CUCU

(HENDRA-NIPAH VIRUS)
1. A 27-year-old man develops acute severe encephalitis that requires hospitalization. Several days
before he got that disease, he recognizes that many pigs in his farm were died.
Which of the following is most appropriated natural host for the pathogen?
a. Arthropod
b. Horse
c. Fruit bats
d. Squirrel
e. Rats

2. A 32-year-old female developed a “flu-like” syndrome with high fever up to 40 0C, anorexia, headache,
and myalgia. Four days later, she become confused and agitated with difficult to breath. Chest x-ray
showed parenchymal infiltrate. One of her kids has also these symptoms, and has already passed
away. In order to provide laboratory conformation of the pathogenic agent, a tissue culture was
ordered.
Which of the following would be the best specimen for isolating the pathogenic agent responsible for
this infection?
a. Stool
b. Blood
c. Saliva
d. Lung biopsy
e. Nasopharyngeal swab

Question 3-4 are linked to the following case:

(RABIES)
A young man was admitted to hospital after increasing left arm pain and paresthesia. Several days ago, he
was bitten by a dog. His symptoms increased and were accompanied by hand spasm and sweating on the
right side of the face and trunk. This patient was admitted to the hospital the day after developing
dysphagia, hydrophobia, hypersalivation, and disorientation.

3. Which of the following pathologic feature is most likely found in dog’s brain?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell

4. Which of the following is available for treating this patient?

a. Immune globulin
b. Live attenuated vaccine
c. Antiviral
d. Antimicrobial
e. Antitoxin
Question 5-6 are linked to the following case:
(ANTRAX-CUTANEOUS)
A 32-year-old worker from a farm comes with a painless dermal papule on his right hand which started to
develop since five days ago. The worker says as the lesion getting bigger, and the skin becomes black. He
has tender axillaries lymph node enlargement.

5. What antibiotic should the doctor give to treat the worker?

a. Tetracycline
b. Aminoglycoside
c. Ciprofloxacin
d. Neomycin
e. Crystalline penicillin G

6. Which of the following virulence factors is most likely to be involved in the pathogenesis of illness?
a. Exotoxin
b. Endotoxin
c. α-hemolysin
d. Lipopolysaccharide
e. Antiphagotic factors

(ANTHRAX-GI)
7. A 53-year-old male farmer developed low-grade fever, abdominal pain, and diarrhea. He has a skin
lesion of black eschar surrounded by vesicle and edema near his mouth. A week before, his notice
many cattle in his farm were sick, but he still eats a half-done beef steak from his cattle.
What is the following microorganism is most likely involved in this case?
a. Bacteroides fragillis
b. Leptospira interrogans
c. Bacillus anthracis
d. Pasteurella pestis
e. Borrelia burgdorferi

Question 8-9 are linked to the following case:

(EMERGING AND RE-EMERGING INFECTIOUS DISEASE)
There is an RNA virus that causes deadly outbreaks of hemorrhagic disease in Africa. The patents have
developed fever, headache, and muscle pain followed by abdominal pain, diarrhea, and rash, with both
internal and external bleeding. In each outbreak, hospital staff became infected. This virus is highly virulent.

8. Which of the following is the most likely transmission for this disease?
a. Contact with blood or body fluid
b. Transmitted by mosquitoes bite
c. Transmitted to human from rodent excreta
d. Aerosol transmission
e. Direct contact with cattle product
9. Which virus is most likely the cause of this outbreak?
a. Dengue virus
b. Menangle virus
c. Lassa virus
d. Ebola virus
e. Influenza virus

10. High priority bioterrorism agents include organisms that pose a risk to national security because they
can be easily disseminated or transmitted from person to person. Which of the following is most likely
to be transmitted from person to person in bioterrorism act?
a. Bacillus anthracis
b. Clostridium botulinum
c. Francisella tularensis
d. Variola major
e. Brucella melitensis

Question 11-12 are linked to the following case:

(AVIAN FLU)
A 31-year-old man presented with complaints of high fever, cough, and shortness of breath. Two hours
before admission, he experienced right-sided chest pain when took a deep breath or coughed. Chest film
showed diffused bilateral interstitial pulmonary infiltrate. Arterial blood gases showed a PO 2 of 60 mmHg
with 91% hemoglobin saturation. The hematologic, serum and liver tests were normal. He lives near the
poultry, and the pathogenic agent is a new virus.

11. Which of the following is the prevention for this disease?

a. Vaccine
b. Antitoxin
c. Antibiotic
d. Antiviral
e. Antidotes

12. Which of the following is probably the reason for the emergence of this infectious disease?
a. Animal husbandry practice
b. Genetically engineering
c. Vector elimination
d. Antibiotic resistance
e. Tsunami impact

13. An 80-year-old man is developing fever, cough, runny nose, headache, and myalgia. He lives in a
nursing home. Many of people in his neighborhood have this disease.
Which immediate course of action would be most appropriate for this patient?
a. Vaccination
b. Immunoglobulin
c. Rimantadine
d. Acyclovir
e. Cytokine
14. A 22-year-old man who works in the pediatric ward of a hospital suffers from malaise, sneezing, and
runny nose. He subsequently develops a mild sore throat, headache, and stuffy nose. The symptoms
resolve within 4 days. Which virus is most likely to be responsible for these symptoms?
a. Rota virus
b. Rubella virus
c. Coxsackie virus
d. Hepadnavirus
e. Influenza virus

(TIFOID)
15. A 48-year-old man with acute gastroenteritis has step ladder night fever since 7 days ago. He also has
abdominal pain, and constipation. He usually eats uncooked vegetables at street vendor (pedagang
kaki lima).
Which of the following is most likely to be a constituent of this organism?
a. Vi antigen
b. Urease
c. Hemolysin
d. Shiga toxin
e. Pili

16. An outbreak investigation note many costumer from a café were admitted to the hospital. They have
fever; nausea-vomiting, constipated or diarrhea, weakness and altered mental status. Rose spots are
seen on the trunk. Blood cultures from patients grow a non-lactose-fermenting gram-negative rod.
These people are infected from the carrier person
In which of the following sites are bacteria most likely to be found in carrier person?
a. Blood
b. Kidney
c. Liver
d. Intestine
e. Gall bladder

Question 17-18 are linked to the following case:

A 28-year old man presented with 8-day history of increasing fever, malaise, headache, and constipation.
He did not receive any prior vaccinations. His vital signs revealed temperature 39 0C, BP 130/90, pulse
72x/min. His physical examination revealed mild hepatospleenomegaly and faint erythematous macules.
17. Which of the following is most likely to have caused this man’s illness?
a. Vibrio cholerae
b. Shigella dysentriae
c. Salmonella typhi
d. Entamoeba histolitica
e. Giardia lambia

18. Which of the following specimen is most appropriate for case above?
 a. Feces
b. Blood
c. Urine
d. Throat swab
e. Biopsy

Question 19-20 are linked to the following case:

(MALARIA)
A 24-year-old man returned from Papua Island. Five days later, he developed repeating intense chills and
high fevers. These severe episodes of fever had been occurring every other day. In between these episodes,
he had low-grade fever, myalgia, nausea, vomiting, and diarrhea. A few hours ago, he was admitted to ICU in
coma. He became progressively somnolent and died a week later.

19. Which of the following organs does this infectious agent initially proliferate after entry in the infected
host?
a. Heart
b. Liver
c. Brain
d. Spleen
e. Renal

20. What is the most common mode of transmission of this agent?

a. Contact with rat’s of urin
b. Transplacental crossing
c. Blood transfusing
d. Bite of a mosquito
e. Eat the contaminated food

21. An apparently run-down but alert 34-year-old woman comes to your office after 6 months spent as a
teacher in a rural West Sumba. Her chief complaints are frequent headaches, occasionally nausea and
vomiting, and periodic fever. To rule out your differential diagnosis, a smear of finger-stick blood was
done. Which of the following choices would fit your diagnosis based on your microscopic examination
of the blood smear?
a. Schizonts in red cells with 8-12 progeny
b. Rounded gametocytes present
c. Enlarged, somewhat misshapen in red cells
d. Large ovoid parasites in some of the red cells
e. Band-shaped tropozoites in infected red cells

(NEUROCYSTICERCOSIS)
22. A 39-year-old woman live in Manokwari, Papua Island developed a major seizure while at work. She
had no history of epileptic disease. A head MRI was remarkable for a lesion surrounding a scolex. The
etiologic agent would most plausibly have been acquired by eating or dinking which of the following
food items?
a. Uncooked vegetables
b. Raw beef
c. Raw pork
d. Uncooked fish
e. Unfiltered water

23. A pork-eating village in the highlands of Papua New Guinea is reported to be suffering from an
epidemic outbreak of epileptiform seizures. You have been sent to investigate. One of the first things
you should investigate is?
a. The level of Balantidium coli in swine stool
b. The practice of consuming raw deceased human brains
c. The presence of taenia eggs in the drinking water
d. The presence of tropozoites in the human blood
e. The quantity of culidae in the village

dr. ANGELA

Question 24-26 are linked to the following case:

(BRUCELLOSIS)
A 45-year-old man from the Middle East had fever and chills, with weight loss, sweats, headache, muscle
pain, fatigue, and depression. From physical examination the doctor found lymphadenopathy and
spleenomegaly. The man is a daily farmer and a couple weeks before the symptoms appeared he drank a
glass of unpasteurized cow milk. The culture of blood grew a tiny Gram-negative coccobacilus, catalase
and oxidase-positive; that resemble fine grains of sand.

24. The patient was probably infected with which of the following microorganism?
a. Mycobcaterium tuberculosis
b. Salmonella typhi
c. Brucella species
d. Pasteurella pestis
e. Staphylococcus aureus

25. Which of the following diagnostic laboratory test should be done for identification of this fastidious
coccobacilus?
a. Fluorescent antibody test
b. Western Blot
c. Culture
d. ELIZA assay
e. PCR

26. How did the man get infected form this disease?
 a. Ingestion of infected unpasteurized cow milk
b. Needle stick injury from a contaminated syringe
c. Direct contact with infected animal parts through intact skin
d. Aedes aegypty bites
e. Fresh orange juice consumption

Question 27-28 are linked to the following case:

(TULAREMIA)
A 55-year-old warden found a dead muskrat on the bank of a stream. He picks up the animal and buried it.
Four days later, he developed a 1.5 cm painful ulcer on the index finger of his right arm, a 1 cm ulcer on his
right forehead, and pain in his right axilla. Physical examination also revealed right axillary
lymphadenopathy.

27. Which of the following is working diagnosis for this patient?

a. Brucellosis
b. Pertusis
c. Leptospirosis
d. Tularemia
e. Hydatidosis

28. Which of the following prevention should be done for high risk persons, such as research laboratory
personnel from this disease?
a. Education
b. Immunization
c. Laboratory precaution
d. Burning infected animal
e. Antibiotics taken

Question 29-33 are linked to the following case:

(LEPTOSPIROSIS)
A volunteer man returning from a tsunami area was admitted to hospital. A week before, he had fever,
headache and myalgia especially at calf. These symptoms resolved, but the day before admission he
became pyrexia and on examination was found to be jaundice and to have an elevated blood urea. Urine
was collected and inoculated into a semisolid agar medium, and examined by dark ground microscopy.

29. Which of the following is your working diagnosis?

a. Syphillis
b. Pertusis
c. Weil’s disease
d. Lyme disease
e. Relapsing fever

30. Which of the following disease is the complication of this disease?

 a. Pulmonary hemorrhage
b. Myopericarditis
c. Aseptic meningitis
d. Osteomyelitis
e. Anemia

31. Which of the following reservoir animal is the source of human infection?
a. Fish
b. Bird
c. Reptile
d. Scallop
e. Rat

32. Which of the following is the prevention after exposure for this case?
a. Human vaccine
b. Health education
c. Vector control
d. Isolation the infected people
e. Prophylaxis antibiotics

33. Which of the following is drug of choice of this disease?

a. Penicillin G
b. Chloramphenicol
c. Erythromycin
d. Gentamycin
e. Rifampin

(LEPTOSPIROSIS)
34. A 27-year-old medical student was admitted to hospital because of sudden onset fever up to 39 0C and
headache. Two weeks previously he volunteers cleaning the canal with others. On examination, he
looked so yellow. Blood tests done shortly after admission indicated renal function abnormality and
elevated liver function tests. Which of the following would be most likely to confirm the diagnosis?
a. Testing serum using the rapid plasma reagin (RPR) test
b. Culture the urine on human diploid fibroblast cells
c. Testing serum by darkfield microscopy
d. Testing serum for antileptospiral antibody
e. Culture of CFS on chocolate agar

Question 35-37 are linked to the following case:

(YAWS)
A young boy had an ulcerating papule on his legs. Later, this lesion destroys the bone of his legs
(gummata), but three are no visceral and nervous system complications. The disease is still endemic in hot
tropical countries, such as Indonesia.

35. Which of the following microorganism is the cause of the disease above?
a. Treponema pertenue
b. Borrelia burgdorferi
c. Leptospira interrogans
d. Spirillum minor
e. Chlamydia trachomatis

36. Which of the following drugs is the drug of choice for the disease above?
a. Tetracycline
b. Penicillin
c. Doxyccycline
d. Vancomycin
e. Clarithromycin

37. Which of the following examination is the most appropriate to diagnosis the disease above?
a. Widal test
b. IgG and IgM of Treponema
c. Dark-field microscope
d. FTA-ABS test and TP-PA test
e. ELIZA assay

dr. ROBERT TEDJA

Question 38-39 are linked to the following case:

(TRAVELER DIARRHEA AND THE PREVENTION)
A female tourist developed gastroenteritis while visiting small town in Indonesia and tried some Indonesian
traditional food. The onset of the disease is abrupt with abdominal cramps and watery diarrhea. She had
no fever or nausea or vomiting. The symptoms have resolved within 24 hour and no subsequent
recurrences. They report the disease to district public health office. The investigation found that one of the
food products eaten by this tourist was contaminated by suspected pathogens.

38. What is the suspected pathogen may cause the disease above?
a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E.coli

39. Which of the following is the natural prevention for the disease above?
 a. Bi Subsalicylate
b. Antibiotic
c. Probiotic
d. Chlorination
e. Hand hygiene

40. Approximately 4 hour after eating a meal in restaurant, 3 members of a tourisms group develop a
sudden onset of nausea, vomiting, severe abdominal cramps, and diarrhea. Nobody got febrile. Which
of the following vaccination is should be given to the traveler?
a. Shigella vaccine
b. Salmonella vaccine
c. Enterobacter vaccine
d. H Pylori vaccine
e. ETEC vaccine

dr. SANDRA

(DHF)
41. A 23-year-old man sees his family physician with a sudden onset of 4-day history of fevers, headache,
retro-orbital pain, myalgia and rash. Physical examination shows diffuse erythroderma with blanching
erythema and petechial formation resulting from pressure applied to her skin. Laboratory test reveal
lymphopenia and thrombocytopenia. Which of the following virus is most likely responsible for this
infection?
a. Morbili
b. Dengue
c. Influenza
d. Coxsackie
e. Rhinovirus

42. A 34-year-old woman complained a sudden onset of high fever for 4 days with nausea, vomiting,
headache, muscle ache. There were petechiae on examination. Which of the following laboratory result
is most appropriate with the patient’s diagnosis?
a. Trombositopenia
b. Neutropenia
c. Anemia
d. Decreased of hematocrit
e. Leucopenia

Question 43-44 are linked to the following case:

A 20-year-old woman came to the emergency room with high fever from 5 days ago. She also has
headache and pain in retroorbita, abdominal pain and bloody stool. On physical examination, she was in an
agitated condition. Her BP 90/60 mmHg, heart rate 110x/ minute, RR 20x/ minute and there were purpura
in her arm, hand and leg.

43. Which of the following examination is the most appropriate to establish the diagnosis?
a. Prick test
b. Dengue IgM-IgG
c. Complete blood test
d. Widal test
e. Stool analysis

44. In this case, she developed epistacsis, melena and purpura in skin. Which of the following is
responsible for his condition?
a. Elevated of thrombocyte increasing coagulation
b. Fibrin degradation make dysfunction of thrombocyte
c. Elevated of kinin in circulation
d. Plasmin elevated coagulation factor
e. Complemen activation by plasmin

dr. DWI

45. A 48 year old lady came to the outpatient clinic with chief complaint of fatigue and difficulty in
concentration for the last 2 weeks. The history taking revealed that she had a balanced diet, no history
of chronic disease and had been a heavy smoker for 20 years. On physical exam it was found that she
had anaemic conjunctiva with other findings was within normal limit. The laboratory examination
showed that she had haemolytic anemia.
Based on the information given above, what is the most likely cause for her condition?
a. Vitamin K deficiency
b. Copper deficiency
c. Vitamin E deficiency
d. Iron deficiency
e. Folate deficiency

46. A 28 year old lady came to the Posyandu to have a nutrition consultation. Last year, she delivered a
stillbirth baby with a spinal disorder. She and her husband start planning to have a baby again. She
asked for suggestion about her dietary intake before she got pregnant.
What kind of diet does she need to prevent the same disorder for her future baby?
a. Dark green vegetables
b. Pasteurized milk
c. Deep water fishes
d. Boiled eggs
e. Lean beef

47. A 1 year old girl came to the Puskesmas with swollen gum for a week. From the history taking it was
found that she was born normal with normal birth weight, had been breastfed up to now and had a
 balanced diet with high intake of cooked vegetable and fruit since 6 months old. She had no history of
chronic diseases. Her other physical and laboratory examination was normal.
Based on the information given above, what is the most likely cause of her complaint?
a. Protein deficiency due to prolonged breastfeeding
b. Carbohydrate deficiency due to increased calorie need
c. Fat soluble vitamin deficiency due to high vegetable/fruit intake
d. Water soluble vitamin deficiency due to cooking process
e. Mineral deficiency due to competition with high vitamin absorption

dr. JULIANA
(TUTOR)

Question 48-49 are linked to the following case:

A 9 year old girl came to the emergency room with difficult of breathing. She had got high fever since 3
days ago. Her temperature was up to 40 oC. She also complained of rhinorhea, cough, and myalgia. On
examination, you found increased tactile fremitus on the right side of the lung, dullness on percussion.
Laboratory result indicated leucopenia.

48. Which criteria of avian influenza is the most appropriate with this patient’s condition?
a. Probable
b. Suspect
c. Confirmed
d. Definitive
e. Absolute

49. Based on its ability to cause disease, avian influenza is broadly divided into highly pathogenic (HPAI)
and low pathogenic (LPAI) strains. Which subtypes are known to cause the HPAI?
a. H1 and H3
b. H2 and H4
c. H5 and H7
d. H6 and H8
e. H9 and H11

50. A 50 year old woman presented to clinic with fluctuated fever (also called as step ladder fever) since 7
days ago. On physical examination, you found “rose spots” on upper abdomen. What is the possible
cause of rose spots on this woman?
a. Eritrocytopenia
b. Leucopenia
c. Thrombocytopenia
d. Limfositosis
e. Deficiency of clotting factor

51. A 27 year old woman in at term pregnancy had fluctuated fever since 2 weeks ago. She looked pale,
generalized weakness, and headache. She went to public health center and was prescribed oral
chloramphenicol in doses of 500 mg four times daily and paracetamol 500 mg three times daily. She
 did not tell to the physician that she was pregnant. What is the expected side effect of the drug you will
find on the baby?
a. Reye syndrome
b. Gray syndrome
c. Down syndrome
d. ADHD
e. Black water fever

52. A 24 year old man, recently returned from Myanmar, presented very unwell febrile. His consciousness
was GCS of 7. His thin blood smear showed malaria falciparum. Which of this following is the best
treatment for this patient?
a. Chloroquine
b. Mefloquine
c. Fansidar
d. Doxycycline
e. Quinine IV

53. A 35 year old man, a businessman, came to private doctor. He asked the physician about his plan to
go to Papua, which is endemic malaria. The physician suggested him to take prophylactic drug. Which
medication (WHO recommended) would be given to this patient for prophylactic?
a. Kina
b. Chloroquine
c. Doxycycline
d. Kuinin
e. Primakuin

54. A 40 year old man came to hospital with four times generalized tonic-clonic seizure since two week
ago. There was no history of seizure and head trauma. A one year ago, he had business in Papua for
six months. During his stay in there, he often consumed under-cooked pork. Brain MRI showed a small
cystic with invaginated scolex inside. What of this following is the most likely inside cyst?
a. Taenia eggs
b. Cycticercosis cellulose
c. Cysticercosis bovis
d. Taenia solium worm
e. Taenia saginata worm

55. A 15 year old girl of African origin was admitted with a history of headaches and a generalised tonic
seizure. Her clinical examination was normal. Within a few hours of her admission she was found dead
in her bed during the ward round. After autopsy, the diagnosis was neurocycticercosis. Which of this
following brain’s location is the possible cause of patient’s sudden death?
 a. The frontal lobe
b. The temporal lobe
c. The parietal lobe
d. The lateral ventricle
e. The fourth ventricle

dr. ROBERT SOETANDIO

56. You are precepting a resident who has just evaluated a 4-year-old incompletely immunized immigrant
boy who has classic varicella lesions and a history that is consistent with this diagnosis. Of the
following, the MOST accurate statement is that
a. Lesions of both varicella and smallpox follow a 7- to 10-day course from eruption to resolution
b. Lesions of both varicella and smallpox frequently produce deep, pitted scars
c. Varicella lesions appear in stages or crops; smallpox lesions are uniformly in the same Stage of
development
d. Varicella lesions are concentrated on the face; smallpox lesions are concentrated over bony
prominences
e. Varicella lesions are transient vesicles; smallpox lesions are persistent pustules until resolution of
the illness

57. An 8-day-old infant was born with the help of shaman (‘dukun beranak’). The mother states his son
became irritable since 2 days ago, and now any loud noise appears to cause him pain, as evidenced
by muscle tightening and back arching causing his head to nearly touch his feet. Physical examination
reveals only a dried packing on his umbilical cord, as is the local custom. He appears normal until he is
stimulated by touch or a loud noise, and then he begins to cry, stiffens, and arches his back. The
stiffness continues until he calms down. Of the following, the MOST likely diagnosis is:
a. Bacterial meningitis
b. Botulism
c. Generalized seizure
d. Tetanus
e. Viral encephalitis

Question 58-59 are linked to the following case:

A worried mother brings her 18-month-old son to the emergency department because of a rash that
developed today. She reports that he has had a runny nose, conjunctivitis, and diarrhea. On physical
examination, he appears severely ill, is temperature to 40°C for the last 3 days and has diffuse 2 – 3 mm
erythematous rash beginning from the hairline behind the ear and spreading to his face and body. On
buccal mucosa, there is a red spot surrounded by white bluish appearance.

58. Of the following, the MOST likely cause of the rash is

a. Rubella virus
b. Coxsackievirus
c. Morbilli virus
d. Human herpesvirus 6
e. Parvovirus B19

59. What is the most severe complication that would happen to the patient above?
a. Osteomylitis
b. Encephalitis
c. Otitis externa
d. Sinusitis
e. Oral thrush

Question 60-61 are linked to the following case:

A 10-year-old boy who has moved to your practice recently has sore throats, get high temperature. The
child reports a runny nose, mild cough, and abdominal pain. Findings on physical examination include a
temperature of 38°C, and vesicular lesions on the soft palate, dorsal and palmar of hands. There is no
cervical adenopathy or rash.

60. Of the following, the MOST likely diagnosis is

a. Adenovirus infection
b. Coxsackie virus infection
c. Mononucleosis
d. Sinusitis
e. Streptococcal pharyngitis

61. What is the name disease what is caused by coxsackie virus and the location in the mouth?
a. HFMD
b. Herpangina
c. Conjungtivitis
d. Pleurodynia
e. Streptococcal pharyngitis

Question 62-64 are linked to the following case:

A 10-year-old girl presents with a history of sore throat and difficulty breathing of 1 day’s duration. On
examination she is very ill-appearing. She has some inspiratory stridor and thick white-gray material
covering her tonsils and faucial pillars, and she has swelling of her neck, no splenomegaly. The lymphocyte
is normal.

62. What is the likely diagnosis?

a. Tonsilitis
b. Angina Plaut Vincent
c. Mononucleosis infectiosa
d. Laryngitis
e. Diphteria

63. Case no 63. if we want to give her DAT. How much should we give DAT?
a. DAT 80.000 IU
b. DAT 50.000 IU
c. DAT 100.000 IU
d. DAT 40.000 IU
e. DAT 60.000 IU

64. According IDAI schedule 2008, when is the child getting the vaccination booster for the disease above
after 18 months?
a. 5 years
b. 4 years
c. 3 years
d. 12 years
e. 15 years

Question 65-66 are linked to the following case:

A 16-year-old boy presents with an annoying cough, which he has had for about 3 weeks. The illness
started with a runny nose. On examination he is completely normal, but he exhibits several episodes of
severe coughing. He has difficulty to take deep breath and usually ends up with vomiting.

65. Of the following, the MOST likely diagnosis is

a. Tonsilitis
b. Bronchiolitis
c. Pertussis
d. Laryngitis
e. Diphteria

66. The boy in case 67 often gets secondary infection. What the most organisms is usually cause the
secondary infection?
a. Stafilokokus aureus
b. Treponema palidum
c. Haemophilus Influenza
d. Serratia marcescens
e. Corynebacterium diphteriae
Question 67-69 are linked to the following case:
A baby is born with a rash identical. History taking reveals that the mother had a febrile illness during the
second trimester of pregnancy. Examination reveals diffuse raised purple skin lesions. There is no pallor,
jaundice, or cyanosis. The baby has cataract, a 3/6 systolic heart murmur, and enlargement of both liver
and spleen. There is no lymphadenopathy.

67. Of the following, the MOST likely diagnosis is?

a. Congenital Toxoplasmosis
b. Congenital Rubella
c. Congenital Cytomegalovirus
d. Congenital Herpes Simplex
e. Congenital Varicella

68. What is vaccination which prevents disease in number 68?

a. Measles
b. Varicella
c. MMR
d. HPV
e. PCV

69. How old is the baby getting the vaccination?

a. 15 months
b. 16 months
c. 17 months
d. 18 months
e. 19 months

dr. HANNA

Question 72-73 are linked to the following case:

A 45-year-old man was seen in the dermatology clinic because of some nodules on his arm and body and
sometimes feel pain with pressure. On examinations we found erythematous nodules, smooth and shiny,
diffuse infiltrate with ill define border, no fluctuation or erosion. There were pain on his elbow with nerve
enlargement.

70. What is the most likely diagnosis?

a. Yaws
b. Leprosy
c. Anthrax
d. Cellulitis
e. Carbuncle

71. What laboratory test would you do to confirm the clinical diagnosis?
a. TPHA and VDRL
b. Gram preparation
 c. KOH preparation
d. Skin scrapping
e. Skin slit smear

72. The 21-year-old man was seen in dermatology clinic because of sore and redness on his previous skin
lesion. He was on MDT treatment since 1.5 year ago. On skin examination they found some painful
erythematous nodule spread over his body especially on arm and legs also fever. What is the most
likely diagnosis ?
a. Celulitis
b. Furuncle
c. Erythema nodosum
d. Multibacillar leprosy
e. Pausibacillar leprosy

73. A laboratory examination of a leprosy patient after 4 months MDT therapy revealed Bacterial index 6+
and morphological index 50%. What is your conclution for this result ?
a. Pausibacillar leprosy patient sensitive to treatment
b. Multibacillar leprosy patient sensitive to treatment
c. Multibacillar leprosy patient resistent to treatment
d. Pausibacillar leprosy patient resistent to treatment
e. Pausibacillar leprosy patient prone to nerve damage

74. A 40-year-old woman presented with a raised redness plaque resemble a doughnut with a raised
border that she already had for 1 year, It was no itchy, no pain, not easily bleeding. Sometime she feel
weakness on her leg and her slipper left behind while walking. On her legs she developed an anular
erythematous sharp border lesion, no scally, shiny surface and enlargement of the popliteal nerve.
What is the most likely diagnosis?
a. Leprosy
b. Yaws
c. Celulitis
d. Anthrax
e. Insect bite

75. What kind of laboratory examination results that can help us make a diagnose of the case above?
a. Dark field examination
b. Gram
c. KOH examination
d. Ziehl neelson
e. Na Cl examination

76. A 30-year-old farmer complaned about weakness on his three fingers that he can not hold a plough .He
found some white patches on his back, tummy arms, he felt numbness on his right hand but not itching
After one year on medication he experience tenderness and sore on his right elbow and the skin
patches became red. What is the most likely diagnosis?
 a. Framboesia
b. Scorpion bites
c. Reversal reaction
d. Lepromatous leprosy
e. Ramsay Hunt syndrome

77. A patient on MDT treatment complaining about red urine that he experinced on the first day of
treatment. What is the suggestion for this condition ?
a. Stop Clofazimin, can cause pink brownish discolouration
b. Continue the medication, it’s not a drug adverse effect
c. Stop the medication because of nefrotoxicity
d. Stop Dapsone can cause anemia hemolytic
e. Change the treatment to single drug therapy

78. A 50-year-old man complained about the treatment for his leprosy since it takes one year medication
with multiple drugs (MDT) every day. Can you give some explaination about the length of treatment ?
a. There is no cure for leprosy
b. Leprosy bacteria can’t be killed by 1 drug
c. M D T treatment can cure the disability
d. To prevent from drug resistancy
e. Due to his low immunity

dr. KRISTO

79. Tuberculosis become one of reemerging infectious disease because

a. More cases of tuberculosis found in developing countries
b. Found more cases in childrek
c. Found more cases of lung cancer
d. Found more cases of drug resistance
e. More people who smoke

80. Antigenic shift of influenza viruses occurred in

a. Haemagglutinin
b. Neuramidase
c. M2 protein
d. NS1
e. NS2

81. Epilepsy which occurs in neurosistiserkosis caused by the

a. Colloidal cyst
b. Vesicular cyst
c. Calcification cyst
 d. Necrosis cyst
e. Granuloma cyst

82. Human infection with the beef tapeworm, Taenia saginata, usually is less serious than infection with the
pork tapeworm, Taenia solium, because
a. Acute intestinal stoppage is less common in beef tapeworm infection
b. Larval invasion does not occur in beef tapeworm infection
c. Toxic by-products are not given off by the adult beef tapeworm
d. The adult beef tapeworms are smaller
e. Beef tapeworm eggs cause less irritation of the mucosa of the digestive tract

83. A woman, recently returned from Lampung, complains of having paroxysmal attacks of chills, fever,
and sweating; these attacks last a day or two at a time and recur every 36 to 48 h. Examination of a
stained blood specimen reveals ringlike and crescent-like forms within red blood cells. The infecting
organism most likely is
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malarie
e. Plasmodium brasilianumi

84. A woman, recently returned from Lampung, complains of having paroxysmal attacks of chills, fever,
and sweating; these attacks last a day or two at a time and recur every 36 to 48 h. Which of the
following is the most appropriate time to take blood specimen to establish the diagnosis?
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever

85. Malaria is a significant worldwide public health problem. Which one of the following control methods for
malaria is currently effective?
a. A vaccine
b. Chemoprophylaxis
c. Antibiotics
d. White clothing
e. Tick repellents

86. A man came to the emergency room with complaints body felt weak, fever, and diarrhea since 7 days
ago. Prior to the emergency room, the patient had been to the clinic 24 hours and given paracetamol
and cloramfenicol for 5 days, but the symptoms did not subside. To establish the diagnosis in patients
with typhoid fever was the doctor taking the material for culture from?
a. blood
 b. urine
c. stool
d. intestinal secretion
e. bone marrow

87. Typhoid fever pathogenesis is not affected by

a. Antigen Vi
b. Antigen H
c. Gastric acidity
d. Amount of bacteria
e. Antacid drug

88. Amantadine, a synthetic antiviral agent used prophylactically againt influenza, is thought to act by
a. preventing production of viral capsid protein
b. preventing virion release
c. preventing penetration of the virus into the host cell
d. preventing uncoating of viral DNA
e. causing lysis of infected host cells by release of intracellular lysosomal enzymes

89. A 27-year-old female has just returned from a trip to Southeast Asia. In the past 24 hours, she has
developed shaking, chills, and a temperature 40o C. A blood smear reveals Plasmodium vivax. Which
of the following agents should be used to eradicate the extra-erythrocytic phase of the organism?
a. Primaquine
b. Pyrimethamine
c. Quinacrine
d. Chloroquine
e. Chologuanide

90. The mechanism of action of chloroquine in Plasmodium falciparum malaria is elimination of?
a. Secondary tissue schizons
b. Exoerythrocytic schizoons
c. Erythrocytic stage
d. Asexual forms
e. Sporozoites

dr. NICO

91. A 33-year-old woman ingested 10 tablets of an analgesic-antipyretic which is metabolized to a quinone

imine. Shortly after ingestion she presented with signs of nausea, vomiting, and generalized malaise.
Within 3-5 days peak hepatic dysfunction occurred and was associated with hepatic necrosis.
 Which of the following is the most likely specific antidote that should be used to treat this patient's over
dosage?
a. Amyl nitrite
b. Atropine
c. BAL
d. EDTA
e. N acetyl sistein

92. A very depressed woman took 20 tablets of a hypnotic drug belonging to her husband about less than
30 minutes ago. As she was being taken to the hospital, she developed hypotension, tachycardia, and
tachypneu. She’s also unconscious. Which of the following is the most appropriate management for
this patient?
a. Give apomorphine intramuscular
b. Doing gastric lavage
c. Infuse with sodium bicarbonate
d. Give activated charcoal via NGT (nasogastric tube)
e. Doing a hemodialysis

93. A 19-year-old woman comes to Emergency Department with signs and symptoms of poisoning of an
agent include nausea, vomiting, abdominal cramps, diarrhea, excessive salivation, headache,
giddiness, rhinorrhea, tightness in chest, pin-point pupils, mental confusion, and muscle twitching.
Which of the following is the most likely agent caused those symptoms?
a. Acetaminophen
b. Barbiturate
c. Carbamate
d. Cyanide
e. Opiate

94. A 61-year-old man was seen in the Neurology Clinic for evaluation of a peripheral neuropathy. He was
found to have dermal hyperpigmentation/depigmentation (salt/pepper) of the skin, scaly palms, and
transverse ridges on his fingernails which were identified as being a result of a chronic chemical
intoxication.
Which of the following is the most likely chemical agent caused that sign and symptoms?
a. Acetaminophen
b. Arsenic
c. Cyanide
d. Fluoride
e. Iron

dr. DINA

Question 95-96 are linked to the following case:

A 3 year old boy was brought to emergency department with weakness of his left leg. He had fever since 5
days ago. His mother said he never had immunization before.

95. What is the most likely immunization that could prevent this disease?
a. DPT
b. Campak
c. Polio
d. BCG
e. Hepatitis B

96. What is laboratory examination to support this diagnosis?

a. Viral isolation from sputum
b. Viral isolation from serum
c. Viral isolation from urine
d. Viral isolation from feces
e. Viral isolation from cerebrospinal fluid

Question 97-98 are linked to the following case:

A 5 year old boy was brought to emergency department with complaining of paresthesia of the fingers and
lower extremity muscle weakness since two days ago. The weakness progress involves the truncal
muscles. Two weeks ago he had upper respiratory tract infection.

97. What is your most likely diagnosis in this case?

a. Guillain-Barré syndrome
b. Poliomyelitis
c. Encephalitis
d. Meningitis
e. Multiple Sclerosis

98. What is the best management in this patient?

a. Amoxicilin
b. Intravenous immunoglobulin
c. Polio Immunization
d. Intubation
e. Albumin

99. A 24 year old woman admitted to the hospital with myalgia and weakness of her right leg. She had
traveled from Saudi Arabia and her immunization had never completed. On examination, she had
normal sensation of the right leg, with normal movement and strength in all other extremities and a
normal cranial nerve examination. Which of the following vaccination is the best prevention for this
disease?
 a. MMR
b. HBIG
c. BCG
d. DPT
e. Oral Sabin

dr. SAYURI

100. Lisa, 37 year old, had a VCT, and the result shows HIV +. Which of the following is not the
transmission route of HIV?
a. Unprotected sexual intercourse (vaginal or anal) with an infected person
b. Transfusion of contaminated blood
c. The sharing of contaminated needles, syringes or other sharp instruments
d. The sharing of meal with an infected person
e. From a mother to her infant during pregnancy, childbirth and breastfeeding.

101. A 36-year-old man, came to the private doctor with unexplained weight lose, persistent fever and
productive cough since 2 months ago. On physical examination, the doctor found generalized
lymphadenopathy, crackles on lung examination, and there was needle injection scar on his both
forearms. Which of the following laboratory examination are not necessary to examine right that time?
a. Tuberculin test
b. Anti HCV
c. Complete Blood Count
d. HIV antibody testing
e. Fasting Blood Glucose

Question 102-103 are linked to the following case:

An HIV (+) patient comes to the emergency room with severe dehydration. The nurse puts an IV line on
him, after that the nurse use her two hand recapping the needle, and got injured by that needle. The nurse
is panicking. You are the doctor on duty in that emergency room.

102. What should you do?

a. Press the injury site to stop the blood
b. Wash immediately using soap under running tap water
c. Use bleach or iodine to clean the injury site
d. Use antibiotic ointment on the injury site
e. Enlarge the injury site by incision to let the blood flow

103. The next step you should do is to ask her to get PEP (post exposure prophylaxis). Which of the
following is true about PEP?
a. Should be started later than 72 hours
b. Should be administered for 28 days
c. Should be offered especially for already HIV (+) person from a previous exposure
 d. Indicated for saliva exposure from known infectious person to the intact skin
e. Using only 1 ART

104. A traffic accident victim was brought to the emergency room. The victim said that he has HIV +.
When the nurse cleans the wound, the blood splash to nurse’s eyes. What should she do?
a. Clean the eye immediately with soap
b. Use disinfectant to clean the eye
c. If contact lenses are worn, immediately remove the contact lenses and after that irrigate the eye
with normal saline
d. Irrigate immediately with water or normal saline
e. Use antibiotic eye drops as much as possible.

105. Rika, 28 year old, is a HIV + pregnant woman. Which of the following is not true about the pregnant
woman with HIV??
a. Start ART in all pregnant women with HIV and CD4 count < 350 cells/mm3, irrespective of clinical
symptoms.
b. CD4 testing is required to identify if pregnant women with HIV and WHO Clin Stg 1 or 2 disease
need to start ART or prophylaxis
c. Start ART in all pregnant women with HIV and WHO Clin Stg 3 or 4, irrespective of CD4 count
d. EFV is the drug of choice during the 1 st trimester of pregnancy
e. She is advised not to breastfeed the child

dr. REZA

106. A 22-year-old G1P0A0 at 14 weeks gestation presents to your office with a history of recent
exposure to her 3-year-old nephew who had a viral infection. In which time period does maternal
infection with rubella virus carry the greatest risk for congenital rubella syndrome in the fetus?
a. Preconception
b. First trimester
c. Second trimester
d. Third trimester
e. Postpartum

107. A 33-year-old woman at 10 weeks pregnancy presents for her first prenatal examination. Routine
labs are drawn and her HBsAg is positive. Liver function tests are normal and her Anti HBc and Anti
HBs are negative. Which of the following is the best way to prevent neonatal infection?
a. Provide immune globulin to the mother.
b. Provide hepatitis B vaccine to the mother.
c. Perform a cesarean delivery at term.
d. Provide hepatitis B vaccine to the neonate.
e. Provide HBIG and the HepB vaccine to the neonate
108. A 20-year-old G1P0A0 patient delivers a live-born infant with cutaneous lesions, limb defects,
cerebral cortical atrophy, and chorioretinitis. Her pregnancy was complicated by pneumonia at 18
weeks. What is the most likely causative agent?
a. Cytomegalovirus
b. Group B streptococcus
c. Rubella virus
 d. Treponema pallidum
e. Varicella zoster

109. A 34-year-old G2 at 36 weeks delivers a growth-restricted infant with cataracts, anemia, patent
ductus arteriosus, and sensorineural deafness. She had flu-like syndrome with rash in early pregnancy.
What is the most likely causative agent?
a. Parvovirus
b. Rubella virus
c. Morbili virus
d. Cytomegalovirus
e. Herpes simplex virus

110. A 25-year-old G3 at 39 weeks delivers a small-for-gestational-age infant with chorioretinitis,

intracranial calcifications, jaundice, hepatosplenomegaly, and anemia. The infant displays poor feeding
and tone in the nursery. The patient denies eating any raw or undercooked meat and does not have
any cats living at home with her. She works as a nurse in the pediatric intensive care unit at the local
hospital. What is the most likely causative agent?
a. Cytomegalovirus
b. Group B streptococcus
c. Hepatitis B
d. Parvovirus
e. T. gondii

111. A 23-year-old G1 with a history of a flulike illness, fever, myalgias, and lymphadenopathy during
her early third trimester delivers a growth-restricted infant with seizures, intracranial calcifications,
hepatosplenomegaly, jaundice, and anemia. She has many pets in her house. What is the most likely
causative agent?
a. Cytomegalovirus
b. Hepatitis B
c. Influenza A
d. Parvovirus
e. T. gondii

VELI

112. A 45 year old man presented chronic skin lesions on both hands for the past 1 year. On
examination, his skin appears erythematous, crusted, fell itching, and having serous discharge. He was
working in the gold refining plant for the past 2 years, works with potassium cyanide and never uses
any gloves. Which of the following mechanism is responsible for this illness?
 a. Immediate respond
b. Acute respond
c. Gradual reactions
d. Delayed reactions
e. Quantal reactions

Question 112-113 are linked to the following case:

Male, 46 years old came to you as a doctor with chief complains shortness of breath especially at the work
place. When he gets home, the symptom is missing. He also complains that he sneezes every morning.
According to him, his sister is using bronchodilator inhaler every day. He just worked at sandblasting
company and expose to dust since 2 weeks ago.

113. Which of the following hazardous material are most possible causes of his disease?
a. Wood
b. Quartz
c. Plant
d. Mercury
e. Tobacco smoke

114. Which of the following is the most appropriate to measure the toxicity of hazardous material in the
case above?
a. Body Mass Index
b. Nutrition and Job description
c. Individual Susceptibility
d. Social pressure
e. Tissue and organs

115. About 80% of the nurses have varicose veins (varises) because they need to stand 6-7 hours
without rest. Which type of hazardous exposure in the Health and Safety Practice?
a. Ergonomic hazard
b. Biological hazard
c. Chemical hazard
d. Psychosocial hazard
e. Physical hazard

116. An outbreak of pulmonary tuberculosis (TB) in a dormitory, and this outbreak were presumed to be
caused by the same source of infection, based on the results of restriction fragment length
polymorphism (RFLP) analysis and other findings. Which of the following health intervention is the most
appropriate for the case above?
a. Rehabilitation
b. Prevention
c. Curative
 d. Medication
e. Environmental Modification

dr. SISI

Question 117-118 are linked to the following case:

The patient was a 3-year-old girl who was seen by her pediatrician for a routine physical examination. Her
mother was concerned about her daughter’s poor appetite. Physical exammmination revealed that the child
was small for her age and had a slightly enlarged liver. Blood was collected for a routine complete blood
count, since she had previously been slightly anemic. Her hemoglobin level was within the normal range;
however, she did have eosinophilia (20%). The child had no history of travel. When questioned about pets,
her mother reported that she spent a great deal of time with her puppy.

117. Of the following, which parasitic infection might be responsible for this patient’s symptoms?
a. Echinococcus granulosus
b. Toxocara canis
c. Strongyloides stercoralis
d. Enterobius vermicularis
e. Trichinella spiralis

118. Of the following, which manifestation of the infection (above case) is known to occur?
a. Creeping eruption
b. Biliary cirrhosis
c. Cholecystitis
d. Pruritus ani
e. Visceral larva migrans

Question 119-120 are linked to the following case:

A 44-year old man on a business trip to South Kalimantan from Jakarta presented to the emergency
department with symptoms of diarrhea and abdominal pain. On physical examination was found pitting
edema of the abdominal wall and of the legs. A stool specimen was sent to the laboratory for culture and
for ova and parasites. Blood was drawn for a CBC. The culture was negative for enteric pathogens. The
patient was found to have eosinophilia. The wet mounts from the concentrated stool specimens revealed
large, ellipsoidal, operculated parasite eggs with thin, transparent shells (140 x 85 µm).
119. Of the following, which parasite can be the cause of this disorder :
a. Schistosoma japonicum
b. Fasciolopsis buski
c. Trichinella spiralis
d. Echinococcus granulosus
e. Clonorchis sinensis

120. Refer to the previous case, the mechanism of edema is due to :

a. Host-allergic response to metabolic wastes of parasite
b. Reaction to the parasite as it migrates through the tissues
c. Reaction to embolization of eggs
d. immediate hypersensitivity reaction to the adult worms in the intestine
e. eggs damage the wall of intestine

Question 121-122 are linked to the following case:

A patient came to the clinic with portal hypertension syndromes. From the interview, the patient was known to
consume raw fish regularly.

121. Of the following, the most likely cause of disease is :

a. Clonorchiasis
b. Paragonimiasis
c. Fasciolopsiasis
d. Echinococcosis
e. Fascioliasis

122. Refer to the previous case, the other complication of this disease is :
a. Colitis
b. Cholangiocarcinoma
c. Bladder cancer
d. Chronic pyelonephritis
e. Liver abscess

123. A patient complains of having nail size excrement from his anus. On the stool examination, parasite
eggs contains a hexacanth embryo with six hooklets surrounded by radially striated spherical shell, 30 to 40
u in diameter were found, the most likely diagnosis of this patient is :
a. Saginata taeniasis
b. Solium taeniasis
c. Cysticercosis
d. Oxyuriasis
e. Ascariasis
Question 124-125 are linked to the following case:
A 40-year-old patient comes with the complaints of uncomfortable stomach & flatulence. From history, the
patient was known live in the valley of Napu, Sulawesi and he had a fever frequently. On physical examination,
his liver was found enlarged.

124. Which one of the following test can be used to confirm the diagnosis?
a. Blood test
b. Liver biopsy
c. Rectal biopsy
d. Stool examination
e. CT scan

125. Referring to the previous question, the most likely caused of the disease is :
a. Schistosoma haematobium
b. Schistosoma mansoni
c. Schistosoma rodentatum
d. Schistosoma japonicum
e. Schistosoma mekongi

126. The mother of a 4-year-old child notes that her child is sleeping poorly and scratching his anal
area. You suspect the child may have pinworms. Which one of the following is the BEST method to
make that diagnosis?
a. Examine the stool for the presence of eggs
b. Examine the stool for the presence of larvae
c. Examine a blood smear for the presence of microfilariae
d. Examine transparent adhesive tape for the presence of eggs
e. Determine the titer of IgE antibody against the parasites

Question 127-128 are linked to the following case:

A 30-year-old woman presents with abdominal pain and diarrhea of 3 day’s duration. She does not complain
of nausea, vomiting, or fever. She has no sick contacts or significant travel history. A stool sample is
obtained, which reveals larvae form of of Strongyloides stercoralis.(descripsi bentuk larva)

127. n condition below adult form of Strongyloides stercoralis can be found in whole digestive tract and its
larvae can be found in visceral organ (lung, liver, gall bladder) is :
a. Eosinofilia
b. Hyperinfection
 c. Retrofection
d. Hypereosinofilia
e. Autoinfection

128. Refer to the previous case, further questioning reveals that the woman frequently gardens in her
backyard. Of the following, which one is the transmitted form?
a. Fecal – anal transmission
b. Fecal – oral transmission
c. Fecal – cutaneous transmission
d. Direct contact with skin scales
e. Intravenous drug abuse

129. A 35-year old man working on pig farm is brought by his employer to the emergency department of
hospital because of seizure and bilateral lower extremity weakness. Computed tomography (CT) scan of
the head reveals several calcified regions. Laboratory examinations show WBC count of 10.800/mm3, with
eosinophils. Brain tissue biopsy reveals scolex with hooklets. Of the following, the most likely diagnosis is :
a. Hydatidosis
b. Cysticercosis
c. Coenurosis
d. Histoplasmosis
e. Toxoplasmosis

130. A 40-year-old man came to the clinic with complaints of having fever more than one-week, nausea, and
fatique. He came back from Samarida, Kalimantan. On blood smear examination, there are late
trophozoites forms, schizonts with 12-24 merozoites, and the infected red cell is enlarged. Of the following,
the most likely diagnosis of this pasient is :
a. Vivax malaria
b. Falciparum malaria
c. Malariae malaria
d. Ovale malaria
e. Knowlesi malaria

Question 131-132 are linked to the following case:

A woman came with the complaints of being uncomfortable and hardened in the left upper side abdomen.
Every four days, she is intermittently feverish. On blood smear examination Plasmodium parasite +.

131. Of the following, which parasite can be the cause of this disorder :
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium malariae
d. Plasmodium ovale
 e. Plasmodium cynomolgi

132. Fever symptom on the previous question referred to :

a. Saorozoites is in the the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed

133. A- 52- year old man is brought to the emergency department in an unconscious condition. On
examination, he was death form more than one hour. On autopsy of the brain, there is cyst‘s fluid
containing protoscoleces with hooklets and many daughter cysts were found. The most likely diagnosis of
the disease is ;
a. Hydatidosis
b. Cysticercosis
c. Cerebral malaria
d. Occult filariasis
e. Trichinosis

Question 134-135 are linked to the following case:

134. An employee who works in Jakarta has a task in Tarakan for 2 weeks. He must has :
a. Radical treatment
b. Currative treatment
c. Prophylaxis treatment
d. Combination therapy
e. Preventive of transmission therapy

135. Referring to the previous question (above 135), possible drug (s) for this condition is :
a. Klorokuin+ primakuin
b. Sulfadoksin-pirimetamin
c. Atersunate +amodiakuin
d. Kina+tetrasiklin
e. Doksisiklin

Question 136-137 are linked to the following case:

136. A 30-year-old man on a business trip to Lampung from Jakarta, having fever for 3 days, with
falciparum rings +++ was given CQ3 (chloroquine for 3 days). After 3 days, the patient is still feverish,
blood smear examination shows falciparum rings ++++, the possible response of CQ is :
a. Sensitivity (S)
b. R I resistance, early recrudescence
c. R I resistance, delayed recrudescence
d. R II resistance
 e. R III resistance

137. Refer to the previous case, the treatment of choice is :

a. Primakuin
b. Amodiakuin
c. Meflokuin
d. Sulfadoksin pirimetamin
e. Artemisinin

Question 138-140 are linked to the following case:

A 23-year-old man presents with extreme swelling of his legs and scrotum. The skin associated with the
swollen areas is thick and scaly. The patient admits to an episode of fever associated with enlarged
inguinal lymph nodes some time ago, but did not think much of it.

138. Which one of the following is the BEST method to make that diagnosis?
a. Examine the stool for the presence of eggs
b. Examine the stool for the presence of larvae
c. Examine a blood smear for the presence of adult worm
d. Determine the titer of IgE antibody against the parasites
e. Examine a blood smear for the presence of microfilaria

139. According to the case above, which of the following is the most appropriate time to take the
specimen for established the diagnosis?
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever

140. The disease above is caused by the obstruction of :

a. The arteries by microfilariae
b. The arteries by adult worm
c. The lymphatics by microfilariae
d. The chronic lymphatics by adult worm
e. Fibrosis of the lymphatic

141. The cattle at animal husbandry are occasionally was dead because of tick paralysis, the species
of arthropod that can be the cause to this disorder is :
a. Rhipicephalus sanguineus
b. Dermacentos andersoni
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria

142. One member of the NGO (Non-Governmental Organization) team from Indonesia has been
reported dead in Mexico because of a spider’s bite. The possible cause of this disorder is ;
 a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis

143. A boy brought by his mother to the emergency department of Siloam hospital because of vomit &
dyspnoea. According to his mother, her son was playing in the backyard. On physical examination, the
boy was found to have high fever (39 ºC) and multiple stinging on the back. The most likely species of
insect bites is :
a. Hymenoptera sp
b. Dermacentos andersoni
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria

144. A 8-year-old-girl brought by her father to the emergency department of hospital with felt itching all
over the whole body and her eyes are swollen. According to her father, his child was playing in the
yard, and was contacting with hairy caterpillars. The possible cause of this disorder is :
a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis

Question 145-146 are linked to the following case:

A 21-year-old woman came to her primary-care doctor with the complaints of swelling in her right leg below
the knee. On physical examination was found enlarged lymph nodes in her right leg. On thick blood smear
examination was found parasite microfilariae. The microfilariae of parasite are sheathed and measure 175
to 230 µm in length. They have nuclei which extend to the tip of the tail, and the two terminal nuclei are
clearly set apart from the others. The sheaths of microfilariae were stained deeply with Giemsa.

145. The most likely cause is the worm of species :

a. Wuchereria bancrofti
b. Brugia malayi
 c. Brugia timori
d. Onchocerca volvulus
e. Loa loa

146. Referring to the previous case (above 145), the symptom of elephantiasis is caused by the
obstruction of :
a. The arteries by microfilariae
b. The arteries by adult worm
c. The lymphatics by microfilariae
d. The chronic lymphatics by adult worm
e. Fibrosis of the lymphatic

147. To know the endemicity of malaria on Pulau Seribu, spleen examination on children aged 2-5 years
was done. The result of this shows that this place is mesoendemicity. What is your interpretation with
this condition?
a. Spleen rates not exceeding 10 %
b. Spleen rates between 11% and 50%
c. Spleen rates constantly over 50%
d. Spleen rates constantly over 75%
e. Parasite rate not exceeding10%

148. At night, a 28-year-old man is brought to the emergency department after his right foot being bitten
by an animal, within 1 hour before admission. The patient said that he heard the sound of the animal.
He complains of pain in his right foot and there are two bitten marks, surrounded by edema and
erythema in the dorsal aspect of his right foot. Initial management of the case described should be
a. Observation
b. Cryotherapy
c. Antivenin
d. Incision and suction
e. Corticosteroids

149. A 29-year-old man has weight loss, white plagues on the pharynx, and purple lesions on the
abdomen, which on biopsy reveal Kaposi sarcoma. Which of the following is the most predictive of the
patient’s prognosis?
a. CD4 cell count
b. CD4/CD8 cell ratio
c. Degree of lympadenopathy
d. Level of HIV-1 RNA in plasma
e. Rate of decline in anti-HIV antibody

150. A 45 year old man came to the dermatology clinic with some lumps on his arms and body which
were pain on pressure. On examination there were some erithematous nodul, shinny, and ill defined
 border, no fluctuation/fluid inside and there were no wound. On his elbow palpation there were painfull
nerve enlargement. What are the suggesting diagnose for this patiet ?
a. Anthrax
b. Leprosy
c. Cellulitis
d. Carbuncle
e. Bullous impetigo

151. A patient come with an itchy recured fungal infection on the feet and need some advice to be cured
and some prevention measures so the diasease will not occure again, doctor already gave him some
medication for fungal infection. What kind of advise can make him healthy?
a. Don’t eat seafood
b. Use always sandals
c. Keep the skin dry and clean
d. Don’t use shoes all day long
e. Don’t scratch, will spread the infection

152. Some runny nose children in Indonesia developed a wide yellowish honey coloured scab around
their nose and mouth, Their parents ignored this condition thought it’s because the changing weather
and would disappear by it self, they did not gave any medication. As a doctor what information would
you give to the parents according this disease?
a. It will recure in the future and can not healed completelly
b. This is a kind of allergy and need an anti allergy drug
c. It is self recovered disease no need medication
d. This condition can lead to glomerulonefritis
e. The disease is inherited and no treatment

153. A 5 year old girl came to the skin clinic with her parents and they were complaining that she was
very irritating for 5 days and the girl’s skin was fell off in layers. She looks red, chilled with high fever.
Her skin was detached almost the entire body in a large sheets of superficial epidermis, especially
around the elbow and knee and trunk. The skin was tender to palpation. What treatment should be
given to the patient ?
a. Anti fungal infection ( griseofulvin ) and an antiseptic bath
b. Antibiotic ( cephalosporin ) and rehydration
c. Anti allergy and steroids
d. Multi Drug Therapy
e. Salicyl powder 2%

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154. A 26-year-old nulliparous woman, in her seventh month of pregnancy complains of a 7 days history
of fever especially at night. As she recall, 2 weeks ago she ate gado-gado in coastal area when she out
for duty for several days. She also had diarrhea and abdominal discomfort. On physical examination
reveals blood pressure 110/70 mmHg, heart rate 60 ×/min, RR 20x/min, temp. 39.1°C. Tongue is
coated and tremor. Fetal USG shows normal.
What is the most likely etiologic factor above?
a. Salmonella typhi
b. Plasmodium falciparum
c. Vibrio cholera
d. Hepatitis A
e. Escherichia coli

155. A young man was admitted to hospital after increasing left arm pain and paresthesia. Several days
ago, he contacted with a dog……. His symptoms increased and were accompanied by hand spasm
and sweating on the right side of the face and trunk. This patient was admitted to the hospital the day
after developing dysphagia, hypersalivation, agitation, and generalized muscle twitching.
Which of the following could rapidly destroy the pathogenic agent of this disease?
a. Infrared radiation
b. Catalase
c. Alkali water
d. Sunlight
e. Heating at 60ºC for 30 minute

156. A 35-year-old man as a farm worker who was working with pesticides is brought to the emergency
room with headache, vomiting, salivation, diarrhea, muscle fasciculation, difficulty walking, and difficulty
speaking. His clothing has been removed, he has been washed, and he has been given activated
charcoal. What is the most effective remaining treatment for this case of pesticide poisoning?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. Hidrochlorothiazide

157. A 27-year-old man came to a clinic with high fever for two days which is started with a chill. He also
complained of swellings in his left inguinal area. They were firm, discrete, and somewhat tender. His
scrotums are also enlarged and tender. His doctor performed a thick blood smear examination using
blood that was taken at night but found nothing. What should the doctor do to make the diagnosis?
a. Biopsy of the scrotum
b. USG of the scrotum
c. CT scan of the scrotum
d. MRI of the scrotum
e. Aspiration of the scrotum fluid

158. A young man presented to his general practitioner with a history of headache and fever together
with a dry cough and muscle ache. His nose was also blocked and his eyes watery.
 What is your clinical diagnosis?
a. Influenza virus infection
b. Human herpes virus
c. Cytomegalovirus
d. Epstein-Barr virus
e. Adenovirus

159. A 4-year-old child presents with fever, cough, conjunctivitis, coryza, photophobia, posterior cervical
adenopathy. Red lesions with a white center are present on the buccal mucosa. A generalized
erythematous rash is also noted. What is the appropriate management of this patient above?
a. Immune globuline
b. MMR vaccine administration
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics

160. To know the endemicity of malaria on Pulau Seribu, spleen examination on children aged 2-5 years
was done. The result shows that this place is mesoendemicity.
What is the meaning of mesoendemicity?
a. Spleen rates not exceeding 10 %
b. Spleen rates between 11% and 50%
c. Spleen rates constantly over 50%
d. Spleen rates constantly over 75%
e. Parasite rate not exceeding10%

161. The cattle at animal husbandry are occasionally was dead because of tick paralysis, the species
of arthropod that can be the cause to this disorder is;
a. Rhipicephalus sanguineus
b. Dermacentos andersoni
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria

162. After contacting with hairy caterpillars, a farmer felt itching all over the whole body and his eyes
are swollen. The possible cause of this disorder is:
a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis

Question 163-164 are linked to the following case:

A 23-year-old man presents with extreme swelling of his legs and scrotum. The skin associated with the
swollen areas is thick and scaly. The patient admits to an episode of fever associated with enlarged
inguinal lymph nodes some time ago, but did not think much of it.
163. Elephantiasis is caused by the obstruction of :
a. The arteries by microfilariae
b. The arteries by adult worm
c. The lymphatics by microfilariae
d. The chronic lymphatics by adult worm
e. Fibrosis of the lymphatic

164. Occult filariasis is Lymphatic filariasis based upon :

a. Infection
b. Allergy
c. Infestation
d. Colonization
e. Genetic

165. A patient complains of having nail size excrement from his anus. On the stool examination, parasite
eggs contains a hexacanth embryo with six hooklets surrounded by radially striated spherical shell, 30 to 40
u in diameter were found, the most likely diagnosis of this patient is :
a. Saginata taeniasis
b. Solium taeniasis
c. Cysticercosis
d. Sparganosis
e. Dipylidiasis

Question 166-167 are linked to the following case:

A 40-year-old man came to the clinic with complaints of having fever more than one-week, nausea, and
fatigue. He came back from Timika, Papua. On blood smear examination, there are late trophozoites forms,
schizonts with 12-24 merozoites, and the infected red cell is enlarged.

166. Of the following, the most likely caused of parasite species is :

a. Plasmodium vivax
b. Plasmodium falciparum
c. Plasmodium malariae
d. Plasmodium ovale
e. Plasmodium cynomolgi
167. Fever symptom on the previous question referred to :
a. Sporozoites is in the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed

168. A 27 year old women suffering fever for 2 day. She brought to emergency department unconsciously
and she had general seizure 2 hour ago. On physical examination she is comatous, GCS (Glasgow
Coma Scale): 3; BP 90/60 mmHg; t 41 °C. Lab. finding: Hb 10, 3 gr%; WBC 5800/mm3; platelet
39.000/mm3; there is schizon form on blood smear. The most likely diagnosis is :
a. Malaria viviax
b. Malaria falciparum
 c. Malaria malariae
d. Malaria ovale
e. Mix infection of malaria vivax and malaria falciparum

169. Sexual life cycle of malaria parasite take place in :

a. Human liver cell
b. Human spleen cell
c. Human erythrocyte
d. Mosquito body
e. Mosquito proboscis

170. Plasmodium falciparum is the most dangerous species because :

a. It make long term relaps
b. Intermittent fever
c. Gametocyte formation take place in visceral organ
d. Can make capillary obstruction in Central Nervous System by parasite contain erythrocyte
e. There are many drug resistance against P. falciparum

Question 171-172 are linked to the following case:

A 30-years-old woman presents abdominal pain and diarrhea for 3 days duration. She does not complain of
nausea, vomiting, or fever. She has no sick contacts or significant travel history. A stool sample is obtained,
which reveals larvae form of of Strongyloides stercoralis.

171. In condition below adult form of Strongyloides stercoralis can be found in whole digestive tract and its
larvae can be found in visceral organ (lung, liver, gall bladder) is :
a. Eosinofilia
b. Hyperinfection
c. Retrofection
d. Hypereosinofilia
e. Autoinfection

172. Refer to the case above; further questioning reveals that the woman frequently gardens in her
backyard. Of the following, which one is the transmitted form?
a. Fecal – anal transmission
b. Fecal – oral transmission
c. Fecal – cutaneous transmission
d. Direct contact with skin scales
e. Intravenous drug abuse

173. A 10-month-old healthy male infant travelling with his family to Africa was exposed 4 days ago to
his 4-year-old native African cousin who was ill at the time with fever, cough, coryza and conjunctivitis.
The baby was at risk to get infected by:
a. Corynebacterium diphtheriae.
b. Haemophilus influenzae
c. Bordetella pertussis
 d. Morbilivirus
e. Coxsackievirus

174. Her mother makes an overseas phone call to your office asking your advice. Appropriate
management of this patient includes:
a. Immune globuline
b. MMR vaccine administration
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics

175. A 3 year old girl came to pediatric outpatient clinic with her parents. Her mother complaint that she
had watery diarrhea since 3 days. This was her 3 rd episode of diarrhea in the last 2 months. Her mother
also noticed that she was delayed in growth and development compared to her siblings. She hardly
gained weight and height since last year. The physical examination showed that her weight and height
was below 5th percentile for girls of her age.
What is the most likely underlying mechanism that caused her repeated episodes of diarrhea?
a. Protein catabolism
b. Reduced food intake
c. Altered lipid metabolism
d. Reduced bactericidal activities

176. A 65-year-old-woman suddenly had flaccid paralysis of her left leg. A few days ago, she had
headache, fever, sore throat, and nausea. She lives with her son; daughter in law and a young
grandchild who’s just received a routine oral vaccination. She is taking immunosuppressant for her
kidney’s transplant. Her vital signs and cranial nerve examination are normal. A head CT scan and
lumbar MRI are also normal.
What is the most likely transmission of her infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite

177. A 4-year-old child presents with fever, conjunctivitis, photophobia, posterior cervical adenopathy,
and coryza. Red lesions with a white center are present on the buccal mucosa. A generalized
erythematous rash is also noted. What is the most likely diagnosis?
a. Rubella
b. Kawasaki disease
c. Adenovirus infection
d. Rubeola
e. Varicella

178. A 41 year old man from overseas come to developing country was admitted to the hospital with
abdominal pain, fever, and diarrhea. He was eating some local food yesterday. There was blood and
mucus on his stool. Which of the following pathogens would most likely be the cause of her illness?
a. Vibrio cholera
 b. Shigella dysentriae
c. Salmonella typhi
d. Campylobacter jejuni
e. Giardia lamblia

179. A 4 years old boy with sickle cell disease is taken to his pediatrician’s because he is pale and is
suffering from repeating intense chills and daily high fever. A blood test shows that WBC was 17.000/µl
and a platelet count is 53.000/µl. What description is relevant to the findings in this patient?
a. Sickle cell trait decreased the patient’s resistant to the virus infection
b. Sickle cell trait promotes infection of erythrocytes by plasmodium
c. Virus infection promotes INF production
d. Virus infection targets erythrocyte precursor cells
e. Bacterial infection activates leukocytes cells

180. A 4-year-old child presents with fever, cough, conjunctivitis, coryza, photophobia, posterior cervical
adenopathy. Red lesions with a white center are present on the buccal mucosa. A generalized
erythematous rash is also noted. What is the most likely diagnosis?
a. Rubella
b. Kawasaki disease
c. Adenovirus infection
d. Rubeola
e. Varicella

181. What is the appropriate management of this patient above?

a. Immune globuline
b. MMR vaccine administration
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics

182. A 31 years old woman complains of difficulty breathing and fever. There were histories many dead
birds at her neighbor poultry. Chest X ray showed wide infiltrates at the both side of the lung. Which
statement is true
a. There is no animal reservoir
b. Influenza virus type B
c. Multiply in cytoplasm hospes
d. Variation antigenic in Ag H and Ag N
e. Contact history within 3 days before the symptoms occurred

183. A 25 year old man came to dr. Mandy’s private clinics, with fever since 10 days ago. The first three
days he complained low-grade fever, diarrhea and looked apathies. Day by day his fever was
worsened especially high at night. Paracetamol and ampicilin was given for three days but his fever
weren’t getting better. What is the further investigation that you need to confirm the diagnosis
a. Peripheral blood smear
b. Fecal culture
c. Viral serology
 d. Cultures of blood for salmonella sp
e. Widal

184. A young man presented to his general practitioner with a history of headache and fever together
with a dry cough and muscle ache. His nose was also blocked and his eyes watery.
What is your clinical diagnosis?
a. Influenza virus infection
b. Human herpes virus
c. Cytomegalovirus
d. Epstein-Barr virus
e. Adenovirus