2014 - GUS System

DIVISI AKADEMIK PROXIMA
MULTIDICIPLINARY EXAMINATION
GENITOURINARY SYSTEM
2017
1. A 50-year-old man has a history of chronic alcoholism and has been vomiting constantly over the past
two weeks. You order ABG test and find that the bicarbonate level is elevated at 45 mEq/L; the arterial
pH is 7.62.
All of the following are major mechanism explaining the abnormal bicarbonate level, EXCEPT
a. Increased H+ secretion in the cortical collecting duct
b. Increased HCO3- generation in the descending limb of loop of Henle*
c. Increased HCO3- reabsorption in the proximal tubule
d. Increased HCl loss into the upper gastrointestinal tract
2. A 7-year old boy was brought by her parents to the hospital with edema for 3 days and oliguria for a day.
Three weeks before his admission, he had a sore throat. Tests showed the following: body weight was
24 kg, blood pressure was 135/90, urine dipstick tests RBC +++, proteinuria +++, the creatinine level was
2.3 mg/dl, and the blood urea nitrogen was 300.6 mg/dl. His serum albumin level was 2.41 g/dl. A blood
sample was collected for bacteria identification.
The result showed ASO level was 1207 U/ml. What is the bacteria causing this disease?
a. Streptococcus pneumonia
b. Streptococcus pyogenes
c. Staphylococcus aureus
d. Staphylococcus epidermidis
e. Escherichia coli
3. Twenty two years old male presenting with right scrotal pain extending to the right inguinal region for
36 hours administered to outpatient Urology clinic. Physical examination revealed right testicular
tenderness and hyperemia in scrotal skin. Assessment with color Doppler ultrasonography (CDU)
demonstrated anheterogenious right testis and vascularity was diminised in the body of testis but
increased in the peritesticular area. Left testis was normal.
What might become an emergency in this case?
a. Epididymitis
b. Infected hydrocele
c. Testicular torsion
d. Orchitis
e. Scrotal abscess
4. A 2-year old boy has a curved penis with urethral opening at the ventral mid shaft of the penis. What is
the most likely abnormality other than the curved penis and abnormal ventral urethral opening?
a. Inflammation of glans penis
b. Constricting preputial ring
c. Dorsal hood preputial skin
d. Redundant ventral preputial skin
e. Discharge from urethral opening
5. A 56-year-old female has hypertension for two years and type II diabetes mellitus for seven years. She
has diabetic nephropathy and peripheral neuropathy. She is on oral glimepiride for diabetes and
hydrochlorthiazide for hypertension. Two years ago, bloodtest showed : Glucose 170 mg/dl, Na+ 140
mEq/l, K+ 5.3 mEq/l, HCO3- 16 mEq/l, BUN 18 mg/dL, creatinine 1.3 mg/dL. Urine analysis showed
specific gravity of 1.015, pH 5, proteinuria -, glycosuria 2+. She came visit you today with BP 148/88
mmHg, HR 76 x/mnt, ronkhi -/-, lower extremity deem +.Now her creatinine is increased to 1.7 mg/dl.
Urine analysis shows a specific gravity of 1.005 pH 5, proteinuria 1+and trace glycosuria. 24 hours urine
shows 1,2 gram of protein.
What is your recommendation for this case?
a. Stop the thiazide diuretic
b. Avoid ACE-inhibitors given the acute renal failure
c. Optimise the blood pressure
d. Place the patient of a high protein diet
e. Observation, stricter control of her diabetes mellitus will not help delay the progression of her kidney
disease
6. A 6-year-old girl complaining of bedwetting and having difficulty to control micturition.

What is the most important data to assist us in diagnosing this patient?
a. Urinary WBC
b. Urinary protein
c. Urinary osmolality
d. Urinary sodium and potassium
e. Urinary specific gravity
7. A 43 year-old male with a history of inflammatory bowel disease came to you with complain of dull pain
on his right flank. On IVU examination there is a radio-opaque stone in the pyelum with the size 20 X 10
mm.
What is the most common calculi composition in this patient?
a. Calcium diphosphate
b. Calcium monophosphate
c. Calcium oxalate
d. Struvite
e. Uric acid
8. A 66-year-old man complains of difficulty voiding and is diagnosed benign prostatic hyperplasia. Which
of the following prostatic lobes is most likely to be responsible for these symptoms?
a. Anterior lobe
b. Posterior lobe
c. Lateral lobe
d. Middle lobe
e. Inferior lobe
9. A 68-year-old male came to the outpatient clinic because of difficulty to urinate. Digital rectal
examination 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 Epithelial cells
c. Corpora amylacea
d. Fibromuscular stroma
e. Spermatocytes
10. A 5-year-old boy admitted to Padjadjaran Teaching Hospital with chief complaint of swelling on whole
body. Since 4 days before admission there was swelling on eyelids in the morning. Micturition 0.8
mL/kgBW/h. On physical examination: Alert, vital sign within normal limit. Swelling on eyelids. Shifting
dullness on abdominal percussion.
Laboratory examination:
Urine: protein +++, WBC: 0-1, RBC: 0-1.
Blood: Ureum: 20 mg/dL
Creatinine: 0.6 mg/dL
What is the most important data to assist us in diagnosing this patient?
a. Cholesterol
b. Albumin
c. CASTO
d. Triglyceride
e. Apolipoprotein
11. A 56 years old male underwent surgery for his prostate cancer with histopathological Gleason score 3+4.
Three years later he develop back pain that getting worse after sitting for a long time. PSA and alkaline
phospatase level were increase. Lumbosacral and pelvic x-ray show no abnormalities.
What information do you expect from further work up?
a. Osteolytic lesion on CT scan
b. Spinal cord or soft tissue abnormalities on MRI scan
c. Neural compression on myelography
d. Slow electrical conduction on electromyography
e. Osteoblastic lesion on bone scan
12. A 5-year-old boy was brought by his mother to hospital with complained mass at his abdomen. His
mother felt that mass suddenly while she was holding him. Imaging examination showed that the mass
came from his kidney.
What is the best description of microscopic appearance for that patient tumor?
a. Nest of cells tumor with abundant eosinophil cytoplasm and mitotics
b. Tumor cells could be composed by mesenchimal cells and blastemal cells
c. Small round blue cells tumor that rosette apparence
d. Tumor cell could be composed by only one kind of epithelial cells
e. Tumor cells have clear cytoplasm and much of mitotic
13. During the fourth to seventh weeks of development the cloaca divides into the urogenital sinus anteriorly
and the anal canal posteriorly.
The ventral portion of the urogenital sinus forms ___________.
a. Proximal urethra of males
b. Proximal urethra of females
c. Urethra of males
d. Bladder of female only
14. A 41-year old woman came to a clinic with headache. She wasknown to have hypertension since 2 years
ago. Since that, she never consulted again to any doctor nor took any medicine.
In physical examination, his blood pressure is 160/100 mmHg, the others are normal. The thorax is
normal; there is no edema in the legs.
The doctor gave her captopril and HCT for 2 weeks.
Preparations Available
Hydrochlorothiazide : 25, 50, 100 mg tablets
After 2 weeks of treatment, her blood pressure is normal. However, she is having cough. What is the
most appropriate suggestion?
a. Change captopril with losartan
b. Reduce the captopril dosage to prevent its side effect
c. Do not change the dosage, but give her antitussive drug
d. Change HCT with furosemide
e. Change HCT with spironolactone
15. Which of the following statements best describe syphilis?

a. Specimen is taken from urinary tract.
b. Microscopy examinations using Gram-staining.
c. Culture is the gold standard for diagnosis.
d. Specimen is obtained from blood.
e. VDRL/RPR and TPHA are serologic examinations needed for diagnostic.
16. Seventy years old man complain left upper abdominal discomfort associated with hematuria.On plain
photo abdomen there is in homogenous opacity with multiple small calcifications at the level left twelfth
thoracic spine to third lumbal spine, the contour is lobulated.
The best examination of the disease is:
a. Intravenous urography
b. Antegrade pyelography
c. Retrograde pyelography
d. Ultrasound
e. CT Scan
17. A 12-year-old boy was admitted to the hospital because of hematuria. He had a history of impetigo 2
weeks earlier. Physical examination showed hypertension, edema and flank pain. He biopsy of his
kidney.
What condition is shown by the white arrow?
a. Endothelial necrosis
b. Endothelial proliferation
c. Podocytes proliferation
d. Tubular epithelial proliferation
e. Tubular epithelial proliferation
18. Which of the following statements is true for urine sample collection?
a. Sample should be collected in the middle of the night.
b. Patients should wash their hands with soap prior to urine collection.
c. Use narrow tube for better measurements.
d. Patients should wash their genitals with soap before collecting urine.
e. Sample can be sent to the laboratory after 24 hours.
19. A 57-year-old man came to hospital with chief complained a mass at his flank. He also complained
sometimes he got bloody urination for several weeks ago. Biopsy was performed, the microscopic
appearance showed nest of tumor cells which have clear cytoplasm with papillary and trabecular
structure, small nuclei but pleomorphic, and abundant of mitotic.
What is the best diagnosis for this patient?
a. Wilm’s tumor
b. Transitional cell carcinoma
c. Adenocarcinoma
d. Clear cell carcinoma
e. Papillary carcinoma
20. Pyelonephritis is a renal disorder affecting the tubules, interstitium and renal pelvis and is one of the
most common diseases of the kidney. One of the type of pyelonephritis is chronic pyelonephritis.
What is the best description of microscopic appearance for this condition?
a. Patchy interstitial suppurative inflammation
b. Intratubular aggregates of neutrophils, and tubular necrosis
c. suppurative inflammation through the renal capsule into the perinephric tissue
d. The tubules show atrophy in some areas and hypertrophy or dilation in others
e. Accumulation of foamy macrophages intermingled with plasma cells
21. A 50-year-old man was suffered from right back pain that radiated to his right lower abdomen. A medical
doctor examined him physically and laboratory and diagnosed the old man as having urinary stone.
Detailed history taking revealed that this old man experienced pain in his lower middle abdomen
frequently for the last 2 months. The doctor gave him a recipe and advised him to drink a lot and to
urinate immediatelly if he felt the urgency.
If the doctor wanted to know the old man's kidney function, which of the following test was most likely
be chosen?
a. Urinalysis
b. Renal USG
c. Renography
d. BUN and blood creatinine
e. KUB X-ray of the abdomen
22. A 45 year old woman complained of recurrent pain in her flank that radiates to the right abdomen. It
was her third visit, the first two occasion, she received pain medication and the complaint resolved within
a week. This time you suggested ultrasonography, and it revealed hyperacoustic shadow at the level of
pelvic inlet.
Which of the following is the most suitable regarding arterial supply of the organ?
a. It is supplied by the ureteric artery
b. It is supplied by inferior renal artery and the parabladder artery
c. It is supplied by various branches depending on the level
d. It is supplied by a branch of common iliac artery
e. It is supplied by the ureteric and inferior renal artery
23. twenty two years old male presenting with right scrotal pain extending to the right inguinal region for 36
hours administered to outpatient Urology clinic. Physical examination revealed right testicular
tenderness and hyperemia in scrotal skin. Assessment with color Doppler ultrasonography (CDU)
demonstrated anheterogenious right testis and vascularity was diminised in the body of testis but
increased in the peritesticular area. Left testis was normal.
Which nuclear medicine procedure might help to diagnose the case?
a. Testicular perfusion imaging using Tc-99m pertechnetate
b. Testicular perfusion imaging using Tc-99m DMSA
c. Infection imaging using In-111 labeled leucocyte
d. Radionuclide cystography using Tc-99m sulphur colloid
e. Renography using Tc-99m MAG-3
24. A young man 45 years old came to your practice complains of an uncontrolled high blood pressure. His
last blood pressure measurement was 160/110 mmHg. This was obtained by a nearby clinic a week ago.
He used to take hypertension drugs before such as: amlodipin 5mg once daily and a bisoprolol fumarate
5 mg once daily, both taken orally. Because of his ankle swelling, he stopped the medications 2 weeks
ago worry about heart failure symptoms. A diabetic family history was noted, his mother died of diabetes
complications and was on haemodialysis. Sometimes he complains also of eating big portion of food ,
always hesitate to go to the toilet 6-7 times a day with a foamy urine and always feeling thirsty. He
smoked 5 cigaretes a day. And his bodyweight is 45 kg even he ate a lot. Used to have a body weight of
70 kg.
What are the risk factors of you patient despite of having hypertension ?
a. Smoking, obesity, chronic renal failure
b. Smoking, hypercholesterol, obesity
c. Smoking, heart failure, diabetes
d. Smoking, obesity, hypercholesterol
e. Smoking, diabetes, suspected renal involvement
25. A 35 year-old man has a troublesome hydrocoele that requires surgery.

In making an incision to correct a vaginal hydrocoele, which one of the following layers will be the last to
be incised before the fluid in the hydrocoele is reached?
a. Cremasteric fascia
b. External spermatic fascia
c. Internal spermatic fascia
d. Parietal layer of the tunica vaginalis
e. Tunica albuginea
26. In the glomerular filtration membrane, erythrocytes are generally prevented from entering the filtrate
at the level of the:
a. Fenestrated endothelium
b. Basal lamina
c. Slit diaphragm
d. Basal lamina and slit diaphragm
27. Please find the correlation with the options given.

Variable reabsorption and secretion of water, K+, Na+, H+, HCO3-
a. Bowman’s capsule
b. Proximal convoluted tubule
c. Loop of Henle
d. Distal Convoluted
e. Collecting Duct
28. A 62-year-old man is brought to Emergency Unit with severe headache since 2 hours ago. He also has
blur vision at the same time. It begins after he forgot taking his short-acting nifedipine. In the physical
examination, his blood pressure is 270/170 mmHg and heart rate is 110 x/min. Blurring optic discs with
indistinct margin are seen on ophthalmologic examination.
The doctor gives him intravenous drip of sodium nitroprusside and lowering his blood pressure until
targeted pressure.When he is stable, the doctor gives him amlodipine, a calcium channel blocker, and
bisoprolol, a ß-adrenergic receptor blocker by daily dosage.
What is the advantage effect of those oral combinations for his hypertension?
a. Bisoprolol can reduce the effect of aldosteron increasing
b. The decreasing of sodium excretion from amlodipine can be handled by bisoprolol
c. The increasing of heart rate from bisoprolol can be prevent by amlodipine
d. Bisoprostol can block the increasing cardiac contractility of amlodipine
e. Amlodipine can inhibit the renin releasing of bisoprolol
29. A 35-year-old male is brought into the Emergency Room with a pelvic fracture following a traffic accident.
He has damage to his urethra and some urine leaks into his deep perineal pouch.
Which of the following structures lies within the deep perineal pouch?
a. Bulbourethral gland
b. External anal sphincter
c. Internal urethral sphincter
d. Ischiocavernous muscle
e. Perineal body
30. A 56-year-old male underwent surgery for his prostate cancer with histopathological Gleason score 3+4.
Three years later he develop back pain that getting worse after sitting for a long time. PSA and alkaline
phospatase level were increase. Lumbosacral and pelvic x-ray show no abnormalities.
What is the most possible working diagnosis for the case?
a. Myelopathy
b. Bone metastasis from prostate cancer
c. Osteoporosis
d. Spondylitis
e. Vertebral disk herniation
31. During the fourth week of development, this organ located in the cervical region represented as 7-10
solid cell groups and then they disappeared.
Which stage of kidney systems will be developed afterwards?
a. Pronephros
b. Mesonephros
c. Metanephros
d. Collecting System
e. Excretory System

Reabsorption of Na+ and Cl-
c. Loop of Henle
e. Collecting Duct
33. A 48-year-old man is undergoing cystoscopic examination. As the cystoscope is placed into the urethra
through the penile portion, which of the following tissues surrounds the urethra?
a. Prostate
b. Corpus spongiosum
c. Seminal colliculus
d. Sphincter urethrae muscles
e. Corpus cavernosum
34. A 56 years old male patient diagnosed with Chronic Kidney Disease Stage 5 non HD with PEM. Body
weight 50 kgs and height 175 cms.
How much protein do the patient need?
a. 20 grams/day
b. 30 grams/day
c. 50 grams/day
d. 60 grams/day
e. 75 grams/day
35. Mr. Adrian, a 22-year- old man came to Puskesmas Jatinangor with chief complaints of ulcer on his penile
shaft since 1 week ago. History taking showed positive sexual contact (genito-genital) with his girlfriend
without condom. Serological testing showed VDRL 1/32 and TPHA reactive. What is the most likely diagnosis
for Mr. Adrian?
a. Durum ulcer
b. Mole ulcer
c. Decubitus ulcer
d. Secondary syphilis
e. Gumatous syphilis
36. A 60-year-old man was admitted to the hospital because of symptoms of episodic weakness, polydipsia, and
polyuria over the past 2 weeks. Vital signs on admission were blood pressure 136/95 mm Hg; heart rate 80
bpm; respirations 13/min. Significant serum results on admission were K+3.1 mEq/L (normal 3.5-5.0 mEq/L);
aldosterone 45 ng/dL (normal 7-30 ng/dL). A computed tomography scan showed bilateral adrenal
hyperplasia.
Which of the following drugs was most likely included in the therapeutic regimen of this patient?
a. Hydrochlorothiazide
b. Mannitol
c. Furosemide
d. Nitroprusside
e. Spironolactone
37. A 36-year-old man came to the outpatient clinic because of hematuria. Cystoscopy was performed and
revealed an irregular erythematous mucosa of the bladder. Biopsy was performed and microscopic finding
was shown in below picture, the mucosa of the bladder was lined by transitional epithelium, the morphology
of the cells was normal. The transitional epithelium grow inward into lamina propria and arranged in
glandular like fashion. The surrounding stroma infiltrated with inflammatory cells, congestion of the
capillary and edema were also seen.
What is the most appropriate condition occuring in this patient bladder?
a. Cystitis cystica
b. Cystitis glandularis
c. Normal condition
d. Papilloma
e. Urothelial carcinoma
38. A 65-five-year old man has suffering Diabetes mellitus since 10 year ago. He come to emergency room with
his complains dyspnea, nausea, vomiting and edema. Physical examination showed blood pressure was
180/100 mmHg, Respiratory Rate 30 time/minute and deep, conjunctiva anemic and edema anasarca.
Laboratory showed Hb 8,5 gr/dl creatinine 8 mg/dl and BUN 120 mg/dl.
Which of the following condition due to uremic acidosis in this patient?
a. Increase albumin synthesis
b. Increase skeletal muscle breakdown
c. Decrease release cortisol
d. Increase Insulin-like growth factor-1
e. Decrease Skeletal muscle breakdown
39. An 18-year-old male with hematuria since yesterday gave a history of sore throat two weeks ago. Physical
examination revealed BP: 150/100 mmHg, bilateral edema of the lower extremities (+).
Which of the following is the best treatment for the patient?
a. Anti-inflammatory drugs
b. Broad spectrum antibiotics
c. Diuretic agent
d. Conservative management
e. Steroid
40. In the cross section of an embryo shown above, which indicated structure gives rise to many of the elements
of the urogenital system in the adult?
a. 3
b. 4
c. 5
d. 6
41. A 20-year-old man was admitted to the hospital due to acute urinary retention.
Which one of the following is true about the use of saline solution for filling balloon foley catheter?
a. Causes the balloon to float on top of the urine resulting in poor drainage
b. Can contain impurities and bacteria
c. It is use for filling balloon folley catheter
d. Can damage catheter material
e. Can cause crystallizing in the inflating channel
42. A 23-year-old man came to the emergency department 3 hours after he met with an accident on his way to
the office. He said his right back was hit by the handle of a motorcycle. An hour later, he experienced bloody
urine. The surgeon examined him and scheduled for a surgery to remove the ruptured organ.
Which of the following sequence of layers from outermost to innermost that protects the ruptured organ?
a. Muscles – paranephric fat – renal fascia – perinephric fat – renal capsule
b. Muscles – renal fascia – paranephric fat – renal capsule – perinephric fat
c. Muscles – paranephric fat – perinephric fat – renal fascia – renal capsule
d. Renal fascia – muscles – perinephric fat – renal capsule – paranephric fat
e. Paranephric fat – muscles – perinephric fat – renal capsule – renal fascia
43. A 50 years old male patient come to the clinic with flank pain. The CVA pain are positive. The abdominal
posterior x-ray image revealed that there are opaque appearance in the left and right calix major. The
patient then diagnosed by urolithiasis. For the dietary management, the doctor advice to restrict meat
consumption.
In this patient, what mineral are avoided regarding to the diet management advice?
a. Uric acid stones
b. Struvite
c. Calcium oxalate
d. Calcium phosphate
e. Cystine
44. An 18-year-old female came to outpatient clinic with palpebral edema especially in the morning, which
resolved later in afternoon. The patient also noticed that she had foamy urine. Besides palpebral edema,
other physical examinations were normal.
Total cholesterol: 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.
Which of the following is the best nutritional 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
45. A 60-year-old woman was admitted to emergency with loss of conciousness and rapid breathing. She was
known to have DM since 10 years ago. She didn't take her medicine regularly. Three days ago, she
complained about painful voiding and fever. She felt nauseated and vomited once. Physical examination
reveals: BP 90/60 mmHg, HR=pulse = 120 x/m, R= 30x deep, temp 38 oC. Her laboratory results Hb 12, 1
g/dl; L 25500/mm3; Tr 320000; BUN 100 mg/dl, creatinine 6 mg/dl; Na 128 meq/L, K 8 meq/L, ; BGA : pH
7,1, pCO2 20 torr, HCO3- 15 meq/L, BE - 10 , Sat O2 98%. Urinalysis results: pH 4, leukocytes: full of HPF;
erythrocytes 1-3.
What is the diagnosis from her BGA?
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis
e. Respiratory metabolic acidosis
46. What do the uterine/fallopian tubes develop from?

a. Mullerian duct
b. Sinus duct
c. Round ligament
d. Gubernaculum
e. Wolffian duct
47. A 39-year-old woman complains of hematuria and severe flank tenderness. She has a history of kidney
stones. A CT scan depicts the abdominal portion of the ureter lying anterior to a muscle. Which of the
following is most likely to be the name of this muscle?
a. Psoas
b. Serratus anterior muscle
c. Obturator muscle
d. Rectus muscle
e. External oblique muscle
48. A 3-year-old boy came to the emergency department with oliguria, his parents said he hasn't been urinating
for the past day. His leg and feet also become swollen.
Which of the following is the most common cause of acute kidney injury in children?
a. Nephrotic syndrome
b. Acute nephritic syndrome
c. Diarrhea
d. Hemolytic uremic syndrome
e. Anemia
49. A 28-year old female came to your clinic. Her main complaint was dysuria. Urine sample was collected and
microbiological examinations were performed. There were Gram-negative rods found by microscopic
examination. Kligler-Iron-Agar tests were yellow slant, yellow butt, H2S negative, gas positive. After culture,
quantitative test resulted > 105 CFU.
What is the bacteria causing the disease?
a. Pseudomonas aeruginosa
b. Shigella flexneri
c. Escherichia coli
d. Proteus sp.
e. Salmonella typhii
50. Mrs Dini, a 25-year-old pregnant woman came to Puskesmas Jatinangor with results of serological test VDRL
1/32 and TPHA reactive. She does not have any skin lesion but did the test because her husband has ulcer
on his penile shaft with VDRL 1/64 and TPHA reactive. The skin test result on this patient showed positive
reaction to benzathine penicillin.
What is the most appropriate therapy for Mrs. Dini?
a. Benzathine penicillin G 2,4 million units IM, in a single dose.
b. Benzathine penicillin G 7,2 million units IM, total administered as 3 doses of 2,4 million units IM each at
1-week interval.
c. Erythromycin 4x100mg/day for 30 days.
d. Doxycycline 2x100mg/day for 30 days.
e. The patient should be desensitized and treated with penicillin
51. A 30-year old female with chief complaint of dysuria came to your clinic. Urine sample was collected and
microbiological examinations were performed. Microscopy examinations shows Gram-positive cocci. There
were growths of white colonies on blood agar, and more than 105 cfu were documented after colony
counting. Biochemical tests: catalase positive, coagulase negative, DNAse positive.
What is the most likely bacteria causing this disease?
a. Streptococcus pyogenes
b. Streptococcus pneumoniae
c. Staphylococcus epidermidis
d. Escherichia coli
e. Staphylococcus aureus
52. A 42-year-old male came to the emergency because of pain at his left flank that radiate to his left testicle.
The pain come suddenly and colicky in nature. On physical examination, there is tenderness on the left flank.
Laboratory examinations are unremarkable except for hematuria on urinalysis.
What is the most probable cause of his symptoms?
a. Concentration of 2 ions at solubility products
b. Concentration of 2 ions above formation products
c. Concentration of 2 ions below solubility products
d. Concentration of 2 ions at undersaturated region
e. Concentration of 2 ions above undersaturated regions
53. A 45 years old woman complained of recurrent pain in her flank that radiates to the right abdomen. It was
her third visit, the first two occasion, she received pain medication and the complaint resolved within a
week. This time you suggested ultrasonography, and it revealed hyperacoustic shadow at the level of pelvic
inlet.
Which of the following most probably describes the organ in question?
a. The ureter is a pair of organ that extends from the apex of kidney intraperitoneally
b. It is 25 cm long, run inferiomedially at the level C7-T12
c. The abdominal part of the ureter runs in the lateral edge of the psoas major
d. The surface marking of the ureter is a line joining a point 15 cm lateral to the L2 spinous process and the
posterior superior iliac spine
e. The organ has two other possible constrictions at the uteropelvic junction and the entrance to bladder
54. What does the filtration barrier in the kidney consists of?
a. The glomerular capillary endothelium, glomerular basement membrane and the epithelial podocyte and
a high polyionic charge and electrical charge
b. The glomerular capillary endothelium, glomerular basement membrane, the epithelial podocyte and the
proximal tubule epithelium and basement membrane
c. The glomerular capillary endothelium and the glomerular basement membrane
d. The glomerular capillary endothelium, glomerular basement membrane, the epithelial podocyte and
associated mesangium
e. Glomerular basement membrane and the epithelial podocyte and a high polyionic charge and electrical
charge
55. During the removal of a patient's kidney, which of the following structure is the most anteriorly located
within the renal sinus?
a. Renal arteries
b. Renal vein
c. Major calyx
d. Minor calyx
e. Renal pelvis
180/100 mmHg, Respiratory Rate 30 time/minute, conjunctiva anemic and edema anasarca. Laboratory
showed Hb 8,5 gr/dl creatinine 8 mg/dl and BUN 120 mg/dl.
Which of the following factor influences of Renin Release?
a. Efferent arteriolar stretch
b. Sodium delivery to macula densa
c. Parasympathetic neural tone
d. Potassium delivery to macula densa
e. Calcium delivery to macula densa
showed creatinine 8 mg/dl and BUN 120 mg/dl.
a. Antibody mediated formation of Immune Complex with endogenous and exogenous antigen.
b. Antibody does not mediate formation of immune complex with endogenous and exogenous antigen.
c. Antibody has not effect direct toxicity to cell in glomerulus.
d. Autoantibody produce component of glomerular basal membrane (GBM).
e. Antibody does not activate alternative complement pathway.
reveals : BP 90/60 mmHg, HR=pulse = 120 x/m, R= 30x deep, temp 38 oC. Her laboratory results Hb 12, 1
g/dl; L 25500/mm3; Tr 320000; BUN 100 mg/dl, creatinine 6 mg/dl.;; Na 128 meq/L, K 8 meq/L, ; BGA : pH
7,1, pCO2 20 torr, HCO3- 15 meq/L, BE - 10 , Sat O2 98%. Urinalysis results: pH 4, leucocytes : full of HPF;
erythrocytes 1-3.
Which of the following is most likely the ECG pattern showed from this patient?
a. Bradycardia
a. Peak and tall T wave
b. Inverted T wave
c. ST segment elevation
d. High pitch R wave
doctor examined him physically and laboratory and diagnosed the old man as having urinary stone. Detailed
history taking revealed that this old man experienced pain in his lower middle abdomen frequently for the
last 2 months. The doctor gave him a recipe and advised him to drink a lot and to urinate immediately if he
felt the urgency.
What kind of kidney stone do you think is most likely in the doctor's mind?
a. Calcium phosphate stone
b. Calcium oxalate stone
c. Uric acid stone
d. Struvite stone
e. Cystine stone
60. Which of the following statements is most likely CORRECT for hypospadia?
a. Circumcision is not a contra indication
b. Circumcision is not advisable before definitive surgery
c. Best operated beyond six year old
d. Estrogen hormone play a role in producing micropenis in hypospadia
e. The etiology is single : hormonal
without condom. Serological testing showed VDRL 1/32 and TPHA reactive.
What is the most likely laboratory examination that can be performed to establish the diagnosis?
a. Gram stain from ulcer specimen shows “school of fish”
b. Gram stain from ulcer specimen shows “railway track”
c. Gram stain from ulcer specimen shows motile spirochete
d. Dark field microscope examination on ulcer specimen shows “school of fish”
e. Dark field microscope examination on ulcer specimen shows motile spirochete
62. All about the epithelium in urinary system:

Which of the statement below correspond to above epithelium?
Urethra
a. Simple Squamous
b. Simple cuboidal
c. Simple columnar
d. Stratified squamous non-keratinized
e. Transitional
63. A 34-year-old man comes to the primary health care to consult about his blood pressure. His blood pressure
reading over the last few months were 148/82, 140/78, 149/88, and 150/77.
Which of the following statement is the most likely true?
a. Because his age and diastolic blood pressure is normal, there is no necessity to treat him
b. His mean pulse pressure is about 100 mmHg
c. He has a statistically higher chance of developing end stage renal disease myocardial infarction over his
lifetime than someone with an averange blood pressure of 120/70 mmHg
d. Given his age, it is more likely that he will have secondary rather than essential hypertension
64. A 45-year-old male came to the ER with the dyspnoea. He also suffered watery diarrheoa associated with
weakness and oliguria for the last 4 days.
The blood gas analysis result showed:
pH : 7.27 (N : 7.35-7.45)
PaCO2 : 27 mmHg (N :35-45 mmHg)
HCO3- : 10 mEq/L (N :22-26 mEq/L).
Which of the following best describe the process of compensation in this patient?
a. Secretion of H+ into the tubular fluid
b. Hypoventilation
c. Reabsorption of the phosphate
d. Hyperventilation
e. Reabsorption of the bicarbonate
65. In which part of the kidney are mesangial cells of the kidney located?
a. Juxtamedullary region
b. Macula densa
c. Capsular space
d. Glomerulus
e. Urinary pole
66. In this tubule, almost 100% of glucose and amino acids are reabsorbed by sodium facilitated cotransport:
a. Proximal convoluted tubule
b. Thin descending segment of Henle’s loop
c. Thin ascending segment of Henle’s loop
d. Thick ascending segment of Henle’s loop
e. Early distal tubule

Ascending thin limb of Henle's loop
a. Simple Squamous
b. Simple cuboidal
c. Simple columnar
d. Stratified squamous non-keratinized
e. Transitional
68. A patient complains of urinary incontinence after a long, difficult vaginal birth. The pelvic floor muscles
were injured altering the position of the neck of the bladder.
Which muscle was most likely injured?
a. Levator ani
b. Piriformis
c. Obturator internus
d. Obturator externus
e. Coccygeus
69. In this tubule new bicarbonates are made:

e. Intercalated cells in late distal tubule and collecting tubule
70. Convulated tubule because of intection

71. In this tubule , potassium is reabsorbed but then excreted again via leakage channels
72. Renal agenesis may result when

a. The ureteric bud fails to reach the metanephric mass
b. Benzathine penicillin G tered ach at 1-week interval.
c. The two ureteric buds fuse in the midline prior to kidney migration
d. The mesonephric duct persists and maintains its attachment to the cloaca
e. The urorectal septum fails to partition the cloaca
73. A 65-year-old man comes to the clinic complaining of inability of urinating since more than a day
accompanied with lower abdominal pain. Upon examination, it is revealed that his suprapubic region is
enlarged with tenderness upon palpation. He was diagnosed with urinary retention due to benign prostatic
hyperplasia
Which of the following best describes the organ that stores the urine?
a. In females it is located posterior to the vagina
b. In males it is located inferior to the prostate
c. It is covered by double layer of serous protective layer
d. It is separated from the pubic bones by the space of Retzius
e. When empty, it is located in the greater pelvis
74. A 4-year-old female child comes with complaint of fever, chills, increase of urinary frequency, and
bedwetting. Gram negative rods were present in her urine culture.She had this complaint for several times
since she was two years old. From radiologic examination there was abnormality in urinary voiding with
moderate ureter dilatation.
Which of the following is the most possible diagnosis in the patient?
a. Enuresis
b. Simple urinary tract infection
c. Nephrotic syndrome
d. Acute nephritic syndrome
e. Complicated urinary tract infection
75. A 47-year-old woman come toa clinic after her hospitalized caused by CRF. She feels more comfortable
after taking her medicines. By some reasons, she could not go to the hospital, while her medicines can only
enough until this afternoon. She does not know the drug's name.
In the physical examination, her blood pressure is 150/90 mmHg and heart rate is 90 x/min.
Herpast lab result (a week ago) is following: serum potassium (K+) level of 5.6mmol/L, normal serum
bicarbonate, and normal renal function. His fasting glucose level was 106 mg/dl.
What drug combinations should be avoided for her hypertension?
A. Bisoprolol+ amlodipine
B. Losartan + spironolactone
C. Captopril + furosemide
D. Propanolol + furosemide
E. Nifedipine + HCT

Secretion of ions, acids, drugs, toxins
A. Bowman’s capsule
B. Proximal convoluted tubule
C. Loop of Henle
D. Distal Convoluted
E. Collecting Duct
77. What does the serum creatinine level predict?

A. Kidney function
B. Glomerular filtration rate
C. Renal Tubular disturbance
D. Renal pelvic disturbance
E. Renal stones formation
In physical examination, his blood pressure is 160/100 mmHg, the others are normal. The thorax is normal;
there is no edema in the legs.
Preparations Available:
If she were pregnant, why you should stop the captopril?
A. Might cause severe hypotension to the mother
B. The risk of fetal anuria
C. Cause proteinuria to the fetal
D. Cause fetal hyperkalemia
E. Disturbance of fetal growth
79. The kidney, initially in the pelvic region, later shifts to a more cranial position in the abdomen. This ascent
of the kidney is caused by diminution of body curvature and by growth of the body in the lumbar and sacral
regions.
When does the definitive kidney become functional during embryonic development?
A. Beginning of the 4th week
B. Week 7
C. Week 8
D. Near the 12th week
E. Week 9
80. An 18-year-old man is diagnosed to have testicular cancer. He underwent surgery. After incising the
scrotum, the surgeon contemplates the approach to the parenchyma of the testes. What is the most
probable layer the surgeon must incise to reach the testicular parenchyma?
A. Buck's fascia
B. Tunica albuginea
C. Dartos fascia
D. Scarpa's fascia
E. Tunica vaginalis
81. 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.
What is the best description of microscopic appearance for this condition?
A. Dilatation of Bowman capsules
B. Dilatation of glomerulus
C. Dilatation of renal calyces
D. Dilatation of renal corpuscle
E. Dilatation of tubules
82. A 63-year-old man with a long history of heart failure was admitted to the emergency department because
of severe dyspnea and edema in his legs, thighs, and lower abdominal wall. The lab results on admission
included a glomerular filtration rate of 20 mL/min.
A diuretic with which of the following mechanism of act ion would be appropriate to relieve the edema in
this patient?
A. Blockade of Na+ reabsorption in the proximal tubule
B. Blockade of Na+ channels in the collecting tubule
C. Blockade of Na+/K+/2Cl- symport in the loop of Henle
D. Inhibition of aldosterone actions in the collecting tubule
E. Blockade of Na+/Cl- symport in the early distal tubule
83. A 10-year boy came to a clinic because of his whole body swelling. The body swelling had appeared since 5
days ago. It was progressively worsening. Firstly, his palpebral was looked swell on the morning but
disappear on afternoon. He didn't have any dark urine. There is no fever before.
In the physical examination, his height was 136 cm and his weight was 45 kg. His vital sign was normal. He
was edematous. There is no abnormality in the thorax. The abdomen looked distance with shifting dullness.
Pitting edema was founded in both legs.
The laboratory showed abnormality in some parameters including albumin is 1.5 gr/dl, cholesterolis 420
mg/dl, and LDL is 354 mg/dl. Urinalysis : urine is yellow and cloudy, pH 6.2; protein 4+; glucose -; bilirubin -
; urobilinogen -; sediment containing many oval fat bodies, no RBC'S and WBC's
In pharmacological therapy, The doctor gave him high dose of prednisone, and furosemide.
What is the most rational precaution while using prednisone in this patient?
A. Used no longer than 4 weeks to prevent adrenal suppression
B. Used lower dose to prevent Cushing's syndrome
C. Routine ranitidine used to prevent peptic ulcer
D. Tapering off the prednisone dose before stop
E. Potassium and magnesium level monitoring
84. A 4-year-old girl presents with nephrotic syndrome. A renal biopsy performed. There are no abnormal
findings on light microscopic or immunofluoresence examination.
Which of the following findings with electron microscopy is most likely in this biopsy?
A. Subepithelial electron-dense lumps
B. Reduplication of glomerular basement membrane
C. Areas of thickened and thinned basement membrane
D. Increased mesangial matrix
E. Effacement of podocyte foot processes
85. A 5-year-old boy was brought by his mother to hospital with complained mass at his abdomen. His mother
felt that mass suddenly while she was holding him. Imaging examination showed that the mass came from
his kidney.
What is the most probably diagnosis for this patient?
A. Neuroblastoma
B. Nephroblastoma
C. Rhabdomyosarcoma
D. Medulloblastoma
E. Retinoblastoma
86. A 55-year-old woman came with throbbing headache and pain on the back of the neck since 3 months ago,
especially in the morning. There was no history of head trauma or infection.
Physical examination:
BMI : 30 kg/m2
BP : 160/90 mmHg, PR: 72x/min, RR: 18x/min
Cardiac left border: 3 cm lateral from the left midclavicular line
Ureum : 35 mg/dL
Creatinine : 1,2 mg/dL
Uric acid : 7 mg/dL
Total cholesterol : 250 mg/dL
LDL cholesterol : 160 mg/dL
HDL cholesterol : 30 mg/dL
Triglyceride : 300 mg/dL
ECG : left ventricular hypertrophy
Which of the following complication would most likely occur in this patient?
A. Diabetes mellitus and dyslipidemia
B. Dyslipidemia and hyperuricemia
C. Hyperuricemia and renal dysfunction
D. Left ventricular hypertrophy and diabetes
E. Left ventricular hypertrophy and renal dysfunction
87. A 28-year-old woman was hospitalized because of acute onset of dysuria, fever with chills and pain on her
back and waist. Her temperature was 39.9oC, BP: 100/60 mmHg, Pulse rate: 110 bpm.
Which of the following 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. Nephrotic syndrome
BMI : 30 kg/m2
Ureum : 35 mg/dL
Uric acid : 7 mg/dL
Which of the following cardiovascular risks would most likely occur in this patient?
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
89. A 13-year-old male comes with complaint of dark urine. He has a history of bacterial infection on his skin
about 3 weeks ago. On physical examination,he was somnolent, no seizure, blood pressure 150/90 mmHg,
swelling on both eyelids.
Which of the following is the most common complication of this disease?
A. Pleural effusion
B. Congestive heart failure
C. Myocarditis
D. Pericardial effusion
E. Cardiac arrhythmia
90. A 36-year-old man came to the outpatient clinic because of hematuria. Cystoscopy was performed and
revealed an irregular erythematous mucosa of the bladder. Biopsy was performed and microscopic finding
was shown in below picture, the mucosa of the bladder was lined by transitional epithelium, the morphology
of the cells was normal. The transitional epithelium grow inward into lamina propria and arranged in
glandular like fashion. The surrounding stroma infiltrated with inflammatory cells, congestion of the
capillary and edema were also seen.
If metaplasia intestinal occur in the epithelial lining of the above case, what is the most appropriate
condition in this patient?
A. Cystitis cystica
B. Cystitis glandularis
C. Normal condition
D. Papilloma
E. Urothelial carcinoma
erythrocytes 1-3.
Which of the following is the most likely reason for this patient to have deep and rapid respiration?
A. To rapidly release CO2
B. To rapidly release HCO3-
C. To rapidly release urine
D. To keep CO2 inside blood stream
E. To keep HCO3-
92. What is the normal interpretation test result of urine microscopic examination for leucocyte?
A. Less than 5 cells/ high power field
B. More than 6 cells/ high power field
C. More than 5 cells/ high power field
D. Between 8 until 10 cells/ high power field
E. Less than 6 cells/ high power field
Minor Calyx
A. Simple Squamous
B. Simple cuboidal
C. Simple columnar
D. Stratified squamous non keratinized
E. Transitional
94. Regarding development of external genitalia:

A. The urethral folds unite in male to give rise to the scrotum
B. The genital swelling remain apart in female to form the labia majora
C. The labia minora of female are homologous of the scrotum of male
D. The female pseudo hermaphrodite does not possess ovaries

Distal convoluted tubule
A. Simple Squamous
B. Simple cuboidal
C. Simple columnar
E. Transitional
96. A 78-year-old man from a nursing home was admitted to theemergency department because of a change
in his mentalstate over the past few hours. He had a medical history ofangina and hypertension presently
treated with isosorbidemononitrate, losartan, and hydrochlorothiazide. Physical examinationshowed a
person with decreased skin turgor anddisorientation to time and place without focal neurologic deficits.
Blood pressure was 110/65 mm Hg on standing and140/88 mm Hg on lying. Pertinent blood tests on
admissionwere Na+ 116 m Eq/L (normal 136-145 mEq/L); K+ 3.1 m Eq/L(normal 3.5-5.0 mEq/L); uric acid
10.2 mg/dL (normal 3.0-8.2 mg/dL); creatinine 3.1 mg/dL (normal 0.6-1.2 mg/dL). The physician thought
that the syndrome was due to diuretictherapy.
Which of the following drug-induced adverse effectsmost likely caused the patient's signs and symptoms?
A. Kidney insufficiency
B. Hypokalemia
C. Hypovolemic hyponatremia
D. Hyperuricemia
E. Hypervolemic hyponatremia
97. A 32 year old male came to the clinic with dull intermittent pain in his right flank. This is his second time
visiting with the same complaint, he was bringing the X-ray he had taken on the first visit. The film showed
radioopacity shadow 2 cm wide in his right pyelum.
Which of the following sentence is most likely describes the organ affected?
A. It is located in the posterior thorax, at the level of T12-L2
B. It is located in the abdomen, partly protected by the 12th ribs
C. It is bound superiorly with the lungs and inferiorly with the transverse colon
D. It lies between the serratus posterior on the posterior side and liver in the anterior
E. The left one is slightly more inferior than the right because of the liver
98. A 4-year-old boy admitted to Padjadjaran Teaching Hospital with swelling on whole body. Since 5 days
before admission patient had swelling especially on the eyelid when waking up in the morning. Urinary
production 1,1 mL/kgBB/h.
Physical examination: Alert, swelling on whole body. Vital sign within normal limit.
Urine: Protein ++++, RBC 2-3,
Blood: ureum: 20 mg/dL. Creatinine: 0.6 mg/dL.
What is the most probable diagnosis for this patient?
A. Nephrotic syndrome
B. Acute kidney injury
C. Kwashiorkor
D. Acute on chronic kidney disease
E. Acute nephritic syndrome
99. A 7-year old boy was brought by her parents to the hospital with edema for 3 days and oliguria for a day.
Three weeks before his admission, he had a sore throat. Tests showed the following: body weight was 24
kg, blood pressure was 135/90, urine dipstick tests RBC +++, proteinuria +++, the creatinine level was 2.3
mg/dl, and the blood urea nitrogen was 300.6 mg/dl. His serum albumin level was 2.41 g/dl. A blood sample
was collected for bacteria identification.
What is the distinctive shape of Treponema pallidum?
A. Isosahedral-shaped
B. Corkscrew-shaped
C. Ciliated body
D. Rod-shaped
E. Cocci-shaped
100. Which of the following risk factors is most important in the pathogenesis of this bladder lesion?
A. Smoking
B. Schistosomiasis
C. Diabetes mellitus
D. Chronic bacterial cystitis
E. Hyperplasia prostat
101. A young man 45 years old came to your practice complains of an uncontrolled high blood pressure. His last
blood pressure measurement was 160/110 mmHg. This was obtained by a nearby clinic a week ago. He used
to take hypertension drugs before such as: amlodipin 5mg once daily and a bisoprolol fumarate 5 mg once
daily, both taken orally. Because of his ankle swelling, he stopped the medications 2 weeks ago worry about
heart failure symptoms. A diabetic family history was noted, his mother died of diabetes complications and
was on haemodialysis. Sometimes he complains also of eating big portion of food , always hesitate to go to
the toilet 6-7 times a day with a foamy urine and always feeling thirsty. He smoked 5 cigaretes a day. And
his bodyweight is 45 kg even he ate a lot. Used to have a body weight of 70 kg.
According to the risk stratification of your patient, he will be assessed for?
A. Life style modification, and start monotherapy with an ACEI class drug
B. Life style modification, and immediately start with 2 drugs combination
C. Life style modification, and start with a beta blocker class drug
D. Life style modification, and start 2 drugs combination of ACEI and ARB
E. No need of life style modification, direct fixed dose combination of CCB nad ARB
102. This tubule is more permeable to water than solutes , approximately 75% of the water is reabsorbed ;
solutes remains , so that intra tubular fluid becomes hypertonic.
A. Proximal convoluted tubule
B. Thin descending segment of Henle’s loop
C. Thin ascending segment of Henle’s loop
D. Thick ascending segment of Henle’s loop
E. Early distal tubule
103. A 34-year-old woman was admitted to the emergency departmentbecause of flushing, itching, nausea,
sneezing, and abdominalcramps. Five days earlier, the patient was diagnosedwith primary syphilis and
started on antibiotic treatment. Vital signson admission were blood pressure 98/56 mm Hg, pulse 125bpm,
respirations 22/min. Physical examination showed acyanotic patient with urticaria, angioedema, and
wheezing.
Which of the following antibiotics most appropriate for treating his primary syphilis?
A. Azithromycin
B. Doxycycline
C. Metronidazole
D. Penicillin G
E. Amikacin
radioopacity shadow 2 cm wide in his right pyelum.
Which of the following is most possibly the nerve that carries pain signal in this patient?
A. Following cutaneous fibers at the level of T10
B. Following parasympathetic nerve through abdominopelvic splanchnic nerve
C. Following the posterior vagal trunk
D. Following the visceral afferent fibers through sympathetic nerve
E. Through sensory nerve that bypass renal nerve plexus
105. Which of the following renal diseases is the most likely to be reversibel in a 40-year-old patients with
elevated serum nitrogen dan creatine levels ?
A. Analgesic nephropathy D. Acute tubular necrosis
B. Benign nephrosclerosis E. Diabethic nephropathy
C. Focal segmental glomerulosclerosis
106. A 40 years old female with acute colicky flank pain and fever. There were history of urolithiasis and
hematuria before. Diagnostic studies was conducted after NSAID administration. Laboratory examination
found hematuria. There were bilateral kidney stones and hydronephrosis on ultrasound. Percutaneous
placement of nephrostomy tubes was conducted, followed by antibiotic administration. Patient planned to
have renal stone removal after the infection subsided. What is the superiority of selected nuclear medicine
procedure compared to the gold standard?
a. Accurate measurement using 24 hour urine collection
b. Measuremet of each kidney function separately
c. Blood sample are inaffected by protein intake
d. Easy kidney function measurement using formula for plasma creatinin level
e. Easy blood sample collection
107. Please find the correlation with the options given :

Filtrate production ?-blood pressure forces small solutes, water, ions from blood into capsule
c. Loop of Henle
e. Collecting Duct
posterior x-ray image revealed that there are opac appearance in the left and right calix major. The patient
then diagnosed by urotlithiasis. For the dietary management, the doctor adviced to restrict meat
consumption. If the cause of patient condition are infection, what is the most probably the cristal are
formed?
a. Uric acid stones
b. Struvite
c. Calsium oxalate
d. Calsium phosphate
e. Cystine
109. A 78 -year old female has ingested more than 3 gr per day of analgesic,for the past 20 years to treat her
chronic athritis.She has blood pressure 150/90 mmHg .Her serum creatine level is 7 mg/dl,urea nitrogen is
60 mg/dl. Which of the following complications is the most likely to develop?
a. Hydronephrosis
b. Chronic glomerulonephritis
c. Renal papillary necrosis
d. Renal cell carcinoma
e. Acute tubular necrosis
110. A 62-year-old man is brought to Emergency Unit with severe headache since 2 hours ago. He also has blur
vision at the same time. It begins after he forgot taking his short-acting nifedipine. In the physical
indistinct margin are seen on ophthalmologic examination. The doctor gives him intravenous drip of sodium
nitroprusside and lowering his blood pressure until targeted pressure.When he is stable, the doctor gives
him amlodipine, a calcium channel blocker, and bisoprolol, a ß-adrenergic receptor blocker by daily dosage.
How can sodium nitroprusside treat this patient?
a. Short-acting vasodilator by increasing the intracellular cGMP
b. Long-acting arteriolar dilator by opening potassium channels
c. Peripheral arteriolar dilator by agonist of dopamine D1 receptors
d. Powerful vasodilator by inhibiting the calcium influx into arterial smooth muscle cells
e. Long-acting anti-hypertension by inhibiting the ACE
111. A 44-year-old male experiences the onset of headache,nausea and vomiting over 72 hours. Physical
examination reveal bilateral papiledema.His blood pressure is 170/150 mmHg. A urinalysis show 2+ protein,
1+ blood,no glucose and no ketones. Which following renal lesions is most likely?
a. Papillary necrosis
b. Acute infarction
c. Necrotizing arteriolitis
d. Acute tubular necrosis
e. Acute pyelonephritis
112. A 55-year-old women was came to the primary health care because of dyspneu. She has a history of
hypertension since she was 45 year old. On physical examination revealed BP 170/100 mmHg, HR 120 x/mnt,
RR 32 x/mnt, cardiomegaly with ronkhi +/+. The doctor give diuretic for her. All of the following statement
regarding this drugs are true, EXCEPT :
a. Carbonic anhydrase inhibition leads to increased reabsorption of NaHCO3
b. Loop diuretics decrease Na+ reabsorption at the loop of Henle by competing for the Cl- site on the
Na+/K+/2C- cotransporter
c. In general, the effectiveness of a diuretic is determined by where it acts in the renal tubule
d. Hydrochlorothiazide decreases uric acid excretion
e. Spironolactone is generally only effective when aldosterone levels are elevated
posterior x-ray image revealed that there are opac appearance in the left and right calix major. The patient
then diagnosed by urotlithiasis. For the dietary management, the doctor adviced to restrict meat
consumption. Recomended diet management in this patient regarding to the kind of calcium salt stone are?
a. High in calcium
b. Low oxalate
c. Increase vegetable intke
d. Increase fruit intake
e. Low in phosphate
114. An 18-year-old female came to outpatient clinic with palpebral edema especially in the morning, which
resolved later in afternoon. The patient also noticed that she had foamy urine. Besides palpebral edema,
other physical examinations were normal.
Total cholesterol: 380 mg/dL
Triglyceride: 150 mg/dL
Serum albumin: 2.5 mg/dL
Total protein: 4.5 mg/dL
Urine: protein: ++++, glucose: negative.
Which of the following is the most likely diagnosis?
a. Acute nephritic syndrome
b. Diabetic kidney disease
c. Chronic kidney disease
d. Nephrotic syndrome
e. Dyslipidemia
115. A 20-year-old man was admitted to the hospital due to acute urinary retention. Which is NOT an indication
for urethral catheterization ?
a. Acute urinary retention due to BPH
b. Chronic urinary retention due to neurogenic bladder
c. To obtain a sterile urine specimen
d. Acute urinary retention due to urethra trauma
e. To monitor accurate urine output, e.g., post-operatively
116. The efferent arteriole of the renal corpuscle

a. Gives rise to the vasa recta and peritubular capillaries
b. Carries oxygen-rich blood into the glomerulus
c. Leaves the glomerulus with an increased blood volume
d. Contains modified smooth muscle cells known as juxtaglomerular cells
e. Is the site of macula densa cells
117. A 12-year-old male comes with complaint of decreased consciousness and seizure. He had history of upper
respiratory tract infection about 1 week ago. On physical examination he was somnolent, no seizure, blood
pressure 150/90 mmHg, swelling on both eyelids. On laboratory examination there was a lot of red blood
cells on urinalysis. Protein (+1) on urinalysis. Which of the following clinical features is suggestive of acute
post streptococcal glomerulonephritis?
a. It has a latent period of disease
b. Family history of glomerular disease
c. Evidence of extra-renal disease
d. Evidence of chronic renal disease
e. Previous history of similar symptoms
118. Which type of epithelial cells line the female urethra?

a. Transitional
b. Pseudostratified columnar
c. Simple squamous
d. Simple columnar
e. Simple cuboidal
119. A 22-year old female came to your clinic. His main complaint was dysuria. Urine sample was collected and
examination. Kligler-Iron-Agar tests were red slant, yellow butt, H2S positive, gas negative. After culture,
quantitative test resulted > 105 cfu. What is the bacteria causing the disease?
a. Pseudomonas aeruginosa
b. Klebsiella pneumoniae
c. Escherichia coli
d. Proteus sp.
e. Salmonella typhi
120. In this tubule , water is impermeable but sodium is permeable.

121. A 56 years old male patient diagnosed with Chronic Kidney Disease Stage 5 non HD with PEM. Body weight
50 kgs and height 175 cms. If the patient are hemodialised, how much protein they consume every day?
a. 0,6 g/KgBW/Day
b. 0,75 g/KgBW/Day
c. 1 g/KgBW/Day
d. 1,1 g/KgBW/Day
e. 1,5 g/KgBW/Day
his bodyweight is 45 kg even he ate a lot. Used to have a body weight of 70 kg.When he arrived at your
office you obtain his blood pressure again twice and recorded a sustained blood pressure of 160/110 mmH.
According to the current JNC-8 or JNC-7 classification of hypertension, His blood pressure is stratified as:
a. Isolated systolic hypertension
b. Stage 1 hypertension
c. Pre-hypertension
d. Stage 2 hypertension
e. Crisis hypertension
radioopacity shadow 2 cm wide in his right pyelum. Which of the following statement is most likely describes
the organ affected?
a. Each kidney consist of cortex, column, and calyces from inside to outside
b. Renal hilum is the entrance to the space inside the kidney, occupied by the renal cortex and column
c. The medial margin of each kidney is concave, whereas its lateral margin is convex.
d. The pelvic is the middle part of kidney where 2-3 of major calyces that formed from the papillae meet
e. Each kidney is covered by renal fascia, perirenal fat, renal capsule, and pararenal fat respectively.
124. Seventy years old man complain left upper abdominal discomfort associated with hematuria.On plain photo
abdomen there is in homogenous opacity with multiple small calcifications at the level left twelfth thoracic
spine to third lumbal spine, the contour is lobulated, the possibility diagnosis is:
a. Nephrolithiasis
b. Nephrocalcinosis
c. Renal tumor
d. Ureterolithiasis
e. Ureteral tumor
125. A 37-year old male admitted to the hospital with a complain of purulent discharged from his penis. There
was no pain. He works as a truck driver. His vital signs were normal. Diplococcus Gram-negative were found
from microscopy examination. What is the most likely diagnosis?
a. Acute prostatitis
b. Acute cystitis
c. Interstitial cystitis
d. Gonococcal urethritis
e. Non-gonococcal urethritis
his bodyweight is 45 kg even he ate a lot. Used to have a body weight of 70 kg. According to the European
Society of Hypertension 2013 risk stratification, your patient is met for :
a. Low risk patient
b. High risk patient
c. Very high risk patient
d. Moderate risk patient
e. No risk patient
pH : 7.27 (N : 7.35-7.45)
HCO3- : 10 mEq/L (N :22-26 mEq/L).
Which of the following interpretation on blood gases that is the most appropriate?
a. Mixed metabolic and respiratory acidosis
b. Metabolic acidosis
c. Metabolic alkalosis
d. Respiratory acidosis
e. Respiratory alkalosis
128. Seventy years old man complain left upper abdominal discomfort associated with hematuria.On plain photo
abdomen there is in homogenous opacity with multiple small calcifications at the level left twelfth thoracic
spine to third lumbal spine, the contour is lobulated. The next preferable examination which non
invasive/non traumatic is:
a. Intravenous urography
b. Antegrade pyelography
c. Retrograde pyelography
d. Ultrasound
e. CT Scan

Reabsorption of water, ions, and all organic nutrients
c. Loop of Henle
e. Collecting Duct
ago. Since that, she never consulted again to any doctor nor took any medicine. In physical examination,
his blood pressure is 160/100 mmHg, the others are normal. The thorax is normal; there is no edema in the
legs. The doctor gave her captopril and HCT for 2 weeks.
If she has a gouty arthritis with previous myocardial infarct, Which drug you should change?
a. Change captopril with losartan
b. Do not have to change the dosage
c. Reduce the HCT dosage to prevent its side effect
d. Change HCT with bisoprolol
e. Change HCT with spironolactone
131. A four-year-old boy came to ER with difficulty to urinate on inspection there was a constricting preputial
ring and non retractable foreskin. Which of the following condition is most likely occured accompanying
with diagnosis above?
a. Balanoposthitis
b. Urethritis
c. Cystitis
d. Pyelonephritis
e. Nephritis
132. 1.passing over the pelvic brim at the bifurcation of the common iliac arteries
2. apices of the renal pelvis at the hila of the kidneys
3. enter the urinary bladder
4. lateral wall of the pelvis
Based on the anatomical description above, which of the following sequence best describes the course of
the ureters?
a. 1-2-3-4
b. 2-1-4-3
c. 2-1-3-4
d. 1-4-2-3
e. 2-3-1-4
133. During early development of kidney, the metanephric cap gives rise to which of the following parts of the
urinary system?
a. Ureter
b. Renal pelvis
c. Major and minor calyces
d. Renal tubules
e. Collecting tubules
134. A 10-year boy came to a clinic because of his whole body swelling. The body swelling had appeared since 5
days ago. It was progressively worsening. Firstly, his palpebral was looked swell on the morning but
disappear on afternoon. He didn't have any dark urine. There is no fever before. In the physical examination,
his height was 136 cm and his weight was 45 kg. His vital sign was normal. He was edematous. There is no
abnormality in the thorax. The abdomen looked distance with shifting dullness. Pitting edema was founded
in both legs. The laboratory showed abnormality in some parameters including albumin is 1.5 gr/dl,
cholesterolis 420 mg/dl, and LDL is 354 mg/dl. Urinalysis : urine is yellow and cloudy, pH 6.2; protein 4+;
glucose -; bilirubin -; urobilinogen -; sediment containing many oval fat bodies, no RBC'S and WBC's
In pharmacological therapy, The doctor gave him high dose of prednisone, and furosemide. This patient
might develop peptic ulcer caused by prednisone used. What is the most correct mechanism of developing
this side effect?
a. Irritating the gastric mucosal
b. Enhancing the histamine effects on acid production
c. Stimulating prostaglandin receptor
d. Blocking the proton pump activities
e. Reducing the mucosal protection
radioopacity shadow 2 cm wide in his right pyelum. Which of the following are the most possible artery for
the organ?
a. Each renal artery divides into 5 segmental arteries
b. Each kidney is supplied by a pair of renal arteries
c. The renal artery is a branch of celiac trunk
d. The renal artery branched into lobar arteries that anastomose with each other
e. The renal artery has a branch that supplies the suprarenal gland
without condom. Serological testing showed VDRL 1/32 and TPHA reactive. What is the most likely
characteristic of the lesion in this disease?
a. The number of the lesions is 3-5.
b. The lesion is not tender on examination
c. There is no induration at the border of the lesion
d. The wall of the ulcer is excavated
e. The base of the lesion is filled with pus, blood, and necrotic tissue
137. The formation of crystal in the urine sample depend on the pH of urine, low acidity urine sample (low pH)
can be form several crystal such as :
a. uric crystals, sodium urates
b. triple phosphate, calcium phosphate
c. calcium carbonate, and ammonium biurate
d. cystine, cholesterol, leucine, thyrocine
e. bilirubin, sulfonamides
138. A 62-year-old man is brought to Emergency Unit with severe headache since 2 hours ago. He also has blur
vision at the same time. It begins after he forgot taking his short-acting nifedipine. In the physical
indistinct margin are seen on ophthalmologic examination. The doctor gives him intravenous drip of sodium
nitroprusside and lowering his blood pressure until targeted pressure.When he is stable, the doctor gives
him amlodipine, a calcium channel blocker, and bisoprolol, a ß-adrenergic receptor blocker by daily dosage.
Why he suddenly got his symptoms when he stop taking hisshort-acting nifedipine?
a. Withdrawal syndrome of ß-adrenergic receptor blocking
b. Up-regulation or supersensitivity of ß-adrenoceptors
c. Increasing of renin release
d. Ca ion cannot efflux from smooth muscle cells
e. Sudden influx of Ca ion into smooth muscle cells
139. A 40-year-old man treated with allopurinol came to the hospital with right flank pain and ultrasound shows
a stone in the proximal ureter but the stone is radioluscent on KUB. Which of the following is most likely
stone composition in this patient?
a. Calcium phosphate
b. Weddelite
c. Xanthine
d. Calcium oxalate
e. Calcium oxalate dyhidrate
erythrocytes 1-3. What is the diagnosis from electrolyte imbalance?
a. Hypermagnesemia and hyponatremia
b. Hypokalemia and hypernatremia
c. Hyponatremia and hyperkalemia
d. Hypernatremia and hyperkalemia
e. Hypercalciuria and hyponatremia
141. The surgeon was about to remove the kidney from a patient who requires a renal transplant. Which of the
muscle's fascia of the following is most likely to be removed by the surgeon?
a. Diaphragm
b. Psoas muscle
c. Quadratuslumborum muscle
d. Transverses abdominis muscle
e. Iliacus muscle
142. A 70-year-old man was brought to the outpatient clinic to remove urinary catheter. He's been in and out of
the clinic for urinary problem. His medical record states his diagnosis were BPH. Which of the procedure can
be done by local physician to examine the organ in question?
a. Digital Rectal Examination
b. Cystoscopy
c. Retrograde urography
d. Plain abdominal X-ray
e. Barium enema
143. A 56-year-old female has hypertension for two years and type II diabetes mellitus for seven years. She has
diabetic nephropathy and peripheral neuropathy. She is on oral glimepiride for diabetes and
hydrochlorthiazide for hypertension. Two years ago, bloodtest showed : Glucose 170 mg/dl, Na+ 140 mEq/l,
K+ 5.3 mEq/l, HCO3- 16 mEq/l, BUN 18 mg/dL, creatinine 1.3 mg/dL. Urine analysis showed specific gravity
of 1.015, pH 5, proteinuria -, glycosuria 2+. She came visit you today with BP 148/88 mmHg, HR 76 x/mnt,
ronkhi -/-, lower extremity deem +. Now her creatinine is increased to 1.7 mg/dl. Urine analysis shows a
specific gravity of 1.005 pH 5, proteinuria 1+and trace glycosuria. 24 hours urine shows 1,2 gram of protein.
Which of the following statements is the most likely true regarding the serum creatinine?
A. She has an increased serum creatinine level due to longstanding diabetes mellitus, with progression of
her kidney disease over the past two years
B. It is unlikely that her serum creatinine is from diabetic nephropathy, as she had no proteinuria two
years ago
C. The hypertension is not contributing to the progression of her kidney disease
D. She has developed acute renal failure due to volume depletion in the setting of diuretic use
E. The increased creatinine level is due to a decrease in total body water
showed creatinine 8 mg/dl and BUN 120 mg/dl
Which of the following effects of the AGE-RAGE signaling axis within the vascular compartment?
A. Blocked of reactive oxygen species (ROS) in endothelial cells
B. Decreased procoagulant activity on endothelial cells and macrophages
C. Inhibited proliferation of vascular smooth muscle cells.
D. Release of cytokines and growth factors, including transforming growth factor ß (TGFß)
E. Inhibited synthesis of extracellular matrix.
145. A 25-year old female came to your clinic. Her main complaint was leucorrhea and vaginal itch. Sample from
vagina was taken and microbiological examinations were performed. Microscopy examination showed
Gram-positive organism. Sabouraud agar was used for culture. Sugar tests were: glucose positive, sucrose
positive, lactose positive, and maltose positive.
The most likely organism causing the disease is:
A. Neisseria gonorrhea
B. Chlamydia
C. Treponema pallidum
D. Candida albicans
E. Candida tropicalis
BMI : 30 kg/m2
Ureum : 35 mg/dL
Uric acid : 7 mg/dL
According to Joint National Committee on Hypertension (JNC) VII classification, the hypertensive stage of
this patient is:
A. I
B. II
C. III
D. IV
E. V
147. A 34-year-old woman was admitted to the emergency departmentbecause of flushing, itching, nausea,
sneezing, and abdominalcramps. Five days earlier, the patient was diagnosedwith primary syphilis and
started on antibiotic treatment. Vital signson admission were blood pressure 98/56 mm Hg, pulse 125bpm,
respirations 22/min. Physical examination showed acyanotic patient with urticaria, angioedema, and
wheezing.
Which of the following antibiotics most likely caused thepatient's signs and symptoms?
A. Azithromycin
B. Doxycycline
C. Metronidazole
D. Penicillin G
E. E. Amikacin
148. A 6-year-old male comes with complaint of bloody urine. He has a history of bacterial infection on his skin
about 3 weeks ago. On physical examination he was alert, no seizure, blood pressure 140/80 mmHg, swelling
on both eyelids. His laboratory examination revealed that there were a lot of red blood cells on urinalysis
with no proteinuria.
Which of the following is the most suitable antibody test for this patient?
A. Anti ds-DNA
B. ASTO
C. ANA test
D. DNAse B
E. Streptozyme test
149. You wish to examine the hilum of the right kidney during surgery.
Which of the following structures must be elevated and reflected during the procedure?
A. Stomach
B. Suprarenal gland
C. Ascending colon
D. Duodenum
E. Liver
doctor examined him physically and laboratory and diagnosed the old man as having urinary stone. Detailed
history taking revealed that this old man experienced pain in his lower middle abdomen frequently for the
last 2 months. The doctor gave him a recipe and advised him to drink a lot and to urinate immediatelly if he
felt the urgency.
Which of these factors is the most likely factor that stimulate the development of kidney stone?
A. Change in the tubular lumen pH.
B. Decreased of the tubular flow.
C. High calcium intake.
D. Less water intake.
E. Hypersaturation.
151. A 32-year old male came to your clinic. His main complaint was dysuria. Urine sample was collected and
examination. Kligler-Iron-Agar tests were red slant, red butt, H2S negative, gas negative. After culture,
quantitative test resulted > 105 cfu. What is the bacteria causing the disease?
A. Pseudomonas aeruginosa
B. Klebsiella pneumoniae
C. Escherichia coli
D. Proteus sp
E. Salmonella typhi
152. A 6-year-old male comes with complaint of bloody urine. He has a history of bacterial infection on his skin
about 3 weeks ago. On physical examination he was alert, no seizure, blood pressure 140/80 mmHg,
swelling on both eyelids. On laboratory examination there were urinary protein ++, decrease C3 level.
Which of the following factors predicts poor prognosis in the future if persistent until 4 weeks?
A. Swelling
B. Positive DNAse B
C. Gross hematuria
D. Proteinuria
E. ASTO
153. A 27-year old man notes a painless penile ulcer. He has recently started a new relationship. He is otherwise
asymptomatic, as is his partner. On examination, the ulcer is indurated and the inguinal lymph nodes are
rubbery and moderately enlarged. The most appropriate examination for exudate from the ulcer is:
A. Microscopy using Giemsa staining
B. Microscopy using Gram staining
C. Light microscopy using fluorescence staining
D. Dark-field microscopy
E. Microscopy using Ziehl-Neelsen technique
154. The voluntary sphincter muscle of the urethra is located in the:

A. Trigone
B. Prostate
C. Deep peroneal pouch
D. Superficial peroneal pouch
155. A 12-year-old boy diagnosed as nephrotic syndrome since the age of 11 years old. Protein in urine still
positive until now. Ureum dan creatinine serum normal. Sodium and potassium within normal limit.
What is the most probable diagnosis for this patient?
A. Chronic kidney disease stage I
B. Chronic kidney disease stage II
C. Chronic kidney disease stage III
D. Chronic kidney disease stage IV
E. Chronic kidney disease stage V
156. A 67-year-old man was found to have a plasma calcium levelof 12.2 mg/dL during a follow-up visit. The man
had a 3-yearhistory of Hodgkin lymphoma. He was recently diagnosedwith nephrolithiasis for which he had
been treated withhydrochlorothiazide for the past 3 weeks.
Which of the followingbest explains the most likely mechanism of thiazideinducedhypercalcemia?
A. Activation of the Na+/Ca2+ exchanger in the distal tubule
B. Increased Ca2+ reabsorption in the proximal tubule
C. Decreased secretion of parathyroid hormone
D. Decreased renal excretion of vitamin D
E. Activation of Na+/K+/2Cl- symporter in the thick ascendingloop of Henle
pH : 7.27 (N : 7.35-7.45)
HCO3- : 10 mEq/L (N :22-26 mEq/L).
Which of the following kidney compensation will most likely occur in this patient?
A. Secretion of potassium
B. Secretion of H+
C. Excretion of phosphate
D. Dissociation of bicarbonic acid
E. Secretion of anti diuretic hormones
158. Following statement is correct

A. Thiazide will trigger more renin activations than furosemide
B. Using thiazide for long periods will induces hypocalcemia
C. Combination of Furosemide 5mg + HCT 6mg induces synergistic diuretic effects
D. Spironolactone and HCT should not be combined because this combination induces more side effects
E. Activation of RAS due to furosemide can be overcome by adding spironolactone
159. A 70-old-year man has experienced increased urinary frequency, nocturia, difficulty in starting and stopping
the stream of urine and overflow dribbling. The doctor said he got hyperplasia of prostate gland.
What is the best pathogenesis for this condition?
A. Disseminated abscesses.
B. Infiltration of inflammation cells around tubular glands.
C. Somatic mutation
D. Excess beta reductase enzyme
E. Excess of Dehydrotestosterone
160. Twenty two years old male presenting with right scrotal pain extending to the right inguinal region for 36
hours administered to outpatient Urology clinic. Physical examination revealed right testicular tenderness
and hyperemia in scrotal skin. Assessment with color Doppler ultrasonography (CDU) demonstrated
anheterogenious right testis and vascularity was diminised in the body of testis but increased in the
peritesticular area. Left testis was normal.
What is the working principle of selected nuclear medicine procedure?
A. MAG-3 present urinary production and outflow
B. Uptake of leucocyte by macrophage on infection area
C. Urinary backflow from bladder detected on scintigram
D. Uptake of DSMA on renal parenchyme
E. Assessing the blood flow on spermatic cord and scrotum
161. A 67-year-old woman was found to have a plasma level ofpotassium 2.8 mEq/L (normal 3.5-5.0 mEq/L)
during a follow-up visit. The woman had been receiving hydrochlorothiazidefor 1 month to treat her recently
diagnosed essentialhypertension.
Which of the following act ions most likelycontributed to the thiazide-induced increase in renal excretion of
potassium?
Increased Na+ load in the lumen of the collecting tubule
A. Blockade of Na+/K+/2Cl- cotransporter
B. Thiazide-induced decrease in renal secretion of uric acid
C. Stimulation of Na+/K+ pump
D. Decreased delivery of bicarbonate to the collecting duct
162. A 70-year-old man was brought to the outpatient clinic to remove urinary catheter. He's been in and out of
the clinic for urinary problem. His medical record states his diagnosis were BPH.
Which of the following best describes the cause of the man's complaint?
A. It has an apex that lies inferior to the neck of the bladder
B. It has posterior surface that is related to the pubic symphysis
C. It has prostatic ducts that joins the prostatic sinuses into ejaculatory ducts
D. It has a cylindrical shape, 3 cm long, resembling the shape of a bean
E. Inferolateral surfaces that are related to the levator ani.
163. A-65-year-old male is now retiring from his job in which he had exposure to aniline dyes ,including use of b-
napthylamine . He has epidode an episode hematuria not accompanied by any abdominal pain. Physical
examination no abdominal findings. A Urinalysis + blood,no ketones,glukose or protein.The urine
microscopic examination reveals RBCs too numerous,no crystal and no cast.
The culture urine result is negative.Which the following conditions does he most likely have?
A. Renal cell carcinoma
B. Hemorrahagic cystitis
C. Tubercular cystitis
D. Urothelial carcinoma of the bladder
E. Squamous cell carcinoma of the urethra
164. The following results were obtained from a 5-year old boy, with swelling of his whole body.
Urinalysis
Color : light yellow
Nitrite : negative
Appearance : cloudy
Urobilinogen : positive
pH :6
Blood : negative
Serum
urea N : 20 mg/ dl ;
creatinine : 0.8 mg/ dl.
What is the purpose of serum creatinine and urea N examination in this case?
A. To diagnose the renal insufficiency of the disease
B. To determine guidance therapy of the disease
C. To perform prognosis of the disease
D. To follow up the disease
E. To determine the complication of the disease
165. A 35-year-old man complains of pain when erection since 3 weeks ago. The physician diagnose peyronie's
disease for this patient. Where is the location of the plaque or fibrosis that would be found when the
physician palpate the penis?
A. Corpus spongiosum
B. Corpus cavernosum
C. Bulb of the penis
D. Orificium urethra externa
E. Proximal of penis
166. The mesonephric (Wolffian) duct gives rise to the:

A. Infundibulum of the uterine tube
B. Prostatic utricle
C. Vas deferens
D. Lower 1/5 of the vagina
167. A 30-year old female with chief complaint of dysuria came to your clinic. Urine sample was collected and
microbiological examinations were performed. Microscopy examinations shows Gram-positive cocci. There
were growths of white colonies on blood agar, and more than 105 cfu were documented after colony
counting. Biochemical tests: catalase positive, coagulase negative, DNAse positive. If there were only 103
cfu were documented after colony counting in scenario above what is your conclusion?
A. The bacteria causing the disease is most likely Escherichia coli.
B. The bacteria identified is Staphylococcus aureus,but is not the cause of the disease.
C. The bacteria identified is Staphylococcus epidermidis, but maybe contamination.
D. The cause of the disease can be determined.
E. The cause of the disease is Proteus sp.
168. A 7-year-old boy admitted to Padjadjaran teaching hospital with chief complaint of difficulty on micturition.
The history began when he ate jengkol bean 1 day before admission. What is the best management for this
patient?
A. Furosemide
B. ACE Inhibitor
C. Natrium bicarbonate
D. Ca Gluconase
E. Packed Red Cell Transfusion
pH : 7.27 (N : 7.35-7.45)
HCO3- : 10 mEq/L (N :22-26 mEq/L).
From the physical examination, the doctor notices that the patient breaths heavily and rapidly.
Which of the following is the best compensatory mechanism that most likely occur in this patient?
A. Decrease in blood pH
B. Removal of carbon dioxide excess
C. Improve the buffering ability of bicarbonate
D. Meet the body’s need of oxygen
E. Decrease intrathoracic pressure
In physical examination, his blood pressure is 160/100 mmHg, the others are normal. The thorax is normal;
there is no edema in the legs.
What is the most correctprescription of HCT for this patient?
A. R/ HCT tab 25 mg no. XXXXII S.3.dd.tab.1.
B. R/ HCT tab 25 mg no. XXXXII S.3.dd.1.tab.
C. R/ HCT 25 mg no. XIV S.1.dd.tab.1
D. R/ HCT 25 mg no. XIV S.1-0-0.tab
E. R/ HCT tab 25 mg no. XIV S.1.dd.tab.1. o.m
171. Mr. Darto, a 28-year-old man came to Puskesmas Jatinangor with chief complaint of ulcer on his penile shaft
since 1 week ago. History taking showed positive sexual contact (genito-genital) with his girlfriend without
condom. Giemsa staining from the ulcer specimen showed multinucleated giant cells.
What is the most likely laboratory examination that can help to establish the diagnosis?
A. Serological test for syphilis: VDRL and TPHA
B. Serological test for herpes: IgM anti HSV-2 and HSV-1
C. Gram staining for Neisseria gonorrhoeae
D. PCR for detection of Chlamydia
E. KOH staining for Candida sp.

Macula densa
A. Simple Squamous
B. Simple cuboidal
C. Simple columnar
E. Transitional
173. As with most organs, differentiation of the kidney involves epithelial mesenchymal interactions. Which
genes below expressed by mesenchyme to initiate kidney differentiation?
A. PAX2
B. WNT4
C. SOX9
D. WT1
E. SRY
174. A 61-year-old woman complained to her physician of a burning sensation when she urinated. Past history
of the patient was significant for serious hypersensitivity to sulfa drugs. Urinalysisrevealed abundant gram-
negative bacteria, and a sensitivitytest showed that they were sensitive to amikacin,piperacillin,
trimethoprim-sulfametoxazole, ciprofloxacin, andceftriaxone. A diagnosis of urinary tract infection was
made,and an antibiotic therapy was prescribed.
Which of the following antibiotics should be avoided in this patient?
A. Trimethoprim-sulfamethoxazole
B. Piperacillin
C. Amikacin
D. Ciprofloxacin
E. Ceftriaxone
175. A 43-year-old-man came to the clinic complaining of right back pain. Three years ago, he experienced
urinating small stone but got better after treatment and never went to the doctor again to undergo further
examination as suggested. His X-ray revealed hyperechoic lesion with acoustic shadow in his right back at
the level of L2 vertebrae
Where is the lesion most likely located?
A. Inside a cavity in the pubic region
B. In the cortex of the kidney
C. In the brim of pelvis where it crosses iliac artery
D. In the junction of renal pelvis and ureter
E. In the end of ureter where it enters urinary bladder

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DIVISI AKADEMIK PROXIMA

6. A 6-year-old girl complaining of bedwetting and having difficulty to control micturition.

15. Which of the following statements best describe syphilis?

25. A 35 year-old man has a troublesome hydrocoele that requires surgery.

27. Please find the correlation with the options given.

32. Please find the correlation with the options given.

46. What do the uterine/fallopian tubes develop from?

62. All about the epithelium in urinary system:

67. All about the epithelium in urinary system:

69. In this tubule new bicarbonates are made:

70. Convulated tubule because of intection

72. Renal agenesis may result when

76. Please find the correlation with the options given.

77. What does the serum creatinine level predict?

94. Regarding development of external genitalia:

95. All about the epithelium in urinary system:

107. Please find the correlation with the options given :

116. The efferent arteriole of the renal corpuscle

118. Which type of epithelial cells line the female urethra?

120. In this tubule , water is impermeable but sodium is permeable.

129. Please find the correlation with the options given.

154. The voluntary sphincter muscle of the urethra is located in the:

158. Following statement is correct

166. The mesonephric (Wolffian) duct gives rise to the:

172. All about the epithelium in urinary system:

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