Final Gus 2009

1 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT

FINAL GUS BATCH 2009

1. dudi

2. What is the source alkaline phosphate in the semen ?a. prostatic glandcairanasamb. bulbourethral glandlubrikanc. seminal vesiclefruktosa, cairanbasad. seminal calliculus apparatus

3. kontraindikasisirkumsisi ? hipospadia

4. 35 y.o man complains pain when erection since 3 weeks ago. The physian diagnose pyeroine’s diseasefor this patient. Where is the location of the plaque or fibrosis that would be found when the physician palpate the penis

a. corpus spongiosumb. corpus cavernosusc. bulb of penisd. orificum urethra externae. proximal of penis

5. You are at surgery and doing deferentomy. During the procedure, parts of ductus deferens ligated and/or exised through incision. Where is the right location to ligate/incision?

a. superior part of scrotumb. after head of epididimisc. inferior to spermaticordd. lateral to pampiriforme. medial to testicular artey

6. Haviz

7. seorangwanita 39 tahunmengeluhkanhematuriandan significant flank tenderness. Diamempunyaisejarahkidney stones. Hasil CT scanmenyatakanabdominal portion dariuterusnya lyinganterior to a muscle. Which of the following most likely to be the name of this muscle ?

a. rectus muscleb. obturatirmusckec. serratus anterior muscked. external oblique musclee. psoas

8. Risdan9. 30 y.o. woman, an absent kidney. WOTF findings is she also likely to have.

a. absent unilateral ovaryb. unicornuate uterusc. imperforate hymend. inguinal herniae. patency of the uterine tube

10. 2 years old boy come to your clinic with his mother. His mother tells you about his seen swelling one of the scrotum and feel tenderness with palpable and accompany by fever

a. orchitisb. hernia scrotalisc. hydroceled. hematocelee. undercensus testis

(soaluntuknomer 10-13) A 2 y.o boy come to your clinic with his mother. His mother tell about his sonn that seen swelling one of the scrotum and feel tenderness when palpable and accompany by fever for 3 days ago.

11. What is diagnostic approach for this case ?a. Transillumination +b. Consistency of scrotal can be soft or hardc. –d. Swelling is because of accumulation of fluid from tunica vaginalis


e. Swelling is because of accumulation of blood

12. The scrotum appears to have a slightly pigmented and wrinkled appearance. What is the explanation for this appearance?

a. Hyperkeratinized squamous epitheliumb. The tunica albuginea, which consist of fibrous capsulec. The dartos fascia, which consist of smooth muscled. The pampiniform plexus of veinse. The spermatic cord, which consist of double layered peritoneal

13. At the first steps on circumcision the physician block anesthesia. What is the name of area for doing anesthetic procedure?

a. Fascia Dartosb. Buck Fasciac. External spermatic fasciad. Internal spermatic fasciae. Cremaster fascia

14. 24 yo man, retention urine &meatal bleeding, sbelumnyakecelakaan motor. Kontraindikasi urethral catetera. Phymosisb. Meatal bleedingsesuai casec. Rentension urine without rupture urethrad. Meataltenosise. Hematuria

15. Male 40 YO, staggering back pain that doesn't change with movement, spiking fever in past 6 hour. radiology: where the dilatation would mast likely be found?

a. In the right paravertebral area, at the level of 12 th ribb. In the lesser pelvic brimc. In the midvertebral line, at the level T11-L2d. In the midvertebral line, at the level T12-L3e. In the left paravertebral area, right above the iliac spine

16. 7years old girl riding bicycle and suddenly hit the car. Jatuhketanahbagianpunggungduluan. Pain at the right flank side, bruises on her skin. Pembuluhygberesiko?

a. internal illiac arteryb. external illiac arteryc. renal arteryd. abdominal arterye. common illiac artery

17. A 28 y.o. Man complaining of bloody urine. He revealed that he often feels colicky pain that doen't change w/ movement. Further examination indicates ureteric stone. From the following structure, on which part is the stone most likely be?

a. In the middle of one third distal from renal pelvicb. At the junction where ureter crosses the pelvic brimc. Halfway through its coursed. On the right uretere. In the middle of one third proximal from its origin

18. An autonomist was doing pelvis & abdomen exploration on male adult cadaver. He found a hollow viscus in the lesser pelvis. Its apex points toward the symphisis pubis. What is the characteristic anatomist of the organ?

a. It's bordered with vagina on the posterior aspectb. Its posterior wall is pierced by two urethrac. It's supplied by external iliac arteryd. Its posterior wall contain detrusor muscle


e. It doesn't have internal sphincter

75 yo man complaint suprapubic pain. Can't urinate for 24 hour.DRE : enlarge prostate, 40 gr, smooth surface, no nodule

19. What convey the pain signal from this patient problem?a. Mixed autonomic fiberb. Presynaptic sympatetic fiberc. postganglionic parasympatetic fiberd. Preganglionic sympatetic fibere. Visceral afferent fiber

20. which structure is mainly compromise from this patient's problema. membranous urethrab. prostatic urethrac. preprostatic urethrad. spongy urethra

21. Have long primary processus from which arise interdigitating pedicle that group capillaries.a. Enddothelial cellb. Podocytec. Mesangiald. Lacis celle. Macula densa

22. Tubulus yang histologinya : low columnar-cuboid, punyamicrovili yang membentuk brush border a. Collecting ductb. Distal convoluted tubulec. Loop of henled. Collecting ducte. Proximal convoluted tubule

23. This urinary tract segments carries urine from the renal pelvis to the urinary bladder. The lumen is narrower than that of the renal pelvis. The wall consist of mucosa, muscularis and adventitia. Wotf is most likely lined the mucous layer of this segment?ureter

a. Stratified cuboidal epitheliumb. Stratified squamous epitheliumc. Stratified columnar epitheliumd. Pseudostratified columnar epitheliume. Urothelium transitional epithelium

24. Epithel lining dari prostatic urethraa. Transtitionalepitelb. Pseudostratified columnarc. Simple squamous d. Simple cuboide. Simple columnar

Membranous urethra psedostratified columnar epitheliumSpongy / penile urethra pseudostratified columnar – stratified squamous epithelium

25. This gland is a collection of 30-50 brancehs of tubuloalveolar glands. This glands are arranged in concentric layers around the urethra. A caracteristic feature of this gland is the presence of corpora amylacea in the lumen of the gland. What od the following organ?

a. Seminal vesicleb. glands of littrec. Bulbourethral glandd. Prostate glande. Seminiferous tubule

26. Female 20 y.o was preventive competing PON because Buccal smear test chromatine (-) punyamale sex chromosome . Which one regarding that case?

a. Female, even though 46 XYb. Androgen (in)-sensitivity syndrome


c. Action of testosteron has no resistanced. Not increase risk of tumor formation

27. Maafgabisanyatet, duduknyadepanpengawasbanget (Intan )

28. Increase Na reabsorbtion associated with K and H secretion at distal tubule. aldosterone

29. Lack of this hormone will increase volume of a patients 24h urine collection with an increase spesific gravity. What hormone?aldosterone

30. Lack of this hormone causing increasing volume urine 24h and decrease spesific gravity. What hormone?ADH (diabetes insipidus)

a. For number 28 – 37b. Aldosteronc. Anti Diuretic Hormoned. Atrial Natriuretic Peptidee. Calcitriolf. Insuling. Norephinephrineh. Parathyroid hormonebikinhypercalcemia. Bikinreabsorbsi calcium tapifosfatgak.i. Thyroid hormone

31. Secretion this hormone will be stimulated if wereduce our dietary salt intake. aldosterone32. Kurangnyahormoninidapatmenyebabkan intracellular edema.thyroid33. Jikahormoninimeningkat, tekanandarahdapatmeningkatjugaakibatkontraktilitasjantungnaik&vasokonstriksiNE

a. pembuluhdarah.34. Long time of this hormone can cause high peripheral resistance because of blood vessel sclerosis.calcitriol (vitamin

D) meningkatkankalsiumdarah35. It reduces phospate reabsorption in renal tubule. PTH36. It enhances phospate reabsorption in renal tubule.Insulin37. It reduce systemic blood pressure. ANP

38. A man comes with metabolic acidosis. He has hypertension & diabetes but never took his medicine regularly. Best bodymechanism to his condition is..

a. reabsorb H+

b. Excretion of HCO3-

c. Neutralize excess acidd. Neutralize excess base

39. Acute Renal Failure:a. BUN with normal valueb. Decrease urea serumc. Decrease creatine serumd. Decrease albumin serume. Increase urea serum


40. Apa yang menyebabkan gross hematuria padakasus acute nephritic syndrome?karena thickening GBMa. Increase hidrostatic pressure at Bowman’s capsule.batub. Decrease hidrostatic pressure in glomerular capillaries.c. Decrease hidrostatic pressure at Bowman’s capsule.d. Increase hidrostatic pressure in glomerular capillaries.e. Increase osmotic colloid pressure at glomerular capillaries.

41. 60 y.o woman, 20 years DM &hipertensi, dibawake ER. Gejala: SOB & leg swelling. Diagnosis: CKD e.c diabetic nephropathy dan metabolic acidosis. Random blood glucose: 172; ureum 60; creatinine: 28; urine: protein +4, glucose +2. Mekanisme proteinuria?

a. increase glomerular hydrostatic pressureb. decrease glomerular hydrostatic pressurec. inactive protein kinase Cd. glycosilating the proteine. decrease GFR

42. 72 y.oman has LUTS with enlargement of prostate on DRE. WOTF enzyme that catalyze this enlargement?a. a.1 alpha reductaseb. b.5 alpha reductasec. c.5 beta reductased. d.5 alpha oxydasee. e.1 alpha oxydase

43. 65 tahun, CHF, dyspnea on exertion, PND, orthopnea, edema perifer, renal function: normal. Terapiantihipertensi. Obatapa yang nurunin BP dengannurunin Na dannurunin blood volume?

a. vasodilatorb. beta blockerc. ACEd. CCBe. diuretik

44. Side effect thiazide:a. Hyperurecemiadan hypokalemia, hyponatremia, hypercalcemia, hyperlipidemia, hyperglycemiab. hyperkalemiac. hypercalcemiad. hypolipidemiae. e....

45. Obat yang menginhibisiperubahan angiotensin I menjadi angiotensin II?a. captoprilb. nifedipinc. thiazided. valsartane. propanolol

46. 60 tahun, pria, pulmo edema, severe dyspnea, anxiety struggling to breath, diberi O2 dan rapidly acting diuretic IV. Obat yang diberikan?

a. furosemideb. acetazolamide


c. HCTd. spironolactonee. manitol

47. 60 tahun, pria, pulmo edema, severe dyspnea, anxiety struggling to breath, diberi O2 dan rapidly acting diuretic IV. site of action diuretikdimana?

a. PCTb. thin descending limbc. thick descending limbd. DCTe. collecting tubule

48. Seorangbapakberusia 70 tahundatangutk follow up rutin. BP: 170/90, HR 76 bpm, random blood glucose level 140. diberikannifedipine. Side effect nifedipineadalah..

a. hyperkalemiab. hyperglycemiac. orthostatic hypotensiond. cardiac arrest

49. 70 y.oman came to the outpatient clinic for routine check up his condition. medrec noted that he is given. (?) BP 170/110 mmHg unchanged after 5 minutes. Other system within normal limit. Most likely appropriate drug?

a. beta blocker + cloridin (symphatolytic)b. valsartan (ACE inhibitor)+ nifedipinec. diltiazem(Ccl) + nifedipined. propanolol + diltiazeme. propanolol + verapamil (ACE)

50. 67 tahun, laki2 pergikepuskesmaskarenahipertensi. BP 210/120 and given a proper dose of direct vasodilator. BP immediately fell down but it became reverse back. What is most likely mechanism that ruins the effect of the drugs?

a. decrease peripheral resistanceb. stimulating RAASc. decrease cardiac outputd. decrease venous returne. chonotropic negative

51. 7 years old boy was brought to the hospital due to generalized edema and oligouria. PE: blood pressure normal. Lab examination: hypercholesterolemia, hypoalbuminemia, proteinuria 4+, given furosemide. What is the most advantage?

a. Increased GFRb. Reduced proteinuriac. Reduces na+ reabsorbtiond. Decrease blood pressuree. Actvated RAAS stimulation

52. 64 years old, pain on the right foot. BP 140/83, at foot found tumor metaphalanges I, rubbor,color, dolor, uric acid 9 mg/dl. Have hypertension but gas been given antihypertension for 6 months. The most possible drug he took:

a. Propanololb. Nifedipinc. Captoprild. Prazosine. Thiazide

53. 66 years old man come to doctor for routine medical follow up. He is noted to have cardiac enlargement. He is given thiazide and captopril. The newest thorax x-ray shows cardiac size is smaller compare to the previous thorax x-ray made severa; months ago. What is the most possible mechanism for the improvement?

a. Reduce aldosteron activationb. Decrease peripheral resistancec. Decrease blood pressured. Decrease urine retensione. Reverse remodelling

54. 70 years old wpman. Physical examination: BP 150/90, edema lower extremities (+/+). Pernahdiberi digoxin. WOTF appropiate diuretic for her?

a. HCTb. Manitolc. Furosemid x


d. Spironolactonee. Azetolamide

jangandikasihyg lowering K+55. 50 years old woman pulsative headache. BP 160/90. HR 104 bpm, no other abnormality.Which of the appropiate drug

for her?a. Alfa blockerb. Beta blockerc. ACE inhibitord. Angiotensin receptor blockere. Ca channel blocker

56. 5 years old boy. Facial puffiness. Periorbital moderate edema.Protein 2.5 mg/dl. Albumin 1.4 mg/dl. Kolesterol 350. Protein selective (+). Diagnosis?

a. Tubular dysfunctionb. Glomerular dysfunctionc. Batu di urinary tractd. Dysuriae. Kidney malformation

57. What is the most possible cause of edema in nephrotic syndrome?a. Renal retention of dietary sodium & waterb. Increased hydrostatic pressure in bowman’s capsulec. Decrease urine formationd. Movement of fluuid from interstitial to vascular spacee. Blockage of lymph return

58. What is he most possible cause of proteinuria in nephrotic syndrome?a. Tubular dysfunctionb. Failure of glomerular capillaryc. Heavy exercised. Increase protein reabsortione. Increase protein intake

59. Student drink 2 litres of water sodium chloride 0,9% in very short time. What the condition?a. Decrease hydrostatic pressure bowman’s capsuleb. Increase osmotic pressurec. Increase hydrostatic pressure in glomerular capillaryd. Increase arterial plasma colloid osmotic pressuree. Decrease net filtration pressure

60. (Sorry lupapisan)

61. Peningkatancreatininemenandakan :a. UTIb. Diabetesc. Kidney Failured. Normal, tidakadakelainane. Urinary stone

62. Yang bertindaksecaralangsungdalammeregulasiekskresicairan di ginjalialaha. ADHb. Medulla oblongatac. Blood plasmad. Lupae. Aldosteron

63. Which part of that process which removes water, ion, and nutrient from the blood?a. Vasa rectab. Loop of henlec. PCTd. Peritubular capillariese. Glomerulus


64. nefron :a. Eliminate waste from bodyb. regulate blood volume&pressurec. control level of electrolytes and metabolitesd. regulate blood pHe. all of above

65. If I am dehydrated my body will increase…a. ATPb. ADPc. Diluted urined. ADHe. Sodium

66. What substance that increase development of uric acid stone?a. low fruit intakeb. low caffeine intakec. high carbohydrate taked. high organ meat intakee. low alcohol intake

67. What dietary factor that increase risk of uric acid stone development?a. High soft drink intakeb. Low physical activityc. Balance water intaked. High ascorbic acid intakee. Moderate daily activity

68. Acidic food...a. Vegetableb. Beveragec. Fatd. Peanute. Milk

69. .65 yo women, 10 tahunmenderita DM danhipertensi, masuk RS dengankeluhan swelling. PE: compos mentis, BP: 160/100, PR: 100, RR:20, T:37C, puffy face, anemic, ascites, CVA-, leg swelling, WBC: 7000 mm3, RBC: 172 mg/dl, ureum 60 mg/dl, creatinine: 2.8 mg/dl, proteinuria+3, glucose 2+, nutritional recommended?

a. Enough calorie, protein restriction, adequate water and fat soluble vitamin, high selenium, high phosphate, low potassium.

b. Enough calorie, protein restriction, adequate water soluble vitamin (vit B1, B6, folic acid, vit C), low vit A, high vit E, low natrium, high vit D, high calcium.

c. High calorie, prot restriction, adequate water, fat soluble vit, low phosphorus, low natrium, high potassium.d. Enough calorie, prot restriction, cholesterol restriction, water soluble vit supplementation, enough fluid

according to the fluid balance status, limit vit A, low natrium, low potassium.e. Low calcium, prot restriction, low cholesterol, low water soluble vit, fat soluble, vit supplementation, mineral

supplementation.

70. Diare, muntah, delirium, BP rendah, RR naik, serum urea 130, creatinine 53, potassium 7, sodium 145. Metabolic acidosis. ECG: hyperkalemia. Priority management :

a. High protein intakeb. High calorie intakec. Water balanced. Electrolyte balancee. Low potassium intake.

71. Which of the following is the most likely condition?a. patient should receive oral feeding with low calorie according to this energy expenditure, protein restrcition,

high potasium intake, natrium, phosphorus aggressively.b. patientshoul receive enough calorie oral feeding, protein restriction, vit.B complex, vit.C, zinc, selenium.c. patient should receive either enteral nutrition or parenteral nutrition, high protein, high sodium, potasium, and

phosphorus aggresively


d. patient should receive parenteral nutrition with low calorie because he had been inadequate oral intake during 5 days, high protein, high vit B complex, vit C, vit E, vit A

e. patient should receive either enteral or parenteral nutrition with enugh calorie, protein restrcition, low sodium,. Potasium, phosphorus, high B complex, vit E, zinc, selenium.

72. -

73. side effect high protein intake padapasien diabetic nephropathy & uremic syndrome?a. increase protein catabolismb. increase renal failure because protein metabolismc. increase carbohidrat catabolismd. increase glycogenolisis& protein katabolismee. decrease muscle wasting

74. rekomendasinutrisi yang dibutuhkanpada ESRD?

75. –

76. 76.=

77. disorder in renal function is not the etiologi for which abnormality?a. high risk osteoporosisb. high risk vit A intoxicationc. anemiad. decrease immunitye. hypertension

78. 79. supplementation of water soluble vit important to?a. lipogenesisb. energy synthesisc. mineralizationd. ...... synthesise. ..................

79. 80. nutritional management in ESRD must be focus on metabolic condition, as example:a. bilirubin levelb. GT levelc. potasium leveld. lactate dehydrogenase levele. C-reactive protein

80. –

81. –

82. what is the most common etiologic for the above infection?a. neisseria gonorrheab. Chlamydia trachomatisc. staphylococcus aureusd. eschericia colie. streptococcus pneumonia

83. Best media culture for the organism (E.coli):a. blood agarb. modification Thayer mayerc. chocolate agar with antibioticd. saboraud dextrose agare. mac conkey agar

84. hat you expected from gram staining extraurethral exudate?a. gram + coccib. gram – rodc. gram - coccid. gram - cocci with neutrhofil

e. gram – cocci with blu G


85. the most common media culture for this bacteria is..a. blood agarb. Thayer martin agarc. mac conkey agard. saboroud glucose agare. Loffler agar

86. bakteri di kultur mac conkey, bakteri gram negative rod, lactosefermenter positif, swarming coloni. Pokoknyajawabannyaproteusmirabilis.

87. Laki-laki 7 tahun. CC: hematuria. Ada eyelid edema. Causative agent?Ans: streptococcus pyogen

88. Laki-laki 20 tahun, 24 jam dysuria, ada “pus-like” discharge diujung penis. History sex dengan 5 partner berbedadalam 6 bulan. Mediakulturuntuketiologinya?

a. blood agarb. chocolate agarc. mac conkey agard. Thayer martin agare. lupa

89. –

90. hematuria di early dan terminal, suhu 39 derajat, fever, shakingchills, gejala lain menunjukkanCa prostate. Microbio yang terlihatapa?

91. 27 th lk2, mengalami urethral discharge, gram staining tdk menunjukkan bakteri, hanya ada neutrofil kurang dari 20 /HPF. Mikroorganisme yg berhubungan?

a. Chlamydia trachomatisb. Candida albicanc. Herpes simplex virusd. N. Gonorrhoeaee. Mycoplasma hominis

92. Faktor patogen dari N. Gonorrhoeae?

a. Kapsulb. Lipooligosakaridac. OPAd. –e. –

93. -

94. 44 th lk2, glucose 80 mg/dl, 2+ urine glucose, diagnosis?a. Acute tubular necrosisb. DM 1c. DM 2d. Glomerulonephritis

95. Mrs X brings a random urine specimen to the laboratory for a glucose analysis. The test result is negative. The physician question the result because the patient has a family history of DM and is experiencing mild clinical symptoms. What type of urine specimen should be collected that would more accurately reflect patient glucose metabolism?

a. First morningb. 2 hours post prandial


c. 3 glass collectiond. 24 hours

96. A construction worker is pinned under collapsed scaffolding for several hours prior being taken to the ER. His abdomen and upper legs are severely bruised, but no fractures are detected. A specimen for urinalysis obtained by catheterization has the following result:

Color : Red – brown Ketones : NegativeClarity : Clear Blood : ++++Sp. Gravity : 1.017 Bilirubin : NegativepH : 6.5 Urobilinogen : Normalprotein : Trace Nitrite : NegativeGlucose : Negative Leukocytes : Negative

Microscopic : RBC : NegativeWBC : NegativeCast : Negative

What is the most probable cause of the positive blood reaction in the dipstick?a. Intravascular haemolysisb. Urinary tract bleedingc. Myoglobinuriad. Kidney damage

97. Results of a urinalysis on avery anemic and jaundiced patient are as follows:Color : Red Ketones : NegativeClarity : Clear Blood : ++++Sp. Gravity : 1.020 Bilirubin : NegativepH : 6.0 Urobilinogen : Highprotein : Negative Nitrite : NegativeGlucose : Negative Leukocytes : Negative

Microscopic : RBC : NegativeWBC : NegativeCast : Negative

Why is the urine bilirubin result negative in this jaundiced patient?a. Circulating Bilirubin is conjugatedb. Circulating Bilirubin is unconjugatedc. Billiary obstructiond. Liver damage

98. An 8-year old boy presents with discolored urine.Color : Red Ketones : NegativeClarity : Clear Blood : +++Sp. Gravity : 1.015 Bilirubin : NegativepH : 6.5 Urobilinogen : Normalprotein : +++ Nitrite : NegativeGlucose : Negative Leukocytes : Negative

Microscopic: erythrocytes = >100 per HPF (almost all dysmorphic). Red cell casts present. What is the most likely diagnosis in this case?

a. UTIb. Lower Urinary Tract Bleedingc. Bladder Stonesd. Glomerulonephritis


99. A 10-year old boy with generalized edema, blood pressure 150/90 mmHg. Urinalysis showed positive for blood, protein, and in microscopic exam: RBC and RBC casts are found. He had sore throat ten days before and recovered without antibiotics. What is the possible diagnosis?

a. Acute tubular necrosisb. Post infectious glomerulonephritisc. UTId. Lower urinary tract bleeding

For question number 100 – 101, refer to scenario below:

A 34-year old woman Is admitted to the ER with the major complaint of “not feeling herself.” For the past week, she has been suffering from extreme fatifue and headaches, but did not feel the need to have it checke out until she has noticed that her vision is “a little fuzzy.” When asked if she is taking any medication, she responds a low dosage birth control, a woman’s daily multivitamin and prednisone for her systemic lupus erythematosus (SLE). An urinalysis is ordered. The nurse notices that the urine has a “sweet” odor to it as she conducts the point of care testing. The urinalysis results are:

Color : Yellow Ketones : ++Clarity : Clear Blood : NegativeSp. Gravity : 1.010 Bilirubin : NegativepH : 7.0 Urobilinogen : Normalprotein : Trace Nitrite : NegativeGlucose : +++ Leukocytes : Negative

Microscopic results:RBC : 2-10/hpfWBC: 0-5/hpf

100. What is the possible diagnosis of this patient?a. UTIb. Post infectious glomerulonephritisc. Prednisone induced diabetesd. Nephrotic syndrome

101. What cause discrepancy between dipstick result for blood with the microscopic findings?a. Cause of this discrepancy is ascorbic acid that the patient is taking (daily multi-vitamin)b. Cause of this discrepancy is Prednisone that the patient is takingc. Cause of this discrepancy is Low dosage birth control that the patient is taking

For the question number 102-103, refer to the scenario below:

An 16-year old female is admitted to the emergency department with left flank pain and blood In the urine. She explains to the doctor that she has been ssen multiple times in the last 6 months by her family doctor as well as the local emergency department and medical aid unit for recurrent left flank pain that is often, but not always, associated with a lower urinary tract infection. She was recently diagnosed two months ago with a nonobstructive kidney stone in her right ureter. Her most recent doctor visit was with her family physician 2 weeks ago for an UTI and was given a 7 day treatment of antibiotic to clear the infection. A CAT scan is ordered along with a urinalysis. The CAT scan shows 2 stones, a 2.0 mm stone in the right kidney and a 2.5 mm stone in the left kidney. The urinalysis results are:

Color : Red Ketones : NegativeClarity : Hazy Blood : ++Sp. Gravity : 1.025 Bilirubin : TracepH : 8.5 Urobilinogen : Normalprotein : +++ Nitrite : NegativeGlucose : Negative Leukocytes : +++

Microscopic results: 20-50 WBC/hpf


Bacteria Positive 0-2 WBC cast/lpf

102. Beside her stone kidney, what is the diagnosis for this patient?a. Pyelonephritisb. Glomerulonephritisc. Post infectious glomerulonephritisd. Nephrotic syndrome

103. What is accounting for the discrepancy between the dipstick reading and microscopic result for blood?a. A high protein will lyse RBC, which accounts for the absence of RBC from the microscopic readingb. A high pH will lyse RBC, which accounts for the absence of RBC from microscopic readingc. Bacteria will lyse RBC, which accounts for the absence of RBC from microscopic reading

104. A 60-year old patient with chronic glomerulonephritis, which did not respond to a previous course of corticosteroids presented with BP 190/110 mmHg. Investigation showed creatinine = 3.4 mg/dL; creatinine clearance = 40 mL/min; urine showed many WBCs. What is the most appropriate strategy for management?

a. Nothing as the disease is essentially progressiveb. Give another course of corticosteroidc. Treat hypertension and UTId. Start hemodialysise. Prepare for renal transplantation

105. A 32-year old previously healthy man is hospitalized because of acute onset of dysuria, urinary frequency, fever, pain in both loins with tenderness and shaking chills. His temperature is 39.9oC, BP: 100/60 mmHg, Pulse is 110 bpm. Which of the following would be the most accurate diagnosis of this acute illness?

a. Acute glomerulonephritis b. Acute renal failurec. Acute pyelonephritisd. Acute cystitise. Nephrotic syndrome

106. A 72-year old man with known BPH develops fever and flank pain. He rapidly becomes very ill. He presents to the emergency room with a blood pressure of 80/40 mmHg, heart rate of remarkable for a white count of 20.000 hematocrit of 28%, and a platelet count of 70.000. which of the following antibiotics is the most appropriate?

a. Ceftriaxone Lb. Ciprofloxacinc. Co-trimoxazoled. Penicilline. Gentamycin

107. Patient known to have chronic renal failure presented with polyuria, thirst, generalized weakness, dyspnea, infrequent fits & lack of Concentration. His blood biochemistry revealed the following:

Test Results Reference RangeSerum K 8 mmol/L 3,5 – 5 mmol/LSerum calcium 6,6 mg/dL 8,5 – 10,5 mg/dLBlood Urea 160 mg/dL 25 – 40 mg/dLSerum creatinine 12 mg/dL 0.6 – 1.2 mg/dL

Which of the following is the best option for treating this patient?

a. Correction of severe hypocalcemiab. Hemodialysisc. Correction of hyperkalemiad. Anti-epileptic drugse. Correction of volume overload


108. A 20 year-old female presented with a one day history of hematuria. Two weeks back she has had an attack of sore throat. Her physical examination revealed BP of 150/100 mmHg & pedal edema. What is the most likely diagnosis?

a. Minimal change glomerulonephritisb. IgA nephropathyc. Post-streptococcal glomerulonephritisd. Mesangial glomerulonephritise. Crescentic glomerulonephritis

109. A diabetic woman, 50 years old, weight 60 kg, with symptoms of dyspnea and vomiting felt since more than 3 months. Blood pressure was 160/100 mmHg, RR 32 per minute, deep and frequent. Edema of both legs, pulmonary rales was found in both basal.

Test Results Reference RangeHemoglobin 73 gr/dL 115 – 165 g/dL (female)Urea 421 mg/dL 8 – 25 mg/dLCreatinine 32 mg/dL 0.6 – 1.5 mg/dLMCV and MCHC NormalWhat is most likely diagnosis for this patient?

a. Acute kidney injuryb. Nephrotic syndromec. Chronic kidney disease Ld. Acute nephritic syndromee. Acute chronic kidney disease

110. Pasien BPH + ada UTI, dikasih antibiotik :a. Ceftriaxone Lb. Ciprofloxacinc. Cotrimoxazoled. Penicilline. Gentamycin

111. Anak umur 5 tahun datang ke pediatric emergency dengan keluhan low back pain saat micturition, ada oliguria dan dysuria, ada riwayat makan jengkol.

a. Prerenal AKIb. Renal AKIc. Postrenal AKI Ld. Upper UTIe. lower UTI

112. jengkol intoxication pathogenesis nya?a. Amount of jengkol ingestedb. Individual susceptibility factorc. The way jengkol is servedd. Preparation with other foode. Genetic factor

113. Novi E

114. Anak 7 tahun, keluhan : oliguria. History makan jengkol 10 pcs. Treatment? E

115. prognosis? (cerita no.114)a. poor, high mortalityb. poor, prone to CKDc. poor, prone to scard. poor, hard to treate. good, easily to treat


116. Demam, chills, poor feeding, urinary frequency, Hb: 15,9 PLT: 140.000 Urinary: WBC: 15-20/HPF, eritrosit : 5-7/HPF nitrit+. Treatment?

a. IV ceftriaxoneb. IV ampicillinc. Oral sulfametoxazole-trimetropimd. oral amoxicilline. oral cefixime

117. which of the following bacteria most common of UTI (cerita no.16)a. klebsiellab. E.colic. Streptococcus beta hemolyticus grup ad. staphylococcus aureuse. pseudomonas

118. 7 year old boy… A lot of blood in the urine… Proteinuria +. Diagnosis?a. nephrotic syndromeb. …c. acute nephritic syndromed. AKIe. CKD

119. Silmi

120. 10 y.o boy seizure, decrease consciousness, hypertension, edema papebral. Urinalysis a lot of RBC proteinuria +. Slight anemia. Diagnosis?

a. AKIb. hypertension encephalopathy et causa IgA glomerulonephritisc. hypertension crisis et causa nephrotic syndromed. hypertension encephalopathy et causa nephrotic syndromee. hypertension crisis et causa IgA glomerulonephritis

121. Anak 12thn, darihasilpemeriksaanternyata bloody urine. Tensi 140/90. Protein +, cast +, leukosit 0-1, lot of RBC. Pertanyaannyalupa. Kalogaksalah yang terjadipadaanakituadalah

a. Atopyb. Infeksikulitc. Infeksigejala yang samad. Konsumsiobate. Seizure

122. 122.7 thn, boy. Hematuria sdh 3 hari. BP 140/90 edema palpebra. Pemeriksaan urin: ada RBC, RBC cast, protein (+), WBC (0-1). Anemia. Treatment?

a. Antibiotik seperti penicillinb. Diuretik Lc. ACE inhibitord. Vasodilatore. Beta-bocker

123. 123.There was history of sore throat 1 week before. Wotf infectious agents is the most possible to proceed this disease of the patient?

a. Respiratory sincytial virusb. Streptococcus pneumoniaec. Staphylococcus aureusd. Rhinoviruse. Streptococcus beta hemolitic

124. 124. Seorangwanita incontinence punya 6 anak. Saatnaiktanggaterasa steak urin. Apa yang terjadipadanya?a. Overflow incontinenceb. Urge incontinence


c. Stress incontinenced. Continous incontinencee. Mixed incontinence

125. 125.A female 60 y.o complaining urinary incontinence. She had 6 children. When she goes upstair to the upper room she feels streaks some urine. What is the risk factor of the patient?

a. Infectionb. DMc. Multiple pregnancyd. Stone e. Stroke

126. –127. –

128. 128. What will you do to the patient first?a. Giving antibioticb. Giving analgesicc. Insert cathetherd. X-Raye. USG

129. –

130. –

131. 32 years old man chief complaint pain during urination, accompanied by purulent urethral discharge. Coitus suspectus was

a. admitted 3 days ago with commercial sex worker without condom. What is treatment choice if no lab exam can be

b. performed?a. Cefixime 500 mg & Azithromycin 1000 mgb. Cefixime 400 mgc. Cefixime 400 mg & Azithromycin 1000 mgd. Levofloxacine 500 mge. Azithromycin 1 gram

132. What test should be done?A. Gram stainB. Gram stain and KOHC. Gram stain, KOH, and culture-resistance testD. *lupa* (pertanyaan n jawabannyasamakokkyknomeryg diatas2nya)E. KOH

133. Infeksi dengan jumlah PMN > 10. Terapi?a. Cefixime 500 mg & Azithromycin 1 gramb. Cefixime 400 mgc. Cefixime 400 mg & Azithromycin 1 gramd. Levofloxacinee. Azithromycin 1 gram

134. The best imaging modality for prostate? transrectal USG

135. What is the most accurate modality to investigate presence urinary stone in renal colic?a. KOBb. Nonenhanced CT scan abdomenc. Ultrasoundd. IVU

136. a new diuretic agent was developed and its effect on healthy volunteers after a single dose was revealed an increase of the natrium fractional excretion from 1% to 20%. likewise, an excretion of kalium and calcium increase but neither glucose nor as.amino were found in the urine.wotf membrane transport protein is inhibit by this drug?a. Na-glucose symporter b. Na-H antiporter c. 1Na-1K-2Cl symporter d. na-cl symporter e. na-chanel


137. A 62 years old woman is brought to the emergency is a state of confusion, is unable to answer question coherently and c. exhibit tachipnea. Mechanism renal excretion of hydrogen ion? La. Combining hydrogen ion & bicarbonate via carbonic anhydrase enzyme.b. Combine hydrogen ion dengan Cl ion bentuk hydroclorice acid.c. Trapp hydrogen ion by amonia untuk bentuk amonium iond. Hydrogen ion by acetate.e. Secreting sulfat hydrogen ion sebagai sulfuric acid.

138. Hyponatremia (reduced Na di plasma dapatterjadiketika effective volume plasma menurun) faktor yang memperngaruhikondisiini?? A. Impaired kidney to excrete sodium free water B. Elevated ANP LC. Elevated Na excretion D. Decrease ADH E. Decrease aldosterone

139. In controlling synthesis secretion of Aldosterone, which of the following factors is least important?A. Renin B. Angiotensin II C. Plasma Na D. Plasma K E. ACTH L

140. –

141. Maafgasempetnyatet :( -Desbass

142. A 35 years old man has PKD with decrease both GFR and renal blood flow (RBF). A nephrologist want to administer a drug that lower both GFR and RBF. GFR and RBF will decrease under which of the following condition?

a. Afferent and efferent arteriole dilateb. Afferent and efferent arteriole constrictc. Only afferent constrictd. Only efferent constricte. Afferent arteriole constrict and efferent dilate L

143. A post op patient develop thready pulse, takikardia dan hipotensi. Lab: plasma angiotensin II naik, GFR naik, proximal tubulus reabsorpsi garam dan air naik oleh proses glomerulotubular balance, yang berkontribusi?

a. tekanan hidrostatik kapiler peritubular naikb. konsentrasi sodium peritubular turunc. tekanan onkitik peritubular naik Ld. proximal tubular flow naike. peritubular capillary flow naik

144. Aku lupa. Maaaaaap!!! -Deso

145. Maaaaaaf ga nyateeet -Kevin

146. Anak usia 2 tahun ginjalnya membesar, banyak kista di korteks dan medula. Penyebab embriologinya? (ARPKD)a. dismorphology during development renal systemb. failure ureteric bud derivatives to join tubulec. division metanephric diverticulumd. failure mesenkin untuk migrasie. fusi pole ginjal

147. AWP- Auliaanbiya- posisitidakmemungkinkanuntuknyatetsoal, maafya :(

148. Painless swelling di left scrotum, feel heaviness di left scrotum. Ukuran tidak berubah kalau posisi berubah.a. Hydroceleb. Scrotal herniac. Testicular tumord. Infeksi di testise. Epididimorchitis

149. What test to diagnose? (dari soal nomer 148)


a. CT scan lumpb. USG lumpc. Biopsy lumpd. Pelvic X-raye. MRI

150. A 6 year old girl came to hospital with chief complaint fever and recurrent UTI in last 6 months. She was referred to clinic and her USG's examination showed a mild hydronephrosis bilaterally. Serum ureum, creatinin in normal limit. (ada satu kalimat lagi tapi aku lupa bangeet, maaaf :( -Urwah). Which of the laboratory test you should investigate?

a. CBCb. Urinalysisc. Urine culture Ld. Lupaa kalau ga salah, USGe. Anti streptolysin-O

151. 1. male 65 y.o. nocturia, 1 bulan increase frequency of urination….next step management: (151)a. ultrasoundb. TRUSc. Pyelogramd. –e. –

152. 2. 67 y.o, male.prostate 40 gr, hypertensi, LUTS, ureumdancreatinintinggi. management yang selanjutnyadilakukanapa? (152)

153. 3. –

154. 4. Endi

155. 5. 56 y.0, women, history UTI. receive drug inhibit ACE. JNC VI recommended a goal for BP< 140/90in uncomplicated hypertension. which of the concominant condition do JNC VI not suggest lower BP? (155)

a. prior history of cardiovascular accident within 6 monthb. type I DM with nephropathyc. type II DM disease without complication d. chronic renal insufficiency (serum creatinine 2.5 %) without proteinuriae. proteinuria (2 mg/day with normal serum creatinine) L

156. 6. DitoRivaldi

157. 25 year-old male scrotal pain. PE : positive inflammation sign right scrotum. You consulted this patient to the nuclear medicine. What is the most appropriate exam?

a. Scrotal scintigraphy for differentiate testis torsion with orchitis epididymitisb. Scrotal scintigraphy for identivy UTI sourcec. Bladder scintigraphy to differentiate UTI with vesicolithiatisd. Ureteral scintigraphy to determine urethritis as etiology of scrotal inflammatione. Penis scintigraphy to determine any priapismus or hypospadias as etiology of UTI

158. 8. 70 y.o. left abdominal discomfort and hematuria. plain abdominal x-ray: homogenous opacity with multiiple small calcification at T12-L3 spine, contour is lobulated. diagnosis? (158)

a. nephrolitiasisb. nephrocalcinosisc. renal tumord. ureterolithiasise. ureteral tumor

159. 9. asal excretory duct (embryologi)? lupapilihannya… (159)

160. 10. origin collecting duct: (160)a. ureteric budb. metanephricblastemac. mesonephric ductd. metanephric ducte. splanchic mesoderm

161. Ajay


162. Diketahuahasilurinalisis: pH 5,5. Blood: moderat. Warnaurin?a. Colorlessb. Yellowc. orange d. pink Le. red black

163. A 65 y.o man with scrotal malignancy his PSA serum is increasing significantly compared with his last month result. X-ray pelvis show abnormality at pelvic bone. Patient then consuled to nuclear medicine. What is the most appropriate exam?

a. Conventional renographyb. GFRc. Kidney Scintigraphyd. Malignancy prostatScintigraphye. Bone Scintigraphy

164. Pasienpria 60 thn, generalized edema, patologi = proliferasimesangial cell dankapilergromelurus ( post streptococcal g)

165. 21 y.owoman experienced urine frequencywith dysuria without discharge from vagina for the past few days. She has no flank pain or tenderness. A urinalysis reveals spesific gravity 1.014, pH 7,5, no glucose, no protein, no blood, nitrite (+) and many WBC. She has serum creatinine of 0.9 mg/dl. Which of the following pathological process best account for these findings?

a. Lupus nephritisb. Urinanry tract lithiasisc. Acute bacterial cystitisd. Malacoplakiae. Transitional cel carcinoma

166. ba 2 years old boy --> progressive peripheral edema. PE: afebrile, BP normal. Lab: decreased albumin, increased cholesterol, BUN &Creatinine normal. A histologic section from renal biopsy ....microscopic?

a. diffuse endocapillary proliferation, leukocytic infiltrationb. focal & segmental sclerosis and hyalunosisc. flattening &fussion of te foot process of podocytesd. mesangial&endocapillary proliferation, GBM thickening,splittinge. diffuse cappilary wall thickening

167. Glomerular disease yang muncul 1-4 minggusetelah streptococcal infection pada pharynx dan skin. Mikroskopisnya :a. Extracappilary proliferation with crescent, necrosisb. Infiltration by leukocyte and proliferation of endothelium and mesangial cell.c. Focal mesangial proliferation glomerulonephritisd. Focl and segmental sclerosis and hyalinosise. Linear IgG and C3………

168. A 25 y.o man was admitted to the emergency room complaining of less frequent of micturition since one day before. Patient didn’t urinate since that morning. For the last three day he complained of massive watery diarrhea without blood 6-8 times a day and accompanied by low grade fever. Laboratories result showed the increasing very high of BUN and creatinine levels. Which is the best pathogenesis that could be happened in his kidney?

a. Hemodynamic alteration that cause reduced GFR because of intrarenal vasoconstrictionb. Direct toxic injury to the tubulesc. Focal tubular epithelial necrosis at multiple points along the nephron, often accompanied by rupture of basement

membrane (tubulorrhexis)d. Most commonly occuring as a hypersensitivity reaction to drugse. Ischemic that caused by alteration of blood flow will make the irrevesrible renal lesion that can destroy

glomerular function

169. A 59 y.o man came to hospital with chief complain a mass at his flank. He also complained sometimes he got bloody urination for several weeks ago. Biopsy was performed, the microscopic appearence showed nest of tumor cell whish is have clear cytoplasm with papillary and trabecular structure, small nuclei but pleomorphic and abundant of mitotic. What is the best diagnosis for this patient?

a. Will’s tumorb. Transitional cell carcinomac. Adenocarcinomad. Clear cell carcinoma Le. Papillary carcinoma


170. Seoranganakberusia 5 tahunsaatdigendongsamaibunyaterasaadamasa di perutnya. Apakahmasaitu? (nephroblastoma)163. 65 yo scrotal malignant, PSA naik, pada X-ray pelvis, adaabnormalitaspada pelvic bone. Examination?

a. Renogramb. GFRc. Kidney scintighrapyd. Malignant prostatscintighrapye. Bone scintigraphy

171. what is the best describe of microscopic appearance for that patient?a. nest of cell tumor with abundant of eosinophil cytoplasm and mytoticb. tumor cell could be composed by mesemchymal cell and blastemal cellc. small round blue cell tumor that rosset appearance. Ld. tumor cell could be composed by only one kind of epithelial celle. tumor cell have clear cytoplasm and much of mitotic

172. –

1. Autosomal dominant (adult) polycistic kidney disease is a hereditary disorder characterized by multiple expanding cyst of both kidneys that ultimately destroy the renal parenchyma and cause renal failure. What is the best describe of microscopic appearance of this dease?a) Bowman capsule are occasionaly involved in cyst formation, and glomerular tufts maybe seen within the cyst spaceb) The cysts have uniform lining of cuboidal cell, reflecting their origin from the collecting ductsc) He cyst are lined by flattened or cuboidal epithelium and are usually surrounded by either inflammatory cells or fibrous tissued) Renal cyst have smooth contour, are almost always avascular, and give fluid rather than solid signals on ultrasonographye) The cyst as a psudocyst that not lined by epithelial cells

2. autosomal-recessive (chilhood) polycystic kidney disease (ARPKD) is geneticaly distinct from ADPKD. The first two are the most common, serious manifestation are usually present at birth, and the young infant might succumb rapidly to renal failure. What is the best describe of microscopic appearance for this disease?a) Bowman capsule are occasionaly involved in cyst formation, and glomerular tufts ma be seen within the cyst spaceb) The cysts have uniform lining of cuboidal cell, reflecting their origin from the collecting ductsc) He cyst are lined by flattened or cuboidal epithelium and are usually surrounded by either inflammatory cells or fibrous tissued) Renal cyst have smooth contour, are almost always avascular, and give fluid rather than solid signals on ultrasonographye) The cyst as a psudocyst that not lined by epithelial cells

175.

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