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Final GIS Perfecten 201 0

FINAL GIS PERFECTEN

1. A 57 yo man was brought to the clinic due to his slurred speech. His family stated that the condition started in the morning upon waking up, and followed by weakness in his right arm. From the neurological examination, it is revealed that he got CN XII paralysis and right hemiparesis. Which of these muscles below did not affected by the paralysis? A. Superior longitudinal muscle B. Inferior longitudinal muscle C. Palatoglossus muscle D. Genioglossus muscle E. Hyoglossus muscle

2. A 3 yo girl brought to the emergency department. Her parents stated that she was playing with Marble and swallowed them. Upon chest X-ray, the foreign body was found logged in the center of the thorax, midway between root of the neck and diaphragm. Where the foreign object would most possibly logged in this case? A. In the cervical constriction, at the pharyngoesophageal junction. Compressed by cricopharyngeal muscle B. At thoracic constriction, compressed by the arc of aorta and left main bronchus C. At esophageal hiatus when it passes the diaphragm D. At diaphragmatic constriction where it passes through the internal esophageal spinchter E. At abdominal constriction where it passes through the cardia For no 3-4: A 36 yo man came to your practice complaining of abdominal pain and nausea. The pain grows more intense these part 2 days. He said that he has been under a lot of stress, so he often skipped meal, and had a lot of coffe to help him concentrate. 3. From these sentences below, which one best describe the organ involve?

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A. It is the expanded part of the alimentary tract between esophagus and small intestine, has curvature, an covered by peritoneum B. It is muscular tube 25 cm long, has 3 constriction along its course, passing through 3 different compartments, and is not covered by peritoneum C. The organ has two curvature. The lesser curvature connects it to the liver. The greater curvature connects it to the colon. Its posterior aspect directly in touch with the spleen D. It is the terminal part of alimentary tract, has a large caliber, its longitudinal muscle make sacculation appearance. Its transverse part attached to greater omentum. E. The organ has four part. Cardia, connects it to the heart, fundus, the dilateated superior part, (body?) between fundus and pyloric, pylorus, the funnel shapped region

4. Which of these sentences below are true regarding the organ arterial supply? A. The left and right gastro-omental arteries are forming anastomosis in the lesser curvature B. The left and right gastro-omental arteries are forming anastomosis in the pyloric antrum C. The left and right gastric arteries are forming anastomosis in the greater curvature D. The anterior and posterior gastric arteries are forming anastomosis in the grater curvature E. The right and left gastric arteries are forming anastomosis in the lesser curvature

5. A 57 yo man was brought to the emergency department because he vomited blood since a . hours. His family said that the blood was bright red. He was diagnose with liver cirrhosis since . ago. What other condition should you examine in the case of portal hypertension? A. Caput medusa, where the anastomosis between central vein and portal vein occurs B. Esophageal varices, where the anastomosis between left gastric vein and the inferior mesenteris vein occurs
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C. Hemorrhoid, where the anastomosis between anterior rectal vein and inferior rectal vein D. Caput medusa, where the anastomosis between paraumbilical vein and epigastric vein E. Hemorrhoid, where the anastomosis between superior rectal vein and the pudendal vein

6. Which statement below is correct regarding the first part of the small intestine? A. The organ was completely covered by peritoneum and connested through mesentery B. The organ in C shaped and has part: anterior, superior, descending, horizontal C. The organ span between the pyloric sphincter and the duodenojejunal junction. It warps around the head of pancreas D. It is the longest part of the small intestine. Its descending part has major papilla which is an opening of major pancreatic duct E. The organ is mostly fixed and has no peritoneal convering, has arterial supply only form the branch of celiac trunk

7. A 32 yo man was found lying on the street with blood coming from his abdomen. He was a victim of a robbery and got stabbed. As you examined the wound, you found that the injury was quite large, some organ was protruding from inside, covered by blood. If the wound was located on the left lower abdominal close to the umbilical, what is the organ and arteri bleedingyou probably see? A. ileum, bleeding fromabdominal wall arteries and branches of SMA B. jejunum bleeding from inferior costal arteries and branches of SMA C. ileum, bleeding from inferior costal arteries and branches celiac trunk D. descending colon, bleeding from abdominal wall arteri and branches of IMA E. jejunum, bleeding from abdominal wall arteri and branches of IMA

8. a 23 yo woman complaining of severe abdominal pain since 6 hours ago. Pain starts in epigastric and moved to right lower part abdomen. She also had fever and loss apetite. PE: tenderness, rebound tenderness on MC

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Burney point, she has difficulty straightening her right leg and (+) psoas sign. Where would you find the organ in most people? A. Right lower quadrant, project from cecum inferiorly toward pelvic brim B. From its orifice in caecum, extend superoposteriorly toward right colic flexure C. Extend posterolaterally, crossed ileocecal junction D. In junction of ileum and caecum, project anterioriorly toward abdominal wall E. From its orifices in cecum, extend anteosuperiorly toward rectus abdominis

9. What are distinctive characteristic of large intestine? A. larger diameter, covered by movable peritoneum, internal surface has extensive pili for absoption B. larger diameter, has specialized longitudinal muscle, internal surface has extensive mucosal fold C. larger diameter, teniae coli caused sacculation, internal surface has extensice mucosal fold D. larger diameter, haustra is dynamic structure depends contraction, its internal surface has smooth appearance on its

E. larger diameter, teniae coli caused formation of haustra, internal surface has smooth appearance

10.a 45 yo man complain rectal bleeding when he has his bowel movement this morning. This is his fifth time having same complaint over last 2 month. This time, bleeding followed by something came out of anus, but quickly went back in on its own. Didnt feel any pain. Source problem? A. Dilataton of superior and middle rectal vein lies on mucosal layer of rectum B. Dilatation of superior and middle rectal vein lies on submucosal layer of rectum C. Dilatation of middle and inferior rectal vein lies on mucosal layer of rectum D. Dilatation of middle and inferior rectal vein lies on submucosal layer of rectum

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E. Dilatation of superior and middle pudendal vein lies on subcutaneous layer of anal skin

11.This ligament is fibrous remnant of fetal dustus venosus, which shunted blood from umbilical vein to IVC, short circuiting the liver. WOTF is most likely ligament? A. Coronary ligament B. Falciform ligament C. Triangular ligament D. Ligamentumteres E. Ligamentumvenosum

12.This part, enclosing portal triad from liver to lesser curvature of stomach and the first 2 cm of superior part of duodenum. Wotf? A. Diaphragmatic surface B. Visceral surface C. Lesser omentum D. Greater omentum E. Peritoneum

13.This ligament is fibrous remnant of umbilical, which carried well oxygenated and nutrient-rich blood from placenta to fetus. Wotf? A. Coronary ligament B. Falciform ligament C. Triangular ligament D. Ligamentumteres E. Ligamentumvenosum

14.This part is posterosuperior extension of subhepatic space, lying between right of visceral surface of liver and right kidney and suprarenal gland. This part is gravity-dependent part of peritoneal cavity in supine position, fluid draining from omental bursa flows into this part. Wotf?

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A. Subphrenic recess B. Hepatorenal recess C. Lesser omentum D. Greater omentum E. Bare area

15.This part extend to right, between IVC and portal hepatis, connecting caudate, and right lobes. Wotf? A. Sagital fissures B. Left lobe C. Quadrate lobe D. Caudate process E. Papillary process

16. On the left side of the descending part of duodenum, the bile duct comes into contact with the main pancreatic duct. These ducts run oblique through the wall of this part of duodenum, where they unite to form this portion. Which of the following is most likely portion? A. Cystic duct B. Common hepatic duct C. Sphincter of the bile duct D. Major duodenal papilla E. Hepatopancreatic ampulla 17. This part of gallbladder is wide end of the organ, projects from the inferior of the liver and is usually located at the tip of the right 9th costal cartilage in teh CML. Which of the following is most likely part? A. Fundus B. Body C. Neck D. Infundibulum E. Cystic duct 18. This portion is the expanded part of the gland that is embraced by the Cshaped curve of the duodenum to the right of the superior mesenteric vessels. It firmly attaches to the medial aspect of the descending and horizontal parts of the duodenum. Which of the following is most likely portion? A. Head of the pancreas B. Neck of the pancreas
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C. Body of the pancreas D. Tail of the pancreas E. Uncinate process 19. This part is located superior to the middle of the inguinal ligament and lateral to the inferior epigastric artery, is the beginning of an evaginatin in the transversalis fascia, forming an opening like the entrance to a cave. Which of the following is most likely part? A. Internal inguinal ring B. Middle inguinal ring C. Superficial inguinal ring D. Internal spermatic fascia E. External spermatic fascia 20. The omental bursa communicates with the greater peritoneal sac through this portion, situated posterior to the free edge of the lesser omentum. This portion can be located by running a finger along the gallbladder to the free edge of the lesser omentum. Which of the following is most likely portion? A. Lesser omentum B. Greater omentum C. Omental foramen D. Peritoneal fold E. Peritoneal recess 21. A pathologist will examine the section of alimentary tract on GERD patient, his objective is to identify the esophagus structure. Which of the following is most likely specific appearance due to his objective? A. Has both skeletal and smooth muscle B. Simple columnar epithelial C. Crypt of liberkun D. Mucosa and submucosa make the fold structure E. Could be found peyerispathces 22. All the region of his part of the alimentary canal display longitudinal folds of the mucosa and submucosa which disappear in the maximal distention. They are lined by a simple columnar epithelium and goblet cells. Which of the following is most likely region? A. Stomach B. Small intestine C. Colon D. Rectum E. Anal canal 23. A 35-year-old female was diagnosed as chronic gastritis, she always complain epigastric pain. She has had numerous episodes nausea and vomiting in past 3 months. Which of the following is most likely cells that has the role to those complain? A. Chief cells B. Mucous neck cells C. Oxyntic cells
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D. Enteroedocrine cells E. Regeneratif cells 24. The mucosa of this region os the alimentary canal is lined by simple columnar epithelium with goblet cells. The submucosa is composed of dense, irregular fibroelastic connective tissue and houses Brunners glands. Which of the following is most likely region? A. Stomach B. Duodenum C. Jejenum D. Ileum E. Caecum 25. A 4-year-old boy brought by his parent to the hospital with watery diarrhea without blood since 3 days ago. The complaint accompanied by low grade fever. Which of the following is most likely part of the organ disturbed in that patient? A. Crypt of liberkun B. Peyeris patches C. Bruners gland D. Villi E. Submucosa gland 26. A 5-year-old baby brought by her parents to emergency unit in Hasan Sadikin Hospital with the chief complaint was constipation since 3 days ago. From imaging examination result showed megacolon. Which of the following is most likely location of the structure that causes of that disease? A. Lamina propia B. Muscularis mucosa C. Muscularis external D. Mucosa E. Serosa 27. This portion of the bile duct system is located in the portal spaces and lined by cuboidal epithelium or columnar epithelium and has distinct connective tissue sheath. Which of the following is most likely portion? A. Bile canaliculus B. Bile ductules C. Bile duct D. Hepatic duct E. Common bile duct 28. This region of the alimentary canal has aricher supply of lymphoid follicle, less crypts of Lieberkuhn, no taeniae. The mucosa is lined by simple columnar epithelium with goblet cells. Which of the following is most likely region? A. Ascending colon B. Transverse colon C. Descending colon D. Appendix E. Caecum

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29. Each exocrine acinus of the pancreas is drained by initial part of exocrine duct with its initial cells, the centroacinar cells inserted into the acinar lumen. Which of the following is most likely epithelial cell that lined this part of exocrine duct? A. Simple squamous B. Simple cuboid C. Simple columnar D. Stratified cuboid E. Stratified columnar 30. This hollow, pear shaped organ attached to the lower surface of the liver. The main function of this organ is to store bile and concentrate it by absorbing its water. Which of the following is most likely epithelial cell types that lined the mucous layer of this organ? A. Simple squamous B. Simple cuboid C. Simple columnar, no goblet cell D. Stratified columnar with goblet cell E. Stratified columnar 31. A newborn baby girl has has meconium in her vagina after undergo physical examination. The doctor also found that she has no anal opening. Which of the following birth defect is most likely? A. Imperforated anus B. Imperforated vagina C. Imperforated vagina anus D. Imperforated anus with rectovaginal fistula E. Anorectal atresia incomplete 32. A newborn baby girl has meconium in her vagina after undergo physical examination. The doctor also found that she has no anal opening. Which of the following development process that most likely? A. Opening of foregut to shift posteriorly of cloaca B. Opening of hindgut to shift anteriorly of cloaca C. Inferior of vagina form from posterior part of the urogenital D. Posterior of vagina form from posterior part of urogenital E. Failure of the urorectal septum For questions number 33 to 35, refer to opstions given belows: A. Duodenal obstruction B. Diaphragma atresia C. Gastroschisis D. Congenital ophalocele 33. Defect near the median plane of ventral abdominal. 34. Failure of intestine to return to the abdominal cavity. 35. Failuer of midgut loop to complete rotation. 36. A newborn baby boy have ABO incompatibility. He is rushed to emergency due to decrease consciousness level. He is then diagnosed as Kernicterus. His indirect bilirubin level highly increase.
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What is the characteristic of indirect bilirubin that most likely caused the baby condition? A. Water insoluble B. Enter the blood brain barrier C. Albumin-binding D. Conjugated in the liver E. Degradated from erythrocyte For questions number 37 to 42, refer to opstions given belows: A. Salivatory gland B. Stomach C. Small Intestine D. Large Intestine E. Pancreas F. Liver G. Gall bladder 37. Substrate secreted by this organ will digest protein at random. 38. Proenzyme secreted by this organ will be activated by enterokinase. 39. Digestion of certain nutrient in this organ is done intraluminary and intracellularly. 40. Instead of breaking protein molecules into a smaller one, an enzyme secreted by this organ will coagulate protein molecules. 41. The main substrate of digestie enzyme secreted by thisorgan is carbohydrate. 42. Proteosa and pepton is the most product of protein degradation of this organ. For question number 43 to 48, refer to options given below: A. Na+ dependent cotransport B. Na+ independent facilitated diffusion C. H+ dependent cotransport D. Anion exchange E. Endocytosis F. Paracelluler route 43. In fetus and neonatal, protein can be taken into the small intestine cells by this route. 44. Short peptides are absorbed by this route. 45. Glucose and galactose are absorbed by this route. 46. glycerol and fatty acids are absorbed by this route. 47. bicarbonate in the stomach are absorbed by this route 48. a 47 years old man suffered from anorexia, weakness, headache for 3 days and then these symptomes dissapeared followed by right upeer quadrant abdominal discomfort, darkening of urine, yellowish of tint eyes. Physical examination revealed a large and tender liver. Laboratory examinationre revealed IgM anti-HAV (+) and the doctor diagnosed him as Acute Hepatitis A. What is the most probable laboratory result that elevated due to this case? a. Direct bilirubin
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b. Indirect bilirubin c. Direct and indirect bilirubin d. Urobilinogen

Questions number 49 to 51, refer to scenario below: A 7 years old boy lives in rural area of Papua. He suffered from chronic diarrhea for the last 6 months. He also suffered from severe malnutrition marasmus kwarshiorkor. 49. what should be given first in to manage nutrient problem this case? a. carbohydrate b. protein c. fat d. mineral e. vitamins 50. his parents give him meat curry. In the next day, the child became very weak and he is taken to the hospital. The doctor examines him and performs laboratory examination and then he diagnosed him ketoacidosis. What is the high lipid will breakdown into in this case? a. Ketonbodies b. Gliserol c. Fatty acids d. Cholesterol e. Chylomicron 51. what is the following process most likely underlie this condition? a. Hyperglycemia condition lead to ketoacidosis b. High lipid diet directly breakdown into keton bodies c. High lipid diet undergo gluconeogenesis process d. Fat will be stored into adipose tissue e. Amino acids will be breakdown into urea

For questions number 52 to 55 refer to scenario below:


Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )

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A 45 years old woman come to the emergency department with the chief complain of dysphagia. She can only eat porridge for the last 3 months. She also looses weight. The doctor performs barium swallow and esophageal manometry and diagnoses her as Achalasia. 52. what part of gastrointestinal sphincter that most likely disturbed in this patient? a. Lower esophageal sphincter b. Upper esophageal sphincter c. Sphincter of Oddi d. Precapillary sphincter e. Pyloric sphincter 53. what is the basic mechanism involve in this disorder? a. Hypertensive relaxed esophageal sphincter b. Hypertensive nonrelaxed esophageal sphincter c. Hypotensive nonrelaxed esophageal sphincter d. Hypotensive relaxed esophageal sphincter e. Normotensive nonrelaxed esophageal sphincter 54. what are the major neurotransmitter that involved in this case? a. Histamin, acetylcholine, vasoactive intestinal polipeptide b. Dopamine, epinephrine, nitric oxide c. Epinephrine, nitric oxide, vasoactive intestinal polipeptide d. Acetylcholine, nitric oxide, vasoactive intestinal polipeptide e. Adenosine, histamin, acetylcholine 55. what is the most responsible nerve plexus due to this disorder? a. Posterior vagal nerve b. Anterior vagal nerve c. Meissners plexus d. Sciatic plexus e. Auerbachs plexus

For questions number 56 to 57, refer to scenario below:


Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )

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A 60-year-old man came to the emergency department with the chief complain of abdominal colic since 12 hours ago. He couldnt drink anything and vomited all the food he had swallowed. He cannot defecate nor flatus. On the physical examination the doctor found that the BP was 80/60 mmHg, HR: 130 x/bpm, RR: 32 x/mnt, tense abdomen with pain and meteorismus. On the DRE, the sphincter was normal, the ampula was collapse, no mass touched, and there was blood on the hand-gloves. The doctor diagnoses him as a total ileus obstructive with severe dehydration and performs an emergency surgery. 56. what is the valve that involves to prevent backflow of fecal contents from the colon into the small intestine? This valve can resist pressure of at least 50 to 60 centimeters of water. a. Houstons valve b. Intestinal valve c. Small intestine valve d. Ileocecal valve e. Ileal valve 57. the complication of ileus obstructive total is dehydration. The basic mechanism of this complication is due to a. Antiperistaltic reflux from the small intestine causes intestinal juices to flow backward into the stomach, and juices are vomited along with the stomach secretions b. Chemoreceptor trigger zone in the brain medulla is activated that lead to severe vomit c. Squeezing action of the muscles of the abdomen associated with simullaneous contraction of the stomach wall d. Excessive distention os irritation od the duodenum provides an especially strong stimulus for vomiting e. Obstruction of the large intestine can finally causes rupture of the intestine

58. a 40-year-old man came to the emergency department with the chief complaint of abdominal pain with severe vomiting for the last 3 days. He also had fever with with constipation. The physical examination revealed tachycardia, febrile, and tachipneu. On abdominal showed distended abdomen, bowel sound decreases. The doctor diagnosed him as acute pancreatitis with complication of ileus paralytics. What is the basic mechanism of complication in this case? a. Obstruction in the mesenteric artery
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b. Drug complication c. Electrolyte imbalance d. Inflamation of the peritoneum due to infection e. Surgery complication 59. what is the enzyme that mostly involved in this disease that it is active in the lumen of the pancreatic duct? a. Trypsin b. Amylase c. Mucin d. Lysozyme e. Amylase 60. the ultrasonography of the abdomen revealed a gallstone. The doctor assumes that this is the cause of the pancreatitis. Which duct that the gallstone seemed to block that can lead to pancreatitis in this case? a. Common bile duct b. Ampulla of Vater c. Cystic duct d. Common hepatic duct e. Hepatic duct 61. gastrointestinal motility works as we consume food every day. It motility depends on its smooth muscle that contract simultaneously. For it purpose the gastrointestinal smooth muscle function as a syncytium. What is the most correct answer due to the smooth muscle in the GI tract: a. One bundle consist of approximately 100 parallel fibers b. The smooth muscle is excited by continual slow, intrinsic electrical activity c. Every single muscle in the GI system contract rhythmically d. In gastrointestinal smooth muscle fibers, Ca channels are fast to open e. There is no electrical peacemakers for smooth muscle 62. A patient with diabetes mellitus presents with gastroesophageal reflux diseaseaccompanying gas........ Which of the following condition most likely occured with thiscondition? A. Solid food empty more rapidly than liquids within the gastric
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )

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B. Meals containing fat empty faster than carbohydrate rich food C. Hyperosmolaliy of duodenal contents initiates a decrease in gastric emptying D. Acidification of the antrum increases gastric emptying E. Vagal stimulation decreases receptive relaxation in the upper portion of the stomach 63. A 27-year-old female medical resident student with irritable bowel syndrome (IBS) has an alterationin intestinal motility resulting in fluctuating constioation in diarrhea. Her condition has worsened in thepast month as the date she has scheduled for her licensure examination approaches. Which of thefollowing statements about small intestinal motility that most likely occured in this case? A. Contractile frequency is constant from duodenum to terminal ileum B. Peristalsis is the only contractile activity that occurs during feeding C. Migrating motor complexes occur during the digestive period D. Vagotomy abolishes contractile activity during the digestive period E. Contractile activity is initiated in response to bowel wall distention 64. A 57-year-old man undergoes resection of the distal 100 cm of the terminal ileum as part of treatmentCrohn's disease. Which of the following substance theat cannot be absorbed in this patient? A. Iron B. Folate C. Lactose D. Bile salt E. Protein 65. A 42-year-old salesman presents with chief complaint of intermittent midepigastric pain that isrelieved by antacids or eating. Gastric analysis reveals that basal and maximal acid output exceed normalvalues. The gastric acid hypersecretion can be explained by an increase in the plasma concentration ofwhich of the following? A. Somatostatin B. Histamine C. Gastrin D. Secretin E. Enterogastrone 66. A 27-year-old female comes to the emergency room because of a 2-day bout of profuse waterydiarrhea. Physical examination reveals dry lips and oropharynx. The patient is diagnosed with acutesecretory diarrhea and dehydration, likely due toEscherichia coli. Which of the following sodiumreabsorptive pathway is inhibited by the bacteria's enerotoxin? A. Sodium-glucose-coupled cotransport B. Electroneutral NaCl transport C. Electrogenic sodium diffussion D. Sodium-hydrogen countertransport E. Sodium-bile salt cotransport 67. A 37-year-old male presents with dehydration and hypokalemic metabolic acidosis. This acid-baseand electrolyte disorder can occur with excess fluid loss from which of the following organ?
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A. Stomach B. Ileum C. Colon D. Pancreas E. Liver 68. A 49-year-old man undergoes vagotomy for his peptic ulcer disease. As a result, which of thefollowing gastrointestinal motor activities will be affected most? A. Secondary esophageal peristalsis B. Distention-induced intestinal segmentation C. Orad stomach acoommodation D. Caudad stomach peristalsis E. Migrating motor complexes 69. A 42-year-old male develops a gatric carcinoma affecting the proximal third of his stomach....Scheduled for a partial gastrectomy of the affecting region. Which of the following processes willprimarily affect by this procedure? A. Accommodation B. Peristalsis C. Retropulsion D. Segmentation E. Trituration For question number 70 to 72, refer to scenario below: A 40-year-old woman suffers from watery diarrhea for 2 months. Her condition is very weak.....examination (Hb) shows 5 gr%. Stool examination is also done. She had a story travelling to Danau .... 70. What species could b the etiology for her disease? A. Schistosomaintercalatum B. Schistosomamekongi C. Schistosomamansoni D. Schistisomahaematobium E. Schistosomajaponicum 71. What is the habitat for the species? A. Intestine B. Hepar C. Lung D. Blood E. Brain 72. What is the diagnostic stadium for the species? A. Egg B. Miracidium C. Cercaria D. Metacercaria E. Adult 73. A 55-year-old man suffer from watery diarrhea since 1 week ago. His body
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )

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weight decrease..... eatingundercooked pork meet. The stool examination is taken. What is the larva for the species? A. Cysticercusbovis B. Cystiercus cellulosae C. Cercaria D. Metacercaria E. Miracidium 74. A 30-year-old woman suffers from diarrhea with abdominal pain since 6 days ago. The ....examination shows no sign of acute abdomen. The stool examination is taken and show (no?) mucus. Sheusually eats beef meet in undercooked condition. What is the true characteristic of this species? A. Scolex has no sucker B. Has no rostellum and hook C. Uterus not branches D. Has no porus genitalis E. The egg has no embryophore 75. A forty four year old fat woman complained of fever and right upper abdominal pain for three days.The pain becomes severe and intensified, and was not relieved by taking pain relief pills. Her eyes lookyellowish since five days before. She often complains of right upper abdominal pain that was radiated tothe back and preceded by nausea and abdominal discomfort, several hours after having a meal. Her doctortold her that she suffered from pancreatitis. To establish the diagnosis, what kind of laboratoryexamination do you suggest to perform? A. SGOT (AST) and SGPT (ALT) B. Amylase dan lipase C. Gamma GT dan ALP D. AFP dan HBDH E. Total cholesterol dan triglycerides 76. A 55 year old man came to your outpatient clinic with upper abdominal pain is his chief complain . He suffered from this disease since 2 years ago, which sometimes released by taking antacid drugs. In crowded kampong where drinking water is very limited. To establish the diagnosis , what kind of laboratory examination do you suggest to perform? A. Stool microscopy B. Blood culture for Helicobacter pylori c. Helicobacter pylori antigen detection in stool D. Urease test from blood E. Urease breath test For questions number 77 to 78

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27 years old man complain of fatigue and yellow tint of eyes since three days ago and the urine was dark yellow since one week ago. He was known to have suffered from infection liver disease by hepatitis B Virus. 77. which of the following result can be found in massive destruction of the liver tissue due to chronic liver disease such as hepatic cirrhosis by above virus? A. Low serum albumin level B. Low serum creatinine levels C. Low serum glucose levels D. Low serum amylase levels E. Low serum lipase levels 78. What is the serologic marker of hepatitis B virus infection that indicates contagious condition of this infection? A. HbcAg B. HbeAg C. HBV DNA D. Hbc Antibody E. Hbs Antibody 79. a Forty seven years old man complained of abdominal discomfort with nausea and vomiting. His urine becomes darker and his eyes and skin look yellowish since two weeks before. Since one year ago he often complained of right upper abdominal pain that was radiated to the back and preceded by nausea and abdominal discomfort . He was diagnosed had an obstructive jaundice by the doctor . On his macroscopic examination of the stool look acholis. What kind of of undigested food that had found in the microscopic examinations of the stool? A. Fat B. Carbohydrate C. Vegetable fibers D. Muscle fibers E. Connective tissue fibers 80. A 10 month old baby girl is diagnosed acute diarrhea by the doctor in pediatric EMG Unit Hasan Sadikin Hospital Bandung. Her laboratory result are blood glucose 115 mg/dl (Normal value 100 mg/dl), stool : clinitest positive. Which of the following is the most likely solution needed for above examination?

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A. Sudan III B. Sudan IV C. Acetic acid glacial D. Acetic glacial E. Lugol 81. Why fecal occult blood (FOB) is necessary used as a screening procedure for early detection of colorectal carcinoma? Because in early stage of colorectal carcinoma : A. No visible sign of bleeding in the stool B. Slight visible sign of bleeding in the stool C. Moderate sign of bleeding in the stool D. Visible sign of bleeding in the stool E. Massive bleeding in the stool

For questions no 82-83 Mira a 10 month old baby girl was diagnosed Acute diarrhea by the doctor in pediatric EMG Unit dr Hasan Sadikin Hospital Bandung. The important of her laboratory results are blood glucose 115 mg/dl (Normal value 100 mg/dl), stool : clinitest is positive

82. From the result of stool examination, what is Mira problem? A. Mlabsorption of carbohydrate B. Malabsorption of protein C. Malabsorption of fat D. Malabsorption of vitamin E. Malabsorption of mineral

83. For that examination , what solution do you need? A. Sudan III B. Sudan IV C. Acetic acid glacial
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D. Acetic glacial E. Lugol 84. Mr Y a sixty year old man comes to OPD unit Dr Hasan Sadikin Bandung hospital with chief complain is chronic diarrhea. He was diagnosed suspect colorectal carcinoma by doctor. The result of stool examination : erythrocyte 35/upf , leukocyte 1-2/upf, mucus negative, egg warm negative. Why Fecal Occult Blood Test (FOB) is necessary used as a screening procedure for early detection of colorectal carcinoma? In early stage of colorectal carcinoma : A. Slight visible sign of bleeding in the stool B. Moderate sign of bleeding in the stool C. No visible sign bleeding in the stool D. Visible sign of bleeding in the stool E. Massive bleeding in the stool

For questions no 85-87 A 55 years old female came to ER with diffused abdominal pain for one day. She had history pain killer consumption, ulcer like symptoms. She had tachycardia, high respiratory rates, low blood pressure , disappeared liver dullness, diffused abdominal pain and loss of bowel sound. 85. According to the information above the diagnosis is : A. Acute peritonitis B. Gastric ulcers C. Duodenal ulcers D. Acute pancreatitis E. Peptic Ulcer 86. What is the causes of this condition? A. Perforated peptic ulcer B. Acute pancreatitis C. Acute cholecystitis D. Chronic Pancreatitis E. Acute cholangitis 87. What is your suggestion the examination?

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A. Abdominal plain photo (erect) B. Esophago-gastro-duodenography C. Upper abdominal endoscopy D. Abdominal ultrasound E. Barrium enema

For questions no 88-90 A 55 years old male came ER with hematemesis. He had history of chronic hepatitis B, Abdominal enlargement and edema. Physical examination findings were hemorrhagic shock, jaundice, spider angiomata and ascites.

88. What is the main etiology of this condition? A. Rupture of esophageal varyx B. Duodenal ulcer bleeding C. Pharingitis D. Mild portal hypertensive gastropathy E. Esophagitis

89. What will you do as first action in the emergency room? A. Endoscopy B. Check airways C. Ultra sound examination D. Nasogastric tube insertion E. Male a laboratory examination

90. What is the drug that could stop bleeding in this patient? A. Ranitidine B. Omeprazole C. Propanolol D. Somatostatin
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E. Sucralfate

For questions number 91 to 93, refer to information given below: A 55 years old male came to ER with abdominal pain (RUQ), febris and jaundice, dark yellow 91. what does diagnosis for him ? a. acute cholecystitis b. acute hepatitis c. acute cholangitis d. liver cirrhosis e. acute pancreatitis 92. what is the name of the triad of this case? a. charchot b. hippocratic c. raynauld d. kusmauld e. pancreatic 93.what is the antimocrobial of choice? a. amoxycillin b. ampicillin c. amikacin d. ciprofloxacin e. gentamycin for question number 94 to 96 refer to information given below: 25 years old female came to clinic due to epigastric pain on and off since 3 months ago. Clinic and laboratory results were normal. She took H2RA and antacid but not improving. Physical examination was normal. 94. what will you suggest to this patient a. endoscopy examination b. giving PPI first (empirical anti secretory therapy)
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c. abdominal CT scan d. giving sucralfate e. abdominal ultrasound 95. two weeks after the patient comes again with the same symptom. What will you do next: a. endoscopy examination with biopsy for H.pylori b. H pylori test only c. abdominal ultrasound d. increasing PPI dose e. additional promotility agents

96. no evidence of structural disease on endoscopy, H.pylori positiveand was eradicated co... symptom persist. What will you do to this patient : a. giving SRRI and promotility agents b. increase PPI dose c. PPI standard dose with promotility agents d. abdominal CT scan e. abdominal ultrasound 97.twenty years old boy went to the clinic because he has elevated live enzymes and HbsAg (+). Physical examination no abnormalities are found. The result of laboratory tesing :CBC within normal limits. ALT :765 U/ml, AST:680 U/ml. HAV IgM antibody (+), HbcIgM antibody (-), Hbe antigen (+), HbcIgG antibody (+). Which of the following is the most likely diagnosis for this patient : a. acute hepatitis B and acute hepatitis A b. chronic hepatitis A and acute hepatitis B c. acute hepatitis A and carrier hepatitis B d. window period of hepatitis B and acute hepatitis A e. acute hepatitis A and chronic hepatitis B

98. if the problem is gastric emptying, what will you do to this patient? a. giving double dose PPI

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b. add on promotility agents c. dietary educations d. add on antimotility agents e. add on mucoprotective agents

99. a 64 year old man undergoes CEA surveillance for cancer because his brother and father (blabla) of the colon. He should be informed that : a. CEA highly sensitive for diagnosis b. if CEA is elevated preoperatively, it implies unresectable disease c. increase in CEA after resection may indicate tumor recurrence d. CEA is highly spesific for the presence of colon cancer e. CEA is present in normal adult

100. A 29 year old woman comes to the clinical OPD complaining of severe abdominal pain, nausea, vomitting, and diarrhea. She looks dehydrated and her temperature is 101F. On further asking, she states that she noted streaks of blood in her stool one day back. Her stool culture shows gram negative, straight rods, unable to ferment lactose. Which organism is the most likely etiological agent in this patient? a. Salmonella typhi b. E.coli c. Vibrio cholerae d. Shigella dysenteriae e. Campylobacter jejuni 101. A 14 years old lorry driver presented with vomiting and severe diarrhoea but with no fever. The stool was watery. He admitted to having eaten a road-side food stall while he was in a city in the tropics. Which of the following organism most likely cause his illness? a. Vibrio cholerae b. e.coli c. Salmonella typhi d. listeria monocytogenes

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e. shigella flexneii 102. you are a primary care physician. A 28 years old man, Mr.ian rushton comes to your surgery. He has been feeling off-colour for a week or two, with anorexia, nausea, and malaise. Now he has low grade jaundice with dark coloured urine and pale stools. You send a blood sample to the laboratory for a hepatitis screen and the results state that IgM antibody to hepatitis A virus was detected. Whic of the scenario below is most likely to have resulted in ians infection? a. through sharing needles when injecting ilegal drugs b. through sexual intercourse with an infected individual c. through eating undercooked meat d. through drinking sewage-contaminated water e. through transfusion with blood from an infected individual

103. rotavirus type A infection commonly occurs among : a. fetuses b. elderly people c. infant and young children d. teenagers e. adults 104. a nurse develops clinical symptoms consistent with hepatitis. Sge recalls sticking herself with a needle approximately 4 months before after drawing blood from a patient. Serologic test for HbsAg, antibodies to HbsAg, and hepatitis A virus (HAV) are all negative, however she is positive for IgM core antibody . which of the following is the most appropriate for that nurse? a. she does not have hepatitis B b. she has hepatitis A c. she is in the late stages of hepatitis B infection d. she in the window period e. she has hepatitis C

105. a 54 yo woman admitted to a clinic complaining of abdominal pain that had been worsening for the past 2 weeks. She stated that it often improved immediately after meal or taking antacid. She also noted occasional heartburn,
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but denied fever, nausea, vomiting, or diarrhea. The patient was a school teacher who worked under stressful conditions. After careful examinations, the doctor in charge thought that this patient suffer from peptic ulcer. The bacteria responsible for such disease is? a. Clostridium difficile b. Campilobacter jejuni c. H.pylori d. E.coli e. Enterobacter

Untuk soal 106-107 : A 41 y.o man was brought to hospital with 3 day history of shaking chills, high fever, headache, abdominal pain, and weakness. Since 2 days earlier he also complaining of constipation. After conduct careful examination to the patient, the doctors working diagnosis is typhoid fever. To confirm this, the doctor in charge ask for culture examination to the laboratory. 106. 1st week of such disease is : a. Stools b. Urine c. Rose Spot d. Blood e. None of all above The best specimen for culture in the

107. culture such bacteria? a. Blood agar b. Nutrient agar c. SS agar d. Mac Conkey Agar e. EMB agar

What

is

selected

medium

use

to

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108. A 9 m.o baby girl was brought to the ER of a hospital because of vomiting, watery diarrhea, and fever. The baby had been well many days before. She had experience acute onset of vomiting, following by multiple episode of diarrhea. She refused to eat and drink a little. After careful examination, the doctor in charge thought that the baby suffer from viral gastroenteritis cause by Rotavirus. Other microorganism that cause watery diarrhea is : a. Shigella dysentriae b. Entamoeba hystolitica c. EHEC d. Vibrio cholera e. None of all above Untuk nomer 109-112 : Gastrointestinal tract infections : A. Salmonella typhi B. Shigella dysentriae C. Enterotoxigenic E. coli D. Vibrio cholera E. Entamoeba coli F. Entamoeba hystolitica G. Giardia lambia H. Balantidium Coli

109. A 12 y.o child presents in a refugee health clinic with history of watery diarrhea for the last 2 days. He reports that he has passed stools 6-8 times which are watery and white in color. questioning he reports that he frequently consumes food and drink brought from roadside vendors.

110. A 30 y.o male works on a pig farm. He presents to his local doctor with history of slimy diarrhea more than 2 months duration. Over the course of the last two weeks he has noticed the presence of blood. Laboratory examination of the stools shows multiple cystic organism with macronuclei. 111. A 26 y.o woman comes to medical clinic with a seven day history of fever especially at night. She has just
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returned from a 2 week holiday at the coast and tells the doctor that she took no precaution........... about she eat there. She also had diarrhea and abdominal discomfort. On physical examination her BP was 110/70, HR 60 bpm, RR 20/min, temperature 39,30C and obvious tongue tremor were noted. 112. A 22 y.o woman returned from a rural area of Papua after 2 week voluntary work comes to a clinic with a history of bloody and slimy diarrhea for the last 5 days. She experiences................movement than usual within each day. She also experiences stomach cramp and pain...........stool. she reports no fever or any other symptoms. There is aslight lower quadran abdomen...............on her examination. She is found to be a little bit dehydrated.

113. A 62 y.o woman come to emergency room due to bloody vomiting and dark-tarry stool....hours before admission. She had history of epigastric pain. She is used to drink traditional remedy to relief pain on her knee for the last 2 month. Examination result BP 90/60 mmHg, pulse 116/min, RR 20/min, temperature afebris. Abdominal examination : pain at epigastric area,ascites ( ), caput med ( ). Hemoglobin 7 gr/dl, WBC 5.400/mm3, thormbocyte 212.000/mm3, creatinine 2.0 mg/dl, ureum 110 mg/dl. What is the most possible diagnosis for this patient? a. Rupture of esophageal varices b. Bleeding portal hypertension gastropathy c. Bleeding peptic ulcer d. Bleeding erosive gastropathy e. Uremic gastropathy Untuk no 114-115 : A 62 y.o woman comes to emergency room due to bloody vomiting an dark-tarry tarry stool 5 hours before admission. She had history of epigastric pain. She is used to drink traditional remedy to relief pain on her knee for the last 2 month. Examination result BP 90/60 mmHg, pulse 116/min, RR 20/min, temperature afebris. Hemoglobin 7 gr/dl, WBC 5.400/mm 3, thormbocyte 212.000/mm3, creatinine 2.0 mg/dl, ureum 110 mg/dl.

114. patient? a. Endoscopy emergency

What is the first step treatment for this

b. Intravenous administration H2 antagonist c. Rescucitation using NaCl 0.9%


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d. Transfussion with Packed Red Cell e. Nasogastric tube insertion

115. patient? a. Proton pump inhibitor b. Ranitidine iv c. Sucralfate d. Tra......... acid e. Vit. K iv

What is the best choice of drug for this

Untuk no 116-117 : A 43 y.o man has complain nausea and vomiting since 1 day prior to admission. He also has fever 4 days ago. On physical examination she looks quiet ill, fever, slightly jaundice, epigastric tenderness and decreased bowel sound. The laboratory test Hb 16 g/dL, L 18.000/mm 3, PCV 50%, thrombocyte 150.000/mm3, blood glucose 228 mg/dl, amilase 800 U/L, lipase 550 U/L, SGOT 110 U/L, SGPT 112 U/L 116. diagnosis of this patient? a. Acute cholangitis b. Acute hepatitis c. Acute pancreatitis d. Acute cholecystitis e. Acute gastritis Which is the most likely clinical

117. this a. Cholelithiasis b. Alcohol intake c. Pancreatic divi..........m d. Hypercalcemia e. Diabetes mellitus

What is the most possible etiology of

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Untuk soal no. 118-119 A 24 y.o male come to emergency room due to fever and jaundice. He has histoy of colic abdomen prior to admission. On physical examination : awake, BP 100/60 mmHg, PR 116/min, RR 24/min, temperature 39 0C. Right upper quadran tenderness, with normal bowel sound. Hb 14 gr/dL, WBC 20.400/mm 3, thrombocyte 212.000/mm3, SGOT 70 U/L, SGPT 85 U/L, total serum bilirubin 8.5 mg/dl with conjugated bilirubin 6.2 mg/dl, Alkaline phosphatase 300 U/ml, GGTT 275 U/ml, DC : 0/5/70/4/17 118. diagnosis of this patient? a. Acute abdomen b. Acute hepatitis c. Acute cholangitis d. Acute pancreatitis e. Acute cholecystitis Which is the most likely clinical

119. fors imaging study? a. Abdominal ultrasound b. CT scan of abdomen c. Plain abdominal x-ray d. MRCP e. ERCP

To confirm the diagnosis, what is the

Untuk no. 120-121 A 2 m.o baby boy was brought to ER with abdominal distension, vomiting and no defecation since 4... ago. There is history of delayed passage of meconium and recurrent obstipation. There also history of excretory diarrhea. 120. likely diagnosis? a. .................... b. acute diarrhea c. enterocolitis d. hirschprung disease e. ulcerative colitis Which of the following is the most

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121. Which of the following is the most likely correct statement concerning management for this patient? a. Nasogastric tube can relief abdominal distention in this patient b. Rectal biopsy should immediately be performed to make definite diagnosis c. CT scan abdomen is the most accurate diagnosis for this case d. Abdominal X-ray and barium enema must be performed after acute condition is managed e. Rectal biopsy can be performed in acute state

122. A 9 month old baby girl brought to emergency unit Hasan Sadikin Hospital with bloody and ... stool. One day before the baby seems restless and crying loudly (this condition repeated periodically) vomiting is also occur. There is no history of fever. On physical finding there is palpable mass at epigastrium, no portio-like appearance on DRE. Which of the following is the most likely diagnosis? a. Ameba dysentry

b. Intussusception c. Haemorrhoid

d. Ulcerative colitis e. Perforated meckels diverticulum

123. A 56-year-old male presents to the clinic with the complaint of rectal bleeding. It has been suffered for ... months and since a month ago he also has been complaining os difficulty in defecation and the blood becoming mixed with mucus and small in size. Tenesmus is not complained. There was no previous history of prolapsed mass from the anal while straining. DRE revealsgood sphincter tone, an irregular, hard, and circumscribed mass on the mucosa with distance of 5cm from anal .. there is some fresh blood on the glove. Abdominal exam has not shown distended abdomen and mass. On proctoscopy there is a circumscribed mass lesion with blood and mucus on the center of the mass. What is the most likely diagnosis of this patient? a. Rectal cancer

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b. Prolapsed internal hemorrhoid c. Rctal polyp d. Rectal adenoma e. Rectal .....?

124. A 2 months old baby boy is brought to you (GP) beecase the mother notice an on and off scrotal lumps. On PE the lump is not exist and positive transillumination. What is the most likely diagnosis of this patients? a. Hydrocele b. Inguinal hernia c. Testicular torsion d. Inguinal lymphadenopathy e. Hydrocele and inguinal hernia

125. A 2 month old baby boy was brought to ER with abdominal distention, vomiting, and no defecation since 4 days ago. There is history of delayed passage of meconeum and recurrent obstipation. There also history of explosive diarrhea. Which of the following statement is the best statement related to condition in this patient? a. Enterocolitis is manifested by fever and obstipation b. Classic clinical manifestation are fever, abdominal distention, and frequent diarrhea c. Typical barium enema studies shows four zone of intestinal column d. Ganglionic segment on barium enema represented by dilated proximal intestinal segment e. Pathological findings of HD is hypotrophic of neuron fibers For question number 126-128, refer to scenario below: An 18 old month baby brought by his parent with chief complaint of fever since 7 days before. He lost his appetite during the illness, and decrease his body weight. The child is still conciousness. PE showed moderate film, severe wasted, no sign of dehydration and edema. His body weight was 6.6 kg. Body heigh 76

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cm. According to WHO Growth Chart Standard his WFH <-3 SD. Lab finding showed glucose level was40 mg/dl, Na 140 mEq/L, K 3.5 mEq/L 126. What is the nutritional status in this patient? a. Normal b. Mild malnutrition c. Moderate malnutrition d. Severe malnutrition marasmic type e. Severe malnutrition kwarshiorkor type

127. What is the treatment for this patient? a. Glucose 10% b. Formula milk c. ORS d. Ringer Lactate e. Natrium chloride

128. If evidence of diarrhea occurs in this patient, what is management for fluid and electrolyte replacement? a. Oral rehydration solution b. Breastfeeding c. Resomal d. Ringer Lactate e. Nothing peroral (?) For question number 129-130, refer to scenario below : You are visiting a post delivery mother in parturient room with his healthy baby boy. She is expecting for exclusive breastfeeding. You explain to her about physiology of lactation for successful breastfeeding. 129. What is the reflex that can be interferred by psychological condition? a. Prolactin reflex b. Oxytocin reflex c. Rooting reflex
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d. Suckling reflex e. Swallowing reflex

130. What is the advantage of this activity for baby? a. High protein levels b. High lactose c. High casein d. High fat e. High calcium

131. An 8 month old child is hospitalized because of vomiting and screaming episodes for 12 hours. During the episodes, the infant draws up his legs as if having abdominal pain. PE reveals a sausage shaped mass in the right upper quadrant. Temperature is 38 C. WBC count is 18.000/mm3. What would be your next step in management? f. Lumbar puncture g. Exploratory laparotomy h. Blood culture i. j. Abdominal ultrasound IV anibiotics

132. A 7 years old boy was exposed to hepatitis 1 year ago. The mother asks your opinion about possibility of this exposure turning into chronic hepatitis. When counseling her, you will explain that the virus most likely to result in chronic hepatitis is? a. Epstein barr b. Hepatitis A c. Hepatitis B d. Hepatitis D e. Hepatitis E

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133. A 15-months old girl developed emesis and intermittent abdominal pain since yesterday, with several smell partialy formed stool. His parent was nor overly concerned because he seemed fine between the pain episodes. Today, however, he has persistent bilious emesis and he had several bloody tools. Examination reveals a lethargic child in mild distress, tachycardia, and fever. He has diffusely tender on the right lower abdomen with a vague tubular mass. What is the most likely diagnosis. a. Intussusception b. Meckels diverticulum c. Perforated duodenal ulcer d. Abdominal wall hematoma e. Cholecystitis and billiary colic For question number 134 to 135, refer to scenario below : A 4 month-old baby boy presents to emergency unit of pediatric departement with profuse and watery bloody diarrhea since 3 days ago. He also had vomiting and low grade fever for the past 2 days. On physycal examination, he looks restless, irritable, and drink eagerly. His eyes and fontanelle are sunken and skin goes back slowly. His body weight is 5 kg. Vital signs : temperature 37,6 C, heart rate 176 and BP 90/50 mmHg. 134. What is the most likely diagnosis for this patient? a. Acute diarrhea without dehydration b. Acute diarrhea, some dehydration c. Acute diarrhea, severe dehydration d. Acute diarrhea, hypovolemic shock e. Acute diarrhea, septic shock

135. Which of the following is te most appropriate initial step in managing the patient? a. Anti diarrheal agent b. Fasting and antiemetic drug c. IV administration Ringer Lactate solution d. Oral rehydration salt e. Antibiotic administration

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136. Barium enema examination on 70 y.o man w/ a history of changing bowel habit, rectal bleeding, and abdominal painfilling defect (apple core) and shouldered margins in the recto sigmoid. WOTF is the most possible plain-film finding for above case? A. Meteorism B. Paralytic ileus C. Small bowel obstruction D. Large bowel obstruction E. Pneumoperitoneum

137. On chest x-ray an air-fluid level is seen in the upper esophagus of a middleaged man. The gastric bubble is either absent or very small. A barium meal shown a smooth tappering of the lower esophagus .......... appearence at the esophagogastric junction to a point of obstruction with a diffuse dilatation of esophagus above this level. Which most likely diagnosis? A. Chalasia B. Achalasia C. Scleroderma D. Esophageal spasm E. Pseudoesophagus

138. An abdominal radiograph of neonatal boy with abdominal distension and failure to pass meconium within the first 48 h of life shows multiple air-fluid level in moderately dilated loops of bowel. Barium enema examination shows an inversion of the recto sigmoid index. What is the diagnosis? A. Hirschprungs disease B. Meconeum ileus C. Ileal atresia D. Colonic atresia E. Functional immaturity of the colon

139. A 70 year old male present with acute onset of abominal pain with peritonitis post ERCP for biliary ... placement. Amylase, lipase, AST, ALT,ALP, Total Bilirubin CBC, WBC are normal. He is hypokalemia, with a BP of 80/50, RR is 30 bpm, no fever. On PE, there is marked rebound tenderness and guarding throughout the abdomen. The following radiograph were performed. Ehat is most likely radiological diagnosis?
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A. Massive ascites B. Cholecystitis C. Intraperitoneal Air D. Abdominal aortic aneurysm

140. A 36 Y.o female presents to int. medicine department w/ chief complain abdominal pain at epigastrium or paraumbilical region, especially after taking meal. From USG finding, there aremultiple hyperechoic w/ acoustic shadow in gall bladder and biliary duct. What is the most likely diagnosis from USG finding? A. Acute pancreatitis B. Chronic pancreatitis C. Cholelithiasis w/ cholecystitis D. Cholelithiasis w/ choledocholithiasis E. Acute cholangitis

For 141-143 When you are in clinic an 18 y.o girl was admitted w/ pain in upper abdomen. This complain occurred after she ate some spicy food. She often complains this abdominal pain for 3 years.Her PE : tenderness at middle and left upper quadrant (+). Lab : normal

141. Why spicy food cause abdominal pain ? A. Allow H. pylori to breed B. Increase gastric juice C. Increase gastric acid D. Attack gastric wall E. Allow H. pylori adhesion

142. What diet can reduce the risk of complication ? A. Dairy product diet B. High meat diet

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C. High fibre diet D. High fat diet E. High protein diet

143. The patient should take a wall balance diet in a small frequent portion. What is the reason ? A. To kill H.pylori effectively B. To raise nutritional status C. To reduce acidity D. To cover gastric wall E. To maintain the gut health

For 144-145 A 42 y.o woman come to hospital w/ yellowish skin. She also complains weak and sometimes epigastric pain for 3 weeks. Her PE : icteric in conjunctiva, tenderness at right upper quadrant abdominal (+) liver palpable hardened edge 2 cm bac, 2 cm bpx, w/o shifting dullness in abdomen area. 144. Assesment her nutritional status will be affected by : A. The virulence of the virus B. The enlargement of the liver C. The colour of the skin D. The surface of the liver E. The change of metabolism 145. The patient is diagnosed by viral HepB,. The giving of fat should be : A. Not more than 10% B. Betweeen 10-20% C. 25% D. 35% E. Enough of essential fatty acid which is 20% For 146-148

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After 15 years, the woman whom infected by hepatitis B , complains bloody vomit, ....swelling and... PE : shifting dullness. 146. What is the coaus of fluid accumulation in her body ? A. Protein depletion B. Oliguria C. Accumulation of sodium D. Protein leakage E. Plenty drink 147. The nutritional treatment should be : A. High potassium intake B. High calorie C. High water intake D. Plenty calorie and protein E. Iron supplementation 148. What is the common change in mineral metabolism ? A. Decrease of sodium B. Decrease of calcium C. Decrease of chloride D. Decrease of potassium E. Decrwease of phosphate 149. A Mr. B 50 yo man is diagnosed w/ chronic HBV infection since 25 yo he was a drug abuse. He has lost his appetite andkeeps loosing his weight. The doctor should give the nutritional intake : A. Increase energy intake/ large meal B. Increase carbohydrate intake C. Give more simple carbohydrate composition D. Balance ratio b/w protein and lipid E. Increase energy intake w/ small frequent meal

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150. Decrease food intake is a common in each person w/ hepatic disease but actually energy needs may be increased or decreased. Its crucial to remember that energy balance. This aspect isnt correction factor to calculate energy intake in hepatic disease : A. Thermogenic effect of food B. Stress factor C. Age D. Gender E. Lactic acid level 151. Before the appropriate nutrition therapy can be implemented, a nutritional assessment must be performed to determine the extent and cause of malnutrition. The best alternative to perform a nutritional assessment in liver disease is : a. Objective parameters b. Quisioner question c. SGA parameter d. Combine of objective and SGA parameter e. Clinical assessment 152. Protein is the most controversial nutrient in liver failure. Sufficient protein is necessary to maintain or restore body strength, as well as to promote immune function. How to give the protein for the patient? a. b. c. d. e. Above 0,8 g/kg BW In situation of stress in liver failure need less of.(fotonya kepotong) Increase branch chain amino acid food resource.. Increase aromatic amino acid food resources Choose ammoniogenic amino acid food resources

153. Ms.Gina, 29 years old is diagnosed Peptic Ulcer. She is given Omeprazol by her doctor. Which of the following is the right answer for Omeprazol? a. b. c. d. e. Antacid Anticholinergic agent H2 receptor blocker Protein pump inhibitor Prostaglandin analog

154. What is inhibited by Omeprazol? a. Adenosine monophosphatase b. The gastric ATP ase c. Cholinergic
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d. Histamine e. Prostaglandin 155. Histamine has a powerful effect on the secretory cells of the stomach, stimulating acid secretion. It does by binding to H 2 receptor on the parietal cells of the stomach, thereby inhibiting a cyclic AMP-mediated cascade of activity. Which of the following drugs competitively block the H 2 histamine receptor? a. b. c. d. e. Misoprostol Pirenzepine Sucralfate Bismuth Ranitidine

156. Misoprostol, a methylester with antisecretory and cytoprotective properties has been approved for the prevention of anti-inflammatory agent induce ulceration. Which of the following is the right statement of misoprostol? a. b. c. d. e. Blocks cholinergic receptor Blocks H2 histamine receptor Stimulates prostaglandin receptor Activated protein kinase Blocks proton pump

157. Which of the following has both acid inhibitory and mucosal protective properties? a. b. c. d. e. Misoprostol Sucralfate Bismuth Antacid Pirenzepine

158. Mrs.Dewi, 45 years old woman is diagnosed gastritis and get antacid as the treatment. At the same she also get tetracyclines for her other disease. Which of the following is the right statement? a. b. c. d. Antacid should given at the same time with tetracycline Antacid affects the absorption of tetracycline Antacid decreasing intragastric pH Antacid should be taken as longterm medication for renal insufficiency patient e. Antacid is weak acid that react with gastric hydrochloride to form a salt and water 159. Which of the following is systemic antacid? a. CaCO3
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b. c. d. e. Al(OH)3 Mg(OH)2 NaHCO3 K HCO3

160. Which of the following has adverse effects transient metabolic alkalosis? a. b. c. d. e. CaCO3 Al(OH)3 Mg(OH)2 NaHCO3 K HCO3

161. Which of the following is used as adjuncts to the H 2 histamin receptors blockers? a. b. c. d. e. Famotidine Pirenzepine Sucralfate Omeprazole Antacid

162. Which of the following is mucosal protective agents? a. Famotidine b. Pirenzepine c. Sucralfate d. Omeprazole e. Antacid 163. A pathologist will examine the section of alimentary tract on GERD patient. His objective is to identified the esophagus structure. The patient got GERD for several years. The pathologist saw the changes in squamous epithelial layer became columnar type of epithelial. What is the terminology of the changes in that epithelial layer? a. b. c. d. e. Carcinoma Adenoma Metaplasia Anaplasia Neoplasia

164. What is the best diagnosis for this patient based on pathological examination? a. b. c. d. e. Neoplasia of stomach Barret esophagus Gastric polyp MALT Gastric adenoma

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165. A 46-year-old woman with no prior medical history was admitted to a local hospital due to progressively increasing upper abdominal discomfort for some weeks, lately associated with jaundice. No weight loss was reported. No mass was palpable at the physical examination. Ultrasound showed a gallbladder hydrops with gallstone in the gallbladder and bilateral dilation of intrahepatic bile ducts, performed operation (cholecystectomy). Which of the following is the microscopic finding in the specimen from cholecystectomy? a. b. c. d. e. Aschoff bodies Invasiveness of the epithelial layer Crypt Rokitansky aschoff Proliferation of lymphoid follicle

166. A 34-year-old man came to emergency unit with the chief complaint right lower quadrant pain. The complaint accompanied by low grade fever, vomiting, and obstipation. From physical examination showed rebound tenderness. He was diagnosed as appendicitis, and appendectomy was performed and the specimen was sent to pathology department. Which of the following is the best describe of the microscopic finding in the specimen from that patient? a. b. c. d. e. Hyperplasia of lymphoid tissue with infiltration of mononuclear cell Fibrosis of the muscular layer Destruction of epithelial layer until serosa layer with PMN cells Atrophic of epithelial layer Proliferation of seromucosa gland

167. What is the best diagnosis for this patient based on the pathological examination? a. b. c. d. e. Appendicitis Chronic appendicitis Acute appendicitis Acute perforated appendicitis Chronic perforated appendicitis

168. A 2-month-old baby boy was brought to ER with abdominal distension, vomiting, and no defecation since 4 days ago. There is history of delayed passage of meconeum and recurrent obstipation. There also history of explosive diarrhea. Biopsy of the gus was performed. Which of the following is the best describe of the microscopic finding from this patient? a. b. c. d. e. Fibrosis of the muscular layer Destruction of epithelial layer There are ganglions in aurbach plexus Absent of ganglion in meisner plexus Hyperplasia of the ganglion

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169. A 57-year-old man came to out patient clinic with chief complaint the blood drips especially after he has his bowel open. He has had such a bleeding four times since two years ago and sometimes it accompanied by the piles coming out from the anus that could be pushed back into the anus by fingers. The doctor gave the suggestion to get the operation of the piles and the operation was done. Which of the following is the best describe of the microscopic finding of the specimen from this patient? a. b. c. d. e. Dilation of the vessel below the epithelial layer Fibrosis of muscular layer Infiltration of inflammation cells Proliferation of the epithelial layer with the atypical cells There is no ganglion in the gut

170. The pathologist gave the diagnosis as internal and external hemorrhoid. Which of the best finding from microscopic feature from this patient? a. b. c. d. e. Dilated vessel with columnar epithelial cells Dilated vessel with squamous epithelial cells Thrombus in the vessel There are blood clots and necrotic tissue Columnar and squamous epithelial layer was found

171. A 55-year-old man came to the out patient clinic with the chief complaint of yellow eye and dark color urine. He ever got hematemesis in several years ago, and was diagnosed as hepatitis. The doctor did the biopsy. Which of the following is the best microscopic finding in this patient? a. b. c. d. e. Bridging necrosis Fibrosis periportal Necrosis of the hepatocyte Hepatocyte was enlargement Infiltration of PMN cells

172. A 24-year-old man was admitted to the hospital through the emergency room with hematemesis and melena. No history of icterus, Injecting Drug Usage or use of NSAIDS. He was pale but in stable hemodynamic conditions. There was slight hepatomegaly and a huge spleen of Schuffner 6 was detected. Which is the most likely etiology of GI bleeding in this case? a. b. c. d. e. Esophageal varices Gastric telangiectasis Gastric Henoch-Schoend (maaf foto ngeblur) Erosive hemorrhagic gas Peptic ulceration

For questions number 173 to 174, refer to scenario below :

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A 2-month-old baby boy admitted to the hospital because of abdominal distention. His mother said that the baby had chronic constipation since he was born, physical examination revealed very distended abdomen, the x ray showed enlargement of the descending colon filled with gases and radioopaque material. Transanalpullthrough operation was performed and the macroscopic finding in descending colon was shown in picture below.

173. Related to the diagnosis of this patient, which microscopic finding will revealed in the A area of this colon? a. b. c. d. e. Normal ganglion Aganglion Hypoganglion Hyperganglion Ganglioneuroma

174. Related to the diagnosis of this patient, which microscopic finding will revealed in the B area of this colon? a. b. c. d. e. Normal ganglion Aganglion Hypoganglion Hyperganglion Ganglioneuroma

175. A 45-year-old female admitted to the hospital because of colicky pain in the right upper quadrant, this symptom accompanied by nausea, vomiting, and fatty food intolerance. USG of the liver and gallbladder showed gallstone and enlargement of the gallbladder. Cholecystectomy was performed and the specimen samples were sent to the pathology laboratory. The macroscopic and microscopic findings were showed in the picture below.

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What is the most appropriate diagnosis of this patient? a. b. c. d. e. Chronic calculouscholecystitis Chronic acalculouscholecystitis Acute calculouscholecystitis Acute acalculouscholecystitis Cholelithiasis

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