2014

FORMATIVE TEST
GENITOURINARY
TWINNING PROGRAM UKM-UNPAD 2011

FK2011
0 Error! No text of specified style in document. | FK2011 6/9/2014
June 9, 2014 FORMATIVE TEST GENITOURINARY

1. A 28 year old previously healthy woman was hospitalized because of acute onset of dysuria,
fever with chills and pain on her back and waist. Her temperature was 39.9C, BP 100/60
mmHg, PR 110
WOTF would be the most accurate diagnosis of this acute illness?
A. Acute cystitis
B. Acute glomerulonephritis (GN)
C. Acute pyelonephritis
D. Acute renal failure
E. Nephritic syndrome

2. A 58 y.o male was diagnosed as chronic renal failure presented with polyuria, thirst,
generalized weakness, dyspnea, infrequent fits & lack of concentration.
His laboratory result was:
Test Results Reference range
Serum potassium 8 mmol/L 3.5-5 mmol/L
Serum calcium 6.6 mmol/L 8.5-10.5 mmol/L
Blood urea 160 mg/dL 24-40 mg/dL
Serum creatinine 12 mg/dL
WOTF is the best option for treating this patient?
A. Anti-epileptic drugs
B. Correction of hyperkalemia
C. Correction of severe hypocalcemia
D. Correction of volume overload
E. Hemodialysis

3. An 18- yo male came with hematuria since yesterday. He had a history of sore throat 2
weeks ago. Physical exam revealed BP : 150/100 mmHg, lower extremity edema (+)
WOTF is the most likely the treatment
A. Anti-inflammatory drugs
B. Broad spectrum antibiotic
C. Diuretics agent
D. Conservative management
E. Steroid

4. A 55 y.o came with throbbing headache at the back of the head and neck since 2 years ago
especially in the morning. There is no history of head trauma or infection
Physical exam:
BMI : 30 kg/m2
BP : 160/90 mmHg, pulse 72 x/min, RR : 18x/min
Cardiac left border : 3 cm lateral to the left midclavicular line
Lab exam:
Ureum : 35 mg/dL HDL cholesterol : 30 mg/dL
Creatinine : 1.2 mg/dL triglyceride : 300 mg/dL
Uric acid : 7 mg/dL random blood sugar : 220 mg/dL
Total cholesterol : 250 mg/dL ECG : left ventricular hypertrophy

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LDL cholesterol : 160 mg/dL

According to JNC VII classification for hypertension, in which stage is this patient?
A. I
B. II
C. III
D. IV
E. V

5. WOTF cardiovascular risks that most likely occurred?

A. Diabetes mellitus and cardiomegaly
B. Dyslipidemia and diabetes mellitus
C. Dyslipidemia and left ventricular hypertrophy
D. Hyperuricemia and obesity
E. Obesity and left ventricular hypertrophy

6. WOTF complication that most likely occurred?

A. DM and dyslipidemia
B. Dyslipidemia and hyperuricemia
C. Hyperuricemia and renal dysfunction
D. LVH and diabetes
E. LVH and renal dysfunction

For question number 7 to 8, refer to scenario below :

An 18 y.o female came to outpatient clinic with palpebral edema especially in the morning, that
resolved to normal later in the afternoon. The patient also noticed that she had foamy urine.
Physical exam : other than palpebral edema : within normal limit. Laboratory exam : total
choslestrol : 380 mg/dL, triglyceride : 150 mg/dL, random blood sugar : 120 mg/dL, serum
albumin : 2.5 mg/dL, total protein : 4.5 mg/dL, urine : protein : ++++ , glucose : negative

7. WOTF is most likely the diagnosis

A. Acute nephritic syndrome
B. Diabetic kidney disease
C. Chronic kidney disease
D. Nephritic syndrome
E. Dyslipidemia

8. WOTF is the most likely nutrition management?

A. High protein and high salt
B. High fiber and plenty of water
C. Low fat and high protein
D. Water and protein restriction
E. High vitamin and low sugar

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For question number 9 to 10, refer to scenario below :

A 34 y.o male came with severe pain at the right flank region that radiates to his right
testicle for 2 hours accompanied with fever. He had similar symptom a week before but the
pain subsided. He also had a history of passing stone in the past month
Physical examination : fever, on right flank region : right kidney was not palpable, but there
was tenderness on palpation
Urinalysis : erythrocyte (+) and leucocyte (++)
Hematology : leucocytosis with normal kidney function

9. WOTF is the first diagnostic method for this patient?

A. Abdominal CT scan
B. KUB
C. Ultrasound of the urinary tract
D. Uroflowmetry
E. VCUG

10. What is the most likely diagnosis of this patient?

A. Bladder stone with complicated UTI
B. Left ureteral stone with complicated UTI
C. Right kidney stone
D. Right kidney tumor
E. Right ureteral stone with complicated UTI

For question number 9 to 10, refer to scenario below :

A 62 y.o female patient had complaint of urinary incontinence. She leaks some urine when she
was coughing and sneezing. She is the mother of 5 children.

11. WOTF that most likely the diagnosis?

A. Continuous incontinence
B. Mixed incontinence
C. Overflow incontinence
D. Stress incontinence
E. Urge incontinence

12. WOTF is the most likely management?

A. Control blood sugar
B. Giving antibiotic
C. Giving antimuscarinic
D. Pelvic floor exercise
E. Reduce body weight

For question number 13 to 14, refer to scenario below :

A 65 y.o male had a complained difficulty in voiding and felt incomplete emptying. He also had lack
of sleep due to nocturia and uncomfortable pain on his lower abdomen. Lately, he was not able to
hold his urination.

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Physical examination revealed full bladder, with tenderness.

13. WOTF is the most likely diagnosis?

A. Continuous incontinence
B. Mixed incontinence
C. Overflow incontinence
D. Stress incontinence
E. Urge incontinence

14. Which of the most likely immediate management plan?

A. Giving analgesics
B. Giving antibiotics
C. Insert the urethral catheter
D. USG examination
E. X-ray examination

For question number 15 to 17, refer to scenario below :

A 60 y.o male came with nocturia in the last month. He also noted that he urinated more frequently
and had sensation of not emptying bladder completely after finished voiding. PE only revealed
prostatic enlargement.

15. WOTF is the lost likely management plan

A. Intravenous urogram to delineate urinary tract anatomy
B. Order and histology examination of the prostate
C. Order an urinary tract ultrasound
D. Quantify the severity of LUTS using IPSS
E. TRUS guided biopsy of the prostate

16. Since the patient refused any surgery, he probable had to use long term catheterization to
urinate. WOTF catheterization type that most appropriate?
A. Coude catheters
B. Folley catheter
C. Robinson catheter
D. Straight catheter
E. Whistle-tip urethral catheter

17. WOTF pathomechanism is most likely occur?

A. Disseminated abscesses
B. Infiltration of inflammation cells around tubular glands
C. Somatic mutation
D. Excess beta reductase enzyme
E. Excess of dehydrotestosterone

18. A 6.yo boy had a lump without pain at his right scrotal region since 2 months ago. The lump
was not decreased or increased in size, and the consistency of the mass was soft. He denied

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that he had a fever during this period. His urination and defecation were within normal
limits.
A. Good, if we treat the patient by giving him diuretics
B. Bad, if we just only perform periodically needle aspiration
C. Fair, if we suggested him to wear a scrotal support
D. Good, if we perform a ligation of lest processus vaginalis
E. Good, if we perform surgical correction in an emergency situation

19. A patient has been diagnosed with recurrent bladder stones.

WOTF food intake that should be limited
A. Animal protein
B. Calcium
C. Fiber
D. Potassium
E. Pyridoxine

20. A 70 y.o male was diagnosed with end stage renal disease. He was undergoing long term
hemodialysis. WOTF is the most appropriate nutrition recommendation?
A. 35 kcal/kg/day 0.8-1 g protein/kg/day
B. 20-25 kcal/kg/day, 0.6 g protein/kg/day
C. 25 kcal/kg/day, 0.8-1 g protein/kg/day
D. 35 kcal/kg/day, 0.6-0.8 g protein/kg/day
E. Very high calorie and protein
For question number 21 to 22, refer to scenario below :

A 5 y.o boy had mass at his abdomen. His mother felt that mass suddenly while she was holding him.
Radiology examination showed that the mass came from his kidney.

21. WOTF is the most probable diagnosis?

A. Neuroblastoma
B. Nephroblastoma
C. Rhabdomyosarcoma
D. Medulloblastoma
E. Retinoblastoma

22. WOTF is the most likely microscopically appearance on his tumor?

A. Nest of cells tumor with abundant eosinophil cytoplasm and mitotics
B. Tumor cells could be composed by mesenchymal cells and blasternal cells
C. Small round blue cells tumor that rosette appearance
D. Tumor cell could be composed by only one kind of epithelial cells
E. Tumor cells have clear cytoplasm and much of mitotic

23. Autosomal-dominant (adult) polycystic kidney disease is a hereditary disorder characterized

by multiple expanding cysts of both kidneys that ultimately destroy the renal parenchyma
and cause renal failure.

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What is the best description of microscopic appearance for this condition?

A. Dilatation of Bowman’s capsule
B. Dilatation of glomerulus
C. Dilatation of renal calyces
D. Dilatation of renal corpuscles
E. Dilatation of tubules

24. A 50 y.o woman, diabetes mellitus patient, was also diagnosed as chronic pyelonephritis.
WOTF microscopic appearance is the best description of for her condition?
A. Patchy intestinal suppurative inflammation
B. Intratubular aggregates of neutrophils and tubular necrosis
C. Suppurative inflammation through the renal capsule into the perinepric tissues
D. The tubules show atrophy in some areas and hypertrophy or dilatation in others
E. Accumulation of foamy macrophages intermingled with plasma cells

25. A 68 y.o male came with difficulty to urinate. DRE showed enlargement of the prostate
approximately 50 gram, no nodule nor tenderness. PSA was 3 mg/dl. TURP was performed
and the tissue sample was sent to pathology laboratory for examination. The microscopic
finding was shown in below picture. What is the structure pointed by white arrow?
A. Basal cells
B. Columnar cells
C. Corpora amylacea
D. Fibromuscular stroma
E. Spermatocytes

For question number 26 to 27, refer to scenario below :

A 60 yo male had left upper abdominal discomfort associated with hemturia.
On a plain photo abdomen there was inhomogenous opacity with multiple small calcifications at the
level of left twefth thoracic spine to the third lumbar spine, the contour was lobulated.
26. WOTF non invasive imaging examination that most preferable
A. Antegrade pyelography
B. CT scan
C. Intravenous urography
D. Retrograde pyelography
E. Ultrasound

27. WOTF imaging examination is most appropriate to determine the organ function and
diagnosis
A. Antegrade pyelography
B. CT scan
C. Intravenous urography
D. Retrograde pyelography
E. Ultrasound

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28. A 50 y.o female had taken her random urine specimen to the lab for a glucose analysis. The
test result was negative. The physician unsure with the result due to her clinical symptoms
and the family history of diabetes mellitus
WOTF urine specimen type is more accurate for her?
A. 24-hour
B. 2-hour postprandial
C. First morning
D. Random test
E. Three-glass collection

For question number 29 to 31, refer to scenario below :

The following lab results were obtained from 5 y.o boy with smelling of his whole body.
Urinalysis :
Color : light yellow Nitrite : negative
Appearance : cloudy urobilinogen : postive
pH :6 blood : negative

serum ;
urea N : 20 mg/dl ; creatinine : 0.8 mg/dl

29. WOTF conditions is the most possible cause of the color of his urine?
A. The nephron excretion of blood-borne
B. The nephron excretion of albumin
C. The glomerulus excretion of blood-borne
D. The glomerulus excretion of ureum
E. The glomerulus excretion of albumin

30. WOTF lab examination is most likely needed

A. Glucose levels of urine
B. Nitrite levels of urine
C. protein levels of urine
D. bilirubin levels of urine
E. Ketone levels of urine

31. What is the purpose of serum creatinine and urea N examination in this case?
A. To diagnose the renal insuffciency of the disease
B. To determine guidance theraphy of the disease
C. To perform prognosis
D. To follow up disease
E. To determine the complication of the disease

32. Result of urinalysis on a very anemic and jaundiced patient are as follows :

Color : Red SP Gravity : 1.620

Clarity : Clear pH : 6.0

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Proteine : Negative Bilirubin : Negative

Glucose : Negative Urobilinogen : High

Ketones : Negative Nitrite : Negative

Blood : 4+ Leukocytes : Negative

Microscopic : RBC negative, WBC negative, Casts negative

Why is urine bilirubin result negative in this jaundiced patient?

A. Biliary obstruction
B. Kidney damage
c. Liver damage
d. The circulating bilirubin is conjugated
e. The circulating bilirubin is unconjugated

33. An 8-year old boy presents with red-colored urine. His urinalysis as follows:

Color : Red Ketones : Negative

Clarity : Clear Blood : 3+

SP Gravity : 1.015 Bilirubin : Negative

pH : 6.5 Urobilinogen : Normal

Protein : 3+ Nitrite : Negative

Glucose : Negative Leukocytes : Negative

Microscopic : erythrocyte = >100 per HPF almost all dysmorphic. Red cell casts present.

What is the most likely diagnosis in this case?

a. Bladder stone

b. Cystitis

c. Glomerulonephritis

d. Lower urinary tract bleeding

e. Urinary tract infection

For questions number 34 to 38, refer to options below:

A. Bowman's capsule

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B. Proximal convoluted tubule

C. Loop of Henle

D. Distal convoluted

E. Collecting duct

34. Filtrate production - blood pressure forces small solutes, water, ions from blood into capsule

35. Reabsorption of water, ions, and all organic nutrients

36. Reabsorption of water (descending limb) - Reabsorption of Na+ and Cl- (ascending limb)

37. Secretion of ions, acids, drugs, toxins

38. Variable reabsorption and secretion of water, Na+, K+, HCO3

For questions number 39 to 43 refer to options below:

A. Hypernatremia
B. Hypokalemia
C. Hyperkalemia
D. Hypocalcemia
E. Hyponatremia

39. Anorexia, nausea, vomiting, headache, lethargy, muscle weakness, twitching, tremors, and seizures

40. Thirst, sticky mucous membranes, lethargy, restlessness, oliguria, irritability, pulmonary edema

41. BP, anorexia, nausea, vomiting, deep tendon reflexes, fatigue, muscular weakness and cramps, peristaltis,
ileus

42. bradycardia and other arrhythmias, nausea, diarrhea, anxiety, muscle weakness, numbness or prickly
sensation

43. muscle cramps and tremors, tetany, bronchospasm, carpopedal spasm, deep tendon reflexes, prolonged
Q-T interval on ECG, positive chvostek’s and trousseau’s signs

44. A patient has suffered from persistent diarrhea lasting for the past seven days. WOTF would be increased
in this patient?

A. The filtered load of HCO3

B. The production of ammonia by the PCT
C. H+ secretion by the distal nephron
D. The anion gap
E. The production of new bicarbonate by the distal nephron

For question number 29 to 31, refer to scenario below :

An 11 y.o boy came to the emergency room with pain on micturition since 3 hours ago.
There was also dysuria and oligouria. There was a history of jengkol ingested.

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45. WOTF diagnosis is appropriate for the boy?

A. Lower urinary tract infection (UTI)

B. Post-renal AKI
C. Pre-renal AKI
D. Renal AKI
E. Upper urinary tract infection (UTI)

46. WOTF factor is most dominant factor to the pathogenesis?

A. Associated with genetic factor

B. Preparation with another food
C. The amount of jengkol consumed
D. The individual susceptibility factor
E. The way of jengkol served

47. WOTF laboratory and imaging examination is most important to diagnose the above disease?

A. Calcium level
B. Fresh specimen urine
C. Plain abdominal x-ray
D. Serum creatinine level
E. Ultrasound of the kidney

For question number 48 to 50, refer to scenario below :

A 7 y.o boy came with bloody urine since 3 days ago.
On physical examination he was alert, BP140/100 mmHg.
There was Also swelling on both palpebra.
Urine examination revealed a lot of red blood cells, erythrocyte cast, protein (+), and leukocyte
Blood examination showed mild anemia.

48. WOTF treatment is the most appropriate in this condition?

A. Angiotensin converting enzyme inhibitor

B. Antibiotics like penincillin
C. Diuretics
D. Vasodilator
E. Β-blocker

49. There was a history of sore throat 1 week before. WOTF infectious agent is the most possible to precede
the disease of the patient?

A. Chlamydia trachomatis
B. Meticillin resistance staphylococcus aureus
C. Pseudomonas sp.
D. Serratia spp
E. Streptococcus β-haemolyticus

50. WOTF mechanism is the most appropriate cause to explain the anemia of the patient?

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A. Diminishing production od erythropoietin

B. Hematuria
C. Hemodilution
D. Iron deficiency
E. Kidney infection

For question no. 51-52

A 2-month old boy came with complaint of fevr, chills, poor feeding, and increasing of urinary frequency. PE:
body temperature 38.9o C. LE: Hb 15.9 g/dl, WBC count: 18000/mm3, thrombocyte: 140000/mm3, urine: WBC
15-20/hpf, RBC: 5-7/hpf, nitrite test +

51 which of the following treatment is the best choice for the best patient

a. Amoxicillin per oral

b. Ampicillin iv
c. Cefixime per oral
d. Ceftriaxone iv
e. Sulfametoxazole trimetoprim per oral

52 which of the following bacteria is the most possible found in this patient urine

a. E.coli
b. Klebsiella
c. Pseudomonas aeruginosa
d. Staphylococcus aureus
e. Streptococcus beta hemolyticus group A

For question no.53-54

a 32 y.o man married came with single painless erosion on his penile shaft since one week ago. He confesses
that he often had sex intercourse with prostitute without condom. At venerological exam there is single
erosion, diameter 1cm, with buldging edge, and clean base. There are not any papules, warts, nor discharge

53 what is most likely diagnosis

a. Syphilis
b. Chancroid
c. Genital herpes
d. Lymphogranuloma venereum
e. Aphtous ulcer

54 what is the best direct lab exam to establish the diagnosis of the case

a. Giemsa staining
b. Ziehl nelson staining
c. KOH exam
d. Specimen collection for culture
e. Dark field microscopic exam

55 what is the drug choice for this patient

a. Ketoconazole

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b. Amoxicillin
c. Metronidazole
d. Penicillin
e. acyclovir

56 a 60 y.o male has been diagnosed as urge incontinencia for a month.what kind of exercise is the best for
this patient

a. abdominal muscle strengthening

b. pubococcygeus strengthening
c. iliopsoas muscle strengthening
d. gluteus medius strengthening
e. hip adductor muscle strengthening

57 a surgeon want to perform nephrectomy.what is the correct order to approach the kidney from the back?

a. Muscle fascia – pararenal fat – renal fascia – perirenal fat – capsule

b. Muscle fascia -perirenal fat – capsule - pararenal fat - renal fascia
c. Muscle fascia - perirenal fat - renal fascia - pararenal fat - capsule
d. renal fascia - pararenal fat - renal fascia - perirenal fat - capsule
e. renal fascia - perirenal fat – capsule - pararenal fat - renal fascia

For question no.58-59

A 45 y.o. man came with dull pain in his right back. The pain has been going on and…usually last for about 20-
30 minutes. PE: costovertebral angle percussion (+)

58. which is the right statement regarding the organ involved in the case?

a. It’s a paired organ lies retroperitoneal in the pelvic cavity at the level of…
b. It’s an ovoid organ lying on either side on diaphragm
c. The organ lies medial to the adrenal gland and inferior to the ureter
d. The organ lis on either side of vertebral column in retroperitoneal
e. The anterior border of the organ is psoas muscle and ureters

59. which arterial branch supplies the organ above

A. Abdominal aorta
B. Pulmonary artery
C. External iliac artery
D. Common iliac artery
E. Celiac trunk

60 from sentence below which are the correct statement for ureteric constriction

(1) The junction of renal pelvis and ureter

(2) Crossing the brim of pelvic inlet
(3) The passage through urinary bladder
(4) Crossing the internal iliac artery
(5) The passage through kidney capsule

A. (1), (2)
B. (2),(3)

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C. (4), (5)
D. (1),(2),(3)
E. (3),(4),(5)

61. After cesarean section, a 35-year old woman complained difficulty of urination, pain when micturition and
hematuria after 3 days. From the x ray and the other symptom, the doctor diagnosed there is rupture at the
fundus of the bladder. Where is the possible location for uterine extravasation?

A. Extraperitoneal cavity
B. Intraperitoneal cavity
C. Rectouteine pouch
D. Retropubic space
E. Retzius space

62. An anatomies is doing pelvic and abdominal exploration on male adult cadaver. He found hollow viscous in
the lesser pelvic. The apex points toward superior aspect of pubic symphisis. It is only covered by peritoneum
on its superior surface. What other caracteristic would the anatomies find in this organs?

A. It is separated with the rectum on its posterior site by the rectovesical pouch
B. Its posterior wall consist of detrussor muscle
C. Its base located on the posterior, opposite of its apex
D. The organ has 4 surfaces and 2 major part
E. The organ is in this tensible

For questions number 63-64, refer to this scheme below:

1. Kidney

2. Abdominal ureter

3. Pelvic ureter

4. Urinary bladdder

5. Urethra

63. What organs does the prostatic venous plexus drain blood from

A. 2
B. 3
C. 1,2
D. 4
E. 1,3

64. What organ does the uterine artery (in female) and inferior vesicle artery (in male) supply

A. 1
B. 2
C. 3
D. 4
E. 2,3

65. Which of the following arrangement is correct for renal vascularization?

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A. Renal arteries - interlobar arteries - interlobular arteries - arcuate artery - afferent arteriole
B. Renal arteries - lobar arteries - lobular arteries - segmental arteries - arcuate arteries - efferent
arteriole
C. Renal arteries - lobar arteries - segmental arteries - arcuate arteries - lobular arteries - afferent
arterioles
D. Renal arteries - segmental arteries - lobar arteries - lobular arteries - arcuate arteries - efferent
arteriole
E. Renal arteries - segmental erteries - interlobar arteries - arcuate arteries - interlobular arteries -
afferent arterioles

66. The surgical resident will performing left adrenalectomies. It was the first time for him to do, so the most
identified vessel that supply the gland he found one vessel joined with the left suprarenal vein before empties
into the renal vein. Which of the following is most likely vein?

A. Hemozigous
B. Left 2nd lumbar
C. Left testicular
D. Left inferior phrenic
E. Left 1st lumbar

67. Ureteric colic can cause pain with the pattern from loin to groin. The pain is refered to the cutaneous area
that innervated by spinal cord. Which of the following is the correct segment involved ?

A. T1-T2
B. T2-T3
C. T4-T5
D. T6-T7
E. T11-L2

68. Examination of a newborn male infant revealed the urethra was opened on the ventral surface of the
ventral surface of the penile at the junction of the shaft of the glands. Which of the statement explain this
condition ?

A. Failure of fusion of urogenital fold

B. Adequate production of androgen
C. Failurw of fusion canalization glandular
D. Complete formation of the spongy penile
E. Adequate receptor site for the hormone

69. A 10-year-old boy suffered severe pain in his left groin while attempting to lift a heavy box. Later be
noticed a lamp in his groin . Physical examination was done he was diagnosed with indirect inguinal hernia.
Which of the following explain the occurence of this condition ?

A. Vaginalis processus developed dorsal to the gubernaculums

B. Vaginalis processus developed ventral to the gubernaculums
C. Gubernaculum descended from the superior poll of the gonad
D. Gubernaculum descended from the posterior poll of the gonad
E. Gubernaculum was degenerated from metanephros

70. A 62 year old woman is brought to the emergency room in a stateof confusion, unable to answer questions
coherently, and exhibits tachypnea. The laboratory results are listed below :

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Plasma findings : Arterial blood findings :

[ Na+] : 144 mEq/L pH : 7.17

[K+] : 4,4 mEq/L pCO2 : 25 mmHgq

[Cl-] : 107 mEq/L Ketonemia is not present

[HCO3-] : 9 mEq/L

In this case, what is the primary abnormality ?

A. Bicarbonate excess
B. Bicarbonate deficiency
C. CO2 excess
D. CO2 deficiency
E. Sodium ion deficiency

71. After the long and hard exercise, the body mantain the water balance into the physiological condition.
Wbat is the most likely mechanism in kidney ?

A. Excretion of water by the kidneys

B. Retention of water by the kidneys
C. Prevention of water filtration in glomerulus
D. Reabsorption of Na-K in glomerulus
E. Feedback mechanism to the hypothalamus to stimulate thirst

72. Which of the following mechanism is important in the renal excretion of hydrogen ion ?

A. Combining of hydogen ion and bicarbonate via the enzyme carbonic anhydrase
B. Combining of hydrogen ion with chloride ion to form hydrochloric acid
C. Trapping of hydrogen ion by ammonia to form ammonium ions
D. Trapping of hydrogen ion by acetate
E. Secreting of sulfate and hydrogen ions as sulfate acid

73. The function of a kidney is to remove the metabolism products that can be used as an indicator of a kidney
disease. In kidney dysfunction which of the following substance will be increased in the blood ?

A. Urea
B. Glucose
C. Albumin
D. Phosphate
E. CO2

74. A 4 year old boy is brought to the department of pediatric complaining of general swelling. His face tends
to be swollen in the morning, and the ankles are swollen latter in the day. The lab findings shows:

Urine: RBC 2-3/hpf ; WBC 3-4/hpf ; protein +4

serum urea N : 10 mg/dL

Which of the following is the most likely cause of hypoalbuminemia in this patient ?

A. Disturbance of electronic gradient in the glomerulus

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B. Protein leakage due to damageof glomerulus

C. Increased protein loss in oroximal tubules
D. Decreased protein absorption in distal tbules
E. Infection in glomerulus

75. A 43 year old male, presented with right flank pain, which was gradually increased, sharp, colicky, and
spread down to the right testical. Investigation results where as follows :

Fist test (+) at right CVA.

Laboratory revealed microscopic hematuria and a lot of "back of envelope" crystal in the urine.

KUB : radio opacity at 3rd right lumbar paravertebral, 10 x 7 mm in size. He was diagnosed with renal calculi.
The most possible composition of this calculi is

A. Cystine
B. Struvite
C. Uric acid
D. Calcium oxalate
E. Calcium phosphate

For questions number 76-78, refer to scenario below :

A patient was diagnosed with acute kidney injury due to dehydration.

Laboratory examination showed :

Hb 15.6 gr%, hematocrit 50%, serum urea 180 mg%, creatinine 5,3 mg%, serum potassium 7 mEq/L, sodium
145 mEq/L. BGA : pH 7.25, HCO3 : 7 mEq/L. Urine analysis normal. Stool analysis : few leukocytes. ECG : tall
and peak T wave and widening QRS complex.

76. Which of the following condition explin the high potassium level in the patient ?

A. Increased reabsorption of potassium in the kidney

B. Reduced potassium filtration in the kidney
C. hemoconcentration
D.decreased urine production
E. activation K Na ATPase

77. Which of the following condition most likely occured in this patient ?

A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Decreased urine production
E. Both metabolic and respiratory acidosis

78. Which of the following structure secrete ammonia (NH4+) in above condition ?

A. Proximal tubule
B. Loop of henle
C. Distal tubule

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D. Collecting tubule
E. Calyces wall

79. Carbonic anhydrase is found abundantly in this part :

A. Proximal tubule
B. Loop of henle
C. Distal tubule
D. Collecting tubule
E. Calyces wall

For question number 80 to 81, refer to scenario below:

A 18 year-old female came with left flank pain, chills, and increased urinary frequency. Gram negative rods are
cultured from her urine

80. The most possible etiology is:

A. Chlamydia trachomatis
B. Leptosira interogans
C. E. coli
D. S. saprophyticus
E. S. aureus

81. The major defense of the urinary tract against this infection is:

A. Urethral gland secretions

B. Alkaline urine
C. Urine flow
D. Colonization resistence
E. The vesicourethral sphincter

82. Urine samples for bacterial culture to diagnose urinary tract infections should be processes immediately,
because

A. The main cause of urinary tract infections are the anaerobic bacteria
B. The bacteria could be autolysed
C. Urine could contaminated in preservation
D. The number of bacteria would raised in urine
E. Urine could change the color in preservation

For question number 83 to 84, refer to scenario below:

A 20 year-old male came with 24 hour history of dysuria and noted some “pus-like” drainage in his underwear
and the tip of his penis. He had a history of being sexually active with 5 different partners in the past 6 months.
Physical exam was significant for a yellow urethral discharge and tenderness at the tip of penis. A Gram-stain
was done in the small lab of the clinic.

83. What do you observed microscopically?

A. Gram positive cocci

B. Gram positive rods
C. Gram negative diplococcic

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D. Gram negative rods

E. Spiral bacteria

84. Which of the following can be used as selective media for culture the etiologic agent of the disease?

A. Blood agar
B. Chocolate agar
C. Mac Conkey agar
D. Thayer Martin agar
E. Mueller Hinton agar

85. A 65 year-old man develops dysuria and hematuria. A Gram stain of urine sample shows Gram negative
rods. Culture of the urine on Mac Conkey agar reveals lactose-negative colonies without evidence of swarming.

Which of the following organism is the cause of his symptoms

A. Chlamydia trachomatis
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Proteus mirabilis
E. Enterococcus faecalis

86. A 20 year-old female student presented with left flank tenderness and low-grade fever. ……….. shows
microscopic evidence of erythrocyte, pyuria, and abundant gram-positive bacteria. …….. urinary trac infection.

Which organism is most likely responsible for the condition?

A. Candida albicans
B. Enterococcus faecalis
C. Streptococcus pyogens
D. Neisseria gonorrhoeae
E. Staphylococcus saprophyticus

87. A 60 year-old man came to the outpatient clinic for medical follow up. He noted as hypertensive and type 2
DM patient for the last 2 years in medical record. On physical examination found blood pressure 160/90
mmHg, no abnormality on PE and laboratory examination. The doctor prescribed oral antidiabetic and ACE
inhibitor for him.

Which of the following drug is most likely?

A. Valsartan
B. Atenolol
C. Captropil
D. Hydralazin
E. Diltiazem

88. A 62 year-old man came to the doctor for routine follow up his disease. BP was 160/90 mmHg, HR 76 bpm.
Randomized blood glucose level was 140 g/L. He is given nifedipine.

What is the most possible side effect of the drug?

A. Decrease blood glucose level

B. Orthostatic hypotension

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C. Cardiac depressant
D. Hyperkalemia
E. Palpitation

89. A 70 year-old man came to the outpatient clinic for routine check up his condition. On physical
examination found blood pressure 170/110 mmHg taken in the dominant arm in the seated position, and this
is unchanged after 5 minutes of rest. Other systems within normal limits.

What are the most likely appropriate drugs?

A. Diltiazem + Nifedipin
B. β-blocker + diltiazem
C. β-blocker + verapamil
D. β-blocker + centrally acting drug
E. Ca-channel blocker + ACE inhibitor

For question number 90 to 91, refer to scenario below:

A 7 year-old boy was brought to the hospital due to red cola urine and legs edema. Physical examination
showed blood pressure 120/80 mmHg, edema palpebral +/+, leg +/+. Urinalysis revealed protein ++, no other
abnormality.

90. He is given furosemide. What is this rug?

A. β adrenoreceptor blocker
B. Vasodilator
C. Diuretics
D. Ca-channel blocker
E. ACE inhibitor

91. The patient was given a drug but his blood pressure remains high.

What is the most appropriate drug should be added?

A. α-blocker
B. β-blocker
C. Vasodilator
D. ACE inhibitor
E. Ca-channel blocker

92. Mr. Joni is diagnosed as hypertension and was given an antihypertensive drug, but he gets coughing after
he took that drugs. Which of the following is drug that was given to him?

A. Captropil
B. Propanolol
C. Clonidine
D. Amlodipine
E. Verapamil

93. A 70 year-old men came to the doctor for routine follow up his disease. Blood pressure was 170/90 mmHg,
HR 76 bpm. Randomized blood glucose level was 140 g/L. He is given nifedipine.

What is the most possible side effect of the drug?

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A. Hyperkalemia
B. Hyperglycemia
C. Extremities edema
D. Cardiac depressant
E. Orthostatic hypotension

94. A 63 year-old woman came to the Primary Health Care with pulsative headache. Physical examination
revealed blood pressure 160/90 mmHg, heart rate 104 bpm, no other abnormality.

Which of the appropriate drug for her?

A. α-blocker
B. β-blocker
C. ACE inhibitor
D. Angiotensin receptor blocker
E. Ca-channel blocker

95. The attachment of the renal fascia determines the path of extension of perinephric abcess.

Which of the following direction is the most correctly way to continue pasting the pus?

A. Inferiorly toward the pelvis

B. Laterally into the body wall
C. Medially across the midline to other kidney
D. Superiorly into contact with the fascia of the diaphragm
E. Anteriorly into the peritoneum

For question number 96-100, refer to options given below:

All about the epithelium in urinary system

A. Simple squamous
B. Simple cuboidal
C. Simple columnar
D. Stratified squamous non keratinized
E. Transitional

Which of the statement below correspond to above epithelium?

96. Distal convoluted tubule

97. Ascending thin limb of Henle’s loop

98. Macula densa

99. Minor calyx

100. Urethra

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