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UJIAN TULIS IPD GRUP C

A 47 year old man came with the complaint of cough. The cough began
approximately 3 months prior to this appointment and it has become more
annoying to the patient. The cough is non-productive, 2-3 times/day, worse at
night, 3 times at night/week. He recently restarted an aexercise program after
approximately 2 years of a more sedentary lifestyle and says he is having a
much harder time with the exertion. He just run out of breath earlier than he
used to and cough a great deal. He has not had any blood-tinged sputum or
weight loss. He does not smoke and has no significant medical history. His
examination is notable for a blood pressure 130/70 mmHg and lungs that are
clear to auscultation bilaterally, except for an occasional expiratory wheeze on
forced expiration. A chest radiograph is read as normal.
1. What is the most likely diagnosis?
a. RBC
b. Asthma
c. Pneumonia
d. Bronchiectasis
e. Chronic obstructive pulmonary disease
2. What is the classification?
a. Acute asthma
b. Mild intermittent
c. Mild persistent
d. Moderate persistent
e. Severe persistent
3. What is the best daily medication for this patient?
a. No daily medication
b. Leukotriene modifier
c. Low dose inhaled steroids
d. Medium dose inhaled steroids and long acting B2 agonist
e. High dose inhaled steroids, long acting B2 agonist and oral steroids
A female, 18 years old, came to the clinic with hair fallen. She had pain at all
joints, reddish at her cheeks, with painless oral ulcer. She also felt fatigue. In
physical examination, there was pale at her conjunctivas.
4. What
a.
b.
c.
d.
e.
5. What
a.
b.
c.
d.
e.
6. What

is the most possible diagnosis of this case?
Tuberculosis
Rheumatoid arthritis
SLE
Sepsis
Osteoarthritis
is the confirmation test for the case?
CD4
HIV elisa
Anti dsDNA
Mantoux test
Viral load
is the main principle to manage this case?

with an INR of 1. Cholesterol reduction does not alter the restenosis rate in patients after cutaneous cardiac intervention . Stage I hypertension. Intravenous tissue plasminogen activator and aspirin c. Extensive Anterior NSTEMI. Cardiopulmonary rescucitation for 1 to 2 mins d. Extensive anterior STEMI. Patient on warfarin for atrial fibrillation. stage I hypertension. Electrocardiography displays: 7. Which of the following statements regarding cholesterol reduction is true? a. e. Left carotid artery occlusion with hemiparesis 1 month ago b. there are no extra heart sounds. and anterior STEMI. stage I hypertension. Heart sounds are normal. Patient age > 70 y. obesity e. stage I hypertension. Intravenous tissue plasminogen activator and heparin d. Pharmacologic cholesterol reduction does not significantly decrease the risk of cardiovascular mortality in patients with known cardiovascular disease b. heart rate of 90 bpm.a. Nutrition Education Glucocorticoid Antibiotics Anti-Retroviral A 48-year-old man with a long history of tobacco use presents to Emergency department 4 hours after the onset of severe substernal crushing chest pain with radiating to the left arm. He has body weight of 90 kg and body height of 179 cm. which of the following would be the optimal management strategy at that time? a. obesity 8. d. respiratory rate of 20 breaths per minute and temperature of 37°C. Which of the following is most consistent with this clinical picture? a. Pharmacologic cholesterol reduction can decrease cardiovascular mortality in patients with and without coronary artery disease c. c. obesity b. Intravenous tissue plasminogen activator alone b. obesity d. heparin and aspirin e. Inferior NSTEMI. obesity c. Anterior segment STEMI. In patients without diabetes mellitus but with cardiovascular disease. e. Intravenous tissue plasminogen activator is contraindicated in this clinical setting 9.8 10. stage I hypertension. Physical examination reveals blood pressure 140/90 mmHg. Absolute contraindications to the use of thrombolytic agents in the setting of emergency department include: a.o. If the patient has no clear-cur medical contraindications to anticoagulation. Inferior NSTEMI. Diabetic retinopathy c. b.The patient was given Atorvastatin 40 mg. Intravenous tissue plasminogen activator. the pharmacologic intervention should be initiated when the LDL cholesterol level is >160 mg/dl d.

Treatment for H.6 months later.What is the diagnosis? a. including stool was negative for occult blood. 11. A 21 year old man with severity of burning epigastric pain b. It is associated with the development of gastric lymphoma e. Cardiovascular morbidity has only been shown to be reduced in the use of HMG-CoA reductase inhibitor A 37 year old executive returns to your office for follow up of recurrent upper abdominal pain.Which of the following is not true of H. which he has experienced occasionally for more than 1 year. She felt fatigue. You advised a change in diet and started him on a n H2 blocker. A 32 year old patient whose symptoms are not relieved with ranitidine d. and . Administration of proton-pump inhibitor e. Acute hepatitis d. he was drinking more caffeine and eating a lot of “take out” foods. It is believed to be the cause of non-ulcer dyspepsia d. The pain usually relieved within 2-3 hours. A 29 year old H. complaining of an increase in frequency and severity of burning epigastric pain. Intravenous fluid resuscitation and preparation for a transfusion 14. Referred to endoscopy c. Pylori d. The rout of transmission is believed to be fecal-oral c. the patient as brought to the emergency room after vomiting bright red blood. pylori positive patient with dyspeptic symptoms c. Physical examination showed BP 120/80 mmHg. Guaiac test for a stool b. light headache. He admitted that stress at work had recently increased and that because of long working hours. Result of the laboratory tests performed at his first visit showed no anemia.e. A 49 year old woman with intermittent right upper quadrant pain following meals A 42-year old female with chief complaint heavy menorrhagia for the past eight month. and it often awakens him at night. Cholelithiasis c. He initially presented 6 weeks ago. Gastritis b. Peptic ulcer disease e. and palpitation.Which one of the following patients should be promptly reffered for endoscopy? a. pylori infection? a. usually when he has an empty stomach. He has a blood pressure of 85/40 mmHg and heart rate 120 bpm. His physical examination was normal. Gastroesophageal reflux disease 12. Now the pain occurs three or four times per week. RR 20 breaths per minute. A 65 year old man with new onset of epigastric pain and weight loss e. HR 110 bpm. It is believe to be the cause of most duodenal and gastric ulcers 13. Which of the following is the best next step? a. His symptoms resolved completely with the diet changes and daily use of the medication. It is more common in developing countries b.

Anemia of chronic disorder e.What is your next step? a. Serologic examination . and blood pressure 94/60 mmHg. total bilirubin 4 mg/dL. Thallasemia d. and drinks only occasionally. albumin 2. her sclerae are icteric. On examination. 18. and platelet count 78. Coomb’s test 17. exercises. Ascites caused by malignancy d. She is thin. Total iron binding capacity d.conjunctiva was pale. leukocytes count 6800/mm 3 and platelet 168.8 mg/dL. Iron deficiency anemia b. Hypoplastic anemia A 49-year-old woman presents to emergency room complaining of a 4-week history of progressive abdominal swelling and discomfort. Diuretics b. She has no peripheral edema. and she has normal appetite and normal bowel habits. Her abdomen is distended. On pointed questioning. Her medical history was three pregnancies. Anemia of Chronic disorder c. She was HIV negative at the time of the birth of her last child. heart rate 88 bpm. she does admit that she was “wild” in her youth. her chest is clear. shifting dullness to percussion. Serum Iron b.What do you need to perform to establish the diagnosis? a. USG work up c. requiring blood transfusion. Hb 7. one of which was complicated by excessive blood loss. does not smoke.000/μL. hypoactive bowel sounds. She is happily married for 20 years.What is the most likely diagnosis in this patient? a. and she had snorted cocaine once or twice at parties many years ago. prothrombin time 15 seconds. Ascites caused by alcoholic hepatitis e.What is the most likely diagnosis? a. Ascites caused by acute viral hepatitis 19. haemoglobin 12 g/dL with MCV 102 fL. Ascites caused by hypoalbumin c. with mild diffuse tenderness.What is the hematologic problem in this patient? a. Microcytic anemia d.000/mm3. Sideroblastic anemia 16. and a fluid wave. and her heart rhythm is regular with no murmur. her complexion is sallow. her temperature is 37. Albumin transfusion d. Aplastic anemia e. Macrocytic anemia b. Normocytic anemia c. however. 15. Ascites caused by hepatic cirrhosis b. Laboratory studies are normal except for Na 129 mEq/L. She has no other gastrointestinal symptoms.8 g/dl with MCV 75 (low). She does not use drugs now. Perform a paracentesis e.9C. Ferritin c. Reticulocytes e.

Which of the following is the most appropriate next step? a. With her full-time job and three children. Recommend weight loss 24. Interaction between the ACE inhibitory and the sulfonylurea agents c. Add insulin pump b.What are the other possible physical examination findings in this patient? a. ANA. hyperemic conjunctiva 21.20. Persistent HbsAg. Which of the following studies should be used next to evaluate this finding? a. Gynecomastia. epigastric pain.What are the tests for Hepatitis C? a. her mother became sweaty. spider naevi. Oral glucose tolerance test c. shaky. Which of the following conditions is most likely to be contributing to these episodes? a. height 155 cm. Recommend repeated fasting or random blood glucose 23. hyperemic conjunctiva e. What is the best next step in her care? a. high ferritin A 46 year old woman presents for her yearly physical examination. and the result is 140 mg/dL. palmar erythema. Her daughter reports that. Gynecomastia. Add metformin c. a fasting plasma glucose test is performed.30 years later. and confused. Diagnose diabetes mellitus and start a biguanide agent c. Excess caloric oral intake b. and she admits that her family eat out frequently. She states that she conscientiously follows her diet and walk 30 minutes to 1 hour daily. 22. Anti-HCV Ab. Obtain start arterial blood gas and serum ketone levels e. Hospitalize her urgently e. Recommend cardiac stress testing d. epigastric pain b. she is brought into the hospital by her daughter for follow up and her creatinine level is 2. she finds it difficult to exercise. Prolonged hypoglycemia 25. Gynecomastia. Her random blood glucose is 90 mg/dL. The patient has not eaten yet today. Worsening renal function d. She currently takes glimepiride for her diabetes and captopril. Add NPH insulin d. presence of HbeAg d. Hyperglycemic amnesia e. Palmar erythema.A 45 year old asymptomatic woman has a random serum glucose level of 165 mg/dL on routine examination. so on your preceptor recommendation. She has been fine and has no complain today. Body weight 65 kg. 2 hour postprandial serum glucose .2 mg/dL. Fasting serum glucose d. Urine glucose b. spider nevi d. Today her blood pressure was 140/95 mmHg. in the past 2 weeks.Her last HbA1c was 7. anti-LKM (liver kidney microsome) e. Low serum ceruloplasmin b. spider nevi. presence of HCV RNA c. High transferrin saturation (>50%). palmar erythema.9%. Palmar erythema. Reassurance that these are normal blood sugars b. epigastric pain c.

Otherwise. Her thyroid is firm and twice the normal size.If the woman became pregnant. Normal both TSH and free T4 level 28. Pheochromocytoma 31. Essential hypertension b. 26. An increase TSH and increase free T 4 level d. no gastrointestinal complaints except for her occasional loose stools. She has been bruising very easily and has hirsutism. and 10 pound weight gain. Long term propranolol c. smooth. Antithyroid antibodies e. Serum thyroid stimulating hormone (TSH) 30. which of the following is the first choice therapy? a. She also has increased obesity. T3 resin uptake d.A 45 year old man is diagnosed with essential hypertension based on two blood pressure of 130/100 mmHg and 156/102 mmHg.e. Surgical thyroidectomy e. and she is afebrile. Which of the . She denies heat or cold intolerance. she feels great. Radioactive iodine ablation d. Propylthiouracil b. her heart rate is 110 bpm. sleepiness. Hashimoto thyroiditis b.A 42 year old woman has recently experienced fatigue. dry skin. Multinodular toxic goiter d. Her eyes are somewhat protuberant. You note a diffusely large. Hyperthyroidism c. blood pressure 160/70 mmHg. especially around her abdomen with striate. Which of the following is the most likely diagnosis? a. and no complaints except of fatigue. a good energy level. An increase TSH and low free T4 level e. Fine needle aspiration 29. Which one of the following laboratory tests is most likely to confirm the suspected diagnosis of hypothyroidism? a. Haemoglobin A1C measurement An 37 year old previously healthy woman presents to your clinic for unintentional weight loss. There is no tremor. she has lost approximately 15 kg without changing her diet or activity level. Graves’ disease c. On examination.What is the most likely diagnosis? a. Serum triiodothyronine T3 c. and her skin is warm and dry. Plummer disease e. Over the past 3 months. Coarctation of the aorta d. nontender thyroid gland.A 30-year old woman is noted to have blood pressure in the 160/100 mmHg range. Cushing syndrome e. A low TSH level and increase free T 4 level c. She has an excellent appetite. Serum thyroxin b. A 2/6 systolic ejection murmur on cardiac examination. Lymphocytic thyroiditis 27. constipation.How could you confirm this? a. A low TSH level and low free T4 level b.

Alpha-blocking agents d. Which of the following is the best management? a. and temperature 37°C. Beta-blocker d. Admit in the hospital and initiate intravenous antihypertensive agents b. Vasodilators such as hydralazine 33. . Thiazide diuretics b. Physical examination reveals blood pressure 110/70 mmHg. and she has trouble concentrating. Restart the clonidine and recheck the blood pressure in 24 to 48 hours c. Refer to a social worker and do not prescribe antihypertensive agents e. Her thyroid is normal to palpation. Vascular biopsy b. and difficulty sleeping. Thiazide diuretics b. she feels her life is meaningless. ACE inhibitor c. she says that she just felt terrible. Nitrates e. bilateral shoulder and neck pain.A 45 year-old man with type II diabetes is noted to have blood pressures of 145/90 and 150/96 mmHg on two separate occasions. He has no complaints and has a blood pressure of 200/104 mmHg. Angiotensin-receptor blockers c. heart rate 80 bpm.A 34 year old woman is noted to be diagnosed with stage 1 hypertension and after an evaluation is noted to have no complications. Which of the following is the best initial therapy for this patient? a. and she is irritable with her children. She cries easily. Another physical examination is normal. She works as a waitress and doesn’t work at least for 2 weeks. She feels unable to keep up with the demands of her work and family. Patient’s enrolment in a clinical trial d. You have seen her frequently over the last 3 months for various complaints. Her heart has normal rate and rhythm without murmur. Which of the following antihypertensive agents are generally considered first line agents for this individual? a. Alpha-blocking agents 34. however. Measurement of serum homocysteine levels e. Left ventricular hypertrophy c. Nitrates e. The patient states that she has regular menses. Change to an angiotensin-converting enzyme (ACE) inhibitor d. Patient’s antihypertensive agents 32.A 30 year old man with chronic hypertension presents at the clinic having run out of his medication. The patient smokes half a pack of cigarettes per day and drinks alcohol per weekends. Her symptoms include intermittent headaches. clonidine. overwhelming fatigue. Over past 2-3 weeks.following would most likely provide prognostic information regarding the patient? a. Change to beta blocker A 45 year old woman returns today to your outpatient clinic for follow up.

38. Glucosamine sulphate and chondroitin sulphate b. with the chief complaint of tender and swallowing of her wrist hand and fingers in both hands. Assess thyroid stimulating hormone (TSH). 39. Osteoporosis 43.The most appropriate diagnosis was: . Gout arthritis e. A woman. especially when she was squatted or goes down the stairs. 1st-5th metacarpophalanx. Knee arthrocentesis A woman. with body weight 68 kg and height 157 cm. ANA (-). in both hands.What is the appropriate diagnosis for this patient? a. There was evidence of crepitation without any swelling in her left knee. The ESR examination was 98 mm/h. what is the most appropriate management for this patient? a. The ESR examination was 15 mm/h. came to the outpatient clinic. complete blood count b. and anti dsDNA (-). 41. Referral to a psychiatrist d.35. Based on clinical examination. The arthritis manifestation was very clear in her both 2nd-4th proximal interphalanx. carpometacarpo. She also complains tenderness of her left knee. 34 years old. she looked mildly ill. electrolytes. with restricted range of motion. 42. There was also Heberden nodal in the 2nd distal interphalanx joint. Rheumatoid arthritis c. she also felt tender and swallowing of her knee and ankle. 57 years old. There was slightly narrowing of left knee joint space in X-Ray examination. Recommend a bone scan 36. The whole vertebrate was within normal limit. Intraarticular hyaluronic acid injection c. There was tenderness of 3rd and 4th proximal and distal interphalanx joint. knee and ankle joint. Ankylosing spondylitis b. came to the out-patient clinic. Systemic corticosteroid (oral or IM) d. Prescribe a tricyclic antidepressant e. Since two months ago. with positive rheumatoid factor. Osteoarthritis d. since eight months ago. with morning stiffness more than 2 hours. with the chief complaint of tenderness of her hand fingers since three months ago. 37. Calcium supplement e. 40. 44.If we found joint effusion and tenderness of the knee. Prescribe a serotonine selective reuptake inhibitor c.What is the best next step? a.

Geriatric syndrome in this patient are: a. Muscle weakness b.On physical examination his temperature 38. nausea. thrombocyte 200. Heart. Need more information before start treatment c. C is a 35 year-old man who comes to your outpatient office complaining of 3 days of diarrhea. respiratory rate 20x/mins. immobilization . come to hospital with chief complaint of sleepless and disoriented since 1 day ago. What is the most possible cause? a. Digital ulcers e. She had diabetes mellitus and hypertension since 20 years. Acute diarrhea d. The abdomen is soft and diffusely tender with hyperactive bowel sounds. she felt pain in her left leg. temperature 37°C. Psoriatic arthritis d. lung and abdominal were within normal limit. she could manage her daily activities by herself.What is the most possible diagnosis? a. Before sick.He was in good health until the morning before he comes to visit you. Osteoarthritis e. Treat him directly because the clinical information is sufficient b. Systemic lupus erythematosus b. she could not hold her urination. so that she had difficulty in walking. Delirium. Joint deformity c. He described the stool being watery and brown without any blood. Joint effusion Mr. Chronic diarrhea c.This patient took place more than four years without any adequate treatment. carried by her son. Any infections (virus or bacterial) d. Laboratory examination: Hb 12. she slipped and fell out in bathroom while walking in. Lactose intolerance b. What is your plan? a. Pancreatitis 48. what is the most possible permanent complication in this patient? a. W. He noticed of poor appetite. 78 years old. Urinalysis within normal limit. diaphoresis. Seven days before admission. Gout arthritis 45. Traveller associated diarrhea 47. Segment 68. Four days before admission. Physical examination: blood pressure 160/100 mmHg. heart rate 70x/mins. She lost appetite and her meal intake was less than before. She only did her activity on her bed. inanition. pulse 100 bpm. Ht 41. Need a laboratory test before starting any treatment d. dry tongue.a.2°C. 49. Nutritional supplements c. He needs to be hospitalized Mrs. Blood glucose level 101.000. BP 110/80 mmHg. Bamboo spine d. Rheumatoid arthritis c. RR 12 breaths per minute. reddish wound in her buttock. 46. Leukocyte 7000. Antibiotics associated diarrhea b.

impecunity. infection d. Functional status can be assessed by using Mini Mental State Examination b. instability 50. infection. Psychoaffective status was assessed by using AMT (Abbreviated Mental Test) d.b.Comprehensive Geriatric Assessment must be assessed for Mrs. Systemic anamnesis will be done. W: a. Immobilization. Activity of Daily Living (ADL) Barthel must be assessed. Nutritional Status must be assessed by using the timed up and go test c. if history of present illness is done b alloanamnesis . independency c. incontinence e. Inanition. Acute confusional stage. before and during illness e. immobilization. impecunity. Incontinence.