kumpulan soal ginjal

8/19/2019 Kumpulan Soal Ginjal

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1. A 42 years old male comes to the Siloam hospitalwith muscular weakness, mild headache aftereating salted fish. Usually he drinks only smallamount of water. He said that usually his bloodpressure is 100/70 mmHg. His blood pressure140/90 mmHg. The doctor sends him to thelaboratory. The result shows serum sodium is 150mEq/L (N: 135 - 155), potassium is 3.5 mEq/L (N:

3.5 – 5.0), random blood glucose 150 mg/dl (N3.5 per 1.73 m

2 per 24

hour), albumin level 1.5g/dL (normal=3.5-5g/dL).What is the principal management in this patient?

A. AlbuminB. FurosemideC. PrednisoneD. ThiazideE. Cyclosporin

10. A 13 year-old-girl was brought to emergency unitwith seizure. Her mother complaint she had fever 2

weeks ago, but has recovered. Now she hasswelling around the eyes and legs and she hasdark urine. From physical exam, she isunconscious. Her blood pressure is 180/120mmHg. Urine sample shows erythrocytes 20/hpfand protein +. Albumin level within normal limit.What other laboratory findings to confirm thediagnosis in this patient?

A. Decreased anti streptolisin O (ASO),increased DNase-B, decreased C3

B. Increased anti streptolisin O (ASO),decreased DNase-B, decreased C3

C. Decreased anti streptolisin O (ASO),

increased DNase-B, increased C3


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D. Increased anti streptolisin O (ASO),decreased DNase-B, increased C3

E. Increased anti streptolisin O (ASO)(untuk faringitis), increased DNase-B(pd nefritik/strepto), decreased C3

11. A 70-year-old male with tuberculosis, he wastreated with daily streptomycin for 1 week. Afterthe last injection, his urine output diminished and

the laboratory test revealed ureum 80 (20 – 40)mg/dL, creatinine 3.0 (0.5 - 1.5) mg/dL. (AIN adaproteinuria, ATN ga daa proteinuria)What is the most likely diagnosis in this patient?

A. Urinary tract infectionB. SepsisC. GlomerulonephritisD. Chronic renal failureE. Acute tubular nephritis

12. What is the most possible cause in this patient? (AIN hypersentivity, ATN ischemic ata toxin)

A. Renal ischemiaB. Direct toxic injuryC. Complex immune responseD. Urinary obstructionE. Drug hypersensitivity

13. A 3 year old boy was brought to emergency unitwith severe diarrhea since three days ago. Onarrival he is not fully alert. His vital sign are asfollows: blood pressure is 80/60 mmHg, pulse isnot palpable, respiratory rate was 36 breaths perminute, and body temperature was 38.4

oC. On

physical exam there is sunken anterior fontanel,

dry mucous membranes, sunken eyes, lack oftears, poor skin turgor, and the capillary refill morethen 2 seconds. The laboratory test in this patientreveal haemoglobin 13 g/dL(11.5-15.5 g/dL),hematocrit 46% (35-45%), WBC 7,000/mm

3(5,500-

15,500/mm3), platelets count 260,000/mm

3

(150,000-400,000 mm3), urea nitrogen 40 mg/dL

(5-18 mg/dL), and creatinine 1.7 mg/dL (0.3-0.7mg/dL). Urine specific gravity is 1.040 (N: 1.003 –1.030)What is the most likely diagnosis in this patient?

A. Acute tubular nephritisB. Prerenal acute kidney injury

C. Intrinsic acute kidney injuryD. Postrenal acute kidney injuryE. Chonic renal failure

14. A 10 year old girl was brought to your clinic withdysuria since 5 days ago. On physical exam she ishealthy with no significant findings. From urineculture is found Eschericia coli wih CFU ! 100,000.

What is the most likely diagnosis in this patient?

A. Acute pyelonephriticB. Reflux nephropathyC. Uncomplicated urinary tract infection

D. Complicated urinary tract infectionE. Chronic urinary tract infection

A 55-year-old man refers to ICU after the procedureopen reduction of femur fracture and bleeding intraoperative. At the third day he became apatis, fever38,5 C with blood pressure 110/60 mmHg, pulse 55x/min, respiratory 20x/min, and urine output decreasedto 10 cc/hour in 24 hours. At laboratory examinationfindings creatinine 4 mg/dL (N: 0.5-1.5), ureum 100mg/dL (N: 20-40), sodium 130 mEq/L (N: 135-155),

potassium serum 7.5 mEq/L (N: 3.5-5.5), blood sugar200 mg/dL (N:


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18. A 75 year old man had urine incontinence since 3months ago. He had been diagnosed dementia bythe doctor since 6 months ago. On examination hehad no prostate problems. What is the cause of hisurination’s problem?

A. Impaired frontal inhibitionB. Impaired pontine inhibitionC. Sympathetic system dysfunction

D. Parasympathetic system dysfunctionE. Sensoric system dysfunction

Yg inhibit hrusnya pons? Brain stimulate pundendaltrus”an. Dementia yg rusak frontal brainnya. Bknfrontal inhibition , tp frontal stimulation hrusnya.19. A 44 year old man was hospitalized for systemic

fungal infection. He was on Amfoterisin Btreatment for 7 days. On examination, he isconscious, BP 120/80 mmHg, pulse 80 x/min, RR16 x/min, temperature 36,7 C. Lab: Hb 13 gr%,HT 37%, WBC 8600, Platelet 340.000. Ureum 91,creatinin 2, 0. Volume urine 800 cc/24 jamWhat is the patognomonic laboratory finding in this

case? A. Increased osmolalityB. LeucocyturiaC. Muddy brown castD. Erythrocyte castE. Haemoglobinuria

20. A 24-year-old woman went to a physician becausepain during urination and frequency. Onexamination, she had has suprapubic pain, but nofever. Her urine was cloudy and showsmicroscopic evidence of erythrocytes, pyuria, andgram-positive bacteria. In the past medical history,

she never had any symptoms like this one. Whichorganism is most likely responsible for thispatient’s illness?

A. Klebsiella pneumoniaB. Pseudomonas aeruginosaC. Escherichia coliD. Proteus mirabilisE. Staphylococcus saprophyticus

21. A 55-year-old male complains hematuria at thephysician’s office for 2 weeks. A cystoscopicexaminations showed a 2 cm,exophytic,friablemass on the right bladder dome.

A biopsy of this lesion show findings mostconsistent with a/an

A. PapillomaB. Verrucous carcinomaC. Transitional carcinomaD. Squamous carcinomaE. Adenocarcinoma

22. A 50-year-old male presents with a month longhistory of flank pain and hematuria.An USGabdominal results a 3 cm bosselated mass,protrudes from cortical are in the rightkidney.Cytologic examination reveals malignant

cells.What is most likely biopsy finding for this patient?

A. Wilms tumorB. Renal Cell CarcinomaC. Transitional carcinomaD. Squamous carcinomaE. Undifferentited carcinoma

23. A 60-year-old male experiences the onzet ofheadache, naussea ,vomitting fo 1 month.Physical examination reveals hypertention,

subfebril. Pyelogram showed the affected kidneyassymmetrically contracted with deformity of thecalyceal system. Gross of the affected kidneyshowed contracted and has irregular granularsurface.The parenchyma is atrophic and replaceby fibrosis. Microscopic showed glomerularsclerosis, hyalinization and atrophi in cortical area.

Another areas showed fibrosis, chronicinflammatory cells with limpocytes agregation.What is the most likely lesions occur in thiskidney?

A. Renal cell carcinomaB. Chronic pyelonephritis

C. Acute nephritisD. Nephrotic syndromeE. Diabetic nephropathy

24. A 5-year-old boy child who had a palpableabdominal mass brought to hospital by his mother.The child later had abdominal distention frombowel obstruction. An USG reveals a 6 cm leftrenal mass with necrosis and hemorrhage.Microscopic showed embryonal tissue withabortive of tubular and glomerular structures.What is the diagnosis ot this patient?

A. Teratoma

B. RetinoblastomaC. Wilms’tumorD. HanarthomaE. Hemangioma

25. A 62-year-old woman presents with hematuria andleft flank pain. Physical examination revealscostovertebral angle tenderness. Renal ultrasoundshows marked left hydronephrosis. Serumcreatinine and CBC are normal.Which of the following diagnostic test is the mostrelevant?

A. Renal biopsy

B. Renal arteriogramC. Palpation for inguinal lymph nodesD. Antinuclear antibody testE. IVP

26. A 34-year-old man comes with 3-day history of lowback pain, urinary hesitancy, and pain withurination. He has not had any urethral dischargeor recent sexual contacts. His temperature is38.2C,Z

27. A 25-year-old man has been crashed by a truck.The doctor suspects that his kidney is rupture, and

then he sent the patient to have IVP.


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What is the most likely the appearance of renalparenchymal rupture in IVP?

A. The kidney shows non functionB. Ekstravasation (urine bocor )C. Hydronephrosis (urine akumulasi di

renal pelvis)D. Normal nephrogramE. Dilatation of calyx

28. A 50-year-old man comes to the clinic withcomplain of abdominal colic. The result of IVPdemonstrates ureteric dilatation.What is the most likely problem?

A. Stone in the pelvicureter junctionB. Kidney cystC. Stone in the vesicoureter junctionD. Renal cell Ca stage IE. Acute inflammation

29. A 24-year-old woman went to a physician becauseof pain during urination. On examination, she hadhas left flank tenderness and low-grade fever. Her

urine was cloudy and shows microscopic evidenceof erythrocytes, pyuria, and gram-positive bacteria.In the past medical history, she never had anysymptoms like this one.Which organism is most likely responsible for thispatient’s illness?

A. Klebsiella pneumoniaB. Pseudomonas aeruginosaC. Escherichia coliD. Proteus mirabilisE. Staphylococcus saprophyticus

30. Which urine specimen is most appropriate for the

culture examination? A. Suprapubic aspirationB. Mid streamC. Straight catheterD. Indwelling catheterE. 24 hours urine collection

31. A 30-year-pregnant woman was complaining fever,pain when urinating, blood in her urine, and severelower back pain. The physician submits her urinefor culture; the next day, the laboratory reports anorganisms growth count of greater than 10

5/ml of

urine. The organism grew well on the blood agar

and producing " –hemolytic colonies.Which important virulence factor for the organismis most likely responsible for this patient’s illness?

A. CapsuleB. P-fimbriae (Ecoli)C. EndotoxinD. Phospolipase CE. Lipooligopolysaccharide

32. A 30-year-old man patient complained of a sharppain in his loin radiating down to his perineum,accompanied by hematuria. He reported that hehad a few days of urinary urgency, frequency, and

burning when urinating. On examination, histemperature was 37.5ºC; other vital sign were

normal; and he appears to be in pain. A urinalysisshows erythrocytes, leukocytes esterase and ahigh pH.Which antigenic composition is most likelyresponsible for this illness?

A. Hemolysin (proteus)B. CatalaseC. FibronectinD. Opa protein go

E. Cord factor tb

33. A 67-year-old man with an episode of acute urineretention was catheterized. Three days later, hedeveloped fever and suprapubic pain. Culture ofurine revealed a thin film of bacterial growth overthe entire blood agar plate, and urease test waspositive.Which of the following is most likely organism tocause this infection?

A. Escherichia coliB. Staphylococcus sapropyticusC. Proteus mirabilis

D. Enterococcus faecalisE. Morganella morgagni

34. A 34-year-old woman presents with pain duringurination and frequency. On examination, she hadhas suprapubic pain, but no fever. Her urine wascloudy and shows microscopic evidence oferythrocytes, pyuria, and bacteria. The urine has ahigh pH. Which of the following bacteria’s strategyis responsible for this condition?

A. Destroy blood vessel in the kidneyB. Exhibits “swarming” motilityC. Ferments many sugars

D. Produce a potent ureaseE. Secretes many exotoxins

35. IVP image of a new born baby shows that leftkidney tremendously enlarged and clearlydemonstrates intra-parenchyma mass. Whatabnormality could possibly occur?

A. horseshoe kidneyB. pelvic kidneyC. unilateral renal agenesisD. polycystic kidney (ada massa)E. pancake kidney

36. Oligohydramnios can be related to malformation inkidney. Why can the amount of amniotic fluiddetermine such malformation?

A. baby drinks the amniotic fluidB. baby cannot drink amniotic fluidC. amniotic fluid mostly contains urineD. little amount of amniotic fluid causes

the pelvic malformationE. little amount of amniotic fluid disturbs

the kidney development

37. A new born baby boy has a malformation ingenitourinary appearance. When he urinates, the

urine comes out from large area below the urethra


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opening. What process could possible failed duringthe development of genitourinary process?

A. closure of genital foldB. closure of genital openingC. closure of genital tubercleD. closure of urogenital sinusE. closure of Wollfian duct

38. Cryptorchid condition results in germ cells failed to

multiply, and then die and only in Sertoli cells existin seminferous tubules. What is the developmentprocess the main cause of cryptorchid?

A. inguinal herniaB. failure of testicular decentC. failure of gubernaculums regressionD. fusion of the tunica albuginea and

peritoneumE. guevedoces

39. A 30-year-old man had nausea, vomiting, andsevere colicky right flank pain radiating into thethigh for 4 hours. He is afebrile. There is right

costovertebral angle tenderness. Urinalysis showsnumerous RBCs and no bacteria.Which of the following is the most likely diagnosis?

A. Acute glomerulonephritisB. Bacterial cystitisC. Benign prostatic hyperplasiaD. UrolithiasisE. Renal cell carcinoma

40. A previously healthy 72-year-old man comes to thephysician because of decreased urinary outputduring the past 2 days; he has had no urinaryoutput for 8 hours. Examination shows suprapubic

fullness and enlarged prostate.Which of the following is the most appropriate nextstep in management?

A. PSA examinationB. Ultrasonography of the kidneysC. CT scan of the abdomenD. Bladder catheterizationE. Intravenous pyelography

41. An otherwise healthy 20-year-old woman is givensulfamethoxazole to treat a bladder infection.Three days after beginning the antibiotic regimen,the patient has moderately severe jaundice and

dark urine. Pain with urination and a low-gradefever have resolved. Her hematocrit is 20%.Substantial numbers of erythrocytes contain Heinzbodies. Her condition worsens until day 6 ofantibiotic therapy, when it begins to resolve.Symptoms are completely gone by day 9 ofcontinued antibiotic therapy.Which of the following conditions is the most likelyexplanation for these findings?

A. Aplastic anemiaB. Generalized cytochrome-b5 reductase

deficiencyC. Glucose-6-phosphate dehydrogenase

deficiencyD. Pyruvate kinase deficiency

E. Steven Johnson Syndrome

42. A 61-year-old man comes to the physicianbecause of a 3-month history of episodes ofheadache, palpitation, and excessive sweating. Hehas had a 10-kg (22-lb) weight loss during thisperiod. While being examined, during an episodehis blood pressure is 210/110 mm Hg. Physical

examination shows no other abnormalities. Urinestudies show increased catecholamineconcentrations. A CT scan of the abdomen is mostlikely to show a mass in which of the followinglocations?

A. Adrenal glands (aldosterone dancatecolamin dan adrenalin)

B. UreterC. UrethralD. BladderE. Right kidney

43. A 6-year-old boy has a large intra-abdominal mass

in the midline just above the symphysis pubis.During an operation, a cystic mass is foundattached to the umbilicus and the apex of thebladder. Which of the following is the most likelydiagnosis?

A. HydroceleB. Meckel cystC. Meckel diverticulumD. OmphaloceleE. Urachal cyst

44. A 69-year-old man with 82 kg is referred to youwith fatigue and laboratory result shows Hb 7 g/dL,

ureum 55 mg/dL, and creatinin 5.4 mg/dL. He hasnot seen a physician for several years.Which finding would help you decide that thiscondition is chronic?

A. Low serum calciumB. Low serum bicarbonateC. Protein detected in urinalysisD. Broad waxy casts in urinalysisE. Elevated serum phosphorus

45. A 52-year-old woman with longstanding type IIdiabetes is referred with microalbuminuria andnormal serum creatinine. Her weight is 85 kg and

height is 160 cm. Blood pressure is 150/100mmHg.Which of the following measures should youadvise to prevent progression to overtnephropathy?

A. Tight glucose controlB. High-protein and low carbohydrate

dietC. Blood pressure controlD. Regular diureticE. Increased water intake

46. A 20-year-old man presents with malaise, nausea,

and decreased urine output. He was previouslywell and his physical examination is normal except


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for an elevated jugular venous pressure (JVP) andpericardia rub. His electrolytes reveal acute renalfailure (ARF).Which of the following findings on the urinalysis ismost likely in keeping with acuteglomerulonephritis?

A. Granular casts (dan epithelial = ATN)B. Erythrocyte castsC. Proteinuria

D. Hyaline casts (prerenal)E. White blood cell casts

47. A 35-year-old women presents with nausea andvomiting of 2 days duration. She is not on anymedications and was previously well until now. Herphysical examination is normal except for posturaldrop in her blood pressure from 110/80 mmHgsupine to 90/80 mmHg standing. Her serumelectrolytes are Sodium 130 mEq/L, Potassium 3mEq/L, Chloride 90 mEq/L, bicarbonate 30 mEq/L,urea 50 mg/dL, and creatinine 0.8 mg/dL.Which of the following electrolytes in the case

above is most likely to be filtered through theglomerulus but unaffected by tubular secretion?

A. PotassiumB. UreaC. CreatinineD. BicarbonateE. Sodium

48. A 68-year-old man came seeing a generalpractitioner with a swelling throughout the body.He also felt urine volume decreases and the urinecolor was red. He denied any pain on urination orin any part of his body, on physical examination

costovertebrae angular test negative. Blood testresults obtained ureum 55 mg/dL (normal 20-40mg/dL) and creatinine 1.7 mg/dL (normal


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creatine 2.1mg/dL (N:


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pH :7 (N : 4.5 – 8) , WBC: 15-20/HPF (N : 0-2/HPF) ; RBC : 5-10/HPF (N: 0/HPF ). Urinesediments show crystals with cuboid shape. (caoksalat)What is the most likely metabolic abnormality?

A. HyperoxaluriaB. HypercalciuriaC. HypercitraturiaD. Hyperuricuria

E. Renal tubular acidosis

64. A 42-year-old man came to the hospital and saidthat his urine’s color is red and he saw vermiformclot. From his statement, could you tell thepossible source of his problem?

A. UreterB. UrethraC. BladderD. Prostate

65. A 50-year-old man is hospitalized for acutemyocardial infarction. He has decreased cardiac

output with hypotension requiring multiple pressoragents. His urine output drops over the next 3days. His serum urea nitrogen increases to 59mg/dL, with creatinine of 2.9 mg/dL. Urinalysisreveals no protein or glucose, a trace blood, andnumerous hyaline casts. Five days later, hedevelops polyuria and his serum urea nitrogendeclines.Which of the following pathologic findings in hiskidneys is most likely to have caused hisazotemia?

A. Patchy tubular necrosisB. Fusion of podocyte foot processes

C. Glomerular crescentsD. Hyperplastic arteriolosclerosisE. Mesangial immune complex

deposition

66. A 26-year-old diabetic woman is seen in the ER forsore throat. Rapid strep test is positive forstreptococcal pharyngitis and she was started onampicillin 500 mg four times a day. Three dayslater, she develops hematuria associated with alow grade fever. On physical examination, she hasa maculopapular rash and a temperature of 38 C.Laboratory studies show: serum creatinine 3.6

mg/dl, WBC 8,700 with 56% PMN, 25% lymphs,3% monos and 15% eosinophils. Urinalysis: pH6.2, protein 2+, blood 3+, 65 RBCs/HPF, 20-30WBCs/HPF, 3-4 WBC casts/HPF. ASTO value isincreased.What is the most likely diagnosis?

A. Diabetic nephropathyB. IgA nephropathyC. Acute interstitial nephritisD. MAcute pyelonephritis

67. A 40-year old man with arthritis has been usingibuprofen (nonsteroidal anti-inflammatory) every 6

hours. He developed renal failure associated withnephrotic range proteinuria.

What is the most likely glomerular lesion in thispatient?

A. Membranoproliferativeglomerulonephritis

B. Minimal change diseaseC. IgA nephropathyD. Diabetic nephropathyE. Focal segmental glomerulosclerosis

68. A 4-year-old-boy was brought to hospital withpuffiness around the eyes, especially in themorning and swelling over the legs. His motheralso complaint he has foamy urine. Urine sampleshows protein ++++ (>3.5 per 1.73 m

2 per 24

hour), albumin level 1.5g/dL (normal=3.5-5g/dL).What is the most likely underlying mechanism inthis patient?What is the principal management in this patient?

A. Albumin 0,5-1 g/kg, iv, follow withfurosemide 1-2 mg/kgBB/iv

B. Prednisone 40 mg/m2/dayC. Prednisone 60 mg/m2/day

D. Reduce sodium intakeE. Alkylating agent

69. A 5 day old baby was hospitalized due to indirecthyperbilirubinemia. On the third day hospitalizationhe had fever and then he was given amoxicillin(beta lactam yang bikin AIN) and gentamycinintravenously. Three days later his urine outputdiminished and the laboratory test revealed ureanitrogen 25 (3-12) mg/dL, creatinine 0.9 (0.2-0.4)mg/dL.What is the most likely diagnosis in this patient?

A. Urinary tract infection

B. SepsisC. Acute renal failureD. Chronic renal failureE. Acute tubular nephritis

A 3 year old boy was brought to emergency unitKarawaci Hospital with severe diarrhea since threedays ago. On arrival he is not fully alert. His vital signare as follows: blood pressure is 80/60 mmHg, pulse isnot palpable, respiratory rate was 36 breaths perminute, and body temperature was 38.4

oC. On

physical exam there is sunken anterior fontanel, drymucous membranes, sunken eyes, lack of tears, poor

skin turgor, and the capillary refill more then 2seconds. The daily urine volume is less than 400 mL.70. In this patient, the tubular epithelial cells are

particular susceptible to ischaemic injury due to: A. Little charged surface for reabsorptionB. Low metabolic rate and oxygen

consumptionC. Decreased levels of salt reaching the

distal tubulesD. Loss of polarity that cause

redistribution of membrane proteinsE. Passive transport systems for ions

and organic acids


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71. The laboratory test in this patient revealhaemoglobin 15 g/dL( 11.5-15.5 g/dL), hematocrit46% (35-45%), WBC 7,000/mm

3 (5,500-

15,500/mm3), platelets count 260,000/mm

3

(150,000-400,000 mm3), urea nitrogen 40 mg/dL

(5-18 mg/dL), and creatinine 1.7 mg/dL (0.3-0.7mg/dL).The most likely diagnosis in this patient is:

A. Acute tubular nephritis

B. Prerenal acute kidney injuryC. Intrinsic acute kidney injuryD. Postrenal acute kidney injuryE. Chonic renal failure

A 10 year old girl was brought to your clinic with disuriasince 5 days ago. On physical exam she is healthywith no significant findings. From urine culture is foundEschericia coli with CFU ! 100,000.72. What is the most likely diagnosis in this patient?

A. Acute pyelonephriticB. Reflux nephropathyC. Uncomplicated urinary tract infection

D. Complicated urinary tract infectionE. Chronic urinary tract infection

73. Factors unfavorable to bacterial growth in thispatient’s urine is:

A. A low pHB. A low concentration of ureaC. The absence of organic acids from a

dietD. A low osmolalityE. The presence of normal

microorganism

74. An 8 years old boy presents with decreased urineoutput, hematuria, high blood pressure, proteinuriaadd rising creatinine. One week ago he had afever and sore throat. A renal biopsy is carried outreveals diffuse proliferative glomerulonephritis.Electron microscope will show abnormal depositsin what location?

A. Between basement membrane andendothelial cells of the glomeruli

B. Between the basement membraneand epithelial cells of the proximaltubule

C. Between the basement membrane

and epithelial cells of the glomeruliD. Within the juxtaglomerular apparatus

75. A 45 years old female has a long history of poorlycontrolled diabetes. She presents now withedema, hypertension and massive proteinuria,hematuria and hyperlipidemia. Renal biopsy showshyaline arteriosclerosis of the arterioles. Whatchanges will be present in the glomeruli?

A. Diffuse proliferative glomerulonephritisB. Membranous proliferative

gomerulonephritisC. Membranous glomerulosclerosis

D. Focal segmental glomerulosclerosisE. Nodular glomerulosclerosis

76. A 64-year-old male presents with hematuria.Examination shows a flank mass and he haselevated hemoglobin. Pathology of the surgicalspecimen shows a clear cell renal cell carcinoma.What is the cell of origin of this tumor?

A. GlomerulocyteB. Glomerular endotheliumC. Glomerular epitheliumD. Proximal tubular epithelium (clear ell n

papilla)E. Histiocyte

Distal (klomoford, oncodi)

77. A 32-year-old female presents with headaches.Investigation reveals hypertension (180/110mmHg) and very high level of aldosteronepresumed due to a tumor. What of the following ischaracteristic of this condition?

A. Elevated serum sodium levelsB. Elevated serum potassium levelsC. Elevated urinary cortisols

D. Elevated urinary bicarbonate

78. An 18-year-old male presents to emergencyfollowing a motorcycle accident. There issignificant blood loss. In the ER, his BP is 90/60mmHg and his pulse is 120 x/min. Whatphysiological response occurs in the kidney?

A. Decreased urine osmolalityB. Reduced release and action of ADHC. Beta adrenergic stimulation of the

vasculatureD. Vasoconstriction of the renal arteriolesE. Reduced aldosterone production and

sodium loss

1. Mr. Edi, 42 year old male, comes to the Siloamhospital with muscular weakness, mild headacheafter eating salted fish. Previously he never eatssalted fish. Usually he drink only small amount ofwater. He said that usually his blood pressure is100/70 mmHg. His blood pressure 140/90 mmHg.The doctor sends him to the laboratory. The resultshows serum sodium is 150 mEq/L, potassium is3.5 mEq/L, glucose 150 mg/dl.In this condition, what will the kidney do?

A. Increase GFR

B. Increase obligatory water reabsorptionC. Increase facultative water reabsortionD. Increase renin secretionE. Increase aldosteron secretion

2. To cover the above function, what mechanism isused?

A. Increase cardiac outputB. Increase frequency of the heartC. Increase secretion of reninD. Increase secretion of antidiuretic hormoneE. Increase secretion of aldosteron

.

3. Which factor support the above mechanism? A. Filtration rate of the glomeruli


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B. Active transport of the tubular cellC. High osmolality of the interstitium of medullaD. Obligatory water reabsortionE. Osmolality of the filtrate in distal convolutedtubule

4. If the urinalysis is also done, what will you see aboutthe glucose in urine?

A. positive ++++B. positive +++C. positive ++D. positive+E. negative

5. In a kidney laboratory, using a micropipette, we canmeasure the hemodynamic pressure of afferentarteriole, pressure in Bowman capsule, and osmoticpressure in glomerular lumen. If the pressure inafferent arteriole is 40 mmHg, in Bowman capsule 1mmHg, the osmotic pressure of glomerulus is 30mmHg, the effective filtration pressure in glomerulus is:

A. 71 mmHgB. 69 mmHgC. 11 mmHgD. 9 mmHgE. – 9 mmHg

6. A patient taking an oral diuretic for about sixmonths, visits your clinic with elevated fasting andpostprandial blood glucose levels. You check thepatient’s Hb A1C and find it is elevated comparedwith normal baseline values obtained 6 monthsago. You suspect the glycemic problems arediuretic-induced. Which of the following drug is the

most likely cause? A. asetazolamideB. amilorideC. chlorothiazideD. spironolactoneE. triamterene

7. Your patient, a 55 year-old man, with heart failure,unacceptably low cardiac output, and intensereflex-mediated sympathetic activation of theperipheral vasculature that is attempting to keepvital organ perfusion pressure sufficiently high. Thepatient is edematous, and has ascites, because of

the poor cardiac function and renal compensationsfor it. Which of the following drug should beavoided in this patient?

A. amilorideB. ethacrynic acidC. hydrochlorothiazideD. mannitolE. spironolactone

8. A 63-year-old-man, with a history of heart failureand edema fails to respond adequately tomaximum recommended dosages ofchlorthalidone.

Which of the following is the most likelyappropriate for restoring the diuretic response?

A. add with hydrochlorothiazideB. add with metolazoneC. replace with furosemideD. replace with hydrochlorothiazideE. increasing the dose of

chlorthalidone

9. A 75-year-old woman with hypertension is beingtreated with thiazide. Her blood pressure is

decrease to 120/76 mm Hg. After several monthson the medication, she complains of being tiredand weak. Which of the following substance inanalysis of blood indicates low values?

A. calciumB. uric acidC. potassiumD. sodiumE. glucose

10. Your patient, a 45-year-old man, usually lives nearthe beach, is planning to have a vacation thatincludes a short hike to the top of Mount Everest

(altitude approx. 29.000 feet above sea-level).You are concern about “mountain sickness”. Hehas no other significant medical conditions andtakes no other drugs that would interact with thedrug you will prescribe for his trip.Which of the following drug you recommend?

A. acetazolamideB. amilorideC. bumetabideD. furosemidE. spironolactone

11. A patient with tuberculosis develops bright

orange-red urine after he drank his anti-tuberculosis drugs and calls his physician in apanic because he is afraid he is bleeding into theurine. The patient has no other urinary tractsymptoms. Which of the following medication isthe most likely to produce this side effect?

A. EthambutolB. IsoniazidC. PyridoxineD. RifampicinE. Streptomycin

12. A 26 year-old young man presents with the

symptoms of gonorrhea. This condition is oftenassociated with infection due to Chlamydiatrachomatis.Which of the following quinolones would be thebest choice for treating him?

A. ciprofloxacinB. nalidixic acidC. norfloxacinD. levofloxacinE. ofloxacin

13. A jaundiced 1-year premature infant with elevatedfree bilirubin is seen in the premature baby

nursery. The mother had received antibiotic


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combination for a urinary tract infection (UTI) 1week before delivery.Which of the following is the most likely cause ofthe baby’s kernicterus ?

A. cefiximeB. amoxicillinC. azithromycinD. erythromycinE. cotrimoxazole

14. A 30 year-old woman with a history of recurrenturinary tract infection. Since 5 days ago, she feltdysuria, urgency, and frequency. Culture of urinesample indicated that the offending organism isEscherichia coli. She receives ciprofloxacin andthe symptoms disappear.Which of the following process is inhibited byciprofloxacin?

A. cell-wall synthesisB. folic acid synthesisC. protein synthesisD. topoisomerase II

E. DNA polymerase

15. A 30 year old man with motorcycle accident comesto the emergency. In the

physical examination, the doctor found that his leftkidney has severe injured.

And the doctor suggested operating his kidney.During the removal of a patient’s kidney,Which of the following structure is the most anterior

within the renal sinus? A. Renal arteriesB. Renal veinC. Major calyx

D. Minor calyxE. Renal pelvis

16. You wish to examine the hilum of the left kidneyduring surgery.

Which of the following structures must be elevated? A. StomachB. Suprarenal glandC. Ascending colonD. DuodenumE. Liver

17. To elevate the kidney within the renal fascia and

the perirenal fat, which of thefollowing muscles must be reflected or incised from

the fascia? A. DiaphragmB. Psoas

C. Quadratus lumborumD. Transverses abdominisE. Iliacus

18. An 18-year-old man is noted to have probabletesticular cancer. He undergoes

surgery. After incising the scrotum, the surgeon

contemplates the approachto the parenchyma of the testes.

Which layer is the most near to the testicularparenchyma?

A. Fascia spermatica externaB. Tunica albugineaC. Fascia sprematica internaD. Scarpa fasciaE. Tunica dartos

19. A 18-year-old man is noted to have dysuria for

several days, and the doctor diagnose that she suffersfrom urinary tract infection.

Which of the following structure of the urinary tractis the most vulnerable to

get infection? A. KidneyB. UreterC. Urinary bladderD. UrethraE. Adrenal gland

20. A 70 year old man came to the emergencydepartment of Karawaci Hospital with

complaint of incomplete urination since 6 monthsago. The urologist performed

rectal examination and found an enlargement ofhis prostate.

Which of the following structure is affected by theenlargement?

A. urethra pars membranaceaB. urethra pars spongiosaC. sphichter urethra internaD. urethra pars prostaticaE. orificium urethra externa

A 4-year-old-boy was brought to hospital with puffiness

around the eyes, especially in the morning andswelling over the legs. His mother also complaint hehas foamy urine. Urine sample shows protein ++++(>3.5 per 1.73 m

2 per 24 hour), albumin level 1.5g/dL

(normal=3.5-5g/dL).

21. What is the principal management in this patient?F. AlbuminG. FurosemideH. PrednisoneI. Diet restrictionJ. Cyclosporin

22. During 4 weeks-treatment, the urine sampleshows protein +.What is your conclusion in this patient?

A. Initial responderB. Late responderC. Drug resistantD. Drug dependent

E. Remission

A 13 year-old-girl was brought to emergency unit withseizure. Her mother complaint she had fever 2 weeksago, but has recovered. Now she has swelling aroundthe eyes and legs and she has dark urine. From

physical exam, she is unconscious. Her bloodpressure is 180/120 mmHg. Urine sample shows


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erythrocytes 20/hpf and protein +. Albumin level withinnormal limit.

23. What other laboratory findings to confirm thediagnosis in this patient?

F. Decreased anti streptolisin O (ASO),increased DNase-B, decreased C3

G. Increased anti streptolisin O (ASO),decreased DNase-B, decreased C3

H. Decreased anti streptolisin O (ASO),increased DNase-B, increased C3

I. Increased anti streptolisin O (ASO),decreased DNase-B, increased C3

J. Increased anti streptolisin O (ASO),increased DNase-B, decreased C3

24. What is the most likely mechanism that underlyingthis patient’s disease?

A. Streptococcal bacteria infectionB. An inflammation of the kidney tubulesC. Increased permeability of glomerulus

membrane

D. Small pores in the podocytes permiterythrocyte loss

E. Heparan sulfate mucopolysaccharide is

low so erythrocyte cross the barrier

A 5 day old baby was hospitalized due to indirecthyperbilirubinemia. On the third day hospitalization hehad fever and then he was given amoxicillin andgentamicin intravenously. Three days later his urineoutput diminished and the laboratory test revealedurea nitrogen 25 (3-12) mg/dL, creatinine 0.9 (0.2-0.4)mg/dL.25. What is the most likely diagnosis in this patient?

F. Urinary tract infectionG. SepsisH. Acute renal failureI. Chronic renal failureJ. Acute tubular nephritis

26. What is the most possible cause in this patient?

F. IschemiaG. Direct toxic injuryH. Complex immune responseI. Urinary obstructionJ. Drug hypersensitivity

27. What is the pathognomonic laboratory finding(urinalysis) in this patient?

A. Increased osmolalityB. ProteinuriaC. Muddy brown castsD. Erythrocyte casts

E. Haemoglobinuria

A 3 year old boy was brought to emergency unitKarawaci Hospital with severe diarrhea since threedays ago. On arrival he is not fully alert. His vital signare as follows: blood pressure is 80/60 mmHg, pulse isnot palpable, respiratory rate was 36 breaths per

minute, and body temperature was 38.4oC. On

physical exam there is sunken anterior fontanel, drymucous membranes, sunken eyes, lack of tears, poorskin turgor, and the capillary refill more then 2seconds. The daily urine volume is less than 400 mL.

28. In this patient, the tubular epithelial cells areparticular susceptible to ischemic injury due to:

F. Little charged surface for reabsorption

G. Low metabolic rate and oxygenconsumption

H. Decreased levels of salt reaching thedistal tubules

I. Loss of polarity that cause redistribution ofmembrane proteins

J. Passive transport systems for ions andorganic acids

29. The laboratory test in this patient revealhaemoglobin 15 g/dL(11.5-15.5 g/dL),

hematocrit 46% (35-45%), WBC7,000/mm

3(5,500-15,500/mm

3), platelets count

260,000/mm3

(150,000-400,000 mm3

), ureanitrogen 40 mg/dL (5-18 mg/dL),and creatinine 1.7 mg/dL (0.3-0.7 mg/dL).What is the most likely diagnosis in this patient?

F. Acute tubular nephritisG. Prerenal acute kidney injuryH. Intrinsic acute kidney injuryI. Postrenal acute kidney injuryJ. Chonic renal failure

30. What is the most prior management in this patient?

A. Bicarbonate

B. Acute DialysisC. FurosemideD. Antibiotic

E. Fluid replacement therapy

A 10 year old girl was brought to your clinic withdysuria since 5 days ago. On physical exam she ishealthy with no significant findings. From urine cultureis found Eschericia coli wih CFU ! 100,000.31. What is the most likely diagnosis in this patient?

F. Acute pyelonephriticG. Reflux nephropathy

H. Uncomplicated urinary tract infectionI. Complicated urinary tract infectionJ. Chronic urinary tract infection

32 .Which of the following factor is unfavorable tobacterial growth in patient’s urine?

F. A low pH (5.5 or less)

G. A low concentration of ureaH. The absence of organic acids from a dietI. A low osmolalityJ. The presence of normal microorganism

33. Which of the following antibiotic is the mostappropriate for this patient?


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A. CeftriaxoneB. CefotaximeC. CeftazidimeD. CotrimoxazoleE. Metronidazole

A 55-year-old man refers to ICU after the procedureopen reduction of femur fracture and bleeding intra

operative. At the third day he became apatis, fever38,5 Celcius with blood pressure 110/60 mmHg, pulse55 x/min, respiratory 20x/min, and urine outputdecreased to 10 cc/hour in 24 hours. At laboratoryexamination findings creatinine 4 mg/dL, BUN 250mg/dL, sodium 130 mEq/L, chloride 90 mEq/L,potassium serum 7.5 mEq/L, blood sugar 200 mg/dL.From blood gas analysis finding pH 7.1, pCO2 30mmHg, pO2 90 mmHg,HCO3 18 mEq/L. ECG examination finds widening ofQRS wave.

34. What is the most critical condition can cause life

threatening the patient?(A) Nothing for awareness(B) creatinine and BUN at very high level(C) hyperkalemia(D) metabolic acidosis(E) Severe hyponatremia

35. What is the best choice of treatment for the clinicalsituation for the patient?

(A) Food restriction with potassium composition(B) Give K sparing diuretic(C) Give regular Insulin 10 U in dextrose 50%

intravenous

(D) Give bicarbonate sodium intravenous(E) Give forced diuretic

36. After the choice procedure, what is the nexttreatment for the patient?

(A) Waiting for the general condition of thepatient became more better

(B) Give diuretic until the urine output will benormally

(C) Hemodialysis immediately(D) Give sodium bicarbonate until pH of

blood became normal(E) Intubation and ventilator to maintain the

respiratory

37. According to RIFLE criteria, what is clinicalcondition of the patient?

(A) Risk(B) Injury(C) Failure(D) Loss(E) End State Kidney Disease

38. Which of the following statements in true ofhematuria caused by bladder cancer?(A) It is usually accompanied by discomfort and

painful voiding(B) It is intermittent and painless

(C) It occurs in a minority of patients with bladdercancer

(D) It commonly causes anemia(E) It occurs primarily only in the initial phase of

the urinary stream

39. A 36-year-old male truck driver is referred to youfor evaluation of recurrent urolithiasis. Thepatient has passed more than 20 calcium

oxalate stones since age 18. Previous therapywith hydrochlorothiazide and cellulosephosphate has been ineffective. Physicalexamination is normal. Laboratory finding:Serum creatinine 1.0 mg/dL, Serum uric acid 8.9mg/dL, Urine pH 5.0Radiographs of the abdomen show smooth renalsilhouettes measuring 13.6 cm on the right and14.2 cm on the left, and no radioopaque atkidney region. From sonography findingsmultiple hyperechoic shadow from both kidneywith measure about 2 – 5 mm.Which of the following treatment is the most

effective for this patient?(A) Dietary sodium restriction

(B) Dietary calcium supplementation(C) High fluid intake and long-term

urine acidification(D) High fluid intake and allopurinol(E) Shock wave lithotripsy

40. A 40-years-patient arrives at ER department with atransthoracic gunshot wound and microscopichematuria.What is the most appropriate supporting diagnostic

technique?(A) Abdominal sonography(B) Intravenous pyelography(C) Immediate laparatomy(D) Clinical observation on the hospital

ward(E) Immediate CT with i.v contrast agents

41. You are asked to evaluate a 38-year-old womanwho has a ten-year history of bipolar disorder. Shehas taken lithium carbonate for seven years. Forthe past two years, she has had severe polyuria(urine volume up to 10 L/24 hr). She refuses to

discontinue lithium therapy.What is the most appropriate agent to reduce the

polyuria?(A) Amiloride(B) Chlorpropamide(C) Furosemide(D) Hydrochlorothiazide(E) Acetazolamide

42. A man 45 years old come with bruise at lowerabdominal and pain. He is suspected withbladder injury,Which of the following statement is true about

bladder injuries?


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(A) They are present 6% -10% in patients withpelvic fracture

(B) More than 80% come with urine retention(C) Delayed diagnosis is the rule

(D) Bladder contusions commonly result ingross hematuria

(E) They are associated with a 50% rate ofurethral tear

43. A 51-year-old man, who is hospitalized fortreatment of Pneumocystis pneumonia, is found tobe HIV seropositive. There is no family history ofkidney disease or hypertension. Temperature is38.1 C (100.6 F). Pulse rate is 102 per minute, andrespirations are 23 per minute. Urinalysis showProtein 3+; 0–2 RBCs; 0–1 WBC/hpf, and Urineprotein is 6230 mg/24 hr. Ultrasonographydemonstrate large, echogenic kidneys.What pathology feature is demonstrated in the

Kidney biopsy?(A) Postinfectious glomerulonephritis

(B) Membranoproliferativeglomerulonephritis

(C) Membranous glomerulopathy(D) Collapsing glomerulopathy(E) Minimal change disease

44. A 36-year-old woman comes to the emergencydepartment because of severe, sharp right flankpain of four hours' duration. During physicalexamination, she cannot lie because of pain.Temperature is 39.0 C (102.2 F), and pulse rate is120 per minute. The right flank is tender to deeppalpation. Leukocyte count is 18,000/cu mm.

Serum creatinine is 2.0 mg/dL. Urinalysis showsprotein 1+; 10–20 WBCs, 10–20 RBCs/hpf.Radiograph of the kidneys, ureters, and bladdershows a 1.5-cm calcific density in the area of theright mid-ureter. Both kidney silhouettes measureapproximately 12 cm pole-to-pole.Ultrasonography shows a hydronephrotic right

kidney and contracted left kidney.What is the most appropriate management for this

woman?(A) Intravenous urography(B) Intravenous ketorolac to relax the ureter(C) Intravenous fluids that allow the stone to

pass(D) Immediate percutaneous nephrostomy(E) Emergency lithotripsy

45. Normal micturition requires that the urinarybladder and the urethral sphincter work togetheras a coordinated unit to store and empty urine.Which of the following is the effect ofparasympathetic system in controlling theurinary bladder?

A. Relaxes external sphincterB. Relaxes internal spinchterC. Relaxes detrussor muscle

D. Contracts detrussor muscleE. Contracts anal spinchter

46. The parasympathetic outflow in the spinal cordoccurs at levels:

A. T3,4B. T 6-10C. S1,2,3D. S2,3,4E. L1,2,3

47. A 75 year old man had urine incontinent since 3months ago. He had been diagnosed dementia bythe doctor since 6 months ago. On examination hehad no prostate problems. What is the cause of hisurination’s problem?F. Impaired frontal inhibitionG. Impaired pontine inhibitionH. Sympathetic system dysfunctionI. Parasympathetic system dysfunctionJ. Sensoric system dysfunction

48. A 40 years old woman, body weight 50 kg, cameto emergency unit with diarrhea (frequency 8

times/day) since 2 days ago. Her urine volumewas 150 cc/12hours. She was conscious, BP85/60 mmHg, pulse 105 x/min, RR 20 x/min,temperature 36,5 C. Laboratory results: Hb 12gr%, Ht 40%, WBC 9000, Platelet 263.000, ureum104, creatinine 3,7.What is the most appropriate initial treatment for

the patient? A. Give an antibioticB. Ringer lactate infusionC. Give vasopressinD. Glucose infusionE. Oral rehydration

49. A 44 year old man was hospitalized for systemicfungi infection. He was on Amfoterisin B treatmetfor 7 days. On examination, he conscious, BP120/80 mmHg, pulse 80 x/min, RR 16 x/min,temperature 36,7 C. Lab: Hb 13 gr%, HT 37%,WBC 8600, Platelet 340.000. Urinalysis: RBC 0-1/HPF, WBC 2-5/HPF, protein (-), granular cast(+). Ureum 91, creatinin 2, 0. Volume urine 800cc/24 jamWhat is the most likely diagnosis?

A. Acute Tubular necrosisB. Acute Glomerular NefritisC. Acute Interstitial nephritisD. Acute Renal FailureE. Chronic Renal failure

50. A young woman went to a physician becausepain during urination and frequency. Onexamination, she had has suprapubic pain, butno fever. Her urine was cloudy and showsmicroscopic evidence of erythrocytes, pyuria,and gram-positive bacteria. In the past medicalhistory, she never had any symptoms like thisone. Which organism is most likely responsible

for this patient’s illness?F. Klebsiella pneumonia


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G. Pseudomonas aeruginosa

H. Escherichia coliI. Proteus mirabilisJ. Staphylococcus saprophyticus

51. Which urine specimen is most appropriate forthe culture examination for the patient above?

A. SuprapubicB. Clean catch

C. Straight catheterD. Indwelling catheterE. 24 hours urine collection

52. A pregnant woman was complaining fever, painwhen urinating, blood in her urine, and severelower back pain. The physician submits her urinefor culture; the next day, the laboratory reportsan organisms growth count of greater than10

5/ml of urine. The organism grew well on the

blood agar and producing " –hemolytic colonies.Which important virulence factor for theorganism is most likely responsible for this

patient’s illness? A. CapsuleB. P-fimbriaeC. EndotoxinD. Phospolipase CE. Lipooligopolysaccharide

53. A male patient complained of a sharp pain in hissuprapubic radiating down to his perineum,accompanied by hematuria. He reported that hehad a few days of urinary urgency, frequency,and burning when urinating. On examination, histemperature was 37,5ºC; other vital sign were

normal; and he appear to be in pain. A urinalysisshows erythrocytes, leukocytes esterase and ahigh pH.Gram stain demonstrates negative coccobacili.Which antigenic composition is most likely

responsible for this illness? A. HemolysinB. CatalaseC. FibronectinD. Opa proteinE. Cord factor

A 45 years old man comes to Siloam Hospitals with

low back pain and painful sensation when urinating. Anamnesis: he has a history of kidney stone. Physicalexamination: pallor, fluctuating pain, blood pressure140/90 mm Hg. Weight 54 kg, Height 167 cm. edemain low extremity. Lab exams: Hb 13,8 g/dL, WBC10.950 mL, Uric acid 7,5 mg/dL, Ureum 86 mg/dL,Creatinin 1,4 mg/dL.

54. What is the most appropriate nutrition for thispatient:

A. Restrict water to 1000 ml/day.B. No restriction for food consistency.

C. Drink fruit juice as much as possible.D. Patients should drink as much as possible.

E. Ask him to drink while thirst only. Choose dryfoods.

55. Protein recommendation: A. No need to restrict proteinB. Use meat based protein not from thelegumes or beansC. Limit protein high in uric Acid such asbeans, seeds

D. Limit protein 0,7 gram/kg BB

After a year he comes with weakness, nausea, musclecramp, and itchy. Physical exam: BW 52 kg, edema inboth legs and palpebras. Blood pressure 170/100mmHg. Lab exam: Hb 7,6 g/dL, Ureum 196 mg/dL.Creatinine 3,7 mg/dL. Uric Acid 11,8 mg/dL. OrganicPhosphorus 11 mg/dL, Calcium 3,4 mg/dL Sodium 147mmol/L, Potassium 5,6 mmol/L.

56. What is the most appropriate method to nourishhim:

A. Parenteral nutrition and nil by

mouthB. Give a fruit juice and add sugar.C. Give milk in enough calories.D. Temporary no fruits and giveblended vegetable.

57. About calcium phosphorus balance in this patient:

A. He needs milk fortified calcium.B. Restrict protein intakeC. Reduce meat base protein andnuts.D. Reduce protein and give high

calories.

58. A 55 year old male complains hematuria atthephysician’s office for 2 weeks.

A cystoscopic examinations showed a 2cm,exophytic,friable mass on the right bladderdome.

A biopsy of this lesion show findings mostconsistent with a/an

F. PapillomaG. Verrucous carcinomaH. Transitional carcinoma

I. Squamous carcinomaJ. Adenocarcinoma

59. A 60 year old male has had multiple recurrenturinary tract infections with 6 month history ofdysuria. Rectal toucher by his physician palpatesprostate enlargement.What is the most appropiate clinical action todiagnose carcinoma prostate ?

A. Trans rectal biopsyB. Trans urethral biopsyC. Transrectal FNABD. Rectal toucher

E. Open surgery


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60. A 50 year old male presents with a month longhistory of flank pain and hematuria.An USGabdominal results a 3 cm bosselated mass,protrudes from cortical are in the rightkidney.Cytologic examination reveals malignantcells. What is most likely biopsy finding for thispatient?

F. Wilms tumorG. Renal Cell Carcinoma

H. Transitional carcinomaI. Squamous carcinomaJ. Undifferentited carcinoma

61. A 60 year old male experiences the onzet ofheadache, naussea ,vomitting fo 1month.Physical examination revealshypertention, subfebril. Pyelogram showed theaffected kidney assymmetrically contracted withdeformity of the calyceal system. Gross of theaffected kidney showed contracted and hasirregular granular surface.The parenchyma isatrophic and replace by fibrosis. Microscopic

showed glomerular sclerosis, hyalinization andatrophi in cortical area. Another areas showedfibrosis, chronic inflammatory cells withlimpocytes agregation.What is the most likely lesions occur in thiskidney?

F. Renal cell carcinomaG. Chronic pyelonephritisH. Acute nephritisI. Nephrotic syndromeJ. Diabetic nephropathy

62. A 5 year old boy child who had a palpableabdominal mass brought to hospital by hismother . The child later had abdominal distentionfrom bowel obstruction. An USG reveals a 6 cmleft renal mass with necrosis and hemorrhage.Microscopic showed embryonal tissue withabortive of tubular and glomerular structures.What is the diagnosis ot this patient?

F. TeratomaG. RetinoblastomaH. Wilms’tumorI. HanarthomaJ. Hemangioma

63. A 62-year-old woman presents with hematuriaand left flank pain. Physical examination revealscostovertebral angle tenderness. Renalultrasound shows marked left hydronephrosis.Serum creatinine and CBC are normal.Which of the following diagnostic test is the most

relevant? A. Renal biopsyB. Renal arteriogramC. Palpation for inguinal lymph nodesD. Antinuclear antibody testE. IVP

64. A 34-year-old man comes with 3-day history oflow back pain, urinary hesitancy, and pain withurination. He has not had any urethral dischargeor recent sexual contacts. His temperature is38.2C, and blood pressure is 120/70 mm Hg.Pulse 96x/min, RR 20x/min. There is nocostovertebral angle tenderness. Abdominalexamination shows no tenderness or masses.Rectal examination shows no tender prostate

and no masses.Specific gravity 1.030; Blood negative; Glucose

negative; Ketones negative;Leukocyte esterase positiveWhat is the most likely diagnosis?

A) Benign prostatic hypertrophyB) CystitisC) ProstatitisD) PyelonephritisE) Urolithiasis

65. A 63 year old female patient came with complainof pain while urinate. She has history of

recurrent urinary infections. Physicalexamination revealed tenderness in CVA region.Urinalysis was done and radiology findingreveals large, bilateral "stag horn" calculi.What kind of stone is likely to be demonstrated

in this case?

A. Calcium oxalate stonesB. Struvite stonesC. Calcium phosphate stonesD. Uric acid stonesE. Cystine stones

66. A 55-year-old man is brought to the emergencydue to acute onset of severe right-sided flankpain. He has a 10-year history of gout. Hisblood pressure is 110/80 mm Hg, pulse is78x/min, and RR 16x/min. Examination showsnormal bowel sounds and no abdominaltenderness or masses. Urinalysis shows 40erythrocytes/hpf. Intravenous pyelographyconfirms a right ureteral calculus.Which of the following underlying mechanism isresponsible for this patient's condition?

A. An increase in urinary pH

B. Damage to the epithelial lining of theuretersC. Lack of inhibitors of crystal formationD. Presence of urease-splitting bacteriaE. Urinary supersaturation with uric acid

A 66 years old, came to Emergency Department withshortness of breath as his chief complaint. He also gotnausea, vomiting and loss of appetite since 3 daysago. No diarrhea was occurred prior to the symptoms.He was taking un regularly anti hypertension drugs for20 years. Physical exam: weight 70 kg, blood pressure

190/110, Pulse 120 times/minute, and Respiratory rate46 times/minute. Pale conjunctiva, fine crackles +/+


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were heard on the both side of the lung. Heart, liverand spleen were normal.Lab results: Hb 7.2 g/dl, WBC 7000/mm3, trombosit225000/mm3, random glucose 135 mg/dl, Ureum 150mg/dl, Creatinin 5.2 mg/dl. Proteinuria +3

67. What is the most possible causes of anemiabased on the case above?

A. B6 deficiency

B. Erithropoeitin deficiencyC. B12 deficiencyD. Iron deficiencyE. Folic deficiency

68. What is the most possible electrolyte level show? A. Phosphate decreasedB. Calcium increasedC. Potassium decreasedD. Phosphate increasedE. Normal Calcium

69. Mrs Jane 35 years old, came to Internal

Department with complain, fatigue andheadache about 1 month . In physicalexamination: pale, butterfly rash at her face,another examination in normal limit. The physiciansuspects that Jane suffers SLE.What’s the most important lab examination to

support the diagnosis:a) Complete Blood Countb) Complement fixation testc) Anti Nuclear Antibodyd) Renal function teste) Liver function test

70. According to case no 1, beside protein uria what isthe most urinalysis result in

this case :a) Glucosuriab) Leukocyte uriac) Hematuriad) Bilirubinuriae) Crystaluria

71. A 25 years old man has been crashed by a truck.The doctor suspects that his kidney is rupture, then hesent the patient to have IVP. What is the most likelythe appearance of renal parenchymal rupture in IVP?

a. The kidney shows non functionb. Ekstravasationc. Hydronephrosisd. Normal nephrogram

72. What is the most likely the appearance of renalartery rupture?

a. The kidney shows non functionb. Ekstravasationc. Hydronephrosisd. Normal nephrogram

73. A 50 years old man comes to the clinic with

complain of abdominal colic. The result of IVPdemonstrates ureteric dilatation.What is the most

likely the problem of ureteric dilatation?a. Stone in the pelvicureter junctionb. Kidney cystc. Stone in the vesicoureter junctiond. Renal cell Ca stage I

74. A 65 years old man is diagnosed with Prostateshypertrophy. What is the most likely feature appearedin cysptography?

a. Indentation of inferior aspect of bladderb. Indentation of superior aspect of bladderc. Indentation of posterior aspect of bladderd. Additional shadow of superior aspect ofbladder

75 A 45 years old woman is diagnosed with Bladderstone. What is the most likely feature appeared incysptography?a. Indentation of inferior aspect of bladderb. Indentation of superior aspect of bladderc. Filling defect in the bladderd. Additional shadow of superior aspect of bladder

1. 109 284. The consumption of oxygen by thekidney

a. Decreases as blood flow increasesb. Is regulated by erythropoietinc. Remains constant as blood flow

increasesd. Directly reflects the level of sodium

transporte. Is greatest in the medulla

2. 110 285. The anion gap will increase with an

increase in the plasma concen-tration ofa. Sodiumb. Potassiumc. Chlorided. Bicarbonatee. Lactate

3. 111 288. In the presence of ADH, the filtrate willbe isotonic to plasma in the

a. Descending limb of the loop of Henleb. Ascending limb of the loop of Henlec. Cortical collecting tubuled. Medullary collecting tubulee. Renal pelvis

4. 112 289. Sodium reabsorption from the distaltubule will be increased if there

is an increase ina. Plasma potassium concentrationb. Plasma volumec. Mean arterial pressured. Urine flow ratee. Plasma osmolality

5. 113 290. ADH will be released from the posteriorpituitary when there is a decrease in

a.Plasma Na+concentrationb.Plasma volumec.Plasma K+concentration

d.Plasma pHe.Plasma Ca2+concentration


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6. 114 291. If 600 mL of water is ingested rapidly,plasma volume will increase by approximately

a400 mLb200 mLc100 mLd50 mLe25 mL

7. 116 293. Renin secretion by the kidney isincreased by

a. Increasing mean blood pressureb. Increasing glomerular filtration ratec. Increasing sympathetic nerve activityd. Increasing angiotensin II synthesise. Increasing atrial natriuretic hormone

secretion8. 117 294. Na+is reabsorbed from the basolateral

surface of the renal epitheliala. cells byb. a Na/H exchangec. Na-glucose cotransportd. Na-K pumpe. Facilitated diffusion

f. Solvent drag9. 118 295. Which of the following is most likely to

cause an increase in the glomerular filtrationrate?

a. Contraction of mesangial cellsb. Blockage of the ureterc. Release of renin from the

juxtaglomerular apparatusd. Dilation of the afferent arteriolese. Volume depletion

10. 119 296. The daily production of hydrogen ionfrom CO2 is primarily buffered by

a. Extracellular bicarbonate

b. Red blood cell bicarbonatec. Red blood cell hemoglobind. Plasma proteinse. Plasma phosphate

11. 120. Glomerular filtration rate would bedecreased by

a. Constriction of the efferent arterioleb. An increase in afferent arteriolar

pressurec. Compression of the renal capsuled. A decrease in the concentration of

plasma proteine. An increase in renal blood flow

12. 121. A freely filterable substance that isneither reabsorbed nor secreted has a renalartery concentration of 12 mg/mL and a renalvein concentration of 9 mg/mL. Calculate thefiltration fraction (GFR/RPF).

a. 0.05b. 0.15c. 0.25d. 0.35e. 0.45

13. 122. Use the following laboratory data todetermine the GFR.

Urine creatinine concentration =196 mg/mL

Plasma creatinine concentration=1.4 mg/mLUrine flow =1 mL/min

The creatinine clearance is approximatelya. 75 mL/minb. 98 mL/minc. 125 mL/mind. 140 mL/mine. 196 mL/min

14. 123. The electrically neutral active transport ofsodium from the lumen of the kidney occurs inthe

a. Proximal tubuleb. Descending limb of the loop of Henlec. Ascending limb of the loop of Henled. Cortical collecting ducte. Medullary collecting duct

15. In metabolic acidosis caused by diabeticketoacidosis, which of the following would begreater than normal?

a. Concentration of plasma HCO3# b. Anion gapc. Arterial PCO2d. Plasma pHe. Blood volume

16. 125. Decreasing the resistance of the afferentarteriole in the glomerulus of the kidney willdecrease

a. The renal plasma flowb. The filtration fractionc. The oncotic pressure of the peritubular

capillary bloodd. The glomerular filtration ratee. None of the above

17. 126. If GFR increases, proximal tubularreabsorption of salt and water will increase bya process called glomerulotubular balance.Contributions to this process include

a. An increase in peritubular capillaryhydrostatic pressure

b. A decrease in peritubular sodiumconcentration

c. An increase in peritubular oncoticpressure

d. An increase in proximal tubular flowe. An increase in peritubular capillary

flow18. 127. Renin release from the juxtaglomerular

apparatus is inhibited bya. Beta-adrenergic agonistsb. Prostaglandins

c. Aldosteroned. Stimulation of the macula densae. Increased pressure within the afferent

arterioles

19. 128. Patients with renal insufficiency developvery high plasma concentrations of urea(uremia) because of

a. An increased synthesis of urea by theliver

b. An increased reabsorption of urea bythe proximal tubules

c. A decreased secretion of urea by the

distal tubulesd. A decreased glomerular filtration rate


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e. An increased renal blood flow20. 129 . Which one of the following statements

about aldosterone is correct?a. It produces its effect by activating

cAMPb. It produces its effect by increasing

distal tubular permeability to sodiumc. It causes an increased reabsorption of

hydrogen ion

d. It has its main effect on the proximaltubule

e. It is secreted in response to anincrease in blood pressure

21. 130 . The effect of antidiuretic hormone (ADH)on the kidney is to

a. Increase the permeability of the distalnephron to water

b. Increase the glomerular filtration ratec. Increase the excretion of Na+d. Increase the excretion of watere. Increase the diameter of the renal

artery

22. 131 . The glomerular filtration rate will increaseif

a. Sympathetic nerve activity to thekidney increases

b. The afferent arteriolar resistanceincreases

c. The efferent arteriolar resistancedecreases

d. The plasma protein concentrationdecreases

e. Urine flow through the urethra isblocked

23. 132 . Potassium-sparing diuretics inhibit

Na+reabsorption in thea. Proximal tubuleb. Thin descending limb of Henle’s loopc. Thick descending limb of Henle’s loopd. Distal convoluted tubulee. Cortical collecting duct

24. 133. Which one of the following values will beabove normal in a diabetic

a. patient with a blood glucoseconcentration of 600 meq/L?

b. Urine flowc. Intracellular volumed. Plasma sodium concentration

e. Arterial pHf. Alveolar PCO2

25. 134 . Which one of the following will beincreased in a patient suffering from persistentdiarrhea?

a. The filtered load of HCO3# b. The production of ammonia by the

proximal tubulec. H+secretion by the distal nephrond. The anion gape. The production of new bicarbonate by

the distal nephron26. 135 . Diuretics, such as acetazolamide, which

produce their effect bya. inhibiting carbonic anhydrase, inhibit

the reabsorption of sodium inb. The proximal tubulec. The thick ascending limb of Henle’s

loopd. The distal convoluted tubulee. The cortical collecting duct

27. 237. Which is a common finding in acuteglomerulonephritis?

a. Pulmonary congestion due to volume

expansionb. Hypovolemia due to tubular

dysfunctionc. Uniformly progresses to chronic renal

failure if untreatedd. Urine showing leukocytes and

eosinophils28. 238. Which finding is fairly specific for chronic

renal failure?a. Anemiab. Hyaline castsc. Broad casts in urinalysisd. Proteinuria

e. Hypocalcemia29. 239. Nephrotic syndrome is associated with

a. Excessive renal salt and water lossb. Hyperlipidemia due to lipoprotein

excessc. Bleeding due to loss of clotting factorsd. Hypothyroidism due to loss of thyroid-

binding globuline. e. The outer medullary collecting duct

30. 240. A patient with chronic renal failure will beexpected to have which of

a. the following findings due to themechanisms described?

b. Hypercalcemic due to elevated PTHhormone

c. Prolonged bleeding due to decreasedsynthesis of clotting factors

d. Anemia due to increased red celldestruction

e. Hypermagnesemia due to decreasedrenal excretion

31. 241. A high fractional excretion of sodium istypically found in

a. Heart failureb. Urinary tract obstruction

c. Acute tubular necrosisd. Acute glomerulonephritise. Hepatorenal syndrome

32. 242. Which of the following nephron segmentis correctly paired with its function?

a. Distal tubule and bicarbonatereclamation

b. Loop of Henle and potassiumregulation

c. Proximal tubule and urinaryconcentration

d. Collecting tubule and water regulation33. 243. Which of the following statements is true

in the management of acute renal failure?a. Metabolic acidosis is fully corrected


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with bicarbonateb. Hyperphosphatemia is primarily

managed with dialysisc. Low-dose dopamine is used to

shorten the duration of renal failured. Hypervolemia is managed with high-

dose loop diureticse. Hyponatremia is corrected by

administration of sodium salts

34. 244. Which of the following describes boneabnormalities in patients with chronic renalfailure?

a. Osteitis fibrosis cystica is a result ofoversuppression of PTH

b. Adynamic bone disease is associatedwith myopathy

c. Osteomalacia is due to excessiveaccumulation of magnesium

d. Hyperparathyroidism responds well to1,25 dihydroxyvitamin D

e. Amyloidosis is similar in etiology topatients who are not on dialysis

35. 245. Which one of the following statements istrue concerning hematologic disorders inCRF?

a. Resistance to erythropoietin is mostcommonly due to aluminum overload

b. Erythropoietin administration isassociated with worseninghypertension

c. The major cause of death in CRF issepsis

d. Abnormal bleeding responds best toplatelet transfusion

e. Leukocyte function is generally

unimpaired36. 246. Which of the following measures has not

been shown to retard progression of renalfailure?

a. Aggressive BP controlb. Decrease in protein intakec. ACE inhibitors above other

antihypertensivesd. Erythropoietin for anemia

37. 247. In patients with chronic renal failure,which of the following adaptations are normal?

a. Fractional excretion of sodiumincreases due to suppression of

aldosteroneb. Metabolic acidosis due to loss of

bicarbonate in the urinec. Increased potassium loss through

extrarenal mechanismsd. Decreased fractional excretion of

water due to ADH resistance38. 248. Which of the following serologic finding is

associated with linear staining of theglomerulus on immunofluorescence?

a. Anti-GBM antibodyb. Low complement immune complex

glomerulonephritis

c. ANCA associated renal diseased. Membranoproliferative

glomerulonephritis39. 249. Antineutrophil cytoplasmic antibody

(ANCA) is typically present in which systemicdisease?

a. Goodpasture’s syndromeb. Wegener’s granulomatosisc. Systemic lupus erythematosusd. Thrombotic thrombocytopenic purpura

40. 252. Prerenal azotemia is associated with

a. High fractional excretion of sodiumb. Granular casts in the urinec. Use of angiotensin-converting enzyme

(ACE) inhibitors in unilateral renald. artery stenosise. Evolution to acute tubular necrosis if

untreated41. 254. Leukocytes and white cell casts in the

urine are typically seen ina. Radiocontrast nephropathyb. Methicillin-induced renal insufficiencyc. Aminoglycoside nephrotoxicityd. Rhabdomyolysis

42. 256. Which may cause acute renal failure inpatients with nephrotic syndrome?

a. Dietary protein restrictionb. ACE inhibitorsc. Lipid-lowering agentsd. Loop diuretics

43. 264. A 25-year-old man with flank pain isfound to have three cysts in each kidney,normal hepatic and renal function, and familyhistory is not clear. He is most likely to have

a. Autosomal dominant polycystic kidneydisease

b. Autosomal recessive polycystic kidney

diseasec. Acquired cystic diseased. Medullary sponge kidney

44. 266. Which is an accurate statementconcerning diabetic nephropathy?

a. Most patients with type 2 diabetes willdevelop this problem

b. It is almost always associated withretinopathy in type 1 diabetes

c. ACE inhibition is only indicated forpatients with hypertension

d. Routine dipstick urine should beperformed to screen for early disease

45. 267. Which of the following is a secondarycause for focal segmental sclerosis?

a. Hodgkin’s diseaseb. Colon cancerc. HIV diseased. Hepatitis C infection

46. 268. A patient with Crohn’s disease passes akidney stone; the most likely

a. composition isb. Calcium phosphatec. Uric acidd. Struvitee. Calcium oxalate

47. 277. Hyperkalemia may be caused bya. Trimethoprim


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b. Albuterolc. Licoriced. Cisplatin

48. 278. A middle-aged patient with an elevatedserum creatinine, hypertension, and mildanemia comes to you for evaluation. Urinedipstick shows trace protein without red cellsor cellular casts. A 24-h urine collection

reveals 5 g of protein. The most likely etiologyis

a. Focal segmental sclerosisb. Hypertensive nephrosclerosisc. Amyloidosisd. Multiple myeloma

49. 279. Which of the following is a commoncause of isolated hematuria with isomorphicred cells in the urine?

a. Alport’s syndrome (hereditarynephritis)

b. Thin basement membrane diseasec. Idiopathic hypercalciuria

d. IgA nephropathy50. 280. A 26-year-old woman with a history of

mitral valve prolapse comes in with 1 week offever that started 3 days after a dentalprocedure. Her urine contains red cells andher rheumatoid factor is elevated. Which of thefollowing serologic abnormalities is expectedto be present?

a. Anti-GBM antibodyb. Low serum complement levelsc. Antineutrophil cytoplasmic antibodyd. Elevated IgA levels

51. 440. A 28-year-old previously healthy female,

with no medical history is now 28 weekspregnant. She complains of trouble seeing,polyuria, polyphagia, and polydipsia. What isher diagnosis?

a. Gestational diabetes mellitusb. Deep venous thrombosisc. Urinary tract infectiond. Preeclampsia

52. 4-38. A 48-year-old man presents withperipheral edema. He has been healthy andphysically active all of his life. His familyhistory is unremarkable. His blood pressure isnormal. On physical examination, the patient is

noted to have anasarca. Kidneys are notpalpable. Urinalysis reveals a moderateamount of proteinuria and “grape clusters” areseen under light microscopy. Which of thefollowing is the most likely diagnosis?

a. Glomerulonephritisb. Rhabdomyolysisc. Nephrotic syndromed. Acute interstitial nephritise. Acute tubular necrosis

53. 6-31. A 50-year-old woman complains ofleakage of urine when she laughs, coughs, or

sneezes. After stress incontinence, the mostcommon causes of this urinary leakage is

a. Detrusor dyssynergiab. Unstable bladderc. Unstable urethrad. Urethral diverticulume. Overflow incontinence

1. To elevate the kidney within the renal fasciaand the perirenal fat, the renal fascia must be

reflected or incised from the fascia of the?

A. diaphragmB. psoas m.C. quadratus lumborum m.D. transverse abdominis m.E. iliacus m.2. Young man, vomit to point where he become

hypovolemic; as evidence by anaccompanying decrease in BP and feeling oflight-headness. The kidney respond byreducing urinary volume flow, thus limiting thepotential effect of hypovolemia. increase in the

plasma level of which of the followinghormones will bring about the most dramaticdecrease in urinary volume flow rate?

A. angiotensin IIB. atrial natriuretic peptideC. PTHD. aldosteroneE. ADH3. 56 y.o. woman is diagnosed w/ small cell lung

ca. she has paraneoplastic effect from the ca,which release of an atidiruetic hormone-likeagent. which of the following is the most likely

to be seen?

A. elevated serum sodiumB. elevated serum osmolarityC. elevated urine sodiumD. elevated urine cathecolamines

4. Histological sections from an abdominal massthat was removed from a 13 month old femalereveal undifferentiated mesenchymal cell,immature tubules, and abortive glomerularformation. What is the best diagnosis for thistumor?

A. DupuytrenB. EwingC. OllierD. WarthinE. Wilms

5. A 63 y.o. woman has type II DM. PE positivefor peripheral neuropathy in the feet andnonproliferative retinopathy. Urinalysis positivefor proteinuria. which of the following treatmentis most likely to attenuate the course of renaldisease?

A. calcium channel blocker

B. ACE inhibitorC. HMG-CoA inhibitor


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D. dietary carbohydrate restrictionE. weight reduction

6. Ingesting antacids with and after a meal sothat gastric pH does not decrease below pH 6will cause a greater than normal secretion of?

A. gastrinB. secretinC. pancreatic bicarbonate

D. cholecystokininE. somatostatin

7. A 16 y.o. girl is reffered to the office becauseof chronic diarrhea and weight loss. She isexperiencing large volume watery diarrheathat is painless. The symptoms persist evenwhen she’s fasting, and there is norelationship to foods or liquids. She’s not onany medication, and there is no travel historyor other constitutional symptoms. Her PE isnormal. Which of the following is the mostlikely diagnosis?

A. partial small bowel obstructionB. partial large bowel obstructionC. osmotic diarrheaD. secretory diarrheaE. IBS

8. A 42 y.o. overweight but otherwise healthywomen present with sudden onset of rightupper abdominal colicky pain in 45 minutesafter meal of ayam goreng. Pain is associatedwith nausea and vomiting, and any attempt toeat since has caused increased pain. What isthe most likely cause?

A. gastric ulcerB. cholelithiasisC. duodenal ulcerD. acute hepatitisE. esophageal spasm

9. A 42 y.o. male, executive, complains ofabdominal pain that began about 6 monthsago, is constant in nature especially aftermeals, and located in the upper midabdomensuperior to umbilicus. He also report some“heartburn” that has been occurring during theprevious year. He as been under a lot of job-

related stress. His stool have changed in colorover the previous 2 months and now areintermittently dark and tarry in consistency.The physician test the patient stool and findoccult fecal blood. What is the most likelydiagnosis?

A. peptic ulcerB. gastritisC. Chron’s diseaseD. gastric polyp

10. A 38 y.o banker with a history of heartburnsuddenly experieces excruciating pain in the

epigastric region of the abdomen. Surgery isperformed immediately on admission to ER.

There is evidence of an ulcer, which hasruptured through the posterior wall ofduodenum. What blood vessel might besubject to erosion?

A. common hepaticB. left gastricC. splenicD. superior mesentericE. gastroduodenal

KIDNEY

54. 42 year old man, muscular weakness, mildheadache after eating salted fish. Smallamount water drink. Usual BP 100/70, Nowbecome 140/90, Na : 150 mEq/ml, K : 3,5,glucose 150. efek?

a. Increase GFRb. Increase obligatory water reabsorbtionc. Increase facultative water

reabsorbtion

d. Increase secretione. Increase aldotesteron secretion55. To cover above function (no 1), what

mechanisma. Increase cardiac outputb. Increase frekuensi heartc. Increase secretion rennind. Increase secretion ADHe. Increase secretion aldosteron

56. Factor yang mensupport prosess diatas ialaha. Filtration late of glomerulib. Active transport of tubular cellc. High osmolalitas of interstitium of

medullad. Obligatory water reabsorbtione. Osmalalitas of filtrate in distal

contortus tubulus57. Pasien dengan heart failure = low CO, perfusi

hanya organ-organ penting. Obat yang tidakbole diberikan? thiazide

58. Pasien dengan heart failure, diberi obatCloro..tiazid/mid dengan maximum dose tidakmerespon. Diberi apa?furosemid

59. Pasien diberikan riazid selama$ tahun. Efekyang terjadi! decrease kalium

60. Mountain sickness merupakan side effect ?

dari?a. czetazolamide->bukan side effect, tpprofilaksis

b. Budenamidec. Amylorided. Furosemidee. Spironolactone

61. Seorang pasien sedang menjalanipengobatan, pasien complaint Bright orange-red urine merupakan side effect dari obat?

a. Ethambutolb. Isoniazidc. Piridizone

d. Rifampisine. Streptomisin


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62. Pasien mengeluh dengan complaint(symtompgonorrhea) treatmentnya?

a. Apnofloxacinb. Nalydixic acidc. Norifloxacind. LEvofloxacin--e. Ofloxacin

63. Jaundice 1 yo, increase blirubinn. Ibunyadiberi antibiotic for UTI, baby mengalami

kernicterus ,disebabkan karena obat ! cotrimoxazole

64. 30 yo waman recurrent UTI, culture E coli dikase aprofloxacin. Penghambat apa?Dnagyrase

65. 30 yo man motor accident most anterior withinrenal sinus.! Renal vein

66. You wish examine the hilum of the left kidneyduring surgery. Which pf following structuremust be elevated. pancreas

a. Stomachb. Suprarenal glandc. Ascending colon

d. Duodenume. Liver

67. To elevate kidney within the renal fascia danperirenal fat which of following muscle

a. Diafragmab. Psoasc. Quadratus lumborumd. Transverse abdominise. Illeus

68. Laki-laki probable testicular cancer, whichlayer is the most near to testicular parenchyma

a. FS xternab. Tunica albuginea

c. FS internad. Scarpa internae. Tunica dartos

69. 18 tahun laki-laki. Dysuria for several day –UTI. Structure yang vulnerable get infection?

a. Kidneyb. Ureterc. Bladderd. Uretrae. Adrenal gland

70. 70 laki-laki – came to emergency room.Incomplete urination since 6 bulan lalu.Structure yang change?

a. Uretral pars membranosab. Uretral pars spongiosac. Uretral pars prostaticad. Uretral orificium uretra

71. During 4 weeks treatment, the urine protein +1, so the diagnosis :

a. Initial responderb. Lat responderc. Drug resistantd. Drug dependente. Remission

72. 13 years old boy comes to ER with seizure,

fever 2 weeks but has recovered, swelling inthe eyes and legs, dark urine. Unconscious ,

bp 180/120. Urine erythrocyte 20/hpf, protein+4, albumin normal. Lab finding

a. ASO decrease, dnase-b increase, c3decrease

b. ASO increase, dnase-b decrease, c3decrease

c. ASO decrease, dnase-b increase, c3increase

d. ASO increase, dnase-b decrease, c3

decreasee. ASO increase, anti dnase-b increase,

c3 decrease Anti-DNase B is a blood test to look for a substanceproduced by Group A Streptococcus, the bacteria thatcause strep throat.

73. Underlying mechanism dari pertanyaan 19 ?a. Streptococcal infectionb. Inflammation of kidney tubulec. Increase permeability of glomerulus

membraned. Small pores in podocyte permit rbc

pass throughe. Heparansulfat polysaccharide is low,

so rbc could cross the BBB74. Anak di rawat karena indirect bilirubinemia. 3

hari kemudian demam, dan diberi gentamicindan amoxicilin. Kenaikan BUN dan creatinine.

Apa mechanisme nya?a. ATNb. AINc. AKId. CKI

75. Kasus no 21 bisa terjadi karena Disebabkanoleh?

a. Iskemikb. Toxic injuryc. Drug hypersensitivityd. Immune Complex

76. 10 tahun, dysuria 5 hari yang lalu. Nosignificcant finding, urine culture E coli >100.000

a. Acute pyelonefritisb. Reflux nephropathyc. Uncomplicated UTId. Complicated UTIe. Chronic UTI

77. Which of the following factor unfavorable to

bacterial growth in patients urinea. A low pH (5,5 or


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b. Injuryc. Faild. Losse. ESKD

80. Pada orang yang mengalami Hematuria inbladder cancer,bagaimana bentuk rasasakitnya! Painless and intermitten

81. PH urine = 5. Uric acid = 8,9a. Lot of fluid + allopurinol

b. Lots of fluid + aciding agent82. 40 tahun old male. Thoracic gunwound,

hematuria. Diagnose?renal?83. Bladder injury. Mostly caused by?trauma84. Polyuria, kasih obat apa?vasopressin85. Pneumocyctis carinii.. WBC increase etc., !

post infection glomerulonefritis86. Pengaruh parasimpatis terhadap bladder !

contraction of detrusor muscle87. Parasimpatic! S2,3,4 dan cranial 3,7,9,1088. Dementia ,cant holding a pee.! frontal lobe89. Diarrhea 8 hari what the best treatment! RL

infusion

90. 44 tahun laki-laki. Systemic fungi infection onamphotericin B treatment for 7 days.Conscious, BP 120/80, pulse 80x/min, RR16x. 36,7 c, HB 13, HT 37, WBC 8600.Platelet 340.000, Urinalisis RBC (0-1), WBC(2-5), protein -, Granular cast +, Ureum 91,creatinin 2,0, urine 800/12 jam

a. ATNb. Acute glomerulonefritisc. Acute interstitial nefritisd. ARFe. CRF

91. Woman, pain during urination and suprapubic

pain, no fever, cloudy urine. Microscopichematuria, pyuria, granular +, no past history

a. Klebsiella pneumoniab. P. aeruginosac. E colid. Proteus mirabilise. S. saphroliticus

92. Which urine specimen most appropriate?Untuk culture

a. Suprapubicb. Clean catchc. Strecth catheterd. Indualing catheter

e. 24 hour urine93. UTI, beta hemolytic virulence factor

a. Capsuleb. P fimbraec. Endotoxind. Fosfolipase ce. Lipopolisaccaride

94. UTI, - gram, coccobacillus, high pH.virulencevactornya?

a. Hemolisinb. Fibronecrinec. Catalased. Cordially

e. Opaprotein

95. Pada orang yang pernah mengalami atausedang mengalami kidney stone,tindakanpreventive apa yang diperlukan agar tidakterjadi penambahan atau recurrenci dari batuginjal tersebut?

a. Restriksi air 100 mlb. Minum jus yang banyakc. Minum sebanyak-banyaknyad. Minum pas haus

e. Makan buah

96. 60 tahun, headache, nausea, vomit 1 bulan.PE : HT, subfebrile. Pyelogram showedaffected kidney asimetri contracted withdeform of calyceal system. Gross of theaffected kidney showed contacted dan hasirregular granular surface. Parenkim atropi andreplace fibrosis. Microscopi : glomerularsclerosis, hyalinisasi, atropi incortical. Anotherarea : fibrosis, chronic inflammation cell withlimfosit aggregation

a. RCC

b. Pyelonefritsc. Nefritisd. NSe. Diabetic nefropathy

97. 5 years old, pale, abdominal mass. Distentionto bowel e=obstraction. USG : 6 cm left renalmass with necrosis and hemorrhage. Micros :embrional tissue with abbortive tubular andglomerular structure! Wilms tumor

98. 62 tahun, hematuri, left flank pain. PE :costovetebral angle tender. USG : lefthydronefrosis. CN and CBC $.

a. Renal biopsy

b. R. ateriogramc. Palpasi lymph noded. ANAe. IVP

99. Renal trauma, terlindas truk, ginjal kenakerusakan. Parenkimnya rusak. Maka yangterjadi pada ginjal tersebut ialah?

a. Ginjal tidak berfungsib. Ekstravasasic. Hidronefrosisd. Normal urogram

100. Injury kena renal artery101. Pada pasien dengan pemeriksaan

Radiology menunjukkan ada pelebaran ureter,maka diperirakan batu berada di?

a. Vesikoureterb. Pelvicc ureter

102. 65, laki-laki, Ada bladder denganperbesaran prostat, kama radiografi. Gimana!

a. penonjolan dari inferior bladderb. Penonjolan dari superior bladderc. Penonjolan dari superior bladderd. Penonjolan dari posterior bladder

103. 50 tahun colic. IVP = uteric dilatation.Kenapa bisa dilatasi?

a. Stone in pelvicureter junctionb. Kedney cysts


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c. Stone in the vesicoureter junctiond. Renal cell CA stage 1

104. 45 wanita, bladder a stone.Cystography

a. Indertaion of inferior aspect of bladderb. Indertation of superior aspect of

bladderc. Filling defect in the bladder

1. 4yrs boy. Puffy eye in the morning,swellingleg, foamy urine, protein +4, serum albumin1,5. Principle management!prednison 60mg.

2. Urine sample dari +4 ke +1 selama 1 bulan.Patient responsive classification: initialresponder

3. Boy, severe diarrhea. Not full alert. Bp 80/60,pulse not palpable, RR 30, temperature38,4°C, sunken fontanele etc (moderate-severe dehydration). Distal tubular susceptibleto ischemic injury : loss of polarity redistribution of membrane protein

1. During the removal of a patient’s kidney, youwould observe which of the following as beingmost anterior within the renal sinus?a. Renal arteriesb. Renal veinc. Major calyxd. Minor calyxe. Renal pelvis

2. You wish to examine the hilum of the rightkidney during surgery. Which of the followingstructures must be elevated and reflected todo so?

a. Stomachb. Suprarenal glandc. Ascending colond. Duodenume. Liver

3. To elevate the kidney within the renal fasciaand the perirenal fat, the renal fascia must bereflected or incised from the fascia of the:a. Diaphragmb. Psoas musclec. Quadratus lumborum muscled. Transverse abdominis muscle

e. Iliacus muscle

4. Which of the following is the male homologueof the female clitoris?a. Epididimisb. Vas deferensc. Penisd. Scrotum

5. The scrotum appears to have a slightlypigmented and wrinkled appearance. What isthe explanation for this appearance?a. Hyperkeratinized squamous epithelium

b. The tunica albugeniac. The dartos fascia

d. The pampiniform plexus

6. An 18-years-old man is noted to haveprobable testicular cancer. He undergoessurgery. After incising the scrotum, thesurgeon contemplates the approach to theparenchyma of the testes. Through whichlayer must the surgeon incise to reach thetesticular parenchyma?

a. Buck’s fasciab. Tunica albugineac. Dartos fasciad. Scarpa’s fascia

7. A 66-year-old man complains of difficultyvoiding and is noted to have probable BPH.Which of the following prostatic lobes is likelyto be responsible for these symptoms?a. Anterior lobeb. Posterior lobec. Lateral lobed. Middle lobe

8. A 48-year-old man is undergoing cystoscopicexamination. As the cystoscope is placed intothe urethra through the penile portion, which ofthe following tissue surrounds the urethra?a. Prostateb. Corpus spongiosumc. Seminal colliculusd. Spinchter urethrae mucles

9. A police detective takes a scraping of somestains to be examined for alkalinephosp

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