FEBRUARI 2009

1. The p53 tumor suppressor gene plays a crucial role in which of the following processes ?
a. Apoptosis
b. Angiogenesis
c. DNA replication
d. Mismatch repair
e. Signal transduction
2. Which paraneoplastic syndrome associated with renal cell carcinoma can often be managed palliated medically ?
a. Polycythemia
b. Stauffers syndrome
c. Neuropathy
d. Hypercalcemia
e. Cachexia
7. In patients with pure seminoma, combination cisplatin- based chemotherapy is appropiate treatment for wich of
the clinical stage?
a. T1N0M0
b. T2N0M0
c. T1N2M0
d. T1N3M0
e. T2N1M0
8. the majority of penile cancer are which of the following histologic types ?
a. Melanomabowenoid papulosis
b. Squamous cell carcinoma
c. Epidemic kaposi sarcoma
d. Verrucous carcinoma
9. The finding of pathologic perineural invasion of cancer (PNI) on a prostatspecimen suggests
a. Organ-confined disease
b. 20% likelihood of capsular penetration
c. 75% likelihood of capsular penetration
d. Pelvic lymph node involvement
e. A bilateral nerve-sparing prostatectomy should not be considered
10. when the dorsal vein complex is devided anteriorly, what is the most..structure that can be damaged, and what is the
most common adverse..
a. Aberrant pudenda arteries impotence
b. Neurovascular bundle impotence
c. Striated urethra spincter incontinence
d. Levator ani mucculature incontinence
11. Pusat supra spinal untuk ereksi penis adalah :
a. Korteks serebri
b. Amila gladia
c. Preoptik lateral
d. Nucleus para ventral hipotalamus
e. Area frontal

12. Presentase penderita yang mengalami .ereksi adalah:

a. 25%
b. 50%
c. 0%
d. 75%
e. 100%
13. Hubungan antara tekanan intrakavernosa dan tekanan darah selama berlangsungnya ereksi :
a. Tidak ada hubungan
b. Tekanan intrakavernosa selalu lebih tinggi dari tekanan darah
c. Tekanan intrakavernosa selalu lebih rendah dari tekanan darah
d. Tekanan intra kavernosa selalu sama dengan tekanan darah
e. Tekanan intrakavernosa dapat lebih tinggi atau lebih rendah
14. Asthenospermia dapat disebabkan oleh hal dibawah ini, kecuali:
a. Abstinensia lama
b. Infeksi traktus genitalis
c. Antisperm antibody
d. Varikokel
e. Semua betul
15. Berapa lama spermatogenesis akan terjadi lagi setelah terapi radiasi?
 a. 2tahun
b. 5 tahun
c. 10 tahun
d. 1 tahun
e. 6 bulan.
16. Obat-obatan dibawah ini ini diketahui menyebabkan gangguan spermatogenesis:
a. Cyclophospamide
b. Nitrogen mustard
c. Methotrexate
d. Chlorambucil
e. Busulvan
17. Hal-hal dibawah ini dapat mempengaruhi kuantitas dan kualitas sperma :
a. Demam
b. Cara pengumpulan yang tidak betul
c. Cirrhosis hepatis
d. Penyakit hubungan kelamin
e. Abstinensi 4 hari
18.
a. uremia dihubungkan dengan penurunan libido,.
b. Biopsi testis pada pasien uremia menunjukkan maturation arrest
c. Pada pasien yang mengalami dialisis kronik terjadi penurunan produksi testoterone
d. Transplantasi ginjal dapat memperbaiki kualitas sperma 3.transplantasi
e. Gagal ginjal kronik dapat mempengaruhi produksi testoterone
19. Pembedahan dibawah ini dapat menyebabkan disfungsi ereksi, kecuali:
a. Prostatektomi radikal
b. Sistektomi radikal
c. Uretrotomi interna
d. Winter procedure
e. Semua prosedur diatas dapat menyebabkan disfungsi ereksi
20. Pilih yang salah tentang disfungsi ereksi pada diabetes mellitus:
a. Diabetes mellitus merupakan penyebab tunggal terbanyak untuk disfungsi ereksi
b. Disfungsi reksi karena diabetea mellitus disebabkan ganguan.persyarafan, hormonal dan kejiwaan
c. Disfungsi ereksi karena DM tidak responsive terhadap injeksi ..penis
d. Terjadinya disfungsi ereksi pada DM tidak dipengaruhioleh.gula darah
e. Semua benar
21. Pada ureter distal ukuran 10x6 mm dengan obstruksi, terapi yang salah.
a. ESWL akan memberi stone free rate 90%
b. URS dengan laser tripsi dengasn kemungkinan stone free rate 9.
c. Konservatif terapi dengsan kemungkinan batu lepas sendiri 80
d. Ureterolithotomi
e. Semua yang diatas
22. Batu saluran kemih yang berada dalam noctur urinaria yangpenyulit metaplasia squamosa ialah batu yang terletak di:
a. Pyelum
b. Calyx
c. Ureter
d. Buli
e. A + D
30. Efek yang bisa terjadi pada batu ginjal yang tidak dieliminasi ialah:
a. Infeksi
b. Obstruksi
c. Kenaikan kreatinin
d. Kenaikan albumin
e. Semua yang diatas
31. Sexual differentation at fetal finish at:
a. End first month
b. End first trimester
c. End second trimester
d. End third trimester
e. After birth
32. Testicular start to descent after:
a. After second month pregnancy
b. After third month pregnancy
c. After fourth pregnancy
d. After fifth month pregnancy
e. After sixth month pregnancy
33. Testicular descent is normally complete at:
a. End of first trimester
 b. Between first-second trimester
c. End of second trimester
d. Between second and third trimester
e. Early of third trimester
34. Most other congenital problem associsated with undescenced testis..
a. Torsio testis
b. Hipospadia
c. Vesicoureteral reflux
d. Patent processus vaginalis
e. Renal aplasia
35. Histologic finding in crytorchid testis include, except :

a. decrease number of leydig cell

b. delayed appear of adult dark spermatogonia
c. early disappearance of gonocytes
d. degeneration of sertoli cell
e. reduced total of germ cell counts
36. Characteristic of hypospadia, except :

a. external urethra meatus at ventral

b. external urethra meatus at dorsal
c. has chordee
d. preputial at ventral not develop well
e. external urethral meatus can be at perineal
37. Surgical approach of hypospadia :

a. should be selected during the pre op evaluation

b. is best decided by the surgeon experience and preference
c. is determined by the location of the meatus before release chordee
d. is determined by the location of the meatus after release chordee
e. varies according to the size of the penis
38. Keypoint for surgical success for bladder extrophia :

a. early reconstruction
b. bladder subtitutior
c. pubic bone reconstruction
d. bladder neck reconstruction
e. epispadia reconstruction
39. Neonates circumcision should not performed at, except :

a. small penis
b. webbed penis
c. dorsal hood deformity
d. large hydrocele
e. all true
40. Micropenis is a normally formed penis that is at least :

a. 0.5 standard deviations (SD) below the mean in size

b. 1 standard deviations (SD) below the mean in size
c.
41. Which of the following regarding 1 therapy for hyponatremia is FALSE ?

a. Fluidoverload as a result of hypertonic saline infusion should be treated witha loop diuretic such as
furosemide
b. Too rapid correction can lead to a cerebral demyelination syndrome
c. Anggressive therapy should be discontinued when the serum sodium concentration is raised 10 % or
sypmtoms subside
d. Intranasal desmopressin is a usefull adjuvant therapy
e. For acute severe hyponatremia with symptoms, a typical infusion rate of hypertonic saline would be 1 ml/kg/h

42. Which of the following statements regarding renal blood flow (RBF) is TRUE?

a. RBF is equal in all parts of the kidney

b. RBF accounts for 5% to 10% of cardiac output
c. Blood enters the glomerulus through the afferent arteriole and exits through efferent venule
d. RBF is similar in men and women
 e. RBF is one of the determinants of the glomerular filtration rate
43. all of the following can increase total GFR EXCEPT increased:
a. RBF
b. Intraglomerular (hydraulic) pressure
c. Glomerular permeability
d. Efferent arteriolar resistance
e. Functioning nephron number
44. ESRD in adults is defined as an irreversible glomerular filtration rate(GFR), how many
mililiters per minute and a serum creatinin level of greater thanmiligrams per
deciliter?

a. 5 ml/min, 10 mg/dl
b. 10 ml/min, 8 mg/dl
c. 15 mlmin, 6 mg/dl
d. 20 ml/min, 5 mg/dl
e. 20 ml/min, 4 mg/dl
45. ..

46. the best solution for preservation af all abdominal organs is:
a. EuroCollins
b. Collins 2
c. Sacks solution
d. University of Wisconsin (UW) solution
e. Lactated Ringers solution with heparin
47. The initial goals of resuscitation of the brain dead cadaver donor.pressure of what level
and urinary output exceeding how many mililiter hour?

a. 100 mmHg, 0,25 mL/kg/hr

b. 60 mmHg, 0,5 mL/kg/hr
c. 90 mmHg, 0,5 mL/kg/hr
d. 90 mmHg, 0,3 mL/kg/hr
e. 80 mmHg, 0,4 mL/kg/hr
48. Six days after partial neprectomy in a solitary kidney the patient is ologuria..fluiod are
coming from the flank drain. The serum creatinin value increased..mg/dl. the next
step I menagemenet is:

a. renal angiography
b. CT scan with intravenous
c. Renal scan
d. Immmediate surgical exploration
e. MRI

49. Dopamine theraphy on acute renal failure:

a. Causes efferent arteriolar vasodilatation

b. Is recommended for routine use after renal transplantation
c. Is sffective due to inprove cardiac function
d. Is an unoroven treatment
e. Improves patients survival
50. The best replacement theraphy for an otherwise healthy 37 year old woman.interstitial
nephritis is:

a. Preemptive transplantation
b. Stabilization with hemodialysis for 1 year, then transplant
c. Stabilization with peritoneal dialysis for 1 year, then transplant.
d. Home hemodialysis
e. Peritoneal dialysis with an automated cycler
51. Which of the following is TRUE regar Jing cystography for diagnosis of bladder injury?

a. If the patient is already undergoing CT for evaluation of associated injuries, CT cystography should be
performed via anterograde filling of the bladder after intravenous administration of radiographic contrast
material and clamping the foley catheter
b. If plain film cystogram are obtained, oblique films are also obtained
c. CT cystogram is best performed withdiluted contrast
d. An absolute indication for immediate cystography is the presence of pelvic fracture and microhematuria
 e. None of the above
52. Which of the following is true about blunt bladder rupture injuries?

a. They are present in 90% of patients presenting with pelvic fracture

b. They coexist with uretral disruption in 50% of cases
c. Extraperitoneal rupture are always amenable to nonoperative tratment
d. High mortality rate is primarily related to nonurologic comorbidities
e. They are associated with microhematuria or no hamaturia in 40% of cases
53. The risk of complications from non operative treatment of extraperitoneal bladder rupture
increased by associated:

a. Orthopedic injury
b. Vaginal injury
c. Urethral injury
d. Rectal injury
e. All of the above
54. Three month after a urethral distraction injury, a patients develop a 2-cm
posterior.urethral obliterative stricture. Which of the following is true about the
repair?

a. One stage, open, perineal anastomotic urethroplasty is preferred

b. Orthopedic hardware in the pubic symphysis area is contraindication to.posterior urethroplasti
c. Buccal mucosa graft urethtroplasty is recommended
d. Urolume stent placement is recommended
e. Incontinence is likely after posterior urethral reconstruction surgery
55. In a blunt trauma patient with pelvic fracture in whom no urine is returned after catheter
placement, what is the best methodevaluated urethral injury?

a. Retrograde urethrography
b. CT of abdomen and pelvis
c. Filforms and followers
d. Bladder sonogram
e. None of the above
56. The high mortality rate associated with perinephric abscess is primarily attributed to:

a. Bacterial hemolysis
b. Diabetes mellitus
c. Delay in diagnosis
d. Inappropiate antimicrobial theraphy
e. Inadequate drainage
57. Most patients with chronic pyelonephritis present with :

a. Hypertension
b. Renal failure
c. Chronic infection
d. Flank pain
e. No symptoms
58. The most effective measure for reducing catheter-associated UTI is :

a. Closed drainage
b. Antimicrobial prophylaxis
c. Catheter irrigation
d. Intermittent catheteration
e. Daily meatal care
59. In spinal cord-injured patients, the bladder drainage technique with the.complication rate
is:

a. Clean intermitten catheterization (CIC)

b. Suprapubic drainage
c. Indwening catheter
d. Condom catheter
e. Suprapubic pressure
60. Fourniers gangrene is not associated with scrotal :

a. Pain
 b. discharge
c. Crepitation
d. Erythema
e. Swelling
61. TURP merupakan modalitas aterapi PPJ yang dianggap sebagai baku emas. Namun dari
segi efektifitas dan durabilitas dianggap masih dibawah:

a. HOLEP
b. Prostatektomi terbuka
c. Prostatektomi simple
d. Prostatektomi retropubik
e. Semua diatas benar
62. Alasan utama merekomendasikan tindakan TURP pada pasien dengan PPJ adalah:

a. Retensi urin kronik

b. Kencing mengedan
c. Nokturia
d. Pasien merasa terganggu sekali dan kualitas hidupnya menurun akibat gangguan berkemihnya
e. Semua diatas benar
63. Disamping gejala ganguan berkemih, maka alasan untuk merekomendasikan tindakan
TURP adalah:

a. Azotemia
b. Hematuriainfeksi saluran kemih rekurenresidu urin lebih dari 100ml
c. A dan C benar
64. Jenis-jenis -blocker yang pernah dipakai untuk pengobatan PPJ dalah:

a. Indoramin
b. Terazosin
c. Afifuzosin
d. Fenoksibenzamin
e. Semua diatas benar
65. Pengobatan PPJ dwengan tujuan mengecilkan prostat juga dapat dicapai dengansupresi
androgen dengan menggunakan obat:

a. LHRH analog (leuprolide)

b. Antiandrogen (flutamide)
c. 5-reduktase inhibitor (dutasteride)
d. Agen progestasi (17-hydroxycortisone)
e. Semua diatas benar
66. Bila berbicara mengenai terapi kombinasi untuk PPJ, maka yang dimaksud adalah:

a. Finasteride + 5-reduktase
b. Tamsulosin + 5-blocker
c. 5-reduktase inhibitor+ alfa2-blocker
d. Alfa2-blocker + 5-reduktase inhibitor
e. Semua diatas benar
67. Gejala gangguan berkemih (LUTS) pada penderita PPJ terutama disebabkan oleh:

a. Adanya obstruksi oleh massa prostat

b. Adanya penyakit penyerta yang mempengaruhi kerja detrusor
c. Adanya proses penuaan yang mempengaruhi kerja detrusosr
d. a+ b + c benar
e. a + c benar
68. Tindakan kastrasi akan menyebabkan:

a. Penurunan 50% total jumlah sel epitel prostat dan penurunan 50% jumlah stroma prostat
b. Penurunan 20% total jumlah sel epitel prostat dan penurunan 30% jumlah stroma prostat
c. Penurunan 90% total jumlah sel epitel prostat dan penurunan 40% jumlah stroma
d. Penurunan 100% total jumlah sel epitel prostat dan penurunan 90% jumlah stroma
e. Bukan salah satu diatas
69. PSA (prostate spesific antigen) merupakan suatu protease serine dan asterase..yang
mempunyai nama lain:
 a. Human kalikrein 1
b. Human kalikrein 2
c. Human kalikrein 3
d. Human kalikrein 11
e. Bukan salah satu diatas
70. Berat molekul PSA:

a. 33 kilo dalton
b. 33,000 kilo dalton
c. 33 nanogram
d. 33 mikrogram
e. Bukan salah satu diatas

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