TROPMED 2013
5. Pasien mengalami demam tinggi pada
TROPMED
1. Patient brought to clinic because of some
nodules on his arm and body and
sometimes feel pain with pressure. On
examinations we found erythematous
nodules, smooth and shiny, diffuse
infiltrate with ill define border, no
fluctuation or erosion. There were pain
on his elbow with nerve enlargement,
best stain for examination?
Leprosy= skin lesion (nodule, macula),
anestesia, claw hand foot, drop nerve
enlargement
A. KOH = jamur
B. Giemsa = bacteria
C. Zn Stain = micobacterium (leprosy),
TB
D
E a. Orthomyxoviridae
2. Metode pengambilan darah untuk orang
infective endocarditis? 3 kali di lokasi
berbeda, atau 1 lokasi interval waktu 10
menit 3 kali
3. Orang kena malaria, dicek demam tinggi,
parasitemia +++, diberikan artemisinin, 3
hari kemudian saat dicek masih ada
demam dan parasitemia ++++, keadaan
spt ini disebut apa?
A. Early treatment failure ( dibawah 28
hari)
B. Late treatment failure (diatas 28 hari)
C. Late paracitemia
D. Early paracitemia
E. Late manifestation
4. Orang datang ke klinik, demam tinggi dll
(malaria), manifestasi klinis pasien ini
terjadi pada saat nyamuk dlm stadium
apa?
A. Tropozoit
B. Sporozoit
C. Merozoit
D. Mikrogametosit
E. Makrogametosit
hari ke 4 dan didiagnosis malaria,
termasuk malaria golongan apa? Malaria
Malariae -> gara” quartana= malariae:
vivax and ovale= tertiana; subtertiana=
falciparum (demamnya continuous)
6. Kerja di salon poultry dan
ayamnya pada mati, ada gejala
influenza, apa virus yg
mungkin nyerang? AI
Adenoviridae= bikin diare;
corona=MERS and SARS; herpes
viridae= cytomegalo and varicella;
LIAT CATETAN
DHARMAWAN!!!!(catetan virus)
Gastroenteritis= rotavirus,
norovirus, astrovirus, adenovirus
7. Zat apa yg digunakan utk membersihkan
feses burung? Dari WHO jawabanya
sodium hypochloride 5%
A. Iodin
B. Etanol 70%
C. Etanol 90%
8. Best virus isolation utk kasus di atas?
A. Blood
B. Nasopharyngeal aspirate = soalnya
adanya di lower respi tract; droplets
soalnya ini yang paling dalem
C. Hand swab
D. Anal swab
E. Nasal swab
9. Orang kena malaria, demam tinggi, kena
parasitemia 3,5%, kenapa terjadi kondisi spt
ini? Merozoit dikeluarkan dari liver menuju
darah ; sel darah merah yang pecah akibat
kluarnya merozoit.
10. 45yo man was seen in the dermaotlogy clinic
because of some nodules on his arm and body
and sometimes feel pain with pressure. On
examination was found erythematous
nodules, smooth and shiny diffused infiltrate
with ill define border, no flunctuation or
 erosion. There were pain on his elbow with
nerve enlargement. Diagnosis?
a. yaws = treponema palidum pertenue, kalo
syphillis= treponema palidum palidum,
bntuknya bs macem” kyk papiloma; non tender
ulcer, samping”nya demarcated( kyk ancur
gtu), ngeinfeksi kulit, tulang sendi; dibagi
primary=ada single lesi= mother yaws->
disseminate-> msk ke secondary stage nodule
non tender ulcer, secondary=daughter yaws,
multiple and lbh kecil, latent= gejala hilang tp
bs relapse sebagai tertiary stg, tertiary= bone
and joint and soft tissue deformities bisa
spontaneously heal abis 3-6 bulan
b. leprosy (ada nerve enlargement bagian elbow
& lutut
c. anthrax = respi problem, black eschar/
carbuncle like lesion
d. cellulitis (jawaban 2012. Yakin neh nggak
ngaco???)
e. carbuncle = ada pus kluar (drainage), tmenya
furuncle, kalo furuncle Cuma 1 kluaran pusnya
tp carbuncle bnyk; furuncle bisa jadi carbuncle
11. A laboratory examination of a leprosy patient
after 4 months MDT therapy revealed
Bacterial index 6+ and morphological index
50%. What is your conclution for this result ?
Mulit gara” bacterial index >50%, 25-75%
morphological indexnya; pausibacillar= 1-5
nodular, morphological may not be acessible;
udh treatment masih gak sembuh-> resistent
a. Pausibacillar leprosy patient sensitive to
treatment
b. Multibacillar leprosy patient sensitive to
treatment
c. Multibacillar leprosy patient resistent to
treatment
d. Pausibacillar leprosy patient resistent to
treatment
e. Pausibacillar leprosy patient prone to nerve
damage
12. Yang harus di considerate untuk pasien
suspect leprosy? Lesi di tubuh yg painless &
numb
13. Pasien kena malaria, best drug of choice:
A. Doxycicline
B. Chloroquine
C. Mefloquine
D. ACT
14. G3P2A0 gejala anak chorioretinitis, cerebral
calcification, hepatomegaly, splenomegaly,
berat badan lahir rendah. Ibunya dalah suster
di RS siloam, tidak pernah kontak dengan
kucong. Diagnosis?
Rubella= malformation berat, lesi pd mata,
glaucoma, defect septum, tuli sensorineural,
hepatosplenomegaly, microcephaly,
perubahan tulang;toxo= smua gejala diatas
cmv= chorioretinitis, microcephaly, iugr,
oligo/polihydramnion, hydrops non imun,
ascites janin, hydrocephalus
a. congenital toxoplasmosis
b. congenital CMV
c. congenital rubella
d. congenital herpes
15. a baby is born with a rash identical.
Questioning reveal that the mother had a febrile
illnes during the second teimester of
pregnancy. Examination reveals diffuse raised
purple skin lesions. There is no pallor, jaundice,
or cyanosis. The eyes are cataract, the heart has a
3/6 systolic murmur and there is enlargement of
both the liver and spleen. There is no
lymphadenopathy. Of the following, the most
likely diagnosis is?
a. congenital toxoplasmosis = calcification
cerebral, hydrocephalus, chorioretinitis
b. congenital rubella = purple skin fix rubella,
c. congenital CMV =IUGR, hepatosplenomegaly
d. congenital malaria
e. congenital varicella
16 A baby is born with a rash identical. History
taking reveals that the mother had a febrile illness
during the second trimester of pregnancy.
Examination reveals diffuse raised purple skin
lesions. There is no pallor, jaundice, or cyanosis.
The baby has spread over his body especially on
arm and legs also fever. What is the most likely
diagnosis ?
a. Celulitis =necrotizing celulitis ->paling
memungkinkan gara” yang lain gak
 cocok gejalanya. Biasa gara” umbilical
infections tp celulitisnya Cuma di
abdominal doang biasanya.
b. Furuncle = gak krn cma superficial, slalu
ada pus
c. Erythema nodosum = biasa di orgtua
d. Multibacillar leprosy = jarang congenital
and symptoms gk kyk gni
e. Pausibacillar leprosy= jarang congenital
and symptoms gk kyk gni
17 Residen mengeluh karena di ruangannya AC
terlalu dingin, suara berisik dan lampu terlalu
silau. Termasuk hazard kategori apa? Physical
hazard
18 A 10-year-old boy who has moved to your
practice recently has sore throats, get high
temperature. The child reports a runny nose,
mild cough, and abdominal pain. Findings on
physical examination include a temperature of
100.3°F (38°C), and vesicular lesions on the
soft palate. There is no cervical adenopathy or
rash. Of the following, the MOST likely
diagnosis is herpangima/ mouth blister= grey pin
head size vesicle rupture to form large, fibrin
covered ulcer., karena coxsackie virus, echovirus,
enterovirus, parechovirus, herpes simplex virus
and adenovirus tp plg sering coxsackie
a. Adenovirus infection = diare”, influenza
b. Coxsackie virus infection=prodrome:
fever, sore throat, dysphagia 1-2 hari
preceeded exanthema, abdominal pain,
oral lesion, headache, vomiting
c. Mononucleosis =
d. Sinusitis
e. Streptococcal pharyngitis =
A 2 years old boy brought to dermatovenereology
clinic because of itching all of the body. He
complains itching on palm, side of finger,
buttock, and abdomen. Clinical manifestations
are papule, vesicle, pustule, erotion, and
excoriation especially at finger web, arm,
abdomen, side of hand and feet, itchy
especially at night.His neighbours have same
problem.He usually play together with his
neighbours.What is the diagnose this patients?
a. Pediculosis corporis = gara” kutu debu
ptirus pubis, lay eggs juga on or near
seams of clothes
b. Scabies = biasa di sela”, ada excoriation (
bekas garukan), webbed space of fingers,
pkoknya ngelay eggs di antara kulit mati
makanya warnanya putih
c. Tinea corporis = jamur sluruh badan
d. Dermatitis atopik = autoimmune, ada
pemicu
e. Psoriasis = autoimmune,
hyperproliferation of skin keratin
20 A patient on MDT treatment complaining
about red urine that he experinced on the first day
of treatment. What is the suggestion for this
condition ?obat rifampicin
a. Stop Clofazimin, can cause pink
brownish discolouration
b. Continue the medication, its not a drug
adverse effect
c. Stop the medication because of
nefrotoxicity
d. Stop Dapsone can cause anemia
hemolytic
e. Change the treatment to single drug
therapy
21. A 27-year-old female has just returned
from a trip to Southeast Asia. In the past
24 hours, she has developed shaking,
chills, and a temperature 40o C. A blood
smear reveals Plasmodium vivax. Which
of the following agents should be used to
eradicate the extraerythrocytic phase of
the organism?
a. Primaquine = 1”nya obat yang bisa
ilangin merozoit
b. Pyrimethamine
c. Quinacrine
d. Chloroquine
e. Chologuanide
22. Ibu hamil mau bepergian ke Papua, obat
prophylaxis yg cocok buat dia?
Mefloquine ( tapi kata dokter sisir pake
kelambu)
(nggak boleh dikasih doxi & kalo dikasih
chloroquin percuma krn mungkin
 resisten)
23. A 26-year-old nulliparous woman, in her
seventh month of pregnancy complains
of a 7 days history of fever especially at
night. As she recall, 2 weeks ago she ate
gado-gado in coastal area when she out
for duty for several days. She also had
diarrhea and abdominal discomfort. On
physical examination reveals blood
pressure 110/70 mmHg, heart rate 60
×/min, RR 20x/min, temp. 39.1°C.
Tongue is coated and tremor. Fetal USG
shows normal.
What is the most likely etiologic factor
above?
a. Salmonella typhi
b. Plasmodium falciparum
c. Vibrio cholera
d. Hepatitis A
e. Escherichia coli
24. Best laboratory examination to detect
S.typhii? Blood smear
25. Best treatment for scabies? Gamexane=
obat buat scabies and pediculocyte
(scabimite= permethrin 5%)
26. Tukang kebon dtg ke klinik dgn keluhan
demam tinggi sampe 39,5 derajat,
profuse sweating, mual muntah, best lab
examination? (suspect malaria) Thick and
thin blood smear
A Blood culture
B Stool
C Saliva
D di darah
E d. The chronic lymphatics by adult worm->
27 Transmisi penyakit yg mungkin utk kasus
diatas? Direct skin scale contact (digigit nyamuk)
Anak demam 2 hari, dokternya suspek DBD.
mau cek apa?
A. NS= <1 mggu (1-8)
B. Hematocrite
C. IgM=primary
infecction baru kluar
hari ke 14=IgG=
secondary hari k2 udh
kluar; IgM= hari k 3-5
ilangnya 60-90 hari;
28 Workplace health hazard can cause
reaction. Asthma, and dermatitis caysed
by whicch reaction?
a. immediate reaction-> alergi, hipersensitivitas;
4 tipe: 1= IgE( asthma and anaphylactic),2=
IgG, IgM ( drug induced hemolytic anemia),
3= circulating antigen antibody immune
complex with complement ( serum sickness),
4= delayed hypersensitivity reaction, mediated
by t cell ( contact dermatitis dari poison
ivy,etc)-> delayed
b. acute ->
c. gradual
d. delayed -> t cell; mononucleocyte; 48-72 jem
abis exposure; type 4( delayed
hypersensitivity)
e. no reaction
30 cowo aktif sexual partner tapi pake pelindung,
terus mau screening. Screening pake apa?
a. HIV-RNA-> confirm diagnosis( lebih untuk
epid studies)
b. CD4 count -> untuk nentuin level severity HIV
c. Rapid test -> untuk screening
d. western blot -> confirm diagnosis
e. HIV-ELISA -> confirm diagnosis
31 Elephantiasis is caused by the obstruction of :
a. The arteries by microfilariae
b. The arteries by adult worm
c. The lymphatics by microfilariae -> biasa
di lymphatics
e. Fibrosis of the lymphatic
32 A 40-year-old man came to the clinic with
complaints of having fever more than one-week,
nausea, and fatigue. He came back from Timika,
Papua. On blood smear examination, there are
late trophozoites forms, schizonts with 12-24
merozoites, and the infected red cell is
enlarged.Diagnosis?vivax sama ovale membesar
makanya dibedain lewat jumlah schizontnya P
vivax-> merozoit eritrosit 12-18, ovale=8-10;
malaria=8; falciparum=8-24
33 A 10-month-old healthy male infant
travelling with his family to Africa was
exposed 4 days ago to his 4-year-old native
African cousin who was ill at the time with
fever, cough, coryza and conjunctivitis. The
baby was at risk to get infected by:
*morbillivirus= measles/ rubeolla= 3C, lbh
bsar drpd rubella, dari leher k sluruh tubuh;
togavirus= rubella/ campak jerman-> demam
lbh ringan, ada lymphadenopathy baru rash
merah” lbh kcl drpd measles dari kepala k
badan; scarlet fever= strawberry tongue, rash
di daerah lipatan, (+) blanching test; varicella=
varicella zoster, reactivation-> herpes zoster,
dari muka ke badan, vesiclenya mix (ada yg
baru and old), nular dari sblm vesicle muncul;
hand foot and mouth disease= coxsackie and
enterovirus, di kaki mulut and tangan, gejala
ringan berupa vesicle-> herpangina trmsuk
HFMD; roseola= demam hilang rash muncul
LIAT TABEL DHARMAWAN!
a. Corynebacterium diphtheriae.
b. Haemophilus influenzae
c. Bordetella pertussis
d. Morbilivirus  measles
e. Coxsackievirus
34 A 65-year-old-woman suddenly had
paralysis of her left leg. A few days ago, she
had headache, fever, sore throat, and nausea.
She lives with her son; daughter in law and a
young grandchild who’s just received a routine
oral vaccination. She is taking
immunosuppressant for her kidney’s
transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan and
lumbar MRI are also normal. -> kemungkinan
polio ( fecal-oral)
What is the most likely transmission of her
infection?
a. Droplet
b. Air borne
c. Fecal-oral (suspect polio)
d. Close contact
e. Animal bite
35 A 5 year old boy was brought to emergency
department with complaining of paresthesia of
the fingers and lower extremity muscle weakness
since two days ago. The weakness progress
involves the truncal muscles. Possible
diagnsosis?
a. Guillain-Barré syndrome (ascending
paralysis) -> biasa dari campilobacter
jejuni(->diare, GI syndrome), cmv,
ebv, hiv/ bacterial infection kyk
campylobacter; trus ada infeksi
sblmnya
b. Poliomyelitis-> lgsg, akut, cuma lower
extremities (biasanya unilateral)
c. Encephalitis
d. Meningitis
e. Multiple Sclerosis -> muncul dari mata
(optic neuritis), weakness, tingling,
numbness, blurred vision
36 A 53-year-old male farmer developed low-
grade fever, abdominal pain, and diarrhea. He
has a skin lesion of black eschar surrounded
by vesicle and edema near his mouth. A week
before, his notice many cattle in his farm were
sick, but he still eats a half-done beef steak
from his cattle.
What is the following microorganism is most
likely involved in this case?
a. Bacteroides fragillis
b. Leptospira interrogans
c. Bacillus anthracis (bakteri gram
positif)
d. Pasteurella pestis
e. Borrelia burgdorferi
37 cowo, MSM (male to males sex),
datang ke poliklinik mau evaluasi
treatment HIV nya. 1 minggu lalu,
HIV + dan CD4 <350. Next step
management?
-Kalo ada secondary infection gak boleh start
arv, takutnya ada reaksi imunnya lgsg tinggi-> 1-
2 mggu baru mulai-> kalo gak bisa ada gejala
sepsis; cd4 <350 baru kasih antiretroviral, >500
harapan hidup sama kyk org normal
a. start arv
b. cek tb
c. kasi prophylaxis
d. rapid test
e. do nothing
38 52- year old man is brought to the
emergency department in an unconscious
condition. On examination, he was death form
more than one hour. On autopsy of the brain,
there is cyst‘s fluid containing
protoscoleces( mature cyst) with hooklets and
many daughter cysts were found. What is the
most likely diagnosis of this disease?
a. Hydatidosis -> soalnya ada daughter
cysts, cystnya bisa pecah-> shock
b. Cysticercosis -> gak ada daughter cyst,
bukan cuma neuro tp bs k otot juga
c. Cerebral malaria
d. Hstoplasmosis
e. Toxoplasmosis
39 A 27 year old women suffering fever for 2
day. She brought to emergency department
unconsciously and she had general seizure 2 hour
ago. On physical examination she is comatous,
GCS (Glasgow Coma Scale) : 3; BP 90/60
mmHg; t 41 °C. Lab. finding: Hb 10, 3 gr%;
WBC 5800/mm3; platelet 39.000/mm3; there is
schizon form on blood smear. Why the
pathogeniv agent of this disease becoming the
most dangerous species?
a. It make long term relaps
b. Intermittent fever
c. Gametocyte formation take place in
visceral organ
d. Can make capillary obstruction in Central
Nervous System by parasite contain
erythrocyte = PFRB1 receptor untuk
masuk ke erythrocyte
e. There are many drug resistance against P.
falciparum
40 A female tourist developed
gastroenteritis while visiting small
town in Indonesia and tried some
Indonesian traditional food. The onset
of the disease is abrupt with
abdominal cramps and watery
diarrhea. She had no fever or nausea
or vomiting. The symptoms have
resolved within 24 hour and no
subsequent recurrences. They report
the disease to district public health
office. The investigation found that one
of the food products eaten by this
tourist was contaminated by suspected
pathogens. What is the suspected
pathogen may cause the disease above?
a. Salmonella typhi -> ada fever, abdominal
cramps, traveller’s diarrhea di India
b. Shigella dysenteriae -> berdarah
c. Enterohemorragic E. coli -> berdarah
d. Staphylococcus aureus
e. Enterotoxigenic E.coli -> traveller’s diarrhea;
bisa giardia lambia, cholera, rotavirus( biasa
di anak kecil), norovirus( di cruise ship
biasanya)
41 A 3-year-old boy was brought to emergency
unit in Tangerang Hospital with stridor,
dyspnea, and “croupy” cough ( ciri” pertussis-
> whooping cough), What is the most likely
pathogenic agent that causes the patient’s
disease? Stridor-> gara” ada pseudomembrane
‘jatoh’
a. Bordetella pertussis-> whooping cough
bukan croupy
b. Haemophilus influenzae
c. Coxsackievirus
d. B. Parapertussis
e. C. diphtheriae -> croupy cough,
pseudomembrane bikin difteri toxin->
hematogenous jd nyebar-> yg bkin
bahaya
42 What is the laboratory test to confirm the
diagnosis in this patient?
a. Blood culture
b. Throat swab culture->definitive diagnosis
c. Chest X-ray
d. Measurement of IgG antibody serum
e. Urine culture
43 A 70 years old women, come to
dermatovenereology clinic because she
complains pain, edema on her left eyelid and
there is some vesicle in her left forehead. She
complain pain on her forehead 2 days ago, but
vesicle come out 1 day ago.She sometimes fells
headache and fever. Clinical manifestation are
grouped vesicle, eritema base at her left
face.What is the diagnose of this patient?
a. Varicella-> latent kalo teraktivasi jadi
zoster; gejala gak sampe parah bngt
b. Herpes zoster -> gejalanya parah sampe
edem, cenderung unilateral
c. Herpes simpleks -> bilateral, bisa mulai
dari oral
d. Dermatitis venenata
e. Dermatitis iritan
44 A 19-year-old woman comes to
Emergency Department with signs and
symptoms of poisoning of an agent include
nausea, vomiting, abdominal cramps,
diarrhea, excessive salivation, headache,
giddiness, rhinorrhea, tightness in chest,
pin-point pupils  parasimpatetik activity,
mental confusion, and muscle twitching.
Which of the following is the most likely
agent caused those symptoms?
a. Acetaminophen
b. Barbiturate
c. Carbamate
d. Cyanide
e. Opiate-> mustinya no chest tightness,
melalui opioid receptor, reduced GI
activity,
45 Orang demam tinggi, nyeri belakang mata,
demam, Hb Ht naek, berdasarkan WHO,
diagnosisnya apa?
A. Dengue fever -> derajat 0
B. DHF (hemokonsentrasi & tanda
perdarahan) -> soalnya Hb Ht naik-> plasma
leakage; DBD derajat 1( tourniquet test
+)&2( pendarahan spontan, )
C. Severe Dengue -> DSS-> derajat 3 (gagal
circulation, nadi and BP turun, mulai altered
mental status, mulai gelisah)&4( shock berat
w/ nadi gak keukur)
46 49 yo man come to dermatologist because of
creeping in left elbow on day 3 trip. Eruption
6cm, linear, erythematobolbulus. Most possible
causees?
a. dermacentor andersoni
b. lactrodectus mancans
c. loxoxsceles laeta
d. lytta sesuatu
e. paederus peregrinus (tomcat) -> bikin
erythematobolbulus
47 A 44-year old man on a business trip to South
Kalimantan from Jakarta presented to the
emergency department with symptoms of
diarrhea and abdominal pain. On physical
examination was found pitting edema of the
abdominal wall and of the legs. A stool
specimen was sent to the laboratory for culture
and for ova and parasites. Blood was drawn for a
CBC. The culture was negative for enteric
pathogens. The patient was found to have
eosinophilia. The wet mounts from the
concentrated stool specimens revealed large,
ellipsoidal, operculated parasite eggs with thin,
transparent shells (140 x 85 µm).
Of the following, which parasite can be the
cause of this disorder :
a. Schistosoma japonicum-> vena
mesenterica superior
b. Fasciolopsis buski -> di hati bikin
hepatosplenomegaly
c. Trichinella spiralis -> di otot
d. Echinococcus granulosus->
hidatidosis
e. Clonorchis sinensis-> makan ikan
mentah
48 hematuria dan oval shaped and ada di terminal
spine?
schistosoma hematobium-> di vena plexus
hemoroidalis ( vena bladder and rectum-> bikin
hematuria)
49 40yo berenang di danau lindu, gatal2, besok
muncul papul, most likely pathogen?
schistosoma japonicum-> telur di feces-> telur
pecah di danau-> pecah jadi miracidium->
sporokista 1-> sporokista 2-> serkaria-
>serkarianya brenang bebas di danau nembus
kulit-> larva and dewasa di intrahepatic blood->
ke vein-> kembang biak disana
50 Bentuk infeksi yg nyerang pasien tsb (soal
49): larva filariform
51 Manifestasi klinisnya: (dari buku UI:
stadium 1 urtikaria, kalo intoksikasi
disertai demam, hepatomegaly &
eosinophilia tinggi ; stadium 2 sindrom
disentri ; stadium 3 sirosis hati &
splenomegaly)->gejalanya schistosoma
japonicum, swimmer itch, complication:
*Toxocara sp. Ascarit dari anjing(canis) sama
kucing(cati), bisa bkin visceral larva migrans,
nyerang anak kecil yg suka eating dirt, symptoms
seizure, encephalitis, myocarditis, hepatomegaly,
pruritic rash, urtikaria, preorbital edema,
a. creeping eruption =associated with cutaneous
larva migrans; filariform larva (hookworms)->
strongyloides stercoralis, necator americanus,
ancylostoma duodenale
b. billiary cirrhosis (gw jawab ini)
c. cholecystitis (jawaban 2012, yakin nih?) ->
karena eggnya ditmukan di gall bladder,
associated with inflammatory granulomatous
infection
d. pruruitus ani = entrobius vermicularis( cacing
kremi)
e. visceral larva migran= toxocara sp
52 a 23yo man presents with extreme swelling of
his legs and scrotum. The skin associated with
the swollen areas is thick and scally. The patient
admits to an episode of fever associated with
enlargement of inguinal lymph nodes some times
ago, but did not think much of it. Which of the
following is the best method to make diagnosis?
*pembesaran scrotum, payudara, full extremities
Cuma di wucheria bancrofti, ada juga hiluria,
nocturnal makanya ceknya harus jem 9 malem
ampe 3 pagi, cacing dewasa di lymph node, kalo
microfilaria di blood maknya ceknya
microfilarianya; brugia timori and malayi di
distal part of extremities
a. examine the stool for presence of eggs
b. examine the stool for the presence of
larvae
c. examine the blood smear for the presence
of adults worm
d. determine the titer of IgE antibody
against the parasites
e. examine the blood smear for the presence
of microfilaria
53 Treatment yg cocok utk case diatas (suspect
filariasis)? DEC (Diethylcarbamazine Citrate)
combination with albendazol=>wkt kt bljr
sempet gw sebut ini
54 A 40 year old man came to hospital with four
times generalized tonic-clonic seizure since two
week ago. There was no history of seizure and
head trauma. A one year ago, he had business in
Papua for six months. During his stay in there, he
often consumed under-cooked pork. Brain MRI
showed a small cystic with invaginated scolex
inside. What of this following is the most likely
inside cyst?
a. Taenia eggs
b. Cycticercosis cellulose =larvanya solium
c. Cysticercosis bovis = larvanya saginata
d. Taenia solium worm
e. Taenia saginata worm
55 Possible etiology case di atas? Undercooked
pork
56. a 39 yo woman whose husband has a pig at
home kept for house purposes come to the family
doctor with symptoms of periorbital edema,
weakness and muscle pain. What is the most
probable parasite causative in this case?
a. schistosoma japonicum = dari snail karena
masuk airnya jadi nimbus kulit
b. f. buski = hepatomegaly, sheep liver fluke
(reservoir di domba), transmisi dari
metacercaria yang ada di watercress plant,
symptom nya biliary colic, jaundice,
generalized abdominal pain, cholecystitis,
cholelithiasis.
c. trichinella spiralis = dari pork atau wild
animals, subconjunctivae hemorrhage
d. echinococcus granulosus = hidatidosis, dari
dog tape worm. Membentuk kista yang dapat
menyebabkan anafilaksis shock.
e. clonorchis sinesis=ikan mentah, ke hati dan
kantong empedu.
57 Etiologic cause case di atas?
a. eating larvae in contaminated food
b. eating eggs in contaminated food
c. eating cyst in contaminated food
d. undercooked pork
e. undercooked beef
58 A patient complains of having nail size
excrement from his anus. On the stool
examination, parasite eggs contains a
hexacanth embryo with six hooklets
surrounded by radially striated spherical
shell, 30 to 40 u in diameter were found, the
most likely diagnosis of this patient is :
a. Saginata taeniasis (di feses biasa
ditemuin proglotid) yang aktif
b. Solium taeniasis yang pasif
c. Cysticercosis
d. Oxyuriasis
e. Ascariasis
59 a 14 yo boy fell from bicycle,
last immunization at 18month,
(4th doses) 4-6 year
immunization wasn’t done.
What terapy should be given?
Tetanus Ig atau antitetanus
serum tp hrs cek
hypersensitivitas dulu sblm
dksh full dose
a. tetanus Ig
b. human iv Ig
c. tetanus toxoid
d. anti tetanic serum
60 Cara ngambil specimen darah yg baik?
Gw lupa pilihannya, pokoknya di
handout dia blg: diambil saat yg tepat
(cthnya pas suhu naek), peralatan yg
baik, ambil pas pasien blm minum
antibiotic
61 56 year old sheep farmer presents with
abdominal pain. Liver is enlarged with
palpable mass at right upper quadrant.
CT scan reveals a large encapsulated
lesion consistent with HYDATID
CYST. What organism may have cased
this? Echinococcus granulosus
62 manifestasi apa yang paling berbahaya
ketika surgucal removal case di atas?
bayangin aj, ni soal di angkatan lu
sempet keluar tp ga ada yg nyatet
atasnya. Anjeng bener emg…!!!!!!!!!!!!!
a. seizure
b. hemorrhage
c. peritonitis
d. anaphylactic shock
e. cardiac arrest
63 The patient was 3 y.o girl who was
seen by her pediatrician for a routine
physical exam. Her mother was
concerned about her daughter’s poor
appetite. Physical exam revealed that
the child was small for her age and had
a slightly enlarged liver. Blood was
collected for a routine CBC, since she
had previously been slightly anemic.
Hb normal, eosinophilia, no travel
history, melihara anak anjing di rumah.
Possible cause? Toxocara canis
64 Manifestasi klinis case di atas? Visceral
larva migrans
65 A 40-year-old man came to the clinic
with complaints of having fever more
than one-week, nausea, and fatigue. He
came back from Timika, Papua. On
blood smear examination, there are late
trophozoites forms, schizonts with 12-
 24 merozoites, and the infected red
cell is enlarged.Diagnosis? P. vivax
66. Cewe, flank pain, pas urinalysis hasilnya
positive nitrate dan many leucoytes, next
step>
a. urine culture= curiga UTI jd
cek jumlah bakteri& penyebab
b. PCT( paracetamol) oral
c. USG
d. .
e. IV ceftriaxone
67. 9 years old susah nafas, noisy breathing
sejak 3 hari yang lalum juga ada fever cough
myalgia headache hoarseness. Refuse to eat
karena sakit tenggorokan, ada pembesaran
KGB leher (bull neck appearance, bisa
gara”edem juga)), white membrane di
tonsil-> ciri”difteri, terbentuk
pseudomembrane. Additional exam?
f. Neck xray to reveal laryngeal
edema
g. CBC – liat infeksi bakteri
h. Throab swab – untuk gram
staining danswab kultur
i. .
j. refer THT
68 A boy brought by his mother to the
emergency department of Siloam hospital
because of vomit & dyspnoea. According to his
mother, her son was playing in the backyard. On
physical examination, the boy was found to have
high fever (39 ºC) and multiple stinging on the
back. The most likely species of insect bites is :
a. Hymenoptera sp = bee
b. Dermacentos andersoni
c. Lactodectus mactan = black widow
d. Loxoxceles laeta =spider
e. Lytta vesicatoria= kumbang
*kumbang paederus= tomcat-> erythematous
bulous lesion, sudden onset
69 21yo man come to emergency department
due to high fever, headache, nausea and
vomiting and constant sleepiness for 5 days. At
admission, he look lethargic and dehydrated.
At PF, he look jaundice, conjuctival injection
and … there are liver dysfunction and
increased creatinine. The relative stated that
the family live in village, tempoarte climate.
Previous 10 days, he worked on irrigation
channel and isinya air sungai. What is your
diagnosis?
a. treponemasis
b. shigelosis
c. salmonelasis
d.
e. leptospirosis =icteri/anicteric, renal failure, ke
brain, uveitis, subconjuctiva hemorrhage,
muscle pain biasanya gastrocnemius
70 A 35-year old man working on pig farm is
brought by his employer to the emergency
department of Siloam hospital because of seizure
and bilateral lower extremity weakness. CT scan
of the head reveals several calcified regions.
Laboratory examinations show WBC count of
10.800/mm3, with eosinophils. Brain tissue
biopsy reveals scolex with hooklets. Which one
is the treatment of choice for this case?
Neurocysticsercosis
a. Sulfadiazine-pirimetamin = obat malaria
b. Artemisinin =obat malaria
c. Albendazol= lbh buat neurosistiserkosis;
praziquantel= 2nd choice,di jaringan lain
and albendazol combination
d. Metronidazol
e. Itrakonazol
71 A 35-year-old man as a farm worker who
was working with pesticides is brought to the
emergency room with headache, vomiting,
salivation, diarrhea, muscle fasciculation,
difficulty walking, and difficulty speaking. His
clothing has been removed, he has been
washed, and he has been given activated
charcoal. What is the most effective remaining
treatment for this case of pesticide poisoning?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine = anticholinergic soalnya dia
keracunan cholinergic berlebihan;
pralidoxine gak boleh dikasih sendiri
soalnya dia nicotinic harus dipake
atropine
e. Hidrochlorothiazide

72. Occcult filariasis is Lymphatic filariasis
based upon
*occult filariasis= bnyk eosinophilia mkanya
ada gejala asthma, bnyk microfilia tp gak ada
gejala kecuali yg kyk asthma gtu-> TPE
(tropical pulmonary eosinophilia)
a. infection
b. allergy= karena IgE
c. infestation
a. rest all day and don’t do his job
b. cannot be cured
c. treatment in leprocy house
d. look out for wound
e. highly contagious and contact his family =
terserah hati kalian!:)
74 a patient come with an itchy recured fungal
infection on feet, doctor already give him
some medication for fungal infection, what
can be advised to make him healthy?
*lucio phenomenon= atrophy sampe necrosis di
leprosy, jadi item”gtu
a. don’t eat seafood
b. always use sandals
c. keep the skin dry and clean
d, don’t use shoes all day long
e. don’t scratch, it will spread the infection
75 Komplikasi demam thypoid paling sering
dimana? Ileum distal-> peyer’s patch, bkin
perforasi (pilihannya wkt itu ada colon gt2)
76 Cewe kena tusuk jarum suntik orang yg kena
HIV, langkah selanjutnya?
A. Rapid test
B. Post-exposure HIV prophylaxis (gw
jawab ini) -> zenovudin atau tenovovir +
lamivudine atau empirisitabin selama 4
wks , initiation secepat hari, lbh
dianjurkan dilakukan <24 jem or else risk
lbh tinggi
C. Start antiviral
D. Do nothing
77 cewe dtg dgn keluhan bengkak di tungkai
bawah, thick blood smear ada microfilaria
ciri deeply stain giemsa, inti sampe ke ekor
d. colonization
e. genetic
73. frustated patient diagnosed with leprosy.
He is afraid that he is cursed abd going to die.
As a medical doctor, what will you say to the
patient?
dan teratur, perbandinga kepala ekor 2:1,
parasit apa?
a. wuchereria bancrofti= ruang kepala 1:1, lekuk
badan halus , penyebaran inti merata, ekor tdk
ada inti tambahan
b. brugia malayi = 2:1, kaku, inti tumpeng tindih,
sarungnya ngambil warna giemsa
c. brugia timori = 3:1, kaku bngt, penyebaran inti
tumpang tindih
d. onchocerca volvulus
e. loa loa = bikin filariasis subkutan
78 One member of the NGO (Non-Governmental
Organization) team from Indonesia has been
reported dead in Mexico because of a spider’s
bite. The possible cause of this disorder is ;
a. Erucism = gara”caterpillar
b. Lepidopterism = gara” adult butterfly
c. Tick paralysis = gara”kutu anjing
d. Arachnidism
e. Delusional parasitosis = gangguan
sikologis dimana pasien ngira dia ada
pruritus gara”parasite, pengguna
metamphetamine
79 Orang HIV, ada riwayat TB dan Hepatitis
B. kombinasi obat yg dipake? Gw lupa, tp gw
jawabnya yg Emicitabine, Tenovovir,
Efavirenz. Pelajarin sendiri aja ye? Lamivudine
+ zidovudine +evafirenze; kalo gak tb eva
diganti nefirapine
80 a 45 yo women, ke rs karena diare 3 hari,
tiap hari 5-6x, sebelumnya dirawat di rs karena
pneumonia. Pernah ada history nasopharunx
CA, faktor yg mempengaruhi diare?
a. agent not usually cause disease in healthy
person
b. evolution of pathogen shg bisa ke new host e?
c. development of drug resistant of pathogen
d. non-adherence pasien dlm minum penumonia
drugs
e. pake counterfeit drugs 3. lab exam buat salmonella?

a. IgM salmonella = awal

81. Anak sekolah diperiksa ada gatel2 dll (gejala
scabies), trus temen2nya di kelas jg ngalami b. anti HCV
keluhan yg sama. Langkah yg seharusnya
dilakukan?

A Preventif 7. which subtype are known to cause HPAI?

B Kuratif
a. H1 and H3
C Rehabilitatif
D Promotif b. H2 and H4
E Environmental modification (gw nembak
jawab ini) = karena scabies sgt sensitive terhdp c. H5 and H7
environment
d. H6 dan H8

TROPMED 2012 e. H9 and H11

(thio) Kerja di poultry dan ayamnya pada mati.

35 tahun, ada gejala influenza, apa virusnya?
8. hep B positive, HIV positive, tb positive,
a. orthomyxoviridae treatment untuk HIV? TEE”

(dion) anak luka trus uda di ksi vaksin tetauns,

12. dari kasus 11, manifestasi apa yang paling
tapi hanya sekali. Management skrg apa?
berbahaya ketika surgucal removal?
Jawaban : Tig
a. seizure

b. hemorrhage
(guntur) 24 thn skoleks ditemukan di CT scan
c. peritonitis
atau MRI.
d. anaphylactic shock
a. taenia solium
b. b. toxo e. cardiac arrest
c. c. echinococcus

2. salmonella typhii, lab diagnosis? 14. manifestation of infection above:

*widal= spesifisitas gak tinggi
a.stool culture= + week ke 3 ilang week 8, di a. creeping eruption
carrier juga ada
b. biliary cirrhosis
b. blood culture= gold std
c. cysticercosis-> mustinya cholesistitis
c. swab
d. pruritus ani
d?
e. visceral larva migrant

21. treatment no 20

15. a 39 yo woman whose husband has a pig at a. metronidszole

home kept for house purposes come to the family
doctor with symptoms of periorbital edema, b. dietilcarbamasin
weakness and muscle pain. What is the most
probable parasite causative in this case? c. mebendazole

a. schistosoma japonicum

b. f. buski 23. 49 yo man come to dermatologist because of

creeping in left elbow on day 3 trip. Eruption
c. trichinella spiralis 6cm, linear, erythematobolbulus. Most possible
causees?
d. echinococcus granulosus
a. dermacentor andersoni
e. clonorchis sinesis
b. lactrodectus mancans

c. loxoxsceles laeta
16. atasnya soal trichinella spiralis?
d. lytta sesuatu
a. eating larvae in contaminated food
e. paederus peregrinus= tomcat
b. eating eggs in contaminated food

c. eating cyst in contaminated food

25. cewe dtg dgn keluhan bengkak di tungkai
d. undercooked pork bawah, thick blood smear ada microfilaria ciri
deeply stain giemsa, inti sampe ke ekor, parasit
e. undercooked beef apa?

a. wuchereria bancrofti
17. ada org datag dengan demam lebih dari 1 b. brugia malayi
minggu. Dari blood smear ada parasit bentuk
cincin dgn pembesaran sel darah merah. Kena c. brugia timori
apa?
d. onchocerca volvulus
a. plasmodium vivax
e. loa loa
b. p. malariae

c. p. falciparum
26. frustated patient diagnosed with leprosy. He
d. p. ovale is afraid that he is cursed abd going to die. As a
medical doctor, what will you say to the patient?
e. p. knowlesi
a. rest all day and don’t do his job

b. cannot be cured
18. demam tiap hari ke-4
c. treatment in leprocy house
jaw : plasmodium malariae= quartana
d. look out for wound
e. highly contagious and contact his family
28. a patient come with an itchy recured fungal
infection on feet, doctor already give him some
medication for fungal infection, what can be
advised to make him healthy?
a. don’t eat seafood
b. always use sandals
c. keep the skin dry and clean
d, don’t use shoes all day long
e. don’t scratch, it will spread the infection
29. a 45yo man was seen in the dermaotlogy
clinic because of some nodules on his arm and
bpdy and sometimes feel pain with pressure. On
examination was found erythematous nodules,
smooth and shiny diffused infiltrate with ill
define border, no flunctuation or erosion. There
were pain on his elbow with nerve enlargement.
Diagnosis?
a. yaws
b. leprosy
c. anthrax
d. celullitis
e. carbuncle
31. a 21 yo man was seen in dermatology clinic
because of sore and redness on his previous skin
lesion. He was on MDT treatment since 1.5 year
ago. On skin examination found some painful
erythematous nodule spread over his body
especially on arm and legs also fever. What is the
most likely diagnosis?
a. celullitis
b. furuncle
c. erythema nodosum
d. multibacillar leprosy
e. pausibacillar leprosy
33. patient on MDT treatment complaining about
red urine that he experience on first dat of
treatment. Suggestion?rifampicin-> continue
medication
a. stop clofazimin, can cause pink brownies
discoloration
b. continue medication, it is not drug adverse
effect
c. stop the medication because of nephrotoxicity
d. stop dapsone can cause anemia hemolytic
e. change the treatment to single drug therapy
35. upper quadrant pain dan fever. Liver
enlargement and tenderness. Baru pulang dari
thailand. Chill and sweat waktu fever. Terlihat
3.5% paracitemia. Explain mna yang benar?
a. paracutemia … from tissue injury
b. paracitemia release of merozoit
c. paracitemia due to sporozoit initiate in human
infection
d. paracitemua dri repeated cycle schizon from
liver to erytocyte
36. treatment malaria
a.
b. chloroquinee HCl intramuscular
c. artemeter + lumefanfrine
d. primaquiine
37. a 45 yo women, ke rs karena diare 3 hari, tiap d. mefloquine 2 days before
hari 5-6x, sebelumnya dirawat di rs karena
pneumonia. Pernah ada history nasopharunx CA, e. primaquine 2 weeks before
faktor yg mempengaruhi diare?

a. agent not usually cause disease in healthy

person 44. management soal no 43:

b. evolution of pathogen shg bisa ke new host a. hospitalisation with iv

c. development of drug resistant of pathogen b. outpatient meal soup

d. non-adherence pasien dlm minum penumonia c.

drugs d. jambu biji
e. pake counterfeit drugs e. domperidone

39. a 14 yo boy fell from bicycle, last
immunization at 18month, (4th doses) 4-6 year
immunization wasn’t done. What terapy should
be given?
a. tetanus Ig
48. G3P2A0 gejala anak chorioretinitis, cerebral
calcification, hepatomegaly, splenomegaly, berat
badan lahir rendah. Ibunya dalah suster di RS
siloam, tidak pernah kontak dengan kucong.
Diagnosis?

b. human iv Ig a. congenital toxoplasmosis

c. tetanus toxoid b. congenital CMV

d. anti tetanic serum c. congenital rubella

d. congenital herpes

41. 6yo girl was brought to clinic, cough,

vomiting. PE found: crackles in both lungs. 49. hematuria dan oval shaped and ada di
Treatment? oseltamivir terminal spine?

42. 24yo woman datang ke dokter pribadi mau ke
papua selama 1 minggu. Ibunya uda menikah, 2
bulan gk haid, diksi prophylaxis apa? Pakenya
kelambu , kalo gak ada pake; kalo sbg obat=
kina+ tetra/clinda/doxy +primaquin (2nd line),
first linenya ACT( artesunat, amodiaquine,
primaquin-> u/ falciparum; kalo yg lain sama tp
primaquinya dilanjutin sampe hari ke …..)
a. sulfa- piremitamin 2 weeks before
b. an…
Jaw : schistosoma
hematobium
50. a 19yo woman come to emergency deoarment
with sugn and sympotms of poisoning of an agent
include nausea, vomiting, abdominal cramp,
diarrhea, excessive salivation, headache,
giddiness, rhinorrhea, tighness in chesr, pin-point
pupil, mental confusion and muscle twitching.
Which of the following is the most likely agent
caused those symptoms?

c. doxycycline 2 days before a. acetaminophen

b. barbiturate
c. carbamate
d. cyanide
e. opiate
51. 40yo berenang di danau lindu, gatal2, besok
muncul papul, most likely pathogen?
c. schistosoma japonicum
53. soal no 51 ditanta bisa nyebapin apa?
a. creeping eruption
b. billiary cirrhosis
c. cholecystitis
d. pruruitus ani
e. visceral larva migran
55. makan gado2, trus ever, lidah coated, termor.
Causative agent menyebabkan perforasi dimana?
a. ileum
57. a 23yo man presents with extreme swelling of
his legs and scrotum. The skin associated with the
swollen areas is thick and scally. The patient
admits to an episode of fever associated with
enlargement of inguinal lymph nodes some times
ago, but did not think much of it.
Which of the following is the best method to
make diagnosis?
a. examine the stool for presence of eggs
b. examine the stool for the presence of
larvae
c. examine the blood smear for the presence
of adults worm
d. determine the titer of IgE antibody
against the parasites
e. examine the blood smear for the presence
of microfilaria
59. cowo, MSM, datang ke poliklinik mau
evaluasi treatment HIV nya. 1 minggu lalu, HIV
+ dan CD4 <350. Next step management?
a. start arv
b. cek tb
c. kasi provilaksis cotrim
d. jgn kasi arv sampao cd4 <200
e. kasi prophylaxis clatromycin
63. 2yo brought to dermatovenereology clinic
because itching all over the body. He complained
of itching on palm, side of finger, buttock and
abdomen. Clinical manifestations are papule,
vescicle, pustule, erotion and excoriation,
especially at finger web, arm, abdomen, side of
hand and feet. Itchy especially at night. His
neighbour have the same problem. He usually
play together with his neighbour. What is the
diagnosis of this patient?
a. pediculosis corporis
b. scabies
c. tinea corporis
d. dermatitis atopik
e. psoriasis
64. 8 day old infant, any loud noise appears to
cause him pain, ada muscle tightening and back
arching, causing the head to nearly touch his
feet. PF reveals only drued packing on his
umbilical cord as is the local custom. He appear
normal until stimulated by loud noise ot touch
and then began to cry, stiffens and arches his
back. The stiffness continues until he calm down.
Most likely diagnosis:
a. bacterial meningitis
b. botulism 72. cewe 55 thn, mau ke makkah, dia uda 10
tahun gak kesna, pemeriksaan fisik normal, perlu
c. generalized seizure vaksin apa?
d. TETANUS a. salmonella typhii
e. viral encephalitis b. tetanus

c. hepatitis a
67. ibu bawa anak umur 18 bulan ke ER dgn d. hepatitis b
keluhan runny nose, conjuctivitis, diarrhea. PF:
fever 40C 3 hari, rash 2-3mm mulai dari muka. e. meningiococcal (arab2)
Most likely causes:

jawban: morbili-> measles

69. a baby is born with a rash identical.
Questioning reveal that the mother had a febrile
illnes during the second teimester of pregnancy.
Examination reveals diffuse raised purple skin
( blueberry muffin) lesions. There is no pallor,
jaundice, or cyanosis. The eyes are cataract, the
heart has a 3/6 systolic murmur and there is
enlargement of both the liver and spleen. There is
no lymphadenopathy. Of the following, the most
likely diagnosis is?
a. congenital toxoplasmosis
b. congenital rubella
c. congenital CMV
d. congenital malaria
73. 21yo man come to emergency department due
to high fever, headache, nausea and vomiting and
constant sleepiness for 5 days. At admission, he
look lethargic and dehydrated. At PF, he look
jaundice, conjuctival injection and … there are
liver dysfunction and increased creatinine. The
relative stated that the family live in village,
tempoarte climate. Previous 10 days, he worked
on irrigation channel and isinya air sungai. What
is your diagnosis?
a. treponemasis
b. shigelosis
c. salmonelasis
d.
e. leptospirosis

e. congenital varicella
75. cowo aktif sexual partner tapi pake pelindung,
terus mau screening. Screening pake apa?

71. ke india 6 hari lalu, foul smelling and a. HIV-RNA

slimmy diarea-> ETEC
b. CD4 count
a. giardia lamblia= Thailand, traveller’s diare,
gak berdarah, steatorrhea c. Rapid Test

b. vibrio cholera= daerah banjir, air cucian beras d. western blot

c. shigella=ada berdarah e. HIV-ELISA

77. 67 yo man with long lasting diabetes and C. organism culture isolation
abscess in pedis dextra. PF BP 120/80, HR
120bpm, RR 28, tempt 37,8C. Hb 8, WBC
21,000, platelet 109,000. Next step evaluation
and management? 81. workplace health hazard can cause reaction.
Asthma, and dermatitis caysed by whicch
a. administer normal saline bolus reaction?

b. obtain culture a. immediate reaction= 1 time event, kyk nausea,

SOB
c. transfusion red pack blood cells
b. acute
d. platelet transfusion
c. gradual= asthma, dermatitis, bisa kambuh
e. bone marrow biopsy
d. delayed”= long term exposure

78. boy 12yo dtang ke klinik demam 4 hari yg
lalu, semam, mual, skait kepala, fatique,
tourniquet +, apa arti hasilnya?
a. increased capillary liability
b. devreased platelet count
e. no reaction
85. nenek dtg kidney transplant tinggal dgn anak
n cucu. Anak bayi baru vaksin. Nenek merasa
kaki lemah sebelah. Vaksin apa bisa prevensi
penyakit ini?

c. increase hematocrit a. HiB

d. decrease platelet function b. orosabin-> Polio yg live attenuated, kalo yg

salk itu yg mati
e. DHF= lab: platelet<100k
c. meningiococcal

d. varicella
79. anak demam 2 hari, dokter suspek DBD, cek?
e. hep B
a. NS1= 1-2 hari dr nata; 1-8 IPD UI

b. hematocrite

c.IgM= 3-5 hari

80. 38yo woman fever 10 days, malam makin

parah, ada fatique, dizzines, stomach discomfort,
constipation, loss of apetite. Suhu 38C BP 100/70
pulse 70x. mild abdominal pain, tremor and
coated tongue. Main specific standart lab exam
for diagnosis?-> Typhoid

a. PCR

b. Widal
MCQ TROPICAL MEDICINE 2010
1. An apparently run-down but alert 34-year-old
woman comes to your office after 6 months
spent as a teacher in a rural West Sumba. Her
chief complaints are frequent headaches,
occasionally nausea and vomiting, and
periodic fever. To rule out your differential
diagnosis, a smear of finger-stick blood was
done. Which of the following choices would
fit your diagnosis based on your microscopic
examination of the blood smear?
a. Schizonts in red cells with 8-12 progeny
b. Rounded gametocytes present
c. Enlarged, somewhat misshapen in red
cells
d. Large ovoid parasites in some of the red
cells
e. Band-shaped tropozoites in infected red
cells
2. A 20-year-old woman came to the emergency
room with high fever from 5 days ago. She
also has headache and pain in retroorbita,
abdominal pain and bloody stool. On
physical examination, she was in an agitated
condition. Her BP 90/60 mmHg, heart rate
110x/ minute, RR 20x/ minute and there were
purpura in her arm, hand and leg. Which of
the following examination is the most
appropriate to establish the diagnosis?
a. Prick test
b. Dengue IgM-IgG
c. Complete blood test
d. Widal test
e. Stool analysis
3. A 32-year-old female developed a “flu-like”
syndrome with high fever up to 400C,
anorexia, headache, and myalgia. Four days
later, she become confused and agitated with
difficult to breath. Chest x-ray showed
parenchymal infiltrate. One of her kids has
also these symptoms, and has already passed
away. In order to provide laboratory
conformation of the pathogenic agent, a
tissue culture was ordered.
Which of the following would be the best
specimen for isolating the pathogenic agent
responsible for this infection?
a. Stool
b. Blood
c. Saliva
d. Lung biopsy
e. Nasopharyngeal swab
4. A 16-year-old boy presents with an annoying
cough, which he has had for about 3 weeks.
The illness started with a runny nose. On
examination he is completely normal, but he
exhibits several episodes of severe coughing.
He has difficulty to take deep breath and
usually ends up with vomiting. Of the
following, the MOST likely diagnosis is
a. Tonsilitis
b. Bronchiolitis
c. Pertusis
d. Laryngitis
e. Diphteria
5. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he was bitten by a dog. His
symptoms increased and were accompanied
by hand spasm and sweating on the right side
of the face and trunk. This patient was
admitted to the hospital the day after
developing dysphagia, hydrophobia,
hypersalivation, and disorientation.
Which of the following pathologic feature is
most likely found in dog’s brain?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell
Question 6-7 are linked to the following case:
A 32-year-old worker from a farm comes with a
painless dermal papule on his right hand which
started to develop since five days ago. The
worker says as the lesion getting bigger, and the
skin becomes black . He has tender axillaries
lymph node enlargement.  anthrax
6. What antibiotic should the doctor give to
treat the worker?
a. Tetracycline
b. Aminoglycoside
c. Ciprofloxacin
d. Neomycin
e. Crystalline penicillin G
7. Which of the following virulence factors is
most likely to be involved in the pathogenesis
of illness?
a. Exotoxin
b. Endotoxin
c. α-hemolysin
d. Lipopolysaccharide
e. Antiphagotic factors
8. A 45-year-old man was seen in the
dermatology clinic because of some nodules
on his arm and body and sometimes feel pain
with pressure. On examinations we found
erythematous nodules, smooth and shiny,
diffuse infiltrate with ill define border, no
fluctuation or erosion. There were pain on his
elbow with nerve enlargement. What
laboratory test would you do to confirm the
clinical diagnosis?  leprae
a. TPHA and VDRL
b. Gram preparation
c. KOH preparation
d. Skin scrapping
e. Skin slit smear
9. A 40-year-old patient comes with the complaints
of uncomfortable stomach & flatulence. From
history, the patient was known live in the valley
of Napu, Sulawesi and he had a fever frequently.
On physical examination, his liver was found
enlarged. Which one of the following test can be
used to confirm the diagnosis?  typhoid
a. Blood test
b. Liver biopsy
c. Rectal biopsy
d. Stool examination
e. CT scan
10. A 53-year-old male farmer developed low-
grade fever, abdominal pain, and diarrhea. He
has a skin lesion of black eschar surrounded
by vesicle and edema near his mouth. A week
before, his notice many cattle in his farm
were sick, but he still eats a half-done beef
steak from his cattle.
What is the following microorganism is most
likely involved in this case?
a. Bacteroides fragillis
b. Leptospira interrogans
c. Bacillus anthracis
d. Pasteurella pestis
e. Borrelia burgdorferi
11. A woman, recently returned from Lampung,
complains of having paroxysmal attacks of
chills, fever, and sweating; these attacks last
a day or two at a time and recur every 36 to
48 h. Which of the following is the most
appropriate time to take blood specimen to
establish the diagnosis?  malaria
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever
12. A very depressed woman took 20 tablets of a
hypnotic drug belonging to her husband
about less than 30 minutes ago. As she was
being taken to the hospital, she developed
hypotension, tachycardia, and tachypneu.
She’s also unconscious. Which of the
following is the most appropriate
management for this patient?
a. Give apomorphine intramuscular 
induce emesis
b. Doing gastric lavage
c. Infuse with sodium bicarbonate
d. Give activated charcoal via NGT
(nasogastric tube)
e. Doing a hemodialysis
13. An outbreak of pulmonary tuberculosis (TB)
in a dormitory, and this outbreak were
presumed to be caused by the same source of
infection, based on the results of restriction
 fragment length polymorphism (RFLP)
analysis and other findings. Which of the
following health intervention is the most
appropriate for the case above?
a. Rehabilitation
b. Prevention
c. Curative
d. Medication
e. Environmental Modification
– ebola hemmorhagic fever
14. There is an RNA virus that causes deadly
outbreaks of hemorrhagic disease in Africa.
The patents have developed fever, headache,
and muscle pain followed by abdominal pain,
diarrhea, and rash, with both internal and
external bleeding. In each outbreak, hospital
staff became infected. This virus is highly
virulent. Which of the following is the most
likely transmission for this disease?  ebola
a. Contact with blood or body fluid
b. Transmitted by mosquitoes bite
c. Transmitted to human from rodent
excreta
d. Aerosol transmission
e. Direct contact with cattle product
15. A 31-year-old man presented with complaints
of high fever, cough, and shortness of breath.
Two hours before admission, he experienced
right-sided chest pain when took a deep
breath or coughed. Chest film showed
diffused bilateral interstitial pulmonary
infiltrate. Arterial blood gases showed a PO2
of 60 mmHg with 91% hemoglobin
saturation. The hematologic, serum and liver
tests were normal. He lives near the poultry,
and the pathogenic agent is a new virus.
Which of the following is the prevention for
this disease?
a. Vaccine
b. Antitoxin
c. Antibiotic
d. Antiviral : oseltamivir
e. Antidotes
Question 16-17 are linked to the following case:
A 28-year old man presented with 8-day history
of increasing fever, malaise, headache, and
constipation. He did not receive any prior
vaccinations. His vital signs revealed temperature
390C, BP 130/90, pulse 72x/min. His physical
examination revealed mild hepatospleenomegaly
and faint erythematous macules.
16. Which of the following is most likely to have
caused this man’s illness?
a. Vibrio cholerae
b. Shigella dysentriae
c. Salmonella typhi
d. Entamoeba histolitica
e. Giardia lambia
17. Which of the following specimen is most
appropriate for case above?
a. Feces
b. Blood
c. Urine
d. Throat swab
e. Biopsy
Question 18-19 are linked to the following case:
A 44-year old man on a business trip to South
Kalimantan from Jakarta presented to the
emergency department with symptoms of
diarrhea and abdominal pain. On physical
examination was found pitting edema of the
abdominal wall and of the legs. A stool specimen
was sent to the laboratory for culture and for ova
and parasites. Blood was drawn for a CBC. The
culture was negative for enteric pathogens. The
patient was found to have eosinophilia. The wet
mounts from the concentrated stool specimens
revealed large, ellipsoidal, operculated parasite
eggs with thin, transparent shells (140 x 85 µm).
18. Of the following, which parasite can be the
cause of this disorder :
a. Schistosoma japonicum
b. Fasciolopsis buski
c. Trichinella spiralis
d. Echinococcus granulosus
e. Clonorchis sinensis
19. Refer to the previous case, the mechanism of
edema is due to :
a. Host-allergic response to metabolic
wastes of parasite
b. Reaction to the parasite as it migrates
through the tissues
 c. Reaction to embolization of eggs
d. Immediate hypersensitivity reaction to
the adult worms in the intestine
e. Eggs damage the wall of intestine
20. A 24-year-old man returned from Papua
Island. Five days later, he developed
repeating intense chills and high fevers.
These severe episodes of fever had been
occurring every other day. In between these
episodes, he had low-grade fever, myalgia,
nausea, vomiting, and diarrhea. A few hours
ago, he was admitted to ICU in coma. He
became progressively somnolent and died a
week later. Which of the following organs
does this infectious agent initially proliferate
after entry in the infected host?
a. Heart
b. Liver
c. Brain
d. Spleen
e. Renal
21. A 61-year-old man was seen in the
Neurology Clinic for evaluation of a
peripheral neuropathy. He was found to have
dermal hyperpigmentation/depigmentation
(salt/pepper) of the skin, scaly palms, and
transverse ridges on his fingernails which
were identified as being a result of a chronic
chemical intoxication.
Which of the following is the most likely
chemical agent caused that sign and
symptoms?
a. Acetaminophen
b. Arsenic : ngumpul di rambut kuku
c. Cyanide
d. Fluoride
e. Iron
22. A 45-year-old man from the Middle East had
fever and chills, with weight loss, sweats,
headache, muscle pain, fatigue, and
depression. From physical examination the
doctor found lymphadenopathy and
spleenomegaly. The man is a daily farmer
and a couple weeks before the symptoms
appeared he drank a glass of unpasteurized
cow milk. The culture of blood grew a tiny
Gram-negative coccobacilus, catalase and
oxidase-positive; that resemble fine grains of
sand. The patient was probably infected with
which of the following microorganism?
a. Mycobcaterium tuberculosis
b. Salmonella typhi
c. Brucella species
d. Pasteurella pestis
e. Staphylococcus aureus
23. A 55-year-old warden found a dead muskrat
on the bank of a stream. He picks up the
animal and buried it. Four days later, he
developed a 1.5 cm painful ulcer on the index
finger of his right arm, a 1 cm ulcer on his
right forehead, and pain in his right axilla.
Physical examination also revealed right
axillary lymphadenopathy. Which of the
following is working diagnosis for this
patient?
a. Brucellosis
b. Pertusis
c. Leptospirosis
d. Tularemia
e. Hydatidosis
Question 24-25 are linked to the following case:
A volunteer man returning from a tsunami area
was admitted to hospital. A week before, he had
fever, headache and myalgia especially at calf.
These symptoms resolved, but the day before
admission he became pyrexia and on examination
was found to be jaundice and to have an elevated
blood urea. Urine was collected and inoculated
into a semisolid agar medium, and examined by
dark ground microscopy.
24. Which of the following is your working
diagnosis?
a. Syphillis
b. Pertusis
c. Weil’s disease
d. Lyme disease
e. Relapsing fever
25. Which of the following disease is the
complication of this disease?
a. Pulmonary hemorrhage
b. Myopericarditis
c. Aseptic meningitis
d. Osteomyelitis
 e. Anemia
26. A 39-year-old woman live in Manokwari,
Papua Island developed a major seizure while
at work. She had no history of epileptic
disease. A head MRI was remarkable for a
lesion surrounding a scolex. The etiologic
agent would most plausibly have been
acquired by eating or dinking which of the
following food items?
a. Uncooked vegetables
b. Raw beef
c. Raw pork
d. Uncooked fish
e. Unfiltered water
27. A young boy had wart-like skin lesions with
the appearance of strawberries in his legs.
Later, this lesion destroys the bone of his legs
(gummata), but there are no visceral and
nervous system complications. The disease is
still endemic in hot tropical countries, such as
Indonesia. Which of the following
examination is the most appropriate to
diagnosis the disease above?  yaws
a. Widal test
b. IgM-IgG of Treponema
c. Dark-field microscope
d. FTA-ABS and TP-PA test
e. ELIZA assay
28. A 27-year-old man develops acute severe
encephalitis that requires hospitalization.
Several days before he got that disease, he
recognizes that many pigs in his farm were
died.
Which of the following is most appropriated
natural host for the pathogen?  nipah
a. Arthropod
b. Horse
c. Bats
d. Squirrel
e. Rats
29. A female tourist developed gastroenteritis
while visiting small town in Indonesia and
tried some Indonesian traditional food. The
onset of the disease is abrupt with abdominal
cramps and watery diarrhea. She had no
fever or nausea or vomiting. The symptoms
have resolved within 24 hour and no
subsequent recurrences. They report the
disease to district public health office. The
investigation found that one of the food
products eaten by this tourist was
contaminated by suspected pathogens. What
is the suspected pathogen may cause the
disease above?
a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E.coli travellers
30. A 23-year-old man sees his family physician
with a sudden onset of 4-day history of
fevers, headache, retro-orbital pain, myalgia
and rash. Physical examination shows diffuse
erythroderma with blanching erythema and
petechial formation resulting from pressure
applied to her skin. Laboratory test reveal
lymphopenia and thrombocytopenia. Which
of the following virus is most likely
responsible for this infection?
a. Morbili
b. Dengue
c. Influenza
d. Coxsackie
e. Rhinovirus
31. A 48 year old lady came to the outpatient
clinic with chief complaint of fatigue and
difficulty in concentration for the last 2
weeks. The history taking revealed that she
had a balanced diet, no history of chronic
disease and had been a heavy smoker for 20
years. On physical exam it was found that she
had anaemic conjunctiva with other findings
was within normal limit. The laboratory
examination showed that she had haemolytic
anemia.
Based on the information given above, what
is the most likely cause for her condition?
a. Vitamin K deficiency
b. Copper deficiency
c. Vitamin E deficiency
d. Iron deficiency
e. Folate deficiency
32. A laboratory examination of a leprosy patient
after 4 months MDT therapy revealed
Bacterial index 6+ and morphological index
50%. What is your conclution for this result ?
 a. Pausibacillar leprosy patient sensitive to
treatment
b. Multibacillar leprosy patient sensitive to
treatment
c. Multibacillar leprosy patient resistent to
treatment
d. Pausibacillar leprosy patient resistent to
treatment
e. Pausibacillar leprosy patient prone to
nerve damage
33. A boy brought by his mother to the
emergency department of Siloam hospital
because of vomit & dyspnoea. According to
his mother, her son was playing in the
backyard. On physical examination, the boy
was found to have high fever (39 ºC) and
multiple stinging on the back. The most
likely species of insect bites is:
a. Hymenoptera sp
b. Dermacentos andersoni: tick paralysis
c. Lactodectus mactan : black widow
d. Loxoxceles laeta : laba2
e. Lytta vesicatoria : kumbang
34. A 28 year old lady came to the Posyandu to
have a nutrition consultation. Last year, she
delivered a stillbirth baby with a spinal
disorder. She and her husband start planning
to have a baby again. She asked for
suggestion about her dietary intake before she
got pregnant.
What kind of diet does she need to prevent
the same disorder for her future baby?
a. Dark green vegetables
b. Pasteurized milk
c. Deep water fishes
d. Boiled eggs
e. Lean beef
35. A 27 year old woman in at term pregnancy
had fluctuated fever since 2 weeks ago. She
looked pale, generalized weakness, and
headache. She went to public health center
and was prescribed oral chloramphenicol in
doses of 500 mg four times daily and
paracetamol 500 mg three times daily. She
did not tell to the physician that she was
pregnant. What is the expected side effect of
the drug you will find on the baby?
a. Reye syndrome
b. Gray syndrome
c. Down syndrome
d. ADHD
e. Black water fever
36. A 35 year old man, a businessman, came to
private doctor. He asked the physician about
his plan to go to Papua, which is endemic
malaria. The physician suggested him to take
prophylactic drug. Which medication (WHO
recommended) would be given to this patient
for prophylactic?
a. Kina
b. Chloroquine
c. Doxycycline
d. Kuinin
e. Primakuin
37. A 40 year old man came to hospital with four
times generalized tonic-clonic seizure since
two week ago. There was no history of
seizure and head trauma. A one year ago, he
had business in Papua for six months. During
his stay in there, he often consumed under-
cooked pork. Brain MRI showed a small
cystic with invaginated scolex inside. What
of this following is the most likely inside
cyst?
a. Taenia eggs
b. Cycticercosis cellulose
c. Cysticercosis bovis
d. Taenia solium worm
e. Taenia saginata worm
38. An 8-day-old infant was born with the help of
shaman (‘dukun beranak’). The mother states
his son became irritable since 2 days ago, and
now any loud noise appears to cause him
pain, as evidenced by muscle tightening and
back arching causing his head to nearly touch
his feet. Physical examination reveals only a
dried packing on his umbilical cord, as is the
local custom. He appears normal until he is
stimulated by touch or a loud noise, and then
he begins to cry, stiffens, and arches his back.
The stiffness continues until he calms down.
Of the following, the MOST likely diagnosis
is:
a. Bacterial meningitis
 b. Botulism duration. On examination she is very ill-
c. Generalized seizure appearing. She has some inspiratory stridor
d. Tetanus and thick white-gray material covering her
e. Viral encephalitis tonsils and faucial pillars, and she has
swelling of her neck, no splenomegaly. The
Question 39-40 are linked to the following case: lymphocyte is normal. What is the likely
A worried mother brings her 18-month-old son to diagnosis?
the emergency department because of a rash that a. Tonsilitis
developed today. She reports that he has had a b. Angina Plaut Vincent
runny nose, conjunctivitis, and diarrhea. On c. Mononucleosis infectiosa
physical examination, he appears severely ill, is d. Laryngitis
temperature to 40°C for the last 3 days and has e. Diphteria
diffuse 2 – 3 mm erythematous rash beginning
from the hairline behind the ear and spreading to 43. A baby is born with a rash identical. History
his face and body. On buccal mucosa, there is a taking reveals that the mother had a febrile
red spot surrounded by white bluish appearance. illness during the second trimester of
pregnancy. Examination reveals diffuse
39. Of the following, the MOST likely cause of raised purple skin lesions. There is no pallor,
the rash is jaundice, or cyanosis. The baby has cataract,
a. Rubella virus a 3/6 systolic heart murmur, and enlargement
b. Coxsackievirus of both liver and spleen. There is no
c. Morbilli virus lymphadenopathy.
d. Human herpesvirus 6 Of the following, the MOST likely diagnosis
e. Parvovirus B19 is?
a. Congenital Toxoplasmosis
40. What is the most severe complication that b. Congenital Rubella
would happen to the patient above? c. Congenital Cytomegalovirus
a. Osteomylitis d. Congenital Herpes Simplex
b. Encephalitis e. Congenital Varicella
c. Otitis externa
d. Sinusitis 44. A 40-year-old woman presented with a raised
e. Oral thrush redness plaque resemble a doughnut with a
raised border that she already had for 1 year,
41. A 48-year-old man with acute gastroenteritis It was no itchy, no pain, not easily bleeding.
has step ladder night fever since 7 days ago. Sometime she feel weakness on her leg and
He also has abdominal pain, and constipation. her slipper left behind while walking. On her
He usually eats uncooked vegetables at street legs she developed an anular erythematous
vendor (pedagang kaki lima). sharp border lesion, no scally, shiny surface
Which of the following is most likely to be a and enlargement of the popliteal nerve. What
constituent of this organism? kind of laboratory examination results that
a. Vi antigen can help us make a diagnose of the case
b. Urease above?  kusta
c. Hemolysin a. Dark field examination
d. Shiga toxin b. Gram
e. Pili c. KOH examination
d. Ziehl neelson
e. Na Cl examination

45. A woman, recently returned from Lampung,

42. A 10-year-old girl presents with a history of complains of having paroxysmal attacks of
sore throat and difficulty breathing of 1 day’s chills, fever, and sweating; these attacks last
 a day or two at a time and recur every 36 to
48 h. Examination of a stained blood
specimen reveals ringlike and crescent-like
forms within red blood cells. The infecting
organism most likely is
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malarie
e. Plasmodium brasilianumi
46. A 33-year-old woman ingested 10 tablets of
an analgesic-antipyretic which is metabolized
to a quinone imine. Shortly after ingestion
she presented with signs of nausea, vomiting,
and generalized malaise. Within 3-5 days
peak hepatic dysfunction occurred and was
associated with hepatic necrosis.
Which of the following is the most likely
specific antidote that should be used to treat
this patient's over dosage?
a. Amyl nitrite
b. Atropine
c. BAL
d. EDTA
e. N acetyl sistein
47. A 27-year-old medical student was admitted
to hospital because of sudden onset fever up
to 390C and headache. Two weeks previously
he volunteers cleaning the canal with others.
On examination, he looked so yellow. Blood
tests done shortly after admission indicated
renal function abnormality and elevated liver
function tests. Which of the following is the
prevention after exposure for this case?
a. Human vaccine
b. Health education
c. Vector control
d. Isolation the infected people
e. Prophylaxis antibiotics
48. A 24 year old woman admitted to the hospital
with myalgia and weakness of her right leg.
She had traveled from Saudi Arabia and her
immunization had never completed. On
examination, she had normal sensation of the
right leg, with normal movement and strength
in all other extremities and a normal cranial
nerve examination. Which of the following
vaccination is the best prevention for this
disease?
a. MMR
b. HBIG
c. BCG
d. DPT
e. Oral Sabin  polio
49. An HIV (+) patient comes to the emergency
room with severe dehydration. The nurse puts
an IV line on him, after that the nurse use her
two hand recapping the needle, and got
injured by that needle. The nurse is
panicking. You are the doctor on duty in that
emergency room. What should you do?
a. Press the injury site to stop the blood
b. Wash immediately using soap under
running tap water
c. Use bleach or iodine to clean the injury
site
d. Use antibiotic ointment on the injury site
e. Enlarge the injury site by incision to let
the blood flow
50. A 33-year-old woman at 10 weeks pregnancy
presents for her first prenatal examination.
Routine labs are drawn and her HBsAg is
positive. Liver function tests are normal and
her Anti HBc and Anti HBs are negative.
Which of the following is the best way to
prevent neonatal infection?
a. Provide immune globulin to the mother.
b. Provide hepatitis B vaccine to the
mother.
c. Perform a cesarean delivery at term.
d. Provide hepatitis B vaccine to the
neonate.
e. Provide HBIG and the HepB vaccine to
the neonate
51. A 34-year-old G2 at 36 weeks delivers a
growth-restricted infant with cataracts, patent
ductus arteriosus, and sensorineural deafness.
She had flu-like syndrome with rash in early
 pregnancy. What is the most likely causative
agent?
a. Parvovirus
b. Rubella virus
c. Morbili virus
d. Cytomegalovirus
e. Herpes simplex virus
52. A 27-year-old female has just returned from a
trip to Southeast Asia. In the past 24 hours,
she has developed shaking, chills, and a
temperature 40o C. A blood smear reveals
Plasmodium vivax. Which of the following
agents should be used to eradicate the extra-
erythrocytic phase of the organism?
a. Primaquine
b. Pyrimethamine
c. Quinacrine
d. Chloroquine
e. Chologuanide
53. A 25-year-old G3 at 39 weeks delivers a
small-for-gestational-age infant with
chorioretinitis, intracranial calcifications,
microcephaly, jaundice, and
hepatosplenomegaly. The infant displays
poor feeding and tone in the nursery. The
patient denies eating any raw or undercooked
meat and does not have any cats living at
home with her. She works as a nurse in the
pediatric intensive care unit at the local
hospital. What is the most likely causative
agent?
a. Cytomegalovirus
b. Epstein-Barr virus
c. Hepatitis B virus
d. Parvovirus
e. Yellow fever virus
54. A 45 year old man presented chronic skin
lesions on both hands for the past 1 year. On
examination, his skin appears erythematous,
crusted, fell itching, and having serous
discharge. He was working in the gold
refining plant for the past 2 years, works with
potassium cyanide and never uses any gloves.
Which of the following mechanism is
responsible for this illness?
a. Immediate respond
b. Acute respond
c. Gradual reactions : dikit2 : sulfonyl urea
d. Delayed reactions
e. Quantal reactions : dosis berapapun
langsung kena : chloramphenicol
55. Male, 46 years old came to you as a doctor
with chief complains shortness of breath
especially at the work place. When he gets
home, the symptom is missing. He also
complains that he sneezes every morning.
According to him, his sister is using
bronchodilator inhaler every day. He just
worked at sandblasting company and expose
to dust since 2 weeks ago. Which of the
following is the most appropriate to measure
the toxicity of hazardous material in the case
above?
a. Body Mass Index
b. Nutrition and Job description
c. Individual Susceptibility
d. Social pressure
e. Tissue and organs
56. The patient was a 3-year-old girl who was
seen by her pediatrician for a routine physical
examination. Her mother was concerned
about her daughter’s poor appetite. Physical
exammmination revealed that the child was
small for her age and had a slightly enlarged
liver. Blood was collected for a routine
complete blood count, since she had
previously been slightly anemic. Her
hemoglobin level was within the normal
range; however, she did have eosinophilia
(20%). The child had no history of travel.
When questioned about pets, her mother
reported that she spent a great deal of time
with her puppy. Of the following, which
manifestation of the infection (above case) is
known to occur?  toxocara
a. Creeping eruption  strongyloides
b. Biliary cirrhosis
c. Cholecystitis
d. Pruritus ani  oxyuris
vermicularis/enterobius
e. Visceral larva migrans
57. A patient complains of having nail size
excrement from his anus. On the stool
examination, parasite eggs contains a hexacanth
embryo with six hooklets surrounded by radially
striated spherical shell, 30 to 40 u in diameter
 were found, the most likely diagnosis of this
patient is :
a. Saginata taeniasis
b. Solium taeniasis
c. Cysticercosis
d. Oxyuriasis
e. Ascariasis
58. The mother of a 4-year-old child notes that
her child is sleeping poorly and scratching his
anal area. You suspect the child may have
pinworms. Which one of the following is the
BEST method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of microfilariae
d. Examine transparent adhesive tape for
the presence of eggs
e. Determine the titer of IgE antibody
against the parasites
Question 59-60 are linked to the following case:
A 30-year-old woman presents with abdominal pain
and diarrhea of 3 day’s duration. She does not
complain of nausea, vomiting, or fever. She has no
sick contacts or significant travel history. A stool
sample is obtained, which reveals rhabditiform(,
filariform: infective) larva strongyloides .
59. In condition below adult form of the pathogenic
agent can be found in whole digestive tract and
its larvae can be found in visceral organ (lung,
liver, gall bladder) is:
a. Eosinofilia
b. Hyperinfection
c. Retrofection
d. Hypereosinofilia
e. Autoinfection
60. Refer to the previous case, further questioning
reveals that the woman frequently gardens in her
backyard. Of the following, which one is the
transmitted form?
a. Fecal – anal transmission
b. Fecal – oral transmission
c. Fecal – cutaneous transmission
d. Direct contact with skin scales
e. Intravenous drug abuse
61. A 40-year-old man came to the clinic with
complaints of having fever more than one-week,
nausea, and fatique. He came back from
Samarida, Kalimantan. On blood smear
examination, there are late trophozoites forms,
schizonts with 12-24 merozoites, and the infected
red cell is enlarged. Of the following, the most
likely diagnosis of this pasient is :
a. Vivax malaria
b. Falciparum malaria
c. Malariae malaria
d. Ovale malaria
e. Knowlesi malaria
62. A- 52- year old man is brought to the emergency
department in an unconscious condition. On
examination, he was death form more than one
hour. On autopsy of the brain, there is cyst‘s fluid
containing protoscoleces with hooklets and many
daughter cysts were found. The most likely
diagnosis of the disease is:
a. Hydatidosis
b. Cysticercosis
c. Cerebral malaria
d. Occult filariasis
e. Trichinosis
63. An-6-year-old girl sustains a large laceration
contaminated with dirt after falling from her
bike. Her mother can’t recall how many
doses of immunization her daughter has
received. Which of the following is the
prevention after exposure for this case?
a. Adult-type TT
b. TIG
c. TT and TIG
d. HiB containing TT and TIG
e. DPT
Question 64-65 are linked to the following case:
A 23-year-old man presents with extreme
swelling of his legs and scrotum. The skin
associated with the swollen areas is thick and
scaly. The patient admits to an episode of fever
associated with enlarged inguinal lymph nodes
some time ago, but did not think much of it. 
filariasis
64. Which one of the following is the BEST
method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of adult worm
d. Determine the titer of IgE antibody
against the parasites
e. Examine a blood smear for the presence
of microfilaria
65. According to the case above, which of the
following is the most appropriate time to take
the specimen for established the diagnosis?
a. Anytime
b. At 10.00 – 12.00 AM
c. At 10.00 – 12.00 PM
d. 30 minutes after fever
e. 120 minutes after fever
66. At night, a 28-year-old man is brought to the
emergency department after his right foot
being bitten by an animal, within 1 hour
before admission. The patient said that he
heard the sound of the animal. He complains
of pain in his right foot and there are two
bitten marks, surrounded by edema and
erythema in the dorsal aspect of his right
foot. Initial management of the case
described should be
a. Observation
b. Cryotherapy
c. Antivenin : antivenom
d. Incision and suction
e. Corticosteroids
67. A 29-year-old man has weight loss, white
plagues on the pharynx, and purple lesions on
the abdomen, which on biopsy reveal Kaposi
sarcoma. Which of the following is the most
predictive of the patient’s prognosis?  HIV
a. CD4 cell count
b. CD4/CD8 cell ratio
c. Degree of lympadenopathy
d. Level of HIV-1 RNA in plasma
e. Rate of decline in anti-HIV antibody
68. A patient come with an itchy recured fungal
infection on the feet and need some advice to
be cured and some prevention measures so
the diasease will not occure again, doctor
already gave him some medication for fungal
infection. What kind of advise can make him
healthy?
a. Don’t eat seafood
b. Use always sandals
c. Keep the skin dry and clean
d. Don’t use shoes all day long
e. Don’t scratch, will spread the infection
69. A woman came with the complaints of being
uncomfortable and hardened in the left upper
side abdomen. Every four days, she is
intermittently feverish. On blood smear
examination Plasmodium parasite +. Fever
symptom on the previous question referred to
:
a. Saorozoites is in the the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts
enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed
70. A 35-year-old man as a farm worker who was
working with pesticides is brought to the
emergency room with headache, vomiting,
salivation, diarrhea, muscle fasciculation,
difficulty walking, and difficulty speaking.
His clothing has been removed, he has been
washed, and he has been given activated
charcoal. What is the most effective
remaining treatment for this case of pesticide
poisoning?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. Hidrochlorothiazide
71. A 65-year-old-woman suddenly had flaccid
paralysis of her left leg. A few days ago, she
had headache, fever, sore throat, and nausea.
She lives with her son; daughter in law and a
young grandchild who’s just received a
routine oral vaccination. She is taking
immunosuppressant for her kidney’s
 transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan and
lumbar MRI are also normal.
What is the most likely transmission of her
infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite
72. A pork-eating village in the highlands of
Papua New Guinea is reported to be suffering
from an epidemic outbreak of epileptiform
seizures. You have been sent to investigate.
One of the first things you should investigate
is?
a. The level of Balantidium coli in swine
stool
b. The practice of consuming raw deceased
human brains
c. The presence of taenia eggs in the
drinking water
d. The presence of tropozoites in the human
blood
e. The quantity of culidae in the village
73. A 34-year-old woman complained a sudden
onset of high fever for 4 days with nausea,
vomiting, headache, muscle ache. There were
petechiae on examination. Which of the
following laboratory result is most
appropriate with the patient’s diagnosis? 
dhf
a. Trombositopenia
b. Neutropenia
c. Anemia
d. Decreased of hematocrit : arusnya naik
e. Leucopenia
74. A 1 year old girl came to the Puskesmas with
swollen gum for a week. From the history
taking it was found that she was born normal
with normal birth weight, had been breastfed
up to now and had a balanced diet with high
intake of cooked vegetable and fruit since 6
months old. She had no history of chronic
diseases. Her other physical and laboratory
examination was normal.
Based on the information given above, what
is the most likely cause of her complaint?
a. Protein deficiency due to prolonged
breastfeeding
b. Carbohydrate deficiency due to increased
calorie need
c. Fat soluble vitamin deficiency due to
high vegetable/fruit intake
d. Water soluble vitamin deficiency due to
cooking process
e. Mineral deficiency due to competition
with high vitamin absorption
75. A 10-year-old boy who has moved to your
practice recently has sore throats, get high
temperature. The child reports a runny nose,
mild cough, and abdominal pain. Findings on
physical examination include a temperature
of 38°C, and vesicular lesions on the soft
palate, dorsal and palmar of hands. There is
no cervical adenopathy or rash.
Of the following, the MOST likely diagnosis
is  hfmd
a. Adenovirus infection
b. Coxsackie virus infection
c. Mononucleosis
d. Sinusitis
e. Streptococcal pharyngitis
76. A 19-year-old woman comes to Emergency
Department with signs and symptoms of
poisoning of an agent include nausea,
vomiting, abdominal cramps, diarrhea,
excessive salivation, headache, giddiness,
rhinorrhea, tightness in chest, pin-point
pupils, mental confusion, and muscle
twitching. Which of the following is the most
likely agent caused those symptoms?
a. Acetaminophen
b. Barbiturate
c. Carbamate
d. Cyanide
e. Opiate
77. A 23-year-old G1 with a history of a flulike
illness, fever, myalgias, and
lymphadenopathy during her early third
trimester delivers a growth-restricted infant
with seizures, intracranial calcifications,
hepatosplenomegaly, jaundice, and anemia.
 She has many pets in her house. What is the
most likely causative agent? torch
a. Trepanema pallidum
b. Trichomonas vaginslis
c. Toxocara canis  ocular dan visceral
larvae migrans
d. Neissheria meningitidis
e. Toxoplasma gondii
78. A 22-year-old man who works in the
pediatric ward of a hospital suffers from
malaise, sneezing, and runny nose. He
subsequently develops a mild sore throat,
headache, and stuffy nose. The symptoms
resolve within 4 days. Which virus is most
likely to be responsible for these symptoms?
a. Rota virus
b. Rubella virus
c. Coxsackie virus
d. Hepadnavirus
e. Influenza virus
79. Approximately 4 hour after eating a meal in
restaurant, 3 members of a tourisms group
develop a sudden onset of nausea, vomiting,
severe abdominal cramps, and diarrhea.
Nobody got febrile. Which of the following
vaccination is should be given to the traveler?
a. Shigella vaccine
b. Salmonella vaccine
c. Enterobacter vaccine
d. H. pylori vaccine
e. ETEC vaccine
80. An outbreak investigation note many
costumer from a café were admitted to the
hospital. They have fever; nausea-vomiting,
constipated or diarrhea, weakness and altered
mental status. Rose spots are seen on the
trunk. Blood cultures from patients grow a
non-lactose-fermenting gram-negative rod.
These people are infected from the carrier
person
In which of the following sites are bacteria
most likely to be found in carrier person?
a. Blood
b. Kidney
c. Liver
d. Intestine
e. Gall bladder
TROPICAL MEDICINE – MCQ 2009
1. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he contacted with a dog.
His symptoms increased and were
accompanied by hand spasm and sweating on
the right side of the face and trunk. This
patient was admitted to the hospital the day
after developing dysphagia, hypersalivation,
agitation, and generalized muscle twitching.
Which of the following could rapidly destroy
the pathogenic agent of this disease?
a. Infrared radiation
b. Catalase
c. Alkali water
d. Sunlight
e. Heating at 60ºC for 30 minute
Question 2-3 are linked to the following case:
A 65-year-old-woman suddenly had paralysis of
her left leg. A few days ago, she had headache,
fever, sore throat, and nausea. She lives with her
son; daughter in law and a young grandchild
who’s just received a routine immunization. She
is taking immunosuppressant for her kidney’s
transplant. Her vital signs and cranial nerve
examination are normal. A head CT scan and
lumbar MRI are also normal.
2. What is the most likely transmission of her
infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite
3. Which of the following is the primary
pathologic effect in this case?
a. Persistent viremia
b. Focal multiplication
c. Immune complexe formation
d. Destruction of infected cells
e. Reduce of acethylcholine receptor
Question 4-5 are linked to the following case:
A young boy is suffering from high fever,
difficult to swallow water, hydrophobia, and
disorientation. On examination, there is a
hypoesthesia on his left arm. Four weeks ago, he
had been bitten by a dog. The characteristics of
etiologic agent were zoonotic, single-stranded,
negative-sense DNA virus.
4. Which of the following is usefull for making
a diagnosis in this case ?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. Clue cell
5. Which of the following is available for
treating this patient?
a. Immune globulin
b. Live attenuated vaccine
c. Antiviral
d. Antimicrobial
e. Antitoxin
Question 6-7 are linked to the following case:
A 24 year old woman admitted to the hospital
with myalgia and weakness of her right leg. She
had traveled from Saudi Arabia and her
immunization had never completed. On
examination, she had normal sensation of the
right leg, with normal movement and strength in
all other extremities and a normal cranial nerve
examination.
6. Which is a target cell receptor for this
pathogenic agent?
a. Silica acid on epithelial cells
b. Acetylcholine on neurons
c. CD4 molecule on T lymphocytes
d. C3d complement on B lymphocytes
e. Immunoglobulin on epithelial cells
7. Which of the following is the best specimen
for diagnosis in case above?
f. LCS
g. Blood
h. Urine
i. Throat swab
j. Rectal swab
8. A 2 year old child presented with a history of
febrile upper respiratory tract infection. His
clinical conditions deteriorate with a
worsening cough and dyspneu. He was
admitted to the hospital. On clinical
examination, the child had obvious evidence
of respiratory distress with rib retraction and
an elevated respiratory rate. A chest x-ray
showed hyperinflation of both lung fields.
What is the most appropriate specimen for
laboratory diagnosis in this case?
a. Nasopharyngeal washing
b. Tracheal aspirate
c. Bronchial washing
d. Nasal swab
e. Blood
Question 9-10 are linked to the following case:
A 31 year old female underwent allogenic bone
marrow transplantation for acute myeloid
leukemia. In the second month post transplant,
she developed high fever, a nonproductive cough
and breathlessness. Physical exam showed
splenomegaly, and laboratory studies showed
anemia, leucopenia, and thrombocytopenia, and
abnormal liver function test. Her chest x-ray
showed diffuse interstitial pulmonary infiltrates.
A bronchoalveolar sample performed infected
kidney cells showed owl eye.
9. What is the best treatment for this infection
disease?
a. Antimicrobial
b. Antiviral
c. Antitoxin
d. Immunosuppressant
e. Antifungal
10. This female’s illness could be most easily
diagnosed by which of the following tests?
a. HSV-1 IgM antibody
b. CMV antigenemia
c. HHV-6 IgM antibody
d. Culture of blood in erythroblastic cells
e. Monospot test
11. In an elementary school many of students
suffer from sore throat, runny nose, cough,
fever, headache, myalgia, and fatigue. The
students who have not been vaccinated
against this infection are offered prophylactic
 treatment with certain antiviral drug. What is
the mechanism of action for this drug?
a. Blockade of nucleocapsid release
b. Blockade of viral attachment
c. Blockade of viral protein synthesis
d. Inhibition of RNA-dependent DNA
polymerase
e. Inhibition of RNA-dependent RNA
polymerase
12. A 28 year old female nurse became ill after
taking care of a patient with pneumonia 2
days ago and was admitted to the hospital
with fever and sore throat. She was placed in
respiratory droplet isolation and quickly
developed respiratory failure, requiring
mechanical ventilation. In 10 days, nine other
patients in the same ward developed the same
symptoms. Which of the following laboratory
test is most appropriate?
a. Blood culture to identify S.pneumoniae
b. Urinary antigen testing for Legionella
pneumophila
c. Virus culture to identify influenza A
d. Serology to demonstrate antibodies to
identify SARS
e. PCR of nasopharyngeal secretion to
identify RSV
13. A young man presented with headache, low
grade fever, and painful blisters on the penis.
He admitted to having had unprotected sex in
the past month. Physical examination
revealed inguinal lypmadenophaty and
blisters on the penis. Which of the following
pathogens is most likely to have caused his
disease?
a. Human papilloma virus
b. Haemophillus ducreyi
c. Treponema pallidum
d. Chlamydia trachomatis
e. Herpes simplex virus
14. A 4 years old boy with sickle cell disease is
taken to his pediatrician’s because he is pale
and is suffering from repeating intense chills
and daily high fever. A blood test shows that
WBC was 17.000/µl and a platelet count is
53.000/µl. What description is relevant to the
findings in this patient?
a. Sickle cell trait decreased the patient’s
resistant to the virus infection
b. Sickle cell trait promotes infection of
erythrocytes by plasmodium
c. Virus infection promotes INF production
d. Virus infection targets erythrocyte
precursor cells
e. Bacterial infection activates leukocytes
cells
15. A 26-year-old nulliparous woman, in her
seventh month of pregnancy complains of a 7
days history of fever especially at night. As
she recall, 2 weeks ago she ate gado-gado in
coastal area when she out for duty for several
days. She also had diarrhea and abdominal
discomfort. On physical examination reveals
blood pressure 110/70 mmHg, heart rate 60
×/min, RR 20x/min, temp. 39.1°C. Tongue is
coated and tremor. Fetal USG shows normal.
What is the most likely etiologic factor
above?
a. Salmonella typhi
b. Plasmodium falciparum
c. Vibrio cholera
d. Hepatitis A
e. Escherichia coli
16. A 4-year-old child presents with fever,
cough, conjunctivitis, coryza, photophobia,
posterior cervical adenopathy. Red lesions
with a white center are present on the buccal
mucosa. A generalized erythematous rash is
also noted. What is the most likely diagnosis?
a. Rubella
b. Kawasaki disease
c. Adenovirus infection
d. Rubeola
e. Varicella
17. A 35-year-old man as a farm worker who was
working with pesticides is brought to the
emergency room with headache, vomiting,
salivation, diarrhea, muscle fasciculation,
difficulty walking, and difficulty speaking.
His clothing has been removed, he has been
washed, and he has been given activated
charcoal. What is the most effective
remaining treatment for this case of pesticide
poisoning?
 a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. Hidrochlorothiazide
18. Mr. Farid is a diabetic. He read in a book that
the main source of the brain fuel is glucose.
His doctor said that insulin in his body is not
enough for entering glucose to the cell. So he
worries about the work of his brain. You
know that the brain is protected from high
molecule particle by blood-brain barrier
(BBB). What do you think?
a. The main brain fuel is not glucose
b. Glucose is not big enough to be block by
blood-brain barrier
c. Glucose enter the brain through the
leakage part of the BBB
d. There is special transporter for glucose to
enter the brain
e. Glucose in the only exception for blood
brain barrier
19. A 45 year old man has chronic otitis media
since 2 years ago. He comes to Siloam
hospital because he suffers headache since a
week ago. The doctor makes some
examinations also radiographic examination
on his head. The doctor fined a round mass
with 3 cm diameter. Which of the most likely
cause of the mass?
a. Neoplasma
b. Aneurisma
c. Infarction
d. Abcess
e. Hemorrhage
Question 20-21 are linked to the following case:
A 5 years old boy came to the clinic with
recurrent blanking out at school for 1 month. He
had recurrent episodes in which he abruptly stops
all activity for about 10 seconds, followed by a
rapid return to full consciousness. After the
episode patient resumes whatever activity he was
previously engaged with no awareness that
anything has occurred.
20. What is the most likely diagnosis?
a. Simple partial seizure
b. Complex partial seizure
c. Absence seizure
d. Atonic seizure
e. Secondarily generalized seizure
21. What is the most appropriate antiepileptic
drug for case above?
a. Carbamazepine
b. Valproic acid
c. Benzodiazepine
d. Lamotrigine
e. Ethosuximide
Question 22-23 are linked to the following case:
A 70 years old man presents to ER with history
of seizure. His wife awakened at 05.00 by an odd
gurgling noise. Her husband’s head was deviated
to the left and his left arm was stiffened. After a
few moments he had generalized body jerking
and was unresponsive. Event lasted 2 minutes but
stopped spontaneously. His wife said he seemed
drowsy and confused. There was no history of
prior seizure. On ER, he was conscious, BP was
140/95 mmHg, HR 96 x/min, RR 20 x/min,
Temperature 36, 5 C. The laboratory examination
revealed Random Blood Glucose was 610 mg/dl.
22. What is the most likely diagnosis?
a. Pseudoseizure
b. Primary epilepsy
c. Secondary epilepsy
d. Acute provoked seizure
e. Generalized seizure
23. What is your treatment for case above?
a. Diazepam intravenous
b. Oral phenytoin
c. Ringer lactate infusion
d. Insulin subcutan
e. Dextrose bolus intravenous
24. A 5-year-old girl brought by her mother to a
clinic because of a-two-day fever and sore
throat. On mouth examination, the doctor
finds a leathery grayish white membrane
adheres to pharyngeal walls and tonsillar
pillars which spread asymmetrically onto the
 soft palate and uvula. What treatment should
be given to the patient?
A. Antibiotic and antiviral
B. Antiviral and antifungi
C. Antitoxin and antifungi
D. Antibiotic and antitoxin
E. antiviral and antitoxin
25. A 22-year-old woman who just got home
from a 2-week voluntary work in rural Papua
comes to a clinic with history of bloody and
slimy diarrhea since her last five days in
Papua. She experiences more than five
bowel movements within each day. She also
experiences stomach cramp and painful
passage of stool. She reports no fever or any
other complains. There is a slight lower
quadrant abdominal tenderness on her
physical examination. She is found to be a
little bit dehydrated. What is the most likely
organism which causes her condition?
a. Entamoeba histolityca
b. Vibrio cholerae
c. Rotavirus
d. Salmonella typhi
e. Escherichia coli
26. A 7-year-old boy presents in emergency unit
with colicky abdominal pain since two days
ago. He also has fever and appears lethargic.
He has experienced constipation for four days
and several greenish vomiting. His vital signs
are deteriorating. On physical examination,
the boy has abdominal tenderness and the
doctor finds palpable abdominal mass in the
hypogastric area. Prior to this, he has
recurring abdominal pain and bloody stool
for several weeks, has history of passage of
worm through his rectum, and has been
treated with antihelminth.The boy and his
family live in a suburb area and he loves to
play marble with his friends. His nails are
dirty and his mother told the doctor that he
often forget to wash his hands before eating.
What is urgent further study the doctor
should take to make the diagnosis?
a. Stool examination
b. Complete blood count
c. Blood glucose level test
d. Plain abdominal radiography
e. Serologic test
27. One member of the NGO (Non-
Governmental Organization) team from
Indonesia has been reported dead in Mexico
because of a spider’s bite. The possible cause
of this disorder is:
a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis
28. A boy brought by his mother to the
emergency department of Siloam hospital
because of vomit & dyspnoea. According to
his mother, her son was playing in the
backyard. On physical examination, the boy
was found to have high fever (39 ºC) and
multiple stinging on the back. The most
likely species of insect bites is:
f. Hymenoptera sp
g. Dermacentos andersoni
h. Lactodectus mactan
i. Loxoxceles laeta
j. Lytta vesicatoria
Question 29-30 are linked to the following case:
29. A 10 years child came with the complaints of
diarrhea, occasionally with blood & mucus. 2
days ago, the patient complained about the
swelling in the anus. On physical
examination was found prolapsed of the
rectum. On stool examination was found
parasite eggs. The most likely cause is the
worm of species:
a. Ascaris lumbricoides
b. Necator americanus
c. Angilostoma duodenale
d. Trichuris trichiura
e. Enterobius vermicularis
30. Refer to the case above, the habitat of this
worm is located on
a. Liver
b. Lung
c. Caecum
d. Small bowel
e. Stomach
Question 31-32 are linked to the following case:
A 35-year-old man was brought to the emergency
department of hospital with seizure. On cerebro
spinal fluid (CSF) examination shows
neutrophils, red blood cells, and amoebae form
on wet microscopy.
31. Which of the following, which parasite can
be the cause of this disorder :
a. Naegleria fowleri
b. Entamoeba histolytica
c. Acanthamoeba castellani
d. Entamoeba coli
e. Plasmodium falciparum
32. What is the transmission of this disease?
a. Ingestion of infected snails
b. Food & water contaminated with parasite
c. Mosquito bites
d. Sexual contact
e. Intranasal infection while swimming in
the warm fresh water
33. A woman came with the complaints of being
uncomfortable and hardened in the left upper
side abdomen. Every four days, she is
intermittently feverish. On blood smear
examination Plasmodium parasite +. Of the
following, which parasite can be the cause of
this disorder :
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium malariae
d. Plasmodium ovale
e. Plasmodium cynomolgi
34. An employee who works in Bogor has a task in
Samarinda for 3 weeks. What is the most
possible drug (s) should be given for this
condition?
a. Chloroquine+ primaquine
b. Sulfadoksin-pirimetamin
c. Atersunate +amodiaquine
d. Kina+tetracycline
e. Doxycycline
35. The mother of a 4-year-old child notes that
her child is sleeping poorly and scratching his
anal area. You suspect the child may have
pinworms. Which one of the following is the
BEST method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of microfilaria
d. Examine transparent adhesive tape for
the presence of eggs
e. Determine the titer of IgE antibody
against the parasites
36. A 23-year-old man presents with extreme
swelling of his legs and scrotum. The skin
associated with the swollen areas is thick and
scaly. The patient admits to an episode of
fever associated with enlarged inguinal
lymph nodes some time ago, but did not think
much of it. Which one of the following is the
BEST method to make that diagnosis?
a. Examine the stool for the presence of
eggs
b. Examine the stool for the presence of
larvae
c. Examine a blood smear for the presence
of microfilaria
d. Examine a blood smear for the presence
of adult worm
e. Determine the titer of IgE antibody
against the parasites
37. A patient came to the clinic with portal
hypertension syndromes. From the interview, the
patient was known to consume raw fish regularly.
Of the following, the most likely cause of disease
is :
a. Paragonimiasis
b. Clonorchiasis
c. Fasciolopsiasis
d. Echinococcosis
e. Fascioliasis
38. A 40-year-old patient comes with the complaints
of uncomfortable stomach & flatulence. From
history, the patient was known live in the valley
of Napu, Sulawesi and he had a fever frequently.
On physical examination, his liver was found
enlarged. What is the most likely caused of the
disease?
a. Schistosoma haematobium
b. Schistosoma mansoni
 c. Schistosoma rodentatum
d. Schistosoma japonicum
e. Schistosoma mekongi
Question 39-40 are linked to the following case:
A 40-year-old man came to the clinic with
complaints of having fever more than one-week,
nausea, and fatigue. He came back from Timika,
Papua. On blood smear examination, there are late
trophozoites forms, schizonts with 12-24
merozoites, and the infected red cell is enlarged.
39. Of the following, the most likely caused of
parasite species is :
a. Plasmodium vivax
b. Plasmodium falciparum
c. Plasmodium malariae
d. Plasmodium ovale
e. Plasmodium cynomolgi
40. Fever symptom on the previous question
referred to :
a. Sporozoites is in the blood
b. Hypnozoites in the liver is formed
c. Merozoites discharged from schizonts
enter the blood
d. The process of gametocytes in the blood
e. Pigment in the parasite is formed
Question 41-42 are linked to the following case:
A 30-year-old man, having fever for 3 days, with
falciparum rings +++ was given CQ3
(chloroquine for 3 days). After 3 days, the patient
is still feverish, blood smear examination shows
falciparum rings ++++.
41. What is the possible response of CQ?
a. Sensitivity (S)
b. R I resistance, early recrudescence
c. R I resistance, delayed recrudescence
d. R II resistance
e. R III resistance
42. Refer to the previous case above, what is the
treatment of choice?
a. Primakuin
b. Amodiakuin
c. Meflokuin
d. Sulfadoksin pirimetamin
e. Artemisinin
43. 52- year old man is brought to the emergency
department in an unconscious condition. On
examination, he was death form more than
one hour. On autopsy of the brain, there is
cyst‘s fluid containing protoscoleces with
hooklets and many daughter cysts were
found. What is the most likely diagnosis of
this disease?
a. Hydatidosis
b. Cysticercosis
c. Cerebral malaria
d. Hstoplasmosis
e. Toxoplasmosis
44. A 27 year old women suffering fever for 2 day.
She brought to emergency department
unconsciously and she had general seizure 2
hour ago. On physical examination she is
comatous, GCS (Glasgow Coma Scale) : 3; BP
90/60 mmHg; t 41 °C. Lab. finding: Hb 10, 3 gr
%; WBC 5800/mm3; platelet 39.000/mm3;
there is schizon form on blood smear. Why the
pathogeniv agent of this disease becoming the
most dangerous species?
a. It make long term relaps
b. Intermittent fever
c. Gametocyte formation take place in
visceral organ
d. Can make capillary obstruction in Central
Nervous System by parasite contain
erythrocyte
e. There are many drug resistance against P.
falciparum
45. A 35-year old man working on pig farm is
brought by his employer to the emergency
department of Siloam hospital because of
seizure and bilateral lower extremity weakness.
CT scan of the head reveals several calcified
regions. Laboratory examinations show WBC
count of 10.800/mm3, with eosinophils. Brain
tissue biopsy reveals scolex with hooklets.
Which one is the treatment of choice for this
case?
a. Sulfadiazine-pirimetamin
b. Artemisinin
c. Albendazol
d. Metronidazol
e. Itrakonazol
46. A female tourist developed gastroenteritis
while visiting small town in Indonesia and
tried some Indonesian traditional food. The
onset of the disease is abrupt with abdominal
cramps and watery diarrhea. She had no
fever or nausea or vomiting. The symptoms
have resolved within 24 hour and no
subsequent recurrences. They report the
disease to district public health office. The
investigation found that one of the food
products eaten by this tourist was
contaminated by suspected pathogens. What
is the suspected pathogen may cause the
disease above?
f. Salmonella typhi
g. Shigella dysenteriae
h. Enterohemorragic E. coli
i. Staphylococcus aureus
j. Enterotoxigenic E.coli
Question 47-48 are linked to the following case:
47. An-8-year-old girl sustains a large laceration
contaminated with dirt after falling from her
bike. Her mother can’t recall how many
doses of tetanus toxoid her daughter has
received. Management of tetanus prophylaxis
in this situation of unknown history of prior
doses of tetanus toxoid includes:
a. Adult-type TT
b. TIG
c. TT and TIG
d. HiB containing TT and TIG
e. DPT
48. If this patient developed seizures, what
substance has responsible in this patient?
a. Tetanospasmin
b. Tetanolisin
c. Adenylate cyclase toxin
d. Fillamentous hemagglutinin
e. Pertactin
Question 49-50 are linked to the following case:
A 3-year-old boy was brought to emergency unit
in Tangerang Hospital with stridor, dyspnea, and
“croupy” cough.
49. What is the most likely pathogenic agent that
causes the patient’s disease?
a. Bordetella pertussis
b. Haemophilus influenzae
c. Coxsackievirus
d. B. Parapertussis
e. C. diphtheriae
50. What is the laboratory test to confirm the
diagnosis in this patient?
a. Blood culture
b. Throat swab culture
c. Chest X-ray
d. Measurement of IgG antibody serum
e. Urine culture
Question 51-52 are linked to the following case:
A 2-year-old boy was brought to emergency unit
Balaraja Hospital with difficulty in breathing,
choking, gasping, and whoop cough.
51. What is your most likely diagnosis?
a. Bordetella pertussis infection
b. Haemophilus influenzae infection
c. Coxsackievirus infection
d. Adenovirus infection
e. Corynebacterium diphtheriae infection
52. In this case all the family members should get
the prophylaxis antibiotics as follow:
a. Amoxicillin 30-50 mg/kg/day p.o. for 14
days
b. Amoxicillin 30-50 mg/kg/day p.o. for 7
days
c. Erithromycin 40-50 mg/kg/day p.o. for
14 days
d. Erithromycin 40-50 mg/kg/day p.o. for 7
days
e. Tetrasiklin 25-50 mg/kg/day p.o. for 7
days
Question 53-54 are linked to the following case:
Male, 46 years old came to you as a doctor with
chief complains shortness of breath especially at
the work place. When he gets home, the symptom
is missing. He also complains that he sneezes
every morning. According to him, his sister is
using bronchodilator inhaler every day. He just complains pain, edema on her left eyelid and
worked at sandblasting company and expose to there is some vesicle in her left forehead. She
dust since 2 weeks ago. complain pain on her forehead 2 days ago,
but vesicle come out 1 day ago.She
53. What are the most possible causes of his sometimes fells headache and fever. Clinical
disease? manifestation are grouped vesicle, eritema
a. Wood base at her left face.What is the diagnose of
b. Quartz this patient?
c. Tobacco smoke a. Varicella
d. Coal b. Herpes zoster
e. Amonia c. Herpes simpleks
d. Dermatitis venenata
54. The doctor gave him sick-leave certificate for e. Dermatitis iritan
2 days and asks the patient to come back
tomorrow to perform spirometry. What is the 58. A 43 years old women, come to
result of spirometry do you expect? dermatovenereology clinic because she
a. FEV1 decreased complains vesicle at genital, and pain, for the
b. FVC decreased first time. Her husband has same problem 2
c. FEV1 and FVC decreased days ago,but it was cured. She is difficult to
d. Normal walk because of pain on her genital and low
e. MVV increased fever. What is the most appropiate treatment
for this patient?
a. Acyclovir 5 x 200 mg, for 7 days
Question 55-56 are linked to the following case: b. Famciclovir 3 x 500 mg,for 7 days
c. Valacyclovir 2 x 250 mg, for 7 days
55. A 2 years old boy brought to d. Acyclovir 2 x 400 mg for 7 days
dermatovenereology clinic because of itching e. Glucocorticoid topical
all of the body. He complains itching on
palm, side of finger, buttock, and abdomen. Question 59-60 are linked to the following case:
Clinical manifestations are papule, vesicle,
pustule, erotion, and excoriation especially at 59. A 34 years old man, come to
finger web, arm, abdomen, side of hand and dermatovenereology clinic, complain itchy
feet, itchy especially at night.His neighbours on his sole. He is a army, that usually
have same problem.He usually play together exercise at dirty land. Clinical manifestations
with his neighbours.What is the diagnose this are burrow 3 cm on his sole, erithema, and
patients? papule. What is the treatment for patient
a. Pediculosis corporis above?
b. Scabies a. Lindane
c. Tinea corporis b. Gamexane
d. Dermatitis atopik c. Albendazole
e. Psoriasis d. Pirantel pamoat
e. Antibiotika
56. What is the best treatment to case above?
a. Sulfur 60. A 30 year old women, come to
b. Gamexane dermatovenereology clinic, because she
c. Crotamiton complains many vesicle on her body, low
d. Lindane fever, muscle pain, and sore throat . She was
e. Permethrine pregnant 3 months. What is the diagnose of
her illness?
57. A 70 years old women, come to a. Varicella
dermatovenereology clinic because she b. Herpes Zoster
 c. Herpes simplex
d. Moluscum Contagiosum
e. Rubella
61. In epidemiological perspective, what is the
tropical disease?
a. Infectious disease in the tropics
b. Any communicable disease
c. Disease which deaths occur in
children under five
d. Disease which deaths occur in
productive age
e. Primarily found in the developing
world or profoundly impact the
health of people living in the tropics
62. Conditions that contribute to the risk for
becoming infected with tropical diseases
agent:
a. Biological factors related to
population density, rural vs. urban
living, nutritional status, climate and
other environmental factors, as well
as socioeconomic circumstances
b. Genetic factors
c. Cultural factors
d. Tropical factors
e. Synergisms on genetic, cultural, and
immune factors
63. Tropical disease category III is group of
tropical disease which control strategy
proven effective, disease burden falling, and
elimination planned. What are the examples
of disease of this category?
a. Leprosy, lymphatic filariasis
b. Malaria, tuberculosis, dengue,
schistosomiasis
c. Ebola, avian influenza, SAR
d. Protein calorie malnutrition, pesticide
intoxication
e. Hepatitis B, pertusis, poliomyelitis
64. A 24-year-old migrant farm worker is rushed
to a nearby emergency room after an
accidental exposure to parathion. He is in
respiratory distress and is bradycardic.
Which of the following drugs can be
given to increase the activity of his
acetylcholinesterase?
a. Atropine
b. Deferoxamine
c. Dimercaprol
d. Physostigmine
e. Pralidoxime
65. A migrant worker presents to the emergency
room in respiratory distress. He had been
spraying parathion in the fields for several
days, and today he began to feel sweaty and
dizzy. By the time he got to the hospital he
was drooling, gasping, and becoming
agitated. These symptoms are due to the
actions of parathion on which of the
following?
a. Acetylcholinesterase
b. Muscarinicreceptors
c. Neuronallipidbilayer
d. Nicotinicreceptors
e. Voltage-gated sodium channels
66. A 25-year-old woman is despondent that her
husband left her for another woman. She
attempts suicide by ingesting 25 tablets of
extra strength acetaminophen (=650 mg). Her
mother finds her and the empty bottle a
couple of hours later and immediately rushes
her to the emergency room. Which of the
following drugs will most likely be given to
this patient?
a. Acetylcysteine
b. Atropine
c. Penicillamine
d. Pralidoxime
e. Protamine
67. A 46-year-old woman comes to a hospital to
have several bunions removed from her right
foot. She chooses conscious sedation rather
than general anesthesia for this procedure.
She is given intravenous midazolam to
supplement the local anesthetics that are
injected into her foot. Midway through the
surgery, she suddenly becomes agitated,
combative, and exhibits involuntary
movements. The anesthesiologist determines
that she is having a paradoxical reaction to
the midazolam. Which of the following is the
 most appropriate drug for counteract that
midazolam?
a. Flumazenil
b. Glucagon
c. Naloxone
d. Nitrite
e. Protamine
68. A 2 year old boy came to the Puskesmas with
ulcer on his left hand. Through the history
taking it was revealed that he had not been
well fed in this past year since his mother
died. From his physical examination it was
found that his BMI (body mass index) was
below 5th percentile for boys of his age. He
was lethargy and looked pale with a face
appearance like a thin old person. His ribs
were very prominent.
Based on this information, he was likely to be
classified in which condition below?
a. Marasmus
b. Kwashiorkor
c. Marasmic-kwashiorkor
d. Energy malnutrition
e. Protein malnutrition
69. A one year old boy was diagnosed with
measles since a week ago. This morning, his
mother noticed that he also suffered for
swollen reddish gums that signified as
scurvy.
What is the most likely mechanism that
underlines his recent condition?
a. Impaired absorption of micronutrients
b. Altered micronutrient metabolism
c. Depletion of micronutrient stores
d. Micronutrient redistribution
e. Negative micronutrient balance
70. An 18 year old girl came to obstetric and
gynecologic outpatient clinic with chief
complaint no menstrual cycle for 2 months.
She also complained for losing weight 5 kg in
the last 3 months. From the history taking
found that she was treated as a tuberculosis
patient since 4 months ago.
What is the most likely underlying
mechanism that affects her nutritional status?
a. Increased gluconeogenesis
b. Increased vitamin excretion
c. Increased resting energy metabolism
d. Increased carbohydrate stores
e. Increased protein anabolic
71. A 53-year-old male farmer presents to the
primary health care complaining about a
mass on his arm. He noticed some mildly
itchy red bumps on his arm since a week
before. They started to blister a day or two
later and then ruptured. During this time he
had a low-grade fever. Futher questioning
reveals he has had no ill contacts and never
had anything like this before. He has cows,
horses, goats, sheep, and chickens on his
farm. On examination of his right upper arm,
you find a 4, 5 cm circular black eschar
surrounded by several blisters and edema. He
has tender axillaries lymph node
enlargement. A gram stain of fluid drained
from a vesicle and a biopsy from the eschar
both show chains of gram-positive bacilli on
microscopy. What organism is the likely
cause of this disease?
a. Bacillus anthracis
b. Bacteriodes fragilis
c. Borrelia burgdorferi
d. Campylobacter jejuni
e. Yersinia enterocolitica
Question 72-75 are linked to the following case:
At night, a 28-year-old man is brought to the
emergency department after his right foot being
bitten by an animal, within 1 hour before
admission. The patient said that he heard the
sound of the animal. He complains of pain in his
right foot and there are two bitten marks,
surrounded by edema and erythema in the dorsal
aspect of his right foot.
72. What is the most likely animal that has bitten
the patient?
a. Cottonmouth snake
b. Copperhead snake
c. Rattlesnake
 d. Latrodectus mactans C. Stool
e. Centruroides exilicauda D. Lung biopsi
E. Nasofaring swab
73. Initial management of the case described
should be
a. Observation
b. Cryotherapy 4. Pertama2 flu like illness, batuk ga
c. Antivenin sembuh2,vomiting, hoarseness,
d. Incision and suction Answer: pertusis
e. Corticosteroids

74. The next step in the management of the 5. bitten by dog become hydrofobia,
patient should be: hypersalivation, spasm, and sweating.
a. Wide excision
b. Fasciotomy a. giant cell
c. Antivenin
d. Incision and suction b. limfosit plasma
e. Corticosteroids
c. negri bodies
75. After 12 hours, the patient complains of d. clue cell
severe pain especially when he moves his
right leg and his right foot becomes pallor
and cold. There are no pulse in the right
dorsalis pedis and posterior tibial artery. 6. kesalahan banker…kehilangan data.. maap yeii
What is the next management of the case
described should be?
a. Wide excision
A 32 year old worker in a farm having painless
b. Fasciotomy
dermal papule on right hand since 5 days ago.
c. Antivenin
The papule is getting bigger, and the skin become
d. Incision and suction
black. He has tender axilaries lymph node
e. Corticosteroids
enlargement.

Anthrax
SOAL UJIAN TROPIAL MEDICINE
2007
7. Which of the following virulance factor is most
likely to be involve in pathogenesis of illness?
1. Putri…kerjasama nya please…. Demi kalian
juga kok a. exotoxin

2. Putri…kerjasama nya please…. Demi kalian b. endotoxin

juga kok
c. alpha hemolysin
3. Anak dengan panas tinggi, myalgia, dan gejala
flu like syndrome lain, ada susah bernapas. d. lipopolysaccharide
Sodaranya sblm nya juga kaya gt n udah
e. antiphagotic factor
meninggal. Apa spesimen paling baik buat
menegakkan diagnosa?
ɑ. Saliva
B. Blood
8. A 45 years old man was seen in the and recur every 36 – 48 jam. Which the ost
dermatology clinic because of some nodules on appropriate time to take a blood specimen?
his arm&body and sometimes feel pain with
pressure. On examinations, we found a. anytime
erythematous nodules, smooth and shiny, diffuse
inflitrate with ill define border, no fluctuation or b. 10 – 12 a
erosion. There were pain on his elbow with nerve c. 10 – 12 pm
enlargement. What laboratorium test would you
do to confirm the clinical diagnosis? d. 30 min after fever
a. TPHA & VDRL
b. Gram preparation e 120 min after fever
c. KOH preparation
d. Skin scrapping
e. Skin slit smear
12. seorang ibu minum 10 tablet hypnotic 30
menit yang lalu sebelum masuk rumah sakit.
gejala yang tampak : hypotension tachypneu,
9. 40 yo patient complaint uncomfortable tachycardi dan tidak sadar )unconsiusnes.
stomach and flatulence. Live in the valley of tindakan sebagai dokter yang yang pertama kali 
Napu, Sulawesi and he had a fever frequently. dilakukan adalah ..
PE: liver enlarged. Test buat confirm? a. apomorphine
a. Blood b.
b. Liver biopsy c. infusion natrium
c. Renal biopsy d. chancoal dgn NGT
d. Stool exam e.hemodyalisis
e. CT-Scan

13. Outbreak TB in a dormitory, with the same

10. A 53 y.o. farmer experiencing sub febris, source of infection, based on RFLP analysis. The
abdominal pain, diarrhea. In his skin there is a most appropriate health intervention?
black eschar surrounded with vesicle and there is a. Rehabilitation
edema near his mouth. A week ago he notices b. Prevention
that his cattle were sick, but his still eat half cook C. Curative
cattle meat. What is the organism? D. Medication
E. Environmental modification
a. Bacteroides fragilis

b. Leptospira interrogans
14. there is rna virus cause deathly outbreak of
c. Bacillus antrhacis hemoragic disease. Patient have feer, muscle
pain, headach, followed by abdominal pain. Rash
d. Pasteurilla pestis with internal n external bleeding. Hospital staff is
e. Borellia brugdorferi infected. Virus are highly virulent transmited by:

a. blood n body fluid

b. mosquito bite

11. a women and recently return from Lapung c. transmission to human from rodent excrata
complaining having paroxymal attack chill, fever d. aerosol transmission
and sweat. These attack last a day 2 days at time
e. ……….. b.dysentri

c. cholera

15. a 31 years old man with complaints of high d. giardia lambia

fever, cough, shortness of breath. 2 hours before
admission he experienced right sided chest pain e. entamoeba hystolitika
when took a deep breath and cough. Chest
radiography shows diffused bilateral interstitial
pulmonary infiltrate. Analysis of blood gas 18. Men, 44 tahun dari Jakarta pergi berbisnis ke
showed PO2= 60 and 91% HB saturation. Kalimantan selatan. Lalu disana dia pergi ke ER.
Hematology serum and liver are normal. He lives
near poultry. Patho agent are new viral. what are Sign and symptom = diare and abdominal
the prevention for prophylaxis? pain
a. vaccines PE = Pitting edema
abdominal and leg
b. Antitoxin
Lab culture = (-) enteric pathogen
c. Antibiotik
Blood = eosinophilia
d. Antiviral
Stool = large ellipsoidal,
e. Antidotes operkuled egg with thin and transparent sheet.
Tekena infeksi apakah bapak ini?

16. A 28 years old ,an comes withu high fever for Schistosoma Japonicum
8 days, malaise, headache and constipations. He Fasiolopsis Buski
denies any vaccines before. Temperature 39 C.
Blood pressure 130/90 pulse 72x/min. on Tricinella Spiralis
Physical examination there are
hepatosplenomegaly and faint erythomatous Echinococcus granulosus
measles.
Clornonsis sinonsis
what are the most likely pathogen?

a.vibrio cholera
19. bagaimana mekanisme terjadinya edema pada
b. Shigiella dysentry cerita diatas?

c. salmonella typhi a. host-allergic reaction because of the parasite

d. entero hystolytica b. the larva penetrate the wall

e. Giardia lambia c. hypersensitivity reaction because adult worm

in GI

d. there are accumulation of egg in GI

17. pasien 28 tahun demam 8 hari ada ciri2
sebagai berikut : erythematousmacula, myalgia, e……..
headache, vaksin tidak lengkap.

a. typhii
20. Pulang dari papua. %hari kemudian ada
intense chill fever. demamnya dengan always 1
day after. between those period, having low grade 24. edo…kerjasama nya please…. Demi kalian
fever, myalgia, nausea, vomitting. datang ke juga kok
klinik , 1jam yang lalu masuk ke ICU-agitated, ga
lama mati. Organism yang masuk ke host ini 25.  Komplikasi plg sring ???
berproliferation dmn? a. Pulmo hemoragik
a.brain B. m miopericarditis
b.liver
c.heart c. encephalitisa
d.spleen
d. Osteomyelitis

e. Anemia
21. 61yr old man,go to the neurolog clinic untuk
evaluasi peripheral neuropathy. He was found to
have dermal
hyperpigmentation/depigmentation(salt/pepper) 26. A 39 years old man, live in Manokwari
of the skin,scaly palms and transverse ridges on papua, developed a major seizure while at work,
hus fingernail which were identified as being a no history of epilepsy. Head MRI showed lesion
result of a chronic chemical intoxication. surrounding a scolex. The etiolohic agent would
What chemical agent? most possibly have been acquired by eat/drink:
A.acetaminophen A. Uncooked vegetables
B.arsenic B. Raw beef
C.cyanide C. Raw pork
D.flouride D. Uncooked fish
E.iron E. Unfiltered water

22. Chandra…kerjasama nya please…. Demi 27. anak cowo ada lesi di kulit seperti
kalian juga kok strawberry, gummata. Exam apa yang paling
cocok untuk diagnosis?

a. widal test
23. a 55 year old man from middle east had fever
and chill with weight loss, sweats, headache, b. IgM-IgG treponema
muscle pain, fatique, depression. The man is
c. dark field
daily farmer and a couple week before symptoms
appeared he drank glass unpasteurized raw milk. d. FTA-ABS
The culture of blood tiny gram (-) cocobacill,
catalase(+) and oxidase (+). Infected organism? e. ELISA
A. M. tuberculosis

B. S. typhii 28. A 27 year old man come with acute severe

encephalitis that require hospitalization. Several
C. Brucell species days before he got that disease he recognize
many pigs in his farm were died. Which of the
D. Pasteurella pestis
following is most appropriated natural host for
E. S. aureus the pathogen?
A. Arthropod
B. Horse b. copper deficiency
C. Bats
D. Squirel c. vitamin E deficiency
E. Rats
d. iron deficiency

29. female tourist gastroenteritis ke Indonesia
makan Indonesia food. Abdominal cramp and
watery diarrhea. No fever or nausea or vomiting.
Symptom resolve 24 hours no recurrent.
Pathogen?
a. s.typhi
e. folate deficiency
32. a lab examinaton of a leprosy patient after 4
months MDT therapy revealed bacterial index 6+
morphological index 50%. Which is your
conclution for this result?

b. shigella dysentriae a. pausibacillar leprosy patient sensitive to

treatment
c. EHEC
b. multibacillar leprosy patient sensitive to
d. s. aureus treatment

e. ETEC c. multibacillar leprosy patient resistant to

treatment

d. pausibacillar leprosy patient resistant to

30. 23 years old male. 4 days history of fever, treatment
headache, retroorbital pain, myalgia and rash. PE
diffuse er e. pausibacillar leprosy patient prone to nerve
damage
resulting from a pressure applied to her skin.

morbili
dengue
influenza
coxackie
rhinovirus
31. a 40 year old lady came to the outpatient
clinic with a chief complaint of fatigue and
difficulty in concentration for the last two weeks.
HT revealed that she had a balance diet, no
history of chronic disease and had been a heavy
smokers for 20 years. On PE it was found that she
had anaemic conjunctiva with other findings was
within normal limits. Lab showed that she had
haemolytic anemia. What is the most likely cause
for her condition?
a. vitamin K deficiency
33. A boy came with his mother to ER Siloam
hospital
His mother said that before this, the boy just
playing in the backyar.
PE: high fever 39'C and multiple stinging on the
back.
What is the most likely species that bite him?
A. Hymenoptera sp.
B. Dermatos andersoni
C. Tactodectus macta
D. Loxoxceles laeta
E. Lytta Vesicatoria
34. A 28 years old lady came to Posyandu to have
a nutrition consultation. Last year, she delivered a
stillbirth baby with a spinal disorder. She and her
husband start planning to have a baby again. She
asked for suggestion about her dietary intake
before she got pregnant.
What kind of diet does she need to prevent the 38. 8 day infant born help of ----, irritable 2
same disorder for her future baby? days ago, noise cause pain episthotonus. PE
umbilical cord dried. Normal stimulated by
a. Dark green vegetables touch/ noise then begin to cry, stiff, arch its back.
b. Pasteurized milk Stiff continue until calm calm down. Diagnosis…
c. Deep water fishes
d. Boiled eggs Bacterial meningitis
e. Lean beef Botulism

35. 27 yrs old women at term pregnancy had
fluctuated fever since 2 weeks ago. She looked
pale, generalized weakness and headache.She
went to public health and was given
chloramphenicol 500mg 4x daily, paracetamol
500mg 3x daily. She is pregnanct and she didn't
tell. What is the side effect drugs will you find in
that baby?
A. Reye syndrome
B. Gray syndrome
C. Down syndrome
D. ADHD
E. Black water fever
General seizure
Tetanus
Viral encephalitis
39. A married mom bring her 18 months son to
ER due to rash that develop today. She reports
that he has had a runny nose, conjunctivitis and
diarrhea. On PE he looks ill, temperature 40oC
and diffuse 2-3 mm erythematous rash begin
from hair line behind ear and spreading to face
and body. On buccal mucosa, red spot are noted.

What is the most likely causing agent?

36. Soalnya ada orang yang mau ke luar dari a. Rubella

jawa dia mau ke papua nah disitu ada banyak b. Coxsackie virus
plasmodium tratment apa buat mencegah c. Morbili
penyakit tersebut d. HSV-6
Jawabannya: doxycycline e. Parvovirus B19

.40 : most severe complication from this disease

37. 40 years old man come to hospital with 4 (morbili)
times generalized tonic clonic seizure since 2           a. osteomyelitis
weeks ago. No history of seizure & head trauma.           b. encephalitis
1 year ago, had bussined in papua for 6 oths.           c. otitis media
During his stay, he ofte osumed undercook pork.           d. sinusitis
Brain MRI show small cyst??           e. oral thrush
a. taenia eggs

b. cysticercus cellulose 41. 48 years old acute gastroenteritis has step

c. t. solium worm nadder night fever since 7 days ago. He also has
abdominal pain and constipation. Biasa makan
d. t.saginata worm uncooked vege at streets . Which is most likely
organism?
A. Vi antigen
B. Urease
C. Hemolysin
D. Shiga toxin B) plasmodium ovale.                             
E. Pili
C) plasmodium malariae.                       

D) plasmodium falciparum.                     
42. Seseorang mengalami sore throat, ada grayish
white di ujung mulut, limfadenopati. E) plasmodium menangle
A. Dipteri
B. Pertusis
C. Tularemia 46. Antidotum untuk keracunan analgesic-
D. .... antipyretic…
E. ....
a. Amylnitrite
b. Atropine
43. Baby rash identically, mother had febrile c. BAL
illness during the second trimester of pregnancy. d. EDTA
Examination reveals diffuse raised purple skin e. N-methyl cystein
lesion. There is no pallor, jaundice or cyanosis.
The baby has cataract a 3/6 systolic heart
murmur. Enlargement of both liver and spleen, no 47. man 47 years old come to your clinic. he has
lymphadenopathy. complain about malaise,high fever,and mialgia,
slightly jaundice.one week ago he has clean a
a. Congenital toxoplasma canal with his friend..apa yang harus kamu
b. Congenital rubella lakukan sebagai dokter untuk profilaksis dalam
c. Congenital cytomegalo kondisi demikian>>
d. Congenital herpes simplex
a. antiviral,
e. Congenital varicella
b. antibiotik
44. 40 years old woman, presented with c.antitoxin
raised redness plaque resemble doughnut with
raised border that she already had for 1 year, no d. vaksin
itchy, weakness on her leg. Her slipper left.
Annular erythematous sharp border, shiny
surface, enlarge popliteal nerve. Lab exam?
48. women come back from Saudi Arabia, has
a. KOH weakness and tingling sensation in her right leg,
b. Zielh nelson other neurology exam is normal including her left
leg..Which immunization did she miss?
c. Gram
d. Na cl a.MMR

b.DPT
45. A girl returned from Lampung with
paroxysmal fever, malaise, and myalgia. The e.Oral  Sabin
fever recurrs every 36 to 48 hour. On microscopic
examination there are ring and cresecent like
shapes inside the red blood cells. This is
49. Seorang anak dengan fever, konjungtivitis,
characteristic of?                 
rash dari line belakang rambut kepala sudah sakit
A) plasmodium vivax.                              sejak 2-3 hari lalu dari genus apakah itu??
Morbili
 D. Delayed reaction
50. Severe complicationnya apa? E. Quantal reaction
Encephalitis
Pilihan yg lain g lupa
55. male, 46 y.o came to you as a doctor with
complaint 'sesak nafas' in
51. 34 yo women, G2 delivers at 36 week of his work place.
growth-restricted infant w/ catarract, PDA, and but when he back to home, 'sesak nafas' is
sensorineural deaf. Mom had flu-like syndrome dissapear. he notice, that
with rash in early pregnancy. Etiology? his sister using broncodilator. he also complaint
A. Porvavirus sneezing in morning.
B. Rubella he work in sandbusting company in last 2 week.
C. Morbili From the following what
D. CMV the appropriate measurement for hazardous thing.
E. HSV a. Body mass index
b. nutrition
52. 27 yo woman, abis travelling southeast asia. c. activity susceptibility
Shaking, chills, 40C. Ada P.vivax. Cr treatment d. -
hypnozoit? e. tissue and organ
A. Primaquine
B. Pyrimethamine
C. Quinine
D. Chloroquine 56. Anak Kecil perempuan berusia 3th
E. Chologuanide mengeluh tidak mau makan, badannya kecil,
terdapat anemia, pada pemeriksaan fisik terdapat
hepatomegaly, pada pemeriksaan lab terdapat
eosiofilia, kata ibunya dirumahnya terdapat
53. Woman 25 y.o, G3 at 39 weeks delivers a anjing dan dia suka main dengan anjing tersebut.
small gestational age infant with chorioretinitis,
intracranial calcification, micro-cephaly, Kemungkinan gejala yang terjadi
jaundice, hepatospleenomegaly. The nurse
reports poor feeding and tone. Mother denies any a. Creeping Eruption
raw or undercooked meat, no cats. She works as b. Biliary Cirrhosis
nurse in pediatric ICU. What is the most likely
causative agents? c. Cholecystitis
A. CMV
B. Epstain Barr virus d. Pruritus Ani
C. Hepatitis B virus
D. Parvovirus e. Visceral Larva Migrans
E. Yellow-fever virus

54. 45 y.o male has a chronic skin lesion both 57. Anak kecil datang ke klinik dengan
hands for 1 year. Skin erythematous, crusted, keluhan gatal2 pada pantatnya, ditemukan
itching, and have serous discharge. Work in a sesuatu seperti kuku, diambil dan didapatkan
gold refining plant for 2 years without protection. telur berdinding radial
Contact with cyanide. Not wearing gloves. What
is the possible mechanism? Penyebabnya..
A. Immediate reaction
B. Acute reaction a. Taeniasis Saginata
C. Gradual reaction
b. Taeniasis Solium
 c. Merozoite discharged from schizont and enter the
blood
d. Oxyuris
Process of gametocyte in blood
e. Ascariasis
Pigment in the parasite is formed

58. Laki2 terkena recurrent fungal infection di

bagian kaki dan gatal2. Dia ke dokter dan telah 61. Symptoms : Fever , nausea, fatigue. Back
dikasih obat. Dia minta advice agar penyakit from Kalimantan. Blood smear revealed schizont
tersebut tdk terulang. Apa yg anda sarankan? isi merozoit 12-24, erythrocyte enlarges. The
pathogen is :
A. Hindari makan seafood a.VivaxMalaria
b.FalciparumMalaria
B. Selalu pake sandal. c. MalariaeMalaria
C. Jaga tetap kering dan bersih. d. OvaleMalaria
e. DowleskiMalaria
D. Selalu pake sepatu
62. 52 years old man is brought to the emergency
E. Jangan digaruk department in an unconscious condition on
examination, he was death form more than one
hour. On autopsy of the brain, there is cyst’s fluid
containing protoscoceles with hooklet and many
A 30 year old woman, presents with abdominal
daughter cysts were found. What is the most
pain and diarrhea of 3 days duration. She doesn't
likely diagnosis of the disease?
complaint of nausea, vommiting or fever. She has
a. Hydatidosis
no sick contact or significant travel history. A
b. Cysticercosis
stool sample is obtained, which reveals
c.Serebralmalaria
rhabditiform larva.
d. Histoplasmosis
e.  Toxoplasmosis
59. In condition below adult form of the
pathogenic agent can be found in the whole GIT
and its larvae can be found in visceral organ
(lung, liver, gallbladder) is : 63. dewi…kerjasama nya please…. Demi kalian
a. eosinophilia juga kok
b. hyperinfection
c. retroinfection 64. dewi…kerjasama nya please…. Demi kalian
d. hypereosinophilia juga kok
e. autoinfection

65. Pengambilan specimen untuk edema pada leg

60. a woman came with the complaint of being dan scrotum pada filariasis adalah terbaik pada
uncomfortable and hardened in the left upper side waktu….
abdomen. Every 4 days, she is intermittently
feverish, on blood smear exam, plasmodium Answer: 10 – 12 pm
parasite (+). Fever symptoms on previous
referred to:
66. livia…kerjasama nya please…. Demi kalian
Sporozoit in blood juga kok
Hypnozoit in liver is found
67.livia…kerjasama nya please…. Demi kalian
juga kok
68. lauren…kerjasama nya please…. Demi kalian
juga kok
69. kesalahan banker… maap yei..
70. 35 years old male, farmer who was working
with pestiside  was taken to ER with headache,
vomiting, salivation, diarrhea, muscle
fasciculation, difficulty walking, difficult
speaking. His cloths has been removed, hes been
washed, has been given activated charcoal. What
is the most effective remains treatement for the
case of pesticide poisoning?
a. Epinephrine
b. Antacid
c. Spironoloctate
d. Atropine
e. HCT
71. A 65 year old woman suddenly had flaccid
paralysis at legs. Few days ago, there are
headache, nausea, fever, sore throat. Her son:
daughter in law, and young grandchild have
vaccine routine oral.. She taking
imunosuppressant for kidney transplant. Vital
sign, cranial nerve, CT-scan and MRI normal..
The transmission?
A. Droplet
B. Airborne
C.fecal oral
D. Close contact
E.animal bite
72. Pork eating village in papua new guinea
epidemic outbreak of epilecticum seizure. The
investigate:
A. Level of balantidium coli in swine stool.
B. Practice of consuming raw decease human
brain
C. Presence taenia eggs in drinking water
D.presence of trophozoite in human blood
E. Quantity of culidare in the village
73. 34 years old women complain sudden onset
high fever 4 days with nausea, vomite, muscle
headache, headache, pretechie + . which of the
following laboratorium result is the most
appropriate with the patiet diagnosis?
a. trombositopenia
b. neutropenia
c. anemia
d. hematocrit decrease
e. leukosit decrease
74. 1 years old baby get swollen gum 1 week. On
history, he has normal body weight, breast feed
until now, balance diet with high intake cooked
vegetable and fruits since 6 month old. No history
of cronic disease. Whats the most likely cause of
the complaining??
a. protein deficiency because of breastfeed
b. Karbohidrat deficiency because of increase
kalori need
c. fat soluble vitamin deficiency because of high
vegetable and fruit intake
d. water soluble vitamin deficiency because of
cooking
e. mineral deficiency because of competition with
vitamin absorbtion
75.Male 10 year old,high fever 38 C,runny
nose,sore throat,mild cough, vesicular lesion at
palatum,dorsal,n palmar of the hand. Most likely
diagnosis:
A.adenovirus
B.coxsackie virus (ini jwbnnya)
C.
D.sinusitis
E.pneumoni
76. 19 years old girl come with sign and skizon 12 – 24, merozoit 20, RBC
symptomp of poisoning. Nausea, vomiting, enlarges. The cause of the fever:
abdominal cramp, diare, excessive saliva, a. Sporozoit in blood
headache, giddiness, rinorhea, pin point pupil, b. Hypnozoit in liver is found
and mental confusion. What ‘s the most possible c. Merozoite discharged from
agent? schizont and enter the blood
d. Process of gametocyte in blood
a. acetaminophen e. Pigment in the parasite is formed
2. 35 years old male, farmer who was
b. barbiturat working with pestiside was taken to ER
c. carbamate with headache, vomiting, salivation,
diarrhea, muscle fasciculation, difficulty
d. sianida walking, difficult speaking. His cloths
has been removed, hes been washed, has
e. opiate been given activated charcoal. What is
the most effective remains treatement for
the case of pesticide poisoning?
a. Epinephrine
77. 22 years old women, G1, complaining flu like
b. Antacid
illness during third trismester early. She delivery
c. Spironoloctate
a growth restricted infant with seizure intracranial
d. Atropine
calcification, jaundice. Whats the most possible
e. HCT
cause?
3. Man, 31 years old, inguinal
a. treponema pallidum lymphadenopathy, blister on penis, had
unprotected sex 1 month ago.
b. T.vaginalis Penyebabnya apa?
a. HPV
c. toxocara sp b. Triponema Pallidum
c. Haemophillus Influenzae
d. neisheria meningitis d. Chlamydia trachomatis
e. HSV
e. toxoplasma gondii
4. 4 years old, child sleeping scratching
anal. Suspect pin worms. BEST diagnosis
is?
78. Influenza virus a. Stools for eggs
b. Stools for larva
c. Blood smear of microfilm
d. Transparent adhesive tape of
79. ETEC eggs
e. Titer IgE antibody
5. Clotted tongue, watery diarrhea, demam
SOAL UJIAN tinggi pas malem
a. Salmonella
TROPICAL MEDICINE BLOCK b. E. Coli
c. Malaria
d. …
e. ..
1. 40 tahun man, fever  1 minggu. Ada 6. Best treatment for scabies
nausea, fatigue. Back from Timika. a. Sulfur
Blood smear revealed late trofozoit, b. Gamexane
c. Crotamiton
 d. Lindane
e. Permethrine
7. 31 years old female underwent allogenic
bone marrow transplant for AML.
Second month after, high fever, non
productive cough, breathlessness,
splenomegaly. Lab : anemia, leucopenia,
thrombositopenia, abnormal liver
function test. X-ray: diffuse interstitial
pulmonary infiltrates. Bronchoalveolar
samnple performed. Infected kidney cells
 owl eye. Best treatment:
a. Anti microbial
b. Anti viral
c. Anti toxin
d. Immunosuppresant
e. Anti fungal
8. this female illness could be most easily
diagnosed by which of the following
test?
a. HSV – 1 IgM Ab
b. CMV antigenemia
c. HHV – 6 IgM Ab
d. Culture of blood in erythroblastic
cell
e. Monospot – test
9. One member of the NGO team from
Indonesia has been reported dead in
Mexico, because of spider’s bite. The
possible cause of this disorder is:
a. Erucism
b. Lepidopterism
c. Tick Paralysis
d. Arachnidism
e. Delusional Parasitosis
10. Ulcer + lethargy + pale + face = thin old
person + rib prominent
a. Marasmus
b. Kwashiorkor
c. Marasmic Kwashiorkor
d. Energy malnutrition
e. Protein malnutrition
11. 46 tahun female, several bunion
removed from her right foot. Chooses
conscious sedation other than general 
become agitated, combative, given IV
midazolam. Drug that counteract
midozolam? (Keracunan obat anesthesia
midazolam di kasih apa?)
a. Flumazenil
b. Glucagon
c. Naloxone
d. Nitrite
e. Protamin
12. 30 years old male, having fever for 3
days, with falciparum rings +++. He was
given CQ3 ( chloroquine for 3 days),
after 3 days, the patients still feverish,
blood smear examination show
falciparum rings ++++. What is the
possible respon of CQ?
a. Sensitivitiy
b. R1 resistance, early
recrudescence
c. R1 resistance, delayed
recrudescence
d. RII resistance
e. RIII resistance
13. Refer to the previous case above, what is
the treatment of choice
a. Primakuin
b. Amodiakuin
c. Meflokuin
d. Sulfadoxine – pyrimethamine
e. Artemisin
14. 24 tahun female, myalgia and weakness
of her right leg. Dari Saudi Arabia,
imunisasi ga komplit. Normal sensation
on right leg, movement and cranial nerve
normal. Which is a target cell receptor
for this pathogenic agent?
a. Silica Acid on mucous cell
b. Ach on neurons
c. CD 4 on T lymphocyte
d. C2d complement on B
lymphocyte
e. Ig on epithelial cell
15. Which one of the following is the best
specimen for diagnosing in case above?
a. LCS
b. Blood
c. Urine
d. Throat swab
e. Rectal swab
16. Young boy, high fever, difficulty
swallowing water, hydrophobia,
disorientation, hypoesthesia. In the left
arm, 4 weeks ago was bitten by dog.
Characteristic of pathogenic : zoonotic,
single stranded, negative sense DNA
virus. Which do you found for diagnosis?
a. Giant cell
 b. Limfosit plasma biru e. Hepatitis B, Hepatitis B, pertusis,
c. Negri bodies poliomyelitis
d. Inclusion bodies 21. Keracunan acetaminophen, kasih apa?
e. Clue cell a. Acetylcysteine
17. Anak laki laki 4 tahun dating dengan b. ..
pucat dan intense chills, daily high fever. c. ..
Memiliki sickle cell disease. Platelet d. ..
53.000, WBC 17.000. Description the e. ..
relevant finding? 22. 45 years old man suffered otitis media 2
a. .. years ago. He has headache a week ago.
b. .. Radiographic exam shows 3 cm round
c. .. mass.
d. . a. Neoplasm
e. .. b. Aneurisma
18. female 27 tahun, fever 2 hari, c. Infarct
unconscious and general seizure 2 hour d. Abscess
ago. Physical Examination : GCS 3, BP e. Hemorrhage
90/60 mmHg, temperature 41 C, Hb 10.3, 23. Appropriate antiepileptic drug for
WBC 5800, platelet 39.000. blood smear Absence Seizure?
ada schizont. State yang di takutin setelah a. Carbamazepine
ini? b. Valproic Acid
a. … c. Benzodiazepine
b. Intermittent fever d. Lumotrigine
c. Gametocyte formation takes e. Ethuxusimide
place in visceral organ 24. 52 tahun man is brought to the
d. Make capillary destruction in emergency department in an unconscious
CNS by parasit contain condition on examination, he was death
erythrocyte form more than one houn on autopsy of
e. There are many drugs resist once the brain, there is cyst’s fluid containing
aginst P.falciparum protoscoceles with hooklet and many
19. A one year old boy was diagnosed with daughter cysts were found. What is the
measles since a week ago. This morning, most likely diagnosis of the disease?
his mother noticed that he also suffered a. Hydatidosis
for swollen, reddish gum that signified as b. Cysticercosis
scurvy. Most likely mechanism that c. Serebral malaria
underlines his recent condition? d. Histoplasmosis
a. Impaired absorption of e. Toxoplasmosis
micronutrients 25. 5 year old girl , 2 hari fever + throat.
b. Altered micronutrients Ada lethargy , grayish white membrane
metabolism di faring, tonsil asimetris, treatment?
c. Depletion of micronutrient stores a. Abx, antiviral
d. Micronutrient redistribution b. Antiviral, antifungi
e. Negative mincronutrient balance c. Antitoxin, antifungal
20. Group III tropical disease d. Abx, antitoxin
a. Leprosy, lymphasis filariasis e. Antiviral, antitoxin
b. Malaria, TB, Dengue, 26. Shortness of breath at work place. At
Schistosomiasis home, symptoms missing. Sneeze every
c. Ebola, Avian Influenza, SARS morning. Worked at sandblasting
d. Protein calory malnutrition, company and expose to dust since 2
pesticide intoxication weeks ago. Possible cause:
a. Wood
 b. Quartz
c. Tobacco smoke
d. Coal
e. Ammonia
27. doctor gave him sick leave certificate 2
days and asks the patient to come back
tomorrow to spirometry. Result of
spirometry do you expect?
a. FEV1 turun
b. FVC turun
c. FEV1 turun, FVC turun
d. Normal
e. MVV naik
28. Seorang bapak tinggal di Lembah Napu
di Sulawesi, terjadi perbesaran hati,
flatulence
a. Schistosoma japonicum
b. Schistosoma mansoni
c. Schistosoma haemotobium
d. Schistosoma rodentisia
e. …
29. Cewe 18 tahun come to obgyn dengan no
menses 2 bulan, lose weight 5 kg for 3
bulan. Lagi dalam proses pengobatan TB
4 bulan yang lalu
a. Increase glukoneogenesis
b. Increase vitamin excretion
c. Increase resting metabolism
d. Increase CHO store
e. Increase protein catabolism
30. 70 tahun cowo ke ER gara gara seizure,
Istrinya jam 5 pagi bangun, lantaran
suaminya seizure. Kepalanya deviasi ke
kiri, tangannya kenceng, trus ada
generalized body jerking +
unconsciousness selama 2 menit, stop
spontaneously. No history of seizure. He
is drowsy and confused. BP 140/195, HR
96, RR 20, susuh 36.5 C, Resting Blood
Glucose 610.
a. Pseudoseizure
b. Primary epilepsy
c. Secondary epilepsy
d. Acute provoked seizure
e. Generalized seizure
31. Treatment  Insulin cutaneous
32. Female tourist developed gastroenteritis
and tasted some Indonesian food. Onset
abrupt with abdominal discomfort and
watery diarrhea. Setelah di periksa,
ditemukan pathogen, yaitu…..
a. Salmonella typhii
b. Shigella dysentriae
c. Enterohemorrhagic coli
d. Enterotoxigenic colli
e. Staphylococcus aureus
33. Seorang pria dari bogor akan pergi ke
samarinda selama 3 minggu, dikasih obat
apa?
a. CQ + PQ
b. Sulfadoxine + PQ
c. Aretusunate + AQ
d. Kina + Tetracycline
e. Doxycycline
34. 65 tahun female, tiba tiba lumpuh kaki
kiri. Beberapa hari lalu, sakit kepala,
fever, sore throat, nausea. Tinggal ama
anak laki lakunya, menantu perempuan,
dan cucu yang masih kecil yang baru
dapet imunisasi rutin, si nenek itu pake
immunosuppressant untuk transplant
ginjal. Vital bagus, cranial nerves ok.
Head CT normal, Lumbar MRI normal.
Cara transmisi?
a. Droplet
b. Airborne
c. Fecal-oral
d. Close contact
e. Animal bite
35. 35 tahun male, seizure, CSF = neutrofil,
RBC, amoeba form on wet microscopy
a. Naegria fowleri
b. Entamoeba histolytica
c. Acanthamoeba costelorii
d. Escherichia colli
e. Plasmodium falciparum
36. 22 tahun, female, 2 week di Papua, blood
and slimy diarrhea dari lasat 5 days in
Papua. > 5 kali bowel movement each
day, stomach cramp, pain stool, no fever,
abdomen tender. Agak dehidrasi
a. E.histolytica
b. Cholera
c. Rotavirus
d. Salmonella
e. E.colli
37. Tidak inget udah imunisasi TT atau the following, which parasite can cause
belum, prophylaxis nya apa? this?
38. Seizure karena tetanus disebabkan oleh? a. P. falciparum
39. 3 years old boy, brought to emergency b. P.vivax
unit in Tangerang hospital with stridor, c. P.malariae
dyspnea, and croupy cough. What is most d. P.ovale
likely pathogenic agent that cause the e. ……
patient’s disease? 47. Lab test buat pertusis?
a. B. pertusis 48. 10 tahun, diarea, blood and mucus, rectal
b. H. influenzae prolapsus
c. Coxsavirus a. Ascaris
d. B. paraapertusis b. Necator
e. C. diphtheriae c. Ancylostoma
40. Keracunan parathion  d. Trichius
acteylcholinesterase e. Enterobius
41. 2 tahun, febrile, deteriorate, worsening 49. parasit ini tinggal di?
cough and dyspnea. Child had obvious a. Liver
respiratory distress with retraction and b. Lung
elevated respi rate. X-ray chest c. Small bowel
hiperinfiltration, both lundg field. What d. Stomach
is the lab? e. Caecum
a. Nasopharyngeal washing 50. Apa yang bisa bunuh virus rabies?
b. Trache aspirate a. Infrared radiation
c. Bronchial washing b. Catalase
d. Nasal swab c. Alkali water
e. Blood d. Sunlight
42. At nite, 28 years old, male, right foot e. Heating at 60 C for 30 minute
bitten by animal 1 hour before. Heard the
sound of the animal. Pain in Right foot, 2
bitten mark, edema, erythema, in dorsal CUCU
right foot. What likely animal?
43. Initial management? (HENDRA-NIPAH VIRUS)
a. Obvservation 1. A 27-year-old man develops acute severe
b. Cryotherapy encephalitis that requires hospitalization.
c. Antivenom Several days before he got that disease, he
d. Inicision and suction recognizes that many pigs in his farm were
e. Corticosteroid died.
44. Next step: Which of the following is most appropriated
a. Wide excision natural host for the pathogen?
b. Fasciotomy f. Arthropod
c. Antivenin g. Horse
d. Incision and suction h. Fruit bats
e. Corticosteroid i. Squirrel
45. after 12 hours, severe pain especially j. Rats
more right leg and leg pallor, cold, no
pulse in R dorsal artery. Treatement??? 2. A 32-year-old female developed a “flu-like”
46. a woman came with the complaint of syndrome with high fever up to 400C,
being uncomfortable and hardened in the anorexia, headache, and myalgia. Four days
left upper side abdomen. Every 4 days, later, she become confused and agitated with
she is intermittently feverish, on blood difficult to breath. Chest x-ray showed
smear exam, plasmodium parasite (+), of parenchymal infiltrate. One of her kids has
 also these symptoms, and has already passed
away. In order to provide laboratory
conformation of the pathogenic agent, a
tissue culture was ordered.
Which of the following would be the best
specimen for isolating the pathogenic agent
responsible for this infection?
f. Stool
g. Blood
h. Saliva
i. Lung biopsi
j. Nasopharyngeal swab
Question 3-4 are linked to the following case:
(RABIES)
3. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he contacted with a
dog……. His symptoms increased and were
accompanied by hand spasm and sweating on
the right side of the face and trunk. This
patient was admitted to the hospital the day
after developing dysphagia, hydrophobia,
hypersalivation, and disorientation.
Which of the following is usefull for making
a diagnosis in this case ?
f. Giant cell
g. Limfosit plasma biru
h. Negri bodies
i. Inclusion bodies
j. Clue cell
4. Which of the following is available for
treating this patient?
a. Immune globulin
b. Live attenuated vaccine
c. Antiviral
d. Antimicrobial
e. Antitoxin
Question 5-6 are linked to the following case:
(ANTRAX-CUTANEOUS)
A 32-year-old worker from a farm comes with a
painless dermal papule on his right hand which
started to develop since five days ago. The
worker says as the lesion getting bigger, and the
skin becomes black. He has tender axillaries
lymph node enlargement.
5. What antibiotic should the doctor give to
treat the worker?
f. Tetracycline
g. Aminoglycoside
h. Ciprofloxacin
i. Neomycin
j. Crystalline penicillin G
6. Which of the following virulence factors is
most likely to be involved in the pathogenesis
of illness?
f. Exotoxin
g. Endotoxin
h. α-hemolysin
i. Lipopolysaccharide
j. Antiphagotic factors
(ANTHRAX-GI)
7. A 53-year-old male farmer developed low-
grade fever, abdominal pain, and diarrhea. He
has a skin lesion of black eschar surrounded
by vesicle and edema near his mouth. A week
before, his notice many cattle in his farm
were sick, but he still eats a half-done beef
steak from his cattle.
What is the following microorganism is most
likely involved in this case?
f. Bacteroides fragillis
g. Leptospira interrogans
h. Bacillus anthracis
i. Pasteurella pestis
j. Borrelia burgdorferi
Question 8-8 are linked to the following case:
(EMERGING AND RE-EMERGING
INFECTIOUS DISEASE)
There is an RNA virus that causes deadly
outbreaks of hemorrhagic disease in Africa. In
each outbreak, hospital staff became infected.
This virus is highly virulent.
8. Which of the following is the most likely
transmission for this disease?
f. Spread by contact with blood or other
body fluid
g. Transmitted by mosquitoes bite
h. Transmitted to human from rodent
excreta
i. Aerosol transmission
j. Direct contact with cattle product

9. Which virus is most likely the cause of this
outbreak?
a. Dengue virus
b. Menangle virus
c. Lassa virus
d. Ebola virus
e. Influenza virus
10. High priority bioterrorism agents include
organisms that pose a risk to national security
because they can be easily disseminated or
transmitted from person to person. Which of
the following is most likely to be transmitted
from person to person in bioterrorism act?
a. Bacillus anthracis
b. Clostridium botulinum
c. Francisella tularensis
d. Variola major
e. Brucella melitensis
Question 11-12 are linked to the following case:
(AVIAN FLU)
A 31-year-old man presented with complaints of
high fever, cough, and shortness of breath. Two
ours before admission, he experienced right-sided
chest pain when took a deep breath or coughed.
Chest film showed diffused bilateral interstitial
pulmonary infiltrate. Arterial blood gases showed
a PO2 of 60 mmHg with 91% hemoglobin
saturation. The hematologic, serum and liver
tests were normal. He lives near the poultry, and
the pathogenic agent is a new virus.
11. Which of the following is the prevention for
this disease?
f. Vaccine
g. Antitoxin
h. Antibiotic
i. Antiviral
j. Antidotes
12. What is the following is probably the reason
for the emergence of this infectious disease?
a. Animal husbandry practice
b. Genetically engineering
c. Vector elimination
d. Antibiotic resistance
e. Tsunami impact
13. An 80-year-old man is developing fever,
cough, runny nose, headache, and myalgia.
He lives in a nursing home. Many of people
in his neighborhood have this disease.
Which immediate course of action would be
most appropriate for this patient?
a. Vaccination
b. Immunoglobulin
c. Rimantadine
d. Acyclovir
e. Cytokine
14. A 22-year-old man who works in the
pediatric ward of a hospital suffers from
malaise, sneezing, and runny nose. He
subsequently develops a mild sore throat,
headache, and stuffy nose. The symptoms
resolve within 4 days. Which virus is most
likely to be responsible for these symptoms?
f. Rota virus
g. Rubella virus
h. Coxsackie virus
i. Hepadnavirus
j. Influenza virus
(TIFOID)
15. A 48-year-old man with acute gastroenteritis
has sub febrile fever since 7 days ago. He
also has abdominal pain, and diarrhea. He
usually eats undercooked egg every morning.
Which of the following is most likely to be a
constituent of this organism?
f. Vi antigen
g. Urease
h. Hemolysin
i. Shiga toxin
j. Pili
16. An outbreak investigation note many
costumer from a café were admitted to the
hospital. They have fever; nausea-vomiting,
constipated or diarrhea, weakness and altered
mental status. Rose spots are seen on the
trunk. Blood cultures from patients grow a
non-lactose-fermenting gram-negative rod.
In which of the following sites is a bacterium
most likely to be found?
f. Blood
g. Kidney
 h. Liver
i. Intestine
j. Gall bladder
Question 17-18 are linked to the following case:
A 28-year old man presented with 6-day history
of increasing fever, malaise, headache, and
constipation. He did not receive any prior
vaccinations. His vital signs revealed bradycardia
and fever of 400C. His physical examination
revealed mild hepatospleenomegaly and faint
erythematous macules.
17. Which of the following is most likely to have
caused this man’s illness?
f. Vibrio cholerae
g. Shigella dysentriae
h. Salmonella typhi
i. Entamoeba histolitica
j. Giardia lambia
18. Which of the following specimen is most
appropriate for case above?
f. Feces
g. Blood
h. Urine
i. Throat swab
j. Biopsy
Question 18-20 are linked to the following case:
(MALARIA)
A 24-year-old man returned from Papua Island.
Five days later, he developed repeating intense
chills and high fevers. These severe episodes of
fever had been occurring every other day. In
between these episodes, he had low-grade fever,
myalgia, nausea, vomiting, and diarrhea. A few
hours ago, he was admitted to ICU in coma. He
became progressively somnolent and died a week
later.
20. Which of the following organs does this
infectious agent initially proliferate after
entry in the infected host?
f. Heart
g. Liver
h. Brain
i. Spleen
j. Renal
21. What is the most common mode of
transmission of this agent?
a. Contact with rat’s of urin
b. Transplacental crossing
c. Blood transfusing
d. Bite of a mosquito
e. Eat the contaminated food
22. An apparently run-down but alert 34-year-old
woman comes to your office after 6 months
spent as a teacher in a rural West Sumba. Her
chief complaints are frequent headaches,
occasionally nausea and vomiting, and
periodic fever. To rule out your differential
diagnosis, a smear of finger-stick blood was
done. Which of the following choices would
fit your diagnosis based on your microscopic
examination of the blood smear?
f. Schizonts in red cells with 8-12 progeny
g. Rounded gametocytes present
h. Enlarged, somewhat misshapen
parasitized red cells
i. Numerous large ovoid parasites in some
of the red cells
j. Numerous band-shaped tropozoites in the
parasitized red cells
(NEUROCYSTICERCOSIS)
23. A 39-year-old woman live in Manokwari,
Papua Island developed a major seizure while
at work. She had no history of epileptic
disease. A head MRI was remarkable for a
lesion surrounding a scolex. The etiologic
agent would most plausibly have been
acquired by eating or dinking which of the
following food items?
f. Uncooked vegetables
g. Raw oysters
h. Raw pork
 i. Uncooked fish
j. Unfiltered water
24. A pork-eating village in the highlands of
Papua New Guinea is reported to be suffering
from an epidemic outbreak of epileptiform
seizures. You have been sent to investigate.
One of the first things you should investigate
is?
f. The level of Balantidium coli in swine
stool
g. The practice of consuming raw human
brains from recently deceased family
members
h. The presence of taenia eggs in the
drinking water
i. The presence of tropozoites in the human
blood
j. The quantity of culidae in the village
dr. ANGELA
Question 25-27 are linked to the following case:
(BRUCELLOSIS)
A 45-year-old man from the Middle East had
fever and chills, with weight loss, sweats,
headache, muscle pain, fatigue, and depression.
From physical examination the doctor found
lymphadenopathy and spleenomegaly. The man
is a daily farmer and a couple weeks before the
symptoms appeared he drank a glass of
unpasteurized cow milk. The culture of blood
grew a tiny Gram-negative coccobacilus, catalase
and oxidase-positive; that resemble fine grains of
sand.
25. The patient was probably infected with which
of the following microorganism?
f. Mycobcaterium tuberculosis
g. Salmonella typhi
h. Brucella species
i. Pasteurella pestis
j. Staphylococcus aureus
26. Which of the following diagnostic laboratory
test should be done for identification of this
fastidious coccobacilus?
a. Fluorescent antibody test
b. Western Blot
c. Culture
d. ELIZA assay
e. PCR
27. How did the man get infected form this
disease?
a. Ingestion of infected unpasteurized cow
milk
b. Needle stick injury from a contaminated
syringe
c. Direct contact with infected animal parts
through intact skin
d. Aedes aegypty bites
e. Fresh orange juice consumption
Question 28-29 are linked to the following case:
(TULAREMIA)
A 55-year-old warden found a dead muskrat on
the bank of a stream. He picks up the animal and
buried it. Four days later, he developed a 1.5 cm
painful ulcer on the index finger of his right arm,
a 1 cm ulcer on his right forehead, and pain in his
right axilla. Physical examination also revealed
right axillary lymphadenopathy.
28. Which of the following is working diagnosis
for this patient?
f. Brucellosis
g. Pertusis
h. Leptospirosis
i. Tularemia
j. Hydatidosis
29. Which of the following prevention should be
done for high risk persons, such as research
laboratory personnel from this disease?
a. Education
b. Immunization
c. Laboratory precaution
d. Burning infected animal
e. Antibiotics taken
Question 30-33 are linked to the following case:
(LEPTOSPIROSIS)
A volunteer man returning from a tsunami area
was admitted to hospital. A week before, he had
fever and headache. These symptoms resolved,
but the day before admission he became pyrexial
and on examination was found to be jaundice and
to have an elevated blood urea. Urine was
collected and inoculated into a semisolid agar
medium, and examined by dark ground a. Testing serum using the rapid plasma
microscopy. reagin (RPR) test
b. Culture the urine on human diploid
30. Which of the following is your working fibroblast cells
diagnosis? c. Testing serum by darkfield microscopy
f. Syphillis d. Testing serum for antileptospiral
g. Pertusis antibody
h. Weil’s disease e. Culture of CFS on chocolate agar
i. Lyme disease
j. Relapsing fever 35. Which of the following is the prevention after
exposure?
f. Human vaccine
g. Health education
h. Vector controll
i. Isolation the infected people
31. Which of the following disease is the j. Antibiotics prophylaxis
complication of this disease?
f. Pulmonary hemorrhage
g. Myopericarditis
h. Aseptic meningitis
i. Osteomyelitis
j. Anemia
Question 36-38 are linked to the following case:
32. Which of the following reservoir animal is (YAWS)
the source of human infection? A young boy had an ulcerating papule on his
a. Fish legs. Later, this lesion destroys the bone of his
b. Bird legs (gummata), but three are no visceral and
c. Reptile nervous system complications. The disease is still
d. Scallop endemic in hot tropical countries, such as
e. Rat Indonesia.

33. Which of the following is drug of choice of 36. Which of the following microorganism is the
this disease? cause of the disease above?
a. Penicillin G a. Treponema pertenue
b. Chloramphenicol b. Borrelia burgdorferi
c. Erythromycin c. Leptospira interrogans
d. Gentamycin d. Spirillum minor
e. Rifampin e. Chlamydia trachomatis

Question 34-35 are linked to the following case: 37. Which of the following drugs is the drug of
(LEPTOSPIROSIS) choice for the disease above?
A 27-year-old medical student was admitted to a. Tetracycline
hospital because of sudden onset fever up to 390C b. Penicillin
and headache. Two weeks previously he c. Doxyccycline
volunteers cleaning the canal with others. Blood d. Vancomycin
tests done shortly after admission indicated renal e. Clarithromycin
function abnormality and elevated liver function
tests. On examination, he looked so yellow. 38. Which of the following examination is the
most appropriate to diagnosis the disease
34. Which of the following would be most likely above?
to confirm the diagnosis? f. Widal test
 g. IgG and IgM of Treponema
h. Dark-field microscope
i. FTA-ABS test and TP-PA test
j. ELIZA assay
dr. ROBERT TEDJA
Question 39-40 are linked to the following case:
(TRAVELER DIARRHEA AND THE
PREVENTION)
A female tourist developed gastroenteritis while
visiting small town in Indonesia and tried some
Indonesian traditional food. The onset of the
disease is abrupt with abdominal cramps and
watery diarrhea. She had no fever or nausea or
vomiting. The symptoms have resolved within 24
hour and no subsequent recurrences. They report
the disease to district public health office. The
investigation found that one of the food products
eaten by this tourist was contaminated by
suspected pathogens.
39. What is the suspected pathogen may cause
the disease above?
k. Salmonella typhi
l. Shigella dysenteriae
m. Enterohemorragic E. coli
n. Staphylococcus aureus
o. Enterotoxigenic E.coli
40. Which of the following is the natural
prevention for the disease above?
a. Bi Subsalicylate
b. Antibiotic
c. Probiotic
d. Chlorination
e. Hand hygiene
41. Approximately 4 hour after eating a meal in
restaurant, 3 members of a tourisms group
develop a sudden onset of nausea, vomiting,
severe abdominal cramps, and diarrhea.
Nobody got febrile. Which of the following
vaccination is should be given to the traveler?
f. Shigella vaccine
g. Salmonella vaccine
h. Enterobacter vaccine
i. H Pylori vaccine
j. Cholera and ETEC vaccine
dr. SANDRA
(DHF)
42. A 23-year-old man sees his family physician
with a sudden onset of 4-day history of
fevers, headache, retro-orbital pain, myalgia
and rash. Physical examination shows diffuse
erythroderma with blanching erythema and
petechial formation resulting from pressure
applied to her skin. Laboratory test reveal
leucopenia and trhrombocytopenia. Which of
the following virus is most likely responsible
for this infection?
f. Morbili
g. Dengue
h. Influenza
i. Coxsackie
j. Rhinovirus
43. A 34-year-old woman complained a sudden
onset of high fever for 3 days with nausea,
vomiting, headache, muscle ache. There was
petechie on examination. The laboratory test
revealed leucopenia, thrombocytopenia, and
elevated of hematocrit. The patient most
likely acquired this infection by which of the
following modes?
a. Intravenous drug use
b. Inhalation of contaminated dust
c. Close contact with a symptomatic patient
d. Bitten by an arthropods
e. Eating some contaminated food
Question 44-46 are linked to the following case:
A 20-year-old woman came to the emergency
room with high fever from 3 days ago. She also
has headache and pain in retroorbita, abdominal
pain and bloody stool. On physical examination,
she was in an agitated condition. Her BP 90/60
mmHg, heart rate 110x/ minute, RR 20x/ minute
and there was red spot in her arm, hand and leg.
44. Which of the following examination is the
most appropriate to diagnose this infection?
f. Prick test
g. Tourniquet test
h. Complete blood test
i. Widal test
j. Urine test
45. The patient was give IV line, and blood
examination was done. Which of the
following result is most appropriate with the
patient’s diagnosis?
f. Trombositosis
g. Leukocytosis
h. Erythrositosis
i. Elevated of hematokrit
j. Elevated of LED
46. In the forth day, the patient developed
epistaksis, melena and more clear
hemorrhage in skin. Which of the following
is responsible for his condition?
a. Elevated of thrombocyte increasing
coagulation
b. Fibrin degradation make dysfunction of
thrombocyte
c. Elevated of kinin in circulation
d. Plasmin elevated coagulation factor
e. Complemen activation by plasmin
dr. DWI
47. A 48 year old lady came to the outpatient
clinic with chief complaint of fatigue and
difficulty in concentration for the last 2
weeks. The history taking revealed that she
had a balanced diet, no history of chronic
disease and had been a heavy smoker for 20
years. On physical exam it was found that she
had anaemic conjunctiva with other findings
was within normal limit. The laboratory
examination showed that she had haemolytic
anaemia.
Based on the information given above, what
is the most likely cause for her condition?
f. Vitamin K deficiency
g. Copper deficiency
h. Vitamin E deficiency
i. Iron deficiency
j. Folate deficiency
48. A 28 year old lady came to the Posyandu to
have a nutrition consultation. Last year, she
delivered a stillbirth baby with a spinal
disorder. She and her husband start planning
to have a baby again. She asked for
suggestion about her dietary intake before she
got pregnant.
What kind of diet does she need to prevent
the same disorder for her future baby?
f. Dark green leafy vegetables
g. Pasteurized milk
h. Deep water fishes
i. Boiled eggs
j. Lean beef
49. A 1 year old girl came to the Puskesmas with
swollen gum for a week. From the history
taking it was found that she was born normal
with normal birth weight, had been breastfed
up to now and had a balanced diet with high
intake of cooked vegetable and fruit since 6
months old. She had no history of chronic
diseases. Her other physical and laboratory
examination was normal.
Based on the information given above, what
is the most likely cause of her complaint?
f. Protein deficiency due to prolonged
breastfeeding
g. Carbohydrate deficiency due to increased
calorie need
h. Fat soluble vitamin deficiency due to
high vegetable/fruit intake
i. Water soluble vitamin deficiency due to
cooking process
j. Mineral deficiency due to competition
with high vitamin absorption
dr. JULIANA
(TUTOR)
Question 50-51 are linked to the following case:
A 9 year old girl came to the emergency room
with difficult of breathing. She had got high fever
since 3 days ago. Her temperature was up to
40oC. She also complained of rhinnorhea, cough,
and myalgia. On examination, you found
increased tactile fremitus on the right side of the
lung, dullness on percussion. Laboratory result g. Gray syndrome
indicated leucopenia. h. Down syndrome
i. ADHD
50. Which criteria of avian influenza is the most j. Black water fever
appropriate with this patient’s condition?
a. Probable 54. A 24 year old man, recently returned from
b. Suspect Myanmar, presented very unwell febrile. His
c. Confirmed consciousness was GCS of 7. His thin blood
d. Definitive smear showed malaria falciparum. Which of
e. Absolute this following is the best treatment for this
patient?
a. Chloroquine
b. Mefloquine
c. Fansidar
d. Doxycycline
e. Quinine IV

51. Based on its ability to cause disease, avian

influenza is broadly divided into highly
pathogenic (HPAI) and low pathogenic
(LPAI) strains. Which subtypes are known to
cause the HPAI?
a. H1 and H3
b. H2 and H4
c. H5 and H7
d. H6 and H8
e. H9 and H11
52. A 50 year old woman presented to clinic with
fluctuated fever (also called as step ladder
fever) since 7 days ago. On physical
examination, you found “rose spots” on
upper abdomen. What is the possible cause of
rose spots on this woman?
a. Eritrocytopenia
b. Leucopenia
c. Thrombocytopenia
d. Limfositosis
e. Deficiency of clotting factor
53. A 27 year old woman in pregnancy had
fluctuated fever since 2 weeks ago. She
looked pale, generalized weakness, and
headache. She went to public health center
and was prescribed oral chloramphenicol in
doses of 500 mg four times daily and
paracetamol 500 mg three times daily. She
did not tell to the physician that she was
pregnant. What is the side effect of
chloramphenicol on this patient?
f. Reye syndrome
55. A 35 year old man, a businessman, came to
private doctor. He asked the physician about
his plan to go to Africa, which is endemic
malaria. The physician suggested him to take
prophylactic drug. Which medication (WHO
recommended) would be given to this patient
for prophylactic?
f. Kina
g. Chloroquine
h. Doxycycline
i. Kuinin
j. Primakuin
56. A 40 year old man came to hospital with four
times generalized tonic-clonic seizure since
two week ago. There was no history of
seizure and head trauma. A one year ago, he
had business in Papua for six months. During
his stay in there, he often consumed under-
cooked pork. Brain MRI showed a small
cystic with invaginated scolex inside. What
of this following is the most likely inside
cyst?
f. Eggs
g. Cycticercosis cellulose
h. Cysticercosis bovis
i. Taenia solium
j. Taenia saginata
57. A 15 year old girl of African origin was
admitted with a history of headaches and a
 generalised tonic seizure. Her clinical g. Botulism
examination was normal. Within a few hours h. Generalized seizure
of her admission she was found dead in her i. Tetanus
bed during the ward round. After autopsy, the j. Viral encephalitis
diagnosis was neurocycticercosis. Which of
this following brain’s location is the possible Question 60-61 are linked to the following case:
cause of patient’s sudden death?
a. The frontal lobe 60. 4. A worried mother brings her 18-month-old
b. The temporal lobe son to the emergency department because of
c. The parietal lobe a rash that developed today. She reports that
d. The lateral ventricle he has had a runny nose, conjunctivitis, and
e. The fourth ventricle diarrhea. On physical examination, he
appears toxic, is temperature to 104ºF (40°C)
dr. ROBERT SOETANDIO for the last 3 days and has diffuse 2- to 3-mm
erythematous rush beginning from their face.
58. You are precepting a resident who has just Of the following, the MOST likely cause of
evaluated a 4-year-old incompletely the rash is
immunized immigrant boy who has classic f. Adenovirus
varicella lesions and a history that is g. Coxsackievirus
consistent with this diagnosis. Of the h. Measles
following, the MOST accurate statement is i. Human herpesvirus 6
that j. Parvovirus B19
a. Lesions of both varicella and smallpox
follow a 7- to 10-day course from 61. Case no 4, if the son got worse. What would
eruption to resolution the complication happened?
b. Lesions of both varicella and smallpox f. Osteomylitis
frequently produce deep, pitted scars g. Encephalitis
c. Varicella lesions appear in stages or h. Otitis externa
crops; smallpox lesions are uniformly in i. Sinusitis
the same Stage of development j. Oral thrush
d. Varicella lesions are concentrated on the
face; smallpox lesions are concentrated Question 62-63 are linked to the following case:
over bony prominences
e. Varicella lesions are transient vesicles; 62. A 10-year-old boy who has moved to your
smallpox lesions are persistent pustules practice recently has sore throats, get high
until resolution of the illness temperature. The child reports a runny nose,
59. You are working in a refugee camp when a mild cough, and abdominal pain. Findings on
mother brings in her 8-day-old boy. The physical examination include a temperature
mother states he started becoming irritable 2 of 100.3°F (38°C), and vesicular lesions on
days ago, and now any loud noise appears to the soft palate. There is no cervical
cause him pain, as evidenced by muscle adenopathy or rash.
tightening and back arching causing his head Of the following, the MOST likely diagnosis
to nearly touch his feet. Physical examination is
reveals only a dried packing on his umbilical f. Adenovirus infection
cord, as is the local custom. He appears g. Coxsackie virus infection
normal until he is stimulated by touch or a h. Mononucleosis
loud noise, and then he begins to cry, stiffens, i. Sinusitis
and arches his back. The stiffness continues j. Streptococcal pharyngitis
until he calms down. Of the following, the
MOST likely diagnosis is
f. Bacterial meningitis
63. What is the name disease what is caused by
coxsackie virus and the location in the
mouth?
a. HFMD
b. Herpangina
c. Conjungtivitis
d. Pleurodynia
e. Streptococcal pharyngitis
Question 64-65 are linked to the following case:
64. A 10-year-old girl presents with a history of
sore throat and difficulty breathing of 1 day’s
duration. She returned 2 days ago from a trip
to Odessa (Ukraine). On examination she is
very ill-appearing. She has some inspiratory
stridor and thick white-gray material
covering her tonsils and faucial pillars, and
she has swelling of her neck, no
splenomegaly. The lymphocyte is normal.
What is the likely diagnosis?
f. Tonsilitis Folikularis
g. Angina Plaut Vincent
h. Mononucleosis infectiosa
i. Laryngitis Akut
j. Faucial Diphteria
65. Case no 64. if we want to give her DAT.
How much should we give DAT?
a. DAT 80.000 IU
b. DAT 50.000 IU
c. DAT 100.000 IU
d. DAT 40.000 IU
e. DAT 60.000 IU
66. According IDAI schedule 2008, when is the
child getting the vaccination booster for the
disease above after 18 months?
a. 5 years
b. 4 years
c. 3 years
d. 12 years
e. 15 years
Question 67-68 are linked to the following case:
67. A 16-year-old boy presents with an annoying
cough, which he has had for about 3 weeks.
The illness started with a runny nose. On
examination he is completely normal, but he
exhibits several episodes of severe coughing.
He is difficult to get inspiratory and usually
finished by vomit. The laboratory results are
leucocytocis and absolute lymphocytes. Of
the following, the MOST likely diagnosis is
f. Tonsilitis Folikularis
g. Bronchiolitis
h. Pertussis
i. Laryngitis Akut
j. Faucial Diphteria
68. The boy in case 67 often gets secondary
infection. What the most organisms is usually
cause the secondary infection?
a. Stafilokokus aureus
b. Treponema palidum
c. Haemophilus Influenza
d. Serratia marcescens
e. Corynebacterium diphteriae
Question 69-71 are linked to the following case:
69. A baby is born with a rash identical.
Questioning reveals that the mother had a
febrile illness during the second trimester of
pregnancy. Examination reveals diffuse
raised purple skin lesions. There is no pallor,
jaundice, or cyanosis. The eyes are cataract,
the heart has a 3/6 systolic murmur, and there
is enlargement of both the liver and the
spleen. There is no lymphadenopathy.
Of the following, the MOST likely diagnosis
is?
f. Congenital Toxoplasmosis
g. Congenital Rubella
h. Congenital Cytomegalovirus
i. Congenital Malaria
j. Congenital Varicella
70. What is vaccination which prevents disease
in number 69?
a. Measles
b. Varicella
c. MMR
d. HPV
e. PCV
71. How old is the baby getting the vaccination?
a. 15 months
b. 16 months
 c. 17 months
d. 18 months
e. 19 months
dr. HANNA
Question 72-73 are linked to the following case:
A 45-year-old man was seen in the dermatology
clinic because of some nodules on his arm and
body and sometimes feel pain with pressure. On
examinations we found erythematous nodules,
smooth and shiny, diffuse infiltrate with ill define
border, no fluctuation or erosion. There were pain
on his elbow with nerve enlaergement.
72. What is the most likely diagnosis?
a. Yaws
b. Leprosy
c. Anthrax
d. Cellulitis
e. Carbuncle
73. What laboratory test would you do to confirm
the clinical diagnosis?
f. TPHA and VDRL
g. Gram preparation
h. KOH preparation
i. Skin scrapping
j. Skin slit smear
74. The 21-year-old man was seen in
dermatology clinic because of sore and
redness on his previous skin lesion. He was
on M D T treatment since 1.5 year ago. On
skin examination they found some painfull
erythematous nodule spread over his body
especially on arm and legs also fever. What
is the most likely diagnosis ?
a. Celulitis
b. Furuncle
c. Erythema nodosum
d. Multibacillar leprosy
e. Pausibacillar leprosy
75. A laboratory examination of a leprosy patient
after 4 months M D T therapy revealed
Bacterial index 6+ and morphological index
50%. What is your conclution for this result ?
f. Pausibacillar leprosy patient sensitive to
treatment
g. Multibacillar leprosy patient sensitive to
treatment
h. Multibacillar leprosy patient resistent to
treatment
i. Pausibacillar leprosy patient resistent to
treatment
j. Pausibacillar leprosy patient prone to
nerve damage
76. A 40-jear-old woman presented with a raised
redness plaque resemble a doughnut with a
raised border that she already had for 1 year,
It was no itchy, no pain, not easily bleeding.
Sometime she feel weakness on her leg and
her sandal left behind while walking. On her
legs she developed an anular erythematous
sharp border lesion, no scally, shiny surface
and enlargement of the popliteal nerve. What
is the most likely diagnosis?
a. Leprosy
b. Yaws
c. Celulitis
d. Anthrax
e. Insect bite
77. A 30-year-old farmer complaned about
weakness on his three fingers that he can not
hold a plough He found some white patches
on his back, tummy arms, he felt numbness
on his right hand but not itching After one
year on medication he experience tenderness
and sore on his right elbow and the skin
patches became red. What is the most likely
diagnosis?
a. Framboesia
b. Scorpion bites
c. Reversal reaction
d. Lepromatous leprosy
e. Ramsay Hunt syndrome
78. A patient on MDT treatment complaining
about red urine that he experinced on the first
day of treatment. What is the suggestion for
this condition ?
a. Stop Clofazimin, can cause pink
brownish discolouration
 b. Continue the medication, its not a drug
adverse effect
c. Stop the medication because of
nefrotoxicity
d. Stop Dapsone can cause anemia
hemolytic
e. Change the treatment to single drug
therapy
79. A 50-year-old man complained about the
treatment for his leprosy since it takes one
year medication with multiple drugs (MDT)
every day. Can you give some explaination
about the length of treatment ?
a. There is no cure for leprosy
b. Leprosy bacteria can’t be killed by 1 drug
c. M D T treatment can cure the disability
d. To prevent from drug resistancy
e. Due to his low immunity
dr. KRISTO
80. Tuberculosis become one of reemerging
infectious disease because
a. More cases of tuberculosis found in
developing countries
b. Found more cases in childrek
c. Found more cases of lung cancer
d. Found more cases of drug resistance
e. More people who smoke
81. Antigenic shift of influenza viruses occurred
in
a. Haemagglutinin
b. Neuramidase
c. M2 protein
d. NS1
e. NS2
82. Epilepsy which occurs in neurosistiserkosis
caused by the
a. Colloidal cyst
b. Vesicular cyst
c. Calcification cyst
d. Necrosis cyst
e. Granuloma cyst
83. Human infection with the beef tapeworm,
Taenia saginata, usually is less serious than
infection with the pork tapeworm, Taenia
solium, because
a. Acute intestinal stoppage is less common
in beef tapeworm infection
b. Larval invasion does not occur in beef
tapeworm infection
c. Toxic by-products are not given off by the
adult beef tapeworm
d. The adult beef tapeworms are smaller
e. Beef tapeworm eggs cause less irritation of
the mucosa of the digestive tract
84. A woman, recently returned from Lampung,
complains of having paroxysmal attacks of
chills, fever, and sweating; these attacks last
a day or two at a time and recur every 36 to
48 h. Examination of a stained blood
specimen reveals ringlike and crescent-like
forms within red blood cells. The infecting
organism most likely is
f. Plasmodium falciparum
g. Plasmodium vivax
h. Plasmodium ovale
i. Plasmodium malarie
j. Plasmodium brasilianumi
85. Malaria is a significant worldwide public
health problem. Which one of the following
control methods for malaria is currently
effective?
a. A vaccine
b. Chemoprophylaxis
c. Antibiotics
d. White clothing
e. Tick repellents
86. A man came to the emergency room with
complaints body felt weak, fever, and
diarrhea since 7 days ago. Prior to the
emergency room, the patient had been to the
clinic 24 hours and given paracetamol and
cloramfenicol for 5 days, but the symptoms
did not subside. For definitive diagnosis in
patients with typhoid fever was the doctor
taking the material for culture from?
a. blood
b. urine
c. stool
d. intestinal secretion
e. bone marrow
87. Typhoid fever pathogenesis is not affected by
a. Antigen Vi
b. Antigen H
c. Gastric acidity
d. Amount of bacteria
e. Antacid drug
88. Amantadine, a synthetic antiviral agent used
prophylactically againt influenza, is thought
to act by
a. preventing production of viral capsid
protein
b. preventing virion release
c. preventing penetration of the virus into
the host cell
d. preventing uncoating of viral DNA
e. causing lysis of infected host cells by
release of intracellular lysosomal
enzymes
89. A 27-year-old female has just returned from a
trip to Southeast Asia. In the past 24 hours,
she has developed shaking, chills, and a
temperature 40o C. A blood smear reveals
Plasmodium vivax. Which of the following
agents should be used to eradicate the
extraerythrocytic phase of the organism?
f. Primaquine
g. Pyrimethamine
h. Quinacrine
i. Chloroquine
j. Chologuanide
90. The mechanism of action of chloroquine in
Plasmodium falciparum malaria is
elimination of?
a. Secondary tissue schizons
b. Exoerythrocytic schizoons
c. Erythrocytic stage
d. Asexual forms
e. Sporozoites
91. A 26-year-old nulliparous woman, in her
seventh month of pregnancy complains of a 7
days history of fever especially at night. As
she recall, 2 weeks ago she ate gado-gado in
coastal area when she out for duty for several
days. She also had diarrhea and abdominal
discomfort. On physical examination reveals
blood pressure 110/70 mmHg, heart rate 60
×/min, RR 20x/min, temp. 39.1°C. Tongue is
coated and tremor. Fetal USG shows normal.
What is the most likely etiologic factor
above?
f. Salmonella typhi
g. Plasmodium falciparum
h. Vibrio cholera
i. Hepatitis A
j. Escherichia coli
92. A young man was admitted to hospital after
increasing left arm pain and paresthesia.
Several days ago, he contacted with a
dog……. His symptoms increased and were
accompanied by hand spasm and sweating on
the right side of the face and trunk. This
patient was admitted to the hospital the day
after developing dysphagia, hypersalivation,
agitation, and generalized muscle twitching.
Which of the following could rapidly destroy
the pathogenic agent of this disease?
a. Infrared radiation
b. Catalase
c. Alkali water
d. Sunlight
e. Heating at 60ºC for 30 minute
93. A 35-year-old man as a farm worker who was
working with pesticides is brought to the
emergency room with headache, vomiting,
salivation, diarrhea, muscle fasciculation,
difficulty walking, and difficulty speaking.
His clothing has been removed, he has been
washed, and he has been given activated
charcoal. What is the most effective
remaining treatment for this case of pesticide
poisoning?
f. Epinephrine
g. Antacid
h. Spironolactone
i. Atropine
j. Hidrochlorothiazide
94. A 27-year-old man came to a clinic with high
fever for two days which is started with a
chill. He also complained of swellings in his
left inguinal area. They were firm, discrete,
and somewhat tender. His scrotums are also
enlarged and tender. His doctor performed a
thick blood smear examination using blood
that was taken at night but found nothing.
 What should the doctor do to make the
diagnosis?
a. Biopsy of the scrotum
b. USG of the scrotum
c. CT scan of the scrotum
d. MRI of the scrotum
e. Aspiration of the scrotum fluid
95. A young man presented to his general
practitioner with a history of headache and
fever together with a dry cough and muscle
ache. His nose was also blocked and his eyes
watery.
What is your clinical diagnosis?
a. Influenza virus infection
b. Human herpes virus
c. Cytomegalovirus
d. Epstein-Barr virus
e. Adenovirus
96. A 4-year-old child presents with fever,
cough, conjunctivitis, coryza, photophobia,
posterior cervical adenopathy. Red lesions
with a white center are present on the buccal
mucosa. A generalized erythematous rash is
also noted. What is the appropriate
management of this patient above?
a. Immune globuline
b. MMR vaccine administration
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics
97. To know the endemicity of malaria on Pulau
Seribu, spleen examination on children aged
2-5 years was done. The result shows that
this place is mesoendemicity.
What is the meaning of mesoendemicity?
a. Spleen rates not exceeding 10 %
b. Spleen rates between 11% and 50%
c. Spleen rates constantly over 50%
d. Spleen rates constantly over 75%
e. Parasite rate not exceeding10%
98. The cattle at animal husbandry are
occasionally was dead because of tick
paralysis, the species of arthropod that can be
the cause to this disorder is;
a. Rhipicephalus sanguineus
b. Dermacentos andersoni
c. Lactodectus mactan
d. Loxoxceles laeta
e. Lytta vesicatoria
99. After contacting with hairy caterpillars, a
farmer felt itching all over the whole body
and his eyes are swollen. The possible cause
of this disorder is:
a. Erucism
b. Lepidopterism
c. Tick paralysis
d. Arachnidism
e. Delusional parasitosis
Question 89-90 are linked to the following case:
A 23-year-old man presents with extreme
swelling of his legs and scrotum. The skin
associated with the swollen areas is thick and
scaly. The patient admits to an episode of fever
associated with enlarged inguinal lymph nodes
some time ago, but did not think much of it.
100. Elephantiasis is caused by the obstruction
of :
a. The arteries by microfilariae
b. The arteries by adult worm
c. The lymphatics by microfilariae
d. The chronic lymphatics by adult worm
e. Fibrosis of the lymphatic
101. Occult filariasis is Lymphatic filariasis
based upon :
a. Infection
b. Allergy
c. Infestation
d. Colonization
e. Genetic
102. A patient complains of having nail size
excrement from his anus. On the stool
examination, parasite eggs contains a hexacanth
embryo with six hooklets surrounded by radially
striated spherical shell, 30 to 40 u in diameter
were found, the most likely diagnosis of this
patient is :
a. Saginata taeniasis
 b. Solium taeniasis c. Human erythrocyte
c. Cysticercosis d. Mosquito body
d. Sparganosis e. Mosquito proboscis
e. Dipylidiasis
107. Plasmodium falciparum is the most
Question 92-93 are linked to the following case: dangerous species because :
f. It make long term relaps
A 40-year-old man came to the clinic with g. Intermittent fever
complaints of having fever more than one-week, h. Gametocyte formation take place in
nausea, and fatigue. He came back from Timika, visceral organ
Papua. On blood smear examination, there are late i. Can make capillary obstruction in Central
trophozoites forms, schizonts with 12-24 Nervous System by parasite contain
merozoites, and the infected red cell is enlarged. erythrocyte
j. There are many drug resistance against P.
103. Of the following, the most likely caused falciparum
of parasite species is :
f. Plasmodium vivax Question 97-98 are linked to the following case:
g. Plasmodium falciparum
h. Plasmodium malariae A 30-years-old woman presents abdominal pain
i. Plasmodium ovale and diarrhea for 3 days duration. She does not
j. Plasmodium cynomolgi complain of nausea, vomiting, or fever. She has no
sick contacts or significant travel history. A stool
104. Fever symptom on the previous question sample is obtained, which reveals larvae form of of
referred to : Strongyloides stercoralis.
f. Sporozoites is in the blood
g. Hypnozoites in the liver is formed 108. In condition below adult form of
h. Merozoites discharged from schizonts Strongyloides stercoralis can be found in whole
enter the blood digestive tract and its larvae can be found in
i. The process of gametocytes in the blood visceral organ (lung, liver, gall bladder) is :
j. Pigment in the parasite is formed a. Eosinofilia
b. Hyperinfection
105. A 27 year old women suffering fever for 2 c. Retrofection
day. She brought to emergency department d. Hypereosinofilia
unconsciously and she had general seizure 2 e. Autoinfection
hour ago. On physical examination she is
comatous, GCS (Glasgow Coma Scale) : 3; BP
90/60 mmHg; t 41 °C. Lab. finding: Hb 10, 3 gr 109. Refer to the case above; further questioning
%; WBC 5800/mm3; platelet 39.000/mm3; reveals that the woman frequently gardens in
there is schizon form on blood smear. The her backyard. Of the following, which one is
most likely diagnosis is : the transmitted form?
a. Malaria viviax a. Fecal – anal transmission
b. Malaria falciparum b. Fecal – oral transmission
c. Malaria malariae c. Fecal – cutaneous transmission
d. Malaria ovale d. Direct contact with skin scales
e. Mix infection of malaria vivax and malaria e. Intravenous drug abuse
falciparum
110. A 10-month-old healthy male infant
106. Sexual life cycle of malaria parasite take travelling with his family to Africa was
place in : exposed 4 days ago to his 4-year-old native
a. Human liver cell African cousin who was ill at the time with
b. Human spleen cell
 fever, cough, coryza and conjunctivitis. The c. Fecal-oral
baby was at risk to get infected by: d. Close contact
a. Corynebacterium diphtheriae. e. Animal bite
b. Haemophilus influenzae 114. A 4-year-old child presents with fever,
c. Bordetella pertussis conjunctivitis, photophobia, posterior
d. Morbilivirus cervical adenopathy, and coryza. Red lesions
e. Coxsackievirus with a white center are present on the buccal
mucosa. A generalized erythematous rash is
111. Her mother makes an overseas phone call also noted. What is the most likely diagnosis?
to your office asking your advice. a. Rubella
Appropriate management of this patient b. Kawasaki disease
includes: c. Adenovirus infection
a. Immune globuline d. Rubeola
b. MMR vaccine administration e. Varicella
c. Measurement of IgG antibody serum
d. Measurement of IgM antibody serum
e. Antibiotics TROPMED 1

112. A 3 year old girl came to pediatric 1. 42yo woman ocme to clinic noted white caps
outpatient clinic with her parents. Her mother in his stools. On stool exam parasit eggs contains
complaint that she had watery diarrhea since hexocant were found. Most likely source:
3 days. This was her 3rd episode of diarrhea in
A. Undercooked pork
the last 2 months. Her mother also noticed
that she was delayed in growth and B. Undercooked beef
development compared to her siblings. She
hardly gained weight and height since last C. Ingestion of larvae on the organism
year. The physical examination showed that contaminated food
her weight and height was below 5th
percentile for girls of her age. D. Ingestion of cystic
What is the most likely underlying
mechanism that caused her repeated episodes E. Ingestion of egg
of diarrhea?
a. Protein catabolism
b. Reduced food intake 2. 40 yo man, fever epistaxis nausea since 2days,
c. Altered lipid metabolism temp 39. Palpable liver. Rumple leed test+. Dhf!
d. Reduced bactericidal activities m confirming lab?
113. A 65-year-old-woman suddenly had A. Ns1
paralysis of her left leg. A few days ago, she
had headache, fever, sore throat, and nausea. B. Platelet count
She lives with her son; daughter in law and a
young grandchild who’s just received a C. Dengie igm igg
routine oral vaccination. She is taking
D. Wbc count
immunosuppressant for her kidney’s
transplant. Her vital signs and cranial nerve E. Ht n eritrosit count
examination are normal. A head CT scan and
lumbar MRI are also normal.
What is the most likely transmission of her
infection? 3. Worried mother bring her 18month son, rash
a. Droplet develop todayn runny nose, conjunctivitis,
b. Air borne diarrhea, lethargy, irritable. Temp 40c for 3days.
Diffuse 2-3mm erythemateous rash beginning 11. IgG dan IgM (+) low avidity IgG.
from face. Sever complication? Management?

A. Sinusitis. A no spesific management

B. Oral thrush B antepartum ganciclovir

C. Osteomyleitis C fetal usg and amnioncentesis

D. Encephalitis D CMV immunoglobin

E. Otiitis externa

12. 32 yo jaundice suffesion conjunctivitis

trombositopenia hepatosplenomegali...
4. 24 yo woman, fever of unknown origin, persist
for 10days, + diarrhea and now become a HbAs Ag
constipated. Brasycardia spleenomegaly
neutropenia lymphatocytosis. Most likely sites of B
infection?
C Anti dengue
A. Ileum
D IgM
B. colon
E MAT for leptospirosis
C. Appendix

D. Caecum
E. Duodenum
9. 28yo male fever productive cough green
mucous 5 hari lalu elevated BP HR 128 RR 28
temp 39,5 diffuse ronchi di chest x ray,
pneumonia
A. Sirs b. Sepsis c viremia d bakteremia
e septic shock
13. A 25 year old man is admitted to the hospital
for evaluating increasing fever of unknown origin
along with malaise, headache, constipation. Nggk
vaksin terus ke daerah rural. Ada bradikardi,
stepladder fever, hepatosplenomegali. Antibiotik
yg dikasih apa?
A. Isnazid
B. vancomycin
C. Clindamycin
D. Metronidazole

E. chloramphenicole
10. 27 yo cold. Unprotected sex. How hiv virus
transmitted?

A saliva b needle stick injury c injecting drugs by 14. Fever high especially at night. Headache and
own needle pain behind eyes. Dignosis

d exposure of intact skin w contaminated blood A. Severe dengue if he was feeling restless and
lethargy
e mostly from mother to infant in gestation

15. Irritable, loud noise gara2 pain karena muscle

tightening and back arching. Phisical examination b. antiviral & supportive therapy
reveals only a dried pcking on his umbilical cord,
as is the local custom appears normal until he's c. supportive therapy & antibiotic
stimulated by touch or loud noise
d. supportive therapy without antiviral
A. Botulism

B. tetanus
19. 45 thn cowo ada nodul di arm & body pain
C. Meningitis with pressure. Erythematous nodules,smooth, and
shiny. Diffuse infiltrate with ill define border,no
D. Encephalitis erosion. Pain in elbow with nerve enlargement.
Lab?
E. generalized seizure
a. slit skin smear

b. skin scrapping
16. Suka main sm puppy, eosinophilia, enlarged
liver c. KOH

A. Pruritus Ani d. VDRL

B. cholecystitis

C. Billiary cirrhosis 20. 67 thn cewe flu like syndrome. Fever 40

derajat,anorexia,headache,muscle ache. 3 days
D. Creeping eruption later cough with sputum. Chest x ray
parenchymal infiltrate. Specimen untuk pcr?
E. visceral larva migrans
a. sputum

b. rectal swab
17. 33 thn cowo with C3 HIV disease.
Fever,nausea,vomiting,hipotensi. Minum c. midstream urine
zidovudin,lamivudine (3TC),abacavir,indinavir.
Develop fatigue, dyspnea,malaise. Then he stop d. CSF
medication. PE: hb turun,ast normal,alt
normal,bilirubin 2 (indirect 1,4). Cause? e. nasopharyngeal aspirate

a. side effect 3TC

b. side effect abacavir 21. Ujungkulon, liver enlarge, on off fever ?

c. side effect indinavir a. Bloodsmear

d. side effect zidovudin b. blood culture

18. 7 thn cowo malaise,anorex,fever,headache. 6 22. Inguinal node swelling, bubo, pustule, ?
classmates kaya gt juga punya symptoms yg diagnosis?
sama. Ada skin lesions macule,papule,vesicle
(multiform). Treatment? a. Tularemia

a. antiviral & antitoxin b. Yaws

 c. Pes

27. 15 years old, male, come to Puskesmas. Fever

since 3 days ago. High fever especially at night.
23. Muscle pain? Headache (+), retroorbital pain (+), nausea (+),
vomit (+). What is the diagnosis according to
a. Trichinella spiralis WHO 2009?

A. Severe dengue if he was feeling restless and

24. Leptospirosis tertular dr mana? lethargy

B. Dengue fever with warning sign if Torniquet

25. 25 years old, male, Balinese. Generalized
seizure. CT scan revealed several calcified
regions. Brain biopsy was performed and
revealed scolex with hooklets. Which parasite is
the most likely the cause:
A. Echinococcus granulosus
B. Trichinella spiralis
test (+)
C. Dengue fever with warning sign if rash (+)
D. Dengue fever with warning sign if abdominal
pain (+) just once last night
E. Dengue fever with warning sign if abdominal
pain (+) more than once last night

C. Taenia saginata 28.

D. Taenia solium

E. Toxocara cati 29. Cowo 30 tahun datang ke puskes dengan

keluhan demam, menggigil, sakit kepala sejak 3
hari. Dengan riwayat demam sejak pergi ke ujung
26. 32 years old, male, come to emergency kulon national park. Pemeriksaan untuk
departement. 1 Week progressive fever, now diagnosa?
become delirium. Jaundice (+), conjungtival
suffusion (+), hepatomegaly (+), Murphy's sign A. VDRL
(-), petechiae on both legs (+). Lab testing was B. HIV ELISA
performed:
C. Urine culture
Leukocyte: 18.000
D. Blood smear
Thrombocyte: 98.000
E. Blood culture
Creatinine: 4

What further examination needed to be done?

30.
A. HBs Ag

B. Widal test
31.
C. Anti-Dengue

D. IgM anti HAV

32.
E. MAT for leptospira

33. 10 y/o had bitten by dog 3 days ago in the
right foot, he was brought to the clinic and
received antibiotic, analgesic and wound
cleansing w/o incision. The bitten site is now
painful, swollen, red and his mother notice that
the boy has fever now. What's possibly happen to
the boy?
A. Local reaction to trauma and need anti..
B. Abscess right foot must get injection of
antibiotic and wound incision
C. Encephalitis stage of rabies infection need to
be isolated and rabies immunoglobulin
D. Local tetanus infection inject anti tetanus
toxoid and tetanus immunoglobulin
E. Rabies infection of right foot inject rabies
immunoglobulin and local vaccination of the
wound
34. 40 y/o man complaint of tingling , itching of
legs 30 minutes after swimming in Lindu lake,
the next day small papules develops followed by
blisters of legs. Which paracyte infected him?
A. Hymenoptera sp
B. Fasciola hepatica
C. Fasciolopsis busci
D. Demencator
E. Schistosoma japonicum
35. 28 y/o man hospitalized for fever more than 7
days, fever higher at noon, felt lower at morning,
fatigue, dizzy, discomfort in stomach,
constipation, lost appetite. Examination reveals
temp 38C, mild pain in abdominal palpated bp
100/70 Hr 70 BPM, tremor, coated tongue. what's
the ethiology of the disease?
A. Escherichia coli
B. Salmonella typhi
C. Bordetella pertusis
D. Shigella dysentriae
E. Campylobacter jejuni
36. 35 y/o man emergency from dyspneu
cyanosis, hemoptisis, chest pain, high fever,
malaise, non productive cough for 1 week. He
works as a sheep farmer and was treated for dark
black skin lesion. Cbc normal, blood + sputum
negative, hemorrhagic mediastitis. Which
virulence factors most likely involved :
A. Exotoxin
B. Endotoxin
C. Alpha hemolytic
D. Lipopolysacharide
E. Antiphagotic factor
37. 45 y.o man, he is going to Mecca for Haji.
What is the vaccine that can be given?
Meningococcal vaccine.
38. 38 y.o man, he is going to Papua for 2 weeks.
What is the prevention drug of malaria?
Doxycycline!
69. a national rescue tem who often travel to
remote areas in indonesia has on-off fever and
chills for 15 days. Arthralgia and headache. PE:
enlarged liver and spleen. He was brought to ER
because suddenly had seizure and finally lost his
conciousness . what is the characteristic of
pathogen that might cause the symptom above?
a. invasion of the RBC by parasite
 b. release of parasite antigen to produce
febrile reaction
c. transmission by injection of
sporozoites
d. digestion of HB in food vacuoles to
produce pigment
e. adherence of infected RBC to small
BV endothel
70. fever since 3 days. High fever all day long.
3rd day platelet :148.000. HT: 42. Treatment
suggestion?
a. inpatient hospital and IV fluid drip
b. inpatient puskes with oral fluid intake
c. inpatient hospital with oral fluid intake
and IV drip when cant take orally
d.outpatient with oral fluid and balik the
next dad u/ cek platelet
e. outparient with oral fluid intake and
balik 3 hari lahi u/ cek platelet
71. HT naik 20%. Digigit sama sapa?
A fruit bat
b. anopheles
c. aedes aegepty
d. close contact with infected person
e. direct contact with infected animal
72. multiple papilomatous skin lesion. Wart like
srawberry. Best bay diagnosed?
a. tissue culture
b. giemsa
c. antitoxin detect
d. darkfield (treponema)
e. gram stain
93. a 40 years old male patient came to the
emergency department due to fever and upper
right abdomen pain since 3 days ago. PE : Blood
pressure 120/80 Heart rate 112 RR 28 Temp 39,5.
Tenderness right upper quadrat. Lab : WBC
17.000 Hb 13,5 Platelet 100.000 SGOT 75 SGPT
17 ureum 80 creatinine 3,3. Hs abdominal USG
shows liver abscess. His condition called….
a. sepsis
b. viremia
c. bacteremia
d. severe sepsis
e. anaphylactic schock
94. Following test would be the most reliable for
confirming the diagnosis in case above :
a. culture of blood
b. complete blood count
c. nucleic acid based test
d. detection of toxin in his serum
95. a 34 years old man comes to dermatology
with hyperpigmentated macules that spread on
his face and his upper arm color lesion white and
feels scaly when t touched. Sometimes he feels
itchy and more itchy when he sweat. Woods light
(+). Lab : large, blunt, short hyphae and thick
wall budding spores (spageti and meatball )
a. candida albicans
b. aspergillus flavus
c. microsporon canis
d. Malassezia furfur
e. Trichosporon belgelii
 marks +, edema, no blister/necrosis. Wound,
tender + on palpation

a) snake toxinspread blood

81. 13 old boy, fever, shaking chill, general ill,
fatigue muscleached & pain. Playing at garden. b) venom -> paralytic muscle
Stung by an insect in dorsal lower right arm. Skin
inflamed, sore, rash, worse in 1st 24hours. c) local inflammation response bite = midvenom
Erythematous surround papulafolicar with pus.
d) envenomation that cause necrotic tissue ->
a. Trepanoma pallidum pain, edema, abscess formation in right calf
b. H ducreyi
c. M. Leprae
d. S. Pyogenes 66. almond smell (intoxication)
e. C minitussismum
a) atropine
82. Rose spot, liver spleen enlarge, drave – b) naloxone
konstipasi, fever 10d, ill, bradikardi. Gold
standard nya? c) physostigmine

d) Na thiosulfate

83. A patient come with an itchy recured fungal

infection on the feet and need some advice to be
cured and some prevention measures so the 67. fever > 1 week, eritrosit winth ringforms and
diasease will not occure again, doctor already enlarged RBC
gave him some medication for fungal infection.
a) ovale
What kind of advise can make him healthy?
b) vivax
f. Don’t eat seafood
g. Use always sandals c) malariae
h. Keep the skin dry and clean
i. Don’t use shoes all day long d)knowlesi
j. Don’t scratch, will spread the infection
e) falciparum

84. 27 y.o pregnant woman found HIV+ on 1. An-8-year-old girl sustains a large
prenatal blood testing, CD4T 410, viral load laceration contaminated with dirt after
35000. Ga mau antriretroviral. To decrease risk falling from her bike. Her mother can’t
nyebar ke anak? recall how many doses of tetanus toxoid
her daughter has received. Management
a. Do nothing of tetanus prophylaxis in this situation of
b. Cesar unknown history of prior doses of tetanus
c. Prophylaxis HSV II toxoid includes:
d. Retroviral after delivery A. Adult-type dT
e. Breast feed until 6 month B. TIG
C. dT and TIG
D. Haemophilus influenzae type b
65. 27 yo man. Snake bite in lower calf 3 hours conjugate vaccine containing tetanus
ago. Swollen, painful, snake: elapidae. Fang toxoid and TIG
 E. DPT
Answer: C
2. If this patient developed seizures, what
substance have responsible in this
patient?
A. Tetanospasmin
B. Tetanolisin
C. Adenylate cyclase toxin
D. Fillamentous hemagglutinin
E. Pertactin
Answer: A
3. A 10-month-old healthy male infant
travelling with his family to Africa was
exposed 4 days ago to his 4-year-old
native African cousin who was ill at the
time with fever, cough, coryza and
conjunctivitis. The baby was at risk to get
infected by:
A. Corynebacterium diphtheriae.
B. Haemophilus influenzae
C. Bordetella pertussis
D. Morbilivirus
E. Coxsackievirus
Answer: D
4. Her mother makes an overseas phone call
to your office asking your advice.
Appropriate management of this patient
includes:
A. Immune globuline
B. MMR vaccine administration
C. Measurement of IgG antibody serum
D. Measurement of IgM antibody serum
E. Antibiotics
Answer: A
5. A 3-year-old boy was brought to
emergency unit Tangerang Hospital with
stridor, dyspnea, and “croupy” cough.
What is your most likely diagnosis?
A. Bordetella pertussis infection
B. Haemophilus influenzae infection
C. Coxsackievirus infection
D. B. Parapertussis infection
E. Corynebacterium diphtheriae
infection
Answer: E
6. What laboratory test to confirm the
diagnosis in this patient?
A. Blood culture
B. Throat swab
C. Chest X-ray
D. Measurement of IgG antibody serum
E. Complete blood count
Answer: B
7. A 2-year-old boy was brought to
emergency unit Balaraja Hospital with
difficulty in breathing, choking, gasping,
and whoop cough.
What is your most likely diagnosis?
A. Bordetella pertussis infection
B. Haemophilus influenzae infection
C. Coxsackievirus infection
D. Adenovirus infection
E. Corynebacterium diphtheriae
infection
Answer: A
8. In this case all the family members
should get the prophylaxis antibiotics as
follow:
A. Amoxicillin 30-50 mg/kg/day p.o. for
14 days
B. Amoxicillin 30-50 mg/kg/day p.o. for
7 days
C. Erithromycin 40-50 mg/kg/day p.o.
for 14 days
D. Erithromycin 40-50 mg/kg/day p.o.
for 7 days
E. Tetrasiklin 25-50 mg/kg/day p.o. for
7 days
Answer: C