1.

A men ke emergency with fever, cyanosis, nose and gum bleeding, trombositopenia (ke arah
ciri"DBD intinya) trus how ini bs terjadi? Develop Dengue Virus

2. 69 years old man undergo to bypass coronary surgery. 10th day postoperative, he got
pneumoniae. multy drug resistant streptococcus pneumoniae. what action do you need to prevent
this disease?
a. immunization
b. Hand hygiene
c. aseptic
d. antibiotic prophylactic

3. A malnourished 12 years old child who lives in a rural area presents with weakness, fever,
cough, abdominal pain, photophobia. His mother tells you that she has seen long, thin worms in
his stool, sometimes with blood. A presumption diagnosis of ascariasis is confirmed by the
presence of ova A. lumbricoides in stools. There is also contains N. americanus' eggs. The best
drugs for his medication is..
A. Diethylcarbamazine
B. Mebendazole
C. Praziquantlel
D. Ivermectin

4. A 22 years old woman came to her family doctor with a complaints of an itchy vaginal
discharge and dysuria. The physicians who examines consider trichomonas vaginalis. Her
husband also has urethral discharge. Which of the following is the most appropriate used to
determine the cause of the disease:
A. stool
B. urine
C. blood
D. urethral discharge

5. A woman visits her ginecologist for a routine pap smear. She has unprotected sex. On genital
exam there were warts on her vulva and perianal. The result of papsmear is dysplasia and the
physician suspects viral infection. Which of the following laboratory investigation is useful to
detect the present of the causative agent?
A. Indian Ink
B. Gram Stain
C. CSF
D. Antibody assay
R. Complete Blood Count

6. A young man present with severe abdominal pain. He also complaints fever, nausea, and
vomiting. His past medical history is unremarkable and not taking any medication. Abdominal
radiograph and ultrasound show an ileus with appendicitis perforation. He now has secondary
abdominal infection due to his rupture appendicitis. Which of the following bacteria those most
commonly cause his condition?
A. Escherichia coli
B. clostridium tetani
C. Fusobacterium spp.
D. Streptococcus viridans
E. mycobacterium tuberculosis

7. a 4 month old baby with acute lymphoblastic leukimia was brought to hospital. He never had
immunization before. Her mother asked you about the immunization for her baby. What vaccine
that maybe given to the baby?
a. Hepatitis B
b. DpaT
c. MMR
d. OPV
e. BCG

8. 1 month baby boy got an intradermal immunization on the right deltoid. What mechanism?
a. Antibody making viremia
b. Antibody with the target cell
c. Delayed hypersensitivity reaction
d. Antibody blocking the spread of organism
e. CD8 activated to kill infected cell

9. in vast savannah africa, some people got seizures, enlargement post cervical lymph nodes
(winterbottom's sign), hepatosplenomegaly. vector: glossina morsitans
a. L. tropica
b. T. Cruzi
c. L. donovani
d. L. Brasiliensis
e. T. rhodiense

10) A 25 year old man is exposed to the Roundworm Ascaris Lumbricoides but doesn't develop
clinical signs of infection. Which of the following mechanisms is likely to be responsible for his
resistance on the infection?

A) IgE Mediated Type 1 Hypersensitivity

B) Antibody Mediated Destruction
C) Complement Mediated Lysis
D) CTL - Induced Apoptosis
E) Phagocytosis

11. Orang AIDS yang terus kan pokoknya dia associated sama Burkitt's lymphoma itu. Kira-kira
causative agent nya menyebar dengan cara apa?
Jawabannya. A. Mitogenic (Gak yakin)

12. Vaksinasi dapat menjaga kita dr virus h1n1 tp tidak dapat menjaga kita terhadap virus h3n2,
ini menunjukan sifat sist imun adaptive yg.... b.spesifik
13. Orang AIDS ada mucosal lesion di posterior faring.oral lesion nya kenapa?
a. histoplasmosis
b. aspergillus
c. candida

14. a 34 years old complain sudden onset of fever for 3 days with nausea, vomiting, headache,
there are petechie, leukopenia, thrombositopenia, high hematocrit. acquired this infection by ?
a. intravenous drug use
b. bitten by antropod
c. inhalation of contaminated dust
d. close contact with symptomatic patients
e. eating contaminated foods.

15. 55 yo man digigit anjing dan gigitannya berkali-kali trus dalem. Sekarang dy rsa ga enak dan
dirawat di ICU. Mikroorganisme apa yang menginfeksi bpk ini?
a. DNA virus
b. Spiral Bacteria
c. Acid bacilli
d. Gram (+) bacteria
e. Gram (-) bacteria

16. symptom: kulit merah2, demam, dll. dulu ngga di vaksin di bulan ke 9, virus penyebabnya
apa?
a. rotavirus
b. flavivirus
c. rhabdovirus
d. filovirus
e. paramyxovirus

17. a 8 month old patient that present with otitis media caused by bacterial infection, immune
component that contributes to his cleaning infection agent during first phase host infection is?
a. cytokine promote antigen formation
b. TLR in neutrophil
c. antigen reseptor in B lymphocytes
d. at cell response to bacterial antigen

18. A foresty worker from brazil come to the clinic with complain of granuloma around the nose.
On examination, destruction of his nose was found. There are many men suffering abberatum
like him. What is the cause of this?
A. Cutenous leishmaniasis
B. Mucocutaneous leishmaniasis
C. Visceral leishmaniasis
D. Toxoplasmosis
E. American trypanosoma
19. Seorang pasien diperiksa PPD (Purified Protein Derivates) untuk memeriksa mycobacterium
tuberculosis setelah terpapar selama 48 jam. Sel apa yang bekerja?
a. B
b. Eosinofil
C. Neutrofil
D. Makrofag
E. NK

20. A 3 years old boy. Symptoms: mild febrile, weak, pale, headache, anorexia, cough, sneeze.
The doctor found: white grayish pseudomembrane in his pharynx and tonsil area, smelly breath
and bull neck. Immunization not clear. Gram stain: grey membrane --> gram positive, small and
polymorphic rods. Growth in tellurite agar. What is the mechanism of action his organisms
virulence factor?
A. Release IgA protease
B. Acting as superantigen
C. Inhibit protein synthesis
D. Stimulation of adenylate cylase
E. Blocking the release of Ach

21. Ada anak suka main di tanah ga pk sepatu. Check di lab nya pake apa? feses

22. A 5 years old girl has a story of cow's milk allergy with symptoms that include generalized
itching and hives after drinking cow's milk. Her symptoms became more severe with subsequent
accidental exposure to cow's milk. what is the role of cow's milk in this patient?
a. hapten
b. antigen
c. adjuvant
d. tolerogen
e. Immunogen

23. A pregnant woman wasn't vacinated against mumps when she was a child. which vaccine
would be relevant for the infant?
a. administrated on the same schedule as mumps vaccine.
b. a vaccine consisting of formalin -inactivated whole ulkus.
c. a vaccine consisting of microorganism extrate.
d. injecting with an immunoglobulin
e. injection with inactivated viral

24. diagnosis: streptococcus pneumonia. virulence factor apa? protein A...?

25. Ada 5 antigen dibuat vaksin, Mana yg induce greatest adaptive immune response?
A. 100000 Da particulate protein from human male
B. 20000 Da soluble protein from human female
C. 100000 Da soluble protein from chimpanzee
D. 200 Da carbohydrate from monkey
E. 100000 Da particulate from bacteria

26. pembesaran skrotum dan kaki gajah gitu terus jenis nyamuknya apa yang mediasi...
a. anopheles
b.mansoni
c.culex

27. Old man 67 tahun udah 2 hari demam, cough, chest pain, short breath .. Dideteksi ad gram
positive diplococcus
a. 23 valent polisacaride
b. Hyperimunity
c. Oral rhimfapin
d. Antitoxoid serum
e. Oral penicilin.

28. during an infection with Streptococcus pyogenes, an individual generated sufficiently high
levels of IgM and IgG antibodies against S.pyogenes antigen with structural similarity with
molecules on the heart that cardiac damaged was caused. What is the underlying mechanism
process?
A. neoantigen
B. epitope spreading
C. molecular mimicry
D. loss of supressor
E. sequestered antigen

29. vomitting, naussea, headache. jantung kebalik jadi kanan. brain abcess. transmisi penyakit
lewat apa ?
a. oral
b.
c. intravenous
d. contact
e.hematogenous.
30. A 40 y o man, fever, cough, malaise, fatigue for 3 months. Ada diare, infeksi upper resp trek.
White plague at mouth. Berat turun 6 kg dlm 3 bulan, used to be drag user. PE:
lymphadenopathy on neck, he is immunodeficiency. What is the pathogen agent?
A. Rotavirus
B. Lentivirus
C. Rabdovirus
D. Herpes virus
E. Coronavirus

31. A 76-year old man diagnosed with E.coli bacterium. What is the initial immune response to
this bacterium? : A (rada lupa, yang receptornya ngenalin lipopolisaccharide gt kalo ngga salah)
32. A 34 years old woman got genital warts with normal vital sign. Visual inspection of
genitalia reveals multiple small (0,5 cm), flesh colored, papular lesions in the perineal area. The
pathogenic agent of this disease could become latent in it's natural history. Which drug caused
her condition?
A. Antiviral
B. Antifungal
C. Antiprotozoal
D. Antihelminths
E. Immunoglobulin

33. Ada bakteri gram positive streptococcus. virulence factornya disebut sebagai "spreading
factor". Virulence tersebut adalah : C. hyaluronidase

34. A 25 years old man, working in the tea garden, come to internal department complain of
itchy feet, redness, and worms appear to move, lack of appetite, weakness. On physical
examination, patients appear pale, the eyes (conjunctivae anemic). Blood examination showed a
low Hb (7 g %) and faeces examination show a positive worm eggs (oval shape measuring 60 x
40 micron, have thin walls, in it there are 4-8 cells). Which is the most likely diagnosis?
A. Ascariasis
B. Enterobiasis
C. Trichuriasis
D. Strongyloidiasis
E. Ankylostomiasis

35. Idiotype-spesific antibody by immunize rabbit with M protein purified from serum of
myeloma. Antibody of M protein has no reaction. With which of following structure would
react?
a. J chain
b. Fc Fragment
C. DH1 dorman
d. Fab Fragment
e. FC receptor binding site

36. laki-laki 47 tahun mengalami end stage renal failure dan melakukan transplantasi ginjal.
setelah 2 minggu dia oligouria, fever, hipertensi dan mengalami tenderness di area transplan. tipe
rejeksi apa? acute rejection

37. 45, female, hepatitis c, fungsi renal turun, hipotensi, anemia, serum C3 turun. Hipersensivitas
tipe berapa?
a. 1
b. 2
c. 3
d. 4
e. 5
38. 30 years old woman , swelling eyelid as big as quail egg. Swelling udah 1 tahun sejak dari
Africa. On P.E found calabar swelling. Penyakit ini transmisi dari mana ?
a. Culicaide
b. Glossina
c. Simulum
d. Chrysops
e. Phlebotom

39. Man has fever,mconvulsion, numbness of leg on which he was bitten by a stray dog. The dog
has been capture for brain analysis. The man was given postexposure human immunoglobulin. If
the dog truly infected which of the following would describe the structu of entologic agent seen
by electron microscop?
A. Bullet shape
B. Filamentous
C. Icosahedral
D. Brick shape
E. Safety-pin shape

40. 7 y.o boy presents with fever and right ear pain for the last 72 hours. The doctor sent a
purulent discharge from middle ear from gram stain, and the result is gram positive cocci in
chain. his past medical history is remarkable for type 1 hypersensitivity allergic reaction to beta-
lactam. which of the following antimicriobial woul you use for this illness?
a. azole
b. macrolide
c. rifamycins
d. cephalosporins
e. aminoglycosides

41. apa yang klo kurang itu, ekspresi MHC class 2 jadi terhambat
a. neutrophi
b. NK
c. macrophage

42. 6 months old infant, diarrhea, extensive fungal infection, skin rashes, failed to gain weight,
deficient T and B cell. Thymus is normal. Which one is the best treatment?
A. Bone marrow transplant
B. Isolation to an antiseptic environment
C. Antibiotic given at regular interval
D. Thymic hormones entire life
E. Exogenous immunoglobulin administrated periodically

43. Sometime ago, people living in the village of Sukabumi suffered from a fever by severe joint
pain. In the area were found a lot of mosquitoes that have a basic color in black with white spots,
especially on the feet and have a picture of the lyra on the back. The disease is transmitted
through the bite of the mosquito of :
A. Anopheles barbirostris
B. Aedes albopictus
C. Aedes aegypti
D. Culex quiquefasciatus
E. Mansonia uniformis

44. a 13 y.o boy was brought by his parents to doctor, complaining of itching in peri-anal area
which "worsened at night" How we diagnose the parasite that cause the disease?
a. egg in stool
b. with adeshive tape checking the eggs
c. rhabditiform larvae in stool
d. larvae in blood circulation
e. Larvae in skin

45. A healthy 17 years-old boy sustained a skin laceration at his leg during a football match. He
complain of pain, swelling, warm, redness, and hard to move his leg. Upon arrival in the
emergency department, he had a temperature of 37,8 C and a heart rate of 136 beats per minute.
His blood leukocyte count was 22.000 cells per uL (reference range: 5.000-10.000 per uL).
Which of the following cells that predominantly found in this patient?
A. Monocyte and macrophage
B. Natural killer cells
C. B lymphocyte
D. T lymphocyte
E. Neutrophils

46. A 33 year old sexually active woman present with 2 days history of dysruia,frequency and
hematuria.She denies fever or chills and not pregnant.Laboratory analysis of urine sample shows
many grame negative bacilli.She still has these clinical symptoms after adequate fluroquinolone
therapy.Which of the following mechanisms is responsible for her condition :
A. Beta lactamse production,
B. Degradation of drug,
C. Plasmid mediated transfer
D. Spontaneous mutation of DNA gyrase ,
E Decrease of efflux pum mechanism activity

47. Following a motor vehicle accident a 25 year old male requires a blood transfussion. Blood
type tests were done prior to the transfussion and involve the use of IgM antibody against A and
B antigens on erithrocytes what is the name of this reaction ?
A. Precipitation reaction
B. Agglutination reaction
C. Single radial immunodiffusion
D.Double radial immunodiffusion
E.Passive agglutination reaction

48. Many people living in the mountanous villages in Africa suffer from onchochercoma. The
transmission of this through fly of which genus/species
A. Chyrsops
B. Glossina
C. Sianulium
D. Phlebolorus
E. Triatoma rubrofascialis

49. A 45 years old women is admitted to the hospital with acute chest pain. On the second
hospital day it is clear that she has had a myocardial infarction. Unfortunately, on the same day
she develops acute diarrhea. A stool culture grows Salmonella (Gram negative bacteria). This
infection is:
a. Iatrogenic
b. Hospital acquired.
C. Community acquired.
D. Superimposed infection

50. At 15 month of age, a child received a mmr vaccine. At age 22 she living with family in
Mexico that has not been vaccinated and she exposed to measles. Despite the exposure, she does
not become infected. Which of the following properties of the adaptive immune system is best
illustrated by this scenario?
A.memory
B. diversity
C.specificity
D.specialization
E.nonreactivity to self

51. 37 yo who is a pharmacist went to a general practioner for a respiratory infection otherwise
he is healthy. the physician prescribe cefixime capsule twice a day for 5 days. He told that
patient that he got viral infection the drug will prevent him from getting secondary infection. The
patient did not buy the drug as he understand that he do not need it. your comment:
a. patient should follow the advise because second infection are common.
b. agree with patient, because viral infection is self limiting.
c. the patient should take drug but 3 days is enough.
d. the physicians should prescribe an antiviral injection.
e. the patient should take drugs to boost his immune system

52. A 25 year old woman brought to the hospital case of sudden high fever for 4 days, she was
weak but fully conscious and complained of headache, pain in her eyes, muscle and bone, felt
discomfort in her hands and there were some red spot on her hands and legs, her gums bleed
easily and also nose bleed. The doctor's diagnosis is a RNA virus infection. Which of the
following viruses becomes etiologic agent?
a)Polio
b) Rabies
c)Herpers
d)mumps
e)Dengue

53. transfusi drah dan sejenis ny tu masuk hipersensivitas tipe brp? Jwbanny 2
54. Man with HIV. Komponen adaptive immune system yang bekerja untuk melawan viral
infection adalah...
A. Secreting IgA
B. Macrophage
C. CD4+ T cells
D. CD8 + T cells
E. NK Cells

55. Salah satu cara stressed cell untuk menghindari imun kita adalah dengan mengurangi
ekspresi MHC klas 1. Sistem imun kta yg encounter ini adalah:
a. T-reg
b. T-helper
c. T-citotoksik
d. Makrofag
e. NK

56. 8 year old boy, Raised, scaly area on the back of his head. Lesion are round/oval with an
inflamed laised border. Under the microscope, septate hyphae in KOH 10% preparation of
scrapings of lesion was shown. What is the most likely diagnosis?
A. Tinea capitis
B. Tinea corporis
C. Tinea unguium
D. Tinea versicolor
E. Dermatophytes

57. 55 yo man d gigit sama doggy deeply berkali2 d kakinya. trus dia skg feeling unwell. (ga d
jelasin doggy nya rabies apa ngga) trus dia d rawat d ICU dengan demam tinggi, Blood pressure
turun. pertanyaan ny organism apa yg mungkin kena k org itu?
A. dna virus
B. spiral bacteria
C. acid bacilli
D. gram + bacteria
E. gram – bacteria

58. a 42 years old man presents to his physician with a 4 day history of terrible headache, fever,
and stiff neck. The physician suspect the man may have cryptococcal meningitis and collects
CSF for examination. Which one of the following result would you most likely expect from this
patients CSF studies?
a. elevated polymorphonuclear cells with hight protein level
b. elevated CSF pressure with increased white cell count
c. elevated lymphocytes with normal glucose level
d. normal CSF pressure with positive gram stain culture
e. normal CSF pressure with negative gram stain culture
59. a 7 y.o baby with severe, intractable chronic diarrhea, and failure to thrive. he was
asymptomatic at birth. his mom died when delivered him by section cesarean. his mom was hiv.
how the baby got the disease?
a. breast feeding
b. during delivery
c. transplancental
d. close contact
e. inhalation

60. Clinical vaccine trial using a nine amino peptide immunogen from an HIV-1 glycoprotein
have been performed. the vaccine is effective at inducing high affinity IgG virus neutralizing
antibodies in only a subset of healthy adult. Which of following immune properties probably
characterized the responsive individual
A. High producer of IL10
B. Lack of IL2 receptor
C. HLA class 2 gene
D. Lack of treg cells
E. Lack of TNF gamma

61. 16 years old boy is bitten by a dog, dan kemungkinan anjingnya terkena rabies. dia diberi
immunoglobin berisi rabies virus antibody. Apakah ini?
a. innate immunity,
b. active humoral immunity,
c. passive humoral immunity,
d. active cell mediated immunity,
e.passive cell mediated immunity

62. a previous healthy 1 year old boy is infected by upper respi tract virus for the first time. Apa
respon imun yang pertama terjadi? innate immune respond

63. 72. 27 years old nursing mother is diagnosed suffering from genital herpes. She has the
history this viral infection. Previously she was responded to a drug used topically apart from her
current problem, she is in good health. Which of the following drugs is most likely to be
prescribe for this patient?

a. ritonavir
b. acyclovir
c. foscarnet
d. trifluridine
e. amantadine

note: ritonavir utk memperlambat proses HIV ke AIDS (tidak mengobati), acyclovir utk herpes
zooster atau bisa juga herpes simplex, acyclovir tidak menyembuhkan tapi bisa menghentikan
penyebaran blister/ rasa sakitnya, foscarnet utk CMV pada pasien AIDS, bisa juga utk HSV
(herpes), trifluridine untuk mengobati infeksi virus pada mata, amantadine utk pengobatan
influenza dan parkinson.
64. A postmenopausal woman presents at your office, your diagnosis is she infected with Candida.
Which of the following drugs is the most appropriate for oral use in vaginal candidisis?

A. Clotrimazole
B. Fluconazole
C. Nystatin
D. Griseofulvin
E. Flucytosine