1 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT

FINAL GUS BATCH 2009

1. Oleh Dudi

2. What is the source alkaline phosphate in the semen ?
a. prostatic glandcairanasam
b. bulbourethral glandlubrikan
c. seminal vesiclefruktosa, cairanbasa
d. seminal calliculus apparatus
NOTE: Composition of human semen:
The components of semen come from two sources: sperm, and "seminal plasma". Seminal plasma, in turn, is produced by
contributions from the seminal vesicle, prostate, and bulbourethral glands.

Seminal plasma of humans contains a complex range of organic and inorganic constituents.

The seminal plasma provides a nutritive and protective medium for the spermatozoa during their journey through the
female reproductive tract. The normal environment of the vagina is a hostile one for sperm cells, as it is very acidic (from
the native microflora producing lactic acid), viscous, and patrolled by immune cells. The components in the seminal plasma
attempt to compensate for this hostile environment. Basic amines such as putrescine, spermine, spermidine and
cadaverine are responsible for the smell and flavor of semen. These alkaline bases counteract the acidic environment of
the vaginal canal, and protect DNA inside the sperm from acidic denaturation.

The components and contributions of semen are as follows:

Testes: 2-5%. Approximately 200- to 500-million spermatozoa (also called sperm or spermatozoans), produced in the
testes, are released per ejaculation.

Seminal vesicle: 65-75% amino acids, citrate, enzymes, flavins, fructose (the main energy source of sperm cells, which rely
entirely on sugars from the seminal plasma for energy), phosphorylcholine, prostaglandins (involved in suppressing an
immune response by the female against the foreign semen), proteins, vitamin C

Prostate: 25-30% acid phosphatase, citric acid, fibrinolysin, prostate specific antigen, proteolytic enzymes, zinc (serves to
help to stabilize the DNA-containing chromatin in the sperm cells. A zinc deficiency may result in lowered fertility because
of increased sperm fragility. Zinc deficiency can also adversely affect spermatogenesis.)

Bulbourethral glands < 1% galactose, mucus (serve to increase the mobility of sperm cells in the vagina and cervix by
creating a less viscous channel for the sperm cells to swim through, and preventing their diffusion out of the semen.
Contributes to the cohesive jelly-like texture of semen.), pre-ejaculate, sialic acid

3. Contraindications of circumcision ? hypospadia
Anatomic Contraindications to Neonatal Circumcision
Hypospadias
Chordee
Penile Torsion
Webbed Penis
Buried Penis
Urethral Hypoplasia
Epispadias
Ambiguous Genitalia

4. 35 y.o man complains pain when erection since 3 weeks ago. The physian diagnose Pyeroines diseasefor this
patient. Where is the location of the plaque or fibrosis that would be found when the physician palpate the
penis
a. corpus spongiosum
b. corpus cavernosus
c. bulb of penis
d. orificum urethra externa
e. proximal of penis
NOTE: Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding
the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and
shortening.

5. You are at surgery and doing deferentomy. During the procedure, parts of ductus deferens ligated and/or
exised through incision. Where is the right location to ligate/incision?

2 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
a. superior part of scrotum
b. after head of epididimis
c. inferior to spermaticord
d. lateral to pampiriform
e. medial to testicular artey

6. Oleh Haviz

7. seorangwanita 39 tahunmengeluhkanhematuriandan significant flank tenderness.
Diamempunyaisejarahkidney stones. Hasil CT scanmenyatakanabdominal portion dariuterusnya
lyinganterior to a muscle. Which of the following most likely to be the name of this muscle ?
a. rectus muscle
b. obturatirmuscke
c. serratus anterior muscke
d. external oblique muscle
e. psoas

8. Oleh Risdan
9. 30 y.o. woman, an absent kidney. WOTF findings is she also likely to have.
a. absent unilateral ovary
b. unicornuate uterus
c. imperforate hymen
d. inguinal hernia
e. patency of the uterine tube
NOTE: Unicornuate uterus (UU): When one mllerian duct is underdeveloped or fails to develop, a banana-shaped half-
uterus is formed. A missing kidney or other kidney problems accompany this asymmetric anomaly more than they do
other mllerian anomalies. This is a rare condition.

Questions 10-13 is based on the following: A 2 y.o boy come to your clinic with his mother. His mother tell about his son
who complains of noticeable swelling one of the scrotum and which feels tender when palpated and this is
accompanied by fever, all these beginning 3 days ago.

10. 2 years old boy come to your clinic with his mother. His mother tells you about his seen swelling one of the
scrotum and feel tenderness with palpable and accompany by fever
a. orchitis
b. hernia scrotalis
c. hydrocele
d. hematocele
e. undercensus testis

11. What is diagnostic approach for this case ?
a. Transillumination +
b. Consistency of scrotal can be soft or hard
c.
d. Swelling is because of accumulation of fluid from tunica vaginalis
e. Swelling is because of accumulation of blood

12. The scrotum appears to have a slightly pigmented and wrinkled appearance. What is the explanation for this
appearance?
a. Hyperkeratinized squamous epithelium
b. The tunica albuginea, which consist of fibrous capsule
c. The dartos fascia, which consist of smooth muscle
d. The pampiniform plexus of veins
e. The spermatic cord, which consist of double layered peritoneal

13. At the first steps on circumcision the physician block anesthesia. What is the name of area for doing anesthetic
procedure?
a. Fascia Dartos
b. Buck Fascia
c. External spermatic fascia
d. Internal spermatic fascia
e. Cremaster fascia


3 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
14. 24 yo man, retention urine & presents with meatal bleeding, who experienced a rood traffic accident
previously. Which of the following is a contraindication for urethral catheterization?
a. Phymosis
b. Meatal bleedingsesuai case
c. Rentension urine without rupture urethra
d. Meataltenosis
e. Hematuria
NOTE: The main two contraindications for urethral catheterization is trauma any part of the lower urinary
tract; and acute prostatitis. Urethral catheterization is contraindicated in the presence of traumatic injury to
the lower urinary tract (eg, urethral tear). This condition may be suspected in male patients with a pelvic or
straddle-type injury. Signs that increase suspicion for injury are a high-riding or boggy prostate, perineal
hematoma, or blood at the meatus. When any of these findings are present in the setting of possible
trauma, a retrograde urethrogram should be performed to rule out a urethral tear prior to placing a
catheter into the bladder

15. Male 40 YO, staggering back pain that doesn't change with movement, spiking fever in past 6 hour. Radiology:
where the dilatation would most likely be found?
a. In the right paravertebral area, at the level of 12 th rib
b. In the lesser pelvic brim
c. In the midvertebral line, at the level T11-L2
d. In the midvertebral line, at the level T12-L3
e. In the left paravertebral area, right above the iliac spine

16. 7years old girl riding bicycle and suddenly hit the car. Jatuhketanahbagianpunggungduluan. Pain at the right
flank side, bruises on her skin. Pembuluhygberesiko?
a. internal illiac artery
b. external illiac artery
c. renal artery
d. abdominal artery
e. common illiac artery

17. A 28 y.o. Man complaining of bloody urine. He revealed that he often feels colicky pain that doen't change w/
movement. Further examination indicates ureteric stone. From the following structure, on which part is the
stone most likely be?
a. In the middle of one third distal from renal pelvic
b. At the junction where ureter crosses the pelvic brim
c. Halfway through its course
d. On the right ureter
e. In the middle of one third proximal from its origin
NOTE: This question is testing about the 3 areas of constriction that you can find in any normal ureter.
The 3 areas of constriction are the junction between renal pelvis of kidney and ureter; ureter crossing
over the pelvic brim; and junction of ureter with bladder [aka vesico-ureteric junction; vesico = bladder]

18. An anatomist was doing pelvis & abdomen exploration on male adult cadaver. He found a hollow viscus in the
lesser pelvis. Its apex points toward the symphisis pubis. What is the characteristic anatomist of the organ?
a. It's bordered with vagina on the posterior aspect
b. Its posterior wall is pierced by two urethra
c. It's supplied by external iliac artery
d. Its posterior wall contain detrusor muscle [NOTE wall of bladder has 3 layers, each is in different
orientation to give added strength. The collection of these 3 layers is known as DETRUSOR muscle.
This triple-layer is found in all parts of bladder wall, not just posterior]
e. It doesn't have internal sphincter

75 yo man complaint suprapubic pain. Can't urinate for 24 hour.DRE : enlarge prostate, 40 gr, smooth surface,
no nodule
19. What convey the pain signal from this patient problem?
a. Mixed autonomic fiber
b. Presynaptic sympatetic fiber
c. postganglionic parasympatetic fiber
d. Preganglionic sympatetic fiber
e. Visceral afferent fiber [which follows the postganglionic parasympathetic fibers]


4 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
20. which structure is mainly compromise from this patient's problem
a. membranous urethra
b. prostatic urethra
c. preprostatic urethra
d. spongy urethra

21. Have long primary processus from which arise interdigitating pedicle that group capillaries.
a. Enddothelial cell
b. Podocyte
c. Mesangial
d. Lacis cell
e. Macula densa

22. Tubulus yang histologinya : low columnar-cuboid, punyamicrovili yang membentuk brush border
a. Collecting duct
b. Distal convoluted tubule
c. Loop of henle
d. Collecting duct
e. Proximal convoluted tubule

23. This urinary tract segments carries urine from the renal pelvis to the urinary bladder. The lumen is
narrower than that of the renal pelvis. The wall consist of mucosa, muscularis and adventitia. Wotf is most
likely lined the mucous layer of this segment?ureter
a. Stratified cuboidal epithelium
b. Stratified squamous epithelium
c. Stratified columnar epithelium
d. Pseudostratified columnar epithelium
e. Urothelium transitional epithelium

24. Epithel lining dari prostatic urethra
a. Transtitionalepitel
b. Pseudostratified columnar
c. Simple squamous
d. Simple cuboid
e. Simple columnar
Membranous urethra psedostratified columnar epithelium
Spongy / penile urethra pseudostratified columnar stratified squamous epithelium

25. This gland is a collection of 30-50 brancehs of tubuloalveolar glands. This glands are arranged in concentric
layers around the urethra. A caracteristic feature of this gland is the presence of corpora amylacea in the
lumen of the gland. What od the following organ?
a. Seminal vesicle
b. glands of littre
c. Bulbourethral gland
d. Prostate gland
e. Seminiferous tubule

26. Female 20 y.o was preventive competing PON because Buccal smear test chromatine (-)punyamale sex
chromosome. Which one regarding that case?
a. Female, even though 46 XY
b. Androgen (in)-sensitivity syndrome
c. Action of testosteron has no resistance
d. Not increase risk of tumor formation

27. Maafgabisanyatet, duduknyadepanpengawasbanget (Intan )

28. Increase Na reabsorbtion associated with K and H secretion at distal tubule. aldosterone

29. Lack of this hormone will increase volume of a patients 24h urine collection with an increase spesific gravity.
What hormone?aldosterone

30. Lack of this hormone causing increasing volume urine 24h and decrease spesific gravity. What
hormone?ADH (diabetes insipidus)


5 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
a. For number 28 37
b. Aldosteron
c. Anti Diuretic Hormone
d. Atrial Natriuretic Peptide
e. Calcitriol
f. Insulin
g. Norephinephrine
h. Parathyroid hormonebikinhypercalcemia. Bikinreabsorbsi calcium tapifosfatgak.
i. Thyroid hormone

31. Secretion this hormone will be stimulated if wereduce our dietary salt intake.aldosterone
32. Kurangnyahormoninidapatmenyebabkan intracellular edema.thyroid
33. Jikahormoninimeningkat,
tekanandarahdapatmeningkatjugaakibatkontraktilitasjantungnaik&vasokonstriksiNE
a. pembuluhdarah.
34. Long time of this hormone can cause high peripheral resistance because of blood vessel sclerosis.calcitriol
(vitamin D) meningkatkankalsiumdarah
35. It reduces phospate reabsorption in renal tubule.PTH
36. It enhances phospate reabsorption in renal tubule.Insulin
37. It reduce systemic blood pressure.ANP

38. A man comes with metabolic acidosis. He has hypertension & diabetes but never took his medicine regularly.
Best bodymechanism to his condition is..
a. reabsorb H
+

b. Excretion of HCO3
-

c. Neutralize excess acid
d. Neutralize excess base

39. Acute Renal Failure:
a. BUN with normal value
b. Decrease urea serum
c. Decrease creatine serum
d. Decrease albumin serum
e. Increase urea serum

40. Apa yang menyebabkan gross hematuria padakasus acute nephritic syndrome?karena thickening GBM
a. Increase hidrostatic pressure at Bowmans capsule.batu
b. Decrease hidrostatic pressure in glomerular capillaries.
c. Decrease hidrostatic pressure at Bowmans capsule.
d. Increase hidrostatic pressure in glomerular capillaries.
e. Increase osmotic colloid pressure at glomerular capillaries.

6 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT

41. 60 y.o woman, 20 years DM &hipertensi, dibawake ER. Gejala: SOB & leg swelling. Diagnosis: CKD e.c diabetic
nephropathy dan metabolic acidosis. Random blood glucose: 172; ureum 60; creatinine: 28; urine: protein
+4, glucose +2. Mekanisme proteinuria?
a. increase glomerular hydrostatic pressure
b. decrease glomerular hydrostatic pressure
c. inactive protein kinase C
d. glycosilating the protein
e. decrease GFR

42. 72 y.oman has LUTS with enlargement of prostate on DRE. WOTF enzyme that catalyze this enlargement?
a. a.1 alpha reductase
b. b.5 alpha reductase
c. c.5 beta reductase
d. d.5 alpha oxydase
e. e.1 alpha oxydase

43. 65 tahun, CHF, dyspnea on exertion, PND, orthopnea, edema perifer, renal function: normal.
Terapiantihipertensi. Obatapa yang nurunin BP dengannurunin Na dannurunin blood volume?
a. vasodilator
b. beta blocker
c. ACE
d. CCB
e. diuretik

44. Side effect thiazide:
a. HyperurecemiaNOTE: and also hypokalemia, hyponatremia, hypercalcemia, hyperlipidemia,
hyperglycemia
b. hyperkalemia
c. hypocalcemia
d. hypolipidemia
e.

45. Obat yang menginhibisiperubahan angiotensin I menjadi angiotensin II?
a. Captopril [note: drugs ending with pril are ACE-I]
b. nifedipin
c. thiazide
d. valsartan
e. propanolol

46. 60 tahun, pria, pulmo edema, severe dyspnea, anxiety struggling to breath, diberi O2 dan rapidly acting
diureticIV. Obat yang diberikan? [note: indicative or possible heart failure]
a. Furosemide [GIVEN IV and used especially in cases of SEVERE EDEM IN EMERGENCY CASES, heart
failure]
b. acetazolamide
c. HCT
d. Spironolactone this is potassium sparing
e. manitol


7 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
47. 60 tahun, pria, pulmo edema, severe dyspnea, anxiety struggling to breath, diberi O2 dan rapidly acting diuretic
IV. site of action diuretikdimana?
a. PCT
b. thin descending limb [nonsense]
c. thick descending limb [yes, part of the Loop of Henle]
d. DCT
e. collecting tubule [no diuretics act here]

48. Seorangbapakberusia 70 tahun dating utk follow up rutin. BP: 170/90, HR 76 bpm, random blood glucose level
140. Diberikannifedipine. Side effect nifedipine is..
a. hyperkalemia
b. hyperglycemia
c. orthostatic hypotension
d. cardiac arrest NIFEDIPINE HAS VASODILATORY ACTION!

49. 70 y.oman came to the outpatient clinic for routine check up his condition. medrec noted that he is given. (?) BP
170/110 mmHg unchanged after 5 minutes. Other system within normal limit. Most likely appropriate drug?
a. beta blocker + cloridin (symphatolytic)
b. valsartan (ACE inhibitor)+ nifedipine
c. diltiazem(Ccl) + nifedipine
d. propanolol + diltiazem
e. propanolol + verapamil (ACE)

50. 67 tahun, laki2 pergikepuskesmaskarenahipertensi. BP 210/120 and given a proper dose of
directvasodilator. BP immediately fell down but it became reverse back. What is most likely mechanism that
ruins the effect of the drugs?
a. decrease peripheral resistance
b. stimulating RAAS
c. decrease cardiac output
d. decrease venous return
e. chonotropic negative
[Due to the resultant hypotension, the RAAS kicked in to restore volume, and hence, blood pressure]
51. 7 years old boy was brought to the hospital due to generalized edema and oligouria. PE: blood pressure normal.
Lab examination: hypercholesterolemia, hypoalbuminemia, proteinuria 4+, given furosemide. What is the
most advantage of giving furosemide in this case?
a. Increased GFR
b. Reduced proteinuria
c. Reduces na+ reabsorbtion
d. Decrease blood pressure
e. Actvated RAAS stimulation
This is a case of NEPHROTIC SYNDROME. Edema and oliguria indicate reduced urine output fluid retention is taking
place. Give a diuretic [such as furosemide] to increase GFR and increase urine production.

52. 64 years old, pain on the right foot. BP 140/83, at foot found tumor metaphalanges I, rubbor,color, dolor, uric
acid 9 mg/dl. Have hypertension but gas been given antihypertension for 6 months. The most possible drug he
took:
a. Propanolol
b. Nifedipin
c. Captopril
d. Prazosin
e. Thiazide [side effect of thiazides GOUT (hyperuricemia)

53. 66 years old man come to doctor for routine medical follow up. He is noted to have cardiac enlargement. He is
given thiazide and captopril. The newest thorax x-ray shows cardiac size is smaller compare to the previous
thorax x-ray made severa; months ago. What is the most possible mechanism for the improvement?
a. Reduce aldosteron activation
b. Decrease peripheral resistance [ reduces burden on the heart ]
c. Decrease blood pressure
d. Decrease urine retension
e. Reverse remodeling [NO SUCH THING]
Note: The smaller heart means there is some improvement; the heart is not working harder than normal and is less
hypertrophied.
54. 70 years old wpman. Physical examination: BP 150/90, edema lower extremities (+/+). Was previously given
digoxin. WOTF appropiate diuretic for her?

8 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
a. HCT
b. Manitol
c. Furosemid x
d. Spironolactone [Because digoxin is contraindicated in hypokalemia; hence give spironolactone
(spares potassium) if you still want to use digoxin]
e. Azetolamide

jangandikasihyg lowering K+


55. 50 years old woman pulsative headache. BP 160/90. HR 104 bpm, no other abnormality.Which of the
appropiate drug for her?
a. Alfa blocker
b. Beta blocker
c. ACE inhibitor
d. Angiotensin receptor blocker
e. Ca channel blocker
Note: Pulsative headache is a sign of postural hypotension. However, she has a very high heart rate. So, the best drug to use
is the BETA BLOCKER because they have DUAL EFFECT one is they reduce HR and prevent occurrence of overworked
hearts; secondaly, they increase vasodilation so the BP can be gradually dropped]

56. 5 years old boy. Facial puffiness. Periorbital moderate edema.Protein 2.5 mg/dl. Albumin 1.4 mg/dl. Kolesterol
350. Protein selective (+). Diagnosis?
a. Tubular dysfunction
b. Glomerular dysfunction
c. Batu di urinary tract
d. Dysuria
e. Kidney malformation

57. What is the most possible cause of edema in nephrotic syndrome?
a. Renal retention of dietary sodium & water
b. Increased hydrostatic pressure in bowmans capsule
c. Decrease urine formation
d. Movement of fluuid from interstitial to vascular space
e. Blockage of lymph return

58. What is he most possible cause of proteinuria in nephrotic syndrome?
a. Tubular dysfunction
b. Failure of glomerular capillary
c. Heavy exercise
d. Increase protein reabsortion
e. Increase protein intake

59. Student drink 2 litres of water sodium chloride 0,9% in very short time. What the condition?
a. Decrease hydrostatic pressure bowmans capsule
b. Increase osmotic pressure
c. Increase hydrostatic pressure in glomerular capillary
d. Increase arterial plasma colloid osmotic pressure
e. Decrease net filtration pressure

60. (Sorry lupapisan)

61. Peningkatancreatininemenandakan :
a. UTI
b. Diabetes
c. Kidney Failure
d. Normal, tidakadakelainan
e. Urinary stone

62. Yang bertindaksecaralangsungdalammeregulasiekskresicairan di ginjalialah
a. ADH
b. Medulla oblongata
c. Blood plasma

9 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
d. Lupa
e. Aldosteron

63. Which part of that process which removes water, ion, and nutrient from the blood?
a. Vasa recta
b. Loop of henle
c. PCT
d. Peritubular capillaries
e. Glomerulus

64. nefron :
a. Eliminate waste from body
b. regulate blood volume&pressure
c. control level of electrolytes and metabolites
d. regulate blood pH
e. all of above

65. If I am dehydrated my body will increase
a. ATP
b. ADP
c. Diluted urine
d. ADH
e. Sodium

66. What substance that increase development of uric acid stone?
a. low fruit intake
b. low caffeine intake
c. high carbohydrate take
d. high organ meat intake
e. low alcohol intake

67. 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 acid intake
e. Moderate daily activity

68. Acidic food...
a. Vegetable
b. Beverage
c. Fat
d. Peanut
e. Milk

69. .65 yo women, 10 tahunmenderita DM danhipertensi, masuk RS dengankeluhan swelling. PE: compos mentis,
BP: 160/100, PR: 100, RR:20, T:37C, puffy face, anemic, ascites, CVA-, leg swelling, WBC: 7000 mm3, RBC: 172
mg/dl, ureum 60 mg/dl, creatinine: 2.8 mg/dl, proteinuria+3, glucose 2+, nutritional recommended?
a. Enough calorie, protein restriction, adequate water and fat soluble vitamin, high selenium, high
phosphate, low potassium.
b. Enough calorie, protein restriction, adequate water soluble vitamin (vit B1, B6, folic acid, vit C), low vit A,
high vit E, low natrium, high vit D, high calcium.
c. High calorie, prot restriction, adequate water, fat soluble vit, low phosphorus, low natrium, high
potassium.
d. Enough calorie, prot restriction, cholesterol restriction, water soluble vit supplementation,
enough fluid according to the fluid balance status, limit vit A, low natrium, low potassium.
e. Low calcium, prot restriction, low cholesterol, low water soluble vit, fat soluble, vit supplementation,
mineral supplementation.

70. Diare, muntah, delirium, BP rendah, RR naik, serum urea 130, creatinine 53, potassium 7, sodium 145.
Metabolic acidosis. ECG: hyperkalemia. Priority management :
a. High protein intake
b. High calorie intake
c. Water balance

10 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
d. Electrolyte balance
e. Low potassium intake.

71. Which of the following is the most likely condition?
a. patient should receive oral feeding with low calorie according to this energy expenditure, protein
restrcition, high potasium intake, natrium, phosphorus aggressively.
b. patientshoul receive enough calorie oral feeding, protein restriction, vit.B complex, vit.C, zinc, selenium.
c. patient should receive either enteral nutrition or parenteral nutrition, high protein, high sodium,
potasium, and phosphorus aggresively
d. patient should receive parenteral nutrition with low calorie because he had been inadequate oral intake
during 5 days, high protein, high vit B complex, vit C, vit E, vit A
e. patient should receive either enteral or parenteral nutrition with enugh calorie, protein
restrcition, low sodium,. Potasium, phosphorus, high B complex, vit E, zinc, selenium.

72. -


73. side effect high protein intake padapasien diabetic nephropathy & uremic syndrome?
a. increase protein catabolism
b. increase renal failure because protein metabolism
c. increase carbohidrat catabolism
d. increase glycogenolisis& protein katabolisme
e. decrease muscle wasting

74. rekomendasinutrisi yang dibutuhkanpada ESRD?

75.

76. 76.=

77. disorder in renal function is not the etiologi for which abnormality?
a. high risk osteoporosis
b. high risk vit A intoxication
c. anemia
d. decrease immunity
e. hypertension

78. 79. supplementation of water soluble vit important to?
a. lipogenesis
b. energy synthesis
c. mineralization
d. ...... synthesis
e. ..................

79. 80. nutritional management in ESRD must be focus on metabolic condition, as example:
a. bilirubin level
b. GT level
c. potasium level
d. lactate dehydrogenase level
e. C-reactive protein

80.

81.

82. what is the most common etiologic for the above infection?
a. neisseria gonorrhea
b. Chlamydia trachomatis
c. staphylococcus aureus
d. eschericia coli
e. streptococcus pneumonia

83. Best media culture for the organism (E.coli):
a. blood agar

11 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
b. modification Thayer mayer
c. chocolate agar with antibiotic
d. saboraud dextrose agar
e. mac conkey agar

84. hat you expected from gram staining extraurethral exudate?
a. gram + cocci
b. gram rod
c. gram - cocci
d. gram - cocci with neutrhofil
e. gram cocci with blu G


85. the most common media culture for this bacteria is..
a. blood agar
b. Thayer martin agar
c. mac conkey agar
d. saboroud glucose agar
e. Loffler agar

86. bakteri di kultur mac conkey, bakteri gram negative rod, lactose
fermenter positif, swarming coloni. Pokoknyajawabannyaproteus
mirabilis.

87. Laki-laki 7 tahun. CC: hematuria.Ada eyelid edema. Causative agent?
Ans: streptococcus pyogen

88. Laki-laki 20 tahun, 24 jam dysuria, ada pus-like discharge di
ujung penis. History sex dengan 5 partner berbedadalam 6 bulan. Media
kulturuntuketiologinya?
a. blood agar
b. chocolate agar
c. mac conkey agar
d. Thayer martin agar
e. lupa

89.

90. hematuria di early dan terminal, suhu 39 derajat, fever, shaking
chills, gejala lain menunjukkanCa prostate. Microbio yang terlihat
apa?

91. 27 th lk2, mengalami urethral discharge, gram staining tdk menunjukkan bakteri, hanya ada neutrofil kurang
dari 20 /HPF. Mikroorganisme yg berhubungan?
a. Chlamydia trachomatis
b. Candida albican
c. Herpes simplex virus
d. N. Gonorrhoeae
e. Mycoplasma hominis

92. Faktor patogen dari N. Gonorrhoeae?
a. Kapsul
b. Lipooligosakarida
c. OPA
d.
e.
93. -
94. 44 th lk2, glucose 80 mg/dl, 2+ urine glucose, diagnosis?
a. Acute tubular necrosis
b. DM 1
c. DM 2

12 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
d. Glomerulonephritis
95. Mrs X brings a random urine specimen to the laboratory for a glucose analysis. The test result is negative. The
physician question the result because the patient has a family history of DM and is experiencing mild clinical
symptoms. What type of urine specimen should be collected that would more accurately reflect patient glucose
metabolism?
a. First morning
b. 2 hours post prandial
c. 3 glass collection
d. 24 hours
96. 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 Ketones : Negative
Clarity : Clear Blood : ++++
Sp. Gravity : 1.017 Bilirubin : Negative
pH : 6.5 Urobilinogen : Normal
protein : Trace Nitrite : Negative
Glucose : Negative Leukocytes : Negative
Microscopic : 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

97. Results of a urinalysis on avery anemic and jaundiced patient are as follows:
Color : Red Ketones : Negative
Clarity : Clear Blood : ++++
Sp. Gravity : 1.020 Bilirubin : Negative
pH : 6.0 Urobilinogen : High
protein : Negative Nitrite : Negative
Glucose : Negative Leukocytes : Negative
Microscopic : 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
98. An 8-year old boy presents with discolored urine.
Color : Red Ketones : Negative
Clarity : Clear Blood : +++
Sp. Gravity : 1.015 Bilirubin : Negative
pH : 6.5 Urobilinogen : Normal
protein : +++ Nitrite : Negative
Glucose : 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

13 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
99. 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
For question number 100 101, refer to scenario below:
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 Ketones : ++
Clarity : Clear Blood : Negative
Sp. Gravity : 1.010 Bilirubin : Negative
pH : 7.0 Urobilinogen : Normal
protein : Trace Nitrite : Negative
Glucose : +++ Leukocytes : Negative
Microscopic results:
RBC : 2-10/hpf
WBC : 0-5/hpf


100. What is the possible diagnosis of this patient?
a. UTI
b. Post infectious glomerulonephritis
c. Prednisone induced diabetes
d. Nephrotic syndrome
101. What cause discrepancy between dipstick result for blood with the microscopic findings?
a. Cause of this discrepancy is ascorbic acid that the patient is taking (daily multi-vitamin)
b. Cause of this discrepancy is Prednisone that the patient is taking
c. Cause of this discrepancy is Low dosage birth control that the patient is taking
For the question number 102-103, refer to the scenario below:
An 16-year old female is admitted to the emergency department with left flank pain and blood In the urine. She explains to
the doctor that she has been ssen multiple times in the last 6 months by her family doctor as well as the local emergency
department and medical aid unit for recurrent left flank pain that is often, but not always, associated with a lower urinary
tract infection. She was recently diagnosed two months ago with a nonobstructive kidney stone in her right ureter. Her
most recent doctor visit was with her family physician 2 weeks ago for an UTI and was given a 7 day treatment of
antibiotic to clear the infection. A CAT scan is ordered along with a urinalysis. The CAT scan shows 2 stones, a 2.0 mm
stone in the right kidney and a 2.5 mm stone in the left kidney. The urinalysis results are:
Color : Red Ketones : Negative
Clarity : Hazy Blood : ++
Sp. Gravity : 1.025 Bilirubin : Trace
pH : 8.5 Urobilinogen : Normal
protein : +++ Nitrite : Negative
Glucose : Negative Leukocytes : +++
Microscopic results:
20-50 WBC/hpf
Bacteria Positive
0-2 WBC cast/lpf

102. Beside her stone kidney, what is the diagnosis for this patient?
a. Pyelonephritis
b. Glomerulonephritis

14 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
c. Post infectious glomerulonephritis
d. Nephrotic syndrome
103. What is accounting for the discrepancy between the dipstick reading and microscopic result for blood?
a. A high protein will lyse RBC, which accounts for the absence of RBC from the microscopic reading
b. A high pH will lyse RBC, which accounts for the absence of RBC from microscopic reading
c. Bacteria will lyse RBC, which accounts for the absence of RBC from microscopic reading
104. 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
105. 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 39.9
o
C, 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
d. Acute cystitis
e. Nephrotic syndrome
106. 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
107. Patient known to have chronic renal failure presented with polyuria, thirst, generalized weakness, dyspnea,
infrequent fits & lack of Concentration. His blood biochemistry revealed the following:
Test Results Reference Range
Serum K 8 mmol/L 3,5 5 mmol/L
Serum calcium 6,6 mg/dL 8,5 10,5 mg/dL
Blood Urea 160 mg/dL 25 40 mg/dL
Serum creatinine 12 mg/dL 0.6 1.2 mg/dL
Which of the following is the best option for treating this patient?
a. Correction of severe hypocalcemia
b. Hemodialysis
c. Correction of hyperkalemia
d. Anti-epileptic drugs
e. Correction of volume overload

108. A 20 year-old female presented with a one day history of hematuria. Two weeks back she has had an attack of
sore throat. Her physical examination revealed BP of 150/100 mmHg & 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
109. A diabetic woman, 50 years old, weight 60 kg, with symptoms of dyspnea and vomiting felt since more than 3
months. Blood pressure was 160/100 mmHg, RR 32 per minute, deep and frequent. Edema of both legs,
pulmonary rales was found in both basal.

15 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
Test Results Reference Range
Hemoglobin 73 gr/dL 115 165 g/dL (female)
Urea 421 mg/dL 8 25 mg/dL
Creatinine 32 mg/dL 0.6 1.5 mg/dL
MCV and MCHC Normal
What is most likely diagnosis for this patient?
a. Acute kidney injury
b. Nephrotic syndrome
c. Chronic kidney disease L
d. Acute nephritic syndrome
e. Acute chronic kidney disease

110. Pasien BPH + ada UTI, dikasih antibiotik :
a. Ceftriaxone L
b. Ciprofloxacin
c. Cotrimoxazole
d. Penicillin
e. Gentamycin
111. Anak umur 5 tahun datang ke pediatric emergency dengan keluhan low back pain saat micturition, ada oliguria
dan dysuria, ada riwayat makan jengkol.
a. Prerenal AKI
b. Renal AKI
c. Postrenal AKI L
d. Upper UTI
e. lower UTI

112. jengkol intoxication pathogenesis nya?
a. Amount of jengkol ingested
b. Individual susceptibility factor
c. The way jengkol is served
d. Preparation with other food
e. Genetic factor

113. Novi E

114. Anak 7 tahun, keluhan : oliguria. History makan jengkol 10 pcs. Treatment? E

115. prognosis? (cerita no.114)
a. poor, high mortality
b. poor, prone to CKD
c. poor, prone to scar
d. poor, hard to treat
e. good, easily to treat

116. Demam, chills, poor feeding, urinary frequency, Hb: 15,9 PLT: 140.000 Urinary: WBC: 15-20/HPF, eritrosit : 5-
7/HPF nitrit+. Treatment?
a. IV ceftriaxone
b. IV ampicillin
c. Oral sulfametoxazole-trimetropim
d. oral amoxicillin
e. oral cefixime

117. which of the following bacteria most common of UTI (cerita no.16)
a. klebsiella
b. E.coli
c. Streptococcus beta hemolyticus grup a
d. staphylococcus aureus
e. pseudomonas

118. 7 year old boy A lot of blood in the urine Proteinuria +. Diagnosis?
a. nephrotic syndrome
b.
c. acute nephritic syndrome

16 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
d. AKI
e. CKD

119. Silmi

120. 10 y.o boy seizure, decrease consciousness, hypertension, edema papebral. Urinalysis a lot of RBC proteinuria
+. Slight anemia. Diagnosis?
a. AKI
b. hypertension encephalopathy et causa IgA glomerulonephritis
c. hypertension crisis et causa nephrotic syndrome
d. hypertension encephalopathy et causa nephrotic syndrome
e. hypertension crisis et causa IgA glomerulonephritis

121. Anak 12thn, darihasilpemeriksaanternyata bloody urine. Tensi 140/90. Protein +, cast +, leukosit 0-1, lot of
RBC. Pertanyaannyalupa. Kalogaksalah yang terjadipadaanakituadalah
a. Atopy
b. Infeksikulit
c. Infeksigejala yang sama
d. Konsumsiobat
e. Seizure

122. 122.7 thn, boy. Hematuria sdh 3 hari. BP 140/90 edema palpebra. Pemeriksaan urin: ada RBC, RBC cast, protein
(+), WBC (0-1). Anemia. Treatment?
a. Antibiotik seperti penicillin
b. Diuretik L
c. ACE inhibitor
d. Vasodilator
e. Beta-bocker

123. 123.There was history of sore throat 1 week before. Wotf infectious agents is the most possible to proceed this
disease of the patient?
a. Respiratory sincytial virus
b. Streptococcus pneumoniae
c. Staphylococcus aureus
d. Rhinovirus
e. Streptococcus beta hemolitic

124. 124. Seorangwanita incontinence punya 6 anak. Saatnaiktanggaterasa steak urin. Apa yang terjadipadanya?
a. Overflow incontinence
b. Urge incontinence
c. Stress incontinence
d. Continous incontinence
e. Mixed incontinence

125. 125.A female 60 y.o complaining urinary incontinence. She had 6 children. When she goes upstair to the upper
room she feels streaks some urine. What is the risk factor of the patient?
a. Infection
b. DM
c. Multiple pregnancy
d. Stone
e. Stroke

126.
127.

128. 128. What will you do to the patient first?
a. Giving antibiotic
b. Giving analgesic
c. Insert cathether
d. X-Ray
e. USG

129.


17 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
130.

131. 32 years old man chief complaint pain during urination, accompanied by purulent urethral discharge. Coitus
suspectus was
a. admitted 3 days ago with commercial sex worker without condom. What is treatment choice if no lab
exam can be
b. performed?
a. Cefixime 500 mg & Azithromycin 1000 mg
b. Cefixime 400 mg
c. Cefixime 400 mg & Azithromycin 1000 mg
d. Levofloxacine 500 mg
e. Azithromycin 1 gram

132. What test should be done?
A. Gram stain
B. Gram stain and KOH
C. Gram stain, KOH, and culture-resistance test
D. *lupa* (pertanyaan n jawabannyasamakokkyknomeryg diatas2nya)
E. KOH

133. Infeksi dengan jumlah PMN > 10. Terapi?
a. Cefixime 500 mg & Azithromycin 1 gram
b. Cefixime 400 mg
c. Cefixime 400 mg & Azithromycin 1 gram
d. Levofloxacine
e. Azithromycin 1 gram

134. The best imaging modality for prostate? transrectal USG

135. What is the most accurate modality to investigate presence urinary stone in renal colic?
a. KOB
b. Nonenhanced CT scan abdomen
c. Ultrasound
d. IVU

136. a new diuretic agent was developed and its effect on healthy volunteers after a single dose was revealed an
increase of the natrium fractional excretion from 1% to 20%. likewise, an excretion of kalium and calcium
increase but neither glucose nor as.amino were found in the urine.wotf membrane transport protein is inhibit
by this drug?
a. Na-glucose symporter b. Na-H antiporter c. 1Na-1K-2Cl symporter d. na-cl symporter e. na-chanel

137. A 62 years old woman is brought to the emergency is a state of confusion, is unable to answer question
coherently and
c. exhibit tachipnea. Mechanism renal excretion of hydrogen ion? L
a. Combining hydrogen ion & bicarbonate via carbonic anhydrase enzyme.
b. Combine hydrogen ion dengan Cl ion bentuk hydroclorice acid.
c. Trapp hydrogen ion by amonia untuk bentuk amonium ion
d. Hydrogen ion by acetate.
e. Secreting sulfat hydrogen ion sebagai sulfuric acid.

138. Hyponatremia (reduced Na di plasma dapatterjadiketika effective volume plasma menurun) faktor yang
memperngaruhikondisiini??
A. Impaired kidney to excrete sodium free water
B. Elevated ANP L
C. Elevated Na excretion
D. Decrease ADH
E. Decrease aldosterone

139. In controlling synthesis secretion of Aldosterone, which of the following factors is least important?
A. Renin
B. Angiotensin II
C. Plasma Na
D. Plasma K
E. ACTH L

18 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT

140.


141. Maafgasempetnyatet :( -Desbass

142. A 35 years old man has PKD with decrease both GFR and renal blood flow (RBF). A nephrologist want to
administer a drug that lower both GFR and RBF. GFR and RBF will decrease under which of the following
condition?
a. Afferent and efferent arteriole dilate
b. Afferent and efferent arteriole constrict
c. Only afferent constrict
d. Only efferent constrict
e. Afferent arteriole constrict and efferent dilate L

143. A post op patient develop thready pulse, takikardia dan hipotensi. Lab: plasma angiotensin II naik, GFR naik,
proximal tubulus reabsorpsi garam dan air naik oleh proses glomerulotubular balance, yang berkontribusi?
a. tekanan hidrostatik kapiler peritubular naik
b. konsentrasi sodium peritubular turun
c. tekanan onkitik peritubular naik L
d. proximal tubular flow naik
e. peritubular capillary flow naik

144. Aku lupa. Maaaaaap!!! -Deso

145. Maaaaaaf ga nyateeet -Kevin

146. Anak usia 2 tahun ginjalnya membesar, banyak kista di korteks dan medula. Penyebab embriologinya?
(ARPKD)
a. dismorphology during development renal system
b. failure ureteric bud derivatives to join tubule
c. division metanephric diverticulum
d. failure mesenkin untuk migrasi
e. fusi pole ginjal

147. AWP- Auliaanbiya- posisitidakmemungkinkanuntuknyatetsoal, maafya :(

148. Painless swelling di left scrotum, feel heaviness di left scrotum. Ukuran tidak berubah kalau posisi berubah.
a. Hydrocele
b. Scrotal hernia
c. Testicular tumor
d. Infeksi di testis
e. Epididimorchitis

149. What test to diagnose? (dari soal nomer 148)
a. CT scan lump
b. USG lump
c. Biopsy lump
d. Pelvic X-ray
e. MRI

150. A 6 year old girl came to hospital with chief complaint fever and recurrent UTI in last 6 months. She was
referred to clinic and her USG's examination showed a mild hydronephrosis bilaterally. Serum ureum, creatinin
in normal limit. (ada satu kalimat lagi tapi aku lupa bangeet, maaaf :( -Urwah). Which of the laboratory test you
should investigate?
a. CBC
b. Urinalysis
c. Urine culture L
d. Lupaa kalau ga salah, USG
e. Anti streptolysin-O

151. 1. male 65 y.o. nocturia, 1 bulan increase frequency of urination.next step management: (151)
a. ultrasound
b. TRUS

19 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
c. Pyelogram
d.
e.

152. 2. 67 y.o, male.prostate 40 gr, hypertensi, LUTS, ureumdancreatinintinggi. management yang
selanjutnyadilakukanapa? (152)

153. 3.

154. 4. Endi

155. 5. 56 y.0, women, history UTI. receive drug inhibit ACE. JNC VI recommended a goal for BP< 140/90in
uncomplicated hypertension. which of the concominant condition do JNC VI not suggest lower BP? (155)
a. prior history of cardiovascular accident within 6 month
b. type I DM with nephropathy
c. type II DM disease without complication
d. chronic renal insufficiency (serum creatinine 2.5 %) without proteinuria
e. proteinuria (2 mg/day with normal serum creatinine) L

156. 6. DitoRivaldi

157. 25 year-old male scrotal pain. PE : positive inflammation sign right scrotum. You consulted this patient to the
nuclear medicine. What is the most appropriate exam?
a. Scrotal scintigraphy for differentiate testis torsion with orchitis epididymitis
b. Scrotal scintigraphy for identivy UTI source
c. Bladder scintigraphy to differentiate UTI with vesicolithiatis
d. Ureteral scintigraphy to determine urethritis as etiology of scrotal inflammation
e. Penis scintigraphy to determine any priapismus or hypospadias as etiology of UTI

158. 8. 70 y.o. left abdominal discomfort and hematuria. plain abdominal x-ray: homogenous opacity with
multiiple small calcification at T12-L3 spine, contour is lobulated. diagnosis? (158)
a. nephrolitiasis
b. nephrocalcinosis
c. renal tumor
d. ureterolithiasis
e. ureteral tumor

159. 9. asal excretory duct (embryologi)? lupapilihannya (159)

160. 10. origin collecting duct: (160)
a. ureteric bud
b. metanephricblastema
c. mesonephric duct
d. metanephric duct
e. splanchic mesoderm
161. Ajay

162. Diketahuahasilurinalisis: pH 5,5. Blood: moderat. Warnaurin?
a. Colorless
b. Yellow
c. orange
d. pink L
e. red black

163. A 65 y.o man with scrotal malignancy his PSA serum is increasing significantly compared with his last month
result. X-ray pelvis show abnormality at pelvic bone. Patient then consuled to nuclear medicine. What is the
most appropriate exam?
a. Conventional renography
b. GFR
c. Kidney Scintigraphy
d. Malignancy prostatScintigraphy
e. Bone Scintigraphy


20 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
164. Pasienpria 60 thn, generalized edema, patologi = proliferasimesangial cell dankapilergromelurus ( post
streptococcal g)

165. 21 y.owoman experienced urine frequencywith dysuria without discharge from vagina for the past few days.
She has no flank pain or tenderness. A urinalysis reveals spesific gravity 1.014, pH 7,5, no glucose, no protein,
no blood, nitrite (+) and many WBC. She has serum creatinine of 0.9 mg/dl. Which of the following pathological
process best account for these findings?
a. Lupus nephritis
b. Urinanry tract lithiasis
c. Acute bacterial cystitis
d. Malacoplakia
e. Transitional cel carcinoma

166. ba 2 years old boy --> progressive peripheral edema. PE: afebrile, BP normal. Lab: decreased albumin,
increased cholesterol, BUN &Creatinine normal. A histologic section from renal biopsy ....microscopic?
a. diffuse endocapillary proliferation, leukocytic infiltration
b. focal & segmental sclerosis and hyalunosis
c. flattening &fussion of te foot process of podocytes
d. mesangial&endocapillary proliferation, GBM thickening,splitting
e. diffuse cappilary wall thickening

167. Glomerular disease yang muncul 1-4 minggusetelah streptococcal infection pada pharynx dan skin.
Mikroskopisnya :
a. Extracappilary proliferation with crescent, necrosis
b. Infiltration by leukocyte and proliferation of endothelium and mesangial cell.
c. Focal mesangial proliferation glomerulonephritis
d. Focl and segmental sclerosis and hyalinosis
e. Linear IgG and C3

168. A 25 y.o man was admitted to the emergency room complaining of less frequent of micturition since one day
before. Patient didnt urinate since that morning. For the last three day he complained of massive watery
diarrhea without blood 6-8 times a day and accompanied by low grade fever. Laboratories result showed the
increasing very high of BUN and creatinine levels. Which is the best pathogenesis that could be happened in his
kidney?
a. Hemodynamic alteration that cause reduced GFR because of intrarenal vasoconstriction
b. Direct toxic injury to the tubules
c. Focal tubular epithelial necrosis at multiple points along the nephron, often accompanied by rupture of
basement membrane (tubulorrhexis)
d. Most commonly occuring as a hypersensitivity reaction to drugs
e. Ischemic that caused by alteration of blood flow will make the irrevesrible renal lesion that can destroy
glomerular function

169. A 59 y.o man came to hospital with chief complain a mass at his flank. He also complained sometimes he got
bloody urination for several weeks ago. Biopsy was performed, the microscopic appearence showed nest of
tumor cell whish is have clear cytoplasm with papillary and trabecular structure, small nuclei but pleomorphic
and abundant of mitotic. What is the best diagnosis for this patient?
a. Wills tumor
b. Transitional cell carcinoma
c. Adenocarcinoma
d. Clear cell carcinoma L
e. Papillary carcinoma

170. Seoranganakberusia 5 tahunsaatdigendongsamaibunyaterasaadamasa di perutnya. Apakahmasaitu?
(nephroblastoma)163. 65 yo scrotal malignant, PSA naik, pada X-ray pelvis, adaabnormalitaspada pelvic bone.
Examination?
a. Renogram
b. GFR
c. Kidney scintighrapy
d. Malignant prostatscintighrapy
e. Bone scintigraphy

171. what is the best describe of microscopic appearance for that patient?
a. nest of cell tumor with abundant of eosinophil cytoplasm and mytotic
b. tumor cell could be composed by mesemchymal cell and blastemal cell

21 FINAL MDE GENITOURINARY SYSTEM BATCH 2009 BRILLIANT
c. small round blue cell tumor that rosset appearance. L
d. tumor cell could be composed by only one kind of epithelial cell
e. tumor cell have clear cytoplasm and much of mitotic
172.

1. Autosomal dominant (adult) polycistic kidney disease is a hereditary disorder characterized by multiple
expanding cyst of both kidneys that ultimately destroy the renal parenchyma and cause renal failure. What is
the best describe of microscopic appearance of this dease?
a) Bowman capsule are occasionaly involved in cyst formation, and glomerular tufts maybe seen within the cyst
space
b) The cysts have uniform lining of cuboidal cell, reflecting their origin from the collecting ducts
c) He cyst are lined by flattened or cuboidal epithelium and are usually surrounded by either inflammatory cells
or fibrous tissue
d) Renal cyst have smooth contour, are almost always avascular, and give fluid rather than solid signals on
ultrasonography
e) The cyst as a psudocyst that not lined by epithelial cells

2. autosomal-recessive (chilhood) polycystic kidney disease (ARPKD) is geneticaly distinct from ADPKD. The first
two are the most common, serious manifestation are usually present at birth, and the young infant might
succumb rapidly to renal failure. What is the best describe of microscopic appearance for this disease?
a) Bowman capsule are occasionaly involved in cyst formation, and glomerular tufts ma be seen within the cyst
space
b) The cysts have uniform lining of cuboidal cell, reflecting their origin from the collecting ducts
c) He cyst are lined by flattened or cuboidal epithelium and are usually surrounded by either inflammatory cells
or fibrous tissue
d) Renal cyst have smooth contour, are almost always avascular, and give fluid rather than solid signals on
ultrasonography
e) The cyst as a psudocyst that not lined by epithelial cells

175.

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