1. 48yo man came to hospital bedause of swelling on both of legs, suffering Hepatitis B since 14 years ago.

PE:
abdomen enlargement, shifting dullness. The meaning of shifting dullness.
a. Method for spleen examination
b. Method for ascites
c. Method for bowel sound investigation
d. Method for gall bladder examination
e. Method for liver examination

2. Cause of glomerolunephritis
a. Renal Stones
b. Trauma
c. Immunologic process
d. Intolerance to foods
e. Shock

3. Hyperkalemia may occur in

a. Diarrhea
b. Hiperemesis
c. Oligouria
d. UTI
e. Stage I CKD

4. 40 y.o man, chief complaint: nausea, vomiting, and general weakness. Urine production decreased since last
3 weeks. Hypertension for 5 years.BP: 160/100mmHg, looked pale and having edema on both legs. Hb:
8,1g/dL (<<), BUN: 96mg/dL (>>) , serum creatinine: 5,6mg/dl (>>), K: 4.3mg/dl. Na:135 mg/dL. Diagnosis
for the px
a. Acute Kidney Injury
b. Glomerolunephritis
c. Chronic Kidney Disease
d. Diabetic Kidney Disease
e. Nephrotic syndrome

5. Anemia in the px above is mostly caused by

a. Folic acid deficiency
b. Bleeding
c. Erythropoietin Deficiency
d. Chronic disease
e. Malignancy

6. Correct definition of AKI

a. Increase SCr by ≥ 0,3mg/dL within 48 hr
b. Urine volume <0,3 ml/kg/h for 48 hr  < 0.5 ml dalam 6 jam
c. Doubling SCr level within >7 days
d. Loss of kidney function more than 3 months
e. Always irreversible

7. Organ damage malignant hypertension

a. Retinal bleeding
b. AKI
c. Acute Myocardial Infarct
d. Epistaxis
e. None of above statement
 8. Complicated UTI
a. UTI with bladder pain
b. UTI with pregnancy
c. UTI in elderly
d. cystitis
e. upper UTI

9. Stone formation in low pH (asam)

a. Oxalate stones
b. Phosphate stones, calsium
c. struvite stones
d. staghorn calculi
e. uric acid stones

10. 48yo, flank pain for last 36 hr. PE: flank pain at left sides and radiates to bladder. Suffering from vomiting
several times, nausea, mild fever, reduced urine production. Urine evaluation: increased of RBC, bacteria ++
+. The test that you choose as first step.
a. Whole body CT scan
b. XRay: IVP urgently, postpone the SCr and BUN
c. Abdominal USG and KUB
d. BUN, SCr, proceed with BOF/KUB, and IVP
e. Urine culture and AB sensitivity test

11. Not stated as main kidney function:

a. Potassium homeostasis
b. Glucose homeostasis
c. Acid base balance
d. Renin production
e. Erythropoetin production

12. The following is the cause of type 1 diabetes mellitus:

a. Destruction of beta cell pancreas
b. Glucagon deficiency
c. Leptin resistance
d. Insulin resistance
e. Corticosteroid abuse

13. Hypoglycemia is acute condition which blood glucose level decrease

a. < 30 mg/dl
b. < 50 mg/dl
c. < 60 mg/dl
d. < 70 mg/dl
e. < 100 mg/dl

14. marker of renal complication in diabetes mellitus is

a. hypertension
b. hematuria
c. proteinuria
d. lekosituria
e. bacteriuria

15. drug that is used for hypothyroid:

a. propylthiouracil
 b. levothyroxine
c. metimazole
d. propranolol
e. hydrocortisone

16. Addison disease is caused by:

a. Cortisol excess
b. Cortisol insufficiency
c. Thyroid excess
d. Thyroid insufficiency
e. Glucagon excess

17. A 19-years old woman is evaluated for palpitation and sweating for 2 months. She had loose of body weight.
Her blood pressure is 150/100mmHg, pulse rate 120 x/min and BMI 17,8. The thyroid gland is diffuse enlarged
with exopthalmus on eye. What is the most probable of her diagnosis?
a. Thyroid cancer
b. Colloid nodule
c. Hashimoto thyroiditis
d. Graves disease-> hypertiroid
e. Subacute thyroiditis

18. A healthy 50-years old man with strong family history of type 2 diabetes mellitus requests an oral glucose
tolerance test to evaluate his risk of developing diabetes mellitus. The results of a 75 gram-2 hours oral glucose
tolerance test are as follows:
Fasting plasma glucose 104 mg/dL
2 hours plasma glucose 168 mg/Dl
which is the following characterizes the patient’s glycemic status:
a. Normal glucose tolerance
b. Type 2 diabetes mellitus
c. Impaired fasting glucose and glucose tolerance
d. Impaired glucose tolerance
e. Impaired fasting glucose

19. A 45-year old man with obesity, came to primary health care with laboratory result as follows:
Fasting plasma glucose 160 mg/dL
2 hours plasma glucose 257 mg/dL
the first line treatment for this patient: DM typ 2
a. Only diet and exercise
b. Penyuluhan, Diet, exercise, and metformin
c. Diet, exercise, and sulfonylurse
d. Diet, exercise, and gliptin therapy
e. Diet. Exercise, and insulin

20. A 60- year old woman came to primary health clinic with hypotension (blood pressure 90/60 mmHg) and
bradycardi (50 x/min). Physical examination showed enlarged of thyroid gland no exopthalmus. On history
taking she also had weakness and increased of body weight. Which the following test you will choose as the
first step: -> hipotiroid
a. Thyroid function test
b. Chest x-ray
c. Thyroid antibody test
d. Thyroid biopsy
e. Thyroid ultrasound
21. Which type of this condition is directly related to bone marrow suppression ?
A. Aplastic Anemia
B. Hemolytic Anemia
C. Sickle Cell Anemia
D. Megaloblastic Anemia
E. Iron Deficiency

22. The medical treatment for Multiple Myeloma is :

A. Leukeran
B. Myleran
C. Alkeran
D. Hydroxyurea
E. Nexavar

23. Bone Marrow Aspiration of AML patient shows

A. Auer Rod
B. Leukemic Gap Negative
C. Myeloblast Cell < 30%
D. Hypocellular
E. Lymphoblast Cell > 30%

24. The Main Purpose of Induction Therapy in Acute leukemia is :

A. To prevent spreading to CNS
B. To prevent relapse
C. Eradication of blast cell
D. Eradication of Infection
E. To prevent bleeding

25. A 65 year old male complained since 3 months there were enlargement of Lymph Nodes on his right and
left neck, never had fever, no epistaxis or other forms of bleeding. On physical examination :
Lymphadenopathy in 3-5 nodes in both right and left neck with 1 cm, the nodes were loose from each other,
liver enlarged 2 fingers s.b.l.c.m, Spleen was also enlarged S2, Hb 12 g%, thrombocyte count 120000/cmm;
WBC 50000; Diff Count -/-/-/10/85/5.
The most probable diagnosis of his disease is
A. Acute Lymphoid Leukemia
B. Chronic Lymphoid leukemia
C. Acute Myeloid Leukemia
D. Chronic Myeloid Leukemia
E. Malignant Hypertension

26. Specific sign of ALL is

A. Leukocytosis
B. Gingival infiltration
C. Anemia
D. CNS infiltration
E. Lymphadenopathy

27. Preformed mediator released by mast cell i.e

A. PAF
B. Tryptase, heparin, chemose, histamine releasing factor
C. Leukotriene
D. Thromboxane
E. Prostaglandin

28. Gold standard for diagnosing food allergy is

A. Skin Prick Test
B. Atopy Patch Test
C. Double blind placebo controlled food challenge test
D. Food elimination diets
E. Food allergen specific serum IgE
conduct a double-blinded, placebo-controlled oral food challenge, which is considered to
be the gold standard for food allergy diagnosis.
29. Adverse food reaction which is mixed IgE and non-IgE mediated i.e
A. Oral Allergy Syndrome
B. Allergic eosinophilic esophagitis
C. Immediate Gastrointestinal hypersensitivity
D. Food Protein induced enteropathy
E. Celiac disease

30. The characterized fever of typhoid fever is :

A. Step Ladder Type
B. Saddle Back fever Type
C. Relapsing Type
D. Remittent type
E. Intermittent Type

31. Pathogenomonic finding in thypoid fever is:

a. hepatomegaly
b. spleenomegaly
c. roseola spot
d. cardiomegaly
e. edema

32. right statement about DHF

a. vector bite 2 times a day
b. incubation period 3 weeks
c. vector lives in dirty area
d. manifestation fever is saddle back
e. secondary infection is less severe

33. Antibiotics for leptospirosis prevention during outbreak

a. ceftriaxon
b. ampicilin
c. doxycyclin
d. cloramphenicol
e. penicilline procaine

34. 50 years old male, fever 5 days. PE : compos mentis, icterus +, ptechiae +. pain in leg. Lab : Hb
13, WBC 14.000, platelet 70.000 (<<). Urine output 200 cc, urine sediment: eritrocyte +++, leucocyte
+++. Most likely diagnosis
a. DHF
b. Weill's disease
c. Thypoid fever
d. Malaria
e. UTI

35. 28 years old ada abnormal ELISA for HIV. Had stick needle injury 8 years ago from HIV seronegative
source patient and did not receive RT prophylaxis. LAB : HIV RNA viral load is slightly elevated at 82
copies (normal <75 copies). Appropriate management is
a. Recheck plasma HIV RNA viral load now
b. Recheck HIV serologic study in 3 months and 6 months
c. Begin highly active ART now
d. Begin highly active ART if CD4 cell count decreases to less than 350 or she becomes symptomatic
e. Check serologic study for opportunistic infection

36. Regiment for Dengue infection

a. antipyretic and artemisine
b. analgesic and cephalosphorin
c. antipyretic and fluid therapy
d. NSAIDs and fluid therapy
e. antiviral and fluid therapy

37. arthritis symmetrical on PIP, MCP, wrist, shoulder, cubitus, specific in

a. arthritis inflammatory
b. OA
c. psoriatic arthritis
d.RA
e. Gout

38. True about gout arthritis

a. most in women
b. Punch out lesion
c. Mostly polyarthritis
d. Steroid is contraindication in acute attack
e. Acte attack occurs during exertion  physical and mental abnormal

39. 56 years old woman complaint joint pain and stiffness. SIgn of symptoms would be indicative as
inflammatory cause of acute arthritis, EXCEPT:
a. LED increase
b. Persistance more than 6 weeks
c. Presence soft tissue swelling around affected joint
d. fatigue, fever, weight loss
e. prolonged meeting stiffness

40. 63 years old male, acutely painful right toe, after drinking binge. The toe is swollen, erythematous,
tender to touch. patient currently taking furosemide, atenolol, ramipril, and aspirin. Most important
investigation is
a. sesrum uric acid
b. plain radiograph
c. synovial fluid aspirate
d. full blood count
e. bood culture

41. which one is the sign or symptom that reflects portal hypertension (caput medusa & hypersplenism) in liver
cirrhosis:
a. spider naevi
b. hypoalbuminemia
c. hyperbilirubinemia
d. splenomegaly
e. hepatomegaly

42. empirical treatment for spontaneous bacterial peritonitis related to liver cirrhosis, based on :
a. ascitic fluid culture
b. pmn cell in ascitic fluid
c. billirubin level
d. ultrasonography finding
e. serum albumin level

43. definitive diagnosis of non alcoholic fatty liver disease is based on :

a. liver function test
b. blood glucose level and lipid profile
c. abdominal ultrasound
d. liver biopsy
e. abdominal ct scan

44. which one option that is true for hepatitis b virus infection
a. hepatitis b virus is rna virus
b. mode of transmission among western countries is vertical transmission
c. acute infection can be resolved
d. no prevention with active immunization
e. this virus is non enveloped
45. the principal management for h. pylory erradication is
a. antacid
b. h2 blocker
c. antibiotics combination
d. prokinetic agents
e. supportive agents

46. definitive diagnosis of gastric ulcer is based on

a. abdominal plain x ray
b. serological test
c. USG
d. upper GIT endoscopy
e. urea breath test

47. this one is true about acute pancreatitis , except:

a. fever
b. positive cullen sign
c. abdominal pain
d. positive murphy sign
e. high amylase and lypase

48. this is true about phospat organic intoxication except

a. acts as cholinesterase inhibitor
b. naloxon is the antidote (for opioid)
c. plasma choline esterase level reflects severity of intoxication
d. has nicotinic effect
e. has muscarinic effect

49. cardiomyopathy which is characterized by impaired ventricular filling because restrictive of myocardium is
a. hypertrophic cardiomyopathy
b. restrictive cardiomyopathy
c. dilated cardiomyopathy
d. peripartum cardiomyopathy stenosis
e. takotsubo cardiomyopathy

50. among heart failure profiles , which has the highest mortality ?
a. wet and warm
b. dry and cold
c. wet and cold

51. in algorithm for management of acute pulmonary edema which must be addressed first ?
a. high blood pressure
b. hypoxemia
c. urine production
d. severe anxiety
e. high blood glucose

52. these minor criteria from duke for diagnosis of IE (infective endocarditis ), EXCEPT :
a. two or more positive blood culture
b. fever
c. vascular phenomenon
d. osler node
e. rheumatoid factor

53. which of the following medication is most useful in a patient with diabetes who is hypertensive and has evidence
for microalbuminuria ?
a. metoprolol
b. valsartan
c. clonidine
d. nifedipine
e. respirine

54. a 65 years old women with a long history of uncontrolled diabetes hypertension and valcular heart disease
presents for evaluation. She is fatique and complains of swelling in her legs and shortness of breath. Which of the
following is the distinguishing feature of left ventricular valvular problem
a. elevated liver enzymes
b. pulmonary edema
c. ascites
d. peripheral edema
e. jugular venous distention

55. a 54 years old women is brought to the ER with palpitation and dizziness. She has a history of arrhythmia .
adenosine is given and the patient converts to a sinus rhythm. Which of the following rythms did this patient most
likely present in the ER ?
a. ventricular tachychardy
b. atrial fibrillation
c. atrial flutter
d. paroxysmal supraventricular tachycardia
e. sinus arrhythmia

56. while examining a 46 y.o woman , you hear diastolic murmurs that is increased when the patient is in the lateral
decubitus position . you ask her to run in place for 3 mins,and the murmer is found to be accentuated as well by
excersise. What is most likely the valvular defect ?
a. aortic regurgitation
b. mitral stenosis
c. tricuspid stenosis
d. pulmonic regurtation
e. vsd

57. while examining the patient you heard a heart murmur. Which one of the following characteristics should
prompt a referral to a cardiologist for further evaluation n
a. any systolic murmur
b. any diastolic murmur
c. any murmur that gets softer with valsava maneuver
d. any murmur that gets softer when the patient stands
e. a late systiolic murmur that is procededed by a mid systolic click

58. 45. Y.o man presents with chest pain , fatigue and dyspnea . he was well until 2 days prior when he noted onset
of sharp chest pain radiating to the left arm. The pain gets worse and is increased when coughing
Bp: 88/50
Pulse : 97
Rr: 20

Ada pict of foto thorax x ray

 a. Acute MI
b. Dissecting aortic aneurysm
c. Acute pericarditis
d. Acute pulmonary embolism
e. Pneumothorax

59. 16 years old boy came to a clinic for sports physical. You followed him for many years and he has always been
healthy. He continues to be healthy and has no concerns. On physical examination, the only abnormality that you
discovered is an irregular heart rhythm. You order a rhythm strip which is shown In figure. Diagnosis ?
a. atrial premature beats
b.sick sinus syndrome
c.SA block
d.Sinus arrhythmia
e.Supraventrucular tachychardia

60 . a 40 y o old man presented to the emergency ward with a history of flu like illness , fever and malaise, followed
by shortness of breath he was not asthmatic . he had a 13 year history of psoriasis treated with topical steroid . an
ecg related t wave inversion is the anterolateral leads. The possible diagnosis for this patient :
a. Acute coronary syndrome
b. Unstable angina
c. infective endocarditis
d. myocarditis
e. cardiomyopathy

66. Mengatasi prolong heart failure klo ga salah:

67.Physical exam of left pneumothorax:

68. Bronchial sound:

69. The characteristic of COPD :

75. COPD diagnosed based on:

76. 45 y.o male cough for 1 month, yellowish sputum, low grade fever, body weight decrease. Physical exam: trachea
retracted to the left, dullness of percussion, bronchovesicular and ronchi on upper part of the left lung, diagnosis?

77.unexplained acute lower respiratory illness with fever, cough, shortness of breath. There was history close
contact with H5N1 patient. Lab exam: influenza A +, but insufficient lab evidence for H5N1. Indication?
a. suspected avian flu
b. probable avian flu
c. confirmed avian flu

78. smear + TB, has been treated with HRZE for 2 month. At the end of intensive phase shows AFB 2+, decision?

79. the empirical treatment for spontaneous bacterial peritonitis related to lives cirrhosis, based on: PMN cells in
ascetic fluid
80. definitive diagnosis of non-alcoholic fatty liver disease (NAFLD) is based on: Liver biopsy
81. the hiker suddenly suffer from shortness of breath and severe hypoxemia. The RR is 36xx/min and the HR is
120x/min. There is a cyanosis in peripheral limb, extremity, accompanied with pink puffy sputum. There is wheezing
and ronchi/rales in the lung. The hiker possibly suffered from :
a. hypovolemic shock
b. HAPE (high altitude pulmo edema)
c. Pneumothorax due to the rupture of the blebs
d. acute exacerbation of asthma bronchiale
e. active tuberculosis

82. as a physician, you have decided to treat 26 yo pregnant woman with category 2 of anti TB drugs, what is TB
drug has to be avoided ?
a. isoniazid
b. rifampicin
c. ethambutol
d.pyrazinamide
e.streptomycin

83. a 17 yo male complainsof having nodules on his neck for a month. According to your examination the nodules
are multiple and soft in both left and right neck which is located behind and along the sternocleidomastoid muscle.
On the history taking , tha patient also has had cough for 2 monthsand decreasing of Bodyweight. Which is the
following test you will choose as the first step?
a. chest xray
b. sputum cytology
c. sputum smear for AFB (Acid Fast Bacili)
d. CT scan of the cervical
e. Lymphnode biopsy for pathological exam

84. a 40 yo man came to the hospital due to cough and shortness of breath. Cough with yellowish sputum since 4
days before. There was also little hemoptysis . there was fever for 4 days, right chest pain during breathing. There
was dullness on the right chest percussion, rhonchi and bronchovesicular breathing sound on auscultation. His
diagnosis is :
a. pneumonia
b. tb
c. lung edema
d. pneumothorax
e. COPD

85. a 55 yo smoker man comes to the ER with chief complaint breathlessness. He had shortness of breath and cough
for 5 years. On the chest physical exam there are barrel chest, and wheezing on both lung. Which of the folllowing
medication as the first choice for this patient? emfisema
a. oxygen
b. antibiotics
c.aminophylline
d.salbutamol inhalation
e. methylprednisolone orally

86. sign and symptoms for anaphylaxis reaction :

1. hypotension
2. urticaria
3. tachycardia
4.laryngeal edema

87. “Alarm symptoms” of dyspepsia syndrome are : (c) -> susah digest
1. obstipasi
2. anemia
3. abdominal discomfort
4. loss of body weight
88. sign and symptoms of “irritable bowel syndrome” consist of :
1. diarrhea
2. obstipasi -- constipation
3. pencil like stool
4. hematoschezia

89. the severe of liver cirrhosis were determined with parameters : protrombin time jugaaa
1. serum albumin level
2. bilirubin level
3. ascites
4. nutritional status

90. screening test for Hepatitis B vaccination are :

1. HBsAg
2. HBeAg
3. HBsAb
4. HBV DNA

91. This condition related with risk factors for hepatocellular carcinoma
1. Viral b hepatitis
2. Liver cirrhosis
3. Viral c hepatitis infection
4. Autoimmune hepatitis

92. Which typical chest pain is considered as unstable angina?

1. Rest angina
2. Increasing in intensity duration and or frequency
3. New onset (less than 2 months) severe angina
4. Retrosternal chest pain  bisa stable jugaa

93. As one of the commonly used drug in hypertension CCB may cause
1. Peripheral edema
2. Flushing
3. Constipation
4. Hyperkalemia

94. Which is true about tension pneumothorax?

1. Gradual onset
2. There are shifting of mediastinum and trachea
3. Increase of tactile fremitus
4. Ipsilateral depressed hemi-diaphragm

95. Cause of aplastic anemia

1. Gold
2. Radiation exposure
3. Viral infection
4. Carbamazepine

96. Which of the following statements regarding SLE is correct?

1. First manifestation of the disease may be idiopathic thrombocytopeni purpura
2. When evidence of mild nephritis is present a renal biopsy is unnecessary
3. There is a female preponderances of 8:1
4. When disease is active the level of c3 and c4 are raised

97. Which of the following statements regarding rheumatoid arthritis is true?

1. Rheumatoid factor is not protective of the disease severity
2. Osteophytes
3. Related gene hla-b-27
4. Synovial proliferation

98. The right statements about leptospirosis:

1. Caused by virus
2. Outbreak often happens on flood area
3. Dx is baswed on stool culture
4. Tx regiment is antibiotic

99. The right statements about HIV/AIDS?

1. Risk factor sxual contact with an infected person parental exposure to infected blood by transfusion or
needle sharing, perinatal exposure
2. Prominent systemic complaints such as sweats, diarrhea, weight loss and wasting
3. Opportunistic infections due to diminished cellular immunity often life threatening
4. Aggressive cancers particularly kaposi sarcoma and extranadol lymphoma

100. Typhoid fever can be chararacterized by the following statements

1. The illness usually is acquired from indigestation of contaminated food, water or milk
2. Leucopenia is more common than leukocytosis in acutely ill person
3. Chloramphenicol is not effective in preventing relapse  uda banyak yang resisten
4. Flurropinolone antibiotics eradicate the organism even in the presence of gallstones  S.thypii suka
tinggal di spleen liver bone marrow