Final Gus

Final GUS Perfecten 201
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1. What is the correct order to approach the kidney from the back?
A. Muscle fascia perirenal fat renal fascia pararenal fat capsule
B. Muscle fascia pararenal fat renal fascia perirenal fat capsule
C. Renal fascia pararenal fat muscle fascia - perirenal fat capsule
D. Muscle fascia perirenal fat capsule pararenal fat renal fascia
E. Renal fascia perirenal fat capsule pararenal fat renal fascia
No 2-3
A 45 yo man came to the clinic complaining of dull pain in his right back. The pain
has been going on and off for the last day, usually lasted for about 20-30 minutes.
This is his second visit to the clinic with the same complaint. The last time his
doctor gave him medicine for treating his pain and advised him to take ultrasound
exam, but he didnt comply.
2. Which is the right statement regarding the organ involved in this mans case?
A. Its a paired organ lies retroperitoneal in the pelvic cavity at the level of L4-S1
B. Its an ovoid organ lying on either side of the diaphragm
C. The organ lies medial to the adrenal gland, and inferior to the ureter
D. The organ lies on either side of vertebral column, in the posterior abdomen
E. The anterior border of the organ is the psoas muscle and ureters
3. Which arterial branch supplies the said organ above?
A. Abdominal aorta
B. Pulmonary artery
C. External iliac artery
D. Common iliac artery
E. Celiac trunk
4. From sentences below, which are the correct numbers for ureteric constrictions?
(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.
B.
C.
D.
E.
(1),
(2),
(4),
(1),
(3),
(2)
(3)
(5)
(2), (3)
(4), (5)
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya.
(Ali bin Abi Thalib )

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5. After section caesarea, a 35 yo woman was complain about difficulty of urination
and feel pain when micturition. And she complained of hematuria after 3 days.
From the X-ray and other symptoms, the doctor diagnosed that there is rupture
bladder at the superior. Where is the possible location for urine extravasation?
A. Intraperitoneal cavity
B. Extraperitoneal cavity(posterior)
C. Retropubic space and cavum douglas
D. Retzius space
E. Intraperitoneal cavity and rectouterine pouch
6. An anatomist is doing pelvic and abdominal exploration on a male adult cadaver.
He found a hollow viscus in the lesser pelvic. The apex point toward superior
aspect of pubic symphisis. It is only covered by peritoneum on its superior
surface. What other characteristics would the anatomist find in this organ?
A. The organ is distensible
B. Its base located on the posterior, opposite of its apex
C. It is separated with the rectum on its posterior side by the rectovesical pouch
D. Its posterior wall consist of detrussor muscle
E. The organ has 4 surfaces and 2 major parts
No 7-10
(1) Lesser splanchnic nerve
(2) Visceral afferent fibers
(3) Pelvic splanchnic nerve
(4) Vagus nerve
(5) Renal nerve plexus
7. Which of the nerves above contributes to sympathetic nerve supply of the
kidney?
A. (1)
B. (2)
C. (3)
D. (2), (3)
E. (3), (4)
8. Which pathway conducts pain in the ureter?
A. (1)
B. (2)
C. (3)
D. (2), (3)
E. (3), (4)

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9. What nerve conducts the motor control of detrussor muscle?
A. (1)
B. (2)
C. (3)
D. (4)
E. (5)
10.Which nerve from the list above mixed nerve type?
A. (1)
B. (2)
C. (3)
D. (4)
E. (5)
For question number 11-12

1.
2.
3.
4.
5.
Kidney
Abdominal Ureter
Pelvis Ureter
Urinary Baldder
Urethra
11. What organ does the prostatic venous plexus drain blood from?
A.
B.
C.
D.
E.
2
3
1,2
4
1,3
12. Where does the uterine artery (in female) and inferior vesical artery (in male)
gives branch of arterial supply?
A.
B.
C.
D.
E.
1
2
3
4
2,3

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13. Which sentence from below is the correct arrangement of
A. Renal artery segmental artery interlobar artery arcuate artery - interlobular
artery -afferent arteriols
B. Renal artery - lobar artery segmental artery arcuate artery - lobular artery
-afferent arteriols
C. Renal artery interlobar artery interlobular artery -arcuate artery - afferent
arteriols
D. Renal artery - lobar artery lobular artery -segmental artery arcuate artery
-efferent arteriols
E. Renal artery- segmental artery lobar artery -lobular artery arcuate artery
-efferent arteriols
14. Near the apex of the wedge shaped liver, the anterior and posterior layers of the
left part of the coronary ligament meet to form this ligament. Which of the following
is most likely ligament?
A.
B.
C.
D.
E.
Falciform ligament
Right triangular ligament
Left triangular ligament
Ligamentumteres
Ligamentumvenosum
15. This part is demarcated by the reflection of the peritoneum from the diaphragm
to it as the anterior and posterior layers of the coronary ligament. Which of the
following is most likely part?
A.
B.
C.
D.
E.
Subphrenic recess
Hepatorenal recess
Lesser omentum
Greater omentum
Bare area
16. This part connects the neck of the gallbladder to the common heaptic duct
passes betweem the layers of lesser omentum usually parallel to the common
hepatic duct. Which of the following is most likely part?

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A.
B.
C.
D.
E.
Fundus
Body
Neck
Infundibulum
Cystic duct
17. The parasympathetic and sympathetic fibers reach the pancreas by passing
alongthe arteries from this plexus. Which of the following is most likely plexus?
A.
B.
C.
D.
E.
Sacral plexus
Hepatic plexus
Superior hypogastric plexus
Superior mesenteric plexus
Inferior mesenteric plexus
18. This part is exit by which the spermatic cord in males, or the round ligament in
females, emerge from the inguinal canal. This is a split that occurs in diagonal,
otherwise parallel fiber of the external oblique aponeurosis just superolateral to the
pubic tubercle . Which of the following is most likely the part?
A.
B.
C.
D.
E.
Internal inguinal ring

External inguinal ring
Superficial inguinal ring
Internal spermatic gascia
External spermatic fascia
19. During hysterectomy, the physician must be careful with the structure
surrounding uterus. In ligation of the uterine vessel can cause rupture the structure
which lies across superiorly. Which of the following structure is the most likely
appropriately?
A.
B.
C.
D.
E.
Round ligament of uterus

Ovarian artery
Ureter
Lumbosacral trunk
Inferior hypogastric plexus

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20. Mr. Sony, 43 yo, complained of right flank pain, come to emergency room of
HasanSadikin hospital. This pain was gradually increased, sharp, colicky, and spread
down to the right testical. Fist test (+) at right CVA. Laboratory revealed microscopic
hematuria and a lot of back of envelope crystals in the urine. KUB :Radioopacity at
3rd right lumbar paravertebral, 10x7 mm in size, doctor diagnosed him as renal
calculi. most possibility of the cryatals composition is :
A.
B.
C.
D.
E.
Cysteine
Struvite
Uric acid
Calcium oxalate
Calcium phosphate
21. Mr. Anwar, 68 y.o came to outpatient clinic of RSHS complained frequent
urination during day and night since 2 months ago. The other complaints were
incomplete emptying and weak stream during voiding, have to wait a long time
before the urine started to flow.
DRE : Prostate 40 gr, rubbery, symmetrical painless, no nodules on palpation. The
diagnosis was BPH LUTS. Whats the most appropriate condition that can cause
increasing prostatic cell number is :
A.
B.
C.
D.
E.
Decreased esterogen
Decreased testosterone
Decreased androgen receptor
Increased progesterone
Increased dehydrotestosterone
For 22-23
Ms. Sandy, 25 yo came to Emergency Room at Hasan Sadikin hospital complaining
small produce of urine that occurred after massive diarrhea and vomiting. It started
3 days before admitted to the hospital. The other complaints were short of breath,
weakness, and fatigue.

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PE revealed : delirious, BP 90/60, small pulse 120x/mnts, RR 34X/mnt, T : 37.5 0C,
her belly was flat, smooth, reduced skin elasticity.
Lab : Hb 15.6 gr%, HCt 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 leucocyte.
ECG : tall and peak T wave and widening QRS complex.
The patient was diagnosed as Acute Kidney Injury due to dehydration.
22. High potassium level in this patient because of following condition below ?
A. Increased reabsorption of potassium in the kidney
B. Reduced potassium filtration in the kidney
C. Hemoconcentration
D. Decrease urine production
E. Activation of K Na ATP ase
23. According to your patient also suffered from the following ?

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

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24. Sodium and potassium are reabsorbed cotransportly as its luminal membrane.
A. Proximal tubule
B. Loop of Henle
C. Distal tubule
D. Collecting tubule
E. Calyces wall
25. Stretch receptors are found here

A. Proximal tubule
B. Loop of henle
C. Distal tubule
E. Calyces wall
26. Ca is mostly reabsorbed here :

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

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27. NH4+ is secreted here in case of acidosis :
A. Proximal tubule
B. Loop of henle
C. Distal tubule
E. Calyces wall
28. Carbonic anhydrase is found abundantly in this part :

A. Proximal tubule
B. Loop of henle
C. Distal tubule
E. Calyces wall
29. Aquaporin (AQP)2 is synthetized in this part :

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

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A 45 yo male came to the emergency department with cc of dyspneu. He suffered
from bad diarrhea for the last 4 days. He also complains weakness and oligouria.
The doctor perform blood gas analysis and the result were pH: 7,27 PaCO2: 7 mmHg
HCO3: 10 mEq/L
30. In a term of acid-base imbalance, a
measurement of PaCO2 indicates the
effectivenes of?
A. Kidney function
B. Lung ventilation
C. Phosphate buffers
D. Bicarbonate buffers
E. Breathing mechanism
31. The kidney responds to acid-base disturbances by

a.
b.
c.
d.
e.
Adjusting PCO3 level

Producing phosphate buffers
Excreting or reabsorbing hydrogen or bicarbonate
Excreting phosphate buffers and water retention
Secreting ADH
32. This Patient breathes heavily and rapidly. We assume that his body attempting
to
a.
b.
c.
d.
e.
Retain carbon dioxide

Get rid of carbon dioxide excess
Improve the buffering ability of bicarbonate
Meet the bodys need of oxygen
Decrease the blood pH
33. What is the interpretation of the blood gas analysis result in this patient?partial

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a.
b.
c.
d.
e.
Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis
Acidosis metabolic with uncompensated acidosis respiratory
34. The doctor perform another laboratory test and the result were: Na: 143 mEq/dL
(N: 135-145 mEq/dL). What is the most right statement regarding this electrolyte?
a.
b.
c.
d.
e.
Primary function is to regulate acid-base balance

Main intracellular fluid cation
Acts as a hydrogen buffer
Influences water distribution with cloride
Unbalance of this electrolyte would drastically affect neuromuscular processes
For question number 35-37, refer to scenario below

A 12 yo female came to the emergency department with the chief complaint of
weakness. Shes suffered from severe vomiting and massive diarrhea for the last 2
days
35. You check the orthostatic hypotension
examination and result was positive.
What does this test refer to?

a.
b.
c.
d.
e.
Hypotension
Low serum osmolality
Hypovolemic shock
Hypovolemia
Life threatening shock
36. You examine the patients hidration status clinically and you agree that this
patient in a severly dehydration condition. What laboratory test that would support
this hypothesis?
a. Elevated serum osmolality
b. Low urine specific gravity

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c. Low serum sodium level(naik)
d. Decrease hematocrite(naik)
e. Elevated heart rate
37. Incorrect type of fluid administration would lead this patient to water
intoxication with cellular edema. What is the type of fluid that would lead to this
complication?
a.
b.
c.
d.
e.
Hypotonic fluid
Hypertonic fluid
Isotonic fluid
Massive isotonic fluid
High electrolyte fluid concentration
38. A 50 years old man came to the clinic with history of high blood pressure. You
perform the blood pressure examination and the result was 160/110 mmHg. He has
no other complain and was visiting you just to have a routine check. The doctor
gave ACE-I to the patient. It is because this case because the first line drug for this
case because this drug
a.
b.
c.
d.
e.
Decrease proteinuria
Regress left ventricle hypertrophy
Lower the activity of venous smooth muscle cell
Increase the stimulus of sympathetic cardiovascular pattern
Also has a diuretic effect
39. A 23 YO man came to the clinic with the chief complaint of edema anasarka. The
doctor diagnoses the patient as nephritic syndrome and gives him proper
treatment. What is the true underlying mechanism in this case?
a.
b.
c.
d.
Osmotic pressure decrease with circulating Angiotensin II increase

Effective blood volume increase follow with sympathetic activation
Renal vascular resistance decrease due to angiotensin II effect
Sodium reabsorption decrease in renal tubulus due to aldosterone activity and the
increase of peritubular pressure

e. Low serum albumin due to the failure of liver production

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40. A 70 yo man came to the emergency department with chief complain of severe
colicky pain since hour ago. The doctor suggest there was an acute urinary tract
obstruction. The pain associated with this condition is a result of which of the
following
a.
b.
c.
d.
e.
Compensatory natriuresis
Decreased medullary blood flow
Renal capsule distention
Vasodilatory prostaglandins
Renal artery vasoconstriction
41. You perform laboratory exam to this patient and the result were serum creatinin
1,5 mg/dL, Sodium 138 mEq/L, potassium 3,8 mEq/L, urine creatinin is 12 mmol.
Using the Cockroft-Gault equation, what is the patient creatinin clearance?
a. 27 mL/min
b. 47 mL/min
c. 70 mL/min
d. 105 mL/min
e. 115 mL/min
42. A 68 year old woman came was diagnosed as a chronic kidney diseases due to
diabetis
mellitus.
The
doctor
worried
that
she
would
developed
renal
osteodystrophy and gives her proper instruction. She was on hemodyalisis for the
the last 2 years.
What is the most important contributor to this late complication?
a. Impaired renal procustion of 1,25-dihydroxyvitamin D3 (1,25(OH)-D3)
b. Hypocalcemia
c. Hypoposphatemia

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d. Loss of vitamin D and calcium via dialysis
e. The use of calcitriol
43. Which of the following statement regarding chronic kidney diaseases is TRUE?
a. CKD is defined as a GFR of less than 30 ml/min/1.73m2 for longer than 3 months.
b. Persistenly increased proteinuria in the setting of a normal or increased GFR
signifities the prescence of stage 1 CKD.(stage 3)
c. Measurement of 24 hours creatinin clearance to assess GFR is more accurate
than estimating GFR from the modification of Diet in renal Diseases (MDRD)
equation.
d Treatment of comorbid conditions, intervention to slow progression of kidney
disease, and measures to reduce cardiovascular diseases should begin during CKD
stage 3.
e. A presence of kidney stone with or without symptoms.
Questions number 44 to 45, refer to scenario below :

Four years ago the patient came to the clinic and was told that she has a creatinin
clearance 48 ml/min. The doctor asked her to take her medicine regularly and diet
recommendation.
44. What stage of chronic renal disease was the patient at?
a. stage 1
b. stage 2
c. stage 3

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d. stage 4
e. stage 5
45. Which of the following statement is TRUE regarding the appropriate diseases in?
a. Aggressive control of hyperglycemia may be more likely to slow progression of
renal diseases in patient with type 1 diabetes mellitus than in patients with type 2
b. The targeted blood pressure should be below 120/80 mmHg.
c. Because this patient has diabetes, microalbuminuria is prodictive of progression
of renal diseases.
d. Smoking is a risk factor for microalbuminuria because of its association with
hypertention.
e. A low protein diet must be prescribed with little concern about deleterious effects.
46. A 27 year old alcoholic presents with the following electrolytes: calcium 6.9
mg/dL, magnesium 0.7 mg/dL, and phosphorus 2 mg/dL.
Which of the following is the most important cause of the hypocalcemia?
a. Poor dietary intake.
b. Hypoalbuminemia.
c. Decreased parathyroid hormone release due to hypomagnesemia.
d. Decreased end organ respone to parathyroid due to hypomagnesemia.
47. What is the True statement regarding calcium as an important electrolyte?

a. 90% of cody calcium is stored in bone(99%)

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b. Serum calcium levels are regulated by parathyroid hormone
c. 0.1% calcium found in the ECF
d. Only the ionized calcium ions play an essential role in neuromuscular and cardiac
excitability
48. A 3 years old girl came to clinic with her mother. She was still in diapers
because she was continually wet. A pediatric urologist examined the child and
observed a small opening in the posterior wall of vagina. After radiologist
examination saw the ectopic ureter in the vagina wall.
Which one of the statement was relate with that case?
a. Complete division of the metanefric diverticulum.(ureteric bud)
b. Incomplete diffusion of the metanefric diverticulum.
c. Complete diffusion of ureteric bud.
d. Incomplete diffusion of the metanefric mesoderm.
e. Incomplete diffusion of metanefic endoderm.
49. The 17 yo women was preventive from competiting in Pekan Olahraga Nasional
because her Buccal smear test was chromatin negative , indicating that she had a
male sex chromosome
Which on of the statements was relate with that case ?
A.
B.
C.
D.
E.
The
The
The
The
The
external genital was male

karyotype was 46 XXY
karyotype was 46 XY
karyotype was 46 XXYY
women was X lin

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50. After bird examination of a new born male infant, it was observed that the
urethra opened on the ventral surface of the penile at the gland a shaft.
Which on of the statement was relate with that case?
a. Failure of fusion of urogenital fold.
b. Adequate production of androgen.
c. Failure of fusion canalization glandular.
d. Complete formation of the spongy penile.
e. Adequate receptor site for the hormone.
51. a 10-yo boy suffered pain in his left groin while attempting to lift box. Later he
notices a lump in his groin then he told his mother about the lump she arranged
appointment with doctor. After a physical exam diagnosis was indirect inguinal
hernia.
Which one of the statement was relate with that case?
a.
b.
c.
d.
e.
Vaginalis processus developed dorsal to the gubernaculum

Vaginalis processus developed ventral to the gubernaculum
Gubernaculum descended from superior poll of the gonad
Gubernaculum descended from posterior of the gonad
Gubernaculum was degenerated from metanephros
52. A woman carries her 4 months baby boys to the pediatric clinic because he was
oliguria. After the pediatric urologist examination with X ray a part of left kidney and
right one was observed multicystic dysplastic kidney
Which one of the statements was correlated with that case?
a. failure the ureteric bud to join the tubulus from mesonephric mesoderm
b. failure the ureteric bud to join the tubulus from mesonephric endoderm

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c. failure the ureteric bud to join the tubulus from metanephric endoderm
d. failure the ureteric bud to join the tubulus from metanephric mesoderm
e. failure the ureteric bud to join the tubulus from metanephric ectoderm
Mr. X 32 y.o man, married, presents to the Dermatology and Venerology Clinic while
you are working there as an assistant. He states that he had single painless erosion
on his penile shaft since one week ago. He worries about his complaint because it
occurred after he had sexual intercourse with prostitute without condom. He also
confesses that he had sexual intercourse with prostitute without condom frequently.
53. The substitute term to painless at erosion is:

a. indolen
b. induration
c. chancre
d. chancroid
e. molle ulcer
54. What is the most important question should be asked to this patient to
a.
b.
c.
d.
e.
Is the ulcer clean or purulent?

Does he take any medication to heal his complaint?
Does the prostitute have the same complaint like him
Is the ulcer come with discharge from his urethral orifice?
When did the last time he has sexual intercourse with prostitute without
condom?(inkubasi)

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55. What is the next direct laboratory examination to exclude other differential
diagnosis of this case?
a. gram staining
b. giemsa staining
c. KOH examination
d. specimen collection for culture
e. dark field microscopic examination
56. If the ulcers are multiple, some confluent, dirty, filled with pus, and feel pain,
with enlargement more than 1 cm at both inguinal lymphatic nodes, we should
diagnose as: (chancroid)
a. syphillis
b. molle ulcer
c. durum ulcer
d. herpes genital infection
e. herpes simplex infection
The direct laboratory examination results of this patient are Gram staining: school of
fish (-) and dark field microscopic examination: motile spirochete (+)
57. The reason that we need dark field microscopy to see the spirochete is:
a. secret from ulcer is easily dry
b. Treponema pallidum has very mobile activity
c. Treponema pallidum has a thin and translucent membrane

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d. Haemophyllus ducreyi shows a better configuration in dark field microscopy
e. dark field microscopy gives a black background so it is easy to see any form of
bacteria
58. The next laboratory examination that should do is:

a. PCR
b. culture
c. antibody titer
d. serological examination
e. immunostaining from ulcer
Then the patient is taken blood
59. Based on those findings

a. primary syphillis
b. secondary syphillis
c. tertiary syphillis
d. early latent syphillis
e. late latent syphillis
60. The cut off of TPHA/RPR to diagnose syphillis is

a. 1/4
b. 1/8

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c. 1/16
d. 1/32
e. 1/64
61.After appropriate treatment, we can diagnose the patient is healed from syphilis if
the titer VDRL
a. declines threefold within 6 months
b. declines threefold within 6 months
c. declines fourfold within 6 months
d. declines fourfold within 12 months
e. declines fourfold within 24 months
62. The appropriate treatment of this case is:
a. Benzathine penicillin 1.2 million IU, IV, single dose
b. Benzathine penicillin 2.4 million IU, IV, single dose
c. Benzathine penicillin 1.2 million IU, IM, single dose
d. Benzathine penicillin 2.4 million IU, IM, single dose
e. Benzathine penicillin 2.4 million IU, IV, three times with
63.The appropriate treatment for genital herpes is:
a. Acyclovir 5x200 mg, for 7 days
b. Acyclovir 5x400 mg, for 7 days
c. Acyclovir 5x800 mg, for 7 days
d. Acyclovir 5x200 mg, for 10 days
e. Acyclovir 5x400 mg, for 10 days
64.Sometime in secondary syphilis, there is a genital flat papule that called:
a. Chancre
b. Genital warts
c. Syphilis warts
d. Condylomalata
e. Condyloma acuminate
65. The non-treponemal test for syphilis is:

a. RPR
b. TPHA
c. Elysa
d. FTA-Abs
e. MH-TPA

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66. In the pathogenesis of syphilis, the formation of ulcer because of
a. activation of cytokines
b. lumen occlusion and skin breakdown
c. sensitization of T-cell makes granuloma formation
d. sensitization of B-cell makes delayed hypersensitivity
e. chemotacting factors attract neutrophils to the inoculation site
67.Treatment for chancroid is:
a. Azitromycin 1 g, per oral, single dose
b. Azitromycin 2x500 g, per oral, 5 days
c. Erytromycin 4x500mg, per oral for 7 days
d. Benzathine penicillin 1.2 million IU, IM, single dose
e. Benzathine penicillin 2.4 million IU, IM, single dose
68.The attachment of the renal fascia determines the path of extension of a
perinephricabcess.
Which of the following direction is the most correctly way to continue passing the
pus?
a. Inferiorly toward the pelvis
b. Laterally into the body wall
c. Medially across the midline in the other kidney
d. Superiorly onti contact with fascia of the diaphragm
e. Anteriorly into the peritoneum
For questions number 69 to 73, refer to options given below:

All about the epithelium in urinary system:
A. Simple squamose
B. Simple cuboidal
C. Simple columnar
D. Stratified squamous non keratinized
E. Transitional
Which of the statement below correspond to above epithelium


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69.
Distal convoluted tubule B
70. Ascending thin limb of Henles loop A
71. Macula densa C
72. Minor calyx E
73. Urethra D
74. Mrs. X brings a random urine specimen to the laboratory for a glucose analysis.
The test result is negative. The physician questions the result because the patient
has a family history of diabetes and is experiencing mild clinical symptoms. What
type of urine specimen should be collected that would more accurately reflected
metabolism?
a. First morning
b. 2 hours postprandial
c. Three glass collection
d. 24-hours
For question no. 75-76

An 18 yo female comes with complaint of the left flank pain. Gram negative rods are
cultured from her urine.

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75. Endogenous genitourinary infection is caused by:

a. Intracellular bacteria
b. obligate anaerobes
c. Spore-forming bacteria
d. members of the resident flora normal
e. sexually transmitted pathogen
76. the most possible etiology is

a. Chlamydia trachomatis
b. leptospirainterogans
c. E.coli
d. S. saprophyticus
e. S. aureus
77. the major defense mech of the urinary tract agains infection is
a. urethral gland secretion
b. alkaline urine
c. urine flow
d. colonization resistence
e. the vesicourethral sphincter

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78. urine samples for bacterial culture to diagnose urinary tract infection should be
processed immunological because:
a. the main cause of urinary infection are 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
A 20 yo male was brought to the hospital by his sister. He gave 24 hours 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.
His physical exam was significant for a yellow urethral discharge and tenderness
after tip of the penis. A gram stain was done in the small lab of the clinic.
Stain was done in the small lab of that
79. What do you observe microscopically?

a. gram + cocci
b. gram + rods
c. gram diplococcic
d. gram rods
e. spiral bacteria

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80. WOTF media can be used as selective media for culture of the etiologic agent of
the disease?
a. blood agar
b. chocolate agar
c. mac conkey agar
d. Thayer-martin agar
e. Mueller hinton agar
81.A 65 yo man develops dysuria and hematuria. Gram stain: negative rods. Culture on
MacConkey agar: lactose-negative colonies without swarming. WOTF is the likely
a.
b.
c.
d.
e.
organism?
Chlamydia trachomatis
Pseudomonas aeruginosa
Escherichia coli
Proteus mirabilis
Enterococcus faecalis
82.After 2 days of increasing pain during urination, a 20 yo female goes to health

center. Upon exam, she complains of left flank tenderness & low-grade fever. Her
urine is cloudy and shows microscopic evidence of erythrocyte, pyuria, and
a.
b.
c.
d.
e.
abundant gram + bacteria. History: no previous UTI.

Candida albicans
Streptococcus pyogenes
Neisseria gonorrhoeae
Staphylococcus saprophyticus
83.A 27yo man complains of urethral discharge. Gram stain: no bacteria but only less
a.
b.
c.
d.
than 20 neutrophils/HPF. WOTF is the most likely organism involved?

Chlamydia trachomatis
Treponema pallidum
Candida albicans
HSV

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e. Mycoplasma hominis
84.E.coli in McConkey agar would exhibit the characteristic of WOTF?
a. Non-lactose fermenter, pink colonies
b. Lactose fermenter, pink colonies
c. No growth
d. Would grow in room temperature
e. Small colonies
85.After 2 days of increasing pain during urination, a 20 yo female goes to health
center. Upon exam, she complains of left flank tenderness & low-grade fever. Her
urine is cloudy and shows microscopic evidence of erythrocyte, pyuria, and
a.
b.
c.
d.
e.
abundant gram + bacteria. History: no previous UTI.

Candida albicans
Streptococcus pyogenes
Neisseria gonorrhoeae
Staphylococcus saprophyticus
86. Which of the best specimen of urinary tract infection?

a. catheter urine
b. a 24 hours urine
c. suprapubis urine
d. midstream urine
e. sterile urine
87. what standard media for susceptibility test of bacteria?

a. blood agar
b. muller hinton agar
c. plate count agar
d. mac conkey agar

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e. nutrient agar
88. an 18-years-old female comes with complaint of left flank pain, fever, child, and
increased urinary frequency. Gram negative rods are cultured from her urine.
The number of bacteria per milliliter of urine in a midstream urine specimen is:
a. indicate significant UTI if more than 103 with 3 kinds of bacteria
b. the only factor use to assess the significance of culture results
c. decrease in pyuria
d. less than 103 indicate in the case of cystitis
e. containing > 105 CFU/ml indicates significant infection
89. a 21-years old woman has experienced urinary frequency with dysuria without
discharge from the vagina for the past few days. She has no flank pain or
tenderness. A urinalysis reveals sp. Gr. 1.014, pH 7.5, no glucose, no protein, no
blood, nitrite positive, and many WBCs. She has serum creatinine of 0.9 mg/dl.
Which of the following microorganisms, that is NOT causing these symptoms?
a. Escherichia coli
b. Staphylococcus sp.
c. Enterobacteriacesae
d. Nesseria gonorrhoeae
e. pseudomonas sp.

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90.A 60 yo man came to out clinic for medical follow-up. He has hypertension and DM
type 2 for the last 2 years. PE: BP 160/90, no other abnormalities. The doctor
a.
b.
c.
d.
e.
prescribed antidiabetic drug and ACE-inhibitors. WOTF is the drug?

Valsartan
Atenolol
Captopril
Hydralazine
Diltiazem
91. A 62yo man come to the doctor for routine follow up his disease. BP 160/90
mmHg HR 76 BPM. Randomized blood glucose was 140g/L. He is given Nifedipine.
What is the most possible side effect of the drug?(CCB)
A.Decrease blood
B. Orthostatic hypotension
C. Cardiac depression
D. Hyperkalemia
E. Palpitation
92. What is Nifedipine?

A. b-adrenoreceptor
B. a1 selective adrenoreceptor blocker
C. Vasodilator
D. Calcium Channel Blocker
E. Diuretics

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93. A 70yo man came for routine check up his condition. Medical record
menyatakan BP 170/110 taken in dominant arm, seat position and measure twice
after rest 5 minutes remain unchanged. Other system within normal limit. What are
the most likely appropiate drug?
A. Diltiazem + Nifedipine(CCB dua2nya)
B. b-Blocker + Diltiazem
C. b-Blocker + Verapamil(ga boleh disatuin)
D. b-Blocker + centrally acting drug
E. Ca-channel-blocker + ACE inhibitor
94. Which of the following prototype of vasodilator?

A. Labetalol
B. Nitroprusside
C. Prazosin
D. Anlodipine
E. Diltiazem
For question number 95 to 96

A 7yo boy was brought to hospital due to red cola urine and legs edema. PE showed
BP 120/80, edema palpebral +/+, leg swelling +/+. Urinalysis revealed protein ++,
no other abnormality.
95. He is given furosemide, what is this drug?


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A. b-Adrenoreceptor
B. Vasodilator
C. Diuretics
D. Ca-Channel blocker
E. ACE inhibitor
96. The patient was given a drug but his BP remains high. What is the most
appropriate drug should be added?
A. a-Blocker
B. b-Blocker
C. Vasodilator
D. ACE inhibitor
E. Ca-channel blocker
97. Mr. Joni diagnosed as hypertension and was given antihypertensive but he
become coughing after took that drugs. Which of the following drug that was given
to him?
A. Captopril
B. Propanolol
C. Clonidine
D. Amlodipine (CCB)
E. Ferapamil (CCB)

0
98. WOTF is the prototype of angiotensin-receptor-blocker?

A. Nifedipine
B. Captopril
C. Losartan(angiotensin reseptor)
D. Carvedilol(beta blocker)
E. Clonidine(centrally acting drug)
99. A 70yo man came to the doctor for routine follow up his disease. BP was 170/90,
HR 76 BPM, Random blood glucose 140g/L. He is given Nifedipine. Most possible
side effect of thoe drug?A. Hyperkalemia
B. Hyperglycemia
C. Extremities edema
D. Cardiac depressant
E. Orthostatic hypotension
100. A 7yo boy was brought to the hospital due to generalized edema and oliguria.
PE showed BP within normal limit. Lab exam results: hypercholesterolemia,
hypoalbuminemia, proteinuria +4. Hi is given furosemide. The most advantage of
this drug?
A. Increase GFR
B. Reduce proteinuria
C. Reduce Na+ reabsorption

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D. Decrease BP
E. Activated RAAS stimulation
101. A 62 year old man came to the Primary Health Care due to pain of the right
foot. Physical examination found blood pressure 140/85 mmHg, local status of
the right foot: tumor of metaphalanges I, rubbor, callor, dollor. Laboratory
result of blood uric acid 9 mg/dL. Medical record noted he is a hypertensive
patient and has been given an anyhipertensive agent for the last 6 months.
What is the most possible drug he took?
a. Propanolol
b. Nifedipine
c. Captropil
d. Prazosin
e. Thiazide
102. 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. -blocker
b. -blocker
c. ACE inhibitor
d. Angiotensin receptor blocker
e. Ca-channel blocker
103. A 60-year-old man works in asbes actory. On the microscopic feature of
bladder biopsy shows pappilary form the highest anaplatic.
What is the diagnostic test for early staging of the bladder cancers?
a. BNO-IVP
b. USG + biopsy
c. Section alta + biopsy
d. Cytoscopy + IVP
e. Cytoscopy + transurethral resection
For questions number 104 to 105, refer to secenario below:
A male, 60 years old has early and terminal dysuria. A nodule in anterior location is
found on digital rectal examination. Prostate cut section shows gritty and firm.
Microscopic feature shows numerous small acini lying back to back.
104. The most reliable method of diagnosing prostate carcinoma is:
a. Prostate acid phosphate
b. Prostate specific antigen (PSA)

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c. Prostate ultrasound
d. Transrectal biopsy
e. MRI
105. Indication of the prostate biopsy is
a. PSA level between 4 10 ng/dl
b. PSA level below 4 ng/dl
c. Nodule om DRE
d. PSA density below 0,15
e. Patient with more than 60 gram prostate weight
106. A 17 year old boy comes to the emergency department because sudden
onset of pain in his right testicle since 2 hours ago. PE shows tender, enlarge
right testicle and absent of cremastic reflex. Urinalysis and blood serum
analysis are within normal limit. The best step in management?
a. Give a strong analgesics and wait for another 5 hours to relive the pain
b. Wait for another 4 hour and perform color Doppler ultrasound
c. Emergent right testicle operation
d. Give empirical antibiotic and observe the mass
e. Order urine culture
107. BPH is most commonly developed in?
a. Transition zone
b. Peripheral zone
c. Anterior fibromuscular zone
d. Central zone
e. Danger zone
108. If long term catheterization is anticipated (> 1 week), is advisable :
a. Robinson catheter
b. Straight catheter
c. Folley catheter
d. Whitsle-tip urethral catheter
e. Coude catheters
109. To prevent of stone formation on patient with hyperuricosuric calcium
nephrolithiasis :
a. Hypoxanthine oxidase inhibitor
b. Xanthine oxidase inhibitor
c. Hypoxanthine oxidase promotor
d. Xanthine oxidase promoter
e. Albendazole
110. A 34 years old male comes to the emergency department because of severe
pain at the right flank region that radiate to his right testicle since 2 hours ago.
He had similar symptoms 1 week ago but the pain subsided. He had a history
of passing stone 1 month ago.

0
The pain in this patient is mostly likely to conveyed by:
a. Visceral afferent fiber conveying pain sensations follow the symphatetic
fibers retrograde to spinal ganglia and cord segment T11-L2
b. Visceral afferent fiber conveying pain sensations follow the parasymphatetic
fibers retrograde to spinal ganglia and cord segment T11-L2
c. Visceral afferent fiber conveying pain sensations follow the parasympathetic
fibers retrograde to spinal ganglia and cord segments vagus nerve
d. Visceral afferent fiber conveying pain sensations follow the symphatetic
fibers retrograde to spinal ganglia and cord segment S2-S4
e. Visceral afferent fiber conveying pain sensations follow the parasympathetic
fibers retrograde to spinal ganglia and cord segments S2-S4
111. VCUG showed mild dilatation of ureter and pyelum, without fornices blunting.
What is your diagnosis now?
a.
b.
c.
d.
e.
VUR
VUR
VUR
VUR
VUR
grade
grade
grade
grade
grade
I(sampe ureter)
II(pyelom tapi blum blunting)
III(mild)
IV(moderate)
V(severe)
112. What substance that increase develompent of uric acid stone?

a. Low fruit intake
b. low caffeine intake
c. High carbohydrate
d. High organ meat
e. Low alcohol intake
113. What dietary factor that increase risk of uric acid stone development?
a. High soft drink intake
b. Low physical activity
c. Balance water intake
d. High ascorbic intake
e. Moderate daily activity

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For question number 114 and 115, refer to scenario below :
When you are at the ER at RSHS, a 25-yo man was admitted to hospital complains
of small producing urine. This complains occured prior to massive diarrheas nd
vomiting. It all started 5 days before admitted to the hospital.
PE : delirious, BP 90/60 mmHg, rapid respiration 34x/min, and Temp 37.5 degrees.
Lab : Hb 15,6 g/dl, HCT 50%, WBC 10.000/mm3, serum urea level 180 mg/dl, serum
creatinine of 5,3 mg/dl, potassium level of 7 meq/L, serum sodium level of 145
meq/L.
BGA : metabolic acidosis,
EKG : hyperkalemia
114. What the priority management for this patient?

a. High protein intake
b. High calorie intake
c. Water balance
d. Electrolyte balance
e. Low potassium intake
115. Which of the following is the most likely condition?

a. Patient should receive oral feeding with low calorie according to his energy
expenditure, protein restriction and high potassium intake, natrium and
phosphorus aggressively.
b. Patients should receive enough calorie oral feeding, protein restriction,
vitamin B complex, vitamin C, zinc, and selenium
c. Patient should receive either enteral nutrition of parenteral nutrition, high
protein, high sodium, and potassium, and phosphorus aggressively.

0
d. patients should receive parenteral nutrition with low calod rie because he had
been inadequate oral intake during five days, high protein, high vitamin B
complex, vitamin C, vitamin E, and vit. A.
e. patients should received either enteral nutrition or parenteral nutrition with
enough calorie, protein restriction, low sodium, potassium, phosphorus, vitamin
B complex, vit. E, zinc, and selenium.
116. What are the side effect from high protein intake in diabetic nephropathy and
uremic sndrome? Bisa dua2nya kemungkinan,
a. Increase protein catabolism
b. Making worse the kidney function because the protein metabolism are
metabolism are acid substance, high potassium
c. Decrease carbohydreate catabolism to prevent protein sparring effect
d. Increase glycogenolysis and protein catabolism
e. decrease muscle wasting
117. Many kind of food resources decrease risk of calcium stone development. What
kind of foods should be limited in this patient? Dijurnal kalsium bisa menghambat
terbentuknya batu
A.
B.
C.
D.
E.
Ca
K
Fiber
Animal protein
Pyridoxine
118. What is the most suitable nutrition recommendation for the patient with ESRD
A. Very low protein intake (0,3-0,4 g/kg/day) with high calorie
B. Low protein diet (0,6-0,8 g/kg/day) and higher plant protein
C. Very low protein diet (0,3-0,4 g/kg/day) and low fat intake
D. Low protein diet (0,6-0,8 g/kg/day) with enough calorie
E. High protein diet (1-1,5 g/kg/day) to minimize protein catabolism

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119. The ESRD patient undergo hemodialysis, what is the most appropiate nutrition
recommendation to this patient?
A. 35 kcal/kg/day, 0,8-1 g protein/kg/day
B. 20-25 kcal/kg/day, 0,6-0,8 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
120. Kidney has many functions in endocrine and exocrine function. Disorder in
renal function are not as etiologic factor in this abnormal condition :
a.
b.
c.
d.
e.
High risk of osteoporosis

High risk of vit. A
Anemia
Decrease of immunity
Hypertension
121. Nutritional management in Nephrotic Syndrome prevent the development of metabolic

complication with clinical implication:
a. malnutrition
b. dyslipidemia
c. hypokalemia
d. calcification
e. hyponatremia
122. Supplementation of water soluble vitamin important to improve biochemical process:

a. lipogenesis
b. energy synthesis
c. mineralization

0
d. protein synthesis initiation
e. enzyme activation
123. A construction worker is pinned under collapsed scaffolding for several hours prior
being taken to the ER. His abdomen and upper legs are severely bruised, but no
fractures are detected. A specimen for urinalysis obtained by catheterization has the
following result:
Color
: Red brown
Clarity
: Clear
Sp. Gravity
: 1.017
pH
: 6.5
protein
: Trace
Glucose : Negative
Microscopic :
Ketones
: Negative
Blood
: ++++
Bilirubin
: Negative
Urobilinogen : Normal
Nitrite
: Negative
Leukocytes
: Negative
RBC : Negative
WBC : Negative
Cast : Negative
What is the most probable cause of the positive blood reaction in the dipstick?
a. Intravascular haemolysis
b. Urinary tract bleeding
c. Myoglobinuria
d. Kidney damage
124.
Results of a urinalysis on avery anemic and jaundiced patient are as follows:
Color
: Red
Clarity
: Clear
Sp. Gravity
: 1.020
pH
: 6.0
protein
: Negative
Glucose : Negative
Microscopic :
Ketones
: Negative
Blood
: ++++
Bilirubin
: Negative
Urobilinogen : High
Nitrite
: Negative
Leukocytes
: Negative
RBC : Negative
WBC : Negative
Cast : Negative
Why is the urine bilirubin result negative in this jaundiced patient?

a. Circulating Bilirubin is conjugated
b. Circulating Bilirubin is unconjugated
c. Billiary obstruction
d. Liver damage
125.
An 8-year old boy presents with discolored urine.

0
Color
: Red
Clarity
: Clear
Sp. Gravity
: 1.015
pH
: 6.5
protein
: +++
Glucose : Negative
Ketones
: Negative
Blood
: +++
Bilirubin
: Negative
Nitrite
: Negative
Leukocytes
: Negative
Microscopic: erythrocytes = >100 per HPF (almost all dysmorphic). Red cell casts
present. What is the most likely diagnosis in this case?
a. UTI
b. Lower Urinary Tract Bleeding
c. Bladder Stones
d. Glomerulonephritis
126. A 10-year old boy with generalized edema, blood pressure 150/90 mmHg. Urinalysis
showed positive for blood, protein, and in microscopic exam: RBC and RBC casts are
found. He had sore throat ten days before and recovered without antibiotics. What is the
possible diagnosis?
a. Acute tubular necrosis
b. Post infectious glomerulonephritis
c. UTI
d. Lower urinary tract bleeding
127. A 34-year old woman Is admitted to the ER with the major complaint of not feeling
herself. For the past week, she has been suffering from extreme fatifue and headaches,
but did not feel the need to have it checke out until she has noticed that her vision is a
little fuzzy. When asked if she is taking any medication, she responds a low dosage birth
control, a womans daily multivitamin and prednisone for her systemic lupus
erythematosus (SLE). An urinalysis is ordered. The nurse notices that the urine has a
sweet odor to it as she conducts the point of care testing. The urinalysis results are:
Color
: Yellow
Clarity
: Clear
Sp. Gravity
: 1.010
pH
: 7.0
protein
: Trace
Glucose : +++
Ketones
: ++
: Negative
Bilirubin
: Negative
Nitrite
: Negative
Leukocytes
: Negative
Blood
Microscopic results:
RBC
: 2-10/hpf
WBC
: 0-5/hpf
What is the possible diagnosis of this patient?
a.
b.
c.
d.
UTI
Post infectious glomerulonephritis
Prednisone induced diabetes
Nephrotic syndrome

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128. A 60-year old patient with chronic glomerulonephritis, which did not respond to a
previous course of corticosteroids presented with BP 190/110 mmHg. Investigation
showed creatinine = 3.4 mg/dL; creatinine clearance = 40 mL/min; urine showed many
WBCs. What is the most appropriate strategy for management?
a. Nothing as the disease is essentially progressive
b. Give another course of corticosteroid
c. Treat hypertension and UTI
d. Start hemodialysis
e. Prepare for renal transplantation
129. A 32-year old previously healthy man is hospitalized because of acute onset of
dysuria, urinary frequency, fever, pain in both loins with tenderness and shaking chills.
His temperature is 39.9oC, BP: 100/60 mmHg, Pulse is 110 bpm. Which of the following
would be the most accurate diagnosis of this acute illness?
a. Acute glomerulonephritis
b. Acute renal failure
c. Acute pyelonephritis (di loins)
d. Acute cystitis(ada disuria sama urinary frequency)
e. Nephrotic syndrome
130. A 72-year old man with known BPH develops fever and flank pain. He rapidly
becomes very ill. He presents to the emergency room with a blood pressure of 80/40
mmHg, heart rate of remarkable for a white count of 20.000 hematocrit of 28%, and a
platelet count of 70.000. which of the following antibiotics is the most appropriate?
a. Ceftriaxone L
b. Ciprofloxacin
c. Co-trimoxazole
d. Penicillin
e. Gentamycin
131. A patient known to have to have chronic renal failure presented with polyuria,
thirst, generalized weekness, dyspnea, infrequent fits & lack of concentration.
His blood biochemistruy revealed the following.
Test
Serum K
Serum Calcium
Blood Urea
Serum Creatinin
Result
Reference range
8 mmol/l
3.3-5
6.6 mg/dL
8.5-10.5
160 mg/dL 25-40
12mg/dL
0.6-1.2
Which of the following is the best option for treating this patient?
f. Correction of severe hypocalcemia
g. Hemodialysis
h. Correction of hyperkalemia

0
i.
j.
Anti-epilectic drugs
Correction of volume overload
132. A 20 yo female presented with a one-day history hematuria. Two weeks back
she has had an attack of sore throat. Her physical examination revealed BP of
150/100mmHg & pedal edema What is the most likely diagnosis?
a. Minimal change glomerulonephritis
b. IgA nephropathy
c. Post-streptococcal glomerulonephritis
d. Mesangial glomerulonephritis
e. Crescentic glomerulonephritis
133. A diabetic woman, 50 years old, weight 60 kg, with symptoms of dyspneu and
vomiting left since more than 3 months. BP was 160/100mmHg respiratory rate
32 times/minute, deep and frequent. Edema of both legs, pulmonary rales was
found in both basal
Test
Hem
Urea
Creatnin
Result
73g/L
421 mg/dL
32mg/dL
reference range
115-165
8-25
0.6-1.5
MCV and MCHC normally What is the most likely diagnosis for this patient?
a. Acute kidney injury
b. Nephritic syndrome
c. Chronic kidney disease
d. Acute nephritic syndrome
e. Acute chronic kidney disease
134. 70 years old diabetic presented with nausea, vomiting and shortness of breath.
Lab investigation showed
Test
Urea
Creatinine
Result
300mg/dl
12.5 mg/dl
What is the best mode of treatment that should

a. High dose of diuretics
b. Oxygen therapy and close monitoring
c. Restrict fluid intake to minimum
d. Hemodialysis
e. IV insulin and glucose
For question number 135 to 137

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A 5 years old boy came to the emergency room pediatric department with low back
pain on micturition since 3 hours ago. There was also problem ingested
135. Which one of the following diagnosis is appropriate for the boy?
a. Pre-renal acute kidney injury (AKI)
b. Renal AKI
c. Post-renal AKI
d. Upper urinary tract infection
e. Lower UTI
136. Which of the following factor is predominate to the pathogenesis of the
disease?
a. the amount of jengkol consumed
b. the individual susceptibility factor
c. the way of jengkol served
d. preparation with another food
e. associated with genetic factor
137. The most important laboratory and imaging examination to diagnose the
disease is the following:
a. fresh specimens urine
b. serum creatinine level
c. plain abdominal x-ray
d. ultrasound of the kidney
e. serum potassium
For questions number 138 to 139, refer to scenario below:

A 7-years-old boy came to the hospital with the chief complaint of oliguria. There
was also a history jengkol ingested for about 10 pieces.

0
138. Which one of the following treatments is the most appropriate for the patient?
a. acute hemodialysis
b. acute peritoneal dialysis
c. correction with calcium glucose
d. correction with sodium bicarbonate
e. gastric lavage
139. Which one of the following prognosis is appropriate for the ..

a. poor, because the mortality rate is high
b. poor, because of the tendency to become chronic kidney disease
c. poor, because of the tendency of formation of renal scar
d. poor, because very difficult to treat
e. good, because most of them can be treated easily
140. WOTF treatment is the most appropriate in this condition of the patient?
a. antibiotics like penicillin
b. diuretics
c. Angiotensin converting enzyme inhibitor
d. Vasodilator
e. Beta-blocker
141. There was history of sore throat 1 week before

Which one of the following infectious agents is the most possible to precede the
disease of the patient?
a. Respiratory sincytial virus

0
b. Streptococcuspneumoniae
c. Staphylococcus aureus
d. Rhinovirus
e. Streptococcus -haemolyticus
For questions number 142 to 144, refer to scenario below:

A female patient 60 year old had complaint urinary incontinence. She had 6 children
and sometimes when she goes upstairs to upper room, she feels streaks some
urine.
142. What is the most probable diagnosis?

a. overflow incontinence
b. urge incontinence (ada urgency dulu)
c. stress incontinence
d. continuous incontinence
e. mixed incontinence
143. What is the risk factor of the patient above?

a. infection
b. DM
c. Multiple pregnancy
d. Stone disease
e. stroke
144. How to manage that patient above?

a. giving antimuscarinic

0
b. pelvic floor exercise
c. giving antibiotic
d. control blood sugar
e. reduce body weight
For questions number 145 to 46, refer to scenario below

A 65-year-old male had complained difficulty in voidly, frequent wake up at night 34x, felt incomplete emptying, 1 day ago he felt uncomfortable of his lower abdomen
also wasnt able to hold his urination and then he meet to hospital for his problem.
145. What is the most probable symptom this patient?
a. stress incontinence
b. urge incontinence
c. overflow incontinence
d. mixed incontinence
e. continuous incontinence
146. What will you do the patient if you are charge in the hospital firstly?
a. giving antibiotics
b. giving analgetics
c. insert the urethral catheter
d. USG examination
e. X-ray examination
147. A 65 yo male came to the outpatient clinic with a cc nocturia since 1 mo ago.
He also noted that he urinated more frequently and had sensation of not
emptying bladder completely after finished voiding. PE is unremarkable except
for prostate enlargement. The next best step in management is :

0
A. Order an urinary tract ultrasound
B. TRUS guided biopsy of the prostate
C. Quantify the severity of LUTS using IPSS
D. Order an histology examination of the prostate
E. Intravenous urogram to delineate urinary tract anatomy
148. A 67-year-old male came to outpatient clinic because of urinary retention.

Urinary catheter was inserted 1 week ago in a rural hospital. Physical
examination is unremarkable, prostate 40 grams. He noted LUTS since 6 month
ago. He also has history of hypertension which is controlled by low salt diet and
captopril. On urinalysis there are many white blood cells and his creatinin serum
is 2.5 others are within normal limit. The next best step in management is:
LUTS(
a. uroflowmetry
b. urodynamic
c. intravenous urogram
d. ultrasound of the urinary tract
e. give an alpha blockers once daily
149. A 6-month-old child brought by his mother to outpatient clinic beccause of a

mass at his left scrotum since 2 month ago. The mothers noted that the mass is
small and soft in the morning and larger at night. Physical examination shows a
healthy child and a mass in his left scrotum, no bowel sound present, not tender
and the mass transilluminates. The best next step in management is:
a. perform detorsion of the left testis
b. perform orchidopexy
c. explore the testis and drain the fluid accumulation
d. observe and wait until the child reach 1 year old

0
150. A 2-year-old boy being evaluated for the development of progresive peripheral
edema. Physical examination is afebrile and blood pressure is within normal
limit. Laboratory examination finds decreased serum albumin, increased serum
cholesterol and normal BUN and creatinine levels. A histological section from
renal biopsy examination examined using electron microscope. What is the best
describe of microscopic appearance for this patient?
a. diffuse endocapillary proliferation, leukocytic infiltration
b. focal and segmental sclerosis and hyalinosis
c. flattening and fusion of the foot processes of the podocytes
d. mesangial and endocapillary proliferation, GBM thickening, splitting
e. diffuse capillary wall thickening
151. This glomerular disease usually appears 1 to 4 weeks after streptococcal

infection of (impetigo). Skin infections are commonly associated with
overcrowding and poor hygiene frequently in children 6 to 10 years of age, but
adults of any age can also be affected. What is the describe of microscopic
appearance for that disease?
a. extracapillary proliferation with crescents; necrosis
b. infiltration by leucocyte and proliferation of endothelial and mesangial cells
c. focal mesangial proliferative glomerulonephritis; mesangial widening
d. focal and segmental sclerosis and hyalinosis
e. linear igg and C3, fibrin in crescents
152. 25 y.o man was admitted to the emergency room complaining of less frequent
of micturition since one day before. Patient did not urinate since that morning.
For the last three days he complained of massive watery diarrhea without blood
6-8 times a day and accompanied by low grade fever. Lab result showed the
increasing very high of BUN and creatinine levels. What is the best pathogenesis
could happened in his kidney?
a. hemodynamic alterations that cause reduced GFR because of intrarenal
vasoconstriction

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b. direct toxic injury to the tubules
c. focal tubular epithelial necrosis at multiple points along the nephron, often
accompanied by rupture of basement membranes (tubulorrhexis)
d. most commonly occurring as a hypersensitivity reaction to drugs
e. ischemic that cause by alterations of blood flow will make the irreversible
renal lesion that can destroy glomerular function
153. 57 y.o man came to hospital with CC a mass at his flank. He also complained
sometimes he got bloody urination for several weeks ago. Biopsy was
performed, the microscopic showed nest of tumor cells which is have clear
cytoplasm with papillary and trabecular appearance showed structure, small
nuclei but pleomorphic and abundant of mitotic. What is the best diagnosis for
this patient?
a. Wilms tumor
b. transitional cell carcinoma
c. adenocarcinoma
d. clear cell carcinoma
e. papillary carcinoma
5 y.o boy was brought by his mother to hospital with complained mass at his
abdomen. His mother felt suddenly while she holds him. Imaging examination
showed that the mass came from his kidney.
154. what is the most probably diagnosis for this patient?
a. neuroblastoma
b. nephroblastoma
c. rhabdomyosarcoma
d. medulloblastoma
e. retinoblastoma

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155. What is the best describe of microscopic appearance for that patient?
A. Nest of cells tumor with abundant eosinophil cytoplasm and mitotics
B. Tumor cells could be composed by mesenchimal and blastemal cells
C. Small round blue cells tumor that rosset apparence
D. Tumor cells could be composed by only one kind of epithelial cells
E. Tumor cells have clear cytoplasm and much of mitotics
156. A 70-year-old man has experience increased urinary frequency, nocturia,

difficulty in starting and stopping the stream of urine, overflow dribbling. The
doctor said he got enlargement of prostatic gland. What is the best
pathogenesis for this disease?
A. Disseminated abscesses as large, coalescent focal areas of necrosis; or as
diffuse edema, congestion and boggy suppuration of the entire gland.
B. Stromal and epithelial cells proliferation caused by DHT and alpha reductase
enzyme in prostate
C. Proliferation of stromal cells because of 5alpha reductase enzyme which is
location in epithelial cells of prostatic gland
D. Infiltration of inflammation cells around tubular glands
E. One very common type of somatic mutation that gives rise to chromosomal
rearrangements that juxtapose the coding sequence of an ETS family
transcription factor gene
157. autosomal dominant (adult) polycystic kidney disease is a hereditary disorder

characterized by multiple expanding cysts of both kidney that ultimately
destroy the renal parenchyma and cause renal failure. What is the best describe
of microscopic appearance for this disease?
a. Bowman capsule are occasionally involved in cyst formation and glomerular
tufts may be seen within the cystic space
b. the cysts have a uniform lining of cuboidal cells, reflecting their origin from
the collecting ducts

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c. he cysts are lined by flattened or cuboidal epithelium and are usually
surrounded by either inflammatory cells or fibrous tissue
d. renal cysts have smooth contours, are almost always avascular and give fluid
rather than solid signals on ultrasonography
e. the cyst is a pseudocyst that not lined by epithelial cells
158. Autosomal-recessive (childhood ) polycystic kidney disease (ARPKD) is

genetically distinct from adult polycystic kidney disease. The first two are the
most common serious manifestations are usually present at birth and the young
infant might succumb rapidly to renal failure. Whats the best describe of
microscopic appearance for this disease ?
A. Bowman capsules are occasionally involved in cyst formation and glomerular
tufts may be seen within cystic space
B. The cyst have a uniform lining of cuboidal cells, reflecting their origin from
the collecting duct
C. The cysts are fixed by flattened or cuboidal epithelium and are usually
surrounded by either inflammatory cells of fibrous tissue
D. Renal cysts have smooth contours, are almost always avascular and give fluid
rather than solid signals on ultrasonography
E. The cyst is a pseudocyst that not lined by epithelial cells
159. Pyelonephritis is a renal disorder affecting the tubule, interstitium, and renal
pelvis and is one of the most common diseases. One of the type of
pyelonephritis is chronic pyelonephritis. What is the best description of
microscopic appearance for this disease?
a. patchy interstitial suppurative inflammation
b. intratubular aggregates of neutrophils and tubular necrosis
c. perinephric abscess is an extension of suppurative inflammation through the
renal capsule to the perinephric tissue
d. the tubules show atrophy in some areas and hypertrophy and dilation in
others

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e. accumulation of foamy macrophages intermingled with plasma cells
68 yo man complain left upper abdominal discomfort associated with hematuria.On

plain photo abdomen there is inhomogenous opacity with multiple small
calcifications at the level left twelfth thoracic spine to third lumbar spine, the
contour is lobulated.
160. The next preferable exam which non invasive/non traumatic is:
A. IV urography
B. Antegrade pyelography
C. Retrograde pyelography
D. Ultrasound
E. CT scan
161. To know the diagnosis of the disease and function of the organ,the most
preferable examination is :
a. Intravenous urography
b. Anterograde pyelography
c. Retrograde pyelography
d. Ultrasound
e. CT Scan
162. The best examination tool of above disease is:

a. Intravenous urography
b. Anterograde pyelography
c. Retrograde pyelography
d. Ultrasound
e. CT Scan

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For question number 163-166, refer to scenario below :
A 4 year old boy comes with whole body swelling. 2 weeks before admission he had
eyelid swelling when he woke up in the morning and decreased during the
afternoon. The symptoms was followed by swelling of her face both legs and an
increase in abdominal circumferences. Since five days ago he has already
compained of body swelling. Hos urine became cloudy, foamy, and was decrease in
volume (1,2 ml/kg/BW/hour) and frequency.
Laboratory result :
Urinalysis
Protein
: 4+
: 4-5/HPF
Leukosit
: 4-6/HPF
Erythrocyte
: 20 mg/dL
Ureum serum
Creatinine serum
: 20 mg/dL
: 0,6 mg/dL
163. Which of the following condition those give the poorest prognosis?
a. Age more than 8 years old
b. Hematuria is present
c. Age less than 1 year old
d. Decrease of C3 complement serum
e. Massive proteinuria is present
164. Which of the following that the most common conplication in this patient
condition?
a. Infection
b. Heart failure
c. Encephalopathy hypertensive
d. Lung edema

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e. Chronic renal failure
165. What is the following treatment that the most suitable for this patient
a. Diuretics
b. Steroid
c. Levamisol
d. ACE inhibitor
e. Cyclosphorin A
166. What is the following statement that most likely as a cause of eyelid swelling?
a. The easiest area to see
b. The influence of gravitation
c. Eyelid is theloose connective tissue
d. Eyelid has abundant vascularization
e. There is a a decrease C3 complement serum
167. A 6 year old boy was brought by his mother complaining that he had a painless
lump in his left scrotal region since 2 months ago. The lump did not decrease or
increase in size, and the consistency of the lump was soft. There was no fever
and there is no change in bowel habit or micturition.
What is the most common surgical complication in this case?
a. Post operative bleeding
b. Severe infection of the operation site
c. Recurrence if processus vaginalis is not ligated properly
d. Enlargement of scrotal region after the operation
e. Atrophy of the testicle

0
168. A 6 month old child brought by his mother to outpatient clinic because of a
mass at .... 2 month ago. The mother noted that the mass is small and soft in
the morning ..... Physical examination shows a healthy child and a mass in his
left scotum, no bowel ....... tender and the mass transilluminates. The best next
step in management is :
a. Perform detorsion of the left testis
b. Perform orchidopexy
c. Explore the testis and drain the fluid accumulation
d. Observe and wait until the child reach 1 year old
e. Perform hydrocellectomy
169. A 6 year old boy conplained that he had a lump at his scrotal region, without
pain since two months ago. The lump was not decreased or increased in size,
and the consistency of the mass was soft. He denied that he a fever during this
period. His urination and defecation were within normal limits. Following these
statements, prognosis for this patient :
a. Good, if we treat the patient by giving him diuretic
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 left processus vaginalis
e. Good, if we perform surgical correction in an emergency situation
170. A 4 year old boy came to ER with difficulty to urinate on inspection there was a
constrictin prenuptial ring and non retractable foreskin.
Which of the following condition is most likely occured accompanying with
diagnosis above?
a. Balanoposthitis
b. Urethritis

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c. Cystitis
d. Pyelonephritis
e. Nephritis
171. Impairment of the micturition process can be caused by upper motor neuron or
lower motor neuron lesion. Which of these lesions can cause incontinence?
A.
B.
C.
D.
E.
Benign prostate hyperplasia

Bladder tumor
Neuropathy
Infection of the urogenital tract
Bladder stone
172. In which of the following cases can bladder training benefit the patient most:
A.
B.
C.
D.
E.
Cystitis
Cerebral palsy
Spinal cord injury
Glomerulonephritis
Stroke
173. The pelvic floor consists of these muscle(s):

A.
B.
C.
D.
E.
Levator ani muscle

Detrusor muscle
Obturator muscle
Iliopsoas muscle
Gluteus medius muscle
174. A 60-years old male has been diagnosed as urge incontinence. What kind of
exercise that appropriate for this patient?
A.
B.
C.
D.
E.
Abdominal muscle strengthening

Pubococcygeus strengthening
Iliopsoas muscle strengthening
Gluteus medius strengthening
Hip adductor muscle strengthening
175. A patient sufferred from SCI three months ago. He as problem in micturition.
The level of lesion is in twelfth thoracal vertebrae. What urodynamic problem
that he has?
A. Urine retention
B. Urine incontinentia

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C. Overflow incontinentia
D. Hyperactive bladder
E. Incompetent of sphincter urethra

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Final GUS Perfecten 201

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For question number 11-12

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Internal inguinal ring

Round ligament of uterus

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23. According to your patient also suffered from the following ?

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25. Stretch receptors are found here

26. Ca is mostly reabsorbed here :

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28. Carbonic anhydrase is found abundantly in this part :

29. Aquaporin (AQP)2 is synthetized in this part :

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measurement of PaCO2 indicates the

31. The kidney responds to acid-base disturbances by

Adjusting PCO3 level

Retain carbon dioxide

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Primary function is to regulate acid-base balance

For question number 35-37, refer to scenario below

35. You check the orthostatic hypotension

examination and result was positive.

What does this test refer to?

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Osmotic pressure decrease with circulating Angiotensin II increase

increase of peritubular pressure

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Questions number 44 to 45, refer to scenario below :

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47. What is the True statement regarding calcium as an important electrolyte?

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external genital was male

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Vaginalis processus developed dorsal to the gubernaculum

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53. The substitute term to painless at erosion is:

Is the ulcer clean or purulent?

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58. The next laboratory examination that should do is:

59. Based on those findings

60. The cut off of TPHA/RPR to diagnose syphillis is

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65. The non-treponemal test for syphilis is:

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For questions number 69 to 73, refer to options given below:

Which of the statement below correspond to above epithelium

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Distal convoluted tubule B

70. Ascending thin limb of Henles loop A

71. Macula densa C

72. Minor calyx E

For question no. 75-76

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75. Endogenous genitourinary infection is caused by:

76. the most possible etiology is

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