Summative 2, Renal and Body Fluid Module, April 27th 2011

1. The purpose of nutrition therapy on renal impairment are

a. Increase body weight to prevent protein catabolism
b. Renal dysfunction cure with nutrition therapy
c. Reduce calorie intake to prevent uremia
d. Improve micronutrient intake with vitamin and mineral supplementation
e. Prevent malnutrition at an early stage of kidney disorder and/or maintain optimal
nutrition status
2. In patient with nephrotic syndrome, protein needs are
a. 0,2 g/ kg BW/day and supplemented keto-analogues and essential amino acids
b. < 0,6 g/ kg BW/day
c. 0,8-1,0 g/ kg BW/day
d. > 1,5g/ kg BW/day
e. > 2 g/ kg BW/day
3. Nutritional therapy in acute renal failure
a. Caloric needs are calculated from actual body weight (BW including edema)
b. Caloric needs are 20-30 kcal/kg/day
c. Increased intake of calories needed to gain weight
d. Restricted protein < 0,6g/kg/day
e. Need full micronutrient supplementation high dose to prevent deficiency
4. In chronic kidney disease, which is recommended
a. High dose vitamin C supplementation, at least 500 mg/day
b. Vitamin A supplementation is not recommended because it often resulted in
accumulation
c. Vitamin D supplementation is not recommended because it often resulted in
accumulation
d. Phosphate and calcium supplementation to prevent osteoporosis
e. Supplementation of potassium to prevent hypertension
5. Dietary protein in renal disease considering
a. Vegetable protein 2/3 of total protein
b. Animal protein 1/3 of total protein
c. Vegetable protein is restricted
d. Enough that meets the essential amino acids
e. Enough that meets the non-essential amino acids
6. Nutritional therapy in kidney disorders should also consider fat intake to prevent dislipidemia.
Diet includes
a. The proportion of fat > 30% non-protein calories
b. The proportion of saturated fat > 20% of total calories
c. The proportion of polyunsaturated fat > 20% of total calories
d. The proportion of monounsaturated fat > 20% of total calories
e. The proportion of cholesterol < 200mg/day
7. Replacement therapy in Chronic kidney disease stage V is
a. Dialysis
b. Plasmapheresis
c. Hemofiltration

d. CRRT
e. SLED
8. Acute renal kidney disorders
a. Caused by perfusion disruption to renal
b. Caused by toxic drug for the kidney
c. Can be found in the cause of prostate hyperthrophy
d. Caused by urolithiasis
e. Caused by excessive bleeding
9. Kidney disease that cuase proteinuria more than 1,5 g/ 24 hours called
a. Pre-renal kidney disease
b. Tubulo-interstitial disease
c. Glomerular disease
d. Obstructive renal disease
e. Vascular renal disease
10. A man, 55 years old, came with the complaint suddenly anuria since a day ago. Patient also
said he has a urinary tract stone surgery 5 years ago.
Result of blood laboratory test: Urea 95 mg/dl; Creatinine 5 mg/dl.
a. This patient was suffering pre-renal kidney disease
b. This patient was suffering drug toxic kidney disease
c. This patient has renal disease infection
d. This patient suffered obstructive renal disease
e. This patient suffered tubule-interstitial kidney disease
11. A patient brought to emergency unit because of decreased consciousness and occasional
seizure. According to relatives, disorder that can occur in this patient is
a. Severe hypokalemia
b. Severe hypocalcemia
c. Severe hypochloremia
d. Severe hyponatremia
e. Severe hypomagnesia
12. A man, 23 years old, came to emergency room taken by his friend with history of frequent
watery defecation and vomiting. On examination was found blood pressure lower than normal
with decreased skin turgor. Sodium content is normal and low blood potassium levels.
Conclusion from the result of patient examination state that the patient experience
a. Severe dehydration
b. Severe hypohidration
c. Severe liquid depletion
d. Severe volume depletion
e. Severe hypovolemia
13. A 49 years old man came to the hospital with haematuria. From anamnesis, there was
information about smoking habits and ever infected by Schistosoma haematobium.
Cytoscospy examination showed a mass in the lateral wall of bladder and multifocal growth.
Biopsy was performed.
Which one of the diagnosis below is appropriate with this condition?
a. Papillary cystitis
b. Chronic cystitis
c. Urothelial carcinoma
d. Papilloma urothelial

e. Adenocarcinoma
No.14-15
A man, 65 years old, came to the hospital with haematuria and costovertebral left pain. Radiology
examination showed tumour mass in the renal and the nephrectomy was performed. Histopatology
examination showed benign tumour mass consist of round cells with uniform nuclei. And
characteristic of this tumour was pink cytoplasms.
14. What is the possible diagnosis of this patient?
a. Renal cell carcinoma
b. Nephroblastoma
c. Angiomyolipoma
d. Renal oncocytoma
e. Renal papillary adenoma
15. What is the cause of pink colour in this tumour?
a. Excess of eosin staining absorption
b. Many mitochondria in the cytoplasm
c. Many lisosom in the cytoplasm
d. Many ribosomes in the cytoplasm
e. Many cyctoskeleton
16. Nephrectomy was performed and gross examination showed tumour mass with yellowish
colour. Microscopically, it showed tumour mass with solid and tubular arrangement. Cells in
polygonal shape and clear cytoplasms. Ther is a paraeoplastic syndrome from clinical
information.
What is the possible diagnosis of this case?
a. Renal cell carcinoma
b. Nephroblastoma
c. Angiomyolipoma
d. Renal oncocytoma
e. Renal papillary adenoma
17. What is the origin of the tumour (no.16)
a. Transitional cell of renal pelvis
b. Epithelial cell of tubule
c. Intercalated cell
d. Parietal cell of Bowmann capsule
e. Visceral cell of Bowmann capsule
18. Elimination of drugs oncludes the following
a. Hepatic metabolism to polar metabolites
b. Hepatic metabolism to active metabolites
c. Renal excretion of parent drug/ active metabolites
d. Renal excretion of polar metabolites
e. Renal excretion of inactive metabolites
19. Drug elimination during haemodialysis is clinically significant if the drug has the following
properties
a. MW > 500 dalton
b. Water soluble, charged
c. Water soluble, uncharged
d. Vd > 1 L/kg

e. Strong binding to plasma protein

20. Dosage adjustment in renal failure is required for the following
a. Drug with large Vd
b. Drugs with strong plasma protein binding
c. Drugs high renal excretion
d. Loading dose
e. Maintenance dose
21. Pharmacokinetics in renal failure include the following alteration
a. Gastric pH becomes more acidic
b. Plasma protein binding of basic drugs
c. Hepatic metabolism of drugs
d. Active tubular secretion of drugs
e. Tubular reabsorption of drugs
22. The following statement is true for supplementation dose after haemodialysis
a. Required if drug celarence by haemodialysis is less than 30% of the total drug
clearance by the body
b. The supplementation dose depends on the molecular weight of the drug
c. The supplementation dose depends on the drug concentration before haemodialysis
d. The supplementation dose depends on the Vd of the drug
e. The supplementation dose depends on the plasma protein binding of the drug
23. The following statement is true for dosage adjustment in renal failure, EXCEPT
a. Depends on the change in the tubular reabsorption
b. Depends on the change in fraction of renal clearance to total clearance.
c. Reduction of maintenance dose with normal closing interval is desired for
antimicrobial drugs with concentration dependant killing
d. Extension of dosing interval with normal maintenance dose is desired for drugs with
narrow margin of safety
e. Calculation is not adequate and patients clinical response is required
24. Co-trimoxazole is indicated for infections caused by
a. Acinetobacter baumannii
b. Pseudomonas aeruginosa
c. Mycobacterium tuberculosis
d. Staphylococcus aureus
e. Pneumocystis jirovecii
25. Fluoroquinolones should not administered concomitantly with
a. Aspirin
b. Metoclopramid
c. Antacid
d. Pehobarbital
e. Heparin
26. Acute pyelonephritis should be treated with
a. Methenamin
b. Cephalexin
c. Nitrofurantoin
d. Amoxicillin
e. Gentamicin

27. Bleeding is a side effects associated with

a. Cefoperazone
b. Ampicillin
c. Ciprofloxacin
d. Nitrofurantoin
e. Ceftriaxone
28. The following agent is contraindicated forpregnant women
a. Cefotaxime
b. Ceftriaxone
c. Co-amoclav
d. Ofloxacin
e. Ceftazidime
29. The following diuretics that can induce hyperclacemia
a. Furosemide
b. Hydrochlorothiazide
c. Triamteren
d. Spironolactone
e. Etacrinic acid
30. The main side effects of Carbonic Anhydrase Inhibitor is
a. Hypokalemia
b. Hypercalcemia
c. Metabolic acidosis
d. Metabolic alkalosis
e. Gynecomastia
31. Diuretics that is beneficial for reducing formation of myocardial fibrosis is
a. Spironolactone
b. Furosemide
c. Thiazide
d. Ethacrinic acid
e. Acetazolamide
32. The diuretics frequently used to reduce cerebral oedema
a. Loop diuretics
b. Carbonic Anhydrase Inhibitor
c. Osmotic diuretics
d. Thiazide diuretics
e. Potassium sparing diuretics
33. The drug of choice for hypertension with hyperaldosteronism is
a. HCT
b. Captopril
c. Hydralazine
d. Amlodipine
e. Spironolactone
34. Antihypertensive of choice for pregnant women
a. Captopril
b. Valsartan
c. Methyldopa

d. Nifedipine
e. Propanolol
35. Long term administration of ACE-inhibitor can induce hyperkalemia in the following
condition
a. Heart failure
b. Renal failure
c. Liver cirrhosis
d. Asthma bronchial
e. Combination with furosemide
36. The following anti-hypertension works as agonist of central alpha-2 receptor
a. Enalaprilate
b. Verapamil
c. Losartan
d. Clonidine
e. Trimetafan

37. Carbonic Anhydrase Inhibitor is indicated for the following condition, EXCEPT
a. Glaucoma
b. Epilepsy
c. Acute mountain sickness
d. Urinary alkalinisation
e. Ascites in liver cirrhosis
38. Calcium antagonist are not recommended for hypertension with the condition below
a. Heart failure
b. Chronic kidney disease
c. Pregnancy
d. Dyslipidemia
e. Diabetes
39. Test that does no used as renal function test
a. BUN
b. Ureum
c. Creatinine
d. Clearance test
e. Glucose
40. In diabetic nephropathy, that does not increased is
a. Urine glucose
b. Urine albumin
c. Urine ureum
d. blood creatinine
e. Blood uric acid
41. Examination of potassium should be done in this condition except

a.
b.
c.
d.
e.

Ascites
Pregnancy
Excessive burns
Dehydration
Captopril administration

42. Blood chloride is not necessary in this condition

a. Hypoaldosteronism
b. SIADH
c. Normal sodium concentration
d. Multiple myeloma
e. Salt-losing nephritis
43. This statement below concerning blood gas analysis is not correct
a. Capillary blood can be used for pH and pCO2
b. Experience personnel should draw blood for BGA
c. Heparin as recommended anti-coagulant
d. Venous blood may be used for complete BGA
e. Glass syringe recommended
No.44-46
A man, 35 years old, came to the emergency room in RSCM with great pain in left hip that spread to
the lower left abdomen at the meeting 5 hours ago. Pain is accompanied by cold sweat, nausea, and
vomiting one time.
On physical examination found the patient was in pain and trying to find a comfortable position to
reduce pain complaint. Vital signs are within normal limits and there is pain in the left corner of the
CVA.
44. Immediate action needs to be done on the patient are
a. BNO/ IVP
b. Giving NSAIDs analgesic/ narcotics
c. Giving antibiotics
d. Giving diuretics
e. Giving allopurinnol
45. If the patient is on the BNO/ IVP have left kidney hydronephrosis grade 3 because of stone
size of 8x10 mm in the distal ureter, the pain does not disappear with analgesic
administration, and patient with fever and full leukosituria, treatment recommended is
a. ESWL
b. Conservative with diuretikum and alpha blocker drug
c. URS and lithotripsy
d. Immediate decompression with percutaneous nephrostomy
e. Giving analgesic
46. Microorganism that produce urease, except
a. E.coli
b. Proteus mirabilis
c. Klabsiella
d. Enterobacter
e. Pseudomonas

No 47-49
A man, 70 years old, retired, complain cannot urinate since 24 hours ago and suffer lower abdominal
pain. There is a history of previous LUTS. On examination, there is a palpable mass on the region
suprasymphisis. By the physician at the emergency room, catheter no.18F is attached and initial urine
out 600 cc, clear yellow.
47. Diagnosis that is not possible in this patient
a. Benign prostate enlargement
b. Stricture urethra
c. Buli stone
d. Prostate carcinoma
e. Neurogenic bladder

48. Below are the clinical signs associated with benign enlargement, EXCEPT
a. Hesitancy
b. Weak urine jets
c. Straining during urination
d. Not flow rapidly
e. Dysuria
49. Investigations recommended for this patient, EXCEPT
a. Urinalisis
b. Prostate Specific Antigen (PSA)
c. Kidney function (ureum and creatinine)
d. BNO/ IVP
e. USG of kidney, bladder, and prostate