Legend:

 _______ : jawaban gw
 _______ : jawaban gw yg diduga salah setelah liat kunci
 _______ : jawaban ragu2 or belum ngerti
 _______ : jawaban kunci, yg gw duga salah
 (italic) : penjelasan/ alasan jawaban

1. In a histological preparation of the skin, we see many structures. Some of these are
nerve ending that serve as sensory receptors. One of these is Pacinian cospuscle.
What stimulus stimulates these receptors?
Pacinian corpuscles are one of the four major types of mechanoreceptor. They are nerve
endings in the skin, responsible for sensitivity to vibration and pressure
A. Noxious (destroying)
B. Warm
C. Cold
D. Vibration
E. Pain

2. Some characteristics of the skin usually can be used to identify some one. Two of these
are: The brown tones of skin that result from pigments produce by:
A. Merkel cells
B. Basal cells
C. Keratinocytes
D. Melanocytes
E. Germinative cells

3. Skin serves as a barrier against many kinds of agents which can make disease. It may
be as physical barrier, chemical barrier, and biological barrier. But also participates in
the immune response. Through what cell or component?
A. Merkel cells
B. Langerhans cells
C. Melanocytes
D. Keratinicytesw
E. Basal cells

4. A 66 year old female presented with multiple bullae in her body. She told that these
lesions are started as an erythematus then evolves into a tense bulla. Biopsy to one of
blisters is performed and microscopic shows a blister covered entirely by epidermis
without acantholysis. The bulla formed is sub-epidermal.
Which of the following disorders is most likely to produce the type of blister based on
microscopic appearance?
A. Impetigo -- crusting
B. Bullous Pemphigoid – without acantholysis
C. Pemphigus Vulgaris – terdapat acantholysis
D. Dermatitis Herpetiformis
E. Herpes simplex
5. A 60 year old male noticed the development of ulceration, darkly pigmented skin in his
right cheek has already been over than 5 months. These area are neither painful nor
pruritic. A biopsy is taken and the microscopic of this lesion consists of characteristic
basal cells. The basal cells form masses of various size and shapes that infiltrate the
epidermis where the periphery of these masses shows an arrangement of palisade cells.
The nuclei of the cells are anaplastic.
Which of the following lesions best account for these findings?
A. Basalioma
B. Melanoma Malignant
C. Nevus intradermal
D. Seborrhea Keratosis
E. Lentigo Maligna

6. A 18-year-old boy with fair skin was seen in dermatology consultation for redness and
pain on his shoulder and back, 1 day after swimming on the beach with his brother for 2
hours at noon. Started with redness and after 6 hours he experience the skin is lightly
swollen itchy and pain except the part covered with by his pants. His brother which has
darker skin color not has any problem with his skin. Why was he experience this kind
of skin problem?
a. Lighter skin absorb sun light more
b. U V ray absorb by basal cells
c. Keratin layer can not penetrate by UV ray
d. Melanin disperse UV ray
e. UV ray penetrates melanin
The photochemical properties of melanin make it an excellent photoprotectant.
It absorbs harmful UV-radiation and transforms the energy into harmless heat
through a process called "ultrafast internal conversion". This property enables
melanin to dissipate more than 99.9% of the absorbed UV radiation as
heat[3] (see photoprotection). This prevents the indirect DNA damage that is
responsible for the formation of malignant melanoma and other skin cancers.

7. A 7-year-old boy was seen in the dermatology clinic with a 2-week history of insect
bites at his leg that progressively became severe and develops boils approximately 5
cm, it had a small blister containing fluid that popped easily and left a rim of free skin.
They’re only able to eat once a day, due to poverty. During physical examination, the
child has fever and pain, and have regional lymph node enlargement. Using a lab test,
Streptococcus aureus was found.
What diagnosis would you give to this patient?
a. Bulous impetigo – ketiak, dada, punggung, komplikasi akhir lymph node
b. Kerion
c. Cellulitis – biasa di kaki, insect bite, gejala konstitusional
d. Varicella
e. Scabies

8. A 8-year-old boy seen in dermatology consultation for some small bumps on his
shoulder and chest that’s not itchy and a bit redness. It was small and a few only but
it’s spread out. The lesion was dome shaped papules with umbilically notch in the
center. What is your most likely diagnosis?
a. Varicella
 b. Herpes zoster
c. Verucca vulgaris
d. Pediculosis corporis
e. Molusccum contagiosum

9. A 25-year-old woman presented with some itch on the scalp that started 3 month ago.
She always covers her hair with a scarf every day from 9 am to 5 pm and worked at
the parking lot. On examination there’s some annular patch which covered with white-
gray fine scales. What is your most likely diagnosis?
a. Psoriasis
b. Seborrheic dermatitis
c. Pediculosis capitis
d. Kerion celsi
e. Gray patch ring worm – keluhan di rambut + hair loss n gray hair

10. A 31-year-old man seen in dermatology consultation with a 3 month history of white
patches over his back, shoulder and arm, with his activity on the sun the spots had
become more noticeable. They had not been red and asymptomatic. The KOH prep.
Revealing short hyphae and spores. What is the most likely diagnosis?
a. Vitiligo
b. Leprosy pausi basiller
c. Dermatitis seborrheic
d. Pityriasis versicolor
e. Psoriasis gutattate

11. What laboratory test would you do to prove your diagnosis?

a. Tzank preparation
b. KOH preparation
c. Gram preparation
d. Skin scrapping for mites
e. Wood’s lamp

12. A 30-year-old man presented with a 2 month history of itching that had become more
intens at night on groin area and genitalia, its spread to interdigital web, wrist, elbow
and axillae. The physical examination revealed excoriations, small papules and
pustules discrete, scattered around. What is the most likely diagnosis?
a. Cutaneus larvae migrans
b. Contact dermatitis
c. Atopic dermatitis
d. Tinea corporis
e. Scabies

13. A 12-year-old man presents to the pediatrician for a follow-up visit regarding his acne.
On his face are numerous comedones and many inflamed papules and pustules, and
there is some evidence of mild scarring. At his first visit three months ago for this
problem, he was prescribed topical retinoid and benzoyl peroxide, which he has been
 using regularly. He feels that the acne has improved slightly with this treatment
regimen. What is the most appropriate treatment for his condition?
A) Add topical erythromycin to the regimen
B) Add oral corticosteroids to the regimen
C) Begin treatment with oral tetracycline only
D) Begin treatment with oral isotretinoin only
E) No change in treatment; re-evaluate in three months

 Comedones: Topical tretinoin

 Mild inflammatory acne: Topical antibiotics, benzoyl peroxide, or both
 Moderate acne: Oral antibiotics
 Severe acne: Oral isotretinoin
 Cystic acne: Intralesional triamcinolone

Mild acne:
 = comedone <20 / inflamm <15 / total <30
 topical corticosteroid, + topical antibiotic, 6wk
Moderate acne:
 = comedone 20 – 100 / inflamm 15 – 50 / total 30 - 125
 oral antibiotic: tetra, doxy, 12wk
Severe acne:
 = cyst >5 / comedone >100 / inflamm >50 / total >125
 oral isotretinoin (teratogenic), 16-20wk, + injection

A 21-year-old male presents to your office with a non-pruritic rash. He says that he
noticed it in the rainy season, and it got worse during the sunny. His past medical history
is insignificant. He does not smoke or consume alcohol, and denies any recreational drug
use. He has been a good husband without any other sexual partner. The physical
examination reveals multiple circular hypopigmented macules on the chest, back and
upper arms.

14. Which of the following is the most likely diagnosis in this patient?
A) Pityriasis rosea
B) Tinea versicolor
C) Secondary syphilis
D) Eczema
E) Impetigo

15. Which of the following is the best treatment for this patient?
A) Oral erythromycin
B) Topical clotrimazole
C) Penicillin IM
D) Topical corticosteroids
E) Oral doxycycline

16. A 14-year-old female presents to the pediatrician complaining of discoloration of her

toenails, which makes it "impossible to wear sandals." She says that some months
 ago, she first noticed the big toes of both feet were affected, and that the yellowish
brown discoloration began with the distal tips of her toenails and spread proximally to
involve the entirety of the nail. On physical examination, the nail plates of all ten toes
are heaped up and irregular. Brownish discoloration is evident. Dermatophytic
hyphae and arthrospores are visible upon KOH examination of scrapings from the nail
bed. What is most effective treatment regimen for this girl’s condition?
A) Ciclopirox
B) Salicilic acid
C) Retinoic acid
D) Griseofulvin
E) Terbinafine

nail infection:
 onychomycosis: fungal infection to nail plate, nail bed. discoloration,
deformed. Tx: no medication, oral terbinafine, itraconazole
 paronychia: staphylococcal infection of periungual (nail margin). Tx:
antibiotic, drainase pus

17. A 17-year-old male presents to a clinic complaining of severe sunburn to his face and
forearms. He was playing soccer ball outdoors for less than one hour on a sunny day
before noticing the sunburn. His past medical history is significant for acne vulgaris,
which he is taking medication for. Physical examination reveals numerous
comedones, papules, and pustules on his face, neck, and chest. There is significant
scarring from previous episodes of acne. Confluent areas of erythema, warmth, and
edema are evident on the patient’s face and forearms.
Which of the following medications is the most likely causative agent of the sunburn?
A) Benzoyl peroxide
B) Erythromycin
C) Clindamycin
D) Doxycycline
E) Acid salicylic

18. A 23-year-old female comes to the physician for the treatment of acne vulgaris. She
has moderate comedonal acne affecting her face, neck, and shoulders. She has no
other medical problems. She is married and does not have any children, although she
has been trying to conceive for the past few weeks. You decided to treat her with
topical retinoids. She also says that her sister is taking oral retinoids and using
contraception. Which of the following is the best advice for this patient?
 A) You should use the medication only in the morning
B) You have to use contraception to avoid pregnancy
C) I will have to check serum triglycerides levels while on topical retinoids
D) I will have to check liver function tests while on topical retinoids
E) Don’t worry; you are using only a topical cream

topical tretinoin: Adverse effects include erythema, burning, stinging, and peeling

Oral isotretinoin is nearly always effective, but use is limited by adverse effects,
including dryness of conjunctivae and mucosae of the genitals, chapped lips,
arthralgias, depression, elevated lipids, and the risk of birth defects if treatment occurs
during pregnancy. Pregnancy tests should be done before beginning therapy and
monthly until 1 mo after therapy stops

19. A 24-year-old man comes to your private practice for a pruritic rash on both his feet.
The rash started between the third and fourth interdigital space on the left side and has
gradually spread over to the sole of his foot. A similar lesion appeared on the right side
two days ago. He is an avid runner, and a member of his school’s marathon team.
Physical examination, there is an erythematous, slightly scaly lesion in between his
toes extending over to the sole. There is clear demarcation between the lesion and the
uninvolved skin. The remainder of his skin examination is normal. Which of the
following is the most likely diagnosis?
A) Tinea pedis
B) Scabies
C) Dyshidrotic eczema
D) Tinea versicolor
E) Atopic dermatitis

20. What is the most appropriate pharmacotherapy to his condition?

A) Lindane lotion – insect repellant, 2nd line
B) Permethrin cream – insect repellant, 1st line
C) Ketoconazole ointment
D) Bethametasone dipropianate 0.05% ointment
E) Mupirocin ointment

21. A 56 years old woman came to the dentist with complaining her jaws. When she open
mouth too wide sometimes is not able to close it again and the jaws are very painfull.
What is the diagnosis of her problem?
a. malocclusion
b. subluxation
c. arthritis of temporo mandibular joint
d. bruxism
e. attrition
22. A patient Tony, 45 years old came to dental clinic with complaining with his corner
of the lips. Almost 3 months the commissural mucosa in the labial commisure of
the mouth there is fissuring and ulceration. The patient an underlying nutrional
deficiency (e.g iron, folic acid or Vit B12) and underlying systemic disease. What
is the diagnosis of that problem?
a. Traumatic lesion
b. Cheek biting
c. Angular cheilitis
d. Minor apthae
e. Lichen planus

23. A male 56 years old, came to siloam hospital wants to check his oral mucosa. Intra
oral examination was found in buccal mucosa there is ulcerations areas with white
papules/ wickham striaea at the margins. The white structures cannot be rubbed
off. Long term management with corticosteroid to relief pain.
What is the suspect of that condition?
a. Oral lichen planus
b. Pemphigus vulgaris
c. Leukoplakia
d. Lupus erythematous
e. Mayor apthae

24. A man, 45 years old, smoker came to the oral medicine department, and main
complaint in his tongue. Intra oral examination was found on left side of the tongue
thickened white patches and cannot be scraped off. The patches develop slowly and
painlessly. He said the roughened tooth (3.6) damaged his tongue almost 6 months,
and already has been extraction 3 months ago, but the white patches was not
disappear.
What the suspect of that condition?
a. Oral Candidiasis
b. Oral lichen planus
c. Oral leukoplakia
d. Oral trush
e. Pseudomembrane candidiasis

Oral leukoplakia:
• Patch of keratosis
• Smoking, HPV, candida, alcohol
Oral lichen planus:
• Chronic inflammatory disease
• Bilateral white striation, papule, plaque, in buccal mucosa
• Autoimmune, T-cell mediated
25. A 68 year old man came to the dentist with complaining in his tongue on the right
side. Intra oaral examination that was found an ulcer on the lining in right side of the
tongue for 6 months ago, that enlarge slowly and fails to heal. The ulceration with
induration at the margins and raised, rolled border and may develop in a white
area.What is the suspect of that problem?
a. Major apthous ulcerations
b. Herpetic ulcerations
c. Lichen planus ulcerations
d. Oral carcinoma
e. Traumatic ulcerations

26. David, 18 years old, came to the dentist for dental check up because he feels
toothache in lower right posterior tooth. A sharp pain triggered by biting or
comsuming hot, cold, or sweet foods and drinks, toothache last only a few minute
and and not continuous pain.Intra oral examination was found a small cavity in 4.6
tooth and the decay penetrates the outer layer of enamel and attack the dentine.
What the diagnosis of that decay?
a. Necrosis pulpa
b. Pulpitis
c. Hyperemia pulpa – di dentin, hampir mencapai pulpa
d. Iritatio pulpa
e. Dental abscess

27. Seorang wanita, 30 tahun, datang ke dokter dengan keluhan, seringkali pilek
dengan ingus yang encer, hidung tersumbat dan kadang bersin sejak 1-2 tahun terakhir.
Keluhan ini tidak tergantung waktu, tempat atau kontak dengan suatu bahan tertentu.
Riwayat atopi, sakit yang lain atau mengkonsumsi obat apapun disangkal.
Pemeriksaan fisik : Keadan umum baik, suhu afebris. Rinoskopi anterior, ditemukan
konka inferior yang udem, sekret yang serous/encer, septum nasi lurus di tengah, tak
didapatkan massa.
Laboratorium : gambaran darah tepi normal, Kadar Ig E serum dalam batas normal,
pemeriksaan sekret hidung: normal. Rontgen sinus paranasal : hipertrofi konka nasalis
inferior bilateral.
Manakah pernyataan dibawah ini yang paling tepat untuk diagnosis pasien tersebut ?
a. Rinitis Alergi – keluhan tidak tergantung lingkungan, no atopi, IgE normal
b. Rinosinusitis kronis – sekret encer
c. Rinitis vasomotor
d. Rinitis Atrofi – tidak ada crusta, or ozonae
e. Polip nasi – tidak ditemukan polip pada rinoskopi anterior
Rhinitis:   Acute rhinitis results in cough, low-grade fever, nasal congestion, rhinorrhea, and
sneezing. Symptoms and signs of chronic rhinitis are similar but may include purulent rhinorrhea
and bleeding.
Atrophic rhinitis results in abnormal patency of the nasal cavities, crust formation, anosmia, and
epistaxis that may be recurrent and severe.

Vasomotor rhinitis results in sneezing and watery rhinorrhea. The turgescent

mucous membrane varies from bright red to purple. The condition is marked by
periods of remission and exacerbation. Vasomotor rhinitis is differentiated from
specific viral and bacterial infections of the nose by the lack of purulent exudate
and crusting. It is differentiated from allergic rhinitis by the absence of an
identifiable allergen.

28. Seorang pasien laki-laki, 20 tahun dengan diagnosa Rinitis Alergi yang datang
berobat ke dokter dengan keluhan bersin-bersin terutama pagi hari, hidung kadang2
tersumbat, tidak ada demam dan tidak ada sakit kepala.
Pada pemeriksaan sitologi sekret hidung, gambaran sel apakah yang akan
ditemukan dalam jumlah meningkat untuk menunjang diagnosis tersebut?
a. sel Netrofil
b. sel Basofil
c. sel Eosinofil
d. sel Limfosit T
e. sel Limfosit B

29. Pada pasien diatas , obat apakah yang paling tepat kita berikan untuk
menanggulangi penyebabnya?
a. Kortikosteroid nasal spray
b. Kortikosteroid oral
c. Antihistamine
d. Oral antibiotik
e. Nasal dekongestan

30. Pemeriksaan apakah yang perlu dilakukan untuk mencari/menentukan penyebab

pada kasus diatas?
a. Rontgen sinusparanasal
b. Sitologi sekret hidung
c. Apusan darah tepi
d. Ig E total serum darah
e. Skin test
Diagnosis
 Clinical evaluation
 Sometimes skin testing, RAST, or both
Allergic rhinitis can almost always be diagnosed based on history alone. Diagnostic testing is not
routinely needed unless patients do not improve when treated empirically; for such patients, skin
tests are done to identify a reaction to pollens (seasonal) or to dust mite, cockroach, animal
dander, mold, or other antigens (perennial), which can be used to guide additional treatment.
Occasionally, skin test results are ambivalent or testing cannot be done (eg, because patients are
taking drugs that interfere with results); then, RAST is done. Eosinophilia detected on nasal smear
plus negative skin tests suggests aspirin sensitivity or nonallergic rhinitis with eosinophilia
(NARES).
Diagnosis of infectious, vasomotor, atrophic, hormonal, drug-induced, and gustatory rhinitis is
usually based on history or therapeutic trials.

Pasien “Melati”, umur 6 tahun, dengan keluhan telinga kanan terasa penuh seperti
kemasukan air, sejak 1 hari yang lalu.

31. Pada pemeriksaan dengan otoskop, telinga kanan didapatkan membrane timpani:
utuh, retraksi dan terdapat bayangan cairan bening dengan gelembung udara.
Telinga kiri normal. Diagnosa kasus ini adalah
a. Otitis media akut stadium hiperemi
b. Otitis media akut stadium presupurasi
c. Otitis media akut stadium supurasi
d. Otitis media akut stadium resolusi
e. Otitis media effusi

32. Pada kasus ini, dari anamnese didapat batuk, pilek sejak 3 hari yang lalu.
Berdasarkan patofisiologi inflamasi telinga tengah, maka penyebab utama adalah
a. Infeksi saluran nafas atas
b. Gangguan fungsi tuba Eustachius
c. Menyusu dengan dot posisi tidur
d. Kelainan maksilofasial
e. Tonsiloadenoid hipertrofi

33. Tes garpu tala Weber pada kasus ini, didapatkan:

a. Memanjang telinga kanan
b. Memanjang telinga kiri
c. Lateralisasi telinga kanan
d. Lateralisasi telinga kiri
e. Memendek telinga kanan.

34. Pasien tersebut diberikan dekongestan topical dan mukolitik. Setelah 3 hari, pasien
tersebut kembali dengan keluhan panas tinggi, nyeri telinga kanan dan
pendengaran berkurang. Pada pemeriksaan telinga kanan ditemukan membrane
timpani utuh, merah, edema luas, bulging dan terdapat cairan keruh kekuningan di
telinga tengah. Tindakan yang sangat penting dilakukan pada kasus ini, adalah:
a. Parasintesa
b. Miringotomi
c. Timpanoplasti
d. Mastoidektomi
e. Miringoplasti

35. Setelah dilakukan tindakan, diberikan antibiotika oral selama 7 hari. Pasien datang
kembali dengan keluhan panas, otore telinga kanan, pendengaran berkurang, nyeri
telinga dan retroauricular kanan. Pada pemeriksaan telinga ditemukan mukopus
 keluar dari telinga tengah ke liang telinga kanan, retroauricular kanan merah,
edema dan nyeri tekan. Diagnosa kasus tersebut adalah:
a. Otitis eksterna akut / Furunkel
b. Otitis media akut stadium supurasi
c. Otitis media akut stadium perforasi
d. Otitis media sub akut
e. Mastoiditis akut.

36. Untuk membantu diagnosis diatas, maka pemeriksaan penunjang yang perlu
dilakukan adalah:
a. Audiometri
b. Timpanometri
c. BERA
d. Lab. hematologi
e. Radiologi

37. Komplikasi yang sudah terjadi pada kasus ini adalah:

A. Labirintitis
B. Sinusitis
C. Petrositis
D. Parese korda timpani
E. Fistula retroauricular

38. Pada pemeriksaan pendengaran: air conduction (AC): telinga kanan (AD) 10 dB,
telinga kiri (AS) 65 dB, bone conduction (BC): telinga kanan 5 dB, telinga kiri 15 dB.
Berdasarkan pemeriksanan ini maka derajat pendengaran kedua telinga adalah:
A. AD Normal dan AS tuli campur sedang
B. AD Normal; AS tuli konduktif sedang
C. AD Normal, AS tuli saraf sedang
D. AD Normal, AS tuli konduktif berat
E. AD Normal, AS tuli saraf berat.

39. Pada pemeriksaan garpu tala maka akan ditemukan:

A. Weber lateralisasi ke kanan
B. Weber lateralisasi ke kiri
C. Rinne kanan negative
D. Rinne kiri positif
E. Rinne kanan positif

40. Penatalaksanaan paling tepat pada kasus ini, adalah:

A. Antibotika oral selama 2 minggu, cuci telinga dengan H2O2 3 %
B. Mastoidektomi dengan / tanpa timpanoplasti
C. Parasintesa dan pemeriksaan kultur resistensi kuman
D. Decongetan
E. Mukolitik

Wanita, 36 tahun, dengan keluhan utama pusing berputar sejak 7 hari yang. Keluhan
tambahan telinga kanan berdenging dan pendengaran berkurang sejak 2 tahun yang lalu
dan 7 hari yang pendengaran telinga kanan menghilang . Pada pemeriksaan telinga tampak
membrane timpani perforasi sentral, dengan secret mukopus. Pemeriksaan audiometric
dengan masking: Air conduction AD 100dB, AS 15 dB; bone conduction : AD tidak
terdengar, AS 10 dB.

41. Diagnosis kasus diatas adalah:

A. Otitis media supuratif kronik benigna dengan vertigo posisi
B. Otitis media supuratif kronik benigna dengan komplikasi labirintitis – perforasi
sentral, radang pada mukosa, tidak ada kolesteatom
C. Otitis media supuratif kronik maligna dengan vertigo posisi
D. Otitis media supuratif kronik maligna dengan komplikasi labirintitis
E. Otitis media supuratif kronik maligna komplikasi intrakranial

A 3 year old girl brought by her mother to the Eye clinic. Her mother said that since a
baby there was a yellow shadow in the center of her right eye, especially at night. Now,
her left eye begin looked the same. On the examination of left eye, light perception seems
normal, but there was no reaction when the doctor offering a toy while simultaneously
covering her left eye. Funduscopy showed yellow reflex called ‘cat’s eye”. Digital eye
pressure of the right eye was normal; the eye was harder than normal.

42. Which of the following is the most likely diagnosis?

A. Glaucoma
B. Retinoblastoma
C. Glioma
D. Adenoma
E. Cataract

43. The most common early sign of the child suffering from that disease is:
A. red eye
B. leucochoria
C. pain
D. itchy
E. IOP decreasing

A woman 60 years old complained that her vision of both eyes become more blurred
slowly since 3 years ago. No pain, neither redness, but she felt glare. Vod 6/30. Vos 6/60.
Pin hole examination was negative. She wear reading glasses S+3.00. IOP of the Right and
Left eye were digitally normal. Lenses look hazy. Fundus reflex decreased, pupil looked
leucochoria. Shadow test examination: positif.

44. Which of the following is the most likely diagnosis?

A. Refractive error
B. Corneal nebula.
C. Lens opacity
D. Vitreous opacity
E. Retinal lesion.

45. Positive Shadow test examination in that patient was positive, meaning the degree of:
A. Incipience cataract
 B. Immature cataract
C. Mature cataract
D. Hypermature cataract
E. Secondary cataract.
insipient negative, immature positif, mature negative, hipermatur pseudopositif

A 56 years man came to the eye doctor because of prolong headache. He often hit
something surround him while riding bicycle.
Visus OD: 20/60, corrected with S+2.50 => 20/25. Visus OS : 1/~ . In Fundus
examination with ophthalmoscopy found that The Cupping Disc Ratio of the Right eye is
0.6 and Left eye is 0.9. Intra Ocular Pressure OD: 25.8 mmHg, OS: 33.0 mmHg.
He brought some medicine from the last doctor he visited last month, and it was: Timolol
Maleat eye drops and Azetazolamide tablet.

46. Which of the following is most likely diagnosis?

A. refractive error
B. primary open angle glaucoma
C. primary closed angle glaucoma
D. low tension glaucoma
E. ocular hypertension

47. For that patient, what is further examination should be done, to know his visual field?
A. biometri
B. campimetri
C. tonometri
D. Funduscopy
E. goniometri

48. 16 year old girl complained blurred vision. She can not read letter written in the board
in front of class. On the examination you found: Visual acuity of the Right Eye was
20/70, Left Eye was 20/100. Her eyes examination was normal without any
inflammation and no pain.
What further examination should be done to that patient?
A. pin hole test
B. tonometry test
C. confrontation test
D. shadow test
E. digital test

In the patients screening of blindness eradication program, we found some people have
blurred vision but not suffering from cataract.
patient A. Man, 64 years old, fatty. VOD 1/300, VOS 4/60. Pin Hole test : not improve.
ODS quite. Fundus Reflex positive. Anamnesis he got Diabetus Mellitus for more than 16
years.
patient X. A woman 52 years old VOD : 0 (no Light Perception). VOS 1/300. ODS Quiet.
Digitally palpation: OD : N++, OS: N++.
Funduscopy: Papil Atropy. She is suffering from severe headache for many years.
patient Z. A woman 58 years old, prolong headache. Blurred vision . VOD : 1/300, VOS :
4/60. no correction could be done.
On Vital sign examination found that the Blood Pressure was 190/110 mmHg. Not so
compliance to go to the doctor.

49. Which of the following is the most likely Diagnosis for patient A?
a. Glaucoma
b. Diabetic Retinopathy
c. Severe Refractive Anomali
d. Retinal Bleeding
e. Neuropathy

50. Which of the following is the most likely Diagnosis for patient X?
a. Absolute Glaucoma
b. Acute Glaucoma
c. Retinal desease
d. Optic nerve desease
e. Mature Cataract

51. Which of the following is the most likely Diagnosis for the patient Z?
a. Presbyop Myop
b. Papil Edema
c. Hypertensive Retinopathy
d. Retinal Bleeding
e. Glaucoma.

52. Why on those patients A,X,Z, could not be priority of the Vision 2020 Program?
a. those deseases are Preventable but not Curable
b.Not Preventable but Curable
c. Not Preventable and not Curable
d. Preventable and curable
e. The medication is too expensive.
Katarak dan Refraksi *
tidak dapat di cegah, tetapi dapat disembuhkan
(Not Preventable but Curable)
Glaukoma, Diabetic Retinopati
(Preventable but not Curable)
Congenital
(Not Preventable and not Curable)
A 45 years old man come to DV clinic, because he complained dysuria since 4 days ago.
He felt burning sensation when he urinated. He excreated purulent uretral discharge 2 days
ago. His wife had same problem with him. He had contact sexual with prostitute women 1
week ago. Physical examination shows purulent uretral discharge, no ulcer. The external
genitalia were normal. Laboratorium test, gram stain show polymorphonuclear
leukocytes(+), erythrocite (-), gram negative intracellular diplococci. KOH10%
examination shows spora (+), pseudohipha (-), hipha (-).

53. What is the best treatment for this patient:

a. Doxycylclin 2 x 100 mg, 5 days
b. Ofloxaxin 400 mg SD
c. Itraconazole 2X400 mg one day
d. Metronidazole 2 x 500 mg, 7 days
e. Benzatin Penisilin G 2,4 million unit SD

54. What is the complication for his wife, if she untreated :

a. Pelvic inflamatory disease
b. Ca Cervix
c. Ovarium Cyst
d. No complication
e. Skin iritation

55. A 43 year old women, come to DV clinic because she complained vesicles on
genital, and pain, for the first time. Her husband had same problem 2 days ago,but
it was cured. She was difficult to walk because of pain on her genital and mild
fever. Clinical manifestation were many vesicle on labia mayora and minora,
shallow ulcer. What is the diagnose of this patients?
a. Lymphogranuloma venerum
b. Herpes genitalis
c. Granuloma Inguinal – kissing lesion
d. Ulcus Molle
e. Scabies

Nita, 27 years old girl, come to DV clinic because she had creamy discharge “cottage
cheeses”, white, vaginal itching. Clinical manifestation showed vaginal covered with
thick, white, crumbly discharge. Infection spread onto the thighs and inguinal, showed red
skin surface with discrete pustulle.

56. What is the laboratory test result to establish the diagnosis?

a. Clue cell > 20% - Bacterial vaginosis
b. Trichomonas (+) – gatal, malodor, pear shaped organism
c. Chlamydia trachomatis (+) -
d. Brown agar culture (+)
e. pseudohyphae (+)
57. Erick, 38 years old, come to dermatovenereology clinic, because he had wound in
his penis 2 days ago . He had contact sexual with prostitute women 1 week ago.
Clinical examination were deep, painfull ulcers. Base of ulcer is purulent, yellow-
gray exudate. Laboratory test showed parallel gram negative cocobacilli (school of
fish). He had low grade fever. There was lymphadenopathy.
What is the diagnosis?
a. Herpes genitalis
b. Syphilis
c. Ulcus Molle
d. Granuloma Inguinale
e. Limphogranuloma venerum

58. Thirty eight old man came to clinic with pruritic in hand, face and neck.
Morphology was lychenified plaques, thick, and dry. He has personal family
history of asthma and rhinitis allergy and relaps chronically. What is your clinical
suspicion?
a. tinea corporis
b. nummular dermatitis
c. atopic dermatitis
d. contact dermatitis
e. Licken Simplex Chronica -- neurologic

59. Which of the following laboratory examination result is most likely to be found?
a. increase of IgG level
b. decrease of IgG level
c. increase of IgE level
d. increase of IgM level
e. increase of IgG and IgM level

60. A thirty years old baby-sitter came to clinic with pruritic lesions in hand since 2
weeks ago. Every day she bathed the baby with warm water and telon oil. in
physical examination, we found eritema, scalling, fissuring, lichenification, and
poor dermacation. Which of the following is the most likely diagnostic?
a. seborrheic dermatitis
b. irritant contact dermatitis – keluhan utama painful disertai gatal, onset
akut
c. allergic contact dermatitis – krn ada gatal, poor demarcation
d. atopic dermatitis
e. tinea manus

61. A fresh fish export company asks you as company doctor to make a screening for
new labors that will wear rubber gloves every time they work. Which of the test
that you will do to the new labors?
a. prick test
b. patch test
c. scrub test
d. IgE level
e. EgG level
62. A fifty years old man came to clinic with pruritic in dorsum pedis region since 2
years ago. In physical examination we found lichenification plaques,
hyperpigmentation. The patient also complaint that he can’t sleep well and has
some problems in works. What is your clinical suspicion?
a. Pompholyx – vesikobulosa di palm n sole
b. Lichen simplex chronics
c. Atopic dermatitis
d. Contact dermatitis
e. Seborrheic dermatitis
This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:
It may begin with something that rubs, irritates, or scratches the skin, such as clothing.
This causes the person to rub or scratch the affected area. Constant scratching causes the
skin to thicken.
The thickened skin itches, causing more scratching, causing more thickening.
The skin may become leathery and brownish in the affected area. This disorder may be
associated with atopic dermatitis(eczema) or psoriasis. It may also be associated
with nervousness, anxiety, depression, and other psychological disorders.

63. Five days after going on nature walk (setelah wisata alam) , a ten years old boy
developed well demarcated, erythematous plaques and vesicles over his arm and
face. The plaques are arranged in linear fashion and are crusting. The boy has some
facial edema. He has no history of fever or chills but complains of pruritus. Which
of the following is the most likely diagnosis?
a. Rubeola
b. Atopic dermatitis
c. Acute contact dermatitis
d. Impetigo
e. Erythema infectiosum – fifth disease, parvovirus, headache, coryza, low-
grade fever, pharyngitis, and malaise.

64. A sixty five old lady came to you clinic with laboratory random plasma glucose
concentration was 378 mg/dl. Physical diagnostic with distal lower extremities
sensory loss, hyperesthesia, and neuropathy syndrome. Which following skin
manifestation that you might found on this patient?
a. Diabetic foot ulcer
b. Achantosis nigricans
c. Granuloma annulare
d. Scleroderma
e. Butterfly skin rash

65. A thirty years old young lady came to your clinic with butterfly skin rash in her
face, photophobic, arthritis, nefropathy, hemolytic anemia. Which following test
are helpful for diagnostic?
a. pathology anatomy examination
b. prick test
c. patch test
d. IgM test
e. Scrub test
 Laboratory testing differentiates SLE from other connective tissue disorders. Routine
testing should include the following:
 Antinuclear antibodies (ANA)
 CBC
 Urinalysis
 Chemistry profile including renal and liver enzymes

66. A gravid 34 weeks primipara 30 years old woman came to your clinic with pruritic
complains in abdominal region. Lessions found with hyperpigmentation. Witch
following is most likely diagnostic?
a. hyperemesis gravidarum
b. striae gravidarum
c. caput medusae
d. preeclampsia syndrome
e. spider naevy

67. Which following diagnostic relevant to a 3 years old patient with fever, eritema
whole body completely in 24 hours, emerge bullaes after 48 hours, then Nicholsky
sign (+)?
a. Pemfigus vulgaris
b. Lupus Eritematosus Syndrome
c. Erysipelas
d. Erythema nodusum
e. Staphylococcus Scalded Skin Syndrome

68. What is main treatment for this disease?

a. Antibiotic
b. Mycostatic
c. Topical Corticosteroid
d. Adrenergic
e. Moisturizer cream

69. A 55-year-old man was seen in the dermatology clinic because of a nodule on his
right temple, It had been present for 3 years and was growing slowly. He was a
sailor. The physical examination revealed a pearly nodule 1 cm, with telangiectasia
and central depression. What is the most likely diagnosis ?
a. Squamous cell carcinoma
b. Molluscum contagiosum
c. Sebaceous hyperplasia
d. Basal cell carcinoma
e. Verucca vulgaris

A 58 old man has a fleshy nodule, dome shaped on his right ear lobe for the past months.
A biopsy is taken and histopathology examination shows a central keratin-filled crater is
surrounded by proliferating squamous epithelium.
70. Which of following diagnose is the most appropriate for this lesion?
A. Squamous carcinoma
B. Basal cell carcinoma
C. Actinic Keratosis
D. Seborheic Keratosis
E. Keratoacanthoma

Keratoacanthoma:
Many pathologists consider it to be a form of squamous cell carcinoma (SCC). 
KA is commonly found on sun exposed skin, and often is seen on the face,
forearms and hands.[4] The defining characteristic of KA is that it is dome
shaped, symmetrical, surrounded by a smooth wall of inflammed skin, and
capped with keratin scales and debris. It always grows rapidly, reaching a
large size within days or weeks, and if untreated will starve itself of
nourishment, necrose (die), slough, and heal with scarring. Diagnosis is best
done with clinical exam and history. It presents as a fleshy, elevated and
nodular lesion with an irregular crater shape and a characteristic central
hyperkeratotic core. Usually the patient will notice a rapidly growing dome-
shaped tumor on sun-exposed skin.

SCC:
SCC of the skin begins as a small nodule and as it enlarges the center
becomes necrotic and sloughs and the nodule turns into an ulcer.
 The lesion caused by SCC is often asymptomatic
 Ulcer or reddish skin plaque that is slow growing
 Intermittent bleeding from the tumor, especially on the lip
 The clinical appearance is highly variable
 Usually the tumor presents as an ulcerated lesion with hard, raised
edges
 The tumor may be in the form of a hard plaque or a papule, often with an
opalescent quality, with tiny blood vessels
 The tumor can lie below the level of the surrounding skin, and eventually
ulcerates and invades the underlying tissue
 The tumor commonly presents on sun-exposed areas (e.g. back of the
hand, scalp, lip, and superior surface of pinna)
 On the lip, the tumor forms a small ulcer, which fails to heal and bleeds
intermittently
 Evidence of chronic skin photodamage, such as multiple actinic
keratoses (solar keratoses)
 The tumor grows relatively slowly
 Unlike basal-cell carcinoma (BCC), squamous-cell carcinoma (SCC) has a
substantial risk of metastasis
 Risk of metastasis is higher in SCC arising in scars, on the lower lips or
mucosa, and occurring in immunosuppressed patients.
About one-third of lingual and mucosal tumors metastasize before diagnosis
(these are often related to tobacco and alcohol use)