SOAL UJIAN TROPIAL MEDICINE 2007 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
3. Anak dengan panas tinggi, myalgia, dan gejala flu like syndrome lain, ada his mouth. A week ago he notices that his cattle were sick, but his still eat half
susah bernapas. Sodaranya sblm nya juga kaya gt n udah meninggal. Apa cook cattle meat. What is the organism?
spesimen paling baik buat menegakkan diagnosa? a. Bacteroides fragilis b. Leptospira interrogans
a. Saliva B. Blood C. Stool c. Bacillus antrhacis d. Pasteurilla pestis
D. Lung biopsy E. Nasofaring swab e. Borellia brugdorferi

4. Pertama2 flu like illness, batuk ga sembuh2,vomiting, hoarseness: pertusis 11. a women and recently return from Lapung complaining having paroxymal
attack chill, fever and sweat. These attack last a day 2 days at time and recur
5. bitten by dog become hydrofobia, hypersalivation, spasm, and sweating. every 36 – 48 jam. Which the ost appropriate time to take a blood specimen?
a. giant cell b. limfosit plasma c. negri bodies d. clue cell a. anytime b. 10 – 12 a c. 10 – 12 pm
d. 30 min after fever e 120 min after fever
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 12. seorang ibu minum 10 tablet hypnotic 30 menit yang lalu sebelum masuk
has tender axilaries lymph node enlargement. rumah sakit. gejala yang tampak : hypotension tachypneu, tachycardi dan
tidak sadar )unconsiusnes. tindakan sebagai dokter yang yang pertama kali 
7. Which of the following virulance factor is most likely to be involve in dilakukan adalah ..
pathogenesis of illness? a. apomorphine b. c. infusion natrium
a. exotoxin b. endotoxin d. chancoal dgn NGT e.hemodyalisis
c. alpha hemolysin d. lipopolysaccharide e. antiphagotic factor
13. Outbreak TB in a dormitory, with the same source of infection, based on
8. A 45 years old man was seen in the dermatology clinic because of some RFLP analysis. The most appropriate health intervention?
nodules on his arm&body and sometimes feel pain with pressure. On a. Rehabilitation b. Prevention C. Curative
examinations, we found erythematous nodules, smooth and shiny, diffuse D. Medication E. Environmental modification
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 14. there is rna virus cause deathly outbreak of hemoragic disease. Patient
confirm the clinical diagnosis? have feer, muscle pain, headach, followed by abdominal pain. Rash with
a. TPHA & VDRL b. Gram preparation internal n external bleeding. Hospital staff is infected. Virus are highly
c. KOH preparation d. Skin scrapping e. Skin slit smear virulent transmited by:
a. blood n body fluid b. mosquito bite
9. 40 yo patient complaint uncomfortable stomach and flatulence. Live in the c. transmission to human from rodent excrata
valley of Napu, Sulawesi and he had a fever frequently. PE: liver enlarged. d. aerosol transmission e. ………..
Test buat confirm?
a. Blood b. Liver biopsy c. Renal biopsy 15. a 31 years old man with complaints of high fever, cough, shortness of
d. Stool exam e. CT-Scan breath. 2 hours before admission he experienced right sided chest pain when
took a deep breath and cough. Chest radiography shows diffused bilateral
interstitial pulmonary infiltrate. Analysis of blood gas showed PO2= 60 and 20. Pulang dari papua. %hari kemudian ada intense chill fever. demamnya
91% HB saturation. Hematology serum and liver are normal. He lives near dengan always 1 day after. between those period, having low grade fever,
poultry. Patho agent are new viral. what are the prevention for prophylaxis? myalgia, nausea, vomitting. datang ke klinik , 1jam yang lalu masuk ke ICU-
a. vaccines b. Antitoxin c. Antibiotik agitated, ga lama mati. Organism yang masuk ke host ini berproliferation
d. Antiviral e. Antidotes dmn? a.brain b.liver c.heart d.spleen

16. A 28 years old ,an comes withu high fever for 8 days, malaise, headache 21. 61yr old man,go to the neurolog clinic untuk evaluasi peripheral
and constipations. He denies any vaccines before. Temperature 39 C. Blood neuropathy. He was found to have dermal
pressure 130/90 pulse 72x/min. on Physical examination there are hyperpigmentation/depigmentation(salt/pepper) of the skin,scaly palms and
hepatosplenomegaly and faint erythomatous measles. transverse ridges on hus fingernail which were identified as being a result of a
what are the most likely pathogen? chronic chemical intoxication.
a.vibrio cholera b. Shigiella dysentry What chemical agent?
c. salmonella typhi d. entero hystolytica e. Giardia lambia A.acetaminophen B.arsenic C.cyanide
D.flouride E.iron
17. pasien 28 tahun demam 8 hari ada ciri2 sebagai berikut :
erythematousmacula, myalgia, headache, vaksin tidak lengkap. 23. a 55 year old man from middle east had fever and chill with weight loss,
a. typhii b.dysentri c. cholera sweats, headache, muscle pain, fatique, depression. The man is daily farmer
d. giardia lambia e. entamoeba hystolitika and a couple week before symptoms appeared he drank glass unpasteurized
raw milk. The culture of blood tiny gram (-) cocobacill, catalase(+) and
18. Men, 44 tahun dari Jakarta pergi berbisnis ke Kalimantan selatan. Lalu oxidase (+). Infected organism?
disana dia pergi ke ER. A. M. tuberculosis B. S. typhii
Sign and symptom = diare and abdominal pain C. Brucell species D. Pasteurella pestis E. S. aureus
PE = Pitting edema abdominal and leg
Lab culture = (-) enteric pathogen 25.  Komplikasi plg sring ???
Blood = eosinophilia a. Pulmo hemoragik B. m miopericarditis
Stool = large ellipsoidal, operkuled egg with thin and c. encephalitisa d. Osteomyelitis e. Anemia
transparent sheet. Tekena infeksi apakah bapak ini?
a.Schistosoma Japonicum b.Fasiolopsis Buski 26. A 39 years old man, live in Manokwari papua, developed a major seizure
c.Tricinella Spiralis d.Echinococcus granulosus while at work, no history of epilepsy. Head MRI showed lesion surrounding a
e. Clornonsis sinonsis scolex. The etiolohic agent would most possibly have been acquired by
eat/drink:
19. bagaimana mekanisme terjadinya edema pada cerita diatas? A. Uncooked vegetables B. Raw beef
a. host-allergic reaction because of the parasite C. Raw pork D. Uncooked fish E. Unfiltered water
b. the larva penetrate the wall
c. hypersensitivity reaction because adult worm in GI 27. anak cowo ada lesi di kulit seperti strawberry, gummata. Exam apa yang
d. there are accumulation of egg in GI paling cocok untuk diagnosis? a. widal test b. IgM-IgG treponema
e…….. c. dark field d. FTA-ABS e. ELISA
28. A 27 year old man come with acute severe encephalitis that require PE: high fever 39'C and multiple stinging on the back.
hospitalization. Several days before he got that disease he recognize many What is the most likely species that bite him?
pigs in his farm were died. Which of the following is most appropriated A. Hymenoptera sp. B. Dermatos andersoni
natural host for the pathogen? C. Tactodectus macta D. Loxoxceles laeta
A. Arthropod B. Horse C. Bats E. Lytta Vesicatoria
D. Squirel E. Rats
34. A 28 years old lady came to Posyandu to have a nutrition consultation.
29. female tourist gastroenteritis ke Indonesia makan Indonesia food. Last year, she delivered a stillbirth baby with a spinal disorder. She and her
Abdominal cramp and watery diarrhea. No fever or nausea or vomiting. husband start planning to have a baby again. She asked for suggestion about
Symptom resolve 24 hours no recurrent. Pathogen? her dietary intake before she got pregnant.
a. s.typhi b. shigella dysentriae What kind of diet does she need to prevent the same disorder for her future
c. EHEC d. s. aureus e. ETEC baby?
a.Dark green vegetables b.Pasteurized milk
30. 23 years old male. 4 days history of fever, headache, retroorbital pain, c.Deep water fishes d.Boiled eggs e.Lean beef
myalgia and rash. PE diffuse er. resulting from a pressure applied to her skin.
a.morbili b.dengue c.influenza d.coxackie e.rhinovirus 35. 27 yrs old women at term pregnancy had fluctuated fever since 2 weeks
ago. She looked pale, generalized weakness and headache.She went to public
31. a 40 year old lady came to the outpatient clinic with a chief complaint of health and was given chloramphenicol 500mg 4x daily, paracetamol 500mg
fatigue and difficulty in concentration for the last two weeks. HT revealed 3x daily. She is pregnanct and she didn't tell. What is the side effect drugs will
that she had a balance diet, no history of chronic disease and had been a heavy you find in that baby?
smokers for 20 years. On PE it was found that she had anaemic conjunctiva A. Reye syndrome B. Gray syndrome C. Down syndrome
with other findings was within normal limits. Lab showed that she had D. ADHD E. Black water fever
haemolytic anemia. What is the most likely cause for her condition?
a. vitamin K deficiency b. copper deficiency 36. Soalnya ada orang yang mau ke luar dari jawa dia mau ke papua nah
c. vitamin E deficiency d. iron deficiency e. folate deficiency disitu ada banyak plasmodium tratment apa buat mencegah penyakit tersebut:
doxycycline
32. a lab examinaton of a leprosy patient after 4 months MDT therapy
revealed bacterial index 6+ morphological index 50%. Which is your 37. 40 years old man come to hospital with 4 times generalized tonic clonic
conclution for this result? seizure since 2 weeks ago. No history of seizure & head trauma. 1 year ago,
a. pausibacillar leprosy patient sensitive to treatment had bussined in papua for 6 oths. During his stay, he ofte osumed undercook
b. multibacillar leprosy patient sensitive to treatment pork. Brain MRI show small cyst??
c. multibacillar leprosy patient resistant to treatment a. taenia eggs b. cysticercus cellulose
d. pausibacillar leprosy patient resistant to treatment c. t. solium worm d. t.saginata worm
e. pausibacillar leprosy patient prone to nerve damage
38.8 day infant born help of ----, irritable 2 days ago, noise cause pain
33. A boy came with his mother to ER Siloam hospital episthotonus. PE umbilical cord dried. Normal stimulated by touch/ noise then
His mother said that before this, the boy just playing in the backyar.
begin to cry, stiff, arch its back. Stiff continue until calm calm down. weakness on her leg. Her slipper left. Annular erythematous sharp border,
Diagnosis: shiny surface, enlarge popliteal nerve. Lab exam?
a.Bacterial meningitis b.Botulism c.General seizure a. KOH b. Zielh nelson c.Gram d.Na cl
d.Tetanus e.Viral encephalitis
45. A girl returned from Lampung with paroxysmal fever, malaise, and
39. A married mom bring her 18 months son to ER due to rash that develop myalgia. The fever recurrs every 36 to 48 hour. On microscopic examination
today. She reports that he has had a runny nose, conjunctivitis and diarrhea. there are ring and cresecent like shapes inside the red blood cells. This is
On PE he looks ill, temperature 40oC and diffuse 2-3 mm erythematous rash characteristic of?                 
begin from hair line behind ear and spreading to face and body. On buccal A) plasmodium vivax B) plasmodium ovale C) plasmodium malariae.
mucosa, red spot are noted.What is the most likely causing agent? D) plasmodium falciparum.                      E) plasmodium menangle
a.Rubella b.Coxsackie virus c.Morbili
d.HSV-6 e.Parvovirus B19 46.Antidotum untuk keracunan analgesic-antipyretic…
a.Amylnitrite b.Atropine c.BAL
40. most severe complication from this disease (morbili) d.EDTA e.N-methyl cystein
a. osteomyelitis        b. encephalitis c. otitis media
d. sinusitis e. oral thrush 47. man 47 years old come to your clinic. he has complain about malaise,high
fever,and mialgia, slightly jaundice.one week ago he has clean a canal with
41. 48 years old acute gastroenteritis has step nadder night fever since 7 days his friend..apa yang harus kamu lakukan sebagai dokter untuk profilaksis
ago. He also has abdominal pain and constipation. Biasa makan uncooked dalam kondisi demikian
vege at streets . Which is most likely organism? a. antiviral, b. antibiotic c.antitoxin d. vaksin
A. Vi antigen B. Urease C. Hemolysin
D. Shiga toxin E. Pili 48. women come back from Saudi Arabia, has weakness and tingling
sensation in her right leg, other neurology exam is normal including her left
42. Seseorang mengalami sore throat, ada grayish white di ujung mulut, leg..Which immunization did she miss?
limfadenopati. a.MMR b.DPT e.Oral  Sabin
A. Dipteri B. Pertusis C. Tularemia
49. Seorang anak dengan fever, konjungtivitis, rash dari line belakang rambut
43. Baby rash identically, mother had febrile illness during the second kepala sudah sakit sejak 2-3 hari lalu dari genus apakah itu?? Morbili
trimester of pregnancy. Examination reveals diffuse raised purple skin lesion.
There is no pallor, jaundice or cyanosis. The baby has cataract a 3/6 systolic 50. Severe complicationnya apa? Encephalitis/Pilihan yg lain g lupa
heart murmur. Enlargement of both liver and spleen, no lymphadenopathy.
a.Congenital toxoplasma b.Congenital rubella 51. 34 yo women, G2 delivers at 36 week of growth-restricted infant w/
c.Congenital cytomegalo d.Congenital herpes simplex catarract, PDA, and sensorineural deaf. Mom had flu-like syndrome with rash
e.Congenital varicella in early pregnancy. Etiology?
A. Porvavirus B. Rubella C. Morbili D. CMV E. HSV
44. 40 years old woman, presented with raised redness plaque resemble
doughnut with raised border that she already had for 1 year, no itchy, 52. 27 yo woman, abis travelling southeast asia. Shaking, chills, 40C. Ada
P.vivax. Cr treatment hypnozoit? a. Taeniasis Saginata b. Taeniasis Solium c.
A. Primaquine B. Pyrimethamine d. Oxyuris e. Ascariasis
C. Quinine D. Chloroquine E. Chologuanide
58. Laki2 terkena recurrent fungal infection di bagian kaki dan gatal2. Dia ke
53. Woman 25 y.o, G3 at 39 weeks delivers a small gestational age infant dokter dan telah dikasih obat. Dia minta advice agar penyakit tersebut tdk
with chorioretinitis, intracranial calcification, micro-cephaly, jaundice, terulang. Apa yg anda sarankan?
hepatospleenomegaly. The nurse reports poor feeding and tone. Mother A. Hindari makan seafood B. Selalu pake sandal.
denies any raw or undercooked meat, no cats. She works as nurse in pediatric C. Jaga tetap kering dan bersih. D. Selalu pake sepatu
ICU. What is the most likely causative agents? E. Jangan digaruk
A. CMV B. Epstain Barr virus
C. Hepatitis B virus D. Parvovirus E. Yellow-fever virus 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
54. 45 y.o male has a chronic skin lesion both hands for 1 year. Skin sick contact or significant travel history. A stool sample is obtained, which
erythematous, crusted, itching, and have serous discharge. Work in a gold reveals rhabditiform larva.
refining plant for 2 years without protection. Contact with cyanide. Not
wearing gloves. What is the possible mechanism? 59. In condition below adult form of the pathogenic agent can be found in the
A. Immediate reaction B. Acute reaction C. Gradual reaction whole GIT and its larvae can be found in visceral organ (lung, liver,
D. Delayed reaction E. Quantal reaction gallbladder) is :
a. eosinophilia b. hyperinfection c. retroinfection
55. male, 46 y.o came to you as a doctor with complaint 'sesak nafas' in d. hypereosinophilia e. autoinfection
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 60. a woman came with the complaint of being uncomfortable and hardened
morning. he work in sandbusting company in last 2 week. From the following in the left upper side abdomen. Every 4 days, she is intermittently feverish, on
what the appropriate measurement for hazardous thing. blood smear exam, plasmodium parasite (+). Fever symptoms on previous
a. Body mass index b. nutrition referred to:
c. activity susceptibility d. - e. tissue and organ a.Sporozoit in blood b.Hypnozoit in liver is found
c.Merozoite discharged from schizont and enter the blood
56.Anak Kecil perempuan berusia 3th mengeluh tidak mau makan, badannya d.Process of gametocyte in blood
kecil, terdapat anemia, pada pemeriksaan fisik terdapat hepatomegaly, pada e.Pigment in the parasite is formed
pemeriksaan lab terdapat eosiofilia, kata ibunya dirumahnya terdapat anjing
dan dia suka main dengan anjing tersebut. Kemungkinan gejala yang terjadi 61. Symptoms : Fever , nausea, fatigue. Back from Kalimantan. Blood smear
a. Creeping Eruption b. Biliary Cirrhosis revealed schizont isi merozoit 12-24, erythrocyte enlarges. The pathogen is :
c. Cholecystitis d. Pruritus Ani e. Visceral Larva Migrans a.VivaxMalaria b.FalciparumMalaria
c. MalariaeMalaria d. OvaleMalaria e. DowleskiMalaria
57.Anak kecil datang ke klinik dengan keluhan gatal2 pada pantatnya,
ditemukan sesuatu seperti kuku, diambil dan didapatkan telur berdinding 62. 52 years old man is brought to the emergency department in an
radial. Penyebabnya.. unconscious condition on examination, he was death form more than one
hour. On autopsy of the brain, there is cyst’s fluid containing protoscoceles following laboratorium result is the most appropriate with the patiet
with hooklet and many daughter cysts were found. What is the most likely diagnosis?
diagnosis of the disease? a. trombositopenia b. neutropenia c. anemia
a. Hydatidosis b. Cysticercosis c.Serebralmalaria d. hematocrit decrease e. leukosit decrease
d. Histoplasmosis e.  Toxoplasmosis
74. 1 years old baby get swollen gum 1 week. On history, he has normal body
65. Pengambilan specimen untuk edema pada leg dan scrotum pada filariasis weight, breast feed until now, balance diet with high intake cooked vegetable
adalah terbaik pada waktu…. and fruits since 6 month old. No history of cronic disease. Whats the most
Answer: 10 – 12 pm likely cause of the complaining??
a. protein deficiency because of breastfeed
70. 35 years old male, farmer who was working with pestiside  was taken to b. Karbohidrat deficiency because of increase kalori need
ER with headache, vomiting, salivation, diarrhea, muscle fasciculation, c. fat soluble vitamin deficiency because of high vegetable and fruit intake
difficulty walking, difficult speaking. His cloths has been removed, hes been d. water soluble vitamin deficiency because of cooking
washed, has been given activated charcoal. What is the most effective remains e. mineral deficiency because of competition with vitamin absorbtion
treatement for the case of pesticide poisoning?
a.Epinephrine b.Antacid c.Spironoloctate 75.Male 10 year old,high fever 38 C,runny nose,sore throat,mild cough,
d.Atropine e.HCT vesicular lesion at palatum,dorsal,n palmar of the hand. Most likely diagnosis:
A.adenovirus B.coxsackie virus C.
71. A 65 year old woman suddenly had flaccid paralysis at legs. Few days D.sinusitis E.pneumoni
ago, there are headache, nausea, fever, sore throat. Her son: daughter in law,
and young grandchild have vaccine routine oral.. She taking 76. 19 years old girl come with sign and symptomp of poisoning. Nausea,
imunosuppressant for kidney transplant. Vital sign, cranial nerve, CT-scan vomiting, abdominal cramp, diare, excessive saliva, headache, giddiness,
and MRI normal.The transmission? rinorhea, pin point pupil, and mental confusion. What ‘s the most possible
A. Droplet B. Airborne C.fecal oral D. Close contact agent?
E.animal bite a. acetaminophen b. barbiturate c. carbamate
d. sianida e. opiate
72. Pork eating village in papua new guinea epidemic outbreak of epilecticum
seizure. The investigate: 77. 22 years old women, G1, complaining flu like illness during third
A. Level of balantidium coli in swine stool. trismester early. She delivery a growth restricted infant with seizure
B. Practice of consuming raw decease human brain intracranial calcification, jaundice. Whats the most possible cause?
C. Presence taenia eggs in drinking water a. treponema pallidum b. T.vaginalis c. toxocara sp
D.presence of trophozoite in human blood d. neisheria meningitis e. toxoplasma gondii
E. Quantity of culidare in the village
78. Influenza virus
73. 34 years old women complain sudden onset high fever 4 days with
nausea, vomite, muscle headache, headache, pretechie + . which of the 79. ETEC