19. Definisi delusi adalah..... An abnormal belief which is held with absolute
subjective certainty, which requires no external proof,
which may be held in the face of contradictory evidence,
and which has personal significance and importance to
the individual concerned. Excluded are those beliefs
which can be understood as part of the subject's cultural
or religious background. While the content is usually
demonstrably false and bizarre in nature, this is not
invariably so. (Oxford Handbook)
20. Apa terminology untuk penurunan daya ingat yang Pseudo amnesia
sering terjadi pada penderita depresi?
21. Jelaskan ke-5 aksis dari evaluasi multiaksial! Axis I: Clinical syndromes (e.g., mood disorders,
schizophrenia, generalized anxiety disorder) and other
conditions that may be a focus of clinical attention
Axis II: Personality disorders, mental retardation, and
defense mechanisms
Axis III: Any general medical conditions (e.g., epilepsy,
cardiovascular disease, endocrine disorders)
Axis IV: Psychosocial and environmental problems (e.g.,
divorce, injury, death of a loved one) relevant to the
illness
Axis V: Global assessment of functioning exhibited by the
patient during the interview (e.g., social, occupational,
and psychological functioning); a rating scale with a
continuum from 100 (superior functioning) to 1 (grossly
impaired functioning) is used
22. Pemeriksaan psikiatrik meliputi? Table 7.1-4 Outline for the Mental Status Examination
1. Appearance
2. Overt behavior
3. Attitude
4. Speech
6. Thinking
a. Form
7. Perceptions
8. Sensorium
a. Alertness
c. Concentration
f. Fund of knowledge
g. Abstract reasoning
9. Insight
10. Judgment
23. Definisi diskinesia? Gerakan involunter abnormal. Biasanya tanda kerusakan
ekstrapiramidalis.
24. Sebutkan 3 contoh diskinesia! Tremors are rhythmic oscillatory movements. They
result from alternating contractions of opposing muscle
groups (e.g., parkinsonian tremor at rest) or from
simultaneous contractions of agonist and antagonist
muscles (e.g., essential tremor). A useful way to
differentiate tremor clinically is to determine whether the
tremor is present under the following conditions: when
the affected body part is at rest, as in parkinsonian
disorders; when posture is maintained (e.g., with arms
outstretched in front of the body or with elbows flexed
with arms in a winged position), as in Wilson disease and
essential tremor (see Chapter 114); when action is
undertaken (e.g., writing or pouring water from a cup), as
in essential tremor that increases with action; or when
intention is present (e.g., finger-to-nose maneuver), as in
cerebellar disease (see Chapter 108).
myoclonus (see Chapter 111) refers to ultra-brief,
shocklike movements that may arise from contractions
or inhibitions (negative myoclonus).
Chorea delineates brief, irregular contractions that,
although rapid, are not as lightning-like as myoclonic
jerks. In classic choreic disorders, such as Huntington
disease (see Chapter 109) and Sydenham chorea (see
Chapter 110), the jerks affect individual muscles as
random events that seem to flow from one muscle to
another. They are not repetitive or rhythmic.
Ballism is a form of chorea in which the choreic jerks are
of large amplitude, producing flinging movements of the
affected limbs.
Chorea is presumably related to disorders of the caudate
nucleus but sometimes involves other structures. Ballism
is more often related to lesions of the subthalamic
nucleus.
Dystonia (see Chapter 113) is a syndrome of sustained
muscle contraction that frequently causes twisting and
repetitive movements or abnormal postures. Dystonia is
represented by the following presentations: (1) sustained
contractions of both agonist and antagonist muscles,
simultaneously and in the same muscle groups
repeatedly (“patterningâ€), in contrast to the
flowing of choreic movements; (2) an increase of these
involuntary contractions when voluntary movement in
other body parts is attempted (“overflow†); (3)
rhythmic interruptions (dystonic tremor) of these
involuntary, sustained contractions when the patient
attempts to oppose them; (4) inappropriate or opposing
contractions during specific voluntary motor actions
(action dystonia); and (5) torsion spasms that may be as
rapid as chorea but differ because the movements are
continual, patterned, and of a twisting nature in contrast
to the random and seemingly flowing movements of
chorea. Torsion spasms may be misdiagnosed as chorea;
the other characteristics frequently lead to the
misdiagnosis of a conversion reaction.
Tics may be simple jerks or complex sequences of
coordinated movements that appear suddenly and
intermittently. When simple, the movements resemble a
myoclonic jerk. Complex tics often include head-shaking,
eye-blinking, sniffing, shoulder-shrugging, facial
distortions, arm-waving, touching parts of the body,
jumping movements, or making obscene gestures
(copropraxia). Usually tics are rapid and brief, but
occasionally they may be sustained motor contractions
(i.e., dystonic). In addition to motor tics, vocalizations
may be a manifestation of tics. These range from sounds,
such as barking, throat-clearing, or squealing, to
verbalization, including the utterance of obscenities
(coprolalia) and the repetitions of one’s own sounds
(palilalia) or the sounds of others (echolalia). Motor and
vocal tics are the essential features of the Tourette
syndrome (see Chapter 112).
Athetosis is a continuous, slow, writhing movement of
the limbs (distal and proximal), trunk, head, face, or
tongue. When these movements are brief, they merge
with chorea (choreoathetosis). When the movements are
sustained at the peak of the contractions, they merge
with dystonia, and the term athetotic dystonia may be
applied.
Akathistic movements are those of restlessness. They
commonly accompany the subjective symptom of
akathisia, an inner feeling of motor restlessness or the
need to move. Today, akathisia is most commonly seen
as a side effect of antipsychotic drug therapy, either as
acute akathisia or tardive akathisia, which often
accompanies tardive dyskinesia. Akathistic movements
(e.g., crossing and uncrossing the legs, caressing the scalp
or face, pacing the floor, and squirming in a chair) may
also be a reaction to stress, anxiety, boredom, or
impatience; it may then be termed physiologic akathisia.
Pathologic akathisia, in addition to that induced by
antipsychotic drugs, may be seen in the encephalopathies
of confusional states, in some dementias and in
Parkinson disease. Picking at the bedclothes is a common
manifestation of akathistic movements in bedridden
patients.
TABLE 16-1 -- LIST OF MOVEMENT DISORDERS
HYPOKINESIA Poverty of movement in speed or amplitude, synonomous with akinesia and bradykinesia
(Parkinsonism)
Pure parkinsonism Akinesia or rest tremor associated with rigidity and/or postural reflex deficits
Parkinsonism-plus Parkinsonism ocourring in association with other signs, such as vertical gaze paresis,
hypotension and dysautonomia, apraxias
HYPERKINESIAS Involuntary movements that occur spontaneously or during activity, synonomous with
dyskinesias
Akathitic movements Stereotypic movements (usually legs) that occur in response to internal restless feelings
Athetosis Twisting cortorsion, a form of dystonia, usually associated with birth injury or
cerebrovascular accidents
Ballism Violent chorea, involving large muscle groups
Chorea Involuntary rapid and irregular movements
Dystonia Twisting, sustained posture
Hemifacial spasm Unilateral facial contractions
Hyperekplexia Enhanced and pathological startle response
Myoclonus Shocklike jerks, focal or generalized
Stereotypy Repetitive movement, simple or complex
Tics Stereotypy that typically involves face, neck and vocal apparatus more than other body
parts
Tremor To-and-fro oscillation around a joint
Kasus :Tn. Freddy, 60 th, berobat ke dokter selama 7 hari karena selama 7 hari tidurnya hanya 2 jam dan selalu
menonton tv, menyanyi keras-keras dan tampak riang. Bila ia ditegur karena mengganggu orang lain, ia marah2
dan melempar barang2. Ia juga dilaporkan suka mencolek pembantunya. Istrinya mengeluh sulit menangkap
pembicaraan suaminya, karena bicaranya cepat dan ganti2 topik pembicaraan. Sejak minum obat yang diberikan
dokter Tn. Freddy jadi gelisah, tidak bs duduk diam, selalu ingin bergerak, dan kakinya bergerak terus.
25. Pada Tn. Fredy didaptkan gejala? sebutkan3! Insomnia, Mood Irritable, Hyperthimia, Pembicaraan
cepat, Flight of Ideas, Hiperaktif.
Setelah minum obat: gelisah, agitasi
26. Kemungkinan obat yang diberikan adalah? Untuk mengobati Gangguan Bipolar digunakan Lithium,
sebutkan 1? Antipsikotik Atipikal, Valproat,
No Soal Pembahasan
1 Saraf kranial di bawah ini mendapat
persarafan ganda, kecuali
a. Nervus Occulomotorius untuk otot
penggerak bola mata
b. Nervus Occulomotorius untuk otot
levator palpebra
c. Nervus fasialis untuk otot orbicularis
oculi
d. Nervus fasialis untuk otot wajah bawah.
e. BSSD
2 Infeksi di bawah ini tidak dapat dicegah Polio dapat dicegah oleh Vaksin Salk dan Sabin
dengan vaksinasi Tetanus dapat dicegah oleh Vaksin DPT
a. poliomielitis paralitik TBC dapat dicegah oleh Vaksin BCG
b. tetanus Rabies dapat dicegah oleh HDCV (Human diploid cell vaccine)
c. rabies
d. meningitis tuberkulosa
e. abses otak oleh Bacteriodes fragilis
3 Perasaan nyeri, suhu, raba pada lidah Somatik Aferen untuk lidah dipersarafi oleh Glosofaringeus
dipersarafi oleh (1/3 posterior lidah/gag refleks). Nervus Fasialis dan
a. Nervus hipoglosus Glossofaringeus mempersarafi sensasi pengecapan.
b. Nervus glosofaringeus
c. Nervus trigeminus
d. Nervus fasialis
e. Nervus asesorius
4 Wanita 32 tahun mengalami serangan kejang
yang ditandai kejang tonik disertai
kehilangan kesadaran, kontraksi otot seluruh
tubuh, disertai periode relaksasi selama 1-2
menit. Carbamazepine = Bangkitan umum tonik-klonik, parsial simple
Semua obat yang disebutkan di bawah ini dan komplek
efektif untuk kondisi tersebut, KECUALI Fenobarbital = Bangkitan umum tonik klonik, parsial
a. carbamazepine Valproat = Absence, Myoklonik, Parsial dan Tonik-Klonik
b. fenobarbital Gabapentin = Parsial, dan Generalista Sekunder
c. asam valproat Fenitoin = Parsial, Tonik-Klonik
d. gabapentin
e. phenitoin
5 Obat di bawah ini memiliki daya penetrasi
sawar darah otak yang baik, KECUALI
a. gentamisin
b. rifampisin
c. kloramfenikol
d. INH
e. metronidazol
6 Cairan otak berwarna merah pada keadaan Kadar Protein tinggi dan Meningitis Purulenta akan membuat
berikut CSF berwarna keruh. Kecuali perdarahan intraserbral,
a. kadar protein tinggi semuanya dapat membuat CSF xantochromia setelah dipusing.
b. hiperkarotenemia
c. meningitis purulenta
d. perdarahan intraserebral
e. ikterus
7 Keadaan patologik pada malaria serebri pada The neurologic symptoms are effects of congestion or
dasarnya terjadi akibat occlusion of capillaries and venules with pigment-laden
a. stenosis akuaduktus serebri parasitized erythrocytes and to the presence of multiple
b. arakhnoitis petechial hemorrhages. Apparently, parasitized erythrocytes
c. ventrikulitis adhere to vascular endothelial cells, thereby obstructing
d. intoksikasi blood flow and causing anoxia. Lymphocytic and
e. oklusi pembuluh darah kecil mononuclear perivascular inflammation and a microglial cell
response may be seen, at times resulting in cerebral edema.
Thrombotic occlusion of vessels and large intracranial
hemorrhages are rare. It is probable that the pathologic
changes in the nervous system are reversible. (Merrit’s)
8 Tes Pandi untuk cairan otak menguji adanya Protein
a. protein
b. albumin
c. globulin
d. glukosa
e. klorida
9 Refleks Chvostek termasuk dalam Tanda Chvostek melibatkan otot-otot di wajah. Gerakan
pemeriksaan nervus kranialis ke- motorik yang terjadi merupakan perangsangan CN VII yang
a. CN V keluar dari foramen stylomastoideus.
b. CN III
c. CN VII
d. CN X
e. CN XII
10 Hal yang TIDAK berhubungan dengan Sudah jelas. Sawar otak akan semakin permeabel sehingga
penderita malaria otak adalah terjadi edema serebri.
a. gangguan aliran darah di kapiler otak
b. produksi radikal bebas di kapiler otak
c. penurunan permeabilitas sawar otak
d. adhesi eritrosit terinfeksi dengan
endotel kapiler otak
e. pembentukkan antigen P. Falciparum
pada permukaan eritrosit.
11 Pemeriksaan sensibilitas permukaan ada 3,
yaitu pemeriksaan yang meliputi
a. sikap, gerak, vibrasi
b. nyeri, suhu, raba
c. nyeri, vibrasi, diskriminasi 2 titik
d. raba, vibrasi, sikap
e. suhu, gerak, sikap
12 Diagnosis pasti ensefalitis toksoplasmik Diagnosis pasti sebenarnya adalah biopsi otak. Namun
diterapkan dengan cara menemukan kombinasi antara serologi dan radiologi dapat membantu
a. IgM spesifik dalam darah penegakkan diagnosis Ensefalitis Toxoplasma
b. IgG spesifik dalam darah
c. takizoit di CSF
d. kista di otak
e. multiple abses pada CT Scan
13 Psikiatri adalah
a. spesialisasi/ cabang dari psikologi
b. terfokus hanya bekerja dengan pasien
gangguan jiwa
c. satu-satunya cabang kedokteran yang
bekerja dengan manusia secara
komprehensif
d. dasar dari terapi kedokteran
komprehensif
e. hanya bekerja dengan psikoterapi
14 Intervensi krisis diperlukan untuk kasus
berikut
a. gangguan stress pasca trauma
b. skizofrenia
c. percobaan bunuh diri
d. problem perkawinan
e. smua tersebut di atas benar
15 Lesi utama pada tabes dorsalis adalah Tabes dorsalis adalah lesi pada kolumna dorsalis atau kolumna
a. demielinisasi kolumna posterior posterior. Penyebab paling sering adalah Neurosifilis.
b. demielinisasi dorsal nerve roots
c. demielinisasi ventral nerve roots
d. atrofi korteks serebri
e. demielinisasi saraf perifer
16 Intervensi psikososial dapat diterapkan pada
a. psikosomatis
b. anak autisme
c. demensia
d. keganasan (cancer)
e. Semua tersebut di atas benar
17 Proses repair pada SSP merupakan peran dari Astrosit merupakan pelindung dari sinaps untuk menjaga
sel homeostasis. Astrosit berperan dalam pembentukan jaringan
a. astrosit parut di otak akibat cedera/kerusakan (gliosis).
b. oligodendrosit Oligodendrosit berperan dalam mielinisasi SSP, sedangkan
c. ependim perifer dimielinisasi oleh Sel Schwann. Microglia merupakan
d. microglia sel fagosit. Sel ependim adalah pelapis ventrikel, di beberapa
e. sel schwann tempat membentuk pleksus koroid yang memproduksi CSF.
18 Saat ini pemeriksaan radiologi yang sangat Pada saat emergensi, pertama kali diperlukan foto polos untuk
diperlukan pada kasus trauma kepala adalah melihat apakah ada fraktur atau tidak. Kemudian dilanjutkan
a. foto polos kepala dengan CT tanpa kontras untuk melihat apakah ada
b. CT scan kepala tanpa kontras perdarahan/mengonfirmasi perdarahan dari LP, dan lokalisasi
c. CT scan kepala dengan kontras cedera otak/perdarahan bila ada.
d. MRI kepala tanpa kontras
e. MRI kepala dengan kontras
19 Sistem saraf terdiri dari
a. sistem digestif, motorik, sensori
b. SSP, motorik, sensorik
c. SSP, perifer, autonom
d. SSP, perifer
e. BSSD
20
27
28 Hipokampus berperan dalam proses kognitif:
a. atensi
b. memory retrieval
c. konsolidasi
d. keterampilan motorik
e. rekognisi visual