1.

A 3-year-old girl was brought due to unconciousnes for 2 hour after experienced fever and
cought for 3 days. She had seizure once a day since the first day of fever but was conscious
afterward. Only after 3rd seizure, the child was unconscious. Temperature 40C, GCS 9,
Physical Examination revealed stiff neck, Brudzinski II, Babinsky pathological reflex were
positive. Cerebrospinal fluid revealed Leucocytes > 1000 mg/dl, Protein 84 mg/dl and
Glucose 50 mg/dl. What is the diagnosis of this girl?
a. Bacterial Meningitis
b. Herpes Simplex Encephalitis
c. Encephalopaty
d. Meningoencepalitis
e. Encephalitis

2. A-2-year-old boy was brought to ER when you were in charge. The boy complained about
abdominal pain and vomiting. He looks irritable. You found HR 120 bpm, RR 30 bpm, body
temperature 36,8C. You also found abdominal distension with metallic sound on
auscultation. What do you choose as the most possible diagnosis in this case?
a. Inflammatory Bowel Disease
b. Pyloric Stenosis
c. Hirschprung disease
d. Invagination
e. Obstructive Ileus

3. A 10 years-old girl experienced itchy skin rashes 10 minutes after monthly benzthine penicillin
(BPG) injection rheumatic heart disease. He had no history of any other allergy. She already had
BPG injection for 5 times with no allergic reactions sign within normal limit. Generalized wheals
and erythema were noticed on the skin. Which of the following statement regarding the next
management will you choose?
a) Desensitization should be performed as the manifestation was an IgE mediated
b) Skin test should be performed if he is going to be given another antibiotic
c) The next injection can be given but under dose monitoring
d) The injection should be switched to other available theraphy for the disease
e) Premedication with antihistamine should be given for the next injection
A 7-year old boy was brought to your practice due to pain and swollen ankle since 2 days before. Mother
reported rash and red spots on both legs since 3 days before. He complained of cough and runny
nose one week before. Appetite was normal. Vital signs were normal. What do you choose as the
pharmacological management for this patient?
a. Ranitidine
b. Azitromicin
c. Ibuprofen
d. Cetirizine
e. Amoxycilin

4. A 10 years-old girl experienced itchy skin rashes 10 minutes after monthly benzthine penicillin
(BPG) injection rheumatic heart disease. He had no history of any other allergy. She already had
BPG injection for 5 times with no allergic reactions sign within normal limit. Generalized wheals
and erythema were noticed on the skin. Which of the following statement regarding the next
management will you choose?
f) Desensitization should be performed as the manifestation was an IgE mediated
g) Skin test should be performed if he is going to be given another antibiotic
h) The next injection can be given but under dose monitoring
i) The injection should be switched to other available theraphy for the disease
j) Premedication with antihistamine should be given for the next injection