A 25 years old woman comes to emergency department, complaint with abdominal pain and vomiting since 1
day. At the physical examination shows the patient looks irritable, apatis, BP 80/50 mmHg, HR 130 x/m, RR 24
X/M, S 38.5o C. At abdominal examination, defance muscular (+), tenderness at all field of abdomen, bowel
sound (-).
What is the condition in this patient?
a. Shock obstruction.
b. Shock cardiogenic.
c. Shock neurogenic.
d. Shock hypovolemic.
e. Shock anaphylactic.


As the diagnosis above, the first step you must do as the emergency doctor is:
a. Antibiotic infusion
b. Strong analgesic i.v
c. Abdominal plain X-Ray
d. Crystalloid rapid infusion
e. Adrenalin s.c


After doing that treatment, the hemodynamic of this patient is still unstable. The Patient still have in shock
condition. What is the next step you must do?
a. Change infusion fluid with Dextrose 5%.
b. Give vasoactive dopamine drug
c. Antipiretic drug i.v
d. Immediately Laparotomy
e. Antiemetic drug i.v


A 25 years old male presents to emergency with suspected closed left femur fracture after motorcycle accident.
He looks confused with blood pressure 80/60 mmHg and pulse 110 /min. The doctor splints the fracture and
gives large bores rapid crystalloid and colloid infusion but unsuccessful in stabilizing the hemodynamic.
What is the most likely cause of the failure?
a. Inadequate splinting
b. Major artery injury of the left femur
c. Underlying heart disease
d. Ongoing bleeding in other parts of the body
e. No blood transfusion


A 35 years old female fall from 5 meters height. She presents with acute abdomen and multiple open fractures
on thigh and leg. Emergency laparotomy and temporary external fixation is performed. After 6 days, the doctor
wants to perform definitive stabilization of the fracture.
The reasons to wait until 6 days is to
a. Achieve early healing of intraabdominal wound
b. Stabilize hemodynamic
c. Control infection
d. Avoid immunosuppression period
e. Reduce inflammatory reaction


A 45 years old male presents with multiple injury and unstable hemodynamic after motorcycle accident. The
doctor found that the lung is clear, no abdominal defans muscular, stable pelvic and intact extremity
Where is the likely source of the bleeding?
a. Thorax
b. Intra peritoneal
c. Retroperitoneal
d. Intracranial
e. Pelvic cavity


Communicate with the patient. She is slightly pale. Advise him to go for Yoga exercise e. A-24-year old woman consulted to you that since 3 weeks ago she felt of constant tiredness after delivery of her second child 15 months ago. what would you do to help him? a. but has normal hemoglobin. and he was kept to wait. A 37 year old man came to Emergency & Accident Unit with feeling of apprehension. After some months. her first child now 3 years old. Give a broad spectrum antibiotic c. Phobic anxiety disorder d. Neurotic disorder 10. Until about 15-20 minutes he had not been attended to. Advise him to go for refreshing 11. Plan for psychoanalytical psychotherapy d. Advise her to reduce physical/emotional overload c. Advise her not to worry. What was the reason for his shaking? a. Doing a vitamin injection as she wants d. What would you think about the suffering that this person had? a. which of the following medication would suit him well: a. Perphenazine 12. tender. Establish osteosarcoma as diagnosis b. But this time the Emergency staffs were busy. Luminal d. Diazepam b. Prescribe drug for this distress c. Pain relieve after 2 weeks of treatment as an endpoint e. The physical examination shows a palpable mass. risk and benefit of treatment option 8. but his fear and palpitation subsided and became calm by it. Brain contusion 2 . Prepare for immediate surgery d. Range of motion of the left knee is decrease. After 3 weeks. A-17-year old woman comes to your private practice with pain on the left knee in which the pain become worse at night for 2 months. he began to shake in his hands and tremble the whole body. even mounting to feeling of impending death. Give some explanation as to the nature of his illness b. Which of the following is the most rational step? a. That is what she wants. She has now returned because the tiredness persists and a friend told her that a vitamin injection would do her good. Ask her to do other laboratory examination 9. Generalized Anxiety Disorder (GAD) c. Sometime she feels fever and night sweat. The radiographic finding shows a “sunray appearance” on the proximal tibia. Every day she works as a secretary from 8 am to 4 pm. and he had to go to the hospital again. the results showed that nothing was wrong. warm. According to the above case. Somatization disorder b. Again considering the above case. Dementia x b. Panic disorder e. What would be your treatment objective in this patient? a. he was admitted to a hospital because of an accident where he banged his head when crossing a wooden bar where he fell unconscious for few minutes. it can resolve soon b. On the third day. There was a history of injury at that knee. He was advised to be hospitalized. he got the same feelings. Chlorpromazine c. his habit increase into heavier drinks such as wine and then even Whiskey and Vodka. Pain is aggravating by activity. fear and palpitation. After being examined by doctor. Gives her the other option of drugs e. Alprazolam e.7. Few more months. A 45 year old man is having the custom of drinking of beer. After being put on some drugs his shaking subsided and he was discharged after being pronounced as recovered from his ailments.

some time he extorted money from them. Mannitol d. Carotid Ultrasound e. Which of the following examination is the most appropriate to exclude intracranial bleeding? a. His CT scan showed a large hypointense lesion in the right frontotemporoparietal lobe with significant edema and midline shift. Echocardiography d. On examination he is alert. HR 90 x/min. Brain PET scan c. blood pressure was 190/100 mmHg. Antihypertension e. otherwise he would threaten to hit them or refusing to be his friends. After his discharge from the hospital and returned to work he began to resume his habitual drinking. Antibiotic 17. RBG 190 g/dl. observing father did a very bad example. Genetic inheritance e. Alcohol intoxication c. if the ECG showed atrial fibrillation. ADHD 15. d. HR 74 x/min irregular. and babinsky sign on left side. What is the classification of this behavior Personality disorder a. Corticosteroids c. A 56 year old man was suddenly being confused and unable to move his left extremities 7 hours ago. weakness of his left leg and loss of fine touch on the left with loss of pain and 3 . Brain MRI b. Wife battering as a result of alcoholism b. Which of the following is an appropriate treatment? a. Transcranial Doppler e. Angiography c. temperature 36.000/mm3. Brain CT scan d. A bully b. Marital discord d. Brain MRI b. left hemiplegia with increased tone on left side. His GCS was E3M5V3. r-TPA b. A 17 year old boy is brought to emergency following fall from 4 meters height one hour before admission. Electroencephalography 18. Even he became irritable and shouted with abusive words against anybody at home even he could beat his wife if she is nagging on. Delirium tremens Blackouts Stroke x x 13. Psychotic disorder 14. A 55 year old man came to emergency with suddenly being unconscious 2 hours before admission after complaining of severe headache and vomit. What would you call this episode of hitting family members? a. Delinquency d. which of the following examination would be most appropriate for the next step? a. RR 16 x/min. For case above. On examination his blood pressure was 200/100 mmHg.c. his wife and family were against this habit of drinking. Personality disorder e. Some time he would throw things and hit his children. but he went on disregarding the advice. Bossy c. Electroencephalography 16. He was disoriented. e. If in this family the children who used to be very dutiful at school works and compliant to family discipline. Lab exam: WBC 12.7oC. The eldest son who is rather big boy and physically robust became acting like a big boss against his schoolmates who are smaller and weaker than him. Some time asking them to bring him candies.

What is your working diagnosis? a. he get repeated seizures. A posterior cord syndrome b.temperature sensation on the right leg at level Th-12 below. Pseudoseizure 23. ` Which of the following is most likely diagnosis at that time? a. A central cord syndrome e. Acute symptomatic seizures d. Partial seizure b. According to the case above. Lumbar corcet 20. He brought to nearest hospital and during transportation for 20 minutes he never gain his consciousness and still convulsive. Panic attack e. A 23 year old man was hospitalized after got head injury. d. Give mannitol d. Symptomatic epilepsy b. In the ER. Reflex seizures d. Give high dose corticosteroid b. A complete cord syndrome d. Complex partial secondarily generalized seizures 22. During under psychological stress in his office. This clinical picture is most consistent with which of the following? a. A hemisection syndrome 19. starred. the result of blood examination in normal limit. except blood glucose was 58 mg/dl. Absence seizure d. Symptomatic epilepsy b. Primary generalized seizure c. A –PWE(patient with epilepsy)-42 year-old-man was treated with Phenobarbital 150 mg once daily but had bad compliance. Provoked seizures c. Acute symptomatic seizures. Pseudo seizures c. Simple partial secondarily generalized seizures e. He has infarct in left capsula interna with risk factor diabetes mellitus 3 months before and never gets seizure. What is your working diagnosis? a. A 52 year old man was sent to ER caused by seizure. he suffered repeated left partial seizures. His wife watched that he suddenly stop his activity. On the second days before underwent craniectomy. Status epilepticus b. what is the type of his attack? a. An anterior cord syndrome c. got involuntary movement on his right hand and then spread to lower and upper right arm and finally became convulsion bilaterally. Psychological episodic attack 4 . Trendelenberg position c. Early phase status epilepticus c. His brain CT Scan showed subdural hematoma and brain contusion in the right temporal region. Idiopathic epilepsy e. Which of the following management is the most appropriate to prevent further damage of spinal cord? a. Cryptogenic epilepsy e. Secondary epilepsy 21. Neuroprotector agent e.

1 b. Which is the priority diagnostic procedure you will perform? a. Intravenous administration of 20 units of oxytocin c. patient looks compos mentis.24. Close with sterile dressing c. According to her husband. During the repair of a midline episiotomy. Weight is 12 kg. What is the initial step you must give at hospital? a. Wound is felt pain. Compress with ice for 15 minutes e. Brain MRI with contrast c. seems no dyspneu. Bulectomy For Number 28-29 A 34-year-old woman just delivered a 4100 g boy after a 15-hour labor. there is a marked increase in the amount of vaginal bleeding. Abdominal hysterectomy d. chest retraction (-). and good perifer perfusion. 3b e. Fluid Infusion Maintenance b. Retained placental fragments b. Fever (-).5 hour second stage. At physical examination. Uterine artery embolization 5 . A 39 year old woman suffering from breast cancer since a year ago. bullae (-). including a 2. Laboratory examination shows anemia and mild leucocytosis. moderate ill. 3c 26. 25. Give tooth pasta b. He cried very loud. dengan luas 21%. Vital sign is normal. Mammography For Number 25-27 A 4 years old boy presents with burn wound on his stomach. Which of the following is the most common cause of immediate postpartum hemorrhage? a. Brain CT Scan with contrast b. brown/black patchy (-). Parlkland resuscitation infusion e. Give topical antibiotic 27. Massage and compression of the uterine fundus b. History of immunization was unknown. Uterine atony c. EEG d. she gets tonic-clonic convulsion this morning. Alergy (-). Localis status of this patient show pink on the wound base. bullae(-). and buttocks after her mother accidentally spilled boiled water one hour before. abses (-). 28. pus (-). tepi tidak rata. hand. 2 c. What is the degree of that burn trauma on this patient? a. necrotic tissue (+). The patient never get this accident before. Give topical antiseptic c. syanosis at extremity (-). Which of the following is the best immediate management of the probable cause of this postpartum hemorrhage? a. tight. At thorax examination. Shower with water for 15 minutes d. Antibiotic d. She has main complaint of headache that sometimes is accompanied with vomit for three weeks. 3a d. Blood examination e. What is the best thing you must do for this patient before bring him to the hospital? a. Vaginal laceration e. Cervical laceration d. Disseminated intravascular coagulation 29.

Pupils were reactive and no obvious focal deficits. Two days ago. A 7 years old boy.000 /mm3. Na. Dedy. K. Blood coagulation – Platelet plug formation – Vascular spasm 33. BP 120/80 mm Hg. A 22-year-old female college student is brought into the emergency room by the police. Hypogastric artery ligation 30. Her first hospital admission 6 . Amylase serum c. Physical examination: Temp 39. What’s the most important laboratory examination do you need for make diagnosis? a.e. Na . Blood coagulation . Febrile seizure b. What is the most appropriate sequent to stop bleeding : a.Blood coagulation – Vascular spasm d. no trauma. have injury falls from bicycle and had wound and bleeding at the lower extremity. Babinsky sign present bilaterally. According to your examination which of the following is the most likely diagnosis? a. place. Cl . A 31 year old man came to emergency depart with complaint severe pain in abdominal area and frequent vomit since 24 hours ago.Vascular spasm . Urinalysis b. Liver function test 35. Na. Random glucose: 70 mg/dL. Lab examination: Hb 14 mg/dL. What kind of laboratory examination is the most appropriate to find non structural causes of unconsciousness? a. Widal serology e. BP 160/95 mm Hg. Refractory epilepsy e. A 40 years old man presented in Emergency unit (ER) with unconsciousness. K . Ureum d. Myoglobin 34.Platelet plug formation . and time. Cl.Blood coagulation c. Renal function. His mother said that his seizures happen continuously since 45 minutes ago. Physical examination: Unconsciousness.Platelet plug formation e. He was lethargic. Platelet plug formation . Leukocyte 11. talking to herself. SGOT/AST e. His wife finds him in the bath room 2 hours ago and brings him to the hospital. A 60 year old man came to emergency unit with history of chest pain 9 days ago. Liver Function Test. Cryptogenic seizure d. Troponin I and T d. Glucose e. Lipase serum d. he also suffers seizure about 40 minute. Na. Glucose. Vascular spasm – Blood coagulation – Platelet plug formation b. Glucose 32. K. Hypoglycemic seizure 31. Which is the most appropriate laboratory examination do you need for this patient? a. The young woman appears to be oriented with respect to person. Vascular spasm . Ureum b. 13 year old man brought to Emergency by his mother with seizures and altered consciousness. Glucose c. Radio imaging: not find sign of perforation. In physical examination looks severe pain. pain pressure abdomen (+) in all area. who found her walking back and forth across a busy street. Status epilepticus c.5⁰C. Electrolyte: in normal limit. CK MB serum c. CPK serum b. Heart Rate 110 X/minute.

Digital rectal examination shows tenderness on 9-12 Clock direction. Blood chemistries taken during the following 48 hours show rising creatine kinase MB fraction (CK-MB). lightheadedness and palpitation. peaking at 5 times the upper limit of normal. Acute cerebral infarction c. Unstable angina 39. c. What is the most likely diagnosis? a. the patient collapse. A 45 year old man fell down after complaining severe headache. she suddenly had shortness of breath and became delirious. Myocardial infarction d. and respiratory rate is 32 x/min. A 20-year female presents with abdominal pain which was initially felt in the centre of abdomen but now felt in the right iliac fossa. What is the most likely disorder? a. ECG findings are equivocal. fatigue. What is the most appropriate investigation needed? a. Examination reveals low fever (37. She denies any other symptom. she has difficulty concentrating. Electroencephalography 37. tripped and injured her right leg 2 days previously and has been bedridden since the accident. d. After a few second. with some degree of flat S-T segment depression over several leads. Two hours ago. ECG shows on Lead II 7 . Which of the following is the most likely diagnosis? a. Transcranial doppler b. her blood pressure is 120/70 mm Hg. CT scan d. Vital sign was normal. Laboratory c. Halusination c. Mid-cycle pain (Mittelschmerz). A 74-year-old woman. complaining about dyspnea. b. Pulse oximetry shows an oxygen saturation of 80%. Pneumonia b. Acute appendicitis. Pulmonary thromboembolism 40. e. Her last menstrual period was 5 days ago. Pulmonary infarction e. Schizoaffective b. and seems to hear voices A phone call to her sister provides the additional information that the girl dropped out of school three months ago and has been living on the street. On physical examination. Cranial X ray e. heart rate is 110. Subendochondral infarction d. Panic 36. An unconscious patient with sepsis in the intensive care unit undergoes a 2-hour period of severe hypotension. Urine toxicology is negative. Stable angina c. Transmural infarction e. Intestinal obstruction 38.was two months ago for a similar condition. Bipolar delusion d. Which of the following is the most likely diagnosis? a. Urinary tract infection. A 60 year old woman comes to emergency room. in otherwise good health. Schizophreniform e. Mesenteric lymphadenitis.9°C) and tender right iliac fossa. During a psychiatric interview. dizziness. Prinzmetal angina b. He was vomits several times after and had meningeal signs.

What is the most likely location of AMI? a. Ht: 51. 42. BE +3 ( 2). Anteroseptal For Number 42-45 A 60 year-old man. Sepsis d. Lateral e. Routine blood examination: Hb: 17. Anterior d.5). what is the most possible cause of the unconsciousness? a. Natrium: 130 (135-145).20 ( 7. FEV1/FVC < 70 b. According to those data. According to his friend. pO2: 50 (>80). He has hypertension and diabetes. Inferior b. pCO2: 82. Kalium 5 (3. The chest X-ray showed lung hyperinflation.000. Echocardiograph c. CO2 narcosis c. the patient is a heavy smoker and often to be hospitalized due to shortness of breath. no smoking and no hypercholesterolemia.5-4. Posterior c. Dopamin e.35-7. FEV1/FVC normal d. Hyponatremia 43. FEV1 > 75 8 . Severe hypoxemia b. Heart surgery d. On physical examination. BP: 100/80. Nitroglycerin sublingual b.What is the initial management for this patient? a. A 61 years old man comes with vomitting. Defibrilator 41. FEV1/FVC > 70 c.000.5 (3545). is brought by his friend to ED because of unconsciousness. dispepsia and sweating. RR: 42x/m.45). What is the lung function test might be showed? a. WBC: 11. Heart rate 120x/m. Platelet 420.8. He feels cool when he plays tennis and fainting for a few minute. Hypokalemia e. SpO2: 88% (>95). Blood gas analysis showed pH: 7. HCO3: 28 (22-26).

Metilphenidate b. 48. Murder Suicide c. Suicide Gesture c. The wife complained that since 3 days ago. Schizophrenic e. his wife come again and reported that he showed shaking his hand and feet. Suicide Gamble d. what medicine should be given to the patient to reduce the symptoms? a. decreased total lung capacity 45. Mass Suicide 9 . In this case. Triheksiphenidil c. increased residual volume d. Risperidone d. Torticolis d. What is the most probably diagnosis? a. Acute Dystonia Reaction b. Self Injury d. increased tidal volume b. Eosinophil x c. Suicide Attempt b. Akathisia c. According to the case above.e. Euthanasia b. Chlorpromazine e. increased expiratory respiratory volume c. which type of the suicide she has? a. Basophil For Number 46-47 46. Panic Disorder c. her husband had disorganized behaviour and speech. Her mother found her diary saying that she really wants to be dead because her boyfriend has another girl and leaved her. What does he suffered from? a. Anxiety Disorder b. decreased functional residual capacity e. After 2 days. Mast cell e. Suicide Attack 50. Parkinsonism e. Depression 49. Tardive Diskinesia 47. If we measure the lung static volume. the doctor gives Haloperidol 3 x 5 mg a day. Neutrophil d. What is the most inflammation cell that plays a role? a. Macrophage b. According to the cases above. Attack Suicide e. FVC > 80 44. what is the most possibility result? a. PTSD d. What is the classification of suicide for the case above? a. Carbamazepine For Number 48-50 A 17 year old girl attempted to suicide by drinking one cup of “Baygon”. Suicide Equivalent e. A 32 year old man brought by his wife to mental hospital.