1.

B
“A viral quasispecies, is a cloud of diverse variants that are genetically linked through
mutation, interact cooperatively on a functional level, and collectively contribute to
the characteristics of the population.”
Contohnya di virus RNA kayak HIV-1, HIV-2, HCV
http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001005
2. A
Virus isolation in culture is the most sensitive method to diagnose poliovirus
infection. Poliovirus is most likely to be isolated from stool specimens. It may also be
isolated from pharyngeal swabs. Isolation is less likely from blood or CSF.
To increase the probability of isolating poliovirus, collect at least two stool specimens
24 hours apart from patients with suspected poliomyelitis. These should be collected
as early in the course of disease as possible (ideally within 14 days after onset).
Real-time reverse transcription PCR is used to differentiate possible wild strains from
vaccine-like strains (“intratypic differentiation”), using virus isolated in culture as the
starting material.
Partial genome sequencing is used to confirm the poliovirus genotype and determine
its likely geographic origin.
Serology may be helpful in supporting the diagnosis of paralytic poliomyelitis,
particularly if a patient is known or suspected to not be vaccinated. An acute serum
specimen should be obtained as early in the course of disease as possible, and a
convalescent specimen should be obtained at least three weeks later. A four-fold
neutralizing antibody titer rise between the acute and convalescent specimens
suggests poliovirus infection. Nondetectable antibody titers in both specimens may
help support the rule out of poliomyelitis but may also be falsely negative in
immunocompromised persons, who are also at highest risk for paralytic poliomyelitis.
3. B
Diagnosis: campak/morbili/measle.
Penyebab: measle virus (MeV), RNA virus, genus Morbilivirus, family
Paramyxoviridae.
Sign/symptom: fever, cough, coryza, conjunctivitis, koplik’s spot (pathognomonic),
red maculopapular rash (muncul awal di belakang telinga beberapa hari setelah onset
demam, menyebar ke kepala leher seluru badan).
4. E
Khasnya P. falciparum sering infeksi multiple parasit dalam satu eritrosit 
trophozoid (bentuknya cincin) ganda, kalo P. malariae jarang infeksi multiple. Di
stadium gametosit bentuknya kayak pisang, kalo P. ovale, vivax, malariae bentuknya
bulat. P. vivax khasnya eritrosit membesar, di trofozoid sitoplasma ireguler, titik
schuffner.
5. D
Diagnosis: Leptospirosis/Weil’s disease
Carier: rodent, anjing, dkk  biasanya di kasus habis kebanjiran, sumbernya dari urin
hewan (krn bakterinya bisa bertahan lama di tubulus renalis).
Penyebab: bakteri Leptospira kelompok spirochaete
 Ada 2 fase klinis (septicemic dan immune):
− Septicemic phase (leptospiremic phase): bakterinya bisa di isolasi dari kultur
darah, CFS. Tanda gejalanya kayak “nonspecific flulike illness”  sudden onset
of high fever, headache, myalgias, conjuctival suffusion (pathognomonic).
− Immune phase (leptospiruric phase): produksi IgM (bertahan 1 bulan), bakteri bisa
di isolasi dari urin di fase ini. Terjadi kerusakan organ spesifik  paling sering
aseptic meningitis, lainnya gejala2 renal (uremia, hematuria, azotemia, pyuria),
pulmonary (cough, dyspnea, ards), liver (kenaikan enzim2 liver, bilirubin,
jaundice, hepatomegali)
Kalo parah bisa sampai Weil’s disease  bentuk paling parah dari leptospirosis, bisa
terjadi kapan saja saat infeksi akut tergantung progresifitas penyakit. Tanda gejala 
“high fever (>40°C), significant jaundice, renal failure, hepatic necrosis, pulmonary
involvement, cardiovascular collapse, neurologic changes and hemorrhagic diathesis,
with a variable clinical course”. Komplikasi paling sering  acute renal failure.
Diagnosis: gold standard kultur tapi susah bgt dan lama, darkfield microscopy susah
mahal  diagnosisnya pake serologi  MAT (microscopic agglutination test  gold
standard buat serologi) ngitung titer antibodinya, lainnya IgM-ELISA.
http://www.jmedicalcasereports.com/content/5/1/7
6. C
Penyebab V. cholera gram negative coma shaped berflagel.
Virulence factor: toxin coregulated pilus (TCP)  untuk adherence & kolonisasi;
cholera toxin (CT)  enterotoxin.
7. E
Kemungkinan uncomplicated UTI karena E. coli.
“Nearly 95% of cases of UTIs are caused by bacteria that typically multiply at the
opening of the urethra and travel up to the bladder.”
8. B
The effects of the normal flora are inferred by microbiologists from experimental
comparisons between "germ-free" animals (which are not colonized by any microbes)
and conventional animals (which are colonized with a typical normal flora). Briefly,
some of the characteristics of a germ-free animals that are thought to be due to lack of
exposure to a normal flora are:
− vitamin deficiencies, especially vitamin K and vitamin B12
− increased susceptibility to infectious disease
− poorly developed immune system, especially in the gastrointestinal tract
− lack of "natural antibody" or natural immunity to bacterial infection
http://textbookofbacteriology.net/normalflora_4.html
9. A
10. B
Kemungkianan typhoid fever
11. A
B sm C kemungkinan masih bisa nularin ke pasien lain soalnya TB penularannya
airborne, yang D sm E setauku kalo pasien paru itu yang pake masker harusnya
 pasiennya juga, petugasnya pake respirator, kecuali kasus HIV yang make masker
yang meriksa soalnya takut kita yang nularin penyakit ke pasiennya.

http://www.cdc.gov/tb/education/corecurr/pdf/chapter7.pdf
12. D
Lama-lama kalo ga ditangani jadi heat stroke
13. C
?? dulu di blok apa gtu ada slide yang bilang paling bagus malah aksila?
14. E
Ada di slide dr. Dhani Redono – Penyakit infeksi bakteri
15. B
Ada di slide dr. Dhani Redono – Penyakit infeksi bakteri
16. D

17. D
HBsAg sama anti HBc tanda lagi infeksi akut.
 Ada HBeAg tanda lagi masa replicative  bisa nularin ke orang lain.

18. B
Kalo pasiennya infeksi HBV harusnya HBsAg terdeteksi kecuali ada mutasi, anti HBs
nya bisa karena vaksinasi.
19. E
20. D
21. A
NS-1 terdeteksi sampai hari ketiga demam, setelah itu yang bisa dideteksi IgMnya.
22. A
Ada kontak langsung dengan bangkai unggas.
23. E
Rotavirus infection alters the function of the small intestinal epithelium, resulting in
diarrhea. The diarrhea was generally considered to be malabsorptive, secondary to
enterocyte destruction (34). In addition to enterocyte destruction, absorption of Na+,
water, and mucosal disaccharidases are decreased (10, 28), while mucosal cyclic
AMP appears not to be altered (16). Malabsorption results in the transit of undigested
mono- and disaccharides, carbohydrates, fats, and proteins into the colon. The
undigested bolus is osmotically active, and the colon is unable to absorb sufficient
water, leading to an osmotic diarrhea (27). Another study suggested that the diarrhea
was malabsorptive and resulted from epithelial damage caused by villus ischemia
(58). A secretory component of the diarrhea was suggested, based on elevated levels
of prostaglandin E2 (PGE2) in the infected gut and the stimulation of secretion by
PGE2 (79). The fact that gut lesions often do not correlate with the presence of
diarrhea stimulated the search for other mechanisms of diarrhea induction. The viral
nonstructural protein NSP4, a secreted fragment of NSP4, or certain NSP4 peptides
were found to have toxin-like activity and to induce diarrhea when inoculated into
mice (3, 23, 77). The NSP4 enterotoxin activity provides a way to mediate
diarrheagenic changes in the absence of significant damage or to mediate changes at
uninfected sites. Recently, it was shown that several drugs that block the action of the
ENS attenuate rotavirus-induced secretion in the intestine, suggesting a role for the
ENS in rotavirus diarrhea (44, 45, 46). It was estimated that ∼67% of the fluid and
electrolyte secretion in rotavirus diarrhea in experiments with mice was due to
activation of the ENS (46). Thus, it is clear that rotavirus diarrhea is multifactoral,
resulting from the direct effects of virus infection and the indirect effects of infection
and the host response.
CDC  The virus enters the body through the mouth. Viral replication occurs in the
villous epithelium of the small intestine. Recent evidence indicates that up to two-
 thirds of children with severe rotavirus gastroenteritis show the presence of rotavirus
antigen in serum (antigenemia). Infection may result in decreased intestinal
absorption of sodium, glucose, and water, and decreased levels of intestinal lactase,
alkaline phosphatase, and sucrase activity, and may lead to isotonic diarrhea.
24. D
Diagnosis: varicella/chicken pox
According to the model of varicella zoster virus (VZV) cell-associated viraemia,
tonsil T cells are infected following VZV inoculation and replication in respiratory
mucosal epithelial cells. T cells traffic into and out of tonsils across the squamous
epithelial cells that line the tonsilar crypts (left panel). VZV has increased tropism for
activated memory T cells that have skin-homing markers, which are common in
tonsils (centre panel). These T cells are programmed for immune surveillance and can
transport the virus across capillary endothelial cells into skin. VZV glycoprotein E
(gE) (through its unique amino terminus), gI and the viral kinases ORF47 and ORF66
are important for T cell infection. Proteins that regulate cellular gene expression are
activated (in the case of signal transducer and activator of transcription 3 (STAT3)) or
inhibited (in the case of STAT1) in infected T cells. The microvasculature is extensive
at the base of hair follicles, where T cells transit into the surrounding skin and initial
VZV replication is observed (right panel).
http://www.nature.com/nrmicro/journal/v12/n3/fig_tab/nrmicro3215_F2.html
25. C
26. C
Kasus mumps/parotitis, penyebab mumps virus (RNA). Penegakan diagnosisnya pake
RT-PCR sampel saliva hari ke 3-5 onset gejala. Juga bisa dideteksi di urin hingga hari
ke 14 setelah onset gejala.
27. E
28. E
Exanthema subitum/roseola infantum
Mirip measle tapi gejala lebih ringan. Menyerang anak usia 6 bulan – 2 tahun. Gejala
demam mendadak beberapa hari (bisa sampai seizure). Setelah demam turun muncul
maculopapular rash mulai dari badan ke leher dan kaki, tidak gatal, 1-2 hari (kalo
measles gatal, bisa sampai 8 hari mulai dari belakang telinga ke leher kepala badan).
Disebabkan infeksi primer HHV-6 (type B) dan HHV-7.
Bisa sembuh spontan, pengobatan simptomatis.
Sumber lain: http://saripediatri.idai.or.id/pdfile/4-3-1.pdf
http://wwwnc.cdc.gov/eid/article/5/3/99-0306_article
29. E
DHF
30. D
Malaria  khas trias malaria: cold stage, hot stage, sweating stage. Demam
intermitten. Gold standard: mikroskopis, apusan tebal buat deteksi ada parasitnya,
untuk tau jenisnya pake apusan tipis.
31. D
Ada opistotonus, spasme, riwayat ketusuk paku berkarat.
32. A
33. E
34. B
DENV-2 paling sering berkaitan dengan DSS  plasma leakage lebih tinggi. DENV-
3 dan DENV-4 kecenderungan ke liver involvement (ditandai dengan kenaikan AST
ALT). – http://apps.who.int/iris/bitstream/10665/148790/1/dbv24p53.pdf
Sebenernya beberapa sumber menyebutkan DENV-3 juga berhubungan dengan DSS.
35. B
DHF is characterised by a transient increase in vascular permeability resulting in
plasma leakage, with high fever, bleeding, thrombocytopenia and
haemoconcentration, which can lead to shock (termed dengue shock syndrome (DSS).

36. D
37. C
Infeksi Enterobius vermicularis  pyrantel pamoat (lainnya albendazo, mebendazol)
single dose awal dan diulang single dose 2 minggu setelahnya (obatnya ga bisa bunuh
telurnya, makanya diulang 2 minggu kemudian buat bunuh cacing dewasa yang netes
dari telur). Sebaiknya anggota keluarga juga ikut diobati sekalian di saat yang
bersamaan.
38. E
39. D
Vermisid: Mebendazol, praziquantel, niklosamida.
40. A
41. B
42. D
43. E
44. D
45. B
Kuliah dr. Brian – dasar infeksi bakteri
46. E
Menghambat COX-1 dan COX-2.
47. B
48. E
WHO GUIDELINES: Faine’s Criteria For Diagnosis Of Leptospirosis
Faine had evolved a criteria for diagnosis of leptospirosis on the basis of clinical,
epidemiological and laboratory data (Parts A, B and C respectively) (Table 4). A
presumptive diagnosis of leptospirosis may be made if:
(i) Parts A and B score = 26 or more (Part C laboratory report is usually not available
before fifth day of illness; thus it is mainly a clinical and epidemiologic diagnosis
during early part of disease)
(ii) Part A+B+C = 25 or more.
A score between 20 and 25 : Suggests a possible but unconfirmed diagnosis of
leptospirosis.
http://www.japi.org/june2005/R-545.pdf

49. A
Kalo di https://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-
related-health-problems/opportunistic-infections/ CD4 <50 cells/mm3 itu MAC. Yang
paling mendekati CMV.
50. D
51. B
Kencing berwarna seperti teh.
52. B
Slide malaria dr. Dhani

53. D
54. C
55. D
Entamoeba coli, E. hartmanni, E. polecki masuk di non pathogenic intestinal
protozoa.
56. A
57. D

58. B
Kasus varicella  ada gambaran tear drop (vesikel dinding tipis sehingga terlihat
seperti kumpulan tetesan air di atas kulit).
59. C
Slide Antibiotik 2014
60. E
Slide Antibiotik 2014

61. A
62. A
63. D
64. A
65. D
66. A
67. C
68. C
69. A
70. E
71. A
72. D
73. D
74. C
75. C
76. C
77. B
78. C
79. E
80. D