EXAM 2026 COMPLETE QUESTIONS AND
SOLUTIONS
⩥ HPI. Answer: A 13-year-old boy had been well until 4 weeks before
admission, when he developed a cough, periorbital edema, ankle
swelling, headaches, and upper abdominal discomfort.
⩥ Admission Findings. Answer: Febrile with facial and ankle edema;
generalized, superficial lymphadenopathy; numerous adventitial sounds
in the lungs; mild hypertension (BP 140/110).
⩥ Hemoglobin. Answer: 72 g/l
⩥ White-cell count. Answer: Normal
⩥ Erythrocyte sedimentation rate (ESR). Answer: 137 mm/h
⩥ Blood urea. Answer: 27.5 mmol/l
⩥ Serum bicarbonate. Answer: 13.6 mmol/l
,⩥ Serum albumin. Answer: 19 g/l
⩥ Creatinine clearance. Answer: 45 ml/min/m2
⩥ Urinary protein loss. Answer: 6.7 g/day
⩥ Serum CH50. Answer: 14 U/ml; NR 25-45
⩥ C3 level. Answer: 0.20 g/l; NR 0.8-1.4
⩥ C4 level. Answer: 0.30 g/l; NR 0.2-0.4
⩥ Chest x-ray findings. Answer: Several rounded opacities in both
lungs.
⩥ Diagnosis. Answer: Acute poststreptococcal disease suggested by low
C3 with acute glomerulonephritis.
⩥ Current Admission Findings. Answer: Heavy proteinuria with a low
serum albumin (22 g/l; NR 35-50).
⩥ Serum CH50 and C3 levels on current admission. Answer: 18 U/ml
and 0.4 g/l, respectively.
,⩥ C3 nephritic factor. Answer: Shows a strong association with
membranoproliferative glomerulonephritis.
⩥ Bilateral renal biopsy results. Answer: 11 glomeruli, all swollen with
proliferation of mesangial, endothelial, and epithelial cells.
⩥ Electron microscopy findings. Answer: Capillary loops showed
basement membrane thickening with electron-dense deposits within the
GBM.
⩥ Immunofluorescence findings. Answer: Intense C3 deposition is
present in the GBM without immunoglobulin staining.
⩥ Diagnosis confirmation. Answer: Characteristic of
membranoproliferative glomerulonephritis with dense intramembranous
deposits (type II MPGN).
⩥ Treatment. Answer: Alternate-day prednisolone 10 mg PO per day for
30 days.
⩥ Principal Procedure. Answer: Where should you Begin to look up the
code in the coding manual - ICD-10-PCS Alphabetic Index
, ⩥ Type of Procedure (Principal). Answer: Excision
⩥ Body System (Principal). Answer: Kidney
⩥ Laterality (Principal). Answer: Right
⩥ Character 1 (Principal). Answer: Section Character - 0
⩥ Character 2 (Principal). Answer: Section Qualifier Character - T
⩥ Character 3 (Principal). Answer: Root Type Character - B
⩥ Character 4 (Principal). Answer: Qualifier Character - 0
⩥ Character 5 (Principal). Answer: Qualifier Character - 4
⩥ Character 6 (Principal). Answer: Qualifier Character - Z
⩥ Character 7 (Principal). Answer: Qualifier Character - X
⩥ Correct Code (Principal). Answer: 0TB04ZX