Departemen Akademik FK UNPAD 2007

MDE GIS 2011

2011-06-22T07:13:00.000-07:00

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

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?

C subcostal nerve

D. 10th intercostal nerve

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

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)

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

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

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

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

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?

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

136. Pernyataan yang benar tentang sucralfate?

A. well absorbed

B. tidak dipengaruhi absorpsinya

C. salt that sulfatized...

138. What is the MOA of misoprostol?

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

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

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

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

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?

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?

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

MDE RESPI 2010

2011-06-22T07:12:00.000-07:00

2. Result of hearing test on the left ear of the boy?

A. conductive hearing loss

B. sensorineural hearing loss

C. mixed hearing loss

D. no hearing loss

3. A 38 y.o. woman. Symptoms : headache, facial pain, nasal purulent drainage, persisted 3 weeks following upper respiratory infection. PE : head and neck normal except nasal exam showing septum ildly deviated to the left. Nasal endoscopy : inflammatory changes with edema & purulent from both left and right middle meatus. Initial treatment?

A. chlarythromycin

B. amoxicillin

C. ciprofloxacin

D. levofloxacin

E. cephalosporin

9. A 4 months old child. Stridor for 2 months. His mom said that his condition improves in prone position. Diagnosis?

A. laryngocele

B. laryomalacia

C. vocal cord paralysis

D. subglottic stenosis

E. foreign body aspiration

10. Inspiratory stridor is caused by obstruction in?

A. subglottic

11. Origin of infection in lateral pharyngeal space?

A. soft palate

B. mastoid

C. tonsil

D. neck

E. floor of mouth

12. A 10 y.o. boy came to ENT clinic with CC of decrease in hearingon the left ear since 2 weeks ago. This condition is not accompanied by pain in the ear, febrile, or otorrhea. From the otoscopy right ear normal, on the left ear there is normal acoustic canal with intact tympanic membrane and there is bubble sign in the tympanic cavity. The most likely diagnosis?

A. external otitis

B. acute OM

C. chronic OM

D. serous OM

E. malignant otitis externa

18. Biopsy lymph node : caseous necrosis , granulomatous, Datia langhans cell.

A. non-hodgkin lymphoma

B. hodgkin lymphoma

C. tubercle

20. Nutrition for COPD?

A. adequate protein, ↑ lipid, adequate CH

B. 20% protein, 25% lipid, 55% CH

C. 10% protein, 50% lipid, 40% CH

D. adequate protein, ↑ lipid, ↓ CH

E. 15% protein, 30% lipid, 55% CH

23. WOTF will protect against lung tissues destruction in COPD?

A. epinephrine

B. glucagon

C. cortisol

D. retinol

E. adrenaline

25. Respon pasien terhadap dyspnea di atas adalah

C. kussmaul breathing

E. shallow breathing

A 29 y.o. man. SOB, cough, yellowish sputum. History of DM. PE : RR 30x/min, T 38^oC, BP 130/80 mmHg, rhonchi (+), wheezing (-), blood glucose 276 mg/dL, chest x-ray infiltrate (+).

29. WOTF is the metabolism of the lung in the patient?

A. ↑ production of glucose in the lungs as the major site of blood glucose production

B. ↑ lung compliance

C. involved in removal of serotonin, prostaglandin, and leukotriens

D. type I cells produce surfactant

E. ↑ pH in lungs

34. PaO₂ 45 mmHg, PaCO₂ 37.5 mmHg, pH 7.4. Condition?

A. baik2 saja

B. respiratory acidosis

C. hypoxia tapi tidak acidosis

D. respiratory alkalosis

E. hypoxia tapi tidak alkalosis

44. WOTF disease is caused by this anomaly?

A. sinusitis

B. pneumonitis

C. esophagitis

D. gastritis

E. candidiasis

45. Premature baby girl, D/ : RDS. WOTF appropriate with her condition?

A. surfactant increase surface tension between air-alveolar septa

B. terminal saccular phase begins at 18 weeks

C. surfactant is produced by type ! cell

D. sufficient surfactant 24-26 weeks

E. the baby has sufficient surfactant since terminal saccular period

48. A 20 y.o. male has asthma experience nocturnal symptoms 4x/week, daily symptoms 3x/week. Category?

A. mild intermittent asthma

B. moderate asthma

C. severe asthma

D. status asthmatic

52. Gejala TB à antibiotic but no improvement. Past history : treatment TB 6 month, completed and cured. Patient status :

A. new patient

B. relapse

C. failure

D. default

E. transfer in

62. Criteria for hospital acquired pneumonia

A. >24 hours after admission

B. >36 hours after admission

C. > 48 hours after admission

D. >60 hours after admission

E. >72 hours after admission

68. A 29 y.o. HIV patient was brought to the hospital with a week long history of fever, SOB, dry cough. Exam revealed fever and mild tachypnea. Sputum specimen was taken and the result of microscopic exam with india ink show yeast cell with capsule surrounding the cell. WOTF pathogens?

A. Cryptococcus neoformans

B. Blastomyces dermtitidis

C. Pneumocystis jirovecii

D. Histoplasma capsulatum

E. Aspergillus fumigatus

70. A 47 yo.o. male farmer complained cough for almost 2 months. AFB was found in sputum smear. Two years ago he had been treated for lung TB and his doctors declared that he was cured. Which of the following antiTB regiment is the most appropriate for this case?

A. streptomycin, INH, rifampin, ethambutol

B. rifampin, INH, ethabutol, pyrazinamide, streptomycin

C. rifampin, pyrazinamide, INH

D. rifampin, streptomycin, ethambutol, pyrazinamide

E. INH, pyrazinamide, ethambutol, ciprofloxacin

71. Ms Elsa 17 y.o. female, a high school student, came to you due to SOB. She usually feels her SOB between midnight to early morning and she feels about 3x a week and sometimes accompanied with cough. Sometims she was absent from school because of her symptoms. On chest exam you only heard wheeze and others were WNL. Which is the diagnosis?

A. COPD stage I

B. COPD stage II

C. mild persistent asthma bronchial

D. severe persistent asthma bronchial

E. moderate persistent asthma bronchial

72. A 65 y.o. man with COPD stage III and a 23 y.o. woman with asthma bronchial moderate persistent. Both were take inhalational corticosteroid. While the woman gains improvemet from this therapy the man is not. Possible explanation?

A. gender difference

B. difference in age

C. difference in spirometri result

D. difference in risk factors

E. difference in inflammatory cells and mediators

73. A 20 y.o. male complained of persistent nasal discharge. This nasal discharge was yellowish and thick. Past history, he had nasal itchy and nasal obstruction when the weather is cold. On water’s film, there’s clouding in maxillary sinus. WOTF is most likely diagnosis?

A. tumor of right maxillary sinus

B. right hematosinus

C. acute sinusitis

D. chronic sinusitis

E. mucocele

74. On PA chest film, there is a cavity in the apical parts of left upper lobe, the wall of cavity is thick and surrounded by patchy consolidation.WOTF is best feature that has been described?

A. lung abscess

B. pulmonary cyst

C. mycetoma in a caity

D. cavitating tumor

E. the cavity of pulmonary TB

For question no. 75-76 refer t the clinical scenario below

A 10 y.o. girl admitted to peaditric clinic with CC difficulty of breathing (dyspnea) since 7 days ago. This complaint was accompanied by cough and high fever. In AP chest x ray, there is a homogenous lung opacification with air bronchograms in the lateral segment of the lung.

75. The segmenta homogenous lung opacification with air bronchograms is

A. an atelectasis

B. a pleural effusion

C. a pneumonia

D. a schwarte

E. a bronchopneumonia

76. This disease begin as a localized infection of

A. terminal air spaces

B. terminal bronchioles

C. respiratory bronchioles

D. acinus

E. interstitial

For question number 77-78, refer to the clinical scenario below

A 25 y.o. female comes to pulmonbary clinic. The patient is coughing more than 3 weeks and accompanied by the production of purulent sputum, night sweats, weight loss, anorexia, general malaise, and weakness.

77. What is the basic standard radiograph for any patient presenting with a cough more than 3 weeks?

A. PA chest film

B. oblique chest film

C. left lateral decubitus film

D. apical lordotic film

E. AP chest film

78. What is the best radiograph for showing the presence of small pleural effusion?

A. lateral decubitus film

B. PA chest film

C. lateral chest film

D. AP film

E. apical lordotic film

79. In PA chest x-ray, there is only calcification on the apex of left lung. It is not clear if there are patchy consolidation in the apex of both lungs, because the clavicles and the ribs overlap with the apex of both lungs. What is the best radiograph for showing the presence of minimal patchy consolidation in the apex of the lungs?

A. oblique chest film

B. left lateral decubitus film

C. apical lordotic film

D. Ap chest film

E. lateral chest film

80. WOTF statements is related to acute exacerbation of asthma?

A. mucous secretion is ↓

B. the peak expiratory flow is ↑

C. the forced expiratory volume in one second is ↓

D. there is no mucosal edema in the airway

E. bacterial infection may be act as trigger

81. Lobar consolidation with positive air bronchograms can be found in?

A. pneumonia

B. pleural effusion

C. atelectasis

D. bronchopneumonia

E. schwarte

82. This cavity is divided by the cartilage and bone septum into 2 bilaterally symmetric cavities that open to the exterior through the nares. Each cavity consists of 2 chambers, anterior and posterior. WOTF statements is correct about anterior portion of this cavity?

A. lined by simple cuboidal epithelium

B. has goblet cells

C. has sweat bodies

D. no sweat glands

E. has sebaceous gland

83. A 20 y.o. male come to the doctor because of facial pain since 3 days ago. He als complains head ache and nasal obstruction. Water x-ray shows air-fluid level at roght maxillary sinuses. WOTF statements is correct about structure that involved in this case?

A. stratified squamous non keratinized epithelium

B. stratified squamous keratinized epithelium

C. stratified columnar epithelium

D. pseudostratified columnar epithelium

E. stratified cuboidal epithelium

84. This irregular space lies in the interior of the temporal bone. It communicates anteriorly with the pharynx via the auditory tube and posteriorly with the mastoid process. WOTF specialized tissue is most likely lined the mucous layer of this space?

A. stratified squamous epithelium

B. pseudostratified columnar epithelium

C. stratified columnar epithelium

D. simple squamous epithelium

E. simple cuboidal epithelium

89. Lung is covered by 2 layers, inner thorax and outer lung. Between 2 layers, it is lined by lubricating film. What is the epithelial tissue lining this part?

A. simple squamous

B. simple cuboidal

C. stratified squamous

D. pseudostratified columnar

E. stratified columnar

93. A 30 y.o. man get trauma, bleeding from the nose for 30 minutes. Anterior pack did not help.

A. anterior epistaxis

B. posterior epistaxis

C. trauma at nose

D. trauma at maxillary

103. inhaled a peanut, nyangkut di?

A. left bronchus

B. left segmental bronchus

C. right bronchus

D. right lower segmental bronchus

E. right upper segmental bronchus

114. A 20 y.o. man came to ER department with SOB, shoulder blades and fatigue suddenly when he was watching television. He also looks pale. Chest x-ray revelaed a 55% pneumothorax of the right lung due to rupture of bleb on the surface of the lung. WOTF statements is the most appropriate for his condition?

A. the chest wall on the affected site recoils inward

B. the V/Q ratio on the affected site is higher than normal

C. the mediastinum shifts further to the right with each inspiration

D. the intrapleural pressure in the affected area is equal with atmospheric pressure

E. there is a hyperventilation of the affected lung

115. A 60 y.o. man have dyspnea. The diffusing capacity of the lung is increased. WOTF conditions best accounts for an increase in diffusing capacity?

A. fibrotic lung disease

B. pulmonary embolism

C. hyperventilation

D. pulmonary hypertension

E. polycythemia

116. A 20 y.o. medical students doing weight training and jogging. WOTF statement is most appropriate?

A. ↓ pulmonary blood flow due to ↓cardiac output

B. ↑ diffusing capacity due to hyperventilation

C. ↑ airway resistance due to hyperventilation

D. ↑ pulmonary vessels resistance due to ↑ pulmonary blood flow

E. ↑ diffusing capacity due to ↑ pulmonary blood flow

117. WOTF is higher at total lung capacity than it is at residual volume?

A. airway resistance

B. lung compliance

C. alveolar pressure

D. anatomical dead space

E. intrapleural pressure

118. An arterial blood gases result from a patient with comatose revelaed hypercapnia. WOTF is the most likely cause of the high arterial pCO₂?

A. prolonged hypoxia

B. depression of respiratory center

C. ↑ alveolar ventilation

D. ↓ metabolic activity

E. obstruction process of expiration

119. A 20 y.o. man came to his family doctor because he has cough without sputum for the last 2 weeks. WOTF most likely happened in this young man?

A. foreign matter irritate nasal pathway

B. the chemistry corrosive matter destroy the alveoli

C. he inspired 2.5 L air while he was cough

D. afferent nerve impuls through vagus nerve

E. automatic sequence triggered by strong compression of the lung

120. A 16 y.o. woman with recurrent SOB accompanied with cough and wheezing. Her parents has history of asthma. She is already taking bronchodilator agent for her condition. The doctor said taht she should do some aerobic exercise as part of her treatment. WOTF statement that most be affected if she has regular aerobic exercise?

A. tidal volume

B. residual volume

C. forced expiratory volume

D. residual capacity

E. inspiratory capacity

121. A 70 y.o. woman with SOB is referred for pulmonary function testing, including lung volumes, flow volume curves, and lung compliance. WOTF statements best characterizes pulmonary compliance?

A. it is equivalent to ΔP/ΔV

B. it is inversely related to the elastic recoil properties of the lung

C. it decreases with advancing age

D. it increases when there is a deficiency of surfactant

E. it increases in patients with pulmonary edema

122. A marathon athlete undergoes pulmonary exercise prior to next exercise program. WOTF occurs during anaerobic exercise?

A. ↓ of blood lactate lead to ↓ of blood pH

B. ↑ of blood lactate due to proportional ↑ of alveolar ventilation

C. ↑ of blood lactate lead to ↓ in blood pH

D. ↑ of oxygen consumption lead to hyperventilation

E. ↓ of blood pH due to increase of alveolar ventilation

123. A patient with congestive heart failure, orthopnea, and paroxysmal nocturnal dyspnea is referred for pulmonary function testing in the supine and upright position. WOTF is higher at the apex of the lung than at the base when a person is upright?

A. ventilation

B. blood flow

C. V/Q ratio

D. PaCO₂

E. lung compliance

124. A young lady becomes very anxious and increase her rate of ventilation. If her rate of CO₂ production remains constant WOTF will decrease?

A. ↓ PaCO₂

B. ↑ PaO₂

C. ↑ V/Q

D. ↓ PaO₂

E. ↓ kPO₂

125. A child has SOB with cyanosis. WOTF statements that most likely for this child condition?

A. excessive amount of deoxygenated Hb

B. excessive profound hypoxemia

C. excessive demand of oxygen

D. excessive amount of carbondioxide

E. excessive amount of carbaminoxide

126. A professional athlete undergoes exercise program to exceed his anaerobic threshold. WOTF is increased as a result of the exercise program?

A. ↑ stimulation to brainstem to ↑ alveolar ventilation

B. ↑ alveolar ventilation resulting in ↑ of PaO2

C. ↑ alveolar ventilation resulting in ↓ of PaCO2

D. ↑ aerobic respiration resulting in ↑ blood lactate

E. ↑ oxygen demand resulting in ↑ of respiratory rate

127. A 34 y.o. man came to the PHC due to cough with bloody sputum. The symptom was felt for the last 3 months, it became worst now. He has consulted to a doctor and he was given 4 drugs which should be taken for 6 months but he stopped taking it just after 2 weeks. What is the most appropriate reason for this long period treatment?

A. microorganism is AFB

B. microorganism is survive in a dormant state

C. microorganism has thick and complicated wall

D. the patient was default the treatment

E. the patient is categorize I

128. A 23 y.o. man came to the doctor complaining poor performance in red-green color vision discrimination leading to fail in getting drive license. On further history taking, he is taking a four regiment drug for pulmonary TB. What is the most likely drug hw took?

A. ethambutol

B. isoniazid

C. pyrazinamide

D. rifampin

E. streptomycin

129. A 38 y.o. man TB patient is given oral antiTB drug. One week later he complained that his urine color become reddish. What is the most likely drug he took?

A. INH

B. rifampin

C. streptomycin

D. pyrazinamide

E. streptomycin

121. A 70 years old woman come into the clinic with shortness of breath. A pulmonary function test was ordered to measure lung compliance. volume, etc. Which of the test is true about lung compliance?

A. ΔP/ΔV

B. inversely proportionated with elastic recoil of lungs

C. ↓ with ↑ age

D. ↑ when there is deficinency of surfactant

133. WOTF is macrolides?

139. Azythromycin digunakan 1x sehari. Alasannya?

B. T ½ lebih lama

149. PCO2 ↑, apa yang terjadi?

A. respiratory alkalosis

B. respiratory acidosis

C. metabolic acidosis

D. metabolic alkalosis

155. A 45 y.o woman history : episode wheezing and cough, selalu diawali dengan minor common cold dan muncul saat hujan. Ibunya juga memiliki gejala yang sama. CBC dan IgE normal. Mekanisme kasus?

A. Akumulasi mast cell di airspace following viral infection

B. Emigrasi eosinophil into bronchi

C. Bronchial hyperresponsiveness induced by viral inflammation

D. sekresi IL4 dan 5 oleh antiviral T cell

E. hyperresponsiveness karena inhlasi spora aspergillosis

157. Kasus pertussis. True about the microorganism?

A. grow on Mac Conkey agar

B. gram (-) rod

D. non fastidious bacteria

E. culture from sputum

158. Characteristic of RSV?

A. RNA double stranded

B. causing pneumonia in children

D. multinucleated giant cell

165. Kasus : anak-anak wheezing. Bukan penyebabnya?

A. rotavirus

174. Cough?

189. A 8 months old boy. RR 61x/min, T 38.9^oC, crackles on auscultation. What is the microorganism that causing this condition?

Male, 21 y.o., ER 3 menit setelah inject heroin. O₂ saturation 70%, BGA : PaO₂ 40 mmHg, PaCO₂ 60 mmHg, pH 7.2. Cause of hypoxemia?

A. ventilation-perfusion mismatch

B. intrapulmonary shunting

C. alveolar hypoventilation

D. inpaired diffuse O₂

E. abnormal de saturation

MDE TROPMED 2011

2011-06-19T01:35:00.000-07:00

3. 2 years old boy, 10 kg, visit emergency departement. History : 4 day high fever,spontaneous ptechiae, without vomiting. Lab Platelet 88.000/ml Ht 36%; further examination platelet 66.000/ml Ht 48%. Management?

A. Orally since there is no vomit

B. 750 cc/24h parenteral and adjust when needed

C. 1000cc/24h parenteral and adjust when needed

D. 1250cc/24h parenteral and adjust when needed

E. 1500cc/24h parenteral and adjust when needed

4. Diagnosis of typhoid fever is confirmed by culturing salmonella strain. WOTF is correct statement?

A. (+) blood culture in 40-60% patient during 2nd week of illness

B. most stool culture (+) during 1st week of illness

C. most urine culture (+) during 1st week of illness

D. bone marrow culture is less sensitive

E. bone marrow culture is the most sensitive since it less influenced by prior antimicrobial therapy

9. A girl with lobar pneumonia with high fever for 3 days. remission of fever < 1 C

A. Continuous

B. Saddle-back

C. Intermittent

D. Remittent

E. Relapsing

14. soalnya lupa, pokoknya mendiskripsikan penyakit DBD, pertanyaan : causative agent nya?

a.lupa

b.lupa

c.lupa

d.lupa

e.single stranded RNA positive --> ini kayaknya jawabannya

19. 9 months old infant, bodyweight 7 kg, receive corticosteroid, sudah dapat vaksinasi BCG waktu umur 1 bulan. dikasih imunisasi apa sekarang ?

A. Measles, DTP

B. Measles, DTaP

C. Measles, hepatitis

D. DTP, OPV

E. DTP, hepatitis B

22. Lesi kulit dipunggung, hypopigmentation. Diagnosis?

Ans : tinea versicolor

25. pasien usia 38 tahun kena leprosy. nerve di elbow medial terhadap epycondile mengalami perbesaran. apa yang terjadi? a. drop wrist

b. claw thumb

c. claw hand

d. drop hand

e. claw finger

29. 31 year old woman comes with her daughter. complant : discrete papular itchy lesion with pinpoint blue color on its top, located at neck and axilla. diagnosis ?

A. Pediculosis capitis

B. Pediculosis corporis

C. Pediculosis pubis

D. Scabies

E. Insect bite

For questions 38 and 39

4 months old baby boy comes with skin patch at neck, ibunya juga memiliki skin lesion yang sama di breast. PE : numular eritropapulosquamous patches with active borders, clear area at middle. di rumah pelihara kucing

38. Gambaran mikroskopis skin scrapingnya seperti apa ?

A. Epithel, long septate-branched hyphae, round spores

B. Epithel, long septate-branched hyphae, arthrospores

C. Epithel, short hyphae, round sometimes oval spores

D. Epithel, budding cells, round spores, germ tubes

E. Epithel, short hyphae, arthrospores, germ tubes

39. tipe funginya ?

A. zoophilic

B. Geophilic

C. Anthropophilic

D. Hydrophilic

E. Keratinophilic

42. Trichrome stain indicated the presence of intestinal pathogenic protozoa.

WOTF statement is correct for lifecycle of all intestinan pathogenic protozoa

A. Infective stage occured in soil

B. Encystation in lower ileum

C. The most frequent primary sites are caecum and rectosigmoid

E. Cysts and trophozoites may be found in liquid feces

Options for 47-50

A. Entamoeba dispar

B. Entamoeba coli

C. Giardia lamblia

D. Trichomonas hominis

E. Entamoeba histolytica

47. amoeboid trophozoite with cytoplasmic pseudopodia and fine granular cytoplasm

48. eccentric karyosome

49. ellipsoidal cyst

For question number 51 until 53, refer to this option:

A. Negative

B. Primary Infection

C. Secondary Infection

D. Invalid

E. Primary and secondary infection

51. C-Line and M-Line are pink color

52. C-Line, M-Line, and G-Line are pink color

53. C-Line, M-Line, and G-Line are white color

58. A 14 y.o. girl typhoid fever. Salmonella antigen harus meningkat berapa kali dari acute sera ke convalescence sera?

A. 1/2x

B. 1x

C. 2x

D. 3x

E. 4x

61. The doctor in charge gives her chloramphenicol. WOTF is the adverse effect of the drug?

A. Aplastic anemia

B. Hypotension

C. Weakness

D. Malaise

E. Dizziness

71. Which statement is TRUE about cerebrospinal fluid?

A. Lumbar puncture may be drawn at L3-L4 intervertebrae level

B. CSF is formed at choroid plexus within the ventricle

C. Choroid plexus only occur along the inferior horn of the lateral ventricle

D. CSF flows through the ventricle and enter arachnoid space

E. CSF drains into the venous system when the venous pressure greater than CSF pressure

72. jenis epitel yang melapisi sisi dalam dari lapisan meningen terluar adalah..

(pokoknya optionnya ada yang simple squamous, simple cuboidal, simple columnar, truz gw lupa apa lagi:)))

88. Pasien datang ke RS dengan demam tiba2 mencapai 39 derajat C, sakit kepala dan jaundice 3 hari yang lalu. Memiliki riwayat pekerjaan bekerja di gudang yang banyak tikus.

Penyebab organisme?

A. Acromonas hydrophila

B. Mycobacterium marinum

C. Streptococcus pyogenes

D. Leptospira interrogans

E. Vibrio Vuilnifiens

89. Which of the following is the characteristic of this microorganism? (Leptospira)A. Rods with microgranular form

B. Spirochetes gram negative

C. Rods gram positive

D. Cocci gram positive

E. Spirochetes with hooked ends

A. P. falciparum

B. P. vivax

C. P ovale

D. P. malariae

95. Schuffner stipple on routine blood examination

102. Pemeriksaan mikroskopis pada pasien malaria menunjukkan adanya sel darah merah dengan ukuran normal, "no stippling", "multiple ring-form", dan pada beberapa sel darah merah terdapat trofozoit yang berkembang yang berbentuk "band". Etiologi apa yang paling mungkin?

A. Plasmodium malariae

B. Plasmodium vivax

C. Plasmodium falciparum

D. Mixed infection (Plasmodium malariae & Plasmodium vivax)

E. Mixed infection (Plasmodium falciparum & Plasmodium malariae)

108. Classification of patient with sepsis

A. Hospitalized in ICU and undergo mechanic ventilation

B. Fever with core temperature more than 38.8'C

C. Hypothermia with core temperature less than 36'C and tachypnea

D. Increase circulating imflamatory mediators

E. Combination of infection with Systemic Inflamatory Response Syndrome

109. Correct statement about plasmodium ?

A. agent does not develop or multiply inside vector

B. agent multiply inside vector

C. agent grow and multiply inside vector

D. agent develop but not multiply inside vector

E. agent grow inside vector

115. Drug nteraction chlorapenicol and phenytoin?

A. half life phenytoin increase

B. serum concentration phenytoin increase

C. half life phenytoin decrease

D. chlorampenicol doesn’t inhibit hepatic microsomal enzyme

E. serum concentration of both increase

118. WOTF characteristic of Dapson?

A. it inhibits protein synthesis

B. resistance can emerge if very high doses are given

C. the combination of dapsone, rifampin and clofazimine is not iniatially recomended

D. Dapsone is well tolerated

E. Dapsone can not be given to renal failure patient

122. Indikasi pemberian clofazimin?

125. Side effect permethrin

A. unpleasant odor

B. staining

C. pruritus

D. itching

E. nonirritating

129. MOA acyclovir?

Maaf jawabnnya lupa T___________T

130. Pharmakokinetic spesification of acyclovir:

a. biovailability is affected by food

b. it is cleared by glomerular filtration

c. it is not cleared by tubular secretion

d. it is not cleared by hemolysis

e. it is cleared by peritoneal hemolysis

136. Manakah diantara obat di bawah ini yg menghambat sistesis ergosterol?

a. Allylamine

b. Polyene

c. triazole

d. Inidazole

142. A 40 year old woman came to the doctor due to high grade intermittent fever for a week. Typically it was started by chills, followed by high fever and sweating. She also had headachen myalgia, nausea, and vomiting. The patient has just come back from the P.falciparum endemic area.

Which of the most appropriate combination antimalaria should be added to amodiaquine?

A. Quinine

B. Mefloquine

C. Artesunate

D. Doxicycline

E. Chloroquine

148. Scaling patch di punggung

A. seborrheic dermatitis

B. pityriasis versicolor

C. pityriasis rosea

D. psoriasis

E. lepra

157. Clue that suggests anaerobic infection:

A. + in facultative anaerobic culture

B. Special cotton swab

C. Foul-smelling discharge

D. Infect mucosal area

E. Grow on McConkey agar

For question 161-162

A 60 year old female complains about red patches, papules, and blisters on a red base at the right side of her face, neck, and upper chest since 3 days ago. She also feels discomfort, pain, numbness, and varies from superficial itching, tingling, and burning sensation in the involved area.

161. What is the source of her infection?

A. Aerosolized droplets of the causative agent

B. Contaminated food or water

C. Sexual activity

D. Puncture with contaminated needle

E. Endogenous reactivation of an earlier infection

163. Diagnosis : diphtheria. Stain?

A. gram stain

B. Ziehl-Neelsen

C. Neisser

D. Burr-gins

E. negative staining…

164. Viruses can be isolated in the embryonated egg into appropriate region. Which part of the embrionated egg for incubation of herpes virus?a. Amniotic cavity

b. Allantoic cavity

c. yolk sac

d. intraembryonal

e. chorioallantoic membrane

168. A 26 year old obese female presents to the clinic with scaly erythematous patches on the grain. Skin scrapping in taken from the lesion, for microscopic examination.

How is morphologic pattern of the etiologic agent of that case when you observe using KOH solution?

A. Spaghetti & meatballs appearance

B. Long branches septate hyphae & arthrospore

C. Pseudohyphae

D. Long branches non septate hyphae

E. Yeast cells with budding

171. 27 years old athletic male. White patch of skin mainly on axilla, back, trunk. No itching. Multiple hypopigmented macules covered by fine scales. Woods lamp : positive yellow fluorescence. Diagnosis : tinea versicolor.

WOTF fungus cause disease?

A. Microsporum canis

B. Malassezia furfur

C. Trichophyton beigelii

D. Epidermophyton werneckii

E. Epidermophyton floccosum

178. A 27 y.o. businessman experienced high fever, serius retroorbital headache, severe joint and back pain for 5 days. Rash appear on his palm and sole that lasted for 2 days. At the same time, his 5 y.o. son experienced mild flu like symptom, collapse after 2-5 days. There were petechiae on his forhead, ecchymosis elsewhere. What is the structure of the virus that aused this disease?

A. double stranded RNA

B. double stranded DNA

C. positive sense single stranded RNA

D. negative sense single stranded RNA

E. single stranded RNA

A. Biologic control

B. Environmental control

C. Vector control

D. Vector survey

195. Alteration in breeding site of vectr

Itraconazole adalah?

A. phenylallamines

B. triazole

C. imidazole

D. allyamines

E. beta-3-glucose synthase inhibitor

MDE GUS 2011

2011-06-19T01:17:00.000-07:00

3. Calcium metabolism is also regulated by kidney because of vit D3 has to be catalyzed by WOTF kidney enzyme?

A. vit D3 phosphorylase

B. vit D3 transferase

C. vit D3 hydroxylase

D. vit D3 kinase

E. vit D3 synthetase

A 50 y.o. woma with 5 year history of uncontrolled hypertension à theray with thiazide diuretic and β-blocker à evaluated because of proteinuria during routine yearly medical visit.

PE : height 167 cm, weight 91 kg, BP 170/100 mmHg, trace pedal edema

Lab : serum creatinine 1.7 mg/dL, BUN 27 mg/dL, creatinine clearance 97 mL/min

Urinalysis : pH 5, protein +3, specific gravity 1.018, no glucose, occasional coarse granules

4. According to the condition of the patient, WOTF pathway is true for her condition?

A. glycolysis

B. glycogenolysis

C. gluconeogenesis

D. glycogenesis

E. lipogenesis

9. Gross appearance of malignant nephrosclerosis?

A. broad U shaped cortical scars overlying dilated calyces in renal poles

B. depressed cortical areas overlying necrotic papillae of varying stages

C. multiple small petechial hemorrhages on the surface

D. multiple small white areas on the surface

E. wedge shaped pale cortical scars

12. A 7 y.o. male come to the hospital with gross hematuria in the morning & disappear in the afternoon. HE had history of throat infection 2 weeks earlier. According to the clinical statements above, what is the most possible cause of the boys’ hematuria?

A. increase globulin in urine

B. Hb in urine

C. leucocyte in urine

D. abnormal number of RBC in urine

E. increase protein in urine

16. Na+ reaborption in the tubule cells membrane is a/an … process.

A. simple diffusion

B. facilitated diffusion

C. active transport

D. endocytosis

E. paracellular transport

18. The forst morning urine is the specimen of choice for routine analysis because?

A. it has a high volume

B. it is produced while the body in resting state

C. more concentrated resulting in better detection of abnormalities

D. more dilute preventing flase (-) reaction

E. more concentrated preventing false (-)

19. Best preservation in urine sediments?

A. boric acid + hydrochloric acid

B. formalin + boric acid

C. formalin + freezing

D. chloroform + refrigeration

E. chloroform + freezing

21. Lubang yang terdapat pada endotel glomerulus adalah?

A. filtration membrane

B. fenestrae

C. filtration slit

D. glomerulus

22. Paisen uncontrolled hypertension, diberi new diuretic target to Na+ reasorption site from basolateral surface of renal epithelial cells. Proses yang dipengaruhi oleh obat tersebut?

A. Na-glucose

B. Na-K

C. Na-H

D. solven drug

E. facilitated diffusion

23. A patient have persistent diarrhea for the last 7 days. WOTF will increased?

A. filtration load of HCO3-

B. NH3 synthesis by proximal tubule

C. H+ secretion by diatal nephron

D. anion gap

E. production of new HCO3- by distal nephron

27. DM à glukosa di urin sebagai konsekuensi proses apa di PCT?

A. saturasi Na/glucose tranporter

B. inhibisi Na/K ATPase

C. saturasi NA/H cotransport

D. stimulasi glucose secretion

E. stimulasi glycogen breakdown

29. A 25 y.o. man has generalized edema prominent in the periorbital regions early in the morning & hypertension. The microscopic feature of kidney shows diffuse thickening of glomerular capillary wall & mesangial proliferation. The following statement is correct for capillary portion of the renal corpuscle?

A. Bowman’s capsule

B. fenestrae

C. podocytes

D. glomerulus

E. renal column

31. Cell that has long primary process and great number of secondary foot process?
A. macula densa

B. mesangial cell

C. podocyte

D. juxtaglomerular

32. This portion is collection of cortical kidney’s tissue found between the medullary pyramids. WOTF structure is most likely?

A. corpuscle

B. medullary ray

C. renal columns of Bertin

D. interlobular cortex

E. renal sinus

33. WOTF contain mesangial cell?

A. renal corpuscle

B. PCT

C. thick ascending limb

D. DCT

34. Structure most commonly found in conical pyramid region?

A. PCT

B. DCT

C. loop of henle

D. renal corpuscle

E. afferent arteriole

40. Iv infusion of 1L of WOTF will be the largest to increase ECF?

A. distilled water

B. hypotonic NaCl

C. isotonic NaCl

D. hypertonic NaCl

E. hypertonic ureum

42. Decreased BP caused by captopril is result from?

A. decreasing of angiotensin I level

B. decreasing of angiotensin II level

C. decreasing of bradykinin

D. blocking angiotensin II receptor

E. decreasing plasma renin level

43. Non pharmacological treatment of hypertension?

Jawaban : reduce body weight

44. The target organ damaged in hypertensive patient is?

A. prostate hypertrophy

B. leukosituria

C. atherosclerosis plaque

D. vein narrowing

E. liver enlargement

47. GFR increased à PCT reabsorption of salt and water increased by glomerotubular balance, include :

A. increase peritubular capillary hydrostatic pressure

B. decrease peritubular sodium concentration

C. increase peritubular oncotic pressure

D. increase proximal tuble flow

E. increase peritubular capillary flow

50. Apa proses yang terjadi pada penicillin di PCT?

Jawaban : sekresi

52. The origin of collecting duct in the kidney?

Jawaban : ureter bud

53. WOTF is correct for development of bladder?

A. developed from hind gut

B. originated from endoderm

C. shaped from mesoderm

D. shaped from urogenital sinus

E. originates from allantois

54. ARPKD. What is the embryological basis of this congenital anomaly?

A. dysmorphology during development of renal system

B. failure of ureteric bud derivates to join the tubule

C. division of the mesonephric diverticulum

D. failure of mesenchymal cells to migrate

E. the poles of the kidney are fixed

55. Anak menderita polycystic di ginjal. Nama penyakit?

JAwaban : ARPKD

57. Penyebab double ureter?

A. splitting of metanephric bud

B. development of ureteric bud

C. splitting of ureteric bud

D. non-dysfunctional of ureteric bud and metanephros blastema

E. splitting of mesonephric bud

59. A 40 y.o. woman with essential hypertension complaining headache, flushing after taking her medicine. Besides, recently she got bad experience in sense of taste. What is the most possible antihypertensive agent she takes?

A. ACE-inhibitors

B. α-blocker

C. β-blocker

D. diuretics

E. vasodilator

61. AN increase of WBC in urine is called?

A. pyelonephritis

B. custitis

C. urethrtis

D. glomerulonephritis

E. pyuria

62. A 6 y.o. had a throat infection three weeks ago. Presently, he has hematuria, oliguria, mild hypertension. On microscopic feature of kidney : proliferation of endothelial and mesangial cells and also shows neutrophil an mnocyte infiltration. WOTF diagnosis is the most possible for the patient?

A. acute post streptococcal glomerulonephritis

B. crescentic glomerulonephritis

C. Goodpasture’s syndrome

D. idiopathic rapidly progressive glomeruloneprhitis

E. Heyman nephritis

63. Lab results from a 5 y.o. boy with swelling of his whole body : urine color light yellow, appearance : cloudy, pH 6, nitrite (-), urobilinogen (+), blood (-); serum : urea 20 mg/dl, creatinine 0.8 mg/dl. OWTF conditions is the most possible color of the urine?

A. the nephron excretion of blood borne

B. the glomerulus excretion of blood borne

C. the glomerulus excretion of albumin

D. the nephron excretion of albumin

E. the glomerulus excretion of ureum

64. The formation of crystal in the urine sample depend on pH of urine. Low acidity urine sample (low pH) can form several crystals such as?
A. uric crystals, sodium urates

B. triple phosphate, calcium phosphate

C. calcium carbonate, ammonium biurate

D. cystine, cholesterol, leucine, thyrocine

E. bilirubin, sulfonamides

65. WOTF is most likely to cause a false positive dry reagent strip test for protein?

A. urine of high specific graity

B. highly buffered alkali urine

C. bence-jones proteinuria

D. salicylates in urine

E. acidic in urine

66. A 40 y.o. male has abdominal discomfort. A mass found on palpation of upper right abdominal. The microscopic featue of kidney shows cysts rising from the tubules throughout the nephron. WOTF diagnosis is the most possible for this patient?

A. autosomal dominant PKD

B. cystic disease of renal medulla

C. acquired cystic disease

D. simple cyst disease

E. autosomal recessive PKD

67. A 30 y.o. man has general edma promeinent in preorbital regions early in the morning and hypertension. The microscopic feature of kidneys shows diffuse thickening of glomerular capillary wall and mesangial proliferation. WOTF is the most possible diagnosis for this patient?

A. minimal change disease

B. focal segmental glomerulosclerosis

C. membranoproliferative glomerulonephritis

D. IgA nephropathy

E. chronic glomerulonephritis

68. A 30 y.o. man medical lab technician recovering from hepatitis B develops hematuria, proteinuria, and red cell cast and oval fat bodies identified by microscopic exam of urine. WOTF statements describes the changes of the kidney in this patient?

A. no deposits of antibodies

B. IgG linier fluorescence along the glomerular basement membrane

C. granular deposits of antibodies in the GBM

D. diffuse GBM thickening by subepithelial immune deposits

E. nodular hyaline glomerulosclerosis

For question no 69-71

A 60 y.o. man works in asbes factory. On the microscopic feature of bladder biopsy shows papillary from and highest anaplastic.

69. WOTF diagnosis is the most possible for this patient?

A. transitional cell papilloma

B. TCC grade I

C. TCC grade II

D. TCC grade III

E. squamous cell carcinoma

70. Approximately 90% epithelial bladder malignancy is?

A. carcinoma in situ

B. adenocarcinoma

C. transitional

D. squamous

E. undifferentiated

71. What is the diagnostic tool for early staging of bladder cancer?

A. BNO-IVP

B. USG + biopsy

C. sectio alta + biopsy

D. cytoscopy + IVP

E. cytoscopy + transurethral resection

72. A 50 y.o. male with painless hematuria undergoes bladder biopsy. ON the microscopic features shows atypical epithelial surface. What is the most possible diagnosis?

A. transitional cell carcinoma

B. TCC

C. squamous cell carcinoma

D. adenocarcinoma

E. mixed carcinoma

73. A 25 y.o. man has general edma promeinent in preorbital regions early in the morning and hypertension. The microscopic feature of kidneys shows diffuse thickening of glomerular capillary wall and mesangial proliferation. WOTF is the most possible diagnosis for this patient?

A. focal segmental glomerulosclerosis

B. membranoproliferative glomerulonephritis

C. membranous glomerulopathy

D. minimal change disease

E. IgA nephropathy

74. A 4 y.o. boy has an abdominal mass, hematuria, and flank pain. Microscopic feature of kidney shows nest of primitive blastema sheet intertwine with mesenchymal abortive glomeruli. What is the most possible diagnosis?

A. cystic renal dysplasia

B. Wilm’s tumor

C. neuroblastoma

D. teratoma

E. hamartoma

For number 75-76

A 60 y.o. man has early and terminal dysuria. A nodule in anterior location is found on DRE. Prostate cut section shows gritty and firm. Micriscopic feature shows numerous small acini lying ‘back to back’.

75. The most reliable method of diagnosing prostatic carcinoma?

A. prostate acid phospatase

B. PSA

C. prostate ultrasound

D. transrectal biopsy

E. MRI

76. Indication of prostate biopsy is?

A. PSA level between 4-10 ng/dl

B. PSA level below $ ng/dl

C. nodule on DRE of prostate

D. PSA density below 0.15

E. prostate weight > 60 gr

87. A 9 y.o boy à difficult to urinate. There was constricting preputial ring and non-retractable foreskin. WOTF condition most likely occurred accompanying disease above?

A. balanoposthitis

B. urethritis

C. cystitis

D. pyeloneprhitis

E. nephritis

88. Most common urinary retention in older men?

A. carcinoma prostate

B. BPH

C. chronic prostatitis

D. urethral stricture

E. prostatic abscess

89. A 5 y.o. female, best method for urine collection?

A. urine bag collector

B. midstream urine

C. urine catheter

D. suprapubic puncture

E. fresh urine

A 7 y.o., dark cola colored urine, voiding 2x/24h. Facial puffiness, no swelling at hands or feet. Headache, blurry vision.

PE : compos mentis, edema anasarca, BP 180/120, PR 100x/min, T 36.9^oC

Lab : Hb 10.6 gr/dL, serum ureum 45 mg/dL, serum creatinine 1.3 mg/dL, WBC 9600/mm³

Urinalysis : dark cola colored, protein +2, many erythrocyte, leucocyte 8-10 HPF

92. WOTF is the criteria to make the diagnosis?

A. hypoalbuminemia

B. hypocholesterolemia

C. hematuria

D. hypertension

E. renal insufficiency

95. What is the most common complication of this disease?

A. infection

B. heart failure

C. encephalopathy hypertension

D. lung edema

E. chronic renal failure

97. WOTF drug is first line for this patient?

A. diuretics

B. antibiotics

C. steroid

D. lovamisol

E. ACE inhibitor

100. Wanita, 18 y.o., arthralgia 6 bulan dengan intermittent fever. BP 165/110, WBC 3200/µL, Hb 10.8, PLT 74000/µL, proteinuria 3.8 gr/day, pleural effusion. Diagnosis?

A. chronic pyeloneprhitis

B. amyloidosis

C. lupus nephritis

D. Alport’s syndrome

E. membranous glomerulonephritis

111. A man has spinal cord injury 3 months ago. He has problem with micturition. The level of the lesion is T12. What urodynamic problem that he has?

A. urine retention

B. urine incontinence

C. overflow incontinence

D. hyperactive of bladder

E. incompetence of urethral sphincter

118. A 57 y.o. male have chief complain of difficulty voiding and have BPH. WOTF prostatic lobe is it likely are possible?

A. middle lobe

B. anterior lobe

C. posterior lobe

D. lateral lobe

E. superior lobe

121. A 40 y.o. male come with complain… X-ray : artery closed with this muscle

A. psoas muscle

B. serratus uscle

C. obturator muscle

D. external oblique muscle

129. You have a patient who has renal failure. While he is currently on dialysis, he is hoping to receive a new transplanted kidney. He asks you if they are going to remove one of his bad kidneys & put the new transplanted kidney back in the same place. Wou tell him WOTF?

A. right kidney à removed, more inferior, and easier to remove

B. left kidney à removed, easier to move descending colon

C. keep both kidneys, new one à left posterior waal,inferior to left kidney

D. new à in iliac fossa in greater pelvis, attach to iliac vessels, connect to bladder

E. left kidney à removed, more inferior and easier

132. Both autonomic and vascular system need to function properly successful male sexual function. WOTF statement concerning erction, emission, and ejaculation in the males is correct?

A. contraction of internal urethral sphincter is under control of parasympathetic nervous system

B. parasympathetic nerves stimulate closure of helical artery

C. sympathetic neuron stimulate helicine artery to dulate and increase blood flow to corpora cavernosum

D. parasympathetic innervations stimulate emission of seminal fluid

E. contraction of bulbospongiosus muscle impede drainage of blood from corpus spongiosum

136. A 65 y.o. woman came with metabolic acidosis. There is history of DM & hypertension. She refused to take medicine and change her lifestyle.What is the mechanism of kidney ot prevent serious condition?

A. reabsorb H+

B. excrete HCO3-

C. neutralize excess acid

D. neutralize excess base

140. Pasien DM + hypertension. WOTF caused the leakage of a protein?

A. increase capillary hydrostatic pressure

B. decrease capillary hydrostatic pressure

C. inhibition of protein kinase C

D. glycating of end product

E. decrease colloid osmotic pressure

141. What is the component of bipyramid crystal?

A. calcium oxalate

B. cystine

C. calcium phosphate

D. uric acid

E. struvite

142. WOTF material that inhibit crystal formation?

A. mangan

B. citrate

C. bicarbonate

D. potassium

E. sodium

143. Enlargement of prostate. Enzyme that catalyze the enlargement?

Jawaban : 5α-reductase

148. NH3?

A. impermeable to epithel

B. titrable acid

C. synthesized in DCT

D. menurunkan HCO3-

E. meningkat di respiratory acidosis

149. A patient with hypertension is given a K+ sparing diuretic. The amount of potassium excreted by the kidney will decrease if WOTF occur?

A. distal tubular flow increase

B. circulating aldosterone increase

C. dietary intake of potassium increase

D. natrium reabsorption by the distal nephron increase

E. the excretion of organic ion decreases

153. A patient with CHF is given loop diuretic : furosemide, K sparing diuretics, and spironolactone. WOTF comparisons between distal nephron and PCT?

A. DCT is more permeable to H+ than PCT

B. DCT is less responsive to aldosterone than PCT

C. DCT has more negative intraluminal potential than PCT

D. DCT secretes less K+ than PCT

E. DCT secretes more H+ than PCT

154. An elderly woman present with spiking fever, shaking chills, nausea, CVA (+) tenderness. Urine cultures are (+), she is hospitalized for pyelonephritis.

158. Malnutrition in CKD karena?

A. hypercatabolism of protein, carbohydrate, lipid

C. abnormalities in lipid metabolism

E. uremic syndrome caused by hypercatabolism of protein, carbohydrate, lipid

160. What kind of food should be limited in a patient with kidney stone?

A. soft drink, vit C, high protein, high calcium

B. soft drink, high cholesterol, high vit C, high selenium

C. soft drink, low cholesterol, low protein, low calcium

D. soft drink, junk food, high natrium, high kalium

E. soft drinks, high natrium, high cholesterol, high lipid, high natrium, high kalium

161. When you are at ER at HAsan Sadikin hospital, A 25 y.o. was admitted to the hospal with the complains of small producing urine. This complains occurred prior to massive diarrhoeas and vomiting. It all started five days before admitted to the hospital. What is the main goal of nutrition recommendation with acute kidney injury?

A. to minimize the protein catabolism cause dby the underlying disease

B. to prevent anorexia

C. to minimize uremic syndrome

D. to prevent progressivity of renal failure

E. to prevent vomit and diarrhea

162. A 34 y.o came to STI clinic with chief complain of dysuria and yellowish urethral discharge since 3 days ago. The rest of the culture revealed that the bacterium is N. gonorrhoeae. The virulence factor that play a role in adherence of the bacteria on the mucosa is?
A. lipopolysaccharide

B. capsule

C. flagella

D. peptidoglycan

E. pili

163. A 30 y.o. male patient was seen by emergency service and reported a 2 week history of penile ukcer. He noted that this ulcer did not hurt. WOTF conclusions/actions is most valid?

A. draw bloof dor a herpes antibody test

B. perform a dark feld exam of the lesion

C. prescribe acyclovir for primary genital herpes

D. even if treated, the lesion will remain for months

E. failure to treat the patient will have no untoward effect, as this is a self limiting infection

164. N. gonorrhoeae is a fastidious bacterium that should be isolated from sites often contaminated with normal flora. The best medium for isolation is?

A. sheep blood agar

B. Loeffler medium

C. Thayer-Martin agar

D. Loewenstein-Jensen medium

E. Mac Conkey agar

165. A 42 y.o. man who has a penile ulcer appears in STI clinic. The base of ulcer is soft and [ainful with suppuration. Microscopic gram stain shows gram (-) rods with school of fish arrangement. The bacteria is?

A. Neisseria gonorrhoeae

B. Haemophilus ducreyi

C. Mycoplasma hominis

D. Ureaplasma urelyticum

E. Treponema pallidum

166. A 24 y.o. sexually active woman develops vaginal discharge, left lower quadrant pain, and fever. On pelvic exam there is tenderness in the left adnexa. Gram staining from cervical discharge reveals low number of leukocyte cells, no gram (-) diplococci. No bacteria grow on selective media for N. gonorrhoeae. The most possible cause of the symptom is?

A. Haemophilus ducreyi

B. Treponema pallidum

C. Gardnerella vaginalis

D. Chlamydia trachomatis

E. Pseudomonas aeruginosa

167. A 33 y.o. woman referred to STI clinic because of vaginal discharge. She has history of sxual contact with several male partner. Microbiological exam reveals that the cause of this symptom is Mycoplasma homini. How is the characteristic of this bacterium?

A. growth in an anatomic site where anaerobic organism thirive

B. the absence of bactria cell wall

C. cannot culture on the artificial media.

D. the absence of cilia on the surface of the host cell

E. gram (-) rods morphology

168. A 60 yo. Man has experienced some frequent, urging, and painful urination. DRE revelaed enlargement of the prostate and he has a history of several catheterization. Culture of the urine on Mac Conkey agar reveals non-lactose fermenter colonies without evidence of swarming and gram stain shows gram (-) rods. WOTF organisms us to be the cause of those symptom?

A. Pseudomonas aeruginosa

B. Proteus mirabilis

C. Escherichia coli

D. Haemophilus ducreyi

E. Chlamydia trachomatis

169. A 30 y.o. female appear with symptoms of dysuria, frequency, and urgency since 2 days ago. She has also been suffering from fever and cills. Urine culture is performed which grow 10⁵ CFU/ml of E.coli. How is the characteristic of this bacterium?

A. non-lactose fermenter

B. cannot grow on Mac Conkey agar

C. gram (-) diplococcic

D. gram (-) rods, lactose fermenter

E. obligate intracellular

170. An adolescent female came to the clinic because of a new and unusual vaginal discharge. She has recently become sexually active and had two new partners during previous minth. A purulent discharge was seen from endocervical canal. WOTF statements about this case is most correct?

A. the endocervical specimen should be analyzed for HAemophilus ducreyi

B. wet mount preparation of endocervical specimen showed clue cells

C. gram staining of endocervical specimen would show Chlamydia trachomatis

D. the possibilities infection caused by Chlamydia trachomatis or N. gonorrhoeae

E. dark field microscopy of endocervical specimen showed spiral bacteria

171. A 25 y.o. young female goes to health center after 2 days increasing pain during urination. Her urine is cloudy and shows microscopic evidence of erythrocyte and pyuria. Urine culture grows colonies of gram (+) cocci, catalase (+), coagulase (-). Her relevant past medical history is significant ofr no previous urinary tract infection. Which organism is ost likely responsible for this infection?

A. Enterococcus faecalis

B. Streptococcus pyogenes

C. Staphylococcus saprophyticus

D. NEisseria gonorrhoeae

E. Escherichia coli

172. A 37 y.o. woman with a history of UTI comes to the ER with burning on urination along with frequency and urgency. She says her urine smells like ammonia. The cause of her UTI is likely to be?

A. Enterobacter aerogenes

B. Proteus mirabilis

C. Citrobacter freundii

D. Escherichia coli

E. Serratia marsescens

173. A 65 y.o. male hospitalized for 7 days as indication of diabetic nephropathy and catheter inserted because of problem I urination. Within this period developed UTI. The most common opportunist pathogen bacteria that cause the infection is?

A. Proteus vulgaris

B. Serratia marsescens

C. Staphylococcus aureus

D. Enterococcus faecalis

E. Escherichia coli

174. A 6 y.o. boy came to the hospital with gross hematuria as the chief complain. There was eyelids swelling in the morning and disappeared in the afternoon. He has history of throat infection two weeks earlier. The causative agent that cause the diasease is?

A. Streptococcus pneumonia

B. Staphylococcus aureus

C. Streptococcus agalactiae

D. Streptococcus pyogenes

E. Staphylococcus epidermidis

175. Pseudomonas aeruginosa is an opportunist pathogen as one of the cause of UTI. WOTF statements about P. aeruginosa is correct?

A. typically susceptible to penicillin G

B. readily grown in anaerobic condition

C. able to penetrate intact normal human tissue

D. gram (-) rods, lactise fermenter

E. have fimbriae which promote attachment to epithelial cells

176. A 50 y.o. man develops UTI. Gram (-) rods from urne ulture grow on Mac Conkey agar produce large sticky, lactose fermenter colonies, does not have flagella. This bacteria is second only to E. coli as a urinary tract pathogen. What bacterium those cause infection of this patient?

A. Enterobacter aerogenes

B, Klebsiella penumoniae

C. Pseudomonas aeruginosa

D. Proteus mirabilis

E. Serratia marsescens

177. The pus of STD that has fishy odor is caused by?

A. N. gonorrhoeae

B. Treponema pallidum

C. Gardnerella vaginalis

D. Trichomonas vaginalis

E. Candida albicans

178. Diagnostic test for Treponema pallidum?

A. gram stain

B. culture in Loefler agar

C. ZN stain

D. TPHA

E. culture in LJ agar

179. To differentiate Staphylococcus epidermidis and S. saprophyticus we can use test?

A. bacitracin disc

B. DNAse test

C. novobiocin disc

D. catalase test

E. coagulase test

180. Differentiate colonies of S. aureus with colonies of E. coli in blood agar?

A. color of colonies

B. lactose fermentate

C. size of colonies

D. color of halo around colonies

E. non hemolytic

181. A 40 y.o. male is consulted to the nuclear medicine for kidney function exam due to chronic kidney failure. What is the most appropriate examination of this patient?

A. effective renal plasma flow

B. glomerular filtration rate

C. renal scintigraphy

D. renal arterial flow rate

E. conventional renography

182. A 40 y.o. male is consulted to the nuclear medicine for kidney function exam due to nephropathy diabeticum. What is the most appropriate examination for this condition?

A. effective renal plasma flow

B. glomerular filtration rate

C. renal scintigraphy

D. renal arterial flow rate

E. conventional renography

183. A 45 y.o. ale come with possibility of renovascular hypertension based on the history of uncontrolled hypertension. USG Doppler examination shows impairment at left kidney renal blood flow. Patient then consulted to nuclear medicine for captopril renography. What is the most possible result?

A. renovascular hypertension, if captopril renogram show decreased left kidney function, while in the captopril renogram is normal.

B. renovascular hypertension, if conventional renogram show decreased left kidney function, while in the conventional renogram is normal.

C. renovascular hypertension not exist, if both captopril and conventional renogram are not normal

D. renovascular hypertension not exist, if captopril renogram show improvement in left kidney function, while conventional renogram shows abnormality.

E. renovascular hypertension, if both show improvement of left kidney

184.A 25 y.o. male came with scrotal pain. From PE found inflammation sign at the right scrotum. You consulted this patient to the nuclear medicine. What is the most appropriate exam?

A. scrotal scintigraphy for differentiate testis torsion with orchitis epidydymitis

B. scrotal cintigraphy for identifying UTI source

C. bladder scintigraphy to differentiate UTI with vesicolithiasis

D. ureteral scintigraphy to determine urethritis as etiology of scrotal inflammation

E. penis scintigraphy to determine any priapismus or hypospadia as etiology of UTI

185. A 65 y.o. male with scrotal malignancy. His PSA serum is increasing significantly compared with last month result. X-ray pelvis show abnormality at pelvic bones. PAsien then consulted to nuclear medicine. What is the most appropriate exam

A. conventional renogram, to evaluate the blood flow to renal

B. GFR to determine each kidney function

C. kidney scintigraphy to fin sign of acute pyelonephritis

D. malignancy prostate scintigraphy localization to find any sequel and recurrency

E. bone scintigraphy to find any metastase to the bone

186. A 60 y.o. came to the outpatient clinic for follow up. He noted as hypertensive and type 2 DM for the last 2 years. On PE found : BP 160/90, no other abnormality on PE and lab exam. The doctor prescribed oral antidiabetic and ACE inhibitor. What is theadvantage og this antihypertensive agent for the patient?

A. it decreases blood glucose level

B. it delays diabetic nephropathy

C. it prevents RAAS stimulation

D. it decreases peripheral resistance

E. it prevents vascular remodeling

187. WOTF is the prototype of ACE inhibitor?

A. valsartan

B. atenolol

C. captopril

D. hydralazin

E. diltiazem

188. A 62 y.o. man came to the doctor for routine follow up. BP was 160/90, HR 76 bpm. Random blood glucose level was 140mg/dl. He is given nifedipine. What is the most possible side effect of the drug?

A. decrease blood glucose level

B. orthostatic hypotension

C. cardiac depressant

D. hyperkalemia

E. palpitation

189. What is nifedipine?

A. beta blocker

B. alpha 1 selective blocker

C. vasodilator

D. calcium channel blocker

E. diuretic

191. A 65 y.o. woman. BP 200/120 à given direct vasodilator à BP increase. Mechanism of drug?

A. decreased peripheral resistance

B. inhibit RAAS

C. decreased CO

D. increased venous return

E. chronotropic negative

Woman, dysuria, no flank pain, no tenderness, pemeriksaan lain within normal limit but many WBC. Other examination needed for diagnostic tool is urine microscopic exam of?

A. protein

B. casts

C. bacteria

Hypertension, proteinuria, height 167, weight 91, BP 170/100, edema, creatinine clearance turun, BUN turun. Urinalysis : pH 5, prot +3, no glucose, occasional course granular cast. Diagnosis?

A. nephropathy

B. neuropathy

C. retinopathy

D. nephrolithiasis

E. nephrovesicolithiasis

Struktur yang mebagi perineum jadi anal triangle dan genitourinary triangle?