1. 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 (karena uda cirrhosis), 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?
a) Anemia with hepatitis acute
b) Anemia with hepatitis chronic active
c) Anemia with hepatitis chronic persistent
d) Anemia with hepatoma. (hepatocellular carcinoma AFP)
e) Anemia with hepatic cirrhosis

2. Which of the following is the most appropriate laboratory examination to determine the type
of anemia? MCHC ABNORMAL CUMA 2 (IRON DEF, SIDEROBLASTIC)
a)MCV, Peripheral blood smear
b) MCH , Peripheral blood smear
c) MCHC, peripheral blood smear
d) MCH, MCHC
e) MCH , urinalysis.

3. 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?
a) Right Conductive hearing loss
b) Left Conductive hearing loss
c) Right Sensory neural hearing loss
d) Left sensory neural hearing loss (positive positive, lateralisasi kanan)
e) Mixed hearing loss (kalo mix, kanan negative rine, laterasis kiri)

4. Which of the following examination is the most appropriate to determine the degree of
hearing loss?
a) Tympanometric After an otoscopy (examination of the ear with an otoscope) to ensure
that the path to the eardrum is clear and that there is no perforation, the test is performed
by inserting the tympanometer probe in the ear canal. The instrument changes the
pressure in the ear, generates a pure tone, and measures the eardrum responses to the
sound at different pressures.

b) Audiometric
c) Pneumo otoscopy (sama kaya otoscopy, untuk liat tambahin tekanan kyk untuk liat
otitis media massa dll)
 d) Audiometric and thympanometric
e) Otoscopy

5. 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
d)Fluorescein test
e) Placido test.
placido utk mengecek kelengkungan kornea:
• lingkaran konsentris: Normal
• lingkaran lonjong: astigmatisma
• lingkaran tidak beraturan: astigmatisma, scarring
• batas tidak tegas: edema kornea

6. 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?
a) Pterygyum
b) Pinguiculitis
c) Conjunctivitis
d) Uvetitis
e) Glaucoma

7. 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?
a) CBC
b) Throat culture
c) Chest X rays
d) Sinus para nasal X Rays
e) Rapid strep tests
A complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein have a low
predictive value and usually are not indicated.
8. 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?
a) Suffering Hepatitis B in prodromal phase
b) Suffering Hepatitis B in recovery phase.
c) Suffering Hepatitis B in active replication phase
d) Suffering Hepatitis B in the past
e) Relaps from Hepatitis B

9. 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?
a) Suffering hepatitis B in recovery phase
b) Suffering hepatitis B in chronic phase.
c) Suffering hepatitis B in acute phase
d) Suffering hepatitis B which is completely resolved
e) Have complete immunity to hepatitis B.(smua negative kec anti hbsag

10. 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.

Interpretation of the hepatitis B panel

Tests Results Interpretation

HBsAg negative susceptible

anti-HBc negative
anti-HBs negative

HBsAg negative immune due to vaccination

anti-HBc negative
anti-HBs positive with >10mIU/mL*
 HBsAg negative immune due to natural infection
anti-HBc positive
anti-HBs positive

HBsAg positive acutely infected

anti-HBc positive
IgM anti-HBc positive
anti-HBs negative

HBsAg positive chronically infected

anti-HBc positive
IgM anti-HBc negative
anti-HBs negative

HBsAg negative four interpretations possible†

anti-HBc positive
anti-HBs negative

* Postvaccination testing, when it is recommended, should be performed 1–2 months following dose #3.

†1. May be recovering from acute HBV infection.

2. May be distantly immune and the test is not sensitive enough to detect a very low level of anti-HBs in
serum.

3. May be susceptible with a false positive anti-HBc.

4. May be chronically infected and have an undetectable level of HBsAg present in the serum.

Hepatitis B surface antigen (HBsAg): A protein on the surface of hepatitis B virus; it can be detected in
high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates
that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal
immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.
■ Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally interpreted as
indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who
has been successfully vaccinated against hepatitis B.
■ Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B
and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B
virus in an undefined time frame.
■ IgMantibodytohepatitisB core antigen (IgM anti-HBc): Positivity indicates recent infection with
hepatitis B
virus (<6 mos). Its presence indicates acute infection.

Diagnosis
Clinical presentation does not reliably establish the viral etiology, so serologic studies are used to
establish a diagnosis. Anti–hepatitis A immunoglobulin M (IgM) establishes an acute hepatitis A infection.
Anti–hepatitis C antibody is present in acute hepatitis C, but the test result may be negative for several
weeks. The hepatitis C RNA assay, which becomes positive earlier in the dis- ease course, often aids in
the diagnosis. Acute hepatitis B infection is diag- nosed by the presence of hepatitis B surface antigen
(HBsAg) in the clinical context of elevated serum transaminase levels and jaundice. HBsAg later dis-
appears when the antibody (anti-HBs) is produced (Figure 11–2). There is often an interval of a few
weeks between the disappearance of HBsAg and the appearance of anti-HBsAb. This period is referred
to as the “window period.” During this interval, the presence of anti–hepatitis B core antigen IgM (anti–
HBc IgM) is indicative of an acute hepatitis B infection. Hepatitis B precore antigen (HBeAg) represents a
high level of viral replication. It is almost always present during acute infection, but its persistence after 6
weeks of illness is a sign of chronic infection and high infectivity. Persistence of HBsAg or HBeAg is a
marker for chronic hepatitis or a chronic carrier state; elevated versus normal serum transaminase levels
distinguish between these two entities, respectively.

11. 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
Anti HCV ( + ) ---------- HCV Immunblot / HCV RNA (+) ---- Viral load

12. 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?
a) Hepatitis in prodromal phase
b) Hepatitis in recovery phase
c) Cholestasis
d) Hemolytic anemia
e) Cholelitiasis

13. 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 (Albumin bagusnya untuk prognosis dan biasanya di chronic,
alfa lala)
b) cholestasis (AP, GGT > ALT)
c) integrity of liver cells (ast alt)
 d) detoxification of liver function (ammonia, bias hepatic coma)
e) viral infection in liver

14. 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
b) Fecal analysis
c) Colonoscopy
d) USG abdomen
e) Biopsy rectum & colon area

15. A 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
b) Renal calculus
c) Glomerulonephritis
d) Pyelonephritis
e) Renal artery stenosis

16. 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

17. 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
b) Bladder carcinoma
c) Urethritis.
d) Bladder calculus
e) Prostatitis

18.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
e. Appendicitis

19.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

20.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
b. Renal cell carcinoma àtrias: hematuria, flank pain, palpable mass
c. Bladder cancer
d. Carcinoma of the ureter
e. Prostatitis
Risk factors include the following:
• Smoking (the most common risk factor, causing ≥ 50% of new cases)
• Excess phenacetin use (analgesic abuse)
• Long-term cyclophosphamide use
• Chronic irritation (eg, in schistosomiasis or by bladder calculi)
• Exposure to hydrocarbons, tryptophan metabolites, or industrial chemicals,
notably aromatic amines (aniline dyes, such as naphthylamine used in the dye
industry) and chemicals used in the rubber, electric, cable, paint, and textile
industries

21.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?
a. Hashimoto’s thyroiditis (hypo: karena thyroidnya diserang sama tubuhnya, autoimun)
b. Pleomorphic adenoma
c. Papillary carcinoma
d. Carcinoma epidermoid
e. Adenocarcinoma
Hashimoto's thyroiditis is characterized by the destruction of thyroid cells by various
cell- and antibody-mediated immune processes. The initiating process is not well
understood.[2, 3, 4] The thyroid gland is typically goitrous but may be atrophic or normal in
size. Antibodies binding to and blocking the TSH receptor have also been described
and may contribute to further impairment in thyroid function. The result is inadequate
thyroid hormone production and secretion, although initially, preformed thyroxine T4 and
triiodothyronine (T3) may "leak" into the circulation from damaged cells.
Patients with Hashimoto's thyroiditis have antibodies to various thyroid antigens, the
most frequently detected of which include anti-thyroid peroxidase (anti-TPO),
antithyroglobulin (anti-Tg), and to a lesser extent, TSH receptor-blocking antibodies.
Nevertheless, a small percentage of patients with Hashimoto's thyroiditis (approximately
10-15%) may be antibody negative.
Other antithyroid antibodies found in AITD (including Hashimoto's thyroiditis) include
thyroid-stimulating antibody and cytotoxic antibody.

Hashimoto's thyro

iditis is a histologic diagnosis. Typically, the thyroid gland shows diffuse lymphocytic and
plasma cell infiltration with formation of lymphoid follicles from follicular hyperplasia and
damage to the follicular basement membrane. Atrophy of the thyroid parenchyma is
usually evident. Correlation with the presence of thyroid autoantibodies, namely anti-
TPO and anti-Tg, is helpful in confirming the diagnosis.

22.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?
a. Metastatic carcinoma
b. Acute myelogemous leukemia
c. Hodgkin disease
d. Follicular lympoma
e. Mycosis Fungiodes
 23.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?
a. 12 weeks
b. 13 weeks
c. 14 weeks
d. 15 weeks
e. 16 weeks
hanya perlu dikoreksi sampai umur 2 tahun
lahir 36 minggu tidak perlu dikoreksi

24.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?
a. 700 kalories/day
b. 910 kalories/day
c. 1050 kalories/day
d. 1150 kalories/day
e. 1200 kalories/day
100 kcal/day x 150% x 7 kg
• Sufficient nutrition
• Treatment of underlying disorder
• Long-term social support

Treatment aims to provide sufficient health and environmental resources to promote satisfactory growth.
A nutritious diet containing adequate calories for catch-up growth (about 150% of normal caloric
requirement) and individualized medical and social supports are usually necessary

Recommended Dietary Reference Intakes* for Some Macronutrients, Food and Nutrition
Board, Institute of Medicine of the National Academies
Category Age or Time Frame (yr) Protein (g/kg) Energy(kcal/kg) Calcium (mg/kg) Phosphorus (mg/kg) Magnesium
(mg/kg)

Infants 0.0–0.5 2.2 108.3 66.7 50.0 6.7

0.5–1.0 1.6 94.4 66.7 55.6 6.7

Children 1–3 1.2 100.0 61.5 61.5 6.2

4–6 1.2 90.0 40.0 40.0 6.0

7–10 1.0 71.4 28.6 28.6 6.1

Males 11–14 1.0 55.6 26.7 26.7 6.0

15–18 0.9 45.5 18.2 18.2 6.1

19–24 0.8 40.3 16.7 16.7 4.9

25–50 0.8 36.7 10.1 10.1 4.4

 51+ 0.8 29.9 10.4 10.4 4.5

Females 11–14 1.0 47.8 26.1 26.1 6.1

15–18 0.8 40.0 21.8 21.8 5.5

19–24 0.8 37.9 20.7 20.7 4.8

25–50 0.8 34.9 12.7 12.7 4.4

51+ 0.8 29.2 12.3 12.3 4.3

Pregnant — 0.9 4.6 18.5 18.5 4.9

Breastfeeding 1st yr 1.0 7.9 19.0 19.0 5.4

*These amounts, expressed as average daily intakes over time, are intended to provide for individual variations among most healthy people living in the US under usual
environmental stresses

25.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
b. Kwashiorkor
c. Marasmus- kwashiorkor
d. Chromosomal abnormality
e. Anemia

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

a. Resomal i
b. Vit A r
c. Zinc r
d. Fe r
e. F 75 i
27.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

28.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
b. Rotavirus
c. Lactose intolerant
 d. Food poisoning
e. Vibrio cholera

29.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

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

a. Amoxiciline
b. Cotrimoxazole
c. Metronidazole
d. Loperamide
e. Antiviral
pilihan:
doxy
tetra
Bactrim
cipro
eritro

31.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 (turgornya lama balik). 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 à plan C
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 à plan B

32.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

Since the 1800s, infectious mononucleosis has been recognized as a clinical syndrome
consisting of fever, pharyngitis, and adenopathy.

Most patients with Epstein-Barr virus (EBV) infectious mononucleosis are asymptomatic and,
therefore, have few if any symptoms. Most adults (approximately 90%) show serological
evidence of previous EBV infection.
The incubation period of EBV infectious mononucleosis is 1-2 months. Many patients cannot
recall close contact with individuals with pharyngitis. Virtually all patients with EBV infectious
mononucleosis report fatigue and prolonged malaise. A sore throat is second only to fatigue and
malaise as a presenting symptom.
Fever is usually present and is low grade, but chills are relatively uncommon. Arthralgias and
myalgias occur but are less common than in other viral infectious diseases.
Nausea and anorexia, without vomiting, are common symptoms.
Various other symptoms have been described in patients with EBV infectious mononucleosis,
including cough, ocular muscle pain, chest pain, and photophobia.
Importantly, patients without CNS involvement experience no cognitive difficulties. CMV
infectious mononucleosis rarely involves the CNS.
Myalgias, which are uncommon, are rarely (if ever) severe.

Early signs include fever, lymphadenopathy, pharyngitis, rash, and/or periorbital edema.
Relative bradycardia has been described in some patients with EBV mononucleosis, but it is not
a constant finding.
Later physical findings include hepatomegaly, palatal petechiae, jaundice, uvular edema,
splenomegaly, and, rarely (1-2%), findings associated with splenic rupture.
CNS findings associated with EBV mononucleosis are rare but usually occur later in the course
of the illness.
Splenic tenderness may be present in patients with splenomegaly.
Pulmonary involvement is not a feature of EBV infectious mononucleosis.
The classic presentation of EBV infectious mononucleosis in children and young adults consists
of the triad of fever, pharyngitis, and lymphadenopathy.

33.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 = z zcore 0
+- 25%..) and her height is 75 cm (<5th percentile).
What is her nutritional status?
a. Stunted
b. Wasted
c. Marasmus
d. Overweight
e. Short stature

34.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

lihat kuliah nutrisi dan metabolism blok repro

2 jam pertama 5 mL/kgBB
jam ke 4 – 10: 5-10mL/kgBB

35.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 – shiga-like toxin
c. Entamoeba histolytica
d. Vibrio Cholera
e. Giardia Lamblia

36.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
b. Endoscopic
c. Hepatitis serologies
d. USG abdomen
e. Peripheral blood smear and coombs test

37.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
 38.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
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

40.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
bayi <1 tahun: 1 jam 30 mL/kgBB RL, 5 jam 70 mL/kgBB Kaen
anak > 1 tahun: ½ jam 30 mL/kgBB RL, 2 ½ jam 70 mL/kgBB Kaen

41.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
b) Acute iritis
c)Acute episcleritis
d)Acute blepharitis
e)Acute conjunctivitis
Keratic precipitate: Cells (e.g. leukocytes) deposited on the endothelium of the cornea which occur as a
result of inflammation of the iris or the ciliary body. They often collect in a triangular pattern with the base
down (Arlt's triangle) on the inferior portion of the endothelial surface. They may also be distributed
diffusely over the endothelium, as in Fuchs' heterochromic iridocyclitis or anterior uveitis, or concentrated
in one area, as in disciform keratitis or herpes simplex keratitis. In granulomatous uveitis they are larger
than in nongranulomatous uveitis, greasy in appearance (called 'mutton fat'). Following treatment of the
primary cause they usually disappear.

42.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

43.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

44.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
b. Muscle Contusion
c. Muscle Strain
d. Compartment syndrome
e. Delayed muscle soreness

45.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

46.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

47.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

48.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 painkiller 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 à efek samping kembung
c. Treat with H2RA for 4-12 weeks
d. Treat with Full dose PPI than step down
e. Treat with PPI + 2 antibiotics
Empiric treatment as long as patient is not at high risk of serious disease
Non pharmacological:lifestyle modifications
Ulcer-like dyspepsia : histamine, receptor antagonist (H2RA) or PPI 4-6weeks
Dysmotility like dyspepsia : prokinetic agents

49.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

50.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

51.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

If the H. pylori test is negative, empiric therapy with a gastric acid suppressant or prokinetic
agent is recommended. If symptoms persist or recur after six to eight weeks of empiric therapy,
endoscopy should be performed.

Omeprazole Dosing: Adults

o Active duodenal ulcer: Oral: 20 mg/day for 4-8 weeks
o Gastric ulcers: Oral: 40 mg/day for 4-8 weeks
o Symptomatic GERD (without esophageal lesions): Oral: 20 mg/day for up to 4 weeks
o Erosive esophagitis: Oral: 20 mg/day for 4-8 weeks; maintenance of healing: 20
mg/day for up to 12 months total therapy (including treatment period of 4-8 weeks)
o Helicobacter pylorieradication: Oral: Dose varies with regimen:
o Manufacturer labeling: 40 mg once daily administered with clarithromycin 500
mg 3 times/day for 14 days or 20 mg twice daily administered with amoxicillin
 1000 mg and clarithromycin 500 mg twice daily for 10 days. Note: Presence of
ulcer at time of therapy initiation may necessitate an additional 14-18 days of
omeprazole 20 mg/day (monotherapy) after completion of combination therapy.

52. 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 à HS IV, CD4
d. Netrophil ingestion of bacteria
e. Antibody-mediated phagocytosis

53.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? measles
a. Eosinophil
b. Monocyte
c. Neutrophil à bacterial
d. Lymphocyte à viral
e. Basophyl

54.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

55. 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 à B3
b. Thiamine à B1
c. Cyanocobalamine à B12
d. Pyridoxine à B6 pyridoxine (vitamin B6) (10–50 mg/day) with isoniazid.
The isoniazid-induced peripheral neuropathy occurring in adult tuberculous
patients results from a deficiency of biologically active pyridoxine.
Vitamin B6 (pyridoxine) supplementation during isoniazid (INH) therapy is
necessary in some patients to prevent the development of
peripheral neuropathy.
 e. Riboflavine à B2

56. 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

57. 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

Examination in the erect position is desirable to reveal fluid levels. The following projections allow a good
assessment of the paranasal sinuses:

• Waters (occipitomental) view

• Caldwell (occipitofrontal) view
• Lateral view
• Modified basilar view (a submental vertex view)
The Waters view (seen in the image below) shows the maxillary antra clearly. The frontal sinus is
projected obliquely, and the ethmoid air cells are obscured, although a few may be seen along the medial
walls of the orbit and within the nose. The sphenoid sinus is seen through the open mouth.
 Polypoid mucosal thickening in the right maxillary sinus with a mucous
retention cyst in the left on a Waters view.
In the Caldwell view, the frontal sinuses are well seen. The floors of the maxillary sinuses are visible. The
floor of the sella turcica, the crista galli, the nasal septum, and the middle and inferior nasal turbinates can
be seen. The anterior ethmoid air cells are also seen. However, the sphenoid sinus is obscured.

In the lateral view, the sphenoid and frontal sinuses are visualized. The rest of the sinuses are
superimposed. The nasopharyngeal soft tissue and the adenoids are also well visualized.

A modified basilar view (a submental vertex view) may be a useful adjunct when dealing with sphenoid
sinus disease.

• Standard views: The goal is to place sinuses close to the film and at an angle that
temporal bone shadows are not superimposed:
o Water's - best for maxillary sinus (Ethmoids and frontals too far from film)
o Caldwell - best for ethmoids and frontal sinus (Temporal bones overlie maxillary)

o Lateral - sphenoid, frontal(?), maxillary (?)

o Submentovertical ("bucket-handle") - ethmoids; Fluid in maxillary sinus will also layer
out

58.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

59.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

60.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

Tx: lithium, valproate, triptan

61. 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 ?
a) Herpes simplex
b) Herpes zoster
c) Bulous impetigo
d) Contact dermatitis
e) Vit B deficiency

62. 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.
63. How would you proof your diagnosis?
a) Gram stain
b) Tzank smear
c) Patch test
d) KOH preparation
e) Skin biopsy
64. 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 ?
a) Gutate psoriasis
b) Tinea corporis
c) Candidosis cutis
d) Pityriasis rosea
e) Secondary syphilis
65. 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.