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1. A 57 yo man was brought to the clinic due to his slurred speech. His family stated that the condition started in the morning upon waking up, and followed by weakness in his right arm. From the neurological examination, it is revealed that he got CN XII paralysis and right hemiparesis. Which of these muscles below did not affected by the paralysis? A. Superior longitudinal muscle B. Inferior longitudinal muscle C. Palatoglossus muscle D. Genioglossus muscle E. Hyoglossus muscle
2. A 3 yo girl brought to the emergency department. Her parents stated that she was playing with Marble and swallowed them. Upon chest X-ray, the foreign body was found logged in the center of the thorax, midway between root of the neck and diaphragm. Where the foreign object would most possibly logged in this case? A. In the cervical constriction, at the pharyngoesophageal junction. Compressed by cricopharyngeal muscle B. At thoracic constriction, compressed by the arc of aorta and left main bronchus C. At esophageal hiatus when it passes the diaphragm D. At diaphragmatic constriction where it passes through the internal esophageal spinchter E. At abdominal constriction where it passes through the cardia For no 3-4: A 36 yo man came to your practice complaining of abdominal pain and nausea. The pain grows more intense these part 2 days. He said that he has been under a lot of stress, so he often skipped meal, and had a lot of coffe to help him concentrate. 3. From these sentences below, which one best describe the organ involve?
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
4. Which of these sentences below are true regarding the organ arterial supply? A. The left and right gastro-omental arteries are forming anastomosis in the lesser curvature B. The left and right gastro-omental arteries are forming anastomosis in the pyloric antrum C. The left and right gastric arteries are forming anastomosis in the greater curvature D. The anterior and posterior gastric arteries are forming anastomosis in the grater curvature E. The right and left gastric arteries are forming anastomosis in the lesser curvature
5. A 57 yo man was brought to the emergency department because he vomited blood since a . hours. His family said that the blood was bright red. He was diagnose with liver cirrhosis since . ago. What other condition should you examine in the case of portal hypertension? A. Caput medusa, where the anastomosis between central vein and portal vein occurs B. Esophageal varices, where the anastomosis between left gastric vein and the inferior mesenteris vein occurs
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
6. Which statement below is correct regarding the first part of the small intestine? A. The organ was completely covered by peritoneum and connested through mesentery B. The organ in C shaped and has part: anterior, superior, descending, horizontal C. The organ span between the pyloric sphincter and the duodenojejunal junction. It warps around the head of pancreas D. It is the longest part of the small intestine. Its descending part has major papilla which is an opening of major pancreatic duct E. The organ is mostly fixed and has no peritoneal convering, has arterial supply only form the branch of celiac trunk
7. A 32 yo man was found lying on the street with blood coming from his abdomen. He was a victim of a robbery and got stabbed. As you examined the wound, you found that the injury was quite large, some organ was protruding from inside, covered by blood. If the wound was located on the left lower abdominal close to the umbilical, what is the organ and arteri bleedingyou probably see? A. ileum, bleeding fromabdominal wall arteries and branches of SMA B. jejunum bleeding from inferior costal arteries and branches of SMA C. ileum, bleeding from inferior costal arteries and branches celiac trunk D. descending colon, bleeding from abdominal wall arteri and branches of IMA E. jejunum, bleeding from abdominal wall arteri and branches of IMA
8. a 23 yo woman complaining of severe abdominal pain since 6 hours ago. Pain starts in epigastric and moved to right lower part abdomen. She also had fever and loss apetite. PE: tenderness, rebound tenderness on MC
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
9. What are distinctive characteristic of large intestine? A. larger diameter, covered by movable peritoneum, internal surface has extensive pili for absoption B. larger diameter, has specialized longitudinal muscle, internal surface has extensive mucosal fold C. larger diameter, teniae coli caused sacculation, internal surface has extensice mucosal fold D. larger diameter, haustra is dynamic structure depends contraction, its internal surface has smooth appearance on its
E. larger diameter, teniae coli caused formation of haustra, internal surface has smooth appearance
10.a 45 yo man complain rectal bleeding when he has his bowel movement this morning. This is his fifth time having same complaint over last 2 month. This time, bleeding followed by something came out of anus, but quickly went back in on its own. Didnt feel any pain. Source problem? A. Dilataton of superior and middle rectal vein lies on mucosal layer of rectum B. Dilatation of superior and middle rectal vein lies on submucosal layer of rectum C. Dilatation of middle and inferior rectal vein lies on mucosal layer of rectum D. Dilatation of middle and inferior rectal vein lies on submucosal layer of rectum
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
11.This ligament is fibrous remnant of fetal dustus venosus, which shunted blood from umbilical vein to IVC, short circuiting the liver. WOTF is most likely ligament? A. Coronary ligament B. Falciform ligament C. Triangular ligament D. Ligamentumteres E. Ligamentumvenosum
12.This part, enclosing portal triad from liver to lesser curvature of stomach and the first 2 cm of superior part of duodenum. Wotf? A. Diaphragmatic surface B. Visceral surface C. Lesser omentum D. Greater omentum E. Peritoneum
13.This ligament is fibrous remnant of umbilical, which carried well oxygenated and nutrient-rich blood from placenta to fetus. Wotf? A. Coronary ligament B. Falciform ligament C. Triangular ligament D. Ligamentumteres E. Ligamentumvenosum
14.This part is posterosuperior extension of subhepatic space, lying between right of visceral surface of liver and right kidney and suprarenal gland. This part is gravity-dependent part of peritoneal cavity in supine position, fluid draining from omental bursa flows into this part. Wotf?
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
15.This part extend to right, between IVC and portal hepatis, connecting caudate, and right lobes. Wotf? A. Sagital fissures B. Left lobe C. Quadrate lobe D. Caudate process E. Papillary process
16. On the left side of the descending part of duodenum, the bile duct comes into contact with the main pancreatic duct. These ducts run oblique through the wall of this part of duodenum, where they unite to form this portion. Which of the following is most likely portion? A. Cystic duct B. Common hepatic duct C. Sphincter of the bile duct D. Major duodenal papilla E. Hepatopancreatic ampulla 17. This part of gallbladder is wide end of the organ, projects from the inferior of the liver and is usually located at the tip of the right 9th costal cartilage in teh CML. Which of the following is most likely part? A. Fundus B. Body C. Neck D. Infundibulum E. Cystic duct 18. This portion is the expanded part of the gland that is embraced by the Cshaped curve of the duodenum to the right of the superior mesenteric vessels. It firmly attaches to the medial aspect of the descending and horizontal parts of the duodenum. Which of the following is most likely portion? A. Head of the pancreas B. Neck of the pancreas
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
Questions number 49 to 51, refer to scenario below: A 7 years old boy lives in rural area of Papua. He suffered from chronic diarrhea for the last 6 months. He also suffered from severe malnutrition marasmus kwarshiorkor. 49. what should be given first in to manage nutrient problem this case? a. carbohydrate b. protein c. fat d. mineral e. vitamins 50. his parents give him meat curry. In the next day, the child became very weak and he is taken to the hospital. The doctor examines him and performs laboratory examination and then he diagnosed him ketoacidosis. What is the high lipid will breakdown into in this case? a. Ketonbodies b. Gliserol c. Fatty acids d. Cholesterol e. Chylomicron 51. what is the following process most likely underlie this condition? a. Hyperglycemia condition lead to ketoacidosis b. High lipid diet directly breakdown into keton bodies c. High lipid diet undergo gluconeogenesis process d. Fat will be stored into adipose tissue e. Amino acids will be breakdown into urea
58. a 40-year-old man came to the emergency department with the chief complaint of abdominal pain with severe vomiting for the last 3 days. He also had fever with with constipation. The physical examination revealed tachycardia, febrile, and tachipneu. On abdominal showed distended abdomen, bowel sound decreases. The doctor diagnosed him as acute pancreatitis with complication of ileus paralytics. What is the basic mechanism of complication in this case? a. Obstruction in the mesenteric artery
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
For questions no 82-83 Mira a 10 month old baby girl was diagnosed Acute diarrhea by the doctor in pediatric EMG Unit dr Hasan Sadikin Hospital Bandung. The important of her laboratory results are blood glucose 115 mg/dl (Normal value 100 mg/dl), stool : clinitest is positive
82. From the result of stool examination, what is Mira problem? A. Mlabsorption of carbohydrate B. Malabsorption of protein C. Malabsorption of fat D. Malabsorption of vitamin E. Malabsorption of mineral
83. For that examination , what solution do you need? A. Sudan III B. Sudan IV C. Acetic acid glacial
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
For questions no 85-87 A 55 years old female came to ER with diffused abdominal pain for one day. She had history pain killer consumption, ulcer like symptoms. She had tachycardia, high respiratory rates, low blood pressure , disappeared liver dullness, diffused abdominal pain and loss of bowel sound. 85. According to the information above the diagnosis is : A. Acute peritonitis B. Gastric ulcers C. Duodenal ulcers D. Acute pancreatitis E. Peptic Ulcer 86. What is the causes of this condition? A. Perforated peptic ulcer B. Acute pancreatitis C. Acute cholecystitis D. Chronic Pancreatitis E. Acute cholangitis 87. What is your suggestion the examination?
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
For questions no 88-90 A 55 years old male came ER with hematemesis. He had history of chronic hepatitis B, Abdominal enlargement and edema. Physical examination findings were hemorrhagic shock, jaundice, spider angiomata and ascites.
88. What is the main etiology of this condition? A. Rupture of esophageal varyx B. Duodenal ulcer bleeding C. Pharingitis D. Mild portal hypertensive gastropathy E. Esophagitis
89. What will you do as first action in the emergency room? A. Endoscopy B. Check airways C. Ultra sound examination D. Nasogastric tube insertion E. Male a laboratory examination
90. What is the drug that could stop bleeding in this patient? A. Ranitidine B. Omeprazole C. Propanolol D. Somatostatin
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
For questions number 91 to 93, refer to information given below: A 55 years old male came to ER with abdominal pain (RUQ), febris and jaundice, dark yellow 91. what does diagnosis for him ? a. acute cholecystitis b. acute hepatitis c. acute cholangitis d. liver cirrhosis e. acute pancreatitis 92. what is the name of the triad of this case? a. charchot b. hippocratic c. raynauld d. kusmauld e. pancreatic 93.what is the antimocrobial of choice? a. amoxycillin b. ampicillin c. amikacin d. ciprofloxacin e. gentamycin for question number 94 to 96 refer to information given below: 25 years old female came to clinic due to epigastric pain on and off since 3 months ago. Clinic and laboratory results were normal. She took H2RA and antacid but not improving. Physical examination was normal. 94. what will you suggest to this patient a. endoscopy examination b. giving PPI first (empirical anti secretory therapy)
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
96. no evidence of structural disease on endoscopy, H.pylori positiveand was eradicated co... symptom persist. What will you do to this patient : a. giving SRRI and promotility agents b. increase PPI dose c. PPI standard dose with promotility agents d. abdominal CT scan e. abdominal ultrasound 97.twenty years old boy went to the clinic because he has elevated live enzymes and HbsAg (+). Physical examination no abnormalities are found. The result of laboratory tesing :CBC within normal limits. ALT :765 U/ml, AST:680 U/ml. HAV IgM antibody (+), HbcIgM antibody (-), Hbe antigen (+), HbcIgG antibody (+). Which of the following is the most likely diagnosis for this patient : a. acute hepatitis B and acute hepatitis A b. chronic hepatitis A and acute hepatitis B c. acute hepatitis A and carrier hepatitis B d. window period of hepatitis B and acute hepatitis A e. acute hepatitis A and chronic hepatitis B
98. if the problem is gastric emptying, what will you do to this patient? a. giving double dose PPI
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
99. a 64 year old man undergoes CEA surveillance for cancer because his brother and father (blabla) of the colon. He should be informed that : a. CEA highly sensitive for diagnosis b. if CEA is elevated preoperatively, it implies unresectable disease c. increase in CEA after resection may indicate tumor recurrence d. CEA is highly spesific for the presence of colon cancer e. CEA is present in normal adult
100. A 29 year old woman comes to the clinical OPD complaining of severe abdominal pain, nausea, vomitting, and diarrhea. She looks dehydrated and her temperature is 101F. On further asking, she states that she noted streaks of blood in her stool one day back. Her stool culture shows gram negative, straight rods, unable to ferment lactose. Which organism is the most likely etiological agent in this patient? a. Salmonella typhi b. E.coli c. Vibrio cholerae d. Shigella dysenteriae e. Campylobacter jejuni 101. A 14 years old lorry driver presented with vomiting and severe diarrhoea but with no fever. The stool was watery. He admitted to having eaten a road-side food stall while he was in a city in the tropics. Which of the following organism most likely cause his illness? a. Vibrio cholerae b. e.coli c. Salmonella typhi d. listeria monocytogenes
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
103. rotavirus type A infection commonly occurs among : a. fetuses b. elderly people c. infant and young children d. teenagers e. adults 104. a nurse develops clinical symptoms consistent with hepatitis. Sge recalls sticking herself with a needle approximately 4 months before after drawing blood from a patient. Serologic test for HbsAg, antibodies to HbsAg, and hepatitis A virus (HAV) are all negative, however she is positive for IgM core antibody . which of the following is the most appropriate for that nurse? a. she does not have hepatitis B b. she has hepatitis A c. she is in the late stages of hepatitis B infection d. she in the window period e. she has hepatitis C
105. a 54 yo woman admitted to a clinic complaining of abdominal pain that had been worsening for the past 2 weeks. She stated that it often improved immediately after meal or taking antacid. She also noted occasional heartburn,
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
Untuk soal 106-107 : A 41 y.o man was brought to hospital with 3 day history of shaking chills, high fever, headache, abdominal pain, and weakness. Since 2 days earlier he also complaining of constipation. After conduct careful examination to the patient, the doctors working diagnosis is typhoid fever. To confirm this, the doctor in charge ask for culture examination to the laboratory. 106. 1st week of such disease is : a. Stools b. Urine c. Rose Spot d. Blood e. None of all above The best specimen for culture in the
107. culture such bacteria? a. Blood agar b. Nutrient agar c. SS agar d. Mac Conkey Agar e. EMB agar
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Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
109. A 12 y.o child presents in a refugee health clinic with history of watery diarrhea for the last 2 days. He reports that he has passed stools 6-8 times which are watery and white in color. questioning he reports that he frequently consumes food and drink brought from roadside vendors.
110. A 30 y.o male works on a pig farm. He presents to his local doctor with history of slimy diarrhea more than 2 months duration. Over the course of the last two weeks he has noticed the presence of blood. Laboratory examination of the stools shows multiple cystic organism with macronuclei. 111. A 26 y.o woman comes to medical clinic with a seven day history of fever especially at night. She has just
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
113. A 62 y.o woman come to emergency room due to bloody vomiting and dark-tarry stool....hours before admission. She had history of epigastric pain. She is used to drink traditional remedy to relief pain on her knee for the last 2 month. Examination result BP 90/60 mmHg, pulse 116/min, RR 20/min, temperature afebris. Abdominal examination : pain at epigastric area,ascites ( ), caput med ( ). Hemoglobin 7 gr/dl, WBC 5.400/mm3, thormbocyte 212.000/mm3, creatinine 2.0 mg/dl, ureum 110 mg/dl. What is the most possible diagnosis for this patient? a. Rupture of esophageal varices b. Bleeding portal hypertension gastropathy c. Bleeding peptic ulcer d. Bleeding erosive gastropathy e. Uremic gastropathy Untuk no 114-115 : A 62 y.o woman comes to emergency room due to bloody vomiting an dark-tarry tarry stool 5 hours before admission. She had history of epigastric pain. She is used to drink traditional remedy to relief pain on her knee for the last 2 month. Examination result BP 90/60 mmHg, pulse 116/min, RR 20/min, temperature afebris. Hemoglobin 7 gr/dl, WBC 5.400/mm 3, thormbocyte 212.000/mm3, creatinine 2.0 mg/dl, ureum 110 mg/dl.
115. patient? a. Proton pump inhibitor b. Ranitidine iv c. Sucralfate d. Tra......... acid e. Vit. K iv
Untuk no 116-117 : A 43 y.o man has complain nausea and vomiting since 1 day prior to admission. He also has fever 4 days ago. On physical examination she looks quiet ill, fever, slightly jaundice, epigastric tenderness and decreased bowel sound. The laboratory test Hb 16 g/dL, L 18.000/mm 3, PCV 50%, thrombocyte 150.000/mm3, blood glucose 228 mg/dl, amilase 800 U/L, lipase 550 U/L, SGOT 110 U/L, SGPT 112 U/L 116. diagnosis of this patient? a. Acute cholangitis b. Acute hepatitis c. Acute pancreatitis d. Acute cholecystitis e. Acute gastritis Which is the most likely clinical
117. this a. Cholelithiasis b. Alcohol intake c. Pancreatic divi..........m d. Hypercalcemia e. Diabetes mellitus
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
119. fors imaging study? a. Abdominal ultrasound b. CT scan of abdomen c. Plain abdominal x-ray d. MRCP e. ERCP
Untuk no. 120-121 A 2 m.o baby boy was brought to ER with abdominal distension, vomiting and no defecation since 4... ago. There is history of delayed passage of meconium and recurrent obstipation. There also history of excretory diarrhea. 120. likely diagnosis? a. .................... b. acute diarrhea c. enterocolitis d. hirschprung disease e. ulcerative colitis Which of the following is the most
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
121. Which of the following is the most likely correct statement concerning management for this patient? a. Nasogastric tube can relief abdominal distention in this patient b. Rectal biopsy should immediately be performed to make definite diagnosis c. CT scan abdomen is the most accurate diagnosis for this case d. Abdominal X-ray and barium enema must be performed after acute condition is managed e. Rectal biopsy can be performed in acute state
122. A 9 month old baby girl brought to emergency unit Hasan Sadikin Hospital with bloody and ... stool. One day before the baby seems restless and crying loudly (this condition repeated periodically) vomiting is also occur. There is no history of fever. On physical finding there is palpable mass at epigastrium, no portio-like appearance on DRE. Which of the following is the most likely diagnosis? a. Ameba dysentry
b. Intussusception c. Haemorrhoid
123. A 56-year-old male presents to the clinic with the complaint of rectal bleeding. It has been suffered for ... months and since a month ago he also has been complaining os difficulty in defecation and the blood becoming mixed with mucus and small in size. Tenesmus is not complained. There was no previous history of prolapsed mass from the anal while straining. DRE revealsgood sphincter tone, an irregular, hard, and circumscribed mass on the mucosa with distance of 5cm from anal .. there is some fresh blood on the glove. Abdominal exam has not shown distended abdomen and mass. On proctoscopy there is a circumscribed mass lesion with blood and mucus on the center of the mass. What is the most likely diagnosis of this patient? a. Rectal cancer
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
124. A 2 months old baby boy is brought to you (GP) beecase the mother notice an on and off scrotal lumps. On PE the lump is not exist and positive transillumination. What is the most likely diagnosis of this patients? a. Hydrocele b. Inguinal hernia c. Testicular torsion d. Inguinal lymphadenopathy e. Hydrocele and inguinal hernia
125. A 2 month old baby boy was brought to ER with abdominal distention, vomiting, and no defecation since 4 days ago. There is history of delayed passage of meconeum and recurrent obstipation. There also history of explosive diarrhea. Which of the following statement is the best statement related to condition in this patient? a. Enterocolitis is manifested by fever and obstipation b. Classic clinical manifestation are fever, abdominal distention, and frequent diarrhea c. Typical barium enema studies shows four zone of intestinal column d. Ganglionic segment on barium enema represented by dilated proximal intestinal segment e. Pathological findings of HD is hypotrophic of neuron fibers For question number 126-128, refer to scenario below: An 18 old month baby brought by his parent with chief complaint of fever since 7 days before. He lost his appetite during the illness, and decrease his body weight. The child is still conciousness. PE showed moderate film, severe wasted, no sign of dehydration and edema. His body weight was 6.6 kg. Body heigh 76
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
127. What is the treatment for this patient? a. Glucose 10% b. Formula milk c. ORS d. Ringer Lactate e. Natrium chloride
128. If evidence of diarrhea occurs in this patient, what is management for fluid and electrolyte replacement? a. Oral rehydration solution b. Breastfeeding c. Resomal d. Ringer Lactate e. Nothing peroral (?) For question number 129-130, refer to scenario below : You are visiting a post delivery mother in parturient room with his healthy baby boy. She is expecting for exclusive breastfeeding. You explain to her about physiology of lactation for successful breastfeeding. 129. What is the reflex that can be interferred by psychological condition? a. Prolactin reflex b. Oxytocin reflex c. Rooting reflex
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
130. What is the advantage of this activity for baby? a. High protein levels b. High lactose c. High casein d. High fat e. High calcium
131. An 8 month old child is hospitalized because of vomiting and screaming episodes for 12 hours. During the episodes, the infant draws up his legs as if having abdominal pain. PE reveals a sausage shaped mass in the right upper quadrant. Temperature is 38 C. WBC count is 18.000/mm3. What would be your next step in management? f. Lumbar puncture g. Exploratory laparotomy h. Blood culture i. j. Abdominal ultrasound IV anibiotics
132. A 7 years old boy was exposed to hepatitis 1 year ago. The mother asks your opinion about possibility of this exposure turning into chronic hepatitis. When counseling her, you will explain that the virus most likely to result in chronic hepatitis is? a. Epstein barr b. Hepatitis A c. Hepatitis B d. Hepatitis D e. Hepatitis E
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
135. Which of the following is te most appropriate initial step in managing the patient? a. Anti diarrheal agent b. Fasting and antiemetic drug c. IV administration Ringer Lactate solution d. Oral rehydration salt e. Antibiotic administration
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
137. On chest x-ray an air-fluid level is seen in the upper esophagus of a middleaged man. The gastric bubble is either absent or very small. A barium meal shown a smooth tappering of the lower esophagus .......... appearence at the esophagogastric junction to a point of obstruction with a diffuse dilatation of esophagus above this level. Which most likely diagnosis? A. Chalasia B. Achalasia C. Scleroderma D. Esophageal spasm E. Pseudoesophagus
138. An abdominal radiograph of neonatal boy with abdominal distension and failure to pass meconium within the first 48 h of life shows multiple air-fluid level in moderately dilated loops of bowel. Barium enema examination shows an inversion of the recto sigmoid index. What is the diagnosis? A. Hirschprungs disease B. Meconeum ileus C. Ileal atresia D. Colonic atresia E. Functional immaturity of the colon
139. A 70 year old male present with acute onset of abominal pain with peritonitis post ERCP for biliary ... placement. Amylase, lipase, AST, ALT,ALP, Total Bilirubin CBC, WBC are normal. He is hypokalemia, with a BP of 80/50, RR is 30 bpm, no fever. On PE, there is marked rebound tenderness and guarding throughout the abdomen. The following radiograph were performed. Ehat is most likely radiological diagnosis?
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
140. A 36 Y.o female presents to int. medicine department w/ chief complain abdominal pain at epigastrium or paraumbilical region, especially after taking meal. From USG finding, there aremultiple hyperechoic w/ acoustic shadow in gall bladder and biliary duct. What is the most likely diagnosis from USG finding? A. Acute pancreatitis B. Chronic pancreatitis C. Cholelithiasis w/ cholecystitis D. Cholelithiasis w/ choledocholithiasis E. Acute cholangitis
For 141-143 When you are in clinic an 18 y.o girl was admitted w/ pain in upper abdomen. This complain occurred after she ate some spicy food. She often complains this abdominal pain for 3 years.Her PE : tenderness at middle and left upper quadrant (+). Lab : normal
141. Why spicy food cause abdominal pain ? A. Allow H. pylori to breed B. Increase gastric juice C. Increase gastric acid D. Attack gastric wall E. Allow H. pylori adhesion
142. What diet can reduce the risk of complication ? A. Dairy product diet B. High meat diet
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
143. The patient should take a wall balance diet in a small frequent portion. What is the reason ? A. To kill H.pylori effectively B. To raise nutritional status C. To reduce acidity D. To cover gastric wall E. To maintain the gut health
For 144-145 A 42 y.o woman come to hospital w/ yellowish skin. She also complains weak and sometimes epigastric pain for 3 weeks. Her PE : icteric in conjunctiva, tenderness at right upper quadrant abdominal (+) liver palpable hardened edge 2 cm bac, 2 cm bpx, w/o shifting dullness in abdomen area. 144. Assesment her nutritional status will be affected by : A. The virulence of the virus B. The enlargement of the liver C. The colour of the skin D. The surface of the liver E. The change of metabolism 145. The patient is diagnosed by viral HepB,. The giving of fat should be : A. Not more than 10% B. Betweeen 10-20% C. 25% D. 35% E. Enough of essential fatty acid which is 20% For 146-148
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
153. Ms.Gina, 29 years old is diagnosed Peptic Ulcer. She is given Omeprazol by her doctor. Which of the following is the right answer for Omeprazol? a. b. c. d. e. Antacid Anticholinergic agent H2 receptor blocker Protein pump inhibitor Prostaglandin analog
154. What is inhibited by Omeprazol? a. Adenosine monophosphatase b. The gastric ATP ase c. Cholinergic
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
156. Misoprostol, a methylester with antisecretory and cytoprotective properties has been approved for the prevention of anti-inflammatory agent induce ulceration. Which of the following is the right statement of misoprostol? a. b. c. d. e. Blocks cholinergic receptor Blocks H2 histamine receptor Stimulates prostaglandin receptor Activated protein kinase Blocks proton pump
157. Which of the following has both acid inhibitory and mucosal protective properties? a. b. c. d. e. Misoprostol Sucralfate Bismuth Antacid Pirenzepine
158. Mrs.Dewi, 45 years old woman is diagnosed gastritis and get antacid as the treatment. At the same she also get tetracyclines for her other disease. Which of the following is the right statement? a. b. c. d. Antacid should given at the same time with tetracycline Antacid affects the absorption of tetracycline Antacid decreasing intragastric pH Antacid should be taken as longterm medication for renal insufficiency patient e. Antacid is weak acid that react with gastric hydrochloride to form a salt and water 159. Which of the following is systemic antacid? a. CaCO3
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
160. Which of the following has adverse effects transient metabolic alkalosis? a. b. c. d. e. CaCO3 Al(OH)3 Mg(OH)2 NaHCO3 K HCO3
161. Which of the following is used as adjuncts to the H 2 histamin receptors blockers? a. b. c. d. e. Famotidine Pirenzepine Sucralfate Omeprazole Antacid
162. Which of the following is mucosal protective agents? a. Famotidine b. Pirenzepine c. Sucralfate d. Omeprazole e. Antacid 163. A pathologist will examine the section of alimentary tract on GERD patient. His objective is to identified the esophagus structure. The patient got GERD for several years. The pathologist saw the changes in squamous epithelial layer became columnar type of epithelial. What is the terminology of the changes in that epithelial layer? a. b. c. d. e. Carcinoma Adenoma Metaplasia Anaplasia Neoplasia
164. What is the best diagnosis for this patient based on pathological examination? a. b. c. d. e. Neoplasia of stomach Barret esophagus Gastric polyp MALT Gastric adenoma
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
165. A 46-year-old woman with no prior medical history was admitted to a local hospital due to progressively increasing upper abdominal discomfort for some weeks, lately associated with jaundice. No weight loss was reported. No mass was palpable at the physical examination. Ultrasound showed a gallbladder hydrops with gallstone in the gallbladder and bilateral dilation of intrahepatic bile ducts, performed operation (cholecystectomy). Which of the following is the microscopic finding in the specimen from cholecystectomy? a. b. c. d. e. Aschoff bodies Invasiveness of the epithelial layer Crypt Rokitansky aschoff Proliferation of lymphoid follicle
166. A 34-year-old man came to emergency unit with the chief complaint right lower quadrant pain. The complaint accompanied by low grade fever, vomiting, and obstipation. From physical examination showed rebound tenderness. He was diagnosed as appendicitis, and appendectomy was performed and the specimen was sent to pathology department. Which of the following is the best describe of the microscopic finding in the specimen from that patient? a. b. c. d. e. Hyperplasia of lymphoid tissue with infiltration of mononuclear cell Fibrosis of the muscular layer Destruction of epithelial layer until serosa layer with PMN cells Atrophic of epithelial layer Proliferation of seromucosa gland
167. What is the best diagnosis for this patient based on the pathological examination? a. b. c. d. e. Appendicitis Chronic appendicitis Acute appendicitis Acute perforated appendicitis Chronic perforated appendicitis
168. A 2-month-old baby boy was brought to ER with abdominal distension, vomiting, and no defecation since 4 days ago. There is history of delayed passage of meconeum and recurrent obstipation. There also history of explosive diarrhea. Biopsy of the gus was performed. Which of the following is the best describe of the microscopic finding from this patient? a. b. c. d. e. Fibrosis of the muscular layer Destruction of epithelial layer There are ganglions in aurbach plexus Absent of ganglion in meisner plexus Hyperplasia of the ganglion
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
170. The pathologist gave the diagnosis as internal and external hemorrhoid. Which of the best finding from microscopic feature from this patient? a. b. c. d. e. Dilated vessel with columnar epithelial cells Dilated vessel with squamous epithelial cells Thrombus in the vessel There are blood clots and necrotic tissue Columnar and squamous epithelial layer was found
171. A 55-year-old man came to the out patient clinic with the chief complaint of yellow eye and dark color urine. He ever got hematemesis in several years ago, and was diagnosed as hepatitis. The doctor did the biopsy. Which of the following is the best microscopic finding in this patient? a. b. c. d. e. Bridging necrosis Fibrosis periportal Necrosis of the hepatocyte Hepatocyte was enlargement Infiltration of PMN cells
172. A 24-year-old man was admitted to the hospital through the emergency room with hematemesis and melena. No history of icterus, Injecting Drug Usage or use of NSAIDS. He was pale but in stable hemodynamic conditions. There was slight hepatomegaly and a huge spleen of Schuffner 6 was detected. Which is the most likely etiology of GI bleeding in this case? a. b. c. d. e. Esophageal varices Gastric telangiectasis Gastric Henoch-Schoend (maaf foto ngeblur) Erosive hemorrhagic gas Peptic ulceration
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
173. Related to the diagnosis of this patient, which microscopic finding will revealed in the A area of this colon? a. b. c. d. e. Normal ganglion Aganglion Hypoganglion Hyperganglion Ganglioneuroma
174. Related to the diagnosis of this patient, which microscopic finding will revealed in the B area of this colon? a. b. c. d. e. Normal ganglion Aganglion Hypoganglion Hyperganglion Ganglioneuroma
175. A 45-year-old female admitted to the hospital because of colicky pain in the right upper quadrant, this symptom accompanied by nausea, vomiting, and fatty food intolerance. USG of the liver and gallbladder showed gallstone and enlargement of the gallbladder. Cholecystectomy was performed and the specimen samples were sent to the pathology laboratory. The macroscopic and microscopic findings were showed in the picture below.
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )
What is the most appropriate diagnosis of this patient? a. b. c. d. e. Chronic calculouscholecystitis Chronic acalculouscholecystitis Acute calculouscholecystitis Acute acalculouscholecystitis Cholelithiasis
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )