NEPHROLOGY EXAMINATION 2012

Scenario 1.

A 45-years female admitted to hospital with flank pain on left waist since 5 days before admission, sharp pain, not radiated, accompanied by high fever, chills,
nausea and vomiting. Patients suffering from diabetes mellitus from 7 years ago, but no regular medical treatment.

From physical examination found moderately ill, overweight, aware, blood pressure is 120/70 mmHg, HR 104 x/mnt, RR 28 x/mnt, temp 38.9°C. Palpable pain on
the lumbar region, no palpable mass, and stabbing pain on left costo-vertebrae region positive.

1. What is the most likely diagnosis in this patients:

a. Ureterolitiasis

b. Acute pyelonephritis

c. Renal abscess

d. Acute cystitis

e. Acute appendicytis

2. What is the most appropriate management for this patient?

a. drink lots of water

b. Stop oral intake

c. Infusion

d. Antiinflammation

e. Empirical antibiotic

Scenario 2.

A 21-years old female comes to clinic with complaint of pain on urination since 1 week ago and had never felt before. The urine volume is enough, and yellow in
color. She had no fever. She has a history of vaginal discharge since teenager. She is sexually active.

From physical examination found painful, well nourished and aware, blood pressure 110/70 mmHg, HR 88x/min, temperature 36 ° C, RR 18 x/min. Found
palpable pain on suprapubic region, no palpable mass, there is no stabbing pain on lumbar region.

3. What is the most likely diagnosis of this case?

a. Urinary tract Stones

b. Acute pyelonephritis

c. Acute cystitis

d. Acute Glomerulonephritis

e. Pelvic inflammatory disease

4. What is the most appropriate management for this patient?

a. Bed rest

b. Infusion

c. Steroid

d. Oral antibiotics

e. Parenteral antibiotics
5. What is the most appropriate radiology examination for this case?

a. Abdominal ultrasound

b. BNO-IVP

c. BNO

d. Abdominal CT scan

e. CT urography

Scenario 3.

A 50-years old male came to the clinic with complaints of waist pain on the right side since 1 week ago, constant pain, sharp pain, accompanied by a high fever
and chills. Patient history out of stone at urination 1 month ago and has already done the installation of stents in the urinary tract by urologist. History of
hypertension for the last 5 years and treated regularly.

From physical examination the patient looks painful, well nourished, aware. Blood pressure 130/80 mmHg, HR 98 x/mnt, temp 38.4 ° C, RR 24 x/min. There is
palpable pain on right lumbar region, no balotemen, and there is a stabbing pain on right costovertebra region.

6. What is the most likely diagnosis for this case?

a. Acute uncomplicated pyelonephritis
b. Acute uncomplicated cystitis
c. Acute complicated pyelonephritis
d. Chronic pyelonephritis
e. Renal abcess
7. What is the risk factor in this case?
a. Male gender
b. Age
c. Urinary tract stone
d. Hypertension
e. Invasive urinary procedure

Scenario 4.

A 20-years old male admitted to hospital with complaint of shortness of breath since 2 days ago. He had nause and vomitted. He had been treated for edema
anasarca 1 month before admission and took methylprednisolon as medication.

From physical examination he looks severely ill and conscious. Blood pressure 170/90 mmHg, HR 102x/min, RR 28x/min, temp 36°C. He has edema on both
superior palpebra, rales on both lungs, ascites and edema on lower extremities.

Urine collection via cathether : 20 cc/h, yellow in color.

8. What is the most likely diagnosis for this patient?

a. Nephrotic syndrome
b. Nephritic syndrome
c. Hypertension
d. RPGN
e. Chronic kidney disease
9. What is the gold standard examination for this case?
a. Abdominal ultrasound
b. Kidney biopsy
c. Serum albumin
d. Lipid profile
e. Chest X-ray
10. What is the indication to initiate renal replacement therapy in this case?
a. Anemia
b. Hypertension
c. Oliguria
d. Uremic syndrome
e. Ascites