Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map

Review of Clinical Signs Review Questions

Nephrotic Syndrome

Bernard M. Karnath, MD

Choose the single best answer for each question.

1. A 20-year-old woman presents to her primary care physician with mild pedal edema. Her past medical history is significant for chronic vesicoureteral reflux and recurrent urinary tract infections. On physical examination, the patient is in no distress. Vital signs include a blood pressure of 135/85 mm Hg, heart rate of 70 bpm, and temperature of 98.5°F. Cardiopulmonary examination is normal with the exception of very mild pedal edema. Laboratory evaluation reveals a serum creatinine level of 1.9 mg/dL. Urinalysis reveals 4+ proteinuria and 1+ hematuria. Urine microscopy reveals granular casts with a few red blood cells. What is the most likely cause of this patient’s renal disease?

  1. Focal segmental glomerulosclerosis
  2. Membranoproliferative glomerulonephritis
  3. Membranous glomerulopathy
  4. Minimal change disease
Click here to compare your answer.


2. A 15-year-old boy presents with periorbital and lower extremity swelling that began 1 week prior. The patient has no significant past medical history and had been feeling well until 1 week ago. On physical examination, blood pressure is 120/80 mm Hg, heart rate is 80 bpm, and temperature is 98.5°F. Periorbital edema is obvious on physical examination, and there is 3+ pitting edema of the lower extremities bilaterally. Cardiac examination reveals regular rhythm with no murmurs, and lung examination is clear to auscultation. Laboratory examination reveals a serum creatinine level of 1.5 mg/dL, blood urea nitrogen (BUN) level of 30 mg/dL, and serum albumin level of 2.0 g/dL. Urinalysis reveals 4+ protein. Urine microscopy reveals many hyaline and fatty casts. A renal biopsy is performed. Examination of the specimen with light microscopy is normal, electron microscopy reveals fusion of the foot processes, and immunofluorescence staining is negative. What is the most likely cause of this patient’s nephrotic syndrome?

  1. Focal segmental glomerulosclerosis
  2. Membranoproliferative glomerulonephritis
  3. Membranous glomerulopathy
  4. Minimal change disease
Click here to compare your answer.


3. A 50-year-old woman with recently diagnosed colon cancer presents with acute onset of shortness of breath and pleuritic chest pain. A ventilation-perfusion scan reveals a high probability of pulmonary embolism. On review of systems, the patient also complains of bilateral lower extremity swelling. On physical examination, blood pressure is 150/90 mm Hg, heart rate is 90 bpm, and respiratory rate is 20 breaths/min. Cardiac examination reveals regular rhythm with no murmurs. Lungs are clear to auscultation. Examination of the lower extremities reveals 3+ pitting edema. Laboratory evaluation results include a serum creatinine level of 1.8 mg/dL, BUN level of 28 mg/dL, and serum albumin level of 1.9 g/dL. Urinalysis reveals 4+ protein, and oval fat bodies, granular casts, and a few red blood cells are identified on urine microscopy. What is the most likely cause of this patient’s nephrotic syndrome?
  1. Focal and segmental glomerulosclerosis
  2. Membranoproliferative glomerulonephritis
  3. Membranous glomerulopathy
  4. Minimal change disease
Click here to compare your answer.


4. A 30-year-old man presents with bilateral lower extremity edema. His past medical history is significant for chronic hepatitis C. On physical examination, blood pressure is 150/100 mm Hg and heart rate is 90 bpm. Cardiac examination reveals regular rhythm with no murmurs. Lungs are clear to auscultation. Examination of the lower extremities reveals 3+ pitting edema. Laboratory examination results include a creatinine level of 1.9 mg/dL, BUN level of 28 mg/dL, serum albumin level of 1.9 g/dL, serum C3 level of 25 mg/dL (normal, 64166 mg/dL), and serum C4 level of 5 mg/dL (normal, 1545 mg/dL). Urinalysis reveals 4+ protein. What is the most likely cause of this patient’s nephrotic syndrome?

  1. Focal and segmental glomerulosclerosis
  2. Membranoproliferative glomerulonephritis
  3. Membranous glomerulopathy
  4. Minimal change disease
Click here to compare your answer.

Click here to read more about The Nephrotic Syndrome
(Requires Adobe Acrobat Reader)




Check our archives to test your knowledge in other clinical signs:

Review of Clinical Signs Archives



Review of Clinical Signs main page


If you do not already have Acrobat Reader, simply click on the icon below, scroll down to the "Get the Free Acrobat Reader" heading and follow the instructions to install the program. Acrobat enables you to convert any document into an Adobe Portable Document Format (PDF) file for easy viewing.

Download Adobe Acrobat Reader

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 11/6/07 • kkj