AIM • KMU Exam Reasoning
KMU Past Paper Practice
Glomerular Disease, Facial Swelling & Nephrotic Syndrome Across the Lifespan
Final Year MBBS • 20 A-Type Single Best Answer MCQs
MCQ 1
A 7-year-old boy presents with facial puffiness and bilateral leg edema. Urine dipstick shows heavy proteinuria, serum albumin is low, and serum creatinine is normal. Which finding would most strongly indicate that this is a predominantly nephrotic rather than nephritic presentation?
Red-cell casts in urine
Marked hypoalbuminemia
Severe hypertension
Oliguria with rising creatinine
Cola-colored urine
Correct Answer: Marked hypoalbuminemia
Explanation: Heavy urinary protein loss causes marked hypoalbuminemia and edema, making this a classic nephrotic pattern.
MCQ 2
A child with generalized edema is being evaluated for nephrotic syndrome. Which test most directly confirms that substantial protein is being lost through the kidneys?
Serum calcium measurement
Chest radiography
Quantification of urinary protein
Liver enzyme measurement
Serum amylase measurement
Correct Answer: Quantification of urinary protein
Explanation: Urinary protein quantification confirms the degree of protein loss and supports the diagnosis of a nephrotic glomerular pattern.
MCQ 3
An 11-year-old girl presents with facial swelling and reduced urine output. Blood pressure is elevated. Urinalysis shows hematuria and moderate proteinuria. Which additional finding would most strongly support an inflammatory glomerular process?
Fatty casts
Red-cell casts
Glucosuria alone
Ketones in urine
Calcium crystals
Correct Answer: Red-cell casts
Explanation: Red-cell casts indicate that bleeding has occurred within the nephron and strongly support glomerular inflammation.
MCQ 4
A 9-year-old boy develops cola-colored urine and periorbital edema 14 days after recovering from impetigo. Blood pressure is elevated. Which mechanism best explains his renal disease?
Direct bacterial invasion of glomeruli
Isolated podocyte injury without inflammation
Immune-mediated glomerular inflammation after infection
Obstruction of both ureters
Primary tubular sodium wasting
Correct Answer: Immune-mediated glomerular inflammation after infection
Explanation: Post-streptococcal glomerulonephritis is an immune-mediated disease occurring after streptococcal infection rather than from direct renal infection.
MCQ 5
A patient with suspected post-streptococcal glomerulonephritis has low serum C3 at presentation. Which interpretation is most appropriate?
It supports complement consumption during immune glomerular injury
It confirms nephrotic syndrome due to minimal change disease
It proves chronic irreversible renal failure
It indicates isolated lower urinary tract infection
It excludes a glomerular cause of hematuria
Correct Answer: It supports complement consumption during immune glomerular injury
Explanation: Low C3 fits the immune-complex and complement-mediated process of post-infectious glomerulonephritis.
MCQ 6
A teenager presents with repeated episodes of visible hematuria occurring whenever he develops an upper respiratory infection. Serum complement is normal. Which investigation would most directly establish the specific glomerular diagnosis if confirmation is required?
Plain abdominal radiograph
Serum lipid profile
Urine culture
Renal biopsy
Chest radiograph
Correct Answer: Renal biopsy
Explanation: Renal biopsy can demonstrate the characteristic mesangial IgA deposition when histological confirmation is clinically indicated.
MCQ 7
A 5-year-old child with edema has heavy proteinuria and low serum albumin. Blood pressure and renal function are normal, and there is no significant hematuria. Which diagnosis best matches this pattern?
Post-streptococcal glomerulonephritis
Minimal change disease
IgA nephropathy
Chronic glomerulonephritis
Acute pyelonephritis
Correct Answer: Minimal change disease
Explanation: Minimal change disease commonly causes a pure nephrotic pattern in children with preserved renal function and little or no active urinary sediment.
MCQ 8
A child with typical nephrotic syndrome is started on therapy. Which response would most strongly support minimal change disease?
Rapid development of severe hypertension
Persistent gross hematuria
Persistent renal failure
Good response to corticosteroid treatment
Progressive reduction in kidney size
Correct Answer: Good response to corticosteroid treatment
Explanation: Typical childhood minimal change disease commonly shows a favorable corticosteroid response.
MCQ 9
A child with nephrotic syndrome has severe generalized edema. Before increasing diuretic therapy, which clinical consideration is most important?
Edema always indicates excessive intravascular volume
Visible edema excludes renal impairment
The patient may have reduced effective circulating volume despite edema
Serum albumin is irrelevant to fluid distribution
Diuretics cannot worsen renal perfusion
Correct Answer: The patient may have reduced effective circulating volume despite edema
Explanation: Nephrotic edema can coexist with intravascular depletion, so volume status must be assessed before aggressive diuresis.
MCQ 10
A 12-year-old child with nephrotic syndrome develops sudden pleuritic chest discomfort and unexplained shortness of breath. Which complication should be considered urgently?
Thromboembolic disease
Iron deficiency anemia
Acute appendicitis
Otitis media
Hyperthyroidism
Correct Answer: Thromboembolic disease
Explanation: Nephrotic syndrome creates a hypercoagulable state, making clinically important thrombosis a recognized complication.
MCQ 11
An adult patient presents with edema and significant proteinuria. Renal ultrasound is normal, and the underlying glomerular lesion remains uncertain. Which investigation is most useful when knowing the exact pathology would change treatment?
Repeat blood pressure alone
Renal biopsy
Electrocardiography
Chest ultrasonography
Stool microscopy
Correct Answer: Renal biopsy
Explanation: Biopsy identifies the glomerular lesion when histological diagnosis is needed to guide management.
MCQ 12
A child with nephrotic syndrome develops fever, abdominal pain and increasing lethargy. Which interpretation should guide the next clinical decision?
The symptoms are expected effects of hypoalbuminemia only
Significant infection should be actively considered
The nephrotic syndrome has necessarily resolved
Renal monitoring is no longer required
The child most likely has isolated hypertension
Correct Answer: Significant infection should be actively considered
Explanation: Children with nephrotic syndrome are more susceptible to important infections; fever and abdominal symptoms require prompt evaluation.
MCQ 13
A 16-year-old patient has microscopic hematuria and mild proteinuria on repeated testing. Renal function is currently normal. Which parameter is most useful for detecting future progression of glomerular disease?
Serial blood pressure, urine protein and renal function
Single serum bilirubin measurement
Annual chest radiograph alone
Repeated stool microscopy
Daily serum amylase
Correct Answer: Serial blood pressure, urine protein and renal function
Explanation: Persistent proteinuria, hypertension and declining renal function are key indicators of progressive glomerular damage.
MCQ 14
An adult with long-standing glomerular disease has persistent hypertension, anemia, elevated creatinine and bilaterally small echogenic kidneys. What is the best interpretation of the imaging finding?
It strongly supports chronic renal parenchymal damage
It confirms acute minimal change disease
It demonstrates isolated urethral obstruction
It indicates acute pyelonephritis only
It excludes chronic kidney disease
Correct Answer: It strongly supports chronic renal parenchymal damage
Explanation: Small echogenic kidneys in the appropriate clinical setting support established chronic renal parenchymal disease.
MCQ 15
A patient with post-infectious glomerulonephritis develops worsening breathlessness, severe hypertension and widespread crackles on chest examination. Which complication is most likely?
Pulmonary edema due to fluid overload
Isolated bronchial asthma
Spontaneous pneumothorax
Simple upper respiratory infection
Chronic obstructive pulmonary disease
Correct Answer: Pulmonary edema due to fluid overload
Explanation: Reduced glomerular filtration can cause sodium and water retention, leading to severe hypertension and pulmonary edema.
MCQ 16
A patient with recurrent hematuria is being differentiated between IgA nephropathy and post-streptococcal glomerulonephritis. Which finding favors IgA nephropathy?
Hematuria occurring several weeks after infection
Low complement following skin infection
Hematuria occurring at the time of respiratory infection
Marked generalized edema with isolated heavy proteinuria
Persistent severe hypoglycemia
Correct Answer: Hematuria occurring at the time of respiratory infection
Explanation: Synpharyngitic hematuria—hematuria during or immediately after a respiratory infection—is a classic clue to IgA nephropathy.
MCQ 17
A child with nephrotic syndrome has edema but no respiratory distress. Which finding would most strongly suggest that the edema has become clinically significant enough to require closer reassessment of volume status?
Stable weight
Increasing abdominal girth with ascites
Normal blood pressure
Improving appetite
Reduction in facial swelling
Correct Answer: Increasing abdominal girth with ascites
Explanation: Increasing ascites indicates worsening generalized edema and should prompt reassessment of fluid status and complications.
MCQ 18
A patient with glomerular disease has increasing serum creatinine over several visits. Why is this finding clinically important?
It indicates improving renal filtration
It suggests progressive reduction in glomerular filtration
It confirms isolated liver dysfunction
It demonstrates increased albumin synthesis
It excludes chronic renal disease
Correct Answer: It suggests progressive reduction in glomerular filtration
Explanation: A rising creatinine over time indicates worsening filtration and may signal progressive renal damage.
MCQ 19
Parents of a child with nephrotic syndrome are being prepared for discharge. Which instruction is most important regarding recurrence?
Edema can never recur after the first response to treatment
Follow-up is unnecessary once serum albumin improves
Recurrence may occur and requires continued monitoring and treatment adherence
Urinary changes are unrelated to disease activity
Medical review is required only for visible hematuria
Correct Answer: Recurrence may occur and requires continued monitoring and treatment adherence
Explanation: Childhood nephrotic syndrome may relapse, so families should understand the importance of adherence, monitoring and follow-up.
MCQ 20
A patient with chronic glomerulonephritis is reviewed in clinic. Proteinuria persists despite improvement in edema. Which management principle remains important for limiting further renal damage?
Stop monitoring once edema resolves
Control blood pressure and persistent proteinuria
Increase dietary sodium intake
Avoid checking renal function
Treat only if visible hematuria develops
Correct Answer: Control blood pressure and persistent proteinuria
Explanation: Persistent hypertension and proteinuria contribute to progressive nephron damage, so both remain important therapeutic targets in chronic glomerular disease.