UPPER ALIMENTARY Dr.

Martinus (3) A 42-year-old male stressed-out executive has a 6-months history of constant upper abdominal pain and heart burn for the past year that was relieved by over-the-counter antacids. His stools have become dar and tarry! which at examination! have occult blood. "ost li ely dia#nosis$ peptic ulcer disease (case for %uestions no.&-'(. &. )astric content exitin# a posterior perforation of the stomach wall will accumulate in the$ A. *eft paracolic #utter +. *eft paravertebral #utter ,. -i#ht paravertebral #utter .. /0mental bursa 1. Hepatorenal recess 2he followin# statement concernin# the peritoneal cavity is correct$ A. A potential space of capillary thinness between parietal peritoneum and abdomen wall +. 2he content of this cavity are the small and lar#e intestine ,. ,ontains 344cc peritoneal fluid .. /there is a communication pathway in females to the exterior body 1. consist of the #reater sac only 2he followin# statements are correct for abdominal cavity! except: A. 5s the location of most di#estive or#ans and ureter! the spleen! and the idneys. +. 6eparated superiorly from the thoracic cavity by the diaphra#m ,. ,ontinuous inferiorly with the pelvic cavity .. /the posterior wall are the lumbar7sacral vertebrae and their intervertebral discs 1. 2heir internal surface lined with the parietal peritoneum.

2.

'.

Dr. u!irita"a (#) 4. 8hich of the followin# statements is correct about histolo#ical structure of esopha#us9 A. "ucosa is lined by eratini:ed stratified s%uamous epithelium +. 1sopha#eal cardiac #lands is located in the submucosa layer ,. "uscularis externa of the upper third of the esopha#us is composed by smooth muscle .. "uscularis externa of the lowest third of the esopha#us is composed by s eletal muscle

1. 1sopha#eal #land proper is located in submucosa layer/ 3. 2he followin# statements are correct about histolo#ical structure of cardiac mucosa! except: A. 2he lamina propria contains simple tubular cardiac #lands +. 2he predominant cell on the cardiac #lands is parietal cells/ ,. 2he #astric pits is more shallow than fundic .. 2here is no chief cells on the cardiac #lands 1. 2he terminal portion of cardiac #land is coiled

Dr. u$etra (3) 6. )enerally! a normal alimentary function is re#ulated by $ A. en:yme +. feed-bac mechanism ,. motoric nerve .. intramural plexus 1. thyroxin ;. <eristaltic always move from oral to anal! because it follow the role of $ A. All or =one +. +oyle ,. *aplace .. =ewton 1. -eceptive -elaxation and *ow of )ut <rotein di#estion in stomach is done by en:yme$ A. ptyalin +. pepsin ,. trypsin .. chymotrypsin 1. renin

>.

Dr. Desa% (#) ?. A 64-year-old patient presents with a history of increasin# fre%uency of passa#e of feces. 0n %uestionin#! he tells you that the stools are pale in colour! are passed in copious amount and difficult to flush away. .oes this su##est$ A. .issacharidae deficiency +. "alabsorption of fat ,. 2he absence of secreted H,l in the stomach .. *actose intolerance 1. 5mpairment of #alactose absorption

&4. 2here are many or#ans that involved in di#estion process and each of them has specific function. 2o absorp of fluid and electrollytes is the function of$ A. 6tomach +. <ancreas ,. )allbladder .. 6mall bowel 1. *ar#e bowel

Dr. Musti%a (#) &&. <atien 34 years old man comes to hospital because of profuse hematemesis. He also has wea ness! anemia and decrease body wei#ht in one year.*aboratory examination shows disturbances in lever function test !5#) for @iral Hep., positive. 2he most commont causes causes of profuse Hematemesis is $ A. 1sopha#eal ,arcinoma +. +arrett 1sopha#us ,. 1sopha#eal @arices .. Acute )astritis 1. <eptic Alcers B,( &2. 8hich one of these statement is not a morpholo#ic feature of pleomorphic adenoma of salivary #land. $ A. ,ystous +. 1pithelial cells ,. 5ntermin#led with myxoid connective tissue. .. "yoepithelial derivation 1. 1ncaptulated. BA( Dr. El&s (#) &'. A boy came with chief complain about pain when swallowin# and also pain at his nec . 0ne day before admission he had history about cho in# and swallowed a fish bone.Cou suspicious about trapped fish bone at the esopha#us.8hat ind of initial ima#in# examination that you advice9 A. <lain photo cervical/ +. <lain photo thoracal ,. <lain photo abdominal .. <haryn#oesofa#o#raphy 1. A)5 study &4. -adiolo#ical appearance of achalasia is $ A. Dilllin# defect of the esopha#us +. 5re#ularitas of the esopha#eal wall

,. .ilatation of the proximal esopha#us and narrowin# of the distal esopha#us with Ebea -li eFappearance/ .. E 8orm-li eF impression alon# the esopha#eal wall. 1. 1sopha#eal diverticle Pr'( A"an (#) &3. Antacid that cause side effect diarrhea is$ A. Aluminum hydroxide +. ,alcium carbonate ,. 6odium carbonate .. "a#nesium hydroxide/ 1. ,ombination of "a#nesiumGAluminum hydroxide &6. 2hese are the li ely side effects of metoclopramid if used in lon# period of time! 1H,1<2$ A. <ar insonism +. )alactorrhea ,. Hyperprolactinemia .. Arrhythmia / 1. 2ardive dys inesia Dr! A!un! (#) &3 years old boy complained about spontaneous pain at his ri#ht upper molar since last ni#ht when he was sleepin#. ,linical findin# shows there is an untreated deep cavity on the surface of that tooth. &;. 6uspected dia#nosis for that condition$ A. <ulp 5rritation +. <ulp Hyperaemia ,. <ulpitis/ .. 6uperficial ,aries 1. ,hronic <eriodontitis &>. <referred medicines which can be prescribed to the patient before bein# admitted to the .ental .epartment$ A. Anal#esic +. Antibiotic ,. Anti inflammation .. ,ombination between option A and +/ 1. ,ombination between option + and ,

Dr De$a Arta (#) &?. A 2 year old boy came with bad #eneral condition! vesicles are found in #in#ival area. 2he boy is also complained convulse and hi#h fever! what is the dia#nosis of this patient$ A. 0ral candidiasis +. <rimary Herpes simplex/ ,. 6econdary Herpes simplex .. -ecurrent 6tomatitis apthous 1. )in##ivitis 24. A '3 year old woman come with chief complain about pain to swallow. 0n the physical examination! vesicles are found on the oral base and mandible #in#ival area. 8hat is the possible dia#nosis of this patient9 A. <rimary herpes simplex +. 6econdary herpes simplex ,. 0ral candidiasis .. Herpes :oster/ 1. -ecurrent 6tomatitis apthous Dr. a!un! putri (#) 2&. A ' year old boy! come with his parent to 6an#lah hospital. His chief complaint is difficulty when swallowin#! after accidentaly swallow -p. 34!- when he played with his friend 2 hours a#o. 0thers complaint that immediately follow the case are$ A. <ain when swallowin# Bordinopha#ia( +. @omittin#/ ,. ,ou#h .. Hoarse 1. 6hortness of breath 22. A &? year old #irl come with chief complaint pain when swallowin# and vomitin# after consume toilet cleanse solution! in suicide attempt because of bro e with her boyfriend. 2he complications that can be occurred after the recovery phase if the mana#ement were not optimum are$ A. 6tricture of oesopha#us/ +. 2umour of oesopha#us ,. Distula trachea oesopha#us .. .iticulum 1. All are correct

<rof 8ibawa

B2(

.r. 6uryadarma B'(

Dr. )ar&ana (#) &. A &-year-old-boy was brou#ht to a polyclinic by his parents because of diarrhea that he had suffered for 2 days. 2he fre%uency was 4-3 times a day! every time the volume was approximately 23 m*! without blood or mucus! and not accompanied with vomitin#. 2he findin#s in physical examination were$ body wei#ht &4 #! lar#e fontanelle was flat! the s in went bac immediately when pinched. +ased on the clinical data above! other symptoms that mi#ht be found are$ A. He loo ed irritable! sun en eyes! dry oral mucous +. =o tears when cryin#! loo ed thirsty! increased breathin# fre%uency ,. <oor feedin#! decreased activity! decreased urine volume .. =ormal activity! last urination was 2 hours before! pulse &44 times per minute 1. Anconscious! fast and deep breathin#! s in pinchin# went bac very slowly

2. 5f the dehydration status has been defined in case no.&! the fluid therapy #iven$ A. ;3 ml of 0-6 after each loose stool +. &44 ml of 0-6 after each loose stool ,. &23 ml of 0-6 after each loose stool .. 5nfused with -* ;44 ml in 4 hours 1. 5nfused with -* &444 ml in 4 hours L*+ER ALIMENTARY Dr. Martinus (#)

An &>-year-old man complains of &2-hour abdominal pain that is initially periumbilical and then mi#rates to the -i#ht *ower Iuadrant B-*I(. He has some nausea and a low #rade fever. 2he abdomen is tender in the -*I and ri#ht lateral re#ion. 2he urinalysis is normal. M'st li%el& dia!n'sis: Acute appendicitis. Cou are at sur#ery for the removal of a suspected appendicitis! but the appendix is not visible. 2he appendix is li ely to be$ A. Anticecal +. <aracecal ,. <aracolic .. /-etrocecal 1. -etrocolic A patient experiencin# infraumbilical Bpubic( pain is li ely to have a disorder of the$ A. Appendix +. Ascendin# colon ,. 5leum .. 6tomach 1. /6i#moid colon

Dr. u$etra (#) .efecation reflex in normal adult$ A. 0ccur 3 times +. 6timulated! if feces insert into the rectum ,. ,annot be postpone .. 6tarted if ascendin# colon is filled 1. ,an be fascilitated by atropin inJection 5leocaecal emptyin# is faster in the present of infection of $ A. 6mall intestine +. Appendix ,. Kidney .. ,olon 1. Areter Dr. ri +ir&a$an (#) &. ,hoose the best description of the duodenum. A "ucosa with crypts and villiL epithelium with scattered #oblet cellsL lamina propria with occasional lymph nodulesL submucosa unspeciali:ed. + "ucosa with crypts but no villiL epithelium with scattered #oblet cellsL lamina propria with occasional lymph nodulesL submucosa unspeciali:ed.

, "ucosa with both crypts and villiL epithelium with scattered #oblet cellsL lamina propria with occasional lymph nodulesL submucosa with mucous #lands. B/( . "ucosa with both crypts and villiL epithelium with scattered #oblet cellsL lamina propria pac ed with mucous #landsL submucosa with numerous lymph nodules. 1 "ucosa with crypts but no villiL epithelium with scattered #oblet cellsL lamina propria with occasional lymph nodulesL submucosa with mucous #lands.

2. ,hoose the best description of the appendix. A "ucosa with short tubular inva#inations but no villiL epithelium lac in# #oblet cellsL lamina propria pac ed with lymphoid tissue containin# numerous #erminal centers. + "ucosa lac in# both tubular inva#inations and villiL epithelium with many #oblet cellsL lamina propria unspeciali:ed! without lymphoid tissue. , "ucosa lac in# both tubular inva#inations and villiL epithelium lac in# #oblet cellsL lamina propria pac ed with lymphoid tissue containin# numerous #erminal centers. . "ucosa with short tubular inva#inations but no villiL epithelium with many #oblet cellsL lamina propria unspeciali:ed! without lymphoid tissue. 1 "ucosa with short tubular inva#inations but no villiL epithelium with many #oblet cellsL lamina propria pac ed with lymphoid tissue containin# numerous #erminal centers.B/(

Dr. Musti%a (#) <atient 23 years old man come to a private doctor with cramps!tenesmus!and colic y lower abdominal pain!he also has chronic relapsin# diarrhea !melena !wea ness and decrease body wei#ht .0n physical examination the patient loo pale! abdominal mass canFt found with palpation!and the hemo#lobine is 6!3 #rM .2he patient also has mi#ratory polyarthritis and then referred to 6an#lah hospital for further examination. 8hich one is the the most li ely dia#nosis between these diseases$ A. "alabsorbtion syndrome +. 5nfectious 1nterocolitis ,. Amoebic dysentery .. ,rohn .isease 1. Alcerative colitis N1O 5n colorectal cancer! dietary factors receivin# the most attention! which one of these is not the most li ely$

A. +. ,. .. 1.

A low content of unabsorbable ve#etable fiber *ow fat content Hi#h content refined carbohydrate .ecreased inta e of vitamin A!, and 1 =itrites derived from nitrates Bfound in food and drin in# water(

B+(

Dr. El&s (#) A 3> year-old man came with chief complaint about bloody stool since this last ' months. He also complained about chan#es in bowel habit. His faeces caliber became smaller and more hard than usual. His body wei#ht also decreased until &3 ilo#rams in this 2 months. He also felt pain at the left lower abdomen. 0n the physical examination! you find a mass at his left lower abdomen. 8hat ind of initial ima#in# examination that you advice for this patient9 A. A)5 study +. +0D/ ,. +arium enema .. +arium follows throu#h. 1. ,2 scan abdomen *ar#e bowel carcinoma usually #ivin# radiolo#ical appearance $ A. .iverticle +. .issapearin# of the haustrae alon# the lar#e bowel. ,. Dillin# defect annular type/ .. <olyp 1. )enerali:ed irre#ularity of the entire colon Pr'( A"an (#) "echanism of action of laxative castor oil! cascara! senna! phenolphthalein is$ A. 5rritate and stimulate lar#e bowel wall/ +. Dormin# a bul y! emollient #el ,. 6often stool material .. *ubricate fecal material 1. 5nhibit peristalsis 2o become active as anti inflammatory this dru# is converted to 3-Amino 6alicylic Acid! and effectively for the treatment of ,olitis Alcerative. 2his dru# is$ A. 6ulfasala:ine/ +. 5nfliximab ,. )lucocorticoid .. "ethotrexate 1. A:athioprine

.r. <urwadi B'(

Dr. udartana (#) A 43 year old male! comes with chief complaints malaise! decrease of appetite! body wei#ht loss 6 # in & month and diarrhea for 6 wee s. 0n physical examination +< $ &&4G;4 mmH#! H-$ >> xGmnt! eyes Bsclera( $ anemis 7G7. -2 $ tumours are not papable. 2he mana#ement of this patients are$ A. -i#ht Hemicole tomy +. *eft Hemicole tomy ,. *ow anterior resection .. ,olostomy 1. -adiotherapy 7 chemotherapy Accordin# to 2=" system! the meanin# of 24 on ,olorectal carcinoma is$ A. 2umour are limited to sub mucosa +. 2umour are reach the serous of the bowel ,. 2umour are reach the muscularis layer of the bowel .. 2umours are spread beyond the serous 1. All are wron# Dr. udartana (,) A '3 year old female comes with chief complaints pain in the anal! especially when defecate! and also bleedin# from anus. 2he bloods are not so copious and Just stic on toilet tissue. 2he most possible dia#nosis of this patient is$ A. 5nternal Haemorrhoid +. <erianal Distula ,. <erianal Abscess .. Dissure ani 1. 2umour of rectum 2he examination that can be used to determine the cause of the complaint of this patient is$ A. Distulo#rafi +. 2ransrectal Altrasono#rafi ,. 2ono#rafi .. +arium in loop 1. -ectal 2oucher 2he most common cause of <erianal Distula is$ A. Anal infection +. ,hrohn disease

,. Alcerative colitis .. 2rauma 1. .iverticulosis 8or in# dia#nisis of internal Haemorrhoid can be determine with$ A. -ectal toucher +. <roctoscopy ,. 6ondase .. Distulo#rafi 1. 2ransrectal A6)

Dr. Dar"a putra (,) A &> year old #irl! comes to emer#ency room with chief complain pain on ri#ht lower %uadrant of abdomen and nausea. About ' hours a#o she suddenly felt pain in the epi#astric re#ion. 0n the physical examination! the #eneral condition of the patients is #ood. +< &&4G>4 mm H#! H- ;6HGm! axilla temperature ';4 ,. <ressed pain and resistance of abdominal muscle are found on the ri#ht lower of the abdomen. 2he examination that need to be done do dismiss the possibility of ureter stone in this patient is$ A. -outine blood examination +. Arine sediment ,. -ectal touchP .. Abdominal plian photo 1. -enal function examination 5f there were no disorders found on the #inecolo#ic and urolo#ic examination! the most possible dia#nosis of this patient is$ A. Acute Appendicitis +. Acute ,holesistitis ,. 5leitis terminalis .. .iverticulitis B of "ec el( 1. 1ntherocolitis A 6 moth old boy is carried by his mother to hospital! present history defecate with blood. Accordin# to his mother! a ni#ht before! the baby suddenly cried and screams. 2he baby stop cried! but cried a#ain! and its happen since that time. 5n the mornin# his stools mixed with blood. 0n the physical examination! the baby in #ood nutrient status! moderate dehydration! distension of the abdomen with increasin# peristaltic. 0n rectal touchP! there were blood with bri#ht red colour and slime on the #love. -ectal temperature '>4 ,! heart rate and respiration rate are increasin#.

8hat examinations that will you do to determine the dia#nosis of this patient9 A. A6) +. Abdomen plain photo ,. +arium in loop .. +lood routine examination 1. 6tool routine examination ,omplication that can be occurred to this patient is$ A. .ehydration +. +alance disorders ,. )an#rene of the pinched bowel se#ment .. <eritonitis 1. All are correct

.r. 6uryadarma B2( .r. <urwadi B2(

Dr. udartana (,) A 33 year old male come with chief complaint tumour on the ri#ht scrotum that still exist since > hours before admission to the hospital. 2here are no abdominal pain! flatus and defecate are normal! difficulty in urinatin#! sometimes he need to QQ. in order to push the urine comes out. 2he most possible dia#nosis of this patient is$ A. Hidrocele dextra +. Hernia in#uinalis medialis dextra irreponibilis ,. Hernia in#uinalis lateralis dextra irreponobilis .. 2orsio testis dextra 1. 2umor testis dextra "ana#ement of this patient is$ A. 1mer#ency 6ur#ery +. "anual reposition ,. "edicamentosa .. 6upportin# devise 1. All are correct 2his statement are correct about femoralis hernia! 1H,1<2$ A. Demale more fre%uent than male +. 0ften become incarserta ,. ,ome out from foramen ovale

.. 0ften become -ichter hernia 1. 2he hi#hest incident on fat women 2he indication of sur#ery of Ambilicalis hernia is$ A. 5f the diameter of hernia R 2 cm +. 5f the diameter of herniaS ' cm ,. 5f the diameter of hernia rin# S 2 cm .. 5f the diameter of hernia rin# R 2 cm 1. 2here are si#ns of infection

-EPAT*.ILIARY Y TEM Dr. uar&a (#) *ocation or topho#raphy of the liver! isGare correct$ A. All lobes located in ri#ht superior %uadrant. +. All lobes located in ri#ht hypochondriac re#ion. ,. <art of the liver located in thoracic cavity. .. ,overin# by part of the thoracic wall. 1. <art of the liver pass over ri#ht costal arc in normal adult. 2hese structures pass throu#h to the hepatic porta! 1xcept$ A. +ile ductGductus choledochus. +. *ymphatic vessels. ,. <ortal vein. .. Hepatic artery. 1. =erves fiber for the liver.

dr. Ma&un (/) 2he feature of the portal lobule is $ A. ,entral vein as it central axis +. 5t has three :ones for metabolism ,. 5t boundared by central veins of three classic lobules / .. 5t has hexa#onal in shape 1. 5t is same with classic lobule dr. u$etra (#) )all blader emptyin# is caused by $ A. 1ntero#astron secreted in duodenum +. ,holecysto inin secreted in duodenum

,. 2he present of carbohydrate di#estion product in small intestine .. ,hyme too acid 1. 2he present of peristaltic in ileum 5n enterohepatic cycle! bile 6A*2 is reabsorbed in $ A. .uodenum +. TeJunum ,. 5leum .. Ascendin# colon 1. Appendix Dr. Desa% +i0andani (#) 8hich of the followin# porphyrin derivates is conJu#ated! reacts directly and is a maJor component of bile9 A. +iliverdin +. +ilirubin di#lucoronide ,. 6tercobilin .. Arobilin 1. Heme 8hich of the followin# prophyrins #ives stools their characteristic color9 A. +iliverdin +. Arobilino#en ,. +ilirubin .. 6tercobilin 1. Heme Dr. Ma0endrade$i (#) A 34 year old man came to the hospital with chief complain massive hematemesis. 5n anamnesis! his wife told that her husband almost always drin alcohol every day since about he was '3 year old. He also felt fati#ue! decrease apetite and body wei#ht. <hysical examination show hepatosplenome#aly! ascites! dilated blood vessels around umbilical and chest. 2he possible dia#nosis of this patient is $ A. hepatic steatosis +. alcoholic hepatitis ,. alcoholic cirrhosis/ .. hepatocellular carcinoma 1. cholan#iocarcinoma 2he most common form of mali#nancy in the #allbladder is $ A. metastatic carcinoma +. an#iosarcoma

,. adenocarcinoma/ .. fibrolamellar carcinoma 1. s%uamous cell carcinoma Dr. El&santi (#) A 33 year-old man come with chief complain about icterus at his eye and s in since 2 wee s a#o! and now! it become worst Bpro#ressive(. He also complain about decreased of body wei#ht drastically in this last month. Cou suspicious about biliary obstruction that caused by mass of the pancreatic head. 5nitial ima#in# examination that is relatively inexpensive and safe that you will advice for this patient $ A. +0D +. Abdominal ultrasound ,. Abdominal ,2 scan / .. Abdominal "-5 . 1. -adioisotop scannin# 5ma#in# that can be used for ma in# dia#nosis of liver cirrhosis with portal hypertension is $ A. A6) / +. "-5 ,. +0D .. 5sotop scannin# 1. An#io#raphy hepatic Dr. +irade$i (#) 0n Hepatic cirrhosis! those condition can be occurred! 1H,1<2$ A. 5ncrease of A*2 +. .ecrease of albumin ,. 5ncrease of +ilirubin .. .ecrease of #lobulin 1. 5ncrease of A*< 5f a patient comes with chief complaint yellow eyes Bicterus(! other than physical examination! laboratory examination that you advised is$ A. .irect +ilirubin +. 5ndirect +ilirubin ,. 6tercobiline urine .. 6)02 1. 6)<2

<rof. 8ibawa B2(

dr. an1a&a (#) A ; years old boy come to doctor with due to complain of nausea! fati#ue! fever and yellowish sclera. his friends were suffer the same symptoms. 2he patient have ' siblin#s$ 4 month old twins! and 3 years old 8ho is the most needed for vaccination 9 A. His 4 months old siblin#s +. His 3 years old siblin#/ ,. His mother .. His father 1. His parents 2he definitive dia#nosis for this patient based on$ A. Anti HA@ 5# "/ +. Anti HA@ 5#) ,. 1levation of 6)02 and 6)<2 .. 1levation of bilirubine level 1. 1levation of the al ali phosphatase

<rof 8ibawa B4( .r. 6uryadarma B4( .r. 6uryadarma B2( .r. <urwadi B2( .r. <urwadi B4( 5nteractive lectures B'(