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Formative Test

FAMILY MEDICINE

Ikatlah ilmu dengan menuliskannya. ( Ali bin Abi Thalib )


For the question number 1 until 3, refer to the scenario below:
Boy 13-year-old boy brought to your clinic by his parents with complaint of physical aggression
to other children including his younger sister. The school was complained to the parents because
he regularly gets into trouble at school for bullying and truants from school and also stealing from
schools cafetaria. He was a nice boy but his behavior start to change and became worse since 2
years ago. Boy comes from a high socioeconomic family. He lives with his parents, his sister, his
grandmother and grandfather, his aunt and his nephews. His father is aharsh and punitive. Her
mother gives more attention to his younger sister. His grandmother wants his to be a doctor and
always encourages him to study hard.

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


A. ADHD
B. Conduct disorder
C. Mood disorder in adolescent
D. Oppositional deviant disorder
E. Antisocial personality disorder

2. Which of the following statements is appropriate in family psycho education for this case?
A. Accep and care for the patient
B. Avoid too much praising and rewarding the patient
C. Confrontates the patient every time he shows aggressive behavior
D. Give a hard punishment to the patient every time he does not behave properly
E. Have a long discussion with the child whenever he does not behave properly, as soon as
possible

3. Which neurobiological factor below hypothesized to play a role in clinical symptoms in this
case?
A. Low level of plasma dopamine -hydroxylase
B. Increase noradrenergic functioning
C. High 5-HIAA levels in CSF
D. Low serotonin levels in blood
E. Lower right frontal EEG activity during rest

4. An 8-year old male is frequently rude, hostile, and always argumentative towards his teachers.
He becomes easily annoyed by others and disobeys classroom rules. He also only has a few friends.
However, he has not been doing something that violates the rights of others.
Which of the following symptoms is mostly directing the diagnosis towards oppositional defiant
disorder rather than conduct disorder?
A. Disobey classroom rules
B. Easily annoyed by others
C. Always argumentative towards his teacher
D. Has not been violating the rights of others
E. Frequently rude and hostile towards his teachers
5. A 50-year old woman claims she is having heart problem. She already had echocardiogram 2
weeks ago with normal results, but she insisted that perhaps there was a mistake, and ask you for
more examination for her cardiac condition. Your physical examination is within normal limits.
Which of the following is the most likely diagnosis?
A. Malingering
B. Hypochondriasis
C. Conversion disorder
D. Factitious disorder
E. Somatization disorder

6. A 40-year old woman comes to your clinic with multiple physical complaints : headache,
nauseous, and palpitation; and her constipation and gluten intolerance. She states that she always
been sick for most of her life. The patient has a long history of doctor shopping.
What is the best approach to this patient?
A. Assess her regularly for other psychiatric illness
B. Convinced the patient that any physical workup is unnecessary
C. A multidisciplinary approach, utilizing many different specialty service
D. Monthly visit with you, limited diagnostic testing and specialty consultation.
E. Explain to the patient not to worry because there is nothing wrong with her

7. Which of the following explainantion is the most apporpiate for your patient in the beginning?
A. Your pain isnt real. But your psychiatric illness is.Its called somatization disorder.
B. You have unexplained symptoms. There is nothing wrong with you.So I will refer you to
the psychiatrist.
C. Please try to relax, because I dont find anything wrong with your body and all your
complaints is due to stress, its all in your head. You better see a psychiatrist.
D. You have a number of symptoms that are very real but cannot be explained by our
investigation. The evidence suggest that you dont have any threatening illness.You have
a well defined disorder and other patient have similar problems.
E. You have a lot of very serious complaints. But my physical exam is inconsistent with your
complaints.Basically I dont believe a word you are saying.You better tell me the
truth.Because the sooner you admit to falsifying these symptoms, the sooner I can start
helping you.

8. A 40-year old male patient came to PHC with complain of decrease vision gradually
accompanied with no red eye. He denied another complain such asf frequently micturition,
drinking, and eating. He does not have any history of hypertension.
Which of the following structure may affected the patient complaints?
A. Cornea
B. Lens
C. Vitreous
D. Retina
E. Conjunctiva

9. A 65-year old female was diagnosed as blindness due to cataract.


Which of the following criteria is most likely fulfill the WHO criteria for blindness?
A. Visual accuity in the better eye more than 1/60
B. Person who cant see the light
C. Visual accuity in the better eye after correction less than 1/60
D. Visual accuity in the better eye after correction less than 3/60
E. Visual accuity in the better eye less than 1/300

For question number 10 until 13, refer to scenario below :


A young medical doctor was doing home visit to a patient, a 65-year old man, post stroke
infarction. He was bedridden and looked grimace if the right shoulder is moved. Four weeks ago,
he has been diagnosed stroke infarction and been hospitalized for that. He also had history of
hypertension and diabetes melitus for 15 years ago but didnt control regularly. He got
antihypertension drug from the doctor after hospitalized and he took it only if he felt headache. He
always ate sate kambing in the weekend. He was retired government officer and had health
insurance.

10. Which of the following is the main problem of this patient?


A. Post stroke infarction
B. Disability and bad adherence
C. Hypertension and DM
D. DM
E. Bedridden and dyslipidemia

11. Where is the location of stroke infarction of this patient?


A. Cerebellum
B. Medulla oblongata
C. Pons
D. Right hemisphere
E. Left hemisphere

12. Which of the following linguistic and communication disorder is most likely occured to this
patient?
A. Sensoric aphasia
B. Transcortical motoric aphasia
C. Global aphasia
D. Motoric aphasia
E. Transcortical sensoric aphasia

13. Which of the following anti platelets drugs that is the most appropriate for this patient?
A. Heparin
B. Warfarin
C. Streptokinase
D. Aspirin
E. Dipyridamol

14. A 58-year old woman had been diagnosed withcervical cancer and complained back pain since
4 weeks ago. She also had radiating pain and tingling in her left leg. Neurological examination
revealed, there are Laseque and Kernig limitation of left leg due to pain, normal physiological
reflex, and pathological reflex (-).
Which of the following management for her back pain?
A. Pain management
B. Medical rehabilitation
C. Physiotherapy
D. Surgery procedure
E. Chemotherapy

15. A 35-year-old women came with progressing nervousness, fatigue, palpitation, and the recent
development of a resting hand tremor.
What is chief complaint for this patient?
A. A 45-year-old came with progressing nervousness, fatigue, palpitation, and the recent
development of a resting hand tremor.
B. A 45-year-old came with nervousness and fatigue
C. Nervousness, fatigue, and palpitation
D. A 45-year-old came with resting hand tremor
E. Tremor

For question number 16 until 17, refer to the scenario below:


A 32-year-old woman came with severe back pain that was not being relieved by analgesics. She
stated that she also has diffuse abdominal pain and severe headaches. She reported general aches
and pains in all her joints which are little better with ibuprofen. More recently, she had noticed a
difficulty with her balance.

16. during her twenties, the patinet experienced excessive menstrual bleeding and complains of
numbness and tingling in her hands. She already seen many doctors but the complaint is persist.
Based on the component of medical record, which of the following answer is correct?
A. History of past
B. Problem list
C. Managemet plan
D. History of present illness
E. Progress note

17. Ms. S stated that she is the only daughter and has always lived with her parents because of her
health problems. She feels her parents are very understanding and supportive.
Based on the component of medical record, which of the following answer is correct?
A. Problem list
B. Family and social history
C. Managemet plan
D. Data base
E. History of past illness

18. A 40-year-old man came with occasional episodes of headache. And he also complained
blurred vision since two days ago. His father died due to hypertension and stroke. He enjoyed high
cholesterol food and very rare to go for exercise. He is found to have a blood pressure of 170/90.
Which can we do to increase adherence in consuming medical treatment?
A. Give expensive medicine
B. Educations to the patient
C. prescribed a lot of medicine
D. Poor communication
E. Watch TV a lot

19. a 70-year-old female came to you with blurred vision. Her vision was less than 3/60 with
available correction or visual fields less than 10 degree.
Which of the condition is the most common cause of her vision problem?
A. Glaucoma and diabetic nephropathy
B. Trachoma, onchocerciasis, and vitamin A deficiency
C. Age related macular degenerative disease
D. Cataract and refractive error
E. Others

20. Vision 2020 is partnership among WHO, IAPB, Ministries of Health, NGDOs, Professions,
and Corporations. In a country it will be implemented in National Vision 2020 bodies.
Which of the following is the service units of Vision 2020?
A. In district level
B. In province level
C. In country level
D. There is not service units for Vision 2020
E. In primary health service

21. Vision 2020 was launched in 1999. There are some pregress towards 2020 for cataract,
trachoma, and onchocerciasis.
Which of the following is not the characteristics of 10 years of success for cataract?
A. Low cost IOLs
B. Training in ECCE initially and now SICS
C. High volume surgery in S.E Asia Region
D. Sustainability models
E. In primary health service

22. A 75-year-old had been diagnosed with stroke infarction. He still has communication disorder
and weakness of right extrimities as a sequale. He lived with his wife and son that has been married
and has a job with 3 years old boy. He bed ridden only. He was a retired government officer. He
cannot work. He was often looked angry because of communication difficulty.
What rehabilitation problems does patient have?
A. Mobilization, vocational, impairment, occupational and disability
B. Mobilization, communication, vocational, occupational and disability
C. Mobilization, communication, impairment, occupational and disability
D. Mobilization, communication, vocational, and occupational
E. Mobilization, communication, occupational, social, and vocational
23. Various tests to determine the cause of short statured one. Complete blood count and
examination of hormonal.
Which of the following hormonal test that most appropriate?
A. Creatinin and ureum
B. Karyotype test
C. T4 and TSH
D. Bone age
E. Brain MRI
24. A 9-year-old boy diagnosed as short stature. The doctor was planning to gave him hormonal
therapy.
Which of the criteria that most likely the boy had?
A. Weight for age below 2 SD at the WHO growth curves
B. Dysmorphic disorder
C. There is a specific syndrome
D. Delayed bone age more than 2 years
E. Height below -3 SD

For question number 25 until 26, refer to the scenario below:


A 17-year-old girl comes to your clinic accompanied by her mother with complaint of overweight
that lead her to low self-esteem. She comes from high socioeconomic family. Her father is a
success bussinessman and runs several bussinesses, including one most famous restaurant in town.
Her mother loves her very much and cooks her favorite foods almost every day since the patient
was a kid, and the patient really enjoy it and obtain comfort from it. The patient eats with rice three
times a day and many times for snacks. Every time she feels uncomfortable emotions, she usually
asks her mother to cook for her of goes to cafe or restaurants and enjoys any food she wants to.
Physical examination is within normal limits.

25. Which of the following situations is most likely to be the psychodynamic of the patinet in this
case?
A. The patients mother love her too much
B. Her mother loves to cook her favorite foods
C. The patient comes from high socioeconomic family
D. The patient used to obtains comfort from eating as children
E. The patients father runs one most famous restaurant in town

26. Nutritional intake can support the optimal growth and development in every step catch up
growth in children. To calculate the nutritional requirement we need the result of nutritional
assessment and many correction factor that influence nutritional requirement, for example?
A. Gender
B. Alergic status
C. Age
D. Body surface area
E. Liver function

27. 30 yo woman, comes to your clinic with mild acne, spent a lot in skin produts and
dermatological consultation. she felt she's "ugly like a monster", then she had social
withdrawal and she quit her job.
What disorder?
A social phobia
B adjustment disorder: maladaptive reaction terhadap stressful event
C delusional disorder: delusi aja
D adjustment disorder
E body dysmorphic disorder

28. A 33 years old complaint of not getting pregnant for 4 years married. She and her parent does
not have any serious reproductive system.But her nutritional status obese since she was
teenager. Her lipid profile and blood glucose is never in normal limit. What the influence her
nutritional status to reproductive quality?
A. Anatomical abnormality in her reproductive system.
B. Hypercholestremia to HPA axis.
C. Artherosclerosis to her system.
D. Blood glucose to insulin resistance.
E. Abnormal meal pattern.

29. The doctor was doing nutritional assessment from cumulative effect borderline food intake
during catch up growth to a 9 y.o girl. WOTF condition that most likely found in this patient?
A. Development parameter
B. Very low immunity status
C. Short stature
D. Extrene underweight
E. No abnormality

30. To solve the difficulty food intake in children, more of the parent have opinion that milk can
fulfill the nutritional requirement.What is the best explaination to your patient about this
opinion?
A. Its the correct action because milk is the ideal nutritional composition..
B. Give more milk can complete with vegetable.
C. Milk with multivitamin can solve the problems.
D. It is incorrect because of low intake of nonprotein calorie
E. You can add more sugar to increse the calorie intake

31. Increase food intake and improve quality of nutrient content is important to support FTT
management. Advise the best method to increase food intake?
A. Full calorie need
B. Increase step by step
C. More animal protein
D. More milk
E. Limit physical activity

32. Nutritional intake can support the optimal growth and development in every step catch up
growth in children. To calculate the nutritional requirement we need the result of nutritional
assessment and many correction factor that influence nutritional requirement, for example?
A. Gender
B. Alergic status
C. Age
D. Body surface area
E. Liver function

33. To provide food choice and menu variation we need this tool to optimal explanation in
nutritional therapy
A. Food recall data
B. Food frequency questionare data
C. Food list exchange
D. Nutritional requirement and data
E. Food weighing data

34. A 50 y.o man was diagnose having stage 1 hypertension. He was doing excercise to control
blood pressure. WOTF appropriate for him
A. Low fat intake
B. Low cholesterol intake
C. The kind of fat is saturated fatty acid.
D. Omega 3 fatty acid consist in fat food sources.
E. They need only monounsaturated fatty acid.

35. The cause of hypertension are multifactorial, because blood pressure is the outcome from
many system organ and cellular regulation in the body. What is micronutrient that involved
in blood pressure regulation?
A. Ferrum and biotin
B. Vitamin A and C
C. Phospor and riboflavin
D. Calcium and vitamin D
E. Zinc and vitamin E

36. You was doing nutritional counseling for a diabetes melitus patient. To provide food choice
and menu variation we need this tool to optimal explanation in nutritional therapy
A. Food recall data
B. Food frequency questionare data
C. Food list exchange
D. Nutritional requirement and data
E. Food weighing data

37. A 50 y.o man was diagnosed having stage 1 hypertension. Nutritional management in
hypertension important to support blood pressure control. How the management of fat that
most appropriate?
A. Low fat intake
B. Low cholesterol intake
C. The kind of fat is saturated fatty acid
D. Omega 3 fatty acid consist in fat food sources.
E. They need only monounsaturated fatty acid

38. The cause of hypertension is multifactorial, because blood pressure is the outcome from many
system organ and cellular regulation.. What is micronutrient that involved in blood pressure
regulation?
A. Ferrum and biotin
B. Vitamin A and C
C. Phospor and riboflavin
D. Calcium and vitamin D
E. Zinc and vitamin E

39. Nutritional management with time schedule arrangement of main course and between meal
snack important to control blood glucose. Snack Should be low calorie and contains high
fiber food. WOTF aspects that can be controlled by this method
A, Hunger satiety
B.Protein absorption
C.Vitamin absorption
D. Increase fat utility
E.Increase mineral absorption

40. Menu planning is very important to fulfill protein and energy requirement to prevent and treat
malnourished patient. We have to determine the nutritional requirements before formulating
the menu. WOTF steps the most appropriate
A. Calculate total calorie requirement calculate protein requirement calculate fat
requirement, calculate carbohydrate requirement
B. Calculate total calorie requirement calculate protein requirement calculate
carbohydrate requirement, calculate fat requirement
C. Calculate total calorie requirement calculate carbohydrate requirement calculate
protein requirement, calculate fat requirement
D. Calculate total calorie requirement calculate carbohydrate requirement calculate fat
requirement, calculate protein requirement
E. Calculate total calorie requirement calculate fat requirement calculate carbohydrate
requirement, calculate protein requirement

41. In meal planning, formulating some variations of menu is needed to maintain balance diet and
adequate appetite. What tool is usefull to formulate some menu variatioans
A. Nutritional requirements data
B. Food composition list
C. Food weighing data
D. Food frequency questionaire data
E. Food recall data

42. What is the correct role of the family in the weight management of adolescent?
A. A.Follow up daily activity living
B. B.Skip many high calori food
C. C.Increase physical activity
D. D.Motivation behavioural changes
E. E.Decrease sedentary lifestyle

43. a 74 year old woman visited your clinic with complaining of left hip pain. She reported that
she awoke with pain in her hip approximately 2 weeks ago, after her fall. It did not radiate,
initially sharp and severe and limiting her activities for first 4 or 5 days. She denied fall, trauma
and unusual or new activities. Before she fall, she often felt dizziness if she stand after sitting.
The pain was occured when she was getting out of bed. Your diagnosis was left hip fracture
secondary to osteoporosis. You prescribed calcium, vitamin D, biphosphonate and educated
her and her husband about fall preventiom and caring for elderly.
When will you refer to PM&R specialist?
A. After operating
B. One week before operating
C. Immediately
D. After she can getting out of bed
E. After she can gait

For Question 41-42


A 18 years old boy who weights 13,6 kg. This is at the 95th percentile for his height and sex. She
is concerned because her family has many numbers who are overweight and she worries that the
future health are at risk.

44. WOTF advice that most likely for the patient?


A. She should commit to a weight reduction program forthwith
B. The child weight related health is not an issue until he reached adolescent
C. The child should be committed to a weight loss program but not before he reach thae age
2 year
D. A child obesity related health issue involve cardiovascular disease, disease, joint health
only and these problem do not begin until adolescent
E. Obesity in childhood is not an issue

45. A couple now prepare to have a new number of the family. The wife was 8-mont pregnant?
WOTF developmental task will be raised in this stage
A. Adapting to the critical needs and interest of preschool children in stimulating growth
promoting ways
B. Coping with energy depletion and lack of privacy as parents
C. Encouraging childrens educational achievement
D. Establishing a mutually satisfying marriage
E. Having, adjusting to, and encouraging the development of children

For Question 43-44


23 years old male, weight 81,5 kg and height 1,78 m. The patient has no family history of
cardiovascular disease, hypertension, and there is no dyslipidemia in his family. He has never
smoked. He is concerned about his weight because his mother was significantly overweight and
died because of heart attack; and his father is modesty overweight. His total cholesterol: 240
mg/dL, LDL: 110 mg/dL, and triglycerides: 130 mg/dL.
46. What is best education regarding this patients weight?
A. Reassure patient no weight-related health problem
B. Diet 1300 calories, 175 grams carbohydrates, 50 grams fat, and 50 grams protein
C. Very low calorie diet
D. Sibutramine for appetite control
E. No plan based on information given above

47. What is Patients perception abaout his disease?


A. Lab result tends to abnormal
B. His appraisal of severity overweight
C. He has risk cardiac disease
D. He has risk obesity
E. His respond to lab result

For Question 45-46


5 years old girl was brought to the office due to her height that shorter than other. Her height was
under 5th percentile in growth curves, even when correct for midparental height. There are many
factors to short stature. She only speaks six-word sentences but they are intelligible.

48. What is family influence could potential cause of her problem?


A. Psychological and social character of parent
B. Spreading infectious disease among family
C. Parental deprivation
D. Klinefelter syndrome
E. Environment condition of family

49. The parents are concerned about her development as well. Which the following respond is the
most appropriate:
A. Refer the child to specialized evaluation of development
B. Arrange conference with child teacher
C. Order MRI of child brain
D. Reassure the parents that the child is developing within normal limit
E. Review of the milestone of growth and development in this child

50. Mr. and Mrs. Purcell, Marry 21 tahun and Bob 17 tahun bersama dr. M. Mary spoke first and
express concern about her fathers long-standing health problem. She blamed her mother
for not taking better care for him. Bob quickly defended his mother by saying she had been
working very hard and mad a lot on her sister. Bob became upset with Mary for attacking
their mother. Mrs. Purcell told Dr. M that her husband had health complains for as long as she
had known him. Mr. Purcell then said that his chest pain were worse since the last doctor
appointment. Family APGAR score = 3.
How hierarcy taking place in this family?
A. Parents in charge to their children
B. Parents is controlled by the children
C. Overtly distributed
D. Covertly distributed
51. Based on family APGAR score,what is the characteristics of this family?
A. Radiate a sense of integrity
B. Share power while negotiating decisions
C. Cope relatively well with adversity
D. creating coercive power differentials
E. coming out of a crisis stronger for the experience

52. Lisa is a 48 yo woman who works in an animal laboratory. At first visit, you note that her
BP has been elevated 160/95 mmHg and 155/100 mmHg respectively. She has no history of
hypertension and is not on any medications. Assuming that the initial evaluation does turn
up surprises, what should be your initial management?
A. Looking for symptoms of end-organ disease
B. Exploring cardiac risk factor
C. Starting with single drug anti hypertension
D. Starting with combination drug anti hypertension
E. Starting with lifestyle modification

For Question 50-51


A 61 years old business executive with a long history of high blood pressure collapsed while
jogging over the lunch hour. His jogging mate quickly contact a police officer who help carry the
man to the hospital just down the road. An MRI was performed that reveal a major blockage of a
major cerebral artery and ischemic changes to a portion of brain. With quick attention, the man
has stabilized and he slowly improved over the next three weeks.The following sign and
symptoms did persist however:
-Paralysis of the right leg and foot
-Loss of sensation of the right leg and foot.
-When blindfolded, unable to identified a tennis ball with his left hand, but ability to named it
when in the right hand.

53. What is a physician role on this stage?


A. Ease the the patient and family axiety and concern
B. Responsible of making a clinical judgement about the amount of information
C. Alert about potential problems that may occurred.
D. Defined psychological state of the patient and family about therapeutic plans.
E. Anticipate the second crisis of adaptation to the outcome.

51. there are many categories to placement a patient into home care program. if you plan for
home program for this patient, wht is the category for this patient?
a. unstable chronic illness
b. acute exacerbations of illness
c. patient still require medical supervision
d. patient requiere rehabilitation
e. advanced illness

For Question 52-53


bambang, 72 yo, retired driver who was admitted to your practice because of back pain. Smoker
for 30 years, smokes 15 cigarettes every day. Bill lives alone in a small house and has lost about
5 kg in the past few months. his diet has deteriorated since his wofe passed away 2 years ago.
Bill's daughter accompanies him to visit GP, as she is concerned about his recent weight loss. his
current medicine history includes ramipril 5 mg once daily in the morning for well-controlled
HT. he has no significant family medical history. on exam bill's BP is 115/78. a bone mineral
density test T-score in the hip is -1,8 and the spine is -2.7.

52. What is your recommendation for him to reduce risk of fracture?


a. hormone replacement therapy
b. hip protective padding
c. gait and balance training
d. prescribing high dose vit D

53. what information would you provide for patient regarding "physical activity"?
a. low impact weight bearing exercises.
b. low impact weight bearing exercises combined with high intensity strength (resistance)
training
c. low impact weight bearing exercises combined with low intensity strength (resistance)
training
d. high impact weight bearing
e. high impact weight bearing exercises combined with low intensity strength (resistance)
training

For Question 54-55


60 yo postmenopausal woman is seeing you for annual check up. she has been in good general
health for the past several years. she experienced menopause in her early 50s and initiated
hormone therapy (H1) with estrogen/progestin for her menopausal symptoms; she has remained
on HT primarily for prevention of osteoporosis. she's currently not on any chronic medication
other than HT.
she has no history of fracture, her older sister has a hip fracture. she is 165 cm and 42 kg. she
smokes cigarettes, drinks several cup of coffee a day and rarely exercise. her height has remained
stable over the past 4 years.

54. what is the patients major risk of future fracture


a. estrogen deficiency at an early age (<45 years)
b. low physical activity
c. alcohol on amounts >2 drinks/day
d. high BMI
e. history of fragility fracture in a first degree relative

55. what is the treatment option for her condition?


a . discontinuation of hormone replacement therapy
b. continued hormone replacement therapy
c. continued hormone replacement therapy and initiation of biphosphonate
d. no need treatment for current condition
For Question 56-58
A 64 years old woman, P4A2, Mrs. Yusi visited you with severe pain in hip area. the pain is
constant, boring sometimes sharp with infrequent electric-shock like sensation radiating to left
foot. She was diagnosed as cervical cancer stadium IIIB patient and receiving chemo
radiotherapy. complaint acompanied by nausea, vomitting, and dyspnea for the last 3 days. she
has not receives any medication for relieving pain.

56. how should a drug be administered?


a. paranteral
b. per enteral
c. injection
d. infusion
e. orally

57. after several weeks, mrs. yusi looked severely ill and she was asking you to assure her family
members that her condition is better and no worries any more. According to "five stages of
dying", the stage of Mrs. Yusi is the following
a. denial
b. anger
c. acceptance
d. bargaining
e. depression

58. Screening is one strategy to prevent cervical cancer. if screening test were negative, what
would be your recommendation?
a. its important to be screened annually
b. its important to be screened every 2 years
c. its important to be screened every 3-5 years
d. not necessarily to be screened in the future

59. Rani, 26 yo, G2P1A0, present in the initial visit with 4th week history of fatigue and nausea.
pregnancy test (+) 2 weeks ago. she has been on multivitamin preparation with folic acid, she has
been immunized against hepatitis B within the past 3 years. from PE she is well appearing,
mildly overweight. Vital sign and other exam are within normal limit. your assessment is
intrauterine pregnancy. considering her weight, what is recommended weight gain during her
pregnancy?
a. 15-18 kg
b. 12,5 - 18 kg
c. 11.5 - 16 kg
d. 7-11,5 kg
e. maximum 6,8 kg

60. You are counseling an expectant couple (woman P0A0) regarding prevention care should be
performed. they are not planning for pregnant at least in the next 3 months. No history of
smoking, alcohol, previous disease and family hereditary disease. What kind of prevention care
should be performed at this time?
a. administrative of MMR, varicella, and hep B vaccines
b. starting prenatal vitamins and/or folic acid supplementation
c. education on the benefit of breast feeding
d. performing amniocentesis
e. administration on tetanus toxoid vaccine

61. interpret the genogram above from lifecycle perspective


a. nuclear family, family with teenagers
b. extended family, family with teenagers
c. nuclear family, family with launching young adults
d. extended family, family with launching young adults
e. nuclear family, middle aged parents

62. dr. Rio, family physician plan to do a clinical audit for his clinical practice
WOTF could be audited in term of structure of care?
a. operating time
b. management of patients
c. mortality
d. health indices

63. prior clinical audit in the management of asthma patient, dr yono develop standard target and
criterion. after developing standard, what should dr yono do
a. reviewing literature
b. compare practice with standard
c. data collection
d. implement change
e. re-audit

64. there isnt much structure here for children and parents often dont set rules or have
guidelines for the child. they dont have many expectation for the children, they avoid conflict
and are more nurturing to the child.. they are more lemient when it comes to misbehaviour and
often dont punish the children for wrong doing. child have hard time communicating with
parents about things they found important to them. what type of this parenting style?
a. authoritarian
b. authoritative
c. permissive
d. uninvolved
e. neglected

65. Which one the structure of family that have better influences?
a. single parents family (mother)
b. single parents family (father)
c. blended family
d. intact family
e. the other

66. 60 yo obese female have DM II. her doctor told her, beside pharmacology treatment, she also
has to modify her lifestyle especially about routine exercise to decrease BW and increase CV
fitness. the exercise can be effective to decrease BW if the duration...
a. 15 min
b. 20 min
c. 30 min
d. 60 min
e. 120 min

67. 40 yo male come with cc headache. his BP 150/90. the family doctor do head to toe PE, LE,
and other supportive exam. then doctor decides to treat him with supportive therapy for headache
and lifestyle modification including exercise. WOTF the most appropriate for the target heart
rate?
a. 220x/min
b. 200x/min
c. 153x/min
d. 135x/min
e. 90x/ min

68. To do continuous aerobic activity, we can use the target heart rate methods if?
a. the patient have pacemaker in the heart
b. the patient have irregular heart rhythm
c. the patient take medication that change the heart rate
d. the patient is overweight but the ECG is normal
e. the patient have atrial fibrillation

69. Which of the following are risk factor for cervical cancer?
a. diabetes, STD
b. multiple sexual partner, smoking
c. hypertension, genetic disorder
d. none of the above

70. What are the principles of palliative care?


a. enhance quality of life
b. relief from pain and other symptom
c. integrates psychological and spiritual aspect to prepare dying in faith
d.. all of above

71. Here are the stages of emotion reactions of terminal illness patient?
a. anger, depression, bargaining, denial, and acceptance
b. denial, anger, bargaining, depression, and acceptance
c. anger, denial, bargaining, acceptance, and depression
d. anger, denial, guilt, depression, and acceptance
72. whom should preconceptional care should be performed?
a. women with history of congenital anomaly child
b. women with underlying medical problems
c. all women of childbearing age
d. only a and b are true

73. when should preconception counseling be performed


a. 6 mo before couple considering pregnancy
b. by the time of the first prenatal visit
c. after married
d. 1-2 years before couple considering pregnancy

74. what are the risk associated with advanced maternal age (>35 years)?
A. pre eclampsia, gestational diabetes, prolonged labor
B. chromosomal anomalies, spontaneous abortion, pr eclampsia
C. fertility increases, post partum haemmorhage, gestational diabetes
D. chromosomal anomalies, fertility increase, gestational diabetes

75. WOTF is important goal of preconceptional care?


A. prevent ununtended pregnancy
B. initiate preventive care measures
C. identify genetic and obstetrical RF
D. all above

76. Ampicillin and Paracetamol cannot be mixed in one preparation, because of what reason?
A. Ampicillin is a causative drug and Paracetamol is a symptomatic drug.
B. Ampicillin need to be given in different time with paracetamol therefore it requires to be
written in different prescription.
C. Paracetamol can be given with Dexamethasone in one preparation
D. Ampicillin can be given with Paracetamol in one preparation because both have to be
given before meal.
E. Ampicillin can only be written in one prescription and as antibiotic, the administration
has to be with meal.
77. A 27 years old woman using oral contraceptive, with tuberculosis infection. Which of the
following is correct?
A. TB drugs are given but the contraceptive is changed into Intrauterine Device (IUD)
B. Oral contraceptive are given but the TB drug only taken for 2 months
C. Oral contraceptive is stopped but TB drug is given all the time
D. Oral contraceptive and TB drug is taken both
E. Oral contraceptive is changed into another drug that have interaction with TB drugs
78. Which of the following TB drug is an inducer metabolism?
A. Streptomycin
B. Isoniazid
C. Rifampycin
D. Pyrazinamide
E. Ethambutol
79. Which of the following drug should be avoided to be given with Salbutamol?
A. Theophyllin
B. Ammoxycillin
C. Ephedrin
D. Diltiazem
E. Simvastatin
80. Nutritional management of hypertension is?
A. High fat diet
B. Low salt diet
C. High protein diet
D. High carbohydrate
E. Low calcium

81. 43 years old man presents to his primary care physician. Which of the following is the risk
factor of primary hypertension?
A. Hypocholesterolemia
B. Obesity
C. Young age
D. Vegetable consumption
E. Vacation
82. Family health belief about illness perception?
A. Biological aspect
B. Physiologic aspect
C. Clinical aspect
D. Comprehensive aspect
E. Cultural aspect
83. What can we do to increase adherence in consuming medical treatment?
A. Give expensive medicine
B. Education to the patient
C. Prescribed a lot of medicine
D. Poor communication
E. Watch TV a lot
84. A 55 years old obese male has been diagnosed as DM type 2. His doctor told him about his
management plan. Beside pharmacology treatment, he also has to modify his lifestyle especially
about routine exercise. The doctor told him that exercise could help decreasing his body weight
and increasing cardiovascular fitness.
Which of the following type of exercise that most appropriate for him?
A. Aerobic
B. Anaerobic
C. Weight training
D. Endurance
E. Resistance
85. A 58 years old with nephropathy diabetes wanted to start exercise program. He took insulin
to control his blood glucose level. The doctor planned to do blood glucose monitoring before,
during, and after exercise before arranging his exercise program.
Which of the following reason that most appropriate for the blood glucose monitoring?
A. Exercise has insulin-type effect
B. Exercise can alter the glucose level
C. Carbohydrates will abruptly decrease during exercise
D. Exercise dosage depends on the glucose blood level after exercise
E. Exercise for nephropathy diabetes can only be done under doctor monitoring
86. A 55 years old male, former tennis athlete, with type 2 DM came to his family doctor. He
also diagnosed as having a moderate cardiovascular disease. He told the doctor that he still
wanted to do some sports.
Which of the following aspect must be done before starting his exercise program?
A. ECG
B. Stress testing
C. CKMB
D. Cardiovascular fitness test
E. Angiography
87. A 56 years old female with type 2 DM came to the doctor and asked an advice about her
exercise program that is most suitable for her. Except for her BMI (obese), her physical
examination and blood glucose level is normal.
Which of the following exercise program that is most appropriate?
A. 30 minutes a day, 3 times a week, mild intensity jogging or swimming
B. 30 minutes a day, 2 times a week, mild intensity jogging or swimming
C. 60 minutes a day, 2 times a week, high intensity weight training
D. 60 minutes a day, 3 times a week, moderate intensity treadmill
E. 30 minutes a day, 3 times a week, mild intensity of static cycling
88. A 50 years old male with hypertension stage 2 now have management plans from his family
doctor. The management plans include lifestyle modification such as exercise. He told the doctor
that he always does sport. He plays badminton twice a week, but uncertain about the duration
because he must did it alternately with his other friends. The doctor told him that that kind of
sport is not enough to improve his health condition.
Which of the following that is most appropriate reason for doctor explanation?
A. Badminton is not aerobic exercise
B. His sport activity is not done regularly
C. There is no weight training in badminton
D. Lack of frequency
E. Badminton makes him prone to injury
89. A 33 years old male had hypertension. But after doing adequate exercise and diet program
for 6 months, now his condition was improving. The blood pressure is normal, and there is no
abnormality at his cardiovascular condition.
Which of the following that most appropriate reason for this improvement?
A. Increasing the symphatetic tone
B. Increasing the blood cathecolamine
C. Lower cardiac output and peripheral vascular resistance
D. Altered renal function lead to decrease elimination of sodium
E. Increasing submaximal exercise peripheral vascular resistance
90. A 55 years old male with hypertension stage 2 with suspected cardiovascular disease needs
exercise prescription for his family doctor.
Which of the following that is most appropriate exercise prescription for him?
A. 20-30 minutes/day continuous aerobic activity at maximum heart rate 50-65%
B. Light moderate intensity until evaluated and conditioned with periodic monitoring
C. Light moderate start with 20-30 minutes lower intensity/day with periodic monitoring
D. 60 minutes/day of aerobic exercise without periodic monitoring.
E. Start with 60 minutes/day of resistance training
91. A 48 years old female with stage 2 hypertension and no cardiovascular disease need exercise
prescription for her family doctor. She felt uncomfortable about exercising.
Which of the following is the most appropriate exercise prescription for her?
A. 20-30 minutes/day continuous aerobic activity at maximum heart rate 50-65%
B. Light moderate intensity until evaluated and conditioned with periodic monitoring
C. Light moderate start with 20-30 minutes lower intensity/day with periodic monitoring
D. 60 minutes/day of aerobic exercise without periodic monitoring.
E. Start with 60 minutes/day of resistance training
92. Dr Amin intends to ask for the second opinion and he writes the letter for his colleagues
including all patients significant problems. State the physicians main findings, the investigation
that have been carried out, all medication and the purpose of consultation.
What type of referral for this case?
A. Formal consultation
B. Informal consultation
C. Interval referral
D. Cross referral
E. Split referral
93. The responsibility of patient is divided more or less evenly between two or more physician.
What type of referral for this case?
A. Formal consultation
B. Informal consultation
C. Interval referral
D. Cross referral
E. Split referral
94. A 22 years old woman has been brought home from a private college because of the
occurrence of seizures that often occurred in her room in womens dormitory. She is hospitalized
and her family doctor visits her at the hospital. He witnesses a seizure and suspects that they are
not organically based, that is hysterical or pseudo seizures.
Which of the following somatoform disorders present in the patient?
A. Conversion disorder
B. Somatization disorder
C. Pain disorder
D. Hypochondriasis
E. Malingering
For question number 95 and 96, refer to the scenario below
A 48 years old man has manifested BP levels of 150/100, 145/95, and 170/105 on consecutive
separate days over a 3 week period. He has a family history of deaths by stroke and renal failure.
95. Which of the following may be the single most appropriate drug to be prescribed?
A. Hydrochlorothiazide
B. ACE Inhibitor
C. Beta adrenergic blocker
D. ACE receptor blocking agent
E. Vasodilator
96. Which of the following is the screening should be performed by his children?
A. Blood pressure every 6 months for people with hypertension
B. Blood pressure every 12 months for people with hypertension
C. Blood pressure every 2 years for people with hypertension
D. Blood pressure every 18 months for people with hypertension
E. Blood pressure every 18 months for people without hypertension
97. A 75 years old man is in good health and mentally competent to care for himself. He
underwent complete examination 5 years ago that included a normal screening colonoscopy, and
he has submitted fecal occult blood test in the intervening years. He lives alone and wishes to
undergo a routine health maintenance examination.
Which of the following would be least fruitful as a screening test?
A. Flexible sigmoidoscopy
B. Thyroid stimulating hormone test
C. Urinalysis
D. Blood pressure reading
E. Up and go test
98. How is fever mediated through a pyrogen?
A. Pyrogen increases thrombocytes
B. Pyrogen increases interleukin-1 production
C. IL-1 stimulates the posterior hypothalamus
D. Prostaglandin stimulates interleukin-1
E. Increase the prostaglandins will decrease the set point
99. What is the body mechanism to get rid the excess heat and how do they work?
A. Prostaglandin stimulates interleukin-1
B. IL-1 stimulates the posterior hypothalamus
C. Sweat glands activated by symphatetic muscarinic receptors to produces heat loss
D. Sweat glands activated bt symphatetic muscarinic receptors to increase the prostaglandin
E. Increase the prostaglandin will decrease the set point
100. On a preventive screening for a 16 years old girl who began menarche at age 12. Her cycles
are every 30 days with 4 days of moderate flow. Her last menstrual period was 2 weeks ago. She
denies ever being sexually active.
At what age should Pap smear be performed on her?
A. At age 16
B. At age 17
C. At age 20
D. At the age of the first sexual activity
E. At the age of regular sexual activity