Formative Test Gus 2014 TWP
Formative Test Gus 2014 TWP
Formative Test Gus 2014 TWP
FORMATIVE TEST
GENITOURINARY
TWINNING PROGRAM UKM-UNPAD 2011
FK2011
0 Error! No text of specified style in document. | FK2011 6/9/2014
June 9, 2014 FORMATIVE TEST GENITOURINARY
1. A 28 year old previously healthy woman was hospitalized because of acute onset of dysuria,
fever with chills and pain on her back and waist. Her temperature was 39.9C, BP 100/60
mmHg, PR 110
WOTF would be the most accurate diagnosis of this acute illness?
A. Acute cystitis
B. Acute glomerulonephritis (GN)
C. Acute pyelonephritis
D. Acute renal failure
E. Nephritic syndrome
2. A 58 y.o male was diagnosed as chronic renal failure presented with polyuria, thirst,
generalized weakness, dyspnea, infrequent fits & lack of concentration.
His laboratory result was:
Test Results Reference range
Serum potassium 8 mmol/L 3.5-5 mmol/L
Serum calcium 6.6 mmol/L 8.5-10.5 mmol/L
Blood urea 160 mg/dL 24-40 mg/dL
Serum creatinine 12 mg/dL
WOTF is the best option for treating this patient?
A. Anti-epileptic drugs
B. Correction of hyperkalemia
C. Correction of severe hypocalcemia
D. Correction of volume overload
E. Hemodialysis
3. An 18- yo male came with hematuria since yesterday. He had a history of sore throat 2
weeks ago. Physical exam revealed BP : 150/100 mmHg, lower extremity edema (+)
WOTF is the most likely the treatment
A. Anti-inflammatory drugs
B. Broad spectrum antibiotic
C. Diuretics agent
D. Conservative management
E. Steroid
4. A 55 y.o came with throbbing headache at the back of the head and neck since 2 years ago
especially in the morning. There is no history of head trauma or infection
Physical exam:
BMI : 30 kg/m2
BP : 160/90 mmHg, pulse 72 x/min, RR : 18x/min
Cardiac left border : 3 cm lateral to the left midclavicular line
Lab exam:
Ureum : 35 mg/dL HDL cholesterol : 30 mg/dL
Creatinine : 1.2 mg/dL triglyceride : 300 mg/dL
Uric acid : 7 mg/dL random blood sugar : 220 mg/dL
Total cholesterol : 250 mg/dL ECG : left ventricular hypertrophy
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According to JNC VII classification for hypertension, in which stage is this patient?
A. I
B. II
C. III
D. IV
E. V
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16. Since the patient refused any surgery, he probable had to use long term catheterization to
urinate. WOTF catheterization type that most appropriate?
A. Coude catheters
B. Folley catheter
C. Robinson catheter
D. Straight catheter
E. Whistle-tip urethral catheter
18. A 6.yo boy had a lump without pain at his right scrotal region since 2 months ago. The lump
was not decreased or increased in size, and the consistency of the mass was soft. He denied
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that he had a fever during this period. His urination and defecation were within normal
limits.
A. Good, if we treat the patient by giving him diuretics
B. Bad, if we just only perform periodically needle aspiration
C. Fair, if we suggested him to wear a scrotal support
D. Good, if we perform a ligation of lest processus vaginalis
E. Good, if we perform surgical correction in an emergency situation
20. A 70 y.o male was diagnosed with end stage renal disease. He was undergoing long term
hemodialysis. WOTF is the most appropriate nutrition recommendation?
A. 35 kcal/kg/day 0.8-1 g protein/kg/day
B. 20-25 kcal/kg/day, 0.6 g protein/kg/day
C. 25 kcal/kg/day, 0.8-1 g protein/kg/day
D. 35 kcal/kg/day, 0.6-0.8 g protein/kg/day
E. Very high calorie and protein
For question number 21 to 22, refer to scenario below :
A 5 y.o boy had mass at his abdomen. His mother felt that mass suddenly while she was holding him.
Radiology examination showed that the mass came from his kidney.
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24. A 50 y.o woman, diabetes mellitus patient, was also diagnosed as chronic pyelonephritis.
WOTF microscopic appearance is the best description of for her condition?
A. Patchy intestinal suppurative inflammation
B. Intratubular aggregates of neutrophils and tubular necrosis
C. Suppurative inflammation through the renal capsule into the perinepric tissues
D. The tubules show atrophy in some areas and hypertrophy or dilatation in others
E. Accumulation of foamy macrophages intermingled with plasma cells
25. A 68 y.o male came with difficulty to urinate. DRE showed enlargement of the prostate
approximately 50 gram, no nodule nor tenderness. PSA was 3 mg/dl. TURP was performed
and the tissue sample was sent to pathology laboratory for examination. The microscopic
finding was shown in below picture. What is the structure pointed by white arrow?
A. Basal cells
B. Columnar cells
C. Corpora amylacea
D. Fibromuscular stroma
E. Spermatocytes
27. WOTF imaging examination is most appropriate to determine the organ function and
diagnosis
A. Antegrade pyelography
B. CT scan
C. Intravenous urography
D. Retrograde pyelography
E. Ultrasound
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28. A 50 y.o female had taken her random urine specimen to the lab for a glucose analysis. The
test result was negative. The physician unsure with the result due to her clinical symptoms
and the family history of diabetes mellitus
WOTF urine specimen type is more accurate for her?
A. 24-hour
B. 2-hour postprandial
C. First morning
D. Random test
E. Three-glass collection
serum ;
urea N : 20 mg/dl ; creatinine : 0.8 mg/dl
29. WOTF conditions is the most possible cause of the color of his urine?
A. The nephron excretion of blood-borne
B. The nephron excretion of albumin
C. The glomerulus excretion of blood-borne
D. The glomerulus excretion of ureum
E. The glomerulus excretion of albumin
31. What is the purpose of serum creatinine and urea N examination in this case?
A. To diagnose the renal insuffciency of the disease
B. To determine guidance theraphy of the disease
C. To perform prognosis
D. To follow up disease
E. To determine the complication of the disease
32. Result of urinalysis on a very anemic and jaundiced patient are as follows :
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A. Biliary obstruction
B. Kidney damage
c. Liver damage
d. The circulating bilirubin is conjugated
e. The circulating bilirubin is unconjugated
33. An 8-year old boy presents with red-colored urine. His urinalysis as follows:
Microscopic : erythrocyte = >100 per HPF almost all dysmorphic. Red cell casts present.
a. Bladder stone
b. Cystitis
c. Glomerulonephritis
A. Bowman's capsule
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C. Loop of Henle
D. Distal convoluted
E. Collecting duct
34. Filtrate production - blood pressure forces small solutes, water, ions from blood into capsule
36. Reabsorption of water (descending limb) - Reabsorption of Na+ and Cl- (ascending limb)
39. Anorexia, nausea, vomiting, headache, lethargy, muscle weakness, twitching, tremors, and seizures
40. Thirst, sticky mucous membranes, lethargy, restlessness, oliguria, irritability, pulmonary edema
41. BP, anorexia, nausea, vomiting, deep tendon reflexes, fatigue, muscular weakness and cramps, peristaltis,
ileus
42. bradycardia and other arrhythmias, nausea, diarrhea, anxiety, muscle weakness, numbness or prickly
sensation
43. muscle cramps and tremors, tetany, bronchospasm, carpopedal spasm, deep tendon reflexes, prolonged
Q-T interval on ECG, positive chvostek’s and trousseau’s signs
44. A patient has suffered from persistent diarrhea lasting for the past seven days. WOTF would be increased
in this patient?
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47. WOTF laboratory and imaging examination is most important to diagnose the above disease?
A. Calcium level
B. Fresh specimen urine
C. Plain abdominal x-ray
D. Serum creatinine level
E. Ultrasound of the kidney
49. There was a history of sore throat 1 week before. WOTF infectious agent is the most possible to precede
the disease of the patient?
A. Chlamydia trachomatis
B. Meticillin resistance staphylococcus aureus
C. Pseudomonas sp.
D. Serratia spp
E. Streptococcus β-haemolyticus
50. WOTF mechanism is the most appropriate cause to explain the anemia of the patient?
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A 2-month old boy came with complaint of fevr, chills, poor feeding, and increasing of urinary frequency. PE:
body temperature 38.9o C. LE: Hb 15.9 g/dl, WBC count: 18000/mm3, thrombocyte: 140000/mm3, urine: WBC
15-20/hpf, RBC: 5-7/hpf, nitrite test +
51 which of the following treatment is the best choice for the best patient
52 which of the following bacteria is the most possible found in this patient urine
a. E.coli
b. Klebsiella
c. Pseudomonas aeruginosa
d. Staphylococcus aureus
e. Streptococcus beta hemolyticus group A
a 32 y.o man married came with single painless erosion on his penile shaft since one week ago. He confesses
that he often had sex intercourse with prostitute without condom. At venerological exam there is single
erosion, diameter 1cm, with buldging edge, and clean base. There are not any papules, warts, nor discharge
a. Syphilis
b. Chancroid
c. Genital herpes
d. Lymphogranuloma venereum
e. Aphtous ulcer
54 what is the best direct lab exam to establish the diagnosis of the case
a. Giemsa staining
b. Ziehl nelson staining
c. KOH exam
d. Specimen collection for culture
e. Dark field microscopic exam
a. Ketoconazole
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b. Amoxicillin
c. Metronidazole
d. Penicillin
e. acyclovir
56 a 60 y.o male has been diagnosed as urge incontinencia for a month.what kind of exercise is the best for
this patient
57 a surgeon want to perform nephrectomy.what is the correct order to approach the kidney from the back?
A 45 y.o. man came with dull pain in his right back. The pain has been going on and…usually last for about 20-
30 minutes. PE: costovertebral angle percussion (+)
58. which is the right statement regarding the organ involved in the case?
a. It’s a paired organ lies retroperitoneal in the pelvic cavity at the level of…
b. It’s an ovoid organ lying on either side on diaphragm
c. The organ lies medial to the adrenal gland and inferior to the ureter
d. The organ lis on either side of vertebral column in retroperitoneal
e. The anterior border of the organ is psoas muscle and ureters
A. Abdominal aorta
B. Pulmonary artery
C. External iliac artery
D. Common iliac artery
E. Celiac trunk
60 from sentence below which are the correct statement for ureteric constriction
A. (1), (2)
B. (2),(3)
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C. (4), (5)
D. (1),(2),(3)
E. (3),(4),(5)
61. After cesarean section, a 35-year old woman complained difficulty of urination, pain when micturition and
hematuria after 3 days. From the x ray and the other symptom, the doctor diagnosed there is rupture at the
fundus of the bladder. Where is the possible location for uterine extravasation?
A. Extraperitoneal cavity
B. Intraperitoneal cavity
C. Rectouteine pouch
D. Retropubic space
E. Retzius space
62. An anatomies is doing pelvic and abdominal exploration on male adult cadaver. He found hollow viscous in
the lesser pelvic. The apex points toward superior aspect of pubic symphisis. It is only covered by peritoneum
on its superior surface. What other caracteristic would the anatomies find in this organs?
A. It is separated with the rectum on its posterior site by the rectovesical pouch
B. Its posterior wall consist of detrussor muscle
C. Its base located on the posterior, opposite of its apex
D. The organ has 4 surfaces and 2 major part
E. The organ is in this tensible
1. Kidney
2. Abdominal ureter
3. Pelvic ureter
4. Urinary bladdder
5. Urethra
63. What organs does the prostatic venous plexus drain blood from
A. 2
B. 3
C. 1,2
D. 4
E. 1,3
64. What organ does the uterine artery (in female) and inferior vesicle artery (in male) supply
A. 1
B. 2
C. 3
D. 4
E. 2,3
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A. Renal arteries - interlobar arteries - interlobular arteries - arcuate artery - afferent arteriole
B. Renal arteries - lobar arteries - lobular arteries - segmental arteries - arcuate arteries - efferent
arteriole
C. Renal arteries - lobar arteries - segmental arteries - arcuate arteries - lobular arteries - afferent
arterioles
D. Renal arteries - segmental arteries - lobar arteries - lobular arteries - arcuate arteries - efferent
arteriole
E. Renal arteries - segmental erteries - interlobar arteries - arcuate arteries - interlobular arteries -
afferent arterioles
66. The surgical resident will performing left adrenalectomies. It was the first time for him to do, so the most
identified vessel that supply the gland he found one vessel joined with the left suprarenal vein before empties
into the renal vein. Which of the following is most likely vein?
A. Hemozigous
B. Left 2nd lumbar
C. Left testicular
D. Left inferior phrenic
E. Left 1st lumbar
67. Ureteric colic can cause pain with the pattern from loin to groin. The pain is refered to the cutaneous area
that innervated by spinal cord. Which of the following is the correct segment involved ?
A. T1-T2
B. T2-T3
C. T4-T5
D. T6-T7
E. T11-L2
68. Examination of a newborn male infant revealed the urethra was opened on the ventral surface of the
ventral surface of the penile at the junction of the shaft of the glands. Which of the statement explain this
condition ?
69. A 10-year-old boy suffered severe pain in his left groin while attempting to lift a heavy box. Later be
noticed a lamp in his groin . Physical examination was done he was diagnosed with indirect inguinal hernia.
Which of the following explain the occurence of this condition ?
70. A 62 year old woman is brought to the emergency room in a stateof confusion, unable to answer questions
coherently, and exhibits tachypnea. The laboratory results are listed below :
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[HCO3-] : 9 mEq/L
A. Bicarbonate excess
B. Bicarbonate deficiency
C. CO2 excess
D. CO2 deficiency
E. Sodium ion deficiency
71. After the long and hard exercise, the body mantain the water balance into the physiological condition.
Wbat is the most likely mechanism in kidney ?
72. Which of the following mechanism is important in the renal excretion of hydrogen ion ?
A. Combining of hydogen ion and bicarbonate via the enzyme carbonic anhydrase
B. Combining of hydrogen ion with chloride ion to form hydrochloric acid
C. Trapping of hydrogen ion by ammonia to form ammonium ions
D. Trapping of hydrogen ion by acetate
E. Secreting of sulfate and hydrogen ions as sulfate acid
73. The function of a kidney is to remove the metabolism products that can be used as an indicator of a kidney
disease. In kidney dysfunction which of the following substance will be increased in the blood ?
A. Urea
B. Glucose
C. Albumin
D. Phosphate
E. CO2
74. A 4 year old boy is brought to the department of pediatric complaining of general swelling. His face tends
to be swollen in the morning, and the ankles are swollen latter in the day. The lab findings shows:
Which of the following is the most likely cause of hypoalbuminemia in this patient ?
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75. A 43 year old male, presented with right flank pain, which was gradually increased, sharp, colicky, and
spread down to the right testical. Investigation results where as follows :
Laboratory revealed microscopic hematuria and a lot of "back of envelope" crystal in the urine.
KUB : radio opacity at 3rd right lumbar paravertebral, 10 x 7 mm in size. He was diagnosed with renal calculi.
The most possible composition of this calculi is
A. Cystine
B. Struvite
C. Uric acid
D. Calcium oxalate
E. Calcium phosphate
Hb 15.6 gr%, hematocrit 50%, serum urea 180 mg%, creatinine 5,3 mg%, serum potassium 7 mEq/L, sodium
145 mEq/L. BGA : pH 7.25, HCO3 : 7 mEq/L. Urine analysis normal. Stool analysis : few leukocytes. ECG : tall
and peak T wave and widening QRS complex.
76. Which of the following condition explin the high potassium level in the patient ?
77. Which of the following condition most likely occured in this patient ?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Decreased urine production
E. Both metabolic and respiratory acidosis
78. Which of the following structure secrete ammonia (NH4+) in above condition ?
A. Proximal tubule
B. Loop of henle
C. Distal tubule
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D. Collecting tubule
E. Calyces wall
A. Proximal tubule
B. Loop of henle
C. Distal tubule
D. Collecting tubule
E. Calyces wall
A 18 year-old female came with left flank pain, chills, and increased urinary frequency. Gram negative rods are
cultured from her urine
A. Chlamydia trachomatis
B. Leptosira interogans
C. E. coli
D. S. saprophyticus
E. S. aureus
81. The major defense of the urinary tract against this infection is:
82. Urine samples for bacterial culture to diagnose urinary tract infections should be processes immediately,
because
A. The main cause of urinary tract infections are the anaerobic bacteria
B. The bacteria could be autolysed
C. Urine could contaminated in preservation
D. The number of bacteria would raised in urine
E. Urine could change the color in preservation
A 20 year-old male came with 24 hour history of dysuria and noted some “pus-like” drainage in his underwear
and the tip of his penis. He had a history of being sexually active with 5 different partners in the past 6 months.
Physical exam was significant for a yellow urethral discharge and tenderness at the tip of penis. A Gram-stain
was done in the small lab of the clinic.
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84. Which of the following can be used as selective media for culture the etiologic agent of the disease?
A. Blood agar
B. Chocolate agar
C. Mac Conkey agar
D. Thayer Martin agar
E. Mueller Hinton agar
85. A 65 year-old man develops dysuria and hematuria. A Gram stain of urine sample shows Gram negative
rods. Culture of the urine on Mac Conkey agar reveals lactose-negative colonies without evidence of swarming.
A. Chlamydia trachomatis
B. Pseudomonas aeruginosa
C. Escherichia coli
D. Proteus mirabilis
E. Enterococcus faecalis
86. A 20 year-old female student presented with left flank tenderness and low-grade fever. ……….. shows
microscopic evidence of erythrocyte, pyuria, and abundant gram-positive bacteria. …….. urinary trac infection.
A. Candida albicans
B. Enterococcus faecalis
C. Streptococcus pyogens
D. Neisseria gonorrhoeae
E. Staphylococcus saprophyticus
87. A 60 year-old man came to the outpatient clinic for medical follow up. He noted as hypertensive and type 2
DM patient for the last 2 years in medical record. On physical examination found blood pressure 160/90
mmHg, no abnormality on PE and laboratory examination. The doctor prescribed oral antidiabetic and ACE
inhibitor for him.
A. Valsartan
B. Atenolol
C. Captropil
D. Hydralazin
E. Diltiazem
88. A 62 year-old man came to the doctor for routine follow up his disease. BP was 160/90 mmHg, HR 76 bpm.
Randomized blood glucose level was 140 g/L. He is given nifedipine.
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C. Cardiac depressant
D. Hyperkalemia
E. Palpitation
89. A 70 year-old man came to the outpatient clinic for routine check up his condition. On physical
examination found blood pressure 170/110 mmHg taken in the dominant arm in the seated position, and this
is unchanged after 5 minutes of rest. Other systems within normal limits.
A. Diltiazem + Nifedipin
B. β-blocker + diltiazem
C. β-blocker + verapamil
D. β-blocker + centrally acting drug
E. Ca-channel blocker + ACE inhibitor
A 7 year-old boy was brought to the hospital due to red cola urine and legs edema. Physical examination
showed blood pressure 120/80 mmHg, edema palpebral +/+, leg +/+. Urinalysis revealed protein ++, no other
abnormality.
A. β adrenoreceptor blocker
B. Vasodilator
C. Diuretics
D. Ca-channel blocker
E. ACE inhibitor
91. The patient was given a drug but his blood pressure remains high.
A. α-blocker
B. β-blocker
C. Vasodilator
D. ACE inhibitor
E. Ca-channel blocker
92. Mr. Joni is diagnosed as hypertension and was given an antihypertensive drug, but he gets coughing after
he took that drugs. Which of the following is drug that was given to him?
A. Captropil
B. Propanolol
C. Clonidine
D. Amlodipine
E. Verapamil
93. A 70 year-old men came to the doctor for routine follow up his disease. Blood pressure was 170/90 mmHg,
HR 76 bpm. Randomized blood glucose level was 140 g/L. He is given nifedipine.
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A. Hyperkalemia
B. Hyperglycemia
C. Extremities edema
D. Cardiac depressant
E. Orthostatic hypotension
94. A 63 year-old woman came to the Primary Health Care with pulsative headache. Physical examination
revealed blood pressure 160/90 mmHg, heart rate 104 bpm, no other abnormality.
A. α-blocker
B. β-blocker
C. ACE inhibitor
D. Angiotensin receptor blocker
E. Ca-channel blocker
95. The attachment of the renal fascia determines the path of extension of perinephric abcess.
Which of the following direction is the most correctly way to continue pasting the pus?
A. Simple squamous
B. Simple cuboidal
C. Simple columnar
D. Stratified squamous non keratinized
E. Transitional
100. Urethra
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