A 4-month-old baby boy did intravenous pyelography (IVP) because high suspicion of ureteropelvic junction obstruction. Post IVP patient became anuric for 24 hr.

Correct Answer: D

Rationale: In this case, the correct answer is D) insulin/dextrose. The baby boy developed anuria after undergoing intravenous pyelography (IVP) due to possible renal impairment following the procedure. Anuria can lead to metabolic acidosis, and insulin with dextrose is used to manage hyperkalemia, a potential consequence of renal impairment. A) Bicarbonate is not the correct choice in this scenario as anuria does not directly indicate a need for bicarbonate administration. B) Beta-agonists are not indicated for anuria or post-procedure renal impairment in this context. C) Diuretics would not be appropriate in a situation of anuria, as the patient is not producing urine and diuretics aim to increase urine output. Educationally, this question highlights the importance of understanding the pathophysiology of anuria and its management in pediatric patients. It emphasizes the need for healthcare providers to be familiar with appropriate interventions to address potential complications following procedures like IVP in infants, particularly when faced with acute renal issues. This case underscores the critical role of pharmacological knowledge in pediatric care and the significance of selecting the most appropriate treatment based on the patient's condition.

Correct Answer: D

Rationale: In pediatrics, diagnosing hypertension is crucial for early intervention and prevention of long-term complications. The correct answer, option D, states that stage 1 hypertension is defined as blood pressure greater than the 95th percentile for age, gender, and height, plus an additional 5 mm Hg. This definition accounts for the dynamic nature of blood pressure in children and the need for multiple measurements to confirm the diagnosis accurately. Option A, >99th blood pressure percentile, is incorrect because it does not include the additional 5 mm Hg criterion, which is essential for defining stage 1 hypertension in children. Option B, 95th to 99th blood pressure percentile, is incorrect as it does not account for the additional 5 mm Hg requirement. Option C, 90th to 95th blood pressure percentile, is incorrect as it falls below the 95th percentile threshold required to diagnose hypertension. Educationally, understanding the criteria for diagnosing hypertension in children is vital for healthcare professionals working with pediatric patients. By knowing the specific definitions and thresholds, clinicians can accurately identify and manage hypertension in children, thus preventing potential cardiovascular risks in the future. Regular monitoring and appropriate intervention based on these criteria can lead to better health outcomes for pediatric patients.

Correct Answer: D

Rationale: In the context of pediatric pharmacology, understanding genitourinary assessment is crucial for identifying and managing conditions affecting the kidneys and associated structures. In this scenario, the correct answer is D) autosomal recessive polycystic kidney disease (ARPKD). Hepatic fibrosis leading to portal hypertension is a common complication of ARPKD due to the congenital hepatic fibrosis associated with this condition. The renal cysts in ARPKD can lead to biliary ductal plate malformation, resulting in fibrosis. This understanding highlights the importance of recognizing this association in pediatric patients with kidney diseases. Regarding the other options: A) Poland syndrome: This condition is characterized by the absence or underdevelopment of chest muscles, not associated with hepatic fibrosis or portal hypertension. B) VACTERL association: This is a cluster of congenital anomalies involving vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities. While renal anomalies are part of VACTERL, hepatic fibrosis and portal hypertension are not typical features. C) Multicystic renal dysplasia: This condition involves non-hereditary cystic kidney disease, but it is not typically associated with hepatic fibrosis and portal hypertension. Educationally, this question underscores the importance of linking pharmacological knowledge with an understanding of disease pathophysiology. By recognizing the hepatic complications of ARPKD, healthcare providers can implement appropriate monitoring and therapeutic strategies for affected pediatric patients. This reinforces the need for a comprehensive approach to pediatric pharmacology that considers both renal and hepatic manifestations of genetic conditions.

Correct Answer: C

Rationale: In the context of pediatric genitourinary assessment, understanding the role of interstitial cells in the renal medulla is crucial for comprehending kidney function. In this question, the correct answer is C) erythropoietin. Erythropoietin is a hormone secreted by interstitial cells in the renal medulla in response to low oxygen delivery, a condition known as hypoxia. This hormone stimulates the production of red blood cells in the bone marrow, helping to increase oxygen-carrying capacity in the blood. Option A) ammonia is a waste product of protein metabolism and is not secreted by interstitial cells in the renal medulla in response to low oxygen delivery. Option B) calcitriol is the active form of vitamin D, synthesized in the kidneys, but it is not specifically secreted by interstitial cells in response to low oxygen delivery. Option D) renin is an enzyme secreted by the juxtaglomerular cells in response to low blood pressure or low sodium levels, not low oxygen delivery. Educationally, understanding the role of erythropoietin in response to hypoxia is essential for assessing renal function, especially in pediatric patients who may be more vulnerable to oxygen delivery issues due to their developing physiology. This knowledge is fundamental for healthcare professionals involved in pediatric pharmacology and genitourinary care.

Correct Answer: C

Rationale: In the context of pediatric genitourinary assessment and pharmacology, understanding the main factor that affects plasma creatinine levels is crucial. The correct answer is C) muscle mass. Plasma creatinine is primarily derived from the breakdown of creatine phosphate in muscle tissue. Therefore, muscle mass directly influences the production of creatinine in the body. In pediatric patients, whose muscle mass can vary significantly during growth and development, understanding this relationship is essential in interpreting creatinine levels accurately. Option A) degree of dehydration can transiently affect creatinine levels due to changes in renal perfusion, but it is not the main factor influencing plasma creatinine. Option B) nutritional state can impact muscle mass indirectly, but it is not the direct cause of changes in creatinine levels. Option D) presence of catabolism can increase creatinine levels due to muscle breakdown, but it is a consequence of muscle mass changes rather than the primary factor. Educationally, grasping the relationship between muscle mass and plasma creatinine levels enhances the student's ability to interpret renal function tests accurately in pediatric patients. This knowledge is vital for proper dosing of medications excreted renally and for assessing renal function in clinical practice.