Dini, a 40-year-old woman presents to General Practitioner.

She complains that since 4

months ago she never has enough energy to do even her routine things such as cleaning her
house, and her body weight decrease about 4 kilos in 4 months. On physical examination:
quite pale, blood pressure 130/70. Pulse rate 94 X / minutes. On abdomen examination:
Liver unpalpable, spleen S II, her abdominal was protuberant with fluid wave and shifting
dullness. Thorax examination: Heart & Lung normal. Extremities: edema in both lower
extremities. Lab result : Hb 9,5 g/dL ( N : 12 – 16 ), WBC 7500/mm3 ( 5000 – 10.000 ),
Platelets 140.000/mm3 ( N :150.000 – 400.000 ). HBsAg : neg (N: neg) Anti HCV : pos ( N:
neg) .ALT and AST : in normal limit, Protein Total 5,4 gr/dL ( N:5,5 – 8 ) Albumin 2,0
gr/dL ( N: 3,5 -5,5) Globulin 3,4 gr/dL( N : 2 – 3,5 ). Urinalysis was normal.

According to your examination which of the following is the most likely diagnosis?
Anemia with hepatitis acute
Anemia with hepatitis chronic active
Anemia with hepatitis chronic persistent
Anemia with hepatoma.
Anemia with hepatic cirrhosis  liver unpapable, bkin splenomegaly (ALT and AST
also normal)

Which of the following is the most appropriate laboratory examination to determine the type
of anemia?
a) MCV, Peripheral blood smear
b) MCH , Peripheral blood smear
c) MCHC, peripheral blood smear
d) MCH, MCHC
e) MCH , urinalysis.

2.To know causes of anemia ( no 1) ,physician ask to laboratory examination Peripheral blood
smear l . The result of examination Peripheral blood smear : Erythrocyte micrositic hipochrom,
several target cells and fragmentocyte . Leukocyte : normal Platelets : Normal.
What kind anemia according the lab result :
a) Iron Defficiency Anemia
b) Bi2 deficiency anemia
c) Folic acid deficiency anemia
d) Anemia causes chronic disease
e) Anemia causes thalasemia.
3) To supporting diagnosis your opinion above( no 2 ). What the examination do you need :

a) Serum Iron concentration and Total Iron Binding Capacity

b) Folic Acid Serum Concentration
c) B 12 Serum concentration
d) Reticulocyte count
e) Hb electroforesa

4. Sinta 11 year old comes to physician with decrease of hearing since one week ago. On
physical examination: Outer ear canal in normal limit, ear drum intact. Test Rinne: - / +, Weber :
right laterisation. Which of the following is the most appropriate diagnosis?

Right Conductive hearing loss

Left Conductive hearing loss

Right Sensory neural hearing loss

Left sensory neural hearing loss

Mixed hearing loss

Rinne Webber Schwabach Diagnosis telinga yang

diperiksa

+ no lateralisasi sama dengan normal

pemeriksa

- ke telinga yang sakit memanjang tuli konduktif

+ ke telinga yang memendek tuli sensorineural

normal

5.To find degree of hearing loss what examination do you need :

a) Tympanometric
b) Audiometric
c) Pneumo otoscopy
d) Audiometric and thympanometric
e) Otoscopy

6. Which of the following examination is the most appropriate to determine the degree of
hearing loss?

a) Tympanometric
b) Audiometric
c) Pneumo otoscopy
d) Audiometric and thympanometric
e) Otoscopy

7. A 40 year-old man came to private doctor with red eyes , blurred vision and pain in both of his
eyes since 2 days ago. Which of the following is the most appropriate initial examination do
you need to establish the diagnosis for this patient?

a) Intra ocular pressure

b) Refraksi examination
c) Slit lamp Examination keratic precipitate
d)Fluorescein test ulcer
e) Placido test. buat macular degeneration

8. A 20-year-old man came to general practitioner with redness on both eyes. Status
ophthalmologicus: Visus OD : 20/20 OS : 20/20, Digital Intra ocular pressure : normal,
Conjunctiva: hyperemis, Cornea : no infiltrate, COA /Iris/Pupil : normal, Lens: Clear, Reflex
fundus : positif. What is the most possible diagnosis?

Pterygyum

Pinguiculitis

Conjunctivitis

Uvetitis  keratic precipitate, sinekia posterior, flare/ tyndall (+)

Glaucoma.
9. A 6-year-old boy comes to hospital with his mother because of congestion for 2 days. In
addition he has sneezing, rhino rhea, mild cough, sore throat and nausea. On examination temp
38,6 ⁰ C, clear nares, white conjunctiva, oro pharynx with palatal petechiae, enlarged
erythematous tonsils and no tonsillar exudates. Other examination was within normal limit.
Doctor gives cold remedies as symptomatic treatment.Two days later he came back to the doctor
and complain he still suffers like the first visit. What is the first examination do you need for this
patient before you give treatment?
CBC
Throat culture
Chest X rays
Sinus para nasal X Rays
Rapid strep tests

10) A 16-year-old boy comes to hospital with his mother because of congestion for 2
days. In addition he has sneezing, rhino rhea, mild cough, sore throat and nausea. On
examination temp 38,6 ⁰ C, clear nares, white conjunctiva, oro pharynx with palatal
petechiae, enlarged erythematous tonsils and no tonsillar exudates. Another
examination in normal limit . Doctor give cold remedies as symptomatic treatment.

Two days later Joko came back to the doctor and complain he still suffer like the first visit.

What the first examination do you need for this patient before you give treatment :

a) CBC
b) Throat culture
c) Chest X rays
d) Sinus para nasal X Rays
e) Rapid strep tests

11. Result of examination above/ no 9 , conclusive : Joko has a bacterial infection. Doctor give
him antibiotic as addition. Three days later the symptoms was relief , not fever but Joko feel
weakness and nausea. What your priority for the next examination :
a) CBC with IgM Dengue Blot Test.
b) CBC with Widal test
c) CBC with Malaria
d) CBC with Liver Function Test.
e) CBC with peripheral blood smear.

12. A 32 year old man comes with complain nausea and vomit. Physical examination : Sclera
ichteric, hepatomegali, AST 150 IU/ L ( N : < 35 ), ALT 167 IU /L ( N < 40), HBsAg +, Anti
HBs – , HBeAg +, Anti HAV - , Anti HCV - .
Which of the following is the most likely diagnosis?
Suffering Hepatitis B in prodromal phase
Suffering Hepatitis B in recovery phase.
Suffering Hepatitis B in active replication phase
Suffering Hepatitis B in the past
Relaps from Hepatitis B
13. a32 year old man come with complain nausea, vomites . Physical examination :Sclera
ichteric, hepatomegali, AST 78 IU/ L ( N : < 35 ), ALT 67 IU /L ( N < 40), HBsAg + ( N: - ),
Anti HBs – ( N:- ), HBeAg + ( N : - ) , Anti HAV - ( N: - ), Anti HCV - ( N: - ).
Diagnosis for this patient is :
a) Suffering Hepatitis B in prodromal/ incubation phase

b) Suffering Hepatitis B in recovery phase.

c) Suffering Hepatitis B in active replication phase

d) Suffering Hepatitis B in the past / several weeks ago

e) Relaps from Hepatitis B

14. According statistic data , possibility of Rudi at the next 6 month will be
a) .40 % will be develops to chronic hepatitis
b) 50 % will be develops to chronic hepatitis

c) 90 % will be develops to chronic hepatitis klo anak2

d) 100 % will be develops to chronic hepatitis

e) 15 % will be develops to chronic hepatitis

15. A 24-year-old woman came to the physician for the second times. At the first visit 2 months
ago, the doctor said that she suffered hepatitis B. Laboratory result this time : HBsAg -, Anti
HBs +, Anti HBc +, AST 56 (N <35) ALT 58 (N<40).

Which of the following is the most appropriate condition?

Suffering hepatitis B in recovery phase

Suffering hepatitis B in chronic phase.

Suffering hepatitis B in acute phase

Suffering hepatitis B which is completely resolved

Have complete immunity to hepatitis B.

16. A 23 year old man came to General practitioner with laboratory result : Anti HCV + (N:
Neg), HBsAg - (N:Neg) Anti HAV : - (N :neg). AST 35 IU/L ( < 35 ) ALT 40 IU / L ( <
40).Other lab result within normal limit. According the lab result, what is the next examination
for this patient?
a) Viral load for Hepatitis Virus
b) HCV RNA
c) USG abdomen
d) Liver biopsy
e) Anti HIV
17. The next 2 months, when she comes to the laboratory to check her blood panel, which of the
following is the most possible expectation of laboratory result?
a) HBsAg -, Anti HBs -,Anti HBc +, AST decrease ,ALT decrease

b) HBsAg -, Anti HBs +,Anti HBc +, AST decrease, ALT decrease

c) HBsAg -, Anti HBs +,Anti HBc -, AST decrease, ALT decrease

d) HBsAg -, Anti HBs -,Anti HBc +, AST increase ALT decrease

e) HBsAg +, Anti HBs -,Anti HBc +,AST decrease, ALT decrease.

Hbe(-) tapi klinis parah  wild type/ super mutant

18. A 23 year old man came to General practitioner with laboratory result : Anti HCV + (N:
Neg), HBsAg - (N:Neg) Anti HAV : - (N :neg). AST 35 IU/L ( < 35 ) ALT 40 IU / L ( < 40).
Other lab result within normal limit. According the lab result, what is the next examination for
this patient?

Viral load for Hepatitis Virus

HCV RNA

USG abdomen

Liver biopsy

Anti HIV

19. A 21 years old man comes to your private practice with fatigue for several months. On
physical examination showed pale, slight ichterus, liver just palpable, lien palpable on Shuffner
2. Laboratory : Bilirubin total 3.00 mg/dL ( N< 1 ), bilirubin indirect 2,7 mg/dL ( N : < 0,7),
bilirubin direct 0,3 mg/dL (N < 0,3) . AST: 35 U/L (N: < 35) ALT: 40 (N: <40), Hb urine :
Positive (N : Negative).

According the data above , what is the most possible diagnosis?

Hepatitis in prodromal phase

Hepatitis in recovery phase

Cholestasis

Hemolytic anemia

Cholelitiasis
20. A 27-year-old man came to your private practice with laboratory result after Laboratory
examination 2 days ago. Complete blood count (Hb , Ht, Erythrocyte count, WBC, Platelets) :
Normal, Liver Function Test : AST : Normal, ALT : Normal , Alkali phosphatase : slight
increase, Bilirubin total : increase, Bilirubin Indirect : Normal, Bilirubin direct : increase,
Gamma GT Increase. Protein total: normal, Albumin : normal, Globulin : normal.
According lab results, what disturbance do you find?
a) sintesis of liver function
b) cholestasis
c) integrity of liver cells
d) detoxification of liver function
e) viral infection in liver

21. A 27-year-old man came to your private practice with laboratory result after Laboratory
examination 2 days ago. Complete blood count (Hb , Ht, Erythrocyte count, WBC, Platelets) :
Normal, Liver Function Test : AST : Normal, ALT : Normal , Alkali phosphatase : slight
increase, Bilirubin total : increase, Bilirubin Indirect : Normal, Bilirubin direct : increase,
Gamma GT Increase. Protein total: normal, Albumin : normal, Globulin : normal.

According lab results, what disturbance do you find?

f) Disturbance of sintesis function liver

g) Disturbance in cholestasis
h) Disturbance of integrity of cells liver
i) Disturbance of detoxivication function liver
j) Disturbance cause of viral infection in liver
22. A 45 year old woman came to General Practitioner with complain diarrhea for 1 week. She
had diarrhea 6 times daily, bleeding and mucinous stool, abdominal pain, bloating and tenesmus.
What is the most appropriate examination to identify the cause of diarrhea in this case?

a) Serologic examination for amubiasisKATA DR THEO (ada bleeding, mucinus and

tenesmus)

- telur ova dan parasit harus request staining tambahan

b) Fecal analysis

c) Colonoscopy

d) USG abdomen

e) Biopsy rectum & colon area.

23. 33-year-old man came to Private Clinic with hematuria and dysuria since 3 days ago. There
was no history of trauma. On physical examination: No fever, he feel pain when the physician
percussion in right flank. Urinalysis showed crystal calcium oxalate (+), leukocyte 3/lpf,
erythrocyte 15/lpf. Other examination was within normal limit. What is your working diagnosis
for this patient?
a) Tumor/ Mass in right flank area kalau RCC ada back pain, teraba massa, hematuria
b) Renal calculus
c) Glomerulonephritis nephrotic/ nephritic
d) Pyelonephritis fever, cva (+), muntah/ mual
e) Renal artery stenosis HTN, muda

24. To make definitive diagnosis this patient , what the most important examination do you
need :
a) Deep Stick Urinalysis
b) Sediment urinalysis
c) Consentration Ureum and creatinine serum
d) Intra venous Pyelografi
e) Plain foto Abdomen.
25. A 34-year-old man came to General Practitioner with dysuria without hematuria and pain at
the beginning of urination . Which of the following is the most likely diagnosis?
a) Acute cystitis biasanya ada suprapubic pain
b) Bladder carcinoma painless, intermittent, hematuri seperti air cucian daging
c) Urethritis.
d) Bladder calculus kalau berubah posisi, gasakit lagi deh
e) Prostatitis LUTS, fever, boggy prostate (kalau acute) || LUTS, perineal pain, recurrent
UTI (kalau chronic)

26. A female 60 year old , came to General Practitioner with complain paraesthesia , itching
frequent urination and weakness in extremity superior and inferior since 1 month ago. What the
most possible diagnosis of Siti’s suffer :
a) Hypothiroidism
b) Vit B12 defficiency
c) Diabetes Mellitus
d) Alkoholism
e)Entrapment syndrome

27. A 60 years old woman came to General Practitioner with complain paraesthesia and itching
in extremity superior and inferior. She also felt general weakness and weight loss 3 kilos in a
month. What is the most appropriate diagnosis?
a) Hypothyroidism
b) Vitamin B12 deficiency
c) Diabetes Mellitus
d) Alcoholism
e)Entrapment syndrome

28. A 60 years old woman came to General Practitioner with complain paraesthesia and itching
in extremity superior and inferior with stocking-glove pattern since 1 month ago. She also felt
general weakness and weight loss 3 kilos in a month. What is the most appropriate diagnosis?

a) Hypothyroidism

b) Vitamin B12 deficiency

c) Diabetes Mellitus
d) Alcoholism

e)Entrapment syndrome

29. A 60 year old man , came to emergency unit at 9.00 pm, He complain from 5.00 pm until
8.00 pm he fell numbness and weakness of his right leg and right arm. Since 8.00 pm the
numbness and weakness disappear. Two weeks before he was fell same symptoms and the
symptoms disappear in 1 hours. In physical examination Blood Pressure 165/100 , HR 88
x/minute, /rr 16 x / minute, temp 37,1 ⁰C. On neurological examination are 5/5 strange in all
extremity superior and inferior. According this case what the most important examination do
you need to this patient :
a) Complete blood count
b) Cholesterol total
c) Fasting blood Glucose and 2 hours post prandial
d) Trigliserida
e)Head MRI

30. A 60 year old man , came to emergency unit at 9.00 pm, He complain from 5.00 pm until
8.00 pm he fell numbness and weakness of his right leg and right arm. Since 8.00 pm the
numbness and weakness disappear. Two weeks before he was fell same symptoms and the
symptoms disappear in 1 hours. In physical examination Blood Pressure 165/100 , HR 88
x/minute, /rr 16 x / minute, temp 37,1 ⁰C. On neurological examination are 5/5 strange in all
extremity superior and inferior. According this case what the most important examination do
you need to this patient :
a) Complete blood count
b) Cholesterol total
c) Fasting blood Glucose and 2 hours post prandial
d) Trigliserida
e)Head MRI

31.A 34 years old man , came to General Practitioner with complain dysuria without hematuria
and felling pain at the beginning of urination . About this symptoms what the most possible
diagnosis :
a) Acute cystitis
b) Bladder carcinoma
c) Urethritis.
d) Vesical calculus
e) Prostatitis
32.A 19-year-old woman presents with severe right-sided flank pain accompanied by fever,
shaking chills, dysuria, and frequency. She is sexually active with one partner and always uses
condoms. Her last menstrual period was 5 days ago. On physical examination, her temperature is
39,2 ° C and her heart rate is 120 beats/min. Blood pressure and respirations are normal.
Abdominal examination reveals suprapubic tenderness with palpation. The patient complains of
pain when percussion is performed with the ulnar surface of the fist over the right costovertebral
angle (CVA). Pelvic examination is normal. Which of the following is the most likely diagnosis?
a. Diverticulitis
b. Acute cystitis
c. Renal calculi
d. Pyelonephritis (uro sepsis)
e. Appendicitis

33.A 34-year-old firefighter presents to the emergency room complaining of the sudden onset of
severe right-sided flank pain that radiates to the right groin and genitalia. He is unable to lie still
on the stretcher of the emergency room. He denies any history of trauma. He denies any dysuria,
frequency, nocturia, or fever. Examination of the genitalia is normal. Abdominal and rectal
examinations are normal. There is positive right costovertebral angle (CVA) tenderness.
Urinalysis reveals blood. Which of the following is the most likely diagnosis?
a. Pyelonephritis
b. Renal calculi
c. Testicular torsion
d. Strangulated hernia
e. Acute prostatitis

34.A 57-year-old man with a history of smoking presents with hematuria. He has owned and
operated a chain of dry cleaners for over 30 years. For this patient with hematuria, choose the
most likely diagnosis.
a. Prostate cancer
masih ga jelas RF nya

b. Renal cell carcinoma

Occupa- tional exposures, chromosomal aberrations, and tumor suppressor genes have
been implicated. Cigarette smoking is the only risk factor consistently linked to RCC by
both epidemiologic case-control and cohort studies (La Vecchia et al, 1990), with most
investigations demonstrating at least a 2-fold increase in risk for the development of RCC
in smokers (Yu et al, 1986). Exposure to asbestos, solvents, and cadmium has also been
associated with an increased incidence of RCC
 c. Bladder cancer
Workers in the chemical, dye, rubber, petroleum, leather, and printing industries are at
increased risk. Spe- cific occupational carcinogens include benzidine, beta-
naphthylamine, and 4-aminobiphenyl, and the latency period between exposure and
tumor development may be prolonged.

d. Carcinoma of the ureter

long history of excessive analgesic intake, those with Balkan nephropathy, and those
exposed to Thorotrast, a contrast agent previously used for retrograde pyelography,
smoking

e. Prostatitis

35.A 55 year old woman has been feeling tired and sluggish for more than 1 year. Her thyroid
gland slightly enlarged on physical examination. She has a decreased serum level of T4, but
serum TSH concentration is greatly increased. FNAB of her thyroid showed prominent
formation of germinal centers. Which of the following conditions is most likely to account for
these findings?
Hashimoto’s thyroiditis
Pleomorphic adenoma
Papillary carcinoma
Carcinoma epidermoid
Adenocarcinoma

36.A 50 year old female experienced a feeling of fullness in her neck. Physical examination
revealed an enlarged ,assymmetric thyroid with one distinct palpable nodule in the left lobe .
Laboratory test findings,including thyroid function test ,are normal.A Fine –needle aspirate of
the thyroid gland showed no malignancy cells.
It is most likely to show findings concistent with :
a) Follicular carcinoma
b) Follicular adenoma
c) Papillary Carcinoma
d)Medullary Carcinoma
e)Anaplastic carcinoma

37.A 45 year old women felt a lump on her right side neck for 3 months. Physical examination
reveals a 4-to 6-cm, firm, mobile,painless mass palpable around her right subauricular.The oral
mucosa appears normal and she does not complain of difficulty chewing food or talking.
A Fine-needle aspiration biopsy showed fragments glandular epithelial without lymphoid tissue
and no malignant cells.
Which of the following conditions is most likely to account for these findings?

A. Sialolithiasis
B. Pleomorphic adenoma
C. Papillary carcinoma
D. Carcinoma epidermoid
E. Adenocarcinoma

38. A 46 year male came to your private practice with result :Fasting Blood Glucose : 95 mg/dL
and Glucose 2 hours Post Prandial : 130 mg/dL .
According this result :
a) Patient in normal limit
b) Patient suffering Diabetes mellitus
c) Patient in Impaired Glucose Tolerance test.
d) Patient in hypoglycemic state
e) Patient in hyperglycemic state
39.A A 25 year male presents with left cervical lymphadenopathy. Physical examination reveals
firm nontender cervical lymph nodes ranging from 1 to 2 cm in diameter.The overlying skin is
intact and non erythematous. A Fine needle aspiration biopsy was performed and showed
dominant Reed Sternberg cells. Which of the following conditions is most likely to account for
these findings?
Metastatic carcinoma
Acute myelogemous leukemia
Hodgkin disease
 Follicular lympoma
Mycosis Fungiodes

40. A 45 year male present with general oedem whole of the body. Physical examination : Blood
Pressure and pulse : in normal limit, oedem ++, Heart and lung normal, Abdomen : liver and
spleen : not palpable. What the most important laboratory examination do you need:
a) ALT and AST
b) Hb, WBC and Platelet
c) CK and CKMB
d) Amylase and lipase serum
e) Urinalysis

41.A premature baby was born on May 10th 2002 with gestational week 32 (N = 40 weeks). She
came to doctor on Oct 11th 2002. Her weight is 8kg ; length 68cm ; head circumference 44 cm.
On what age do you plot this patient on the growth curve?

12 weeks
13 weeks
14 weeks
15 weeks
16 weeks

Usia koreksi: usia gestasi+usia kronologis-40 minggu

Usia kronologis: tanggal pemeriksaan-tanggal lahir

42.Baby Hero was a 12months old baby, he was a normal delivery term with a birth weight
3,5kg. He had no medical history of note. When attended to the primary care, his weight is 7 kg.
How much calories intake that should be given to the baby to catch up his normal growth?

700 kalories/day
910 kalories/day
1050 kalories/day
1150 kalories/day
1200 kalories/day

Catch-up growth equation is expressed as recommended nutrient intake per

kilogram weight gain per day for weight age multiplied by the ideal body
weight for age, then divided by the actual weight.
43.A child was admitted to hospital with complain lack of energy and irritable. Physical
examination shows no edema, with wrinkled skin, old man face, baggy pants, the ribs looks like
bony structure and hairfall. Which of the following is the most likely diagnosis?
Marasmus
Kwashiorkor
Marasmus- kwashiorkor
Chromosomal abnormality
Anemia

44.What is your initial management according to the case above?

Resomal tnda2 dehidrasi dan ada malnutrisi
Vit A
Zinc
Fe
F 75

45.A mother come to your clinic with her 18 months old son with diarrhea and vomiting. She
mentioned that her son has defecated about 5-6 times per day for 4 days. The consistency of the
diarrhea is watery and no blood found. She also mentioned that her son’s body weight was 12 kg
and after a physical examination you found that his body weight has decreased to 11 kg.What is
the most appropriate management for this case?
Isotonic i.v solution 30 ml/kg body weight in 30 minutes (dehidrasi berat)
Isotonic i.v solution 100 ml/kg body weight in five hours
ORALIT 100 ml every diarrhea or vomiting (tanpa dehidrasi)
ORALIT 100 ml/kg body weight for 3 hours
ORALIT 75 ml/kg body weight for 3 hours
46.After further examination and history taking you found out that his body temperature has
increased to 37.8 degree Celsius and the child is currently experiencing cough and flu. What is
the most possible cause of the disease?

E. coli
Rotavirus
Lactose intolerant
Food poisoning
Vibrio cholera
47.A 12-year-old child come with complain of watery diarrhea since 3 days ago. He mentioned
that he likes to buy food and drinks on the side road, which he thinks are not very clean. He said
that he defecated 4 times a day and the feces consistency is watery and white color, his mother
said that it looks like a the color of water which had been used to wash rice. What is the most
likely diagnosis?

Entamoeba coli
Giardia lamblia
Rota virus
Vibrio cholera (tetracycline)
Entamoeba Histolytica

48.What is the proper medication for the disease above?

Amoxiciline
Cotrimoxazole
Metronidazole
Loperamide
Antiviral

49.A 9 month old is brought to the emergency room. She had been having emesis and diarrhea
with decrease of urine output for several days. Her weight is 9 kg, down from 11 kg. She is
lethargic and you note that her skin to be doughy. After confirming that her status was stable,
you send electrolytes which you expect to be abnormal. In this case, which of the following
management is the most appropriate?
Isotonic i.v solution 30 ml/kg body weight in one hour
Isotonic i.v solution 70 ml/kg body weight in five hours
ORALIT 100 ml every diarrhea or vomiting
ORALIT 100 ml/kg body weight for 3 hours
ORALIT 75 ml/kg body weight for 3 hours
50.A 14 year-old boy is seen in the emergency room because of a 3-week history of
fever,lethargy, and 3 kg weight loss. Physical examination reveals marked cervical and
inguinal adenopathy, enlarged tonsils with exudates, small hemorrhages on the soft palate, a
WBC differential that has 50% lymphocytes (10% atypical), and a palpable spleen 2 cm below
the left costal margin. Which of the following conditions is the likely diagnosis?
a. Malaria
b. Roseola
c. Kawasaki disease (autoimmune : lymph node)
d. Streptococcal throat infection
e. Infectious mononucleosis

51.A 2-year-old girl come to you for a general check up. You did a physical examination to
evaluate her growth and you found out that her body weight is 13 kg (65th percentile) and her
height is 75 cm (<5th percentile). What is her nutritional status?

Stunted (BB n, TB kurang)

Wasted (BB kuran, TB n)
Marasmus
Overweight
Short stature

52.A 3-year-old child came to your clinic with his mother. She complained that her son is
experiencing watery diarrhea since yesterday. In the physical examination you found prominent
ribs and baggy pants. His oral mucousal is dry and his skin turgor has decreased. What would
you do to prevent/treat the dehydration for the first 2 hours?
a. RESOMAL 10ml/kgBB, per oral
b. RESOMAL 5ml/kgBB, IV
c. Normal saline 5ml/kgBB, IV
d. Ringer lactate 10ml/kgBB, IV
e. RESOMAL 5ml/kgBB, per oral

53.A 8-year-old boy came with his mother to the general physician with presents mucinous
diarrhea, 8 times/day, bloody stool, abdominal cramping, sweats, fevers, poor appetite and 8kg
weight lose, reduced turgor of skin. Sometimes he eats bread in his school without washing his
hand. His weight 20 kg now, temperature 38.6 C. Other examination was within normal limit.
What the most patologic organism appropriate of this case?
EnteroToxin E Coli
Entero Pathogenic E Coli
Entamoeba histolytica
Vibrio Cholera
Giardia Lamblia

54.A 41-year-old female presents to your clinic with a week of jaundice. He has mild
fever, abdominal pain, dark urine and weight loss. Physical examination shows normal
function of the heart and lung. His SGPT is 40u/L (N: < 40 ) and his SGOT 18 u/L (N <
35), urinalysis Hb urine (+).Bilirubin direct normal, indirect : increase. What is the most
appropriate next management step?

Antibiotics and observation

Endoscopic

Hepatitis serologies

USG abdomen

Peripheral blood smear and coombs test

55.A 30-year-old man presents to the ER with fever, chills, myalgia, yellow eyes, and abdominal
pain since 5 days ago. His fever remained high (40°C). He denies having any diarrhea, vomiting,
or respiratory symptoms. He reports no blood in his stool or urine. He has no significant medical
or surgical history. He recently returned from a 2-month trip to Equatorial Guinea 4 days ago and
he eating in the unhygienic restaurant, many rats surrounding around in that restaurant. What is
the most likely diagnosis?

A. Hepatitis A
B. Yellow fever
C. Malaria
D. Leptospyrosis
E. Dengue fever

56.A10-year-old girl was admitted to puskesmas due to pain when she swallowing, pain around
the ear, she hard to open her mouth because of pain since 2 days ago. She’s very like “chiki”
snack and never wash her hand before have a meal. There are no family history and no previous
medical conditions. But she has history of nasal congestion, cough, fever 1 weeks ago.

On examination temperature 39,5 C, clear nares, there are tiny red spots on hard palate, tonsil
was sweeling and erythema, and cervical lymphadenopathy. She never take a medication before.

What is the gold standard for diagnose?

Radiologic test

Ultrasonography

Computer tomographic

Needle aspiration

Throat swab

57.A
39.A 9-month-old is brought to the emergency center by ambulance. The child had been having
emesis and diarrhea with decreased urine output for several days, and the parents noted that she
was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9-
month checkup. You note her heart rate and blood pressure to be normal. She is lethargic, and
her skin is noted to be “doughy.” After confirming that her respiratory status is stable, you send
electrolytes, which you expect to be abnormal. You start an IV. The best solution for an initial IV
bolus would be

a. 1⁄4normal saline (38.5 meq sodium/L)

b. D10 water (100 g glucose/L)

c. Normal saline (154 meq sodium/L)
d. 3% saline (513 meq sodium/L)
e. Fresh-frozen plasma
58.In the preceding case, management for this child should include

a. Slow rehydration over 5 hours

b. Rapid volume expansion

c. Packed red blood cells

d. CT scan to evaluate for CNS tumor causing SIADH

e. Urinary electrolytes

59.A 30 years old woman came to the eye clinic with red eye and blurred vision on her right eye.
The patient also had photophobia, flare and keratic precipitate. Which of the following is the
most possibility diagnosis?
a) acute scleritis
- Biasanya bilateral, sering pada perempuan
- Perasaan sakit yang berat yang dapat menyebar ke dahi, alis, dan dagu
- Terkadang penderita bangun dari tidurnya karena nyeri kambuh.
 - Mata merah berair
- Fotofobia dengan penglihatan menurun
- Onset mendadak
- Kondisi berat, nyeri menetap,
- Pemb drh slera tdk menghilang dg tetes phenylephrine 10%
- Penglihatan kabur, diplopia, nyeri saat ada gerakan bola mata
- Tidak mengeluarkan kotoan.
- Terlihat benjoan berwarna sedikit biru jingga, terkadang mengenai seluruh lingkaran
kornea sehingga terlihat sebagai skleritis anular.
- Dalam kasus yang parah skleritis nekrosis, slklera dapat menjadi transparan karena
peradangan kronis, mengungkapkan biru gelap yang mendasari koroid tersebut.

b) Acute iritis

c)Acute episcleritis sakit, nyeri tekan di sklera. Tx  corticosteroid drop

- Umumnya unilateral
- Mata kering
- Rasa sakit ringan yang mengganjal
- Gambaran khusus : benjolan setempat dengan batas tegas dan warna merah ungu di
bawah kojungtiva yang apabila konjungtiva atasnya ditekan akan menimbulkan rasa sakit
yang menjalar disekitar mata.
- Kadang-kadang, ada bintil putih translusen terpusat didaerah yang
meradang (episkleritis nodular)
- Perjalanan penyakit akut, beberapa minggu-bulan, dapat berulang.
- Pembuluh darah mengecil dengan vasokonstriktor.

d)Acute blepharitis peradangan kelopak mata dan margo palpebra

e)Acute conjunctivitis pedes, merah, kelilipan, belekan di pagi hari, gatel, visusu
normal

60.A 45 years old man came to the outpatient clinic with red eye and blurred vision on left eye.
The eye ball tension was increase with corneal edema, pupil dilatation, nausea and vomit. Which
of the following is the most possible diagnosis?
a) Acute scleritis
b) Acute episcleritis
c) Acute keratitis
d) Acute glaucoma
e) Acute iridocyclytis
Iridocyclitis herpes dapat terjadi tanpa ditandai dengan inflamasi kornea aktif dan biasanya
disertai aktivitas virus langsung. Tekanan intraokular meningkat kemungkinan diakibatkan
karena trabekulitis. Pada iritis herpes peningkatan tekanan intraokular karena steroid sering
dijumpai
Untuk mendiagnosis pasti dapat dilakukan PCR dengan bahan dari aqueous. Pengobatan dapat
diberikan dengan topikal steroid tetapi sebagai tambahan dapat diberikan aciclovir oral.1

61.Based on case above, if the eye ball tension was normal, with corneal infiltration gritty
sensation and fluorecein test was negative. Which of the following is the most possible
diagnosis?
a) Acute keratitis
b)Acute conjunctivitis
c)Acute scleritis
d) Acute episcleritis
e) Acute uveitis

62.A 45 years old man came to the outpatient clinic with red eye and blurred vision on left eye.
The eye ball tension was increase with corneal edema, pupil dilatation, nausea and vomit. Which
of the following is the most possible diagnosis?
a) Acute scleritis
b) Acute episcleritis
c) Acute keratitis
d) Acute glaucoma (closed angle)
e) Acute iridocyclytis

63.A 24 years old man athlete , complaint about diffuse pain on both his lower leg after running for
minutes and will disappear after he stop running. The patient look otherwise healthy, muscle power is
normal and no neurologic deficit is found. What is the most probable diagnosis?

Muscle Transectio

Muscle Contusion

Muscle Strain

Compartment syndrome pain dulu baru ada paralysis

Delayed muscle soreness

64.A 35 years old woman, complaint about pain on the right thigh after falling from riding motorcycle.
On physical examination, there is ecchymoses, local swelling and tenderness on anterior thigh. No
deformity is found. The pain increase on active resisted extension of the knee. No increase of pain with
weight bearing. What is the most probable diagnosis?

Skin bruise

Bone bruise

Muscle bruise

Ligament sprain pain and bruising di sendi dan ada swelling

Compartment syndrome

65.A 35 years old woman, complaint about pain on the right thigh after falling from riding motorcycle.
On physical examination, there is ecchymoses, local swelling and tenderness on anterior thigh. No
deformity is found. The pain increase on active resisted extension of the knee. No increase of pain with
weight bearing. What is the most probable diagnosis?

Skin bruise

Bone bruise

Muscle bruise

Ligament sprain pain and bruising di sendi dan ada swelling

Compartment syndrome

66. A 45 years old man complaint about pain on his right calf every time after playing tennis. On
physical examination, there is no discoloration, no deformity and no swelling. There is mild
tenderness on gastrocnemius muscle. Which part of the muscle is the most probable affected?
a. Tendon
b. Muscle body
c. Muscle fascia
d. Muscle tendon junction
e. Tendon insertion

67.A 25 years old female patient comes to a private practice because of abdominal discomfort.
She feels bloated and epigastric pain since 2 weeks ago, but no heartburn. She has no fever,
weight loss, hematemesis, melena. She doesn’t know any of her family’s medical history. She
denies using pain killer or any drug to relieve the abdominal discomfort. On physical
examination, the patient reveals normal. Which of the following is the most appropriate
treatment?

Treat with prokinetic drug

Treat with antacids
Treat with H2RA for 4-12 weeks nocturnal break through
Treat with Full dose PPI than step down
Treat with PPI + 2 antibiotics

68.A 48 year old male patient comes to a private practice because of black stool since 3 days
ago. He had abdominal discomfort since 1 month ago. He had no weight loss. He says he never
use pain killer. On physical examination, the patient’s conjunctiva look pale, but other
examination reveals normal. What is the next step the doctor should do?
Refer for oesophagogastroduodenoscopy
Refer for ultrasound
Refer for rectosigmoidoscopy
Refer for plain abdominal X-Ray
Refer for abdominal CT scan

69.A 60 year old man comes to a private practice for the second time because of burning
sensation radiating from epigastrium toward the neck. He already received PPI for 4 weeks, but
he has no improvement. What is the next step the doctor should do?
Refer for endoscopy
Refer for ultrasound
Refer for tumor marker
Refer for abdominal CT scan
Refer for plain abdominal X-Ray

70.A 55 year old woman comes to the private practice with abdominal discomfort. She already
has done oesophagography examination which shows gastric ulcer. She also brings her urea
breath test results that reveals negative. What is the next step the doctor should do?

a. Treat with H2RA/PPI for 4-8 weeks e. Lifestyle modification only

b. Treat with H2RA/PPI for 8-12 weeks

c. Treat with PPI + 2 antibiotics

d. Treat with PPI + 2 antibiotics + Bismuths


71. A 30 year old man has a chronic cough
with the infiltrates spreading on both of the
lung. Sputum is positive with acid fast
bacilli . Which of the following is the
principle of defense to fight the condition?
a. Ig A mediated hypersensitivity
b. Ig E mediated hypersensitivity
c. Cell – mediated immunity wenberger
hal 310
d. Netrophil ingestion of bacteria
e. Antibody-mediated phagocytosis
72.A 15 year old boy comes to visit
Emergency room with sore throat and high
fever. He also had rash and “koplik spot” on
bucal mucous. Which of the following cells
are dominant on differential count?
a. Eosinophil
b. Monocyte
c. Neutrophil
d. Lymphocyte
e. Basophyl
73.25 year old woman presents to outpatient-clinic with a severe left-sided throbbing headache associated
with nausea, vomiting, and photophobia. She has been having similar headaches three to four times per
month for the past two years. He mother had a similar problem. She had tried taking panadol without
relief. Her mother had a similar problem. Her examination is normal. Which of the following is the most
appropriate therapy for her condition?

Ergotamine tartrate

Nitroglycerine

Phenobarbital

Amytriptyline

Corticosteroid

74. A 60 years old man is being treated for pulmonal tuberculosis with isoniazid and rifampin. To avoid
additional signs of neuropathy, which of the following agents should be administered along with these
antibiotics?

Niacine B3

ThiamineB1

Cyanocobalamine b12

Pyridoxine B6

Riboflavine b2

75. A 60 year-old-woman presents to outpatient-clinic with numbness and occasional pain in her left
hand. Examination of her left hand reveals that it is well-perfused and not edematous. She has decreased
sensation over the left hypothenar and digit 4 and 5. Flexion of these digits is also weaker on the left than
on the right. Tinel and Phalen tests are negative. Which of the following nerve is the most likely
involved?

Median

Ulnar

Radial

Brachial plexus

Radix Cervical 7,
76.

A 37 year old man was complaining of chronic bilateral pain above and around her eyes. He had history
of rhinitis allergy since 2 years ago. These complaints only accompanied with nasal congestion and post-
nasal drip. Which of the following examination is the most appropriate to establish the diagnosis?

Skull X ray

Waters position x-ray

Tonometry IOP

Panoramic x-ray buat gigi

Blood culture

77.A 54 years old man underwent a spinal tap 12 hours prior for evaluation of foot numbness. He now
complains a significant headache and nausea when he rises from a supine (lying flat) to an upright
position. There is no meningeal sign. Which of the following is the most likely for this condition?

Subarachnoid hemorrhage thunderclap headache

Low intracranial pressure

Pseudotumor cerebri

Increased intracranial pressure cushing triad (irregular respiration ec brainstem dysfunction,

bradycardia, systolic HT widening pulse pressure)

Hypovolemic state

78.A38-year-old man was suddenly complaining severe headache associated with vomiting. He never
suffered this complaint previously. There was no weakness and no fever. On neurological examination
showed GCS = 15, there was neck stiffness and subhyaloid bleeding on funduscopy. Which of the
following is the most likely diagnosis?
Encephalitis
Meningitis
Subarachnoid bleeding
Cluster headache
Brain tumor

79.A 30 year old man was complaining headache for 2 months ago. He felt severe and cruciating
headache on his left temple and eye, especially on night. This complaint associated with swelling and
lacrimation on his left eye. Head CT scan and other examination revealed no abnormality. Which of the
following is the most likely diagnosis?
Tension headache
Migraine with aura
Migraine without aura
 Temporal arteritis
Cluster headache

80. A 45 year old, live in Lippo village came dermatology clinic with rashes on his right cheek beside the
lips and pain. Since 4 days ago he suffered pain that spread per his right temple to the cheek. Before he
experienced the rashes he went to beauty salon for head massage ( creambath), since he already had mild
fever, malaise and cramped over his right part pf the head and temple. After massage he feel itchy , pain
and the area became red with some boils on it. He put some betadine lotion on the boils but it won’t help
the condition . He never experience this kind of illness before and no family member affected by this kind
disease. He also never experience food , drug or cosmetic allergy.On physical examination doctor found
some group of vesicles on an erythematous base, some pustules, weep and crust on his right cheek and on
felt pain when skin over the area touched . No nerve enlargement or reduced of sensibility.What is the
most likely diagnosis ?
Herpes simplex
Herpes zoster
Bulous impetigo
Contact dermatitis

Vit B deficiency

81. Which main symptom lead you to the diagnosis ?

a) Before he had mild fever, malaise and cramped over his right temple

b) Never experience this kind of illness before

c) Pain spread over is right temple to the cheek

d) Never experience food, drug and cosmetic allergy

e) He put some betadine lotion.

82. How would you proof your diagnosis?

a) Gram stain d) KOH preparation

b) Tzank smear e) Skin biopsy

c) Patch test

83. A 35 year old woman, married and live in Karawaci, came to dermatology clinic with rashes
on her back and chest . Since 2 weeks ago she experienced ichiness on her back and found a red
patched , well dermacated on her tummy that enlarge gradually , soon after she developed some
red spots that gradually enlarge spread over her tummy , chest and back. She suffered mild fever,
malaise 2 days before the first itchy patched and went to a doctor who prescribe Panadol and
multivitamins.She had two daughters after five years of marriage and no history of miscarriage
.She never had this kind of skin rashes before , she had no record of food and drug
allergy.Physical examination : general condition good.Skin examination reveals oval ,
minimally elevated, scaling patches and plagues mainly on the trunk, red colour follow the skin
cleavage lines likened a Christmas tree. No rashes o the palm and sole.What id the most likely
diagnosis ?
Gutate psoriasis (bentuk kurva linier)  pada anak bersifat swasirna. Lesi papul
eruptif 1-10 mm berwarna merah salmon menyebar diskret secara sentripetal
terutama pada badan, dapat mengenai ekstremitas dan kepala. Infeksi strep beta
mengawali munculnya penyakit ini
Tinea corporis lesi bulat atau lonjong, berbatas tegas tdd atas eritema, skuama, ada
vesikel dan papul di tepi. Di daerah tengahnya tenang
Candidosis cutis papul kemerahann tertutup krusta tebal berwarna kuning
kecoklatan dan melekat erat pada dasarnya (kalau yg granulomatosa) , bisa juga di
lipatan2 ada sateli2 berupa vesikel2, diaper rash
Pityriasis rosea
Secondary syphilis painless, solitary

84. What main symptoms leas you to the diagnosis ?

a) Before the rash , she had mild fever, malaise

b)Two weeks ago experience some itchiness on her back

c) She had two daughters and no history of miscarriage

d) Had no record of food and drug allergy

e) A red patched that enlarge gradually , then developed some red spot that spread

over her body.

61 b 62 c 63 b 64 d 65 e

85. A 49 man year old came with complain oedem on whole body. Physical examination: Ascites
(+) . Laboratory result : Albumin serum decrease, Globulin normal. Urinalysis : Normal.
According this what most possible diagnosis :
a) Congestive Heart Failure d) Protein malnutrition
b) Cirrosis hepatis e) Deficiency Vitamin B
c) Renal insufficiency

86. For supporting diagnose this patien above ( no 39) what kind examination do you need :
a) USG abdomen d) Intravenous pyelografi
b) Thoraks foto e) Head CT scan.
c) Plain foto abdomen

87 A 3 year old girl came to the Puskesmas with ulcer on her left leg. Through the history taking
in wan revealed that Meri had not been well fed in this past year sence her father lost his job.
From her physical examination it was found that her BMI (body mass index) ws below – 2 SD
(standart deviation) for girl of her age. She was fully alert but looked pale with a face appearance
like thin old person. Her rib were very prominent but her both les were oedema.
Based on this information, Meri was likely to be classified :
a.) Marasmus d.) Energy malnutrition
b.) Kwarshiokor e.) Protein malnutrition
c.) Marasmic –kwarshiokor

88.A 3 mont old baby boy was brought to clinic due to rashes over his cheeks ans elbows since a
week go.He was exclusively breastfed since birth . Perinatas history wan unremarkable. From the
detailed history, his mother ate shrimp and squid almost every day for a week since 2 weeks ago
and his cloths were washed uding a liquid detergent since birth. Family history revealed that
hies6 year old eldest brother wan diagnosed as intermitetent asthma. Physical finding showed dry
skin with erythematouus , popular diffuse orders, bizarre shape eith soe erosion and crust over
the elbows and cheeks.
What is the most likely diagnosis for thie case ?
a) Allergic contact dermatitis d) Dermatitis herpeiform
b) Irritant contact dermatitis e) Nummular dermatitis
c) Atopic dermatitis

89.What is the most likely pathophysiologic basis for this case ?

a) Immediate hypersensitivity
b) Cytotoxic or antibody mediated hypersensitivity reaction
c) Immune complex- mediated hypersensitivity reaction
d) Delayed type hypersensitivity reaction
e) Non immunologic reaction.

90. A 35 year old men came to General Practitioner with complain red urine and low back pain.
What the most important examination do you need to supporting diagnose :
a) USG abdomen
b) Thorax foto
c) Hb analyses
d) Blooding time and PT, APTT
e) Stool examination

91.A 29 years old man come to General Practitioner with complain fatigue and weakness about 4
weeks. In physical examination : vital sign in normal limit, Sclera : ichteric. Laboratory result :
HBsAg + (pos), ALT and AST increase. Five month later he recheck to laboratory and he has
antibody for hepatitis B.
What kind of cell to product antibody :
a) T cells d) Plasma cells hasilin antibody
b) B cells hasilin plasma e) Lymphocytes
c) NK cells

92.A 54 year old, came to Emergency unit with Unconsciousness, Allo anamnesis : He suffered
fever about 10 days, had been treated with paracetamol but condition not being well, and until 2
days ago he was unconsciousness Physical Examination : BP 100/65, RR : 24 X /minute ,Temp
40,1 ⁰C. Ptechiae and echimosis over lower and upper extremities. Laboratory examination : Hb
: 10,4 g/dL 13,5 – 17 , WBC: 16500/ UL ( N : 5000- 10000), Platelet 79.000/UL (N: 150.000 –
400.000), Fibrinogen level : 122 mg/dL ( N 150 – 400), PT 14 ( N: 11 – 13 seconds) D Dimer
2,5 mg/L ( N : < 0,5 mg/L). Doctor diagnosis this patient in condition overt DIC
According this data what the most laboratory data to supporting diagnosis overt DIC ?
a) Platelet count
b) Fibrinogen level
c) PT
d) D Dimer level
e) WBC level

93. A 5 years old boy came to a Pediatrician with his parents. They complaint that his boy was
very often suffered from epistaxis and found many tiny red spots on his skin since 1 month ago .
In the Physical examination: conjunctiva : pale, temperature : 38⁰ C, swollen lymph nodes,
enlarged liver , several petechiae over tibia.
Which of the following thing is the best being examined for the boy’s situation?
a) Liver function test
b) Complete Blood Count
c) Hemostasis
d) Bone marrow examination.
e) Widal test
94. A 35 year old woman, came to General Practitioner. PE :Hepatomegali , Ichteric. Laboratory
result : Anti HAV IgM (+) positive, HBsAg (-) negative, Anti HCV (-) negative, SGOT/AST :
345 ( N; < 40) SGPT 550 ( N< 40), Bilirubin plasma : increase.
According result above what is the most possible diagnosis :
a) Acute Hepatitis A
b) Chronic Hepatitis A
c) Hepatoma
d) Cirrhosis Hepatis
e) Hepatitis A recovery phase

95. What about prognosis of this patient :

a) good d) poor
b) dubia ad bonam e) very poor
c) dubia ad malam
96.A child was admitted to hospital with complain lack of energy and irritable. Physical
examination shows no edema, with wrinkled skin, old man face, baggy pants, the ribs looks like
bony structure and hairfall. Which of the following is the most likely diagnosis?
a. Marasmus d. Chromosomal abnormality
b. Kwashiorkor e. Anemia
c. Marasmus- kwashiorkor

97.What is your initial management according to the case above?

a. Resomal d. Fe
b. Vit A e. F 75
c. Zinc

98.A mother come to your clinic with her 18 months old son with diarrhea and vomiting. She
mentioned that her son has defecated about 5-6 times per day for 4 days. The consistency of the
diarrhea is watery and no blood found. She also mentioned that her son’s body weight was 12 kg
and after a physical examination you found that his body weight has decreased to 11 kg.
What is the most appropriate management for this case?
a. Isotonic i.v solution 30 ml/kg body weight in 30 minutes
b. Isotonic i.v solution 100 ml/kg body weight in five hours
c. ORALIT 100 ml every diarrhea or vomiting
d. ORALIT 100 ml/kg body weight for 3 hours
e. ORALIT 75 ml/kg body weight for 3 hours
99.After further examination and history taking you found out that his body temperature has
increased to 37.8 degree Celsius and the child is currently experiencing cough and flu. What is
the most possible cause of the disease?
a. E. coli d. Food poisoning
b. Rotavirus e. Vibrio cholera
c. Lactose intolerant

100.A 12-year-old child come with complain of watery diarrhea since 3 days ago. He mentioned
that he likes to buy food and drinks on the side road, which he thinks are not very clean. He said
that he defecated 4 times a day and the feces consistency is watery and white color, his mother
said that it looks like a the color of water which had been used to wash rice. What is the most
likely diagnosis?
a. Entamoeba coli
b. Giardia lamblia
c. Rota virus
d. Vibrio cholera
e. Entamoeba Histolytica
101.What is the proper medication for the disease above?
a. Amoxiciline
b. Cotrimoxazole
c. Metronidazole
d. Loperamide
e. Antiviral

102.A 9 month old is brought to the emergency room. She had been having emesis and diarrhea
with decrease of urine output for several days. Her weight is 9 kg, down from 11 kg. She is
lethargic and you note that her skin to be doughy. After confirming that her status was stable,
you send electrolytes which you expect to be abnormal. In this case, which of the following
management is the most appropriate?
a. Isotonic i.v solution 30 ml/kg body weight in one hour
b. Isotonic i.v solution 70 ml/kg body weight in five hours
c. ORALIT 100 ml every diarrhea or vomiting
d. ORALIT 100 ml/kg body weight for 3 hours
e. ORALIT 75 ml/kg body weight for 3 hours

103.A 14 year-old boy is seen in the emergency room because of a 3-week history of fever,
lethargy, and 3 kg weight loss. Physical examination reveals marked cervical and inguinal
adenopathy, enlarged tonsils with exudates, small hemorrhages on the soft palate, a WBC
differential that has 50% lymphocytes (10% atypical), and a palpable spleen 2 cm below the left
costal margin. Which of the following conditions is the likely diagnosis?
a. Malaria
b. Roseola
c. Kawasaki disease
d. Streptococcal throat infection
e. Infectious mononucleosis

104.A 2-year-old girl come to you for a general check up. You did a physical examination to
evaluate her growth and you found out that her body weight is 13 kg (65th percentile) and her
height is 75 cm (<5th percentile).
What is her nutritional status?
a. Stunted
b. Wasted
c. Marasmus
d. Overweight
e. Short stature

105.A 3-year-old child came to your clinic with his mother. She complained that her son is
experiencing watery diarrhea since yesterday. In the physical examination you found prominent
ribs and baggy pants. His oral mucousal is dry and his skin turgor has decreased. What would
you do to prevent/treat the dehydration for the first 2 hours?
a. RESOMAL 10ml/kgBB, per oral
b. RESOMAL 5ml/kgBB, IV
c. Normal saline 5ml/kgBB, IV
d. Ringer lactate 10ml/kgBB, IV
e. RESOMAL 5ml/kgBB, per oral

106.A 8-year-old boy came with his mother to the general physician with presents mucinous
diarrhea, 8 times/day, bloody stool, abdominal cramping, sweats, fevers, poor appetite and 8kg
weight lose, reduced turgor of skin. Sometimes he eats bread in his school without washing his
hand. His weight 20 kg now, temperature 38.6 C. Other examination was within normal limit.
What the most patologic organism appropriate of this case?
a. EnteroToxin E Coli
b. Entero Pathogenic E Coli
c. Entamoeba histolytica
d. Vibrio Cholera
e. Giardia Lamblia

107.A 41-year-old female presents to your clinic with a week of jaundice. He has mild fever,
abdominal pain, dark urine and weight loss. Physical examination shows normal function of the
heart and lung. His SGPT is 40u/L (N: <40 ) and his SGOT 18 u/L (N < 35), urinalysis Hb urine
(+). What is the most appropriate next management step?
a. Antibiotics and observation d. USG abdomen
b. Endoscopic e. Peripheral blood smear&coombs test
c. Hepatitis serologies

108.A 30-year-old man presents to the ER with fever, chills, myalgia, yellow eyes, and
abdominal pain since 5 days ago. His fever remained high (40°C). He denies having any
diarrhea, vomiting, or respiratory symptoms. He reports no blood in his stool or urine. He has no
significant medical or surgical history. He recently returned from a 2-month trip to Equatorial
Guinea 4 days ago and he eating in the unhygienic restaurant, many rats surrounding around in
that restaurant. What is the most likely diagnosis?
a. Hepatitis A d. Leptospyrosis
b. Yellow fever e. Dengue fever
c. Malaria

109.A10-year-old girl was admitted to puskesmas due to pain when she swallowing, pain around
the ear, she hard to open her mouth because of pain since 2 days ago. She’s very like “chiki”
snack and never wash her hand before have a meal. There are no family history and no previous
medical conditions. But she has history of nasal congestion, cough, fever 1 weeks ago. On
examination temperature 39,5 C, clear nares, there are tiny red spots on hard palate, tonsil was
sweeling and erythema, and cervical lymphadenopathy. She never take a medication before.
What is the gold standard for diagnose?

a. Radiologic test
b. Ultrasonography
c. Computer tomographic
d. Needle aspiration
e. Throat swab

110.A 9-month-old is brought to the emergency center by ambulance. The child had been having
emesis and diarrhea with decreased urine output for several days, and the parents noted that she
was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9-
month checkup. You note her heart rate and blood pressure to be normal. She is lethargic, and
her skin is noted to be “doughy.” After confirming that her respiratory status is stable, you send
electrolytes, which you expect to be abnormal. You start an IV. The best solution for an initial IV
bolus would be
a. 1⁄4normal saline (38.5 meq sodium/L)
b. D10 water (100 g glucose/L)
c. Normal saline (154 meq sodium/L)
d. 3% saline (513 meq sodium/L)
e. Fresh-frozen plasma

111.In the preceding case, management for this child should include
a. Slow rehydration over 5 hours
b. Rapid volume expansion
c. Packed red blood cells
d. CT scan to evaluate for CNS tumor causing SIADH
e. Urinary electrolytes

112.A 30 years old woman came to the eye clinic with red eye and blurred vision on her right
eye. The patient also had photophobia, flare and keratic precipitate. Which of the following is the
most possibility diagnosis?
a) acute scleritis d)Acute blepharitis
b) Acute iritis e)Acute conjunctivitis
c)Acute episcleritis
113.Based on case above, if the eye ball tension was normal, with corneal infiltration gritty
sensation and fluorecein test was negative. Which of the following is the most possible
diagnosis?
a) Acute keratitis d) Acute episcleritis
b)Acute conjunctivitis e) Acute uveitis
c)Acute scleritis

114.A 45 years old man came to the outpatient clinic with red eye and blurred vision on left eye.
The eye ball tension was increase with corneal edema, pupil dilatation, nausea and vomit. Which
of the following is the most possible diagnosis?
a) Acute scleritis d) Acute glaucoma
b) Acute episcleritis e) Acute iridocyclytis
c) Acute keratitis

115.A 24 years old man athlete , complaint about diffuse pain on both his lower leg after running
for minutes and will disappear after he stop running. The patient look otherwise healthy, muscle
power is normal and no neurologic deficit is found. What is the most probable diagnosis?
a. Muscle Transection d. Compartment syndrome
b. Muscle Contusion e. Delayed muscle soreness
c. Muscle Strain

116.A 35 years old woman, complaint about pain on the right thigh after falling from riding
motorcycle. On physical examination, there is ecchymoses, local swelling and tenderness on
anterior thigh. No deformity is found. The pain increase on active resisted extension of the knee.
No increase of pain with weight bearing. What is the most probable diagnosis?
a. Skin bruise
b. Bone bruise
c. Muscle bruise
d. Ligament sprain
e. Compartment syndrome

117.A 45 years old man complaint about pain on his right calf every time after playing tennis.
On physical examination, there is no discoloration, no deformity and no swelling. There is mild
tenderness on gastrocnemius muscle. Which part of the muscle is the most probable affected?
f. Tendon
g. Muscle body
h. Muscle fascia
i. Muscle tendon junction
j. Tendon insertion

118.A 20 years old soccer player gets injured and presents with pain and ecchymosed on
hamstring muscle. On physical examination the doctor said that he needs surgery. What is the
most probable diagnosis?
a. Muscle Contusion
b. Muscle Transection
c. Muscle Strain
d. Delayed muscle soreness
e. Compartment syndrome

119.A 25 years old female patient comes to a private practice because of abdominal discomfort.
She feels bloated and epigastric pain since 2 weeks ago, but no heartburn. She has no fever,
weight loss, hematemesis, melena. She doesn’t know any of her family’s medical history. She
denies using pain killer or any drug to relieve the abdominal discomfort. On physical
examination, the patient reveals normal. Which of the following is the most appropriate
treatment?
a. Treat with prokinetic drug
b. Treat with antacids
c. Treat with H2RA for 4-12 weeks
d. Treat with Full dose PPI than step down
e. Treat with PPI + 2 antibiotics

120.A 48 year old male patient comes to a private practice because of black stool since 3 days
ago. He had abdominal discomfort since 1 month ago. He had no weight loss. He says he never
use pain killer. On physical examination, the patient’s conjunctiva look pale, but other
examination reveals normal. What is the next step the doctor should do?
a. Refer for oesophagogastroduodenoscopy
b. Refer for ultrasound
c. Refer for rectosigmoidoscopy
d. Refer for plain abdominal X-Ray
e. Refer for abdominal CT scan

121.A 60 year old man comes to a private practice for the second time because of burning
sensation radiating from epigastrium toward the neck. He already received PPI for 4 weeks, but
he has no improvement. What is the next step the doctor should do?
a. Refer for endoscopy
b. Refer for ultrasound
c. Refer for tumor marker
d. Refer for abdominal CT scan
e. Refer for plain abdominal X-Ray

122.A 55 year old woman comes to the private practice with abdominal discomfort. She already
has done oesophagography examination which shows gastric ulcer. She also brings her urea
breath test results that reveals negative. What is the next step the doctor should do?
a. Treat with H2RA/PPI for 4-8 weeks
b. Treat with H2RA/PPI for 8-12 weeks
c. Treat with PPI + 2 antibiotics
d. Treat with PPI + 2 antibiotics + Bismuths
e. Lifestyle modification only

123. A 30 year old man has a chronic cough with the infiltrates spreading on both of the lung.
Sputum is positive with acid fast bacilli . Which of the following is the principle of defense to
fight the condition?
a. Ig A mediated hypersensitivity
b. Ig E mediated hypersensitivity
c. Cell – mediated immunity
d. Netrophil ingestion of bacteria
e. Antibody-mediated phagocytosis

124.A 15 year old boy comes to visit Emergency room with sore throat and high fever. He also
had rash and “koplik spot” on bucal mucous. Which of the following cells are dominant on
differential count?
a. Eosinophil
b. Monocyte
c. Neutrophil
d. Lymphocyte
e. Basophyl

125.A 25 year old woman presents to outpatient-clinic with a severe left-sided throbbing
headache associated with nausea, vomiting, and photophobia. She has been having similar
headaches three to four times per month for the past two years. He mother had a similar problem.
She had tried taking panadol without relief. Her mother had a similar problem. Her examination
is normal. Which of the following is the most appropriate therapy for her condition?
a. Ergotamine tartrate
b. Nitroglycerine
c. Phenobarbital
d. Amytriptyline
e. Corticosteroid

126. A 60 years old man is being treated for pulmonal tuberculosis with isoniazid and rifampin.
To avoid additional signs of neuropathy, which of the following agents should be administered
along with these antibiotics?
a. Niacine
b. Thiamine
c. Cyanocobalamine
d. Pyridoxine
e. Riboflavine

127. A 60 year-old-woman presents to outpatient-clinic with numbness and occasional pain in

her left hand. Examination of her left hand reveals that it is well-perfused and not edematous.
She has decreased sensation over the left hypothenar and digit 4 and 5. Flexion of these digits is
also weaker on the left than on the right. Tinel and Phalen tests are negative. Which of the
following nerve is the most likely involved?
a. Median
b. Ulnar
c. Radial
d. Brachial plexus
e. Radix Cervical 7,8

128. A 37 year old man was complaining of chronic bilateral pain above and around her eyes. He
had history of rhinitis allergy since 2 years ago. These complaints only accompanied with nasal
congestion and post-nasal drip. Which of the following examination is the most appropriate to
establish the diagnosis?
a. Skull X ray
b. Waters position x-ray
c. Tonometry
d. Panoramic x-ray
e. Blood culture

129.A 54 years old man underwent a spinal tap 12 hours prior for evaluation of foot numbness.
He now complains a significant headache and nausea when he rises from a supine (lying flat) to
an upright position. There is no meningeal sign. Which of the following is the most likely for this
condition?
a. Subarachnoid hemorrhage
b. Low intracranial pressure
c. Pseudotumor cerebri
d. Increased intracranial pressure
e. Hypovolemic state

130.A 38-year-old man was suddenly complaining severe headache associated with vomiting. He
never suffered this complaint previously. There was no weakness and no fever. On neurological
examination showed GCS = 15, there was neck stiffness and subhyaloid bleeding on funduscopy.
Which of the following is the most likely diagnosis?
a. Encephalitis
b. Meningitis
c. Subarachnoid bleeding
d. Cluster headache
e. Brain tumor

131.A 30 year old man was complaining headache for 2 months ago. He felt severe and
cruciating headache on his left temple and eye, especially on night. This complaint associated
with swelling and lacrimation on his left eye. Head CT scan and other examination revealed no
abnormality. Which of the following is the most likely diagnosis?
a. Tension headache
b. Migraine with aura
c. Migraine without aura
d. Temporal arteritis
e. Cluster headache

PERSIAPAN ICM 1
SELECTIVE QUESTION
Neuro

12. Cewe 40 tahun, dia merasa unpleasant pas naik mobil terutama saat mobilnya accelation &
deceleration. Yg involve apa?
Sacculus vertical, utriculus horizontal
A. Sacculus
B. Utriculus
C. Semicircular canal horizontal
D. Semicircular canal anterior
E. Semicircular canal posterior

14. Motion sickness mostly stimulated by

A. Unpleasant memory
B. Familiar movement
C. Proprioceptive and vestibular
D. Vestibular and visual
E. Visual and proprioceptive

24 y.o med student notice while brushing her teeth that she can't move her left side of the face.
She can't wrinkle her left forehead, can't show her teeth nor can't purse her left lips. Diagnosed as
Bell's Palsy. Another symptoms?
A.
B.
C. Abnormal taste 2/3 left anterior tongue

26. 30 yr old man had a motorcycle accident. Have loss of fine touch and pain sensory on the
thunb and index finger. Which dermatomes?
C6 c7

28. 45 y.o, wide base gait, paraplegia, both lower limb loss vibration, fine touch and
proprioception, other sensory and motoric modalitis normal, destruction di tract mana?
A. Gracilis fasciculus  deep touch, vibration, visceral pain, proprioception of lower limb and
trunk
B. Cuneate fasciculis fine touch, vibration, fine pressure, proprioception of UPPER
EXTREMITIES
C. Lateral spinothalamic pain and temperature
D. Ventral spinothalamic nociceptive, crude touch
E. Spinocerebellar

32. co 32 th, unconsciousness, dari pf ditemukan papiledema positif, neck extension positif, ada
history of fever&headache sebelumnya. diagnosis?
A. hemorrhage,
B. stroke,
C. meningitis,
D. obstructive
E. hydrocephalus

37 y.o man fell down when he fired the roof of his house. His back hit the big stone on the
ground then suddenly he feel of sensory deficit for temperature and pain. Which tract of spinal
cord?
A. Fasciculus gracilis
B. Fasciculus cuneatus
C. Spinothalamic anterior
D. Spinothalamic lateral
E. Spino cereberallis

37. When evaluating a patient with nystagmus, one must be aware of a brainstem disease if the
nystagmus is...
Lesi central : nystagmus ke segala arah; lesi peripher : ke satu arah.
A. Pendular
B. Nystagmoid jerk
C. Rotatory
D. Vertical
E. Horizontal

50. 52 years old man, with ptosis, exotropia. Saat disinari senter di mata kiri, mata kiri ga
konstrik tp mata kanan konstrik. Salahnya dmna?
A. Opticus
B. Oculomotor
C. Trochlear
D. Abducens
E. Sympatetik activity

54. Patient with left leg weakness. Physical exam ankle reflex absent, with sensory loss of calf,
lateral aspect and sole of the foot. Most probable is injury in ..
A. Anterior horn cell
B. Corticospinal tract
C. Muscles of the calf
D. Peripheral nerve
E. Lateral region of cerebellum
55. 40 tahun jatuh dr atap, complete paralysis lower limb, pain sensation loss. Pemeriksaan di
bawah level vertebra thoracal 9. Light sensation dll masih ada. Diagnosis?
A. Anterior cord syndrome (motorik ,sensorik, temperature)
B. Posterior cord syndrome (masih ada light sensation)
C. Central something syndrome
D. Brown sequard syndrome
 motoric ilang ipsilateral, sensori ilang kontralateral
57. A patient is suffering from Bell's plasy, a condition in which inflammation has blocked
function of the facial nerves on one side. Which one of the following symptoms patient
experience?
A. Inability to open eye
B. Exessive salivation
C. Loss of lacrimation
D. Loss of sense of smell
E. Loss of tactile sensation in the face

59. Org kena gunshot kena di right hemisection T10. Apa yg ditemukan dalam pemeriksaan?
A. Absent cremaster refleks di kanan
B. Extensor plantar reflex dan clonus di kiri
C. Gangguan dorsal column kiri
D. Gangguan spinothalamic kanan
E. Spastic Paralysis di kanan

72. A 50 y.o man ada riwayat jatuh, tangannya (hand) ga bisa digerakin. Pada pemeriksaan fisik
ditemukan pasien ga bisa dorsofleksi. Nerve apa yang terganggu?
A. Ulnaris
B. Medianus
C. Radialis
D. Axilary

73. Pasien menghilangnya gw sensorik pain dan temperature di left side. Dan memiliki gejala
spastic paralysis dan hilang procioceptive di sebelah kanan
A. Hemisection syndrome (brown squard syndrome)

SKIN

1. 13yrs old itching more intense at night in the interdigital space and spread to wrist elbow
axillae.his friend in the camp experience the same pf shows excoriation small papules and
pustule.
diagnosis?
sarcoptes scabiei

4. anak kena tb di kulit. obat? 2 bulan rhze 4 bulan rifampisin isoniazide

5. the cold receptor is:

a. Merkel unencapsulated modified free nerve ending (touch)
b. Pacinian receptor (pressure, vibration)
c. encapsulated free nerve ending
d. Ruffini receptor (contonous pressure)

7. Mr Agus had motorcycle accident, he got a laceration wound on his arm. He went to his
doctor and he was given an antibiotic cream to prevent infection and fasten healing. Mechanism
to prevent infection:
A. Epidermis prevent infection
B. Dermis prevent infection
C. Hypodermis prevent infection
D. Subcutaneous prevent infection
E. Dermatosome prevent infection

11. Anak, dengan gejala dermatitis alergi, history bokapnya asma dan dermatitis alergi juga.
Topical corticosteroid dgn moisturizer

12. a 20 year old man has blurred vision on both eyes. the examination reveals S+1.50 right eye,
S+1.00 left eye. before using the spectacles, where would be the image location in the eyes?
A. di dpn retina
B. at the retina
C. blkg retina
D. infinite
E. (lupa)

14. man, 50yo, hitting fence & running to people while walking, iop 35mmHg, visus 6/30,
enlargement of cup ratio with cupping. drugs?
a. carbonic anhydrase acute (gilbert)
b. beta agonist maintanace
c.
d.
e.

15) which part of eye is involved in the condition above

A) choroid
B) sclera
C) trabecular meshwork (gua pilih ini)
D) internal limiting membrane
E) sclera

16. Org iop naik. Blurrred 2 tahun ga mendadak. Mata gk merah. Lens clear.
Mechanism apa yg bkin dia gamgguan penglihata?
A.
B. Lens haziness
C. Optic neuropathy
D.
E. Neovascularisasi
Man 67 thn, blurred vision since 2 years ago. No pain/red/trauma. Visual acuity right
: 6/20 left: 6/24. IOP right:35 left:32. Cup disc ratio 0,8. Mechanism of blurred
vision?
A. Image located in front of retina
B. Lens haziness
C. Optic nerve neuropathy
D. Rupture of the retinal vessel
E. Neovascularisation

17. 70 tahun datang dengan keluhan penglihatan mata kanan menurun. Lensa kanan hazzy, IOP
Obat apa yg dipakai akan menimbulkan kontraindikasi pada kondisi di psirn ini?
A. Timolol
B. Acetazolamide
C. Sulfa atropine
D. Lapanopras
E. Prednison
18.anak kecil kena bola berdarahh, blurred, red, pain sehingga ada darah di anterior chamber.
komplikasi yg mgkn trrjadi? glaukoma, keratitis,

12 yo boy got hit by soccer ball. There was pain redness in eye, naisea vomiting. No relative
afferent pupil defect. There was blood in anterior chamber of eye. What is the complication
?
A. Konjungtivitis
B. Blepharitis
C. Glaucoma
D. Presbiopi
E. Exotropi

19. 55 yo woman. diabetes ga terkontrol, tensi 130/80, visus normal, lens clear. kemungkinan
ntar dia yg didapet dr fundusskopi apa?
jawab: cotton wool

Pasien dengan tanda diabetic retinopathy pada funduskopi akan ditemukan?

a. cotton wool appearance
b. Retinal exudate
c. Cherry red spot
d.

20 . cowok 28 thn .red eye blured vision . pas naik motor ada forign body yg masuk . cuma bs
liat lambaian tgn . ada ciliary injection . mukopurulent sekret . pmeriksaan apa yg harus di
lakukan ?
a.amsler grid
b. shadow test.
fluorecent tes
24 YO man with blurred vision since 1 week ago. History of foreign sensation while riding
motorcycle since 1 week ago. He is in pain and mucopurulent secretion. Visual acuity is hand
movement. On examination there is white lesion on cornea, conjunctival and cilliary injection.
What is the appropriate test?
a. Amsler grid
b. Fluorescent test
c. Lupa sorry
d. Hischburg test
e. Shadow test

21. Gangguan lihat hijau-merah, bagian retina apa yg affected? cone

 A 15 y/o teenager was brought to test his color vision. It was revealed he had red-green deficiency.
Which part of the retina is most likely to be affected?
A. Muller cells
B. Cone cells
C. Rod cells
D. Bipolar cells
E. Retinal pigment epithelium cells

23. A 35 years old woman came to the clinic because of diplopia. On examination hirchbersg test
show light in cornea edge in temporal side. Whats the most possible diagnosis :
A. Exotropia 30 derajat
B. Esotropia 30 derajat
C. Exotropia 45 derajat
D. Esotropia 45 derajat
E. Orthophoria

24. bayi 1 bulan. lens hezzynes, iop meningkat, kornea lebar. kira2 penyebabnya organ pa?
a. kornea
b. lensa.
c. cilliary bkdy
d. vitreous body primary hyperplastic vitreous
e. sclera

25. seorang pria dtg ke UGD karena kecelakaan. ga ad syncope, ada moderate head injury. saat
di pf ada esotrophia 15 drajat mata kiri. cranial nerve yg mana yg kena ?
a. ii
b.iv
c. v
d. vi
e. viii

26. On further examination from the patient above, there is lagophtalmos causing watery eyes.
What structure involed?
A. Levator palpebrae muscle
B. Muller muscle
C. Orbicularis oculi muscle
D. Cilliary muscle
E.
28. 50 yo man came to eye clinic with complain of hitting chair while walking in his house. After
confrontation test, it was revealed that he got reduction in visual field loss in nasal side of both
eyes. The most probable site to cause this deficit is: (harusnya bitemporal heminopsia kt dr
endang)
a. edinger-wesphal nuclei
b. cortical association
c. optic radiation
d. optic chiasm bku UI hal 275
e. macular degeneration

31. 20 yo woman present with redness in the eye, associated with pain. Especially in the
morning.Dia udh alami ini berkali-kali. ditetesin tetes mata, matanya ga merah lagi (maaf lupa
namanya apa). Penyebab mata merahnya adalah
A.
B. Connective tissue
C. Aqueous outflow
D. Herpes
E. UV light

33. 51 years old man konsultasi ke internal medicine untuk evaluasi dan manage dry and red
eyes. Ada history palpitasi and mild tremor. Dia mengeluhkan horizontal binocular diplopia on
extreme gaze tapi diplopianya gak dirasakan mengganggu. Ada staring eye juga. PF= restriction
upper ocular motility and exophthalmus. Next initial diagnostic test:
A. Orbital CT scan imaging dr endang
B. Hirschberg test
C. Schirmer and Ferning Test
D. CBC
E. Hertel exopthalmometer dr welinson
35. 55 tahun, ada ulcerative ihomogen di lidah, makin membesar, ada penurunan berat badan.
A. herpes,
B. scc,
C. parotitis ,
D. fibroma

37. 17 y.o boy come to the dentist because he is unhappy with dark brown discoloration of all his
teeth. Medical history show that his mother took antibiotics during pregnancy. What is the
antibiotic that cause the problem?
A. Amoxicillin
B. Clindamycin
C. Tetracyclin
D. Azithromycin
E. Cephalosporin

38. 10 year old boy, decline in hearing left ear. tes garpu tala lebih jelas ke mastoid. apa yg di
dapat dari tes weber?
a. kanan lbh keras dari kiri
b. kiri lebih keras dari kanan
c. sama aja
d. ga dgr apa2
e. lupa

39. A 8 year old girl, feeling full and watery in the ear. She feeling cold and cough since 3 days
ago. What's the main cause?
A. Upper respiratory infection
B. Gangguan tuba eustachius
C.
D.
E.

40. Pemeriksaan audiometry terdapat gap 25 dB,BC 10 dB dan AC 35 dB, maka dapat
disimpulkan terdapat:
A. Tuli saraf ringan
B. Tuli saraf sedang
C. Tuli konduksi ringan
D. Tuli konduksi sedang
E. Tuli campur

Jwb: conduction deaffness yg light

41. berdasarkan soal nomer 40, tuli konduktif telinga kiri, kalo tes weber:
c. lateralisasi telinga kiri

43. Pemeriksaan audiometri menunjukkan

AC: 10 (ka), 65 (ki)
BC: 5 (ka), 15 (ki)
Diagnosa?
A. AD normal, AS tuli campuran
B. AD normal, AS tuli konduktif
C. AD normal, AS tuli sensori
D. AD normal, AS tuli konduktif berat
E. AD normal, AS tuli sensori berat

44. a 34 year old man brought to ER after being falling down from ladder and hit his head. the
patient complain that he cannot be smell anything after that acident where is the location on the
brain?? A
A. Frontal
B. Temporal
C.
D. Amygdala

46. 21 yo man loss of taste and apetite. Doctor explain about physiology of taste. Which
statement is correct?
A. Sweet and bitter taste depolarizes through G protein
B. Sour and salty through Na+ ions
C. Salty tastebud less sensitive to acid
D. Taste bud less sensitive to bitter taste of sucrose
E. Salty and sour taste depolarizes through H+ ions

47. 27, male, spinning sensation, nausea, vomiting. Terutama saat bergerak. 1 minggu
sebelumnya: fever, greenish discharge dari telinga kanan. Other examination: normal.
Diagnosis?
A. Non vestibular vertigo
B. Central vertigo
C. Peripheral type of vestibular vertigo
D. Central type of vestibular vertigo
E. Cerebellar vertigo

48. 6 year old boy with fever 38, myalgia, pain when swallowing, sneeze and cough. Physical
exam : enlarged lymph node, pharynx hiperemis, T1/T1, no rash in skin.
A. Corynebacterium Diphteriae
B. RSV ujung2nya pneumoni/ Lower respiratory
C. Haemophilus influenzae
D. Paramyxovirus
E. Strepto b hemolitik

49. Headache, ad keluar discharge dari telinga tympanic membrane

Otoscopy= tympanic mebrane bulging and eritem
Kenapa tympanic membrane bulging?
A. Protrusi blood vessel
b. disfungsi eustachian tube
C.retraksi timpani
D. Purulent

51. 8y.o.girl come to the clinic with complaining about her right ear feel full, like water filling
since 1 day ago. P.E. Right ear tympanic membrane intact, retraction+, there is clear fluid
shadow and air bubbles. Left ear normal, patient got cough and colds since 3 days ago. Based on
patophysiology of meddle ear infection, what is the main cause?
A. Upper resp.tract infection.
B. Tube eustachius dysfunction.
C. Feeding time dleep position.
D. Maxillofacial abnormalities.
E. Tonsiloadenoid hypertrophy.

53. Child, 5yo, snoring and sleep deprivation. Breath trough the mouth and have abnormal face.
Ada episode ispa n exudative otitis media. Diagnosis?
Adenoid hyperplasia

57. Runny nose, konka hipotrofi, sekret hijau berbau

Answer: rhinitis atrofi

56. 9 yr old sakit telinga dan keluar cairan sudah 5 hari. Sebelumnya ada pilek demam 1-2 mgg
lalu. Diagnosis?
A. Acute otitis media
B. Chronic supurative otitis media
C. ...

59. 31 years old male came with chief complain pain and reddish lesions, about firmly on his
thigh. There were involvement of dermal lymphatic vessel. The etiology was beta streptococcus
hemolytic. What is the diagnosis?
a. impetigo krustosa
b. furuncle
c. ektima
d. erysipelas
e. folliculitis

61. 25 y.o sexual inter course 1month ago. ulcer di vagina. ilang muncul red spot di bada .
VDRL 1/80 . Dx apa?
a. sifilis =jawaban
b. GO
c. Ulcus molle
d. varicella
e. LGV

62. A 14-year old female presents to the pediatrician complaining of discoloration of her
toenails, which makes it impossible to wear sandals. She says that months ago, she first notice
the big toes of both feet were affected, and that the yellowish brown discoloration began with the
distal tips of her toenails and spread proximally to involve entirely of the nail. On physical
examination, the nail plats of all ten toes are heaped up and irregular. Brownish discoloration is
evident. Dermatophytic hyphae and arthrospores are visible upon KOH examination of scraping
from the nail bed. What is most effective treatment regimen for this girl’s condition?
Ketoconazole topical

63. A 17 year old male presents to a clinic complaining of severe sunburn to his face and
forearms. He was playing soccer ball outdoors for less then one hour on a sunny day before
noticing the sunburn. His past medical history is significant for acne vulgaris, which he is taking
medication for. Physical examination reveals numerous comedones, papules, and pustules of his
face, neck, and chest. There is significant scaring from previous episodes of acne. Confluent
areas of erythema, warmth, and edema are evident on the patient's face and forearms. Which of
the following medications is the most likely causative agent of the sunburn?
A. Benzoyl peroxide
B. Erythromycin
C. Clindamycin
D. Doxycycline (gw jwb ini)
E. Acid salicylic

64. 32 yo woman come over the clinic for the rash over her knee since 2 weeks ago. No
itch/joint, no significant past medical history, she takes oral contraceptive regularly. PE:
symmetric, erythematous plaques with well-defined margin on anterior aspect of knee. The rash
is covered with thick, silvery scale. What is the appropriate treatment?
a. Topical hydrocortisone 1% cream = cream ga nembus karena ketebelan
B. Topical bethametason 0.05 % cream = cream ga nembus karena ketebelan
C. 60 mg oral prednisone every day for 2 weeks -> kelamaan 2 minggu
d. Phototherapy with UV B radiotherapy
e. Low dose methotrexate daily for 2 weeks = kalo emergency

65. 30yo woman was using 50% salycilic acid to took off the warts on the ankle. She developed
markedly pruritic eruption on the sire and surrounding area. The PE revealed 1 cm ulcer and 10
cm surrounding erythematous, papulovesicular rash and wheal. What is your DD?
A. Insect bite
2. contact dermatitis
3. Herpes simplex virus eruption
D. Scc
E. Verucca vulgaris with infection

66. A 25 years old man comes to the doctor because of painful boils in his beard area since 2
days ago. On skin examination: pustule with hair in the center of pustule. Skin scrapping test on
lesion: gram positive grape-like cocci. What is the possible diagnosis?
a. Furuncle
b. Carbuncle
c. Foliculitis
d. Impetigo
e. Acne Vulgaris

67. orang di cek igm dan igg positif dengue dan platelet count menurun. gambaran dermatology
yg muncul?
jwban : petechiae

69. epidermis healing process:Inflammatory phase - proliferative phase - maturation phase

70. anak lahir dengan development defect lip daan palate. saat pregnant mother kekurangan folic
acid dan pernah ter expose chemical materials. diagnosis?
a. lip tumor
b. palate tumor
c. cleft lip and palate
d. hemangioma
e. lymphangioma

-Malodorous grayish discharge, hasnt had sex since husband died, e. bV

-a 17 girl went to DV clinic with skin rash on chest back arm since 1 week ago. physical
examination christmas tree, herald patch positive. diagnosis? D
a. (lupa)
b. eritroderma
c. psoriasis vulgaris
d. pytiaris rosea
e. para psoriasi

-patient man 54 yo come to ED with massive nosebleed. the bleeding could be seen through the
back of the mouth. the source of bleeding could not be easily found. treatment :
a. anterior tampon
b. posterior tampon
c. nose pressure
d. head tilt posterior

-58 year old woman presented with some itch on the scalp that started w/ 3 month ago. She
always cover her hair with a scarf every day from 9 am to 5 pm and worked at the parking lot.
On examination there some annular patch which coveres with white gray fine scales. What is
your diagnosis:
A. Psoriasis
B. Deborrheic dermatitis
C. Pediculosis capitis
D. Kerion celsi
E. Gray patch ring worm – keluhan di rambut + hair loss n gray hair

-gw inget 1 soal, anak 5 tahun pas tidur snoring, kata dokternya ada sleep deprivated, dia
bernafas lewat mulut, kesulitan menelan, malaise, ada reccurent respi infection,diagnosis?
chronic tonsilitis, acute tonsilitis, difteri tonsilitia, phyaringitis, adenoid hypertrophy

50. 15 tahun, cowo can't breath at right side nose. ada epistaxis massive, disertai runny nose dan
serous discharge. tdk ada berat badan turun, normal nasal septum dan ada easy bleed white mass
on right posterior. diagnosis?
A. left polyp extend to nasopharynx
B. antrochoaral polyp
C. nasal squamous cell carcinoma
D. nasopharingeal angiofibroma
E. right septum deviation

52. ibu2 pusing keleyengan BPHH. diperburuk dengan movement head. Jadi jawabanny:
otoconia bertebangan

2. A 50 yo woman, red thick silver white scaly plaque, auspitz sign, fenomena tetsan lilin (+).
A. Scabies
b. Suborroic dermatitis
c. Psoriasis vulgaris
D. Parapsoriasis

8. prevent/barrier of skin evaporation:

a. stratum corneum
b. stratum lucidum
c. stratum granulosum
d. stratum spinosum
e. stratum basale

6. Cold temperature pathway :

A. Anterior spinothallamic
B. ....... Spinocerebelar
C.
D. Lateral spinothalamic
29. Wanita, uda berumur. Buram saat melihat dekat dan jelas saat melihat jauh. Saat diberikan
kcmt +2 penglihatan normal , sebelumnya tidak ada masalah dengan penglihatan sebelumnya
baik" saja tanpa gangguan. Diagnosa :presbiopi

55. stroke periksa pendengaran pake apa? BAER

42. Laki-laki 28th datang ke klinik dengan keluhan decreased hearing di telinga kiri, waktu kecil
pernah menderita otorhea. Keluhan lainnya yaitu runny nose, nasal congestion, batuk, trouble
tasting in left tongue, ear exam normal, ada pus dari telinga tengah dan ada perforasi. Komplikasi
yang sudah ada ?
A. Labyrinthitis vertigo
B. Sinusitis
C. Petrositis diplopia
D. Chorda tympani parese
E. Retro-auricular fistula

-Tes konfrontasi yang mata kiri gak normal... direct pupilary test normal... Yang salah cranial
nerve berapa?
A.2 C. 4 E. 6
B. 3 D. 5