Kidney MCQ 2013

1. Mr. X datang ke RS dgn keluhan diare 20kali dalam 2 hari. Keluhan lain ada vomit dan nausea.
Blood press. 100/70, rr 26. Cr 3.2. (N =1.2) urine 330 ml, edema di kedua kaki urea creatinine
naek, diagnosisnya apa:
A. aki risk
B. aki injury (Based on the RIFLE criteria)
C. aki failure (diatas 3,6 creatinine)
D. ckd
E. GN

2. pasien flank pain hilang timbul (indicates stone and if its on and off then its more towards
uretro or ureterolithiasis) sejak sebulan dan ada pain saat urinating (lutzs iritative) pf ada
tenderness di suprapubic
A. Vesicolithiasis
B. Uretrolithiasis (urethra)
C. Cystitis (kalo cystitis gk ada renal colic)
D. Ureterolithiasis (ureter)

- Kalo kena di lower ada frequency, hesitance, nocturia

3. No soal

4. Mrs x 40 thn dtg bp 160/90 hr 92 per min rr 32 per min,ada history muka sembab,bengkak.
Waktu pf ada vomit,rhonki positif, malar rash konjungtiva anemis,palpebra
edema,ekstremitas jg edema. Diagnosis?
A. lupus nephritic
B. ain
C. atn
D. gn
E. decreased renal perfusion

5. A 55 year old ke ugd, ada sob since yesterday (if sob showed up earlier and for longer then it
could indicate uremic). Pf: rales both sides. Dialysis regularly tp miss yg kemarin. Hasil lab apa
yg bisa determine management?
A. Normal creatinine
B. Hyperkalemia (if asked lab test) [first calcium gluconate, second insulin, third loop
diuretic, kalo kalium lebih dari 7 di dialysis]
C. Oliguria (checked for PE)
D. Alkalosis
6. No soal
7. No soal

8. Tapi lupa persisnya kyk gimana. Pokoknya intinya kita lg belah ginjal gitu, trus ketemu sel yg
sitoplasmanya basophilic, lumen jelas, inti sel lebih dari 5.
A. TKD (inti banyak)
B. TKP (inti dikit)
C. trus lupa pilihan lainnya apa aja

9. Examining a piece of tissue from medulla with large lumen lined by low cuboid epithelial cell
with clearly seen intercellular cell borders. What tube or duct are you probably examining?
A. TKD
B. TKP
C. Loop of henle thin segment
D. Loop of henle thick segment
E. Collecting duct

10. Star Shaped lumen, longitudinal circrular muscle.

A. Ureter.

11. A 75 y.o women got femur fracture. Dia operasi setelah it di kasih aminoglikosida. Setelah 5
hari urine outputnya decreased. Kira kira knapa ?
A. Altered renal hemodynamic
B. Interstitial yg lain lupaaaa (acute interstitial nephritis)

12. Lumen besar, otot tidak beraturan. Jawab: vesica urinaria.

13. No soal
14. No soal
15. No soal
16. No soal
17. No soal

18. bapak umur 62 laki-laki bed rest unconcious dengan diagnosis intracranial hemorrhage
(dibagian medial bisa muncul dengan dysregulation of kantung kemih, bisa karena catheter
atau clearance). 2 hari kemudian demam dan symptoms gangguan kemih. Bagaimana hal
ini bisa terjadi?
A. (-)
B. Bacteria spreads via blood stream
C. Biofilm (2-4 days bacterial infection can already manifest) from catheter
D. Descending infection from kidney to (lower)
E. Bacteri colonization in mouth of urethra.
20. Male 65 yo, said that he has problem to start and end with urination. The doctor perform RT
and found enlargement of the prostate gland. The urologist then perform a biopsy
(transurethral) and found out hyperplasia of the gland.
A. BPH
B. Prostatitis
C. Option lainnya lupa

- Kapan mulai screening prostate = annual 50 yrs old, kalo high risk 45.

21. No soal

22. 5 yo boy brought by his mother with possible nephritic. Light microscopy and flourosen
negative (indication of minimal change disease like keyword). Periorbital edema. Possible
cause?
A. Fsgs
B. membrano glomerulosclerosis
C. diabetic nefropathy (nodular sclerosis)
D. lipoid nefropathy (sama dengan minimal change disease / niehl’s disease)
E. amyloidosis

- orang dewasa kalo nsaid bisa D juga

23. Cause of polyuria in diabetes insipidus (DM = due to osmotic diuresis of glucose [insulin],
Diabetic insipidus due to ADH disturbance)
A. decreased aldosterone
B. decreased ANP
C. decreased ADH
D. increased secretion of glucose
E. increased Na secretion

24. Mechanism of ADH to increase reabsorption of water through:

A. Insertion of Aquaporin 1 in proximal convoluted tubule
B. Secondary active transport of kalium in collecting tubule
C. Insertion of Aquaporin 2 in collecting tubule
D. V1 receptor in collecting tubule
E. Primary active secretion of kalium in collecting tubule

25. No soal
26. No soal

27. Johny 24 years old, ketelen air laut jadi nya harus dan karena hypernatremi

= Jawaban nya execive natrium, ecf decrease (karena air masuk), icf increase
28. No soal
29. No soal
30. No Soal

31. A 63 y.o man with past medical history, presents with a recent increase in prostate-specific
antigen from 2,2 to 4,3 ng/ml. Digital Rectal Examination reveals a 0,5 cm nodule on the left
lobe of prostate. What is the next step in the evaluation of this patient?
A. CT Scan & bone scan
B. Prostate biopsy
C. Radical prostatectomy
D. Treat patient with a 7 day course of antibiotics & recheck prostate-specific antigen level
in 3 month
E. Urinalisis

- If PSA normal sama DRE abnormal kita Transurethral ultrasound guided biopsy

32. BP naik. Edem facial n feet. Sore throat 2 minggu. Urinalysis:-blood +3 -protein +2. Best
diagnosis
A. AKI
B. Nephrotic syndrome
C. Nephritic syndrome (post streptococcal glomerulo nephritis)
D. Myoglobinuria

33. 55 y.o. man colic pain in left flank. Murphy punch test positive in the left. Vital sign normal.
Creatinine 4.0 g/dl sama ureum 1.5 g/dl. Stonee on paravertebral. Reindeer calyxes.
A. Ureterolithiasis
B. Nephrolithiasis staghorn
C. Urethrolithiasis
D. Pyelonephritis

34. A 56 year old male with known chronic renal failure mengalami 3 days history of Shortness
of Breath and weight gain . An examination menunjukkan adanya S3 gallop, crackles at the
bases, dan moderate venous jugular distention. What the next step of evaluation?
A. Perform electrocardiogram
B. X-ray Thorax (check pulmonary edema)
C. Calculate GFR
D. Retrograde Pyelogram
E. Cek enzyme jantung
35. Examination of abdominal kidney, 18 month baby female, the kidney tissue terlihat
immature mesenchymal , abortive tubule. Diagnosis untuk hasil dari examinationnya?

Jawabannyaa: wilms' tumor

36. Man muntah dan mual (indication of fluid loss hence signs of shock) 2 hari. Bp 80/60. Ureum
96 creatinin 6.2

Diagnosis? Pre renal AKI

37. A 40 yo male come to the er with acute onset right abdomen pain and radiating to back. He
drink less than 2L usually. Bp 130/100, hr 92, imaging was done and radioopaque at
paravertebral t10 - L1, what is the possible cause?
A. Urolithiasis
B. Nephrolithiasis (kidney anatomically in t12-l3)
C. Pyelonephritis (ada demam)
D. Kolelithiasis
E. Pankreatitis

38. A 50 years old man complains fatigue since 3 months. He also had nausea, vommiting ,
decrease of urine output since 5 days ago . He has a diabetes mellitus. On physical
examination, BP 160/100 mmHg , Temp 36'C, HR 80/m, RR 22/min ,bilateral ... and oedema
legs. On blood examination RBG 237 , Hb 9.8 (dec) , Urea 50 , creatinine 2.5. What is your
diagnosis
A. Diabetic nephropathy
B. Hypertension nephropathy
C. AKI prerenal
D. AKI renal
E. CKD

- diabetic nephropathy caused CKD?

39. No soal

40. 56 years old women with osteoarthritis and chronic use of analgesic (can induce Interstitial
nephritis). Physical examination reveals kidney damage and elevated serum ureum and
creatinine. Urinalysis showed eusinofilia. She got.
A. Chronic kidney disease
B. Interstitial nephritis (use of NSAIDS and eusinofilia)
C. Glomerulonehritis
D.
E. Urolithiasis
41. No soal
42. 67 year old, DM 5 tahun. Minum metformin (gk boleh kasih ke orang AKI/CKD) 2x500mg.
Comorbidity urolithiasis + hypertension selama 2 tahun. Pernah dirawat di RS berulang. Lab
rest ureum 105, creatinin 3,4. Urinalysis proteinuria +3. USG terlihat contracted kidney dan
gak ada hydronephrosis. Cause dari kidney damagenya?
A. Hyperglycemia
B. Urolithiasis
C. Hypertension
D. ATN (amphotericin B)
E. obat antidiuretic oral

43. 58 tahun pria, seizure 2 jam. USG ditemukan CKD. Lab result increasing level of ureum
creatinine and hypocalcemia. Cause dari seizure?
A. Decreasing level of PTH (inc in hypocalcemic conditions)
B. Decreasing level of vit d (vit d causes hypocalcemia which can cause seizures)
C. Decreasing level of bone mineral density
D. Decreasing level of sodium
E. Decreasing level of potassium

44. Cwe 65 thn dgn uncontrolled diabetes dtg dgn lemes dan brt bdn turun. Pmrkksaan nmrl.
Blood gas analysis pco2 35 po2 125 hco3 18 be -2. Na 136 k 2.4 ureum 75 creatine 2.5 no
blood keton. Hasil abnormal dr Blood gas analysis krn?
A. Lactate acidosis
B. Ckd
C. Renal tubular acidosis
D. diabetes ketoasidos (no ketone found or RBG)
E. intoxivikasi

45. Male 32 tahun dgn severe hypertension, ada stenosis arteri di kidney, yg mana?
A. Arteri renalis
B. V. Renalis
C. A. Peritubular renalis
D. V. Peritubular renalis
E. A. Vasa rectalis

46. A 46 years old man comes with left colic abdominal flank pain (still upper). PE shows positive
left ballotment test. USG shows no acoustic shadows on renal and ureter but left kidney
enlargement is indicated. Which of these structure is the most possible location of the stone?
A. Pelvis Renal (usually asymptomatic till severe)
B. Ureter
C. Vesico ureteral junction (with suprapubic pain)
D. Vesica Urinaria
E. Urethra
If Pelvico urethero junction is there pick that (more specific)
47. No soal

48. Man dateng swelling edema, electrolyte apa yang kelebihan:

A. Magnesium
B. Sodium
C. Potassium
D. Calcium
E. Chloride

49. Female 42 y.o, fatigue for 2 months,ureum and creatinine level elevate. Lipid profile normal.
What is the most common cast found?
A. oval fat bodies cast
B. Hyaline cast
C. waxy cast [CKD] (woman 42 yrs old, could be anorexic)
D. myoglobin cast
E. leukosit cast

50. 65 year old male came with gross hematuria. From physical examination revealed mass in
left abdomen with + ballotement. The urinalysis showed full hematuria & several RBC cast.
What do you advice to perform?
A. Repeated urinalisis
B. Renal USG
C. Abdomen ct scan (dipakai untung staging setelah confirm diagnosis keganasan)
D. Ct urography
E. Uroflowmetry

51. Cewe 31 thn, LUTS kecuali frecuency, suprapubic tenderness, leukosit 10-12, eritrosit lupa
kalo ga slh 0-2, nitrite, bakteri +, penyebabny...
A. Proteus mirabillis
B. Staphylococcus
C. E.coli
D. Streptococcus
E. Proteus mirabillis

52. Cewe 45 thn. Dia ngalamin frequency several times dan ud 3 bln ini. Urinalisis na leukosit 8-
10, eritrosis 2-4, ada leukosit esterase..
A. Stone obstruction
B. Abnormal contraction bladder
C.
D. Lung infection
E. Gastro parasir infection
53. 27 pregnant woman, leukosit +, bacteri + (UTI). Obatnya apa?
A. Amoxicilin
B. Cefixime
C. Sisanya lupa (Mungkin cefotaxime)

54. A 32 Year old came to the clinic with pain when ejaculating and slight fever. Rectal touche is
performed, bilateral prostate tenderness is found. Urinalysis show leukocyte 10-12,
Erithrocyte 0-2, positive nitrit. What is the diagnosis?
A. Prostatitis
B. Urethritis
C. Vesiculitis
D. Lupa

55. 28 woman fishy odour flour albus positif erythrocyte and leukocyte,symptoms is caused by?
A. n.gonnorhae
B. chlamydia trachomatis
C. s.aureus
D. g.vaginalis
E. p.mirabilis

56. No soal

57. A women diagnosed with ckd and diabetic nephropathy, urea 67 creatinine 2,5. Her weight
50 kg, proteinuria 5 kg/. How many protein she can consume? Kurang info Urine Output
A. 30 mg
B. 35 mg (0.6x50 + 5)??
C. 40 mg
D. 45 mg
E. 50 mg

58. A 5 year old boy with one testis was brought to hospital. Physical examination confirmed that
there was only one testis on the scrotal sac on the left side and noticed an inguinal hernia on
the right side. This abnormality is described as:
A. Epispadias
B. Hypospadias
C. .
D. Cryptorchidism
E. .
59. No soal
60. No soal

61. A patient came to OPD. Physical examination shows swelling on his hands, feet, abdomen and
face. Urinalysis shows foamy and bubbly urine. Patient is suspected to have glomerular
damage. Glomerular damage can specifically damage which of the following structure:
A. Renal corpuscle
B. Renal pyramids
C. Loop of Henle
D. Renal tubular system
E. Collecting duct

62. 65 year old male, sub febrile, right flank pain, assymetric, right kidney atrophy, on one cross
section hyalination, sclerosis. Chronic inflammatory cells on other cross section:
A. RCC
B. Chronic Pyelonephritis
C. ATN
D. TCC
E. AKI

63. Dr Tino. First year resident. Rotation in Radiology. He has difficulty using usg to locate the
kidney. What would he find?
A. Kidney at bilateral and retroperitoneal.

64. No soal

65. male 35th left flank pain repeated since 1 week. urine cloudy. blood normal. erytrocyte 20-
24, leucocyte 10-15, positif nitrit and leukosit esterase. positif oxalate crystal. single
radiograph exam as gold standard?
A. abdominal x ray
B. abdominal usg
C. IVP
D. abdominal ct scan
E. lupa

Jawaban: D
66. A 63 years old male has difficulty urinating since 2 days ago. There were severe motorcycle
before, he can't move his feet and can't feel sensation from abdomen to feet. What is his
problem?
A. Enlargement of prostate
B. Obstruction of urethra by stobe
C. Fibrosis of urethra
D. Hyperactive bladder
E. Neurogenic bladder

Jawaban ; E

67. No soal

68. 45 year old male came w fever, flank pain, dysuria. Leukocyte 25,000. Urinalysis leukocyte
20-30, erythrocyte 0-2, protein 1+. What to give him?
A. Ciprofloxacin
B. Cefixime
C. Ceftazidime (kata dr. Andree???, tp soal sblumnya ada juga yg mirip)
D.
E. wait for urine culture

Jawaban: A

69. Transitional cell Ca, less common originates at?

A. Pelvic renalis epithelial
B. Vesica urinaria epithelial
C. Calyx minor pelvic renalis epithelial
D. Proximal Ureter
E. Orificium urethra external

70. 56 yo women fatigue since 2 months ago. Has hypertension 1y ago and urolithiasis 10y ago.
Usg show ckd and kidney contract. What do u recommend:
A. Protein restriction
B. Low and medium calorie
C. High intake fat
D. High intake of trace of mineral
E. High intake of fruits

71. No soal
72. No soal
73. 43 taun, male, colicky pain 1 bulan. Renal USG shows acoustic shadow in lower pooled left
renal. Diameter 3,5cm. Treatment recommend ?
A. Lifestyle modif
B. Increase water intake
C. ESWL
D. percutaneous nephron lithotripsy
E. Observation

74. A 68 years ols male came with difficulty to start n stop urination. From rectal toucher was
found enlargement of bilateral prostate with no nodule. PSA level was 1,2 mg/ml. He has
already taken Tamsulosin 1x0,4 mg for 6 months but there was no improvement. What you
advice to him?
A. Increase dose of drug
B. Prostatectomy
C. Transurethral resection of prostate
D. Chemotherapy
E. Hormon therapy

75. A 50 yo woman came to you arthalgia on her right wrist and index finger. Shown chronic
kidney disease. On X-Ray, there is a calcification of soft tissue. What is the possible cause?
A. Metabolic bone disease
B. Arthritis rheumatoid
C. Gout arthritis
D. Pseudo-gout arthritis
E. Artherosclerosis

76. No soal

77. 67 years old woman. With uncontrolled diabetes. Take jamu pegal linu mefenamic acid &
nsaid. Tensi 150/90 Creatinin 1.7. Etiology?
A. Decrease efferent
B. Injure tubular
C. AIN
D. Increase afferent
E. Trigger glomerulus inflammation

78. No soal

79. A 24 year old man came with a complain of repeated collic flank pain at the right abdomen
since about a month ago. The ureum and creatinine were 24 and 0.6 mg/dl, respectively. The
 ultrasound imaging shows hydronephrosis dextra. What is the next step of management of
the man's problem?
A. Intravenous pyelography
B. Urinalysis
C. Magnetic Resonance Angiography
D.
E. Watch and Wait

80. 21 yo female came to clinic with several urinalysis showing microscopic hematuria. She has
done renal USG, abdominal x-ray, abdominal CT-scan and intravenous pyelography. What
should be done next? (Renal Biopsy)

81. 41 y.o female . Lab finding normal except leukosit 0-2 , yeast (+) . Advice?
A. Repeated urinalisis
B. Midstream culture
C. Usg
D. CT
E. Flurocunazole

82. Seorang wanita 40thn dtg dgn keluhan lemas dan hpertensi 160/100. Kalium 2.1 (normal)
GALS 333/333. Apa yg menyebabkan hipertensi?
A. Hiperaldosterone
B. .
C. .
D. .

83. A 67year-old male came to you with uncontrolled DM since 20 year ago. He had HT 2 year
ago. He also got increased uris acid level. The ureum and creatinine concentration were 156
and 10.5, respectively. The urinalysis showed proteinuria +3 (kyknya atau 2 ya) , eritrocyte
20-25. The patof progression?
A. Diabetic nephropathy
B. .
C. .
D. .

84. 25 y.o gross hematuriaa edema pretobial bp naik urea naik cr naikk
A. Oval fat bodies
B. Dysmorphic eritrocyte
C. Uric acid
D. Tripdle phosphate
E. Ca oxalat
85. A 35 years old female came with lower urinary tract symptoms. She was told to perform
midstream urine analysis. Which test result best confirmed the diagnosis?
A. Microorganism >1000 colonies/ml urine
B. Microorganism >5000 colonies/ml urine
C. Microorganism >10,000 colonies/ml urine
D. Microorganism >50,000 colonies/ml urine
E. Microorganism >100,000 colonies/ml urine

86. A 23 years old female admitted to the hospital with dyspneu. On physical examination her BP
was 200/120, she has edema anasarca and rales on both lungs. She never has hypertension.
She had sore throat 3 weeks ago. What is the possible mechanism?
A. Sodium excess
B. Decreased angiotensin 2
C. Increased aldosterone
D. Water retension
E. Peripheral vasoconstriction

87. A 25 years old female brings along medical record. She afraid of having kidney disease, which
exam would be the best?
A. Concentration ureum plasma
B. Concentration creatinine plasma
C. Creatinine Clearance Rate
D. Urine sediment analysis
E. Urine dip stick test

88. A 72 year old male come to your office with chief complaint decrease urination. He just have
2 days of bloody diarrhea and take 2 pills of ibuprofen to relieve his abdominal cramp. What
is the pathophysiological mechanism of this patients?
A. Pre renal azotemia
B. Intra renal azotemia
C. Post renal azotemia
D. CKD
E. GN

89. 56 tahun kena heart failure. Trus dia urine outputnya turun. Apa penyebab dari penurunan
urine output itu?
90. A 76 year old woman come to emergency for femur fracture and was given Aminoglycoside
orally. Ureum was increasing 1,8. Pathophysiology penyebab nya adalah
A. ATN
B. AIN
C. GN
D. Homosytemic renal

Random number

1. 37 yrs old man with severe hypertension. He has no familial history of hypertension. Actually
he had taken antihypertensive drug captopril 3x 25mg but the prvious dr said that he could
not take that drug anymore because make him hyperkalemic. Ureum 40 creatinine 1.3. What
is the cause of hypertension?
A. Primary hypertension
B. Hyperthyroidism
C. Heochromocytoma
D. Hyperaldosteronism
E. Renovascular dz