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Renovascular hypertension in pediatric patients: update on diagnosis and management | 1. What is the main mechanism that leads to RVH? a) Increased cardiac output due to an amplified sympathetic tone b) Increased nitric oxide release c) Increased plasma volume if intact contralateral kidney d) Increased renin release by the hypoperfused nephrons | d |
Renovascular hypertension in pediatric patients: update on diagnosis and management | 2. Which of these explains the abrupt fall in GFR after the administration of ACE-I or ARB in patients with bilateral renal stenosis? a) These medications impair the vasoconstriction of the efferent arteriole elicited by Ang II, which maintains the GFR in the hypoperfused nephrons. b) These medications increase vasoconstriction of the afferent arteriole, decreasing the GFR. c) These medications increase vasoconstriction of the efferent arteriole, decreasing the GFR. d) These medications decrease renal sodium reabsorption, decreasing the GFR. | a |
Renovascular hypertension in pediatric patients: update on diagnosis and management | 3. Which of these imaging tests makes possible a therapeutic intervention at the same time as the exam performance? a) Magnetic Resonance Angiography b) Renal Scintigraphy c) Digital Subtraction Angiography d) Doppler Renal Ultrasonography | c |
Renovascular hypertension in pediatric patients: update on diagnosis and management | 4. Why is angioplasty often favored over surgical procedures in the treatment of RVH? a) Angioplasty usually has a lower restenosis rate. b) Angioplasty is less invasive and has a smaller risk of complications. c) Surgery has a high mortality rate. d) Angioplasty has a better outcome for all patients. | b |
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen | 1. What factors determine the treatment response to rituximab? A. Patient factors, such as disease severity B. Rituximab dose C. Maintenance immunosuppression D. All of the above | D |
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen | 2. Which of the following regimens has shortest relapse-free survival? A. Low dose (375 mg/m2) alone B. Medium dose (750 mg/m2) alone C. Low dose (375 mg/m2) with maintenance therapy D. High dose (750 mg/m2) with maintenance therapy | A |
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen | 3. Which of the following B cell subsets is more relevant to relapse after rituximab? A. Transitional B cells B. Mature B cells C. IgM Memory B cells D. Switched Memory B cells | D |
Rituximab in children with steroid sensitive nephrotic syndrome: in quest of the optimal regimen | 4. How many patients develop persistent hypogammaglobulinemia following rituximab? A. Less than 5% B. 5% to 10% C. 10% to 15% D. More than 15% | D |
Seasonal variation of blood pressure in children | 1. What is the increased prevalence of hypertension in children according to a study from 1999 to 2008 for boys and girls? a) 9.2% and 5.8% respectively b) 15.8% and 8.2% respectively c) 12.8% and 15.2% respectively d) 19.2% and 12.6% respectively e) 29.1% and 22.6% respectively | d |
Seasonal variation of blood pressure in children | 2. The prevalence of BP in the hypertensive range in children... a) decreases by 50-75% in the cold season. b) decreases by 5-17% in the warm season. c) increases by 15-17% in the warm season. d) increases by 17-50% in the cold season. e) increases by 50-57% in the cold season. | e |
Seasonal variation of blood pressure in children | 3. The systolic BP change between winter and summer in children described by Miersch et al. amounts to approximately: a) 2-15 mmHg b) 2-31 mmHg c) 2.4 mmHg d) 4.5 mmHg e) 15-31 mmHg | d |
Seasonal variation of blood pressure in children | 4. According to this review, potential mediators of seasonal blood variation in children seem to include… a) sympathetic activation of the nervous system, elevated levels of norepinephrine and hypercoagulability, but not vitamin D nor hydration status. b) sympathetic activation of the nervous system, elevated levels of norepinephrine and hydration status, but not vitamin D nor hypercoagulability. c) vitamin D and hydration status, but not sympathetic activation of the nervous system, elevated levels of norepinephrine nor hypercoagulability. d) sympathetic activation of the nervous system, elevated levels of norepinephrine, hypercoagulability and hydration status but not vitamin D. e) vitamin D and hydration status, but not sympathetic activation of the nervous system, elevated levels of norepinephrine nor hypercoagulability. | a |
Seasonal variation of blood pressure in children | 5. What are the main suggestions summarized in this review considering seasonal BP variation in children? a) regular monitoring in healthy children as well as patients treated for hypertension, more research regarding seasonal BP differences b) monthly BP measurement in patients treated for hypertension, more research regarding seasonal BP differences c) monthly BP measurement in patients treated for hypertension, more research regarding pathophysiological mechanisms of seasonal BP differences d) monthly BP measurement in patients treated for hypertension, more research regarding the long-term effects of seasonal BP differences in children e) triple BP measurement for every adolescent in the routine check-up examination, more research regarding the long-term effects of seasonal BP differences in children | a |
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension | 1. What are the most commonly prescribed antihypertensive drugs in children after renal transplantation? a) ACEI b) ARB c) Beta-blockers d) CCB e) Diuretics | d |
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension | 2. Which class of antihypertensive drugs was able to increase glomerular filtration rate in transplanted adults? a) ACEI b) ARB c) Beta-blockers d) CCB e) Diuretics | d |
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension | 3. Which class of antihypertensive drugs was able to reduce proteinuria in transplanted patients? a) ACEI b) Alpha-blockers c) Beta-blockers d) CCB e) Diuretics | a |
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension | 4. Which class of antihypertensive drugs has the best BP lowering effect in transplanted patients? a) ACEI b) ARB c) CCB d) Diuretics e) The classes have similar BP lowering effect | e |
Should ACE inhibitors or calcium channel blockers be used for post-transplant hypertension | 5. Which class of antihypertensive drugs should be avoided in the immediate post-transplant period? a) ACEI b) Alpha-blockers c) Beta-blockers d) CCB e) Diuretics | a |
Substance use among adolescents and young adults with chronic kidney disease or kidney failure | 1. Which of the following is NOT true regarding electronic nicotine delivery systems (ENDS)? a) Use of ENDS devices has been associated with sleep disturbances. b) Menthol or tobacco flavored e-liquids are less harmful than appealing flavored e-liquids like candy or fruit. c) ENDS have not been proven to be effective smoking cessation tools. d) Elevated blood pressure has been observed in those who use ENDS. | b |
Substance use among adolescents and young adults with chronic kidney disease or kidney failure | 2. Which of the following is NOT true regarding adolescents with chronic kidney disease who consume alcohol? a) They participate in binge drinking. b) More male than female adolescents consume alcohol. c) Higher medication count per day is associated with less alcohol consumed. d) Alcohol ingestion at the time of sexual activity is not uncommon. | b |
Substance use among adolescents and young adults with chronic kidney disease or kidney failure | 3. Regarding the use of cannabinol and recreational marijuana, which of the following is true? a) Optimal dose of cannabinol to alleviate CKD-related nausea has been determined. b) Adolescent patients with CKD have a high-risk perception of marijuana use. c) Age at first use of marijuana is similar between adolescents with CKD and their healthy peers. d) Studies suggest that marijuana use in adolescents is completely benign. | c |
Substance use among adolescents and young adults with chronic kidney disease or kidney failure | 4. Methamphetamines are known to cause acute kidney injury (AKI). Which of the following best describes the pathophysiology of AKI caused by this illicit substance? a) Tubular injury secondary to rhabdomyolysis b) Vasoconstriction c) Malignant hypertensive nephropathy d) All the above | d |
Substance use among adolescents and young adults with chronic kidney disease or kidney failure | 5. Which of the following is accurate regarding opioid use in chronic kidney disease (CKD)? a) Opioids are contraindicated for pain control in patients with chronic kidney disease. b) Illicit use of opioids has been directly associated with membranoproliferative glomerulonephritis. c) Compared to their healthy peers, adolescents with chronic kidney disease use illicit opioids more frequently. d) Inducing systemic inflammation is a pathophysiologic mechanism of illicit IV opioid use. | d |
The CKiD study overview and summary of findings related to kidney disease progression | 1. The primary aim of the CKiD study is to: a. Identify CKD progression risk factors b. Measure the impact of kidney function on growth c. Describe cardiovascular risk factors in children with CKD d. All of the above | d |
The CKiD study overview and summary of findings related to kidney disease progression | 2. Which study design describes CKiD? a. Cross-sectional study b. Prospective cohort study c. Case control study d. Clinical trial | b |
The CKiD study overview and summary of findings related to kidney disease progression | 3. The most unbiased estimate of GFR in 18–26 year olds with CKD can be obtained using: a. The CKiDSCr-Cystatin equation b. The classic Schwartz formula c. The simple mathematical average of the CKiDSCr and CKD-EPI equations d. The CKD-EPI equation | c |
The CKiD study overview and summary of findings related to kidney disease progression | 4. All of the following have been identified as risk factors for CKD progression in the CKiD cohort EXCEPT: a. Elevated blood pressure b. Income c. Proteinuria d. Glomerular disease | b |
The CKiD study overview and summary of findings related to kidney disease progression | 5. Short stature in CKiD subjects has been identified with: a. Poorer renal function post-transplant b. Faster CKD progression c. Hypertension d. Glomerular disease | a |
The old becomes new advances in imaging techniques to assess nephron mass in children | 1. Ex vivo studies have shown that the following imaging modality has been the least accurate determinant of kidney volume: a) CT scan b) 2D ultrasound using an ellipsoid formula c) 3D MRI d) No modality has shown superiority | b |
The old becomes new advances in imaging techniques to assess nephron mass in children | 2. The use of the ellipsoid formula to calculate total kidney volume is 100% accurate in assessment of nephron mass: a) True b) False | b |
The old becomes new advances in imaging techniques to assess nephron mass in children | 3. Renal parenchymal area accounting for various degrees of pelvicalyceal dilatation has been studied in bladder outlet obstruction and has shown the following: a) Increased RPA prenatally can predict progression to ESKD b) Decreased RPA prenatally can predict progression to ESKD c) Decreased RPA postnatally is associated with ESKD d) Both b and c | d |
The old becomes new advances in imaging techniques to assess nephron mass in children | 4. Indexing TKV by BSA results in the following distribution of values: a) Normally distributed and Gaussian or bell-shaped curve b) Non-normally distributed c) Normally distributed only in certain populations d) None of the above | a |
The old becomes new advances in imaging techniques to assess nephron mass in children | 5. Contrast-enhanced ultrasound has the following potential applications in renal imaging: a) Renal mass characterization b) Diagnosis of vesicoureteral reflux c) Kidney volume determination d) All of the above | d |
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children | 1. Why should an AVF be preferred compared to a CVL when HD is required? a) It is recommended by the European Society of Pediatric Nephrology Dialysis Working Group b) It has been shown that children with an AVF have fewer hospitalizations compared to those with CVLs. c) Creating an AVF promotes the “limb salvage”, whereas when a CVL has been created, this might compromise the future of the vessels in the arm of interest d) Because the “Fistula First Initiative” has been applied already in adults but not in children yet. | b |
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children | 2. Which are the barriers to AVF formation in children? a) Surgical challenges of placing and maintaining an AVF in young children b) Patients’ preference c) Timing of transplantation (planned transplant in the next 6–12 months) d) Late referral to a pediatric nephrologist or to a dedicated pre-dialysis unit e) All the above | e |
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children | 3. What are the measures that each pediatric nephrology unit should appraise in order to increase the rate of AVF creation? a) Refer any child with an eGFR < 30 ml/min/1.74 m2 to a dedicated vascular access team b) Educate the child and the parents about vein preservation c) Surgical assessment of the realistic possibilities for creating an AVF d) The type of vascular access for HD should be a multidisciplinary decision alongside with the child’s and parent’s preferences e) All the above | e |
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children | 4. Which is the best cannulation technique of an AVF in children? a) Area puncture b) Rope ladder c) Buttonhole technique d) Rope ladder or buttonhole technique depending on an individualized risk-assessment for each patient e) Rope ladder if the AVF is more than 2 cm long | d |
Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children | 5. In terms of surveillance, which is the optimal way of assessing an AVF in children? a) A 3 to 6 monthly imaging by venography. b) The ultrasound dilution method (UDM) is the only accurate way of assessing an AVF in children. c) A systematic ‘ABCDE’ assessment is recommended at every HD session. d) A systematic clinical assessment is recommended at every HD session with diagnostic ultrasound imaging every 3–6 monthly provided there are no concerns identified on clinical examination. e) Both a, b and c. | d |
Use of diuretics in the neonatal period | 1. Which of the following is not a therapeutic indication of loop diuretics? a) Sodium-retaining states b) Hyperkalemic states c) Hypercalcemic states d) Nephrogenic diabetes insipidus e) Assessment of distal acidification | d |
Use of diuretics in the neonatal period | 2. Which of the following is not a side effect of loop diuretics? a) Ototoxicity b) Hyperglycemia c) Hyperuricemia d) Gynecomastia e) Nephrocalcinosis | d |
Use of diuretics in the neonatal period | 3. Which of the following is a possible side effect of inhibitors of carbonic anhydrase? a) Metabolic alkalosis b) Hyperkalemia c) Hypercalcemia d) Hypokalemia e) Hirsutism | d |
Use of diuretics in the neonatal period | 4. Which diuretic among the following inhibits the sodium-potassium-chloride cotransporter NKCC? a) Acetazolamide b) Spironolactone c) Amiloride d) Hydrochlorothiazide e) Furosemide | e |
When should we start and stop ACEi/ARB in paediatric chronic kidney disease | 1. Which of the following is not predictive for kidney disease progression in both glomerular and non-glomerular CKD? A. High blood pressure B. Significant proteinuria C. Age D. Hypoalbuminaemia | C |
When should we start and stop ACEi/ARB in paediatric chronic kidney disease | 2. Which of the following is not preferred in the management of paediatric CKD? A. ACEi monotherapy B. ACEi and ARB combination therapy C. Normal protein intake D. Attaining a normal vitamin D level | B |
When should we start and stop ACEi/ARB in paediatric chronic kidney disease | 3. Which of the following predicts good kidney outcomes after RAAS blockade? A. Significant initial reduction in proteinuria B. Acute changes of GFR C. Hyperkalaemia D. Hypotension | A |
When should we start and stop ACEi/ARB in paediatric chronic kidney disease | 4. What factors should be considered when one decides on the use of RAASi in advanced CKD? A. Baseline patient characteristics e.g. underlying renal diagnosis B. Treatment response, e.g. proteinuria reduction C. Side effect profiles, e.g. hyperkalaemia D. All of the above | D |
Pediatric onco-nephrology: time to spread the word | You were consulted for evaluation of proteinuria in a 15-month-old boy with urine protein-creatinine ratio of 10. Upon exam, you noticed that he has ambiguous genitalia, and the kidney US that you ordered just came back and showed unilateral kidney mass. The underlying genetic defect mostly involves: a TRIM37 b PTCH1 c WT1 d PIK3CA | c |
Pediatric onco-nephrology: time to spread the word | The mechanism of AKI in the setting of methotrexate therapy is: a Oxidative stress b Increase peritubular capillary pressure c Interstitial nephritis d Crystal deposition | d |
Pediatric onco-nephrology: time to spread the word | The mechanism of kidney injury in children receiving CAR-T therapy includes a Decreased effective renal blood flow due to increased capillary leakage and third spacing b CRS c TLS d a and b e a, b, and c | e |
Pediatric onco-nephrology: time to spread the word | You were called by your oncology colleague to discuss the plan to decrease the risk of AKI following CT with IV contrast for a 5-year-old patient with abdominal mass. The patient weight at admission was 34 kg, and his current weight is 30 kg. The laboratory results from 2 h ago showed Na 152 mEq L−1, K 5.9 mEq L−1, BUN 55 mg dL−1, and serum osmolality 320 mOsm kg−1 H2O. Which of the following is the most crucial intervention to decrease the risk of development of CI-AKI? a Give the patient D5W + 45 mEq L−1 NaCl for 12 h before and after the CT at a rate of 30 mL h−1. b Use diatrizoate contrast media with osmolality of 1570 mOsm kg−1 H2O c Give the patient a bolus of 20 mL kg−1 of 0.9% NS and postpone the CT until he is fully hydrated d Stop the night dose of amlodipine the day before the CT is done and use the ICM agent iodixanol 320 (Visipaque) 290 mOsm kg−1 H2O | c |
Pediatric onco-nephrology: time to spread the word | You discussed with your fellow that the most appropriate initial management for a 6-year-old girl who was recently diagnosed with Burkitt’s lymphoblastic B-ALL and has a uric acid of 10 mg dL−1, is: a Daily laboratory tests, IV fluids, and initiation of allopurinol immediately b Start IV fluids, close cardiac monitoring, start rasburicase, and check laboratory tests every 6 h | b |
A clinical approach to tubulopathies in children and young adults | The following is not a cause of a generalised proximal tubulopathy: a) Galactosaemia b) Cystinosis c) Wilson’s disease d) Proximal RTA (type 2 RTA) e) Mitochondrial ciliopathy | d |
A clinical approach to tubulopathies in children and young adults | Genetic testing is important in the tubulopathies as it can: a) Provide a definitive diagnosis b) Allow the commencement of disease-specific therapy c) Facilitate family planning d) All of the above | d |
A clinical approach to tubulopathies in children and young adults | Which statement is incorrect when reviewing proximal and distal RTA? a) Both present with a hypokalaemic metabolic acidosis b) Both are associated with nephrocalcinosis c) Proximal RTA is secondary to an inability to reabsorb bicarbonate d) Distal RTA is secondary to an inability to secrete protons | b |
A clinical approach to tubulopathies in children and young adults | Which statement is incorrect when reviewing tubulopathies that affect magnesium handling of the kidney? a) When assessing hypomagnesaemia, urinary calcium is an important tool to guide diagnosis b) Individuals with variants in CLDN10 present with a salt wasting tubulopathy with hypomagnesaemia c) Individuals with variants in CLDN16/19 present with a salt wasting tubulopathy with hypomagnesaemia d) Familial hypomagnesaemia with hypocalcaemia results from variants in TRMP6 | b |
A clinical approach to children with C3 glomerulopathy | A kidney biopsy performed in a child with C3 glomerulopathy can show: a) Intramembranous dense deposits b) Mesangial proliferation c) Subepithelial humps d) All of the above e) None of the above | d |
A clinical approach to children with C3 glomerulopathy | Membranoproliferative glomerulonephritis is a histological pattern which may be secondary to alternative pathway of complement dysregulation a) Very rarely b) Frequently, especially in children c) Only in adults d) Only if there is C3 predominance by IF e) In all cases | b |
A clinical approach to children with C3 glomerulopathy | The complement system is involved in the pathogenesis of C3G. Which of the following serological tests does not fit in the pattern of increased C3 turnover? a) low C3 levels b) normal C3 levels c) normal factor B d) auto-antibodies against AP convertase C3bBb e) all of the above | c |
A clinical approach to children with C3 glomerulopathy | Optimal treatment of C3 glomerulopathy requires a) Supportive care with RAAS inhibition and low-salt diet b) Mycophenolate mofetil when proteinuria is ≤ 0.5 g/day c) Eculizumab d) Therapy targeting the alternative pathway of complement e) All of the above | e |
A clinical approach to children with C3 glomerulopathy | Among therapeutic agents targeting complement, which of the following statements is true? a) Eculizumab is the only agent approved for use in C3G b) ACH4471 targets Factor B c) CCX168 is a C5aR1 antagonist d) APL-2 is orally administered e) LNP023 targets the C5 convertase | c |
Acute kidney injury in pediatrics an overview focusing on pathophysiology | What is the GFR change in each AKI pathophysiological phase? a) Initiation (slow GFR decrease), extension (fast GFR decrease), maintenance (GFR stabilization), recovery (GFR increase). b) Initiation (slow GFR decrease), extension (fast GFR decrease), maintenance (slow GFR increase), recovery (fast GFR increase). c) Initiation (fast GFR decrease), extension (slow GFR decrease), maintenance (GFR stabilization), recovery (GFR increase). d) Initiation (fast GFR decrease), extension (slow GFR decrease), maintenance (GFR increase), recovery (GFR stabilization). | c |
Acute kidney injury in pediatrics an overview focusing on pathophysiology | Considering the pathophysiology of Sepsis-associated Acute Kidney Injury (SA-AKI), choose the correct answer: a) SA-AKI’s pathophysiology is similar to other AKI etiologies, with hypoperfusion and ischemic injury being the main mechanisms. b) The most accepted mechanism associated with SA-AKI is a decrease in global kidney blood flow, but differently from other AKI causes, it does not lead to Acute Tubular Necrosis. c) There is more than one pathway for the development of SA-AKI, including ischemia–reperfusion injury, inflammation, alterations in microcirculation and metabolic reprogramming. d) Microcirculatory dysfunction is one of the mechanisms associated with SA-AKI, through endothelial injury, thrombotic microangiopathy and alteration of the kidney blood flow with preserved capillary density. | c |
Acute kidney injury in pediatrics an overview focusing on pathophysiology | Which of the following causes of intrinsic kidney disease is not associated with drug-induced nephrotoxicity? a) Acute Tubular Necrosis. b) Acute Interstitial Nephritis. c) Tumor Lysis Syndrome. d) Rapidly Progressive Glomerulonephritis | c |
Acute kidney injury in pediatrics an overview focusing on pathophysiology | Which pregnancy-related event favours AKI onset in neonatology? a) Late term delivery. b) Antenatal glucocorticoid administration. c) Placental abruption. d) Use of centrally-acting anti-hypertensive agents. | c |
Acute kidney injury in pediatrics an overview focusing on pathophysiology | Which parameter/condition is most widely used to determine AKI in hospitalized patients? a) Reduction of urine output or anuria. b) Increase in baseline serum creatinine (SCr). c) Reduction of glomerular filtration rate (GFR). d) Need for kidney replacement therapy. | b |
Acute and chronic kidney complications in children with type 1 diabetes mellitus | Acute kidney injury in children at T1DM onset… a) … could manifest in about 2/3 of children with DKA b) … is extremely rare c) … is usually not reversible d) … could manifest in about of 2/3 of children without DKA | a |
Acute and chronic kidney complications in children with type 1 diabetes mellitus | In AKI pathophysiology for patients at the onset of T1DM, all of the following factors are involved with the exception of: a) Osmotic polyuria b) Delayed T1DM diagnosis c) Acidosis d) Older age at T1DM onset | d |
Acute and chronic kidney complications in children with type 1 diabetes mellitus | The presence of diabetic kidney disease may be indicated by all the following parameters with the exception of: a) Urine albumin to creatinine ratio > 30 mg/g creatinine b) eGFR < 60 mL/min/1.73 m² c) Urine albumin to creatinine ratio > 300 mg/g creatinine d) Glycosuria | d |
Acute and chronic kidney complications in children with type 1 diabetes mellitus | The first-choice pharmacological treatment for hypertension in children with T1DM is: a) Angiotensin-converting enzyme inhibitors b) Calcium channel blockers c) Diuretics d) Beta-blockers | a |
Acute and chronic kidney complications in children with type 1 diabetes mellitus | The risk of developing DKD increases in case of: a) Poor glycemic control b) Previous AKI episode c) Untreated hypertension d) All of the above | d |
Anemia after kidney transplantation | Early post-transplant anemia is defined as anemia diagnosed: a) Within 12 months after kidney transplant b) Within 6 months after kidney transplant c) Within the first month after kidney transplant d) At the 3 month post-transplant visit e) Any time after transplant | b |
Anemia after kidney transplantation | Which of the following is NOT a risk factor for post-transplant anemia? a) Pre-transplant anemia b) Delayed graft function c) Iron deficiency d) Corticosteroids e) Viral infections | d |
Anemia after kidney transplantation | Post-transplant anemia has been associated with a variety of clinical outcomes in adults including: a) All-cause mortality b) Allograft dysfunction c) Left ventricular hypertrophy d) Congestive heart failure e) All of the above | e |
Anemia after kidney transplantation | The initial diagnostic evaluation for PTA in children should include all of the following EXCEPT: a) Measurement of biomarkers of iron status including ferritin and transferrin saturation b) Review of medications to identify those associated with increased risk for anemia c) Measurement of reticulocyte count d) Ultrasound to assess for intra-abdominal hematoma e) Testing for the presence of hemolysis if clinical suspicion is high | d |
Anemia after kidney transplantation | The optimal post-transplant hemoglobin level in children: a) Has not been defined b) Is the same as the optimal hemoglobin level in adult kidney transplant recipients c) Depends on the dose of erythropoiesis stimulating agent they are treated with d) Is lower for those receiving iron supplementation e) Is > 11 g/dl | a |
An update on lipid apheresis for familial hypercholesterolemia | Which of the statements below is wrong? a) It is recommended to check plasma lipid levels in children if there is a 1st and 2nd degree relative before the age of 55 (men) or 60 years (women) with early cardiovascular disease. b) An affected parent should undergo genetic testing first and when the diagnosis has been confirmed, genetic testing in the potentially affected child should be performed. c) It is recommended to check plasma lipid levels in every child once, regardless of anamnestic hints or clinical features. d) It is only recommended to look for secondary reasons for elevated lipid levels if no pathogenic mutation can be found. | d |
An update on lipid apheresis for familial hypercholesterolemia | Which of the statements below is correct? a) Serum lipid levels are age dependent. b) LDL-target levels are the same in children and adults. c) LDL-target levels can only be reached with a multimodal treatment of medication and lipid apheresis. d) LDL-target levels can only be reached with a multimodal treatment of medication and lipid apheresis twice a week. | a |
An update on lipid apheresis for familial hypercholesterolemia | Which of the statements below is wrong? a) A mutation in the PCSK9 gene decreases LDL receptors and subsequently causes hypercholesterolemia. b) LDL receptor mutations can result in medication resistance. c) LDLR gene mutations are causative in 60–80% of genetically diagnosed cases of hypercholesteronemia. d) If an underlying mutation can be identified, the treatment should always be a multimodal intense therapy because all mutations cause LDL plasma values elevated to a comparable level. | d |
An update on lipid apheresis for familial hypercholesterolemia | Which is the correct next step in diagnostics or therapy when a child . . . a) is newly diagnosed and has no medication yet? Start with a combination of statins, intestinal cholesterol uptake inhibitors and PCSK9 inhibitors to lower the burden of LDL as fast as possible. b) is on statins, intestinal cholesterol uptake inhibitors and PCSK9 inhibitors, and does not show a satisfactory decrease in LDL levels? Check underlying mutation and eventually terminate statins and PCSK9 inhibitors. c) is on lipid apheresis and does not show a satisfactory decrease in LDL levels? Increase the plasma volume to treat, because more treated plasma in a session results in a long-lasting decrease in mean LDL. d) is on lipid apheresis and does not show a satisfactory decrease in LDL levels? Check eluted liquids for co-eliminated factors, because they can be washed out completely. | b |
An update on lipid apheresis for familial hypercholesterolemia | Which of the statements below is correct? a) Endothelial dysfunction and thickening of the arterial vessel wall in hypercholesterolemia can already be present in children. b) Severe atherosclerotic lesions like aortic valve stenosis and supravalvular aortic stenosis cannot be present before adolescence. c) Lipid apheresis does not influence coagulation and rheological pathways, adhesive proteins, immunological/inflammatory properties and vessel compliance. d) Other substances besides LDL can only be found in the DALI column | a |
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation | Which of the following is not associated with an increased risk for new-onset diabetes after transplant (NODAT)? a) High dosage of corticosteroids b) Younger age c) Obesity d) Tacrolimus use | b |
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation | Which of the following foods is not consistent with the Dietary Approaches to Stop Hypertension (DASH) diet? a) 4-5 servings of fruits per day b) 4-5 servings of vegetables per day c) 2-3 servings of dairy per day d) > 8 oz of red meat per day | d |
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation | Which of the following is recommended by the American Heart Association for children with high-risk health conditions, including kidney transplant recipients? a) At least 5 hours of physical activity weekly b) More than 8 servings of fruits and vegetables daily c) Less than 180 minutes of screen time daily d) At least two servings of red meat daily | a |
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation | Therapeutic lifestyle changes that may be associated with benefit on cardiometabolic parameters among pediatric kidney transplant recipients include: a) Reducing sugar-sweetened beverage intake b) Reducing sodium intake to < 2.3 g daily c) Increasing full-fat dairy intake d) A and B e) All of the above | d |
Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation | Which of the following is a reasonable first step for lowering cholesterol levels in pediatric kidney transplant recipients? a) Switching from tacrolimus to sirolimus b) Blood pressure reduction c) Starting a statin empirically, regardless of the age of the patient d) Increasing consumption of plant-based foods | d |
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy | Citrate toxicity involves which of the following manifestations?a. High anion gap metabolic acidosis.b. High anion gap metabolic alkalosis.c. High total serum calcium to ionized calcium ratio (> 2.5). d.All of the above. | d |
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy | If heparin-induced thrombocytopenia (HIT) is suspected in a dialysis patient, which of the available alternative anticoagulants might be a more appropriate option? a. Enoxaparin b. Nadroparin c. Hirudin d. Dalteparin e. Reviparin | c |
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy | In a patient with acute kidney injury on intermittent hemodialysis, which anticoagulant does NOT require dose adjustment? a. Danaparoid b. Fondaparinux c. Argatroban d. Enoxaparin e. Hirudin | c |
Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy | What is the mechanism of action of prostacyclin as potential anticoagulant to prolong CKRT circuit life? a. Irreversibly inhibits thrombin. b. Reversibly inhibits platelet function and decreases aggregation by inhibiting GP IIb-IIIa receptor activation. c. Inhibits serine protease and targets protein factors IXa, Xa, Xia, VIIa, and thrombin (IIa). d. Chelation of calcium and decreases adhesions between platelets and red blood cells. e. None of the above. | b |
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes | Identified risk factors for the development of chronic kidney disease in children with CAKUT include: a) the underlying CAKUT diagnosis b) kidney size c) baseline eGFR d) family history of CAKUT e) a, b, and c f) all of the above | e |
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes | The specific CAKUT category most likely associated with the long-term outcome of kidney failure is: a) multicystic dysplastic kidney b) unilateral renal agenesis c) renal hypodysplasia d) posterior urethral valve e) none of the above | d |
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes | A term newborn in the level 1 nursery was found to have antenatal hydronephrosis on a third-trimester ultrasound with an APD of 12 mm. What is the next best step in management? a) Refer to Nephrology for appointment within the first month of life b) Monitor urine output prior to discharge home c) Obtain kidney bladder ultrasound at 48 h of life d) Schedule patient for VCUG e) Urgent referral to Urology | c |
Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes | Essential components of a successful multidisciplinary pediatric CAKUT care team include: a) pediatric nephrologist b) specialty nurse c) social worker d) dietitian e) pharmacist f) geneticist g) psychologist h) all of the above | h |
Care of the pediatric patient on chronic peritoneal dialysis | Which of the following are advantages of PD compared with HD?\na. Improved preservation of residual kidney function\nb. Fewer dietary restrictions\nc. Fewer fluid restrictions\nd. Avoidance of systemic anticoagulation\ne. All of the above | e |
Care of the pediatric patient on chronic peritoneal dialysis | Which of the following is NOT an absolute contraindication to PD?\na. Omphalocele\nb. Diaphragmatic hernia\nc. Colostomy\nd. Gastroschisis\ne. Bladder exstrophy | c |
Care of the pediatric patient on chronic peritoneal dialysis | Which of the following is one strategy to reduce PD catheter-related infections?\na. Intraoperative antibiotic prophylaxis administration within 30 min prior to incision for PD catheter placement\nb. Downward or lateral-facing exit site\nc. Use of sutures in securing the PD catheter\nd. Avoidance of dressing changes for 2 weeks after catheter placement\ne. Placement of g-tube after PD catheter placement | b |
Care of the pediatric patient on chronic peritoneal dialysis | Low transporters are characterized by:\na. High membrane permeability, rapid solute clearance, poor ultrafiltration, high protein loss\nb. Low membrane permeability, slow solute clearance, good ultrafiltration, low protein loss\nc. Low membrane permeability, rapid solute clearance, good ultrafiltration, high protein loss\nd. High membrane permeability, slow solute clearance, poor ultrafiltration, low protein loss | b |
Care of the pediatric patient on chronic peritoneal dialysis | Which of the following are healthcare disparities in children receiving maintenance PD in lower-income countries?\na. Higher mortality risk\nb. Higher cardiovascular-related death\nc. Smaller height\nd. High mineral bone disease\ne. All of the above | e |
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions | A 14-year-old girl was evaluated by the ED trauma team after a motor vehicle accident. She was referred to pediatric nephrology for an incidental CT finding of five simple kidney cysts. Noticing a pale macule on her arm, the astute nephrologist entertains the possibility of TSC. Which of the following would make this diagnosis? a) Finding additional hypomelanotic macules on her torso b) Finding additional hypomelanotic macules on her torso and eliciting a history of febrile seizure c) Finding additional hypomelanotic macules on her torso and noticing that the CT reports sclerotic lesions in the thoracic vertebrae d) Realizing her acne might be facial angiofibroma | c |
Cystic kidney disease in tuberous sclerosis complex: current knowledge and unresolved questions | Which of the following statements about renal imaging is true for patients with TSC? a) Infants do not need renal imaging at the time of diagnosis. b) Imaging is recommended at least every one to three years in all patients, regardless of kidney findings. c) Kidney ultrasound is preferable to MRI or CT scan in patients unable to cooperate. d) CT scan without iv contrast is the preferred imaging modality for patients already known to have kidney lesions. | b |