MIDTERM 2010 (CRP-BHP-PHOP)

Soal CRP
17. Geometrical model for population projection?

36. (Soal tentang twinning med student) What info do you need to decide if this is an oubreak?

West Java diarrhea case per 100.000 people approximately 150
Sukarasa  2005 : 154 cases, 2006 : 145 cases, 2007 : 150 cases
Sukawangi  2005 : 120 cases, 2006 : 60 cases, 2007 : 100 cases
Sukadana  2005 : 100 cases, 2006 : 110 cases, 2007 : 150 cases
Sukaresik  2005 : 175 cases, 2006 : 164 cases, 2007 : 109 cases
Sukarame  2005 : 100 cases, 2006 : 130 cases, 2007 : 200 cases
40. Diarrhea outbreak in 2007?
A. Sukarasa
B. Sukawangi
C. Sukadana
D. Sukaresik
E. Sukarame

58. Most appropriate for epidemic curve?
A. Line chart
B. Bar chart
C. Histogram
D. Pie chart
E. Scatter chart

61. Public health sureillance include which activities?
A. Data minimalization
B. Data collection
C. Data presentation
D. Data reporting
E. Disease control

78. If you already have BMI data, the appropriate command in Epi info to answer “What percentage of the...” is
A. READ BMI_1  ASSIGN BMI_1  FREQ BMI_1
B. RECODE BMI_1  ASSIGN BMI_1  FREQ BMI_1
C. RECODE BMI_1  FREQ BMI_1  ASSIGN BMI_1
D. DEFINE BMI_1  RECODE BMI_1  FREQ BMI_1
e. DEFINE BMI_1  RECODE BMI_1  FREQ BMI_1

Soal BHP
2. The doctor gives transfusion to the patient without doing cross match. Bertentangan dengan prinsip apa?
A. nonmaleficence
B. beneficence
C. justice
D. autonomy
E. integrity

3. A 36 y.o male diagnosed having AML that is incurable, the treatment is only symptomatic by giving blood transfusion if the symptom getting worse. Which ia the most appropriate action done by the doctor?
A. Explain the condition & let him decide the treatment
B. Explain the condition & decide the treatment
C. Tell the patient not to worry about his condition
D. Not tell the diagnosis & refer the patient to other doctor
E. Not tell diagnosis, but to family

17. Anak leukemia. Dokter menyarankan transplantasi bone marrow. Tapi pasien menolak dan rencana dibatalkan. Ethic yang dilakukan dokter?
A. Beneficence
B. Autonomy
C. Non maleficence
D. Justice

Soal PHOP
11. UV can cause cataract

14. UV can cause cataract

17. Usualy found in batteries, solder, or drinking water if pipes are used. Accumulation in bone.

nb : sori ya ga lengkap,emang ga pada ngumpulin waktu itu,nampak gara2 sama ama soal yg waktu 08...:)

FINAL PHOP II 2010

MDE FINAL PHOP 2

Frenz, ini soal Final PHOP kemaren… Urutan soalnya ngacak, tapi semuanya lengkap 40” nya hehe…
Trus jawabannya tolong dicek-ricek lagi yah…
Gudlak semuanya!

These are the answers for questions number 1-4 :
A. CO
B. SO2
C. Particle
D. O3
E. NO

1. Molecules that bind to Hb 200-300 times stronger than Hb O2 bound. (Ans: CO)
2. After several days, people become tolerant, but persons with asthma may still develop airflow obstruction. (Ans: O3)
3. Causing acid rain, which causing London Fog. (Ans: SO2)
4. Source from fireplace and tobacco smoking. (Ans: ga yakin -> NO / particle)

5. Gas can cause chemical asphyxiant? (Ans: hydrogen cyanide )

These are the answers for questions number 6-10 :
a. waterborne disease
b. water privation disease
c. water-based disease
d. water related disease
e. water dispersed infection

6. Disease like malaria, dengue, yellow fever, and Japanese encephalitis are include in… (Ans : -related)
7. Disease that affected more by quantity rather than quality. (Ans : -privation)
8. Arise from the contamination of water by human or animal feces or urine infected by pathogenic viruses or bacteria… (Ans : -borne)
9. Water provides the habitat for intermediate host organism to pass their life cycle... (Ans : -based)
10. Pathogen proliferate in fresh water and enter to the body from respiratory tract? (Ans : -dispersed)

11. Which is the following is a chemical that can combine with hemoglobin and form methemoglobin?
a. arsenic
b. fluoride
c. iodine
d. nitrates
e. cyanides
Ans : D

12. Which is the following substance which in lack condition can cause thyroid gland enlargement?
a. arsenic
b. fluoride
c. iodine
d. nitrates
e. cyanides
Ans : C

13. Zat yang digunakan untuk pengolahan air : :
a. chlorine & arsenic
b. ? & arsenic
c. chlorine & cyanide
d. ? & cyanide
e. aluminium & iron
Ans : kemungkinan Al & Fe (E), soalnya masa mau dikasih sianida & arsen…

14. Proses pencemaran air secara tidak langsung dari pencemaran udara disebut …
a. eutrophication
b. algae
c. acidification
Ans: kemungkinan acidification (C), makanya ada acid rain akibat polusi udara…
Eutrophication = dorongan terhadap pertumbuhan organism yang berlebihan sehingga merugikan organism lain dalm ekosisitemyang sama akibat pasokan gizi secara berlebihan. (Dorland)

15. Penyebab diare akibat virus pada anak-anak …
a. rotavirus
b. hepatitis a
c. hepatitis b
Ans : A

These are the answers for questions number 16-20 :
The hierarchy of control based on ALARA is below :
a. Elimination
b. Subtitution
c. Engineering controls
d. Administration controls
e. Personal protective equipment

16. Synthetic pyrethroid insecticides instead of organophoshates. (Ans : substitution )
17. Permits for high-risk tasks. (Ans : administration)
18. Removal of asbestos from buildings. (Ans : elimination)
19. Enclosing the process & increasing ventilation to get rid of steam & hot air. (Ans : engineering)
20. Rotation job. (Ans: administration)

21. What is index that indicates distribution of such vector aedes aegypty surveillance?
a. Breateau Index
b. Water Index
c. Container index
d. Mosquito Index
e. ?
Ans: A
According to the WHO definition, this index is the number of positive containers (i.e. containing _Aedes aegypti_ larvae) per 100 premises inspected. That is number of positive containers for Aedes aegypti per 100 houses is represented as Breteau index. When it is 50 or more then the risk of transmission is high and when it is 5 then risk of transmission is low. (internet)

22. The insecticide that classified as organochlorine?
a. abate
b. malathion
c. DDT
Ans : C

23. Penemuan jenis insektisida pertama untuk vector-borne control termasuk dalam kelas?
a. natural
b. organochlorine
c. organophosphate
d. carbamate
e. fumigants
Ans: B, yang dimaksud di sini adalah DDT.

24. Which is the following sentence is advantage of larvicidal application ?
a. Cost effectively
b. The operation carried out in long time
c. Maybe toxic to human
d. Some larvacidal may harm other organism
e. Many effective larvicide is widely available
Ans : E

25. Alasan memilih insecticide untuk metode residual wall spraying :
a. Technically simple methods
b. No need trained personnel
c. Cheaper
d. Technical involvement of the community
e. Requiring high investment for a limited period
Ans : D.

26. What is the early vector control program?
a. The use of treated mosquito net
b. The use of mosquito net
c. The use of carbamate
d. The use of insecticide vaporizer
e. The use of protective clothing
Ans : B

27. DDT is no longer use because of…
a. Short life
b. Non highly toxic
c. Merusak lingkungan
d. Biodegradable
e. Expensive
Ans : C

28. Which is classified as natural repellent? (Ans : pyrethrum)

29. Community control … ?
a. membasmi breeding in and around house
b. use self protection
c. wall spraying
Ans : C (kalo ga salah sih ada option wall spraying…)

30. Aedes mosquito play a role in what disease?
a. Japanese encephalitis
b. Malaria
c. Dengue Hemorrhagic Fever
d. Schistosomiasis
e. Trypanosomiasis
Ans : C

31. Warfare yang dilakukan oleh kaum lemah yang terbatas sumber dayanya, terhadap kaum yang lebih dominan/kuat, serangannya periodik dan tidak terduga, daripada serangan langsung…
a. Biological warfare
b. Chemical warfare
c. Nuclear warfare
d. ?
e. Guerilla warfare
Ans : E

32. Sinar ultra violet yang menyebabkan kerusakan kulit dan tanning?
a. UV-A
b. UV-B
c. UV-C
d. UV-A dan UV-B
e. UV-A dan UV-C
Ans : kemungkinan D, karena UV-B jelas merusak kulit, UV-A membantu si UV-B (kata Dorland), UV-C ga nyampe ke bumi…

33. Which of the following is the right gas of greenhouse gas?
a. Carbon dioxide
b. Carbon monoxide
c. Sulfur dioxide
d. Volatile organic compound
e. Ozone
Ans : A

34. Characteristic of technological disaster? (no idea … T_T)
a. responsibility usually without agent
b. objective magnitude of loss usually great
c. perceived magnitude of loss is usually maximized
d. nature of disaster is clean & unavoidable
e. community support for those affected is usually non-judgmental

35. Effect of ozone depletion?
a. Immunological
b. GI tract
c. Urogenital
d. Reproductive
e. Respiratory
Ans : A

These are the answers for questions number 36-40 :
a. pathological waste
b. infectious waste
c. pharmaceutical waste
d. radioactive waste
e. chemical containing heavy metal waste

36. Body waste (Ans : A)
37. Feces (Ans : B)
38. Expired drugs (Ans : C)
39. Waste from drug industry (Ans : D)
40. Broken thermometer (Ans : E)

MDE DMS 2010

MDE DMS 2010 (BATCH 2007)

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

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

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

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

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

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

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

12.Shoulder dislocation is always clue to injured rotator cuff muscle. Some muscle rotator the arm medially.Which nerve innervate?
a.Supraclavicular
b.Thoracodorsal
c.Subscapular
d.Subclavian
e.Axillary

13. axillary nerve injured. Otot apa yang terkena?

14. lubricants in synovial fluid?

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

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

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

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

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

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

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

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

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

27.If skeletal muscle is stimulated by the threshold stimulation,WOTF condition will occur?
a.Depolarization
b.Repolarization
c.Polarization
d.Hyperpolarization
e.Nothing happend

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

98. Outer layer dari muscle?
A. sarcoplasma
B. sarcolemma
C. endomysium
D. perimysium
E. epimysium
100. a cross section muscle. How many thin filament surround each thick filament?
a.2
b.3
c.4
d.5
e.6

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

161. Hyperpigmentation without any sunlight protection,growth hyperplastic in solid arrangement
A. epidermoid cancer
B. BCC
C. melanoma malignant
D. nevus dermal
E. lentigo
162. 25 years old woman, good healthy, underwent extraction of impacted 3rd molar teeth. In the evening, she developed fever. 2 days later swelling of bilateral submandible. Her tongue was elevated, dyspnea, paroxysm with evidence of respiratory paralysis. Which of the following spaces involved in this case?
a. sublingual, submandibular
b.sublingual, submental
c. sublingual, submandibular, submental
d. submandibular, submucus
e. submentalis, buccalis

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

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

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


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

169. Vertebral deformity, vertebral destruction. WBC infiltration. Necrosis : epitheloid langhans cell. Apakah itu? Spondylitis TB.
170. A 25 y.o. woman is 5 months pregnant had swelling at her gum at frontal region of the upper jaw since 3 months ago. The swelling was as big as a green pea. This is a reactive lesion of gingival composed of stratified squamous epithelium granulatum tissue and chronic inflammatory infiltrate. What is the diagnose?
a. mucocele
b. oral thrush
c. epulis granulomatosa
d. aphtuous ulcer
e. leukoplagia


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MDE HIS 2010

1. the special type of lymphatic capillaries in the small intestine are called?
a. lacteals
b. rugae
c. pylorus
d. fundus
e. corpus

2. tempat maturasi T-cell? thymus

4. thymus produces hormones that stimulate lymphocyte maturation.. what is the hormone?
a. oxytocine
b. thymocyine
c. calcitonine
d. progesterone
e. esterogen

5. jalur lymphatic vessels
a. afferent-sinus-efferent

9. Which of the following is the most presence in SLE ?
A. hyperreactivity B cell
B. hyperreactivity T cell
C. hyperreactivity B and T cell
D. hyperreactivity stem cell
E. hyperreactivity thrombocyte

10. WOTF most likely cause of SLE?
a. complement fixation factor
b. anti DNA ab factor
c. immune complex factor
d. autoantibody factor
e. coagulation factor

12.part of immunoglobulin molecule that bind to its antigen is called region (VH & VL) because it has a variability in its:
a. molecular weight
b. amino acid sequence
c. …(ga jelas tulisannya)
d. number of polymeration
e. antigen recognition ability

for number 13-17
a. G6PD
b. Methemoglobin reductase
c. ALA synthase
d. Phosphoglycerate mutase
e. NADH oxidase
13. deficiency of this enzyme reduce NADPH level inside RBC causing hemolytic anemia
14. deficiency this enzyme will maintain heme FE in that reducing from fe2+
15. product of their enzyme is important in regularly that binding of O2 to Hb
16. this enzyme is the key to regulating enzyme in controlling heme biosynthesis
17. this enzyme plays a key role in producing potent microbial agent inside active leukocyte

18. 5 years old boy ke RSHS karena bleeding from nostril. Doctor perform hemostasis test, most common anticoagulant yang digunakan dalam pemeriksaan lab kasus di atas?
a. sodium citrate
b. sodium oxalate
c. sodium heparin
d. ….heparin
e. EDTA

21. the clinical laboratory staff performed PT & APTT on 8 years old boy come with prolonged bleeding after circumcisition, and the resul are: PT 12 sec (N:10-14), APTT: 67 sec (N:25-40). What is the additional test will be suggested?
a. bleeding time
b. clotting time
c. rumple leede test
d. substitution test
e. platelet aggregation test

22. A 5 y.o. boy,epistaxis,prolonged aPTT,yang lain normal. Ada history pada male family member. What is the diagnosis?

23. tujuan torniquete test?
a. ability of capillary to resist pressure
b. ability of platelet to resist pressure
c. ability of capillary to resist heat
d. ability of platelet to resist heat
e. ability of platelet and capillary to resist pressure

24. because of the severe bleeding during delivery of her baby, the doctor gave blood transfusion of a whole blood which was taken 5 days before. What is biochemical change during storage of the blood?
a. plasma potassium naik
b. plasma sodium naik
c. plasma Hb turun
d. 2,3 DPG naik
e. pH naik

25. WBC = 15.000, apa itu?
a. leukocytosis
b. leucopenia

26. bagaimana rumus mencari MCV?

27. jika kadar Hb = 10, Ht = 31%, maka berapa nilai MCHC?

28. Mary’s CBC  Hb: low, MCV: 67 fL, possible morphology RBC  hypochromic microcytic

29. a 5 year, fever, red dots on his extremities. Platelet count 50.000. term?
a. thrombocytopenia
b. thrombocytosis
c. thromboasthenia
d. thrombopathia
e. thrombosis

30. 21 y.o. woman, chronic fatigue, prolonged mens, conjunctivae anemic. Lab test: Hb: 8,3; RBC: 4,15x109; WBC: 4800, MCH:23, PCV: 26%, PLT: 374rb, MCV: 67 fL, MCHC: 29, reticulocyte: 0,5. Diagnosis…
a. normocytic-normochromic anemia
b. microcytic-normochromic anemia
c.microcytic-hypochromic anemia
d. normocytic-hypochromic anemia
e. macrocytic-normochromic anemia

32. fever, mild sore throat, easy bruising, gingival bleeding. Hb , RBC , PLT, WBC, diff count: blast: 73%, promyelocyte: 10%, myelocyte: 10%, lymphocyte: 7%. Diagnosis?
a. AML
b. acute myelomonoblastic leukemia
c. ALL
d. CML
e. CLL

33. anak 7 thn, lymphadenopathy, spleenomegaly. Blast 78%, neutrofil 3%, limfosit 24%. Diagnosis?
a. AML
b. ALL
c. CLL
d. CML
e. burkitt’s lymphoma

35. a 15 y.o. girl experiences flushing, pruritus, and urticaria, which began during a class trip to the local botanical garden. She is restless and uncomfortable and describes a sensation of burning in her skin. Which of the following is the best characterized her condition?
a. superantigen activation of CD4+ T cells
b. CD8+ cell mediated cytolysis of keratinocyte in the skin
c. CD4+ cell mediated delayed type hypersensitivity to poison ivy
d. complement activation by antibody-antigen immune complex in the skin
e. activation of IgE coated mast cell induce release of histamine

37. increased HbA2 found in..
a. IDA
b. sideroblastic
c. megaloblastic
d. aplastic
e. thalasemia

39. in hemolytic anemia, there will be?

40. in aplastic anemia you will find:
a. pancytopenia
b. polychromasia
c. poikylocytosis
d. anisocytosis
e. normoblastosis

41. an 11 year old male presented in ER with persistent epistaxis. Mother stated he was never sick before in his entire life. No history of recent viral infection, no family history of bleeding disorder and no organomegaly. Result blood test:
Hb :13.2 g/dl (N:12-16)
RBC : 4.52 million/mm3 (N :3.8-5.2 million/mm3)
PCV : 38.2% (N:36-46)
Platelet : 10.000 (N: 150000-440000)
WBC : 5300 (N:4000-11000)
MCV 82.30 (N: 80-100)
MCH : 29.7 pg/dl (N: 26-34)
MCHC : 35.9% (N 31-37%)
Diff count : PMN: 47%, lymphocyte : 39%, monocyte :14%
Result of blood smear exam:
RBC morphology : normocytic, normochromic
WBC morphology : within normal limit
PLT morphology : appear increased in size
Result of coagulation test
APTT : 24.8 sec (N: 23-34)
TT : 15.8 sec (N: 13-18)
What is the most likely diagnosis?
a. Secondary thrombocytopenia
b. Thrombotic thrombocytopenic purpura
c. Dengue hemorrhagic fever
d. Immune thrombocytopenic purpura
e. Drug induce thrombocytopenia
42. which PE result is causing a blood donor rejection?
a. weight of 55 kg
b. pulse of 75 bpm
c. temperature of 36.50 C
d. diastolic pressure of 110 mmHg
e. Hb of 13.5 g/dl

43. what would be result of group A blood given to a group O patient?
a. non immune transfusion reaction
b. immediate hemolytic transfusion reaction
c. delayed hemolytic transfusion reaction
d. immediate non immune transfusion reaction
e. delayed non immune transfusion reaction

44. a patient with present a platelet count of 350 x 10?./L and bleeding time of 12 minutes. These result most probably suggest:
a. decreased platelet production
b. defective platelet function
c. increased platelet production
d. increased platelet destructive
e. decreased platelet destructive

45. neutrophilic granulocyte development occurs in bone marrow. Which is the following stages development of that cell?
a. promyelocyte, myeloblast, myelocyte, metamyelocyte, band, and segmented neutrophils
b. myeloblast, promyelocyte, myelocyte, metamyelocyte, band, and segmented neutrophils
c. myeloblast, myelocyte, promyelocyte,metamyelocyte, band, and segmented neutrophils
d. myeloblast, promyelocyte, metamyelocyte,myelocyte, band, and segmented neutrophils
e. segmented neutrophils, band, metamyelocyte, promyelocyte, myelocyte, and myeloblast,

46. A 40 year old man with an acute inflammation is reffered to Hasan Sadikin Hospital, which is the following laboratory test useful in this case?
a. Hb, Leukocyte, platelet
b. Hb, Leukocyte, Differential counting
c. leukocyte, platelet, and differential counting
d. leukocyte, erythrocyte, platelet
e. Hb, leukocyte, erythrocyte

47. a 20 year old man had been complaining of fatigue. She look pale and has come some unexplained large bruises. Hepatomegaly was present, but lymphadenopathy was absent. A routine CBC reveals: Hb 10g/dl, WBC: 110.000/ mm3, platelet: 35.000/ mm3, the differential count as follows : blast cell 53%, promyelocyte 12%, myelocyte 8%, metamyelocyte 6%, band 4%, segmented neutrophils 10%, lymphocyte 7%, auer rod was seen in many blast.
What is the most possible diagnosis in this case?
a. Acute lymphoblastic leukemia
b. Chronic lymphoblastic leukemia
c. Acute lymphocytic leukemia
d. Acute myeloblastic leukemia
e. Acute myelocytic leukemia

48. A 25 year old woman has suffered wheals in her arms, trunk, and chest two hours after she ate prawn. She feels severe itching and stinging. The clinical manifestation is more severe when she scratched the lesion. Which of the following substances is the most likely involved?
a. IgA
b. IgD
c. IgE
d. IgM
e. IgG

49. an 11 year old boy come to dermatology outpatient with chief complaint itchy skin rashes on both elbows. He also complained about dry skin on limbs. His mother has a history of allergy to seafood and cat dander. The dermatological status reveal erythematous papules, scales, and lichenification on both elbows. Which of the following is the most common predilection of this case?
a. face, especially cheeks
b. scalp
c. diaper area
d. extensor area of the extremities
e. flexural fold of the extremities

50. a 45 year old man has had recurrent blister on his body since 1 year ago. No itchy. Nickolsky sign positive. No history drug allergy. His skin lesion improved with corticosteroid. Which of the following is the most likely finding on histopatological of his skin?
a. intra epidermal blister
b. sub epidermal blister
c. infrabasal blister
d. infradermal blister
e. intradermal blister

51. a nurse that works at operation room comes to dermatovenerologist with chief complaint rash and papules at her hands that felt itchy and stinging. The complaint occurs after she used a new brand gloves. She has history of sneezing and running nose in the morning. The dermatological status reveal erythematous macules and papules on her both hands. Which of the following is the most mechanism that plays role in the pathogenesis in this case?
a. type I hypersensitivity
b. type II hypersensitivity
c. type III hypersensitivity
d. type IV hypersensitivity
e. autoimmunity

52. A 15 year old boy has occasional fever, malar rash, athralgia. He looks pale and weakness. The malar rash is not itchy which became more severe on sun exposure. Which of the following laboratory findings is the most likely to be abnormal?
a. urinalisis: bilirubin (+)
b. Hb : 16 gr/dl
c. SGOT/SGPT 50/60
d. leukosit 2000/mm3
e. urinalysis: urobilinogen (+)

54. 54 y.o.male, chief complaint: burning stinging dusky red macule on lip and genitalia. Appear after taking ibuproven 6 months ago. Dermatological status: rounded erythematosus, hyperpigmentia macule on lip and genitalia. Diagnose?
a. exenthematous eruption
b. pustular eruption
c. fixed drug eruption
d. bulous eruption
e. drug induced lichenoid

57. most important cell in hypersensitivity type IV?

58. 24 y.o. man complain : crust, hyperemic nasal mucus.. total body surface affected 35%. What is the diagnose?  TEN

59. 25 y.o. female comes to hospital with chief complaint of redness, itchy oatches and some blister on her neck. For a week she has redness itchy patches and small blister on her neck, color area which spread rapidly involving upper chest. 2 weeks ago, using imitation neckless. 6 months ago suffered redness itchy patches on wrist after using new bracelet. PE dan lab normal. Patch test positive 3 to nickel. Diagnosis?
a. contact urticaria
b. irritant contact dermatitis
c. atopic dermatitis
d. allergic contact dermatitis
e. seborrheic dermatitis

61. a y.o boy come to the hospital with chief complaint redness, itchy patches on both knees and elbows. He also has rhinitis and a history of redness itchy patches on cheeks when he was 2 years old. PE within normal limit. Lab result: IgE total 500. What is the most likely diagnosis?
a. sebrrhoic dermatitis
b. nummular dermatitis
c. acrodermatitis
d. atopic dermatitis
e. stasis dermatitis

63. a histosection show an organ with large amount of lymph tissue including nodules with germinal centers and deeply in vaginated mucosal surface formed by stratified but poorly defined epitel?
a. liver
b. spleen
c. palatine tonsil
d. thymus gland
e. payer patche

64. a developing erythrocyte + neutrophil in RBM may be differentiated from one another by presence of:
a. golgi apparatus
b. granule
c. mitochondria
d. peroxisome
e. RER

66. antigen specific binding that occurs in graft rejection as result from..
a. T-Cell
b. plasma cell
c. monocyte
d…..
e. …

67. a 25 y.o.man is being evaluated for his anemia. On PE the doctor finds his sclera are subicteric and his spleen is enlarged (Schuffner II). What is the most possible of this patient?
a.iron deficiency anemia
b. hemolytic anemia
c. aplastic anemia
d. pernicious anemia
e. sideroblastic anemia

68. a 60 y.o. woman presented to the physician with easy satiety and fullnesss in her abdomen. Her spleen was enlarged (scuffner II). Lab test showed Hb: 17.5 g/dl, Ht 54%, WBC 30.000/ mm3, PLT 600.000/ mm3. Which of the following is the most possible diagnosis of her problem?
a. myelofibrosis with myeloid metaplasia
b. chronic granulocytic leukemia
c. lymphocytic chronic leukemia
d. polycytemia vera rubra
e. multiple myeloma

69. a 35 y.o woman comes to your clinic with a chief complaint of physical weakness since 2 months ago. She looks pale and on physical examination you find papilla atrophy of her tongue and spoon nail. What is the most important factor in managing this patient?
a. elimination the cause
b. avoid certain diet
c. while blood transfusion
d. vitamin supplementation
e. hematinic agent therapy

70. a 20 y.o. male present with a chief complaint of unilateral painless masses in the right neck region of 3 months duration. He has weight loss from 40 kg to 35 kg over a 3 month-interval. He has no fever and no diameter, rubbery, non tender and mobile. He has no splenomegaly. What is the most appropriate examination to diagnose this patient?
a. chest X-ray
b. lymph node biopsy
c. abdominal CT scan
d. neck ultrasonography
e. peripheral blood smear

71. a 40 y.o male is referred to an internist by a surgeon for an evaluation of anemia. The patient will undergo operation for his internal hemorrhoid and the laboratory screening before operation shows that his Hb level is 8 g/dl. The internist finds that the patient’s conjunctivae are pale and there is papilla atrophy of his tongue and spoon nail. What is another most possible findings on physical examination of this patient?
a. moist hand
b. brittle hair
c. clubbing finger
d. hepatomegaly
e. splenomegaly

72. a 20 y.o woman comes to your private practice with swelling and stiffness as chief complaint. Over the past month she has been extremely tired and unable to keep up with her coursework. She falls asleep in classes and has found some difficulty with concentration. Recently, she has felt feverish, but has not bothered to take her temperature. She comments that her hair seems to be falling out after brushing or washing her hair. PE revealed a raised, warm rash on her cheeks and small ulceration on the hard palate. Mild tender synovitis are found in both wrist as well as in the second and third metacarpointerphalangeal joints of both hands. A small effusion is present in the left knee. Test principal diagnostic result specific for this condition is a high titer of an autoantibodies against. Which of the following the most appropriate serologic test for this patient?
a. VDRL
b. anti nuclear antibody
c. Rheumatoid factor
d. Anti ds-DNA
e. Anti ss-DNA

73. a 14 year old male complains of spontaneous joint bleeding on his left leg. There was history of bleeding after circumcision when he was 7 year old. PE reveals hemarthrosis, no other obvious bleeding. Lab findings show Hb 14 g/dl, WBC 8000/ml, PLT 225.000/ml. which of the following is the most likely explanation of his problem?
a. quantitative platelet disorder
b. qualitative platelet disorder
c. coagulation disorder
d. thrombosis disorder
e. vascular disorder

74. a 50 y.o male presents with a chief complaint of bilateral painless masses in the neck region of 6 months duration. He also has fever, night sweat and weight loss from 60 to 50 kg over a 6 month interval. On PE, the patient found to have bilateral supraclavicular and cervical lymphadenopathy, diameter 2-3 cm, rubbery, non tender and mobile. He has no splenomegaly. What is the most possible factor to determine the prognosis in this case?
a. liver enzyme level
b. creatinine level
c. LDH level
d. uric acid level
e. Hb level

75. 72. a 20 y.o woman comes to your private practice with swelling and stiffness as chief complaint. Over the past month she has been extremely tired and unable to keep up with her coursework. She falls asleep in classes and has found some difficulty with concentration. Recently, she has felt feverish, but has not bothered to take her temperature. She comments that her hair seems to be falling out after brushing or washing her hair. PE revealed a raised, warm rash on her cheeks and small ulceration on the hard palate. Mild tender synovitis are found in both wrist as well as in the second and third metacarpointerphalangeal joints of both hands. A small effusion is present in the left knee. Which of the following appearance should be expected on histopatological examination if biopsy was taken from the skin lesion?
a. pathology findings like with IgA dermatitis
b. microscopically: there is basal cell vacuolization but without lymphocyte infiltration
c. immunofluoresence studies no granular band of immunoglobulin and complements
d. microscopically there are epidermis atrophy with hydrophic generation
e. hyperkeratosis and parakeratosis usually can fined in the microscopic findings

for question 76 to 77, refer to scenario below:
a 24 year old man comes to the physician because of spontaneous gum bleeding since 2 days before. He has also been complaining fatigue and dizziness since a month ago and has been feeling a little feverish in the evening for two weeks. He looks pale, gingival bleeding is noted. There are no lymphadenopathies nor liver and spleen enlargement. Kab result show: Hb: 7 g/dl, Ht: 18 %, WBC: 2500/mm3, PLT 35.000/mm3
76. if his bone marrow smear shows cellular hypoplasia, which of the following is the most likely to predict the prognosis of his disease?
a. Hb
b. Ht
c. RBC count
d. WBC count
e. PLT count

77. if his bone marrow smear shows cellular hypoplasia and he needs blood transfusion, what kind of transfusion would you give to this patient?
a. fresh whole blood
b. packed red cell
c. washed red cell
d. platelet concentrate
e. fresh frozen plasma

for question number 78-79, refer to scenario below:
a 40 y.o. man is admitted to the ward with anemia. He has history of fever for a month, and gum bleeding occasionally. Lab result: Hb : 6 g/dl, wbc: 60.000/mm3, PLT: 57.000/mm3
78. if his bone marrow shows poorly differentiated blast more than 30% of the cells, with auer rod in the cytoplasm, what is the diagnose of the patient?
a. acute myeloblastic leukemia- M0
b. acute myeloblastic leukemia- M1
c. acute myeloblastic leukemia- M2
d. acute myeloblastic leukemia- M3
e. acute myeloblastic leukemia- M4

79. what is the next appropriate step in making diagnosis?
a. cytochemistry
b. cytogenetic
c. immunophenotyping
d. absolute values
e. peripheral smear

80. a 20 y.o. man presents with chief complaint of unilateral painless masses in the right neck region of 3 months duration. He has weight loss from 44 to 35 kg over a 3 month interval. He has no fever and no night sweat. On PE, the patient has three right cervical lymphadenopathies, 3-4 cm in diameter, rubbery, non-tender, and mobile. He has no splenomegaly. Which of the following viral is the most likely cause of the lymphadenopathy?
a. Hepatitis C virus
b. Hepatitis B virus
c. Ebstein Barr virus
d. Human papiloma virus
e. HTLV-1

81. a 20 y.o. female complains of easy bruising of the arm and legs for several months. She also has recurrent bleeding from the nose and heavy menstrual bleeding since 2 weeks. Physical examination reveals echymoses and petechiae on the thighs and forearm, no other obvious bleeding. Laboratory findings show Hb 13 g/dl, WBC 4000/ mm3, PLT 25.000/ mm3. what is the most life threatening complication in this case?
a. intracranial bleeding
b. DIC
c. Gastrointestinal bleeding
d. menomethorrhargi
e. joint bleeding

82. a a 20 y.o.woman is screened to asses her complaint of weakness. The vital signs are normal. She looks pale and her sclera are slight jaundice. There are also mild hepatosplenomegaly. Her liver enzyme are normal, with total bilirubin 3.2 mg/dl and direct bilirubin 1.1 mg/dl.if direct and indirect coombs’ test are positive, what is the best treatment for this patient?
a. blood transfusion
b. splenectomy
c. corticosteroid
d. immunoglobulin
e. radiotherapy

83. a 50. Y.o female presents with painless neck swelling. She notes fevers, night sweats for the last 6 months. No history of bleeding. On PE you note a 4 cm left anterior cervical lymph node, multiple right anterior right cervical lymph nodes, no palpable axillary lymph node, 2-3 cm and a 3 cm right inguinal lymph node. They are non tender and mobile. The oropharynx is clear. She has hepatosplenomegaly. What is the most appropriate treatment of this patient?
a. antibiotic
b. cytostatic
c. tuberculostatic
d. operation
e. radiation

84. a 14 y.o. male complains of pain and swelling on his right knee. There is a history of the same symptom with his younger brother. PE reveals hemarthrosis on his right knee, no anemia. Lab findings show Hb 14 g/dl, WBC 8000/ mm3, PLT 225.000/ mm3 BT 1 minute (N: 1-3), prothrombin time in normal limit, APTT 70 sec (N: control 35 sec). which of the following is the most likely explanation of his problem?
a. vascular disorder
b. thrombosis disorder
c. coagulation disorder
d. qualitative platelet disorder
e. quantitative platelet disorder

85. a 50 y.o. man has had progressive weakness and dyspnea with exertion for 3 months. He appears malnourished and the conjunctivae are pale, and there are scattered petechiae. Lab studies shows: Hb: 6 g/dl, WBC: 3500/ mm3 with hypersegmented neutrophils, PLT 60.000/ mm3, MCV 115 fL, Reticulocyte count: 0.5%. the bone marrow smear of this patient shows:
a. Erythropoietic hypoplasia
b. granulopoietic hypoplasia
c. thrombopoietic hypoplasia
d. giant stab cell
e. giant platelet

86. a 55 y.o woman is hospitalized with anemia. She has enlarged cervical lymph nodes and splenomegaly (Schuffner III). Lab result: 6 gr/dl, WBC 60.000/ mm3, PLT 57.000/ mm3. the peripheral blood lymphocyte count is 40.000/ mm3. the most likely diagnosis of this patient:
a. chronic myelocytic leukemia
b. chronic lymphocytic leukemia
c. multiple myeloma
d. myelofibrosis
e. leukemoid reaction

87. a 15 y.o boy is brought to the physician by his mother due to masses on his right neck. He has also been fatigue since a month. The physician notes that his conjunctivae are anemic and there are lymph nodes palpated on his right neck, 1-3 cm in diameter, rubbery and not painful. There are also hepatosplenomegaly and bruising on his leg. Lab result shows : Hb 8gr/dl, WBC 3000/ mm3 PLT 60.000 /mm3, the peripheral smears shows pancytopenia and smudge cells. If his bone marrow shows blast more than 30% of the cells, within 1-2 nucleoli, what is the prognosis of his disease?
a. curable with radiotherapy
b. curable with chemotherapy
c. curable with chemoradiation
d. curable with immunotherapy
e. curable with antibiotics

88. a 55 y.o woman has had progressive weakness and numbness on her extremities. Lab studies shows: Hb 8gr/dl, WBC: 4500/ mm3 with hypersegmented neutrophils, PLT: 150.000/ mm3, MCV: 125 fL, reticulocyte count: 1 %. Which is the most possible abnormality found on the PE?
a. conjunctivitis
b. gingivitis
c. arthrititis
d. stomatitis
e. glossitis

89. which statement is true for arterial thrombosis?
a. long term use if oral contraceptive pill
b. stasis in blood vessel
c. begin with endothelial injury
d. deficiency of natural inhibitor is the basic process
e. deficiency of plasminogen activator inhibitor I (PAI-1)

90. 50 y.o female, chief complaint of bilateral painless masses in the neck region of 6 months duration. He also has fever, night sweat and weight loss (60kg 50kg) over 6 months interval. PE : bilateral supraclavicular and cervical lymphadenopathy. Diameter 2-3 cm, rubbery, non tender and mobile, no hepatospleenomegaly. Which of the following is the most likely cause of the lymphadenopathy?
a. inflammation
b. infection
c. metastases malignancy
d. lymphnode malignancy
e. autoimmune

93. if biopsy of the lymph node reveals no reed Stenberg cells and abdominal ultrasound shows paraaortic lymph node enlargement, which of the following is the most likely diagnosis?
a. non hodgkin’s malignant lymphoma stadium II
b. non hodgkin’s malignant lymphoma stadium III
c. hodgkin’s lymphoma stadium, stadium III
d. hodgkin’s lymphoma stadium II
e. non hodgkin’s malignant lymphoma stadium IV

96.gen untuk replikasi HIV? …
a. gp120
b. tat
c. gp41
d. p11

104. the highest concentration of immunoglobulin that secreted by gut…
a. IgG
b. IgA
c. IgM
d. IgD
e. IgE

106. 35 y.o woman: allergic rhinitis, sneezing, nasal obstruction, and impaired QOL. Which of the following test is the safest and sensitive for her?
a. intradermal test
b. patch test
c. prick test
d. radioallergosorbent test
e. skin end point titration test

108. 33 years old man came to ENT clinic with bilateral nasal obstruction followed by on and off runny nose for 6 months. The symptom is worst in the morning and cold temperature. No fever, headache, no nasal itching. PE : boggy edematous in lateral wall nose, septum, and especially in turbinates. Lab test are normal. Which of the following is most appropriate diagnose of this case?
a. fungal rhinitis
b. allergic rhinitis
c. vasomotor rhinitis
d. occupational rhinitis
e. medicamentosa rhinitis

111.which Ig that has a role in allergic rhinitis?
a. IgG
b. IgA
c. IgD
d. IgE
e. IgM

112. seorang wanita 24 tahun, hamil 32 minggu datang ke klinik alergi chief complaint  runny nose dan nasal stiffing. PE: enlarge inferior turbinate, watery mucous, ada latar belakang keluarga alergi dan asma. Which of the following substance beside histamine that make nasal problem?
a. bradikinin
b. esterogen
c. leukotrien
d. prostaglandin
e. progesterone

113. 90% of ATP needed by RBC is generated by :
A. Hexose monophospate shunt
B. Kreb’s cycle
C. Leukering-rappaport pathway
D. Embden-meyerhof glycolytic pathway
E. MetHb reductase pathway

115. the clinical manifestation that distinguish pernicious anemia from folic acid anemia with the presence of..
a. neurologic abnormalities
b. fatigue
c. weakness
d. shortness of bresth
e. slight jaundice

117. following hospital admission with loss of consciousness and hypotension after an antibiotic injection of primary health center. A 6 y.o. girl, atopic with 18 kg BW was given aqueous epinephrine subcutaneous. Dosisnya?
a. 0,18 ml 1:1000
b. 0,36 ml 1:1000
c. 3,6 ml 1:1000
d. 0,18 ml 1:1000
e. 0,36 ml 1:1000

118. 7 y.o. boy come to the clinic after taking acetylsalycilat acid. He come with symmetric blistering around arms and legs, painful ulcer, hemorrhage in lip and mucous and conjunctiva ulcer involving in cornea. Total skin lesion less than 10% BSA. What is thee best treatment for this disease?
a. glucocorticoid
b. NSAID
c. Cyclosporin
d. immunoglobulin
e. cyclosulphate

119. anak kecil, habis makan shrimp  angioedema dan gatal2. Obat yang cocok?
 antihistamine
121. following administration with loss of consciousness and hypotension, a 7 y.o. girl, body weight 22 kg was given injection aqueous epinephrine. Which of the following was the hypersensitivity cause?
a. type I
b. type II
c. type III
d. type IV
e. type I-IV

122. kinds of urticaria that immediately appear after vigorous swimming at seawater in the beach, at high noon on hot summer day, except:
a. heat urticaria
b. solar urticaria
c. cholinergic urticaria
d. psychogenic urticaria
e. aquagenic urticaria

123. lymphoid organ yang perkembangannya tidak dipengaruhi antigen…
a. spleen
b. thymus
c. bone marrow
d. bursa equivalent
e. yolk sac

124. in which hypersensitivity determination plasma/serum tryptase is helpful?
a. DD IgE mediated and non IgE mediated type I
b. diagnose type I hypersensitivity
c. diagnose type II hypersensitivity
d. diagnose type III hypersensitivity
e. diagnose type IV hypersensitivity

125. which of the following antibody, involve in atopic disease?
 ans: IgE

126. 12 y.o. boy follow skin prick test. The purpose of the test is to identified….
a. IgE mediated type I hypersensitivity
b. non IgE mediated type I hypersensitivity
c. IgE & non IgE type I hypersensitivity
d. type II hypersensitivity
e. type III hypersensitivity

128. diagnosis thalasemia trait is frequently misdiagnosed with…
a. IDA
b. aplsatic anemia
c. megaloblastic anemia
d. autoimmune hemolytic anemia
e. sideroblastic anemia

129. what is the right indicating to do ceasarian section operation in HIV pregnant mother?
e. transversal transmission preventing

130. bayi lahir normal, 3 kg dari ibu yang menderita HIV. Dilahirkan secara cesar pada minggu 38 kehamilan. Pendekatan diagnosis untuk konfirmasi bayi itu sudah terinfeksi HIV atau belum..
a. anti HIV-1
b. HIV p-24
c. HIV RNA
d. HIV DNA
e. culture

132. antibody yang dapat ditransfer dari ibu ke janin melalui transplacental?
a. IgE
b. IgA
c. IgG
d. IgD
e. IgM

133. characteristic of cutaneous lesion of NLE:
a. facial
b. acral
c. extensor
d. diffuse
e. photo distribution

138. which of the following clinical manifestation is permanent in NLE?
a. congenital heart block
b. cutaneous lesion
c. pulmonary involvement
d. neurology involvement
e. thrombocytopenia

142. appropriate treatment for IDA
a. blood transfusion
b. multivitamin intake
c. oral ferrous sulfate
d. intramuscular iron dextrant
e. an iron fortified cereal

146. WOTF agent would be the most likely to dampen the immune response in organ transplantation and autoimmune disease…
a. levimasole
b. thalidomide
c. serolimus
d. IFN
e. IL-2

154. WOTF is the site of action of corticosteroid in allergic reaction?
a.
b. inhibiting IgE class switching on plasma cells
c. inhibiting interaction on mast cell
d. inhibiting phospolipase-A2 liberated arachidonic acid
e. inhibiting leukotriene binding its receptor on eosinophils

156. drugs that need intrinsic factor for its absorption?
a. pyridoxine
b. folic acid
c. cyanocobalamine
d. riboflavin
e. Iron

158. moleku yang membantu absorbs non heme Fe..
a. vit C
b. vit B12
c. Vit B6
d. Vit D
e. Vit A

159. which of the following drug yang punya efek ke numbness and weakness?
a. vit b12
b….
c. pyridoxine
d….
e…..

163. which of the following statement is correct about phenothiazine?
a. produce marked sedation
b. produce marked adverse GI bleeding
c. may cause increase appetite weight gain
d. also act as antitussive
e. only marketed as sleeping aid

164. which of the following statement is regarding the effect of H1 receptor antagonist is true?
a. poor absorbed after oral administration
b. have limited use in allergic bronchospasm
c. all have muscarinic-cholinergic antagonis activity
d. not induce microsomal enzymes
e. cause increase in appetite

165. Mengenai alegy dan hypersensitivity
a. delayed reaction occurs in asthma
b. histamine play role in bronchospasm
c. hay fever, other than histamine lead to nose irritation
d. red flare and hives in urticaria karena mixture toxic leukotrient
e. anaphylaxis : localized reaction in vascular system

166. girl 5 y.o., chief complaint rash di trunk dan extremities, easy brushing, no fever, no history bleeding, PE no splenomegaly. Lab : Hb,Hct, WBC  normal, platelet 15.000. treatment for this patient?
a.
b.
c. suspension for thrombocyte
d.
e.

168. 4 y.o boy, chief complaint: bruishing on his right knee and joint pain, there are palpable bruises on the right thigh and hemarthrosis on the right knee. Lab: Hb: 12.8, HCT: 38.5%, WBC: 9000, platelet: 220.000, BT 3 min, PT: 11 sec, APTT: 98 sec. his brother has same history. WOTF lab result is supposed to be abnormal in this patient..
a. factor I deficiency
b. factor V deficiency
c. factor VII deficiency
d. factor VIII deficiency
e. factor XIII deficiency

170. ……. Neurological examination show tetraparesis, stocking glove paresethesia and decreased physiologic reflex. Lumbar puncture is done. What is the result?
a. increased glucose with normal cell
b. increased glucose with increased protein
c. decreased protein with normal cell
d. decreased protein with decreased glucose
e. decreased protein with increased glucose

171. which is the most possible cause of this case…
a. H.influenza
b. campylobacter jejuni
c. CMV
d. salmonella thypii
e. Herpes zoster

174. which of the following has been the mainstay treatment for this patient (SJS)
a. glucocorticoid
b. NSAID
c. cyclosporine
d. immunoglobulin
e. cyclophospamide

177. red eye, pain, easy tearing. Peripheral corneal ulcer. Treatment..
a. oral antibiotic
b. anti fungal
c. topical corticosteroid
d.antihistamin
e. topical antibiotic

179. male, 50 y.o. chief complain red eye,pain, excessive tearing, objective exam : peripheral corneal ulcer. Main treatment?
A. oral antibiotic
B. antifungal
C. topical corticosteroid
D. antihistamine
E. topical antibiotic

184. immunoglobulin paling terpengaruh untuk melindungi tubuh seperti contohnya toxic infection : dipteri?
A .IgG
b. IgM
c. IgA
d. IgD
e. IgE

189. 54 y.o. woman terkena rhinitis. Dia menggunakan nasal spray. Obat tersebut dapat menyebabkan apa?
a.
b. rebound phenomenon
c. mulberry rhinitis
d.
e.

199. bleeding time which of the following option is markedly prolonged?
a. VIII deficiency
b. Taking high dose of aspirin
c. malabsorption of vit.k
d. abnormal liver function
e. ….

MDE HIS 2008

For number 1-3, refer to clinical scenario below
28 y.o woman with heavy periods & fatigue comes to thr outpatient dept. These complaints occur since 3 months ago. Her conjunctivae are anemic. There is koilonychia without hepatosplenomegaly on physical examination. Lab findings : Hb 8.0 g/dl, WBC 5000/m3, thrombocyte 475.000/mm3
1. What is the most possible findings on the physical exam?
A. icteric sclerae
B. gum hypertrophy
C. atrophy of lingual papilae
D. lymphadenopathy on the neck
E. mass on the abdomen
Jawaban : C
Alasan : koilonychia  salah satu tanda iron deficiency anemia. A  tanda hemolytic anemia. B&D  tanda AML. E  tanda hepatosplenomegaly, tidak ada di kasus (Wintrobe ch 28)

2. Which of the following cells in erythropoiesis is dominant on her BM smear?
A. pronormoblast
B. basophilic normoblast
C. polychromatophilic normoblast
D. acidophilic normoblast
E. reticulocyte
Jawaban : E?
Alasan : sebenernya jawabannya “lack of stainable iron in reticuloendothelial cells”, tapi ga ada di pilihan.

3. What is the first to treat the patient?
A. blood transfusion
B. iron therapy
C. folate therapy
D. cobalamine therapy
E. eliminate the cause
Jawaban : B
Alasan : 1st choice treatment untuk IDA adalah mengembalikan kadar Fe. A indikasi Hb <7mg/dl. C&D  manifestasi klinis berbeda. (Wintrobe ch 28)

For number 4-5 refer to clinical scenario below
A 25 y.o woman admitted to hispital with complaints of fatigue & increased shortness of breath with exercise. The patient appeared pale and was tachycardia. Results of lab tests included HB 5.6 gr/dL, WBC 10.000/mm3, RBC 4.5x106, MCV 68.6 fL, MCH 16pg, MCHC 23%. Examination of perpheral blood smear revealed microcytic, hypochromic, and minimal anisopoikilocytosis.
4. Which of the folowing process is the most likely for the patient?
A. excess Hb synthesis
B. vit B12 deficiency
C. A quantitative defect in Hb synthesis
D. A qualitative defect in globin protein chains
E. folate deficiency
Jawaban : C
Alasan :peripheral blood smear menunjukkan IDA (Harmening hlm 103)

5. Which of the following test may useful in confirming the diagnosis?
A. measurement of serum Fe dan TIBC
B. Hb electrophoresis
C. vit B12 deficiency
D. chromosome analysis
E. flow cytometry
Jawaban : A
Alasan : kasus di atas adalah IDA, jadi pemeriksaan selanjutnya adalah pengukuran serum Fe dan TIBC (Harmening hlm 103-106)

6. A 12 month old boy presents to your office with a chief complaint of pallor. He has inadequate nutritional intake. On physical exam : pale conjunctivae, no liver & spleen enlargement. Lab : WBC 8100/m3, Hb 7.2 gr/dL, PLT 250.000/mm3. Peripheral blood smear : microcytosis, hypochromia.
What is the most likely etiology of this anemia?
A. vit B12 deficiency
B. folic acid deficiency
C. iron deficiency
D. beta globin deficiency
E. G6PD deficiency
Jawaban : C
Alasan: microcytosis, hypochromia  ciri IDA

7. What kind of peripheral blood smear appearances will be found?
A. Hypochromic, microcytic, anisopoikilocytosis with abundant of pencil cells
B. Hypochromic, microcytic, anisopoikilocytosis with abundant of target cells
C. Normochromic, normocytic, anisopoikilocytosis with abundant of target cells
D. Normochromic, normocytic, anisopoikilocytosis with abundant of pencil cells
E. Normochromic, macrocytic, anisopoikilocytosis with abundant of target cells
Jawaban : B
Alasan : ciri IDA (Harmening hlm 108 tabel 6-13)

8. What kind of lab exam will be found ?
A. Low serum Fe level, low TIBC, low transferrin saturation
B. Low serum Fe level, increased TIBC, low transferrin saturation
C. Low serum Fe level, low TIBC, increased transferrin saturation
D. Increased serum Fe level, increased TIBC, increased transferrin saturation
E. Increased serum Fe level, increased TIBC, increased ferritin saturation
Jawaban : C
Alasan : Harmening hlm 108 tabel 6-13

9. What is the most appropriate recommended treatment for this patient?
A. Multivitamin
B. Blood transfusion
C. Oral ferrous sulphate
D. An iron fortified cereal
E. Intramuscular iron dextran
Jawaban : C
Alasan : untuk memperbaiki status iron dalam serum

10. A 32 y.o. woman was referred to your hospital for evaluating her low level of Hb. She looks pale and on physical exam you found papillae atrophy of her tongue and dry skin. Which of the following is most likely epithelium damaged for her tongue?
A. Simple stratified keratinized
B. simple stratified nonkeratinized
C. simple squamous
D. simple cuboidal
E. simple ciliated columnar
Jawaban : B
Alasan : lidah termasuk simple stratified nonkeratinized

For number 11&12, refer to clinical scenario below
A 24 y.o woman presents to the hospital with multiple bruises on her arms. This symptoms occurs since 2 days ago. There is no recent illness or problems with bleeding or bruising in the past and she takes no medication. On exams, there are several purpuric lesion on each of her forearms. There is no adenopathy or organomegaly.
11. What is the 1st lab study would you order to investigate this?
A. Complete blood count (CBC)
B. bleeding time (BT)
C. Clotting time (CT)
D. Prothrombin time (PT)
E. activated partial thromboplastin time (aPTT)
Jawaban : A
Alasan : bruising  kelainan hemostasis. Oleh karena itu perlu dicek terlebih dahulu jumlah keseluruhan dari sel darah melalui CBC (Harmening hlm 517)

12. IF the PLT count is low which will be prolonged?
A. CT
B. BT
C. thrombin time (TT)
D. PT
E. aPTT
Jawaban : B
Alasan : BT  evaluasi PLT dan fungsi vaskular untuk membentuk PLT plug (Labman HIS)

13. A 4 m.o. boy was brought to the ER dept by his parents. The boy hsa bleeding from his arm after his hepatitis immunization. There was history of bleeding in the male family members. The ab shows normal CBC, BT 2 min(N:1-3min), aPTT 70sec (N:24-45), PT 12sec (N:10-14), TT 14 sec (N:11-15).
What is the other test will be suggested?
A. bone marrow smear
B. Cytokimia
C. Factor assay
D. Lupus anticoagulant
E. Hb electrophoresis
Jawaban : C
Alasan : bleeding  kelainan hemostasis, history of bleeding in male family member  penyakit genetik, BT & CBC normal  bukan kelainan PLT ata vaskular, PT normal  extrinsic dan common pathway normal, TT normal  common pathway normal, aPTT prolonged  kelainan pada intrinsic pathway  perlu factor assay (Wintrobe figure 51.8)

14. A 3 y.o. boy is referred to pediatric dept with fever as chief complaint which occur since 5 days ago. At the hospital, doctor performed Rumple leede test on him.
Which of the following ability is measured by this test?
A. the capillaries to resist pressure
B. the PLT to resist pressure
C. the capillaries to resist heat
D. the PLT to resist heat
E. the fibrinogen to resist heat
Jawaban : A
Alasan : a test in which the increased bleeding tendency characteristic of various disorders (as scarlet fever and thrombocytopenia) is indicated by the formation of multiple petechiae on the forearm following application of a tourniquet to the upper arm

For number 15-16 refer to this scenario below
A 50 y.o man present with pain in the right calf. He states that his mother had pulmonary emboli. Lab findings : aPTT 70 sec (N:24-25), PT 12 sec (N:10-14), ACA-IgG 80gpl. A Doppler ultrasound reveals a deep vein thrombosis.
15. What is the diagnosis of this case?
A. Factor V Leiden
B. antithrombin III deficiency
C. antiphospholipid syndrome
D. protein C deficiency
E. protein S deficiency
Jawaban : C
Alasan : DVT, pulmonary emboli (di kasus ada family member)  tanda APS (Harmening ch 27)

16. What is the additional test will be suggested?
A. Factor assay
B. Lupus anticoagulant assay
C. TPHA
D. ASTO
E. blood smear
Jawaban : B
Alasan : APS biasanya disebabkan oleh lupus anticoagulant atau anticardiolipin antibodies (Harmening ch 27)

For number 17-18 refer to the scenario below
A 3 y.o. boy is referred to the hematology dept with a chief complaint of bruising of his right thigh. He also noted that there were red dots on his extremities since 2 days ago. Lab results : Hb 12.8 gr/dL, Hct 38.5%, WBC 6000/mm,. Peripheral blood smear shows giant PLT and normal morphology of red and white blood cell lines.
17. What is the cause of the bleeding?
A. fibrinolysis disorder
B. vascular disorder
C. coagulation disorder
D. Quantitative PLT disorder
E. Qualitative PLT disorder
Jawaban : D
Alasan : giant PLT  menandakan kompensasi jumlah PLT yang kurang

18. What is most likely appearance of the bone marrow smear of this patient?
A. large promegakaryocyte
B. large megakaryoblast
C. small promegakaryocyte
D. megakaryocyte with PLT formation
E. megakaryocyte without PLT formation
Jawaban : D
Alasan : megakaryocyte with increased or normal number (Harmening hlm 474-475)

19. What is PLT receptor for von Willebrand factor?
A. glycoprotein Ia
B. glycoprotein Ib
C. glycoprotein IIa
D. glycoprotein Iib
E. glycoprotein III
Jawaban : B
Alasan : primary receptor for vWF is GpIb (Harmening ch 23)

20. A 12 y.o boy was brought to the emergency dept by his parents. The boy suffered from hemarthrosis. There was a history of bleeding in the male family members. The lab results shows normal CBC. What is the appearance of lab results on this patient?
A. PT prolonged, aPTT normal
B. CT normal, BT normal
C. BT prolonged, CT normal
D. PT normal, aPTT prolonged
E. PT normal, aPTT normal
Jawaban :
Alasan :
21.D. kasus kita kan ITP, untuk treatment dari penyakit autoimun, maka kita harus berikan obat imunosupressan.. di sini kortikosteroid. (wintrobe: ITP-Treatment)
22.B. keadaan ini kita curiga ke hemophilia, jadi untuk memastikan apakah ini hemophilia atau bukan, maka kita melakukan melakukan assay dari factor VIII
23. C. sudah terlihat dengan jelas dengan aptt yang prolonged. Bukan von willebrand, karena biasanya von willebrand yang turun sering diikuti dengan bleeding time yang naik .
24.D Hemophillia  jelas ya dari hasil pemeriksaan dan eksklusi dari option yang ada.
25. E. cryoprecipitate itu mengandung factor VIII ag dan c, Faktor XIII,dan fibrinogen, & dengan orang hemophilia tipe A, akan mendapatkan transfuse ini. Apabila dalam keadaan severe hemophilia, maka akan diberikan purified factor yang bersangkutan.
26. D. dalam hal ini dengan prolonged aptt dan pt dan normal fibrinogen, yang terjadi kemungkinan adalah vit k deficiency. DIC, biasanya diikuti dengan penurunan kadar fibrinogen.
27. D. Vit K
28. C. di Nelson ebook, untuk treatment vit-k deficiency ya diberikan vit-K karena vit-k sudah jadi specific antidote. Jadi kalo masih berdarah yang kita takutkan adalah keadaan hypovolemic . jadi mikirnya diberikan fresh frozen plasma.
29.E. Unperturbed EC possess procoagulant activities that promote coagulation after vascular injury or perturbation. However, in the absence of initiating stimuli, these activities remain latent and do not contribute to thrombosis. Major prothrombotic activities of resting EC include binding sites (receptors) for coagulation zymogens or proteases [factor XII, factor XI, factors X and Xa, factors IX and IXa , and thrombin] and cofactor proteins [high-molecular-weight kininogen , factor VIIIa , and factor Va] and synthesis and expression of factor V and von Willebrand factor. –wintrobe chapter 22 endothelium angiogenesis and regulation hemostasis.
30. A. kalo option E itu biasanya dengan gejala yang purpura, petechiae dll yang mencirikan masalah pada kapiler.
31.c. vWF bisa dilakukan assay untuk mendeteksi kadarnya secara terpisah dari FVIII-vWF complex.
32. B. DDAVP therapy of choice for vWD (type 1) dan hemophilia A minor. DDAVP mengakibatkan transient increase of VIIIc and VIIIag
33. C
34. E. sebenernya ga dapet dimana2, tapi dari buku wintrobe, Williams, dan Hoffman serta robin bilangnya bahwa CLL bisa mengarah transformasi ke prolymphocytic leukemia apabila di blood smearnya banyak prolymphocyte (sekitar >56%) dan mixed type (10-56%), ga ada keterangan dari bone marrow. Tapi kecurigaan saya itu adanya statement “B-cell dengan prolymphocytoid transformation), jadi kemungkinan jawabannya adalah E.
35.A. jelas primarynya jumlah trombosit yang dibawah 150rb
36.B
37.D, karena ga ada tanda2 lymphadenopathy
38. C
39.D. kecurigaannya adalah CLL  karena ada keterlibatan hematopoietic cells di bone marrow dan lymphadenopathy. Jadi untuk kofirmasi setelah peripheral blood smear, kita smear ke tempat yg dicurigai, yaitu bone marrow.
40.b.
41. Jawaban : E. Stage IV
Penjelasan :
Penyakit yang dimaksud adalah CLL (Chronic Lymphocytic Leukemia).
Staging menurut Rai System :
0 : lymphocytosis in peripheral blood & bone marrow
I : + lymphadenopathy
II : + splenomegaly
III : + anemia
IV : + thrombocytopenia
(Harmening, 310)

42. Jawaban : B/C/E(?) tapi akademik 2006 jawab A. hyperkalemia
Penjelasan :
Salah satu hasil lab CLL adalah hypogammaglobulinemia (Harmening, 302).
Dari beberapa sumber internet ada yang mengikutsertakan hyperkalemia (B), hyperuricemia (E), & hypernatremia (C).

43. Jawaban : A. Increased sensitivity of hematopoietic stem cell to erythropoietin
Penjelasan :
Penyakit yang dimaksud adalah PV (Polycythemia Vera) ->soalnya ga lengkap.
“Erythroid progenitors are extremely sensitive to low levels of EPO supplied by serum that is inherently present in the basic culture medium.” (Harmening, 342)

44. Jawaban : A. Phlebotomy
Penjelasan :
Komplikasi utama dari PV adalah thrombosis akibat hiperviskositas darah & transisi PV menjadi MPD. Tujuan utama terapi adalah reduksi massa total RBC. Untuk itu dapat dilakukan terapi phlebotomy & cytotoxic myelosupressive agent. (Harmening, 346-347)

45. Jawaban : C.(?) tapi akademik 2006 jawab E. polycythemia, burned out, leukemic phase
Penjelasan :
“As previously mentioned, PV progress through several stages. In active erythrocytic phase, RBC can be maintained at satisfactory level. Many patients enter anemia period, and this spent phase (=burned out phase, from internet) ia associated with transformation to myelofibrosis. Presence of teardrop RBC on peripheral heralds transition PV to IMF.” (Harmening, 348)
Saya cenderung jawab C. erythrocte, burned out, myelofibrosis.

46. Jawaban : D. Lymphocytic lymphoma well-differentiated
Penjelasan :
“This pattern is diffuse & no lymphoid follicles are identified. The lymph node is replaced by an infiltrate of small (mature-appearing) neoplastic lymphocytes.” (Labman Pathology Anatomy)

47. Jawaban : A. Diffuse large B-cell lymphoma
Penjelasan :
“The malignant lymphocytes here are very large with moderately abundant cytoplasm, & the nuclei are round to ovoid with prominent nucleoli & occasional mitoses. Demonstration of CD-19 & CD-20 antigens would classify it as B-cell origin.” (Labman Pathology Anatomy)

48. ga ada soalnya…

49. ga ada soalnya…

50. Jawaban : C. Follicular lymphoma
Penjelasan :
“These lymphomas (-> follicular center lymphomas) are composed predominantly (more than 50%) of large cleaved cell (large cebtrocytes) & large non-cleaved (centroblast) cell. (Harmening, 405).

51. ga ada soalnya…

52. Jawaban : B. Epstein-Barr virus
Penjelasan :
Penyakit yang dimaksud adalah Burkitt’s lymphoma.
Ciri-cirinya : “Apoptosis is also very high & a starry-sky pattern of tingible-body macrophages is usually evident owing to phagocytosis of the apoptotic debris.” (Harmening, 413)
“The endemic & immunodeficiency-related cases are also assiciated with a high frequency of tumor cell incorporated EBV genomes.” (Harmening, 414)

53. ga ada soalnya…

54. ga ada soalnya…

55. Jawaban : A. Afferent lymphatics, medullary sinuses, hilus, efferent lymphatics
Penjelasan :
Struktur lymph node :
Lymphatic vessel : afferent vessel -> sub-capsular sinuses -> trabecular sinuses -> medullary sinuses -> hilum -> efferent vessel. (Labman Histology & Junquiera)

56. Jawaban : B/C(?) tapi akademik 2006 jawab D.HTLV-1
Penjelasan :
Penyakit yang dimaksud adalah Hodgkin’s lymphoma.
Karena ada non-painful lymph node swelling (Harmening, 402) dan gejalanya sesuai dengan klasifikasi Ann-Arbor (Harmening, 403).
Salah satu kemungkinan etiologinya adalah RNA-tumor-virus & EBV (Epstein-Barr virus). Kemungkinan lain adalah cytomegalovirus (B) & herpes virus 6 (C). (Harmening, 398-399).
HTLV-1 ditemukan pada non-Hodgkin’s lymphoma (Harmening, 416).

57. Jawaban : C. A nucleated Reed-Sternberg cell with large, inclusion nucleoli, & abundant cytoplasm is surrounded by mature lymphocytes
Penjelasan :
“The cytologic hallmark of Hodgkin’s lymphoma is the presence of unusual giant cell, the Reed-Sternberg cell. Features : large size, abundant acidophilic cytoplasm, multinucleated / polylobulated nucleus, & gigantic inclusion-like nucleoli.” (Harmening, 399)

58. Jawaban : D. Stage III B
Penjelasan :
Berdasarkan Ann-Arbor Staging :
I : involvement of single lymph node region / localized single extralymphatic site (IE)
II : involvement of 2/more lymph node regions at the same side of diaphragm / associated extralymphatic site (IIE)
III : involvement of lymph node regions on both side of diaphragm / associated extralymphatic site (IIIE)
IV : disseminated (multifocal) involvement of extralymphatic site & associated lymph nodes
Tambahan : A = asymptomatic, B = symptomatic (weight loss >10% in 6 months, fever >38°C, night sweat)
(Harmening, 403)
Pada kasus ini bilateral cervical & inguinal lymphadenopathy (=stage III) & ada symptom weight loss, fever, night sweat (=B).

59. Jawaban : B. Radiation
Penjelasan :
“Current modalities for the therapy of Hodgkin’s lymphoma are radiation, chemotherapy, or combination.” (Harmening, 403)

60. Jawaban : A G6PD-deficiency
Penjelasan :
Tabel 10-2 (Harmening, 159) chloramphenicol bisa menyebabkan G6PD deficiency.
Gejalanya anemia normochromic normocytic, back pain, hemoglobinuria & jaundice. (Harmening, 159)

61. E. Severe anemia (Hb < 7g/dl)
62. D. Karena : 8 mo, mild icterus, hepatosplenomegaly, decreased Hb, RDW increased, microcytosis, hypochromic
63. D jelas
64. D. WRBC = RBC, depleted of plasma, platelets, and leukocytes which can be deleterious to the recipient. Indication : for patients with antibodies to IgA or IgE immunoglobulins or thalassemic patients.
Packed red cell = RBC + small amounts of plasma with anticoagulant.

65. B. Semua sign n symptoms mengarah pada hemolytic anemia
66. A. Sign symptoms mengarah pada megaloblastic anemia ( terutama : malnourished). Di peripheral blood smear ditemukan : pancytopenia, macro-ovalocytes, hypersegmented neutrophils
67. B. Semua ciri2 pasien kita mengarah pada thalassemia. Peripheral blood smear : microcytic, hypochromic, >>> target cells (Harmening 196)
68. C (liat no 64)
69. B. Pasien kita terkena Megaloblastic anemia (increased MCV, weakness, fatigue,shortness of breath). Hb may be Normal to Low, absolute reticulocyte count is decreased. Pathogenesis : the defective nuclear maturation caused by a decrease in TTP synthesis from UMP. This deficiency interferes with nuclear maturation, DNA replication, and cell division.
70. C. Alasan diperkuat krn multiple Auer rod were seen.
71. D. Pasien kita anemia, leukocytosis,thrombocytopenia. Sepertinya dia kena leukemia.
72. B. Aplastic anemia : CBC shows pancytopenia, often with anemia being the most notable. The anemia is usually normochromic normocytic (Harmening 133)
73. B. Pasiennya mengalami pancytopenia (bukan leukemia), tapi aplastic.
74. C. Transfusion transmitted diseases : Hepatitis B, Hepatitis C, HIV, HTLV-1, CMV, HGV, Malaria, Babesiosis, Leishmaniasis, Lyme Disease, Chagas Disease - Chagas' Disease TTV, Creutzfeldt-Jakob CJD, KS and HHV-8, Toxoplasmosis, Cryoglobulinemia, Bacterial Contamination of Blood Products
75. C. Each unit of PRBCs is expected to raise circulating Hb by 1g/dl.
76. C. Disturbed cell = platelet (don’t have nuclear in mature cell, function : hemostasis, have OCS)
77. gtww..sorii
78. A.Adults = posterior superior iliac crest (most commonly), sternum (avoided in children), anterior superior iliac crest, spinal processes / vertebral bodies. Newborns and infant = upper end of the tibial bone. Jadi kalo diliat dr optionnya, maka jwbnnya A (Harmening 43)
79. D. Jelas,merupakan treatmenu utk IDA
80. B. Ferric iron is typically converted into ferrous state by the ACID of the stomach. (Harmening 101)
81. A.Folic Acid
That is important in synthesis of nucleid acid. It is interdependent with vit B12. Both of this are required for rapidly dividing cells. Deficiency of folic acid can cause megaliblastic anemia and also use for prevent neural tube defect (spine bifida)
82. E. Cyanocobalamine
It is the other name of vit B12. Necessary for synthesis of nuceid acid, maintenance of myelin production in nervous system and proper function od folic acid. Deficiency of vit B12 affect near all body tissue,particularly those cell containing rapidly dividing cell. So,deficiency of these vitamin also caue anemia,anemia megaloblastic. Loss of myelin cause decrease function of nervous system. The symptoms are paraesthesia,decrease of tendon reflex,and others.
83. A. Blood Transfusion
The diagnose of this patient is Iron Deficiency Anemia. So,the proper treatment (from the options) is blood transfusion. Blood transfusion is needed to do to treat the patient with Iron Deficiency Anemia if Hb decrease under 6 g/dl.
84. B. Urokinase
It is the enzyme endogenously produced by kidney present in blood and urine that is capable of breking up blood clots. It is activated plasminogen directly to plasmin,which dissolves blood clots.
85. the question is not complete
87. A. Decrese of basophilic color
The changes of RBC maturation,particularly in cytoplasma is from basophilic to red cytoplasma because of increase of HB.
88. C. Yolc sac - liver and spleen – red bone marrow
See harmening page 9
89. B. Briliant cresyl blue staining
See harmening page 80
90. C. Tissue hypoxia
See harmening page 15
91. B. Pelger-huetanomaly
Netrophil that has a bilobus nuclei or monolobed/round
93. B. ITP
More closed diagnose from the option is ITP
96.
98.
99. mechanism of action of allopurinol
Inhibitor to enzyme xanthin oxidase in uric acid production to treat of gout.

101)

102) ANS : D
EXP : tonsil incompletely encapsulated,each tonsil has 10-20 ep.invaginations that penetrate the tonsil deeply,forming crypts,whose lumen contain desquamated ep.cells,live & dead lymphocytes & bacteria (basic histology,junqueira,11th ed,pg 263-264)

103)

107)

108)

110) ANS : D
EXP : cytolytic T lymphocytes (CTLs) respond to antigen recognition by killing the antigen-bearing cell.these cells are usually CD8 & recognize antigen in the context of MHC class 1 molecules. (medical immunology,lange,10th ed,pg 141-142)

111) ANS : C
EXP : Thalidomide is very harmful to the fetus. Therefore, thalidomide should be avoided during pregnancy. Men and women who are taking thalidomide should use appropriate methods of birth control. Moreover, women of childbearing age should practice two forms of birth control concurrently. Men taking thalidomide should not donate sperm, and thalidomide users should not donate blood since the recipients of the sperm and blood may receive small amounts of thalidomide.
NURSING MOTHERS: It is not known whether thalidomide is excreted in breast milk.
SIDE EFFECTS: The most common side effects are drowsiness, dizziness, low blood pressure, weakness, rash and increased sensitivity to sunlight. Thalidomide also causes nerve damage and a decrease in white blood cells. Symptoms of nerve damage are tingling, numbness and pain in the feet or hands. (MedicineNet.com)


112)

113) ANS : E
EXP : corticosteroidadvantages :
• Promote normal intermediary metabolism
• Increase resistance to stress – high glucosegive high energyincrease resistance to stress(exp;trauma,fright,infection)
• Alter blood cell levels in plasma – cause decrease in eosinophils,basophils, monocytes & lymphocytes by redistributing them from the circulation to lymphoid tissue;increase blood levels of erythrocytes,hb,platelets PMN
• Anti-inflammatory action – exact mech.not fully understood.however,the lowering & inhition of peripheral lymphocytes & macrophages is known to play a role.interference in mast cell degranulation results in decreased histamine & capillary permeability.
• Affect other components of endocrine system
• Effects on other systems
(Lippincott,pharmacology,3rd ed,308-309)

114) ANS : C
EXP : dexamethasone=corticosteroids group;corticosteroid eye drops to control acute severe allergic conjunctivitis should be used very sparingly fro brief periods only,with careful monitoring by an ophtgalmologist (medical immunology,lange,10th ed,358)




115) ANS : C
EXP : side effects of glucocorticoidhyperglycemia may develop & lead to DM,other side-osteoporosis,increase risk of infection & classic Cushing-like syndrome (pharmacology,Lippincott,3rd ed,pg 312)

116)

117) ANS : A
EXP : pemphigus vulgaris – skin biopsy shows a suprabasal intraepidermal blister with loss of cohesion of keratinocytes(acantholysis);blisters that most commonly affect the scalp,chest,umbilicus,body folds;direct immunofluorescence reveals the deposition of IgG in virtually all patients & complement components (mostly C3) on epidermal cell surface forming a honeycomb pattern in 50% of all patients. (medical immunology,lange,10th ed,pg 504-505)

118) ANS : D
EXP : refer to explanation of the answer above

119) ANS : E
EXP : refer to explanation of the ans no. 117

120) ANS : B
EXP :

121. Which of the following is the best place in-patient care ?
a. burn unit room
b. recovery room
c. high care unit room
d. standard in-patient room
e. intensive care unit room
Ans.
a/e
Since the age of 4, an 8 yo girl has been suffering sneezing, watery rhinorrhea, nasal blockage resulting in nasal voice, severe itch in her nose and throat, accompanied with red, watery, severe itching eyes without fever. It recurs everytime she is in the rice stock ham, rice, and ricefields, especially in harvest time. The eye’s topical glucocorticoid treatment, need monitoring of an ophthalmologist, due to defective cell mediated immunity.
122. Which of the following is the most unlikely sign of PE ?
a. allergic salute
b. Dennie-Morgan folds
c. facial twitching or grimacing
d. hyperemic nasal mucous
e. transverse nasal crease
Ans.
d
PE pada allergic rhinitis :
- facial twitching or grimacing
- allergic salute
- dennie-morgan folds
- transverse nasal crease
123. The eye’s topical glucocorticoid treatment, needs monitoring of an ophthalmologist, due to defective cell mediated immunity. Which one of the following needs to be detected early by ophthalmologist ?
a. cataract
b. corneal ulcer
c. glaucoma
d. herpes simplex virus infection
e. sight threatening side effect
Ans.
c
Topical glucocorticoid therapy frequently  intraocular pressure in normal eyes and exacerbates intraocular hypertension in patient with antecedent glaucoma. Intraocular pressure should be monitored when glucocorticoid are applied to the eye for more than 2 weeks.
A 4 months old baby girl comes to clinic with rash skin on her cheeks, which spare the perioral skin. It appears first as typical dryness (1 week ago) developing into red scaly plaques since 4 days ago. On the first day of life, she was given cow’s milk formula and was exclusively breastfed there after. Since 8 days ago cow’s milk formula containing porridge was added to her daily feeding. Her brother (5 yo) will wheeze and her mother sneeze after exposure to dust.
124. Which one of the following is the most likely diagnosis ?
a. contact dermatitis
b. irritant dermatitis
c. atopic dermatitis
d. Steven Johnson’s Syndrome
e. Streptococcal skin scalded syndrome
Ans.
c
Terjadi akibat konsumsi susu sapi.
125. Which one of the following is the most likely cause of this baby’s disease ?
a. house dust
b. house dust mite
c. wheat
d. cow’s milk
e. breast milk
Ans.
d
Telah diberikan selama 8 hari.
20 yo with runny nose as chief complaint. It occurs since he was 4 yo. There is also nasal blockage, itchy-nose, sneezing especially after dust inhalation. He wotks as bus driver. PE : facies adenoid and allergic shinners, enlargement inferior and middle turbinate with a boggy, pale, and bluish mucosa. Lab : IgE levels : 600 IU/ml
129. Runny nose. Major substance release ?
Ans.
IgE
130. for the above case, what is the most suitable H. I. Antihistamine for this patient ?
a. ceftrizine hydrochloride
b. chlorpheniramine maleat
c. promethazine hydrochloride
d. tripehennamite hydrochloride
e. diphenhydramine hydrochloride
Ans.
a
Sesuai dengan case. Efek samping pada CNS rendah.
132. A 32 yo mother who was 32 weeks pregnant (G1P0A0) came to allergic clinic with a runny nose and stuffy nose as a chief complaint. This nose problem was firstly notice in 2nd trimester. PE reveal allergic shinners, enlarged inferior turbinate and watery-clear mucus. Lab : IgE serum 340 IU/ml. Which of the following substance beside histamine might cause the nose problem to this patient ?
a. estrogen
b. bradykinin
c. prostaglandin
d. progesterone
e. leukotrienes
Ans.
e
Menampakkan late phase mediator yang memiliki efek sama dengan histamine namun lebih potent.
137. 5 yo boy comes to ENT clinic. Runny nose since 3 yo, also suffered nasal blockage, itchy, and sneezing especially when inhaled dust. Lab : IgE serum 600 IU/ml. Most frequent co-morbidity on pharynx in PE ?
a. pale mucosa
b. post nasal drip
c. pseudomembrane
d. hyperemic mucosa
e. cobblestone appearance
Ans.
b
terjadi akibat produksi mucus .
139. During christmast dinner, female is hospitalized because of tight throat and shortness of breath after eating shrimp. What is the diagnosis ?
a. choking
b. anaphylactic shock
c. shrimp in throat
d. laryngeal edema
e. asthma
Ans.
b
141. 5 yo went to Pangandaran. Swimming vigorously in sea water at high noon which spread multiple pruritic papules, develop immediately, small which 1-3 mm diameter surrounded with excessive ... What type of urticaria is she having ?
a. aquagenic urticaria
b. cholinergic urticaria
c. heat urticaria
d. psychogenic urticaria
e. solar urticaria
Ans.
b
Cholinergic urticaria is a disease of unknown cause in which small (1-3 mm) wheals with prominent surrounding flare appear after exercise, heat, or emotional stress.
161. From case 160. Permanent symptom in NLE
A. Cutaneous lesion
B. Congenital heart block
C. Pulmonary involvement
D. Neurologic involvement
E. Thrombocytosis
Jawab : B

162. Major cause of death to chronic corticosteroid administration ?
A. Infection
B. Nephritis
C. CNS disease
D. Pulmonary hemorrhage
E. Myocardial infarction
Jawab : A
Kenapa bukan E ? Karena kelainan jantung yang bisa disebabkan oleh corticosteroid adalah heart failure (terutama congestive heart failure), bukan myocardial infarction (= heart attack).

163. IV drug user, Anti-HIV (+), CD4 = 66, shortness of breath, bilateral infiltrate of lung. Which is true ?
A. Risk of multiple opportunistic infection
B. Risk of myocardial infarction
C. Risk of autoimmune disease
D. Risk of hematological disease
E. Risk of drug allergy
Jawab : A

164. 30 y.o. male had symptom of anemia, diagnosed as megaloblastic anemia. Drug avoided through …
A. Oral
B. Intravenous
C. Intravascular
D. Subcutaneous
E. Intracutaneous
Jawab : B
Penyebab megaloblastic anemia adalah defisiensi vitamin B12 atau asam folat. Untuk vitamin B12, bisa diberikan secara per oral atau intramuscular atau subcutaneous. Untuk asam folat, biasa diberikan secara oral.

165. Patient with malar rash, photosensitivity, atrophic lesion at periauricular, ANA (+), dsDNA (-), no protein in urine. Diagnosis ?
A. DLE
B. SLE
C. CLE
D. Acute SLE
E. Acute CLE
Jawab : E
Dari criteria SLE, yang terpenuhi hanya 3, yakni malar rash, photosensitivity, dan ANA (+), sehingga belum memenuhi diagnosis SLE (minimal 4 dari 11 kriteria). Jadi jelas termasuk CLE. Mengapa acute, bukan subacute atau chronic ? Bentuk lesi khas acute adalah malar rash, subacute lesi khasnya annular dan hyperkeratotic, chronic : discoid/DLE.

166. 45 y.o. female has rheumatoid arthritis for 6 years and has been treated with NSAIDs and, sometimes, corticosteroids for severe exacerbation. She feels the disease gets worsen. Due to acute exacerbation, she is treated with methotrexate. What is MoA of the last drug ?
Jawab :
Methotrexate adalah first choice untuk disease-modifying antirheumatic drugs (DMARDs). MoA-nya menginhibisi aminoimidazolecarboxamide ribonucleotide (AICAR) transformylase dan thymidylate synthetase dan efek sekunder (bukan utama) ke dyhidrofolate reductase dan penghambatan chemotaxis dari PMN. Penghambatan enzim-enzim ini menyebabkan berkurangnya sintesis thymidylate, purine nucleotide, dan serine dan methionine. Sehingga menyebabkan intervensi thd pembentukan DNA, RNA, dan protein sel.

167. –


168. Patient present with polyarthritis around small joint of hand and feet. According to Americal College of Rheumatology for rheumatoid arthritis ?
A. Systemic symptom
B. Swan neck appearance
C. Rheumatoid nodules
D. Oligoarthritis
E. Osteosclerosis
Jawab : maaf, saya kurang tahu maksud pertanyaannya >.<
Kriteria diagnosis untuk RA dari American College of Rheumatology (minimal 4 terpenuhi  diagnosis RA) :
1. Morning stiffness > 1 hour for at least 6 weeks
2. Arthritis and soft tissue swelling of >3 of 14 joints/joint groups, present for at least 6 weeks
3. Arthritis of hand joints, present for at least 6 weeks
4. Symmetric arthritis, present for at least 6 weeks
5. Subcutaneous nodules in specific places
6. Rheumatoid factor at level above 95th percentile
7. Radiological changes suggestive of joint erosions

169. –

170. Histopathology for above case :

171. Chief complaint : difficulty of breathing
3 weeks ago, had diarrhea and febrile.
General practitioner gave antibiotic and antidiarrhea, these drugs decrease the symptoms.
2 weeks ago, felt numbness and weakness in both extremities, which become worse.
PE : alert, RR 14/min, temperature 36.7
Neurological exam : symmetrical and bilateral tetraplegic, flaccid, gloves & stocking anesthetic.
Physiologic reflex absent
Oxygen saturation is decreased
CSF analysis : cytoalbuminic dissociation
Which of the following type of hypersensitivity is the most likely occur in this case ?
A. 1
B. 2
C. 3
D. 4
E. 1 – 4
Jawab : D
Dari chief complain “difficulty of breathing”, riwayat adanya infeksi gastrointestinal sebelumnya, hasil pemeriksaan neurologis yang menunjukkan adanya ascending paralysis, sepertinya ini adalah Guillain-Barre Syndrome, yang disebabkan reaksi hypersensitivity tipe 4.

172. –

173. HIV antibodies positive since 5 years
CD4 = 65
Difficulty in breathing.
Which one is true ?
A. High risk for infection
B. High risk for myocardial infection (infarction mgkn maksudnya)
C. High risk for hematologic disease
D. High risk for drug allergy
Jawab : A

174. Which of the following causes that can proceed to respiratory failure in this case ?
A. Ascending paralysis
B. Descending paralysis
C. Uncal herniation
D. Rostrocaudal herniation
E. Transtentorial herniation
Jawab : kalau ini kasus GBS, jawabnya A.

175. –

176. –

177. Appropriate tools to confirm diagnostic for baby’s HIV infection state ?
A. HIV DNA PCR
B. HIV RNA PCR
C. HIV culture
D. HIV p24 Ag ex
E. Anti-HIV-1
Jawab : B

178. Based on Indonesian Medical, what is appropriate drug for treatment for neonatal HIV infection ?
A. AZT + 3TC + NVP, 6 weeks
B. AZT + 3TC + ZDV, 6 weeks
C. AZT + ZDV
D. AZT + ZDV
E. Antimycotic
Jawab : A
untuk terapi AIDS, diperlukan gabungan 2 NRTI + 1 NNRTI atau 1 protease inhibitor. AZT dan 3TC termasuk NRTI, NVP termasuk NNRT, ZDV termasuk NRTI.

179. Which one of the following is mediator of early phase of mast cell degranulation ?
A. Prostaglandin
B. Leukotriene
C. PAF
D. Tryptase
E. IL-4
Jawab : D
Degranulasi mast cell menyebabkan pengeluaran histamine, heparin, dan tryptase pada fase awal (karena ketiga substansi itu ada di preformed granule). Di fase lambat, arachidonic acid, leukotriene, prostaglandin, cytokine, TNF, dan IL dilepaskan.

180. Which of the following molecule is opsonin that facilitates efficient phagocytosis of microbes by neutrophil and macrophage ?
A. IgA
B. IgG
C. IgE
D. CRP
E. IF
Jawab : B
Tabel 2-10 Lange Medical Immunology hal. 36 menyebutkan, opsonin dari macrophage salah satunya adalah immunoglobulin, especially IgG

181.8 months old boy, mild icterus, mycrocytosis, hypocromia, anisopoikilicytosis, polychromasia, basophilic stippling.Most appropiate condition

a. moderate anemia+splenomegali
b. moderate anemia+ hepatosplenomegali
c. severe anemia+ hepatomegali
d. severe anemia+ splenomegali
e. severe anemia+ hepatosplenomegali


182.which of following is present to facilitate efficient phagocytosis of microbe by neutrophil and macrophage
a.IgA d.CRP
b.IgG e.IF
c.IgE

Alasan: IgG protect against bacteria and virus by enhancing phagocytosis, neutralizing toxins, and triggering complement system.

183. a man diagnosed with AIDS 5 years ago.CD4+ count decreased.What is big risk
a.he is at risk getting oppurtunistic infection
b.he is at risk of getting trauma
c.he is at big risk of getting malformation
d.he is at risk of getting inflamation

Alasan: CD4+ cell ato helper T-cell berperan dalam proses imun system sehingga saat kadarnya rendah maka proses imun system juga akan menurun sehingga resiko terinfeksi tinggi.

184.63 year female has symetrical sweeling of proximal phalanges joints and small subcutaneus nodules over extensor surface on her arm. She report had pain and stiffness is most pronounced on arising in morning.which of following laboratory test result is typical in of patient disease?
a.positive IgM specific to streptococcal antigen
b.positive IgG specific to streptococcal
c.positive anti-double stranded DNA
d.positive rheumatoid factor
e.positive ASLO

Alasan:diagnosis kasus diatas ialah rheumatoid karena terdapat symetrical swelling in join kecil dan subcutaneus nodul uang disebut rheumatoid nodule dan pada RA rasa sakit terjadi saat bangun pagi dan improve throughtout of the day
Dimana ciri RA ialah: presence rheumatoid factorbin serum and synovial fluid, infiltartion lymphocyte and activated macrophage into involved synovium, dan local production TNF- alpha dan other proinflamatory cytokines in inflamed synovium.

185.SLE is the diseasse of autoimmune origin.Which of following act as antigen from the production of antibodies in the case
a.snRNP (small nuclear ribonucleoprotein)
b.Mrna
c.rRNA (ribosomal ribonucleic acid)
d.cDNA (circular deoxyribonucleic acid)
e.dsDNA (double stranded DNA)

alasan: high titer of anti-ds-DNA antibodies are characterized of SLE.in contrast, anti ss-DNA are not specific and can be found in other autoimune disease ( RA, cronic active hepatitis dsb)\

186.lihat soalny di buku kumpulan soal
a.hair fall d.difficult concentration
b.skin rash e.symetrical polyarticular inflamation
c.systemic symptom

alasan: main problem / chief complain ialah keluhan yang mebuat seseorang datang beribat ke dokter.

187.one morning, as a medical student, you are observing in rheumatology clinic of hasan sadikin general hospital, a 20 years old woman presented with symetrical painful and swollen joints including proximal interphalanges (PIPs).metacarpophalanges (MCPs), wrist,knee and ankles. The other symptom were fever and subcutaneus nodules.Which of the following is thhe most likely diagnosis in this case
a.SLE d.artritis reactive
b.Rheumatoid artritis e.osteomyelitis
c.spondyloartritis alasan : lihat pembahasan no 184

188.patient with symetric polyartritis particularly off small joints of the hands and feet should be checked for rheumatoid factor.which of the following symptom were included in the american college of rheumatology duagnostic criteria for rheumatoid artritis
a.systemic symptom d.oligoartritis
b.swan neck deformities e.osteoslerosis
c.rheumatoid nodule

Alasan: most characteristic feature of hand in RA are
- ulnar deviation (boutonniere) deformity = flexion of proximal interphalanges joint and hyperextention of distal interphalanges joint resulting from volar slippage of lateral band of superficial extensor tendons.
- swan neck deformities (hyperextention of proximal interphalange joint and
- flexion of distal interphalange joints resulting from contarcture of intinsic muscle of the hand)
189.a young man, 24 years old had a history back pain and stiffness especially in the morning, over the past 3 months and relieved by increased avtivity or anti-inflamatory medication.he did not have constitutional complaints of fever or weight loss.in addition for the last months he has sweeling and stiffness in his knees and unable to walk.rheumatology finding: legs,knees,and ankles were inflamed and swollen, spine: schober test (+).what is the differential diagnosis in this patient
A.gouty artritis and osteoartritis
b.rheumatoid artritis and spondyloartritis
c.septic artritis and rheumatoid artritis
d.osteoartritis and rheumatoid artritis
e.SLE and spondyloartritis

Alasan: diagnosis kasus diatas ialah RA karna ada stiffness saat pagi hari dan spondyloartritis karna ada schober test (+) yang umumnya pada sacroiliac joint, spine and large periperal joints.yang ditanya adalah differential diagnosis

190.48 year old business man had history of mild hypertention.usually he had no symptoms and for the hypertension he has had hydochlorothiazole theraphy for 3 days.he wake up in the night with painful and warm in hiss feet.one hour later his symptom become worst, warm and redness.he called the doctor and received analgesic.what kind of drugs can induce the acute attack of gouty artritis
a.low dose aspirin d.paracetamol
b.allupurinol e.prednisone
c.hydrochlorothiazide

alasan: drugs (including diuretics ex hydrochlothiazide and cyclosporine A), and chronic ethanol (especially beer and hard liquor) can induce GA.asprin juga bisa mengakibatkan GA tapi tidak saat low dose.

192.an 18 year old in room full of people who are coughing and sneezing.the influenza viral particle that she inhales attach to respiratory epithalium and viral transformation reduce the class I MHC molecules on these epithelial cells.which of the following cell that respond to destroy the infected cells.
a.neutrophile d.NK cells
b.monocyte e.dendritic cell
c.CD4 cells

alasan: infected target cell by viral> fragment dipecah dan diikat ke permukaan sel oleh MHC> cytotoxic CD4 > melekat ke MHC> CD4 release cytotoxic substance cause death infected cell by release perforin dan granzyme.

193.in rsponse with mucobacterium tuberculosis, agranuloma forms in the lung. Within the granulooma ae cell expressing class II MHC antigens.these cell liberate cytokines that promote fibroblastic production in colagen within granulomma.WOTF blood leucocyte are in the mechanism
a.neutrophle d.NK cells
b.monocyte e.basophile
c.B cell

Alasan: MHC II diekspresi oleh APC (dendritic cell, macrophage, dan B cell)

194.a 43 year old male presents several flaccid lesion with crusts on his back.patology anatomy diagnosis from the biopsy which obtained from the lesion was pemphigius folaceus.Which of the most appropiate histopatologic appereance for the case above
a.spongiosis within epidermis
b.superficial perivascular lymphocytic infiltrate
c.intraepidermal blister with acantholitic
d.dermal and epidermal edema and mast cell degranulation
e.subcorneal blister with acantholitic cells.

Alasan: microscopic pada pemphigius folaceus ialh subcorneal clister is apparent with acantholysis.

196.Gouty artritis that is caused by overproduction of uric acid.which of the following is a precursor of uric acid
a.pyrimidine d.thymine
b.purine e.uracil
c.cytosine

alasan: uric acid produced by xanthine oxidase from xanthine and hypoxanthine, which in true produced from purine.

197.allupurinol is compound used to trear gout.which of the follwing is the mechanism of action of the dug above
a.inhibit degradation of guanosine to guanine
b.inhibits degradation of guanine to xanthine
c.increase excretion of hypoxanthine
d.activates degradation of uric acid to allantoin
e.inhibit degradation of hypoxanthine to xanthine

alasan: allopurinol inhibit synthesis xanthine oxidase and prevent synthesis of urate from hypoxanthine and xanthine (xanthine oxidase: ubah degradasi xypoxanthine menjadi xanthine)

198.according to the origin and physiologic process of ejaculation, antigenicity of the semen is divided into antigens derived from testes, epididymis and spermatozoa and antigen derived from the secretions of reproductive accesory glands.WOTF is most likely the sperm coating antigen originated from seminal plasma:
a.trasferrin d.albumin
b.acid phosphatase e.globulin
c.scaferrin

199.breakdown of normal protective mechanism, ex the blood testis barier, appear to be the major factor cause of antigen leakage causing antisperm antibody (ASA) formation.ASA may cause fertility by which of the following ways
a.interfering with spermmatozoa production
b.interfering with spermatozoa capacitation
c.reducing the amount of spermatozoa
d.reducing the mobility of spermatozoa
e.agglutinating and immobilizing the spermatozoa

200.WBC have been found found to carry numerous different antigen in HLA system.the presence of a particular region on leucocyte means that a corrsponding alleles is the present in genotype making up that person.which of the followinh is most likely explanation pf HLA symptom

a. objective of transplantation
b. antigens in the HLA system are controlled by cromosome 8
c. alleles of the genotype maybe homoxygous and heteroxygous
d. alleles of the genotype are always homozygous
e. alleles of the genotype are always heterozygous

alasan: the succes of organ or tissue tranplantation depends on histocompability –that is, the tissue histocompability between donor and the recipient.tissue typing (histocompability testing) is done before any organ transplant.antigen of HLA system are controlled by cromosome 6.