GASTRO

1. What is the function of bolus formation?

A. The preparation for swallowing

B. The preparation for starch digestion in mouth

C. The preparation for carbohydrate in intestine

D. The preparation for protein in gaster

E. The preparation for lipid in mouth

2. HCl diproduksi oleh apa?

A. D cell

B. Parietal cell

C. G cell

D. Pyloric gland

E. Chief cell

3. Process pharyngeal ketika menelan yaitu…

A. Voluntary

B. Penutupan something

C. Pharyngeal contraction push bolus to esophagus

D. Smooth muscle contract bolus to cardiac sphincter

E. Relaxation of cardiac sphincter

4. Enterokinase aktivasi enzim apa?

A. Chymotripsin
B. Tripsin

C. Procarboxypeptidase

D. Proelaste

E. Ribonuclease

5. Lipid absorption process

Emulsi triglyseride - micelles - fatty acid and monoglycerol - resintesis triglycerides - chylomicron –
exocytosis to lymphatic vessels

6. Fungsi sekretin adalah…

Merangsang sekresi getah pancreas, ( terutama NaHCO 3 ) Getah pancreas inget “ ALTEN “ Amilase,
Lipase, Tripsinogen, Enterokinase, NaHCO3.

7. What is the function of somatostatin?

Somatostatin dijumpai di sel D pulau Langerhans pancreas. Menghambat sekresi insulin, glukagon, dan
polipeptida pankreas dan mungkin bekerja lokal di dalam pulau pankreas secara parakrin.

8. Maltose dipecah menjadi…

Glucose + glucose

Tambahan : Maltosa  2 Glukosa, Laktosa  Glukosa & Galaktosa, Sukrosa  Glukosa dan Fruktosa

9. What intestinal digestive enzyme will break down polypeptide to amino acid?

A. Trypsin

B. Pepsin

C. Chemotrypsin

D. Polypeptidase

E. Peptidase
10. Gaster stretch stimulate apa? (gak terlalu inget sori)

Parasympathetic increase buat tingkatin kerja gaster

11. Effect of protein and fatty chyme in duodenum is…

A. Sekresi secretin

B. Sekresi motilin

C. Sekresi bicarbonate

D. Sekresi CCK

12. Tentang penurunan gastric activity

Kalo ga salah inget, karena saraf simpatetik menyebabkan decreased gastric activity.

Duodenal Inhibition of Gastric Secretion

The acid and semi-digested fats in the duodenum trigger the enterogastric reflex – the duodenum
sends inhibitory signals to the stomach by way of the enteric nervous system, and sends signals
to the medulla that (1) inhibit the vagal nuclei, thus reducing vagal stimulation of the stomach,
and (2) stimulate sympathetic neurons, which send inhibitory signals to the stomach. Chyme also
stimulates duodenal enteroendocrine cells to release secretin and cholecystokinin. They primarily
stimulate the pancreas and gall bladder, but also suppress gastric secretion and motility. The
effect of this is that gastrin secretion declines and the pyloric sphincter contracts tightly to limit
the admission of more chyme into the duodenum. This gives the duodenum time to work on the
chyme it has already received before being loaded with more.[1] The enteroendocrine cells also
secrete glucose dependent insulinotropic peptide. Originally called gastric-inhibitory peptide, it
is no longer thought to have a significant effect on the stomach, but to be more concerned with
stimulating insulin secretion in preparation for processing the nutrients about to be absorbed by
the small intestine.[1]

13. Main function of saliva apa?

A. Softening of food

B. Lubrication of food

C. Amylum digestion
14. Digestive enzyme with optimal pH of 1 – 3 is…

A. Amylase

B. Maltase

C. Lipase

D. Trypsin

E. Pepsin

15. Bile salt function in fat digestion is…

Emulsify

16. Digestive fat masuk ke lymphatic dalam bentuk apa?

A. Monoacylglycerol

B. Emulsi

C. Chylomicron

D. Micelles

E. Glycolioid

17. The entire process of protein digestion is finalized by the action of…

A. Trypsin

B. Chymotrypsin

C. Carboxylpeptidase

D. Aminopeptidase

E. Dipeptidase
18. Taste buds ditemukan di mana?

Papila circumvallate

19. Certain terapi antibiotik slow replacement of the cells lining the small intestines. Cause loss which
type of tissue?

A. Cilliated pseudostratified columnar epithelium

B. Simple cuboid epithelium

C. Simple columnar epithelium

D. Pseudostratified columnar epithelium with stereocilia

20. Taenia coli, adalah struktur organ spesifik pada lapisan…

A. Muscularis Mucosa

B. Muscularis Externus

C. Mucosa

D. Submucosa

E. Lamina propria
21. What will happen if the amount of Paneth cell is decreased?

A. Decreased fat digestion

B. Increased undigested protein

C. Decreased mucus production

D. Decreased glycocalyx

E. Increased bacteria amount in the intestine

22. Diarrhea may result if which of the following organs fails to carry out its role in absorbing water from
the feces?

A. Anal canal

B. Caecum

C. Colon

D. Jejunum

E. Duodenum

23. 63-year-old man comes to the ER with complaint yellow in eyes since 1 month ago. He feels unwell
since 2 month ago and his has weight loss. He is slightly fever and nausea. Physical Examination shows
sclera icteric, liver was not palpable, but the spleen was palpable. Lab test shows Hb 11, WBC 4900,
platelet 80000, SGPT 60, SGOT 75, Total bilirubin 4, direct bilirubin 3.1, HBsAg (+), AFP 450. What is the
best assist to diagnostic this patient?

A. Endoscopy

B. Plain X-ray

C. Ultrasound

D. CT scan with contrast

24. What is the most likely occur as the complication of the above case?

A. Septic shock
B. Chronic diarrhea

C. Hematemesis

D. Renal failure

E. Heart failure

25. A blood tap was taken on the patient. What is most likely to be shown?

A. Decreased potassium level

B. Decreased globulin level

C. Increased CEA level

D. Increased sodium level

E. Increased PT and INR

26. A 56 years old businessman came to the ER after coffee ground vomit. He regularly takes aspirin
prescribed by his doctor for coronary artery disease. On endoscopic procedure, the doctor found an
ulcer on the lesser curvature on the pyloric part of the stomach. Which of the following vessels is likely
to be ruptured in this case?

A. Right gastro epiploic artery

B. Left gastro epiploic artery

C. Right gastric artery

D. Left gastric artery

E. Gastro duodenal artery

27. 50 year old female come to ER with solid food dysphagia since 6 months ago. She drinks beer, like
spicy food, smoker. She consume Hydrochlorothiazide for her hypertension. Upper endoscopy distal
esophagus show stricture and..... Esophagus biopsy show benign mucosa with chronic infection. H pylori
blabla…

Etiology of the stricture?

A. Alcohol ingestion
B. Tobacco

C. Gastric Reflux

D. Hydroclorothiazide

E. Spicy food

28. The patient is at risk for which of the following conditions:

A. Esophageal Squamous Cell Carninoma

B. Esophageal Adenocarninoma

C. Gastric Cancer

D. Gastric Lymphoma

E. Duodenal Adenocarninoma

29. A 30 years old woman suffer with gastric pain and burning sensation all the time and relieved by food
and antacids. Family doctor asks her to get endoscopic examination and found ulcer in the surface of
gastric mucosa. The pathogen that may cause the disease above is…

A. Enteroaggregative E. coli

B. Helicobacter pylori

C. Yersinia enterolitica

D. Campylobacter jejuni

E. Vibrio parahaemolyticus

30. H pylori menyebabkan mekanisme apa terganggu?

LES relaxation

31. 1-month-old baby present with diarrhea since 2 days before admission. He has watery diarrhea fir 4-
6 times per day with no blood, no mucus, and acid smell, not bulky, not oily. His mother complained that
the baby has rash around his buttock. What substance that’s not properly absorbed in the case above?
A. Fats

B. Protein

C. Carbohydrate

D. Vitamin

E. Mineral

32. Pergi ke Aceh, trs pulangnya diare, no blood, no mucus

Vibrio cholera

33. (Vibrio cholerae) what is the important bacterial factor from the case above?

A. Lipopolysaccharides

B. IgA Protease

C. R antigen

D. H antigen

E. K antigen

34. Fastest drugs

Antacids

35. Different between gastric and fundus part of stomach?

Pylorus mucosanya setengah submukosa

36. Wanita, colic pain beberapa jam setelah ke Minang restaurant. Apa yang naik?

A. Unconjugated bilirubin

B. Albumin
C. Globulin

D. Conjugated bilirubin

37. Which of these structures are possibly affected?

A. Pancreatic duct

B. Common hepatic duct

C. Ascending part of duodenum

D. Cystic duct

E. Bile duct

38. 48-year-old female comes to the ER with complaint of 24 hours of epigastric pain, nausea, and
vomiting after eating a large meal at a restaurant. There is Right Upper Quadrant pain on the day before.
Her temperature is 38,5oC and her pulse is 100. Her physical examination is unremarkable. There is
epigastric tenderness on palpation, no bowel sounds, no rebound tenderness and guarding. Her
laboratory tests showed amylase 1980 (53-153) and lipase 2500 (10-150). First examination?

A. X-ray

B. USG

C. CT Scan

39. Female, 24 years old, datang dengan keluhan vomiting black tarry blood and has history of epigastric
pain after meals. Doctor performs gastric lavage and prescribe antacid and sucralfate via nasogastric
tube. Mechanism of the medicine?

A. Depressed vomit center in the brainstem

B. Increase peristaltic movement

C. Coating gastric necrotic tissue

D. Block proton pump

E. Block H2 receptor
41. A-10-month-old boy brought to the emergency department by his mother with abdominal pain and
vomiting in the recent 2 hour. The boy was brought to a pediatrician yesterday because of diarrhea; the
last stool was like red-currant-jelly and has stopped since the boy suffers the pain. On the examination
there is distended and tender abdomen, a palpable mass with sausage like appearance on right side of
abdomen, and increased bowel sound.

Which of the following findings may be seen on the plain abdominal photos?

A. Air distribution in the sigmoid colon

B. Free air under the diaphragm

C. Enlargement of liver

D. Thickening of the wall of appendix

E. Dilated small bowel with air fluid level

42. Where is the most possible anatomical location of their pathologic condition?

A. Transverse colon

B. Duodenum

C. Liver

D. Ileocecal Junction

E. Appendix

44. What is the basic mechanism that can cause shock in this patient?

A. Fluid loss due to vomiting

B. Fluid loss due to diarrhea

C. Blood loss to the intra lumen

D. Blood loss into peritoneal cavity

E. Sequestration of fluid into third space

Soal untuk 45, 46

40 year old man came to his doctor with 2 months history of intermittent upper abdominal pain. He
described the pain as dull, gnawing ache. Physical examination reveals a healthy man with epigastric
tenderness. He had been taking Piroxicam for his osteoarthritis.

45. A 40 year old man presents to his primary care physician with an intermittent upper abdominal pain.
He describes the pain as a dull, gnawing ache. The pain sometimes wakes him at night, and is relieved by
food and drinking milk. Physical examination reveals a fit, apparently healthy man. The only abnormal
finding is mild epigastric tenderness on palpation of the abdomen. He has been taken Piroxicam for the
past six months for his osteoarthritis medication. What is the protective factor of mucosal integrity that
may be impaired in this condition?

A. Mucus

B. Bicarbonate

C. Mucosal blood flow

D. Prostaglandin

E. Cell renewal

47. A 58 years old male attends accident & emergency department because of black and tarry stool. He
routinely consumes herbal medicine in powder form, bought from a local traditional drug shop. His
pulse rate was 90/min. BP 110/70 mmHg and he had no stigmata of chronic liver disease. What's the
most likely cause of black stool in patient?

A. Stomach carcinoma

B. Mallory werss tear

C. Peptic ulcer

D. Grosive gastropathy

E. Rupture esophageal varices

48. 46 years old female complaining blood in her stool 5 days ago. She had hemorrhoids since 5 years
ago when giving birth to her 5th child. With regard to the blood supply of the rectum and anus:

A. The veins do not correspond to the arteries.

B. The anal canal is the site of portosystemic anastomoses

C. It is principally from the inferior rectal artery

D. The vessel do not supply the full thickness of the anal wall.

49. A 15 year old junior high school was stabbed in the abdomen. Under laparotomy, the Inferior
mesenteric artery was ruptured. What may be found when you do surgery?

A. The descending branch of the left colic supplies the sigmoid colon only

B. There are very few anastomoses between its branches

C. Inferior mesenteric artery ends at superior rectal artery

D. Inferior mesenteric artery rise from aorta at the level L2

50. Female, icteric sclera, abdominal discomfort, hepatomegaly tenderness. Serology IgM HAV +. Which
following characteristic increase risk of fulminant hepatic failure?

A. She is pregnant

B. She is patient of chronic HCV infection

C. She had post exposure Hepatitis A during infancy

D. She is patient of chronic renal failure

E. She has previously exposure HBV and develops anti Hbs

51. ERCP masukin fiber optic-nya lewat sphincter apa?

A. Sphincter of oddi

B. Cardiac sphincter

C. Pyloric sphincter

D. Ileocecal valce

E. Ureter valve

52. A 3 year old girl, came to puskesmas with ulcer on her left leg. Through the history taking it was
revealed that she had not been well feed in the past year. BMI below SD -2. She is fully alert, but looked
pale, face appearance like thin old person. Ribs were prominent, but both legs were edema. Condition of
girl:

A. Marasmus

B. Kwashiokor

C. Marasmus-Kwashiokor

D. Energy malnutrition

E. Protein malnutrition

53. While examining a Tissue of GIT track, you notice many lymphoid tissue, surrounding a relative small
lumen. No intestinal villi is seen. What part of GIT are you examining?

A. Duodenum

B. Jejunum

C. Ileum

D. Colon

E. Appendix

54. a 62 years old man with chief complains nausea, vomiting and epigastric pain. He was given stomach
medication, three hours later, he had dyskinesia and rigidity (extra pyramidal symptoms). Which of the
following drug is most appropriate that can cause this situation?

A. Domperidone

B. Metoclopramide

C. Ondansetrone

D. Omeprazole

E. Sucralfate

55. The 18 old male presents with intermittent abdominal pain, no bloody diarrhea. The diarrheas wake
him from sleep. The few occasions, he had fever, nausea, and vomiting. PE: normal. Patient describes his
work as being stressful. He had an oral aphthous ulcer. (Sariawan) and poorly localized lower abdominal
to mid abdominal tenderness without peritoneal signs. Anal and rectal examination is normal. Fecal
occult blood (-), there are stool leukocytes. The sigmoidoscopy (normal). Hb 11.5 and Ht 34 %.

A. Acute appendicitis

B. Crohn disease

C. Colon cancer

D. IBS

E. Ulcerative colitis

56. For months, 60 years old woman had experience burning substernal pain after meal. Endoscopy
biopsy revelaed Barret's oesophagus.

A. Chronic Esophagitis

B. Ulcerative esophagitis

C. Columnar Metaplasia

D. Squamous Metaplasia

E. Benign neoplasm

57. A 30-year old women suffers gastric pain and burning sensation all the time and relieved by food and
antacid. Radiology showed ulcer at pylorus part of stomach. The doctor thinks that may be cause
infection. Most convenient test for infection?

A. Endoscopy-guide biopsy

B. Microscopic culture

C. Rapid urease test

D. Urea breath

E. CLO-slide test

58. A/An 8-year-old boy had difficulty in swallowing. Endoscopic exam reveals that there was an
abnormal relaxation of lower esophageal sphincter. Pathological examination shows a ganglionosis. What
is the diagnostic?
A. Stricture

B. Paralysis

C. Primary Achalasia

D. Secondary Achalasia (Chagas' Disease)

E. Esophagitis

59. A 55 years old male with a long history of duodenal ulcers was seen in ER after vomiting blood and
exhibiting severe hypovolemic shock. Assuming the ulcers had perforated the posterior wall of the first
part of duodenum, which artery most likely to have been eroded?

A. Splenic artery

B. Right gastric artery

C. Gastroduodenal artery

D. Right epiploica artery

E. Hepatic propia artery

60. A girl, 20 months, came with diarrhea since 2 days ago. She suffered from severe vomiting 4 days ago
for about 2 days. The vomit was the resolving but followed with watery stools 5-8 times in a day. She
started to get fever since yesterday but still able to drink a lot. What might be the most possible cause of
diarrhea?

A. bacteria

B. protozoa

C. Rotavirus

D. Coronavirus

E. Adenovirus

61. A 45 year old man was admitted to the emergency department complaining of severe pain in the
right lower quadrant of the anterior abdominal wall. He had repeatedly vomited, & his temp and pulse
rate were elevated. On examination the muscles of the lower part of the anterior abdominal wall in the
right lower quadrant showed tenderness at the McBurney point. You are at surgery for removal, but the
organ is not visible. What position of this organ is likely to be?

Retrocaecal

62. A 51-year-old man comes to your private practice with a history of mid epigastric upper abdominal
pain that diminished by eating or taking antacid tablets. He drinks 2-3 glasses of beer every night, also
taking 2-3 tablets of aspirin frequently for his stress related headache. PE reveals no evidence for blood
in the stool. You advised him to replace the aspirin with acetaminophen and stop his drinking of beer;
you give him a prescription of famotidine 20 mg bid.

Which of the following is the mechanism of action of famotidine?

A. Eradication of H. pylori

B. Increase gaster motility

C. Inhibit acid secretion

D. Naturalized gastric acid

E. Protect gastric mucosa

63. 58 year old lady who has intermittent cramping abdominal pain continuous for 2 weeks. The
abdominal radiograph shows no free air and none of the bowel sound indentified. The colonoscopy
shows patchy areas on the mucosa erythema and necrosis at ascending and descending colon. What is
the diagnosis from the finding?

A. Acute Appendicitis

B. Ischemia Colitis

C. Amoebiasis colon

D. Adenocarcinoma

E. Crohn's disease

64. A 25 years old female comes to the clinic with chief complaint of diarrhea form that 1 week duration.
The diarrhea is watery with blood and mucous. Microscopic examination shows protozoan with
pseudopodia. Which of the following is the most likely diagnosis?
A. Minuta stage of Entamoeba histolytica

B. Vegetative stage of Entamoeba histolytica

C. Cystic stage of Entamoeba histolytica

D. Vegetative stage of Entamoeba coli

E. Cystic stage of Entamoeba coli

65. Of the following, which one is the most likely mode by which this disease (upper clinical case) as
acquired?

A. Ingestion of the larvae on the organism in contaminated food

B. Ingestion of the egg on the organism in contaminated food

C. Ingestion of the cystic on the organism in contaminated food

D. Drinking unboiled water supply

E. Penetration of the skin by the organism while

66. Cewe, punya anak 2, ada lump di antara iliac crest dan tubercle pubis. Diagnosis?

A. Femoral hernia

B. Inguinal hernia

67. A 44 year old lady has had increasing nausea, vomit, colicky for the past week. The USG showed
some stones in the gallbladder. Operation was done. Which of the following specific changes is most
likely found in the gallbladder wall?

A. Atrofi mukosa epitel

B. Chronic inflammation

C. Acute inflammation

D. Sinus Rokkitansky

E. Irregular area of fibrosis

68. 78 years old dengan OA complain uncontrolled pain padahal udah dikasih paracetamol. Suggest
treatment dikasih NSAIDs tapi he has history of peptic ulcer. Obat apa yg dikasih sama NSAIDs biar gak
ada recurrence upper GI ulceration?

A. Antimuscarinic

B. Bismuth

C. Dopamine

D. PPI

E. Simple antacids

69. Kasus orang colon cancer (kalo gk salah). Trus surgery. T3N1M0 abis surgery. CEA 60… blablabla tmpt
plg sering metastasis?

A. Bone

B. Brain

C. Liver

D. Surgical scar

70. Ranitidine buat apa?

Buat block H ion dengan ngeblock H2 receptor

71. A 62 year old woman lost 11 kg in 3 months accompanied w/ loss of appetite, fatigue and decreased
sexual interest. She has no history of depression. What is the most likely diagnosis?

A. Rectal Ca

B. Hypochondriasis

C. Bullimia

D. Masked Depression

72. Blood tap done, what is the the expected result?

A. Increased CEA

B. Increase ureum and creatinin

C. Increase Ca -125

D. Increased natrium

E. Increased kalium

73. Soalnya dari ibu tua 62 thn yg rectal ca. Ada bakteri apa? (ini kalo gk salah dianulir)

A. Streptoccocus

B. Sterile, no bacteria

C. Staphylococcus aureus

74. Therapy H. pylori -> OCA

75. A boy, 7 month, came with watery stool since 3 days before. No mucus and blood found. He vomited
several times a day, and he started to get fever since yesterday. He still breastfed and eager to be fed. His
mother never clean his breast every times her baby breastfed. He started his first meal 1 month ago, and
his mother started to give him formula milk since 4 days ago. What is lose in the diarrhea?

A. Nutrient, electrolyte, mineral

B. Electrolyte, mineral, glucose

C. Glucose, mineral, nutrient

D. Electrolyte, mineral, water

E. Water, electrolyte, nutrient