1.

A 28 year old female nurse became ill after taking care of a patient with pneumonia 2
days ago and was admitted to the hospital with fever and sore throat. She was placed in
respiratory droplet isolation and quickly developed respiratory failure, requiring
mechanical ventilation. In 10 days, nine other patients in the same ward developed the
same symptoms. Which of the following laboratory test is most appropriate?
a. Blood culture to identify S.pneumoniae
b. Urinary antigen testing for Legionella pneumophila
c. Virus culture to identify influenza A
d. Serology to demonstrate antibodies to identify SARS
e. PCR of nasopharyngeal secretion to identify RSV

2. A young boy is suffering from high fever, difficult to swallow water, hydrophobia, and
disorientation. On examination, there is a hypoesthesia on his left arm. Four weeks ago,
he had been bitten by a dog. The characteristics of etiologic agent were zoonotic, single-
stranded, negative-sense DNA virus. Which of the following is usefull for making a
diagnosis in this case?
a. Giant cell
b. Blue lymphocyte
c. Negri bodies
d. Inclusion bodies
e. Clue cell

3. A 3-year-old boy was brought to emergency unit with stridor, dyspnea, and “croupy”
cough. What is the most likely pathogenic agent that causes the disease?
a. Bordetella pertusis
b. Haemophilus influenzae
c. Coxsackievirus
d. C. diphteriae
e. B. parapertussis

4. A 65-year-old-woman suddenly had paralysis of her left leg. A few days ago, she had
headache, fever, sore throat, and nausea. She lives with her son; daughter in law and a
young grandchild who’s just received a routine immunization. She is taking
immunosuppressant for her kidney’s transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan and lumbar MRI are also normal. What is the
most likely transmission of her infection?
a. Droplet
b. Air borne
c. Fecal-oral
 d. Close contact
e. Animal bite

5. 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

6. A female tourist developed gastroenteritis while trying Indonesian local food. The onset
of disease was abrupt with abdominal cramps and watery diarrhea. She had no fever or
nausea or vomiting. Symptoms resolved after 24 hours. What is the suspected pathogen
which causes the disease?
a. Salmonella typhi
b. Shigella dysentriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E. coli

7. 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. Which of the following is your
working diagnosis?
a. Type A hepatitis
b. Yellow fever
c. Weil’s disease
d. Lyme disease
e. Chikungunya

8. 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. Leptospira antibody
d. Widal test
e. Stool analysis

9. An-8-year-old girl sustains a large laceration contaminated with dirt after falling from her
bike. Her mother admitted the girl didn’t get full immunization. If this patient developed
seizures, what substance causes seizure in this patient?
a. Tetanospasmin
b. Tetanolisin
c. Adenylate cyclase toxin
d. Fillamentous hemagglutinin
e. Pertactin

10. 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 ring-like and crescent-like forms
within red blood cells. What is the mechanism of fever in this patient?
a. Sporozoites is in the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed

11. A 26-year-old woman complains of a 7 days history of fever especially at night. As she
recall, 2 weeks ago she ate gado-gado in coastal area when she out for duty for several
days. She also had diarrhea and abdominal discomfort. On physical examination reveals
blood pressure 110/70 mmHg, heart rate 60 ×/min, RR 20x/min, temp. 39.1°C. Tongue is
coated and tremor. What is the best therapy for the patient?
a. Ciprofloxacin
b. Quinidine
c. Interferon
d. Mebendazole
e. Artemisunate
12. A 15 year-old boy was brought to emergency room with altered consciousness. His
parents reported he had massive rice-water diarrhea. There was no abdominal pain and
blood in stool. He was severely dehydrated. What is the pathophysiology of this disease?
a. The toxin migrates through intestine wall to paralyze the muscular layer
b. The toxin activates intracell enzyme and secretes chloride ions
c. The toxin causes necrosis of secretory glands of colon
d. The toxin causes necrosis and slough of the intestinal mucosa
a. The toxin causes irritable bowel disease

13. 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. Dermacentos andersoni
b. Lactodectus mactan
c. Loxoxceles laeta
d. Hymenoptera sp
e. Lytta vesicatoria

14. A migrant worker presents to the emergency room in respiratory distress. He had been
spraying parathion in the fields for several days, and today he began to feel sweaty and
dizzy. By the time he got to the hospital he was drooling, gasping, and becoming
agitated. What is disrupted by parathion that causes the symptoms?
a. Acetylcholin esterase
b. Muscarinic receptors
c. Neuronal lipid bilayer
d. Nicotinic receptors
e. Voltage-gated sodium channel

15. 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. What is
the most likely animal that has bitten the patient?
a. Cottonmouth snake
b. Copperhead snake
c. Rattlesnake
d. Latrodectus mactans
e. Centruroides exilicauda