TROPMED

1. A 35 years old female came to the outclinic with bloody diarrhea with watery consistency 4-5x
daily since 4 days ago, abdominal cramp and uncomfortable after defecation. What is the
possible pathogen?
A. Staphylococcus aureus
B. Giardia lamblia  (diarenya berlendir, tanpa darah)
C. Salmonella typhi  (konstipasi)
D. Shigella sp  (ada tenesmus)
E. Campylobacter sp  (bloody diare, tapi gk ada tenesmus)

2. A 37 year old male came to a clinic with chief complain of 7 day fever. His fever occured on
every 3 days. His high fever preceeded with chills and afterwards he sweat profusely. He had a
vacation to the jungle of Borneo a week prior to his fever. He had not taken chloroquine
prophylaxis before he went to Ujung Kulon. What factor contributed to his fever?

A. Evolution of the pathogen

B. Resistance of vectors to pesticide
C. His succeptibility to infection
D. Resistance of the pathogen to the prophylaxis drug

*Chill/stadium dingin, afterward sweat/stadium keringatan, jelas bgt ini tanda malaria (dia belum minum
klorokuin)

3. Man lump arm no pain on pressure. Erythematous nodule shiny Ill define border no fluid no
wound. Lab exam?
A. Dark field exam
B. Zn
C. Gram
D. Koh
E. NaCl

*Eritrematous nodule, No Pain On Pressure  Suspek kena Leprosy. Leprosy itu kuman Mycobacterium,
kita stainnya sama Zield Nielsen

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 4. Patient with infective endocarditis. Which of the following is the most appropiate for blood
collection?
A. 1 sets before & after the fever spike
B. 2 sets on day 1  (yang paling mendekati)
C. 1 sets from a separate peripheral site
D. 2 sets from 2 separate sites during the first 1-2h

*Menurut Manual Praktikum Mikrobio dr. Cucu :

Acute Endocarditis :
o Volume darah yang diambil 60 ml.
o Lakukan pada 3 tempat beda, dengan selang waktu 10 menit tiap setnya. ( Kayak Non Acute
Febril, tapi semuanya 2x10 ml dibagi 2 botol)
 Ambil Pertama : 2x10ml darah untuk 2 botol, 1 aerob, 1 unaerob, pada tempat pertama
 Begitu pula yang kedua dan yang ketiga.
Subacute Endocarditis :
o Sama seperti Acute Endocarditis
o Tapi Interval ambilnya bukan 10 menit, dia jadinya 30-60 menit.

5. N / A

6. Egyptian man came to the clinic with chief complain of hematutia. On the urine analysis shows
many red blod cell and a few of WBC, oval shapped egg with terminal spine. Which parasite can
cause the disease?
A. Schistosoma hematobium
B. Schistosoma mansoni  (bleeding per rectum)
C. Plasmodium falciparum  (malaria, gk ada oval shaped eggnya)
D. Wuchereria Bancfrofti  (kaki gajah, gejalanya elephantiasis)
E. Trichinella spiralis  (ditemukan kista pada sediaan otot)

*Oval Shapped egg with terminal spine  Scihistosoma.

Terus dia hematuria  Berarti S. Hematobium.

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 7. 9-year-old girl, came to clinic with her mother with fever since 10 days ago. She is also difficulty
swallowing and diarrhea. 2 weeks ago, buy snack from the roadside. Physical examination
reveals temperature 40, pulse 90x per minute. Ada liver enlargement, hyperemic throat,
coated tongue. but chest examination was normal. She denies contact with animals. What is
the laboratory exam?
A. Tubex  ???
B. Widal  (Simple, tapi bukan gold culture)
C. NS1  (Ini Gold Standard untuk DBD Bukan untuk Typoid)
D. IgM/IgG dengue  (Ini Untuk DBD, Tapi bukan gold standard, cocok di hari ke 4)
E. Blood culture

*Coated Tongue ya pastinya Tyfoid Fever. Gold Standardnya Blood Culture

8. A 3 year old girl come to emergency department with 2 days of shortness of breath and fever.
She lives in slum area with chicken and ducks. Bleeding saat dia mau remove white patches di
mulutnya. What is the contributing factor of her disease?

A. Evolution of pathogen
B. Development of pathogen resistance towards antibiotic
C. Non-adherence of the patient to previously prescribed antibiotic
D. Incomplete vaccination
E. Use of counterfeit drugs

*White Patches, ya kan Diptheri.

Nah Chicken and Ducks ini cuman jadi jebakan aja supaya kamu mikirnya ke Flu Burung.

Diptheri muncul biasanya karena ga di vaksin

9. A 32 y'o male come to emergency clinic with a week of progressive fever. PE: jaundice, delirium,
hepatomegaly. Murphy sign negative. Creatinine 3.7, WBC 13.000, platelet dibawah 100.000.
Cek lab?
A. Hbsag
B. Widal test
C. Dengue

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 D. IgM for leptospirosis  (IgM itu tanda lagi ada MUSUH, IgG tanda tentaranya sudah disuruh
perang). Hepatomegali, Creatinine naik, fever (ini jelas WEILS SYNDROME) Tanda jelas Leptospirosis.

10. Dari cerita sebelumnya, setelah ditanyakan lagi, pasien biasa gardening di backyardnya. Apa cara
transmisi yang RARE dalam penyebaran penyakitnya?
A. Direct contact with animal urine
B. Indirect contact with animal urine
C. Direct contact with human urine
D. Contaminated soil

*Gak tau nih, soalnya kalo ditanya rare, berarti kan yang paling jarang, aku mikirnya D nih. Coba diskusi
yah. Ada juga yang menjawab C. Mohon dipertimbangkan yah. Thanks.

11. Following number 9, hasil urine bisa diliat setelah berapa lama?
A. 1 mnggu
B. 2 mnggu
C. 3
D. 4

*Tes urine dapat diuji dalam 10-14 hari  ga tau baca dimana. Coba dibaca lagi ya temen temen hehehe.

12. A 39 y.o. poultry farmer comes with fever and difficulty breathing since 3 days ago. A week ago
there are died poultry in his farm. On physical examination found the patient is pale, BP 140/80,
hr 130 bpm, rr 44x/min and temp 40C. His throat shows mild congestion and exudate in
nasopharynx. Chest examination auscultation similar in both lungs where bronchial sound with
rales. Chest percussion is dull and increased tactile fremitus. What is the type of virus causing
the disease?
A. Paramyxoviridae
B. RSV
C. Orthomyxoviridae  (semua influenza golongannya Orthomyxoviridae)
D. Coronavirus
E. CMV

*Jelas dari tanda yg dibold ini H5N1. Jawabnya ya Orthomyxoviridae

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 13. zat apa yang digunakan untuk membersihkan feses burung?
A. Chlorine
B. ethanol 70%  (untuk disinfektan, tidak spesifik buat feses burung which is cegah flu burung)
C. ethanol 90%  (lebih efektif yang 70%, soalnya 90% lebih cepat nguap, dan reaksinya lebih
cepat dengan bungkusan bakteri sehingga penetrasinya kurang.)
D. Iodine  (emang ada ya ngebersihin feses burung pake betadine?)
E. Chlorhexidine  (chlorhexidine itu adalah obat antiseptic kumur)

14. Best virus isolation from the case above?

A. Blood
B. Nasopharyngeal aspirate
C. Throat swab
D. Nasal swab
E. Hand swab

15. A surgeon complains to his chief that he cannot concentrate during surgery. After the operating
theatre was surveyed, it was found that the OT was too cold, too bright, and too noisy. What
kind of hazard?
A. Ergonomic hazard  (karena salah posisi dan sikap)
B. Psychological hazard  (Misalnya Bully, Dikata-katain, Dihina, Stress gitu-gitu)
C. Biological hazard  (infeksius agent)
D. Biochemical hazard  (bahan kimia)
E. Physical hazard

16. A 37-year-old man intermittent fever, nausea, abdominal discomfort especially at the right side
of upper abdomen. Chills rigor sweats when fever comes. Liver enlargement and tenderness,
same sign and symptoms last year. Never been occurred in a year after the treatment. What is
the causes?
A. Sporozoit
B. Merozoit
C. Hypnozoit

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 D. Trophozoit
E. Gametosit

Pernah sakit, sembuh, 1 tahun lagi muncul, ini berarti Rekurens  Rekurens karena Hipnozoit

17. penyebaran polio lewat mana  polio lewat fecal oral

18. 37 tahun MSM dateng evaluasi HIV. HIV +, CD4+ 350. Dia nanya boleh minta Arv gada ?
A. start Arv
B. cotri prophylaxis
C. tahan Arv sampe CD 250
D. evaluasi TBC
E. start clarythromicin prophylaxis

*Kalo ga salah maksud soalnya kemarin, dia belum dapet obat sama sekali. Dia cuman mau memastikan
dia beneran HIV atau nggaknya. Makanya di start ARV aja.

19. A 45 year old businessman datang dengan abdominal upper quadrant pain and fever 39.9oC. 3
week di papua baru pulang 1 minggu lalu. Suffering intermintent chills and sweats durring fever
episodes. Liver enlargement and tenderness in PF. Thin blood smear shows ring forms of inside
the erythrocytes at 3.5% parasitemia. What is the cause of parasetemia?
A. Release of sporozoit to tissue
B. Release of merozoit
C. Repeated cycle schizon from liver to erythrocyte
D. Org nya immunocompromised

20. (Kalau gak salah, nomor 20nya ngomongin malaria berat.) According to the case above, which of
the following is the most appropiate treatment?
A. Intramuscular chloroquine HCL 1.5g single dose
B. Intravenous metronidazole 500mg 3x1
C. Oral primaquine 30mg 1x1 14 day
D. Oral artemether/ lumefantrine 4x2 3 day

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 E. Intravenous quinidine gluconate 15mg/kgBB continues 7.5mg/kgBB over 4 hours

*Pengobatan Malaria berat urut-urutannya :

i. Artesunat IV
ii. Artemeter IM
iii. Kina / Quinin IV

Ini jawabnya Oral Arthemeter / Lumefantrine ya.

Soalnya Quinidine itu adalah Obat Antiaritmia Jantung. Bukan Quinine / Kina.

21. A 32 years old man come to dermatology with red and soreness in skin lesion. He’s on MDT for
1.5 year, on examination painful erythematous nodule spread over his body especially on arms
and legs. Diagnosis?
A. Cellulitis
B. Furuncle
C. Multibacillary leprosy
D. Paucibacillary leprosy
E. Erythema nodusum  (ini disebut Response type II of leprosy)

22. Anak usia 4 tahun keluhan difteri. Diagnosis tes apa yang paling cepat dan praktis : PCR

23. A 18 year old girl got an open minor wound from walking in the garden. Her father brought her
to the emergency unit for suturing the wound. She had the last immunization when she was 18
months old and she had not repeated her DPT at 4-6 year old. Appropriate tetanus prophylaxis?
A. Penicillin G
B. Anti-tetanus serum
C. Tetanus toxoid
D. Tetanus immunoglobulin
E. Human intravenous immunoglobulin

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 *Pasien kasus termasuk golongan Primary immunization incomplete or boosters not up to date.
Seharusnya tetanus toxoid + immunoglobulin.

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 24. 56 years old sheep farmer came for examination. his physician found enlargement of liver with
palpable mass on right upper quadrant of the abdomen. CT scan of liver showed large
encapsulated lesion consistent with hydatid cyst. which of the following parasites cause this?
A. echinococcus granulosus
B. toxocara canis
C. schistosoma japonicum
D. taenia saeginata
E. taenia solium

25. 56 y.o sheep farmer was examined for abdominal pain. his physician found large liver with a
palpable mass in the right upper quadrant of abdomen. a ct scan of the liver revealed a large
encapsulated lesion consistent with hydatid cyst. of the following what is the most dangerous
complication that could occur during surgical removal or aspiration of the cyst?
A. seizure
B. cardiac arrest
C. anaphylactic shock
D. haemorrhage
E. peritonitis

26. 34 tahun farmer, dtg ke emergency dengan insidious ~(tersembunyi dan membahayakan)~
fever, night sweats, malaise dan arthralgia. Lagi liburan di Tangerang dan kerja di barn di iran.
Suka makan susu dan keju dari goat. Culturenya gram (-) coccobacil. Diagnosis?
A. Acute brucellosis  (ingestion unpasteurized milk/undercooked meat)
B. Bubonic plague
C. GI Anthrax
D. Thypoid tularemia

27. A 7 years old girl was taken to emergency department by her father with feeling of itching all
over her body and swolleh eyes. Her father said that she was playing in the yard and was
contacting with hairy caterpillar. What is the cause of the disease?
A. Erucism  (caterpillars)

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 B. Lepidopterism  (butterfly)
C. Tick paralysis
D. Arachnidism  (spider, other arachnids)
E. Delusional Parasitosis

28. A 28 years old woman, 3rd pregnancy. In the 39th week of gestation, she give birth to a small for
gestation age infant with chorioretinitis, intracerebral calcification, jaundice,
hepatosplenomegaly, and anemia. Infant displays poor feeding. She denies eating
raw/undercooked meat and doesn’t have cats at home. She work as a nurse in pedi. Intensive
care. Most possible diagnosis?
A. Congenital herpes simplex
B. Congenital rubella
C. Congenital toxoplasmosis  (beberapa gejala cocok (calcifications, chorioretinitis) tetapi tidak ada
RFx, dan sisa gejala tidak bisa disebabkan oleh T. gondii. Selain itu, semua gejala di pertanyaan cocok
dengan congenital CMV)
D. Congenital varicella
E. Congenital cytomegalovirus

29. 4 tahun, sore throat, difficult swallowing, hoarseness, malaise, headache. Tonsil uvula ada
adherent membrane. Ada lymphadenopathy dan bull neck appearance. Treatment as soon as
possible?
A. Ertiromisin  (ada juga yang jawab erythromycin, karena pilihan yang bisa menyembuhkan, tetapi
tidak digunakan untuk emergency/upon clinical suspicion)

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 B. Clindamycin
C. Diphteri antitoxin  untuk emergency (soon as possible), harus segera dilakukan, tetapi tidak bisa
menyembuhkan pasien. Harus menggunakan Abx (Penicillin G DoC, erythromycin juga bisa).
D. Azithromycin
E. Clarithromycin

30. Seorang laki2 datang dengan keluhan demam, headache, retroorbital pain, nausea with
vomiting in each meal (dengan ttv sesuai soal tahun lalu). Sesuai dengan WHO 2009 maka
diagnosis yg tepat untuk pasien tsb adalah
A. Dengue fever
B. Dengue fever with warning signs  ini jawaban tahun lalu, kalo masih ragu-ragu jawab ini aja.
C. Severe dengue
D. DHF
E. DHF kategori 2

* seinget gw TTV soal tahun ini dirubah sedikit menjadi lebih parah dan gejala juga diganti.

31. you are working in refugee camp when a mother bring in 8 day old infant. any loud noise
appears to cause him pain, ada muscle tightening and back arching, causing the head to nearly
touch his feet. PF reveals only dried packing on his umbilical cord as is the local custom. He

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 appear normal until stimulated by loud noise or touch and then began to cry, stiffens and arches
his back. The stiffness continues until he calm down. Most likely diagnosis:
A. bacterial meningitis
B. botulism
C. generalized seizure
D. tetanus  dried packing on umbilical cord, unhygienic delivery + refugee camp RFx besar untuk
tetanus. Opisthotonos di newborn juga clue besar untuk tetanus.
E. viral encephalitis

32. 25 y.o man who works in Jakarta has task in Papua fpr 2 weeks. He come to his family doctor
and ask what is the prevention of malaria. What kind of drug is appropriate for this condition?
A. Klorokuin
B. Doksisiklin
C. Sulfadoksin-pirimetamine
D. Artemisin
E. Amodiakuin

33. orang dtg kena dengue udh 4 hari demam, rumple leeds test positive, hct 50an%, platelet 72,
000 checknya pake apa?
A. igg/igm dengue  week 2 baru jelas
B. NS1  w/n minggu pertama (pasien masih 4 days)
C. pcr
D. iga dengue

34. 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, parasymphatetic activity, mental
confusion, and muscle twitching. Which of the following is the most likely agent causing those
symptoms?
A. Acetaminophen
B. Barbiturate

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 C. Carbamate  stimulate ANS, dimana PNS>SNS
D. Cyanide
E. Opiate

35. A mother delivers a baby with a rash identical. Questioning reveals that the mother had a flu-like
syndrome with rash during the second trimester of pregnancy. Examination reveals diffuse
raised purple skin lesions. There is no pallor, jaundice, or cyanosis. The Eyes are cataract, the
heart has a 3/6 systolic murmur and there is enlargement of both the liver and spleen. There is
no lymphadenopathy. Of the following, the most likely diagnosis is?
A. Congenital toxoplasmosis
B. Congenital rubella  blueberry muffin sign (raised purple skin lesions) + cataract, cardiac
abnormalities (walaupun tidak tercatat adanya deafness, gak semua komponen triad rubella harus
terpenuhi)
C. Congenital CMV
D. Congenital malaria
E. Congenital varicella

36. 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. What is the
most likely diagnosis of this disease?
A. Hydatidosis
B. Cysticercosis
C. Cerebral malaria
D. Histoplasmosis
E. Toxoplasmosis

37. 4 yr old children come with fever, malaise. ttv normal. reflex (-), flaccid paralysis asymetreical,
intact sensation. diagnosis?
A. GBS  bilateral symmetric involvement, biasanya ada RFx past GI infx, paling sering Campylobacter
jejuni.

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 B. Poliomyelitis

38. A 38 years old American male was admitted to hospital with increasing fever along with malaise,
headache and constipation since 2 weeks ago. He visited a rural area of Jakarta a week ago but
didn’t receive any prior vaccination. Physical examination, BP 130/90, HR 88bpm, Temperature
39 celcius, Mild hepatosplenomegally, faint erythematous macular over the trunk. There was
neutropenia with lymphocitosis on CBC. In the case above, if there is a perforation, where is the
most likely site it will happen?
A. Gaster
B. Duodenum
C. Jejunum
D. Ileum  typhoid biasanya perforasi di distal ileum
E. Colon

39. A 28-year-old farmer was admitted to the emergency unit complaint a high-grade fever and
painless and necrosis skin ulcer. He was known to have a suspicibilty died cow couple days
before. PE found extensive edema and lymphadenopathy. Gram stain ulcer revealed a gram +
rod. diagnosis?
A. Grandular brucellosis
B. Ulcergrandular tularemia
C. Cutaneus antrax  terdapat eschar + RFx cows + lymphadenopathy
D. Bubonic plaque
E. Thyphoid

40. Worried mother brings 18 months old son karena rash developed today, ada runny nose,
conjungtivitis, diare. PF: toxic appearance, temp 40 derajat last 3 days and diffuse 2-3 mm
erythematous rash begining from face. Most likely to cause rash?
A. Adenovirus
B. Coxackie
C. Morbili  termasuk rubella, rubeola
D. Human herpes 6

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 E. Parvo B19

41. 25 years old man come with chief complain fever all day long and preorbital pain. Temp 38.1,
110/90, rr 23. Management??
A. Fluid management outpatient with water and soup
B. Outpatient acetaminophen 3 times daily
C. Outpatient domperidone 3 times daily
D. Hospital management with ringer lactate 3-5 ml/kgBB
E. Hospital management with ringer lactate 10-20 ml/kgBB

42. Cowo 21 tahun, keluhannya chronic intermittent diarrhea. Karakteristiknya foul smelling dan
slimy diarrhea. Riwayat travel di india balik 6 hari yg lalu. Organism?
A. Cryptosporidium parvum
B. Aeromonas hydrophila
C. Giardia lamblia  foul smelling, slimy diarhhea
D. Shigella dysentriae
E. Vibrio cholerae

43. A 42 years old woman come with unconsciousness to the emergency department. She had
fever, tachycardia, RR 20bpm, with a BP 80/60; extremity warm; have history of chemotherapy 5
years ago for cervix cancer. Neutrophil 540/uL. She had been given 1L ringer lactate, but BP only
increased to 90/60. What is the most appropriate next step for management of the patient?
A. Take blood culture  bukan management, melainkan tindakan diagnostic.
B. Give another bolus of 2 L RL
C. give ceftriaxone 2 mg
D. Insert central venous line
E. Give vasoconstrictor  cairan gagal, kasih obat-obat vasoconstrictor coba

44. A 21-year-old male was admitted to the emergency unit by his relatives due to high fever since 5
days. He also complaint of headache, nausea & vomiting, and decreased consciousness. At
admission, he was lethargic and clinically dehydrated. Physical examination revealed jaundice

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 skin, conjunctival injection, and petechia on the soft palate region. Urinalysis showed
microscopic hematuria and pyuria. There were increased liver enzymes and increased serum
creatinine levels. Two weeks previously he had worked without gloves cleaning sewer in a
community work in his neighborhood. What is the diagnosis of this patient?
A. Amubiasis
B. Shigellosis
C. Salmonellosis
D. Leptospirosis  jaundice, fever, renal involvement
E. Trepanosomiasis

45. A worried mother bring her 18 months old son to ER due to rash that developed today. she
reports that he has had a runny nose, conjunctivitis and diarrhea. on PE, he looks ill,
temperature 40oC and diffuse 2-3 mm erythematous rash begin from hairline behind ears and
spreading to face and body. On buccal mucosa, red spots are noted. What is the most likely
causing agent?
A. rubella
B. coxsackie
C. morbili
D. hsv-6
E. parvovirus b19

*Sudah ada 2 tanda C (coryza and conjunctivitis), rash tipikal mulai dari behind ears lalu menyebar
keseluruh tubuh dan wajah, ada spots di buccal mucosa (curiga koplik’s spots). Most likely diagnosis nya
measles karena infeksi measles virus (genus Morbilivirus).

46. N/A

47. In the case above, which route the hazardous material entered the body?
A. Inhalation
B. Ingestion
C. Skin
D. Ear

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 E. Eye contam

*(kasus diatas nya kalau gasalah mengenai cutaneous anthrax, berarti jawab nya skin. Tapi kalau kasus
diatas nya measles paling cocok melalui inhalasi, bisa melalui droplet juga).

48. A 57 year old woman came with unconsciousness to the emergency ward. She had fever,
tachycardia, RR 21 bpm, with a BP 80/60; extremity warm; have history of chemotherapy 2
weeks ago for breast cancer. Neutrophil 540/uL. She had been given 1L ringer lactate, but BP
only increased to 90/60. What should you do next?
A. Take blood culture  (gw jawab ini karena kalau dihitung MAP pasien masih diatas 65, akral masih
hangat, jadi kita ambil darah buat cek sepsis).
B. Another bolus 2L ringer lactate
C. 2gr Ceftriaxone
D. Central Venous Line insertion
E. Give vasopressor  (gw tidak jawab ini karena kalau dikasi vasopressor, target yang harus dicapai
adalah MAP 65. Sedangkan pasien ini MAP sudah diatas 65).

49. a previously healthy 10 years old boy develops uncomplicated varicella. as part of his initial
management, evidence-based practice support the regular use of what oral treatment?
A. acetaminophen
B. acetylsalicylic acid
C. acyclovir  (evidence-based treatment for varicella).
D. antibiotic
E. immunoglobulin

50. A 21-year-old male came with unconsciousness since 12 hours before admission. He and his
friends drank wine 75% and "Kukubima". After 2 days in the hospital, he's awake but he cannot
see firmly. What is his problem?
A. Cortical blindness
B. Retinopathy
C. Bleeding in his eyes

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 D. Optica Neuritis  (karena konsumsi oplosan biasa nya mengalami toxication dari methanol 
causing optic nerve inflammation).
E. Wernicke Encelopathy

51. A 28 yo patient come with complaint of tingling and itching of the leg 30 min after swimming in
Lindu Lake. Afterwards, there are vesicles created. Parasites that creates this symptoms:
A. Fasciolopsis buski
B. Fasciola hepatica
C. Scistosomosis japonicum  (lokasi endemik di danau Lindu dan lembah Napu)
D. Hymenoptera sp.
E. Dercemecus

52. Schistosomiasis (japonicum), according to the previous case above, which larval stage of the
organism causing the infection?
A. Filariform
B. Cysticercus
C. Maridiform
D. Cercaria  (untuk schistosomiasis pada fase cercaria sudah bisa menginfeksi manusia).

53. Of the following, which manifestation of infection know to occur?

A. Creeping eruption  (seharus nya swimmer’s itch, jadi ini yang paling mendekati)
B. Biliary cirrhosis
C. Choleocystitis
D. Pruritus ani
E. Visceral larva migrans

54. A frustated patient was diagnosed with leprosy. He is afraid that he is cursed and goint to die.
Apa yang harus diperhatiin oleh pasiennya?
A. Rest all day and don’t do his job
B. It cannot be cured
C. Treatment in leprosy house

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 D. Look out for the wound  (pertanyaan nya apa yang harus diperhatikan oleh si pasien jadi
jawabannya jangan sampai dia kena luka tapi ga sadar).
E. Highly contagious and contact his family

55. Man from South Borneo comes to ER with abdominal pain and diarrhea. Stool specimen shows
large, elipsoidal, operculated with thin transparent shells 140x85. What is the parasite?
A. Fasciolopsis buski  (lihat dari endemik Kalimantan Selatan [Sei Papuyu] dan lihat dari ciri-ciri telur
nya).
B. Trichinella
C. Echinococcus
D. Schistosoma japonicum
E. Clonorchis

56. Apa yg harus dimengerti doktet di Indonesia mengenai leprosy?

Lesi yg numb, white patches.

57. A 21 year old college student comes with rash, mainly centripetal distribution, starting from the
trunk, to the face and spreading to other parts of the body. The rash was mainly papules,
vesicles and scabs. Many of her friends have the same symptoms. Which of the following health
intervention is the best approach to reduce the transmission of the disease?
A. Preventive  (curiga varicella, bisa dicegah dengan vaksinasi).
B. Curative
C. Rehabilitative

58. A 4 years old boy came to dermatovenereology clinic because of itching all over the body
especially at palms, side of fingers, abdomen, and buttocks. Clinical manifestations: papules,
vesicles, pustules, erotion, and excoriation on his finger webs, sides of palms and feet, hands,
abdomen. Itchy especially at night. His neighbors have the same problem, and he often plays
with them. What is the most likely diagnosis?
A. Psoriasis

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 B. Scabies  (lesi di finger webs, gatal saat malam biasanya, ada keluhan serupa pada orang-orang
sekitar).
C. Dermatitis atopik
D. Tinea corporis
E. Pedikulosis corporis

59. A patient was diagnosed septicemia. Blood culture and urinalysis was taken and analyzed. When
is the best time for taking blood culture?
A. After 36 hours obtain 3 sets of blood culture
B. Before initiation of antimicrobial treatment  (ini lebih penting sepertinya, percuma kalau pas
fever tapi habis minum antibiotik)
C. At 10 o’clock AM
D. When patient has fever

60. When a clinician does a blood culture examination, what should be concerned to create the best
results?
A. The most critical step in collecting is the proper cleaning of site  (bisa keliru dengan flora
normal kulit)
B. Draw the blood at fever spikes
C. Determine type of culture bottles as indicated per physician order
D. Amount of blood for culture drawn less than 10 ml.

61. A 51 years old man came to OPD with eruption in his left elbow since 3 days of his trip. The area
6 cm, linear, erythema to bulbous lesion. The possible causes?
A. Dermacentor andersoni
B. Paederus peregrimus  (lesi khas pada serangan tomcat)
C. Lactrodectus mactans
D. Loxoxceles laeta
E. Lytaa versicatoria

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 62. A 7 years old girl had runny nose that developed a yellowish-honey coloured scab around her
nose and mouth since 2 weeks ago. Her parents consulted with their family physician whether
they should ignored this condition because it was related to the changing whether and would
disappear by itself and that there is no need to give any medication. As family physician, what
information would you give to the parents?
A. It will recure in the future and cannot be healed completely.
B. This is kind of allergy and need anti allergy drugs
C. It is self-recovery diseases and no need medication
D. This can cause glomerulonephritis  (sebagai dokter harus menjelaskan possible complication
walau memang bisa sembuh sendiri).
E. This is inherited and no need treatments

63. A man living in Bali came to the ER presenting with generalized seizure. CT of the brain shows
calcification. On brain biopsy reveals scolex with rostelum. Causative agent is?
A. T. Solium  (scolex parasit tersebut ada rostelum nya)
B. E. Granulosus
C. T. Spiralis
D. T. Saginata
E. T. Cati

64. Of the following, which one is the most likely mode by which this disease in the above clinical
case acquired?
A. Ingestion of larvae in contaminated food
B. Ingestion of cyst in contaminated food
C. Ingestion of egg in contaminated food  (untuk bisa menyebabkan cysticercosis harus menelan
telur T. solium dalam makanan atau minuman [tidak harus kosumsi daging babi]).
D. Ingestion of poorly cooked beef
E. Ingestion of poorly cooked pork

65. A laboratory examination of a leprosy patient after 4 months M D T therapy revealed Bacterial
index 6+ and morphological index 50%. What is your conclusion for this result?

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 A. Pausibacillar leprosy patient sensitive to treatment
B. Multibacillar leprosy patient sensitive to treatment: Setelah treatment morophological index
turun sampe 25%an
C. Multibacillar leprosy patient resistent to treatment  (BI sampai +6 udah masuk MB Leprosy.
Lalu setelah diberikan obat masih 50% MI  curiga resistant).
D. Pausibacillar leprosy patient resistent to treatment
E. Pausibacillar leprosy patient prone to nerve damage

66. A 5 years old boy came to a paeditrician because of poor appetite. Physical examination shows
he is small for his age and had a slightly enlarged liver. Lab examination found marked
eosinophillia. When questioned about pets her mother reported her son likes to spend a gread
deal of time with his puppy. Of the following, which of the parasitic below is responsible ??
A. Echinococcus granulosus
B. Strongyloides stercoralis
C. Enterobius vermicularis
D. Trichinella spiralis
E. Toxocara canis  (lebih most likely daripada E. granulosus, karena kalau E. granulosus biasanya ada
di daerah endemik sheepdogs. Namun T. canis dan E. granulosus kedua nya bisa sebabkan liver
enlargement).

67. (Lanjutan soal toxocara) From the case above (toxocara), what is the clinical manifestation
of the infection is known to occur?
A. Creeping Eruption
B. Visceral larva migrans  ex. Toxocara canis, Toxocara catii
C. Biliary cirrhosis
D. Cholangitis
E. Pruritus ani

68. A 36-year-old man attended outpatient clinic with complains of fever more than 1 week. Blood
smear examination show erythrocyte with ring form, and infected red cell is enlarged. Of the
following, which is the most likely diagnosis of this patient?

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 A. Vivax malaria  enlarged rbc
B. Falciparum malaria  x enlarged rbc
C. Malariae malaria  x enlarged rbc
D. Ovale malaria
E. Knowlesi malaria

69. cowo 10 tahun, difficulty breathing dan noisy breathing 2 hari. Ada fever, cough, myalgia,
headache, hoarseness. PF ketemu bilateral neck lymph node enlargement, white membrane di
tonsil. Mau exam apa selanjutnya?
A. Throat swab - liat gram staining dan culture  white membrane di tonsil curiga diphteri
B. CBC – searching for any clue of bacterial infection
C. Bronkoskopi – you to check any airway obstruction
D. Neck x-ray – to reveal any laryngeal edema
E. Consult to ENT specialist

70. 45tahun male pelihara pig di rumahnya terus penyakitnya kena apa?
A. schistosoma japonicum
B. entamoeba histolitica
C. trichinella spiralis
D. clonorchis sinensis

71. Of the following disease, most likely source?

A. Eating larva in contaminated food
B. Eating eggs in contaminated food
C. Eating cyst in contaminated food
D. Undercooked pork
E. Undercooked beef

72. A patient on MDT drugs complaining about red urine that he experienced on the first day of
treatment. What would you suggest to this patient?
A. Stop clofazemin, cause dark brownish discoloration

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 B. Stop medication cause of nephrotoxicity
C. Stop dapsone, cause hemolytic anemia
D. Continue medication, it’s not medication adverse effect  continue medication, efek dari
rifampicin bisa bkin red urine
E. Change to single agent therapy

73. 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 +. Of the following, which parasite can be the cause of this disorder:
A. Plasmodium falciparum
B. Plasmodium vivax
C. Plasmodium malariae  malaria kuartana (demam setiap 4 hari)
D. Plasmodium ovale
E. Plasmodium cynomolgi

74. Referring to the case above, what is the pathogenesis of the fever?
A. Sporozoites in blood
B. Hypnozoite in liver is formed
C. Pigment in parasite is formed
D. Gametocyte in blood
E. Merozoite release from schizont in blood  ini yang menyebabkan terjadinya fever

75. A 23 years old man presents with extreme swelling of his legs and scrotum. The skin associated
with the swollen area is thick and scally. The patient admits to an episode of fever associated
with enlargement of inguinal lymph nodes some times ago, but did not think much of it.Which
of the following is the best method to make diagnosis?
A. Examine the stool for the presence of egg
B. Examine the stool for the presence of larvae
C. Examine the blood smear for the presence of Adult worms
D. Determine the titer of IgE antibody against the parasites

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 E. Examine the blood smear for the presence of microfilaria  untuk diagnosis dari lymphatic
filariasis

76. On the following, which is the most appropiate treatment for this condition above?
A. Surgical excision
B. DEC  Drug of choice
C. Metronidazole
D. Mebendazole
E. Thiabendazole

77. Ada pembesaran di kaki kanan. Pada pemeriksaan mikroskopik, ada mikrofilaria dengan ciri
deeply stained with giemsa, nuclei from tip to tail, in tail there is 2 separated nuclei.
A. Brugia timori  (ruang kepala 3:1, lekuk tubuh kaku banget, penyebaran inti tumpang tindih,
sarung tidak mengambil warna, ekor 2 inti tambahan)
B. Brugia malayi  (ruang kepala 2:2, penyebaran inti tumpang tindih, lekuk badan kaku, ekor 1-2 inti
tambahan, sarung mengambil warna)
C. Ovavulus
D. Wuchereria bancrofti  (ruang kepala 1:1, penyebaran inti merata, ekor tidak ada inti tambahan,
lekukan tubuh halus, sarung gk mengambil warna)

78. Referring to the previous cases, causes of the symptoms (elephantiasis) is?
A. Obstruction of arteries by microphilariae
B. Obstruction of arteries by adult worm
C. Obstruction of lymphatic by microphilariae
D. Obstruction of chronic lymphatic by adult worm
E. Fibrosis in lymphatic vessel

79. N/A

80. N/A

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 81. HIV +, dalam pengobatan TB sejak 1 bulan lalu, dan Hep. B +, intial antiretroviralnya?
A. Zidovudine + Lamivudine + Efavirenz
B. Tenofovir + Emtricitabine + Efavirenz
C. Tenofovir + Emtricitabine + Nevirapine
D. Zidovudine + Lamivudine + Nevirapine
E. Zidovudine + Lamivudine + Ritonavir/Iopinavir

82. A 45 tahun wanita, datang ke RS karena diare selama 3 hari, sebanyak 5-6x, sebelumnya dia
dirawat di RS karena pneumonia. Ada riwayat nasopharynx Ca, faktor yg mempengaruhi diare?
A. Agent not usually cause disease in healthy person
B. Evolution of pathogen sehingga bisa ke new host
C. Development of drug resistant of pathogen
D. Non-adherence pasien dalam minum pneumonia drugs
E. Pake counterfeit drug

83. A 29 year old female come to her family physician for a consult. She will go to Papua next one
week. She is married and have not had her period for 2 months. What drugs for prophylaxis?
A. Atovaquone/proguanil 2 days before departure
B. Doxycycline 2 days before departure
C. Mefloquine a week before departure  (utk Ibu Hamil)
D. Primaquine a week before departure
E. Sulfadoxine-pyrimethamine a week before departures

84. A boy 8 y.o. was brought to the emergency department by his mom because of vomiting and
dyspnea. He has fever 39.9°C. He was playing in the backyard, on examination the were several
stings mark on his backs. What is the most possible insect bites?
A. Permacentos andersoni
B. Lactodectus mactans  black widow spider
C. Loxoxceles laeta  laba”
D. Hymenoptera sp.  lebah (sting; bisa multiple karena bisa menyerang berkelompok/spesies
tertentu bisa sting berkali”)

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 E. Lytta vesicatoria  emerald green beetle

85. Orang tertusuk jarum suntik orang lain yang belumjelas status HIV nya, langkah selanjutnya?
A. Rapid test
B. Post-exposure HIV prophylaxis
C. Start antiviral
D. Do nothing

No Number

1. Woman septicimia, wants to do blood culture and analysis. When a clinician does a blood
culture examination, what should be concerned to create the best results?
A. The most critical step in collecting is the proper cleaning of site
B. Draw the blood at fever spikes
C. Determine type of culture bottles as indicated per physician order
D. Amount of blood for culture drawn less than 10 ml.

2. a 34 year old male came to a clinic with chief complain of 7 day fever. His high fever occured
every 3 days. His high fever preceeded by chills and afterward he sweat profusely. He had a
vacation to the jungle of borneo a week prior to his fever. He had not take chloroquine as
prophylaxis before he went to Borneo. What factor contributing to his fever?
A. evolution of pathogen
B. resistance of vectors to insectiside
C. his susceptibility to infections  karena pasien tidak mengambil langkah” prevensi
D. resistance of the pathogen of the prophylaxis drug

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