MDE GIS 2011

1. You deliver a newborn baby girl that has an umbilical hernia with part of another organ attached to it’s inner surface. What portion of the GIT is most likely to be attached to inner surface of the umbilical hernia?

A. anal canal

B. appendix

C. cecum

D. ileum

E. stomach

2. Where is the anatomic location of gallbladder?

A. between left and caudate lobe liver

B. between right and quadrate lobe liver

C. ligament falciform

D.

E.

5. Lateral umbilical fold and inner abdominal wall is formed by?

6. Omental bursa is continuous with?

8. Saraf yang mempersarafi abdominal wall yang mencegah direct inguinal hernia?

A.

B.

C subcostal nerve

D. 10th intercostal nerve

E.

9. Mucosal necrosis of rectum will not result from occlusion of inferior mesenteric artery. Why?

A. arterial supply to rectum is from anastomosis connection from SMA

B. arterial supply to rectum is from left colic artery with anastomoses to branches of internal iliac artery

C. IMA does not supply the rectum

D. principal branch of external iliac artery is major supply for rectum

E. middle rectal artery, a branch of internal iliac artery, supplies rectum

10. A 55 y.o. woman came with red bright blood vomit. Liver was palpated 5 cm below right costal margin. She was an alcoholic. The most possible diagnosis?

A. peptic ulcer

B. gastric ulcer

C. gastric telangiectasia

D. cirrhosis

E. hepatitis

12. Pathology within abdominal organ can occasionally cause referred pain in shoulder & neck region, C3-C5, because the diaphragm receives motor and afferent innervation from this level as a result of its cranioembriologic development. WOTF abdominal organ cause unilateral shoulder/neck pain?

A. liver, left pain

B. gallbladder, right pain

C. pancreas, right pain

D. spleen, right pain

E. appendix, left pain

15. A surgeon enterong the abdominal cavity through the abdominal wall will take care to avoid injury to the vessels and nerves within the wall. The main portion of this vessels and nerves will be found immediately deep to the?

A. skin

B. superficial fascia

C. external abdominal oblique muscle

D. internal abdominal oblique muscle

E. transversus abdominis muscle

16. As a surgeon performing an appendectomy, you encounter an artery and vein in the superficial fascia of the lower abdominal wall. These vessels most likeli the?

A. superior epigastric artery

B. superficial circumflex artery and vein

C. intercostal artery and vein

D. inferior epigastric artery and vein

E. superior epigastric artery and vein

17. During surgery, you must incise the anterior rectus sheath between the xiphoid process and the umbilicus. In this region the sheath is derived from the aponeurosis of the?

A. external abdominal oblique only

B. internal abdominal oblique only

C. external and internal abdominal oblique

D. internal oblique and tranversus abdominis

E. transversus abdominis only

18. During laparoscopic procedure, you observe the inferior epigastric vessels ascending on the posterior surface of the rectus abdominalis muscle. They suddenly disappear from view by passing superior to the?

A. falx inguinalis

B. linea semilunaris

C. falciform ligament

D. arcuate line

E. transversalis fascia

19. As a physician examining the inguinal region of a patient, the inguinal ligament will be key landmark. This structure feature is derived from WOTF?

A. superfical fascia

B. fascia lata of the thigh

C. aponeurosis of the external abdominal muscle

D. aponeurosis of the internal abdominal muscle

E. aponeurosis of the transversus abdominis

20. You are in the process of repairing a direct inguinal hernia. WOTF anatomical realtions will you find during the surgery?

A. the hernia will enter deep inguinal ring

B. the hernia will enter the femoral ring

C. the hernia will lie lateral to the inferior epigastric vessels

D. the hernia will lie medial to the inferior epigastric vessels

E. the hernia will lie inferior to the inguinal ligament

21. A 30 y.o. female present with heartburn and abdominal pain after taking a meal. Endoscopic result : ulcer at the alimentary canal area which has villi and Brunner’s gland at the submucosa. WOTF organ is mist likely as ulcer location?

A. duodenum

B. jejunum

C. ileum

D. cecum

E. rectum

22. The lumen of this alimentary canal is usually collapsed and open only during the process of swallowing and convey the masticated fod from oral pharynx to the stomach. WOTF epithelial tissue is most likely lined this mucous layer of this canal?

A. stratified cuboidal epithelium

B. stratified columnar epithelium

C. pseudostratified columnar epithelium

D. keratinized stratified squamous epithelium

E. non keratinized stratified squamous epithelium

23. A biopsy from patient with inflammatory bowel disease shows a part of mucous membrane longitudinal folds, called colums of morgagni of large intestine. WOTF is most likely portion?

A. doudenum

B. cecum

C. colon

D. rectum

E. anus

24. This organ temporarily holds ingested food, adding mucus, HCL, and enzyme pepsinogen. Muscular contraction of this organ blend this components into a viscous mixture called chyme. WOTF is correct about wall layer of this organ?

A. consist of mucosa, submucosa, muscularis, and serosa

B. consist of mucosa, submucosa, muscularis, and adventitia

C. consist of mucosa, muscularis, adventitia, and serosa

D. consist of mucosa, muscularis, perimuscularis, and serosa

E. consist of mucosa, muscularis, perimuscularis, and adventitia

25. These cells have round, basally located nuclei and cytoplasm is eosinophilic. These cells manufacture HCL and intrinsic factor into the lumen of the stomach. WOTF cells is most likely cells?

A. surface lining cells

B. mucous nek cells

C. DNES cells

D. chief cells

E. parietal cells

26. These cells which are derived from monocyte precursors, have main function to metabolize erythrocyte, digest Hb, and destroys bacteria. WOTF is most likely location of these cells?

A. duodenum

B. liver

C. pancreas

D. cecum

E. appendix

27. The inflammation of this cecum diverticulum is caused by obstruction of the lumen, accompanied by swelling and severe pain in the lower right quadrant of the abdomen. WOTF is correct about microscopic structure of this organ?

A. contains mucosal vertical folds

B. contains shallow crypts of Lieberkuhn

C. contains hemorrhoidal plexus

D. contains taenia coli

E. contains plicae circularis

28. This hollow, pear shaped organ attached to the lower surface of the liver. It main function is to store and concentrate bile and to release stored bile in response to CCK. WOTF following tissue is most likely lined the mucous layer of this organ?

A. simple squamous epithelial tissue

B. simple cuboidal epithelial tissue

C. simple columnar epithelial tissue

D. transitional epithelial tissue

E. stratified squamous epithelial tissue

29. The muscular layer of this part of alimentary canal is composed of smooth mucle fibers oriented in 3 main directions. The external layer is longitudinal, the middle layer is circular, and the internal layer is oblique. WOTF is most likely canal?

A. esophagus

B. stmach

C. small interintine

D. appendix

E. cecum

30. The main functions of this gland is to produce digestive enzymes and to secrete hormones. The presence of centroacinar cells in the center of the acinus is distinguishing characteristics of this gland. WOTF is most likely gland?

A. Brunner’s gland

B. liver

C. pancreas

D. gastric gland

E. parotid gland

31. A 27 y.o. female medical student wth irritable bowel syndrome (IBS) has an alteration in intestinal motility resulting in fluctuating constipation and diarrhea. Her condotion has worsened in the past month as the date she has scheduled for minor thesis examination. WOTF statement about small intestine motiliy is correct?

A. contactule frequency is constant from duodenum to terminal ileum

B. peristalsis is the only contractile activity that occurs during feeding

C. migrating motor complexes occur during digestive period

D. vagotomy abolishes contractile activity during the digestive period

E. contractile activty is initiated in response to boel wall distention

32. A 42 y.o. salesman presents with chief complaint of internittent misepigastric pain taht is relieved by antacids or eating. Gastric analysis reveals that basal and maximal acid output exceed normal values. WOTF subtances can cause gastric acid hypersecretion?

A. somatostatin

B. histamine

C. gastrin

D. secretin

E. enterogastrone

33. A 27 y.o. female comes to ER because of 2 day profuse watery diarrhea. Physical exam reveals dry lips and oropharynx. This patient is diagnosed with acute secretory diarrhea and dehydration, likely due to Escherichia coli. WOTF sodium reabsorption pathway is inhibited by the enterotoxin?

A. sodium-glucose coupled cotransport

B. electroneutral NaCl cotransport

C. electrogenic sodium diffusion

D. sodium-hydrogen cotransport

E. sodium-bile salt cotransport

34. A 37 yo male present with dehydration&hypokalemi with metabolic acidosis WOTF that excess fluid loss can cause acid base & electrolyte disorder?

A. stomach

B. ileum

C. colon

D. pancreas

E. liver

35. A 68 y.o. woman with rheumatoid arthritis, who has been taking NSAIDs for the past 10 years, complaints of burning epigastric pain that is relieved by antacids, but worsened with food. Her doctos discontinues the NSAIDs and starts her on cimetidine. WOTF is true regarding the pharmacological blockade of histamine H₂-receptors in the gastric mucosa?

A. it inhibits both gastrin- and acetylcholine mediated secretion of acid

B. it inhibits gastrin-induced but meal-induced secretion of acid

C. i has no effect on either gastrin-induced and meal-induced secretion of acid

D. it prevents activation of adenyl cyclase by gastrin

E. it causes an increase in potassium transport by gastric parietal (oxyntic) cells

36. A 37 y.o. with AIDS presents with a fever, anorexia, weight loss, and GI vleeding. Physical exam reveals a palpavbel abdominal mass. Endoscopy and biopsy reveal a small bowel malignancy, indicating surgical resection. WOTF most likely result in a decrease due to segment removal?

A. basal acid output

B. maximal acid output

C. gastric emptying of fluids

D. gastric emptying of solids

E. pancreatic enzyme secretion

37. A 33 y.o woman complains of abdominal cramps and bloating that are relieved by defecation. Subsequent clinical evaluation reveals an increased maximal acid output, decreased serumcalcium and iron concentrations, and microcytic anemia. Inflammation in which area of the GI tract best explains these findings?

A. stomach

B. duodenum

C. jejunum

D. ileum

E. colon

38. Gastric emptying studies performed on a 49 y.o. female reveal a time to one-half emptying of liquids is 18 min (normal 20 min) and a time to one-half emptying of solids is 150 min (normal 120 min). WOTF best explains the data?

A. increased amplitude of antral contraction

B. decreased orad stomach compliance

C. pyloric stenosis

D. sectionaing of the vagus nerves to the stomach

E. inflammation of the proximal small intestine

39. A 57 y.o. female undergoes resection of the terminal ileum as a pert of trwatment of her chronic IBD. Removal of the terminal ileum will most likely result in WOTF?

A. increased bile acid concentration

B. decreased glucose absorption

C. increased water content of the feces

D. decreased fat absorption

E. increased fat absorption

40. A 67 y.o. male with a history of alcohol abse present to the ER with severe epigastruc pain, hypotension, abdominal distention, and diarrhea with steatorrhea. Serum amylase and lipase are found to be greater than normal, leading to a diagnosis of panceratitis. The steatorrhea can be accounted for by a decrease in the intraluminal concentration of which following pancreatic enzyme?

A. amylase

B. trypsin

C. chymotrypsin

D. lipase

E. colipase

41. A patient’s abdominal pain is subdued after eating. WOTF is true regarding contraction of gallbladder following meal?

A. it is inhibited by fat rich meal

B. it is inhibited by the presence of amino acid in duodenum

C. it is stimulated by atropine

D. it occurs in response to CCK

E. it occurs simultaneously with the contraction of sphincter of Oddi

42. A 70 y.o. woman presents with abdominal pain, microcytic anemia, and weight loss. Colonoscopy biopsy confirms colon cancer. WOTF statement about the colon is correct?

A. absorption of Na in colon is under hormonal (aldosterone) control

B. bile acids enhance absorption of water from the colon

C. net absorptionof HCO₃^- occurs in colon

D. net absorptionof K⁺ occurs in colon

E. the luminal potential in colon is positive

43. An 18 y.o. college student reports that she experiences severe abdominal bloating and diarrhea within 1 hour of consuming dairy products. A subsequent H₂-breath is abnormal. The diarrhea and bloating can be best explained by WOTF?

A. a deficiency in brush border enzyme lactase

B. carbohydrate induced secretory diarrhea

C. decreased intestinal surface area

D. decreased carbohydrate absorption

E. a decrease in pancreatic secretion

44. A patient with alcoholic cirrhosis comes in vomiting blood. After stabilizing him with IV fluids, the next step should be administration of an agonist/analog that can inbhibit gastric acid secretion and visceral blood flow. WOTF is most likely agent?

A. gastrin

B. somatostatin

C. histamine

D. pepsin

E. acetylcholine

45. A patient has vomiting and severe watery diarrhea after eating fish sushi, IV fluid and electrolyte replacement was started and stool specimen was taken,which came back positive for Vibrio cholerae. Which of the following statement bst describe water and electrolyte absorption in GI tract?

A. most water and electrolyte come from ingested fluid

B. the small intestine and colon have similar absorptive capacities

C. osmotic equilibrium of chyme occurs in the stomach

D. the majority of absorption occurs in jejunum

E. cholera toxin inhibits sodium coupled nutrient transport

46. An 18 y.o. female dcides to get a tattoo for her birthday. Two months later she present with fever, right upper quadrant pain, nausea, vomiting, and jaundice. WOTF lab value would most likely be found in a patient with infectious hepatitis?

A. an increase in plasma alkaline phospatase

B. an increase in plasma bile acid

C. an increase in both direct and indirect plasma bilirubin

D. an increase in direct and a decrease in indirect plasma bilirubin

E. a decrease in both direct and indirect plasma bilirubin

For questions number 47-49 refer to the scenario below

A beggar patient had an acute onset of diarrhea and abdominal pain. The diarrhea worsened and he became weak and unable to walk. He was admitted to the hospital. Physical exam revealed the following BP 50/60 mmHg, pulse : 130/min. Lab : Hct and total serum protein was increased. Serum sodium level was normal.

47. WOTF statement that is the most appropriate explanation about elevated serum protein and Hct?

A. red cells and plasma protein become more diluted because they are ECF

B. red cells and plasma protein become more concentrated because they are not lost

C. red cells and plasma protein become more diluted because they are not move to intracellular

D. red cells and plasma protein become more concentrated because they are lost

E. red cells and plasma protein become more concentrated because they are ICF

48. Why is the blood pressure low and heart rate high?

A. decrease blood volume à decrease cardiac output à increase heart rate

B. sympathetic discharge in response to to the elevated heart rate

C. parasympathetic discharge in response to to the elevated heart rate

D. increase Hct à decrease cardiac output à increase heart rate

E. increase heart rate à decrease cardiac output à decrease blood pressure

49. If the patient was given NaCl rehydration and oral water rehydration, WOTF statement taht can explain the fall in serum sodium?

A. sodium serum is diluted

B. water continues to loss

C. serum sodium is concentrated

D. only water is given replacement

E. sodium serum is increased

50. A 63. y.o. female is diagnosed with an intractable duodenal ulcer. After consultation with a surgeon, it is recommended that she undergoes a parietal cell vagotomy. Subsequently the patient experiences nausea and vomiting after ingestion of mixed meal. WOTF best explains her symptoms?

A. increased gastric emptying of solids

B. decreased gastric emptying of solids

C. increased gastric emptying of liquids

D. decreased gastric emptying of liquids

E. increased gastric emptying of liquids and solids

51. A 75 y.o. man comes with swallowing difficulty for the past 1 month. He ia a chain smoker for the last 50 years. Endoscopy examination reveals an ilcerative mid-esophageal, 3 cm mass that partially occludes the esophageal lumen. He undergoes esophagetomy. What is the most likely pathological appearance?

A. multinucleated cell eith intranuclear inclusion

B. squamous cell carcinoma

C. dense collagenous scar

D. adenocarcinoma

E. thrombosed vascular channels

For questions number 52-53 refer to clinical scenario below

A 56 y.o. female come with hematemesis since 2 days ago. She has episodic epigastric pain, nausea and vomiting since 1 month ago. She takes NSAID for her chronic arthritis since 2 years ago.

52. WOTF defense mechanism that most likely failed to protect gastric mucosa in this patient?

A. mucus secretion of surface epithelial in duodenum

B. bicarbonate acid secretion to the surface of the gaster

C. rapid epithelial regenaration of the gaster

D. ptyalin secretion at the gaster

E. regularity of gastric emptying time

53. WOTF lesion will gastric biopsy most probably show?

A. epithelial dysplasia

B. hyperplastic polyp

C. acute gastritis

D. adenocarcinoma

E. H. pylori infection

54. A 30 y.o. has acute abdominal pain. His abdomen diffusely distended, with absent bowel sounds. He undergoes removal of 20 cm terminal ileum segment within the surgery. The pathologic examination show chronic inflammation with lymphoid aggregates and deep fissure extending into the muscularis is also seen. What is the most likely diagnosis?

A. diverticulitis

B. Crohn’s disease

C. colitis ulcerative

D. celiac disease

E. enterocolitis

55. Significant passage of meconium fails to occur after a normal birth at term. Three days post partum, the baby vomits all oral feedings. An abdominal ultrasound shows marked colonic dilatation above narrowed region shows an absence of ganglion cells in the muscle wall and submucosa. What is the most likely diagnosis?

A. duodenal atresia

B. Hirschprung disease

C. necrotizing enterocolitis

D. volvulus

E. intussuception

For questions number 56-57 refer to scenario below

A biopsy result from a 58 y.o. man with ascites shows cirrhosis hepatic appearances.

56. What is the most important histopathological finding in the biopsy?

A. hepatocyte injury with balooning degeneration

B. bridging fibrosis in lobulus and portal tract

C. massive infiltration of eosinophil and plasma cell

D. fatty liver

E. ground glass appearances of hepatocyte

57. he has a history of having blood transfusion 20 years ago. WOTF virus is the most possible etiologic agent in his disease?

A. HAV and HEV

B. HBC and HCV

C. HBV and HAV

D. HCV and HEV

E. HAV and HBV

For number 58-59, refer to scenario below

A 45 y.o. woman had abdominal cramp and diarrhea since 3 weeks ago. Stool specimen : blood, mucous, but no egg/ parasite. Symptoms periodic for the last 10 years. Colonoscopy revealed diffuse uninterrupted mucosal inflammation, superficial ulceration extending from rectum to ascending colon. Histopathology : diffuse, predominated lymphocyte infiltrate to lamina propria.

58. Diagnosis?

A. Crohn disease

B. Fat malabsorption

C. ulcerative colitis

D. ischemic colitis

E.

59. Complication of the disease?

A. carcinoma colon

B. carcinoid of rectum

C. fat malabsorption

D. pseudomonal colitis

E. lymphoma malignant

For question number 61-62, refer to clinical scenario below

A 17 y.o. man came to the hospital due to right lower abdominal pain. The doctor diagnosed that he had an acute appendicitis.

61. WOTF statement is appropriate for acute appendicitis?

A. macroscopically the appendix is pale and atrophic

B. microsopically the mucosa and serosa is infiltrated by PMN cells

C. feces is usuallu found within the appendix

D. blood smear shows monocytosis

E. macroscopically the appendix is shrunked

62. What is the most common etiology of acute appendicitis?

A. worm

B. bilestone

C. fecalith

D. bacteria

E. tumor

65. A 20 y.o. male came to hospital with chief complain of yellowish skin & eyes. Doctor suspect hepatitis viral infection. Which enzyme most effective to detect this disease?

A. ALP

B. leucine aminopeptidase

C. acid phosphatase

D. GGT

E. serum glutamate pyruvate transaminase

68. WOTF condition we can find decreased ALP?

A. obstructive jaundice

B. hemolytic jaundice

C. hyperparathyroidism

D. hyperthyroidism

E. hypophosphatemia

69. Jaundice, fever, icteric

A. acute hepatitis

B. chronic hepatitis

C. cirroshis

D. hepatic carcinoma

E. biliary obstruction

70. Patient with fever. Lab : increased unconjugated bilirubin. Diagnosis?

A. malaria

B. choledocholithiasis

C. acute hepatitis

D. chronic hepatitis

E. drug induced hepatitis

71. Urin urobilinogen will increase in patient with obstructive jaundice if there is an infection. Where is the infection in this case?

A. proximal obstruction

B. distal obstruction

C. duodenum

D. jejunum

E. colon

72. Orang yang dijadwalkan untuk gallbladder surgery. Bilirubin total 2.5 (normal <1), bilirubin direct 0.75 (normal <0.3). Kelainannya?

A. prehepatic (?)

B. hepatic

C. posthepatic (obstruction)

D.

E. prehepatic (RBC destruction)

75. Result of severe BGA, severe vomiting. pH 7.5, pCO2 55 mmHg, HCO₃^- 40 mmHg.

A. metabolic acidosis

B. respiratory acidosis

C. metabolic alkalosis

D. respiratory alkalosis

76. Examining feces from 2 y.o. boy who has acute bloody diarrhea. WOTF aspect that has inaccurate result?

A. stool stored at room temperature 24 hours before testing

B. stool collected in small container

C. stool collected in container contaminated with urine

D. stool collected in filling lid

E. stool stored at room temperature 2 hours before testing

77. A 40 y.o. man taking OTC drug medication for gastric reflux reported passing frequent black stool. FOB (-). Possible non-pathological cause?

A. gastric reflux medication containing bismuth may produce black stool

B. gastric reflux medication containing iodine may produce black stool

C. gastric reflux medication containing colchicine may produce black stool

D. gastric reflux medication containing rauwolfia may produce black stool

E. gastric reflux medication containing barium may produce black stool

80. Seorang laki-laki 34 tahun, copious diarrhea dan abdominal cramp sejak 2 hari yang lalu. Diare 10-12 kali. Diare no blood dengan mucus. Bagaimana mekanisme yang terjadi?

A. adhesion heat labile toxin

B. stimulus adenyl cyclase

C. stimulus guanylate cyclase

D. adhere and endocytosis bacteria

E. destruction of mature enterocyte

For number 83-84 refer to scenario below

A 6 month old baby had diarrhea. Temp 37.1^oC, no blood/mucus

83. Etiology?

A. rotavirus

B. adenovirus

C. salmonella

D. norwalk

E. necrotizing enterocolitis

84. Characteristic of the etiology?

87. People who attend party got sick, with vomiting, fever, headache. Consume beans, cheese cake shrimp. A 26 y.o. 2 month pregnant womanhad miscarriage ane day later. Lab test : gram (+) β-hemolytic short, rod shaped, spore forming in coleslaw. What is the cause?

A. S. aureus

B. L. monocytogenes

C. C. perfringens

D. C. botulinum

E. Salmonella

88. Boil hand, out of refrigerator, eat mayonnaise, sandwich.

A. S. aureus enterotoxin

B. coagulase S. aureus

C. S. aureus leukocidin

D. C. perfringens toxin

E. penicillinase

89. Symptoms of C. botulinum caused by food poisoning include double vision, inability to speak, and respiratory paralysis. WOTF is consistent with the symptoms?

A. invasion of the gut epithelium by C. botulinum

B. secretion of enterotoxin

C. endotoxin shock

D. ingestion of neurotoxin

E. activation of cAMP

92. PAtoent has all GI symptoms infection with Hepatitis A. History of drinking contaminated water source. Test for HAV IgG & HAV IgM (-). Which is the cause of infection?

A. HAV

B. HBV

C. HCV

D. HDV

E. HEV

93. Kecenderungan mendapatkan penyakit opportunistic?

A. TBC paru pada medical student

B. TBC paru pada chemotherapy leukemia

C.

D.

E.

95. A newborn baby has extrusion of abdominal content on her umbilical region ata right lateral side. What is her abnormality?

A. omphalocele

B. volvulus

C. gastroschisis

98. Barium enema à funnel shape appearance. What is the embryological basic?

102. The primordium of which structure is located in septum transversum?

A. dorsal pancreas

B. lung

C. liver

D. thymus

E. spleen

103. Location of Meckel diverticulum is usually at?

A. jejunum

B. ileum

C. asceding colon / descending colon

D. cecum

E. transverse colon

104. A 20 y.o. patient complains abdominal pain. Pain is releved with antacid. Mechanism?

A. HCl stimulated by histamine

B.

C.

D.

E.

105. You’re eating chocolate for snack. WOTF mechanism assure this chocholate final product absorbed in the small intestine?

A. simple diffusion

B. Na⁺ dependent co-transport

C. H⁺ dependent co-transport

D. Na⁺ independent facilitated diffusion

E. H⁺ independent facilitated diffusion

106. A young researcher assessing gallstone composition by its primary bile acid in bole. WOTF subtances that can be found?

A. deoxychlic acid

B. lithocolic acid

C. cholic acid

D. bilirubin

E. biliverdin

109. Umat muslim berpuasa selama 12 jam, kadar glukosa dalam tubuh tetap normal. Selama puasa subtansi apa yang diubah sehingga kadar glukosa darah teteap normal?

A. acetone

B. ketone bodies

C. fatty acid

D.

E.

110. A poor beggar is starvation but still alert. WOTF substances can be alternative fuel for the brain?

A. galactose

B. glycerol

C. fatty acid

D. ketone bodies

E. amino acid

114. If Rh (-) has Rh (+) fetus, there will be Rh factor antibody days after infant is born. Therefore infant would get jaundice and CNS damage. WOTF enzyme is predominantly affected?

A. Heme oxygenase

B. Bilirubin reductase

C. Bilirubin degydrogenase

D. SGOT

E. UDP-glucose dehydrogenase

115. Female, acute abdominal pain in RUQ & pain in back after consuming meal of fried chicken and cheese coated french fries. The appropriate mechanism for bile synthesis in gallbladder?

A. primary bile is synthesized by liver synthesis from cholic-deoxycholic acid

B. secondary bile is produced by conjugation of primary bile + glycin

C. 7-dehydroxilation produce secondary bile acid

D. daily bile secretion equal to bile synthesis

E. conjugated bile interact with lipid

116. Epigastic pain, didn’t relieved by eating. Take stomach pill for 1 month. Associated with the disease?

A. gastric acid + pepsin

B. gastric acid + pepsinogen

C. gastric acid + trypsin

D. gastric acid + renin

E. gastric acid + amylase

123. decrease protein à untuk decrease nitrogen

125. Antacid characteristic?

A. weak acid

B. increase acid production in stomach

C. with HCl form salt and water

D.

E.

126. What is the effects of drug interaction between antacid and other medication?

A. antacid can influence the metabolism of other drugs

B. antacid concentration is increased by other drugs

C. antacid decrease intragastric pH acidity hence influence other drugs absorption

D. antacid must be given within 2 hours with other drugs

E. long use antacid for kidney insufficiency

128. How does ranitidine work?

A. stimulate base secretion

B. exhibit competitive inhibitor at parietal cell

C. decrease base secretion

D. increase parietal cell AMP

E. have little 1st metabolism & bioavailability almost 100%

129. Obat yang mengakibatkan impotence dan gynecomastia pada pria dan galctorrhea pada wanita?

A. ranitidine

B. nizatidine

C. famotidine

D. antacid

E. cimetidine

130. Ranitidine?

A.

B. it may cause tachycardia

C. it may cause hypertension

D. it doesn’t bind to cytochrome P450

E. it doesn’t compete with other drugs

132. How omeprazole administered in our body?

A. active drug

B. inactive drug

C. active prodrug

D. inactive prodrug

E. acid labile prodrug

133. Omeprazole + diazepam?

A. omperazole hambat diazepam

B. diazepam hambat omeprazole

C. omeprazole tidak mempengaruhi

D. diazepam tidak mempengaruhi

134. Obat yang bioavailability nya paling tinggi?

A. omeprazole

B. ansoprazole

C. rabeprazole

D. pantoprazole

E.

136. Pernyataan yang benar tentang sucralfate?

A. well absorbed

B. tidak dipengaruhi absorpsinya

C. salt that sulfatized...

D.

E.

138. What is the MOA of misoprostol?

A.

B.

C.

D.

E. inhibit acidity & mucosal protective

140. A 53 y.o. woman dysphagia on chemotherapy for leukemia. Examination with?

A. videofluoroscopy

B. monometry

C. endoscopy

D. scintigraphy

E. USG

141. Laki-laki, 49 tahun, minum cairan pembesih toilet untuk bunuh diri. Initial management?

A. endoscopy dalam 12-24 jam

B. broadspectrum AB

C. corticosteroid

D. milk

142. A 50 y.o. man comes to radiology department due to barium examination. During swallowing barium found that a peristaltic and dilation oesofagus with failure to relax LES. WOTF disorder that most likely for this condition?

A. scleroderma

B. presbiesofagus

C. diffuse esophageal spasm

D. barret esophagitis

E. achalasia

143. Tes untuk mendeteksi esophageal reflux?

A. Bernstein test

B. Smith test

C.

D.

E.

144. A 53 y.o. woman came to ENT clinic with complaint of intermittent swallowing difficulty. She was diagnosed as achalasia. Most likely found on HT?

A. heart burn, epigastric & retrosternal pain after eat, husky voice, vomit

B. slowly progressive intermittent dysphagia, regurgitation, aspiration

C. dysphagia especially to raw food, heart burn

D. intermittent dysphagia, sheer emotional, chest pain

E. spontaneous regurgitation, dysphagia

149. USG : multiple gastric ulcer. Berdasarkan klasifikasi Forres, komplikasi yang paling sering adalah?

A. GI bleeding

B. peritonitis

C.

D.

E.

151. A 43 y.o. female complains vomit 1 day prior to admission. Fever 4 days ago. PE : ill, fever, slightly jaundice, epigastric tenderness, decreased bowel sound.

For 154-156 refer to scenario below

A 24 y.o. male came to ER with fever, jaundice. History of colic abdomen 3 days ago. PE : awake, BP 100/60, PR 116x/min, RR 24x/min, temp 39^oC. RUQ tenderness, normal bowel sound. Hb 14 gr/dl, WBC 20.400/mm³, PLT 212.000/mm³. Total serum bilirubin 8.5 mg/dl, conjugated bilirubin 6.2 mg/dl, SGOT 70 U/L, SGPT 85 U/L, ALP 300 U/ml, GGT 275 U/ml. Diff count 0/7/49/4/12.

154. Diagnosis?

A. acute abdomen

B. acute hepatitis

C. acute cholangitis

D. acute pancreatitis

E. acute cholecystitis

155. To confirm diagnosis?

A. USG abdominal

B. CT scan

C. plain abdominal x-ray

D. MRCP

E. ERCP

156. Etiology?

A. gallbladder stone

B.

C.

D.

E.

157. Imaging: biliary ectasis with tubular structure noted at distal of CBD. The best treatment?

A.

B. therapeutic ERCP

C. PTBD

D. cholecystectomy

E. antibiotic and antihelminthic

159. Perforating peptic ulcer cause?

163. Female. Rectal bleeding. Mass protrude when defecating. No pain. What is the diagnosis?

A.

B.

C. prolapse internal hemorrhoid

D. prolapse external hemorrhoid

E. rectal prolapse

Inability to defecate, frequent colicky abdominal pain, distended abdomen, no lump in abdominal region.

164. Diagnosis?

A. acute cholangitis with reynold’s pentad

B. acute cholangitis due to bile duct stone

C. sclerosing cholangitis

D. acute cholangitis due to ascaris

E. Mirrizi syndrome

For number 166-169, refer to scenario below

One month old baby boy came with abdominal distention and constipation since birth. He has history of delayed meconium and his nutrition status is underweight.

168. Rectal suction biopsy shows the absence of ganglion cell and the presence of hypertonic nerve trunks. WOTF contrast enema finding is typical for this disease?

A. string sign

B. funnel shape appearace

C. dilated loop

D. air fluid level

E. cupping sign

171. Which of the following about gastroschizis formation theory?

a. failure of upper abdominal fold formation theory

b. failure of lower abdominal fold formation theory

c. failure of right umbilical vein degeneration

d. right umbilical vein involution theory

e. failure of lateral abdominal fold formation

176. Non advance radiology?

A. plain abdominal x-ray

B. endoscopy

C. CT abdomen

D. MRCP

E. CT angiography

181. Sign and symptom class II hemorrhagic shock?

A. blood loss 500 ml

B. RR 30-40x/min

C. blood loss 15-30%

D. pulse rate 130 bpm

E. urine production 5-15 ml/min

182. Untuk ukur stunting?

Jawab : height for age

183. The best anthropometric index to determine obesity in children?

A. height for age

B. mid arm circumference

C. head circumference

D. BMI for age

E. skin fold thickness

186. Seorang ibu setiap kali defekasi berdarah, ada massa yang keluar dari anal, tidak sakit.

A. external hemorrhoid

B. internal hemorrhoid

C. colonic cancer

188. What is the definition of nutritional assessment?

189. What is the definition of nutritional diagnosis?

190. What is the definition of nutritional intervention?

191. What is the definition of nutritional monitoring and evaluation?

196. Mechanism for ascites in this patient?

A.

B. underfill theory

C. fluidic shift theory

D. infection

E. hyponatremia

What is the 1st imaging study that is needed for etiology of the disease?

A. plain abdominal x-ray

B. CT scan of abdomen

C. ultrasound

D. MRCP

E. ERCP