MDE DMS 2006

For question 44-47
A 35-year-old man complained thick scaling at elbow & knee area accompanied by mild otching and reddish.

44. Which of the following is likely the diagnosis?
A. Psoriasis
B. Erythroderma
C. Sun burn
D. Lichen planus
E. Dermatitis
Jawaban : A.
Pembahasan :
Psoriasis adalah kelainan kulit akibat hiperproliferasi keratosit pada epidermis, dengan ciri lesi erythrosquamous (kemerahan & pengelupasan sisik).

45. Which of the following test is appropriate to diagnose this disease?
A. Auspitz test
B. Prick test
C. Skin test
D. KOH test
E. Woods test
Jawaban : A.
Pembahasan :
Auspitz’s sign  gambaran titik perdarahan halus bila sisik diangkat dari plak psoriasis, disebabkan oleh penipisan epiddermis di atas dermal-papilae.

46. Which of the following microscopic findings is characteristic for the lesion?
A. Hyperkeratosis
B. Acanthosis
C. Dysphasia
D. Abscess Monroe
E. Hyperplasia
Jawaban : (?)  B/D.
Pembahasan :
Menurut pembahasan 1001 soal  B. acanthosis
Pendapat lain  D. abscess Monroe = kumpulan sel PMN secara fokal pada bagian parakeratosis stratum corneum, ciri khas pada psoriasis.

47. Which of the following layer of the skin is most likely to be affected?
A. Stratum corneum
B. Stratum lucidum
C. Stratum granulosum
D. Stratum spinosum
E. Stratum basale
Jawaban : (?)  A/D.
Pembahasan :
Menurut pembahasan 1001 soal  D. stratum spinosum (hiperplasia difus stratum spinosum = acanthosis)
Pendapat lain  A. stratum corneum (abscess Munroe terdapat pada stratum corneum)

48. Shake lotion refer to a vehicle mixture made from?
A. Powder and solution
B. Powder and tincture
C. Ointment and solution
D. Powder and ointment
E. Powder and ointment and solution
Jawaban : A.
Pembahasan :
Lecture Dermoterapi:
Lotion = solution + powder
Cream = solution + ointment
Paste = powder + ointment
Cold paste = solution + powder + ointment

51. Which one is correct regarding arrector pili muscle?
A. They are composed of bundles of myoepithelial
B. They help to push sebum onto skin surface
C. They have no effect on hair position on humans
D. They attach directly to the external root sheath by desmosomes
E. They contain capillary networks that nourish growing hairs
Jawaban : (?)  B/D
Pembahasan :
A. salah, harusnya smooth muscle
B. mungkin membantu mendorong sebum ke permukaan kulit?
C. salah, harusnya punya efek pada posisi rambut
D. mungkin menempel pada external root sheath, walaupun harusnya dermal root sheath
E. salah, karena tidak ada kapiler

52. Which is the function of the skin?
A. Produce vit.C
B. Produce vit.B
C. Produce melatonin
D. Secretion of hormones
E. Vit.D metabolism
Jawaban : E.
Pembahasan : sinar UV matahari mengaktifkan precursor vit.D pada kulit

53. Burn injury 1% (grade II) at left arm due to flame. Deepest layer affected?
A. Stratum corneum
B. Stratum lucidum
C. Stratum granulosum
D. Stratum basale
E. Stratum papillary
Jawaban : E.
Pembahasan :
2nd degree burn :
A. Superficial Partial Thickness  sampai upper dermis / papillary layer (+ blister, pain, moist)
B. Deep Partial Thickness  sampai lower dermis / reticular layer (+ mottled, less sensation, hypertrophic scar result)

56. D. Retinoblastoma
57. A. it occur primarily in children
Retinoblastoma is rare congenital tumor of young children
Sumber 56 dan 57: pathophisiology,Mosby
59. C. cell are polymorph
Retinoblastoma may contain both undifferentiated and differentiated elemet
Sumber: robin cotran 1442
58. C. seidel test
Seidel test is the test to indicate leakage of aquoes humour
60. B. decomposition
Decomposition is the late change in cadaver. It is start 24 hours after death
61.C. It is persist until the decomposition process start
Livor mortis will be disappear with appearance of decomposition
Sumber 60 dan 61: slide Thanatology
62. E. several vesicle must be active
Myosin dan actin sarcomerefilamentmyofibrilmuscle fiberfascicleskeletal muscle
Agar skeletal muscle bisa manghasilkan movement maka beberapa fascicle harus aktif
Sumber: tortora, 295
63. C. shape of bony component of each joint
Bentuk-bentuk tulang yang bergabung dalam membentuk sebuah sendi akan mempengaruhi jenis peregerakan dari sendi tersebut
65. D. burn grade II- III 36%
Grade of burn injury
1. 1.only epidermis without blister
2. 2.with blister: A. upper layer of dermis(papillary) berwarna pink. B. deeper layer of dermis(reticular)
3. involve all layer of dermis
4. not only the skin but also involve subcutaneous and struktur under the skin like tendon,ligament,and others
Rule of nine
1. Face and head: 9 %
2. Each upper limb: 9%
3. Each lower limb: 18%
4. Trunk : anterior 18%,posterior 18%
5. Perineum :1 %
Sumber: case review 2006 and 2007
66. A. lactate ringer
Lactat ringer is the most extensively used for rescusitation fluid to maintain intravascular volume initially after burn injury
Colloid is the protein replacement therapy. It is not administered before 24 hours after burn injry
Sumber: case review 2006,treatment of burn injury
67.B. 7200 cc in the 1st 24 hours
Parkland formula= 4 ml lactate ringers x TBSA % of burn injury x weigh in KG in the 1st 24 hours
68. B. grade IIa
Lihat penjelasan no 65
69. B. silver sulfaniazid ointment
It is the broad spectrum antibiotic fot treating burns
70. A. chest X-ray
73. B. le fort II: pyramidal fracture of maxilla
Fracture of face bone
1. Le fort I : horizontal maxillary fracture
2. Le fort II : pyramidal fracture of maxilla
3. Le fort III: transverse facial fracture
Sumber: case review 2007, facial bone fracture
74. Hemangioma:
1. Strawberry hemangioma: start appear on 3-5 week after birth,superficial lesion,elevated skin
2. Covernosus hemangioma: primarily in head and neck area,bluish red color,less distinctive border,deep lesion,spongy mass
75. D. covernosus hemangioma
Sumber 74 dan 75: andrew’s 684
76. A. observation for spontaneous regression
Sumber: andrew’s 686
77. D. serratus anterior
The function of the serratus anterior muscle: protract scapula,hold it against thoracic wall. It is innervated by long thoracic wall.
Paralysis of this muscle cause wing sacapula
Sumber : moore anatomy,752-753
78.A.tuberculous spondylitis of T12 vertebrae with neurologic deficit
79.B. spine
Tuberculous Spondylitis
80.A. Compresion of spinal cord by bony fragment
83.B. Hematogenic
84. E. DEXA
Apley’s,116
85. A. thin bone cortex,thin trabeculae,diminished number
85. B. lung
86. A.concervative
87. A. green stick fracture
Sumber: Apley’s 540
90. C
91. C
92. A
Sumber: andrew’s 803
94. B
95. C
96. B
97.E
98. B
Sumber: moore 28
99. B
100. B
102. B
105. E
106. D
107. E
Sumber: tortora 312
111. nevus
112. C
114. A
115. C
117. C
118. D
119. C
120. A
121. A
Sumber: case review 2006,clinical Finding(CF) of seborrhoid dermatitis
122. E
Sumber: case review 2006, CF of psoriasis
123. D
126.C
127. B
128. A
131. D
134. C
135. B
137. B
138. A
141. D
For question 192-195 :
A 25-year-old woman, good health, underwent extraction of impacted 3rd molar teeth. In the evening, she developed fever. 2 days later swelling of bilateral submandible. Her tongue was elevated, dyspnea, paroxysm with evidence of respiratory paralysis.

192. Which of the following spaces involved in this case?
A. Sublingual, submandibular, submucus
B. Sublingual, submental, subperitoneal
C. Sublingual, submandibular, submental
D. Submandibular, parapharyngeal, submental
E. Submandibular, buccalis, sublingual
Jawaban : C.
Pembahasan :
Kemungkinan pasien ini mengalami Ludwig’s angina, maka space yang terkena adalah : sublingual, submandibular, submental.

193. Which one is the diagnosis?
A. Osteodynitis
B. Cellulitis
C. Submandibular abscess
D. Ludwig’s angina
E. Lymphadenitis
Jawaban : D.
Pembahasan : -jelas-

194. Which of the following is the most likely to be cause of mortalitiy for above disease?
A. Asphyxia and dehydration
B. Sepsis and dehydration
C. Sepsis and asphyxia
D. Dehydration and dysphagia
E. Asphyxia and dysphagia
Jawaban : C.
Pembahasan :
Komplikasi paling sering adalah asphyxia / sulit bernafas karena pembengkakan mouth floor. Komplikasi lain adalah sepsis.
195. This patient may have risk to suffer from acute necrotizing Ulcerative Gingivitis. Which of the following factors related to this complication?
A. Poor oral hygiene, local trauma, smoking
B. Local trauma, drug, systemic disease
C. Smoking, drug
D. Drug, poor oral hygiene
E. Poor oral hygiene, smoking
Jawaban : E.
Pembahasan :
Acute necrotizing ulcerative gingivitis (ANUG) adalah infeksi progresif disertai rasa nyeri, bengkak, ulcer, & sloughing-off jaringan mati dari mulut / tenggorokan akibat infeksi gusi. Penyebabnya terutama infeksi, poor oral hygiene, stress, merokok.

196. A 25-year-old woman is 5 months pregnant had swelling at her gum at frontal region of the upper jaw since 3 months ago. The swelling was as big as a green pea. This is a reactive lesion if ginggivae composed of stratified squamous epithelium lining granulation tissue and chronic inflammatory infiltrate. What is the diagnosis?
A. Mucocele
B. Oral trush
C. Epulis granulomatosa
D. Apthous ulcer
E. Leukoplakia
Jawaban : C.
Pembahasan :
Mucocele  pembengkakan pada lower lip / buccal / tongue / mouth floor, akibat obstruksi / ruptur dari salivary gland
Oral trush  akibat candida, oral cavity keputihan
Epulis granulomatosa  tumor gusi, berupa tonjolan paling sering pada rahang atas, mudah berdarah namun tidak sakit, subtipe gravidarum
Apthous ulcer  ulcer pada oral mucosa, berupa lesi halo berwarna putih-kuning, sangat sakit
Leukoplakia  plak putih pada oral cavity, akibat merokok / alkohol


197. Fracture of the bony callus in fracture repair is followed by :
A. Hematoma formation in the middle of callus
B. Fibrocartilaginous callus formation after bone remodeling
C. Bone remodelling to convert woven bone to compact bone
D. Formation of granulation tissue to compact bone
E. Protein release from the callus
Jawaban : C.
Pembahasan :
Tahapan bone fracture repair :
Hematoma formation  Fibrocartilaginous callus formation  Bony callus formation  Bone remodelling

198. Which of the following is NOT true about hyphema?
A. Blood accumulation at anterior chamber
B. It can cause glaucoma
C. It is treated with antibiotic
D. Patient should be in bed rest
E. Topical steroid is necessary
Jawaban : C.
Pembahasan :
Hyphema = perdarahan pada anterior chamber, biasanya akibat trauma tumpul pada mata. Bisa mengakibatkan naiknya tekanan intra-okular (glaucoma). Treatment meliputi bed rest, pain reliever, tetes mata steroid untuk mencegah inflamasi, proteksi mata (coverings).