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 40 0C, 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.  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?  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?  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?  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  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 – ebola hemmorhagic fever
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?  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 of the following is most likely to 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?  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?  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.coli 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?  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  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-age infant 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?  toxocara
a. Creeping eruption  strongyloides
b. Biliary cirrhosis
 c. Cholecystitis
d. Pruritus ani  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) larva strongyloides .

59. In condition below adult form of the pathogenic agent 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

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.  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?  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?  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  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, and lymphadenopathy
during her early third trimester delivers a growth-restricted infant 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  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