MDE TropMed KPBI 2007

1. A 14 months old infant suddenly develops a fever of 40 degree Celsius. Physical examination shows an alert, active infant who drinks milk eagerly. No physical abnormalities are noted. The WBC count and Hb content are normal. After the fever subsides, there are generalized maculopapular skin rash appear. The most likely diagnosis:

A. Rubella
B. Roseola infantum
C. Rubeola
D. Scarlet feve
E. Kawasaki disease

4. The diagnosis of typhoid fever is confirmed by culturing Salmonella strain. Which of the following is the correct statement?
A. Positive results of blood culture found in 40-60% of patients during 2nd week of illness
B. Most stool culture positive during 1st week of illness
C. Most urine culture positive during 1st week of illness
D. Bone marrow culture is less sensitive during late stage of illness
E. Bone marrow sensitive during late stage illness since it less influenced by prior antimicrobial therapy


A. continuous
B. saddleback
C. intermittent
D. remittent
E. relapsing


6. Dede - chief complaint: high fever 3days, gap of low fever 1 day and additional high fever for 2 days. Type of fever?

8. The experience fever for 14 days, not too high, highest temperature was found in the late evening and during night; in the morning fever slightly reduced but never reached normal temperature. Type of fever?

12. dlm past yr..soalan dengue yg ad kotak tu


13. Diagnosis of amebiosis through examination of fecal is a diagnose as :-
A.finding of throphozoites with 1-4 nuclei
B.finding of throphozoites with ingested erythrocyte


14.Your patient is a 13 years old boy with a chief complaint of high fever for 3 days. Her mother told you that his son had bleeding from his nose, a symptom of headache and some red spots in his forearm. Laboratory examination shows thrombocytopenia.
What is the characteristics of the virus that cause the disease?
A. Double stranded DNA
B. Single stranded DNA
C. Double stranded RNA
D. Single stranded positive-sense RNA
E. Single stranded negative-sense RNA


15. a 21 years old comes to er with continuous fever,intermittent spikes for 6 days. jaundice+,resp distress, change in behaviour,confusion, etc.. blood smear: banana form trophozoite. drug to prevent transmission:
A. pyrimethamine
B. Sulfadoxine
C.proguanil
D.primaquine
E. chloroquine


16. 47 year old man came to ER complaining the presence of high fever, intermittent every 2 consecutive days. The fever characteristically started with chills and followed by high fever and sweating, accompanied by headache, myalgia, nausea, vomiting & hepatosplenomegaly.
What is the most appropriate drug to prevent transmission of this parasite? :
*cet penat salin soklan pnjang2*
A. mefloquine
B. quinne
C. atovaquone
D. artesunate
E. pyrimethamine


17.Which of d following clinical feature suggest diagnosis of d above disease(malaria)? A.intermittent fever,anemia,lymphadenopathy
B.intermittent fever,anemia,splenomegaly
C.intermittent fever,leukopenia,splenomegaly
D.remittent fever,anemia,splenomegaly
E.remittent fever,anemia,lymphadenopathy



18. 14 y.o boy, fever and diarrhea after eating eggs. what cause this?
A. Enterobacteria
B. Listeria
C. Salmonella
D. Shigella
E. Vibrio


19. a 9 months old infant, 7kg BW, have been giving corticosteroid therapy 15mg per day for 2 weeks. he was bought by his mother for routine immunization. he had only BCG vaccine at 1 month. which vaccination should be admistered by this time?
A. measles virus vaccine and DTP
B. measles virus vaccine and DTaP
C. measles virus vaccine and Hepatits
D.DTP and OPV
E.DTP and Hep B

20. Skin layer likely affected in discoloration (ptyriasis vesicolor)
A.stratum basale
B.s.spinosom
C.s.granulosum
D.s.lucidum
E.s.corneum


21. What is your expectation of direct microscopic exam of skin scraping of these lesions? (Pityriasis Versicolor)
A. Epithelial cells, long septate branched hyphae, round spores
B. Epithelial cells, long septate branched hyphae, arthospores
C. Epithelial cells, short hyphae, round spores, spaghetti and meatball appearance
D. Epithelial cells, budding cells, round spores, germ tubes
E. Epithelial cells, short hyphae, arthospore, germ tubes


22. Athlete, have discoloration in his skin. What is the possible diagnosis?
A. Tinea Versicolor
B. Tinea corporis
C. Tinea cruris
D. Pityriasis Alba
E. Tinea facialis


23. A 6 years old girl has scaly patch on her scalp. On primary smear and culture scale and hair negative. Few week,she had inflammation lesion.Hair under wood’s light and smear scalp hair show septate hyphae. She also had a pet at home> What the diagnosis of her disease?
A. Microsporum audocini
B. Microsporum canis
C. Trychophyton tonsuran
D. Trychophyto rubrum
E. Epidermophyton floccosum



24. 15 year old boy come w hard tender red folliculo, centeric nodule and pain on his buttock skin
A. Impetigo crustosa
B. Furuncle
C. Echthyma
D. Erysipelos
E. Folliculitis


25. A 38 year old diagnosed as leprosy. On PE nerve at elbow enlarge and tender. Consequences’ which deformity?
A. Drop wrist
B. Claw thumb
C. Claw hand
D. Extended wrist
E. Claw finger


27. A 55 years old woman, obese come to the clinic with chief complain of itching in infra-mammary area; especially during hot weather. From PE reveals erythematous patches along fold of infra-mammary area surrounded with satellite lesions. What is the diagnosis?
A. Tinea Cruris
B. Tinea Corporis
C. Candidiasis Cutis
D. Pityriasis Versicolor
E. Tinea capitis


28. 12 years old girl.a furuncle on buttock and very pain and hard.When incision and drainage are indicated for furuncle?
A. Lesion localize and show definite fluctuation
B. Lesion localize and show no postulation
C. Lesion becomes erythematous
D. Lesion become nodular stage
E. Lesion become two or more


29. A 31 year old women and her daughter complain of many discrete papular itchy lesion with pin point blue colour on its top, located on neck and axillas. The most possible diagnosis is?
A. Pedicolosis capitis
B. Pediculosis corporis
C. Pediculosis pubis
D. Scabies
E. Insect bite


30. 65 years old man comes to clinic with cutaneous eruption consist painful and pruritic vesicles and blister follow unilateral dermatomal distribution, prodromal pain precede the development of lesion. Which of the following stain can demonstrate the infection cause of herpes zoster?
A. Acid fast stain and examine by light microscope
B. Gram stain
C. Giemsa stain
D. Silver stain
E. Dark field


Question 30-31:
A 65 years old man, come to the clinic with cutaneous eruption. Painful and pruritic vesicles and blister. Tend to follow unilateral, dermatomal distribution. Prodomal pain precede the the development of the lesions.
31. Which of the following diagnosed expected?
A. Herpes zoster
B. Varicella
C. Herpes simplex
D. Photo allergic dermatitis
E. Steven Johnson Syndrome


Question 32-33:
7 years old boy, cutaneous eruptions consist of successive crops of diffuse pruritic vesicles and papules from trunk to upper arm, face and oral mucosa

32. Drug treatment. Which is the mainstay of treatment in early disease?
A. Pirazinamide
B. Acyclovir
C. Prednisone
D. Erythromycin
E. Amoxyllin


33. Which of the following disease cause of the physical finding?
A. Human Papilloma
B. Varicella
C. Herpes Zoster
D. Herpes Simplex
E. Coxsakie

Question 34-35:
5 years old boy visit an outpatient clinic with his mother due to skin pruritic patch on his cheek since 8 days ago. His mother told the doctor that he had cat as a pet. On PE, doctor found that the boy had 1 rounded lesion with active border consist of erythematous papules, minute vesicles and scales, and somewhat clear on the middle area



34. What is the diagnosis of the patient above?
A. Tinea corporis
B. Tinea cruris
C. Candidiasis cutis
D. Ptyriasis versicolor
E. Tinea unguium


35. From the case above, the type of fungi to be found could be :
A. Zoophilic
B. Geophilic
C. Antrophilic
D. Hydrophilic
E. Keratinophilic


Question 36-37:
A 25 years old man came to your clinic with chief complaint of itching in his finger web for 1 week. His family member also had similar complain. He has visited health centre without any improvement


36. If PE revealed papules and papulovesicles, crust of his fingers web, which part of body should be examined?
A. Nose and ear
B. Arm pit and umbilical area
C. Nasal mucosa
D. Scalp
E. Extensor area of extremities


37. What is the most probable diagnosis of this patient?
A. Dermatitis
B. Prurigo
C. Mycosis
D. Scabies
E. Pediculosis


Question 38-39:
9 month old baby boy visit outpatient clinic with his mother for skin patch on his neck. While history taking, mother told doctor she also suffered from similar patch on her breast. On physical examination, doctor found both patients had similar lesions:numular eryhtropapulosquamous patches with active borders and clear in middle area. The mother also told that she had a cat as a pet.


38. What is your expectation of direct microscopic examination of skin scrapings from these lesions?
A. Epithelial cells, long septate branch hyphae, round spores
B. Epithelial cells, long septate branch hyphae, arthrospores
C. Epithelial cells, short hyphae, round spores sometimes oval spores
D. Epithelial cells, budding cells, round spores, germ tubes
E. Epithelial cells, short hyphae, arthrospores, germ tube


39. From case above, type of fungi to be found could be:
A. Zoophylic
B. Geophylic
C. Anthropophylic
D. Hidrophylic
E. Keratinophylic


Question 40-41:
25 years old man came with bloody and mucous-laden diarrhea. Stool examination by saline wet mount revealed motile trophozoite and with Trichrome stain revealed trophozoite with finely granular cytoplasm and ingested RBC.

40. Which of the following is the most likely route of entry.
A. Eating contaminated food containing 8 nucleated cysts.
B. Eating contaminated food containing 4 nucleated cysts
C. Eating contaminated food containing trophozoite stage
D. Flies acting as mechanical vector
E. The parasite enter through skin transmission



41. WOTF is correct for infective stage of parasite that causes the diarrhea?
A. Infective stage hatch in colon
B. Infective stage multiply in duodenum
C. Only can be found in soil
D. Infective stage invasion to intestinal wall
E. Infective stage enter blood circulation


42. Trichrome stain indicated the presence o intestinal pathogenic protozoa. Which of the following statement is correct life cycle of all intestinal protozoa?
A. Infective stage occured in soil
B. Encystation in lower ileum
C. The most frequent primary sites are cecum & rectosigmoid
D. Encystation occur in the ascending colon
E. Cyst and trophozoites can be found in liquid feces


43. The life cycle of a parasite consists of two stages, the cyst and the trophozoite, and tropozoite stage are found in the upper part of the small intestine and also are found in the gallbladder. Which of the following is the most likely organism?
A. Entamoeba Histolytica
B. Endolimax Nana
C. Clonorchis Sinensis
D. Giardia Lambia
E. Trichomonas Hominis


44. 15 years old girl visits an outpatient dept with CC of pain at upper right of abdomen. She also had bloody & mucous laden diarrhea for the last 10 days. The fecal examination shows trophozoites containing 1-4 nuclei. The doctor suspects she has extraintestinal amebiasis. Which of the following is the most likely cause of above infection?
A. E. Histolytica
B. E. Coli
C. E. Hartmanni
D. Endolimax Nana
E. Iodamoeba Bustchlii


45. A 4 years old boy took metronidazole. What is the adverse effect?
A. Optic neuropathy
B. Constipation
C. Dry m0uth
D. Blurred visi0n.
E. Tachycardia


46. 26 years old man present with bloody mucus laden diarrhea, tenesmus & fever. In his watery diarrhea found E.Histolytica. Which is the most appropriate combination & tissue amebicides?
A. Diloxamide furoate

B. Metronidazole

C. Dehydroemitine

D. Iodoquinole

E. Paromomycin

Question 47-50:

A. Entamoeba dispar
B. Entamoeba coli
C. Giardia lamblia
D. Trichomonas hominis
E. Entamoeba histolytica


47. A 25 years old man with bloody mucoid diarrhea, fecal exam with trichrome stain revealed ameboid trophozoid with ectoplastic pseudopodia with finely granular cytoplasm


48. Fecal examination with saline wet mount revealed motile trophozite with Trichome stain revealed ameboid trophozoite with rough granular cytoplasm, 1 nucleus with eccenteris karyosome

49. A 6 years old boy has a chronic diarrhea. Fecal exam & staining shows ellipsoidal cyst with thick & colourless layer with two nuclei with large central karyosome


50. A 30 years old woman suffering from diarrhea with characteristically bulky and has an offensive odor. Fecal examination with saline wet mount revealed motile trophozoite with fingerlike ectoplasmic pseudopodia are extended rapidly
A. Negative
B. Primary infection

C. Secondary infection

D. Invalid

E. Primary & secondary infection


Most likely result interpretation for dengue infection:
51. C & M line are pink colour.
52. C, M & G line are pink colour.

53. a 11 y.o boy present to ER with high fever for the last 4days accompanied by headache, myalgia, and epigastric pain. the body temperature is range from 38.5-39.8, occur all day n night. on 3rd day the body temperature decrease but on the next day it elevated again. PE revealed high fever, petechiae, +ve tourniquet test. LE Hb 15.5g/dl WBC 4400mm3 Ht 49%, platelet 85000/mm3. result rapid test for dengue is C-line white, M n G line white


54. 28 yo,businessman,fever,intense headache,exarvating pain in joint,faint macular rash in trunk.WOTF virus cause?
A.dengue
B.viral encephalitis
C.viral influenza
D.yellow fever
E.varicella


For question number 56 and 57


A 17 y old woman is hospitalized with dengue virus infection. On routine PE exam the blood is 95/80mmHg while on admission was 105/80mmHg

56.What is your working diagnosis?
A. DF
B. DHF without shock
C. DHF with shock
D. Silent infection of dengue virus
E. undifferentiated fever


58. +ve salmonella thypii. Interpretation result from Widal test only valuable if the titer rise from the 1st sera to 2nd sera?
A.1/2 fold
B.1 fold
C.2 fold
D.3 fold
E.4 fold


60. Which is true about Salmonella antigens
a. H antigens are activated by heating under 60 degree celcius
b. Antibodies against H antigen are predominantly IgG
c. O antigens are sensitive to prolong heating at 100 degree celcius
d. Antibodies against O antigens are predominantly IgM
e. O antigens are prepared from motile bacilli


66) 6 y.o boy, chronic meningitis..hydrocephalus kenapa?
A)CSF produksi banyak
B)backflow CSF kembali ke aliran darah
C)increase venous pressure
D)gangguan flow CSF disebabkan scarring di choroid plexus
E)gangguan flow CSF disebabkan scarring pada arachnoid villi


71. Which of the following is TRUE about spinal meninges?
A th dura sac ends at the L4
B the subarachnoid space end at the LI vertebral level
C the denticulate ligaments lies between dorsal and ventricular root of spinal cord
D the piam ater easily dissected from the surface of spinal cord
E the veins of the epidural space are richly supply with valves

73-75 based on scenario.77. What to be done for case aboveQuestion 80-81:


24 y.o man broght to RSHS with chief complain decrease lvl of unconsciousness.History of fever within 2days, headache & vomit. X significant complain of increase ICP. P.E shows somnolent, fever, tachycardia and tachypnea. Purulent discharge found in left ear. Neurologic exam reveals signs of meningeal irritation.



73. What is the most likely diagnosis?
A. Encephalitis
B. Meningitis
C. Cerebral sinus thrombosis
D. Myelitis
E. Cysticercosis

75. In order to achieve definite diagnosis of causative organism. What examination should be done?
A) Lumbar puncture
b)Ct scan
c)chest x ray
d)MRI
e) Blood test



A. Antibiotic adminstered only
B. Corticorsteroid only
C. Antibiotic given prior to corticosteroid
D. AB given following with corticosteriod
E. Give coke

78. (Long story short...Patient had lumbar puncture. Refer Q.77 for same case or past year aso got). Which antibiotic most suitable to eradicate causative organism?
a. Antibiotics of choice should be able to pass BBB
b. Antibiotics of choice should be water soluble
c. Antibiotics of choice should not have wide spectrum coverage
d. vancomycin is the drug of choice
e. macrolide is the drug of choice

79. 7y.o acute meningitis. Gram postive rod. Etio
A) menigistis group A
B) meningistis group B
C)strep a
D)......
E).......




A 24 years old women with sudden onset of fever and severe headache shows in Emergency Room. Neurological examination reveals meningeal signs. The doctor performs spinal tap. Gram stain of the spinal fluid reveals many neutrophil and gram negative diplococci
81. Which of the following bacteria is the most likely cause of this disease?
A. Haemophilus Influenza
B. Neisseria Meningitides
C. Streptococcus Aureus
D. Staphylococcus Aureus
E. Pseudomonas Aeruginosa


Fever,headache meningeal symptoms,spinal taps : many neutrophils,gram '-' diplococci
81. What is physycological character of bacteria that play role in this disease?
A. caosule + villi adheres to specific tissue
B. capsule of polystatic acid, product of bacteria
C. synthesize protein toxin as result of colonization
D. a cell tropis for only brain tissue
E. toxin A and B


Question 83-86
A 21 years old male presented to Emergency Room with jaundice in the last 3 days. Symptoms started 7 days before with gradual onset of fever accompanied with muscle ache especially in calves, headache and nausea.

83) what lab exam is the most appropriate test?
A) blood ureum, creatinine, CBC
B) Blood alkali phosphatase n glucose
C) Blood creatini, lipid, Hb
D) Blood glucose n CBC
E) Blood cholesterol and ureum


84. Jaundice,muscle ache,headache. What is definitive lab exam to confirm the diagnosis of disease to the serovar level?
A. macroscopic inhibition test
B. slide preoxidase test
C. microscopic agglutination test
D. tube agglutination test
E. coagulation test


85. How is the best visualized d above causative agent? (Lepto)
A. Light microscope
B. Darkfield microscope
C. Inverted microscope
D. Electron microscope
E. Binocular microscope


87. 35 years old man complains with high fever for the last 2 weeks after big float in his house. He also complains jaundice, red eye, severe headache. Physical exam shows hepatomegaly. WOTF is the most suitable medium culture for above microbe?
A. Feely Gorman Blood
B. Saboraud Glucose agar
C. Egg yolk agar
D. Fletcher semsolid agar
E. Eosin Metylen Blue agar


88. A 27 years old male was admitted to hospital because of sudden onset of fever to 39C, headache and jaundice in the last 3 days. The patient has a history of working in a warehouse where there were many rats and exposed to polluted water. Blood test done shortly after admission indicated renal function abnormalities, increased bilirubin and liver function test.
Which organism is most likely responsible?
A. Acromonas hydrophilia
B. Mycobacterium marinum
C. Streptococcus pyrogens
D. Leptospira interrogans
E. Vibrio vulnifiens


89. which of the following is the characteristic?
A. rod and microgrannion form
B. spirochetes gram -ve
C. rod gram +ve
D. cocci gram +ve
E. spirochete and hooked end


dari soklan 88-90


90. Which of the following laboratory examinations would be the most likely to confirm the diagnosis?
A. testing acute and convalescence phase sera using RPR test
B. culture of uring on human fibroblast cell
C. testing serum by dark field microscope for the presence of leptospira
D. testing acute and convalescence phase sera for antileptospiral antibodies
E. culture of cerebrospinal fluid on blood and chocolate agar.


91. 40 year old man have periodic fvr, sweating, chills, malaise, headache, just came from colombia. WOTF is relevant diagnosis test.
A. HIV/Elisa
B. VDRL
C. Thin and thick blood smear
D. Blood culture
E. Urine culture


92-96
a. Plasmodium falciparum
b. Plasmodium ovale
c. Plasmodium vivax
d. Plasmodium malariae


92. A period of 72 hours is needed for the development of mature schizont, which resembles rosette with only 8 to 10 merozoites.


93. An important diagnostic feature is the irregular appearance of the edges of the infected red blood cell


96. Microscopic examination from thin blood smear revealed multiple rings in a single erythrocyte and ring forms are located at the periphery of the erythrocyte


97. Vector transmitter is very important in certain parasitic disease. There are many types of transmission method by vector. Which of the following type of transmission method is correct related to benign tertian malaria?
A. Transovarial transmission
B. Cyclico developmental
C. Propagative
D. Cyclic propagative
E. Hereditary


98. 40y.o has fever and body aches. PE:pale,jaundice (sclera) and splenomegaly. Diagnosis: severe malignant tertian malaria. Stage can be found during blood smear exam using Giemsa stain?
A.microgamete
B.mature trophozoite
C.microgametocyte
D.mature schizont
E.ring form


99. which of the following is correct for life cycle of the causative agent? (in malignant tertian malaria)
a.diagnostic stage always in all intraerythrocytic stage
b. infective stage occured inside human body
c. in life cycle, infective stage produces trophozites in hepatocytes cell
d. Intraerythrocytic stage occurs every 48 hours
e. always have hypnozoites stage in life cycle.


101. Inside the intestinal lumen of Anopheles Sundaicus mosquito, which of the following stage of P.vivax has the ability to penetrate the intestinal wall and further develop outside the intestinal wall?
A. Gametocyte
B. Zygote
C. Macrogamete
D. Oocyst
E. Ookinete


102. Microscopic exam of a thin blood smear from a patient suspected of having malaria reveals numerous normal size erythrocytes without stippling but with a ring stages. Many with multiple ring stages and appliquéd forms. Several erythrocytes show developing trophozoites that are spread across the erythrocytes in a band pattern. Which of the following is the most likely cause of infection?
A. P.vivax
B. P.malariae
C. P.falciparum
D. Mixed infection with 2 plasmodium sp (P.malariae and P.vivax)
E. Mixed infection with 2 plasmodium sp (P.falciparum and P.malariae)


103. A 50 years old leprosy patient has acute stage of ulnar nerve damage. What is the most appropriate bed positioning to prevent disability in this patient?
A. Supine, shoulder abduct 900, elbow flex 900, wrist and hand flex in hand splint
B. Supine, shoulder abduct 900, elbow flex 900, wrist extend, use finger splint
C. Supine, shoulder partial abduct, elbow extend, wrist and hand extend
D. Supine, shoulder slight abduct, elbow flex 900, wrist and finger in flexion
E. Prone, shoulder extend, elbow extend, wrist and hand use hand roll


104. A 50 years old leprosy patient has acute stage of ulnar nerve damage. Which of the following characteristic is most suitable for this nerve?
A. It courses descend lateral arm
B. It passes medial to posterior epicondyle of human
C. Ulnar nerve is terminated branch of of C5-C6-T11 of brachial plexus
D. It is innervated skin of hand medial to axial line of digit 4
E. It is innervated skin of hand lateral to axial line of digit 4



106.A 53-year-old suffered from leprosy with gangrene complication underwent right below knee amputation. He will be given proper bed position and arranged to be given prosthese below knee. Heart and lung assessment were within normal limit. What is the best position for him?
A.Prone position with hip and knee are extended
B.Prone position with hip slight flexed and knee is extended
C.Supine position with hip slight flexed and knee is extended
D.Side lying position with hip and knee are extended
E.Supine position with hip is extended and pillow is placed under the thigh.


108)Classification of sepsis???(past year question)
Anwers- inferction combined with SIRS


Pilihan jwpn sama ngn 108-112


110. A 20 years old male visit the hospital with fever as chief complaint. He has had this high fever for 3 days and a gap of reduce fever for 1 day followed by an addition high fever for 2 days.


111. A 15 years old girl is experiencing fever for 2 weeks. The fever occured every 3 days and proceeded by chills and followed by sweating. After that, fever subsides reached the normal body temperature.


112. A lobar pneumonia is experiencing high fever for 3 days, the fever was high, the remission of fever was slight not exceeded 1•c


113. Which of the following is the antimicrobial activity of chloramphenicol?
A. A potent inhibitor of microbial lipid synthesis
B. It binds reversibly to 30S subunit of the bacterial ribosome
C. It inhibits the peptidyl transferase step of protein synthesis
D. A bactericidal broad spectrum
E. It is active against aerobic gram positive and negative organism only


116. Other antibiotic usually given are ampicillin, amoxycillin and trimethropin-sulfamethaxazole. Resistant strain to those drugs usually susceptible to 3rd generation cephalosporin such as ceftriaxone, cefotaxime, cefixime. In adult, ciprofloxacin at dose 500mg two times a day for 7-10 days is effective and associated with low relapse rate.


Which of the following mechanism of action of trimethropin-sulfamethaxazole?
A. Combination is bactericidal
B. Inhibit bacterial dihydrofolic base reductase
C. Step leading to synthesis purines and RNA
D. Reduced cell permeability of tetrahydrofolic acid
E. Altered reductase with increase drug binding



118. 25 year old Mat Hasan present to the clinic with anesthetic hypopigmentation macule and pruritis on left hand. Diagnosed as leprosy with neuritis left ulnar. Treated with dapsine and rifampicin. Which of the following is a characteristic of dapsone?
A. Not a protein synthesis
B. Will cause resistance if high dose were given
C. Combination with other drugs are not recommended
D. Well-tolerated
E. Cannot give to heart failure patient

119. many patients develop some hemolysis after given dapsone. Which of the following is the reason?120. How does dapsoe work in human body?

A. GI intolerance
B. G6PD
C. metHBemia
D. erythema


A. It is distributed throughout body fluid
B. It is distributed throughout tissues
C. It is distributed throughout body fluids and tissue
D. It is not absorbed from gut
E. It is not retained inlver and kidney


124..characteristic of permethrin
A.neurotoxin
B.affected to pityriasis humanis
C.not absorbed percutaneously
D.no residual drug
E.nonirritating


125. Side effect of permethrin
A.neurotoxic
B.pruritus
C.itching


126. Lindane is also an effective scabicide. What is the contraindication for lindane's therapy?
A. Infants
B. Seizure disorder
C. Children
D. Pregnant woman
E. Breastfeeding woman


127.WOTF is specific characteristic for Lindane?
A. not concentrated in fatty tissue
B. available in syampoo
C.not excreted in urine
D. serum level will be at steady state.
E. uneffective pediculicide


128. Mr Herbi, 56 yrs old male suffered from Herpes Zoster at left side of his neck, face, upper chest for 3 days. The rash accompanied by pain & paresthesia in the involved dermatome precede the eruption . PE revealed localization & distribution of rash nearly unilateral, consist of closely grouped erythematous macules,papules and vesicles with regional lymph node enlargement. The patient was treated with antiviral systemic acyclovir and prednisone to avoid post herpetic neuralgic & ramsay Hunt syndrome. One month later, he came to clinic looking healthy.


What is the clinical activity of acyclovir? :
A. HSV-1
B. Epstein Bar
C. Cytomegalovirus
D. Human herpes virus 6
E. Zoster virus.


129.What is d mechanism of action of acyclovir?
A.require 2 phosphorylation steps for activation
B.it activates and accumulate in d infected cells
C.inhibit RNA synthesis
D.terminal chain into RNA........


130. What is the pharmacokinetics of acyclovir?


131. WOTF mechanism of resistance to Acyclovir
A. Thru alteration in viral thymidine kinase
B. thru alteration in viral RNA polymerase
C. thru alteration in viral thymidine
D. thru alteration in viral RNA kinase
E. diffuse into most tissue and body fluid.


132. Agent can be use for vzv
A.tetracycline
B.azithromycin
C.aminogigcosides
D.trifluridine
E.spiramycin


133. Itraconazole?
A. Polyenes
B. Imidazole
C. Triazole
D. Allyamine
E. E-3-glycan synthase inhibitor


134. Contraindication of Itraconazole?
A. Patient with bone marrow suppression
B. Patient with hypokalemia
C. Patient with enteric colitis
D. Patient with renal failure
E. Patient with Chronic Heart Failure


135. WOTF drug cause anemia?
A. Amphotericin B
B. Ketonazole
C. Fluconazole
D. Terbinafine
E. Gnseofulvin

136. Inhibit ergosterol synthesis
A. Allylamines
B. Polynes
C. Triazoles
D. Inidazoles
E. Griseofulvins


137. Which of the following can cause bone marrow suppression?
A. Ketoconazole
B. Fluconazole
C. Flucytocin
D. Terbinafine
E. Nystatin


139. A 30 years old man comes to the Primary Health Care with skin lesion as a chief complain. He was taking antimalarial agent for last 2 weeks. From medical record, he is noted psoriasis patient. The most possible antimalarial agent that he took is:
A. Quinine
B. Mefloquine
C. Doxycycline
D. Primaquine
E. Chloroquine


140. Patient drug malaria. Anemias after taking the drug.doc consider G6PD deficiency. Most appropriate anti malarial drug that had been taken?
A. Quinine
B. Mefloquine
C. Doxycyclin
D. Primaquine
E. Cholroquine


141. An 18 year old man come to doctor for consultation of antimalarian drug. The patient would go to the malaria endemic area for surfing on the next day so he would espose to direct sunlight. Which of the following is the most appropriate?
A. Quinine
B. Malarone
C. Mefloquine
D. Doxicycline
E. Chloroquine


142. A 40 years old woman come to doctor due high grade intermittent fever start with chils, high fever, sweating, headche, myagia, nausea, and vomit. Patient just comes back from pfalciparum endemic area. Which should be added to amodiaquine
A. Quninine
B. Mefloquine
C. Artesunate
D. Doxycylin
E. Cholroquine


142. A 40 year old woman came to the doctor due to high grade intermittent fever for a week. Typically it was started by chills, followed by high fever and sweating. She also had headache and myalgia, nausea, and vomiting. The patient has just come back from the P. Falciparum endemic area.
Which of the most appropriate combination antimalaria should be added to amodiaquine?
A. Quinine
B. Mefloquine
C. Artesunate
D. Doxicycline
E. Chloroquine



143. A 36 years old woman comes to consult antimalarial drugs. She would go to endemic area of malaria. Medical records noted her as epilepsy patient. Doctor gave antimalarial and educate about the drug. Which antimalarial should be avoided?
A. Quinine
B. Mefloquine
C. Doxycycline
D. Primaquine
E. Chloroquine


144. 56 years old man, consultation about antimalarial drug
Lab: creatinie: 4.5 mg/dl. Which drug can be given safely?
A. Quinine
B. Malarone
C. Proguanil
D. Mefloquine
E. Doxicycline


145. 25 y old man came to doctor for consultation. Experience high grade intermittent fever each 2 days. Condition occurs for several week 2 month ago. Fever disappear after eat antimalaria drug give by friend. He is still weak. And physical exam shows hepatosplenomegaly. Which drug?
A. Quinine
B. Mefloquine
C. Doxycyclin
D. Primaquine
E. Chloroquine


146. 6yo children with dysentry. Abdominal pain. The most appropriate drug is
A. Emitine
B. Paramomycin
C. Iodoquinol
D. Metronidazole
E. Diloxanide furoate


147. 20 years old woman came to doctor for consultation of lab result. She has no medical problem except that her lab result showed amoeba in microscopic feces examination.
What is the appropriate drug for this condition?
A. Emetin
B. Iodoquinol
C. Paramomycin
D. Metronidazole
E. Diloxanide Furoat



148. 30 years old man, patch covered by fine scales at his back. Wood's lamp exam show positive fluorescence. Possible diagnose?
A. Seborrhoic dermatitis
B. Ptyriasis versicolor
C. Pityriasis rosea
D. Psoriasis
E. Leprosy


149. A 39 years old man came with active border and middle central healing patch at his both inguinal and thigh region. He is an athletic athlete and had the same symptom last month. Microbial examination showed T. Rubrum. Which of the following is the most possible diagnosis?
A. Tinea cruris
B. Tinea Capitis
C. Tinea versicolor
D. Tonea pedis
E. Tinea nigra


151. Brain tissue is obtained at autopsy from person who died of rabies.
What procedure could be used to confirm presence of scabies infected cell in brain tissues?
A. Negri inclusion bodies and presence of viral protein by immunofluorescence
B. Detection of rising titers of antibody between acute and covalescent stages of infection
C. Virus isolation in chorioallantoic membrane of embryonated eggs
D. Hemagglutination Inhibition (HI) tests when disease manifested
E. Rapid culture technique whereby viral antigen are detected 2-4 days after inoculation


152. A 24 years old student just loves his new bulldog puppy. After approximately 3 months of proud puppy ownership and smooching, this guy noticed that his moustache begin itching and his upper lip become swollen and inflamed, and small pustular areas become apparent among the sparse hairs of his moustache. He visits his dermatologist. What was the likely cause of his symptom?
A. Microsporum canis
B. Aspergillus niger
C. Malessezia furfur
D. Piedraia hortae
E. Candida albicans


153. 42 years old male develop cellulitis on the back and arms 24hours after exercise. Skin swabs were taken from abraded lesion for microscopic examination and culture. Gram +ve cocci were present and develop clear hemolytic on sheep blood agar. Catalase test is -ve.
What are the possible bacteria for this disease?
A. Staphylococcus aureus
B. Staphylococcus epidermidis
C. Enterococcus faecium
D. Streptococcus pyogenes
E. Streptococcus viridans


154. A 6 years old boy develops a severe sore throat. On examination grayish exudate(pseudomembrane) is seen over the tonsilo pharynx. The primary mechanism in the pathogenesis of the disease is due to the bacteria as the causative agent.
A. Have an action of pyrogenic exotoxin as a superantigen
B. Increase in intracellular cyclic AMP
C. Produe exotoxin that is responsible for the necrotizing effect
D. Have an action of enterotoxin A
E. Inactivate of acetylholine esterase


19 years old girl is admitted to hospital because of fever, headache, weakness & anorexia. 10 days prior to admission she had diarrheal illness that lasted about 36 hrs. She has been constipated for the last 3 days.

155. What is the best specimen to diagnose this disease during this time?
A. CSF
B. Blood
C. Urine
D. Stool
E. Sputum


156. The culture for this patients grows a non-lactose fermenting gram -ve rod, oxidase -ve & motile. Which of the following is the most likely cause of her illness?
A. Shigella Sonnei
B. Salmonella Typhi
C. Pseudomonas Aeruginosa
D. E. Coli
E. Entamoeba Cloacae


157. 23 yr old man had perirectal abscess. Drain surgically. Suspect anaerob bacteria. Clues suggest anaerobs?
A. Positive in condition facultative anaer0b
B. Special c0tton swab can be use
C. Foul smell odour
D. Infect mucosa
E. Grow in Mac Conkey agar



158. A 48 years old man present with 2 days of abdominal pain, diarrhea, weakness, chills and fever followed by 1 day constipation
He denies any contact with anyone with same symptoms and always has his meal from street. What selective media use for isolation of his stool?
A. Blood agar
B. SS agar
C. Thayer martin agar
D. Blood agar
E. Chocolate agar



159. A 7 years old boy, have high fever last for 5 days with abrupt onset, body temperature range from 38.9- 39.5C, occurs all day and night. On 3rd day, body temp decrease37.5- 38C, but on the next day elevated again as it occurred on previous days. Which one of the characteristic of virus causes the disease:
A. Can grow in cell culture
B. Usually resistant to ether
C. Usually cause symptomatic infection
D. Transmission by arthropod vector
E. Closely related to parvovirus


160. Virus infects cells often develop morphologic changes referred to as cytopathic effect. Which one of the following statements best describes the cytopathic effects of viruses on host cells?
A. Causes morphological changes of the cells
B. Often associated with changes in mitochondrial membrane
C. Can be seen using Gram Staining
D. Rarely associated with cell death
E. Can only be seen with an electron microscope


Question 161-162:

A 60 years old female patient complains about red patches with papules and blister on a red base at the right side of her face, neck and upper chest since 3 days. She also feels discomfort, pain, numbness and varies from superficial itching, tingling, burning sensation in the involved area.


161. What is the cause of her disease?
A. Aerosol droplets of the causative agent
B. Contaminated food or water
C. Puncture from contaminated needle
D. Endogenous reactivation from previous infection


162. Characteristics of the virus that can cause the disease is:
A. Enveloped, double stranded DNA, icosahedral capsid
B. Enveloped, single stranded DNA, helical symmetry
C. Non enveloped, double stranded RNA, icosahedral capsid
D. Non enveloped, single stranded RNA, helical symmetry
E. Non enveloped, double stranded DNA, helical symmetry


163. Special staining for bacteria that cause diphteria?
A. Ziehl Nielsen stain
B. Gram stain
C. Neisser stain
D. Burri Gins stain
E. Negative stain


164. Some viruses can be isolated in embryonated egg into appropriate region. Which part of embryonated egg for inoculation of herpes virus?
A. Amniotic cavity
B. Allantoic cavity
C. Yolk sac
D. Intraembryonal
E. Chorioallantoic membrane


165. visualization of virus using electron microscope requires 10^6 virus particles per ml specimen. what virus can be detected in the fecal specimen using this method?
a)HPV
b)molluscum contagiosum virus
c)VZV
d)smallpox virus
e)rotavirus


166. serology is 1 of diagnostic methods in virology.what is criterion for diagnosing of primary infection in viral dz?
A.2fold n more increase in titer IgG or total antibody btwn acute n convalescent sera
B.4fold n more
C.single low titer IgG or total antibody
D.absence or slightly increase IgM

E.presence IgG antibody


168. A 20y obese female presents to the clinic with scaly erythematous patches on the groin. Skin scrapping is taken from the lesion for microscopic exam.
How is the morphologic pattern of the etiologic agent of that case when you observe using KOH solution?
A. Spaghetti and meatball appearance
B. Long branches septate hyphae & arthrospores
C. Pseudohyphae
D. Long branches non septate hyphae
E. Yeast cell with budding


170. A 5 years old boy hospitalized for acute meningitis. Gram staning showed gram negative rod?
A.Listeria monocytogenes
B.haemophilus influenza


171. A 27 years old male athlete visited the dermatological clinic with chief complain of white patch of his skin mainly in axilla, back and trunk. Dermatological examination revealed multiple hypopigmented maculescovered by fine scales. Wood lamp examination showed positive yellow fluorescence. He was diagnosed as tinea versicolor. Which of the following fungus is the cause of the disease?
A. Microsporum canis
B. Malassezia Furfur
C. Tricophyton Beigelli
D. Epidermophyton Werneckii
E. Epidermophyton Floccosum



172. Based on Leptospirosis case, WOTF lab exam will be the most likely to confirm diagnosis?
a. Testing acute & convalescence phase sera using RPR test
b. Culture of urine on human fibroblast cell
c. Testing serum by darkfield microscope for the presence of leptospira
d. Testing acute & convalescence phase sera for antileptospiral antibodies
e. Culture of CSF on blood & chocolate agar



178) kasusny panjang,ayah dan anak punya gejala sama.diagnosis : dengue fever,dengue virus adalah : single-stranded positive sense RNA (maaf,da lupe pilihan jawapan,jadi sy kasi jwpn die terus


54 years old man is a farmer in tropical area of this country, he developed persistent scaly papule of his leg.It is suspected of fungal infection


183. which statement regarding fungal goal and morphology is correct?
A pseudohyphae are produced by all yeast
B milds produce hyphae that may or may not partitioned with cross wall or septae
C conidia are produced by sexual reproduction
D most yeast reproduce by budding and lack cell wall
E most pathogenic dimorphic molds produce hyphae in the host and yeast at 30celcius


185. Million of cases of leprosy worldwide but predominate in tropical countries such as Asia & Africa. CLinical spetrum of tis disease characterized by:

A. Immunologic energy
B. Chronic pneumonitis
C. Peripheral neuritis
D. Bacili in lesions that digest tisssue
E. Erythematous lesion resembling concentric circle


187. 25/75 (nt sure) yr old man, 11days fever, muscle ache, frontal headache, constipation, widal O>1/320
a) Salmonella not case of classic typhoid fever
b) small number of organism basically a chronic carrier stage
c)cause enlargemenmt of Payer’s patch
d) Liver and spleen increase in size
e) bleeding and ulcer often

Case for no.189 & 190: 35yo man, chief complaint of fever intermittent every 2 days accompanied with shivering and headache. Just came back from Maluku.


189. True bout malariae
A. Male Anopheles the one who bites human
B. Vivax and Ovale are fatal
C. Gametocytes ends in mosquitoes
D.
E. Intraerythrocytes begins when merozoites produce Trophoziotes

190: WOTF pathology appearance that is most appropriate?
a. in chronic stage, parasites formation solid masses as brown black malarial pigment called hemozoin
b. in malignant vivax there is extreme congestion of the pigment reaction in the brain
c. in acute stages, splenic congestion and pigment reaction can be seen within red cells.
d. pigment react with stain for ferrous iron resembles hematin
e. same pigment also not be found in hepatocyte cells..
191. 3 year old dsyntri diarhea 7 day ago. Stool no leukocyte (+) E.histolitica. Pathology: microorganism invade crypt of the colon through tunica progress to muscularis mucosa. Which is infected?
A. Transverse and decending colon
B. Sigmoid and decending colon
C. Cecum and ascending colon
D. Rectisygmoid colon
E. Sigmoid



193. A 50 year-old man has white patches at his chest and upper extremity. There was no itching or pain at the lesion. histopathology leprosy examination may be interpreted a granulomatous not developed, but consists of only a few chronic inflammation.
What is the most appropriate diagnosis
a. Borderline tuberculoid leprosy
b. Borderline lepromatous leprosy
c. Indeterminate leprosy
d. True borderline leprosy
e. Tuberculoid leprosy


193. 50 years old , white patches with chest and upper extrimity, no itching pain at lession.Leprosy.Granulamatous not develope but consits a few chrronic inflammation?
A. Borderline tuberculosis
B. Borderline leprematous
C. True borderline
D. Intermediate borderline
E. Tuberculoid leprosy


195) Because of increase resistance to commonly used insecticide among important vector sp. this alternative effort can be taken such as involving alteration of breeding sites of vector. This effort is called?
A) Biological control
B) Environmental management
C)Vector Surveillance
D)Vector control
E) Larva .......


196)Public health interventions to prevent typhoid include the provision of safe water supply.what is the indicator for safe water supply in extent of bacteriological parameter?
A. presence of colored organic matter associated with the soil humus fraction
B. number of s.typhi
C. growth of microorganisms n may taste,odor,color,corrosion
D. thermotderant coliform bacteria
E. harmful chemical waste


197. A 20 years old researcher has a periodic fever accompanied by shivering and headache. He just got back from Papua for animal research. Trophozoite was found from his blood smear. Which of the following is the most appropriate prevention for this disease?

A. Human behaviour
B. Larva control
C. Chemoprophylaxis
D. Indoor residual spraying
E. Insecticide treated nets


199. 55 years old constructing worker has fever accompanied with jaundice and gastrocnemius pain. He had complaint after work at old building basement without shoes. WOTF that most appropriate prevention strategy?
A. Usage at open defecation as excreta disposal
B. Screening & treating promptly other family member
C. improve water supply sanitation
D. animal vaccination
E. doxicylin 200mg single dose


200. A 2 years old boy come to puskesmas with diarrhea 2 weeks ago. The doctor found cyst and eggs from feces examination.
Which of the following is the appropriate prevention?
A. Usage at open defecation as excreta disposal
B. Screening & treating promptly other family member
C. Improve water supply sanitation
D. Animal vaccination
E. Doxicylin 200mg single dose