TROPMED 2013
Kerja di poultry dan ayamnya
TROPMED
1. Patient brought to clinic because of
some nodules on his arm and body and
sometimes feel pain with pressure. On
examinations we found erythematous
nodules, smooth and shiny, diffuse
infiltrate with ill define border, no
fluctuation or erosion. There were pain
on his elbow with nerve enlargement,
best stain for examination?
A. KOH
B. Giemsa
C. Zn Stain
D C. Hand swab
E D. Anal swab
2. Metode pengambilan darah untuk orang
infective endocarditis? 3 kali di lokasi
berbedainterval waktu 10 menit
3. Orang kena malaria, dicek demam
tinggi, parasitemia +++, diberikan
artemisinin, 3 hari kemudian saat dicek
masih ada demam dan parasitemia
++++, keadaan spt ini disebut apa?
A. Early treatment failure
B. Late treatment failure
C. Late paracitemia
D. Early paracitemia
E. Late manifestation
4. Orang datang ke klinik, demam tinggi
dll (malaria), manifestasi klinis pasien
ini terjadi pada saat nyamuk dlm
stadium apa?
A. Tropozoit
B. Sporozoit
C. Merozoit
D. Mikrogametosit
E. Makrogametosit
5. Pasien mengalami demam tinggi pada
hari ke 4 dan didiagnosis malaria,
termasuk malaria golongan apa?
Malaria Malariae
6.
pada mati, ada gejala
influenza, apa virus yg
mungkin nyerang?
a. Orthomyxoviridae
7. Zat apa yg digunakan utk membersihkan
feses burung?
A. Iodin
B. Etanol 70%
C. Etanol 90%
8. Best virus isolation utk kasus di atas?
A. Blood
B. Nasopharyngeal aspirate
E. Nasal swab
9. Orang kena malaria, demam tinggi, kena
parasitemia 3,5%, kenapa terjadi kondisi spt
ini? Merozoit dikeluarkan dari liver menuju
darah
10. 45yo man was seen in the dermaotlogy
clinic because of some nodules on his arm
and body and sometimes feel pain with
pressure. On examination was found
erythematous nodules, smooth and shiny
diffused infiltrate with ill define border, no
flunctuation or erosion. There were pain on
his elbow with nerve enlargement.
Diagnosis?
a. yaws
b. leprosy (ada nerve enlargement bagian elbow
& lutut
c. anthrax
d. cellulitis (jawaban 2012. Yakin neh nggak
ngaco???)
e. carbuncle
11. A laboratory examination of a leprosy
patient after 4 months MDT therapy
revealed Bacterial index 6+ and
morphological index 50%. What is your
conclution for this result ?
(MULTIBASILER: >6, SIMETRIS)
a. Pausibacillar leprosy patient sensitive to
treatment
b. Multibacillar leprosy patient sensitive to
treatment
c. Multibacillar leprosy patient resistent to
treatment
d. Pausibacillar leprosy patient resistent to
treatment
e. Pausibacillar leprosy patient prone to nerve
damage
12. Yang harus di considerate untuk pasien
suspect leprosy? Lesi di tubuh yg painless
&numb
13. Pasien kena malaria, best drug of choice:
A. Doxycicline
B. Chloroquine
C. Mefloquine
D. ACT
14. G3P2A0 gejala anak chorioretinitis, cerebral
calcification, hepatomegaly, splenomegaly,
berat badan lahir rendah. Ibunya dalah suster
di RS siloam, tidak pernah kontak dengan
kucong. Diagnosis?
a. congenital toxoplasmosis
b. congenital CMV karna ga ada kucing
(heart defect, blueberry muffin
baby, hepatosplenomegaly,
ventriculomegaly, periventricular
calcification)
c. congenital rubella (retinopathy,
congenital cataract, microphthalmia,
congenital heart disease)
d. congenital herpes (vesicular eruption,
ensefalitis)
15. a baby is born with a rash identical.
Questioning reveal that the mother had a febrile
illnes during the second teimester 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
c. congenital CMV
d. congenital malaria
e. congenital varicella
16 A baby is born with a rash identical. History
taking reveals that the mother had a febrile
illness during the second trimester of pregnancy.
Examination reveals diffuse raised purple skin
lesions. There is no pallor, jaundice, or cyanosis.
The baby has spread over his body especially on
arm and legs also fever. What is the most likely
diagnosis ?
a. Celulitis
b. Furuncle
c. Erythema nodosum
d. Multibacillar leprosy
e. Pausibacillar leprosy\
17 Residen mengeluh karena di ruangannya AC
terlalu dingin, suara berisik dan lampu terlalu
silau. Termasuk hazard kategori apa? Physical
hazard
18 A 10-year-old boy who has moved to your
practice recently has sore throats, get high
temperature. The child reports a runny nose,
mild cough, and abdominal pain. Findings on
physical examination include a temperature of
100.3°F (38°C), and vesicular lesions on the soft
palate. There is no cervical adenopathy or rash.
Of the following, the MOST likely diagnosis is
a. Adenovirus infection
b. Coxsackie virus infection
c. Mononucleosis
d. Sinusitis
e. Streptococcal pharyngitis
A 2 years old boy brought to
dermatovenereology clinic because of itching all
of the body. He complains itching on palm, side
of finger, buttock, and abdomen. Clinical
manifestations are papule, vesicle, pustule,
erotion, and excoriation especially at finger web,
arm, abdomen, side of hand and feet, itchy
especially at night.His neighbours have same
problem.He usually play together with his
neighbours.What is the diagnose this patients?
 a. Pediculosis corporis area when she out for duty for several
b. Scabies days. She also had diarrhea and
c. Tinea corporis abdominal discomfort. On physical
d. Dermatitis atopik examination reveals blood pressure
e. Psoriasis 110/70 mmHg, heart rate 60 ×/min, RR
20x/min, temp. 39.1°C. Tongue is
20 A patient on MDT treatment complaining coated and tremor. Fetal USG shows
about red urine that he experinced on the first normal.
day of treatment. What is the suggestion for this
condition ? What is the most likely etiologic factor
above?
a. Stop Clofazimin, can cause pink
brownish discolouration a. Salmonella typhi
b. Continue the medication, a drug adverse b. Plasmodium falciparum
effect c. Vibrio cholera
c. Stop the medication because of d. Hepatitis A
nefrotoxicity e. Escherichia coli
d. Stop Dapsone can cause anemia
hemolytic 24. Best laboratory examination to detect
e. Change the treatment to single drug S.typhii? Blood culture
therapy
25. Best treatment for scabies? Gamexane
21. A 27-year-old female has just returned
from a trip to Southeast Asia. In the past 26. Tukang kebon dtg ke klinik dgn keluhan
24 hours, she has developed shaking, demam tinggi sampe 39,5 derajat,
chills, and a temperature 40o C. A blood profuse sweating, mual muntah, best lab
smear reveals Plasmodium vivax. Which examination? (suspect malaria)
of the following agents should be used
to eradicate theextraerythrocytic phase A Blood culture
of the organism? B Stool
C Saliva
a. Primaquine D Blood smear
b. Pyrimethamine E
c. Quinacrine
d. Chloroquine 27 Transmisi penyakit yg mungkin utk kasus
e. Chologuanide diatas? Direct skin scale contact (digigit
nyamuk)
22. Ibu hamil mau bepergian ke Papua, obat
prophylaxis yg cocok buat dia? Anak demam 2 hari, dokternya suspek
Mefloquine DBD.mau cek apa?
A. NS1
B. Hematocrite
(nggak boleh dikasih doxi & kalo C. IgM
dikasih chloroquin percuma krn
mungkin resisten)

28 Workplace health hazard can cause

23. A 26-year-old nulliparous woman, in reaction. Asthma, and dermatitis caysed
her seventh month of pregnancy by whicch reaction?
complains of a 7 days history of fever
especially at night. As she recall, 2 a. immediate reaction
weeks ago she ate gado-gado in coastal
b. acute lumbar MRI are also normal.
c. gradual
d. delayed What is the most likely transmission of her
e. no reaction infection?
a. Droplet
30 cowo aktif sexual partner tapi pake b. Air borne
pelindung, terus mau screening. Screening pake c. Fecal-oral (suspect polio)
apa? d. Close contact
e. Animal bite
a. HIV-RNA
b. CD4 count 35 A 5 year old boy was brought to emergency
c. Rapid test department with complaining of paresthesia of
d. western blot the fingers and lower extremity muscle
e. HIV-ELISA weakness since two days ago. The weakness
progress involves the truncal muscles. Possible
31 Elephantiasis is caused by the obstruction of : diagnsosis?
a. The arteries by microfilariae
b. The arteries by adult worm a. Guillain-Barré syndrome (ascending
c. The lymphatics by microfilariae paralysis)
d. The chronic lymphatics by adult worm b. Poliomyelitis
e. Fibrosis of the lymphatic c. Encephalitis
d. Meningitis
32 A 40-year-old man came to the clinic with e. Multiple Sclerosis
complaints of having fever more than one-week,
nausea, and fatigue. He came back from Timika, 36 A 53-year-old male farmer developed low-
Papua. On blood smear examination, there are grade fever, abdominal pain, and diarrhea. He
late trophozoites forms, schizonts with 12-24 has a skin lesion of black eschar surrounded
merozoites, and the infected red cell is by vesicle and edema near his mouth. A week
enlarged.Diagnosis? P vivax before, his notice many cattle in his farm were
sick, but he still eats a half-done beef steak
33 A 10-month-old healthy male infant from his cattle.
travelling with his family to Africa was
exposed 4 days ago to his 4-year-old native What is the following microorganism is
African cousin who was ill at the time with most likely involved in this case?
fever, cough, coryza and conjunctivitis. The a. Bacteroides fragillis
baby was at risk to get infected by: b. Leptospira interrogans
a. Corynebacterium diphtheriae. c. Bacillus anthracis (bakteri gram positif)
b. Haemophilus influenzae d. Pasteurella pestis
c. Bordetella pertussis e. Borrelia burgdorferi
d. Morbilivirus à measles
e. Coxsackievirus 37 cowo, MSM, datang ke poliklinik mau
evaluasi treatment HIV nya. 1 minggu lalu, HIV
34 A 65-year-old-woman suddenly had + dan CD4 <350. Next step management?
paralysis of her left leg. A few days ago, she
had headache, fever, sore throat, and nausea. a. start arv
She lives with her son; daughter in law and a b. cek tb
young grandchild who’s just received a c. kasi prophylaxis
routine oral vaccination. She is taking d. rapid test
immunosuppressant for her kidney’s e. do nothing
transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan and 38 52- year old man is brought to the
emergency department in an unconscious above?
condition. On examination, he was death form a. Salmonella typhi
more than one hour. On autopsy of the brain, b. Shigella dysenteriae
there is cyst‘s fluid containing protoscoleces c. Enterohemorragic E. coli
with hooklets and many daughter cysts were d. Staphylococcus aureus
found. What is the most likely diagnosis of e. Enterotoxigenic E.coli
this disease?
41 A 3-year-old boy was brought to emergency
a. Hydatidosis unit in Tangerang Hospital with stridor,
b. Cysticercosis dyspnea, and “croupy” cough, What is the most
c. Cerebral malaria likely pathogenic agent that causes the patient’s
d. Hstoplasmosis disease?
e. Toxoplasmosis a. Bordetella pertussis
b. Haemophilus influenzae
39 A 27 year old women suffering fever for 2 c. Coxsackievirus
day. She brought to emergency department d. B. Parapertussis
unconsciously and she had general seizure 2 e. C. diphtheriae
hour ago. On physical examination she is
comatous, GCS (Glasgow Coma Scale) : 3; BP 42 What is the laboratory test to confirm the
90/60 mmHg; t 41 °C. Lab. finding: Hb 10, 3 diagnosis in this patient?
gr%; WBC 5800/mm3; platelet 39.000/mm3;
there is schizon form on blood smear. Why the a. Blood culture
pathogeniv agent of this disease becoming the b. Throat swab culture
most dangerous species? c. Chest X-ray
d. Measurement of IgG antibody serum
a. It make long term relaps e. Urine culture
b. Intermittent fever
c. Gametocyte formation take place in 43 A 70 years old women, come to
visceral organ dermatovenereology clinic because she
d. Can make capillary obstruction in complains pain, edema on her left eyelid and
Central Nervous System by parasite there is some vesicle in her left forehead. She
contain erythrocyte -> rosette complain pain on her forehead 2 days ago, but
e. There are many drug resistance against vesicle come out 1 day ago.She sometimes fells
P. falciparum headache and fever. Clinical manifestation are
grouped vesicle, eritema base at her left
40 A female tourist developed face.What is the diagnose of this patient?
gastroenteritis while visiting small
town in Indonesia and tried some a. Varicella
Indonesian traditional food. The onset b. Herpes zoster (acyclovir and B1)
of the disease is abrupt with c. Herpes simpleks
abdominal cramps and watery d. Dermatitis venenata
diarrhea. She had no fever or nausea e. Dermatitis iritan
or vomiting. The symptoms have
resolved within 24 hour and no 44 A 19-year-old woman comes to
subsequent recurrences. They report Emergency Department with signs and
the disease to district public health symptoms of poisoning of an agent include
office. The investigation found that nausea, vomiting, abdominal cramps,
one of the food products eaten by this diarrhea, excessivesalivation, headache,
tourist was contaminated by suspected giddiness, rhinorrhea, tightness in chest,
pathogens. What is the suspected pin-point pupils parasimpatetik activity,
pathogen may cause the disease mental confusion, and muscle twitching.
 Which of the following is themost likely
agent caused those symptoms?
a. Acetaminophen (liver failure)
b. Barbiturate
c. Carbamate
d. Cyanide
e. Opiate (ga bisa pakai SLUDGE and
DUMBEL)
45 Orang demam tinggi, nyeri belakang mata,
demam, Hb Ht naek, berdasarkan WHO,
diagnosisnya apa?
A. Dengue fever
B. DHF (hemokonsentrasi & tanda
perdarahan)
C. Severe Dengue
46 49 yo man come to dermatologist because of
creeping in left elbow on day 3 trip. Eruption
6cm, linear, erythematobolbulus.Most possible
causees?
a. dermacentor andersoni
b. lactrodectus mancans
c. loxoxsceles laeta
d. lytta sesuatu
e. paederus peregrinus (tomcat)
47 A 44-year old man on a business trip to South
Kalimantan (Sei Papuyu) from Jakarta presented
to the emergency department with symptoms of
diarrhea and abdominal pain. On physical
examination was found pitting edema of the
abdominal wall and of the legs. A stool
specimen was sent to the laboratory for culture
and for ova and parasites. Blood was drawn for a
CBC. The culture was negative for enteric
pathogens. The patient was found to have
eosinophilia. The wet mounts from the
concentrated stool specimens revealed large,
ellipsoidal, operculated parasite eggs with thin,
transparent shells (140 x 85 µm).
Of the following, which parasite can be the
cause of this disorder :
a. Schistosoma japonicum (danau
lindu)
b. Fasciolopsis buski
c. Trichinella spiralis
d. Echinococcus granulosus
e. Clonorchis sinensis
48 hematuria dan oval shaped and ada di
terminal spine?
schistosoma hematobium
49 40yo berenang di danau lindu, gatal2, besok
muncul papul, most likely pathogen?
schistosoma japonicum
50 Bentuk infeksi yg nyerang pasien tsb (soal
49): SERKARIA
51 Manifestasi klinisnya: (dari buku UI:
stadium 1 urtikaria, kalo intoksikasi
disertaidemam, hepatomegaly &
eosinophilia tinggi ; stadium 2 sindrom
disentri ; stadium 3 sirosis hati &
splenomegaly)
a. creeping eruption
b. billiary cirrhosis (gw jawab ini)
c. cholecystitis (jawaban 2012, yakin nih?)
d. pruruitus ani
e. visceral larva migran
52 a 23yo man presents with extreme swelling
of his legs and scrotum. The skin associated with
the swollen areas 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 presence of eggs
b. examine the stool for the presence of
larvae
c. examine the blood smear for the
presence of adults worm
d. determine the titer of IgE antibody
against the parasites
e. examine the blood smear for the
presence of microfilaria
53 Treatment yg cocok utk case diatas (suspect
filariasis)? DEC (Diethylcarbamazine Citrate)
=>wkt kt bljr sempet gw sebut ini
54 A 40 year old man came to hospital with four
timesgeneralized tonic-clonic seizure sincetwo
week ago. There was no history of seizure and
head trauma. A one year ago, he hadbusiness in
Papua for six months. During his stay in there,
he often consumed under-cookedpork. Brain
MRI showed a small cystic with invaginated
scolex inside. What of thisfollowing is the most
likely inside cyst?
a. Taenia eggs
b. Cycticercosis cellulose (di mata, CNS,
kulit) -> nama lain cysticercus larva
c. Cysticercosis bovis
d. Taenia solium worm
e. Taenia saginata worm
55 Possible etiology case di atas? Undercooked
pork
56. a 39 yo woman whose husband has a pig at
home kept for house purposes come to the
family doctor with symptoms of periorbital
edema, weakness and muscle pain. What is the
most probable parasite causative in this case?
a. schistosoma japonicum
b. f. buski (edema extremitas and muka)
c. trichinella spiralis
d. echinococcus granulosus
e. clonorchis sinesis (cholangitis, obstructive
jaundice, thailand, kantung empedu)
57 Etiologic cause case di atas?
a. eating larvae in contaminated food
b. eating eggs in contaminated food
c. eating cyst in contaminated food (lebih ini)
d. undercooked pork
e. undercooked beef
58 A patient complains of having nail size
excrement from his anus. On the stool
examination, parasite eggs contains a
hexacanth embryo with six hooklets
surrounded by radially striated spherical shell,
30 to 40 u in diameter were found, the most
likely diagnosis of this patient is :
a. Saginata taeniasis (di feses biasa
ditemuin proglotid)
b. Solium taeniasis (keluar cuma pas
boker)
c. Cysticercosis
d. Oxyuriasis
e. Ascariasis
59 a 14 yo boy fell from bicycle,
last immunization at 18month,
(4th doses) 4-6 year
immunization wasn’t done.
What terapy should be given?
a. tetanus Ig
b. human iv Ig
c. tetanus toxoid
d. anti tetanic serum (vaksin)
60 Cara ngambil specimen darah yg baik?
Gw lupa pilihannya, pokoknya di
handout dia blg: diambil saat yg tepat
(cthnya pas suhu naek), peralatan yg
baik, ambil pas pasien blm minum
antibiotic
61 56 year old sheep farmer presents with
abdominal pain. Liver is enlarged with
palpable mass at right upper quadrant.
CT scan reveals a large encapsulated
lesion consistent with HYDATID
CYST. What organism may have cased
this? Echinococcus granulosus
62 manifestasi apa yang paling berbahaya
ketika surgucal removal case di
atas?bayangin aj, ni soal di angkatan lu
sempet keluar tp ga ada yg nyatet
atasnya. Anjeng bener
emg…!!!!!!!!!!!!!
a. seizure
b. hemorrhage
c. peritonitis
d. anaphylactic shock
e. cardiac arrest
63 The patient was 3 y.o girl who was
seen by her pediatrician for a routine
physical exam. Her mother was
concerned about her daughter’s poor
appetite. Physical exam revealed that
the child was small for her age and
had a slightly enlarged liver. Blood
 was collected for a routine CBC, since
she had previously been slightly
anemic. Hb normal, eosinophilia, no
travel history, melihara anak anjing di
rumah. Possible cause? Toxocara
canis
64 Manifestasi klinis case di atas? Visceral
larva migrans
65 A 40-year-old man came to the clinic
with complaints of having fever more
than one-week, nausea, and fatigue.
He came back from Timika, Papua.
On blood smear examination, there
are late trophozoites forms, schizonts
with 12-24 merozoites, and the
infected red cell is
enlarged.Diagnosis? P. vivax (kalo
ovale, merozoitnya 8-12)
66. Cewe, flank pain, pas urinalysis hasilnya
positive nitrate dan many leucoytes, next
step>
a. urine culture
b. PCT oral
c. USG
d. .
e. IV ceftriaxone
67. 9 years old susah nafas, noisy breathing
sejak 3 hari yang lalum juga ada fever cough
myalgia headache hoarseness. Refuse to eat
karena sakit tenggorokan, ada pembesaran
KGB leher, white membrane di tonsil.
Additional exam?
f. Neck xray to reveal laryngeal
edema
g. CBC – liat infeksi bakteri
h. Throab swab – untuk gram
staining danswab kultur
i. .
j. refer THT
68 A boy brought by his mother to the
emergency department of Siloam hospital
because of vomit & dyspnoea. According to his
mother, her son was playing in the backyard. On
physical examination, the boy was found to have
high fever (39 ºC) and multiple stinging on the
back. The most likely species of insect bites is :
a. Hymenoptera sp (lebah)
b. Dermacentos andersoni (kutu
anjing)
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria
69 21yo man come to emergency department
due to high fever, headache, nausea and
vomiting and constant sleepiness for 5 days.
At admission, he look lethargic and
dehydrated. At PF, he look jaundice,
conjuctival injection and … there are liver
dysfunction and increased creatinine.The
relative stated that the family live in village,
tempoarte climate. Previous 10 days, he
worked on irrigation channel and isinya air
sungai. What is your diagnosis?
a. treponemasis
b. shigelosis
c. salmonelasis
d.
e. leptospirosis
70 A 35-year old man working on pig farm is
brought by his employer to the emergency
department of Siloam hospital because of
seizure and bilateral lower extremity weakness.
CT scan of the head reveals several calcified
regions. Laboratory examinations show WBC
count of 10.800/mm3, with eosinophils. Brain
tissue biopsy reveals scolex with hooklets.
Which one is the treatment of choice for this
case?
a. Sulfadiazine-pirimetamin
b. Artemisinin
c. Albendazol
d. Metronidazol
e. Itrakonazol
71 A 35-year-old man as a farm worker who
was working with pesticides is brought to the
emergency room with headache, vomiting,
salivation, diarrhea, muscle fasciculation,
difficulty walking, and difficulty speaking. His
clothing has been removed, he has been
washed, and he has been given activated
charcoal. What is the most effective remaining
treatment for this case of pesticide poisoning?
a. Epinephrine
 b. Antacid microfilaria ciri deeply stain giemsa (, inti
c. Spironolactone sampe ke ekor dan teratur, perbandinga
d. Atropine kepala ekor 2:1, parasit apa?
e. Hidrochlorothiazide
a. wuchereria bancrofti (1:1)
72. Occcult filariasis is Lymphatic filariasis b. brugia malayi
based upon c. brugia timori (3:1)
a. infection
b. allergy d. onchocerca volvulus
c. infestation e. loa loa
d. colonization
e. genetic 78 One member of the NGO (Non-
Governmental Organization) team from
Indonesia has been reported dead in Mexico
because of a spider’s bite. The possible cause of
73. frustated patient diagnosed with leprosy.
this disorder is ;
He is afraid that he is cursed abd going to
die. As a medical doctor, what will you say
a. Erucism
to the patient?
b. Lepidopterism
a. rest all day and don’t do his job
c. Tick paralysis
b. cannot be cured
d. Arachnidism
c. treatment in leprocy house
e. Delusional parasitosis
d. look out for wound
e. highly contagious and contact his family
79 Orang HIV, ada riwayat TB dan Hepatitis
B. kombinasi obat yg dipake?Gw lupa, tp gw
74 a patient come with an itchy recured
jawabnya yg Emicitabine, Tenovovir,
fungal infection on feet, doctor already give
Efavirenz. Pelajarin sendiri aja ye?
him some medication for fungal infection,
what can be advised to make him healthy?
80 a 45 yo women, ke rs karena diare 3 hari,
tiap hari 5-6x, sebelumnya dirawat di rs karena
a. don’t eat seafood
pneumonia.Pernah ada history nasopharunx
b. always use sandals
CA, faktor yg mempengaruhi diare?
c. keep the skin dry and clean
ORANGNYA HIV MAYBE OR CHEMO
d, don’t use shoes all day long
a. agent not usually cause disease in healthy
e. don’t scratch, it will spread the infection
person
b. evolution of pathogen shg bisa ke new host
75 Komplikasi demam thypoid paling
c. development of drug resistant of pathogen
sering dimana?Ileum distal (pilihannya wkt
d. non-adherence pasien dlm minum penumonia
itu adacolon gt2)
drugs
e. pake counterfeit drugs
76 Cewe kena tusuk jarum suntik orang yg kena
HIV, langkah selanjutnya?
81. Anak sekolah diperiksa ada gatel2 dll (gejala
scabies), trus temen2nya di kelas jg ngalami
A. Rapid test
keluhan yg sama. Langkah yg seharusnya
B. Post-exposure HIV prophylaxis (gw
dilakukan?
jawab ini)
C. Start antiviral
A Preventif
D. Do nothing
B Kuratif
C Rehabilitatif
77 cewe dtg dgn keluhan bengkak di
D Promotif
tungkai bawah, thick blood smear ada
E Environmental modification (gw nembak
 jawab ini) d. H6 dan H8

e. H9 and H11
TROPMED 2012
(thio) Kerja di poultry dan ayamnya pada mati.
35 tahun, ada gejala influenza, apa virusnya? 8. hep B positive, HIV positive, tb positive,
treatment untuk HIV? TEE
a. orthomyxoviridae

(dion) anak luka trus uda di ksi vaksin tetauns, 12. dari kasus 11, manifestasi apa yang paling
tapi hanya sekali. Management skrg apa? berbahaya ketika surgucal removal?

Jawaban : Tig a. seizure

b. hemorrhage

(guntur) 24 thn skoleks ditemukan di CT scan c. peritonitis

atau MRI. d. anaphylactic shock
a. taenia solium e. cardiac arrest
b. b. toxo
c. c. echinococcus

14. manifestation of infection above:

2. salmonella typhii, lab diagnosis?
a. creeping eruption
a.stool culture
b. biliary cirrhosis
b. blood culture
c. cysticercosis
c. swab
d. pruritus ani
d?
e. visceral larva migrant
e?

15. a 39 yo woman whose husband has a pig at

3. lab exam buat salmonella? home kept for house purposes come to the
family doctor with symptoms of periorbital
a. IgM salmonella edema, weakness and muscle pain. What is the
b. anti HCV most probable parasite causative in this case?

a. schistosoma japonicum

7. which subtype are known to cause HPAI? b. f. buski

a. H1 and H3 c. trichinella spiralis

b. H2 and H4 d. echinococcus granulosus

c. H5 and H7 e. clonorchis sinesis

 b. lactrodectus mancans

16. atasnya soal trichinella spiralis? c. loxoxsceles laeta

a. eating larvae in contaminated food d. lytta sesuatu

b. eating eggs in contaminated food e. paederus peregrinus

c. eating cyst in contaminated food

d. undercooked pork 25. cewe dtg dgn keluhan bengkak di tungkai

bawah, thick blood smear ada microfilaria ciri
e. undercooked beef deeply stain giemsa, inti sampe ke ekor, parasit
apa?

a. wuchereria bancrofti
17. ada org datag dengan demam lebih dari 1
minggu. Dari blood smear ada parasit bentuk b. brugia malayi
cincin dgn pembesaran sel darah merah. Kena
apa? c. brugia timori

a. plasmodium vivax d. onchocerca volvulus

b. p. malariae e. loa loa

c. p. falciparum

d. p. ovale 26. frustated patient diagnosed with leprosy. He

is afraid that he is cursed abd going to die. As a
e. p. knowlesi medical doctor, what will you say to the patient?

a. rest all day and don’t do his job

18. demam tiap hari ke-4 b. cannot be cured
jaw : plasmodium malariae c. treatment in leprocy house

d. look out for wound

21. treatment no 20 e. highly contagious and contact his family
a. metronidszole

b. dietilcarbamasin 28. a patient come with an itchy recured fungal

infection on feet, doctor already give him some
c. mebendazole medication for fungal infection, what can be
advised to make him healthy?

23. 49 yo man come to dermatologist because of a. don’t eat seafood

creeping in left elbow on day 3 trip. Eruption b. always use sandals
6cm, linear, erythematobolbulus.Most possible
causees? c. keep the skin dry and clean
a. dermacentor andersoni d, don’t use shoes all day long
e. don’t scratch, it will spread the infection c. stop the medication because of nephrotoxicity

d. stop dapsone can cause anemia hemolytic

29. a 45yo man was seen in the dermaotlogy e. change the treatment to single drug therapy
clinic because of some nodules on his arm and
bpdy and sometimes feel pain with pressure. On
examination was found erythematous nodules,
35. upper quadrant pain dan fever. Liver
smooth and shiny diffused infiltrate with ill
define border, no flunctuation or erosion. There enlargement and tenderness. Baru pulang dari
were pain on his elbow with nerve enlargement. thailand. Chill and sweat waktu fever. Terlihat
Diagnosis? 3.5% paracitemia. Explain mna yang benar?

a. yaws a. paracutemia … from tissue injury

b. leprosy b. paracitemia release of merozoit

c. anthrax c. paracitemia due to sporozoit initiate in human

infection
d. celullitis
d. paracitemua dri repeated cycle schizon from
e. carbuncle liver to erytocyte

31. a 21 yo man was seen in dermatology clinic 36. treatment malaria

because of sore and redness on his previous skin
lesion. He was on MDT treatment since 1.5 year a.
ago. On skin examination found some painful b. chloroquinee HCl intramuscular
erythematous nodule spread over his body
especially on arm and legs also fever. What is c. artemeter + lumefanfrine
the most likely diagnosis?
d. primaquiine
a. celullitis

b. furuncle
37. a 45 yo women, ke rs karena diare 3 hari,
c. erythema nodosum tiap hari 5-6x, sebelumnya dirawat di rs karena
pneumonia. Pernah ada history nasopharunx CA,
d. multibacillar leprosy faktor yg mempengaruhi diare?
e. pausibacillar leprosy a. agent not usually cause disease in healthy
person

33. patient on MDT treatment complaining b. evolution of pathogen shg bisa ke new host
about red urine that he experience on first dat of c. development of drug resistant of pathogen
treatment. Suggestion?
d. non-adherence pasien dlm minum penumonia
a. stop clofazimin, can cause pink brownies drugs
discoloration
e. pake counterfeit drugs
b. continue medication, it is not drug adverse
effect
39. a 14 yo boy fell from bicycle, last siloam, tidak pernah kontak dengan
immunization at 18month, (4th doses) 4-6 year kucong.Diagnosis?
immunization wasn’t done. What terapy should
be given? a. congenital toxoplasmosis

a. tetanus Ig b. congenital CMV

b. human iv Ig c. congenital rubella

c. tetanus toxoid d. congenital herpes

d. anti tetanic serum

49. hematuria dan oval shaped and ada di
terminal spine?
41. 6yo girl was brought to clinic, cough,
vomiting. PE found: crackles in both lungs. Jaw : schistosoma
Treatment? hematobium

42. 24yo woman datang ke dokter pribadi mau
ke papua selama 1 minggu. Ibunya uda menikah,
2 bulan gk haid, diksi prophylaxis apa?
a. sulfa- piremitamin 2 weeks before
b. an…
c. doxycycline 2 days before
d. mefloquine 2 days before
e. primaquine 2 weeks before
50. a 19yo woman come to emergency
deoarment with sugn and sympotms of
poisoning of an agent include nausea, vomiting,
abdominal cramp, diarrhea, excessive salivation,
headache, giddiness, rhinorrhea, tighness in
chesr, pin-point pupil, mental confusion and
muscle twitching. Which of the following is the
most likely agent caused those symptoms?
a. acetaminophen
b. barbiturate
c. carbamate

d. cyanide
44. management soal no 43:
e. opiate
a. hospitalisation with iv

b. outpatient meal soup

51. 40yo berenang di danau lindu, gatal2, besok
c. muncul papul, most likely pathogen?
d. jambu biji c. schistosoma japonicum
e. domperidone

53. soal no 51 ditanta bisa nyebapin apa?

48. G3P2A0 gejala anak chorioretinitis, cerebral a. creeping eruption
calcification, hepatomegaly, splenomegaly, berat
badan lahir rendah. Ibunya dalah suster di RS b. billiary cirrhosis
c. cholecystitis
d. pruruitus ani
e. visceral larva migran
55. makan gado2, trus ever, lidah coated, termor.
Causative agent menyebabkan perforasi dimana?
a. ileum
57. a 23yo man presents with extreme swelling
of his legs and scrotum. The skin associated with
the swollen areas 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 presence of eggs
b. examine the stool for the presence of
larvae
c. examine the blood smear for the
presence of adults worm
d. determine the titer of IgE antibody
against the parasites
e. examine the blood smear for the
presence of microfilaria
59. cowo, MSM, datang ke poliklinik mau
evaluasi treatment HIV nya. 1 minggu lalu, HIV
+ dan CD4 <350. Next step management?
a. start arv
b. cek tb
c. kasi provilaksis cotrim
d. jgn kasi arv sampao cd4 <200
e. kasi prophylaxis clatromycin
63. 2yo brought to dermatovenereology clinic
because itching all over the body. He
complained of itching on palm, side of finger,
buttock and abdomen. Clinical manifestations
are papule, vescicle, pustule, erotion and
excoriation, especially at finger web, arm,
abdomen, side of hand and feet. Itchy especially
at night. His neighbour have the same problem.
He usually play together with his neighbour.
What is the diagnosis of this patient?
a. pediculosis corporis
b. scabies
c. tinea corporis
d. dermatitis atopik
e. psoriasis
64. 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 drued packing on his
umbilical cord as is the local custom. He appear
normal until stimulated by loud noise ot 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
e. viral encephalitis
67. ibu bawa anak umur 18 bulan ke ER dgn
keluhan runny nose, conjuctivitis, diarrhea. PF:
fever 40C 3 hari, rash 2-3mm mulai dari muka.
Most likely causes:
jawban: morbili
69. a baby is born with a rash identical.
Questioning reveal that the mother had a febrile
illnes during the second teimester of pregnancy. days, he worked on irrigation channel and isinya
Examination reveals diffuse raised purple skin air sungai. What is your diagnosis?
lesions. There is no pallor, jaundice, or cyanosis.
The eyes are cataract, the heart has a 3/6 systolic a. treponemasis
murmur and there is enlargement of both the
b. shigelosis
liver and spleen. There is no lymphadenopathy.
Of the following, the most likely diagnosis is? c. salmonelasis
a. congenital toxoplasmosis d.
b. congenital rubella e. leptospirosis
c. congenital CMV

d. congenital malaria 75. cowo aktif sexual partner tapi pake

e. congenital varicella pelindung, terus mau screening. Screening pake
apa?

a. HIV-RNA
71. ke india 6 hari lalu, foul smelling and
b. CD4 count
slimmy diarea

a. giardia lamblia c.

b. vibrio cholera d. western blot

c. shigella e. HIV-ELISA

72. cewe 55 thn, mau ke makkah, dia uda 10
tahun gak kesna, pemeriksaan fisik normal,
perlu vaksin apa?
a. salmonella typhii
77. 67 yo man with long lasting diabetes and
abscess in pedis dextra. PF BP 120/80, HR
120bpm, RR 28, tempt 37,8C. Hb 8, WBC
21,000, platelet 109,000. Next step evaluation
and management?

b. tetanus a. administer normal saline bolus

c. hepatitis a b. obtain culture

d. hepatitis b c. transfusion red pack blood cells

e. meningiococcal d. platelet transfusion

e. bone marrow biopsy

73. 21yo man come to emergency department

due to high fever, headache, nausea and
vomiting and constant sleepiness for 5 days. At
admission, he look lethargic and dehydrated. At
PF, he look jaundice, conjuctival injection and
… there are liver dysfunction and increased
creatinine. The relative stated that the family
live in village, tempoarte climate. Previous 10
78. boy 12yo dtang ke klinik demam 4 hari yg
lalu, semam, mual, skait kepala, fatique,
tourniquet +, apa arti hasilnya?
a. increased capillary liability
b. devreased platelet count
c. increase hematocrit a. HiB

d. decrease platelet function b. orosabin

e. DHF c. meningiococcal

d. varicella

79. anak demam 2 hari, dokter suspek DBD, e. hep B

cek?

a. NS1

b. hematocrite

c.IgM

80. 38yo woman fever 10 days, malam makin

parah, ada fatique, dizzines, stomach discomfort,
constipation, loss of apetite. Suhu 38C BP
100/70 pulse 70x.mild abdominal pain, tremor
and coated tongue. Main specific standart lab
exam for diagnosis?

a. PCR

b. Widal

C. organism culture isolation

81. workplace health hazard can cause reaction.

Asthma, and dermatitis caysed by whicch
reaction?

a. immediate reaction

b. acute

c. gradual

d. delayed

e. no reaction

85. nenek dtg kidney transplant tinggal dgn anak

n cucu. Anak bayi baru vaksin.Nenek merasa
kaki lemah sebelah. Vaksin apa bisa prevensi
penyakit ini?
MCQ TROPICAL MEDICINE 2010
1. An apparently run-down but alert 34-year-
old woman comes to your office after 6
months spent as a teacher in a rural West
Sumba. Her chief complaints are frequent
headaches, occasionally nausea and
vomiting, and periodic fever. To rule out
your differential diagnosis, a smear of
finger-stick blood was done. Which of the
following choices would fit your diagnosis
based on your microscopic examination of
the blood smear?
a. Schizonts in red cells with 8-12 progeny
b. Rounded gametocytes present
c. Enlarged, somewhat misshapen in red
cells
d. Large ovoid parasites in some of the red
cells
e. Band-shaped tropozoites in infected red
cells
2. A 20-year-old woman came to the
emergency room with high fever from 5
days ago. She also has headache and pain in
retroorbita, abdominal pain and bloody
stool. On physical examination, she was in
an agitated condition. Her BP 90/60 mmHg,
heart rate 110x/ minute, RR 20x/ minute and
there were purpura in her arm, hand and leg.
Which of the following examination is the
most appropriate to establish the diagnosis?
a. Prick test
b. Dengue IgM-IgG
c. Complete blood test
d. Widal test
e. Stool analysis
3. A 32-year-old female developed a “flu-like”
syndrome with high fever up to 400C,
anorexia, headache, and myalgia. Four days
later, she become confused and agitated with
difficult to breath. Chest x-ray showed
parenchymal infiltrate. One of her kids has
also these symptoms, and has already passed
away. In order to provide laboratory
conformation of the pathogenic agent, a
tissue culture was ordered.
Which of the following would be the best
specimen for isolating the pathogenic agent
responsible for this infection?
a. Stool
b. Blood
c. Saliva
d. Lung biopsy
e. Nasopharyngeal swab
4. A 16-year-old boy presents with an
annoying cough, which he has had for about
3 weeks. The illness started with a runny
nose. On examination he is completely
normal, but he exhibits several episodes of
severe coughing. He has difficulty to take
deep breath and usually ends up with
vomiting. Of the following, the MOST
likely diagnosis is
a. Tonsilitis
b. Bronchiolitis
c. Pertusis
d. Laryngitis
e. Diphteria
5. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he was bitten by a dog.
His symptoms increased and were
accompanied by hand spasm and sweating
on the right side of the face and trunk. This
patient was admitted to the hospital the day
after developing dysphagia, hydrophobia,
hypersalivation, and disorientation.
Which of the following pathologic feature is
most likely found in dog’s brain?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell
Question 6-7 are linked to the following case:
A 32-year-old worker from a farm comes with a
painless dermal papule on his right hand which
started to develop since five days ago. The
worker says as the lesion getting bigger, and the
skin becomes black . He has tender axillaries
lymph node enlargement. àanthrax
6. What antibiotic should the doctor give to
treat the worker?
a. Tetracycline
b. Aminoglycoside
c. Ciprofloxacin
d. Neomycin
 e. Crystalline penicillin G
7. Which of the following virulence factors is
most likely to be involved in the
pathogenesis of illness?
a. Exotoxin
b. Endotoxin
c. α-hemolysin
d. Lipopolysaccharide
e. Antiphagotic factors
8. A 45-year-old man was seen in the
dermatology clinic because of some nodules
on his arm and body and sometimes feel
pain with pressure. On examinations we
found erythematous nodules, smooth and
shiny, diffuse infiltrate with ill define
border, no fluctuation or erosion. There were
pain on his elbow with nerve
enlargement.What laboratory test would you
do to confirm the clinical diagnosis? à
leprae
a. TPHA and VDRL
b. Gram preparation
c. KOH preparation
d. Skin scrapping
e. Skin slit smear
9. A 40-year-old patient comes with the complaints
of uncomfortable stomach & flatulence. From
history, the patient was known live in the valley
of Napu, Sulawesi and he had a fever frequently.
On physical examination, his liver was found
enlarged. Which one of the following test can be
used to confirm the diagnosis? à typhoid
a. Blood test
b. Liver biopsy
c. Rectal biopsy
d. Stool examination
e. CT scan
10. A 53-year-old male farmer developed low-
grade fever, abdominal pain, and diarrhea.
He has a skin lesion of black eschar
surrounded by vesicle and edema near his
mouth. A week before, his notice many
cattle in his farm were sick, but he still eats
a half-done beef steak from his cattle.
What is the following microorganism is
most likely involved in this case?
a. Bacteroides fragillis
b. Leptospira interrogans
c. Bacillus anthracis
d. Pasteurella pestis
e. Borrelia burgdorferi
11. A woman, recently returned from Lampung,
complains of having paroxysmal attacks of
chills, fever, and sweating; these attacks last
a day or two at a time and recur every 36 to
48 h. Which of the following is the most
appropriate time to take blood specimen to
establish the diagnosis? à malaria
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever
12. A very depressed woman took 20 tablets of
a hypnotic drug belonging to her husband
about less than 30 minutes ago. As she was
being taken to the hospital, she developed
hypotension, tachycardia, and tachypneu.
She’s also unconscious. Which of the
following is the most appropriate
management for this patient?
a. Give apomorphine intramuscular à
induce emesis
b. Doing gastric lavage
c. Infuse with sodium bicarbonate
d. Give activated charcoal via NGT
(nasogastric tube)
e. Doing a hemodialysis
13. An outbreak of pulmonary tuberculosis (TB)
in a dormitory, and this outbreak were
 presumed to be caused by the same source
of infection, based on the results of
restriction fragment length polymorphism
(RFLP) analysis and other findings. Which
of the following health intervention is the
most appropriate for the case above?
a. Rehabilitation
b. Prevention
c. Curative
d. Medication
  most likely to
e. Environmental Modification
14. There is an RNA virus that causes deadly
outbreaks of hemorrhagic disease in Africa.
The patents have developed fever, headache,
and muscle pain followed by abdominal
pain, diarrhea, and rash, with both internal
and external bleeding. In each outbreak,
hospital staff became infected. This virus is
highly virulent. Which of the following is
the most likely transmission for this disease?
à ebola
a. Contact with blood or body fluid
b. Transmitted by mosquitoes bite
c. Transmitted to human from rodent
excreta
d. Aerosol transmission
e. Direct contact with cattle product
15. A 31-year-old man presented with
complaints of high fever, cough, and
shortness of breath. Two hours before
admission, he experienced right-sided chest
pain when took a deep breath or coughed.
Chest film showed diffused bilateral
interstitial pulmonary infiltrate. Arterial
blood gases showed a PO2 of 60 mmHg with
91% hemoglobin saturation. The
hematologic, serum and liver tests were
normal. He lives near the poultry, and the
pathogenic agent is a new virus. Which of
the following is the prevention for this
disease?
a. Vaccine
b. Antitoxin
c. Antibiotic
d. Antiviral : oseltamivir
e. Antidotes
Question 16-17 are linked to the following case:
A 28-year old man presented with 8-day history
of increasing fever, malaise, headache, and
constipation. He did not receive any prior
vaccinations. His vital signs revealed
temperature 390C, BP 130/90, pulse 72x/min.
His physical examination revealed mild
hepatospleenomegaly and faint erythematous
macules.
–16.Which
ebola hemmorhagic feveris
of the following
have caused this man’s illness?
a. Vibrio cholerae
b. Shigella dysentriae
c. Salmonella typhi
d. Entamoeba histolitica
e. Giardia lambia
17. Which of the following specimen is most
appropriate for case above?
a. Feces
b. Blood
c. Urine
d. Throat swab
e. Biopsy
Question 18-19 are linked to the following case:
A 44-year old man on a business trip to South
Kalimantan from Jakarta presented to the
emergency department with symptoms of
diarrhea and abdominal pain. On physical
examination was found pitting edema of the
abdominal wall and of the legs. A stool
specimen was sent to the laboratory for culture
and for ova and parasites. Blood was drawn for a
CBC. The culture was negative for enteric
pathogens. The patient was found to have
eosinophilia. The wet mounts from the
concentrated stool specimens revealed large,
ellipsoidal, operculated parasite eggs with thin,
transparent shells (140 x 85 µm).
18. Of the following, which parasite can be the
cause of this disorder :
a. Schistosoma japonicum
b. Fasciolopsis buski
c. Trichinella spiralis
d. Echinococcus granulosus
e. Clonorchis sinensis

19. Refer to the previous case, the mechanism
of edema is due to :
a. Host-allergic response to metabolic
wastes of parasite
b. Reaction to the parasite as it migrates
through the tissues
c. Reaction to embolization of eggs
d. Immediate hypersensitivity reaction to
the adult worms in the intestine
e. Eggs damage the wall of intestine
20. A 24-year-old man returned from Papua
Island. Five days later, he developed
repeating intense chills and high fevers.
These severe episodes of fever had been
occurring every other day. In between these
episodes, he had low-grade fever, myalgia,
nausea, vomiting, and diarrhea. A few hours
ago, he was admitted to ICU in coma. He
became progressively somnolent and died a
week later. Which of the following organs
does this infectious agent initially proliferate
after entry in the infected host?
a. Heart
b. Liver
c. Brain
d. Spleen
e. Renal
21. A 61-year-old man was seen in the
Neurology Clinic for evaluation of a
peripheral neuropathy. He was found to
have dermal
hyperpigmentation/depigmentation
(salt/pepper) of the skin, scaly palms, and
transverse ridges on his fingernails which
were identified as being a result of a chronic
chemical intoxication.
Which of the following is the most likely
chemical agent caused that sign and
symptoms?
a. Acetaminophen
b. Arsenic : ngumpul di rambut kuku
c. Cyanide
d. Fluoride
e. Iron
22. A 45-year-old man from the Middle East
had fever and chills, with weight loss,
sweats, headache, muscle pain, fatigue, and
depression. From physical examination the
doctor found lymphadenopathy and
spleenomegaly. The man is a daily farmer
and a couple weeks before the symptoms
appeared he drank a glass of unpasteurized
cow milk. The culture of blood grew a tiny
Gram-negative coccobacilus, catalase and
oxidase-positive; that resemble fine grains
of sand. The patient was probably infected
with which of the following microorganism?
a. Mycobcaterium tuberculosis
b. Salmonella typhi
c. Brucella species
d. Pasteurella pestis
e. Staphylococcus aureus
23. A 55-year-old warden found a dead muskrat
on the bank of a stream. He picks up the
animal and buried it. Four days later, he
developed a 1.5 cm painful ulcer on the
index finger of his right arm, a 1 cm ulcer on
his right forehead, and pain in his right
axilla. Physical examination also revealed
right axillary lymphadenopathy. Which of
the following is working diagnosis for this
patient?
a. Brucellosis
b. Pertusis
c. Leptospirosis
d. Tularemia
e. Hydatidosis
Question 24-25 are linked to the following case:
A volunteer man returning from a tsunami area
was admitted to hospital. A week before, he had
fever, headache and myalgia especially at calf.
These symptoms resolved, but the day before
admission he became pyrexia and on
examination was found to be jaundice and to
have an elevated blood urea. Urine was collected
and inoculated into a semisolid agar medium,
and examined by dark ground microscopy.
24. Which of the following is your working
diagnosis?
a. Syphillis
b. Pertusis
c. Weil’s disease
d. Lyme disease
e. Relapsing fever

25. Which of the following disease is the
complication of this disease?
a. Pulmonary hemorrhage
b. Myopericarditis
c. Aseptic meningitis
d. Osteomyelitis
e. Anemia
26. A 39-year-old woman live in Manokwari,
Papua Island developed a major seizure
while at work. She had no history of
epileptic disease. A head MRI was
remarkable for a lesion surrounding a
scolex. The etiologic agent would most
plausibly have been acquired by eating or
dinking which of the following food items?
a. Uncooked vegetables
b. Raw beef
c. Raw pork
d. Uncooked fish
e. Unfiltered water
27. A young boy had wart-like skin lesions with
the appearance of strawberries in his legs.
Later, this lesion destroys the bone of his
legs (gummata), but there are no visceral
and nervous system complications. The
disease is still endemic in hot tropical
countries, such as Indonesia. Which of the
following examination is the most
appropriate to diagnosis the disease above?
à yaws
a. Widal test
b. IgM-IgG of Treponema
c. Dark-field microscope
d. FTA-ABS and TP-PA test
e. ELIZA assay
28. A 27-year-old man develops acute severe
encephalitis that requires hospitalization.
Several days before he got that disease, he
recognizes that many pigs in his farm were
died.
Which of the following is most appropriated
natural host for the pathogen? ànipah
a. Arthropod
b. Horse
c. Bats
d. Squirrel
e. Rats
29. A female tourist developed gastroenteritis
while visiting small town in Indonesia and
tried some Indonesian traditional food. The
onset of the disease is abrupt with
abdominal cramps and watery diarrhea. She
had no fever or nausea or vomiting. The
symptoms have resolved within 24 hour and
no subsequent recurrences. They report the
disease to district public health office. The
investigation found that one of the food
products eaten by this tourist was
contaminated by suspected pathogens. What
is the suspected pathogen may cause the
disease above?
a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E.colià travellers
30. A 23-year-old man sees his family
physician with a sudden onset of 4-day
history of fevers, headache, retro-orbital
pain, myalgia and rash. Physical
examination shows diffuse erythroderma
with blanching erythema and petechial
formation resulting from pressure applied to
her skin. Laboratory test reveal lymphopenia
and thrombocytopenia. Which of the
following virus is most likely responsible for
this infection?
a. Morbili
b. Dengue
c. Influenza
d. Coxsackie
e. Rhinovirus
31. A 48 year old lady came to the outpatient
clinic with chief complaint of fatigue and
difficulty in concentration for the last 2
weeks. The history taking revealed that she
had a balanced diet, no history of chronic
disease and had been a heavy smoker for 20
years. On physical exam it was found that
she had anaemic conjunctiva with other
findings was within normal limit. The
laboratory examination showed that she had
haemolytic anemia.
Based on the information given above, what
is the most likely cause for her condition?
 a. Vitamin K deficiency
b. Copper deficiency
c. Vitamin E deficiency
d. Iron deficiency
e. Folate deficiency
32. A laboratory examination of a leprosy
patient after 4 months MDT therapy
revealed Bacterial index 6+ and
morphological index 50%. What is your
conclution for this result ?
a. Pausibacillar leprosy patient sensitive to
treatment
b. Multibacillar leprosy patient sensitive to
treatment
c. Multibacillar leprosy patient resistent to
treatment
d. Pausibacillar leprosy patient resistent to
treatment
e. Pausibacillar leprosy patient prone to
nerve damage
33. A boy brought by his mother to the
emergency department of Siloam hospital
because of vomit & dyspnoea. According to
his mother, her son was playing in the
backyard. On physical examination, the boy
was found to have high fever (39 ºC) and
multiple stinging on the back. The most
likely species of insect bites is:
a. Hymenoptera sp
b. Dermacentos andersoni: tick paralysis
c. Lactodectus mactan : black widow
d. Loxoxceles laeta : laba2
e. Lytta vesicatoria : kumbang
34. A 28 year old lady came to the Posyandu to
have a nutrition consultation. Last year, she
delivered a stillbirth baby with a spinal
disorder. She and her husband start planning
to have a baby again. She asked for
suggestion about her dietary intake before
she got pregnant.
What kind of diet does she need to prevent
the same disorder for her future baby?
a. Dark green vegetables
b. Pasteurized milk
c. Deep water fishes
d. Boiled eggs
e. Lean beef
35. A 27 year old woman in at term pregnancy
had fluctuated fever since 2 weeks ago. She
looked pale, generalized weakness, and
headache. She went to public health center
and was prescribed oral chloramphenicol in
doses of 500 mg four times daily and
paracetamol 500 mg three times daily. She
did not tell to the physician that she was
pregnant. What is the expected side effect of
the drug you will find on the baby?
a. Reye syndrome
b. Gray syndrome
c. Down syndrome
d. ADHD
e. Black water fever
36. A 35 year old man, a businessman, came to
private doctor. He asked the physician about
his plan to go to Papua, which is endemic
malaria. The physician suggested him to
take prophylactic drug. Which medication
(WHO recommended) would be given to
this patient for prophylactic?
a. Kina
b. Chloroquine
c. Doxycycline
d. Kuinin
e. Primakuin
37. A 40 year old man came to hospital with
four times generalized tonic-clonic seizure
since two week ago. There was no history of
seizure and head trauma. A one year ago, he
had business in Papua for six months.
During his stay in there, he often consumed
under-cooked pork. Brain MRI showed a
small cystic with invaginated scolex inside.
What of this following is the most likely
inside cyst?
a. Taenia eggs
b. Cycticercosis cellulose
c. Cysticercosis bovis
d. Taenia solium worm
e. Taenia saginata worm
38. An 8-day-old infant was born with the help
of shaman (‘dukun beranak’). The mother
states his son became irritable since 2 days
ago, and now any loud noise appears to
 cause him pain, as evidenced by muscle
tightening and back arching causing his head
to nearly touch his feet. Physical
examination reveals only a dried packing on
his umbilical cord, as is the local custom. He
appears normal until he is stimulated by
touch or a loud noise, and then he begins to
cry, stiffens, and arches his back. The
stiffness continues until he calms down. Of
the following, the MOST likely diagnosis is:
a. Bacterial meningitis
b. Botulism
c. Generalized seizure
d. Tetanus
e. Viral encephalitis
Question 39-40 are linked to the following case:
A worried mother brings her 18-month-old son
to the emergency department because of a rash
that developed today. She reports that he has had
a runny nose, conjunctivitis, and diarrhea. On
physical examination, he appears severely ill, is
temperature to 40°C for the last 3 days and has
diffuse 2 – 3 mm erythematous rash beginning
from the hairline behind the ear and spreading to
his face and body. On buccal mucosa, there is a
red spot surrounded by white bluish appearance.
39. Of the following, the MOST likely cause of
the rash is
a. Rubella virus
b. Coxsackievirus
c. Morbilli virus
d. Human herpesvirus 6
e. Parvovirus B19
40. What is the most severe complication that
would happen to the patient above?
a. Osteomylitis
b. Encephalitis
c. Otitis externa
d. Sinusitis
e. Oral thrush
41. A 48-year-old man with acute gastroenteritis
has step ladder night fever since 7 days ago.
He also has abdominal pain, and
constipation. He usually eats uncooked
vegetables at street vendor (pedagang kaki
lima).
Which of the following is most likely to be a
constituent of this organism?
a. Vi antigen
b. Urease
c. Hemolysin
d. Shiga toxin
e. Pili
42. A 10-year-old girl presents with a history of
sore throat and difficulty breathing of 1
day’s duration. On examination she is very
ill-appearing. She has some inspiratory
stridor and thick white-gray material
covering her tonsils and faucial pillars, and
she has swelling of her neck, no
splenomegaly. The lymphocyte is normal.
What is the likely diagnosis?
a. Tonsilitis
b. Angina Plaut Vincent
c. Mononucleosis infectiosa
d. Laryngitis
e. Diphteria
43. A baby is born with a rash identical. History
taking reveals that the mother had a febrile
illness during the second trimester of
pregnancy. Examination reveals diffuse
raised purple skin lesions. There is no pallor,
jaundice, or cyanosis. The baby has cataract,
a 3/6 systolic heart murmur, and
enlargement of both liver and spleen. There
is no lymphadenopathy.
Of the following, the MOST likely diagnosis
is?
a. Congenital Toxoplasmosis
b. Congenital Rubella
c. Congenital Cytomegalovirus
d. Congenital Herpes Simplex
e. Congenital Varicella
44. A 40-year-old woman presented with a
raised redness plaque resemble a doughnut
with a raised border that she already had for
1 year, It was no itchy, no pain, not easily
bleeding. Sometime she feel weakness on
her leg and her slipper left behind while
walking. On her legs she developed an
anular erythematous sharp border lesion, no
 scally, shiny surface and enlargement of the
popliteal nerve. What kind of laboratory
examination results that can help us make a
diagnose of the case above? à kusta
a. Dark field examination
b. Gram
c. KOH examination
d. Ziehl neelson
e. Na Cl examination
45. A woman, recently returned from Lampung,
complains of having paroxysmal attacks of
chills, fever, and sweating; these attacks last
a day or two at a time and recur every 36 to
48 h. Examination of a stained blood
specimen reveals ringlike and crescent-like
forms within red blood cells. The infecting
organism most likely is
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malarie
e. Plasmodium brasilianumi
46. A 33-year-old woman ingested 10 tablets of
an analgesic-antipyretic which is
metabolized to a quinone imine. Shortly
after ingestion she presented with signs of
nausea, vomiting, and generalized malaise.
Within 3-5 days peak hepatic dysfunction
occurred and was associated with hepatic
necrosis.
Which of the following is the most likely
specific antidote that should be used to treat
this patient's over dosage?
a. Amyl nitrite
b. Atropine
c. BAL
d. EDTA
e. N acetyl sistein
47. A 27-year-old medical student was admitted
to hospital because of sudden onset fever up
to 390C and headache. Two weeks
previously he volunteers cleaning the canal
with others. On examination, he looked so
yellow. Blood tests done shortly after
admission indicated renal function
abnormality and elevated liver function
tests. Which of the following is the
prevention after exposure for this case?
a. Human vaccine
b. Health education
c. Vector control
d. Isolation the infected people
e. Prophylaxis antibiotics
48. A 24 year old woman admitted to the
hospital with myalgia and weakness of her
right leg. She had traveled from Saudi
Arabia and her immunization had never
completed. On examination, she had normal
sensation of the right leg, with normal
movement and strength in all other
extremities and a normal cranial nerve
examination. Which of the following
vaccination is the best prevention for this
disease?
a. MMR
b. HBIG
c. BCG
d. DPT
e. Oral Sabin à polio
49. An HIV (+) patient comes to the emergency
room with severe dehydration. The nurse
puts an IV line on him, after that the nurse
use her two hand recapping the needle, and
got injured by that needle. The nurse is
panicking. You are the doctor on duty in that
emergency room. What should you do?
a. Press the injury site to stop the blood
b. Wash immediately using soap under
running tap water
c. Use bleach or iodine to clean the injury
site
d. Use antibiotic ointment on the injury
site
e. Enlarge the injury site by incision to let
the blood flow
50. A 33-year-old woman at 10 weeks
pregnancy presents for her first prenatal
examination. Routine labs are drawn and her
HBsAg is positive. Liver function tests are
 normal and her Anti HBc and Anti HBs are
negative. Which of the following is the best
way to prevent neonatal infection?
a. Provide immune globulin to the mother.
b. Provide hepatitis B vaccine to the
mother.
c. Perform a cesarean delivery at term.
d. Provide hepatitis B vaccine to the
neonate.
e. Provide HBIG and the HepB vaccine to
the neonate
51. A 34-year-old G2 at 36 weeks delivers a
growth-restricted infant with cataracts,
patent ductus arteriosus, and sensorineural
deafness. She had flu-like syndrome with
rash in early pregnancy. What is the most
likely causative agent?
a. Parvovirus
b. Rubella virus
c. Morbili virus
d. Cytomegalovirus
e. Herpes simplex virus
52. A 27-year-old female has just returned from
a trip to Southeast Asia. In the past 24 hours,
she has developed shaking, chills, and a
temperature 40o C. A blood smear reveals
Plasmodium vivax. Which of the following
agents should be used to eradicate the extra-
erythrocytic phase of the organism?
a. Primaquine
b. Pyrimethamine
c. Quinacrine
d. Chloroquine
e. Chologuanide
53. A 25-year-old G3 at 39 weeks delivers a
small-for-gestational-ageinfant with
chorioretinitis, intracranial calcifications,
microcephaly, jaundice, and
hepatosplenomegaly. The infant displays
poor feeding and tone in the nursery. The
patient denies eating any raw or
undercooked meat and does not have any
cats living at home with her. She works as a
nurse in the pediatric intensive care unit at
the local hospital. What is the most likely
causative agent?
a. Cytomegalovirus
b. Epstein-Barr virus
c. Hepatitis B virus
d. Parvovirus
e. Yellow fever virus
54. A 45 year old man presented chronic skin
lesions on both hands for the past 1 year. On
examination, his skin appears erythematous,
crusted, fell itching, and having serous
discharge. He was working in the gold
refining plant for the past 2 years, works
with potassium cyanide and never uses any
gloves. Which of the following mechanism
is responsible for this illness?
a. Immediate respond
b. Acute respond
c. Gradual reactions : dikit2 : sulfonyl urea
d. Delayed reactions
e. Quantal reactions : dosis berapapun
langsung kena : chloramphenicol
55. Male, 46 years old came to you as a doctor
with chief complains shortness of breath
especially at the work place. When he gets
home, the symptom is missing. He also
complains that he sneezes every morning.
According to him, his sister is using
bronchodilator inhaler every day. He just
worked at sandblasting company and expose
to dust since 2 weeks ago. Which of the
following is the most appropriate to measure
the toxicity of hazardous material in the case
above?
a. Body Mass Index
b. Nutrition and Job description
c. Individual Susceptibility
d. Social pressure
e. Tissue and organs
56. The patient was a 3-year-old girl who was
seen by her pediatrician for a routine
physical examination. Her mother was
concerned about her daughter’s poor
appetite. Physical exammmination revealed
that the child was small for her age and had
a slightly enlarged liver. Blood was
collected for a routine complete blood count,
since she had previously been slightly
anemic. Her hemoglobin level was within
the normal range; however, she did have
eosinophilia (20%). The child had no history
of travel. When questioned about pets, her
mother reported that she spent a great deal
 of time with her puppy. Of the following,
which manifestation of the infection (above
case) is known to occur? à toxocara
a. Creeping eruption à strongyloides
b. Biliary cirrhosis
c. Cholecystitis
d. Pruritus ani à oxyuris
vermicularis/enterobius
e. Visceral larva migrans
57. A patient complains of having nail size
excrement from his anus. On the stool
examination, parasite eggs contains a hexacanth
embryo with six hooklets surrounded by radially
striated spherical shell, 30 to 40 u in diameter
were found, the most likely diagnosis of this
patient is :
a. Saginata taeniasis
b. Solium taeniasis
c. Cysticercosis
d. Oxyuriasis
e. Ascariasis
58. The mother of a 4-year-old child notes that
her child is sleeping poorly and scratching
his anal area. You suspect the child may
have pinworms. Which one of the following
is the BEST method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of microfilariae
d. Examine transparent adhesive tape for
the presence of eggs
e. Determine the titer of IgE antibody
against the parasites
Question 59-60 are linked to the following case:
A 30-year-old woman presents with abdominal
pain and diarrhea of 3 day’s duration. She does not
complain of nausea, vomiting, or fever. She has no
sick contacts or significant travel history. A stool
sample is obtained, which reveals rhabditiform(,
filariform: infective) larvaà strongyloides .
59. In condition below adult form of the pathogenic
agentcan be found in whole digestive tract and
its larvae can be found in visceral organ (lung,
liver, gall bladder) is:
a. Eosinofilia
b. Hyperinfection
c. Retrofection
d. Hypereosinofilia
e. Autoinfection
60. Refer to the previous case, further questioning
reveals that the woman frequently gardens in
her backyard. Of the following, which one is the
transmitted form?
a. Fecal – anal transmission
b. Fecal – oral transmission
c. Fecal – cutaneous transmission
d. Direct contact with skin scales
e. Intravenous drug abuse
61. A 40-year-old man came to the clinic with
complaints of having fever more than one-week,
nausea, and fatique. He came back from
Samarida, Kalimantan. On blood smear
examination, there are late trophozoites forms,
schizonts with 12-24 merozoites, and the
infected red cell is enlarged. Of the following,
the most likely diagnosis of this pasient is :
a. Vivax malaria
b. Falciparum malaria
c. Malariae malaria
d. Ovale malaria
e. Knowlesi malaria
62. A- 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. The most
likely diagnosis of the disease is:
a. Hydatidosis
b. Cysticercosis
c. Cerebral malaria
d. Occult filariasis
e. Trichinosis
63. An-6-year-old girl sustains a large laceration
contaminated with dirt after falling from her
 bike. Her mother can’t recall how many
doses of immunization her daughter has
received. Which of the following is the
prevention after exposure for this case?
a. Adult-type TT
b. TIG
c. TT and TIG
d. HiB containing TT and TIG
e. DPT
Question 64-65 are linked to the following case:
A 23-year-old man presents with extreme
swelling of his legs and scrotum. The skin
associated with the swollen areas is thick and
scaly. The patient admits to an episode of fever
associated with enlarged inguinal lymph nodes
some time ago, but did not think much of it.
àfilariasis
64. Which one of the following is the BEST
method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of adult worm
d. Determine the titer of IgE antibody
against the parasites
e. Examine a blood smear for the presence
of microfilaria
65. According to the case above, which of the
following is the most appropriate time to
take the specimen for established the
diagnosis?
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever
66. At night, a 28-year-old man is brought to the
emergency department after his right foot
being bitten by an animal, within 1 hour
before admission. The patient said that he
heard the sound of the animal. He complains
of pain in his right foot and there are two
bitten marks, surrounded by edema and
erythema in the dorsal aspect of his right
foot. Initial management of the case
described should be
a. Observation
b. Cryotherapy
c. Antivenin : antivenom
d. Incision and suction
e. Corticosteroids
67. A 29-year-old man has weight loss, white
plagues on the pharynx, and purple lesions
on the abdomen, which on biopsy reveal
Kaposi sarcoma. Which of the following is
the most predictive of the patient’s
prognosis? à HIV
a. CD4 cell count
b. CD4/CD8 cell ratio
c. Degree of lympadenopathy
d. Level of HIV-1 RNA in plasma
e. Rate of decline in anti-HIV antibody
68. A patient come with an itchy recured fungal
infection on the feet and need some advice
to be cured and some prevention measures
so the diasease will not occure again, doctor
already gave him some medication for
fungal infection. What kind of advise can
make him healthy?
a. Don’t eat seafood
b. Use always sandals
c. Keep the skin dry and clean
d. Don’t use shoes all day long
e. Don’t scratch, will spread the infection
69. 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 +. Fever
symptom on the previous question referred
to :
a. Saorozoites is in the the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts
enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed
70. A 35-year-old man as a farm worker who
was working with pesticides is brought to
the emergency room with headache,
vomiting, salivation, diarrhea, muscle
fasciculation, difficulty walking, and
 difficulty speaking. His clothing has been
removed, he has been washed, and he has
been given activated charcoal. What is the
most effective remaining treatment for this
case of pesticide poisoning?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. Hidrochlorothiazide
71. A 65-year-old-woman suddenly had flaccid
paralysis of her left leg. A few days ago, she
had headache, fever, sore throat, and nausea.
She lives with her son; daughter in law and a
young grandchild who’s just received a
routine oral vaccination. She is taking
immunosuppressant for her kidney’s
transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan
and lumbar MRI are also normal.
What is the most likely transmission of her
infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite
72. A pork-eating village in the highlands of
Papua New Guinea is reported to be
suffering from an epidemic outbreak of
epileptiform seizures. You have been sent to
investigate. One of the first things you
should investigate is?
a. The level of Balantidium coli in swine
stool
b. The practice of consuming raw deceased
human brains
c. The presence of taenia eggs in the
drinking water
d. The presence of tropozoites in the
human blood
e. The quantity of culidae in the village
73. A 34-year-old woman complained a sudden
onset of high fever for 4 days with nausea,
vomiting, headache, muscle ache. There
were petechiae on examination. Which of
the following laboratory result is most
appropriate with the patient’s diagnosis? à
dhf
a. Trombositopenia
b. Neutropenia
c. Anemia
d. Decreased of hematocrit : arusnya naik
e. Leucopenia
74. A 1 year old girl came to the Puskesmas
with swollen gum for a week. From the
history taking it was found that she was born
normal with normal birth weight, had been
breastfed up to now and had a balanced diet
with high intake of cooked vegetable and
fruit since 6 months old. She had no history
of chronic diseases. Her other physical and
laboratory examination was normal.
Based on the information given above, what
is the most likely cause of her complaint?
a. Protein deficiency due to prolonged
breastfeeding
b. Carbohydrate deficiency due to
increased calorie need
c. Fat soluble vitamin deficiency due to
high vegetable/fruit intake
d. Water soluble vitamin deficiency due to
cooking process
e. Mineral deficiency due to competition
with high vitamin absorption
75. A 10-year-old boy who has moved to your
practice recently has sore throats, get high
temperature. The child reports a runny nose,
mild cough, and abdominal pain. Findings
on physical examination include a
temperature of 38°C, and vesicular lesions
on the soft palate, dorsal and palmar of
hands. There is no cervical adenopathy or
rash.
Of the following, the MOST likely diagnosis
is à hfmd
a. Adenovirus infection
b. Coxsackie virus infection
c. Mononucleosis
d. Sinusitis
e. Streptococcal pharyngitis
76. 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, mental confusion, and muscle
twitching. Which of the following is the
most likely agent caused those symptoms?
a. Acetaminophen
b. Barbiturate
c. Carbamate
d. Cyanide
e. Opiate
77. A 23-year-old G1 with a history of a flulike
illness, fever, myalgias,
andlymphadenopathy during her early third
trimester delivers a growth-restrictedinfant
with seizures, intracranial calcifications,
hepatosplenomegaly, jaundice,and anemia.
She has many pets in her house. What is the
most likely causative agent? torch
a. Trepanema pallidum
b. Trichomonas vaginslis
c. Toxocara canis à ocular dan visceral
larvae migrans
d. Neissheria meningitidis
e. Toxoplasma gondii
78. A 22-year-old man who works in the
pediatric ward of a hospital suffers from
malaise, sneezing, and runny nose. He
subsequently develops a mild sore throat,
headache, and stuffy nose. The symptoms
resolve within 4 days. Which virus is most
likely to be responsible for these symptoms?
a. Rota virus
b. Rubella virus
c. Coxsackie virus
d. Hepadnavirus
e. Influenza virus
79. Approximately 4 hour after eating a meal in
restaurant, 3 members of a tourisms group
develop a sudden onset of nausea, vomiting,
severe abdominal cramps, and diarrhea.
Nobody got febrile. Which of the following
vaccination is should be given to the
traveler?
a. Shigella vaccine
b. Salmonella vaccine
c. Enterobacter vaccine
d. H. pylori vaccine
e. ETEC vaccine
80. An outbreak investigation note many
costumer from a café were admitted to the
hospital. They have fever; nausea-vomiting,
constipated or diarrhea, weakness and
altered mental status. Rose spots are seen on
the trunk. Blood cultures from patients grow
a non-lactose-fermenting gram-negative rod.
These people are infected from the carrier
person
In which of the following sites are bacteria
most likely to be found in carrier person?
a. Blood
b. Kidney
c. Liver
d. Intestine
e. Gall bladder
TROPICAL MEDICINE – MCQ 2009
1. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he contacted with a dog.
His symptoms increased and were
accompanied by hand spasm and sweating
on the right side of the face and trunk. This
patient was admitted to the hospital the day
after developing dysphagia, hypersalivation,
agitation, and generalized muscle twitching.
Which of the following could rapidly
destroy the pathogenic agent of this disease?
a. Infrared radiation
b. Catalase
c. Alkali water
d. Sunlight
e. Heating at 60ºC for 30 minute
Question 2-3 are linked to the following case:
A 65-year-old-woman suddenly had paralysis of
her left leg. A few days ago, she had headache,
fever, sore throat, and nausea. She lives with her
son; daughter in law and a young grandchild
who’s just received a routine immunization. She
is taking immunosuppressant for her kidney’s
transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan and
lumbar MRI are also normal.
2. What is the most likely transmission of her
infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite
3. Which of the following is the primary
pathologic effect in this case?
a. Persistent viremia
b. Focal multiplication
c. Immune complexe formation
d. Destruction of infected cells
e. Reduce of acethylcholine receptor
Question 4-5 are linked to the following case:
A young boy is suffering from high fever,
difficult to swallow water, hydrophobia, and
disorientation. On examination, there is a
hypoesthesia on his left arm. Four weeks ago, he
had been bitten by a dog. The characteristics of
etiologic agent were zoonotic, single-stranded,
negative-sense DNA virus.
4. Which of the following is usefull for making
a diagnosis in this case ?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell
5. Which of the following is available for
treating this patient?
a. Immune globulin
b. Live attenuated vaccine
c. Antiviral
d. Antimicrobial
e. Antitoxin
Question 6-7 are linked to the following case:
A 24 year old woman admitted to the hospital
with myalgia and weakness of her right leg. She
had traveled from Saudi Arabia and her
immunization had never completed. On
examination, she had normal sensation of the
right leg, with normal movement and strength in
all other extremities and a normal cranial nerve
examination.
6. Which is a target cell receptor for this
pathogenic agent?
a. Silica acid on epithelial cells
b. Acetylcholine on neurons
c. CD4 molecule on T lymphocytes
d. C3d complement on B lymphocytes
e. Immunoglobulin on epithelial cells
7. Which of the following is the best specimen
for diagnosis in case above?
f. LCS
g. Blood
h. Urine
i. Throat swab
j. Rectal swab
8. A 2 year old child presented with a history
of febrile upper respiratory tract infection.
His clinical conditions deteriorate with a
worsening cough and dyspneu. He was
admitted to the hospital. On clinical
examination, the child had obvious evidence
of respiratory distress with rib retraction and
an elevated respiratory rate. A chest x-ray
showed hyperinflation of both lung fields.
What is the most appropriate specimen for
laboratory diagnosis in this case?
a. Nasopharyngeal washing
b. Tracheal aspirate
c. Bronchial washing
d. Nasal swab
e. Blood
Question 9-10 are linked to the following case:
A 31 year old female underwent allogenic bone
marrow transplantation for acute myeloid
leukemia. In the second month post transplant,
she developed high fever, a nonproductive
cough and breathlessness. Physical exam
showed splenomegaly, and laboratory studies
showed anemia, leucopenia, and
thrombocytopenia, and abnormal liver function
test. Her chest x-ray showed diffuse interstitial
pulmonary infiltrates. A bronchoalveolar sample
performed infected kidney cells showed owl eye.
9. What is the best treatment for this infection
disease?
a. Antimicrobial
b. Antiviral
 c. Antitoxin
d. Immunosuppressant
e. Antifungal
10. This female’s illness could be most easily
diagnosed by which of the following tests?
a. HSV-1 IgM antibody
b. CMV antigenemia
c. HHV-6 IgM antibody
d. Culture of blood in erythroblastic cells
e. Monospot test
11. In an elementary school many of students
suffer from sore throat, runny nose, cough,
fever, headache, myalgia, and fatigue. The
students who have not been vaccinated
against this infection are offered
prophylactic treatment with certain antiviral
drug. What is the mechanism of action for
this drug?
a. Blockade of nucleocapsid release
b. Blockade of viral attachment
c. Blockade of viral protein synthesis
d. Inhibition of RNA-dependent DNA
polymerase
e. Inhibition of RNA-dependent RNA
polymerase
12. A 28 year old female nurse became ill after
taking care of a patient with pneumonia 2
days ago and was admitted to the hospital
with fever and sore throat. She was placed in
respiratory droplet isolation and quickly
developed respiratory failure, requiring
mechanical ventilation. In 10 days, nine
other patients in the same ward developed
the same symptoms. Which of the following
laboratory test is most appropriate?
a. Blood culture to identify S.pneumoniae
b. Urinary antigen testing for Legionella
pneumophila
c. Virus culture to identify influenza A
d. Serology to demonstrate antibodies to
identify SARS
e. PCR of nasopharyngeal secretion to
identify RSV
13. A young man presented with headache, low
grade fever, and painful blisters on the
penis. He admitted to having had
unprotected sex in the past month. Physical
examination revealed inguinal
lypmadenophaty and blisters on the penis.
Which of the following pathogens is most
likely to have caused his disease?
a. Human papilloma virus
b. Haemophillus ducreyi
c. Treponema pallidum
d. Chlamydia trachomatis
e. Herpes simplex virus
14. A 4 years old boy with sickle cell disease is
taken to his pediatrician’s because he is pale
and is suffering from repeating intense chills
and daily high fever. A blood test shows that
WBC was 17.000/µl and a platelet count is
53.000/µl. What description is relevant to
the findings in this patient?
a. Sickle cell trait decreased the patient’s
resistant to the virus infection
b. Sickle cell trait promotes infection of
erythrocytes by plasmodium
c. Virus infection promotes INF
production
d. Virus infection targets erythrocyte
precursor cells
e. Bacterial infection activates leukocytes
cells
15. A 26-year-old nulliparous woman, in her
seventh month of pregnancy complains of a
7 days history of fever especially at night.
As she recall, 2 weeks ago she ate gado-
gado in coastal area when she out for duty
for several days. She also had diarrhea and
abdominal discomfort. On physical
examination reveals blood pressure 110/70
mmHg, heart rate 60 ×/min, RR 20x/min,
temp. 39.1°C. Tongue is coated and tremor.
Fetal USG shows normal.
What is the most likely etiologic factor
above?
a. Salmonella typhi
b. Plasmodium falciparum
c. Vibrio cholera
d. Hepatitis A
e. Escherichia coli
16. A 4-year-old child presents with fever,
cough, conjunctivitis, coryza, photophobia,
posterior cervical adenopathy. Red lesions
 with a white center are present on the buccal
mucosa. A generalized erythematous rash is
also noted. What is the most likely
diagnosis?
a. Rubella
b. Kawasaki disease
c. Adenovirus infection
d. Rubeola
e. Varicella
17. A 35-year-old man as a farm worker who
was working with pesticides is brought to
the emergency room with headache,
vomiting, salivation, diarrhea, muscle
fasciculation, difficulty walking, and
difficulty speaking. His clothing has been
removed, he has been washed, and he has
been given activated charcoal. What is the
most effective remaining treatment for this
case of pesticide poisoning?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. Hidrochlorothiazide
18. Mr. Farid is a diabetic. He read in a book
that the main source of the brain fuel is
glucose. His doctor said that insulin in his
body is not enough for entering glucose to
the cell. So he worries about the work of his
brain. You know that the brain is protected
from high molecule particle by blood-brain
barrier (BBB). What do you think?
a. The main brain fuel is not glucose
b. Glucose is not big enough to be block
by blood-brain barrier
c. Glucose enter the brain through the
leakage part of the BBB
d. There is special transporter for glucose
to enter the brain
e. Glucose in the only exception for blood
brain barrier
19. A 45 year old man has chronic otitis media
since 2 years ago. He comes to Siloam
hospital because he suffers headache since a
week ago. The doctor makes some
examinations also radiographic examination
on his head. The doctor fined a round mass
with 3 cm diameter. Which of the most
likely cause of the mass?
a. Neoplasma
b. Aneurisma
c. Infarction
d. Abcess
e. Hemorrhage
Question 20-21 are linked to the following case:
A 5 years old boy came to the clinic with
recurrent blanking out at school for 1 month. He
had recurrent episodes in which he abruptly
stops all activity for about 10 seconds, followed
by a rapid return to full consciousness. After the
episode patient resumes whatever activity he
was previously engaged with no awareness that
anything has occurred.
20. What is the most likely diagnosis?
a. Simple partial seizure
b. Complex partial seizure
c. Absence seizure
d. Atonic seizure
e. Secondarily generalized seizure
21. What is the most appropriate antiepileptic
drug for case above?
a. Carbamazepine
b. Valproic acid
c. Benzodiazepine
d. Lamotrigine
e. Ethosuximide
Question 22-23 are linked to the following case:
A 70 years old man presents to ER with history
of seizure. His wife awakened at 05.00 by an
odd gurgling noise. Her husband’s head was
deviated to the left and his left arm was
stiffened. After a few moments he had
generalized body jerking and was unresponsive.
Event lasted 2 minutes but stopped
spontaneously. His wife said he seemed drowsy
and confused. There was no history of prior
seizure. On ER, he was conscious, BP was
140/95 mmHg, HR 96 x/min, RR 20 x/min,
Temperature 36, 5 C. The laboratory
examination revealed Random Blood Glucose
was 610 mg/dl.
22. What is the most likely diagnosis?
 a. Pseudoseizure
b. Primary epilepsy
c. Secondary epilepsy
d. Acute provoked seizure
e. Generalized seizure
23. What is your treatment for case above?
a. Diazepam intravenous
b. Oral phenytoin
c. Ringer lactate infusion
d. Insulin subcutan
e. Dextrose bolus intravenous
24. A 5-year-old girl brought by her mother to a
clinic because of a-two-day fever and sore
throat. On mouth examination, the doctor
finds a leathery grayish white membrane
adheres to pharyngeal walls and tonsillar
pillars which spread asymmetrically onto the
soft palate and uvula. What treatment should
be given to the patient?
A. Antibiotic and antiviral
B. Antiviral and antifungi
C. Antitoxin and antifungi
D. Antibiotic and antitoxin
E. antiviral and antitoxin
25. A 22-year-old woman who just got home
from a 2-week voluntary work in rural
Papua comes to a clinic with history of
bloody and slimy diarrhea since her last five
days in Papua. She experiences more than
five bowel movements within each day. She
also experiences stomach cramp and painful
passage of stool. She reports no fever or any
other complains. There is a slight lower
quadrant abdominal tenderness on her
physical examination. She is found to be a
little bit dehydrated. What is the most likely
organism which causes her condition?
a. Entamoeba histolityca
b. Vibrio cholerae
c. Rotavirus
d. Salmonella typhi
e. Escherichia coli
26. A 7-year-old boy presents in emergency unit
with colicky abdominal pain since two days
ago. He also has fever and appears lethargic.
He has experienced constipation for four
days and several greenish vomiting. His
vital signs are deteriorating. On physical
examination, the boy has abdominal
tenderness and the doctor finds palpable
abdominal mass in the hypogastric area.
Prior to this, he has recurring abdominal
pain and bloody stool for several weeks, has
history of passage of worm through his
rectum, and has been treated with
antihelminth.The boy and his family live in
a suburb area and he loves to play marble
with his friends. His nails are dirty and his
mother told the doctor that he often forget to
wash his hands before eating. What is urgent
further study the doctor should take to make
the diagnosis?
a. Stool examination
b. Complete blood count
c. Blood glucose level test
d. Plain abdominal radiography
e. Serologic test
27. One member of the NGO (Non-
Governmental Organization) team from
Indonesia has been reported dead in Mexico
because of a spider’s bite. The possible
cause of this disorder is:
a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis
28. A boy brought by his mother to the
emergency department of Siloam hospital
because of vomit & dyspnoea. According to
his mother, her son was playing in the
backyard. On physical examination, the boy
was found to have high fever (39 ºC) and
multiple stinging on the back. The most
likely species of insect bites is:
f. Hymenoptera sp
g. Dermacentos andersoni
h. Lactodectus mactan
i. Loxoxceles laeta
j. Lytta vesicatoria
Question 29-30 are linked to the following case:

29. A 10 years child came with the complaints
of diarrhea, occasionally with blood &
mucus. 2 days ago, the patient complained
about the swelling in the anus. On physical
examination was found prolapsed of the
rectum. On stool examination was found
parasite eggs. The most likely cause is the
worm of species:
a. Ascaris lumbricoides
b. Necator americanus
c. Angilostoma duodenale
d. Trichuris trichiura
e. Enterobius vermicularis
30. Refer to the case above, the habitat of this
worm is located on
a. Liver
b. Lung
c. Caecum
d. Small bowel
e. Stomach
Question 31-32 are linked to the following case:
A 35-year-old man was brought to the
emergency department of hospital with seizure.
On cerebro spinal fluid (CSF) examination
shows neutrophils, red blood cells, and amoebae
form on wet microscopy.
31. Which of the following, which parasite can
be the cause of this disorder :
a. Naegleria fowleri
b. Entamoeba histolytica
c. Acanthamoeba castellani
d. Entamoeba coli
e. Plasmodium falciparum
32. What is the transmission of this disease?
a. Ingestion of infected snails
b. Food & water contaminated with
parasite
c. Mosquito bites
d. Sexual contact
e. Intranasal infection while swimming in
the warm fresh water
33. 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
d. Plasmodium ovale
e. Plasmodium cynomolgi
34. An employee who works in Bogor has a task
in Samarinda for 3 weeks. What is the most
possible drug (s) should be given for this
condition?
a. Chloroquine+ primaquine
b. Sulfadoksin-pirimetamin
c. Atersunate +amodiaquine
d. Kina+tetracycline
e. Doxycycline
35. The mother of a 4-year-old child notes that
her child is sleeping poorly and scratching
his anal area. You suspect the child may
have pinworms. Which one of the following
is the BEST method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of microfilaria
d. Examine transparent adhesive tape for
the presence of eggs
e. Determine the titer of IgE antibody
against the parasites
36. A 23-year-old man presents with extreme
swelling of his legs and scrotum. The skin
associated with the swollen areas is thick
and scaly. The patient admits to an episode
of fever associated with enlarged inguinal
lymph nodes some time ago, but did not
think much of it. Which one of the following
is the BEST method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of microfilaria
d. Examine a blood smear for the presence
of adult worm
 e. Determine the titer of IgE antibody
against the parasites
37. A patient came to the clinic with portal
hypertension syndromes. From the interview, the
patient was known to consume raw fish
regularly. Of the following, the most likely
cause of disease is :
a. Paragonimiasis
b. Clonorchiasis
c. Fasciolopsiasis
d. Echinococcosis
e. Fascioliasis
38. A 40-year-old patient comes with the complaints
of uncomfortable stomach & flatulence. From
history, the patient was known live in the valley
of Napu, Sulawesi and he had a fever frequently.
On physical examination, his liver was found
enlarged. What is the most likely caused of the
disease?
a. Schistosoma haematobium
b. Schistosoma mansoni
c. Schistosoma rodentatum
d. Schistosoma japonicum
e. Schistosoma mekongi
Question 39-40 are linked to the following case:
A 40-year-old man came to the clinic with
complaints of having fever more than one-week,
nausea, and fatigue. He came back from Timika,
Papua. On blood smear examination, there are late
trophozoites forms, schizonts with 12-24
merozoites, and the infected red cell is enlarged.
39. Of the following, the most likely caused of
parasite species is :
a. Plasmodium vivax
b. Plasmodium falciparum
c. Plasmodium malariae
d. Plasmodium ovale
e. Plasmodium cynomolgi
40. Fever symptom on the previous question
referred to :
a. Sporozoites is in the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts
enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed
Question 41-42 are linked to the following case:
A 30-year-old man, having fever for 3 days,
with falciparum rings +++ was given CQ3
(chloroquine for 3 days). After 3 days, the
patient is still feverish, blood smear examination
shows falciparum rings ++++.
41. What is the possible response of CQ?
a. Sensitivity (S)
b. R I resistance, early recrudescence
c. R I resistance, delayed recrudescence
d. R II resistance
e. R III resistance
42. Refer to the previous case above, what is the
treatment of choice?
a. Primakuin
b. Amodiakuin
c. Meflokuin
d. Sulfadoksin pirimetamin
e. Artemisinin
43. 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. Hstoplasmosis
e. Toxoplasmosis
44. A 27 year old women suffering fever for 2
day. She brought to emergency department
unconsciously and she had general seizure 2
hour ago. On physical examination she is
comatous, GCS (Glasgow Coma Scale) : 3;
BP 90/60 mmHg; t 41 °C. Lab. finding: Hb
10, 3 gr%; WBC 5800/mm3; platelet
39.000/mm3; there is schizon form on blood
smear. Why the pathogeniv agent of this
disease becoming the most dangerous species?
a. It make long term relaps
b. Intermittent fever
 c. Gametocyte formation take place in
visceral organ
d. Can make capillary obstruction in Central
Nervous System by parasite contain
erythrocyte
e. There are many drug resistance against P.
falciparum
45. A 35-year old man working on pig farm is
brought by his employer to the emergency
department of Siloam hospital because of
seizure and bilateral lower extremity
weakness. CT scan of the head reveals several
calcified regions. Laboratory examinations
show WBC count of 10.800/mm3, with
eosinophils. Brain tissue biopsy reveals scolex
with hooklets. Which one is the treatment of
choice for this case?
a. Sulfadiazine-pirimetamin
b. Artemisinin
c. Albendazol
d. Metronidazol
e. Itrakonazol
46. A female tourist developed gastroenteritis
while visiting small town in Indonesia and
tried some Indonesian traditional food. The
onset of the disease is abrupt with
abdominal cramps and watery diarrhea. She
had no fever or nausea or vomiting. The
symptoms have resolved within 24 hour and
no subsequent recurrences. They report the
disease to district public health office. The
investigation found that one of the food
products eaten by this tourist was
contaminated by suspected pathogens. What
is the suspected pathogen may cause the
disease above?
f. Salmonella typhi
g. Shigella dysenteriae
h. Enterohemorragic E. coli
i. Staphylococcus aureus
j. Enterotoxigenic E.coli
Question 47-48 are linked to the following case:
47. An-8-year-old girl sustains a large laceration
contaminated with dirt after falling from her
bike. Her mother can’t recall how many
doses of tetanus toxoid her daughter has
received. Management of tetanus
prophylaxis in this situation of unknown
history of prior doses of tetanus toxoid
includes:
a. Adult-type TT
b. TIG
c. TT and TIG
d. HiB containing TT and TIG
e. DPT
48. If this patient developed seizures, what
substance has responsible in this patient?
a. Tetanospasmin
b. Tetanolisin
c. Adenylate cyclase toxin
d. Fillamentous hemagglutinin
e. Pertactin
Question 49-50 are linked to the following case:
A 3-year-old boy was brought to emergency unit
in Tangerang Hospital with stridor, dyspnea, and
“croupy” cough.
49. What is the most likely pathogenic agent
that causes the patient’s disease?
a. Bordetella pertussis
b. Haemophilus influenzae
c. Coxsackievirus
d. B. Parapertussis
e. C. diphtheriae
50. What is the laboratory test to confirm the
diagnosis in this patient?
a. Blood culture
b. Throat swab culture
c. Chest X-ray
d. Measurement of IgG antibody serum
e. Urine culture
Question 51-52 are linked to the following case:
A 2-year-old boy was brought to emergency unit
Balaraja Hospital with difficulty in breathing,
choking, gasping, and whoopcough.
51. What is your most likely diagnosis?
a. Bordetella pertussis infection
 b. Haemophilus influenzaeinfection
c. Coxsackievirus infection
d. Adenovirus infection
e. Corynebacterium diphtheriae infection
52. In this case all the family members should
get the prophylaxis antibiotics as follow:
a. Amoxicillin 30-50 mg/kg/day p.o. for 14
days
b. Amoxicillin 30-50 mg/kg/day p.o.
for7days
c. Erithromycin 40-50 mg/kg/day p.o. for
14 days
d. Erithromycin 40-50 mg/kg/day p.o.
for7days
e. Tetrasiklin 25-50 mg/kg/day p.o. for 7
days
Question 53-54 are linked to the following case:
Male, 46 years old came to you as a doctor with
chief complains shortness of breath especially at
the work place. When he gets home, the
symptom is missing. He also complains that he
sneezes every morning. According to him, his
sister is using bronchodilator inhaler every day.
He just worked at sandblasting company and
expose to dust since 2 weeks ago.
53. What are the most possible causes of his
disease?
a. Wood
b. Quartz
c. Tobacco smoke
d. Coal
e. Amonia
54. The doctor gave him sick-leave certificate
for 2 days and asks the patient to come back
tomorrow to perform spirometry. What is
the result of spirometry do you expect?
a. FEV1 decreased
b. FVC decreased
c. FEV1 and FVC decreased
d. Normal
e. MVV increased
Question 55-56 are linked to the following case:
55. A 2 years old boy brought to
dermatovenereology clinic because of
itching all of the body. He complains itching
on palm, side of finger, buttock, and
abdomen. Clinical manifestations are
papule, vesicle, pustule, erotion, and
excoriation especially at finger web, arm,
abdomen, side of hand and feet, itchy
especially at night.His neighbours have
same problem.He usually play together with
his neighbours.What is the diagnose this
patients?
a. Pediculosis corporis
b. Scabies
c. Tinea corporis
d. Dermatitis atopik
e. Psoriasis
56. What is the best treatment to case above?
a. Sulfur
b. Gamexane
c. Crotamiton
d. Lindane
e. Permethrine
57. A 70 years old women, come to
dermatovenereology clinic because she
complains pain, edema on her left eyelid and
there is some vesicle in her left forehead.
She complain pain on her forehead 2 days
ago, but vesicle come out 1 day ago.She
sometimes fells headache and fever. Clinical
manifestation are grouped vesicle, eritema
base at her left face.What is the diagnose of
this patient?
a. Varicella
b. Herpes zoster
c. Herpes simpleks
d. Dermatitis venenata
e. Dermatitis iritan
58. A 43 years old women, come to
dermatovenereology clinic because she
complains vesicle at genital, and pain, for
the first time. Her husband has same
problem 2 days ago,but it was cured. She is
difficult to walk because of pain on her
genital and low fever. What is the most
appropiate treatment for this patient?
a. Acyclovir 5 x 200 mg, for 7 days
b. Famciclovir 3 x 500 mg,for 7 days
 c. Valacyclovir 2 x 250 mg, for 7 days
d. Acyclovir 2 x 400 mg for 7 days
e. Glucocorticoid topical
Question 59-60 are linked to the following case:
59. A 34 years old man, come to
dermatovenereology clinic, complain itchy
on his sole. He is a army, that usually
exercise at dirty land. Clinical
manifestations are burrow 3 cm on his sole,
erithema, and papule. What is the treatment
for patient above?
a. Lindane
b. Gamexane
c. Albendazole
d. Pirantel pamoat
e. Antibiotika
60. A 30 year old women, come to
dermatovenereology clinic, because she
complains many vesicle on her body, low
fever, muscle pain, and sore throat . She was
pregnant 3 months. What is the diagnose of
her illness?
a. Varicella
b. Herpes Zoster
c. Herpes simplex
d. Moluscum Contagiosum
e. Rubella
61. In epidemiological perspective, what is the
tropical disease?
a. Infectious disease in the tropics
b. Any communicable disease
c. Disease which deaths occur in
children under five
d. Disease which deaths occur in
productive age
e. Primarily found in the developing
world or profoundly impact the
health of people living in the tropics
62. Conditions that contribute to the risk for
becoming infected with tropical diseases
agent:
a. Biological factors related to
population density, rural vs. urban
living, nutritional status, climate and
other environmental factors, as well
as socioeconomic circumstances
b. Genetic factors
c. Cultural factors
d. Tropical factors
e. Synergisms on genetic, cultural, and
immune factors
63. Tropical disease category III is group of
tropical disease which control strategy
proven effective, disease burden falling, and
elimination planned. What are the examples
of disease of this category?
a. Leprosy, lymphatic filariasis
b. Malaria, tuberculosis, dengue,
schistosomiasis
c. Ebola, avian influenza, SAR
d. Protein calorie malnutrition,
pesticide intoxication
e. Hepatitis B, pertusis, poliomyelitis
64. A 24-year-old migrant farm worker is
rushed to a nearby emergency room after an
accidental exposure to parathion. He is
in respiratory distress and is
bradycardic. Which of the following
drugs can be given to increase the
activity of his acetylcholinesterase?
a. Atropine
b. Deferoxamine
c. Dimercaprol
d. Physostigmine
e. Pralidoxime
65. A migrant worker presents to the emergency
room in respiratory distress. He had been
spraying parathion in the fields for several
days, and today he began to feel sweaty and
dizzy. By the time he got to the hospital he
was drooling, gasping, and becoming
agitated. These symptoms are due to the
actions of parathion on which of the
following?
a. Acetylcholinesterase
b. Muscarinicreceptors
c. Neuronallipidbilayer
d. Nicotinicreceptors
e. Voltage-gated sodium channels
66. A 25-year-old woman is despondent that her
husband left her for another woman. She
attempts suicide by ingesting 25 tablets of
extra strength acetaminophen (=650 mg).
Her mother finds her and the empty bottle a
couple of hours later and immediately rushes
her to the emergency room. Which of the
following drugs will most likely be given to
this patient?
a. Acetylcysteine
b. Atropine
c. Penicillamine
d. Pralidoxime
e. Protamine
67. A 46-year-old woman comes to a hospital to
have several bunions removed from her right
foot. She chooses conscious sedation rather
than general anesthesia for this procedure.
She is given intravenous midazolam to
supplement the local anesthetics that are
injected into her foot. Midway through the
surgery, she suddenly becomes agitated,
combative, and exhibits involuntary
movements. The anesthesiologist determines
that she is having a paradoxical reaction to
the midazolam. Which of the following is
the most appropriate drug for counteract that
midazolam?
a. Flumazenil
b. Glucagon
c. Naloxone
d. Nitrite
e. Protamine
68. A 2 year old boy came to the Puskesmas
with ulcer on his left hand. Through the
history taking it was revealed that he had not
been well fed in this past year since his
mother died. From his physical examination
it was found that his BMI (body mass index)
was below 5th percentile for boys of his age.
He was lethargy and looked pale with a face
appearance like a thin old person. His ribs
were very prominent.
Based on this information, he was likely to
be classified in which condition below?
a. Marasmus
b. Kwashiorkor
c. Marasmic-kwashiorkor
d. Energy malnutrition
e. Protein malnutrition
69. A one year old boy was diagnosed with
measles since a week ago. This morning, his
mother noticed that he also suffered for
swollen reddish gums that signified as
scurvy.
What is the most likely mechanism that
underlines his recent condition?
a. Impaired absorption of micronutrients
b. Altered micronutrient metabolism
c. Depletion of micronutrient stores
d. Micronutrient redistribution
e. Negative micronutrient balance
70. An 18 year old girl came to obstetric and
gynecologic outpatient clinic with chief
complaint no menstrual cycle for 2 months.
She also complained for losing weight 5 kg
in the last 3 months. From the history taking
found that she was treated as a tuberculosis
patient since 4 months ago.
What is the most likely underlying
mechanism that affects her nutritional status?
a. Increased gluconeogenesis
b. Increased vitamin excretion
c. Increased resting energy metabolism
d. Increased carbohydrate stores
e. Increased protein anabolic
71. A 53-year-old male farmer presents to the
primary health care complaining about a
mass on his arm. He noticed some mildly
itchy red bumps on his arm since a week
before. They started to blister a day or two
later and then ruptured. During this time he
had a low-grade fever. Futher questioning
reveals he has had no ill contacts and never
had anything like this before. He has cows,
horses, goats, sheep, and chickens on his
farm. On examination of his right upper
arm, you find a 4, 5 cm circular black eschar
surrounded by several blisters and edema.
He has tender axillaries lymph node
enlargement. A gram stain of fluid drained
 from a vesicle and a biopsy from the eschar dorsalis pedis and posterior tibial artery.
both show chains of gram-positive bacilli on What is the next management of the case
microscopy. What organism is the likely described should be?
cause of this disease? a. Wide excision
a. Bacillus anthracis b. Fasciotomy
b. Bacteriodes fragilis c. Antivenin
c. Borrelia burgdorferi d. Incision and suction
d. Campylobacter jejuni e. Corticosteroids
e. Yersinia enterocolitica

SOAL UJIAN TROPIAL MEDICINE

2007
Question 72-75 are linked to the following case:

At night, a 28-year-old man is brought to the

emergency department after his right foot being 1. Putri…kerjasama nya please…. Demi kalian
bitten by an animal, within 1 hour before juga kok
admission. The patient said that he heard the
2. Putri…kerjasama nya please…. Demi kalian
sound of the animal. He complains of pain in his
juga kok
right foot and there are two bitten marks,
surrounded by edema and erythema in the dorsal 3. Anak dengan panas tinggi, myalgia, dan
aspect of his right foot. gejala flu like syndrome lain, ada susah
bernapas. Sodaranya sblm nya juga kaya gt n
72. What is the most likely animal that has udah meninggal.Apa spesimen paling baik buat
bitten the patient? menegakkan diagnosa?
a. Cottonmouth snake ɑ. Saliva
b. Copperhead snake B. Blood
c. Rattlesnake C. Stool
d. Latrodectus mactans D. Lung biopsi
e. Centruroides exilicauda E. Nasofaring swab
73. Initial management of the case described
should be
a. Observation 4. Pertama2 flu like illness, batuk ga
b. Cryotherapy sembuh2,vomiting, hoarseness,
c. Antivenin Answer: pertusis
d. Incision and suction
e. Corticosteroids
5. bitten by dog become hydrofobia,
74. The next step in the management of the
hypersalivation, spasm, and sweating.
patient should be:
a. Wide excision a. giant cell
b. Fasciotomy
c. Antivenin b. limfosit plasma
d. Incision and suction
e. Corticosteroids c. negri bodies

75. After 12 hours, the patient complains of d. clue cell

severe pain especially when he moves his
right leg and his right foot becomes pallor
and cold. There are no pulse in the right
6. kesalahan banker…kehilangan data.. maap c. Renal biopsy
yeii d. Stool exam
e. CT-Scan

A 32 year old worker in a farm having painless

dermal papule on right hand since 5 days ago.
The papule is getting bigger, and the skin
become black. He has tender axilaries lymph
node enlargement.
Anthrax
10. A 53 y.o. farmer experiencing sub febris,
abdominal pain, diarrhea. In his skin there is a
black eschar surrounded with vesicle and there is
edema near his mouth. A week ago he notices
that his cattle were sick, but his still eat half
cook cattle meat. What is the organism?

a. Bacteroides fragilis
7. Which of the following virulance factor is b. Leptospira interrogans
most likely to be involve in pathogenesis of
illness? c. Bacillus antrhacis

a. exotoxin d. Pasteurilla pestis

b. endotoxin e. Borellia brugdorferi

c. alpha hemolysin

d. lipopolysaccharide

e. antiphagotic factor 11. a women and recently return from Lapung

8. A 45 years old man was seen in the
dermatology clinic because of some nodules on
his arm&body and sometimes feel pain with
pressure. On examinations, we found
erythematous nodules, smooth and shiny, diffuse
inflitrate with ill define border, no fluctuation or
erosion. There were pain on his elbow with
nerve enlargement. What laboratorium test
would you do to confirm the clinical diagnosis?
a. TPHA & VDRL
b. Gram preparation
c. KOH preparation
d. Skin scrapping
e. Skin slit smear
9. 40 yo patient complaint uncomfortable
stomach and flatulence. Live in the valley of
Napu, Sulawesi and he had a fever frequently.
PE: liver enlarged. Test buat confirm?
a. Blood
b. Liver biopsy
complaining having paroxymal attack chill,
fever and sweat. These attack last a day 2 days at
time and recur every 36 – 48 jam. Which the ost
appropriate time to take a blood specimen?
a. anytime
b. 10 – 12 a
c. 10 – 12 pm
d. 30 min after fever
e 120 min after fever
12. seorang ibu minum 10 tablet hypnotic 30
menit yang lalu sebelum masuk rumah sakit.
gejala yang tampak : hypotension tachypneu,
tachycardi dan tidak sadar )unconsiusnes.
tindakan sebagai dokter yang yang pertama kali
dilakukan adalah ..
a. apomorphine
b.
c. infusion natrium
d. chancoal dgn NGT e. Antidotes
e.hemodyalisis

16. A 28 years old ,an comes withu high fever

13. Outbreak TB in a dormitory, with the same for 8 days, malaise, headache and constipations.
source of infection, based on RFLP analysis. He denies any vaccines before. Temperature 39
The most appropriate health intervention? C. Blood pressure 130/90 pulse 72x/min. on
a. Rehabilitation Physical examination there are
b. Prevention hepatosplenomegaly and faint erythomatous
C. Curative measles.
D. Medication
E. Environmental modification what are the most likely pathogen?

a.vibrio cholera

14. there is rna virus cause deathly outbreak of b. Shigiella dysentry

hemoragic disease. Patient have feer, muscle
c. salmonella typhi
pain, headach, followed by abdominal pain.
Rash with internal n external bleeding. Hospital d. entero hystolytica
staff is infected. Virus are highly virulent
transmited by: e. Giardia lambia
a. blood n body fluid

b. mosquito bite 17. pasien 28 tahun demam 8 hari ada ciri2

sebagai berikut : erythematousmacula, myalgia,
c. transmission to human from rodent excrata headache, vaksin tidak lengkap.
d. aerosol transmission a. typhii
e. ……….. b.dysentri

c. cholera
15. a 31 years old man with complaints of high d. giardia lambia
fever, cough, shortness of breath. 2 hours before
admission he experienced right sided chest pain e. entamoeba hystolitika
when took a deep breath and cough. Chest
radiography shows diffused bilateral interstitial
pulmonary infiltrate. Analysis of blood gas
showed PO2= 60 and 91% HB saturation. 18. Men, 44 tahun dari Jakarta pergi berbisnis ke
Hematology serum and liver are normal. He Kalimantan selatan. Lalu disana dia pergi ke ER.
lives near poultry. Patho agent are new viral.
Sign and symptom = diare and abdominal
what are the prevention for prophylaxis?
pain
a. vaccines
PE = Pitting edema
b. Antitoxin abdominal and leg

c. Antibiotik Lab culture = (-) enteric pathogen

d. Antiviral Blood = eosinophilia

 Stool = large ellipsoidal, A.acetaminophen
operkuled egg with thin and transparent sheet. B.arsenic
Tekena infeksi apakah bapak ini? C.cyanide
D.flouride
Schistosoma Japonicum E.iron
Fasiolopsis Buski

Tricinella Spiralis 22. Chandra…kerjasama nya please…. Demi

kalian juga kok
Echinococcus granulosus

Clornonsis sinonsis
19. bagaimana mekanisme terjadinya edema
pada cerita diatas?
a. host-allergic reaction because of the parasite
b. the larva penetrate the wall
23. a 55 year old man from middle east had
fever and chill with weight loss, sweats,
headache, muscle pain, fatique, depression. The
man is daily farmer and a couple week before
symptoms appeared he drank glass
unpasteurized raw milk. The culture of blood
tiny gram (-) cocobacill, catalase(+) and oxidase
(+). Infected organism?

c. hypersensitivity reaction because adult worm A. M. tuberculosis

in GI
B. S. typhii
d. there are accumulation of egg in GI
C. Brucell species
e……..
D. Pasteurella pestis

E. S. aureus
20. Pulang dari papua. %hari kemudian ada
intense chill fever.demamnya dengan always 1
day after. between those period, having low
grade fever, myalgia, nausea, vomitting. datang 24. edo…kerjasama nya please…. Demi kalian
ke klinik , 1jam yang lalu masuk ke ICU- juga kok
agitated, ga lama mati. Organism yang masuk ke 25. Komplikasi plg sring ???
host ini berproliferation dmn? a. Pulmo hemoragik
a.brain
b.liver B. m miopericarditis
c.heart
d.spleen c. encephalitisa

d. Osteomyelitis

21. 61yr old man,go to the neurolog clinic untuk e. Anemia

evaluasi peripheral neuropathy. He was found to
have dermal
hyperpigmentation/depigmentation(salt/pepper)
of the skin,scaly palms and transverse ridges on 26. A 39 years old man, live in Manokwari
hus fingernail which were identified as being a papua, developed a major seizure while at work,
result of a chronic chemical intoxication. no history of epilepsy. Head MRI showed lesion
What chemical agent? surrounding a scolex. The etiolohic agent would
most possibly have been acquired by eat/drink:
A. Uncooked vegetables
B. Raw beef 30. 23 years old male.4 days history of fever,
C. Raw pork headache, retroorbital pain, myalgia and rash.
D. Uncooked fish PE diffuse er
E. Unfiltered water
resulting from a pressure applied to her skin.

morbili
27. anak cowo ada lesi di kulit seperti
strawberry, gummata. Exam apa yang paling dengue
cocok untuk diagnosis? influenza
a. widal test coxackie
b. IgM-IgG treponema rhinovirus
c. dark field

d. FTA-ABS 31. a 40 year old lady came to the outpatient

clinic with a chief complaint of fatigue and
e. ELISA
difficulty in concentration for the last two
weeks. HT revealed that she had a balance diet,
no history of chronic disease and had been a
28. A 27 year old man come with acute severe heavy smokers for 20 years. On PE it was found
encephalitis that require hospitalization. Several that she had anaemic conjunctiva with other
days before he got that disease he recognize findings was within normal limits. Lab showed
many pigs in his farm were died. Which of the that she had haemolytic anemia. What is the
following is most appropriated natural host for most likely cause for her condition?
the pathogen?
A. Arthropod a. vitamin K deficiency
B. Horse
C. Bats b. copper deficiency
D. Squirel c. vitamin E deficiency
E. Rats
d. iron deficiency

e. folate deficiency
29. female tourist gastroenteritis ke Indonesia
makan Indonesia food. Abdominal cramp and
watery diarrhea. No fever or nausea or vomiting.
Symptom resolve 24 hours no recurrent. 32. a lab examinaton of a leprosy patient after 4
Pathogen? months MDT therapy revealed bacterial index
6+ morphological index 50%. Which is your
a. s.typhi conclution for this result?
b. shigella dysentriae a. pausibacillar leprosy patient sensitive to
treatment
c. EHEC
b. multibacillar leprosy patient sensitive to
d. s. aureus treatment
e. ETEC
c. multibacillar leprosy patient resistant to A. Reye syndrome
treatment B. Gray syndrome
C. Down syndrome
d. pausibacillar leprosy patient resistant to D. ADHD
treatment E. Black water fever
e. pausibacillar leprosy patient prone to nerve
damage
36. Soalnya ada orang yang mau ke luar dari
jawa dia mau ke papua nah disitu ada banyak
plasmodium tratment apa buat mencegah
33. A boy came with his mother to ER Siloam penyakit tersebut
hospital Jawabannya: doxycycline
His mother said that before this, the boy just
playing in the backyar.
PE: high fever 39'C and multiple stinging on the
back. 37. 40 years old man come to hospital with 4
What is the most likely species that bite him? times generalized tonic clonic seizure since 2
A. Hymenoptera sp. weeks ago. No history of seizure & head trauma.
B. Dermatos andersoni 1 year ago, had bussined in papua for 6 oths.
C. Tactodectus macta During his stay, he ofte osumed undercook pork.
D. Loxoxceles laeta Brain MRI show small cyst??
E. Lytta Vesicatoria
a. taenia eggs

b. cysticercus cellulose
34. A 28 years old lady came to Posyandu to
have a nutrition consultation. Last year, she c. t. solium worm
delivered a stillbirth baby with a spinal disorder.
She and her husband start planning to have a d. t.saginata worm
baby again. She asked for suggestion about her
dietary intake before she got pregnant.
38. 8 day infant born help of ----, irritable 2
What kind of diet does she need to prevent the days ago, noise cause pain episthotonus. PE
same disorder for her future baby? umbilical cord dried. Normal stimulated by
touch/ noise then begin to cry, stiff, arch its
a. Dark green vegetables
back. Stiff continue until calm calm down.
b. Pasteurized milk Diagnosis…
c. Deep water fishes
d. Boiled eggs Bacterial meningitis
e. Lean beef
Botulism

35. 27 yrs old women at term pregnancy had General seizure

fluctuated fever since 2 weeks ago. She looked
Tetanus
pale, generalized weakness and headache.She
went to public health and was given Viral encephalitis
chloramphenicol 500mg 4x daily, paracetamol
500mg 3x daily. She is pregnanct and she didn't
tell. What is the side effect drugs will you find in
that baby? 39. A married mom bring her 18 months son to
ER due to rash that develop today. She reports
that he has had a runny nose, conjunctivitis and The baby has cataract a 3/6 systolic heart
diarrhea. On PE he looks ill, temperature 40oC murmur. Enlargement of both liver and spleen,
and diffuse 2-3 mm erythematous rash begin no lymphadenopathy.
from hair line behind ear and spreading to face
and body. On buccal mucosa, red spot are noted. a. Congenital toxoplasma
b. Congenital rubella
What is the most likely causing agent? c. Congenital cytomegalo
d. Congenital herpes simplex
a. Rubella
e. Congenital varicella
b. Coxsackie virus
c. Morbili
d. HSV-6 44. 40 years old woman, presented with
e. Parvovirus B19 raised redness plaque resemble doughnut with
raised border that she already had for 1 year, no
itchy, weakness on her leg. Her slipper left.
.40 : most severe complication from this disease Annular erythematous sharp border, shiny
(morbili) surface, enlarge popliteal nerve. Lab exam?
a. osteomyelitis
b. encephalitis a. KOH
c. otitis media b. Zielh nelson
d. sinusitis c. Gram
e. oral thrush d. Na cl

41. 48 years old acute gastroenteritis has step 45. A girl returned from Lampung with
nadder night fever since 7 days ago. He also has paroxysmal fever, malaise, and myalgia. The
fever recurrs every 36 to 48 hour. On
abdominal pain and constipation. Biasa makan
uncooked vege at streets . Which is most likely microscopic examination there are ring and
organism? cresecent like shapes inside the red blood cells.
This is characteristic of?
A. Vi antigen
B. Urease A) plasmodium vivax.
C. Hemolysin
D. Shiga toxin B) plasmodium ovale.
E. Pili
C) plasmodium malariae.

D) plasmodium falciparum.
42. Seseorang mengalami sore throat, ada
grayish white di ujung mulut, limfadenopati. E) plasmodium menangle
A. Dipteri
B. Pertusis
C. Tularemia
46. Antidotum untuk keracunan analgesic-
D. ....
antipyretic…
E. ....
a. Amylnitrite
b. Atropine
43. Baby rash identically, mother had febrile c. BAL
illness during the second trimester of pregnancy. d. EDTA
Examination reveals diffuse raised purple skin e. N-methyl cystein
lesion. There is no pallor, jaundice or cyanosis.
47. man 47 years old come to your clinic. he has hypnozoit?
complain about malaise,high fever,and mialgia, A. Primaquine
slightly jaundice.one week ago he has clean a B. Pyrimethamine
canal with his friend..apa yang harus kamu C. Quinine
lakukan sebagai dokter untuk profilaksis dalam D. Chloroquine
kondisi demikian>> E. Chologuanide

a. antiviral,

b. antibiotik 53. Woman 25 y.o, G3 at 39 weeks delivers a

c.antitoxin
d. vaksin
48. women come back from Saudi Arabia, has
weakness and tingling sensation in her right leg,
other neurology exam is normal including her
left leg..Which immunization did she miss?
a.MMR
small gestational age infant with chorioretinitis,
intracranial calcification, micro-cephaly,
jaundice, hepatospleenomegaly. The nurse
reports poor feeding and tone. Mother denies
any raw or undercooked meat, no cats. She
works as nurse in pediatric ICU. What is the
most likely causative agents?
A. CMV
B. Epstain Barr virus
C. Hepatitis B virus
D. Parvovirus
E. Yellow-fever virus

b.DPT 54. 45 y.o male has a chronic skin lesion both

e.Oral Sabin
49. Seorang anak dengan fever, konjungtivitis,
rash dari line belakang rambut kepala sudah
sakit sejak 2-3 hari lalu dari genus apakah itu??
Morbili
50. Severe complicationnya apa?
Encephalitis
Pilihan yg lain g lupa
51. 34 yo women, G2 delivers at 36 week of
growth-restricted infant w/ catarract, PDA, and
sensorineural deaf. Mom had flu-like syndrome
with rash in early pregnancy. Etiology?
A. Porvavirus
B. Rubella
C. Morbili
D. CMV
E. HSV
52. 27 yo woman, abis travelling southeast asia.
Shaking, chills, 40C.Ada P.vivax.Cr treatment
hands for 1 year. Skin erythematous, crusted,
itching, and have serous discharge. Work in a
gold refining plant for 2 years without
protection. Contact with cyanide. Not wearing
gloves. What is the possible mechanism?
A. Immediate reaction
B. Acute reaction
C. Gradual reaction
D. Delayed reaction
E. Quantal reaction
55. male, 46 y.o came to you as a doctor with
complaint 'sesak nafas' in
his work place.
but when he back to home, 'sesak nafas' is
dissapear. he notice, that
his sister using broncodilator. he also complaint
sneezing in morning.
he work in sandbusting company in last 2 week.
From the following what
the appropriate measurement for hazardous
thing.
a. Body mass index
b. nutrition
c. activity susceptibility
d. - D. Selalu pake sepatu
e. tissue and organ
E. Jangan digaruk

56. Anak Kecil perempuan berusia 3th

mengeluh tidak mau makan, badannya kecil,
terdapat anemia, pada pemeriksaan fisik terdapat
hepatomegaly, pada pemeriksaan lab terdapat
eosiofilia, kata ibunya dirumahnya terdapat
anjing dan dia suka main dengan anjing tersebut.
Kemungkinan gejala yang terjadi
a. Creeping Eruption
b. Biliary Cirrhosis
c. Cholecystitis
d. Pruritus Ani
e. Visceral Larva Migrans
A 30 year old woman, presents with abdominal
pain and diarrhea of 3 days duration. She doesn't
complaint of nausea, vommiting or fever. She
has no sick contact or significant travel history.
A stool sample is obtained, which reveals
rhabditiform larva.
59. In condition below adult form of the
pathogenic agent can be found in the whole GIT
and its larvae can be found in visceral organ
(lung, liver, gallbladder) is :
a. eosinophilia
b. hyperinfection
c. retroinfection
d. hypereosinophilia
e. autoinfection

57. Anak kecil datang ke klinik dengan 60. a woman came with the complaint of being
keluhan gatal2 pada pantatnya, ditemukan uncomfortable and hardened in the left upper
sesuatu seperti kuku, diambil dan didapatkan side abdomen. Every 4 days, she is
telur berdinding radial intermittently feverish, on blood smear exam,
plasmodium parasite (+). Fever symptoms on
Penyebabnya.. previous referred to:
a. Taeniasis Saginata Sporozoit in blood
b. Taeniasis Solium Hypnozoit in liver is found
c. Merozoite discharged from schizont and enter
the blood
d. Oxyuris
Process of gametocyte in blood
e. Ascariasis
Pigment in the parasite is formed

58. Laki2 terkena recurrent fungal infection di

bagian kaki dan gatal2. Dia ke dokter dan telah 61. Symptoms : Fever , nausea, fatigue. Back
dikasih obat.Dia minta advice agar penyakit from Kalimantan. Blood smear revealed
tersebut tdk terulang.Apa yg anda sarankan? schizont isi merozoit 12-24, erythrocyte
enlarges. The pathogen is :
A. Hindari makan seafood
a.VivaxMalaria
B. Selalu pake sandal. b.FalciparumMalaria
c. MalariaeMalaria
C. Jaga tetap kering dan bersih. d. OvaleMalaria
e. DowleskiMalaria
62. 52 years 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 protoscoceles
with hooklet and many daughter cysts were
found. What is the most likely diagnosis of the
disease?
a. Hydatidosis
b. Cysticercosis
c.Serebralmalaria
d. Histoplasmosis
e. Toxoplasmosis
63. dewi…kerjasama nya please…. Demi kalian
juga kok
64. dewi…kerjasama nya please…. Demi kalian
juga kok
65. Pengambilan specimen untuk edema pada
leg dan scrotum pada filariasis adalah terbaik
pada waktu….
Answer: 10 – 12 pm
66. livia…kerjasama nya please…. Demi kalian
juga kok
67.livia…kerjasama nya please…. Demi kalian
juga kok
68. lauren…kerjasama nya please…. Demi
kalian juga kok
69. kesalahan banker… maap yei..
is the most effective remains treatement for the
case of pesticide poisoning?
a. Epinephrine
b. Antacid
c. Spironoloctate
d. Atropine
e. HCT
71. A 65 year old woman suddenly had flaccid
paralysis at legs. Few days ago, there are
headache, nausea, fever, sore throat. Her son:
daughter in law, and young grandchild have
vaccine routine oral..She taking
imunosuppressant for kidney transplant. Vital
sign, cranial nerve, CT-scan and MRI normal..
The transmission?
A. Droplet
B. Airborne
C.fecal oral
D. Close contact
E.animal bite
72. Pork eating village in papua new guinea
epidemic outbreak of epilecticum seizure. The
investigate:
A. Level of balantidium coli in swine stool.
B. Practice of consuming raw decease human
brain
C. Presence taenia eggs in drinking water
D.presence of trophozoite in human blood
E. Quantity of culidare in the village
73. 34 years old women complain sudden onset
high fever 4 days with nausea, vomite, muscle
headache, headache, pretechie + . which of the
following laboratorium result is the most
appropriate with the patiet diagnosis?

70. 35 years old male, farmer who was working a. trombositopenia

with pestiside was taken to ER with headache,
b. neutropenia
vomiting, salivation, diarrhea, muscle
fasciculation, difficulty walking, difficult c. anemia
speaking. His cloths has been removed, hes been
washed, has been given activated charcoal. What d. hematocrit decrease
e. leukosit decrease
74. 1 years old baby get swollen gum 1 week.
On history, he has normal body weight, breast
feed until now, balance diet with high intake
cooked vegetable and fruits since 6 month old.
No history of cronic disease. Whats the most
likely cause of the complaining??
a. protein deficiency because of breastfeed
b. Karbohidrat deficiency because of increase
kalori need
c. fat soluble vitamin deficiency because of high
vegetable and fruit intake
d. water soluble vitamin deficiency because of
cooking
e. mineral deficiency because of competition
with vitamin absorbtion
75.Male 10 year old,high fever 38 C,runny
nose,sore throat,mild cough, vesicular lesion at
palatum,dorsal,n palmar of the hand. Most likely
diagnosis:
A.adenovirus
B.coxsackie virus (ini jwbnnya)
C.
D.sinusitis
E.pneumoni
76. 19 years old girl come with sign and
symptomp of poisoning. Nausea, vomiting,
abdominal cramp, diare, excessive saliva,
headache, giddiness, rinorhea, pin point pupil,
and mental confusion. What ‘s the most possible
agent?
a. acetaminophen
b. barbiturat
c. carbamate
d. sianida
e. opiate
77. 22 years old women, G1, complaining flu
like illness during third trismester early. She
delivery a growth restricted infant with seizure
intracranial calcification, jaundice. Whats the
most possible cause?
a. treponema pallidum
b. T.vaginalis
c. toxocara sp
d. neisheria meningitis
e. toxoplasma gondii
78. Influenza virus
79. ETEC
SOAL UJIAN
TROPICAL MEDICINE BLOCK
1. 40 tahun man, fever ≥ 1 minggu. Ada
nausea, fatigue. Back from Timika.
Blood smear revealed late trofozoit,
skizon 12 – 24, merozoit 20, RBC
enlarges. The cause of the fever:
a. Sporozoit in blood
b. Hypnozoit in liver is found
c. Merozoite discharged from
schizont and enter the blood
d. Process of gametocyte in blood
e. Pigment in the parasite is
formed
2. 35 years old male, farmer who was
working with pestiside was taken to ER
with headache, vomiting, salivation,
diarrhea, muscle fasciculation, difficulty
walking, difficult speaking. His cloths
has been removed, hes been washed, has
 been given activated charcoal. What is c. Anti toxin
the most effective remains treatement d. Immunosuppresant
for the case of pesticide poisoning? e. Anti fungal
a. Epinephrine 8. this female illness could be most easily
b. Antacid diagnosed by which of the following
c. Spironoloctate test?
d. Atropine a. HSV – 1 IgM Ab
e. HCT b. CMV antigenemia
3. Man, 31 years old, inguinal c. HHV – 6 IgM Ab
lymphadenopathy, blister on penis, had d. Culture of blood in
unprotected sex 1 month ago. erythroblastic cell
Penyebabnya apa? e. Monospot – test
a. HPV 9. One member of the NGO team from
b. Triponema Pallidum Indonesia has been reported dead in
c. Haemophillus Influenzae Mexico, because of spider’s bite. The
d. Chlamydia trachomatis possible cause of this disorder is:
e. HSV a. Erucism
4. 4 years old, child sleeping scratching b. Lepidopterism
anal. Suspect pin worms. BEST c. Tick Paralysis
diagnosis is? d. Arachnidism
a. Stools for eggs e. Delusional Parasitosis
b. Stools for larva 10. Ulcer + lethargy + pale + face = thin
c. Blood smear of microfilm old person + rib prominent
d. Transparent adhesive tape of a. Marasmus
eggs b. Kwashiorkor
e. Titer IgE antibody c. Marasmic Kwashiorkor
5. Clotted tongue, watery diarrhea, demam d. Energy malnutrition
tinggi pas malem e. Protein malnutrition
a. Salmonella 11. 46 tahun female, several bunion
b. E. Coli removed from her right foot. Chooses
c. Malaria conscious sedation other than general à
d. … become agitated, combative, given IV
e. .. midazolam. Drug that counteract
6. Best treatment for scabies midozolam? (Keracunan obat anesthesia
a. Sulfur midazolam di kasih apa?)
b. Gamexane a. Flumazenil
c. Crotamiton b. Glucagon
d. Lindane c. Naloxone
e. Permethrine d. Nitrite
7. 31 years old female underwent allogenic e. Protamin
bone marrow transplant for AML. 12. 30 years old male, having fever for 3
Second month after, high fever, non days, with falciparum rings +++. He was
productive cough, breathlessness, given CQ3 ( chloroquine for 3 days),
splenomegaly. Lab : anemia, leucopenia, after 3 days, the patients still feverish,
thrombositopenia, abnormal liver blood smear examination show
function test. X-ray: diffuse interstitial falciparum rings ++++. What is the
pulmonary infiltrates. Bronchoalveolar possible respon of CQ?
samnple performed. Infected kidney a. Sensitivitiy
cells à owl eye. Best treatment: b. R1 resistance, early
a. Anti microbial recrudescence
b. Anti viral
 c. R1 resistance, delayed
recrudescence
d. RII resistance
e. RIII resistance
13. Refer to the previous case above, what
is the treatment of choice
a. Primakuin
b. Amodiakuin
c. Meflokuin
d. Sulfadoxine – pyrimethamine
e. Artemisin
14. 24 tahun female, myalgia and weakness
of her right leg. Dari Saudi Arabia,
imunisasi ga komplit. Normal sensation
on right leg, movement and cranial
nerve normal. Which is a target cell
receptor for this pathogenic agent?
a. Silica Acid on mucous cell
b. Ach on neurons
c. CD 4 on T lymphocyte
d. C2d complement on B
lymphocyte
e. Ig on epithelial cell
15. Which one of the following is the best
specimen for diagnosing in case above?
a. LCS
b. Blood
c. Urine
d. Throat swab
e. Rectal swab
16. Young boy, high fever, difficulty
swallowing water, hydrophobia,
disorientation, hypoesthesia. In the left
arm, 4 weeks ago was bitten by dog.
Characteristic of pathogenic : zoonotic,
single stranded, negative sense DNA
virus. Which do you found for
diagnosis?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell
17. Anak laki laki 4 tahun dating dengan
pucat dan intense chills, daily high
fever. Memiliki sickle cell disease.
Platelet 53.000, WBC 17.000.
Description the relevant finding?
a. ..
b. ..
c. ..
d. .
e. ..
18. female 27 tahun, fever 2 hari,
unconscious and general seizure 2 hour
ago. Physical Examination : GCS 3, BP
90/60 mmHg, temperature 41 C, Hb
10.3, WBC 5800, platelet 39.000. blood
smear ada schizont. State yang di takutin
setelah ini?
a. …
b. Intermittent fever
c. Gametocyte formation takes
place in visceral organ
d. Make capillary destruction in
CNS by parasit contain
erythrocyte
e. There are many drugs resist
once aginst P.falciparum
19. A one year old boy was diagnosed with
measles since a week ago. This
morning, his mother noticed that he also
suffered for swollen, reddish gum that
signified as scurvy. Most likely
mechanism that underlines his recent
condition?
a. Impaired absorption of
micronutrients
b. Altered micronutrients
metabolism
c. Depletion of micronutrient
stores
d. Micronutrient redistribution
e. Negative mincronutrient
balance
20. Group III tropical disease
a. Leprosy, lymphasis filariasis
b. Malaria, TB, Dengue,
Schistosomiasis
c. Ebola, Avian Influenza, SARS
d. Protein calory malnutrition,
pesticide intoxication
e. Hepatitis B, Hepatitis B,
pertusis, poliomyelitis
21. Keracunan acetaminophen, kasih apa?
a. Acetylcysteine
b. ..
c. ..
d. ..
e. ..
22. 45 years old man suffered otitis media 2
years ago. He has headache a week ago.
 Radiographic exam shows 3 cm round b. FVC turun
mass. c. FEV1 turun, FVC turun
a. Neoplasm d. Normal
b. Aneurisma e. MVV naik
c. Infarct 28. Seorang bapak tinggal di Lembah Napu
d. Abscess di Sulawesi, terjadi perbesaran hati,
e. Hemorrhage flatulence
23. Appropriate antiepileptic drug for a. Schistosoma japonicum
Absence Seizure? b. Schistosoma mansoni
a. Carbamazepine c. Schistosoma haemotobium
b. Valproic Acid d. Schistosoma rodentisia
c. Benzodiazepine e. …
d. Lumotrigine 29. Cewe 18 tahun come to obgyn dengan
e. Ethuxusimide no menses 2 bulan, lose weight 5 kg for
24. 52 tahun man is brought to the 3 bulan. Lagi dalam proses pengobatan
emergency department in an TB 4 bulan yang lalu
unconscious condition on examination, a. Increase glukoneogenesis
he was death form more than one houn b. Increase vitamin excretion
on autopsy of the brain, there is cyst’s c. Increase resting metabolism
fluid containing protoscoceles with d. Increase CHO store
hooklet and many daughter cysts were e. Increase protein catabolism
found. What is the most likely diagnosis 30. 70 tahun cowo ke ER gara gara seizure,
of the disease? Istrinya jam 5 pagi bangun, lantaran
a. Hydatidosis suaminya seizure. Kepalanya deviasi ke
b. Cysticercosis kiri, tangannya kenceng, trus ada
c. Serebral malaria generalized body jerking +
d. Histoplasmosis unconsciousness selama 2 menit, stop
e. Toxoplasmosis spontaneously. No history of seizure. He
25. 5 year old girl , 2 hari fever + throat. is drowsy and confused. BP 140/195,
Ada lethargy , grayish white membrane HR 96, RR 20, susuh 36.5 C, Resting
di faring, tonsil asimetris, treatment? Blood Glucose 610.
a. Abx, antiviral a. Pseudoseizure
b. Antiviral, antifungi b. Primary epilepsy
c. Antitoxin, antifungal c. Secondary epilepsy
d. Abx, antitoxin d. Acute provoked seizure
e. Antiviral, antitoxin e. Generalized seizure
26. Shortness of breath at work place. At
home, symptoms missing. Sneeze every
morning. Worked at sandblasting 31. Treatment à Insulin cutaneous
company and expose to dust since 2
weeks ago. Possible cause:
a. Wood 32. Female tourist developed gastroenteritis
and tasted some Indonesian food. Onset
b. Quartz
c. Tobacco smoke abrupt with abdominal discomfort and
d. Coal watery diarrhea. Setelah di periksa,
e. Ammonia ditemukan pathogen, yaitu…..
27. doctor gave him sick leave certificate 2 a. Salmonella typhii
days and asks the patient to come back b. Shigella dysentriae
tomorrow to spirometry. Result of c. Enterohemorrhagic coli
spirometry do you expect? d. Enterotoxigenic colli
a. FEV1 turun e. Staphylococcus aureus
33. Seorang pria dari bogor akan pergi ke d. B. paraapertusis
samarinda selama 3 minggu, dikasih e. C. diphtheriae
obat apa? 40. Keracunan parathion à
a. CQ + PQ acteylcholinesterase
b. Sulfadoxine + PQ 41. 2 tahun, febrile, deteriorate, worsening
c. Aretusunate + AQ cough and dyspnea. Child had obvious
d. Kina + Tetracycline respiratory distress with retraction and
e. Doxycycline elevated respi rate. X-ray chest
34. 65 tahun female, tiba tiba lumpuh kaki hiperinfiltration, both lundg field. What
kiri. Beberapa hari lalu, sakit kepala, is the lab?
fever, sore throat, nausea. Tinggal ama a. Nasopharyngeal washing
anak laki lakunya, menantu perempuan, b. Trache aspirate
dan cucu yang masih kecil yang baru c. Bronchial washing
dapet imunisasi rutin, si nenek itu pake d. Nasal swab
immunosuppressant untuk transplant e. Blood
ginjal. Vital bagus, cranial nerves ok. 42. At nite, 28 years old, male, right foot
Head CT normal, Lumbar MRI normal. bitten by animal 1 hour before. Heard
Cara transmisi? the sound of the animal. Pain in Right
a. Droplet foot, 2 bitten mark, edema, erythema, in
b. Airborne dorsal right foot. What likely animal?
c. Fecal-oral 43. Initial management?
d. Close contact a. Obvservation
e. Animal bite b. Cryotherapy
35. 35 tahun male, seizure, CSF = neutrofil, c. Antivenom
RBC, amoeba form on wet microscopy d. Inicision and suction
a. Naegria fowleri e. Corticosteroid
b. Entamoeba histolytica 44. Next step:
c. Acanthamoeba costelorii a. Wide excision
d. Escherichia colli b. Fasciotomy
e. Plasmodium falciparum c. Antivenin
36. 22 tahun, female, 2 week di Papua, d. Incision and suction
blood and slimy diarrhea dari lasat 5 e. Corticosteroid
days in Papua. > 5 kali bowel movement 45. after 12 hours, severe pain especially
each day, stomach cramp, pain stool, no more right leg and leg pallor, cold, no
fever, abdomen tender. Agak dehidrasi pulse in R dorsal artery. Treatement???
a. E.histolytica 46. a woman came with the complaint of
b. Cholera being uncomfortable and hardened in
c. Rotavirus the left upper side abdomen. Every 4
d. Salmonella days, she is intermittently feverish, on
e. E.colli blood smear exam, plasmodium parasite
37. Tidak inget udah imunisasi TT atau (+), of the following, which parasite can
belum, prophylaxis nya apa? cause this?
38. Seizure karena tetanus disebabkan oleh? a. P. falciparum
39. 3 years old boy, brought to emergency b. P.vivax
unit in Tangerang hospital with stridor, c. P.malariae
dyspnea, and croupy cough. What is d. P.ovale
most likely pathogenic agent that cause e. ……
the patient’s disease? 47. Lab test buat pertusis?
a. B. pertusis 48. 10 tahun, diarea, blood and mucus,
b. H. influenzae rectal prolapsus
c. Coxsavirus a. Ascaris
 b. Necator j. Nasopharyngeal swab
c. Ancylostoma
d. Trichius Question 3-4 are linked to the following case:
e. Enterobius (RABIES)
49. parasit ini tinggal di? 3. A young man was admitted to hospital after
a. Liver increasing left arm pain and paresthesia.
b. Lung Several days ago, he contacted with a
c. Small bowel dog……. His symptoms increased and were
d. Stomach accompanied by hand spasm and sweating
e. Caecum on the right side of the face and trunk. This
50. Apa yang bisa bunuh virus rabies? patient was admitted to the hospital the day
a. Infrared radiation after developing dysphagia, hydrophobia,
b. Catalase hypersalivation, and disorientation.
c. Alkali water Which of the following is usefull for making
d. Sunlight a diagnosis in this case ?
e. Heating at 60 C for 30 minute f. Giant cell
g. Limfosit plasma biru
h. Negri bodies
CUCU i. Inclusion bodies
j. Clue cell
(HENDRA-NIPAH VIRUS)
1. A 27-year-old man develops acute severe 4. Which of the following is available for
encephalitis that requires hospitalization. treating this patient?
Several days before he got that disease, he a. Immune globulin
recognizes that many pigs in his farm were b. Live attenuated vaccine
died. c. Antiviral
Which of the following is most appropriated d. Antimicrobial
natural host for the pathogen? e. Antitoxin
f. Arthropod
g. Horse
h. Fruit bats
i. Squirrel Question 5-6 are linked to the following case:
j. Rats (ANTRAX-CUTANEOUS)
A 32-year-old worker from a farm comes with a
2. A 32-year-old female developed a “flu-like” painless dermal papule on his right hand which
syndrome with high fever up to 400C, started to develop since five days ago. The
anorexia, headache, and myalgia. Four days worker says as the lesion getting bigger, and the
later, she become confused and agitated with skin becomes black. He has tender axillaries
difficult to breath. Chest x-ray showed lymph node enlargement.
parenchymal infiltrate. One of her kids has
also these symptoms, and has already passed 5. What antibiotic should the doctor give to
away. In order to provide laboratory treat the worker?
conformation of the pathogenic agent, a f. Tetracycline
tissue culture was ordered. g. Aminoglycoside
Which of the following would be the best h. Ciprofloxacin
specimen for isolating the pathogenic agent i. Neomycin
responsible for this infection? j. Crystalline penicillin G
f. Stool
g. Blood 6. Which of the following virulence factors is
h. Saliva most likely to be involved in the
i. Lung biopsi pathogenesis of illness?
 f. Exotoxin
g. Endotoxin
h. α-hemolysin
i. Lipopolysaccharide
j. Antiphagotic factors
(ANTHRAX-GI)
7. A 53-year-old male farmer developed low-
grade fever, abdominal pain, and diarrhea.
He has a skin lesion of black eschar
surrounded by vesicle and edema near his
mouth. A week before, his notice many
cattle in his farm were sick, but he still eats
a half-done beef steak from his cattle.
What is the following microorganism is
most likely involved in this case?
f. Bacteroides fragillis
g. Leptospira interrogans
h. Bacillus anthracis
i. Pasteurella pestis
j. Borrelia burgdorferi
Question 8-8 are linked to the following case:
(EMERGING AND RE-EMERGING
INFECTIOUS DISEASE)
There is an RNA virus that causes deadly
outbreaks of hemorrhagic disease in Africa. In
each outbreak, hospital staff became infected.
This virus is highly virulent.
8. Which of the following is the most likely
transmission for this disease?
f. Spread by contact with blood or other
body fluid
g. Transmitted by mosquitoes bite
h. Transmitted to human from rodent
excreta
i. Aerosol transmission
j. Direct contact with cattle product
10. High priority bioterrorism agents include
organisms that pose a risk to national
security because they can be easily
disseminated or transmitted from person to
person. Which of the following is most
likely to be transmitted from person to
person in bioterrorism act?
a. Bacillus anthracis
b. Clostridium botulinum
c. Francisella tularensis
d. Variola major
e. Brucella melitensis
Question 11-12 are linked to the following case:
(AVIAN FLU)
A 31-year-old man presented with complaints of
high fever, cough, and shortness of breath. Two
ours before admission, he experienced right-
sided chest pain when took a deep breath or
coughed. Chest film showed diffused bilateral
interstitial pulmonary infiltrate. Arterial blood
gases showed a PO2 of 60 mmHg with 91%
hemoglobin saturation. The hematologic, serum
and liver tests were normal. He lives near the
poultry, and the pathogenic agent is a new virus.
11. Which of the following is the prevention for
this disease?
f. Vaccine
g. Antitoxin
h. Antibiotic
i. Antiviral
j. Antidotes
12. What is the following is probably the reason
for the emergence of this infectious disease?
a. Animal husbandry practice
b. Genetically engineering
c. Vector elimination
d. Antibiotic resistance
e. Tsunami impact

13. An 80-year-old man is developing fever,

9. Which virus is most likely the cause of this cough, runny nose, headache, and myalgia.
outbreak? He lives in a nursing home. Many of people
a. Dengue virus in his neighborhood have this disease.
b. Menangle virus Which immediate course of action would be
c. Lassa virus most appropriate for this patient?
d. Ebola virus a. Vaccination
e. Influenza virus b. Immunoglobulin
 c. Rimantadine
d. Acyclovir
e. Cytokine
14. A 22-year-old man who works in the
pediatric ward of a hospital suffers from
malaise, sneezing, and runny nose. He
subsequently develops a mild sore throat,
headache, and stuffy nose. The symptoms
resolve within 4 days. Which virus is most
likely to be responsible for these symptoms?
f. Rota virus
g. Rubella virus
h. Coxsackie virus
i. Hepadnavirus
j. Influenza virus
(TIFOID)
15. A 48-year-old man with acute gastroenteritis
has sub febrile fever since 7 days ago. He
also has abdominal pain, and diarrhea. He
usually eats undercooked egg every
morning.
Which of the following is most likely to be a
constituent of this organism?
f. Vi antigen
g. Urease
h. Hemolysin
i. Shiga toxin
j. Pili
16. An outbreak investigation note many
costumer from a café were admitted to the
hospital. They have fever; nausea-vomiting,
constipated or diarrhea, weakness and
altered mental status. Rose spots are seen on
the trunk. Blood cultures from patients grow
a non-lactose-fermenting gram-negative rod.
In which of the following sites is a
bacterium most likely to be found?
f. Blood
g. Kidney
h. Liver
i. Intestine
j. Gall bladder
Question 17-18 are linked to the following case:
A 28-year old man presented with 6-day history
of increasing fever, malaise, headache, and
constipation. He did not receive any prior
vaccinations. His vital signs revealed
bradycardia and fever of 400C. His physical
examination revealed mild hepatospleenomegaly
and faint erythematous macules.
17. Which of the following is most likely to
have caused this man’s illness?
f. Vibrio cholerae
g. Shigella dysentriae
h. Salmonella typhi
i. Entamoeba histolitica
j. Giardia lambia
18. Which of the following specimen is most
appropriate for case above?
f. Feces
g. Blood
h. Urine
i. Throat swab
j. Biopsy
Question 18-20 are linked to the following case:
(MALARIA)
A 24-year-old man returned from Papua Island.
Five days later, he developed repeating intense
chills and high fevers. These severe episodes of
fever had been occurring every other day. In
between these episodes, he had low-grade fever,
myalgia, nausea, vomiting, and diarrhea. A few
hours ago, he was admitted to ICU in coma. He
became progressively somnolent and died a
week later.
20. Which of the following organs does this
infectious agent initially proliferate after
entry in the infected host?
f. Heart
g. Liver
h. Brain
i. Spleen
j. Renal
21. What is the most common mode of
transmission of this agent?
a. Contact with rat’s of urin
b. Transplacental crossing
 c. Blood transfusing
d. Bite of a mosquito
e. Eat the contaminated food
22. An apparently run-down but alert 34-year-
old woman comes to your office after 6
months spent as a teacher in a rural West
Sumba. Her chief complaints are frequent
headaches, occasionally nausea and
vomiting, and periodic fever. To rule out
your differential diagnosis, a smear of
finger-stick blood was done. Which of the
following choices would fit your diagnosis
based on your microscopic examination of
the blood smear?
f. Schizonts in red cells with 8-12 progeny
g. Rounded gametocytes present
h. Enlarged, somewhat misshapen
parasitized red cells
i. Numerous large ovoid parasites in some
of the red cells
j. Numerous band-shaped tropozoites in
the parasitized red cells
(NEUROCYSTICERCOSIS)
23. A 39-year-old woman live in Manokwari,
Papua Island developed a major seizure
while at work. She had no history of
epileptic disease. A head MRI was
remarkable for a lesion surrounding a
scolex. The etiologic agent would most
plausibly have been acquired by eating or
dinking which of the following food items?
f. Uncooked vegetables
g. Raw oysters
h. Raw pork
i. Uncooked fish
j. Unfiltered water
24. A pork-eating village in the highlands of
Papua New Guinea is reported to be
suffering from an epidemic outbreak of
epileptiform seizures. You have been sent to
investigate. One of the first things you
should investigate is?
f. The level of Balantidium coli in swine
stool
g. The practice of consuming raw human
brains from recently deceased family
members
h. The presence of taenia eggs in the
drinking water
i. The presence of tropozoites in the
human blood
j. The quantity of culidae in the village
dr. ANGELA
Question 25-27 are linked to the following case:
(BRUCELLOSIS)
A 45-year-old man from the Middle East had
fever and chills, with weight loss, sweats,
headache, muscle pain, fatigue, and depression.
From physical examination the doctor found
lymphadenopathy and spleenomegaly. The man
is a daily farmer and a couple weeks before the
symptoms appeared he drank a glass of
unpasteurized cow milk. The culture of blood
grew a tiny Gram-negative coccobacilus,
catalase and oxidase-positive; that resemble fine
grains of sand.
25. The patient was probably infected with
which of the following microorganism?
f. Mycobcaterium tuberculosis
g. Salmonella typhi
h. Brucella species
i. Pasteurella pestis
j. Staphylococcus aureus
26. Which of the following diagnostic
laboratory test should be done for
identification of this fastidious
coccobacilus?
a. Fluorescent antibody test
b. Western Blot
c. Culture
d. ELIZA assay
e. PCR
27. How did the man get infected form this
disease?
 a. Ingestion of infected unpasteurized cow g. Pertusis
milk h. Weil’s disease
b. Needle stick injury from a contaminated i. Lyme disease
syringe j. Relapsing fever
c. Direct contact with infected animal parts
through intact skin
d. Aedes aegypty bites
e. Fresh orange juice consumption

Question 28-29 are linked to the following case: 31. Which of the following disease is the
(TULAREMIA) complication of this disease?
A 55-year-old warden found a dead muskrat on f. Pulmonary hemorrhage
the bank of a stream. He picks up the animal and g. Myopericarditis
buried it. Four days later, he developed a 1.5 cm h. Aseptic meningitis
painful ulcer on the index finger of his right arm, i. Osteomyelitis
a 1 cm ulcer on his right forehead, and pain in j. Anemia
his right axilla. Physical examination also
revealed right axillary lymphadenopathy. 32. Which of the following reservoir animal is
the source of human infection?
28. Which of the following is working diagnosis a. Fish
for this patient? b. Bird
f. Brucellosis c. Reptile
g. Pertusis d. Scallop
h. Leptospirosis e. Rat
i. Tularemia
j. Hydatidosis 33. Which of the following is drug of choice of
this disease?
29. Which of the following prevention should be a. Penicillin G
done for high risk persons, such as research b. Chloramphenicol
laboratory personnel from this disease? c. Erythromycin
a. Education d. Gentamycin
b. Immunization e. Rifampin
c. Laboratory precaution
d. Burning infected animal Question 34-35 are linked to the following case:
e. Antibiotics taken (LEPTOSPIROSIS)
A 27-year-old medical student was admitted to
Question 30-33 are linked to the following case: hospital because of sudden onset fever up to
(LEPTOSPIROSIS) 390C and headache. Two weeks previously he
A volunteer man returning from a tsunami area volunteers cleaning the canal with others. Blood
was admitted to hospital. A week before, he had tests done shortly after admission indicated renal
fever and headache. These symptoms resolved, function abnormality and elevated liver function
but the day before admission he became pyrexial tests. On examination, he looked so yellow.
and on examination was found to be jaundice
and to have an elevated blood urea. Urine was 34. Which of the following would be most
collected and inoculated into a semisolid agar likely to confirm the diagnosis?
medium, and examined by dark ground a. Testing serum using the rapid plasma
microscopy. reagin (RPR) test
b. Culture the urine on human diploid
30. Which of the following is your working fibroblast cells
diagnosis? c. Testing serum by darkfield microscopy
f. Syphillis
 d. Testing serum for antileptospiral
antibody
e. Culture of CFS on chocolate agar
35. Which of the following is the prevention
after exposure?
f. Human vaccine
g. Health education
h. Vector controll
i. Isolation the infected people
j. Antibiotics prophylaxis
Question 36-38 are linked to the following case:
(YAWS)
A young boy had an ulcerating papule on his
legs. Later, this lesion destroys the bone of his
legs (gummata), but three are no visceral and
nervous system complications. The disease is
still endemic in hot tropical countries, such as
Indonesia.
36. Which of the following microorganism is
the cause of the disease above?
a. Treponema pertenue
b. Borrelia burgdorferi
c. Leptospira interrogans
d. Spirillum minor
e. Chlamydia trachomatis
37. Which of the following drugs is the drug of
choice for the disease above?
a. Tetracycline
b. Penicillin
c. Doxyccycline
d. Vancomycin
e. Clarithromycin
38. Which of the following examination is the
most appropriate to diagnosis the disease
above?
f. Widal test
g. IgG and IgM of Treponema
h. Dark-field microscope
i. FTA-ABS test and TP-PA test
j. ELIZA assay
dr. ROBERT TEDJA
Question 39-40 are linked to the following case:
(TRAVELER DIARRHEA AND THE
PREVENTION)
A female tourist developed gastroenteritis while
visiting small town in Indonesia and tried some
Indonesian traditional food. The onset of the
disease is abrupt with abdominal cramps and
watery diarrhea. She had no fever or nausea or
vomiting. The symptoms have resolved within
24 hour and no subsequent recurrences. They
report the disease to district public health office.
The investigation found that one of the food
products eaten by this tourist was contaminated
by suspected pathogens.
39. What is the suspected pathogen may cause
the disease above?
k. Salmonella typhi
l. Shigella dysenteriae
m. Enterohemorragic E. coli
n. Staphylococcus aureus
o. Enterotoxigenic E.coli
40. Which of the following is the natural
prevention for the disease above?
a. Bi Subsalicylate
b. Antibiotic
c. Probiotic
d. Chlorination
e. Hand hygiene
41. Approximately 4 hour after eating a meal in
restaurant, 3 members of a tourisms group
develop a sudden onset of nausea, vomiting,
severe abdominal cramps, and diarrhea.
Nobody got febrile. Which of the following
vaccination is should be given to the
traveler?
f. Shigella vaccine
g. Salmonella vaccine
h. Enterobacter vaccine
i. H Pylori vaccine
j. Cholera and ETEC vaccine
dr. SANDRA
(DHF)

42. A 23-year-old man sees his family physician
with a sudden onset of 4-day history of
fevers, headache, retro-orbital pain, myalgia
and rash. Physical examination shows
diffuse erythroderma with blanching
erythema and petechial formation resulting
from pressure applied to her skin.
Laboratory test reveal leucopenia and
trhrombocytopenia. Which of the following
virus is most likely responsible for this
infection?
f. Morbili
g. Dengue
h. Influenza
i. Coxsackie
j. Rhinovirus
43. A 34-year-old woman complained a sudden
onset of high fever for 3 days with nausea,
vomiting, headache, muscle ache. There was
petechie on examination. The laboratory test
revealed leucopenia, thrombocytopenia, and
elevated of hematocrit. The patient most
likely acquired this infection by which of the
following modes?
a. Intravenous drug use
b. Inhalation of contaminated dust
c. Close contact with a symptomatic
patient
d. Bitten by an arthropods
e. Eating some contaminated food
Question 44-46 are linked to the following case:
A 20-year-old woman came to the emergency
room with high fever from 3 days ago. She also
has headache and pain in retroorbita, abdominal
pain and bloody stool. On physical examination,
she was in an agitated condition. Her BP 90/60
mmHg, heart rate 110x/ minute, RR 20x/ minute
and there was red spot in her arm, hand and leg.
44. Which of the following examination is the
most appropriate to diagnose this infection?
f. Prick test
g. Tourniquet test
h. Complete blood test
i. Widal test
j. Urine test
45. The patient was give IV line, and blood
examination was done. Which of the
following result is most appropriate with the
patient’s diagnosis?
f. Trombositosis
g. Leukocytosis
h. Erythrositosis
i. Elevated of hematokrit
j. Elevated of LED
46. In the forth day, the patient developed
epistaksis, melena and more clear
hemorrhage in skin. Which of the following
is responsible for his condition?
a. Elevated of thrombocyte increasing
coagulation
b. Fibrin degradation make dysfunction of
thrombocyte
c. Elevated of kinin in circulation
d. Plasmin elevated coagulation factor
e. Complemen activation by plasmin
dr. DWI
47. A 48 year old lady came to the outpatient
clinic with chief complaint of fatigue and
difficulty in concentration for the last 2
weeks. The history taking revealed that she
had a balanced diet, no history of chronic
disease and had been a heavy smoker for 20
years. On physical exam it was found that
she had anaemic conjunctiva with other
findings was within normal limit. The
laboratory examination showed that she had
haemolytic anaemia.
Based on the information given above, what
is the most likely cause for her condition?
f. Vitamin K deficiency
g. Copper deficiency
h. Vitamin E deficiency
i. Iron deficiency
j. Folate deficiency

48. A 28 year old lady came to the Posyandu to
have a nutrition consultation. Last year, she
delivered a stillbirth baby with a spinal
disorder. She and her husband start planning
to have a baby again. She asked for
suggestion about her dietary intake before
she got pregnant.
What kind of diet does she need to prevent
the same disorder for her future baby?
f. Dark green leafy vegetables
g. Pasteurized milk
h. Deep water fishes
i. Boiled eggs
j. Lean beef
49. A 1 year old girl came to the Puskesmas
with swollen gum for a week. From the
history taking it was found that she was born
normal with normal birth weight, had been
breastfed up to now and had a balanced diet
with high intake of cooked vegetable and
fruit since 6 months old. She had no history
of chronic diseases. Her other physical and
laboratory examination was normal.
Based on the information given above, what
is the most likely cause of her complaint?
f. Protein deficiency due to prolonged
breastfeeding
g. Carbohydrate deficiency due to
increased calorie need
h. Fat soluble vitamin deficiency due to
high vegetable/fruit intake
i. Water soluble vitamin deficiency due to
cooking process
j. Mineral deficiency due to competition
with high vitamin absorption
dr. JULIANA
(TUTOR)
Question 50-51 are linked to the following case:
A 9 year old girl came to the emergency room
with difficult of breathing. She had got high
fever since 3 days ago. Her temperature was up
to 40oC. She also complained of rhinnorhea,
cough, and myalgia. On examination, you found
increased tactile fremitus on the right side of the
lung, dullness on percussion. Laboratory result
indicated leucopenia.
50. Which criteria of avian influenza is the most
appropriate with this patient’s condition?
a. Probable
b. Suspect
c. Confirmed
d. Definitive
e. Absolute
51. Based on its ability to cause disease, avian
influenza is broadly divided into highly
pathogenic (HPAI) and low pathogenic
(LPAI) strains. Which subtypes are known
to cause the HPAI?
a. H1 and H3
b. H2 and H4
c. H5 and H7
d. H6 and H8
e. H9 and H11
52. A 50 year old woman presented to clinic
with fluctuated fever (also called as step
ladder fever) since 7 days ago. On physical
examination, you found “rose spots” on
upper abdomen. What is the possible cause
of rose spots on this woman?
a. Eritrocytopenia
b. Leucopenia
c. Thrombocytopenia
d. Limfositosis
e. Deficiency of clotting factor
53. A 27 year old woman in pregnancy had
fluctuated fever since 2 weeks ago. She
looked pale, generalized weakness, and
headache. She went to public health center
and was prescribed oral chloramphenicol in
doses of 500 mg four times daily and
paracetamol 500 mg three times daily. She
did not tell to the physician that she was
pregnant. What is the side effect of
chloramphenicol on this patient?
f. Reye syndrome
 g. Gray syndrome
h. Down syndrome
i. ADHD
j. Black water fever
54. A 24 year old man, recently returned from
Myanmar, presented very unwell febrile. His
consciousness was GCS of 7. His thin blood
smear showed malaria falciparum. Which of
this following is the best treatment for this
patient?
a. Chloroquine
b. Mefloquine
c. Fansidar
d. Doxycycline
e. Quinine IV
55. A 35 year old man, a businessman, came to
private doctor. He asked the physician about
his plan to go to Africa, which is endemic
malaria. The physician suggested him to
take prophylactic drug. Which medication
(WHO recommended) would be given to
this patient for prophylactic?
f. Kina
g. Chloroquine
h. Doxycycline
i. Kuinin
j. Primakuin
56. A 40 year old man came to hospital with
four times generalized tonic-clonic seizure
since two week ago. There was no history of
seizure and head trauma. A one year ago, he
had business in Papua for six months.
During his stay in there, he often consumed
under-cooked pork. Brain MRI showed a
small cystic with invaginated scolex inside.
What of this following is the most likely
inside cyst?
f. Eggs
g. Cycticercosis cellulose
h. Cysticercosis bovis
i. Taenia solium
j. Taenia saginata
57. A 15 year old girl of African origin was
admitted with a history of headaches and a
generalised tonic seizure. Her clinical
examination was normal. Within a few
hours of her admission she was found dead
in her bed during the ward round. After
autopsy, the diagnosis was
neurocycticercosis. Which of this following
brain’s location is the possible cause of
patient’s sudden death?
a. The frontal lobe
b. The temporal lobe
c. The parietal lobe
d. The lateral ventricle
e. The fourth ventricle
dr. ROBERT SOETANDIO
58. You are precepting a resident who has just
evaluated a 4-year-old incompletely
immunized immigrant boy who has classic
varicella lesions and a history that is
consistent with this diagnosis. Of the
following, the MOST accurate statement is
that
a. Lesions of both varicella and smallpox
follow a 7- to 10-day course from
eruption to resolution
b. Lesions of both varicella and smallpox
frequently produce deep, pitted scars
c. Varicella lesions appear in stages or
crops; smallpox lesions are uniformly in
the same Stage of development
d. Varicella lesions are concentrated on the
face; smallpox lesions are concentrated
over bony prominences
e. Varicella lesions are transient vesicles;
smallpox lesions are persistent pustules
until resolution of the illness
59. You are working in a refugee camp when a
mother brings in her 8-day-old boy. The
mother states he started becoming irritable 2
days ago, and now any loud noise appears to
cause him pain, as evidenced by muscle
tightening and back arching causing his head
to nearly touch his feet. Physical
examination reveals only a dried packing on
his umbilical cord, as is the local custom. He
appears normal until he is stimulated by
touch or a loud noise, and then he begins to
cry, stiffens, and arches his back. The
stiffness continues until he calms down. Of
the following, the MOST likely diagnosis is
 f. Bacterial meningitis
g. Botulism
h. Generalized seizure 63. What is the name disease what is caused by
i. Tetanus coxsackie virus and the location in the
j. Viral encephalitis mouth?
a. HFMD
Question 60-61 are linked to the following case: b. Herpangina
c. Conjungtivitis
60. 4. A worried mother brings her 18-month- d. Pleurodynia
old son to the emergency department e. Streptococcal pharyngitis
because of a rash that developed today. She
reports that he has had a runny nose, Question 64-65 are linked to the following case:
conjunctivitis, and diarrhea. On physical
examination, he appears toxic, is 64. A 10-year-old girl presents with a history of
temperature to 104ºF (40°C) for the last 3 sore throat and difficulty breathing of 1
days and has diffuse 2- to 3-mm day’s duration. She returned 2 days ago
erythematous rush beginning from their from a trip to Odessa (Ukraine). On
face. Of the following, the MOST likely examination she is very ill-appearing. She
cause of the rash is has some inspiratory stridor and thick white-
f. Adenovirus gray material covering her tonsils and
g. Coxsackievirus faucial pillars, and she has swelling of her
h. Measles neck, no splenomegaly. The lymphocyte is
i. Human herpesvirus 6 normal. What is the likely diagnosis?
j. Parvovirus B19 f. Tonsilitis Folikularis
g. Angina Plaut Vincent
61. Case no 4, if the son got worse. What would h. Mononucleosis infectiosa
the complication happened? i. Laryngitis Akut
f. Osteomylitis j. Faucial Diphteria
g. Encephalitis
h. Otitis externa 65. Case no 64. if we want to give her DAT.
i. Sinusitis How much should we give DAT?
j. Oral thrush a. DAT 80.000 IU
b. DAT 50.000 IU
Question 62-63 are linked to the following case: c. DAT 100.000 IU
d. DAT 40.000 IU
62. A 10-year-old boy who has moved to your e. DAT 60.000 IU
practice recently has sore throats, get high
temperature. The child reports a runny nose, 66. According IDAI schedule 2008, when is the
mild cough, and abdominal pain. Findings child getting the vaccination booster for the
on physical examination include a disease above after 18 months?
temperature of 100.3°F (38°C), and a. 5 years
vesicular lesions on the soft palate. There is b. 4 years
no cervical adenopathy or rash. c. 3 years
Of the following, the MOST likely diagnosis d. 12 years
is e. 15 years
f. Adenovirus infection
g. Coxsackie virus infection Question 67-68 are linked to the following case:
h. Mononucleosis
i. Sinusitis 67. A 16-year-old boy presents with an
j. Streptococcal pharyngitis annoying cough, which he has had for about
3 weeks. The illness started with a runny
 nose. On examination he is completely 71. How old is the baby getting the vaccination?
normal, but he exhibits several episodes of a. 15 months
severe coughing. He is difficult to get b. 16 months
inspiratory and usually finished by vomit. c. 17 months
The laboratory results are leucocytocis and d. 18 months
absolute lymphocytes. Of the following, the e. 19 months
MOST likely diagnosis is
f. Tonsilitis Folikularis
g. Bronchiolitis dr. HANNA
h. Pertussis Question 72-73 are linked to the following case:
i. Laryngitis Akut
j. Faucial Diphteria A 45-year-old man was seen in the dermatology
clinic because of some nodules on his arm and
body and sometimes feel pain with pressure. On
examinations we found erythematous nodules,
68. The boy in case 67 often gets secondary smooth and shiny, diffuse infiltrate with ill
infection. What the most organisms is define border, no fluctuation or erosion. There
usually cause the secondary infection? were pain on his elbow with nerve
a. Stafilokokus aureus enlaergement.
b. Treponema palidum
c. Haemophilus Influenza 72. What is the most likely diagnosis?
d. Serratia marcescens a. Yaws
e. Corynebacterium diphteriae b. Leprosy
c. Anthrax
Question 69-71 are linked to the following case: d. Cellulitis
e. Carbuncle
69. A baby is born with a rash identical.
Questioning reveals that the mother had a 73. What laboratory test would you do to
febrile illness during the second trimester of confirm the clinical diagnosis?
pregnancy. Examination reveals diffuse f. TPHA and VDRL
raised purple skin lesions. There is no pallor, g. Gram preparation
jaundice, or cyanosis. The eyes are cataract, h. KOH preparation
the heart has a 3/6 systolic murmur, and
there is enlargement of both the liver and the i. Skin scrapping
spleen. There is no lymphadenopathy. j. Skin slit smear
Of the following, the MOST likely diagnosis
is? 74. The 21-year-old man was seen in
f. Congenital Toxoplasmosis dermatology clinic because of sore and
g. Congenital Rubella redness on his previous skin lesion. He was
h. Congenital Cytomegalovirus on M D T treatment since 1.5 year ago. On
i. Congenital Malaria skin examination they found some painfull
j. Congenital Varicella erythematous nodule spread over his body
especially on arm and legs also fever. What
70. What is vaccination which prevents disease is the most likely diagnosis ?
in number 69? a. Celulitis
a. Measles b. Furuncle
b. Varicella c. Erythema nodosum
c. MMR d. Multibacillar leprosy
d. HPV
e. PCV e. Pausibacillar leprosy
75. 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
conclution for this result ?
f. Pausibacillar leprosy patient sensitive to
treatment
g. Multibacillar leprosy patient sensitive to
treatment
h. Multibacillar leprosy patient resistent to
treatment
i. Pausibacillar leprosy patient resistent to
treatment
j. Pausibacillar leprosy patient prone to
nerve damage
76. A 40-jear-old woman presented with a
raised redness plaque resemble a doughnut
with a raised border that she already had for
1 year, It was no itchy, no pain, not easily
bleeding. Sometime she feel weakness on
her leg and her sandal left behind while
walking. On her legs she developed an
anular erythematous sharp border lesion, no
scally, shiny surface and enlargement of the
popliteal nerve. What is the most likely
diagnosis?
a. Leprosy
b. Yaws
c. Celulitis
d. Anthrax
e. Insect bite
77. A 30-year-old farmer complaned about
weakness on his three fingers that he can not
hold a plough He found some white patches
on his back, tummy arms, he felt numbness
on his right hand but not itching After one
year on medication he experience tenderness
and sore on his right elbow and the skin
patches became red. What is the most likely
diagnosis?
a. Framboesia
b. Scorpion bites
c. Reversal reaction
d. Lepromatous leprosy
e. Ramsay Hunt syndrome
78. A patient on MDT treatment complaining
about red urine that he experinced on the
first day of treatment. What is the suggestion
for this condition ?
a. Stop Clofazimin, can cause pink
brownish discolouration
b. Continue the medication, its not a drug
adverse effect
c. Stop the medication because of
nefrotoxicity
d. Stop Dapsone can cause anemia
hemolytic
e. Change the treatment to single drug
therapy
79. A 50-year-old man complained about the
treatment for his leprosy since it takes one
year medication with multiple drugs (MDT)
every day. Can you give some explaination
about the length of treatment ?
a. There is no cure for leprosy
b. Leprosy bacteria can’t be killed by 1
drug
c. M D T treatment can cure the disability
d. To prevent from drug resistancy
e. Due to his low immunity
dr. KRISTO
80. Tuberculosis become one of reemerging
infectious disease because
a. More cases of tuberculosis found in
developing countries
b. Found more cases in childrek
c. Found more cases of lung cancer
d. Found more cases of drug resistance
e. More people who smoke
81. Antigenic shift of influenza viruses occurred
in
a. Haemagglutinin
b. Neuramidase
c. M2 protein
d. NS1
e. NS2
82. Epilepsy which occurs in neurosistiserkosis
caused by the
a. Colloidal cyst
 b. Vesicular cyst patients with typhoid fever was the doctor
c. Calcification cyst taking the material for culture from?
d. Necrosis cyst a. blood
e. Granuloma cyst b. urine
c. stool
83. Human infection with the beef tapeworm, d. intestinal secretion
Taenia saginata, usually is less serious than e. bone marrow
infection with the pork tapeworm, Taenia
solium, because 87. Typhoid fever pathogenesis is not affected
a. Acute intestinal stoppage is less common by
in beef tapeworm infection a. Antigen Vi
b. Larval invasion does not occur in beef b. Antigen H
tapeworm infection c. Gastric acidity
c. Toxic by-products are not given off by the d. Amount of bacteria
adult beef tapeworm e. Antacid drug
d. The adult beef tapeworms are smaller
e. Beef tapeworm eggs cause less irritation 88. Amantadine, a synthetic antiviral agent used
of the mucosa of the digestive tract prophylactically againt influenza, is thought
to act by
84. A woman, recently returned from Lampung, a. preventing production of viral capsid
complains of having paroxysmal attacks of protein
chills, fever, and sweating; these attacks last b. preventing virion release
a day or two at a time and recur every 36 to c. preventing penetration of the virus into
48 h. Examination of a stained blood the host cell
specimen reveals ringlike and crescent-like d. preventing uncoating of viral DNA
forms within red blood cells. The infecting e. causing lysis of infected host cells by
organism most likely is release of intracellular lysosomal
f. Plasmodium falciparum enzymes
g. Plasmodium vivax
h. Plasmodium ovale 89. A 27-year-old female has just returned from
i. Plasmodium malarie a trip to Southeast Asia. In the past 24 hours,
j. Plasmodium brasilianumi she has developed shaking, chills, and a
temperature 40o C. A blood smear reveals
85. Malaria is a significant worldwide public Plasmodium vivax. Which of the following
health problem. Which one of the following agents should be used to eradicate the
control methods for malaria is currently extraerythrocytic phase of the organism?
effective? f. Primaquine
a. A vaccine g. Pyrimethamine
b. Chemoprophylaxis h. Quinacrine
c. Antibiotics i. Chloroquine
d. White clothing j. Chologuanide
e. Tick repellents
90. The mechanism of action of chloroquine in
86. A man came to the emergency room with Plasmodium falciparum malaria is
complaints body felt weak, fever, and elimination of?
diarrhea since 7 days ago. Prior to the a. Secondary tissue schizons
emergency room, the patient had been to the b. Exoerythrocytic schizoons
clinic 24 hours and given paracetamol and c. Erythrocytic stage
cloramfenicol for 5 days, but the symptoms d. Asexual forms
did not subside. For definitive diagnosis in e. Sporozoites
91. A 26-year-old nulliparous woman, in her
seventh month of pregnancy complains of a
7 days history of fever especially at night.
As she recall, 2 weeks ago she ate gado-
gado in coastal area when she out for duty
for several days. She also had diarrhea and
abdominal discomfort. On physical
examination reveals blood pressure 110/70
mmHg, heart rate 60 ×/min, RR 20x/min,
temp. 39.1°C. Tongue is coated and tremor.
Fetal USG shows normal.
What is the most likely etiologic factor
above?
f. Salmonella typhi
g. Plasmodium falciparum
h. Vibrio cholera
i. Hepatitis A
j. Escherichia coli
92. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he contacted with a
dog……. His symptoms increased and were
accompanied by hand spasm and sweating
on the right side of the face and trunk. This
patient was admitted to the hospital the day
after developing dysphagia, hypersalivation,
agitation, and generalized muscle twitching.
Which of the following could rapidly
destroy the pathogenic agent of this disease?
a. Infrared radiation
b. Catalase
c. Alkali water
d. Sunlight
e. Heating at 60ºC for 30 minute
93. A 35-year-old man as a farm worker who
was working with pesticides is brought to
the emergency room with headache,
vomiting, salivation, diarrhea, muscle
fasciculation, difficulty walking, and
difficulty speaking. His clothing has been
removed, he has been washed, and he has
been given activated charcoal. What is the
most effective remaining treatment for this
case of pesticide poisoning?
f. Epinephrine
g. Antacid
h. Spironolactone
i. Atropine
j. Hidrochlorothiazide
94. A 27-year-old man came to a clinic with
high fever for two days which is started with
a chill. He also complained of swellings in
his left inguinal area. They were firm,
discrete, and somewhat tender. His scrotums
are also enlarged and tender. His doctor
performed a thick blood smear examination
using blood that was taken at night but
found nothing. What should the doctor do to
make the diagnosis?
a. Biopsy of the scrotum
b. USG of the scrotum
c. CT scan of the scrotum
d. MRI of the scrotum
e. Aspiration of the scrotum fluid
95. A young man presented to his general
practitioner with a history of headache and
fever together with a dry cough and muscle
ache. His nose was also blocked and his
eyes watery.
What is your clinical diagnosis?
a. Influenza virus infection
b. Human herpes virus
c. Cytomegalovirus
d. Epstein-Barr virus
e. Adenovirus
96. A 4-year-old child presents with fever,
cough, conjunctivitis, coryza, photophobia,
posterior cervical adenopathy. Red lesions
with a white center are present on the buccal
mucosa. A generalized erythematous rash is
also noted. What is the appropriate
management of this patient above?
a. Immune globuline
b. MMR vaccine administration
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics
97. To know the endemicity of malaria on Pulau
Seribu, spleen examination on children aged
2-5 years was done. The result shows that
this place is mesoendemicity.
What is the meaning of mesoendemicity?
a. Spleen rates not exceeding 10 %
b. Spleen rates between 11% and 50%
c. Spleen rates constantly over 50%
 d. Spleen rates constantly over 75%
e. Parasite rate not exceeding10%
98. The cattle at animal husbandry are
occasionally was dead because of tick
paralysis, the species of arthropod that can
be the cause to this disorder is;
a. Rhipicephalus sanguineus
b. Dermacentos andersoni
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria
99. After contacting with hairy caterpillars, a
farmer felt itching all over the whole
body and his eyes are swollen. The possible
cause of this disorder is:
a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis
Question 89-90 are linked to the following case:
A 23-year-old man presents with extreme
swelling of his legs and scrotum. The skin
associated with the swollen areas is thick and
scaly. The patient admits to an episode of fever
associated with enlarged inguinal lymph nodes
some time ago, but did not think much of it.
100. Elephantiasis is caused by the
obstruction of :
a. The arteries by microfilariae
b. The arteries by adult worm
c. The lymphatics by microfilariae
d. The chronic lymphatics by adult worm
e. Fibrosis of the lymphatic
101. Occult filariasis is Lymphatic filariasis
based upon :
a. Infection
b. Allergy
c. Infestation
d. Colonization
e. Genetic
102. A patient complains of having nail size
excrement from his anus. On the stool
examination, parasite eggs contains a hexacanth
embryo with six hooklets surrounded by radially
striated spherical shell, 30 to 40 u in diameter
were found, the most likely diagnosis of this
patient is :
a. Saginata taeniasis
b. Solium taeniasis
c. Cysticercosis
d. Sparganosis
e. Dipylidiasis
Question 92-93 are linked to the following case:
A 40-year-old man came to the clinic with
complaints of having fever more than one-week,
nausea, and fatigue. He came back from Timika,
Papua. On blood smear examination, there are late
trophozoites forms, schizonts with 12-24
merozoites, and the infected red cell is enlarged.
103. Of the following, the most likely caused
of parasite species is :
f. Plasmodium vivax
g. Plasmodium falciparum
h. Plasmodium malariae
i. Plasmodium ovale
j. Plasmodium cynomolgi
104. Fever symptom on the previous question
referred to :
f. Sporozoites is in the blood
g. Hypnozoites in the liver is formed
h. Merozoites discharged from schizonts
enter the blood
i. The process of gametocytes in the blood
j. Pigment in the parasite is formed
105. A 27 year old women suffering fever for 2
day. She brought to emergency department
unconsciously and she had general seizure 2
hour ago. On physical examination she is
comatous, GCS (Glasgow Coma Scale) : 3;
BP 90/60 mmHg; t 41 °C. Lab. finding: Hb
10, 3 gr%; WBC 5800/mm3; platelet
39.000/mm3; there is schizon form on blood
smear. The most likely diagnosis is :
a. Malaria viviax
b. Malaria falciparum
 c. Malaria malariae
d. Malaria ovale
e. Mix infection of malaria vivax and
malaria falciparum
106. Sexual life cycle of malaria parasite take
place in :
a. Human liver cell
b. Human spleen cell
c. Human erythrocyte
d. Mosquito body
e. Mosquito proboscis
107. Plasmodium falciparum is the most
dangerous species because :
f. It make long term relaps
g. Intermittent fever
h. Gametocyte formation take place in
visceral organ
i. Can make capillary obstruction in Central
Nervous System by parasite contain
erythrocyte
j. There are many drug resistance against P.
falciparum
Question 97-98 are linked to the following case:
A 30-years-old woman presents abdominal pain
and diarrhea for 3 days duration. She does not
complain of nausea, vomiting, or fever. She has no
sick contacts or significant travel history. A stool
sample is obtained, which reveals larvae form of
of Strongyloides stercoralis.
108. In condition below adult form of
Strongyloides stercoralis can be found in
whole digestive tract and its larvae can be
found in visceral organ (lung, liver, gall
bladder) is :
a. Eosinofilia
b. Hyperinfection
c. Retrofection
d. Hypereosinofilia
e. Autoinfection
109. Refer to the case above; further
questioning reveals that the woman frequently
gardens in her backyard. Of the following,
which one is the transmitted form?
a. Fecal – anal transmission
b. Fecal – oral transmission
c. Fecal – cutaneous transmission
d. Direct contact with skin scales
e. Intravenous drug abuse
110. A 10-month-old healthy male infant
travelling with his family to Africa was
exposed 4 days ago to his 4-year-old native
African cousin who was ill at the time with
fever, cough, coryza and conjunctivitis. The
baby was at risk to get infected by:
a. Corynebacterium diphtheriae.
b. Haemophilus influenzae
c. Bordetella pertussis
d. Morbilivirus
e. Coxsackievirus
111. Her mother makes an overseas phone
call to your office asking your advice.
Appropriate management of this patient
includes:
a. Immune globuline
b. MMR vaccine administration
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics
112. A 3 year old girl came to pediatric
outpatient clinic with her parents. Her
mother complaint that she had watery
diarrhea since 3 days. This was her 3rd
episode of diarrhea in the last 2 months. Her
mother also noticed that she was delayed in
growth and development compared to her
siblings. She hardly gained weight and
height since last year. The physical
examination showed that her weight and
height was below 5th percentile for girls of
her age.
What is the most likely underlying
mechanism that caused her repeated
episodes of diarrhea?
a. Protein catabolism
b. Reduced food intake
c. Altered lipid metabolism
d. Reduced bactericidal activities
113. A 65-year-old-woman suddenly had
paralysis of her left leg. A few days ago, she
had headache, fever, sore throat, and nausea.
She lives with her son; daughter in law and a
 young grandchild who’s just received a B. Platelet count
routine oral vaccination. She is taking
immunosuppressant for her kidney’s C. Dengie igm igg
transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan D. Wbc count
and lumbar MRI are also normal. E. Ht n eritrosit count
What is the most likely transmission of her
infection?
a. Droplet
b. Air borne 3. Worried mother bring her 18month son, rash
c. Fecal-oral develop todayn runny nose, conjunctivitis,
d. Close contact diarrhea, lethargy, irritable. Temp 40c for 3days.
e. Animal bite Diffuse 2-3mm erythemateous rash beginning
114. A 4-year-old child presents with fever, from face. Sever complication?
conjunctivitis, photophobia, posterior
cervical adenopathy, and coryza. Red A. Sinusitis.
lesions with a white center are present on the
B. Oral thrush
buccal mucosa. A generalized erythematous
rash is also noted. What is the most likely C. Osteomyleitis
diagnosis?
a. Rubella D. Encephalitis
b. Kawasaki disease
c. Adenovirus infection E. Otiitis externa
d. Rubeola
e. Varicella
4. 24 yo woman, fever of unknown origin,
persist for 10days, + diarrhea and now become
TROPMED 1
constipated. Brasycardia spleenomegaly
1. 42yo woman ocme to clinic noted white caps neutropenia lymphatocytosis.Most likely sites of
in his stools. On stool exam parasit eggs infection?
contains hexocant were found. Most likely
A. Ileum
source:
B. colon
A. Undercooked pork
C. Appendix
B. Undercooked beef
D. Caecum
C. Ingestion of larvae on the organism
contaminated food E. Duodenum
D. Ingestion of cystic

E. Ingestion of egg 9. 28yo male fever productive cough green

2. 40 yo man, fever epistaxis nausea since 2days,
temp 39. Palpable liver. Rumple leed test+.
Dhf!m confirming lab?
A. Ns1
mucous 5 hari lalu elevated BP HR 128 RR 28
temp 39,5 diffuse ronchi di chest x ray,
pneumonia
A. Sirs b. Sepsis c viremia d bakteremia
e septic shock

10. 27 yo cold. Unprotected sex. How hiv virus
transmitted?
A saliva b needle stick injury c injecting drugs
by own needle
d exposure of intact skin w contaminated blood
e mostly from mother to infant in gestation
11. IgG dan IgM (+) low avidity IgG.
Management?
A no spesific management
B antepartum ganciclovir
C fetal usg and amnioncentesis
D CMV immunoglobin
12. 32 yo jaundice suffesion conjunctivitis
trombositopenia hepatosplenomegali...
a HbAs Ag
B liver
C Anti dengue
D IgM
E MAT for leptospirosis
13. A 25 year old man is admitted to the hospital
for evaluating increasing fever of unknown
origin along with malaise, headache,
constipation. Nggk vaksin terus ke daerah
rural.Ada bradikardi, stepladder fever,
hepatosplenomegali. Antibiotik yg dikasih apa?
A. Isnazid
B. vancomycin
C. Clindamycin
D. Metronidazole
E. chloramphenicole
14. Fever high especially at night. Headache and
pain behind eyes. Dignosis
A. Severe dengue if he was feeling restless and
lethargy
15. Irritable, loud noise gara2 pain karena
muscle tightening and back arching. Phisical
examination reveals only a dried pcking on his
umbilical cord, as is the local custom appears
normal until he's stimulated by touch or loud
noise
A. Botulism
B. tetanus
C. Meningitis
D. Encephalitis
E. generalized seizure
16. Suka main sm puppy, eosinophilia, enlarged
A. Pruritus Ani
B. cholecystitis
C. Billiary cirrhosis
D. Creeping eruption
E. visceral larva migrans
17. 33 thn cowo with C3 HIV disease.
Fever,nausea,vomiting,hipotensi. Minum
zidovudin,lamivudine (3TC),abacavir,indinavir.
Develop fatigue, dyspnea,malaise. Then he stop
medication. PE: hb turun,ast normal,alt
normal,bilirubin 2 (indirect 1,4). Cause?
a. side effect 3TC
b. side effect abacavir 21. Ujungkulon, liver enlarge, on off fever ?

c. side effect indinavir a. Bloodsmear

d. side effect zidovudin b. blood culture

18. 7 thn cowo malaise,anorex,fever,headache. 6 22. Inguinal node swelling, bubo, pustule,
classmates kaya gt juga punya symptoms yg ?diagnosis?
sama. Ada skin lesions macule,papule,vesicle
(multiform). Treatment? a. Tularemia

a. antiviral & antitoxin b. Yaws

b. antiviral & supportive therapy c. Pes

c. supportive therapy & antibiotic

d. supportive therapy without antiviral 23. Muscle pain?

a. Trichinella spiralis

19. 45 thn cowo ada nodul di arm & body pain

with pressure. Erythematous nodules,smooth,
and shiny. Diffuse infiltrate with ill define 24. Leptospirosis tertular dr mana?
border,no erosion. Pain in elbow with nerve
enlargement.Lab?
25. 25 years old, male, Balinese.Generalized
a. slit skin smear seizure. CT scan revealed several calcified
b. skin scrapping regions. Brain biopsy was performed and
revealed scolex with hooklets. Which parasite is
c. KOH the most likely the cause:

d. VDRL A. Echinococcus granulosus

B. Trichinella spiralis

20. 67 thn cewe flu like syndrome. Fever 40 C. Taenia saginata

derajat,anorexia,headache,muscle ache. 3 days
later cough with sputum. Chest x ray D. Taenia solium
parenchymal infiltrate.Specimen untuk pcr? E. Toxocara cati
a. sputum

b. rectal swab 26. 32 years old, male, come to emergency

c. midstream urine departement. 1 Week progressive fever, now
become delirium.Jaundice (+), conjungtival
d. CSF suffusion (+), hepatomegaly (+), Murphy's sign
(-), petechiae on both legs (+). Lab testing was
e. nasopharyngeal aspirate performed:

Leukocyte: 18.000
Thrombocyte: 98.000
Creatinine: 4
What further examination needed to be done?
A. HBs Ag
B. Widal test
C. Anti-Dengue
D. IgM anti HAV
E. MAT for leptospira
27. 15 years old, male, come to Puskesmas.
Fever since 3 days ago.High fever especially at
night.Headache (+), retroorbital pain (+), nausea
(+), vomit (+). What is the diagnosis according
to WHO 2009?
A. Severe dengue if he was feeling restless and
lethargy
B. Dengue fever with warning sign if Torniquet
test (+)
C. Dengue fever with warning sign if rash (+)
D. Dengue fever with warning sign if abdominal
pain (+) just once last night
E. Dengue fever with warning sign if abdominal
pain (+) more than once last night
28.
29. Cowo 30 tahun datang ke puskes dengan
keluhan demam, menggigil, sakit kepala sejak 3
hari. Dengan riwayat demam sejak pergi ke
ujung kulon national park.Pemeriksaan untuk
diagnosa?
A. VDRL
B. HIV ELISA
C. Urine culture
D. Blood smear
E. Blood culture
30.
31.
32.
33. 10 y/o had bitten by dog 3 days ago in the
right foot, he was brought to the clinic and
received antibiotic, analgesic and wound
cleansing w/o incision. The bitten site is now
painful, swollen, red and his mother notice that
the boy has fever now. What's possibly happen
to the boy?
A. Local reaction to trauma and need anti..
B. Abscess right foot must get injection of
antibiotic and wound incision
C. Encephalitis stage of rabies infection need to
be isolated and rabies immunoglobulin
D. Local tetanus infection inject anti tetanus
toxoid and tetanus immunoglobulin
E. Rabies infection of right foot inject rabies
immunoglobulin and local vaccination of the
wound
34. 40 y/o man complaint of tingling , itching of
legs 30 minutes after swimming in Lindu lake,
the next day small papules develops followed by
blisters of legs. Which paracyte infected him?
A. Hymenoptera sp
B. Fasciola hepatica
C. Fasciolopsis busci
D. Demencator
E. Schistosoma japonicum
35. 28 y/o man hospitalized for fever more than
7 days, fever higher at noon, felt lower at
morning, fatigue, dizzy, discomfort in stomach,
constipation, lost appetite. Examination reveals
temp 38C, mild pain in abdominal palpated bp
100/70 Hr 70 BPM, tremor, coated tongue.
what's the ethiology of the disease?
A. Escherichia coli
B. Salmonella typhi
C. Bordetella pertusis
D. Shigella dysentriae
E. Campylobacter jejuni
36. 35 y/o man emergency from dyspneu
cyanosis, hemoptisis, chest pain, high fever,
malaise, non productive cough for 1 week. He
works as a sheep farmer and was treated for dark
black skin lesion. Cbc normal, blood + sputum
negative, hemorrhagic mediastitis. Which
virulence factors most likely involved :
A. Exotoxin
B. Endotoxin
C. Alpha hemolytic
D. Lipopolysacharide
E. Antiphagotic factor
37. 45 y.o man, he is going to Mecca for Haji.
What is the vaccine that can be given?
Meningococcal vaccine.
38. 38 y.o man, he is going to Papua for 2
weeks. What is the prevention drug of malaria?
Doxycycline!
69. a national rescue tem who often travel to
remote areas in indonesia has on-off fever and
chills for 15 days. Arthralgia and headache. PE:
enlarged liver and spleen. He was brought to ER
because suddenly had seizure and finally lost his
conciousness .what is the characteristic of
pathogen that might cause the symptom above?
a. invasion of the RBC by parasite
b. release of parasite antigen to produce
febrile reaction
c. transmission by injection of
sporozoites
d. digestion of HB in food vacuoles to
produce pigment
e. adherence of infected RBC to small
BV endothel
70. fever since 3 days. High fever all day long.
3rd day platelet :148.000. HT: 42. Treatment
suggestion?
a. inpatient hospital and IV fluid drip
b. inpatient puskes with oral fluid intake
c. inpatient hospital with oral fluid
intake and IV drip when cant take orally
d.outpatient with oral fluid and balik the
next dad u/ cek platelet
e. outparient with oral fluid intake and
balik 3 hari lahi u/ cek platelet
71. HT naik 20%. Digigit sama sapa?
A fruit bat
b. anopheles
c. aedes aegepty
 d. close contact with infected person
e. direct contact with infected animal
72. multiple papilomatous skin lesion. Wart like
srawberry. Best bay diagnosed?
a. tissue culture
b. giemsa
c. antitoxin detect
d. darkfield (treponema)
e. gram stain
93. a 40 years old male patient came to the
emergency department due to fever and upper
right abdomen pain since 3 days ago. PE : Blood
pressure 120/80 Heart rate 112 RR 28 Temp
39,5. Tenderness right upper quadrat.Lab : WBC
17.000 Hb 13,5 Platelet 100.000 SGOT 75
SGPT 17 ureum 80 creatinine 3,3. Hs abdominal
USG shows liver abscess. His condition
called….
a. sepsis
b. viremia
c. bacteremia
d. severe sepsis
e. anaphylactic schock
94. Following test would be the most reliable for
confirming the diagnosis in case above :
a. culture of blood
b. complete blood count
c. nucleic acid based test
d. detection of toxin in his serum
95. a 34 years old man comes to dermatology
with hyperpigmentated macules that spread on
his face and his upper arm color lesion white and
feels scaly when t touched. Sometimes he feels
itchy and more itchy when he sweat. Woods
light (+).Lab : large, blunt, short hyphae and
thick wall budding spores (spageti and meatball
)
a. candida albicans
b. aspergillus flavus
c. microsporon canis
d. Malassezia furfur
e. Trichosporon belgelii
81. 13 old boy, fever, shaking chill, general ill,
fatigue muscleached & pain. Playing at
garden.Stung by an insect in dorsal lower right
arm. Skin inflamed, sore, rash, worse in 1st
24hours. Erythematous surround papulafolicar
with pus.
a. Trepanoma pallidum
b. H ducreyi
c. M. Leprae
d. S. Pyogenes
e. C minitussismum
82. Rose spot, liver spleen enlarge, drave –
konstipasi, fever 10d, ill, bradikardi. Gold
standard nya?
83.A patient come with an itchy recured fungal
infection on the feet and need some advice to be
cured and some prevention measures so the
diasease will not occure again, doctor already
gave him some medication for fungal infection.
What kind of advise can make him healthy?
f. Don’t eat seafood
g. Use always sandals
h. Keep the skin dry and clean
 i. Don’t use shoes all day long d)knowlesi
j. Don’t scratch, will spread the infection
e) falciparum

84. 27 y.o pregnant woman found HIV+ on
prenatal blood testing, CD4T 410, viral load
35000. Ga mau antriretroviral.To decrease risk
nyebar ke anak?
a. Do nothing
b. Cesar
c. Prophylaxis HSV II
d. Retroviral after delivery
e. Breast feed until 6 month
65. 27 yo man. Snake bite in lower calf 3 hours
ago. Swollen, painful, snake: elapidae. Fang
marks +, edema, no blister/necrosis. Wound,
tender + on palpation
a) snake toxinspread blood
1. An-8-year-old girl sustains a large
laceration contaminated with dirt after
falling from her bike. Her mother can’t
recall how many doses of tetanus toxoid
her daughter has received. Management
of tetanus prophylaxis in this situation
of unknown history of prior doses of
tetanus toxoid includes:
A. Adult-type dT
B. TIG
C. dT and TIG
D. Haemophilus influenzae type b
conjugate vaccine containing
tetanus toxoid and TIG
E. DPT
Answer: C

b) venom -> paralytic muscle 2. If this patient developed seizures, what

substance have responsible in this
c) local inflammation response bite = midvenom patient?
d) envenomation that cause necrotic tissue -> A. Tetanospasmin
pain, edema, abscess formation in right calf B. Tetanolisin
C. Adenylate cyclase toxin
D. Fillamentous hemagglutinin
E. Pertactin
66. almond smell (intoxication) Answer: A

a) atropine 3. A 10-month-old healthy male infant

travelling with his family to Africa was
b) naloxone
exposed 4 days ago to his 4-year-old
c) physostigmine native African cousin who was ill at the
time with fever, cough, coryza and
d) Na thiosulfate conjunctivitis. The baby was at risk to
get infected by:
A. Corynebacterium diphtheriae.
B. Haemophilus influenzae
67. fever> 1 week, eritrosit winth ringforms and C. Bordetella pertussis
enlarged RBC D. Morbilivirus
E. Coxsackievirus
a) ovale
Answer: D
b) vivax
4. Her mother makes an overseas phone
c) malariae
call to your office asking your advice.
 Appropriate management of this patient
includes:
A. Immune globuline
B. MMR vaccine administration
C. Measurement of IgG antibody
serum
D. Measurement of IgM antibody
serum
E. Antibiotics
Answer: A
5. A 3-year-old boy was brought to
emergency unit Tangerang Hospital
with stridor, dyspnea, and “croupy”
cough.
What is your most likely diagnosis?
A. Bordetella pertussis infection
B. Haemophilus influenzaeinfection
C. Coxsackievirus infection
D. B. Parapertussis infection
E. Corynebacterium diphtheriae
infection
8. In this case all the family members
should get the prophylaxis antibiotics as
follow:
A. Amoxicillin 30-50 mg/kg/day p.o.
for 14 days
B. Amoxicillin 30-50 mg/kg/day p.o.
for7days
C. Erithromycin 40-50 mg/kg/day p.o.
for 14 days
D. Erithromycin 40-50 mg/kg/day p.o.
for7days
E. Tetrasiklin 25-50 mg/kg/day p.o. for
7 days
Answer: C

Answer: E

6. What laboratory test to confirm the

diagnosis in this patient?
A. Blood culture
B. Throat swab
C. Chest X-ray
D. Measurement of IgG antibody
serum
E. Complete blood count

Answer: B

7. A 2-year-old boy was brought to

emergency unit Balaraja Hospital with
difficulty in breathing, choking, gasping,
and whoopcough.
What is your most likely diagnosis?
A. Bordetella pertussis infection
B. Haemophilus influenzaeinfection
C. Coxsackievirus infection
D. Adenovirus infection
E. Corynebacterium diphtheriae
infection
Answer: A