FMS4 - MCQ 2009

DIRECTIONS: Choose the one best answer!

Question 1-2 are linked to the following case:
A 33-year-old HIV-positive man presented with a 2-week history of moderate fever and chills, and a
progressively worsening headache. Physical examination revealed a febrile patient (T: 39C) with
lethargy, nuchal rigidity, and diminish reflexes. Chest x-ray was normal. After see the result of
CSFs analysis, the doctor diagnoses him with meningitis. An India ink test of a CSF smear
performed large transparent capsule surrounding the budding cell.
1. Which of the following virulence factors is most likely to be involved in the pathogenesis of
illness?
A. Soluble -1, 3 glucan polymer
B. Granuloma-forming soluble antigen
C. Atypical cell-wall peptidoglycan
D. Polysaccharide capsule
E. Arthroconidial mitogen
2. The patients inability to control this infection is most likely due to a deficiency in which of the
host response?
A. PMN response
B. Mucosal IgA response
C. Humoral IgM response
D. Esterase inhibitory response
E. Alternate complement pathway
3. A 2 year-old baby boy was brought to hospital with sudden onset of high fever, chills, stiff neck
and vomiting. On physical examination, the baby has a haemorrhagic skin rash in the
extremities, neck rigidity, a positive Kernigs sign, and positive papilloedema. Chest x-ray was
normal. The doctor diagnose with meningitis cause by a gram negative and diplococcus
organism. The ability of the pathogen to colonize is associated with its ability to synthesize
which of the following?
A. Hemolysin
B. Protein M
C. Hyaluronidase
D. Pyrogenic exotoxin
E. Lipooligosaccaride

4. A 23-year-old woman complained of abnormal vaginal discharge for 6 days. She denied
symptoms of urinary tract infections. Examination revealed a thin discharge, pH is 5.1 [normal
< 4.5], which had a distinct fishy odor. Which of the following pathogens is most likely to have
caused this illness?
A. Trichomonas vaginalis
B. Treponema palidum
C. Gardnerella vaginalis
D. Candida albicans
E. Chlamydia trachomatis
Question 5-6 are linked to the following case:
A 67-year-old man presented 2-day history of high fever, productive cough, pleuritic left-sided chest
pain, and shortness of breath. His chest radiograph was remarkable for consolidation in the left
lower lobe. The doctor diagnoses him with pneumonia caused by gram-positive diplococci with
many PMNs.
5. Which of the following is activated immune system at the first?
A. Kinin
B. Tirosin-Kinase
C. Alternative Complemen
D. Terminal Complemen
E. Classic Complemen
6. A patient at risk for development of similar infection due to this pathogen should receive which
of the following prophylactic?
A. Hyperimmune immunoglobulin
B. 23-valent polysaccride vaccine
C. Oral rifampin
D. Antitoxoid serum
E. Oral penicillin V
7. A 34-year-old woman complained a sudden onset of high fever for 3 days with nausea,
vomiting, headache, muscle ache. There were petechiae 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

8. A 27-year-old boy is suffering from high fever, difficult to swallow water, hydrophobia, and
disorientation. On examination, there is a hypesthesia on his left arm. 4 weeks ago, he has
been bitten by a dog. The characteristics of etiologic agent were zoonotic, single-stranded,
negative-sense DNA virus. Which of the following usefull for making a diagnosis in this case ?
A. Giant cell
B. Limfosit plasma biru
C. Negri bodies
D. Inclusion bodies
E. Clue cell
9. A 34-year-old man has been recieving blood products for hemophillia since childhood. He is
now suffering from low-grade fever, weight loss, thrush, serious bouts of diarrhea, and
symptoms of pneumonia. CD4+ T-cell count is 76/L (Normal: 400-1200/ L). A deficiency in
the production of which substance would be most pronounced in this illness?
A. Complement components
B. Immunoglobulin G
C. Interferon-alfa
D. Interferon-gamma
E. Interleukin-1
Question 9-11 are linked to the following case:
A 25-year-old woman is exposed to a virus during the first trimester of pregnancy. The woman give
birth to an infant who is deaf and has cataract, a heart murmur,and microcephaly. She never had
immunization.
10. Which of the following is the pathogenic agent for the motherillness?
A. Coxsackievirus A
B. Rubella virus
C. Measles virus
D. Rhinovirus
E. Poliovirus
11. Which immune function would have protected the infant from this viral disease?
A. Inhibition of viral replication by IFN
B. Inhibition of viremia spread by antibodies
C. Neutralization of the virus by macrophages.
D. Killing of virus-infected cells by cytotoxic T-cells
E. Killing of virus-infected cells by natural killer cells
12. If the infants mother was not vaccinated againts the virus when she was child. Which vaccine
would be relevant for the infant?
A. A vaccine consisting of formalin-inactivated whole virus
B. A vaccine consisting of microorganism extract
C. Administrated on the same schedule as mumps vaccine
D. Injecting with an immunoglobulin

E. Injection with inactivated toxoid

13. A 19-year-old girl suffering from fatigue, sneezing, and runny nose. She has no fever, but she
soon develops a mild sore throat, headache, and stuffy nose. Some of her classmate have
same symptoms. Which of the following is the most appropriate for the transmission of this
disease?
A. Arthropod bite
B. Air-borne
C. Oral-fecal
D. Sexual
E. Transfusion
14. A 18 year-old man visits a public hospital because he has a muculopapular rash, cough and
runny nose. On the physical examination, there were conjungtivitis, small lesions on the buccal
mucosa, and temperature is 38,5C. The doctor said that he suffered from measles. Immune
control of this infection requires a response involving which factor?
A. Immunoglobulin A
B. Immunoglobulin E
C. Interleukin-1
D. B cell
E. T cell
15. A 3-year-old female developed meningitis caused by bacterial infection. The childs
immunization history was questionable. The doctor took CNS and blood specimens for culture
and Gram-stain. The organism grow well on chocolate agar containing hemin and NAD +.
Which of the following prophylactic drugs or biologicals can be used to prevent this illness in
the pediatric population?
A. Pneumococcal polysaccaride vaccine
B. Hib polyribose phosphate
C. Human immunoglobulin
D. Antitoxoid serum
E. Polypeptide antigen
16. A 5-year-old boy is brought into emergency unit with a sore throat and fever for 4 days. On
examination, this child is anxious, tachypneu, and ill appearing. Her temperature is 39C,
tonsillar and pharyngeal area were edema with the presence of a grey membrane coating of
the tonsil. He has swelling of lymph nodes in neck (bull neck). Her immunization status was
questionable. Gram stain of grey membrane revealed gram positive, and look like chinese
characters; this organism was growth on tellurite agar.
The mechanism of action of this organisms virulence factor can be characterized by which of
the following?
A. Blocking the release of acetylcholine
B. Inhibits protein syntehesis
C. Stimulation of adenylate cyclase
D. Release IgA protease
E. Acting as a superantigen

17. A 7-year-old child had fever for 5 days. On examination there was a bright red lingual papillae;
purulent inflammation of the posterior oropharynx and tonsillar area; and cervical
lymphadenopahy. To differentiate with other tonsilopharyngitis, the doctor took throat swab
specimen to laboratory investigation. Gram-stain of throat swab yielded Gram-positive cocci in
chain. Which of the following is the most appropriate and rapid laboratory investigation to know
the etiologic agent of this disease?
A. Anti Streptolysin O
B. Hemagglutination Inhibition
C. Polymerase Chain Reaction
D. Enzyme Immunoassay
E. Indirect Fluorescence Antibody
18. A 67-year-old man inpatient at ICU presented temperature 39C, blood pressure 110/70 mmHg,
heart rate 108 x/minute, RR 32x/minute, PaCO 2 < 32 mmHg, and leucocytes 16.000/mm 3 with
multiorgan failure. He had diabetes mellitus. On this condition, organism could be stimulating
some mediator. Which of the following is the appropriate mediator?
A. Interleukin-2
B. Interleukin-8
C. Interferon-
D. Immunoglobulin
E. Tumor necrosis factor-
19. An 8-year-old boy presented grouped yellow-grey papules and pustules surrounding the
erythematic skin on his left arm. He also had fever. The etiologic agent is gram positive cocci in
cluster. Which of the following is a major virulence factor of this pathogen?
A. Protein F attach to epithelial tissue
B. Protein A bind to Ig molecule
C. Cytolitic effect on target cells
D. Spreading factor cause dissemination
E. Produce intracellular material
20. A 6-year-old girl suffering from fever, fatigue which follow by milky vesicle in hand, feed, and
mouth. The pathogenic agent is a small virus with infectious genome, and resistant to
detergent. This illness is spread from oro-fecal transmission. Which of the following is most
likely causing her illness?
A. Coxsackie
B. Rubulavirus
C. Varicella-zoster virus
D. Herpes-simplex virus
E. Paravaccinia virus

21. A 50-year-old woman comes to emergency room with unconscious suddenly after she got
penicillin intravenous injection. His blood pressure 80/60 mmHg, HR 120x/m, RR 25x/m. Her
skin was pale and cold. What type of hypersensitivity that occurs in this patient?
A. V
B. IV
C. III
D. II
E. I
Question 21-22 are linked to the following case:
22. A 22-year-old man presents to the STD clinic with a 5-day history of burning on urination and a
3-day history of purulent urethral discharge. He is sexually active with many female partners
and does not use condoms. No prior history of STD. Which of the following most likely shows
the laboratory findings from his endourethral exudates?
A. A negative gonorrhea culture
B. Abundant intracellular diplococci in neutrophils
C. Immunofluorescence to serotypes A C
D. Intracellular elementary bodies
E. Abundant extracellular diplococci in neutrophils
23.Which part of the bacteria structures has an immunologic effect?
A. Polysaccharida capsule
B. Peritrikh flagel
C. Outer membrane protein
D. Granule
E. Lipopolysaccharida cell wall
24. In a patient with helminthes infection can cause disease by highly allergenic hypersensitivity
reaction type I. Which immunoglobulin is usually involved?
A. IgA
B. IgG
C. IgE
D. IgD
E. IgM
25. A 28-year-old woman with clinical diagnosis of vulvovaginitis; the vaginal discharge is thick,
yellow-green, and odorless. The patients specimen were sent to the laboratory for wet
preparation. What the most appropiate organism would you accepted?
A. Flagellate with three flagella
B. Diplocci intracellulare
C. The presence of clue cell
D. Gram-negative bacilli
E. Sclerotic bodies with hypa

26. A 1-month baby boy was given an intradermal immunization in his right deltoid. Four weeks
later, there was ulcer in his right deltoid. Which of the following is the mechanism of immune
response for that immunization?
A. Delayed hypersensitivity reaction
B. Antibody against the target cell
C. Antibody making viremia
D. Antibody blocking the spread of organism
E. CD8 activated to kill infected cell
Question 26-28 are linked to the following case:
Human sub-clinically infected with Mycobacterium tuberculosis may harbor live organisms for the
rest of their lives. If these persons were subjected to restraint stress there will be possibility that the
infection may reactivate. Similarly tuberculosis increases in human populations in war zones,
possibly due to reactivation of latent disease. In the whole world, tuberculosis also increases with
the rising of HIV infection
27. The pathognomonic test to determine activity of tuberculosis
A. ESR (Erythrocytes Sedimentation Rate)
B. Chest X-ray
C. CRP (C-reactive Protein)
D. Mantoux test
E. PCR (Polymerase Chain Reaction)
28. Tuberculin test is considered as hypersensitivity reaction of what type?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Unclassified
29. Which of the following is the preformed granule mediator of mast cells?
A. Leukotriene D4
B. Prostaglandin D2
C. TNF-
D. Histamine
E. IL-4 (Interleukin-4)

Question 29-31 are linked to the following case:

A married couple has unmatched Rh factor. She was concerned as her Rh factor is negative while
her spouses is positive.
30. If this couple is to have children, which of the following is most possible become unaffected
child?
A. First child
B. Second child
C. Third child
D. Fourth child
E. Fifth child
31. Which of diseases is most possible this affected baby suffered from?
A. X-linked agammaglobulinemia
B. Wiskott-Aldrich syndrome
C. HDNB (Hemolytic Disease of the Newborn)
D. X-linked SCID (Severe Combined Immunodeficiency)
E. X-linked CGD (Chronic Granulomatous Disease)
32. Rh factor belongs to what histocompatibility Ag?
A. MHC class 1
B. MHC class 2
C. Minor HC
D. M&N blood group
E. Lewis blood group
33. In organ transplant, the histocompatibility antigens that is most important to be matched
between Recipient and Donor is
A. HLA-A
B. HLA-B
C. HLA-C
D. HLA-D
E. Blood group
34. A 26-year old woman with AIDS develops cryptococcal meningitis. She refuses IV medication.
Which of the following antifungal agents is the best choice for oral therapy of the meningitis?
A. Amphotericin B
B. Ketoconazole
C. Nystatin
D. Fluconazole
E. Metronidazole
35. A 19-year-old patient being treated for leukemia develops fever. You give several agents that
will cover bacterial, viral, and fungal infections. Two days later, he develops acute renal failure.
Which of the following drugs was most likely responsible?
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A.
B.
C.
D.
E.

Acyclovir
Ceftazidime
Vancomycin
Amphotericin B
Penicillin G

36. After backpacking in the mountains, a 24-year old man develops diarrhea. He acknowledges
drinking stream water without purification, and you suspect that he is showing symptoms of
giardiasis. Because you know that laboratory detection of cyst or trophozoites in the feces can
be difficult, you decide to treat the patient empirically with :
A. Chloroquine
B. Metronidazole
C. Cotrimoxazole
D. Emetine
E. Pentamidine
Question 36-37 are linked to the following case:
A missionary is sent to work in a region where Onchocerca volvulus is endemic. Infections resulting
from this tissue nematode are a cause of river blindness because microfilariae migrate through
subcutaneous tissue and concentrate in the eyes.
37. Which of the following drugs should be used prophylactically to prevent onchocerciasis?
A. Bithionol
B. Ivermectin
C. Suramin
D. Diethylcarbmazine
E. Oxamniquin
38. Which of the following fly being a vector of this disease?
A. Glossina
B. Simulium
C. Chrysops
D. Triatoma rubrofasciatus
E. Phlebotomus

39. A 43-year old man, an immunocompromized patient, visits your office and he complains of
symptoms that reveal he infected with Candida. This organism is a major cause of nosocomial

blood-stream infection. This opportunistic infection in this patient could have been prevented
by administration of?
A. Caspofungin
B. Ketokonazole
C. Itrakonazole
D. Nystatin
E. Amphotericin B
40. A postmenopausal woman presents at your office, your diagnosis is she infected with Candida.
Which of the following drugs is the most appropriate for oral use in vaginal candidisis?
A. Clotrimazole
B. Fluconazole
C. Nystatin
D. Griseofulvin
E. Flucytosine
41. A 27-yer old nursing mother is diagnosed is suffering from genital herpes. She has the history
this viral infection. Previously she was responded to a drug used topically. Apart from her
current problem, she is in good health. Which of the following drugs is most likely to be
prescribed for this patient?
A. Acyclovir
B. Foscarnet
C. Trifluridine
D. Amantadine
E. Ritonavir
42. Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes
anaphylaxis following exposure to amoxicillin. Worried about compliance, you would like to
treat this patient with a single dose, so you choose
A. Cefixime
B. Ceftriaxone
C. Ciprofloxacine
D. Kanamycine
E. Tetracycline
43. A 37 year old man, went to a general practioner for a respiratory infection, otherwise he is
healthy. The patient asked to prescribe him an antibiotic, but the doctor refused and told him
that he got viral infection. What is your comment about the situation?
A. Agree that the patient should get antibiotic to prevent the secondary infection
B. Agree that the drug is not indicated, cause viral infection is self limiting
C. The patient should take antibiotic, but 3 days is enough
D. The physician should prescribe an antiviral drug for him
E. The patient should take drugs to boost his immune system

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44. A 35 year old woman went to PUSKESMAS to ask for capsules for treating diarrhea for her 12
year-old daughter who do not want to see the doctor. She is afraid the Doctor will give her
injection. You are the reponsible physician. Your action will be:
A. Give oral rehydration and tell her to bring her daughter to the Puskesmas
B. Give her 15 caps of 500 mg tetracycline to be taken 3 times daily
C. Send her home without any drug
D. Tell her to bring her daughter for an injection because oral drug are not absorbed during
diarrhea
E. Tell her that diarrhea is a mild disorder and no drug is nessessary
45. A 10 year-old boy has a valvular lesion of the heart and had to undergo a dental extraction.
The dentist plan to use amoxillin but patient is allergic to penicillins. Which (group of) drug is a
good alternative of penicillins against gram-possitive microorganisms:
A. Tetracyclines
B. Macrolides
C. Chloramphenicol
D. Aminoglycoside
E. Quinolones
46. A 73 year-old man had an infection of the prostate. He was treated with Clindamycin. On the
fourth day, he got bloody diarrhea. Which of the following is the most likely diagnosis of this
patient?
A. Candidiasis superinfection
B. Ulcerative colitis
C. Pseudomembranous colitis due to C. difficile overgrowth
D. Gastrointestinal hemorrhage cause by irritation by the drug
E. Hemorrhage cause by toxin release from the killed bacteries
Question 46-47 are linked to the following case:
A 5-year-old girl is brought by her mother to pediatric department with complain often itchy anus,
especially at night, difficult to sleep and less appetite. Her mother also reported that in perianal
area appears to have worms, measuring approximately 1 cm, such as coconut pulp.
47. Which of the following is the most diagnosis?
A. Ascariasis
B. Nekatoriasis/ ankilostomiasis
C. Enterobiasis/ oksiuriasis
D. Strongyloidiasis
E. Trichuriasis
48. Which laboratory test would you order in the case above?
A. Examination of feces culture
B. Elisa test
C. PCR test
D. Feces examination directly

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E. Examination with an "anal swab"

Question 48-49 are linked to the following case:
49. A 7 years old boy was brought by his mother to the pediatric department complain within worm
come out the time defecate such as noodle approximately the length between 20-30 cm. On
physical examination, the child looks thin, pale and weak. Which of the following diagnosis is
the most like diagnosis?
A. Ankylostomiasis
B. Trichuriasis
C. Ascariasis
D. Enterobiasis / oxyuriasis
E. Necatoriasis
50. Possibility of transmitting infection on a child in the cases above can occur through:
A. Larvae rhabditiform penetrate skin
B. Larvae filariform penetrate skin
C. Contaminated bed, towel and so on
D. Consumed eggs infective contain larvae
E. Auto-infection
51. A 25 years old man, working in the tea garden, come to internal department complain of itchy
feet, redness, and worms appear to move, lack of appetite, weakness. On physical
examination, patients appear pale, the eyes (conjunctivae anemic). Blood examination showed
a low Hb (8 g %), eosinofil increased. In the feces examination, found a positive worm eggs
(oval shape measuring 60 x 40 micron, have thin walls, in it there are 4-8 cells). Which is the
most likely diagnosis?
A. Ascariasis
B. Ankylostomiasis
C. Enterobiasis
D. Strongyloidiasis
E. Trichuriasis
Question 51-52 are linked to the following case:
52. A 3100-g baby at 38-39 weeks gestation was born to a 32 year-old G2P1 mother by
spontaneous, vaginal delivery. The baby was born in good condition with Apgar score 8 and
10. Two hours later the laboratory test revealed his mother had HBsAg positive. What will you
do in this situation?
A. HBIg with Hepatitis B vaccine for the baby
B. Check the HBsAg serum baby
C. Check the anti HBs serum mother
D. Check the anti HBs serum baby
E. HBIg with Hepatitis B vaccine for the mother

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53. Where is the best site of injection for this baby?

A. M. vastus medialis
B. M. vastus lateralis
C. M. deltoideus
D. M. rectus femoralis
E. M. biceps brachii
54. In next February, all the students from the first grade of Karawaci Primary School joint the BIAS
programme. What are the vaccines that you have to prepare for this programme?
A. DPT and polio
B. Polio and Hepatitis B
C. Hepatitis B and DT
D. DT and polio
E. Campak and DPT
Question 54-55 are linked to the following case:
55. A six week-baby boy was brought to your clinic for routine evaluation. From physical exam he
was in good condition. He had Polio vaccines once and Hepatitis B vaccine twice. What
vaccination will you give to him in this time?
A. Hepatitis B 3
B. DPT 1
C. Polio 2
D. Campak
E. BCG
56. How is the route of the vaccine that you will give for this patient?
A. Intramuscular
B. Deep subcutaneous
C. Superficial subcutaneous
D. Intradermal
E. Intravenous
57. A two month-old boy was brought to hospital with recurrent fevers, abdominal masses, and
bruising on his legs. On physical exam, he was pale and his temperature was 38 OC. He had
lymphadenopathy and hepatospenomegaly. His complete blood count revealed a WBC count
165,000/L, an Hb of 7 g/dL, and platelet count of 28,000/L. The differential has 84% large
blast. Her mother asked you about the immunization programmed for her baby. What are the
vaccines that should not be given for him?
A. BCG and Hepatitis B
B. OPV and BCG
C. OPV and Hepatitis B
D. DPT dan OPV
E. DPT dan Hepatitis B

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58. A 30-year-old female patient employed as a dishwasher came to the clinic with the complaints
of her finger nails being brittle, changing color and having uneven surface. This condition has
already lasted for 3 months. The most likely diagnosis is:
A. Tinea pedis
B. Tinea unguium
C. Tinea cruris
D. Tinea versicolor
E. Tinea nigra palmaris
59. A 32-year-old woman who has just completed a course of oral antibiotics is coming to the clinic
with the complaint of feeling itching and having a copious vaginal discharge resembling
cottage cheese. Of the following, the MOST appropriate laboratory test which can help to
confirm the diagnosis is
A. gram stain of the discharge
B. Potassium hydroxide (KOH) mount of skin scrapings
C. Sabourauds agar culture of the discharge
D. Fluorescent-antibody stain of the discharge
E. 4-fold rise in antibody titer against the organism
60. An 8-year-old girl has been brought by her mother to the clinic with the complaint of pruritic
rash on her chest. Lesions are round or oval with an inflamed border and central clearing. The
lesions contain both papules and vesicles. On examination under the microscope, septate
hyphae in KOH 10 % preparation of scrapings from the lesion was shown. The most likely
diagnosis of this patient is :
A. Tinea corporis
B. Tinea capitis
C. Tinea unguium
D. Tinea versicolor
E. Dermatophytoses
61. A student aged 18 came to the clinic with the complaints of hyper pigmentation speckle on the
face and neck, which is felt itching when sweating. On examination the skin scrapings showed
spore groups and short hyphae groups. The most likely diagnosis is:
A. Tinea corporis
B. Tinea capitis
C. Tinea unguium
D. Pityriasis versicolor
E. Dermatophytoses

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62. A 65-old-female patient with false teeth came to her dentist with the complaint of being unable
to eat because of stomatitis with white patches on the tongue and gum. On examination, the
result, after taking swabs in her mouth, shows yeast cells and pseudo hyphae on preparation
with KOH 10%. The most likely diagnosis is:
A. Actinomycosis
B. Candidiasis
C. Dermatophytoses
D. Histoplasmosis
E. Cryptococcosis
63. A 20-year-old woman in her 30 th weeks of pregnancy came to clinic for the routine antenatal
care. An ultrasound examination revealed a growth in retarded fetus with a large head
(indicating hydrocephalus) and calcifications within the brain. Umbilical blood was cultured and
crescent-shaped trophozoites were found in growth. Which of the following organisms is the
MOST likely cause?
A. Candida albicans
B. Cryptococcus neoformans
C. Toxocara canis
D. Toxoplasma gondii
E. Trichomonas vaginalis
64. A 35-year-old male patient came to the clinic with the complaints of urethral discharge,
urethritis and prostatitis. The result of laboratory examination from this patient showed that the
parasites have four anterior flagella and one posterior flagella attached to the undulating
membrane. Of the following specimens, which is the most appropriate one used to determine
the cause of the disease (above case)?
A. Urethral discharge
B. Vaginal discharge from his wife
C. Urine
D. Blood
E. Stool
65. In the rural area with vast savannah in Africa, many residents died after having seizures and
decrease of awareness. They also previously had the symptoms of high fever, enlargement of
the posterior cervical lymph nodes (Winter bottoms sign) followed by enlargement of liver and
spleen. Savannah is known to be a good breeding place for the flies of Glossina morsitans.
The MOST likely species of parasites that can be the cause of this disease is :
A. Leismania donovani
B. Leismania tropica
C. Leismania brasilensis
D. Trypanosoma rhodisiense
E. Trypanosoma cruzi

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66. A 50-year-old male patient was known live in Semarang came to the clinic with complaints of
extreme swelling of his scrotum and legs liked elephant feet (elephantiasis). The transmission of
this disease is through the bite of the mosquito of :
A. Anopheles barbirostris
B. Aedes aegypti
C. Aedes albopictus
D. Culex quiquefasciatus
E. Mansonia uniformis
67. Sometime ago, people living in the village of Sukabumi suffered from a fever by severe joint
pain. In the area were found a lot of mosquitoes that have a basic color in black with white
spots, especially on the feet and have a picture of the lyra on the back. The disease is
transmitted through the bite of the mosquito of :
A. Anopheles barbirostris
B. Aedes albopictus
C. Aedes aegypti
D. Culex quiquefasciatus
E. Mansonia uniformis
68. A 30-year- old woman came to the clinic with the complaints of swelling of eyelid as big as a
quail egg. This swelling has been suffered for 1 year since returning from Africa. On physical
examination was found calabar swelling. The transmission of the disease is through the bite of
the insect of :
A. Glossina
B. Simulium
C. Chrysops
D. Culicoides
E. Phlebotomus
69. A group of health teams from Indonesia came to the rural area of Sudan, Africa. In the area are
found many teenagers with symptoms of cachexia and hepatosplenomegaly. Entomologists of
the team have found that there are a lot of flies identified as Phlebotomus. The most possible
disease suffered by the teenagers is:
A. Cutaneous leishmaniasis
B. Mucocutaneous leishmaniasis
C. Visceral leishmaniasis
D. African trypanosomiasis
E. American trypanosomiasis

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Question 69-72 are linked to the following case:

A 67 years old woman hospitalized for 10 days with localized pus on the plantar pedis that still
getting worst although already treated with antibiotic. Several days before occurrence of the pus,
she went to a local clinic and got wound dressing using instruments and antiseptic. She got
antibiotics for at least 10 days. After 3 days take the antibiotic and his wound looked well, she
stopped that drug. But, the wound was getting worst and had discharge (pus). She was then
admitted to the hospital. She also has diabetes mellitus and experience of irregular anti diabetic
therapy. Three days ago, her physician asked the microbiology laboratory to take the specimen
from her wound for identification and drug susceptibility pattern of the pathogen. The results are
Gram-positive cocci in clustered formation and resistant to all beta-lactam antibiotics tested.
70. The possibility pathogen mentioned in this case above is
A. Methicillin Resistant Pseudomonas aeruginosa
B. Methicillin Resistant Staphylococcus aureus
C. Methicillin Resistant Streptococcus viridan
D. Vancomycin Resistant Staphyloccus aureus
E. Vancomycin Resistant Enterococci
71. This old woman seems got a nosocomial infection during her hospitalization. The statements
below are correct for preventions of hospital acquired infections
A. Type of hospital may cause hospital acquired infection
B. Urinary bladder catheterization must be sustain for all the hospital stay
C. Frequent changes of clean surgical wound dressing or drainage may prevent hospital
acquired infection
D. Attitude of health care workers to wash their hands between patients or before procedures
is a critical point in hospital infection control
E. Intravenous (IV) procedure for delivering medication, transfusion or nutrition is a best
procedure that may prevent hospital acquired infection
72. According to drug susceptibility profile, this patient also seems experience of antibiotic
rsistance. Mechanism of resistance in beta lactam antibiotics is
A. Alter the receptor that transports the drug entering the cell
B. Blockade the metabolic pathway of the drug
C. Pumping the drug out or the cell by specialized membrane proteins
D. Inactivation of the drug by enzyme derived by mutation of the pathogen
E. None of those statements above
73. The pustule wound of this woman seems occurred due to inaccurate treatment of would
cleaning at the first time treatment in local clinic. Below is the proper method to sterilized of
stainless steel instruments used for cleaning the wound in this patient :
A. By germicide agents
B. By antiseptic agents
C. By autoclave procedure

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D. By liquid filtration
E. By sanitizer agents
Question 73-74 are linked to the following case:
74. A 28 old male patient came to the emergency department due to fever and productive cough
with green mucous since 5 days a go. On physical examination, BP: 120/80 mmHg, HR: 112
x/m, RR: 28 x/m, Temp: 39, 5C, and diffuse ronchi on his chest. His Chest X-Ray shows
pneumonia. What is his condition called?
A. Bacteriemia
B. Viremia
C. Sepsis
D. SIRS
E. Septic shock
75. An immunosuppressive patient presented meningoencephalitis caused by Epstein-Barr virus
infection. This patient was taking immunosuppressant drug. Which of the following is viral
mechanism causes the disease?
A. Mast cell binds immunoglobulin E via its Fc-Receptor
B. Malignant transformation will occur due to chromosomal translocation
C. Ag-sensitized T cells release lymphokines following secondary contact
D. Immune complex released cytokines and are deposited in the tissue
E. Infected B and T cells released cytokines activate and attract macrophage

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