MCQ TROPICAL MEDICINE 2010

1. An apparently run-down but alert 34-year-old woman comes to

your office after 6 months spent as a teacher in a rural West
Sumba. Her chief complaints are frequent headaches, occasionally
nausea and vomiting, and periodic fever. To rule out your
differential diagnosis, a smear of finger-stick blood was done.
Which of the following choices would fit your diagnosis based on
your microscopic examination of the blood smear?
a. Schizonts in red cells with 8-12 progeny
b. Rounded gametocytes present
c. Enlarged, somewhat misshapen in red cells
d. Large ovoid parasites in some of the red cells
e. Band-shaped tropozoites in infected red cells

2. A 20-year-old woman came to the emergency room with high

fever from 5 days ago. She also has headache and pain in
retroorbita, abdominal pain and bloody stool. On physical
examination, she was in an agitated condition. Her BP 90/60 mmHg,
heart rate 110x/ minute, RR 20x/ minute and there were purpura in
her arm, hand and leg. Which of the following examination is the
most appropriate to establish the diagnosis?
a. Prick test
b. Dengue IgM-IgG
c. Complete blood test
d. Widal test
e. Stool analysis

3. A 32-year-old female developed a “flu-like” syndrome with high

fever up to 400C, anorexia, headache, and myalgia. Four days later,
she become confused and agitated with difficult to breath. Chest x-
ray showed parenchymal infiltrate. One of her kids has also these
symptoms, and has already passed away. In order to provide
laboratory conformation of the pathogenic agent, a tissue culture
was ordered.
Which of the following would be the best specimen for isolating the
pathogenic agent responsible for this infection?  AI
a. Stool
b. Blood
c. Saliva
 d. Lung biopsy
e. Nasopharyngeal swab

4. A 16-year-old boy presents with an annoying cough, which he has

had for about 3 weeks. The illness started with a runny nose. On
examination he is completely normal, but he exhibits several
episodes of severe coughing. He has difficulty to take deep breath
and usually ends up with vomiting. Of the following, the MOST likely
diagnosis is
a. Tonsilitis
b. Bronchiolitis
c. Pertusis
d. Laryngitis
e. Diphteria
5. A young man was admitted to hospital after increasing left arm
pain and paresthesia. Several days ago, he was bitten by a dog. His
symptoms increased and were accompanied by hand spasm and
sweating on the right side of the face and trunk. This patient was
admitted to the hospital the day after developing dysphagia,
hydrophobia, hypersalivation, and disorientation.
Which of the following pathologic feature is most likely found in
dog’s brain?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell

Question 6-7 are linked to the following case:

A 32-year-old worker from a farm comes with a painless dermal papule
on his right hand which started to develop since five days ago. The
worker says as the lesion getting bigger, and the skin becomes black.
He has tender axillaries lymph node enlargement.

6. What antibiotic should the doctor give to treat the worker?

a. Tetracycline
b. Aminoglycoside
c. Ciprofloxacin
d. Neomycin
e. Crystalline penicillin G
7. Which of the following virulence factors is most likely to be
involved in the pathogenesis of illness?
a. Exotoxin
b. Endotoxin
c. α-hemolysin
d. Lipopolysaccharide
e. Antiphagotic factors

8. A 45-year-old man was seen in the dermatology clinic because of

some nodules on his arm and body and sometimes feel pain with
pressure. On examinations we found erythematous nodules, smooth
and shiny, diffuse infiltrate with ill define border, no fluctuation or
erosion. There were pain on his elbow with nerve enlargement.
What laboratory test would you do to confirm the clinical diagnosis?
a. TPHA and VDRL
b. Gram preparation
c. KOH preparation
d. Skin scrapping
e. Skin slit smear

9. A 40-year-old patient comes with the complaints of

uncomfortable stomach & flatulence. From history, the patient was
known live in the valley of Napu, Sulawesi and he had a fever
frequently. On physical examination, his liver was found enlarged.
Which one of the following test can be used to confirm the
diagnosis?
a. Blood test
b. Liver biopsy
c. Rectal biopsy
d. Stool examination
e. CT scan

10. A 53-year-old male farmer developed low-grade fever, abdominal

pain, and diarrhea. He has a skin lesion of black eschar surrounded
 by vesicle and edema near his mouth. A week before, his notice
many cattle in his farm were sick, but he still eats a half-done beef
steak from his cattle.
What is the following microorganism is most likely involved in this
case?
a. Bacteroides fragillis
b. Leptospira interrogans
c. Bacillus anthracis
d. Pasteurella pestis
e. Borrelia burgdorferi

11. A woman, recently returned from Lampung, complains of having

paroxysmal attacks of chills, fever, and sweating; these attacks
last a day or two at a time and recur every 36 to 48 h. Which of the
following is the most appropriate time to take blood specimen to
establish the diagnosis?
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever

12. A very depressed woman took 20 tablets of a hypnotic drug

belonging to her husband about less than 30 minutes ago. As she
was being taken to the hospital, she developed hypotension,
tachycardia, and tachypneu. She’s also unconscious. Which of the
following is the most appropriate management for this patient?
a. Give apomorphine intramuscular
b. Doing gastric lavage
c. Infuse with sodium bicarbonate  alkalisasi urin buat enhance
pengeluaran phenobarbital dan other long acting barbiturates
d. Give activated charcoal via NGT (nasogastric tube)
e. Doing a hemodialysis
13. An outbreak of pulmonary tuberculosis (TB) in a dormitory, and
this outbreak were presumed to be caused by the same source of
infection, based on the results of restriction fragment length
polymorphism (RFLP) analysis and other findings. Which of the
following health intervention is the most appropriate for the case
above?

a. Rehabilitation

b. Prevention

c. Curative

d. Medication

e. Environmental Modification

14. There is an RNA virus that causes deadly outbreaks of

hemorrhagic disease in Africa. The patents have developed fever,
headache, and muscle pain followed by abdominal pain, diarrhea,
and rash, with both internal and external bleeding. In each
outbreak, hospital staff became infected. This virus is highly
virulent. Which of the following is the most likely transmission for
this disease?
a. Contact with blood or body fluid
b. Transmitted by mosquitoes bite
c. Transmitted to human from rodent excreta
d. Aerosol transmission
e. Direct contact with cattle product

15. A 31-year-old man presented with complaints of high fever,

cough, and shortness of breath. Two hours before admission, he
experienced right-sided chest pain when took a deep breath or
coughed. Chest film showed diffused bilateral interstitial pulmonary
infiltrate. Arterial blood gases showed a PO 2 of 60 mmHg with 91%
hemoglobin saturation. The hematologic, serum and liver tests
were normal. He lives near the poultry, and the pathogenic agent is
a new virus. Which of the following is the prevention for this
disease?
a. Vaccine
b. Antitoxin
 c. Antibiotic
d. Antiviral
e. Antidotes

Question 16-17 are linked to the following case:

A 28-year old man presented with 8-day history of increasing fever,
malaise, headache, and constipation. He did not receive any prior
vaccinations. His vital signs revealed temperature 390C, BP 130/90,
pulse 72x/min. His physical examination revealed mild
hepatospleenomegaly and faint erythematous macules.

16. Which of the following is most likely to have caused this man’s
illness?
a. Vibrio cholerae
b. Shigella dysentriae
c. Salmonella typhi
d. Entamoeba histolitica
e. Giardia lambia

17. Which of the following specimen is most appropriate for case

above?
a. Feces  untuk carrier
b. Blood
c. Urine
d. Throat swab
e. Biopsy

Question 18-19 are linked to the following case:

A 44-year old man on a business trip to South Kalimantan from Jakarta
presented to the emergency department with symptoms of diarrhea
and abdominal pain. On physical examination was found pitting edema
of the abdominal wall and of the legs. A stool specimen was sent to
the laboratory for culture and for ova and parasites. Blood was drawn
for a CBC. The culture was negative for enteric pathogens. The patient
was found to have eosinophilia. The wet mounts from the
concentrated stool specimens revealed large, ellipsoidal, operculated
parasite eggs with thin, transparent shells (140 x 85 µm).
18. Of the following, which parasite can be the cause of this disorder
:
a. Schistosoma japonicum
b. Fasciolopsis buski
c. Trichinella spiralis
d. Echinococcus granulosus
e. Clonorchis sinensis

19. Refer to the previous case, the mechanism of edema is due to :

a. Host-allergic response to metabolic wastes of parasite
b. Reaction to the parasite as it migrates through the tissues
c. Reaction to embolization of eggs
d. Immediate hypersensitivity reaction to the adult worms in the
intestine
e. Eggs damage the wall of intestine

20. A 24-year-old man returned from Papua Island. Five days later, he
developed repeating intense chills and high fevers. These severe
episodes of fever had been occurring every other day. In between
these episodes, he had low-grade fever, myalgia, nausea, vomiting, and
diarrhea. A few hours ago, he was admitted to ICU in coma. He
became progressively somnolent and died a week later. Which of
the following organs does this infectious agent initially proliferate
after entry in the infected host?
a. Heart
b. Liver
c. Brain
d. Spleen
e. Renal

21. A 61-year-old man was seen in the Neurology Clinic for evaluation
of a peripheral neuropathy. He was found to have dermal
hyperpigmentation/depigmentation (salt/pepper) of the skin, scaly
 palms, and transverse ridges on his fingernails which were
identified as being a result of a chronic chemical intoxication.
Which of the following is the most likely chemical agent caused that
sign and symptoms?
a. Acetaminophen
b. Arsenic
c. Cyanide
d. Fluoride
e. Iron

22. A 45-year-old man from the Middle East had fever and chills, with
weight loss, sweats, headache, muscle pain, fatigue, and
depression. From physical examination the doctor found
lymphadenopathy and spleenomegaly. The man is a daily farmer
and a couple weeks before the symptoms appeared he drank a
glass of unpasteurized cow milk. The culture of blood grew a tiny
Gram-negative coccobacilus, catalase and oxidase-positive; that
resemble fine grains of sand. The patient was probably infected
with which of the following microorganism?
a. Mycobcaterium tuberculosis
b. Salmonella typhi
c. Brucella species
d. Pasteurella pestis
e. Staphylococcus aureus

23. A 55-year-old warden found a dead muskrat on the bank of a

stream. He picks up the animal and buried it. Four days later, he
developed a 1.5 cm painful ulcer on the index finger of his right
arm, a 1 cm ulcer on his right forehead, and pain in his right axilla.
Physical examination also revealed right axillary lymphadenopathy.
Which of the following is working diagnosis for this patient?
a. Brucellosis
b. Pertusis
c. Leptospirosis
d. Tularemia
e. Hydatidosis

Question 24-25 are linked to the following case:

A volunteer man returning from a tsunami area was admitted to
hospital. A week before, he had fever, headache and myalgia
especially at calf. These symptoms resolved, but the day before
admission he became pyrexia and on examination was found to be
jaundice and to have an elevated blood urea. Urine was collected and
inoculated into a semisolid agar medium, and examined by dark
ground microscopy.

24. Which of the following is your working diagnosis?

a. Syphillis
b. Pertusis
c. Weil’s disease
d. Lyme disease
e. Relapsing fever

25. Which of the following disease is the complication of this

disease?
a. Pulmonary hemorrhage
b. Myopericarditis
c. Aseptic meningitis  anicteriic
d. Osteomyelitis
e. Anemia

26. A 39-year-old woman live in Manokwari, Papua Island developed

a major seizure while at work. She had no history of epileptic
disease. A head MRI was remarkable for a lesion surrounding a
scolex. The etiologic agent would most plausibly have been
acquired by eating or dinking which of the following food items?
a. Uncooked vegetables
b. Raw beef
c. Raw pork
d. Uncooked fish
e. Unfiltered water

27. A young boy had wart-like skin lesions with the appearance of
strawberries in his legs. Later, this lesion destroys the bone of his
legs (gummata), but there are no visceral and nervous system
complications. The disease is still endemic in hot tropical
countries, such as Indonesia. Which of the following examination is
the most appropriate to diagnosis the disease above?
a. Widal test
 b. IgM-IgG of Treponema
c. Dark-field microscope
d. FTA-ABS and TP-PA test
e. ELIZA assay

28. A 27-year-old man develops acute severe encephalitis that

requires hospitalization. Several days before he got that disease,
he recognizes that many pigs in his farm were died.
Which of the following is most appropriated natural host for the
pathogen?
a. Arthropod
b. Horse
c. Bats
d. Squirrel
e. Rats

29. A female tourist developed gastroenteritis while visiting small

town in Indonesia and tried some Indonesian traditional food. The
onset of the disease is abrupt with abdominal cramps and watery
diarrhea. She had no fever or nausea or vomiting. The symptoms
have resolved within 24 hour and no subsequent recurrences. They
report the disease to district public health office. The investigation
found that one of the food products eaten by this tourist was
contaminated by suspected pathogens. What is the suspected
pathogen may cause the disease above?
a. Salmonella typhi
b. Shigella dysenteriae  bloody
c. Enterohemorragic E. coli  bloody
d. Staphylococcus aureus  nausea
e. Enterotoxigenic E.coli
30. A 23-year-old man sees his family physician with a sudden onset
of 4-day history of fevers, headache, retro-orbital pain, myalgia and
rash. Physical examination shows diffuse erythroderma with
blanching erythema and petechial formation resulting from pressure
applied to her skin. Laboratory test reveal lymphopenia and
thrombocytopenia. Which of the following virus is most likely
responsible for this infection?
a. Morbili
b. Dengue
c. Influenza
 d. Coxsackie
e. Rhinovirus

31. A 48 year old lady came to the outpatient clinic with chief
complaint of fatigue and difficulty in concentration for the last 2
weeks. The history taking revealed that she had a balanced diet, no
history of chronic disease and had been a heavy smoker for 20
years. On physical exam it was found that she had anaemic
conjunctiva with other findings was within normal limit. The
laboratory examination showed that she had haemolytic anemia.
Based on the information given above, what is the most likely cause
for her condition?
a. Vitamin K deficiency
b. Copper deficiency
c. Vitamin E deficiency
d. Iron deficiency
e. Folate deficiency

32. A laboratory examination of a leprosy patient after 4 months MDT

therapy revealed Bacterial index 6+ and morphological index 50%.
What is your conclution for this result ?
a. Pausibacillar leprosy patient sensitive to treatment
b. Multibacillar leprosy patient sensitive to treatment
c. Multibacillar leprosy patient resistent to treatment
d. Pausibacillar leprosy patient resistent to treatment
e. Pausibacillar leprosy patient prone to nerve damage

33. A boy brought by his mother to the emergency department of

Siloam hospital because of vomit & dyspnoea. According to his
mother, her son was playing in the backyard. On physical
examination, the boy was found to have high fever (39 ºC) and
multiple stinging on the back. The most likely species of insect
bites is:
a. Hymenoptera sp
b. Dermacentos andersoni
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria
34. A 28 year old lady came to the Posyandu to have a nutrition
consultation. Last year, she delivered a stillbirth baby with a spinal
disorder. She and her husband start planning to have a baby again.
She asked for suggestion about her dietary intake before she got
pregnant.
What kind of diet does she need to prevent the same disorder for
her future baby?
a. Dark green vegetables
b. Pasteurized milk
c. Deep water fishes
d. Boiled eggs
e. Lean beef

35. A 27 year old woman in at term pregnancy had fluctuated fever

since 2 weeks ago. She looked pale, generalized weakness, and
headache. She went to public health center and was prescribed
oral chloramphenicol in doses of 500 mg four times daily and
paracetamol 500 mg three times daily. She did not tell to the
physician that she was pregnant. What is the expected side effect
of the drug you will find on the baby?
a. Reye syndrome
b. Gray syndrome
c. Down syndrome
d. ADHD
e. Black water fever

36. A 35 year old man, a businessman, came to private doctor. He

asked the physician about his plan to go to Papua, which is
endemic malaria. The physician suggested him to take prophylactic
drug. Which medication (WHO recommended) would be given to this
patient for prophylactic?
a. Kina
b. Chloroquine
c. Doxycycline
d. Kuinin
e. Primakuin
37. A 40 year old man came to hospital with four times generalized
tonic-clonic seizure since two week ago. There was no history of
seizure and head trauma. A one year ago, he had business in Papua
for six months. During his stay in there, he often consumed under-
cooked pork. Brain MRI showed a small cystic with invaginated
scolex inside. What of this following is the most likely inside cyst?
a. Taenia eggs
b. Cycticercosis cellulose
c. Cysticercosis bovis
d. Taenia solium worm
e. Taenia saginata worm

38. An 8-day-old infant was born with the help of shaman (‘dukun
beranak’). The mother states his son became irritable since 2 days
ago, and now any loud noise appears to cause him pain, as
evidenced by muscle tightening and back arching causing his head
to nearly touch his feet. Physical examination reveals only a dried
packing on his umbilical cord, as is the local custom. He appears
normal until he is stimulated by touch or a loud noise, and then he
begins to cry, stiffens, and arches his back. The stiffness continues
until he calms down. Of the following, the MOST likely diagnosis is:
a. Bacterial meningitis
b. Botulism
c. Generalized seizure
d. Tetanus
e. Viral encephalitis

Question 39-40 are linked to the following case:

A worried mother brings her 18-month-old son to the emergency
department because of a rash that developed today. She reports that
he has had a runny nose, conjunctivitis, and diarrhea. On physical
examination, he appears severely ill, is temperature to 40°C for the
last 3 days and has diffuse 2 – 3 mm erythematous rash beginning from
the hairline behind the ear and spreading to his face and body. On
buccal mucosa, there is a red spot surrounded by white bluish
appearance.

39. Of the following, the MOST likely cause of the rash is

a. Rubella virus
b. Coxsackievirus
c. Morbilli virus
d. Human herpesvirus 6
e. Parvovirus B19

40. What is the most severe complication that would happen to the
patient above?
a. Osteomylitis
b. Encephalitis
c. Otitis externa
d. Sinusitis
e. Oral thrush

41. A 48-year-old man with acute gastroenteritis has step ladder

night fever since 7 days ago. He also has abdominal pain, and
constipation. He usually eats uncooked vegetables at street vendor
(pedagang kaki lima).
Which of the following is most likely to be a constituent of this
organism?
a. Vi antigen
b. Urease
c. Hemolysin
d. Shiga toxin
e. Pili

42. A 10-year-old girl presents with a history of sore throat and

difficulty breathing of 1 day’s duration. On examination she is very
ill-appearing. She has some inspiratory stridor and thick white-gray
material covering her tonsils and faucial pillars, and she has
swelling of her neck, no splenomegaly. The lymphocyte is normal.
What is the likely diagnosis?
a. Tonsilitis
 b. Angina Plaut Vincent
c. Mononucleosis infectiosa
d. Laryngitis
e. Diphteria

43. A baby is born with a rash identical. History taking reveals that
the mother had a febrile illness during the second trimester of
pregnancy. Examination reveals diffuse raised purple skin lesions.
There is no pallor, jaundice, or cyanosis. The baby has cataract, a
3/6 systolic heart murmur, and enlargement of both liver and
spleen. There is no lymphadenopathy.
Of the following, the MOST likely diagnosis is?
a. Congenital Toxoplasmosis
b. Congenital Rubella
c. Congenital Cytomegalovirus
d. Congenital Herpes Simplex
e. Congenital Varicella

44. A 40-year-old woman presented with a raised redness plaque

resemble a doughnut with a raised border that she already had for 1
year, It was no itchy, no pain, not easily bleeding. Sometime she
feel weakness on her leg and her slipper left behind while walking.
On her legs she developed an anular erythematous sharp border
lesion, no scally, shiny surface and enlargement of the popliteal
nerve. What kind of laboratory examination results that can help us
make a diagnose of the case above?
a. Dark field examination
b. Gram
c. KOH examination
d. Ziehl neelson
e. Na Cl examination

45. A woman, recently returned from Lampung, complains of having

paroxysmal attacks of chills, fever, and sweating; these attacks
last a day or two at a time and recur every 36 to 48 h. Examination
of a stained blood specimen reveals ringlike and crescent-like
forms within red blood cells. The infecting organism most likely is
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
 d. Plasmodium malarie
e. Plasmodium brasilianumi

46. A 33-year-old woman ingested 10 tablets of an analgesic-

antipyretic which is metabolized to a quinone imine. Shortly after
ingestion she presented with signs of nausea, vomiting, and
generalized malaise. Within 3-5 days peak hepatic dysfunction
occurred and was associated with hepatic necrosis.
Which of the following is the most likely specific antidote that
should be used to treat this patient's over dosage?
a. Amyl nitrite
b. Atropine
c. BAL
d. EDTA
e. N acetyl sistein

47. A 27-year-old medical student was admitted to hospital because

of sudden onset fever up to 39 0C and headache. Two weeks
previously he volunteers cleaning the canal with others. On
examination, he looked so yellow. Blood tests done shortly after
admission indicated renal function abnormality and elevated liver
function tests. Which of the following is the prevention after
exposure for this case?
a. Human vaccine
b. Health education
c. Vector control
d. Isolation the infected people
e. Prophylaxis antibiotics  doxycicline

48. A 24 year old woman admitted to the hospital with myalgia and
weakness of her right leg. She had traveled from Saudi Arabia and
her immunization had never completed. On examination, she had
normal sensation of the right leg, with normal movement and
strength in all other extremities and a normal cranial nerve
examination. Which of the following vaccination is the best
prevention for this disease?
a. MMR
 b. HBIG
c. BCG
d. DPT
e. Oral Sabin

49. An HIV (+) patient comes to the emergency room with severe
dehydration. The nurse puts an IV line on him, after that the nurse
use her two hand recapping the needle, and got injured by that
needle. The nurse is panicking. You are the doctor on duty in that
emergency room. What should you do?
a. Press the injury site to stop the blood
b. Wash immediately using soap under running tap water
c. Use bleach or iodine to clean the injury site
d. Use antibiotic ointment on the injury site
e. Enlarge the injury site by incision to let the blood flow

50. A 33-year-old woman at 10 weeks pregnancy presents for her

first prenatal examination. Routine labs are drawn and her HBsAg is
positive. Liver function tests are normal and her Anti HBc and Anti
HBs are negative. Which of the following is the best way to prevent
neonatal infection?
a. Provide immune globulin to the mother.
b. Provide hepatitis B vaccine to the mother.
c. Perform a cesarean delivery at term.
d. Provide hepatitis B vaccine to the neonate.
e. Provide HBIG and the HepB vaccine to the neonate

51. A 34-year-old G2 at 36 weeks delivers a growth-restricted infant

with cataracts, patent ductus arteriosus, and sensorineural
deafness. She had flu-like syndrome with rash in early pregnancy.
What is the most likely causative agent?
a. Parvovirus
b. Rubella virus
c. Morbili virus
d. Cytomegalovirus
e. Herpes simplex virus
52. A 27-year-old female has just returned from a trip to Southeast
Asia. In the past 24 hours, she has developed shaking, chills, and a
temperature 40o C. A blood smear reveals Plasmodium vivax. Which
of the following agents should be used to eradicate the extra-
erythrocytic phase of the organism?
a. Primaquine
b. Pyrimethamine
c. Quinacrine
d. Chloroquine
e. Chologuanide

53. A 25-year-old G3 at 39 weeks delivers a small-for-gestational-age

infant with chorioretinitis, intracranial calcifications, microcephaly,
jaundice, and hepatosplenomegaly. The infant displays poor feeding
and tone in the nursery. The patient denies eating any raw or
undercooked meat and does not have any cats living at home with
her. She works as a nurse in the pediatric intensive care unit at the
local hospital. What is the most likely causative agent?
a. Cytomegalovirus
b. Epstein-Barr virus
c. Hepatitis B virus
d. Parvovirus
e. Yellow fever virus

54. A 45 year old man presented chronic skin lesions on both hands
for the past 1 year. On examination, his skin appears erythematous,
crusted, fell itching, and having serous discharge. He was working
in the gold refining plant for the past 2 years, works with potassium
cyanide and never uses any gloves. Which of the following
mechanism is responsible for this illness?
a. Immediate respond
b. Acute respond
c. Gradual reactions
d. Delayed reactions
e. Quantal reactions
55. Male, 46 years old came to you as a doctor with chief complains
shortness of breath especially at the work place. When he gets
home, the symptom is missing. He also complains that he sneezes
every morning. According to him, his sister is using bronchodilator
 inhaler every day. He just worked at sandblasting company and
expose to dust since 2 weeks ago. Which of the following is the
most appropriate to measure the toxicity of hazardous material in
the case above?
a. Body Mass Index
b. Nutrition and Job description
c. Individual Susceptibility
d. Social pressure
e. Tissue and organs

56. The patient was a 3-year-old girl who was seen by her
pediatrician for a routine physical examination. Her mother was
concerned about her daughter’s poor appetite. Physical
exammmination revealed that the child was small for her age and
had a slightly enlarged liver. Blood was collected for a routine
complete blood count, since she had previously been slightly
anemic. Her hemoglobin level was within the normal range;
however, she did have eosinophilia (20%). The child had no history
of travel. When questioned about pets, her mother reported that she
spent a great deal of time with her puppy. Of the following, which
manifestation of the infection (above case) is known to occur?
a. Creeping eruption  ancylostoma
b. Biliary cirrhosis
c. Cholecystitis
d. Pruritus ani
e. Visceral larva migrans

57. A patient complains of having nail size excrement from his anus.
On the stool examination, parasite eggs contains a hexacanth
embryo with six hooklets surrounded by radially striated spherical
shell, 30 to 40 u in diameter were found, the most likely diagnosis
of this patient is :
a. Saginata taeniasis
b. Solium taeniasis
c. Cysticercosis
d. Oxyuriasis
e. Ascariasis

58. The mother of a 4-year-old child notes that her child is sleeping
poorly and scratching his anal area. You suspect the child may
 have pinworms. Which one of the following is the BEST method to
make that diagnosis?
a. Examine the stool for the presence of eggs
b. Examine the stool for the presence of larvae
c. Examine a blood smear for the presence of microfilariae
d. Examine transparent adhesive tape for the presence of eggs
e. Determine the titer of IgE antibody against the parasites

Question 59-60 are linked to the following case:

A 30-year-old woman presents with abdominal pain and diarrhea of 3
day’s duration. She does not complain of nausea, vomiting, or fever.
She has no sick contacts or significant travel history. A stool sample is
obtained, which reveals rhabditiform larva. Rhabditiform larva di stool
 khas strongiloides

59. In condition below adult form of the pathogenic agent can be

found in whole digestive tract and its larvae can be found in
visceral organ (lung, liver, gall bladder) is:
a. Eosinofilia
b. Hyperinfection
c. Retrofection
d. Hypereosinofilia
e. Autoinfection

60. Refer to the previous case, further questioning reveals that the
woman frequently gardens in her backyard. Of the following, which
one is the transmitted form?
a. Fecal – anal transmission
b. Fecal – oral transmission
c. Fecal – cutaneous transmission
d. Direct contact with skin scales
e. Intravenous drug abuse

61. A 40-year-old man came to the clinic with complaints of having

fever more than one-week, nausea, and fatique. He came back from
 Samarida, Kalimantan. On blood smear examination, there are late
trophozoites forms, schizonts with 12-24 merozoites, and the
infected red cell is enlarged. Of the following, the most likely
diagnosis of this pasient is :
a. Vivax malaria
b. Falciparum malaria
c. Malariae malaria
d. Ovale malaria
e. Knowlesi malaria

62. A- 52- year old man is brought to the emergency department in an

unconscious condition. On examination, he was death form more
than one hour. On autopsy of the brain, there is cyst‘s fluid
containing protoscoleces with hooklets and many daughter cysts
were found. The most likely diagnosis of the disease is:
a. Hydatidosis
b. Cysticercosis
c. Cerebral malaria
d. Occult filariasis
e. Trichinosis

63. An-6-year-old girl sustains a large laceration contaminated with

dirt after falling from her bike. Her mother can’t recall how many
doses of immunization her daughter has received. Which of the
following is the prevention after exposure for this case?
a. Adult-type TT
b. TIG
c. TT and TIG
d. HiB containing TT and TIG
e. DPT

Question 64-65 are linked to the following case:

A 23-year-old man presents with extreme swelling of his legs and
scrotum. The skin associated with the swollen areas is thick and
scaly. The patient admits to an episode of fever associated with
enlarged inguinal lymph nodes some time ago, but did not think much
of it.

64. Which one of the following is the BEST method to make that
diagnosis?
a. Examine the stool for the presence of eggs
b. Examine the stool for the presence of larvae
c. Examine a blood smear for the presence of adult worm
d. Determine the titer of IgE antibody against the parasites
e. Examine a blood smear for the presence of microfilaria

65. According to the case above, which of the following is the most
appropriate time to take the specimen for established the
diagnosis?
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever

66. At night, a 28-year-old man is brought to the emergency

department after his right foot being bitten by an animal, within 1
hour before admission. The patient said that he heard the sound of
the animal. He complains of pain in his right foot and there are two
bitten marks, surrounded by edema and erythema in the dorsal
aspect of his right foot. Initial management of the case described
should be
a. Observation
b. Cryotherapy
c. Antivenin
d. Incision and suction
e. Corticosteroids

67. A 29-year-old man has weight loss, white plagues on the pharynx,
and purple lesions on the abdomen, which on biopsy reveal Kaposi
sarcoma. Which of the following is the most predictive of the
patient’s prognosis?
a. CD4 cell count
b. CD4/CD8 cell ratio
c. Degree of lympadenopathy
 d. Level of HIV-1 RNA in plasma
e. Rate of decline in anti-HIV antibody
68. A patient come with an itchy recured fungal infection on the feet
and need some advice to be cured and some prevention measures
so the diasease will not occure again, doctor already gave him
some medication for fungal infection. What kind of advise can make
him healthy?
a. Don’t eat seafood
b. Use always sandals
c. Keep the skin dry and clean
d. Don’t use shoes all day long
e. Don’t scratch, will spread the infection

69. A woman came with the complaints of being uncomfortable and

hardened in the left upper side abdomen. Every four days, she is
intermittently feverish. On blood smear examination Plasmodium
parasite +. Fever symptom on the previous question referred to :
a. Saorozoites is in the the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed

70. A 35-year-old man as a farm worker who was working with

pesticides is brought to the emergency room with headache,
vomiting, salivation, diarrhea, muscle fasciculation, difficulty
walking, and difficulty speaking. His clothing has been removed, he
has been washed, and he has been given activated charcoal. What
is the most effective remaining treatment for this case of pesticide
poisoning?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. Hidrochlorothiazide

71. A 65-year-old-woman suddenly had flaccid paralysis of her left

leg. A few days ago, she had headache, fever, sore throat, and
nausea. She lives with her son; daughter in law and a young
grandchild who’s just received a routine oral vaccination. She is
 taking immunosuppressant for her kidney’s transplant. Her vital
signs and cranial nerve examination are normal. A head CT scan
and lumbar MRI are also normal.
What is the most likely transmission of her infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite

72. A pork-eating village in the highlands of Papua New Guinea is

reported to be suffering from an epidemic outbreak of epileptiform
seizures. You have been sent to investigate. One of the first things
you should investigate is?
a. The level of Balantidium coli in swine stool
b. The practice of consuming raw deceased human brains
c. The presence of taenia eggs in the drinking water
d. The presence of tropozoites in the human blood
e. The quantity of culidae in the village

73. A 34-year-old woman complained a sudden onset of high fever for

4 days with nausea, vomiting, headache, muscle ache. There were
petechiae on examination. Which of the following laboratory result
is most appropriate with the patient’s diagnosis?
a. Trombositopenia
b. Neutropenia
c. Anemia
d. Decreased of hematocrit
e. Leucopenia

74. A 1 year old girl came to the Puskesmas with swollen gum for a
week. From the history taking it was found that she was born
normal with normal birth weight, had been breastfed up to now and
had a balanced diet with high intake of cooked vegetable and fruit
 since 6 months old. She had no history of chronic diseases. Her
other physical and laboratory examination was normal.
Based on the information given above, what is the most likely cause
of her complaint?
a. Protein deficiency due to prolonged breastfeeding
b. Carbohydrate deficiency due to increased calorie need
c. Fat soluble vitamin deficiency due to high vegetable/fruit intake
d. Water soluble vitamin deficiency due to cooking process
e. Mineral deficiency due to competition with high vitamin
absorption

75. A 10-year-old boy who has moved to your practice recently has
sore throats, get high temperature. The child reports a runny nose,
mild cough, and abdominal pain. Findings on physical examination
include a temperature of 38°C, and vesicular lesions on the soft
palate, dorsal and palmar of hands. There is no cervical adenopathy
or rash.
Of the following, the MOST likely diagnosis is
a. Adenovirus infection
b. Coxsackie virus infection
c. Mononucleosis
d. Sinusitis
e. Streptococcal pharyngitis

76. A 19-year-old woman comes to Emergency Department with signs

and symptoms of poisoning of an agent include nausea, vomiting,
abdominal cramps, diarrhea, excessive salivation, headache,
giddiness, rhinorrhea, tightness in chest, pin-point pupils, mental
confusion, and muscle twitching. Which of the following is the most
likely agent caused those symptoms?
a. Acetaminophen
b. Barbiturate
c. Carbamate
d. Cyanide
 e. Opiate

77. A 23-year-old G1 with a history of a flulike illness, fever,

myalgias, and lymphadenopathy during her early third trimester
delivers a growth-restricted infant with seizures, intracranial
calcifications, hepatosplenomegaly, jaundice, and anemia. She has
many pets in her house. What is the most likely causative agent?
a. Trepanema pallidum
b. Trichomonas vaginslis
c. Toxocara canis
d. Neissheria meningitidis
e. Toxoplasma gondii

78. A 22-year-old man who works in the pediatric ward of a hospital

suffers from malaise, sneezing, and runny nose. He subsequently
develops a mild sore throat, headache, and stuffy nose. The
symptoms resolve within 4 days. Which virus is most likely to be
responsible for these symptoms?
a. Rota virus
b. Rubella virus
c. Coxsackie virus
d. Hepadnavirus
e. Influenza virus

79. Approximately 4 hour after eating a meal in restaurant, 3

members of a tourisms group develop a sudden onset of nausea,
vomiting, severe abdominal cramps, and diarrhea. Nobody got
febrile. Which of the following vaccination is should be given to the
traveler?
a. Shigella vaccine
b. Salmonella vaccine
c. Enterobacter vaccine
d. H. pylori vaccine
e. ETEC vaccine
80. An outbreak investigation note many costumer from a café were
admitted to the hospital. They have fever; nausea-vomiting,
constipated or diarrhea, weakness and altered mental status. Rose
spots are seen on the trunk. Blood cultures from patients grow a
non-lactose-fermenting gram-negative rod. These people are
infected from the carrier person
In which of the following sites are bacteria most likely to be found
in carrier person?
a. Blood
b. Kidney
c. Liver
d. Intestine
e. Gall bladder

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