MDE GUS KPBI 2007

5. This diuretic is the most frequent to treat essential UTI

A. acetazolamide

B. amiloride

C. chlorothiazide

D. furosemide

E. triamterene

6.  The release of antidiuretic hormone is caused by all of the following factors, except:

A. Dehydration

B. Hypovolemia

C. Caffeine

D. Nicotine

E. Positive-pressure breathing

8. A man, the victim of superficial knife wound to the lower abdomen during a barroom brawl, subsequently develops a direct inguinal hernia. Damage to which of the following nerves is most likely responsible for the predisposing weakness of the abdominal wall.

A. Genitofemoral nerve

B. Illioinguinal nerve

C. The subcostal nerve

D. Pelvic splanchnic nerve

E. The nerve of 10th intercostal space (T10)

8. What is the normal value of the lab result above?

A. creatinine

B. BUN

C. protein urine

D. coarse granular

E. creatinine clearance

9. which one is the gross appearance of kidney is the most characteristic of malignant nephrosclerosis?

A. Broad U-shaped cortical scars overlying dilated calyx in renal poles

B. depressed cortical areas overlying necrotic papillae of varying stages

C. multiple small petechiae hemorrhages on the surface

D. multiple small white areas on the surface

E. wedge shaped pole cortical scars

10. what is the disease that causing hypertension in the case above
A. increase in blood volume
B. increase in stroke volume
C. increase in frequency of infection
D. increase rennin by ischemia of kidney
E. increase renal volume by cyst

A 2 year old boy has enlargement of the kidneys. On cut section of the kidney shows numerous cysts in the cortex and medulla and consistence of kidney like sponge. Microscopic examination reveals cylindrical cells as like as collecting tubule cells.

12.According to the clinical statement above, what is the influence to the composition and nutrients of the patients urine?
A- Increasing protein
B- Increasing of glucose
C- decreasing of proteins
D- Increasing of cholesterol
E- Decreasing of glucose

16. Sodium reabsorption in the tubule cell membrane is a/an ............. process
A. Simple diffusion
B. Facilitated difussion
C. Active transport
D. Endocytosis
E. Paracellular transport

17. A 21 y o woman has experienced urinary frequency with dysuria without discharge from vagina for the past few days. She has no flank pain or tenderness. A urinalysis from suprapubic puncture reveal specific gravity 1.014,pH 7.5, no glucose, no protein, no blood, nitrite positive, and many WBC. What is the most possible mechanism of disease in the case above?
A. Inflammation of glomeruli
B. Inflammation of urinary bladder
C. Inflammation of wall of renal pelvis
D. Inflammation of kidney
E. Inflammation of pyelum

19.the best preservation of the urinary sediments, preservatives of choice are? a.boric acid&hcl acid
b.formalin& boric acid
c.formalin acid& freezing
d. chloroform &refrigeration
e. chloroform & freezing

20. what is the pathologic finding best describe this disease?
a. lupus nehpritis
b. urinary lithiasis
c. acute bacterial cystitis
d. malokoplakia
e. transitional cell carcinoma

21.          Opening in endothelial cell that line glomerular capillaries?

A.            Filtration membrane

B.            Fenestrae

C.            Filtration slit

D.            Glomerulus

E.            Renal sinus

22.          Patient with uncontrolled hypertension is placed on new diuretic targeted on Na+ reabsorption site from basolateral surface of the renal epithelial cell. What transport process is the new drug affecting?

A.            Na+- glu cotransport

B.            Facilitated diffusion

C.            Solvent drag

D.            Na+/H+ exchange

E.            Na+-K+ pump

23.          65 years old man came to hospital with metabolic acidosis. He had 15 years history of hypertension and DM. He did not take his medication regularly and refused to change his lifestyle. What is the most powerful buffer substance to counter the acidity?

A.            Phosphate

B.            Protein

C.            Bicarbonate

D.            Hb

E.            Carbonate

24.          Urinary tract segment from renal pelvis to the bladder. What is the mucosal layer?

Ans: Transitional

25.          This portion of urinary tract exist directly from neck of urinary bladder, receive prostate and ejaculatory duct. What type of epithelium lines the inner layer?

A.            Simple squamous epithelium

B.            Pseudostratified columnar epithelium

C.            Transitional epithelium

D.            Stratified columnar epithelium

E.            Stratified squamous epithelium

26.          What is most likely explanation of the elevated excretion of albumin (albuminuria) and diminish plasma albumin (hypoalbuminemia)?

A.            Increase tubular proximal reabsorption

B.            Decrease glomerular membrane permeability

C.            Increased synthesis without increase excretion

D.            Decrease tubular distal secretion

E.            Increase glomerular membrane permeability

27.          An individual has adult- onset DM, has increase level of glucose in urine and brisk diuresis. Appearance of glucose in urine is a consequence of following process in PCT?

A.            Saturation of Na+- glucose transporter

B.            Inhibition of Na+-K+- ATPase

C.            Saturation of Na+-H+ exchanger

D.            Stimulation of glucose secretion

E.            Glycogen breakdown

28.          This tube is lined by simple low cuboidal epithelium with no brush border, making its lumen appear wider. The epithelium forms a disk of tightly packed columnar cells called a macula densa at the point near vascular pole of a renal corpuscle where it contacts an afferent areteriole. Which of the following is most likely tube?

A.            PCT

B.            Thin limb of loop of henle

C.            Thick ascending loop of henle

D.            Thick descending loop of henle

E.            DCT

29.          The following statement is correct for capillary portion of renal corpuscle?

A.            Bowman’s capsule

B.            Fenestrae

C.            Podocyte

D.            Glomerulus

E.            Renal column

30. Collective name for capillary membrane, bowman’s capsule and pedicles?

A.            Filtration membrane

B.            Fenestrae

C.            Podocyte

D.            Glomerulus

E.            Renal column

31. These cells have long primary processes, from which arise from interdigitating foot processes (pedicels) that grasp the glomerular capillaries like fingers around a broom handle. Which of the folowing is most likely the cells?

      B.  Podocytes

32. This portion is the collection of cortical kidney’s tissue formed between medullary portion. WOTF is the most likely portion?

A.            Renal corpuscle

B.            Medullary ray

C.            Renal column of Bertin

D.            Interlobular cortex

E.            Renal sinus

33. Which of the following parts of nephron contains mesangial cells?

A.            Renal corpuscle

B.            PCT

C.            Henle loop

D.            DCT

E.            Collecting tubules

34. This kidney’s light staining region consists of several conical pyramids whose apices (renal papillae) point inward, toward the renal sinus. Which of the following structure is the most likely found in this conical pyramid region?

A.            Loop of Henle

B.            Renal corpuscle

C.            Proximal convoluted tubule

D.            Collecting tubule

E.            Collecting duct

36.          A 45 year old, pneumonia. Treated with antibiotic and fluid. On 3rd day hospitalization, his BP within normal limit, Na+ concentration lower from 142 to 130 mEq/ml. Urine osmolality is450 Osm/kgH2O. Why hyponatremia?

A.            Low ingestion of Nacl

B.            High renal excretion of Nacl

C.            Shift of H2O ICF to ECF

D.            Shift of Na+ ECF to ICF

E.            Positive water balance

37. A 62 years old women is brought to ER is at state of confusion, unable to answer questions coherently and exhibits tachypnea. The lab results are listed below :

• Plasma findings : [Na+] = 144 mEq/L

                                       [K+] = 4.4 mEq/L

                                       [Cl-] = 107 mEq/L

                                       [HCO3-] = 9 mEq/L

• Arterial blood findings : pH = 7.17

                                                      Pco2 = 25 mmHg

Which of the following mechanism is important in renal excretion of hydrogen ion?

A.            Combining H+ and HCO3- via enzyme carbonic anhydrase

B.            Combining H+ and Cl- to form hydrochloric acid

C.            Trapping of H+ by ammonia to form ammonium ion

D.            Trapping of H+ by acetate

E.            Secreting of sulfate and H+ as sulfuric acid

38. A 55 yr old women came to the ER with severe flank pain caused by renal stone lodged in her right ureter. Test revealed that renal stone formed bcoz of demineralization of bone & increase serum level of PTH. A benign PTH-secreting adenoma of parathyroid was identified. The high levels of serum PTH in this women would be expected to decrease Pi resorptionin which of the segment of nephron?

A. glomerulus

B. proximal tubule

C. thick ascending loop of Henle

D. distal tubule

E. collecting tubule

39. A 48 years old woman has congestive heart failure with generalized edema. Which of the following mechanism plays an important role in the formation of edema in this woman?

A.            ↑ interstitial hydrostatic pressure

B.            ↓ interstitial oncotic pressure

C.            ↑ plasma oncotic pressure

D.            ↓ renal excretion of sodium

E.            ↓ venous pressure

 Question 41-45

A 55 years old woman has a history of hypertension. As part of her therapy she receives a drug that inhibits ACE

41. Which of the following is the effects?

Renin    Aldosterone       Bradykinin

↑           ↓           ↑

↓           ↓           ↑

↑           ↑           ↓

↓           ↓           ↓

↑           ↑           ↑

               

                                A.

                                B.

                                C.

                                D.

                                E.

42. Decrease blood pressure caused by captopril is result from?

A.            Decrease angiotensin I level

B.            Decrease angiotensin II level

C.            Decrease bradykinin level

D.            Blocking of angiotensin II receptor

E.            Decrease of plasma renin level

43. Non pharmacological treatment of hypertension is?

A.            Drinking alcohol

B.            Reduce body weight

C.            Non aerobic sport

D.            Reduce calcium bicarbonate food

E.            Reduce food with KCL

44. The target organ damaged in hypertension patient is:

A.            Prostate hypertrophy

B.            Leukosituria

C.            Atherosclerosis plaque

D.            Vein narrowing

E.            Liver enlargement

45. The peripheral resistance is determined by the following ion?

A.            Calcium

B.            Magnesium

C.            Sodium

D.            Potassium

E.            Chloride

46. A reduction in dietary K+ intake would be expected to alter K+ transport in which segment?

A.            PCT

B.            Thick ascending loop

C.            Thin ascending loop

D.            DCT

E.            Collecting duct

47. If GFR increase, proximal tubule reabsorption of salt and water also increase, in a process call glomerulotubular balance. Contribution to this process include?

A.            Increase in peritubular hydrostatic pressure

B.            Decrease in peritubular sodium concentration

C.            Increase in peritubular oncotic pressure

D.            Increase in proximal tubules flow

E.            Increase in peritubular capillary flow

49. Asuming the subject on the preceeding question is normal adult. what is the mechanism of potassium?

A.            Filtered Not reabsorb/secrete

B.            Reabsorb Not filtered/secrete

C.            Secrete Not filtered/reabsorb

D.            Filtered & secrete

E.            Filtered & reabsorb

50. In the proximal tubule, penicillin is:

A.            Actively secreted into the tubule

B.            Actively reabsorbed from the tubule

C.            Passively reabsorbed from the tubule

D.            Metabolized by the tubule cells

E.            Neither secreted or reabsorbed nor metabolized

51.  Origin of excretory system?

        A.  Lateral mesodermal

        B.  Endoderm

        C.  Splanchnic mesoderm

        D.  Intermediate mesoderm

        E.  Ectoderm 

52.  Origin of collecting duct of kidney?

        Ans : A. Ureteric bud

53.  Development of bladder?

        Ans : Urogenital Sinus

54.  Embryologic basis of congenital anomaly of PKD?

A.     Dysmorphology ... development of renal system.

B.     Failure of ureteric bud to join tubules.

C.     Division of metanephric diverticulum.

D.     Division of mesenchymal cell to migrate.

E.      Poles of kidney are fused.

58.  (question no.169 2006)why most likely reason adding beta-blocker?

60.  65 years old chronic hypertension male patient come to outpatient clinic for routine follow up of

       his disease.

       PE : BP 140/90, HR 84 bpm

       Medical Record :  month ago, he diagnosed to have 3rd stage hypertension and decompensated

       cordis. He was given hydralazine. The vasodilator effect that ...... basic of relieving the symptom

       was:

A.       Positive inotropic

B.      Increasing afterload

C.      Positive chronotropic

D.      Coronary vasodilator

E.       Baroreflex

61. ↑ WBC in urine. Diagnosis?

A.            Pyelonephritis

B.            Cystitis

C.            Uretherolithiasis

D.            Glomerulonephritis

E.            Pyuria

72. 50 y.o women came with painless hematuria. She undergo bladder biopsy. The biopsy shows atypical epithelial surface?

A. Transitional cell papilloma

B. Transitional cell carcinoma

C. Squamous cell carcinoma

D. Adenocarcinoma

E. Mixed carcinoma

73. 25 y.o man has general edema prminent in preobital regions early in mornin & hypertension. Microscpoic kindey shows difuse thickening of glomerular capilllary wall & mesangial proliferation. Most cause in adult?

A. Focal segmental glomerulonephritis

B Membranoproliferative glomerulonephritis

C. Membranous glomerulopathy

D. Minimal change dss

E. IgA nephropathy

75. Standard diagnostic test for prostatic Ca?

Ans: PSA?

76. Indication of prostate biopsy.

A. PSA 4-10

B. PSA <4

C. DRE

D. PSA Density <0.5

E. Prostate >60g

77. 6 months old kid brought by his mother because of left scrotal mass since 2 months ago. It is small and soft but larger at night. PE all normal but with left mass transluminate. Best management:

A. Detortion of 1 testis

B. Orchidopexy

C. Drain fluid

D. Observe and wait until kid is a year old

E. Hydrocellectomy

78 : Blood at beginning of urination?

79. 17 y.o boy come to ER cuz of sudden onset of pain at right kidney testis since 2 hrs ago. PE shows tender, enlarged right testis & absent cremastic refle. Urinalysis & blood serum normal. Best step management:

A. give strong analgesic & wait another 5 hrs to relieve pain

B. wait another 4hrs & perform color Doppler ltrasound

C. Emergent right testicle operation

D. Give empirical Ab & observe mass

E. orer urine culture

A 4 year-old boy comes with whole body swelling. 2 weeks before admission he had eyelid swelling when he woke up in the morning & decreased during afternoon. The symptom was followed by swelling on her face, both legs & an increase in abdominal circumferences. Since 5 days ago, he has already complained of body swelling. His urine become cloudy, foamy & was decrease in volume (1.2ml/kg/BW/hour) & frequency.

Lab result : urinalysis

Protein : 4+

Leukocyte : 4-5/HPF

Eryhtrocyte : 4-6/HPF

ureum serum : 20mg/dL

creatinine serum : 0.6mg/dL

91. What is the most likely diagnosis?

A. Acute nephritic syndrome

B. Nephrotic syndrome

C. Acute renal failure

D. Kwashiorkor

E. Acute on CKD

92. Which of the following is the criteria to make a working diagnosis?

A. Hypoalbunemia

B. Hypercholesterolemia

C. Hematuria

D. Hypertensive

E. Renal insufficiency

93. What is the following treatment that most suitable for this patient?

A. Diuretics

B. Steroid

C. Levamisol

D. ACE inhibitor

E. cyclosporin

95. Which of the following is the most common complication?

A. Infection

B. Lung edema

C. Heart failure

D. Encephalopathy

E. Chronic renal failure

96. A 7-year-old boy comes to pediatric department with the chief complaint of dark “cola colored” urine. He has not been voiding as much as usual, only 2 times in the past 24 hours. Over the past 2 days facial puffiness has been noted by mother without swelling of his hands or feet. He also complains headache and blurry vision. He has never had these complaints before. PE reveals compos mentis, edema anasarca, BP: 180/120 mmHg, PR 100x/min, temperature 36.90C. Laboratory :

•             Hb : 10.6 g/dL

•             Ureum serum : 45 mg/dL

•             Creatinine serum : 1.3 mg/dL

•             WBC : 9600/mm3

Urine :

•             Dark cola colored

•             Protein +2

•             Erythrocytes : many

•             Leucocytes : 8-10/HPF

96. Which of the following most likely is the cause of anemia in this patient?

      A. Decrease erythropoietin

      B. Bacterial infection

      C. Hemodilution

      D. Hematuria

      E. Decrease of iron production

97.  What is d first line drug shud b gven 2 d boy?

a.diuretics

b.antibiotics

c.steroids

d.levamisol

e.ACE inhbtor

98. massive proteinuria is a one of characteristic diagnosis of

a)nephritic syndrome

b)nephrotic syndrome

99. 30yo man medical lab technician recovering hepB dvlops hematuria,proteinuria, red cell casts, oval fat bodies.identified by microscopic xm of urine. ths finding is probably 2 be seen wif~

a.ascending pyelonephritis

b.nephritic syndrome

c.nephrotic syndrome

d.obstructive uropathy

e.renal infarction

100. An 18 years old woman has had arthralgia for about 6 months with intermittent fevers. Her BP is 165/110 mmHg, WBC 3200/uL, Hb 10.8 g/uL and platelet 74000/uL. She has proteinuria of 3.8 g/day and chest radiograph reveal pleura effusions. The most likely cause of her renal disease is...

A. chronic pyelonephritis

B. amyloidosis

C. lupus nephritis

D. Alport's syndrome

E. membranous glomerulonephritis

101. A 57 years old male has been bothered by arthritis. As a consequence, without reading the labels on over-the-counter medicine, he has consumed large quantities (> 3g/yr) of analgesic (aspirin, phenocitine, acetaminophen) for past 10 years. He now has CRF. Which of the following is the most pathologic finding in this patient?

      A. Acute tubular necrosis

      B. Transitional cell carcinoma

      C. Chronic interstitial nephritis

      D. Diffuse glomerulonephritis

      E. Urinary tract lithiasis

102. A 50-year-old man has an episode of hematuria with marked lower abdominal pain and later passes a small calculus in the urine. Analysis of this stone reveals that it is composed of magnesium ammonium phosphate. The most likely underlying condition accompanying these findings is

       A. Gout

       B. Pyelonephritis

       C. Hyperparathyroidism

       D. Chronic liver disease

       E. Oxalosis

103. A 25 years old man has general edema prominent in the periorbital regions early in the morning and hypertension. The microscopic feature of kidney shows diffuse thickening of glomerular capillary wall and mesangial proliferation. What kind of finding?

        A. Hypocholesterolemia, hypotriglyceride

        B. Hypoalbuminemia, hyperlipidemia

        C. Hyperglycemic, hyperalbuminemia

        D. Hypoglycemic, hypoalbuminemia

        E. Hyperthyroidism, hypomagnesium

104. An 18 years old female comes with complaint of left flank pain, fever, chills and increase urinary frequency. Gram negative rods are cultured from her urine. What kind of empirical antibiotic therapy?

       A. Penicillin

       B. TMP-SMZ

       C. Macrolide

       D. Nimetilide

       E. Cephalosporin

105. Rate of water reabsorption from proximal tubule determined by?

       A. Rate of dissolved solute reabsorption at proximal tubule

       B. Number of ADH in blood

106.

107.

108.

109.

110. A 60 years old male has been diagnosed as urge incontinence. What exercise is the most appropriate?

       A. Abdominal muscle strengthening

       B. Pubococcygeus strengthening

       C. Iliopsoas muscle strengthening

       D. Gluteus medius strengthening

       E. Hip adductor muscle strengthening

117. Through which layer must the surgeon incise to reach the testicular parenchyma?

A. Buck’s fascia

B. Dartos ‘s fascia

C. tunica albuginea

D. scapas fascia

Pampiniform plexus

118. A 57 year old man complains of difficulty in voiding and probably has BPH. Which of the following likely to be responsible for the symptoms?

A. Middle lobe

B. Anterior lobe

C. Posterior lobe

D. Lateral lobe

E. Superioi lobe

119. A 39 year old man is undergoing cystoscopic exam. The cystoscope is placed into the urethra through the penile portion. Which of the following tissue surrounds the urethra?

A. Seminal coliculus

B. Prostate

C. Corpus spongiosum

D. Sphincter urethra

E. Bulbourethral glands

120. A police detective takes a scraping of some staining to be examined for alkaline phosphataseto assess whether these might be ejaculate. What is the source of alkaline phospahatase in semen?

A. phosphate gland

B. bulbourethral gland

C. seminal colliculus

D. corpus spongiosum

E. seminal vesicle

120. A 40 y.o Taiwanese woman. Chief complain: jaundice since 1 week ago, nausea & vomit. 3 months ago underwent laparoscopic cholecystectomy due to acute cholecystitis & multiple cholithiasis. On PE: looks quiet ill, hectic fever, greenish jaundice. No stigmata of chronic liver disease, slight hepatomegaly, neither ascites nor edema were noted. What is the biochemical basic of patient’s problem?

A. Inflammatory process in which pancreatic enzyme auto digest the gland & hpertriglyceridemia

B. It can occur intermittently, distributing to the functional and ….-logic of the gland

C. Long standing alcohol consumption & biliary stone disease

D. Viral & bacterial infection

E. Scorpion & snake bites

121. A 41 yr old man complain of hematuria & significant flank tenderness. He has a history of kidney stones. A CT scan depicts abdominal portion of ureterlying anterior muscle. WOTF is the most likely the muscle?

A. serratus anterior

B. Psoas muscle

C. obturator muscle

D. rectus abdominalis muscle

E. external oblique muscle

122. You wish to examine hilum of the right kidney, what structure has to be elevated
A. duodenum
B. stomach
C. adrenal glands
D. ascending colon
E. liver

128. When one touches the upper medial thigh or scrotum of most young males, the testicles pulled upwards the external inguinal ring. This is called cremastic reflex.
The afferent limb of the cremastic reflex is provided by?
A. Femoral branch of genitofemoral nerve
B. Genital branch of genitofemoral nerve
C. Illioinguinal nerve
D. Pudendal nerve
E. Lumbar nerve

129. You have a patient who has renal failure as a result of an Alport’s syndrome. While he is currently in dialysis, he is hoping to receive a transplanted kidney. He asked you if they are going to remove one of his bad kidney and put the new transplanted kidney back in the same place. You tell him which of the following?
A. The right kidney is always removed since it is more inferior and easier to remove the new kidneys and put the new kidney will go in its place
B. The left kidney wil be removed descending colon out of the way and newly transplanted kidney will go on its place
C. He will keep both of his kidneys, and the new transplanted kidney will be placed on the left posterior wall just inferior to his left kidney since there is more room because the left kidney is higher
D. The newly transplanted kidney will be placed in the iliac fossa in the greater pelvis, attached to branched iliac vessels and ureter connected directly to bladder
E. The left kidney is always remove since it is inferior and easier to remove

131. soklan past yr... psal hysterectomy tuh.. which that can be damage? ureter jwpan de..

132:both the autonomic and vascular systemneed to function properly for successful male sexual function.which of the following statements concerning erection,emission and ejaculation in male is correct?
A. contraction of the internal urethral spinchter is under control of the parasympathetic nervous system
B. the pararasympathetic nerve stimulate closure of the helical artery
C. sympathetic neuraons stimulate the helicine arteries to dilate and increase blood flow to the corpora cavernosum
D. parasympathetic innervation stimulates emission of seminal fluid
E. contraction of the bulbospongiosus muscle impedes the drainage of blood from corpus spongiosum.

133.                        BPH associated with enlargement of which of the following?

A.      Entire prostate gland

B.      Lateral /posterior lobe

C.      Mucosal and submucosal region

D.      Anterior region

E.       Detrussor muscle

134.                        Which of the following structure divide perineum into the genitourinary and anal triangle?

A.      Levator ani muscle

B.      Superficial transverse perineal muscle

C.      Line from the ischial tuberosities

D.      Anal verge

E.       Puborectal muscle

135.                        A patient had persistent diarrhea which last for 7 days. Which of the following increase in patient?

A. filtered load HCO₃ˉ

B. production of ammonium in PCT

C. H⁺ secretion by DCT

D. Anion gap

E. Production of new bicarbonate by DCT

136.                        65 year old metabolic acidosis has history of hypertension and DM since 15 year ago. He did not take medicine regularly and refuse to change lifestyle. Function of kidney the most powerful to prevent this problem?

A.      Reabsobtion of H+

B.      Excretion of HCO3

C.      Neutralize excess acid

D.      Neutralize excess base

E.       Reabsorbtion of H+

137.                        A 27 year old, small urine production occurs prior to massive diarrhea, vomiting, SOB, fatigue. Diagnosis = ARF,BGA: PH=7.25, PO2 = 94 cmH2O, bicarbonate ion= 7

A.     Metabolic acidosis

B.     Metabolic alkalosis

C.     Respiratory alkalosis

D.     Respiratory acidosis

E.      Metabolic base excess

138.                        What is the patient lab diagnosis?

A.      Low BUN

B.      Low urea in serum

C.      Low serum creatinine

D.      High urea in serum

139.                        6 year old boy has acute nephritic syndrome prior to throat infection, gross hematuria, BP= 120/75 and facial swelling. What is the cause of gross hematuria?

A.      High hydrostatic pressure in Bowman’s capsule

B.      High hydrostatic pressure in Glomerular capillary

C.      Low hydrostatic pressure in Bowman’s capsule

D.      Low hydrostatic pressure in Glomerular capillary

E.       High colloid osmotic pressure in Glomerular capillary

140.                        A patient came to hospital and is diagnosed having chronic kidney disease with diabetic nephropathy with metabolic acidosis. Blood glucose high, proteinuria. Increase protein leakage thru the capillary by?

A.      Increase glomerular hydrostatic pressure

B.      Decrease glomerular hydrostatic pressure

C.      Inactivate protein kinase C

D.      Glycosilating the protein

E.       Decrease GFR

141.                        25 year old man with general edema prominent in preorbital region early in morning and has hypertension. The microscopic features of kidneys show a diffuse thickening of glomerular and capillary wall and mesangial proliferation. What is the most component of by pyramidal crystals?

A.      Ca oxalate

B.      Cystine

C.      Struvite

D.      Calcium phosphate

E.       Uric acid

142. Which of the following inhibit crystal formation?

A.      Mangan

B.      Citrate

C.      Bicarbonate

D.      K+

E.       Na+

143. 72 years old man has Lower Urinary Tract Syndrome (LUTS) with prostate enlargement on DRE. Which enzyme catalyse this enlargement?

B.  5-alpha reductase

144. If a substance appears in renal artery but not in renal vein, WOTF is true?

A.      It must be filtered by kidney

B.      It must be reabsorbed by kidney

C.      Its clearance is equal to GFR

D.      Its clearance is equal to renal plasma flow

E.       Its urinary concentration must be higher than its plasma concentration

145. A 35 years old male with polycystic kidney disease has a decrease both GFR and renal blood flow. A nephrologist wants to administer a drug that will increase both GFR and renal blood flow GFR and renal blood flow increase in?

A.    Efferent and afferent both dilate

B.     Efferent and afferent both constrict

C.     Only afferent constrict

D.    Only efferent constrict

E.     Afferent constrict and efferent dilate

146. Most of the glucose that is filtered through glomerulus undergoes reabsorbtion in which of the following?

A.      Proximal tubule

B.      Descending loop of Henle

C.      Ascending loop of Henle

D.      Distal tubule

E.       Collecting tubule

148.        Patient with type IV renal tubular acidosis has a defect in aldosterone secretion and ammonium excretion. Which of the following statement about NH3 is correct?

A.            Impermeable to epithelial cell of PCT

B.            Classified as titrable acid

C.            Produced by epithelial cell in distal nephron

D.            Reduce concentration of bicarbonate in plasma

E.            Synthesis in respiratory acidosis

149. A patient with hypertension is given K+ sparing diuretic. The amount of K+ secreted by the kidney will decrease if which of the following occurs?

A.      Distal tubular flow increase

B.      Circulating level of aldosterone increase

C.      Dietary intake of K+ increase

D.      Sodium reabsorption by distal nephron decrease

E.       Excretion of organic ion decrease

150. Which will more concentrated the end of PCT than at the beginning of PCT?

A. glucose

B. creatinine

C. sodium

D. bicarbonate

E. phosphate

151. Decreasing the resistance of afferent arteriole in glomerulus of the kidney will decrease which of the following?

A.      GFR

B.      Renal plasma flow

C.      Filtration fraction

D.      Oncotic pressure of peritubular capillary blood

E.       Renin release from juxtaglomerular cells

152. AOOMY

153. A patient with congestive heart failure is given the loop diuretic furosemide, along with K+ sparing diuretics, spironolactone. Which of the following comparison between distal nephron and PCT is correct?

A.      Distal nephron is more permeable to H+ than PCT

B.      Distal nephron less responsive to aldosterone than PCT

C.      Distal nephron has more negative intraluminal potential than PCT

D.      Distal nephron secretes less K+ than PCT

E.       Distal nephron secretes more H+ than PCT

154. An elderly woman present with spiking fever, shaking chills, nausea & CVA tenderness. Decrease GFR with a result of increase NaCl delivered intraluminal fluid to the thick ascending limb of loop of Henle. Under these conditions, this mechanism will increase the formation & release which of the following substances?

A.      ADH

B.      Aldosterone

C.      Adenosine

D.      Renin

E.       Angiotensin

154. Macula dense form and release, which of the substances?

A. ADH

B. Aldosterone

C. Adenosine

D. Renin

E. Angiotensinogen

154.  Macula densa will increase formation and release of ?

          A.  ADH

          B.  Aldosterone

          C.  Adenosine

          D.  Renin

          E.  Angiotensinogen

155. A patient suffers from persistent diarrhea for the past 7 days. Which of the following will increase?

A.      The filtered load of HCO3-

B.      The production of ammonia by the proximal tubule

C.      H+ secretion by distal nephron

D.      The anion gap

E.       The production of new bicarbonate by the distal nephron

156. A 39 years old man presents with severe writhing back pain, hematuria & nausea. An IVP confirms a diagnosis of renal calculi. The presence of strongly opaque stones on the plain film is suggestive of calcium oxalate stones, which have an increase incidence of hypophosphatemia. The renal clearance of phosphate is increase by which of the following hormones?

A.      Aldosterone

B.      Parathyroid hormones

C.      Norepinephrine

D.      Vasopressin

E.       Angiotensin

157. The most proper nutritional management for CKD patient is?

     E.   Low calorie, restrict protein, low water soluble vitamin, low fat soluble vitamin, low

           mineral

158. TAPA

159. What is the side effect of high intake of protein in CRF patient?

A.      Increase protein catabolism

B.      Worsen the kidney function because protein metabolism increase acidity, increase nitrogen and increase phosphate

C.      ....

D.      ....

E.       Decrease muscular wasting

161. In ER. 25 yr old man with low production of urine complaint prior to massive diarrhea & vomiting. The main goal for nutritional management in acute kidney injury?

A.      Minimize proteinuria caused by underlying disease

B.      Prevent anorexia

C.      Minimize vomiting

D.      Prevent progressivity to chronic kidney

E.       …….

162. A 34 years old man came to STI clinics of Hasan Sadikin Hospital with a chief complaint of dysuria and yellowish urethral discharge since 3 days ago. The result of culture revealed that the bacterium N. gonorrhea.
The virulence factor that play a role in adherence of bacteria on the mucosa is:

A.      Lipopolysaccharide

B.      Capsule

C.      Flagella

D.      Peptidoglycan

E.       Pili

163.  A man got penile ulcer but the ulcer not hurt. What to do?

          A.  Draw blood for herpes antibody exam.

          B.  Dark field exam of ulcer

          C.  prescribe acyclovir for primary genital herpes

          D.  If treat, lesion remain for month

          E.  No need to treat, self limited infection

164.  Best medium for culturing N.gonorrhoea.

           Ans : C. Thayer Martin agar

165.  A 42 years old man who has a penile ulcer appears in a STI clinic of hospital. The base ofulcer is

          soft and painful with a suppuration. Microscopic examination of Gram staining specimen

          shows gram negative rods with school of fish arrangement. Which bacteria?

A.   N.gonorrhea

B.  Haemophilus duereyi

C.  Mycoplasma Hominis

D.  Ureaplasma urealyticum

E.   Treponema pallidum

 170.  Female,sexually active, have 2 partner. Vaginal purulent discharge. Endocervix specimen?

           A.  Endocervix specimen should be analyze for H.ducrati

           B.  Wet mount preparation – show clue cell

           C.   Gram-stain – chlamydia

           D.  Possible infection chlamydia and gonorrhea

            E.  Dark field microscopy show spiral

172.  37 years old man, history of UTI come to ER with burning on urination along frequency and 

          urgency. Urine smells like ammonia. Cause of UTI likely to be:

A.       Enterobacteraerogenes

B. Proteus mirabilis

C. Citrobacter freundii

D.      E.coli

E. Serratia marsescans

173. A 65 years old male, hospitalized for 3 days as indication of diabetic nephropathy and catheter is inserted because of problem in urination. Within this period, he developed UTI. Most common opportunistic pathogen that causes this infection is?

A.      Proteus Vulgaris

B.      Serratia Marsescens

C.      Staphylococcus Aureus

D.      Enterococcus Fecalis

E.       E. Coli

177.  Sex transmitted disease with fishy odor.

178.  Test for treponema pallidum

179.  Differential test for epidermidis and saprofitikus

185. 65 y.o male with scrotal malignancy. His OSa serum is increasing significantly compared with his last month result X ray pelvis shows abnormality at pelvic bones. Patient consulted to nuclear medicine. appropriate management
A. Conventional renogram to evaluate blood flow to renal
B. GFR to determine kidney function
C. Kidney scintigraphy to find sign of acute pyelonephritis
D. Malignancy prostate scintigraphy localization to findany sequel & recurrency
E. Bone scintigraphy to find any metastase to bone

188. Nifedipine side effect

A. Low blood glucose

B. Orthostatic hypotension

C. Cardiac depresent

D. Hyperkalemia

E. Palpitation

189. Nifidipine is a

A. ACE-inhibitor

B. Alpha-blocker

C. Beta-blocker

D. CCB

E. Vasodilator

190. A 70yo man with BP taken 170/110 with dominant arm. After 5 mins of rest, it was stil the same. What is the most appropriate drug to be given?
A. Diltiazam + Nifedipin
B. B-blocker + diltiazam
C. B-blocker + verapamil
D. B-blocker + centrally acting drug
E. Ca-channel blocker + ACE inhibitor

191. 65 y.o hpertensive under observation at PUSKESMAs due to high BP. PE shows 200/120mmHg & given direct vasodilator.BP immediately fall back & increase again. Most likely mechanism that ruins drug effect?
A.Increase peripheral resistance
B Inhibit RAA system
C. Decrease cardiac output
D. Increase venous return
E. Chronotropic negative