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1 MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT

FINAL GUS BATCH 2009
1.

dudi

2.

What is the source alkaline phosphate in the semen ?

a. prostatic glandcairanasam
b. bulbourethral glandlubrikan
c. seminal vesiclefruktosa, cairanbasa
d. seminal calliculus apparatus

3.

kontraindikasisirkumsisi ? hipospadia

4.

35 y.o man complains pain when erection since 3 weeks ago. The physian diagnose pyeroines diseasefor this patient.
Where is the location of the plaque or fibrosis that would be found when the physician palpate the penis
a. corpus spongiosum
b. corpus cavernosus
c. bulb of penis
d. orificum urethra externa
e. 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 scrotum
b. after head of epididimis
c. inferior to spermaticord
d. lateral to pampiriform
e. 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 muscle
b. obturatirmuscke
c. serratus anterior muscke
d. external oblique muscle
e. psoas

8.
9.

Risdan
30 y.o. woman, an absent kidney. WOTF findings is she also likely to have.
a. absent unilateral ovary
b. unicornuate uterus
c. imperforate hymen
d. inguinal hernia
e. 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. orchitis
b. hernia scrotalis
c. hydrocele
d. hematocele
e. 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 hard
c.
d. Swelling is because of accumulation of fluid from tunica vaginalis
e. Swelling is because of accumulation of blood

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12.

The scrotum appears to have a slightly pigmented and wrinkled appearance. What is the explanation for this
appearance?
a. Hyperkeratinized squamous epithelium
b. The tunica albuginea, which consist of fibrous capsule
c. The dartos fascia, which consist of smooth muscle
d. The pampiniform plexus of veins
e. 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 Dartos
b. Buck Fascia
c. External spermatic fascia
d. Internal spermatic fascia
e. Cremaster fascia

14.

24 yo man, retention urine &meatal bleeding, sbelumnyakecelakaan motor. Kontraindikasi urethral cateter
a. Phymosis
b. Meatal bleedingsesuai case
c. Rentension urine without rupture urethra
d. Meataltenosis
e. 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 rib
b. In the lesser pelvic brim
c. In the midvertebral line, at the level T11-L2
d. In the midvertebral line, at the level T12-L3
e. 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 artery
b. external illiac artery
c. renal artery
d. abdominal artery
e. 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 pelvic
b. At the junction where ureter crosses the pelvic brim
c. Halfway through its course
d. On the right ureter
e. 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 aspect
b. Its posterior wall is pierced by two urethra
c. It's supplied by external iliac artery
d. Its posterior wall contain detrusor muscle
e. It doesn't have internal sphincter

19.

75 yo man complaint suprapubic pain. Can't urinate for 24 hour.DRE : enlarge prostate, 40 gr, smooth surface, no
nodule
What convey the pain signal from this patient problem?
a. Mixed autonomic fiber
b. Presynaptic sympatetic fiber
c. postganglionic parasympatetic fiber

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d.
e.

Preganglionic sympatetic fiber

Visceral afferent fiber

20.

which structure is mainly compromise from this patient's problem

a. membranous urethra
b. prostatic urethra
c. preprostatic urethra
d. spongy urethra

21.

Have long primary processus from which arise interdigitating pedicle that group capillaries.
a. Enddothelial cell
b. Podocyte
c. Mesangial
d. Lacis cell
e. Macula densa

22.

Tubulus yang histologinya : low columnar-cuboid, punyamicrovili yang membentuk brush border
a. Collecting duct
b. Distal convoluted tubule
c. Loop of henle
d. Collecting duct
e. 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 epithelium
b. Stratified squamous epithelium
c. Stratified columnar epithelium
d. Pseudostratified columnar epithelium
e. Urothelium transitional epithelium

24.

Epithel lining dari prostatic urethra

a. Transtitionalepitel
b. Pseudostratified columnar
c. Simple squamous
d. Simple cuboid
e. Simple columnar
Membranous urethra psedostratified columnar epithelium
Spongy / 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 vesicle
b. glands of littre
c. Bulbourethral gland
d. Prostate gland
e. 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 XY
b. Androgen (in)-sensitivity syndrome
c. Action of testosteron has no resistance
d. 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

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30.

Lack of this hormone causing increasing volume urine 24h and decrease spesific gravity. What hormone?ADH
(diabetes insipidus)
a.
b.
c.
d.
e.
f.
g.
h.
i.

31.
32.
33.
34.
35.
36.
37.

For number 28 37
Aldosteron
Anti Diuretic Hormone
Atrial Natriuretic Peptide
Calcitriol
Insulin
Norephinephrine
Parathyroid hormonebikinhypercalcemia. Bikinreabsorbsi calcium tapifosfatgak.
Thyroid hormone

Secretion this hormone will be stimulated if wereduce our dietary salt intake. aldosterone
Kurangnyahormoninidapatmenyebabkan intracellular edema.thyroid
Jikahormoninimeningkat, tekanandarahdapatmeningkatjugaakibatkontraktilitasjantungnaik&vasokonstriksiNE
a. pembuluhdarah.
Long time of this hormone can cause high peripheral resistance because of blood vessel sclerosis.calcitriol (vitamin
D) meningkatkankalsiumdarah
It reduces phospate reabsorption in renal tubule. PTH
It enhances phospate reabsorption in renal tubule.Insulin
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 HCO3c. Neutralize excess acid
d. Neutralize excess base

39.

Acute Renal Failure:

a. BUN with normal value
b. Decrease urea serum
c. Decrease creatine serum
d. Decrease albumin serum
e. Increase urea serum

40.

Apa yang menyebabkan gross hematuria padakasus acute nephritic syndrome?karena thickening GBM
a. Increase hidrostatic pressure at Bowmans capsule.batu
b. Decrease hidrostatic pressure in glomerular capillaries.
c. Decrease hidrostatic pressure at Bowmans capsule.
d. Increase hidrostatic pressure in glomerular capillaries.
e. Increase osmotic colloid pressure at glomerular capillaries.

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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 pressure
b. decrease glomerular hydrostatic pressure
c. inactive protein kinase C
d. glycosilating the protein
e. decrease GFR

42.

72 y.oman has LUTS with enlargement of prostate on DRE. WOTF enzyme that catalyze this enlargement?
a. a.1 alpha reductase
b. b.5 alpha reductase
c. c.5 beta reductase
d. d.5 alpha oxydase
e. 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. vasodilator
b. beta blocker
c. ACE
d. CCB
e. diuretik

44.

Side effect thiazide:

a. Hyperurecemiadan hypokalemia, hyponatremia, hypercalcemia, hyperlipidemia, hyperglycemia
b. hyperkalemia
c. hypercalcemia
d. hypolipidemia
e. e....

45.

Obat yang menginhibisiperubahan angiotensin I menjadi angiotensin II?

a. captopril
b. nifedipin
c. thiazide
d. valsartan
e. propanolol

46.

60 tahun, pria, pulmo edema, severe dyspnea, anxiety struggling to breath, diberi O2 dan rapidly acting diuretic IV.
Obat yang diberikan?
a. furosemide
b. acetazolamide
c. HCT
d. spironolactone
e. 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. PCT

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b.
c.
d.
e.

thin descending limb

thick descending limb
DCT
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. hyperkalemia
b. hyperglycemia
c. orthostatic hypotension
d. 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)+ nifedipine
c. diltiazem(Ccl) + nifedipine
d. propanolol + diltiazem
e. 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 resistance
b. stimulating RAAS
c. decrease cardiac output
d. decrease venous return
e. 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 GFR
b. Reduced proteinuria
c. Reduces na+ reabsorbtion
d. Decrease blood pressure
e. 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. Propanolol
b. Nifedipin
c. Captopril
d. Prazosin
e. 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 activation
b. Decrease peripheral resistance
c. Decrease blood pressure
d. Decrease urine retension
e. Reverse remodelling

54.

70 years old wpman. Physical examination: BP 150/90, edema lower extremities (+/+). Pernahdiberi digoxin. WOTF
appropiate diuretic for her?
a. HCT
b. Manitol
c. Furosemid x
d. Spironolactone
e. Azetolamide

55.

jangandikasihyg lowering K+
50 years old woman pulsative headache. BP 160/90. HR 104 bpm, no other abnormality.Which of the appropiate drug
for her?
a. Alfa blocker

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b.
c.
d.
e.

Beta blocker
ACE inhibitor
Angiotensin receptor blocker
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 dysfunction
b. Glomerular dysfunction
c. Batu di urinary tract
d. Dysuria
e. Kidney malformation

57.

What is the most possible cause of edema in nephrotic syndrome?

a. Renal retention of dietary sodium & water
b. Increased hydrostatic pressure in bowmans capsule
c. Decrease urine formation
d. Movement of fluuid from interstitial to vascular space
e. Blockage of lymph return

58.

What is he most possible cause of proteinuria in nephrotic syndrome?

a. Tubular dysfunction
b. Failure of glomerular capillary
c. Heavy exercise
d. Increase protein reabsortion
e. 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 bowmans capsule
b. Increase osmotic pressure
c. Increase hydrostatic pressure in glomerular capillary
d. Increase arterial plasma colloid osmotic pressure
e. Decrease net filtration pressure

60.

(Sorry lupapisan)

61.

Peningkatancreatininemenandakan :
a. UTI
b. Diabetes
c. Kidney Failure
d. Normal, tidakadakelainan
e. Urinary stone

62.

Yang bertindaksecaralangsungdalammeregulasiekskresicairan di ginjalialah

a. ADH
b. Medulla oblongata
c. Blood plasma
d. Lupa
e. Aldosteron

63.

Which part of that process which removes water, ion, and nutrient from the blood?
a. Vasa recta
b. Loop of henle
c. PCT
d. Peritubular capillaries
e. Glomerulus

64.

nefron :
a. Eliminate waste from body
b. regulate blood volume&pressure
c. control level of electrolytes and metabolites
d. regulate blood pH
e. all of above

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65.

If I am dehydrated my body will increase

a. ATP
b. ADP
c. Diluted urine
d. ADH
e. Sodium

66.

What substance that increase development of uric acid stone?

a. low fruit intake
b. low caffeine intake
c. high carbohydrate take
d. high organ meat intake
e. low alcohol intake

67.

What dietary factor that increase risk of uric acid stone development?
a. High soft drink intake
b. Low physical activity
c. Balance water intake
d. High ascorbic acid intake
e. Moderate daily activity

68.

Acidic food...
a. Vegetable
b. Beverage
c. Fat
d. Peanut
e. 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 intake
b. High calorie intake
c. Water balance
d. Electrolyte balance
e. 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.

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73.

side effect high protein intake padapasien diabetic nephropathy & uremic syndrome?
a. increase protein catabolism
b. increase renal failure because protein metabolism
c. increase carbohidrat catabolism
d. increase glycogenolisis& protein katabolisme
e. 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 osteoporosis
b. high risk vit A intoxication
c. anemia
d. decrease immunity
e. hypertension

78.

79. supplementation of water soluble vit important to?

a. lipogenesis
b. energy synthesis
c. mineralization
d. ...... synthesis
e. ..................

79.

80. nutritional management in ESRD must be focus on metabolic condition, as example:

a. bilirubin level
b. GT level
c. potasium level
d. lactate dehydrogenase level
e. C-reactive protein

80.

81.

82.

what is the most common etiologic for the above infection?

a. neisseria gonorrhea
b. Chlamydia trachomatis
c. staphylococcus aureus
d. eschericia coli
e. streptococcus pneumonia

83.

Best media culture for the organism (E.coli):

a. blood agar
b. modification Thayer mayer
c. chocolate agar with antibiotic
d. saboraud dextrose agar
e. mac conkey agar

84.

hat you expected from gram staining extraurethral exudate?

a. gram + cocci
b. gram rod
c. gram - cocci
d. gram - cocci with neutrhofil
e. gram cocci with blu G

85.

the most common media culture for this bacteria is..

a. blood agar
b. Thayer martin agar
c. mac conkey agar
d. saboroud glucose agar
e. Loffler agar

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86.

bakteri di kultur mac conkey, bakteri gram negative rod, lactose

fermenter positif, swarming coloni. Pokoknyajawabannyaproteus
mirabilis.

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 di

ujung penis. History sex dengan 5 partner berbedadalam 6 bulan. Media
kulturuntuketiologinya?
a. blood agar
b. chocolate agar
c. mac conkey agar
d. Thayer martin agar
e. lupa

89.

90.

hematuria di early dan terminal, suhu 39 derajat, fever, shaking

chills, gejala lain menunjukkanCa prostate. Microbio yang terlihat
apa?

91.

27 th lk2, mengalami urethral discharge, gram staining tdk menunjukkan bakteri, hanya ada neutrofil kurang dari
20 /HPF. Mikroorganisme yg berhubungan?
a. Chlamydia trachomatis
b. Candida albican
c. Herpes simplex virus
d. N. Gonorrhoeae
e. Mycoplasma hominis

92.

Faktor patogen dari N. Gonorrhoeae?

a. Kapsul
b. Lipooligosakarida
c. OPA
d.
e.

93.

94.

44 th lk2, glucose 80 mg/dl, 2+ urine glucose, diagnosis?

a. Acute tubular necrosis
b. DM 1
c. DM 2
d. 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 morning
b. 2 hours post prandial
c. 3 glass collection
d. 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 : Negative

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Clarity
Sp. Gravity
pH
protein
Glucose
Microscopic :

: Clear
: 1.017
: 6.5
: Trace
: Negative

Blood
Bilirubin
Urobilinogen
Nitrite
Leukocytes

: ++++
: Negative
: Normal
: Negative
: Negative

RBC : Negative
WBC : Negative
Cast : Negative

What is the most probable cause of the positive blood reaction in the dipstick?
a. Intravascular haemolysis
b. Urinary tract bleeding
c. Myoglobinuria
d. Kidney damage
97.

Results of a urinalysis on avery anemic and jaundiced patient are as follows:

Color
: Red
Ketones : Negative
Clarity
: Clear
Blood
: ++++
Sp. Gravity : 1.020
Bilirubin
: Negative
pH
: 6.0
Urobilinogen
: High
protein
: Negative
Nitrite
: Negative
Glucose
: Negative
Leukocytes
: Negative
Microscopic :

RBC : Negative
WBC : Negative
Cast : Negative

Why is the urine bilirubin result negative in this jaundiced patient?

a. Circulating Bilirubin is conjugated
b. Circulating Bilirubin is unconjugated
c. Billiary obstruction
d. Liver damage
98.

An 8-year old boy presents with discolored urine.

Color
: Red
Clarity
: Clear
Sp. Gravity : 1.015
pH
: 6.5
protein
: +++
Glucose
: Negative

Ketones : Negative
Blood
: +++
Bilirubin
: Negative
Urobilinogen
: Normal
Nitrite
: 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. UTI
b. Lower Urinary Tract Bleeding
c. Bladder Stones
d. 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 necrosis
b. Post infectious glomerulonephritis
c. UTI
d. Lower urinary tract bleeding

For question number 100 101, refer to scenario below:

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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 womans 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
: Negative
Sp. Gravity : 1.010
Bilirubin
: Negative
pH
: 7.0
Urobilinogen
: Normal
protein
: Trace
Nitrite
: Negative
Glucose
: +++
Leukocytes
: Negative
Microscopic results:
RBC : 2-10/hpf
WBC : 0-5/hpf

100.

What is the possible diagnosis of this patient?

a. UTI
b. Post infectious glomerulonephritis
c. Prednisone induced diabetes
d. 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 taking
c. 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
Clarity
Sp. Gravity
pH
protein
Glucose

: Red
: Hazy
: 1.025
: 8.5
: +++
: Negative

Ketones : Negative
Blood
: ++
Bilirubin
: Trace
Urobilinogen
: Normal
Nitrite
: 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. Pyelonephritis
b. Glomerulonephritis
c. Post infectious glomerulonephritis
d. 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 reading

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b. A high pH will lyse RBC, which accounts for the absence of RBC from microscopic reading
c. 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 progressive
b. Give another course of corticosteroid
c. Treat hypertension and UTI
d. Start hemodialysis
e. 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 failure
c. Acute pyelonephritis
d. Acute cystitis
e. 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 L
b. Ciprofloxacin
c. Co-trimoxazole
d. Penicillin
e. 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
Serum K
Serum calcium
Blood Urea
Serum creatinine

Results
8 mmol/L
6,6 mg/dL
160 mg/dL
12 mg/dL

Reference Range
3,5 5 mmol/L
8,5 10,5 mg/dL
25 40 mg/dL
0.6 1.2 mg/dL

Which of the following is the best option for treating this patient?
a.
b.
c.
d.
e.

Correction of severe hypocalcemia

Hemodialysis
Correction of hyperkalemia
Anti-epileptic drugs
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 glomerulonephritis
b. IgA nephropathy
c. Post-streptococcal glomerulonephritis
d. Mesangial glomerulonephritis
e. 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
Hemoglobin

Results
73 gr/dL

Reference Range
115 165 g/dL (female)

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Urea
421 mg/dL
Creatinine
32 mg/dL
MCV and MCHC Normal
What is most likely diagnosis for this patient?
a. Acute kidney injury
b. Nephrotic syndrome
c. Chronic kidney disease L
d. Acute nephritic syndrome
e. Acute chronic kidney disease

8 25 mg/dL
0.6 1.5 mg/dL

110.

Pasien BPH + ada UTI, dikasih antibiotik :

a. Ceftriaxone L
b. Ciprofloxacin
c. Cotrimoxazole
d. Penicillin
e. 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 AKI
b. Renal AKI
c. Postrenal AKI L
d. Upper UTI
e. lower UTI

112.

jengkol intoxication pathogenesis nya?

a. Amount of jengkol ingested
b. Individual susceptibility factor
c. The way jengkol is served
d. Preparation with other food
e. 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 mortality
b. poor, prone to CKD
c. poor, prone to scar
d. poor, hard to treat
e. 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 ceftriaxone
b. IV ampicillin
c. Oral sulfametoxazole-trimetropim
d. oral amoxicillin
e. oral cefixime

117.

which of the following bacteria most common of UTI (cerita no.16)

a. klebsiella
b. E.coli
c. Streptococcus beta hemolyticus grup a
d. staphylococcus aureus
e. pseudomonas

118.

7 year old boy A lot of blood in the urine Proteinuria +. Diagnosis?

a. nephrotic syndrome
b.
c. acute nephritic syndrome
d. AKI
e. CKD

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119.

Silmi

120.

10 y.o boy seizure, decrease consciousness, hypertension, edema papebral. Urinalysis a lot of RBC proteinuria +.
Slight anemia. Diagnosis?
a. AKI
b. hypertension encephalopathy et causa IgA glomerulonephritis
c. hypertension crisis et causa nephrotic syndrome
d. hypertension encephalopathy et causa nephrotic syndrome
e. 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. Atopy
b. Infeksikulit
c. Infeksigejala yang sama
d. Konsumsiobat
e. 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 penicillin
b. Diuretik L
c. ACE inhibitor
d. Vasodilator
e. 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 virus
b. Streptococcus pneumoniae
c. Staphylococcus aureus
d. Rhinovirus
e. Streptococcus beta hemolitic

124.

124.
a.
b.
c.
d.
e.

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. Infection
b. DM
c. Multiple pregnancy
d. Stone
e. Stroke

126.
127.

128.

128. What will you do to the patient first?

a. Giving antibiotic
b. Giving analgesic
c. Insert cathether
d. X-Ray
e. USG

129.

130.

Seorangwanita incontinence punya 6 anak. Saatnaiktanggaterasa steak urin. Apa yang terjadipadanya?
Overflow incontinence
Urge incontinence
Stress incontinence
Continous incontinence
Mixed incontinence

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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 mg
b. Cefixime 400 mg
c. Cefixime 400 mg & Azithromycin 1000 mg
d. Levofloxacine 500 mg
e. Azithromycin 1 gram

132.

What test should be done?

A. Gram stain
B. Gram stain and KOH
C. Gram stain, KOH, and culture-resistance test
D. *lupa* (pertanyaan n jawabannyasamakokkyknomeryg diatas2nya)
E. KOH

133.

Infeksi dengan jumlah PMN > 10. Terapi?

a. Cefixime 500 mg & Azithromycin 1 gram
b. Cefixime 400 mg
c. Cefixime 400 mg & Azithromycin 1 gram
d. Levofloxacine
e. 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. KOB
b. Nonenhanced CT scan abdomen
c. Ultrasound
d. 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? L
a. 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 ion
d. 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 L
C. 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

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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 dilate
b. Afferent and efferent arteriole constrict
c. Only afferent constrict
d. Only efferent constrict
e. 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 naik
b. konsentrasi sodium peritubular turun
c. tekanan onkitik peritubular naik L
d. proximal tubular flow naik
e. 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 system
b. failure ureteric bud derivatives to join tubule
c. division metanephric diverticulum
d. failure mesenkin untuk migrasi
e. 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. Hydrocele
b. Scrotal hernia
c. Testicular tumor
d. Infeksi di testis
e. Epididimorchitis

149.

What test to diagnose? (dari soal nomer 148)

a. CT scan lump
b. USG lump
c. Biopsy lump
d. Pelvic X-ray
e. 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. CBC
b. Urinalysis
c. Urine culture L
d. Lupaa kalau ga salah, USG
e. Anti streptolysin-O

151.

1.
a.
b.
c.
d.
e.

152.

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

153.

3.

154.

4.

Endi

male 65 y.o. nocturia, 1 bulan increase frequency of urination.next step management: (151)
ultrasound
TRUS
Pyelogram

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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 month
b. type I DM with nephropathy
c. type II DM disease without complication
d. chronic renal insufficiency (serum creatinine 2.5 %) without proteinuria
e. proteinuria (2 mg/day with normal serum creatinine) L

156.

6.

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 epididymitis
b. Scrotal scintigraphy for identivy UTI source
c. Bladder scintigraphy to differentiate UTI with vesicolithiatis
d. Ureteral scintigraphy to determine urethritis as etiology of scrotal inflammation
e. 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. nephrolitiasis
b. nephrocalcinosis
c. renal tumor
d. ureterolithiasis
e. ureteral tumor

159.

9.

160.

10. origin collecting duct: (160)

a. ureteric bud
b. metanephricblastema
c. mesonephric duct
d. metanephric duct
e. splanchic mesoderm
Ajay

161.

DitoRivaldi

asal excretory duct (embryologi)? lupapilihannya (159)

162.

Diketahuahasilurinalisis: pH 5,5. Blood: moderat. Warnaurin?

a. Colorless
b. Yellow
c. orange
d. pink L
e. 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 renography
b. GFR
c. Kidney Scintigraphy
d. Malignancy prostatScintigraphy
e. 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 nephritis
b. Urinanry tract lithiasis
c. Acute bacterial cystitis
d. Malacoplakia
e. Transitional cel carcinoma

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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 infiltration
b. focal & segmental sclerosis and hyalunosis
c. flattening &fussion of te foot process of podocytes
d. mesangial&endocapillary proliferation, GBM thickening,splitting
e. diffuse cappilary wall thickening

167.

Glomerular disease yang muncul 1-4 minggusetelah streptococcal infection pada pharynx dan skin. Mikroskopisnya :
a. Extracappilary proliferation with crescent, necrosis
b. Infiltration by leukocyte and proliferation of endothelium and mesangial cell.
c. Focal mesangial proliferation glomerulonephritis
d. Focl and segmental sclerosis and hyalinosis
e. 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 didnt 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 vasoconstriction
b. Direct toxic injury to the tubules
c. 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 drugs
e. 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. Wills tumor
b. Transitional cell carcinoma
c. Adenocarcinoma
d. Clear cell carcinoma L
e. 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. Renogram
b. GFR
c. Kidney scintighrapy
d. Malignant prostatscintighrapy
e. 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 mytotic
b. tumor cell could be composed by mesemchymal cell and blastemal cell
c. small round blue cell tumor that rosset appearance. L
d. tumor cell could be composed by only one kind of epithelial cell
e. 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 space
b) The cysts have uniform lining of cuboidal cell, reflecting their origin from the collecting ducts
c) He cyst are lined by flattened or cuboidal epithelium and are usually surrounded by either inflammatory cells or fibrous tissue
d) Renal cyst have smooth contour, are almost always avascular, and give fluid rather than solid signals on ultrasonography
e) The cyst as a psudocyst that not lined by epithelial cells

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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 space
b) The cysts have uniform lining of cuboidal cell, reflecting their origin from the collecting ducts
c) He cyst are lined by flattened or cuboidal epithelium and are usually surrounded by either inflammatory cells or fibrous tissue
d) Renal cyst have smooth contour, are almost always avascular, and give fluid rather than solid signals on ultrasonography
e) The cyst as a psudocyst that not lined by epithelial cells

175.
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