MDE DMS 2010

Sabtu, 17 April 2010

MDE DMS 2010 (BATCH 2007)

1. During insertion of an IV cannula in the median cubital vein, a patient suddenly lost his feeling on the radial side of the forearm. Which of the following nerve is the most likely injured for this case?
a. musculocutaneus N
b. superficial radial N
c. lateral antebrachial cutaneus N
d. medial antebrachial cutaneus N
e. posterior antebrachial cutaneus N

2. A saphenous cut down is a surgical procedure that involves cutting through the skin locate the greater saphenous vein. Best way to find that vessel ?
a. Anterior to the medial malleolus
b. Through the saphenous opening
c. Anterior to medial epicondyle
d. Tributaries to the posterior tibial vein
e. Subcutaneous branches of the posterior tibial artery
3. An elderly woman presented with severe pain beneath her left eye, radiating into lower eye lid, lateral side of the nose and upper lip. WOTF nerve is most likely appropriate?
a. supratrochelar
b. infraorbital
c. zygomatic
d. buccal
e. mental

4.which of the following muscle can produce the expression of grimace?
a. platysma
b. buccinators
c. zygomatic major
d. levator anguli oris
e. levator labii superioris

5. muscle yang disupply oleh medeial pterygoid nerve:
a. tensor velli palatine
b. levator velli palatine
c. palatopharyngeus
d. palatoglossus
e. uvula

6. Triangle  superior ansa cervicalis separated with hypoglossal nerve?
7. Muscle to elevate tongue?
a. medial pterygoid
b. lateral pterygoid
c. buccinators
d. temporalis
e. masseter

8. Dislocation of jaw  spasm. Which muscle injured?

9. Severe neck injury in C6. Left transverse process is fractured. Artery injured ?
a. Common carotid
b. Internal carotid
c. Vertebral
d. Costocervical
e. Inferior thyroid
10. Conus medullaris terletak di ?
a. T8-T10
b. T10-T12
c. L2-L3
d. L5-S1
e. S2-S4
11. After ramming the points of his shoulder into a practice dummy, a football player suffered a severe shoulder aeparation. The one that give the joint its greatest strength and stability?
A. supraspinatus tendon
B. coracoacromal ligament
C. coracoclavicular ligament
D. acromioclavicular ligament

12.Shoulder dislocation is always clue to injured rotator cuff muscle. Some muscle rotator the arm medially.Which nerve innervate?

13. axillary nerve injured. Otot apa yang terkena?

14. lubricants in synovial fluid?

16.The action of group contrictor pharyngeal muscle is to contrict the pharingeal cavity.Which of the following nerves is the most likely innervate that muscles?
a.Glossopharyngeal nerve
b.Spinal accessory nerve
c.Symphatetic trunk
d.Hypoglossal nerve
e.Vagus nerve

17.Irrigation of maxillary sinus through its opening is a supportive measure to accelerate the resolution of maxillary sinus infection.
Which of the following nasal spaces is the most likely approach to the sinus opening?
a. Choana
b. Inferior meatus
c. Middle meatus
d. Superior meatus
e. Sphenoethmoidal recess

18.A Six-year-old,whose medical history include a rather difficult birth, has a pemanently tilted head posture,with the right ear near the right shoulder and face turned upward and to the left.Which of the following muscles was very likely damaged during birth?
b.Anterior scalene

19.A.patient who has sustained a fracture at the base of cranium following a fall from a height, might have nerve injury.The fracture located at the foramen ovale.
Which of the following nerves that enter the foramina is the most likely injured?
a. Facial
b. Abduscen
c. Maxillary
d. Occulomotor
e. Mandibular

20.During an industrial accident, a sheet metal lacerates the anterior surface of a worker wrist at the junction pf his wrist and hand.Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb.Which of the following nerves is most likely injured?
a.Lateral antebrachial cutaneus
b.Medial antebrachial cutaneus

21.A 50-year-old male patient says that he has pain in his groin and uppert thigh.Upon examination, you palpate a lump located below the inguinal ligament lateral to it’s attachment to the pubic tubercle.You suspect that this may be a hernia.
Which of the following is the structure that passes through the hernia?
a. Femoral canal
b. Obturator canal
c. Adductor hiatus
d. Deep inguinal ring
e. Superficial ingunal ring

For 22-24
The skeletal system develops from mesenchyme, which is derived from the mesodermal germ layer and from neural crest.match the description below with the appropiate skeletal abnormality.
a. Scoliosis
b. Syndactily
c. Spina bifida
d. Acromegaly
e. Achondroplasia
22.This result from imperfect fusion or non-union of the vertebral arches
23.This is a conditiont have two succesive vertebrae fuse asymetrically or have half a vertebrae missing.
24.This is an abnormality of conversion of cartilage into bone, primarily affecting the epiphyses of long bones, in which epiphyseal growth is retarded.

25.Pattern of muscle formation are controlled by connective tisssue into which myoblasts migrate.
Which of the following pattern of muscle formation are directed by connective tissue elements derived from neural crest cells?
a. In the head
b. In the limbs
c. In tthe body wall
d. In the cervical region
e. In the occipital region

26.Pharyngeal apparatus contributes greatly to the formation of the head and neck.It consists of pharyngeal arches,-pouch,-grooves,and-membrane.
WOTF cartilage of the ear derived from pharyngeal arch 2?
a. Incus
b. Stapes
c. Maleus
d. Stapedius
e. Tensor tympany

27.If skeletal muscle is stimulated by the threshold stimulation,WOTF condition will occur?
e.Nothing happend

For no 28-33
a. Keratin alfa
b. Collagen
c. Elastin
d. Hyaluronic acid
e. Myosin
f. Actin
28.These molecules produce high tensile strength without stretch
29.These molecules produce two way stretch with elasticity
30.These molecules are the constituent of almost the entire dry weight of the hair.
31.The synthesis of these molecules requires vitamin C
32.These molecules serve as lubricants in synovial of joint

33.An 18-year old woman with chief complaint of papules on face and back, her diagnosis is acne vulgaris for lesion of the face and doctor plans to give for systemic treatment: Tetracycline 500 mg cap.orally 3 times a aday 1 hour before meal for 5 day.
Which of the following is the most likely prescription for the patient.
a. R/Tetracycline cap 500 mg No.V
S.t.d.d. cap.1.1 h.p.c
b. R/Tetracycline 500 mg cap No.XV
S.t.d.d. cap.1 1 h.a.c
c. R/Tetracycline cap No.XV
S.t.d.d. cap.1 1 h.p.c
d. R/Tetracycline cap No.XV 500 mg
S.t.d.d. 3 cap. 1 h.p.c.
E. R/Tetracycline cap.500 mg
S.t.d.d. cap. 1 h.a.c.

35.The doctor also gives erythromycin 2% cream, quantity of tube 20 gr, number of tube 1, twice daily. Whivh of the following is the most likely prescription for the patient?
a. R/ Erythromycin 2 % cream tube 20 gr. No.1.
S.b. d.d.part.dol.applic
b. R/ Erythromycin cream tube 1, 20 g.
S.t. d.d.part.dol.applic.
c. R/ 2 % Erythromycin cream 20 g tube 1
d. R/ Erythromycin cream 20 g. 2%
S d.d.part.dol.applic.
e. R/ Erythromycin 20 g.
S. b.d.d.part.dol.applic.

36. A 60 year old has moderate hypertension controlled with HCT 12.5 mg once daily and Losartan 50 mg once daily. He is prescribed Rofecoxib 50 mg once daily to control osteoarthritis pain. After 3 months of this therapy, his BP begins to rise. This increase in blood pressure is most likely due to:
a. Arteriolar contraction in the peripheral circulation caused by inhibition of COX-1 by rofecoxib.
b. weight gain caused by rofecoxib’s ability to decrease basal metabolic rate
c. Increased Excretion of HCT due to increased renal blood flow by rofecoxib
d. Inhibition of COX-2 by rofecoxib which leads to decreased renal blood flow
e. Increased metabolism of Losartan due to induction of CYP2C9 by rofecoxib

37. A 60 year old man with a history of echzema and heavy alcohol use begins taking ibuprofen to control hip and knee pain due to osteoarthrititis. Over the course of 10 months as the pain worsens, he increase her dosage to high level (600 mg four times daily). What toxicity is most likely to occur?
a. Abnormal heart rythmes
b. murotizing fasciitis
c.confusion and ataxia
d. eosinophilia
e. Gastric ulceration

38. A patient with coronary artery disease is particularly challenging anesthesia, since alteration in vascular responsiveness and myocardial function may put them at risk. In this respecet which statement correctly describes the cardiovascular action of agents that should be taken into account when planning anesthesia for such patients?
a. all halogenated hydrocarbon inhalation anesthetics sensitize the myocardium to cathecolamine induce cardiac arrhythmias
b.halogenated hydrocarbon inhalation agents reduce cardiac output equally well
c. sevoflurane directly stimulates symphatetic action
d. reflex symphatetic stimulation is a mayor component of halotane’s cardiovascular profile
e. several halogenated hydrocarbon produce vascular relaxation to renal blood pressure

39. Remifentanil has recently gained popularity as a high dose opioid anesthesia because:
a. it induce anesthesia in patient faster than any other drug
b. phenylperidine type opioids release histamine from mast cells
c. it is metabolize by non specific esterase in red cells and other tissue
d. it has long duration of action following IV infusion
e. It does not produce chest wall rigidity

40. which of hypothtetical anesthetic would you expect anesthetic partial pressure to be achieved relatively quickly?
a. an agent that is highly soluble in blood and other body tissue
b. an agent with a low minimum alveolar concentration
c. an agent with a high Oswald solubility coefficient
d. an agent whose rate of rise of partial pressure in the lung is influenced minimally by uptake into the blood, supplied as a gas rather than ???
e. an agent supplied as a gas rather than one supplied as a volatile liquid

41. which of the following opiods has analgesically active metabolite?
a. Naloxone
b. Meferidine
c. Propoxyphene
d. Codein
e. Nelmefene

42. which of the following statement about relecoxib is true?
a. it irreversible acetylates the COX-2 enzymes
b. inhibits both the inducible and constitutive COX-2 Enzyme
c. it produce no GI bleeding
d. it is indicated only for the disease , osteoarthritis
e. it increases healing of GI ulcers

43. morphine produces an analgesic effect due to:
a. a block of potassium efflux from a neuron
b. an increase in C-AMP accumulation in a neuron
c. a decrease in intracellular Ca in a neuron
d. interaction with a G-protein in the neuron
e. an increase in calcium channel phosphorylation in the neuron

44. K-opioid receptor activation is a required to observe:
a. Respiratory depression
b. bradycardia
c. myosis
d. mydriasis
e. hypocapnia

45. which of the following statements about fentanyl paths is true?
a. they produce no respiratory depression
b. they no produce no anesthesia and analgesia
c. they no produce constipation
d. they can be use during pregnancy
e. they cannot be used in ambulatory patients

46. a patient has been receiving 5 fluorouracil as a palliative for adebocarcinoma. You suspect that the patient has become resistant to the treatment. You want to understand the most likely cause of the resistance before you select another agent. Which of the following is the most likely cause?
a. drug transport into cells is decreased
b. P-glycoprotein is increased
c. the tumor can no longer activate the lung
d. the tumor is detoxifying the drug more rapidly
e. the tumor has developed an increase in metallothionein content

47. damage to the peripheral nerve motor neuron in the somatic nerves system produce:
a. high voltage and short duration potential
b. high voltage and long duration potential
c. low voltage and short duration potential
d. low voltage and long duration potential
e. silent potential

48. the period between muscle twitch IS relaxation period and during this period the one of the very important mechanism is such as follow:
a. sarcomeres shorten as result of myosin cross bridge cycling
b. Tension is reduced, muscle returns to original length
c. sarcolema and T-tubules depolarize
d. Ca released to cytosol

49. detachment of the cross bridges from actin is directly triggered by:
a. depolarization of plasma membrane
b. attachement of ATP to myosin head
c. repolarization of T-tubules
d. hydrolysis of ATP
e. calcium ions

50. prolongation of contraction with high frequency is called:
a. treppe
b. twitch
c. summation
d. complete tetanic contraction
e. incomplete tetanic contraction

51. the sac like region of the sarcoplasmic reticulum that serve as specialized reservoir of calcium ions is:
a. Triad
b. T-tubule
c. Myofibril
d. Terminal cisternae
e. Sarcoplasmic reticulum

52. select its correct definition on the term below for short, rapid contraction/relaxation cycles due to high frequency of stimulation:
a. treppe
b. fatigue
c. complete tetanus
d. incomplete tetanus
e. temporal summation

53. when movement causes someone gets fatigue rapidly, it is resulting from:
a. red muscle type of skeletal muscle
b. dystrophy muscular progressive
c. anterior motoneuron disorder
d. peripheral neuropathy
e. myasthenia gravis

For question number 54 to 56, refer to options below
Choose in correct name to each participant in the sliding filament theory:
54. has a binding site of ATP
55. responsible for disconnecting the cross bridge
56. has a binding site for calcium

57. a man came to emergency room RSHS with difficulty to lift right arm maximally. According to physical diagnostic M.deltoideus seem to be atrophy and according to EMG tracing during resting state found fibrillation potentials. What is the cause of the M.Deltoideus become atrophy?
a.myasthenia gravis
b. peripheral neurophaty
c. spinal motor neuron disorder
d. dystrophy muscular progressive

For question number 59 to 60, refer to scenario below:
A 17 year old girl come to emergency room with complained of burn injury to her body. From anamnesis, her parents said one hour before admission to the hospital, she was in the kitchen, suddenly their stove exploded. so her hair, face, and clothes were burned. She is alert, with blood pressure is 110/70 mmHg, pulse 100 times per minute, respiratory rate: 28-30 times per minute, with temperature in 370 C. there is hiperemis and blister of her skin on face, neck, and chest. And also her eyebrow and eyelash is burned.
59. How much percentage of areas affected in her body according to rule of nine and the degree of burn injury?
a. first degree, ± 14 %
b. first degree, ± 18 %
c. second degree, ± 14 %
d. second degree, ± 18 %
e. third degree, ± 18 %

60. what is the first complication ffrom this case if she was treated not properly?
a. shock.
b. airway problem
d. respiratory acidosis
e. electrolyte imbalance

For question number 61 to 62, refer to scenario below
A 25 year old come to ER with BP: 70/40 mmHg, pulse 120 bpm, RR: 26-28 times per minute and still conscious. From anamnesis, when he was riding a motorcycle with a helmet in high velocity, he collided with a car from opposite direction. There is deformity of his right thigh and leg, wound on anterior side of middle third of thigh with bone exposed. The pelvic is not stable in the examination.
61. what should you do first to this patient if he came to ER when you are in charge?
a. Reduction the bone and then immobilize it with splintage
b. do the primary & secondary survey stimultantly
c. close the wound with moist gauze
d. binding the pelvis with the sheet
e. resuscitate the circulation

62. which radiographs are required in the initial assessment of the patient?
a. AP & lateral view of thigh and leg
b. lateral view of neck, AP view of the chest, AP view of pelvis
c. AP & lateral view of pelvis, AP & lateral view of thigh and leg
d. AP view of the chest, an AP view of pelvis, AP & lateral view of thigh and leg
e. lateral view of neck, AP view of the chest, an AP view of pelvis, AP & lateral view of thigh and leg

For question number 63 to 64, refer to scenario below
A 30 year old man comes to the hospital because of an accident. When he was walking on the street, he was collided by a motor cycle from his right side. He complains about pain in his right thigh & leg, and also his right forearm. He’s alert, with vital sign in normal range. There is deformity on his right thigh, leg, and forearm with wound and bone exposed on right leg. From the X-ray is found the bone discontiunuity of middle third of radius-ulna and thigh, bone discontinuity of distal third of tibia-fibula.

63. what is the suitable first action for this patient?
a. surgical debridement in operating room
b. open reduction and external fixation
c. open reduction with internal fixation
d. irrigation for wound
e. splint the fracture

64. if there are hypesthesia of his right foot, what should we suspect to?
a. rupture of the spinal nerve
b. compartment syndrome
c. inferior aorta rupture
d. neurogenic shock
e. muscle rupture

65. the sequence of “5P” sign of compartment syndrome is…
a. pale, pain, paralysis, paraesthesia, pulselessness
b. pain, pale, paraesthesia, pulselessness, paralysis
c. paraesthesia, pain, pale, pulselessness, paralysis
d. pain, pale, pulselessness, paraesthesia, paralysis
e. pale, pain, paraesthesia, pulselessness, paralysis

66.a 34 year old man comes to your hospital with chief complaint of purulent discharge from his right upper leg for the last 6 months. There was a history of open fracture of right proximal tibia 15 years ago and undergo open reduction and internal fixation. The implant is not removed until now. The patient still able to stand and walk. There is history of fever. From laboratory findings, you found leucocytoses, elevated ESR, and CRP quantitative. From radiological findings, you found sclerotic, lytic lesion and new bone formation on right proximal tibia. What is the most possible diagnose for this patient?
a. cellulitis
b. osteosarcoma
c. septic arthrititis
d. osteomyelitis
e. non union of tibial fracture

67. A 27 year old man comes to our clinic with chief complaint of fluctuate lump on his right inguinal. There is a history of chronic back pain radiating to his right lower leg, accompanied with night sweating and decrease of body weight. There is no history of trauma before. From lab findings, you found elevated ESR. What is the most possible diagnosis for this patient?
a. malignancy of pelvic organ
b. TB spondylitis
c. scrotal hematoma
d. lympahadenopathy
e. inguinal hernia

68. An 11 year old young athlete girl under heavy training for a marathon, experiences pain on his ankle after the 4th week training. Tenderness is found in her lateral malleolus which relieved by rest. The most likely diagnosis is:
a. calcaneal spur
b. Achilles tendinitis
c. fasciitis plantaris
d.osteoarthritis of ankle joint
e. stress fracture of distal fibula

69. a 30 year old man sustained an acute injury to his left shoulder while lifting weights. He reports pain with abduction and external of the shoulder and he has weakness with the internal rotation. Inspection shows loss of contour of the axillary fold. The most likely injured structure is:
a. deltoid muscle
b.supraspinatus muscle
c. pectoralis major
d. biceps tendon
e. teres minor muscle

70. a tennis player complaints of acute weakness of abduction after hand serving with his raquets. The most likely injured structure is:
a. trapezius muscle
b. teres minor muscle
c. infraspinatus muscle
d. supraspinatus muscle
e. brachial plexus injury

71. A 20 year old man, falls onto outstretch hand, and complaints of pain on his right shoulder, on PE, the patient support the arm with the opposite hand, lateral outline shoulder flattened, a bulge felt just below the clavicle. The most possible of this kind injury is…
a. posterior dislocation of shoulder
b. inferior dislocation of shoulder
c. anterior dislocation of shoulder
d. superior dislocation of shoulder
e. clavicle fracture

72. a 20 year old man came to allergic clinic with runny nose as the chief complaint which he had already experienced since 4 years old. He also been complaining nasal blockage, itchy nose, sneezing,especially after dust inhaling. His occupation is a bus driver. PE reveals facies adenoid, allergic shiners, enlargement of inferior and mmiddle turbinate with a boggy, pale, and bluish mucosa. Laboratory studies show IgE serum 600 IU/mL. which is the most likely diagnose for this case?
a. allergic rhinitis
b. atrophic rhinitis
c. vasomotor rhinitis
d. occupational rhinitis
e. drug induce rhinitis

73. a 5 year old boy come to ENT clinic with runny nose as chief complaint since he was 3 years old. He also suffered nasal blockage, itchy, sneezing especially when he inhaled dust. On PE there was allergic shiners, Dennie-Morgan fold, pale, and bluish nasal mucosa. Lab result showed IgE serum 600 IU/mL. which of the following is the most frequent comorbidity on the pharynx in the PE?
a. Pale mucosa
b. post nasal drip
d. hyperemic mucosa
e. cobblestone appearance

74. a 21 year old afebrile man sees you for a headache. You notice he has an infected cholesteatoma in the right ear. You immediately investigate to find out if he has an obvious complication. To do this you immediately:
a. look ay his eyes with ophthalmoscope
b. senf him for a CT scan
c. send him for MRI scan
d. test his deep tendon reflex
e. have him count backward by sevens

75. you treated a 5 year old girl 2 weeks ago with an obvious bilateral acute suppurative otitis media. She improved immediately and was doing well; then her mother called you today and said the child having a little pain in the left ear again. You should suspect:
a. persistent otitis media
b. recurrent otitis media
c. sigmoid sinus thrombophlebitis
d. extradural abscess
e. mastoiditis

For question number 76 to 77, refer to scenario below
Mrs.M is 35 years old, come to ENT clinic with off and on nasal bleeding (not massive) since 2 years ago.
76. what is the most frequent lymph node location in nasopharynx tumor?
a. level I
b. level II
c. level III
d. level IV
e. level V

77. if diagnosis of this case is angiofibroma, which statement is appropriates?
a. angiofibroma only happened in female
b. bleeding in angiofibroma usually only slight
c. only happened in old male
d. usually happened in young male
e. angiofibroma metastasis quite often

78. in nasopharynx CA intracranial infiltration/ extension most frequently through..
a. foramen magnum
b. foramen ovale
c. foramen spinosum
d. foramen lacerum
e. foramen jugulare

79. The most frequent intracranial nerve damage that happened in patient with nasopharynx CA is:
a. IX
b. X
c. V
d. VI
e. VII

80. In making diagnosis of nasopharyngeal angiofibroma by clinical examination, which factor is important?
a. soft mass in nasopharynx
b. neck mass associated with mass in nasopharynx
c. hard mass in nasopharynx in 15 years old girl
d. hard mass in nasopharynx in 17 year old boy
e. mild epistaxis

81. in nasopharynx CA, extension of tumor into skull base causing N.VI paralysis is through:
a. foramen rotundum
b. foramen ovale
c. foramen magnum
d. foramen lacerum
e. foramen spinosum

82. Nasopharynx CA can cause vocal cord paralysis if it destroys
a. N.V
b. N.VI
c. N.X
d. N.XII
e. N.IX

83. area 4 in neck metastasis is:
a. jugular superior
b. submental
c. mid jugular
d. lower jugular
e. posterior triangle of the neck

86. A 45 year old man is hospitalized with diagnosis 2nd-3rd grade burn injury covering 25% of body surface, including neck, shoulders, chest, and left thigh. At risk of contracture development. Prevent musculoskeletal complication?
a. Shoulder abduction 90°, external rotation, neck extension, hip abduction, external rotation
b. Shoulder abduction 90°, external rotation, neck flexion, hip abduction, external rotation
c. Shoulder abduction 90°, external rotation, neck extension, hip abduction, no external rotation
d. Shoulder abduction 90°, internal rotation, neck flexion, hip abduction, no external rotation
e. Shoulder abduction 90°, internal rotation, neck extension, hip abduction, no external rotation
87. Burn injury 45 year old by flame, both hands. Functional problem should be thinked. Appropriate for this condition?
A. communication
B. mobilization
C. vocational activity
D. avocational activity
E. psychosocial

88.TB spondylitis , at risk ulcer development. What is the predisposing factor?
a. thick skin
b. water mattress
c. upright position
d. sensory impairment
e. always change position

88(?). Patient in rehab, at risk of pressure sores. Predisposing factors?
89.A. 55 years old woman complain about painon her both knee.She can’t stand or walk. She can’t do reguler social gathering.
From a field of medical rehabilitation, what is her main problem?
c.Self care activities
d.Vocational activities
92.What do you suggest with the goal of preventing of second disabilies and handicapped.
a.Taking anagesic
b.Range of motion exercise
c.Endurance extremities for lower extremities muscle
d.Doing high impact aerobic exercise
e.Take part in community activities

93.Secondary disabilities?
a.Osteomyelitis/ osteoatritis
b.Isolation from community
c.Contractute of knee

94. Type of bone (tibia)…
a. dense
b. woven
c. immature
d. spongy
e. cancellous

95. Which cell that involved in bone remodelling ?
a. Osteoblast
b. Osteon
c. Osteoclast
d. Osteocytes
96.Fracture pada 1/3 tibia.What type of basic tissue?
e. a.Nerve’ c.Connective tissue
f. b.Muscle d.Cartilage

98. Outer layer dari muscle?
A. sarcoplasma
B. sarcolemma
C. endomysium
D. perimysium
E. epimysium
100. a cross section muscle. How many thin filament surround each thick filament?

101.18 year old girl came to clinic with acne since 3 weeks ago.What is type of gland is associated with her problem?
a.Apocrine c.Holocrine e.Sitokrine
b.Eccrine d.Paracrine

For question number 104 to 109, refer to scenario below:
After heavy rain & thunderstorm on a mountain, a flood over flow over a river, causing a boat with with 3 passengers turned upside down. 1 week later, decomposed bodies are recovered on the riverbank, 2 male, 2 female, 1 boy, an adult skeleton, and a femur are recovered. Only 3 families claimed of losing their family member. Mrs.X and her daughter claimed the lost of Mr.X, a female reported her brother, Mr.Y. Mr.Z asked for Mrs.Z, his 3 months pregnant wife. All families brought the photographs of their loved ones.

104. Mrs. Z is better to be identified with this method…
a. autopsy
b. nuclear DNA
c. Y chromosome
d. mitochondrial DNA
e. photo superimposed

105.An easy and reliable method to estimate the boys’ age
a.Epiphiseal plate c.Weight e.Teeth
b.Skull circumference d.Height

106.The best professional to identify the skeleton is..
a.A dentist
b.An orthopedist
c.A paleontologist
d.A forensis pathologist
e.A physical antropologist
107. We can conclude positive identification based on DNA examination of victims if probability of identity least reach?
A. 100 %
B. 99,99 %
C. 99,85 %
D. 99 %
E. 98,5 %

109. Mitochondria DNA for forensic examination…
a. non mendellian mode of inheritance
b. inherited through maternal lineage
c. exist in non nucleated cell
d. non copy number

110. WOTF is the manifestation from brain stem death?
a. No pulsation
b. No breath
c. No pupil reflex

111. The doctor found Mrs. X is not breathing, pale, no pulse, purple, and stiff. What causes the skin purple?
a. erythrocyte in the lower body
b. high un-oxygenated Hb
c. low ATP
b.Perubahan epithelial kulit

112.muscke stiffness is caused by..
a.high level of CO2
b. coagulation of muscle protein
c. high level of calcium in muscle
d. inability myosin to detach from actin

113. Apa yang seharusnya dilakukan dokter umum pada mayat wanita yang meninggal karena stroke (nature)?
A. do cardipulmonary resuscitation
B. consult to forensic doctor
C. report to police
D. tulis surat kematian
E. embalm Mrs. X

114. Exercising muscle actually consists of cyclic attachment and detachment of which of the following structure ?
a. Globular head region of myosin to F-actin
b. Globular head region of myosin to G-actin
c. Helix (tail) region of myosin to F-actin
d. Helix (tail) region of myosin to G-actin
e. G-actin to F-actin
116. thick scalling on elbow & knee + mild itching + reddish. Diagnose?
a. psoriasis
b. erythroderma
c. sunburn
d. lichen planus
e. dermatitis

For question number 117 to 118, refer to scenario below:
A 60 y.o man came to the hospital with breathing difficulty and poor conditions. He said his weight loss about 10 kg in last 3 months. Cough without sputum occurred. Last month, PE was found normal vital sign, anemic conjunctivae; lung auscultation: ronchi (+) in left chest. In left extremity the doctor found 3 black nodules 2x3x1 cm in diameter, painless , wall border, left inguinal lymph node just palpable.

117. what is the possible diagnose for this man?
a. keratoacanthoma
b. melanoma maligna
c. basal cell carcinoma
d. epidermoid CA
e. squamous cell CA

118. Black nodule occure due to?
a. hemorrhagic crust
b. increase of melanocyte
c. inflammation
d. necrotic tissue
e. disturbance of lymph system

121. A 45 years old man came to the clinic with chief complaint chillness and redness. It spreads to most of his body since 6 months ago. From PE there are no lesions on his elbow and knee area. What is the predilection site area?
a. sun exposure area
b. traumatic area
c. flexor area
d. extensor area
e. neck area

122. 17 year old female, red pimples on cheek. Lesion : comedo, papule, pustule on forehead, jaw, cheek. Diagnosis?
A. common acne
B. cica...? acne
C. conglobata acne
D. comedone acne
E. papule-pustule acne
124. 30 y.o. female, long history of sexual and non-other specific complaints that shown no evidence of verifiable disease. Patient has a long history of doctor shopping. On interview, she complains of back and chest pains, dyspareunia and excessive menstrual bleeding. She also points out that “no body been able to figure out why I can’t feel anything on the back side of my arm”. Past history: multiple surgeries for abdominal complains, no findings. “I’ve always been sickly, most of my life”
a. pain disorder
b. malingering
c. hysterical personality disorder
d. somatization
e. major depressive disorder

125. a 56 year old man come to clinic with hoarseness for the last 6 months with slightly dyspnea. On PE revealed more than 1 of his vocal cord having tumor with impair mobility & 4 cm neck node in his mid jugular. No node could be detected in other part of the body. Which of the following is the most likely “T”?
a. T1
b. T1s
c. T2
d. T3
e. T4

127. lab test spondylitis TB, menunjukan:
a. ESR 12/20
b. ESR 60/90

128. running for long time will decreased ATP, molecule is used an immediate source of energy…
a. fatty acid
b. keton bodies
c. muscle protein
d. oxygen
e. creatinine phosphate

129. in osteomyelitis, the radiological feature of sequester is:
a. radioopaque surrounded by luscent shadow
b. radioluscent surrounded by radioopaque shadow
c. cannot be seen on radiology photos
d. solid radioopaque appearance
e. wide radioluscent appearance

130. what is the most possible diagnosis for lesion at epiphyse with soap bubble appearance?
a. osteoma
b. osteosarcoma
c. osteochondroma
d. giant cell tumor
e. multiple myeloma

131. a 19 year old male, came to hospital with pain at the back and unable to walk as a chief complaint. He is complained about persistent pain since 3 months ago, and concomitantly unable to walk since 1 week ago. He also complained about night sweat, loss of appetite as well as loss of body weight. He looks so skinny and both of his lower limb muscle are wasted. Laboratory revealed elevated ESR and low Hb, otherwise are normal. Vertebral X-ray revealed compression fracture at T12, with kyphotic deformity. Which of the following is the most frequent site of skeletal tuberculosis?
a. the ribs
b. the spine
c. the clavicles
d. the skull
e. the hip

132. the radiological feature of tuberculous spondylitis are:
a. destruction of vertebrae bodies
b. paravertebral abscess always exist
c. destruction of pedicles
d. on chest X-ray photo, there is always lung tuberculosis
e.used to affect cervical vertebras

133. a positive tuberculine skin test indicates:
a. no immunity to M.tuberculosis infection
b. active pulmonary tuberculosis
c. active non tuberculosis mycobacterium infection
d. prior exposure to M.tuberculosis
e. prior immunity to M. tuberculosis infections

134. the following bacteria is a gram negative cocci:
a. Staphylococcus aureus
b. Streptococcus pneumoniae
c. Staphylococcus epidermidi
d. Neisseria gonorrhoe
e. Haemophilus influenza

135. The primary stain of the acid fast stain procedure is:
a. methylene blue
b. carbol fuschin
c. acid alcohol
d. crystal violet
e. safranin

136. A 9 year old boy came to a dentist for a routine dental examination. The dentist found that he has caries at most of his teeth. The dentist also notes that his oral hygiene is poor, as a possible cause of the caries. The other cause of caries is a bacterial multiplication at oral cavity. Bacteria responsible for this condition:
a. Streptococcus haemolyticus
b. streptococcus mutants
c. staphylococcus epidermidis
d. staphylococcus aureus
e. staphylococcus haemolyticus
137. a 42 year old man has visited the ophthalmologist. He complained about watery discharge from both eyes, which become puffy and red. What is the most likely microorganism cause his condition?
a. bacteria
b. virus
c. arthropoda
d. fungi
138. gram stain is probably the most important and widely uses microbiological differential stain. Reagents that use in gram staining procedure are crystal violet, gram’s iodine, safranin, ethyl alcohol 95 %, and water as well. Which of the following part of bacterial cell that makes the difference?
a. cytoplasm of the bacteria
b.cytoplasmic membrane
c. periplasm
d. peptidoglycan layer
e. lipopolysaccharida layer

139. the acid fast stain is a differential staining method, is used to distinguish certain bacteria that contain a high content of mycolic acid in their wall. Which of the following is the most primary stain in this staining method?
a.methylene blue
b. carbol fuschin
c. malachite green
d. safranin
e. acid alcohol

140. a 19 year old male came to health center because of pain, redness, and tenderness of the eye lid margin and then followed by a small, round, and tender area of indurations. He also felt a foreign body sensation, lacrimation, and photophobia. The doctor in charge diagnosed the disease as styes. In the gram staining preparation, those bacteria appear as:
a. gram +, coccus, in chain
b.gram +, coccus, in cluster
c. gram +, coccus, in pair
d. gram -, coccus, in pair
e. gram -, rod, in chain

141. some bacteria produce an internal structure known as endoscope. This structure is produce by the vegetative cells by process called sporogenesis. Which of the following is the most likely bacteria produce such structure?
a. Mycobacterium tuberculosis
b. Chlamydia trachomatis
c. Pseudomonas aeruginosa
d. Clostridium tetani
e. Proteus vulgaris

142. which of the following is the function of the skin?
a. production of vitamin C
b. production of vitamin B
c. production of melatonin
d. secretion of hormones
e. Vitamin D metabolism

143. which one of the following statements is mainly for the fracture repair?
a. osteoprogenitor cell in outer circumferential lamellae
b. osteoprogenitor cell in inner circumferential lamellae
c. osteoprogenitor cell in interstitial lamellae
d. osteoprogenitor cell in harvesian system
e. osteoprogenitor cell in endosteum

144. formation of the bony callus in repair is followed by:
a. hematoma formation in the middle of callus
b. fibrpcartilaginous callus formation after the bone remodeling
c. bone remodeling to convert woven bone to compact bone
d. formation of granulation tissue to compact bone
e. protein release from the callus

147. sel apakah yang berperan dalam growth & bone repair?
a. osteoprogenitor sel di periosteum
b. osteoblast sel di periosteum
c. osteoclast sel di periosteum
d. osteocyte sel di periosteum
e. fibrocyte sel di periosteum

148. What is the MOST effective treatment of milliaria?
a. put the person in hot environment
b. put the person in cool environment
c. put the person in non air conditioned room
d. avoid using rotating fan
e. avoid bathing

149. Psoriasis is a disease with…
a. Mycobacterium tb infection
b. Skin lesion usually on sun exposure area
c. Caused by
d. Psoriasis usually uncommon
e. Salah satu komplikasinya erythroderma

151. Found erythematous macule
A. change skin thickness
B. change skin surface
C. color
D. humidity
E. texture

152. What is likely to cause the case (erythroderma)
A. psoriasis vulgaris
B. eczema
C. seborrheic dermatitis
D. erythema multiforme

153. a girl 17 y.o., punya pimples di both of her cheeks. Dia jarang pakai kosmetik. PE menunjukan papules, comedones, pustules. Diagnose?
a. common acne
b. conglobata acne
c. comedone acne
d. papullo-pustule acne

154. 19 years old boys is hospitalized. Anamnesis from his mother revealed he had pimplies 3 days ago, and he was given cream from his friend. PE: decrease consciousness, BP: 120/90, HR: 100 BPM, RR: 24, Temp: 40.30 C. Red papules (+), stiff neck (+). Which of this treatment is suitable for him?
a. on the ward
b. on the ward with special caution
c. ICU
d. isolation room
e. isolation room in ICU

155. Shake lotion mixture from…
a. Powder and lotion
b. Powder and tincture

158. a 45 y.o man complains of chronic cough for the last 2 months. Doctor give PPD 5TU test and result confirm he got TB. Principle of this test?
a. hypersensitivity
b. humoral mediated sensitivity
c. erythema & induration caused by neutrophil
d. CD4+ T lymphocyte isn’t involved
e. skin reaction requires 24-48 Hours to develop following antigen challenge

159. a 30 year old male is suffering exfoliative dermatitis. What lab result do you expect?
b. high level of IgM
c. hyperalbuminemia
d. (+) nitrogen balance
e. anemia

160. 25 year old man came to clinic, chief complaint reddish plaque, plaque, pruritus on entire body + chillness since 1 months ago, started on knees, elbow, and buttock. Lesion have large scalling that exfoliated profusely. Microscopic findings from skin biopsy : epithelial hyperplasia, hyperkeratosis, parakeratosis, spongiosis. What is the diagnose?
a. erythema multiforme
b. lupus vulgaris
c. psoriasis vulgaris
d. bullous pemphigus
e. pemphigus vulgaris

161. Hyperpigmentation without any sunlight protection,growth hyperplastic in solid arrangement
A. epidermoid cancer
C. melanoma malignant
D. nevus dermal
E. lentigo
162. 25 years old woman, good healthy, 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. Which of the following spaces involved in this case?
a. sublingual, submandibular
b.sublingual, submental
c. sublingual, submandibular, submental
d. submandibular, submucus
e. submentalis, buccalis

163. a 28.y.o woman admitted to hospital complaining of pain and firm massive mass swelling in lower right jaw. Radiographic feature: large multioculer cyst contained with unerrupted mandible 3rd molar. Body temp: Normal. Microscopically there is islands of cells which were growing through stroma. Diagnose?
a. Ludwigg angina
c. mandible osteosarcoma
d. odontoma
e. sory lupa..

164. in the dental clinic at OPD of hospital X, you see a young lady at her twenties already seated on a dental chair. Result of her examination:
- general condition: conscious, pale, body temperature 390C
- extraoral : edema of tissue along the lower jaw area up to the chin forming a bull neck appearance.
- the neck area is hard and tense as a massive board, as well as shiny and reddish.
- intraoral : tongue is noticed pushed upward and trismus was clearly detected. Deep caries of the 3rd mandible molar was obvious. A complete history of treatment of the tooth was never been achieved.
For caries to occur, the following factors must exist:
a. susceptible host and microorganism
b. susceptible host, microorganism, and time
c. susceptible host, microorganism, time, and substrate
d. susceptible host, microorganism, time, substrate, and saliva
e. susceptible host, microorganism, time, substrate, saliva, and demineralization of the tooth structure

165. 40 y.o. man, teeth mobility at anterior lower jaw Since past 4 months. Pain (-), gum easily bleed esp. when brushing teeth. Clinical exam: many plaque and calculus, supragingival, subgingival, gingival recession at anterior region. Radiological :alveolar bone loss. Diagnose?
a. Chronic gingivitis
b. chronic periodontitis
d. juvenile periodontitis
e.periodontitis abscess

168. A 15 y.o. female has a black wart on his upper lips as large as corn seed since 10 years ago. Histopathological examination of the tumor shows plump cells under the squamous epithelial cells. Some of the cells contain melanin. Which of the following diagnosis is the most likely?
a. blue nevus
b. nevus sebaceous
c. compound nevus
d. junction nevus
e. intradermal nevus

169. Vertebral deformity, vertebral destruction. WBC infiltration. Necrosis : epitheloid langhans cell. Apakah itu? Spondylitis TB.
170. A 25 y.o. 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 of gingival composed of stratified squamous epithelium granulatum tissue and chronic inflammatory infiltrate. What is the diagnose?
a. mucocele
b. oral thrush
c. epulis granulomatosa
d. aphtuous ulcer
e. leukoplagia

172. soalnya lupa… tapi carcinoma yang ada gambaran histopatologis pallisading nuclei..
a. BCC
b. SCC
c. malignant melanoma
d. nevus pigmentosus
e. vervucuous vulgaris

174. which of the following statement is Strongyloid stercoralis life cycle?
b. skin penetration-lung-adult in intestine-egg-rhabditiform-filariform-autoinfection, direct and indirect developmental external environmental.

177. 35 y.o. farmer suffered from snake bites on his right foot. Two hours later the wounds swollen and bleeding and is difficult to stop. He also experience double vision and difficulty to close his eye lids. Which of thee following is the life threatening condition as neurological complication?
a. renal failure
b. respiratory failure
c. hypovolemic shock
d. cardiogenic shock
e. compartment syndrome

181. 35 y.o. former suffered from a snake bite on his right foot also experience double vision & difficult open eyelid mechanism.. kenapa bisa kaya gitu?
a. paralysis CN
b. destruction CN
c. demyelination CN
d. blockade NMJ
e. rhabdomyelisis

182.pasien 2 tahun dengan cleft lift and palate.Trdap hypernasal voice dan articulation disturbance.disability in this patient? Speeh disturbance

183. The best wound closure is by:
a. spontaneous closure
b. secondary closure
c. primary closure
d. delayed primary closure
e. epithelialization

185)burn-head & neck;half of right arm,chest & abdomen,fully right thigh
A)degree 2 – 32% D)degree 2-3 – 45%
B)degree 2 – 46% E)degree 2 – 48%
C)degree 2-3 – 38%

186)10y.o,asymmetry of shoulder,diagnosis-idiopathic scoliosis,thoracolumbar area,25 degree,when do you treat scoliosis of spine with braces :
A)patient is still growing D)when complication to other organ
B)patient reaches adulthood E)patient has many complain
C)when spine unbalance

187)the most possible diagnosis for lesion at epiphysis with soap bubble appearance:
A)osteoma D)giant
B)osteosarcoma E)multiple myeloma

188)male come to emergency 2 hours after burn injury,burn at face,neck,whole right arm abdomen,chest & inguinal,how long burn at whole right arm can heal?
A)2-3 weeks D)10 weeks
B)>3 weeks E)1 week
C) >3 months

189)1 y.o girl,comes to outpatient clinic with the red spot in the left upper eyes.the diameter is 3 cm,soft elevated from the skin,compressible,popular lesion with sharp was a pin point red spot at birth.which is most likely diagnosis of the patient :
A)port wine stain D)cavernous hemangioma
B)strawberry hemangioma E)mixed hemangioma
C)nevi flammers
190.Farmer with corneal ulcer on right eye.We want to determine the etiology of ulcer scrapping. We give natamycin.
Microorganisme yang paling sering ditemukan?
a. Gram rod
b. Gram – coccus
c. Hyphae
d. Tropozoid
e. Cyts

191. a 20 year old had motor vehicle accident.He complaint about pain and sweeling.Ada blurred vision.Ophthalmic exam: reduce tension eyeball as well as shallow anterior chamber.
Pemeriksaan apa yang tepat untuk pemeriksaan mata?
a.flourescin test
b.Schrimer test
c.Seidel test
d.Shellen test
e.Anell test

192. Management corneal ulcer?
193. Optic lens origin?
195. Ion  fundamental basis for local anasthetic for dental procedure?
196.Vasontrictor yang sering digunakan untuk menghambat penyerapan/penyerapan anesthesia?
a.Coccain c.Dopamin e......
b.Epinephrine d.....

198. Regiment anti TB?
199. a 19.y.o girl, have an accident. She has fracture in her Radius. Callus dalam bone healing terbentuk dalam fase apa?

200. a 19 y.o. man come to health center because of pain, redness, & tenderness of the eyelid margin and then followed by small, round, and tender area of indurations. He also felt a foreign body sensation, lacrimation, & photophobia. The doctor in charge diagnose the disease as styes. Which of the following is the most etiologic agent?
a. streptococcus mutants
b. streptococcus pyogens
c. staphylococcus aureus
d. neisseria gonorrheae
e. pseudomonas aeruginosa

?? seorang pemain bola tertendang pada bagian kaki anteriornya,, terbentuk hematoma pada anterior compartmennya,, gejala klinis yang dapat timbul:
a. loss sensory of foot
e.foot drop

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