstructive diuresis

C.                 Acute pancreatitis

D.                 Protracted vomiting

E.                  Treatment with spironolactone




6)         10 years old boy admitted to ICU after car accident, he is comatosed.  You are called because of water retention, you suspect SIADH.


            The following laboratory findings are consistent with SIADH except:


A.                 Plasma osmolality 260 mosm/kg

B.                 Serum sodium 115 mmol/L

C.                 Urine osmolality 200 mosm/kg

D.                 S. urea 2.5 mmol/L

E.                  S. potassium 4 mmol/L




7)         12 years old girl referred to you with short history (few months) of recurrent fever, weight loss, photophobia, joint pain.  She was diagnosed 4 months ago as having mononeuritis multiplex, 2 months later she developed recurrent hemoptysis, progressive difficulty in breathing, gross hematuria, proteinuria.  There was history of asthma; laboratory investigations showed Hb 9.0 gm/dl, WBC 20,000/mm2, esonophils 6%, rheumatoid factor, positive complement normal, (cANCA) positive.  Renal biopsy showed pauciimmune-necrotizing and cresentic glomerulonephritis immunoflourescence shows scanty immunostaining.


            The most likely diagnosis is:


A.                 Churg-Strauss syndrome

B.                 Wegener granulomatosis

C.                 Microscopic polyangiitis

D.                 HSP

E.                  SLE



8)         5 years old boy referred to you because of severe hypertension.  There was a history of arthralgia, recurrent abdominal pain, flank abdominal pain, hematuria.  Examination there was multiple skin gangrenes, nodules and livedoreticularis.  Stool for occult blood was positive, ESR high, ANA negative, ANCA negative, renal angiogram showed peripheral aneurysm.


The following statements regarding management of that condition is true except:


A.                 Treatment with steroids, proved to be useful in Saudi Arabia

B.                 Plasma exchange is the treatment of choice

C.                 Cyclophosphamide is a good complimentary therapy with steroid

D.                 Azathioprine can be used to maintain remission

E.                  Severe GI involvement had a worse prognosis



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