KEMENTERIAN PENDIDIKAN NASIONAL

UNIVERSITAS HASANUDDIN
FAKULTAS KEDOKTERAN
SISTEM GASTROENTEROHEPATOLOGI (GEH)
Sekretariat: Bagian Bedah Fakultas Kedokteran UNHAS
Jl. Perintis Kemerdekaan Kampus Tamalarea Km. 10 Makassar 90245
Telp. 081543060855 Fax. 0411-586296. Email: geh.fkunhas@gmail.com

REMEDIAL TEST
ACADEMIC PHASE 2012/2013
Friday, October 5th, 2012

Location

: GA 306 FKUH LT. 3

Time

: 10.00 11.40 (100 minutes)

Test code

:1

INSTRUCTION:
A. Choose the best answer (A, B, C, D, or E)
B. Some questions can have just 4 four choices (A, B, C, and D)
C. For some questions with options 1, 2, 3, and 4: choose A if 1, 2, and 3 are correct; B if
1 and 3 are correct; C if 2 and 4 are correct; D if only 4 is correct; E if all statements are
Choose the best answer (A, B, C, D, or E)
correct

1.

46-year-old farmer woman was brought by ambulance to the hospital in acute

distress with symptoms of severe pain in the right upper abdominal region. In the
past she has had repeated attacks of severe pain in the right upper quadrant of the
abdomen, frequently following a heavy meal. She suffers from indigestion and gas
pain on her stomach, particularly after eating fatty foods and eggs.
What is the organ that might be suffering in this patient ?
A. Stomach
B. Duodenum
C. Liver D. Gall bladder E. Ascending
Colon

2.

A 24-year-old woman was admitted to the hospital with jaundice since the last 7
days. She also reported the darkening of her urine for 3 days before admission. On
X-ray examination without contrast, there are seen multiple calcified stones in the
right upper quadrant. According to the above scenario, which one of the biliary
system involve.
A. Liver
B. Gall bladder
C. Pancreatic duct
D. Common bile duct
E. Common hepatic duct

3.

Our throat divides into two separate tubes: the windpipe and the gullet. What
prevents food from entering the windpipe?
A. The uvula B. The tongue C. The trachea D. The epiglottis E.The oesophagus

4.

Where does the partly-digested food (in liquid form) go after it leaves the stomach?
A. The gullet
B. The appendix
C. The small intestine
D. The large intestine
E. The Sigmoid colon

5.

A 20 year-old boy, came to the clinic department complaining ofpain at right lower
quadrant abdomen from sleep last night. This chief complaint is associated with with
nausea and episodes of vomiting. The patient also reports that he has chills.
What is the organ/structure might be suffering in this patient?
A. Appendix vermiformis
B. Oesophagus (abdominal part) C. Duodenum
D. Stomach
E. Pancreas

6.

What are the organs that located retroperitoneal (lay behind peritoneum)?
A. Ileum, jejunum
B. Transverse and sigmoid colon
C. Ascending and descending colon
D. Abdominal
oesophagus
E. Both right and left lobe of liver

7.

part

of

Mouth or oral cavity divided into two area, vestibule and oral cavity proper. Which
of the following statement is correct due to vestibule?
A. Space behind alveolar processes B. Space between cheeks and alveolar
processes
C. Hard and soft palate as roof
D. Large space in the oral cavity
E. Tongue located in this area

8 . The following statement is not in gaster :

A. Simple cylindris epithelium
B. Fovea gastricae
C. Crypt lieberkhun
D. Simplex tubular gland
E. Rugae
9. The appendices epiloicae :
A. Appendix
B. Esophagus
C. Gaster
D. Small intestine
E. Large intestine
10. The following statement is not in vesica felea :
A. Simple cylindris epithelium
B. A thin submucosa
C. Sinus Rochitansky Aschoff
D. Capillaries in lamina propia
E. The serosa is covered by mesothelium
11. The centrum of liver lobules is :
A. Portal area
B. Portal vein
C. Central vein
D. Sinusoid
E. Trigonum Kiernan
For questions no. 12 14 with options 1, 2, 3, and 4:
Choose
A.
if 1, 2, and 3 are correct;
B. if 1 and 3 are correct;
C. if 2 and 4 are correct;
D. if only 4 is correct;
E. if all statements are correct
12. The characteristics of large intestine are:
1. Many goblet cells
2. Small villi

3. Crypt Lieberkuhn
4. Small plica circularis

13. The characteristic mucosa of small intestine are:

1. Villi
3. Plica Circularis Kerkringi
2. Crypt Lieberkuhn
4. Rugae
14. The Acinus Hepar:

1.
2.

Rappaport cs
Divided in 3 zone

3. Rhomboid
4. Trigonum of Kiernan

Choose the best answer (A, B, C, D, or E)

15. A 40-year-old policeman presents with the chief complaint of intermittent midepigastric pain
that is relieved by antacids or eating. Gastric analysis reveals that basal and maximal acid
output exceed normal values. The gastric acid hypersecretion can be explained by an
increase in the plasma concentration of which of the following?
A. Gastrin
B. Histamine
C. Somatostatin
D. Secretin
E. Enterogastrone
16. A patient presents with a chronic cough. The patient also reports substernal burning pain that
is most pronounced after ingestion of coffee, chocolate, french fries, and alcohol. Which of
the following is the most likely cause of gastroesophageal reflux disease (GERD) in this
patient?
A. Hiatal hernia
B. Delayed gastric emptying
C. Decreased esophageal motility
D. Decreased lower esophageal sphincter tone
E. Decreased upper esophageal sphincter tone
17. A 28-year-old male presents to the emergency room with a 48-hour bout of diarrhea with
steatorrhea. Which of the following best accounts for the appearance of excess fat in the
stool?
A. Delayed gastric emptying
B. Decreased bile salt pool size
C. Decreased gastric acid secretion
D. Decreased gastric accommodation
E. Decreased secretion of intrinsic factor
18. After secretion of trypsinogen into the duodenum, the enzyme is converted into its active
form, trypsin, by which of the following?
A. Enteropeptidase
B. Carboxypeptidase
C. Pancreatic lipase
D. Chymotrypsin
E. An alkaline pH
19. Which of the following is the major mechanisms for absorption of protein from the small
intestine?
A. Na+ - H+ exchange
B. Cotransport with sodium C. Electrogenic transport
D. Neutral NaCl absorption
E. Solvent drag
20. A young mother calls the pediatrician because she is concerned that her infant defecates after
every meal. Which of the following is the cause of these normal bowel movements in
newborns?
A. The gastroileal reflex
B. The gastrocolic reflex
C. Peristaltic rushes
D. The intestino-intestinal reflex
E. The defecation reflex

21. An 18-year-old male with pernicious anemia lacks intrinsic factor, which is necessary for the
absorption of cyanocobalamin. Intrincsic factor is produced by:
A. Oxyntic cell B. Parietal cell
C. G cell
D. D cell
E. S cell
22. Which one of the following factors is possible to stimulate gastrin secretion?
A. HCl
B. Secretin
C. Calcitonin
D. VIP
E. Nutrient proteins
23. Which one of the following hormones to stimulate the contraction of the gall bladder?
A. Gastrin
B. Glucagon
C. Cholecystokinin D. Enterocrine E. Secretin
24. Which one of the following enzymes is exoenzyme?
A. Pepsin
B. Trypsin
D. -amylase
E. Carboxypeptidase

C. Elastase

25. Which one of the following is needed to convert biliverdin to bilirubin?

A. NADP+ + O2
B. Carbonmonoxide
C. Heme oxygenase
D. Bilverdin reductase
E. UDP-glucuronyl transferase
26. Bile salts is primarily derived from:
A. Trigliserides
B. Phopholipids
D. CholesterolsE. Globin

C. Hemeproteins

27. Hepatitis D virus is a defective virus that can replicate only in cell which already infected
with which of the following viruses?
A. HIV
B. Hepatitis G Virus
C. Hepatitis A Virus
D. Hepatitis B Virus
E. Herpes Simplex Virus.
For Question no. 28 29
Woman 31 years old is brought in after vomiting in a large amount. She is dizzy and complains an
abdominal cramp and looks ill. This is her first such illness. She has just finished her fried rice lunch in a
canteen around 30 minutes ago.
28.

What did likely happen to the woman?

a.
b.
c.
d.
e.
29.

a.
b.
c.
d.
e.

Dyspepsia
Cholera
Salmonellosis
Food intoxication
Food infection
What was likely the cause of the case above?
Bacillus cereus
Campylobacter jejuni
Salmonella typhii
Vibrio cholerae
Clostridium perfringens

For Question no. 30 - 31

6

A 23 years old man presents with fever that lasting since a week ago, the febrile is intermittent
and often occur in the evening preceded by shivering. He also complains an abdominal cramp
and diarrhea a couple days ago. Today he has just vomiting twice.
30.

If the blood specimen of the patient is taken to microbiology laboratory reveal a gram
negative rod bacterium, with negative lactose and positive H2S in biochemistry test, what is
the possible bacterium infected him?
a. Shigella flexneri
b. Salmonella typhii
c. Escherichia coli
d. Bacillus cereus
e. Clostridium botulinum

31.

a.
b.
c.
d.
e.

What is the characteristic of that bacterium?

Aerobe
Non-motile
Food borne bacterium
Can be also cultured from urine in first week of disease
Has ability to cross the gastric acid barrier in a small amount

For Question no. 32 - 33

A 15 years old boy presents to the hospital with extremities flaccid paralysis since 2 hours ago.
This is the first episode of paralysis for him. He has no history of neurologic disease, and never
taken certain drugs for a long period. A day ago he ate a canned fish.
a.
b.
c.
d.
e.

What is likely the cause of the disease?

Shigella flexneri
Salmonella typhii
Escherichia coli
Bacillus cereus
Clostridium botulinum

a.
b.
c.
d.
e.

What is the best diagnostic test taken to make sure the diagnosis?
Gram staining
Biochemistry test
Cultured of blood sample
Electroencephalography
PCR based assays

32.

33.

34.

The following properties of Hepatitis A virus is :

A. Incubation period HAV 2 - 6 weeks.
B. Replicates in the nucleus of infected cell
C. Mortality rate : more than 1 %
D. Replicative cycle different to that replicative cycle of polio virus
E. HAV infection of culture cells produced cytoplasmic effect.

35.

HBV is also called as the helper virus for HDV, because:

A. HDV does have the genes for its envelope protein.
7

B.
C.
D.
E.

HDV requires an established Hepatitis B virus infection to be able to replicate.

HDV can replicate in cells also infected with HEV or HCV.
HDV uses HbcAg as its envelope protein.
Hepatitis D virus is can replicate on its own.

For Question no. 36 - 42

Patient, male 57 yo, was hospitalized a few days ago. Symptoms: fatigue, fever(subfebrile),
anorexia. Physical examinations: jaundice, pale, pruritus. Laboratory tests: RBC:
3.100.100/cmm, WBC: 9.100/cmm, Plt: 210.000/cmm, Hb: 8,5 gr/dl, Hct: 31%, AST: 100 U/l,
ALT: 360 U/l, Total bilirubin: 8mg, Blood glucose: 100mg/dl, Urine: Bilirubinuria (++).
1.
2.
3.
4.

Differential Diagnosis:
Viral hepatitis
DHF
Hemolytic anemia
CKD

1.
2.
3.
4.

Alanine Amino Transferase (ALT)= 360 U/l (High)

Chronic hepatitis
Mononucleosis
Cholecyctitis
Myocard infarct

1.
2.
3.
4.

Total bilirubin= 8,0 mg/dl

Fatty liver degeneration
Chirosis toxication (Alcoholic ingestion)
Ductus biliaris occlusion
Acute viral hepatitis, cholestatic type

36.

37.

38.

39. Jaundice, etiology

1.
2.
3.
4.

Bacterial infection
Parasitic infection(falciparum)
Haemorrhargic disease
Haemolytic anemia

1.
2.
3.
4.

Bilirubin indirect
Water soluble
Bilirubin proteinat
Conjugated bilirubin
Serum bilirubin

1.
2.
3.
4.

Laboratory tests to make a diagnosis of hepatitis B ;

HBsAg
ALT(20-50x upper limit)
Anti-HBs
AFP

40.

41.

42.

Vaccination of hepatitis B&C for all case :

1. Basic vaccination: anytime
8

2. Booster I (Second dosage): 1-2 months after basic

3. Booster II (Third dosage): 4-6 months after basic
4. Booster III: Very important dosage
For question no. 43 44:
A 25-year-old man come to health centre with diarrhea. He states that his stool was mixed with
blood and mucus. Examination of his stool reveals parasite with characteristics as follow:
irregular shaped, ectoplasm sharply separated from endoplasm, has one nucleus with a small
central compact karyosome, and endoplasm contain red blood cell.
43. Which one of the following organisms is the most likely found in this mans stool?
A. Trophozoite of Giardia lamblia
B. Trophozoite of Entamoeba coli
C. Trophozoite of Endolimax nana
D. Trophozoite of Balantidium coli
E. Trophozoite of Entamoema histolytica
44. What is the best diagnosis for the case above?
A. Giardiasis
B. Amebiasis
D. Isosporiasis
E. Balantidiasis

C. Shigellosis

For question no. 45 46:

A 7-years-old girl presents to health centre with diarrhea. Examination of her stool reveals fat
granules and parasite with characteristics as follow: bilaterally symetric, pear-shaped, rounded on
anterior part, pointed on posterior part, has two nuclei in the anterior, four flagella, and two
axostlyes.
45. Which one of the following organisms is the most likely found in this girls stool?
A. Trophozoite of Entamoeba hystolitica B. Trophozoite of Balantidium coli
C. Trophozoite of Entamoeba coli
D. Trophozoite of Giardia lamblia
E. Oocyst of Isospora belli
46. What is the best diagnosis for the case above?
A. Giardiasis
B. Amebiasis
D. Isosporiasis
E. Balantidiasis

C. Shigellosis

For question no. 47 48:

A 45-year-old woman hospitalized due to difficulty in swallowing. A tumor in her oesophagus
located at near the stomach-oesophageal junction was found by endoscopic examination.
47. Type of tumor that could be found mostly at that location is:
A. Adenocarcinoma
B. Basal Cell Carcinoma
C. Squomous Cell Carcinoma
D. Undifferentiated Carcinoma.
E. Adenosquamous Carcinoma
48. The tumor occurred at that location initiated by metaplastic change and displatic change due
to the present of chronic irritation by stomach acid reflux. The distal part of esophagus that
metaplastic change occurred is called:
A. Atresia esophagus
B. Stricture esophagus C. Varices esophagus
D. Barret esophagus
E. Burkitt esophagus
For question no. 49 50:
A 30-year-old woman came to doctor with frequent epigastric pain. The doctor diagnose her as a
chronic gastritis patient. Because she suffered from the disease in long period, the doctor worried
9

about the possibility of cancer development, and he asked her to visit a gastroenterologist to
know the actual cause of the disease.
49. Among the possible cause of the disease (chronic gastritis) which one of them having
highest possibility to develop stomach cancer:
A. Gastric outlet obstruction
B. Chronic functional dyspepsia
C. Chronic infection by Helicobacter pylori
D. Chronic chemical gastritis caused by bile reflux
E. Chronic autoimmune gastritis of parietal cells by antibody
50. The endoscopic examination followed by biopsy of the gastric lesion was performed at the
gastroenterology department. The pathologic examination of biopsy specimens found the
cause of the chronic gastritis having a very high risk to develop stomach cancer, and the
pathologist reports the present of intestinal metaplasia and dysplasia of the stomach
epithelial. The conclusion is:
A. Chronic gastritis is not severe.
B. Chronic gastritis is severe and stomach cancer already present.
C. Chronic gastritis is severe but dont worry for development of stomach cancer
D. Chronic gastritis is severe and high risk for the development of stomach cancer
A 61-year-old woman came to doctor with hematemesis, melena, and frequent epigastric pain.
She showed sign of anemia with 4 gr% of hemoglobin level. By endoscopic examination the
diagnosis was ulcer in the stomach.
51. The incorrect statement about stomach ulcer is:
A. Peptic ulcer in the stomach never cause perforation
B. Ulcer penetration in acute ulcer reaches muscular layer
C. The most cause of ulcer of stomach is Helicobacter Pylori
D. Term erosion is used if the ulcer penetration limited on mucous layer
E. The ulcer may couse massive bleeding if ulcer affected a big blood vessel
52. 37 years old woman, visit her doctor, complaining of epigastric pain, doctor s Diagnosis,
she is suffering gastritis. Doctor gives her Proton Pump Inhibitor(PPI), The drug is :
A. Simetidine 150 mg B. Ranitidine 200 mg C. Omoperazole 20 mg,
D. Domperidon 10 mg E. Sucralfat 500 mg
53. A man age 21 years old,vertigo and gaster discomfort . The doctor chooses drug that action
Inhibit nausea and vomiting. Side action of this drug at central and perifer of body.
A. Domperidon B. Loperamid C. Metoclopramid D. Cisapride E. Hyocianin
54. Man 45 years old ,tourist, abdominal pain and diarrhea without bloody stool. Doctor
praescribes 3 drugs . one of those drug is anti diarrhea classified narcotic. This drug is:
A. Kodein B. Norit C. pektin D. Loperamid E, Attapulgide
55. Woman 35 years old ,consume drug for treat his menstruation pain from dispensary.
Complain mydriasis and retensi urinary . This is side effect of :
A. Anti spasmodic
B Analgetik
C.Antasida
D. Non steroid antiinflamation drug
E. Antibiotik

10

56. One patien ( 40) comes to his doctor ,his case internal haemoroid. The doctor praescribes
drug per rectal( suppositoria). One component of that drug is steroid anti inflamasi. That
drug is
A. Benzocain B. Prednisolon C. Dimenhidrinat D. Lidocain E. Diphenhidramine
57. Lipotropic drug is :
A. Simvastatin, B, Gemfibrosil C.Cholin D. Fenofibrate E.Pravastatin .
For question no. 58 - 60
A 62-year-old man presents to the emergency department (ED) with a chief complaint of waking
up with abdominal pain. He states that over the past week he has had intermittent, gaslike
epigastric pain and a sensation "like I need to burp". It is now radiating in a bandlike pattern
throughout the patient's upper abdomen and to his back. The patient has mild nausea but has not
vomited. He has not experienced any chills or fever, and he denies having any diarrhea. No chest
pain, shortness of breath, or palpitations are noted. He has no chronic medical conditions and
does not take any medications like nonsteroidal anti-inflammatory drugs (NSAIDs).
58. What is the cause of the patient's abdominal pain?
A.
Gastroesophageal reflux disease
B.
Cholecystitis
C.
Acute pancreatitis
D.
Peptic ulcer
E.
Gastric Tumor
59. Which of the following is the most common cause of the above patient's condition?
A.
Helicobacter pylori infection
B.
NSAIDs
C.
Smoking
D.
Alcohol
E.
Chronic steroid use
For question no. 60 - 61
Three month later, the patient comes again because of melena, from history taking he was
suffering from rematoid arthritis and using prednisone with non-steroid anti inflammatory drugs
(NSAIDs) for a past few years. Upper GI tract reveal as peptic ulcer .
60. The pathomechanism of gastroduodenal injury related to NSAIDs:
A. Indirect accumulation of NSAID in epitel gastroduodenal causing inflammation and later
giving necrosis with epitelial haemorrhagic
B. Inhibition of cyclo-oxygenase receptor with direct accumulation of NSAID
C. Direct accumulation causing inflmmation, decreased of prostaglandin and neutrofil
formation
D. Direct inhibition of cyclo-oxygenase receptor causing increased of prostaglandin and
decreasing neutrofil formation with indirect accumulation of NSAID
E. Indirect inhibition of cyclo-oxygenase receptor causing prostaglandin decrease and
neutrofil formation increase with direct accumulation of NSAIDs
61. Recommendation for this patients to avoid the complication, such as:
A. Discontinue NSAIDs and ulcerogenic drug
B. Using PPI while NSAIDs continue or change to COX-2 selective inhibitors
C. Identify high risk patient : age > 60 y.o, prior GI bleed, high dose NSAID, concurrents
steroid
D. A and C choice
11

E. B and D choice
For question no. 62-64
A 45-year-old presents to you, he has experienced the gradual onset of rectal bleeding over the
past 3 months. He first noticed it with wiping, but it has become more overt with blood
associated with passing bowel movements. His stool frequency has increased to approximately 45 trips to the toilet daily. He is experiencing an urgent sensation to defecate just before going to
the toilet. He has no other health issues. Physical examination shows anemia, eritema nodusum,
mild abdominal distention and pain in left lower hipochondrium.
62.
According to anamnesis and physical examination, suspicious diagnosis of this patient is :
A.
Dysentri
B.
Diverticulosis
C.
Irritable bowel syndrome
D.
Colitis infection
E.
Inflammatory bowel disease
63.
A.
B.
C.
D.
E.

Simple diagnostic procedure as a doctor in primary health care:

Rectal examination
Endoscopy of lower GI tract
Colon in Loop
Ultrasonography of abdomen
Take serologic laboratory study

64. Long term complication of this patient disease should always to take attention:
A. Toxic megacolon
B. Bleeding and perforation
C. Cachexia
D. Impairement the quality of life
E. Colorectal cancer

For question no. 65 - 66

A 25 years old male patient complain with nausea, vomiting, artralgia, anorexia and malaise
within 2 weeks. After 7 days, patient have dark yellow urine and according his friends, yellow
eyes was appear on his eyes recently.
Physical examination reveal : sclera icteric and light pain palpable in upper hypochondrium
dextra; laboratory : Billirubin total 16,8 mg%, Billirubin direk 8,5 mg%, SGOT=250 U/L,
SGPT=400 U/L.
65. Temporary diagnosis of this patient:
A. Cholestatic disease
B. Chronic Liver Disease

C. Acute Hepatitis
D. Acute Pancreatitis
12

E. Acute Cholecystitis

66. Which of the following tests is used to screen patients for evidence of HBV infection?
A. Hepatitis B surface antigen (HBsAg)
B. Hepatitis B surface antibody (anti-HBs)
C. Hepatitis B core antibody (anti-HBc)
D. Hepatitis B envelope antigen (HBeAg)
E. Hepatitis B envelope antibody (anti-HBe)
For question no. 67-68
A 56 years old female patient enter to hospital with abdominal distention, edema in foot within 3
months. Bleeding with dark blood are find in mouth and anal. Physical examination: sclera
icteric, conjungtiva, anemis, eritema palmaris, shifting dulness , edema tibial and pretibial.
Laboratory findings: Bill total = 20.5 mg%, SGOT= 59 U/L, SGPT=65 U/L, protein total=5,2
gr/dl, albumin=2.0 gr/dl.
67.
Diagnosis according anamnesis, physical examination and laboratory are:
A. Ascites
C. Compensated Liver Cirrhosis
B. Chronic liver disease
D. Decompensated Liver Cirrhosis
E. Acute hepatitis
68.
Complication can occur according diagnosis of the patient:
1. Variceal Bleeding
3. Hepatorenal syndrome
2. Spontaneous Bacterial Peritonitis 4. Hepatic Encephalopathy
For question no. 69 71:
A boy, 6 years of age complained abdominal pain, especially at right lower quadrant. It had been
felt since 3 days ago and become severe now until the right leg was pain. The child had fever and
sometimes vomiting. Micturation were in normal limit and bowel movement were less today.
69. According to find the etiology of abdominal pain, the first step is to look for:
A. Nutritional status
B. Gender
C. History of medicine before
D. Age
E. Other complaining signs
70. If there is Rovsings sign in physical examination, the possibility of diagnosis is:
A. Urinary tract infection
B. Gastritis
C. Diverticulitis
D. Appendicitis
E. Constipation
71. The diagnostic adjunct must be done at first step is:
A. BNO
B. Colon in loop
C. Abdominal USG D. Complete blood count E. IVP
For question no. 72 76:
A girl, 2 years of age had watery stool yesterday with less waste, she can drink less water but get
vomit. Her general condition was nervous. The girl has well nutrition.
72. The girl possibly suffer from:
A. Severe dehydration diarrhea B. Mild-moderate dehydration acute diarrhea
C. Acute diarrhea
D. Chronic diarrhea
E. Persistent diarrhea
73. The most possible cause of her diarrhea is:
13

A. Salmonella B. Virus

C. Shigella

74. The first line management for this condition is:

A. Anti-bacterial
B. Anti-virus
D. Oral rehydration solution
E. Anti-diarrhea

D. Worm

E. Fungi

C. Breast milk

75. The main problem of neonatal jaundice:

A. Physiologic Jaundice
B. Breast milk Jaundice
C. Jaundice caused by dehydration D. Jaundice caused by immaturity of liver
function
E. Obstructive Jaundice
76. Physiological jaundice:
A. Direct hyperbilirubinemia
C. Normal indirect bilirubin
E. Disappear completely

B. Direct and indirect hyperbilirubinemia

D. Caused by abnormality of the biliary tract

For question no. 77-79

Patient, 2 years old, female. Admitted to the hospital with a bulge (swelling) in the groin which at
times may extend into the right scrotum. The bulge may appear and then disappear with some
regularity, especially during straining, crying,or coughing.There is no vomiting and no
abdominal distention. Rectal toucher in normal limite.
77. What is the Clinical diagnosis?
a. Inguinal Hernia Reponible Dextra
b. Hydrocele uncommunicantes Dextra
c. Femoralis Hernia Dextra
d. Ca Testis Dextra
e. Orchitis Dextra
78. Differential Diagnosis For this case with use transiluminasi test positiveis:
a. Incarcerata hernia
b. Strangulata hernia
c. Iguinalis hernia
d. Hydrocele
e. Ca Testis
79. The treatment for this case is :
a. Herniotomy
b. Hidrocelectomy
c. Orchidectomy
d. Concervative
e. Orchidopexi
For question no. 80-82
Patient, 2 month years old,male. Admitted to the hospital (policlinic of pediatric surgery) with a
bulge (swelling) in umbilical region, There is no changing color of skin in bulging area, others
physical examination is normal limite.The bulge may appearduring straining, crying,or
coughing.There is no vomiting and no abdominal distention.
14

80. What is the diagnose?

a. Umbilical Fistel
b. Umbilical Hernia
c. Omphalocele
d. Umbilical Granuloma
e. Ductus Omphalomesentricus persisten
81.

The correct answer for this case treatment is.

a. Firstulectomy
b. Directly operate (Cito)
c. Observe until age 3 to 4 years
d. Incidence of incarcerata is higher
e. Exicision Granuloma

82.

Surgical management of this case is:

a. Laparotomy exploration
b. Wide excision of granuloma
c. Fistulectomy
d. Repair Omphalocele
e. Repair Hernia Umbilical

83.

Seorang wanita muda berumur 19 tahun, mengeluh nyeri perut tiba-tiba pada abdomen
kanan bawah. Pemeriksaan fisik abdomen ditemukan adanya nyeri pada kwadran kanan
bawah. Pada colok dubur juga didapatkan adanya nyeri. Suhu tubuh 37,3 0 C, leukosit
10.000/mm3. Diagnosis yang paling mungkin adalah :
A. Penyakit Inflamasi Pelvik
B. Infeksi traktus urinarius
C. Appendisitis Epiploika
D. Ruptur Folikel Graaf
E. Appendisitis Akut

84.

Pada anak anak proses penyakit yang di salah diagnosiskan dengan appendisitis akut
adalah :
A. Lymphadenitis mesenteric akut
B. Enteritis regional akut
C. Gastroenteritis akut
D. Pyelonephritis akut
E. Intususepsi
85. Penyebab utama cholesistitis akut adalah
A.
Infeksi Klebsiella
B.
Infeksi Salmonella
C.
Batu empedu multiple
D.
Infeksi Escherichia Coli
E.
Obtruksi duktus sistikus
86. Seorang laki-laki berumur 75 tahun, masuk Rumah sakit dengan ikterus obstruksi yang
dialami sejak 2 minggu terakhir. Prosedur awal terbaik dalam menentukan penyebab
ikterus obstruksi adalah
A.
CT scanning
B.
Ultrasonography
C.
Radionuclide scanning
D.
Percutaneus transhepatic cholangiography (PTC)
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E.

Endoscopic retrograde cholangiopancreatography (ERCP)

87. Wanita, 45 th masuk rumah sakit dengan ikterus obstruksi yang dialami sejak 3 bulan
lalu, pada pemeriksaan MRCP dan ERCP ( gambar diatas menunjukkan bayangan
radiopak pada distal duktus sistikus yang menekan common bile duck sehingga aliran
empedu terhambat, diagnosis penyakit ini dikenal dengan
A.
Pankreatitis
B.
Cholesistitis
C.
Mirizzi syndrome
D.
Mallory Wheiss syndrome
E.
Penyakit Obstruktif menahun
For question no. 88 - 90
Laki-laki umur 60 tahun datang ke rumah sakit dengan keluhan tidak bisa buang air besar.
Dialami sejak 5 hari yang lalu. Sebelumnya penderita mengeluh sering sakit perut. Para foto
polos abdomen ditemukan gambaran friemaan-Dahl dan dengan pemeriksaan barium terdapat
gambaran Birk beak appearance.
88. Kemungkinan diagnosa penderita ini :
a. Perforasi gaster
b. Appendisitis acut
c. Diverticulitis
d. Volvulus sigmoid
e. Chrons disease
89. Penanganan pada penderita ini, kecuali :
a. Konservatif
b. Pemasangan NGT
c. Pemasangan katether
d. Operasi laparatomi
e. Sigmoidektomi
90. Pada kasus di atas yang merupakan kontra indikasi tindakan :
a.
Terapi entheral feeding
b.
Terapi parentheral feeding
c.
Puasa
d.
Pasang NGT
e.
Foto polos abdomen

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91. Man, 28 years old, with BMI 25.7 kg/m2, waist circumference 95 cm came to clinic because
of heart burn especially after have a meal.
What do you suggest to him for nutrition intake?
A. Have a soft meal
B. Have a small portion of meal but frequently
C. Have a coffe after having a meal D. Have a meal early as possible
E. Have a cold meal
92. Man, 48 years old, come to private clinic because of bloating and pain in the abdomen. To
maintain the mucous intestinal, what nutrient shoud be given to this man?
A. Arginine
B. Probiotic
C. Proline
D. Glutamine
E. Prebiotic
93. College student, 22 years old, always complaining for pain in the epigastric area. Now he
loses his weight about 2 kg since 2 months ago. What do you suggest for him about his
intake to prevent another weight loss?
A. Avoid high protein food
B. Avoid high carbohydrate food
C. Have probiotic
D. Have immunonutrition supplement
E. Have high fiber food
94. Woman, 60 years old have a tumour in her stomach. Now, she has jejunal tube feeding. Food
should be given as slowly as it can. If she has abdominal fullness and crampy. What is the
sign stand for?
A. Re-feeding syndrome
B. Untolerance syndrome
C. Chrons syndrome
D. Dumping syndrome
E. Tolerance syndrome
95. Woman, 38 years old, come to emergency room because of pain in the epigastric and
radiating to the back. What is nutrition management for this woman?
A. Stop oral intake
B. Give liquid diet
C. Give fish oil supplement
D. Give small portion and frequent meal
E. Give curcumine supplement
96. The routine position of plain abdominal radiography in case of acute abdomen is:
A. Supine-erect-right lateral decubitus
B. Supine-erect-left lateral decubitus
C. Supine-prone-erect
D. Supine-prone-lateral decubitus
E. Supine-prone-erect-lateral decubitus
97. A 44-year-old housewife is admitted to the ward with nausea and pain especially over the
right upper abdominal. She has a history of fever and medication. In physical exam is
unremarkable. The most appropriate investigation for this patient is ?
A. MRI
B. USG
C. MRCP
D. CT Scan
E. Plain photo
98. A 60 years-old man with melena. Which of the following radiologic examination you recommend
to be performed?
A. Sialography
B. Barium enema
C. Follow through
D. Bronchography
E. Gastroduodenography
99. A 45 years-old man with hematemesis melena. Esophagogram showing cobble-stone
appearance . The most likely diagnosis is
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A. Achalasia

B. Varices

C. Tumor

D. Diverticle

E. Polyp

100. A women 65 years-old was referred to radiology department for gastroduodenography with
the clinical history of haematemesis. Gastroduodenogram showed persistent filling defect
with irregular border along the wall of stomach body. The most likely diagnosis is:
A. Ulcer
B. Diverticle
C.Gastritis
D. Polyp
E. Malignant
tumor

*****

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