1. Hemolytic Uremic Syndrome is characterized by all the following except:
1. Microangiopathic hemolytic anemia
2. Thrombocytosis
3. Renal failure
4. Absence of neurological features

Answer: The answer is (b). Hemolytic uremic syndrome is characterized by microangiopathic hemolytic anemia, Thrombocytopenia, renal failure, elevated serum LDH, normal coagulation profile and absence of neurological abnormalities.

A 12-year-old girl was admitted to the emergency room with sudden onset swelling of the face and feet. The previous week she had gone out for dinner and had taken rare steak. Following this she had developed diarrhea and fever. Now her urine was red in color and scanty in quantity. On examination there was generalized edema. Her blood pressure was 160/100 mmHg. Labs revealed hemoglobin of 8 g/dL and a platelet count of 20,000 per cumm. Her blood urea nitrogen was 64 mg/dL and her serum creatinine was 2.4 mg/dL.

2. The microbe responsible for the clinical presentation in this girl is
1. E.Coli O157:H7
2. Staphylococcus
3. Giardia
4. Echovirus

Answer: The answer is (a). E Coli O157:H7 is known to cause a diarrheal disease, which is followed by hemolytic uremic syndrome. The clinical picture of anemia, Thrombocytopenia and renal failure fits the description of hemolytic uremic syndrome. There is also history of intake of rare steak followed by diarrheal illness. This is probably caused due to the E coli.

3. The pathophysiological difference between hemolytic uremic syndrome and thrombotic thrombocytopenic purpura is
1. The vascular beds involved
2. The type of antibodies produced
3. The coagulation cascade disorder
4. Platelet function

Answer: The answer is (a). The basic pathophysiology of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura are similar except for the fact that the vascular beds involved are different.

4. A kidney biopsy is done in this child to confirm the diagnosis. It is most likely to reveal
1. Intra epithelial deposits
2. Glomerular sclerosis
3. Endothelial hyaline thrombi in glomeruli
4. Mesangial proliferation

Answer: The answer is (c). Hemolytic Uremic Syndrome is characterized by endothelial hyaline thrombi. The remaining features described are characteristic of various types of glomerulonephritis.