A 25-year-old woman is exposed to a virus during the first trimester of pregnancy.

The woman give birth to an infant who is deaf and has cataract, a heart murmur,and microcephaly. She never had immunization. 1. Which of the following is the pathogenic agent for the motherillness? A. Coxsackievirus A B. Rubella virus C. Measles virus D. Rhinovirus E. Poliovirus 2. A 50-year-old woman comes to emergency room with unconscious suddenly after she got penicillin intravenous injection. His blood pressure 80/60 mmHg, HR 120x/m, RR 25x/m. Her skin was pale and cold. What type of hypersensitivity that occurs in this patient? A. V B. IV C. III D. II E. I 3. A 1-month baby boy was given an intradermal immunization in his right deltoid. Four weeks later, there was ulcer in his right deltoid. Which of the following is the mechanism of immune response for that immunization? A. Delayed hypersensitivity reaction B. Antibody against the target cell C. Antibody making viremia D. Antibody blocking the spread of organism E. CD8 activated to kill infected cell Human sub-clinically infected with Mycobacterium tuberculosis may harbor live organisms for the rest of their lives. If these persons were subjected to restraint stress there will be possibility that the infection may reactivate. Similarly tuberculosis increases in human populations in war zones, possibly due to reactivation of latent disease. In the whole world, tuberculosis also increases with the rising of HIV infection 4. Tuberculin test is considered as hypersensitivity reaction of what type? A. Type I B. Type II C. Type III D. Type IV E. Unclassified Question 5-6 are linked to the following case: A married couple has unmatched Rh factor. She was concerned as her Rh factor is negative while her spouses is positive. 5. If this couple is to have children, which of the following is most possible become unaffected child? 1

A. B. C. D. E.

First child Second child Third child Fourth child Fifth child

6. Which of diseases is most possible this affected baby suffered from? A. X-linked agammaglobulinemia B. Wiskott-Aldrich syndrome C. HDNB (Hemolytic Disease of the Newborn) D. X-linked SCID (Severe Combined Immunodeficiency) E. X-linked CGD (Chronic Granulomatous Disease) 7. A 26-year old woman with AIDS develops cryptococcal meningitis. She refuses IV medication. Which of the following antifungal agents is the best choice for oral therapy of the meningitis? A. Amphotericin B B. Ketoconazole C. Nystatin D. Fluconazole E. Metronidazole 8. After backpacking in the mountains, a 24-year old man develops diarrhea. He acknowledges drinking stream water without purification, and you suspect that he is showing symptoms of giardiasis. Because you know that laboratory detection of cyst or trophozoites in the feces can be difficult, you decide to treat the patient empirically with : A. Chloroquine B. Metronidazole C. Cotrimoxazole D. Emetine E. Pentamidine A missionary is sent to work in a region where Onchocerca volvulus is endemic. Infections resulting from this tissue nematode are a cause of river blindness because microfilariae migrate through subcutaneous tissue and concentrate in the eyes. 9. Which of the following drugs should be used prophylactically to prevent onchocerciasis? A. Bithionol B. Ivermectin C. Suramin D. Diethylcarbmazine E. Oxamniquin Question 10-11 are linked to the following case: A 5-year-old girl is brought by her mother to pediatric department with complain often itchy anus, especially at night, difficult to sleep and less appetite. Her mother also reported that in perianal area appears to have worms, measuring approximately 1 cm, such as coconut pulp. 2

10. Which of the following is the most diagnosis? A. Ascariasis B. Nekatoriasis/ ankilostomiasis C. Enterobiasis/ oksiuriasis D. Strongyloidiasis E. Trichuriasis 11. Which laboratory test would you order in the case above? A. Examination of feces culture B. Elisa test C. PCR test D. Feces examination directly E. Examination with an "anal swab" 12. 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 (8 g %), eosinofil increased. In the feces examination, found 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. Ankylostomiasis C. Enterobiasis D. Strongyloidiasis E. Trichuriasis Question 13-14 are linked to the following case: 13. A six week-baby boy was brought to your clinic for routine evaluation. From physical exam he was in good condition. He had Polio vaccines once and Hepatitis B vaccine twice. What vaccination will you give to him in this time? A. Hepatitis B 3 B. DPT 1 C. Polio 2 D. Campak E. BCG 14. How is the route of the vaccine that you will give for this patient? A. Intramuscular B. Deep subcutaneous C. Superficial subcutaneous D. Intradermal E. Intravenous 15. A 30-year-old female patient employed as a dishwasher came to the clinic with the complaints of her finger nails being brittle, changing color and having uneven surface. This condition has 3

already lasted for 3 months. The most likely diagnosis is: A. Tinea pedis B. Tinea unguium C. Tinea cruris D. Tinea versicolor E. Tinea nigra palmaris 16. An 8-year-old girl has been brought by her mother to the clinic with the complaint of pruritic rash on her chest. Lesions are round or oval with an inflamed border and central clearing. The lesions contain both papules and vesicles. On examination under the microscope, septate hyphae in KOH 10 % preparation of scrapings from the lesion was shown. The most likely diagnosis of this patient is : A. Tinea corporis B. Tinea capitis C. Tinea unguium D. Tinea versicolor E. Dermatophytoses 17. A student aged 18 came to the clinic with the complaints of hyper pigmentation speckle on the face and neck, which is felt itching when sweating. On examination the skin scrapings showed spore groups and short hyphae groups. The most likely diagnosis is: A. Tinea corporis B. Tinea capitis C. Tinea unguium D. Pityriasis versicolor E. Dermatophytoses 18. 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 19. A 30-year- old woman came to the clinic with the complaints of swelling of eyelid as big as a quail egg. This swelling has been suffered for 1 year since returning from Africa. On physical examination was found calabar swelling. The transmission of the disease is through the bite of the insect of : A. Glossina B. Simulium C. Chrysops D. Culicoides E. Phlebotomus

20. A group of health teams from Indonesia came to the rural area of Sudan, Africa. In the area are found many teenagers with symptoms of cachexia and hepatosplenomegaly. Entomologists of the team have found that there are a lot of flies identified as Phlebotomus. The most possible disease suffered by the teenagers is: A. Cutaneous leishmaniasis B. Mucocutaneous leishmaniasis C. Visceral leishmaniasis D. African trypanosomiasis E. American trypanosomiasis Question 21-22 are linked to the following case: A 67 years old woman hospitalized for 10 days with localized pus on the plantar pedis that still getting worst although already treated with antibiotic. Several days before occurrence of the pus, she went to a local clinic and got wound dressing using instruments and antiseptic. She got antibiotics for at least 10 days. After 3 days take the antibiotic and his wound looked well, she stopped that drug. But, the wound was getting worst and had discharge (pus). She was then admitted to the hospital. She also has diabetes mellitus and experience of irregular anti diabetic therapy. Three days ago, her physician asked the microbiology laboratory to take the specimen from her wound for identification and drug susceptibility pattern of the pathogen. The results are Gram-positive cocci in clustered formation and resistant to all beta-lactam antibiotics tested. 21. The possibility pathogen mentioned in this case above is A. Methicillin Resistant Pseudomonas aeruginosa B. Methicillin Resistant Staphylococcus aureus C. Methicillin Resistant Streptococcus viridan D. Vancomycin Resistant Staphyloccus aureus E. Vancomycin Resistant Enterococci 22. This old woman seems got a nosocomial infection during her hospitalization. The statements below are correct for preventions of hospital acquired infections A. Type of hospital may cause hospital acquired infection B. Urinary bladder catheterization must be sustain for all the hospital stay C. Frequent changes of clean surgical wound dressing or drainage may prevent hospital acquired infection D. Attitude of health care workers to wash their hands between patients or before procedures is a critical point in hospital infection control E. Intravenous (IV) procedure for delivering medication, transfusion or nutrition is a best procedure that may prevent hospital acquired infection