Soal Kidney – Mungud 
appropriate for restoring the diuretic response?
1. A 42 years old male comes to the Siloam hospital
with muscular weakness, mild headache after
eating salted fish. Usually he drinks only small
amount of water. He said that usually his blood
pressure is 100/70 mmHg. His blood pressure
140/90 mmHg. The doctor sends him to the
laboratory. The result shows serum sodium is 150
mEq/L (N: 135 - 155), potassium is 3.5 mEq/L (N:
3.5 – 5.0), random blood glucose 150 mg/dl (N
<140).
In this condition, what will the kidney do?
A. Increase glomerular filtration rate
B. Increase obligatory water reabsorption
C. Increase facultative water reabsortion
D. Increase renin secretion
E. Increase aldosteron secretion
2. To cover the above function, what mechanism is
used?
A. Increase cardiac output
B. Increase frequency of the heart
C. Increase secretion of renin
D. Increase secretion of antidiuretic hormone
E. Increase secretion of aldosteron
3. Which factor support the above mechanism?
A. Filtration rate of the glomeruli
B. Active transport of the tubular cell
C. High osmolality of the interstitium of medulla
D. Obligatory water reabsortion
E. Osmolality of the filtrate in distal convoluted
tubule
4. If the urinalysis is also done, what will you see
about the glucose in urine?
A. positive ++++
B. positive +++
C. positive ++
D. positive+
E. negative
5. In a kidney laboratory, using a micropipette, we
can measure the hemodynamic pressure of
afferent arteriole, pressure in Bowman capsule,
and osmotic pressure in glomerular lumen. If the
pressure in afferent arteriole is 40 mmHg, in
Bowman capsule 1 mmHg, the osmotic pressure
of glomerulus is 30 mmHg, the effective filtration
pressure in glomerulus is: (40-1-30)
A. 71 mmHg
B. 69 mmHg
C. 11 mmHg
D. 9 mmHg
E. – 9 mmHg
6. A 63-year-old-man, with a history of heart failure
and edema fails to respond adequately to
maximum recommended dosages of
chlorthalidone.
Which of the following is the most likely
A. add with hydrochlorothiazide
B. add with metolazone
C. replace with furosemide
D. replace with hydrochlorothiazide
E. increasing the dose of chlorthalidone
7. A 75-year-old woman with hypertension is being
treated with thiazide. Her blood pressure is
decrease to 120/76 mm Hg. After several months
on the medication, she complains of being tired
and weak. Which of the following substance in
analysis of blood indicates low values?
A. calcium
B. uric acid
C. potassium
D. sodium
E. glucose
8. A jaundiced 1-week premature infant with elevated
free bilirubin is seen in the premature baby
nursery. The mother had received antibiotic
combination for a urinary tract infection (UTI) 1
week before delivery.
Which of the following is the most likely cause of
the baby’s kernicterus?
A. cefixime
B. amoxicillin
C. azithromycin
D. erythromycin
E. cotrimoxazole
9. A 4-year-old-boy was brought to hospital with
puffiness around the eyes, especially in the
morning and swelling over the legs. His mother
also complaint he has foamy urine. Urine sample
shows protein ++++ (>3.5 per 1.73 m 2 per 24
hour), albumin level 1.5g/dL (normal=3.5-5g/dL).
What is the principal management in this patient?
A. Albumin
B. Furosemide
C. Prednisone
D. Thiazide
E. Cyclosporin
10. A 13 year-old-girl was brought to emergency unit
with seizure. Her mother complaint she had fever 2
weeks ago, but has recovered. Now she has
swelling around the eyes and legs and she has
dark urine. From physical exam, she is
unconscious. Her blood pressure is 180/120
mmHg. Urine sample shows erythrocytes 20/hpf
and protein +. Albumin level within normal limit.
What other laboratory findings to confirm the
diagnosis in this patient?
A. Decreased anti streptolisin O (ASO),
increased DNase-B, decreased C3
B. Increased anti streptolisin O (ASO),
decreased DNase-B, decreased C3
C. Decreased anti streptolisin O (ASO),
increased DNase-B, increased C3
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 D. Increased anti streptolisin O (ASO),
decreased DNase-B, increased C3
E. Increased anti streptolisin O (ASO)
(untuk faringitis), increased DNase-
B(pd nefritik/strepto), decreased C3
11. A 70-year-old male with tuberculosis, he was
treated with daily streptomycin for 1 week. After
the last injection, his urine output diminished and
the laboratory test revealed ureum 80 (20 – 40)
mg/dL, creatinine 3.0 (0.5 - 1.5) mg/dL. (AIN ada
proteinuria, ATN ga daa proteinuria)
What is the most likely diagnosis in this patient?
A. Urinary tract infection
B. Sepsis
C. Glomerulonephritis
D. Chronic renal failure
E. Acute tubular nephritis
12. What is the most possible cause in this patient?
(AIN hypersentivity, ATN ischemic ata toxin)
A. Renal ischemia
B. Direct toxic injury
C. Complex immune response
D. Urinary obstruction
E. Drug hypersensitivity
13. A 3 year old boy was brought to emergency unit
with severe diarrhea since three days ago. On
arrival he is not fully alert. His vital sign are as
follows: blood pressure is 80/60 mmHg, pulse is
not palpable, respiratory rate was 36 breaths per
minute, and body temperature was 38.4 oC. On
physical exam there is sunken anterior fontanel,
dry mucous membranes, sunken eyes, lack of
tears, poor skin turgor, and the capillary refill more
then 2 seconds. The laboratory test in this patient
reveal haemoglobin 13 g/dL(11.5-15.5 g/dL),
hematocrit 46% (35-45%), WBC 7,000/mm 3(5,500-
15,500/mm3), platelets count 260,000/mm3
3
(150,000-400,000 mm ), urea nitrogen 40 mg/dL
(5-18 mg/dL), and creatinine 1.7 mg/dL (0.3-0.7
mg/dL). Urine specific gravity is 1.040 (N: 1.003 –
1.030)
What is the most likely diagnosis in this patient?
A. Acute tubular nephritis
B. Prerenal acute kidney injury
C. Intrinsic acute kidney injury
D. Postrenal acute kidney injury
E. Chonic renal failure
14. A 10 year old girl was brought to your clinic with
dysuria since 5 days ago. On physical exam she is
healthy with no significant findings. From urine
culture is found Eschericia coli wih CFU ≥ 100,000.
What is the most likely diagnosis in this patient?
A. Acute pyelonephritic
B. Reflux nephropathy
C. Uncomplicated urinary tract
infection
D. Complicated urinary tract infection
E. Chronic urinary tract infection
A 55-year-old man refers to ICU after the procedure
open reduction of femur fracture and bleeding intra
operative. At the third day he became apatis, fever
38,5 C with blood pressure 110/60 mmHg, pulse 55
x/min, respiratory 20x/min, and urine output decreased
to 10 cc/hour in 24 hours. At laboratory examination
findings creatinine 4 mg/dL (N: 0.5-1.5), ureum 100
mg/dL (N: 20-40), sodium 130 mEq/L (N: 135-155),
potassium serum 7.5 mEq/L (N: 3.5-5.5), blood sugar
200 mg/dL (N: <140).
From blood gas analysis finding pH 7.1, pCO2 30
mmHg, pO2 90 mmHg,
HCO3 18 mEq/L. ECG examination finds widening of
QRS wave.
15. What is the most critical condition can cause life
threatening the patient?
A. nothing for awareness
B. ureum and creatinine at very high lvl
C. hyperkalemia (CKD, AKI)
D. metabolic acidosis
E. severe hyponatremia
16. What is the treatment for the critical condition
above?
A. Waiting for the general condition of the
patient became more better
B. Give diuretic until the urine output will
be normally
C. Hemodialysis immediately
(hiperkalemi parah)
D. Give sodium bicarbonate until pH of
blood became normal
E. Intubation and ventilator to maintain
the respiratory
17. A 36-year-old male truck driver is referred to you
for evaluation of recurrent urolithiasis. The patient
has passed more than 20 calcium oxalate stones
since age 18. Previous therapy with
hydrochlorothiazide and cellulose phosphate has
been ineffective. Physical examination is normal.
Laboratory finding: Serum creatinine 1.0 mg/dL,
Serum uric acid 8.9 mg/dL, Urine pH 5.0
Radiographs of the abdomen show smooth renal
silhouettes measuring 13.6 cm on the right and
14.2 cm on the left, and no radioopaque at kidney
region. From sonography findings multiple
hyperechoic shadow from both kidney with
measure about 2 – 5 mm.
Which of the following treatment is the most
effective for this patient?
A. Dietary sodium restriction
B. Dietary calcium supplementation
C. High fluid intake and long-term urine
acidification
D. High fluid intake and allopurinol(untuk
asam urat=radiolucent)
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 E. Shock wave lithotripsy A. Wilms tumor
B. Renal Cell Carcinoma
18. A 75 year old man had urine incontinence since 3 C. Transitional carcinoma
months ago. He had been diagnosed dementia by D. Squamous carcinoma
the doctor since 6 months ago. On examination he E. Undifferentited carcinoma
had no prostate problems. What is the cause of his
urination’s problem? 23. A 60-year-old male experiences the onzet of
A. Impaired frontal inhibition headache, naussea ,vomitting fo 1 month. Physical
B. Impaired pontine inhibition examination reveals hypertention, subfebril.
C. Sympathetic system dysfunction Pyelogram showed the affected kidney
D. Parasympathetic system dysfunction assymmetrically contracted with deformity of the
E. Sensoric system dysfunction calyceal system. Gross of the affected kidney
showed contracted and has irregular granular
19. A 44 year old man was hospitalized for systemic surface.The parenchyma is atrophic and replace
fungal infection. He was on Amfoterisin B by fibrosis. Microscopic showed glomerular
treatment for 7 days. On examination, he is sclerosis, hyalinization and atrophi in cortical area.
conscious, BP 120/80 mmHg, pulse 80 x/min, RR Another areas showed fibrosis, chronic
16 x/min, temperature 36,7 C. Lab: Hb 13 gr%, inflammatory cells with limpocytes agregation.
HT 37%, WBC 8600, Platelet 340.000. Ureum 91, What is the most likely lesions occur in this
creatinin 2, 0. Volume urine 800 cc/24 jam kidney?
What is the patognomonic laboratory finding in this A. Renal cell carcinoma
case? B. Chronic pyelonephritis
A. Increased osmolality C. Acute nephritis
B. Leucocyturia D. Nephrotic syndrome
C. Muddy brown cast E. Diabetic nephropathy
D. Erythrocyte cast
E. Haemoglobinuria 24. A 5-year-old boy child who had a palpable
abdominal mass brought to hospital by his mother.
20. A 24-year-old woman went to a physician because The child later had abdominal distention from
pain during urination and frequency. On bowel obstruction. An USG reveals a 6 cm left
examination, she had has suprapubic pain, but no renal mass with necrosis and hemorrhage.
fever. Her urine was cloudy and shows Microscopic showed embryonal tissue with
microscopic evidence of erythrocytes, pyuria, and abortive of tubular and glomerular structures.
gram-positive bacteria. In the past medical history, What is the diagnosis ot this patient?
she never had any symptoms like this one. Which A. Teratoma
organism is most likely responsible for this B. Retinoblastoma
patient’s illness? C. Wilms’tumor
A. Klebsiella pneumonia D. Hanarthoma
B. Pseudomonas aeruginosa E. Hemangioma

C. Escherichia coli 25. A 62-year-old woman presents with hematuria and

D. Proteus mirabilis
E. Staphylococcus saprophyticus
21. A 55-year-old male complains hematuria at the
physician’s office for 2 weeks. A cystoscopic
examinations showed a 2 cm,exophytic,friable
mass on the right bladder dome.
A biopsy of this lesion show findings most
consistent with a/an
A. Papilloma
B. Verrucous carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Adenocarcinoma
22. A 50-year-old male presents with a month long
history of flank pain and hematuria.An USG
abdominal results a 3 cm bosselated mass,
protrudes from cortical are in the right
kidney.Cytologic examination reveals malignant
cells.
What is most likely biopsy finding for this patient?
left flank pain. Physical examination reveals
costovertebral angle tenderness. Renal ultrasound
shows marked left hydronephrosis. Serum
creatinine and CBC are normal.
Which of the following diagnostic test is the most
relevant?
A. Renal biopsy
B. Renal arteriogram
C. Palpation for inguinal lymph nodes
D. Antinuclear antibody test
E. IVP
26. A 34-year-old man comes with 3-day history of low
back pain, urinary hesitancy, and pain with
urination. He has not had any urethral discharge
or recent sexual contacts. His temperature is
38.2C,Z
27. A 25-year-old man has been crashed by a truck.
The doctor suspects that his kidney is rupture, and
then he sent the patient to have IVP.
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 What is the most likely the appearance of renal
parenchymal rupture in IVP?
A. The kidney shows non function
B. Ekstravasation (urine bocor )
C. Hydronephrosis (urine akumulasi di
renal pelvis)
D. Normal nephrogram
E. Dilatation of calyx
28. A 50-year-old man comes to the clinic with
complain of abdominal colic. The result of IVP
demonstrates ureteric dilatation.
What is the most likely problem?
A. Stone in the pelvicureter junction
B. Kidney cyst
C. Stone in the vesicoureter junction
D. Renal cell Ca stage I
E. Acute inflammation
29. A 24-year-old woman went to a physician because
of pain during urination. On examination, she had
has left flank tenderness and low-grade fever. Her
urine was cloudy and shows microscopic evidence
of erythrocytes, pyuria, and gram-positive bacteria.
In the past medical history, she never had any
symptoms like this one.
Which organism is most likely responsible for this
patient’s illness?
A. Klebsiella pneumonia
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Proteus mirabilis
E. Staphylococcus saprophyticus
30. Which urine specimen is most appropriate for the
culture examination?
A. Suprapubic aspiration
B. Mid stream
C. Straight catheter
D. Indwelling catheter
E. 24 hours urine collection
31. A 30-year-pregnant woman was complaining fever,
pain when urinating, blood in her urine, and severe
lower back pain. The physician submits her urine
for culture; the next day, the laboratory reports an
organisms growth count of greater than 105/ml of
urine. The organism grew well on the blood agar
and producing β–hemolytic colonies.
Which important virulence factor for the organism
is most likely responsible for this patient’s illness?
A. Capsule
B. P-fimbriae (Ecoli)
C. Endotoxin
D. Phospolipase C
E. Lipooligopolysaccharide
32. A 30-year-old man patient complained of a sharp
pain in his loin radiating down to his perineum,
accompanied by hematuria. He reported that he
had a few days of urinary urgency, frequency, and
burning when urinating. On examination, his
temperature was 37.5ºC; other vital sign were
normal; and he appears to be in pain. A urinalysis
shows erythrocytes, leukocytes esterase and a
high pH.
Which antigenic composition is most likely
responsible for this illness?
A. Hemolysin (proteus)
B. Catalase
C. Fibronectin
D. Opa protein
E. Cord factor
33. A 67-year-old man with an episode of acute urine
retention was catheterized. Three days later, he
developed fever and suprapubic pain. Culture of
urine revealed a thin film of bacterial growth over
the entire blood agar plate, and urease test was
positive.
Which of the following is most likely organism to
cause this infection?
A. Escherichia coli
B. Staphylococcus sapropyticus
C. Proteus mirabilis
D. Enterococcus faecalis
E. Morganella morgagni
34. A 34-year-old woman presents with pain during
urination and frequency. On examination, she had
has suprapubic pain, but no fever. Her urine was
cloudy and shows microscopic evidence of
erythrocytes, pyuria, and bacteria. The urine has a
high pH. Which of the following bacteria’s strategy
is responsible for this condition?
A. Destroy blood vessel in the kidney
B. Exhibits “swarming” motility
C. Ferments many sugars
D. Produce a potent urease
E. Secretes many exotoxins
35. IVP image of a new born baby shows that left
kidney tremendously enlarged and clearly
demonstrates intra-parenchyma mass. What
abnormality could possibly occur?
A. horseshoe kidney
B. pelvic kidney
C. unilateral renal agenesis
D. polycystic kidney (ada massa)
E. pancake kidney
36. Oligohydramnios can be related to malformation in
kidney. Why can the amount of amniotic fluid
determine such malformation?
A. baby drinks the amniotic fluid
B. baby cannot drink amniotic fluid
C. amniotic fluid mostly contains urine
D. little amount of amniotic fluid causes
the pelvic malformation
E. little amount of amniotic fluid disturbs
the kidney development
37. A new born baby boy has a malformation in
genitourinary appearance. When he urinates, the
urine comes out from large area below the urethra
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 opening. What process could possible failed during
the development of genitourinary process?
A. closure of genital fold
B. closure of genital opening
C. closure of genital tubercle
D. closure of urogenital sinus
E. closure of Wollfian duct
38. Cryptorchid condition results in germ cells failed to
multiply, and then die and only in Sertoli cells exist
in seminferous tubules. What is the development
process the main cause of cryptorchid?
A. inguinal hernia
B. failure of testicular decent
C. failure of gubernaculums regression
D. fusion of the tunica albuginea and
peritoneum
E. guevedoces
39. A 30-year-old man had nausea, vomiting, and
severe colicky right flank pain radiating into the
thigh for 4 hours. He is afebrile. There is right
costovertebral angle tenderness. Urinalysis shows
numerous RBCs and no bacteria.
Which of the following is the most likely diagnosis?
A. Acute glomerulonephritis
B. Bacterial cystitis
C. Benign prostatic hyperplasia
D. Urolithiasis
E. Renal cell carcinoma
40. A previously healthy 72-year-old man comes to the
physician because of decreased urinary output
during the past 2 days; he has had no urinary
output for 8 hours. Examination shows suprapubic
fullness and enlarged prostate.
Which of the following is the most appropriate next
step in management?
A. PSA examination
B. Ultrasonography of the kidneys
C. CT scan of the abdomen
D. Bladder catheterization
E. Intravenous pyelography
41. An otherwise healthy 20-year-old woman is given
sulfamethoxazole to treat a bladder infection.
Three days after beginning the antibiotic regimen,
the patient has moderately severe jaundice and
dark urine. Pain with urination and a low-grade
fever have resolved. Her hematocrit is 20%.
Substantial numbers of erythrocytes contain Heinz
bodies. Her condition worsens until day 6 of
antibiotic therapy, when it begins to resolve.
Symptoms are completely gone by day 9 of
continued antibiotic therapy.
Which of the following conditions is the most likely
explanation for these findings?
A. Aplastic anemia
B. Generalized cytochrome-b5 reductase
deficiency
C. Glucose-6-phosphate dehydrogenase
deficiency
D. Pyruvate kinase deficiency
E. Steven Johnson Syndrome
42. A 61-year-old man comes to the physician
because of a 3-month history of episodes of
headache, palpitation, and excessive sweating. He
has had a 10-kg (22-lb) weight loss during this
period. While being examined, during an episode
his blood pressure is 210/110 mm Hg. Physical
examination shows no other abnormalities. Urine
studies show increased catecholamine
concentrations. A CT scan of the abdomen is most
likely to show a mass in which of the following
locations?
A. Adrenal glands (aldosterone dan
catecolamin dan adrenalin)
B. Ureter
C. Urethral
D. Bladder
E. Right kidney
43. A 6-year-old boy has a large intra-abdominal mass
in the midline just above the symphysis pubis.
During an operation, a cystic mass is found
attached to the umbilicus and the apex of the
bladder. Which of the following is the most likely
diagnosis?
A. Hydrocele
B. Meckel cyst
C. Meckel diverticulum
D. Omphalocele
E. Urachal cyst
44. A 69-year-old man with 82 kg is referred to you
with fatigue and laboratory result shows Hb 7 g/dL,
ureum 55 mg/dL, and creatinin 5.4 mg/dL. He has
not seen a physician for several years.
Which finding would help you decide that this
condition is chronic?
A. Low serum calcium
B. Low serum bicarbonate
C. Protein detected in urinalysis
D. Broad waxy casts in urinalysis
E. Elevated serum phosphorus
45. A 52-year-old woman with longstanding type II
diabetes is referred with microalbuminuria and
normal serum creatinine. Her weight is 85 kg and
height is 160 cm. Blood pressure is 150/100
mmHg.
Which of the following measures should you
advise to prevent progression to overt
nephropathy?
A. Tight glucose control
B. High-protein and low carbohydrate
diet
C. Blood pressure control
D. Regular diuretic
E. Increased water intake
46. A 20-year-old man presents with malaise, nausea,
and decreased urine output. He was previously
well and his physical examination is normal except
5
 for an elevated jugular venous pressure (JVP) and
pericardia rub. His electrolytes reveal acute renal
failure (ARF).
Which of the following findings on the urinalysis is
most likely in keeping with acute
glomerulonephritis?
A. Granular casts (dan epithelial = ATN)
B. Erythrocyte casts
C. Proteinuria
D. Hyaline casts (prerenal)
E. White blood cell casts
47. A 35-year-old women presents with nausea and
vomiting of 2 days duration. She is not on any
medications and was previously well until now. Her
physical examination is normal except for postural
drop in her blood pressure from 110/80 mmHg
supine to 90/80 mmHg standing. Her serum
electrolytes are Sodium 130 mEq/L, Potassium 3
mEq/L, Chloride 90 mEq/L, bicarbonate 30 mEq/L,
urea 50 mg/dL, and creatinine 0.8 mg/dL.
Which of the following electrolytes in the case
above is most likely to be filtered through the
glomerulus but unaffected by tubular secretion?
A. Potassium
B. Urea
C. Creatinine
D. Bicarbonate
E. Sodium
48. A 68-year-old man came seeing a general
practitioner with a swelling throughout the body.
He also felt urine volume decreases and the urine
color was red. He denied any pain on urination or
in any part of his body, on physical examination
costovertebrae angular test negative. Blood test
results obtained ureum 55 mg/dL (normal 20-40
mg/dL) and creatinine 1.7 mg/dL (normal <1.1
mg/dL). Obtained urine lab protein 2 + and 50-60
red blood cells.
Which of the following diuretics is the most
appropriate for treating the patient above?
A. Acetazolamide
B. Furosemide
C. Hidrochlorothiazid
D. Spironolactone
E. Triamteren
49. A 10 month pregnant woman complained lower
abdominal pain, and suffering from dysuria for 48
hours. Patient has mild fever, urine analysis
showed 1+ protein, but did not find any glucose,
and blood. Gram stain shows a gram negative
bacteria.
Which of the following drugs is the most
appropriate for this patient condition?
A. Chloramphenicol
B. Cefixime (ibu hamil), ga bleh
quinolone
C. Cephadroxil
D. Cotrimoxazole
E. Tetracycline
50. A 6-year-old girl, brought by her mother to the
clinic with complaints of swelling that begins from
both of eyelid throughout her body. Blood tests
obtained: albumin 2 g / dL, total cholesterol 250
mg / dL. On examination of urine obtained protein
+3. Which of the following is the most likely
diagnosis for the case above?
A. Nephritic syndrome
B. Nephrotic syndrome
C. Acute renal failure
D. Chronic renal failure
E. Glomerulonefritis
51. According to the case above, which of the
following is the most likely pathophysiology that
caused of swelling?
A. Infection
B. Hypercholesterolemia
C. Hypoalbuminemia
D. Proteinuria
E. Water retention
52. A 39-year-old woman with a history of recurrent
urinary tract infections and now suffering that
infection. Culture examination of urine samples
showed Escherichia colli as the cause of infection.
Patients were given doses of ciprofloxacin in the
treatment and symptoms of infection disappear.
Which of the following is the most correct process
or enzyme that inhibited by the drug?
A. Cell membrane synthesis
B. Cell protein synthesis
C. Dehidrofolate sintetase
D. DNA gyrase
E. DNA polimerase
53. A 74 years old man was admitted to the hospital
for swollen ankle, hands and eyelids. Her skin was
pale, damp and cool. The patient’s vital signs
were: blood pressure 170/90 mmHg, heart rate
100 beats/min, deep respiration 18 breath/min,
and temperature 37.8°C. The patient had no urine
output and the laboratory report showed that the
patient’s blood urea nitrogen [BUN], creatinine,
potassium and phosphate level s was all higher
than normal. A chest x-ray showed white, fluffy
patches that spread outward from the hilar areas
to the peripheral border of both lungs. Her left
ventricle appeared moderately enlarged. Which of
the following is the most likely caused of an altered
renal function in this case?
A. Elevated BUN level
B. No urine output
C. Heart failure
D. Pulmonary disease
E. Infection
54. A 50-year-old woman went to a Puskesmas
complaining of edema in both legs which became
worse along the day. Her Blood pressure is 160/95
mmHg, pulse rate 70/min. She also had a history
of an ischemic stroke. Laboratory test are,fasting
blood sugar 150 mg/dL (N: <121 mg/dL), serum
6
 creatine 2.1mg/dL (N: <1.1 mg/dL), ureum 100mg
%, urinary protein ++. (CKD)
Which of the following is the most appropriate drug
should be given to the patient in order to prevent
secondary stroke attack?
A. Propranolol
B. Captopril
C. Reserpin
D. Hydrochlorothiazide
E. Furosemid
55. A 63-year-old man, came to a clinic with of pain on
her knees, there are also looked swelling and
redness at her both of knees. She said that she
also suffering edema in both legs which became
worse along the day. Her Blood pressure is
180/100 mmHg, pulse rate 90/min. Laboratory test
result: Hb: 10.8 gram%, serum creatine 2.7mg/dL
(N: <1.1 mg/dL), ureum 80mg%, urinary protein +
+. You are suggesting giving an aspirin (NSAID)
h3X500 mg with caution.
Which of the following is the most reason that you
give the drug with caution?
A. It is ineffective
B. It causes hypokalemia
C. It worsen anemia
D. its metabolite is nephrotoxic
E. It decrease kidney filtration
56. A 55-year-old male complained at the physician’s
office of his hematuria for 2 weeks now. Urine
cytologic examination showed malignancy cells. A
cystoscopic examination found a 2 cm, exophytic,
friable mass on the right bladder dome.
A biopsy of this lesion will likely to show findings
that mostly consistent with,
A. Papilloma
B. Verrucous carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Adenocarcinoma
57. Which of the following risk factors is most likely to
have led to development of this lesion?
A. Diabetes mellitus
B. Recurrent urinary tract infection
C. Therapy with methicillin
D. Cigarette smoking
E. Tuberous sclerosis
58. A 50-year old male was present with a month-long
history of flank pain and hematuria. An USG
abdominal imaged a 3-cm bosselated mass which
protruded from cortical in the right kidney. The
cytologic examination revealed malignant cells.
A biopsy of this mass will likely to show findings
that mostly consistent with,
A. Wilms tumor
B. Renal Cell Carcinoma
C. Transitional carcinoma
D. Squamous carcinoma
E. Undifferentited carcinoma
59. On physical examination to a 60-year old male
revealed hypertension and subfebril. He has had
history of nausea, vomit and right lateral
abdominal pain for 2 months. Pyelogram showed
that the right kidney smaller than of the left,
asymmetrically contracted with deformity of the
calyceal system. The right nephrectomy was
performed which showed contraction and it has
irregular granular surface. The parenchyma is
atrophic and replaced by fibrosis. The microscopic
showed glomerular sclerosis, hyalinization and
atrophy in cortical area. Another area showed
fibrosis, with lymphocytes aggregation.
Which of the following lesions could likely to
happen in this kidney?
A. Renal cell carcinoma
B. Chronic pyelonephritis
C. Acute nephritis
D. Nephrotic syndrome
E. Diabetic nephropathy
60. A 5-year-old boy child who had a palpable
abdominal mass was brought to hospital by his
mother. The child later had abdominal distention
from bowel obstruction. An USG revealed a 6cm
left renal mass with necrosis and hemorrhage.
The microscopic showed embryonal tissue with
abortive of tubular and glomerular structures.
The depicted lesion will most likely be,
A. Teratoma
B. Retinoblastoma
C. Wilms’tumor
D. Hanarthoma
E. Hemangioma
61. A 45 years old man, came to the hospital. And told
the doctor that he had episodic severe pain in the
left abdomen and radiated into his flank and
sometimes into his testical (ipsilateral). From USG
the doctor found 6 mm stone in his urinary tract.
What location is the most possible for the
obstruction?
A. Upper ureter
B. Middle ureter
C. Lower ureter
D. Vesicae urinariae
E. Urethra
62. If the patient felt the pain radiated from left
abdomen to the testicle cause of a stone in his
ureter, what level of sympathetic fibers is the most
responsible for ureter?
A. T 7-8
B. S 2-4 (parasimpatik)
C. T 11-12 (simpatik bladder)
D. L1-3
E. L4-5
63. A 50-year-old man came to his doctor and told the
doctor that for the last 2 months, he felt burning on
urination and the color was dark. The doctor told
him to check his urine. And the result:
7
 pH :7 (N : 4.5 – 8) , WBC: 15-20/HPF (N : 0-
2/HPF) ; RBC : 5-10/HPF (N: 0/HPF ). Urine
sediments show crystals with cuboid shape. (ca
oksalat)
What is the most likely metabolic abnormality?
A. Hyperoxaluria
B. Hypercalciuria
C. Hypercitraturia
D. Hyperuricuria
E. Renal tubular acidosis
64. A 42-year-old man came to the hospital and said
that his urine’s color is red and he saw vermiform
clot. From his statement, could you tell the
possible source of his problem?
A. Ureter
B. Urethra
C. Bladder
D. Prostate
65. A 50-year-old man is hospitalized for acute
myocardial infarction. He has decreased cardiac
output with hypotension requiring multiple pressor
agents. His urine output drops over the next 3
days. His serum urea nitrogen increases to 59
mg/dL, with creatinine of 2.9 mg/dL. Urinalysis
reveals no protein or glucose, a trace blood, and
numerous hyaline casts. Five days later, he
develops polyuria and his serum urea nitrogen
declines.
Which of the following pathologic findings in his
kidneys is most likely to have caused his
azotemia?
A. Patchy tubular necrosis
B. Fusion of podocyte foot processes
C. Glomerular crescents
D. Hyperplastic arteriolosclerosis
E. Mesangial immune complex
deposition
66. A 26-year-old diabetic woman is seen in the ER for
sore throat. Rapid strep test is positive for
streptococcal pharyngitis and she was started on
ampicillin 500 mg four times a day. Three days
later, she develops hematuria associated with a
low grade fever. On physical examination, she has
a maculopapular rash and a temperature of 38 C.
Laboratory studies show: serum creatinine 3.6
mg/dl, WBC 8,700 with 56% PMN, 25% lymphs,
3% monos and 15% eosinophils. Urinalysis: pH
6.2, protein 2+, blood 3+, 65 RBCs/HPF, 20-30
WBCs/HPF, 3-4 WBC casts/HPF. ASTO value is
increased.
What is the most likely diagnosis?
A. Diabetic nephropathy
B. IgA nephropathy
C. Acute interstitial nephritis
D. Acute pyelonephritis
67. A 40-year old man with arthritis has been using
ibuprofen (nonsteroidal anti-inflammatory) every 6
hours. He developed renal failure associated with
nephrotic range proteinuria.
What is the most likely glomerular lesion in this
patient?
A. Membranoproliferative
glomerulonephritis
B. Minimal change disease
C. IgA nephropathy
D. Diabetic nephropathy
E. Focal segmental glomerulosclerosis
68. A 4-year-old-boy was brought to hospital with
puffiness around the eyes, especially in the
morning and swelling over the legs. His mother
also complaint he has foamy urine. Urine sample
shows protein ++++ (>3.5 per 1.73 m 2 per 24
hour), albumin level 1.5g/dL (normal=3.5-5g/dL).
What is the most likely underlying mechanism in
this patient?
What is the principal management in this patient?
A. Albumin 0,5-1 g/kg, iv, follow with
furosemide 1-2 mg/kgBB/iv
B. Prednisone 40 mg/m2/day
C. Prednisone 60 mg/m2/day
D. Reduce sodium intake
E. Alkylating agent
69. A 5 day old baby was hospitalized due to indirect
hyperbilirubinemia. On the third day hospitalization
he had fever and then he was given amoxicillin
(beta lactam yang bikin AIN) and gentamycin
intravenously. Three days later his urine output
diminished and the laboratory test revealed urea
nitrogen 25 (3-12) mg/dL, creatinine 0.9 (0.2-0.4)
mg/dL.
What is the most likely diagnosis in this patient?
A. Urinary tract infection
B. Sepsis
C. Acute renal failure
D. Chronic renal failure
E. Acute tubular nephritis
A 3 year old boy was brought to emergency unit
Karawaci Hospital with severe diarrhea since three
days ago. On arrival he is not fully alert. His vital sign
are as follows: blood pressure is 80/60 mmHg, pulse is
not palpable, respiratory rate was 36 breaths per
minute, and body temperature was 38.4oC. On
physical exam there is sunken anterior fontanel, dry
mucous membranes, sunken eyes, lack of tears, poor
skin turgor, and the capillary refill more then 2
seconds. The daily urine volume is less than 400 mL.
70. In this patient, the tubular epithelial cells are
particular susceptible to ischaemic injury due to:
A. Little charged surface for reabsorption
B. Low metabolic rate and oxygen
consumption
C. Decreased levels of salt reaching the
distal tubules
D. Loss of polarity that cause
redistribution of membrane proteins
E. Passive transport systems for ions
and organic acids
8
71. The laboratory test in this patient reveal
haemoglobin 15 g/dL( 11.5-15.5 g/dL), hematocrit
46% (35-45%), WBC 7,000/mm3 (5,500-
15,500/mm3), platelets count 260,000/mm3
(150,000-400,000 mm3), urea nitrogen 40 mg/dL
(5-18 mg/dL), and creatinine 1.7 mg/dL (0.3-0.7
mg/dL).
The most likely diagnosis in this patient is:
A. Acute tubular nephritis
B. Prerenal acute kidney injury
C. Intrinsic acute kidney injury
D. Postrenal acute kidney injury
E. Chonic renal failure
A 10 year old girl was brought to your clinic with disuria
since 5 days ago. On physical exam she is healthy
with no significant findings. From urine culture is found
Eschericia coli with CFU ≥ 100,000.
72. What is the most likely diagnosis in this patient?
A. Acute pyelonephritic
B. Reflux nephropathy
C. Uncomplicated urinary tract infection
D. Complicated urinary tract infection
E. Chronic urinary tract infection
73. Factors unfavorable to bacterial growth in this
patient’s urine is:
A. A low pH
B. A low concentration of urea
C. The absence of organic acids from a
diet
D. A low osmolality
E. The presence of normal
microorganism
74. An 8 years old boy presents with decreased urine
output, hematuria, high blood pressure, proteinuria
add rising creatinine. One week ago he had a
fever and sore throat. A renal biopsy is carried out
reveals diffuse proliferative glomerulonephritis.
Electron microscope will show abnormal deposits
in what location?
A. Between basement membrane and
endothelial cells of the glomeruli
B. Between the basement membrane
and epithelial cells of the proximal
tubule
C. Between the basement membrane
and epithelial cells of the glomeruli
D. Within the juxtaglomerular apparatus
75. A 45 years old female has a long history of poorly
controlled diabetes. She presents now with
edema, hypertension and massive proteinuria,
hematuria and hyperlipidemia. Renal biopsy shows
hyaline arteriosclerosis of the arterioles. What
changes will be present in the glomeruli?
A. Diffuse proliferative glomerulonephritis
B. Membranous proliferative
gomerulonephritis
C. Membranous glomerulosclerosis
D. Focal segmental glomerulosclerosis
E. Nodular glomerulosclerosis
76. A 64-year-old male presents with hematuria.
Examination shows a flank mass and he has
elevated hemoglobin. Pathology of the surgical
specimen shows a clear cell renal cell carcinoma.
What is the cell of origin of this tumor?
A. Glomerulocyte
B. Glomerular endothelium
C. Glomerular epithelium
D. Proximal tubular epithelium (clear ell n
papilla)
E. Histiocyte
Distal (klomoford, oncodi)
77. A 32-year-old female presents with headaches.
Investigation reveals hypertension (180/110
mmHg) and very high level of aldosterone
presumed due to a tumor. What of the following is
characteristic of this condition?
A. Elevated serum sodium levels
B. Elevated serum potassium levels
C. Elevated urinary cortisols
D. Elevated urinary bicarbonate
78. An 18-year-old male presents to emergency
following a motorcycle accident. There is
significant blood loss. In the ER, his BP is 90/60
mmHg and his pulse is 120 x/min. What
physiological response occurs in the kidney?
A. Decreased urine osmolality
B. Reduced release and action of ADH
C. Beta adrenergic stimulation of the
vasculature
D. Vasoconstriction of the renal arterioles
E. Reduced aldosterone production and
sodium loss
1. Mr. Edi, 42 year old male, comes to the Siloam
hospital with muscular weakness, mild headache
after eating salted fish. Previously he never eats
salted fish. Usually he drink only small amount of
water. He said that usually his blood pressure is
100/70 mmHg. His blood pressure 140/90 mmHg.
The doctor sends him to the laboratory. The result
shows serum sodium is 150 mEq/L, potassium is
3.5 mEq/L, glucose 150 mg/dl.
In this condition, what will the kidney do?
A. Increase GFR
B. Increase obligatory water reabsorption
C. Increase facultative water reabsortion
D. Increase renin secretion
E. Increase aldosteron secretion
2. To cover the above function, what mechanism is
used?
A. Increase cardiac output
B. Increase frequency of the heart
C. Increase secretion of renin
D. Increase secretion of antidiuretic hormone
E. Increase secretion of aldosteron
.
3. Which factor support the above mechanism?
A. Filtration rate of the glomeruli
9
 B. Active transport of the tubular cell
C. High osmolality of the interstitium of medulla
D. Obligatory water reabsortion
E. Osmolality of the filtrate in distal convoluted
tubule
4. If the urinalysis is also done, what will you see about
the glucose in urine?
A. positive ++++
B. positive +++
C. positive ++
D. positive+
E. negative
5. In a kidney laboratory, using a micropipette, we can
measure the hemodynamic pressure of afferent
arteriole, pressure in Bowman capsule, and osmotic
pressure in glomerular lumen. If the pressure in
afferent arteriole is 40 mmHg, in Bowman capsule 1
mmHg, the osmotic pressure of glomerulus is 30
mmHg, the effective filtration pressure in glomerulus is:
A. 71 mmHg
B. 69 mmHg
C. 11 mmHg
D. 9 mmHg
E. – 9 mmHg
6. A patient taking an oral diuretic for about six
months, visits your clinic with elevated fasting and
postprandial blood glucose levels. You check the
patient’s HbA1C and find it is elevated compared
with normal baseline values obtained 6 months
ago. You suspect the glycemic problems are
diuretic-induced. Which of the following drug is the
most likely cause?
A. asetazolamide
B. amiloride
C. chlorothiazide
D. spironolactone
E. triamterene
7. Your patient, a 55 year-old man, with heart failure,
unacceptably low cardiac output, and intense
reflex-mediated sympathetic activation of the
peripheral vasculature that is attempting to keep
vital organ perfusion pressure sufficiently high. The
patient is edematous, and has ascites, because of
the poor cardiac function and renal compensations
for it. Which of the following drug should be
avoided in this patient?
A. amiloride
B. ethacrynic acid
C. hydrochlorothiazide
D. mannitol
E. spironolactone
8. A 63-year-old-man, with a history of heart failure
and edema fails to respond adequately to
maximum recommended dosages of
chlorthalidone.
Which of the following is the most likely
appropriate for restoring the diuretic response?
A. add with hydrochlorothiazide
B. add with metolazone
C. replace with furosemide
D. replace with hydrochlorothiazide
E. increasing the dose of
chlorthalidone
9. A 75-year-old woman with hypertension is being
treated with thiazide. Her blood pressure is
decrease to 120/76 mm Hg. After several months
on the medication, she complains of being tired
and weak. Which of the following substance in
analysis of blood indicates low values?
A. calcium
B. uric acid
C. potassium
D. sodium
E. glucose
10. Your patient, a 45-year-old man, usually lives near
the beach, is planning to have a vacation that
includes a short hike to the top of Mount Everest
(altitude approx. 29.000 feet above sea-level).
You are concern about “mountain sickness”. He
has no other significant medical conditions and
takes no other drugs that would interact with the
drug you will prescribe for his trip.
Which of the following drug you recommend?
A. acetazolamide
B. amiloride
C. bumetabide
D. furosemid
E. spironolactone
11. A patient with tuberculosis develops
bright orange-red urine after he drank his anti-
tuberculosis drugs and calls his physician in a
panic because he is afraid he is bleeding into the
urine. The patient has no other urinary tract
symptoms. Which of the following medication is
the most likely to produce this side effect?
A. Ethambutol
B. Isoniazid
C. Pyridoxine
D. Rifampicin
E. Streptomycin
12. A 26 year-old young man presents with the
symptoms of gonorrhea. This condition is often
associated with infection due to Chlamydia
trachomatis.
Which of the following quinolones would be the
best choice for treating him?
A. ciprofloxacin
B. nalidixic acid
C. norfloxacin
D. levofloxacin
E. ofloxacin
10
13. A jaundiced 1-year premature infant with elevated surgery. After incising the scrotum, the surgeon
free bilirubin is seen in the premature baby contemplates the approach
nursery. The mother had received antibiotic to the parenchyma of the testes.
combination for a urinary tract infection (UTI) 1 Which layer is the most near to the testicular
week before delivery. parenchyma?
Which of the following is the most likely cause of A. Fascia spermatica externa
the baby’s kernicterus ? B. Tunica albuginea
A. cefixime C. Fascia sprematica interna
B. amoxicillin D. Scarpa fascia
C. azithromycin E. Tunica dartos
D. erythromycin
E. cotrimoxazole 19. A 18-year-old man is noted to have dysuria for
several days, and the doctor diagnose that she suffers
14. A 30 year-old woman with a history of recurrent from urinary tract infection.
urinary tract infection. Since 5 days ago, she felt Which of the following structure of the urinary tract
dysuria, urgency, and frequency. Culture of urine is the most vulnerable to
sample indicated that the offending organism is get infection?
Escherichia coli. She receives ciprofloxacin and A. Kidney
the symptoms disappear. B. Ureter
Which of the following process is inhibited by C. Urinary bladder
ciprofloxacin? D. Urethra
A. cell-wall synthesis E. Adrenal gland
B. folic acid synthesis
C. protein synthesis 20. A 70 year old man came to the emergency
D. topoisomerase II department of Karawaci Hospital with
E. DNA polymerase complaint of incomplete urination since 6 months
ago. The urologist performed
15. A 30 year old man with motorcycle accident comes rectal examination and found an enlargement of
to the emergency. In the his prostate.
physical examination, the doctor found that his left Which of the following structure is affected by the
kidney has severe injured. enlargement?
And the doctor suggested operating his kidney. A. urethra pars membranacea
During the removal of a patient’s kidney, B. urethra pars spongiosa
Which of the following structure is the most anterior C. sphichter urethra interna
within the renal sinus? D. urethra pars prostatica
A. Renal arteries E. orificium urethra externa
B. Renal vein
C. Major calyx A 4-year-old-boy was brought to hospital with puffiness
D. Minor calyx around the eyes, especially in the morning and
E. Renal pelvis swelling over the legs. His mother also complaint he
has foamy urine. Urine sample shows protein ++++
16. You wish to examine the hilum of the left kidney (>3.5 per 1.73 m2 per 24 hour), albumin level 1.5g/dL
during surgery. (normal=3.5-5g/dL).
Which of the following structures must be elevated?
A. Stomach 21. What is the principal management in this patient?
B. Suprarenal gland
C. Ascending colon F. Albumin
D. Duodenum
E. Liver G. Furosemide
17. To elevate the kidney within the renal fascia and
the perirenal fat, which of the H. Prednisone
following muscles must be reflected or incised from
the fascia? I. Diet restriction
A. Diaphragm
B. Psoas J. Cyclosporin

C. Quadratus lumborum
D. Transverses abdominis
E. Iliacus 22. During 4 weeks-treatment, the
urine sample shows protein +.
18. An 18-year-old man is noted to have probable
testicular cancer. He undergoes
11
 What is your conclusion in this patient? had fever and then he was given amoxicillin and
gentamicin intravenously. Three days later his urine
A. Initial responder output diminished and the laboratory test revealed
urea nitrogen 25 (3-12) mg/dL, creatinine 0.9 (0.2-0.4)
mg/dL.
B. Late responder
25. What is the most likely diagnosis in this patient?
C. Drug resistant
F. Urinary tract infection
D. Drug dependent
G. Sepsis
E. Remission
H. Acute renal failure
A 13 year-old-girl was brought to emergency unit with
I. Chronic renal failure
seizure. Her mother complaint she had fever 2 weeks
ago, but has recovered. Now she has swelling around
the eyes and legs and she has dark urine. From J. Acute tubular nephritis
physical exam, she is unconscious. Her blood
pressure is 180/120 mmHg. Urine sample shows 26. What is the most possible cause in this patient?
erythrocytes 20/hpf and protein +. Albumin level within
normal limit.
F. Ischemia
23. What other laboratory findings to confirm the
diagnosis in this patient?
G. Direct toxic injury
F. Decreased anti streptolisin O (ASO),
H. Complex immune response
increased DNase-B, decreased C3

I. Urinary obstruction
G. Increased anti streptolisin O (ASO),
decreased DNase-B, decreased C3
J. Drug hypersensitivity
H. Decreased anti streptolisin O (ASO),
increased DNase-B, increased C3

I. Increased anti streptolisin O (ASO), 27. What is the pathognomonic laboratory finding
decreased DNase-B, increased C3 (urinalysis) in this patient?

J. Increased anti streptolisin O (ASO), A. Increased osmolality

increased DNase-B, decreased C3
B. Proteinuria

C. Muddy brown casts

24. What is the most likely mechanism that underlying
this patient’s disease? D. Erythrocyte casts

A. Streptococcal bacteria infection E. Haemoglobinuria

B. An inflammation of the kidney tubules
C. Increased permeability of glomerulus
membrane
D. Small pores in the podocytes permit
erythrocyte loss
E. Heparan sulfate mucopolysaccharide is
low so erythrocyte cross the barrier
A 5 day old baby was hospitalized due to indirect
hyperbilirubinemia. On the third day hospitalization he
A 3 year old boy was brought to emergency unit
Karawaci Hospital with severe diarrhea since three
days ago. On arrival he is not fully alert. His vital sign
are as follows: blood pressure is 80/60 mmHg, pulse is
not palpable, respiratory rate was 36 breaths per
minute, and body temperature was 38.4oC. On
physical exam there is sunken anterior fontanel, dry
mucous membranes, sunken eyes, lack of tears, poor
skin turgor, and the capillary refill more then 2
seconds. The daily urine volume is less than 400 mL.
28. In this patient, the tubular epithelial cells are
particular susceptible to ischemic injury due to:
F. Little charged surface for reabsorption
12
 G. Low metabolic rate and oxygen
consumption
H. Decreased levels of salt reaching the
distal tubules
I. Loss of polarity that cause redistribution of
membrane proteins
J. Passive transport systems for ions and
organic acids
29. The laboratory test in this patient reveal
haemoglobin 15 g/dL(11.5-15.5 g/dL),
hematocrit 46% (35-45%), WBC
7,000/mm3(5,500-15,500/mm3), platelets count
260,000/mm3 (150,000-400,000 mm3), urea
nitrogen 40 mg/dL (5-18 mg/dL),
and creatinine 1.7 mg/dL (0.3-0.7 mg/dL).
What is the most likely diagnosis in this patient?
F. Acute tubular nephritis
G. Prerenal acute kidney injury
H. Intrinsic acute kidney injury
I. Postrenal acute kidney injury
J. Chonic renal failure
30. What is the most prior management in this patient?
A. Bicarbonate
B. Acute Dialysis
C. Furosemide
D. Antibiotic
E. Fluid replacement therapy
A 10 year old girl was brought to your clinic with
dysuria since 5 days ago. On physical exam she is
healthy with no significant findings. From urine culture
is found Eschericia coli wih CFU ≥ 100,000.
31. What is the most likely diagnosis in this patient?
F. Acute pyelonephritic
G. Reflux nephropathy
H. Uncomplicated urinary tract infection
I. Complicated urinary tract infection
J. Chronic urinary tract infection
32 .Which of the following factor is unfavorable to
bacterial growth in patient’s urine?
F. A low pH (5.5 or less)
G. A low concentration of urea
H. The absence of organic acids from a diet
I. A low osmolality
J. The presence of normal microorganism
33. Which of the following antibiotic is the most
appropriate for this patient?
A. Ceftriaxone
B. Cefotaxime
C. Ceftazidime
D. Cotrimoxazole
E. Metronidazole
A 55-year-old man refers to ICU after the procedure
open reduction of femur fracture and bleeding intra
operative. At the third day he became apatis, fever
38,5 Celcius with blood pressure 110/60 mmHg, pulse
55 x/min, respiratory 20x/min, and urine output
decreased to 10 cc/hour in 24 hours. At laboratory
examination findings creatinine 4 mg/dL, BUN 250
mg/dL, sodium 130 mEq/L, chloride 90 mEq/L,
potassium serum 7.5 mEq/L, blood sugar 200 mg/dL.
From blood gas analysis finding pH 7.1, pCO2 30
mmHg, pO2 90 mmHg,
HCO3 18 mEq/L. ECG examination finds widening of
QRS wave.
13
 (E) End State Kidney Disease

34. What is the most critical condition can cause life

threatening the patient? 38. Which of the following statements in true of
hematuria caused by bladder cancer?
(A) Nothing for awareness (A) It is usually accompanied by discomfort and
painful voiding
(B) creatinine and BUN at very high level (B) It is intermittent and painless
(C) It occurs in a minority of patients with bladder
(C) hyperkalemia cancer
(D) It commonly causes anemia
(D) metabolic acidosis (E) It occurs primarily only in the initial phase of
the urinary stream
(E) Severe hyponatremia
39. A 36-year-old
male truck driver is referred to you for evaluation
of recurrent urolithiasis. The patient has passed
35. What is the best choice of treatment for the clinical more than 20 calcium oxalate stones since age
situation for the patient? 18. Previous therapy with hydrochlorothiazide
and cellulose phosphate has been ineffective.
(A) Food restriction with potassium composition Physical examination is normal. Laboratory
finding: Serum creatinine 1.0 mg/dL, Serum uric
(B) Give K sparing diuretic acid 8.9 mg/dL, Urine pH 5.0
Radiographs of the abdomen show smooth renal
silhouettes measuring 13.6 cm on the right and
(C) Give regular Insulin 10 U in dextrose 50%
14.2 cm on the left, and no radioopaque at
intravenous
kidney region. From sonography findings
multiple hyperechoic shadow from both kidney
(D) Give bicarbonate sodium intravenous
with measure about 2 – 5 mm.
Which of the following treatment is the most
(E) Give forced diuretic
effective for this patient?
(A) Dietary sodium restriction

36. After the choice procedure, what is the next (B) Dietary calcium supplementation
treatment for the patient? (C) High fluid intake and long-term
urine acidification
(D) High fluid intake and allopurinol
(A) Waiting for the general condition of the
(E) Shock wave lithotripsy
patient became more better
40. A 40-years-patient arrives at ER department with a
(B) Give diuretic until the urine output will be
transthoracic gunshot wound and microscopic
normally
hematuria.
What is the most appropriate supporting diagnostic
(C) Hemodialysis immediately
technique?
(A) Abdominal sonography
(D) Give sodium bicarbonate until pH of (B) Intravenous pyelography
blood became normal (C) Immediate laparatomy
(D) Clinical observation on the hospital
(E) Intubation and ventilator to maintain the ward
respiratory (E) Immediate CT with i.v contrast agents

41. You are asked to evaluate a 38-year-old woman

who has a ten-year history of bipolar disorder. She
37. According to RIFLE criteria, what is clinical has taken lithium carbonate for seven years. For
condition of the patient? the past two years, she has had severe polyuria
(urine volume up to 10 L/24 hr). She refuses to
(A) Risk discontinue lithium therapy.
What is the most appropriate agent to reduce the
(B) Injury polyuria?
(A) Amiloride
(C) Failure (B) Chlorpropamide
(C) Furosemide
(D) Loss (D) Hydrochlorothiazide
14
 (E) Acetazolamide parasympathetic system in controlling the
urinary bladder?
42. A man 45 years old come with bruise at lower A. Relaxes external sphincter
abdominal and pain. He is suspected with B. Relaxes internal spinchter
bladder injury, C. Relaxes detrussor muscle
Which of the following statement is true about D. Contracts detrussor muscle
bladder injuries? E. Contracts anal spinchter
(A) They are present 6% -10% in patients with
pelvic fracture 46. The parasympathetic outflow in the spinal cord
(B) More than 80% come with urine retention occurs at levels:
(C) Delayed diagnosis is the rule A. T3,4
B. T 6-10
(D) Bladder contusions commonly result in C. S1,2,3
gross hematuria D. S2,3,4
(E) They are associated with a 50% rate of E. L1,2,3
urethral tear
47. A 75 year old man had urine incontinent since 3
43. A 51-year-old man, who is hospitalized for months ago. He had been diagnosed dementia by
treatment of Pneumocystis pneumonia, is found to the doctor since 6 months ago. On examination he
be HIV seropositive. There is no family history of had no prostate problems. What is the cause of his
kidney disease or hypertension. Temperature is urination’s problem?
38.1 C (100.6 F). Pulse rate is 102 per minute, and F. Impaired frontal inhibition
respirations are 23 per minute. Urinalysis show G. Impaired pontine inhibition
Protein 3+; 0–2 RBCs; 0–1 WBC/hpf, and Urine H. Sympathetic system dysfunction
protein is 6230 mg/24 hr. Ultrasonography I. Parasympathetic system dysfunction
demonstrate large, echogenic kidneys. J. Sensoric system dysfunction
What pathology feature is demonstrated in the
Kidney biopsy? 48. A 40 years old woman, body weight 50 kg, came to
(A) Postinfectious glomerulonephritis emergency unit with diarrhea (frequency 8
(B) Membranoproliferative times/day) since 2 days ago. Her urine volume
glomerulonephritis was 150 cc/12hours. She was conscious, BP
(C) Membranous glomerulopathy 85/60 mmHg, pulse 105 x/min, RR 20 x/min,
(D) Collapsing glomerulopathy temperature 36,5 C. Laboratory results: Hb 12 gr
(E) Minimal change disease %, Ht 40%, WBC 9000, Platelet 263.000, ureum
104, creatinine 3,7.
44. A 36-year-old woman comes to the emergency What is the most appropriate initial treatment for
department because of severe, sharp right flank the patient?
pain of four hours' duration. During physical A. Give an antibiotic
examination, she cannot lie because of pain. B. Ringer lactate infusion
Temperature is 39.0 C (102.2 F), and pulse rate is C. Give vasopressin
120 per minute. The right flank is tender to deep D. Glucose infusion
palpation. Leukocyte count is 18,000/cu mm. E. Oral rehydration
Serum creatinine is 2.0 mg/dL. Urinalysis shows
protein 1+; 10–20 WBCs, 10–20 RBCs/hpf. 49. A 44 year old man was hospitalized for systemic
Radiograph of the kidneys, ureters, and bladder fungi infection. He was on Amfoterisin B treatmet
shows a 1.5-cm calcific density in the area of the for 7 days. On examination, he conscious, BP
right mid-ureter. Both kidney silhouettes measure 120/80 mmHg, pulse 80 x/min, RR 16 x/min,
approximately 12 cm pole-to-pole. temperature 36,7 C. Lab: Hb 13 gr%, HT 37%,
Ultrasonography shows a hydronephrotic right WBC 8600, Platelet 340.000. Urinalysis: RBC 0-
kidney and contracted left kidney. 1/HPF, WBC 2-5/HPF, protein (-), granular cast (+).
What is the most appropriate management for this Ureum 91, creatinin 2, 0. Volume urine 800 cc/24
woman? jam
(A) Intravenous urography What is the most likely diagnosis?
(B) Intravenous ketorolac to relax the ureter A. Acute Tubular
(C) Intravenous fluids that allow the stone to necrosis
pass B. Acute
(D) Immediate percutaneous nephrostomy Glomerular Nefritis
(E) Emergency lithotripsy C. Acute
Interstitial nephritis
45. Normal micturition requires that the urinary D. Acute Renal
bladder and the urethral sphincter work together Failure
as a coordinated unit to store and empty urine. E. Chronic Renal
Which of the following is the effect of failure
15

50. A young woman went to a physician because
pain during urination and frequency. On
examination, she had has suprapubic pain, but
no fever. Her urine was cloudy and shows
microscopic evidence of erythrocytes, pyuria,
and gram-positive bacteria. In the past medical
history, she never had any symptoms like this
one. Which organism is most likely responsible
for this patient’s illness?
F. Klebsiella pneumonia
G. Pseudomonas aeruginosa
H. Escherichia coli
I. Proteus mirabilis
J. Staphylococcus saprophyticus
51. Which urine specimen is most appropriate for
the culture examination for the patient above?
A. Suprapubic
B. Clean catch
C. Straight catheter
D. Indwelling catheter
E. 24 hours urine collection
52. A pregnant woman was complaining fever, pain
when urinating, blood in her urine, and severe
lower back pain. The physician submits her urine
for culture; the next day, the laboratory reports
an organisms growth count of greater than
105/ml of urine. The organism grew well on the
blood agar and producing β–hemolytic colonies.
Which important virulence factor for the
organism is most likely responsible for this
patient’s illness?
A. Capsule
B. P-fimbriae
C. Endotoxin
D. Phospolipase C
E. Lipooligopolysaccharide
53. A male patient complained of a sharp pain in his
suprapubic radiating down to his perineum,
accompanied by hematuria. He reported that he
had a few days of urinary urgency, frequency,
and burning when urinating. On examination, his
temperature was 37,5ºC; other vital sign were
normal; and he appear to be in pain. A urinalysis
shows erythrocytes, leukocytes esterase and a
high pH.
Gram stain demonstrates negative coccobacili.
Which antigenic composition is most likely
responsible for this illness?
A. Hemolysin
B. Catalase
C. Fibronectin
D. Opa protein
E. Cord factor
A 45 years old man comes to Siloam Hospitals with
low back pain and painful sensation when urinating.
Anamnesis: he has a history of kidney stone. Physical
examination: pallor, fluctuating pain, blood pressure
140/90 mm Hg. Weight 54 kg, Height 167 cm. edema
in low extremity. Lab exams: Hb 13,8 g/dL, WBC
10.950 mL, Uric acid 7,5 mg/dL, Ureum 86 mg/dL,
Creatinin 1,4 mg/dL.
54. What is the most appropriate nutrition for this
patient:
A. Restrict water to 1000 ml/day.
B. No restriction for food consistency.
C. Drink fruit juice as much as possible.
D. Patients should drink as much as possible.
E. Ask him to drink while thirst only. Choose dry
foods.
55. Protein recommendation:
A. No need to restrict protein
B. Use meat based protein not from the
legumes or beans
C. Limit protein high in uric Acid such as
beans, seeds
D. Limit protein 0,7 gram/kg BB
After a year he comes with weakness, nausea, muscle
cramp, and itchy. Physical exam: BW 52 kg, edema in
both legs and palpebras. Blood pressure 170/100
mmHg. Lab exam: Hb 7,6 g/dL, Ureum 196 mg/dL.
Creatinine 3,7 mg/dL. Uric Acid 11,8 mg/dL. Organic
Phosphorus 11 mg/dL, Calcium 3,4 mg/dL Sodium 147
mmol/L, Potassium 5,6 mmol/L.
56. What is the most appropriate method to nourish
him:
A. Parenteral nutrition and nil by
mouth
B. Give a fruit juice and add sugar.
C. Give milk in enough calories.
D. Temporary no fruits and give
blended vegetable.
57. About calcium phosphorus balance in this patient:
A. He needs milk fortified calcium.
B. Restrict protein intake
C. Reduce meat base protein and
nuts.
D. Reduce protein and give high
calories.
58. A 55 year old male complains hematuria at
thephysician’s office for 2 weeks.
A cystoscopic examinations showed a 2
cm,exophytic,friable mass on the right bladder
dome.
A biopsy of this lesion show findings most
consistent with a/an
F. Papilloma
G. Verrucous carcinoma
H. Transitional carcinoma
I. Squamous carcinoma
J. Adenocarcinoma
16
59. A 60 year old male has had multiple recurrent
urinary tract infections with 6 month history of
dysuria. Rectal toucher by his physician palpates
prostate enlargement.
What is the most appropiate clinical action to
diagnose carcinoma prostate ?
A. Trans rectal biopsy
B. Trans urethral biopsy
C. Transrectal FNAB
D. Rectal toucher
E. Open surgery
60. A 50 year old male presents with a month long
history of flank pain and hematuria.An USG
abdominal results a 3 cm bosselated mass,
protrudes from cortical are in the right
kidney.Cytologic examination reveals malignant
cells. What is most likely biopsy finding for this
patient?
F. Wilms tumor
G. Renal Cell Carcinoma
H. Transitional carcinoma
I. Squamous carcinoma
J. Undifferentited carcinoma
61. A 60 year old male experiences the onzet of
headache, naussea ,vomitting fo 1
month.Physical examination reveals
hypertention, subfebril. Pyelogram showed the
affected kidney assymmetrically contracted with
deformity of the calyceal system. Gross of the
affected kidney showed contracted and has
irregular granular surface.The parenchyma is
atrophic and replace by fibrosis. Microscopic
showed glomerular sclerosis, hyalinization and
atrophi in cortical area. Another areas showed
fibrosis, chronic inflammatory cells with
limpocytes agregation.
What is the most likely lesions occur in this
kidney?
F. Renal cell carcinoma
G. Chronic pyelonephritis
H. Acute nephritis
I. Nephrotic syndrome
J. Diabetic nephropathy
62. A 5 year old boy child who had a palpable
abdominal mass brought to hospital by his
mother . The child later had abdominal distention
from bowel obstruction. An USG reveals a 6 cm
left renal mass with necrosis and hemorrhage.
Microscopic showed embryonal tissue with
abortive of tubular and glomerular structures.
What is the diagnosis ot this patient?
F. Teratoma
G. Retinoblastoma
H. Wilms’tumor
I. Hanarthoma
J. Hemangioma
63. A 62-year-old woman presents with hematuria
and left flank pain. Physical examination reveals
costovertebral angle tenderness. Renal
ultrasound shows marked left hydronephrosis.
Serum creatinine and CBC are normal.
Which of the following diagnostic test is the most
relevant?
A. Renal biopsy
B. Renal arteriogram
C. Palpation for inguinal lymph nodes
D. Antinuclear antibody test
E. IVP
64. A 34-year-old man comes with 3-day history of
low back pain, urinary hesitancy, and pain with
urination. He has not had any urethral discharge
or recent sexual contacts. His temperature is
38.2C, and blood pressure is 120/70 mm Hg.
Pulse 96x/min, RR 20x/min. There is no
costovertebral angle tenderness. Abdominal
examination shows no tenderness or masses.
Rectal examination shows no tender prostate
and no masses.
Specific gravity 1.030; Blood negative; Glucose
negative; Ketones negative;
Leukocyte esterase positive
What is the most likely diagnosis?
A) Benign prostatic hypertrophy
B) Cystitis
C) Prostatitis
D) Pyelonephritis
E) Urolithiasis
65. A 63 year old female patient came with complain
of pain while urinate. She has history of
recurrent urinary infections. Physical
examination revealed tenderness in CVA region.
Urinalysis was done and radiology finding
reveals large, bilateral "stag horn" calculi.
What kind of stone is likely to be demonstrated
in this case?
A. Calcium oxalate stones
B. Struvite stones
C. Calcium phosphate stones
D. Uric acid stones
E. Cystine stones
66. A 55-year-old man is brought to the emergency
due to acute onset of severe right-sided flank
pain. He has a 10-year history of gout. His
blood pressure is 110/80 mm Hg, pulse is
78x/min, and RR 16x/min. Examination shows
normal bowel sounds and no abdominal
tenderness or masses. Urinalysis shows 40
erythrocytes/hpf. Intravenous pyelography
confirms a right ureteral calculus.
Which of the following underlying mechanism is
responsible for this patient's condition?
A. An increase in urinary pH
B. Damage to the epithelial lining of the
ureters
C. Lack of inhibitors of crystal formation
D. Presence of urease-splitting bacteria
17
 E. Urinary supersaturation with uric acid d. Normal nephrogram

72. What is the most likely the appearance of renal

A 66 years old, came to Emergency Department with artery rupture?
shortness of breath as his chief complaint. He also got a. The kidney shows non function
nausea, vomiting and loss of appetite since 3 days b. Ekstravasation
ago. No diarrhea was occurred prior to the symptoms. c. Hydronephrosis
He was taking un regularly anti hypertension drugs for d. Normal nephrogram
20 years. Physical exam: weight 70 kg, blood pressure
190/110, Pulse 120 times/minute, and Respiratory rate 73. A 50 years old man comes to the clinic with
46 times/minute. Pale conjunctiva, fine crackles +/+ complain of abdominal colic. The result of IVP
were heard on the both side of the lung. Heart, liver demonstrates ureteric dilatation.What is the most
and spleen were normal. likely the problem of ureteric dilatation?
Lab results: Hb 7.2 g/dl, WBC 7000/mm3, trombosit a. Stone in the pelvicureter junction
225000/mm3, random glucose 135 mg/dl, Ureum 150 b. Kidney cyst
mg/dl, Creatinin 5.2 mg/dl. Proteinuria +3 c. Stone in the vesicoureter junction
d. Renal cell Ca stage I
67. What is the most possible causes of anemia
based on the case above? 74. A 65 years old man is diagnosed with Prostates
A. B6 deficiency hypertrophy. What is the most likely feature appeared
B. Erithropoeitin deficiency in cysptography?
C. B12 deficiency a. Indentation of inferior aspect of bladder
D. Iron deficiency b. Indentation of superior aspect of bladder
E. Folic deficiency c. Indentation of posterior aspect of bladder
d. Additional shadow of superior aspect of
68. What is the most possible electrolyte level show? bladder
A. Phosphate decreased
B. Calcium increased 75 A 45 years old woman is diagnosed with Bladder
C. Potassium decreased stone. What is the most likely feature appeared in
D. Phosphate increased cysptography?
E. Normal Calcium a. Indentation of inferior aspect of bladder
b. Indentation of superior aspect of bladder
69. Mrs Jane 35 years old, came to Internal c. Filling defect in the bladder
Department with complain, fatigue and d. Additional shadow of superior aspect of bladder
headache about 1 month . In physical examination:
pale, butterfly rash at her face, another
examination in normal limit. The physician
suspects that Jane suffers SLE. 1. 109 284. The consumption of oxygen by the
What’s the most important lab examination to kidney
support the diagnosis: a. Decreases as blood flow increases
a) Complete Blood Count b. Is regulated by erythropoietin
b) Complement fixation test c. Remains constant as blood flow
c) Anti Nuclear Antibody increases
d) Renal function test d. Directly reflects the level of sodium
e) Liver function test transport
e. Is greatest in the medulla
70. According to case no 1, beside protein uria what is 2. 110 285. The anion gap will increase with an
the most urinalysis result in increase in the plasma concen-tration of
this case : a. Sodium
a) Glucosuria b. Potassium
b) Leukocyte uria c. Chloride
c) Hematuria d. Bicarbonate
d) Bilirubinuria e. Lactate
e) Crystaluria 3. 111 288. In the presence of ADH, the filtrate will
be isotonic to plasma in the
71. A 25 years old man has been crashed by a truck. a. Descending limb of the loop of Henle
The doctor suspects that his kidney is rupture, then he b. Ascending limb of the loop of Henle
sent the patient to have IVP. What is the most likely the c. Cortical collecting tubule
appearance of renal parenchymal rupture in IVP? d. Medullary collecting tubule
a. The kidney shows non function e. Renal pelvis
b. Ekstravasation 4. 112 289. Sodium reabsorption from the distal
c. Hydronephrosis tubule will be increased if there

18
is an increase in
a. Plasma potassium concentration
b. Plasma volume
c. Mean arterial pressure
d. Urine flow rate
e. Plasma osmolality
5. 113 290. ADH will be released from the posterior
pituitary when there is a decrease in
a.Plasma Na+concentration
b.Plasma volume
c.Plasma K+concentration
d.Plasma pH
e.Plasma Ca2+concentration
6. 114 291. If 600 mL of water is ingested rapidly,
plasma volume will increase by approximately
a400 mL
b200 mL
c100 mL
d50 mL
e25 mL
7. 116 293. Renin secretion by the kidney is
increased by
a. Increasing mean blood pressure
b. Increasing glomerular filtration rate
c. Increasing sympathetic nerve activity
d. Increasing angiotensin II synthesis
e. Increasing atrial natriuretic hormone
secretion
8. 117 294. Na+is reabsorbed from the basolateral
surface of the renal epithelial
a. cells by
b. a Na/H exchange
c. Na-glucose cotransport
d. Na-K pump
e. Facilitated diffusion
f. Solvent drag
9. 118 295. Which of the following is most likely to
cause an increase in the glomerular filtration
rate?
a. Contraction of mesangial cells
b. Blockage of the ureter
c. Release of renin from the
juxtaglomerular apparatus
d. Dilation of the afferent arterioles
e. Volume depletion
10. 119 296. The daily production of hydrogen ion
from CO2 is primarily buffered by
a. Extracellular bicarbonate
b. Red blood cell bicarbonate
c. Red blood cell hemoglobin
d. Plasma proteins
e. Plasma phosphate
11. 120. Glomerular filtration rate would be
decreased by
a. Constriction of the efferent arteriole
b. An increase in afferent arteriolar
pressure
c. Compression of the renal capsule
d. A decrease in the concentration of
plasma protein
e. An increase in renal blood flow
12. 121. A freely filterable substance that is neither
reabsorbed nor secreted has a renal artery
concentration of 12 mg/mL and a renal vein
concentration of 9 mg/mL. Calculate the
filtration fraction (GFR/RPF).
a. 0.05
b. 0.15
c. 0.25
d. 0.35
e. 0.45
13. 122. Use the following laboratory data to
determine the GFR.
Urine creatinine concentration =196 mg/mL
Plasma creatinine concentration=1.4 mg/mL
Urine flow =1 mL/min
The creatinine clearance is approximately
a. 75 mL/min
b. 98 mL/min
c. 125 mL/min
d. 140 mL/min
e. 196 mL/min
14. 123. The electrically neutral active transport of
sodium from the lumen of the kidney occurs in
the
a. Proximal tubule
b. Descending limb of the loop of Henle
c. Ascending limb of the loop of Henle
d. Cortical collecting duct
e. Medullary collecting duct
15. In metabolic acidosis caused by diabetic
ketoacidosis, which of the following would be
greater than normal?
a. Concentration of plasma HCO3−
b. Anion gap
c. Arterial PCO2
d. Plasma pH
e. Blood volume
16. 125. Decreasing the resistance of the afferent
arteriole in the glomerulus of the kidney will
decrease
a. The renal plasma flow
b. The filtration fraction
c. The oncotic pressure of the peritubular
capillary blood
d. The glomerular filtration rate
e. None of the above
17. 126. If GFR increases, proximal tubular
reabsorption of salt and water will increase by
a process called glomerulotubular balance.
Contributions to this process include
a. An increase in peritubular capillary
hydrostatic pressure
b. A decrease in peritubular sodium
concentration
c. An increase in peritubular oncotic
pressure
d. An increase in proximal tubular flow
e. An increase in peritubular capillary
flow
18. 127. Renin release from the juxtaglomerular
apparatus is inhibited by
a. Beta-adrenergic agonists
b. Prostaglandins
c. Aldosterone
d. Stimulation of the macula densa
19
 e. Increased pressure within the afferent
arterioles
19. 128. Patients with renal insufficiency develop
very high plasma concentrations of urea
(uremia) because of
a. An increased synthesis of urea by the
liver
b. An increased reabsorption of urea by
the proximal tubules
c. A decreased secretion of urea by the
distal tubules
d. A decreased glomerular filtration rate
e. An increased renal blood flow
20. 129 . Which one of the following statements
about aldosterone is correct?
a. It produces its effect by activating
cAMP
b. It produces its effect by increasing
distal tubular permeability to sodium
c. It causes an increased reabsorption of
hydrogen ion
d. It has its main effect on the proximal
tubule
e. It is secreted in response to an
increase in blood pressure
21. 130 . The effect of antidiuretic hormone (ADH)
on the kidney is to
a. Increase the permeability of the distal
nephron to water
b. Increase the glomerular filtration rate
c. Increase the excretion of Na+
d. Increase the excretion of water
e. Increase the diameter of the renal
artery
22. 131 . The glomerular filtration rate will increase
if
a. Sympathetic nerve activity to the
kidney increases
b. The afferent arteriolar resistance
increases
c. The efferent arteriolar resistance
decreases
d. The plasma protein concentration
decreases
e. Urine flow through the urethra is
blocked
23. 132 . Potassium-sparing diuretics inhibit
Na+reabsorption in the
a. Proximal tubule
b. Thin descending limb of Henle’s loop
c. Thick descending limb of Henle’s loop
d. Distal convoluted tubule
e. Cortical collecting duct
24. 133. Which one of the following values will be
above normal in a diabetic
a. patient with a blood glucose
concentration of 600 meq/L?
b. Urine flow
c. Intracellular volume
d. Plasma sodium concentration
e. Arterial pH
f. Alveolar PCO2
25. 134 . Which one of the following will be
increased in a patient suffering from persistent
diarrhea?
a. The filtered load of HCO3−
b. The production of ammonia by the
proximal tubule
c. H+secretion by the distal nephron
d. The anion gap
e. The production of new bicarbonate by
the distal nephron
26. 135 . Diuretics, such as acetazolamide, which
produce their effect by
a. inhibiting carbonic anhydrase, inhibit
the reabsorption of sodium in
b. The proximal tubule
c. The thick ascending limb of Henle’s
loop
d. The distal convoluted tubule
e. The cortical collecting duct
27. 237. Which is a common finding in acute
glomerulonephritis?
a. Pulmonary congestion due to volume
expansion
b. Hypovolemia due to tubular
dysfunction
c. Uniformly progresses to chronic renal
failure if untreated
d. Urine showing leukocytes and
eosinophils
28. 238. Which finding is fairly specific for chronic
renal failure?
a. Anemia
b. Hyaline casts
c. Broad casts in urinalysis
d. Proteinuria
e. Hypocalcemia
29. 239. Nephrotic syndrome is associated with
a. Excessive renal salt and water loss
b. Hyperlipidemia due to lipoprotein
excess
c. Bleeding due to loss of clotting factors
d. Hypothyroidism due to loss of thyroid-
binding globulin
e. e. The outer medullary collecting duct
30. 240. A patient with chronic renal failure will be
expected to have which of
a. the following findings due to the
mechanisms described?
b. Hypercalcemic due to elevated PTH
hormone
c. Prolonged bleeding due to decreased
synthesis of clotting factors
d. Anemia due to increased red cell
destruction
e. Hypermagnesemia due to decreased
renal excretion
31. 241. A high fractional excretion of sodium is
typically found in
a. Heart failure
b. Urinary tract obstruction
c. Acute tubular necrosis
d. Acute glomerulonephritis
20
 e. Hepatorenal syndrome
32. 242. Which of the following nephron segment
is correctly paired with its function?
a. Distal tubule and bicarbonate
reclamation
b. Loop of Henle and potassium
regulation
c. Proximal tubule and urinary
concentration
d. Collecting tubule and water regulation
33. 243. Which of the following statements is true
in the management of acute renal failure?
a. Metabolic acidosis is fully corrected
with bicarbonate
b. Hyperphosphatemia is primarily
managed with dialysis
c. Low-dose dopamine is used to
shorten the duration of renal failure
d. Hypervolemia is managed with high-
dose loop diuretics
e. Hyponatremia is corrected
administration of sodium salts
34. 244. Which of the following describes bone
abnormalities in patients with chronic renal
failure?
a. Osteitis fibrosis cystica is a result of
oversuppression of PTH
b. Adynamic bone disease is associated
with myopathy
c. Osteomalacia is due to excessive
accumulation of magnesium
d. Hyperparathyroidism responds well to
1,25 dihydroxyvitamin D
e. Amyloidosis is similar in etiology to
patients who are not on dialysis
35. 245. Which one of the following statements is
true concerning hematologic disorders in
CRF?
a. Resistance to erythropoietin is most
commonly due to aluminum overload
b. Erythropoietin administration
associated with worsening
hypertension
c. The major cause of death in CRF is
sepsis
d. Abnormal bleeding responds best to
platelet transfusion
e. Leukocyte function is generally
unimpaired
36. 246. Which of the following measures has not
been shown to retard progression of renal
failure?
a. Aggressive BP control
b. Decrease in protein intake
c. ACE inhibitors above
antihypertensives
d. Erythropoietin for anemia
37. 247. In patients with chronic renal failure,
which of the following adaptations are normal?
a. Fractional excretion of sodium
increases due to suppression of
aldosterone
b. Metabolic acidosis due to loss of
bicarbonate in the urine
c. Increased potassium loss through
extrarenal mechanisms
d. Decreased fractional excretion of
water due to ADH resistance
38. 248. Which of the following serologic finding is
associated with linear staining of the
glomerulus on immunofluorescence?
a. Anti-GBM antibody
b. Low complement immune complex
glomerulonephritis
c. ANCA associated renal disease
d. Membranoproliferative
glomerulonephritis
39. 249. Antineutrophil cytoplasmic antibody
(ANCA) is typically present in which systemic
disease?
a. Goodpasture’s syndrome
b. Wegener’s granulomatosis
c. Systemic lupus erythematosus
by d. Thrombotic thrombocytopenic purpura
40. 252. Prerenal azotemia is associated with
a. High fractional excretion of sodium
b. Granular casts in the urine
c. Use of angiotensin-converting enzyme
(ACE) inhibitors in unilateral renal
d. artery stenosis
e. Evolution to acute tubular necrosis if
untreated
41. 254. Leukocytes and white cell casts in the
urine are typically seen in
a. Radiocontrast nephropathy
b. Methicillin-induced renal insufficiency
c. Aminoglycoside nephrotoxicity
d. Rhabdomyolysis
42. 256. Which may cause acute renal failure in
patients with nephrotic syndrome?
a. Dietary protein restriction
b. ACE inhibitors
c. Lipid-lowering agents
is d. Loop diuretics
43. 264. A 25-year-old man with flank pain is found
to have three cysts in each kidney, normal
hepatic and renal function, and family history
is not clear. He is most likely to have
a. Autosomal dominant polycystic kidney
disease
b. Autosomal recessive polycystic kidney
disease
c. Acquired cystic disease
d. Medullary sponge kidney
44. 266. Which is an accurate statement
concerning diabetic nephropathy?
a. Most patients with type 2 diabetes will
other develop this problem
b. It is almost always associated with
retinopathy in type 1 diabetes
c. ACE inhibition is only indicated for
patients with hypertension
d. Routine dipstick urine should be
performed to screen for early disease
45. 267. Which of the following is a secondary
cause for focal segmental sclerosis?
21
 a. Hodgkin’s disease amount of proteinuria and “grape clusters” are
b. Colon cancer seen under light microscopy. Which of the
c. HIV disease following is the most likely diagnosis?
d. Hepatitis C infection a. Glomerulonephritis
46. 268. A patient with Crohn’s disease passes a b. Rhabdomyolysis
kidney stone; the most likely c. Nephrotic syndrome
a. composition is d. Acute interstitial nephritis
b. Calcium phosphate e. Acute tubular necrosis
c. Uric acid
d. Struvite 53. 6-31. A 50-year-old woman com- plains of
e. Calcium oxalate leakage of urine when she laughs, coughs, or
47. 277. Hyperkalemia may be caused by sneezes. After stress incontinence, the most
a. Trimethoprim common causes of this urinary leakage is
b. Albuterol a. Detrusor dyssynergia
c. Licorice b. Unstable bladder
d. Cisplatin c. Unstable urethra
d. Urethral diverticulum
48. 278. A middle-aged patient with an elevated e. Overflow incontinence
serum creatinine, hypertension, and mild
anemia comes to you for evaluation. Urine
dipstick shows trace protein without red cells 1. To elevate the kidney within the renal fascia
or cellular casts. A 24-h urine collection and the perirenal fat, the renal fascia must be
reveals 5 g of protein. The most likely etiology reflected or incised from the fascia of the?
is
a. Focal segmental sclerosis A. diaphragm
b. Hypertensive nephrosclerosis B. psoas m.
c. Amyloidosis C. quadratus lumborum m.
d. Multiple myeloma D. transverse abdominis m.
49. 279. Which of the following is a common E. iliacus m.
cause of isolated hematuria with isomorphic
red cells in the urine? 2. Young man, vomit to point where he become
a. Alport’s syndrome (hereditary hypovolemic; as evidence by an
nephritis) accompanying decrease in BP and feeling of
b. Thin basement membrane disease light-headness. The kidney respond by
c. Idiopathic hypercalciuria reducing urinary volume flow, thus limiting the
d. IgA nephropathy potential effect of hypovolemia. increase in the
50. 280. A 26-year-old woman with a history of plasma level of which of the following
mitral valve prolapse comes in with 1 week of hormones will bring about the most dramatic
fever that started 3 days after a dental decrease in urinary volume flow rate?
procedure. Her urine contains red cells and
her rheumatoid factor is elevated. Which of the A. angiotensin II
following serologic abnormalities is expected B. atrial natriuretic peptide
to be present? C. PTH
a. Anti-GBM antibody D. aldosterone
b. Low serum complement levels E. ADH
c. Antineutrophil cytoplasmic antibody
3. 56 y.o. woman is diagnosed w/ small cell lung
d. Elevated IgA levels
ca. she has paraneoplastic effect from the ca,
51. 440. A 28-year-old previously healthy female,
which release of an atidiruetic hormone-like
with no medical history is now 28 weeks
agent. which of the following is the most likely
pregnant. She complains of trouble seeing,
to be seen?
polyuria, polyphagia, and polydipsia. What is
her diagnosis? A. elevated serum sodium
a. Gestational diabetes mellitus B. elevated serum osmolarity
b. Deep venous thrombosis C. elevated urine sodium
c. Urinary tract infection D. elevated urine cathecolamines
d. Preeclampsia
52. 4-38. A 48-year-old man presents with
peripheral edema. He has been healthy and 4. Histological sections from an abdominal mass
physically active all of his life. His family that was removed from a 13 month old female
history is unremarkable. His blood pressure is reveal undifferentiated mesenchymal cell,
normal. On physical examination, the patient is immature tubules, and abortive glomerular
noted to have anasarca. Kidneys are not formation. What is the best diagnosis for this
palpable. Urinalysis reveals a moderate tumor?
22
A. Dupuytren meals, and located in the upper midabdomen
B. Ewing superior to umbilicus. He also report some
C. Ollier “heartburn” that has been occurring during the
D. Warthin previous year. He as been under a lot of job-
E. Wilms related stress. His stool have changed in color
over the previous 2 months and now are
intermittently dark and tarry in consistency.
5. A 63 y.o. woman has type II DM. PE positive The physician test the patient stool and find
for peripheral neuropathy in the feet and occult fecal blood. What is the most likely
nonproliferative retinopathy. Urinalysis positive diagnosis?
for proteinuria. which of the following treatment A. peptic ulcer
is most likely to attenuate the course of renal B. gastritis
disease? C. Chron’s disease
A. calcium channel blocker D. gastric polyp
B. ACE inhibitor
C. HMG-CoA inhibitor
D. dietary carbohydrate restriction 10. A 38 y.o banker with a history of heartburn
E. weight reduction suddenly experieces excruciating pain in the
epigastric region of the abdomen. Surgery is
performed immediately on admission to ER.
6. Ingesting antacids with and after a meal so There is evidence of an ulcer, which has
that gastric pH does not decrease below pH 6 ruptured through the posterior wall of
will cause a greater than normal secretion of? duodenum. What blood vessel might be
A. gastrin subject to erosion?
B. secretin A. common hepatic
C. pancreatic bicarbonate B. left gastric
D. cholecystokinin C. splenic
E. somatostatin D. superior mesenteric
E. gastroduodenal

7. A 16 y.o. girl is reffered to the office because of

chronic diarrhea and weight loss. She is
experiencing large volume watery diarrhea
that is painless. The symptoms persist even
when she’s fasting, and there is no relationship
to foods or liquids. She’s not on any
medication, and there is no travel history or
other constitutional symptoms. Her PE is
normal. Which of the following is the most
likely diagnosis?
A. partial small bowel obstruction
B. partial large bowel obstruction
C. osmotic diarrhea
D. secretory diarrhea
E. IBS
8. A 42 y.o. overweight but otherwise healthy
women present with sudden onset of right
upper abdominal colicky pain in 45 minutes
after meal of ayam goreng. Pain is associated
with nausea and vomiting, and any attempt to
eat since has caused increased pain. What is
the most likely cause?
A. gastric ulcer
B. cholelithiasis
C. duodenal ulcer
D. acute hepatitis
E. esophageal spasm
9. A 42 y.o. male, executive, complains of
abdominal pain that began about 6 months
ago, is constant in nature especially after
KIDNEY
54. 42 year old man, muscular weakness, mild
headache after eating salted fish. Small
amount water drink. Usual BP 100/70, Now
become 140/90, Na : 150 mEq/ml, K : 3,5,
glucose 150. efek?
a. Increase GFR
b. Increase obligatory water reabsorbtion
c. Increase facultative water
reabsorbtion
d. Increase secretion
e. Increase aldotesteron secretion
55. To cover above function (no 1), what
mechanism
a. Increase cardiac output
b. Increase frekuensi heart
c. Increase secretion rennin
d. Increase secretion ADH
e. Increase secretion aldosteron
56. Factor yang mensupport prosess diatas ialah
a. Filtration late of glomeruli
b. Active transport of tubular cell
c. High osmolalitas of interstitium of
medulla
d. Obligatory water reabsorbtion
e. Osmalalitas of filtrate in distal
contortus tubulus
57. Pasien dengan heart failure = low CO, perfusi
hanya organ-organ penting. Obat yang tidak
bole diberikan? thiazide
23
58. Pasien dengan heart failure, diberi obat c. Bladder
Cloro..tiazid/mid dengan maximum dose tidak d. Uretra
merespon. Diberi apa?furosemid e. Adrenal gland
59. Pasien diberikan riazid selama… tahun. Efek 70. 70 laki-laki – came to emergency room.
yang terjadi  decrease kalium Incomplete urination since 6 bulan lalu.
60. Mountain sickness merupakan side effect? Structure yang change?
dari? a. Uretral pars membranosa
a. czetazolamide->bukan side effect, tp b. Uretral pars spongiosa
profilaksis c. Uretral pars prostatica
b. Budenamide d. Uretral orificium uretra
c. Amyloride
d. Furosemide 71. During 4 weeks treatment, the urine protein +1
e. Spironolactone , so the diagnosis :
61. Seorang pasien sedang menjalani a. Initial responder
pengobatan, pasien complaint Bright orange- b. Lat responder
red urine merupakan side effect dari obat? c. Drug resistant
a. Ethambutol d. Drug dependent
b. Isoniazid e. Remission
c. Piridizone 72. 13 years old boy comes to ER with seizure,
d. Rifampisin fever 2 weeks but has recovered, swelling in
e. Streptomisin the eyes and legs, dark urine. Unconscious ,
62. Pasien mengeluh dengan complaint(symtomp bp 180/120. Urine erythrocyte 20/hpf, protein
gonorrhea) treatmentnya? +4, albumin normal. Lab finding
a. Apnofloxacin a. ASO decrease, dnase-b increase, c3
b. Nalydixic acid decrease
c. Norifloxacin b. ASO increase, dnase-b decrease, c3
d. LEvofloxacin-- decrease
e. Ofloxacin c. ASO decrease, dnase-b increase, c3
63. Jaundice 1 yo, increase blirubinn. Ibunya increase
diberi antibiotic for UTI, baby mengalami d. ASO increase, dnase-b decrease, c3
kernicterus ,disebabkan karena obat  decrease
cotrimoxazole e. ASO increase, anti dnase-b increase,
64. 30 yo waman recurrent UTI, culture E coli di c3 decrease
kase aprofloxacin. Penghambat apa?Dna Anti-DNase B is a blood test to look for a substance
gyrase produced by Group A Streptococcus, the bacteria that
65. 30 yo man motor accident most anterior within cause strep throat.
renal sinus.  Renal vein
66. You wish examine the hilum of the left kidney 73. Underlying mechanism dari pertanyaan 19 ?
during surgery. Which pf following structure a. Streptococcal infection
must be elevated. pancreas b. Inflammation of kidney tubule
a. Stomach c. Increase permeability of glomerulus
b. Suprarenal gland membrane
c. Ascending colon d. Small pores in podocyte permit rbc
d. Duodenum pass through
e. Liver e. Heparansulfat polysaccharide is low,
67. To elevate kidney within the renal fascia dan so rbc could cross the BBB
perirenal fat which of following muscle 74. Anak di rawat karena indirect bilirubinemia. 3
a. Diafragma hari kemudian demam, dan diberi gentamicin
b. Psoas dan amoxicilin. Kenaikan BUN dan creatinine.
c. Quadratus lumborum Apa mechanisme nya?
d. Transverse abdominis a. ATN
e. Illeus b. AIN
68. Laki-laki probable testicular cancer, which c. AKI
layer is the most near to testicular parenchyma d. CKI
a. FS xterna 75. Kasus no 21 bisa terjadi karena Disebabkan
b. Tunica albuginea oleh?
c. FS interna a. Iskemik
d. Scarpa interna b. Toxic injury
e. Tunica dartos c. Drug hypersensitivity
69. 18 tahun laki-laki. Dysuria for several day – d. Immune Complex
UTI. Structure yang vulnerable get infection? 76. 10 tahun, dysuria 5 hari yang lalu. No
a. Kidney significcant finding, urine culture E coli >
b. Ureter 100.000
24
 a. Acute pyelonefritis 92. Which urine specimen most appropriate?
b. Reflux nephropathy Untuk culture
c. Uncomplicated UTI a. Suprapubic
d. Complicated UTI b. Clean catch
e. Chronic UTI c. Strecth catheter
77. Which of the following factor unfavorable to d. Indualing catheter
bacterial growth in patients urine e. 24 hour urine
a. A low pH (5,5 or <) 93. UTI, beta hemolytic virulence factor
b. Low concentration urea a. Capsule
c. Abscense of organic … a diet b. P fimbrae
d. Low osmolality c. Endotoxin
e. Presence of normal microorganism d. Fosfolipase c
78. Antibiotik untuk UTI first line e. Lipopolisaccaride
a. Ceftriaxone 94. UTI, - gram, coccobacillus, high pH.virulence
b. Cefotaxime vactornya?
c. Ceftrazidime a. Hemolisin
d. Cotrimoxazole b. Fibronecrine
e. Metronidazole c. Catalase
79. Gfr <15% d. Cordially
Rifle criteria e. Opaprotein
a. Risk 95. Pada orang yang pernah mengalami atau
b. Injury sedang mengalami kidney stone,tindakan
c. Fail preventive apa yang diperlukan agar tidak
d. Loss terjadi penambahan atau recurrenci dari batu
e. ESKD ginjal tersebut?
80. Pada orang yang mengalami Hematuria in a. Restriksi air 100 ml
bladder cancer,bagaimana bentuk rasa b. Minum jus yang banyak
sakitnya  Painless and intermitten c. Minum sebanyak-banyaknya
81. PH urine = 5. Uric acid = 8,9 d. Minum pas haus
a. Lot of fluid + allopurinol e. Makan buah
b. Lots of fluid + aciding agent
82. 40 tahun old male. Thoracic gunwound, 96. 60 tahun, headache, nausea, vomit 1 bulan.
hematuria. Diagnose?renal? PE : HT, subfebrile. Pyelogram showed
83. Bladder injury. Mostly caused by?trauma affected kidney asimetri contracted with
84. Polyuria, kasih obat apa?vasopressin deform of calyceal system. Gross of the
85. Pneumocyctis carinii.. WBC increase etc.,  affected kidney showed contacted dan has
post infection glomerulonefritis irregular granular surface. Parenkim atropi and
86. Pengaruh parasimpatis terhadap bladder  replace fibrosis. Microscopi : glomerular
contraction of detrusor muscle sclerosis, hyalinisasi, atropi incortical. Another
87. Parasimpatic  S2,3,4 dan cranial 3,7,9,10 area : fibrosis, chronic inflammation cell with
88. Dementia ,cant holding a pee. frontal lobe limfosit aggregation
89. Diarrhea 8 hari what the best treatment RL a. RCC
infusion b. Pyelonefrits
90. 44 tahun laki-laki. Systemic fungi infection on c. Nefritis
amphotericin B treatment for 7 days. d. NS
Conscious, BP 120/80, pulse 80x/min, RR 16x. e. Diabetic nefropathy
36,7 c, HB 13, HT 37, WBC 8600. Platelet 97. 5 years old, pale, abdominal mass. Distention
340.000, Urinalisis RBC (0-1), WBC (2-5), to bowel e=obstraction. USG : 6 cm left renal
protein -, Granular cast +, Ureum 91, creatinin mass with necrosis and hemorrhage. Micros :
2,0, urine 800/12 jam embrional tissue with abbortive tubular and
a. ATN glomerular structure  Wilms tumor
b. Acute glomerulonefritis 98. 62 tahun, hematuri, left flank pain. PE :
c. Acute interstitial nefritis costovetebral angle tender. USG : left
d. ARF hydronefrosis. CN and CBC ….
e. CRF a. Renal biopsy
91. Woman, pain during urination and suprapubic b. R. ateriogram
pain, no fever, cloudy urine. Microscopic c. Palpasi lymph node
hematuria, pyuria, granular +, no past history d. ANA
a. Klebsiella pneumonia e. IVP
b. P. aeruginosa 99. Renal trauma, terlindas truk, ginjal kena
c. E coli kerusakan. Parenkimnya rusak. Maka yang
d. Proteus mirabilis terjadi pada ginjal tersebut ialah?
e. S. saphroliticus a. Ginjal tidak berfungsi
25
 b. Ekstravasasi
c. Hidronefrosis
d. Normal urogram
100. Injury kena renal artery
101. Pada pasien dengan pemeriksaan
Radiology menunjukkan ada pelebaran ureter,
maka diperirakan batu berada di?
a. Vesikoureter
b. Pelvicc ureter
102. 65, laki-laki, Ada bladder dengan
perbesaran prostat, kama radiografi. Gimana
 a. Epididimis
a. penonjolan dari inferior bladder
b. Penonjolan dari superior bladder
c. Penonjolan dari superior bladder
d. Penonjolan dari posterior bladder
103. 50 tahun colic. IVP = uteric dilatation.
Kenapa bisa dilatasi?
a. Stone in pelvicureter junction
b. Kedney cysts
c. Stone in the vesicoureter junction
d. Renal cell CA stage 1
104. 45 wanita, bladder a stone.
Cystography
a. Indertaion of inferior aspect of bladder
b. Indertation of superior aspect of
bladder
c. Filling defect in the bladder
1. 4yrs boy. Puffy eye in the morning,swelling leg,
foamy urine, protein +4, serum albumin 1,5.
Principle managementprednison 60mg.
2. Urine sample dari +4 ke +1 selama 1 bulan.
Patient responsive classification: initial
responder
3. Boy, severe diarrhea. Not full alert. Bp 80/60,
pulse not palpable, RR 30, temperature
38,4°C, sunken fontanele etc (moderate-
severe dehydration). Distal tubular susceptible
to ischemic injury : loss of polarity re
distribution of membrane protein
1. During the removal of a patient’s kidney, you
would observe which of the following as being
most anterior within the renal sinus?
a. Renal arteries
b. Renal vein
c. Major calyx
d. Minor calyx
e. Renal pelvis
2. You wish to examine the hilum of the right
kidney during surgery. Which of the following
structures must be elevated and reflected to
do so?
a. Stomach
b. Suprarenal gland
c. Ascending colon
d. Duodenum
e. Liver
3. To elevate the kidney within the renal fascia
and the perirenal fat, the renal fascia must be
reflected or incised from the fascia of the:
a. Diaphragm
b. Psoas muscle
c. Quadratus lumborum muscle
d. Transverse abdominis muscle
e. Iliacus muscle
4. Which of the following is the male homologue
of the female clitoris?
b. Vas deferens
c. Penis
d. Scrotum
5. 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 albugenia
c. The dartos fascia
d. The pampiniform plexus
6. An 18-years-old man is noted to have
probable testicular cancer. He undergoes
surgery. After incising the scrotum, the
surgeon contemplates the approach to the
parenchyma of the testes. Through which layer
must the surgeon incise to reach the testicular
parenchyma?
a. Buck’s fascia
b. Tunica albuginea
c. Dartos fascia
d. Scarpa’s fascia
7. A 66-year-old man complains of difficulty
voiding and is noted to have probable BPH.
Which of the following prostatic lobes is likely
to be responsible for these symptoms?
a. Anterior lobe
b. Posterior lobe
c. Lateral lobe
d. Middle lobe
8. A 48-year-old man is undergoing cystoscopic
examination. As the cystoscope is placed into
the urethra through the penile portion, which of
the following tissue surrounds the urethra?
a. Prostate
b. Corpus spongiosum
c. Seminal colliculus
d. Spinchter urethrae mucles
9. A police detective takes a scraping of some
stains to be examined for alkaline
phosphatase to assess whether these might
be ejaculate. What is the source of alkaline
phosphatase in the semen?
a. Prostatic gland
b. Bulbourethral glands
c. Seminal vesicles
d. Seminal colliculus apparatus
26

10. A 39 yo woman complains of hematuria and
significant flank tenderness. She has a history
of kidney stones. A CT scan depicts the
abdominal portion of the ureter lying anterior to
a muscle. Which of the following is most likely
to be the name of this muscle?
a. Psoas
b. Serratus anterior muscle
c. Obturator muscle
d. Rectus muscle
e. External oblique muscle
11. An individual is known to be suffering from
DM. Recently, he has developed hypertension.
His doctor suspects that the patient may be
developing renal insufficiency that is leading to
a reduced glomerular filtration and, as a result,
hypervolemia and hypertension. The doctor
wishes to evaluate kidney function by
measuring the GFR. Which is the best
substances for estimating the GFR from the
urine?
a. Creatinine
b. Para-aminohippuric acid (PAH)
c. Urea
d. Glucose
e. Sodium
12. A 21 yo man has been vomiting to the point
where he has become hypovolemic, as
evidence by an accompanying decrease in
blood pressure and a feeling of light-
headedness. The kidneys respond by reducing
urinary volume flow, thus limiting the potential
extent of hypovolemia. Increase in the plasma
levels of which of the following hormones will
bring about the most dramatic decrease in
urinary volume flow rate?
a. Angiotensin II
b. Atrial natriuretic peptide
c. PTH
d. Aldosterone
e. ADH
13. A 56 yo woman is diagnosed with small cell
carcinoma of the lung. She has a
paraneoplastic effect from the cancer, with
release of an antidiuretic hormone-like agent.
Which of the following is the most likely to be
seen?
a. Elevated serum sodium
b. Elevated serum osmolarity
c. Elevated urine sodium
d. Elevated urine catecholamines
14. An individual has adult-onset diabetes. She
has high levels of glucose in the urine and is
experiencing a brisk diuresis. The appearance
of glucose in the urine is a consequence of
which of the following processes in the
proximal tubules?
a. Inhibition of Na-K ATPase (Na+ pump)
b. Saturation of the Na-glucose cotransporter
c. Saturation of the Na-H exchanger
d. Stimulation of glucose secretion
e. Stimulation of glycogen breakdown
15. A student under stress has been feeling light-
headed, especially after standing, and has
developed a brisk diuresis. He has the smell of
acetone on his breath. Upon admission to the
emergency room he is diagnosed with diabetic
ketoacidosis, which is accompanied by
extreme hypovolemia, supposedly because of
the brisk diuresis. The brisk diuresis is a
consequence of which of the following?
a. High levels of glucose in the tubular
fluid/urine
b. Increased GFR
c. Suppression of ADH secretion
d. Suppression of aldosterone secretion
e. Decreased angiotensin II plasma levels.
16. A hypertensive patient was placed on the
diuretic Lasix (furosemid) to increase urinary
output. Furosemid, a “high-ceiling” diuretic, is
a potent diuretic because it binds to and
inhibits which of the following transport
processes?
a. The Na-glucose co transporter in the
proximal tubule
b. The Na-K exchange pump in all nephron
segments
c. The Na-K-Cl cotransporter in the thick
ascending limb
d. The Na-Cl cotransporter in the distal
convoluted tubule
e. The Na channel in the cortical collecting
duct.
17. A hypertensive patient is prescribed a loop
diuretic such as Lasix without any
supplements. One week later the patient
returns to the clinic complaining of dizziness,
weakness, and nausea. The most likely cause
of the patients worsening condition is the
development of :
a. Metabolic acidosis
b. Hyponatremia
c. Hypocalcaemia
d. Hypokalemia
e. Hypovolemia
18. A 35 yo female is noted to have new onset
hypertension that is thought to be due to an
aldosterone-secreting adrenal tumor. Which of
the following is likely to be seen in this patient?
a. Hypertension markedly improved with
furosemid
b. Elevated serum sodium level
c. Elevated serum potassium level
d. Elevated urinary cortisol level
19. A renal biopsy from an adult who presented
with progressive renal failure and hematuria
27
 reveals linear deposits of IgG within the
glomeruli. What type of autoantibody is most
likely to be present in this individual?
a. Anti-basement membrane antibodies
b. Anti-centromere antibodies
c. Anti-double-stranded DNA antibodies
d. Antimitochondria antibodies
e. Anti-smooth muscle antibodies
20. Which one of the following combinations of
signs and symptoms is most consistent with a
diagnosis of nephritic syndrome?
a. Hematuria, hypertension, and proteinuria
b. Massive proteinuria, edema, and
hyperlipidemia
c. Oliguria, hydronephrosis, and abdominal
rebound tenderness
d. Painful hematuria, flank pain, and palpable
abdominal mass
e. Painless hematuria, polycythemia, and
increased skin pigmentation
21. A 30 yo female patient presents with a new
onset of peripheral edema. PE finds
hypertension & bilateral pedal edema.
Urinalysis finds massive proteinuria, and
evaluation of her serum finds elevated levels
of cholesterol. A silver stain of a renal biopsy
specimen reveals a characteristic “spike and
dome pattern, and electron microscopy finds a
uniform deposition of small electron dense
deposits in a subepithelial location. Which one
of the following immunofluorescence patterns
is most characteristic of this patient’s renal
disease?
a. Granular pattern of IgA and C3
b. Granular pattern of IgG and C3-acute
glomerulonephritis
c. Linear pattern of IgD and C4
d. Linear pattern of IgE and C4
e. Linear pattern of IgM and C3
22. A 54 yo man presents with worsening pain on
the left side accompanied by gross hematuria.
Workup finds a 4.5 cm pas in the upper pole of
the left kidney. What is the characteristic
histological appearance of the conventional
type of malignancy in this location?
a. Disorganized groups of immature tubules
b. Sheets of transitional epithelial cells
c. Small cells forming numerous papillary
structures
d. Undifferentiated cells demonstrating
abortive glomerular formation
e. Uniform cells with clear cytoplasm
resulting from glycogen
23. Histological sections from an abdominal mass
that was removed from a 13-month-old female
reveal undifferentiated mesenchymal cells,
immature tubules, and abortive glomerular
formation. What is the best diagnosis for this
tumor?
a. Dupuytren tumor
b. Ewing tumor
c. Ollier tumor
d. Warthin tumor
e. Wilms tumor
24. A 69 yo man has lost a friend to prostate
cancer, and would like to be evaluated for the
disease. He has no urinary symptoms. Which
of the following test is most likely indicated to
screen him for prostate cancer?
a. Prostate ultrasound
b. Digital Rectal Examination (DRE)
c. DRE and prostate specific antigen (PSA)
d. PSA
e. None of above
25. A 63 yo woman has Type II DM, which is well-
controlled. Her physical examination is positive
for peripheral neuropathy in the feet and
nonproliferative retinopathy. A urinalysis is
positive for proteinuria. Which of the following
treatment is most likely to attenuate the course
of renal disease?
a. Calcium channel blockers
b. ACE inhibitors
c. Hepatic hydroxymethylglutaryl coenzyme
A (HMG-CoA) inhibitors
d. Dietary carbohydrate restriction
e. Weight reduction
26. A 22 yo woman come to the clinic with sign of
septic shock. The doctor prescribe her to
consume antibiotic for 2 weeks. After one
week taking the medications she come to the
doctor with complain of decrease in urine
volume, and edema. On physical examination
found that the blood pressure is 140/90, heart
rate 80, and RR=20. The urinalysis show
proteinuria and muddy brown cast were found.
What is the most possible antibiotic that can
cause this symptoms?
a. Amoxycillin
b. ceftriaxone
c. cefixim
d. Levofloxacin
e. Gentamycin
27. A 69 yo woman present with left flank pain and
hematuria. Physical examination suggest a left
side abdominal mass. CT scan of abdomen
reveal 5cm mass in the left kidney. Which of
the following laboratory abnormalities might
also be present?
a. Polycythemia
b. Thrombocytopenia
c. Hypocalcemia
d. Leukocytosis
e. High rennin hypertension
28. A 60 yo man with heart failure and normal
renal function is start of furosemid (Lasix)
80mg/day. She notice a good diuretic
response every time she take the medication.
28
 A few week later, she is feeling unwell
because of muscle weakness and fatigue, but
her heart failure are better. Which of the
following is the most likely explanation for her
muscle weakness?
a. Hyponatremia
b. Hypernatremia
c. Hypokalemia
d. Hyperkalemia
e. Anemia

29. A 78 yo man is brought to the hospital

because of nausea and vomiting. On the
physical examination he appear dry, his
abdominal is soft, the JVP is not visible. His
laboratory test reveal hypernatremia and free
water deficit is approximately 3L. In what part
of the normal kidney is most of the water
reabsorb from?
a. Colleting duct
b. Proximal tubulus
c. Distal tubulus
d. Ascending loop of Henle
e. Descending loop of Henle

30. A 25 yo woman present with pain on his back

and abdomen. She also complain of having
fever, nausea and vomiting. About 1 year ago
she has history of renal stone and sometimes
she found some solid material in her urine. On
histopathology examination found
glomerulosclerosis, thickening of the artery,
granulation tissue, and limfosit. What is your
working diagnosis according to the
histopathology?
a. Nephroblastoma
b. Chronic pyelonephritis
c. Acute tubular necrosis
d. Cystitis
e. Acute pyelonephritis

31. A 63 yo man with an 8 year history of recurrent

severe arthritis in his large toes has dysuria.
He also had pain that comes from his back
that is radiating to the scrotum. Which of the
following mechanism is the most likely
explanation for his symptoms?
a. Uric acid kidney stones
b. ARF
c. Renal parenchymal uric acid crystals
d. Chronic pyelonephritis
e. Acute pyelonephritis

29