(MCQS 289-291) :A 2 month old girl has an ante- natal diagnosis of right hydronephrosis

Question:289
Correct Answer: B
Explanation:
Buccal exostoses are less common than the palatal or lingual tori, and they tend to form a nodular bony shelf on the buccal aspect of the jaws, more commonly in the maxilla than mandible and without gender predilection.

Question:290
 
Correct Answer: B
Explanation:
Transferrin saturation (serum iron / total iron binding capacity) is the most sensitive blood test for hemochromatosis. A fasting sample is ideal. Unlike serum ferritin, it is abnormal at a young age in homozygotes and for this reason, it has been proposed as the preferred test in large scale screening studies such as in blood donors.1 Serum iron is an unreliable screening test with marked diurnal variation. Serum transferrin is a component of the total iron binding capacity and falls late in the disease. Serum ferritin is a marker of body iron stores and increases with age. It can also be elevated in the setting of inflammation and neoplasia. Both the serum ferritin and transferrin saturation should be interpreted with consideration of the patient's age, sex and other conditions predisposing to abnormalities in these tests. The mean serum ferritin and transferrin saturation in homozygote proband males at this centre is 2911µg/L and 85%, and in females is 1499 µg/L and 72%, respectively. The yield of investigating an isolated serum ferritin less than 1000 µg/L in an asymptomatic person with a normal transferrin saturation and no family history of hemochromatosis is low. An annual serum ferritin can be done in this setting and a rising ferritin would be a stronger indication to proceed to liver biopsy if no other source of chronic inflammation is apparent.

Question:291
Correct Answer: C
Explanation:
It is important to distinguish true outlet obstruction from among the non-obstructive conditions that may be associated with hydronephrosis Quantitation of renal function has become easier, more practical, and more accurate than ever using nuclear techniques. The voiding cystourethrography (VCU) has become widespread in the evaluation of reflux, and renal morphology studies have become invaluable in children with pyelonephritis. Nuclear medicine techniques have become procedures of first choice in the diagnosis of renovascular hypertension and in the differential diagnosis of hydronephrosis The tracer of choice has become Tc-99m MAG3 due to rapid clearance from the blood and consequent prompt filling of the renal pelvis. DTPA, in many patients, is cleared from the plasma too slowly and, therefore, fills the pelvis too gradually to permit adequate assessment of pelvic drainage Diuresis renography is a highly accurate method of differentiating renal obstruction and nonobstruction in hydronephrosis and hydroureteronephrosis in infants and in children. Indications for diuresis : Uteropelvic junction obstruction, Megaureter ( Obstructive, nonobstructive, refluxing ), horseshoe kidney , Multicyctic and polycyctic kidney , Upper collecting system duplication , Prune belly syndrome , Ectopic ureterocele , Renal transplant rejection , Urethral valve , Ureteral injury, Postoperative ( Pyeloplasty, ureteral reimplantation, urinary diversion)


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