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MCQ Gastro Batch 2016

1. Proses menelan pada Oral stage: Tongue is drawn upwards and backwards against hard
palate

3. Effect of gastrin: Increases gastric secretion & motility

4. What effect of somatostatin ? Inhibits gastric secretion

5. the effect of CCK in digestion process? Increases pancreatic enzyme

(*Secretion of CCK is stimulated by proteins and fats that enter the small intestine)

6. Small peptide diubah jadi amino acid lewat enzyme apa?

a. carboxypeptidase
b. pepsin
c. trypsinogen
d. chemotrypsin
e. peptidase

7.what do they need to transport fruktosa into cytosol?

a.glut1
b.glut 2
c.glut3
d. glut 4
e.glut 5

8. yang carry monoglycerides + free fatty acids masuk ke intestinal lumen

a. chyme
b. pancreatic enzyme
c. micelles
d. intestinal enzyme
e. chymokine

10. Acid chyme di duodenum efeknya adalah

A. Increase gastrin
B. Increase secretin
C. Increse somatostatin
D. Increase cck
E. Decrease gastrin/ secretin

15. komplikasi nomer 14

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17. 65-year-old woman presents with abdominal pain, night sweat, and early satiety. Physical
Examination shows multiple enlarged lymph nodes in supraclavicular and mass in epigastric
region. Hb 7 g/dL, WBC normal. What is the gold standard for diagnose and treatment this
patient?
A. Upper GI X-Ray
B. Peripheral Blood Smear
C. CT scan of abdomen
D. Upper endoscopy with biopsy
E. USG with contrast

18. 1 month old baby present with diarrhea since 2 days before admission. he has watery
diarrhea for 4-6 times per day with no blood, no mucus, and acid smell, not bulky, not oily. his
mother complained that the baby has rash around his buttock. what substance that was not
properly absorbed in the case above? (Lactose Intolerance)
a. fats
b. protein
c. carbohydrate
d. vitamin
e. mineral

22. 45 y.o. complained discomfort & abdominal pain localized to the RUQ. An abdominal USG
showed a multiple diffuse nodules in liver. Biopsy showed tumour cells that have more
prominent nucleoli, coarser chromatin & Mallory’s hyaline. This finding typical for
A. HC adeno
B. HCC
C. Cavernous hemangioma
D. Cholangio sarcoma
E. Hamartoma

25. A 43-year-old woman came to a clinic with complains of yellowish colour on her eyes
and skin. Five days ago she suffered right upper abdominal colicky pain for several days
especially after eating fatty food. Now the colic is gone for two days.
Which substance that most likely to be increase in the serum? (Post-hepatic Jaundice)
a. Unconjugated bilirubin
b. Albumin
c. Globulin
d. Cholecystokinin
e. Conjugated bilirubin (v)

26. Which of the following structure is most likely to be altered on the case above?
A. Ductus pancreaticus
B. Ascending part of duodenum
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C. Ductus hepaticus communis

D. Ductus cysticus
E. Common bile duct

29. Hypovolemic shock in acute pancreatitis is caused by?

a. fluid loss due to vomiting
b. fluid loss due to diarrhea
c. blood loss to intestinal lumen
d. blood loss to peritoneal cavity
e. sequestration of fluid to the third place

30. upper burning epigastric pain. which drug is the fastest to relieve that symptom?
a. metronidazole
b. some h2 inhibitor
c. antacid

33. Female, 24 years old come with complaints of black tarry blood and has history of epigastric
pain after meal. Doctor perform gastric lavage and prescribe antacid and sucralfate via
nasogastric tube. Mechanism of the medicine?
A. Depress vomit centre in the brain stem
B. Increase peristaltic movement
C. Coating gastric necrotic tissue
D. Block proton pump
E. Block H2 receptor

35. 40 yo has long history of chronic alcohol abuse. PE = his liver edge is firm on palpation. He
most likely remains at risk for development of which of the following disease:
HCC (AFLD → Steatohepatitis → Fibrosis → Cirrhosis → HCC)

37. a 55 year old man who has had no medical care since childhood presents with no symptoms
but ask about test for lower gastrointestinal cancer, he has no family history for any cancer.
What test would you advice?
a. series of 3 occult blood tests (FOBT)
b. abdominal ultrasonography
c. colonoscopy
d. digital rectal examination
e. abdominal CT scan

“At present, the American Cancer Society suggests fecal Hemoccult screening annually and
flexible sigmoidoscopy every 5 years beginning at age 50 for asymptomatic individuals having
no colorectal cancer risk factors.”

38. A 60-year-old male, come to the Siloam Hospital with a chief complain of bloody vomiting.
The blood was red and fresh. The patient also tells that his stool was dark. At physical
examination, there are palmar erythema, spider naevi, and ascites at the abdomen. The USG
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show a nodule on the right lobule of the hepar. Which of the following test that can help you
diagnose?
a. CA 19-9
b. α-feto protein
c. PSA
d. CA-153
e. Seromoeba

39. 58 years old man goes to ER because of black and tarry stool. He regularly drink herbal
medicine in powder form that he buy from the traditional market. No history of liver disease.
What is the reason for his black stool?
A. Erosive gastropathy
B. Encephalopathy
C. Gastric carcinoma
D. Peptic ulcer
E. Perforated esophageal varices

43. Meri, a 3-year-old girl, came to the Puskesmas with ulcer on her left leg (K). Through
the history taking it was revealed that Meri had not been well fed in this past year since her
father lost his job. From her physical examination it was found that her BMI (body mass index)
was below -2 SD (standard deviation) for girls of her age. She was fully alert but looked pale
with a face appearance like a thin old person (M). Her ribs were very prominent (M) but
her both legs were oedema (K). Based on this information, Meri was likely to be classified in
which condition below?
a. marasmus
b. kwashiorkor
c. marasmic-kwashiorkor
d. energy malnutrition
e. protein malnutrition

44. Aganglionosis (??) Primary achalasia*

45. A 53 year old male with history of constipation and weight loss has positive stool occult
blood on routine rectal examination. Colonoscopy: mass 6 cm diameter. Colectomy was carried
out. Gross appearance: cauliflower-annular encircling mass in upper portion of descending
colon & several lymphonodules of mesocolon around this mass. Which condition most likely
present?
a. Squamous cell carcinoma
b. Nonhodgkin lymphoma
c. Hodgkin lymphoma
d. Adenocarcinoma
e. Leiomyosarcoma
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48. A 45- year old man was admitted to the emergency department complaining of severe
pain in the right lower quadrant of the anterior abdominal wall. He had repeatedly vomited,
and his temperature and pulse rate were elevated. On examination, the muscles of the lower
part of the anterior abdominal wall in the right lower quadrant showed tenderness at the MC
Burney point. You are at surgery for removal, but the organ is not visible.
What position of this organ is likely to be?
A. Paracecal
B. Paracolic
C. Retrocecal
D. Iliocecal Retrocoli

49. 78 years old man came with osteoarthritis which doesn't relieved by paracetamol. Treatment
with NSAID is suggested. He also has peptic ulcer. Which class of drugs when given with
NSAID is the most effective in preventing the recurrence esophageal GI ulceration? 3
recommended options: Misoprostol, PPI, or H2-RA
A. Anti-Muscarinic
B. Bismuth chelates
C. Dopamine antagonist
D. Proton pump inhibitor (Lansoprazole)
E. Simple antacid (aluminum

50. A 18 years old man presents with intermittent cramp abdominal pain, no blood diarrhea,
weight loss 5 kg over 6 months. The diarrhea wakes him from sleep. On a few occasion, he has
had fever, nausea, and vomiting. The patient describes his work as being stressful. PE: normal
vital signs. He has an oral aphthous ulcer and poorly localized lower abdominal to mid
abdominal tenderness without peritoneal signs. Anal and rectal examinations are normal. A
stool guaiac test is negative. Stool leucocytes are present. Hb 11,5 and Ht 34%. Result of
sigmoidoscopy are normal. Which of the following is most likely diagnosis for the patient?
A. Acute Appendicitis
B. Crohn disease
C. Colon cancer
D. Irritable Bowel Syndrome
E. Ulcerative Colitis

58. 70 thn male, ada weakness, easy fatigue & mild abdominal discomfort. PE is pallor at skin's
mucous membrane. Rectal exam ada enlarged prostate. Next step management? <TRUS>
a. Perform endoscopy
b. Perform schilling test....
c. Stool for occult blood
d. Detect serum iron level
e. Blood transfusion

61. Anak lahir jam 9 PM, prematur. Di kasih susu, sakit, muntah cairan kuning. Sakit apa?
A. Duodenal atresia (Vomiting occurs within 24h after birth)
B. Pyloric Stenosis
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62. seorang wanita menjalani right colon cancer surgery. pada follow up setahun kemudian,
ada kenaikan serum CEA. pemeriksaan thorax dan abdomen normal. Ke mana paling
mungkin tumor bermetastasis?
a. brain
b. bone
c. liver
d.
e. surgical scar

70. 25 years old woman come to ER complain of diffuse abdominal pain since last 4 days ago.
She developed right lower abdominal pain. It become severe then yesterday the pain bla bla....
(Clue: Pain migration dari epigastric → RLQ → diffuse)
what pathological changes have occured?
D. Acute bacterial inflammatory peritonitis due to perforated appendicitis
Pilihan lain lupa maaf

73. A boy, 7 month, came with watery stool since 3 days before. No mucus and blood found.
He vomited several times a day, and he started to get fever since yesterday. He still breastfed
and eager to be fed. His mother never clean his breast every times her baby breastfed. He started
his first meal 1 month ago, and his mother started to give him formula milk since 4 days ago.
What is lost in the diarrhoea?
A. Nutrient, electrolyte, mineral
B. Electrolyte, mineral, glucose
C. Glucose, mineral, nutrient
D. Electrolyte, mineral, water
E. Water, electrolyte, nutrient

75. Cowo, 21 thn, dull pain, pas dikasih obat langsung fast relieve tapi pas lepas treatment
lgsg sakit lagi, hasil biopsi duodenal ulcer, dikasih obat apa yg relievenya cepat
A. Somatostatin Antagonis Reseptor
B. Gastric Acid pH Buffer (Antacid)
C. Histamin 2 Antagonis Reseptor
D. H-K-ATPase Agonis
E. Gastrin Reseptor Agonis

[ GADA NOMOR ]

Thomas, A 45 year old man suddenly experience sharp pain and spread to his back. His
abdomen looks puffed up. He has history of heavy drinking alcohol since young. His physician
suggest that he has a problem in pancreas enzyme or intestinal digestion. What is the effect of
CCK digestion process?
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a. Increase pancreatic enzyme secretion from pancreas

b. Increase bicarbonate ion secretion from pancreas
c. Decrease gastrin secretion in gaster
d. Decrease acid secretion in gaster
e. Increase intestinal enzyme secretion
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18. Taste buds ditemukan di mana? (Any papillae but the filiformis)
Papila circumvallate

19. Certain terapi antibiotik slow replacement of the cells lining the small intestines. Cause
loss which type of tissue?
A. Cilliated pseudostratified columnar epithelium
B. Simple cuboid epithelium
C. Simple columnar epithelium
D. Pseudostratified columnar epithelium with stereocilia

20. Taenia coli, adalah struktur organ spesifik pada lapisan…

A. Muscularis Mucosa
B. Muscularis Externus
C. Mucosa
D. Submucosa
E. Lamina propria

21. What will happen if the amount of Paneth cell is decreased?

A. Decreased fat digestion
B. Increased undigested protein
C. Decreased mucus production
D. Decreased glycocalyx
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E. Increased bacteria amount in the intestine

22. Diarrhea may result if which of the following organs fails to carry out its role in absorbing
water from the feces?
A. Anal canal
B. Caecum
C. Colon
D. Jejunum
E. Duodenum

23. 63-year-old man comes to the ER with complaint yellow in eyes since 1 month ago. He
feels unwell since 2 month ago and his has weight loss. He is slightly fever and nausea.
Physical Examination shows sclera icteric, liver was not palpable, but the spleen was
palpable. Lab test shows Hb 11, WBC 4900, platelet 80000, SGPT 60, SGOT 75, Total
bilirubin 4, direct bilirubin 3.1, HBsAg (+), AFP 450. What is the best assist to diagnostic this
patient?
A. Endoscopy
B. Plain X-ray
C. Ultrasound
D. CT scan with contrast

24. What is the most likely occur as the complication of the above case?
A. Septic shock
B. Chronic diarrhea
C. Hematemesis (Portal hypertension → Esophageal Varices)
D. Renal failure
E. Heart failure

25. A blood tap was taken on the patient. What is most likely to be shown?
A. Decreased potassium level
B. Decreased globulin level
C. Increased CEA level
D. Increased sodium level
E. Increased PT and INR (due to decreased production of coagulation factor)
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26. A 56 years old businessman came to the ER after coffee ground vomit. He regularly takes
aspirin prescribed by his doctor for coronary artery disease. On endoscopic procedure, the
doctor found an ulcer on the lesser curvature on the pyloric part of the stomach. Which of the
following vessels is likely to be ruptured in this case?
A. Right gastro epiploic artery
B. Left gastro epiploic artery
C. Right gastric artery
D. Left gastric artery
E. Gastro duodenal artery

27. 50 year old female come to ER with solid food dysphagia since 6 months ago. She drinks
beer, like spicy food, smoker. She consume Hydrochlorothiazide for her hypertension. Upper
endoscopy distal esophagus show stricture and..... Esophagus biopsy show benign mucosa with
chronic infection. H pylori blabla…
Etiology of the stricture?
A. Alcohol ingestion
B. Tobacco
C. Gastric Reflux
D. Hydroclorothiazide
E. Spicy food

28. The patient is at risk for which of the following conditions:

A. Esophageal Squamous Cell Carninoma
B. Esophageal Adenocarninoma
C. Gastric Cancer
D. Gastric Lymphoma
E. Duodenal Adenocarninoma

29. A 30 years old woman suffer with gastric pain and burning sensation all the time and
relieved by food and antacids. Family doctor asks her to get endoscopic examination and found
ulcer in the surface of gastric mucosa. The pathogen that may cause the disease above is…
A. Enteroaggregative E. coli
B. Helicobacter pylori
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C. Yersinia enterolitica
D. Campylobacter jejuni
E. Vibrio parahaemolyticus

30. H pylori menyebabkan mekanisme apa terganggu?

LES relaxation

32. Pergi ke Aceh, trs pulangnya diare, no blood, no mucus

Vibrio cholera

33. (Vibrio cholerae) what is the important bacterial factor from the case above?
A. Lipopolysaccharides (Khas Gram (-))
B. IgA Protease
C. R antigen
D. H antigen
E. K antigen

35. Different between pyloric and fundus part of stomach?

Pylorus mucosanya setengah submukosa

38. 48-year-old female comes to the ER with complaint of 24 hours of epigastric pain, nausea,
and vomiting after eating a large meal at a restaurant. There is Right Upper Quadrant pain
on the day before. Her temperature is 38,5oC and her pulse is 100. Her physical examination
is unremarkable. There is epigastric tenderness on palpation, no bowel sounds, no rebound
tenderness and guarding. Her laboratory tests showed amylase 1980 (53-153) and lipase 2500
(10-150). First examination? (Probable: Acute Cholecystitis)
A. X-ray
B. USG
C. CT Scan

41. A-10-month-old boy brought to the emergency department by his mother with abdominal
pain and vomiting in the recent 2 hour. The boy was brought to a pediatrician yesterday because
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of diarrhea; the last stool was like red-currant-jelly and has stopped since the boy suffers the
pain. On the examination there is distended and tender abdomen, a palpable mass with sausage
like appearance on right side of abdomen, and increased bowel sound.
(INTUSSUSCEPTION)
Which of the following findings may be seen on the plain abdominal photos?
A. Air distribution in the sigmoid colon
B. Free air under the diaphragm
C. Enlargement of liver
D. Thickening of the wall of appendix
E. Dilated small bowel with air fluid level

42. Where is the most possible anatomical location of their pathologic condition?
A. Transverse colon
B. Duodenum
C. Liver
D. Ileocecal Junction
E. Appendix

Soal untuk 45, 46

40 year old man came to his doctor with 2 months history of intermittent upper abdominal pain.
He described the pain as dull, gnawing ache. Physical examination reveals a healthy man with
epigastric tenderness. He had been taking Piroxicam for his osteoarthritis.

45. A 40 year old man presents to his primary care physician with an intermittent upper
abdominal pain. He describes the pain as a dull, gnawing ache. The pain sometimes wakes him
at night, and is relieved by food and drinking milk. Physical examination reveals a fit,
apparently healthy man. The only abnormal finding is mild epigastric tenderness on palpation
of the abdomen. He has been taken Piroxicam for the past six months for his osteoarthritis
medication. What is the protective factor of mucosal integrity that may be impaired in this
condition?
A. Mucus
B. Bicarbonate
C. Mucosal blood flow
D. Prostaglandin
E. Cell renewal
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48. 46 years old female complaining blood in her stool 5 days ago. She had hemorrhoids since
5 years ago when giving birth to her 5th child. With regard to the blood supply of the rectum
and anus:
A. The veins do not correspond to the arteries.
B. The anal canal is the site of portosystemic anastomoses
C. It is principally from the inferior rectal artery
D. The vessel do not supply the full thickness of the anal wall.

49. A 15 year old junior high school was stabbed in the abdomen. Under laparotomy, the
Inferior mesenteric artery was ruptured. What may be found when you do surgery?
A. The descending branch of the left colic supplies the sigmoid colon only
B. There are very few anastomoses between its branches
C. Inferior mesenteric artery ends at superior rectal artery
D. Inferior mesenteric artery rise from aorta at the level L2

50. Female, icteric sclera, abdominal discomfort, hepatomegaly tenderness. Serology IgM
HAV +. Which following characteristic increase risk of fulminant hepatic failure?
A. She is pregnant
B. She is patient of chronic HCV infection
C. She had post exposure Hepatitis A during infancy
D. She is patient of chronic renal failure
E. She has previously exposure HBV and develops anti Hbs
“, but rare fulminant cases of hepatitis A occur primarily in older adults and in persons with
underlying chronic liver disease, including, according to some reports, chronic hepatitis B and
C.”

51. ERCP masukin fiber optic-nya lewat sphincter apa?

A. Sphincter of oddi
B. Cardiac sphincter
C. Pyloric sphincter
D. Ileocecal valce
E. Ureter valve
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53. While examining a Tissue of GIT track, you notice many lymphoid tissue, surrounding a
relative small lumen. No intestinal villi is seen. What part of GIT are you examining?
A. Duodenum
B. Jejunum
C. Ileum
D. Colon
E. Appendix

54. a 62 years old man with chief complains nausea, vomiting and epigastric pain. He was
given stomach medication, three hours later, he had dyskinesia and rigidity (extra pyramidal
symptoms). Which of the following drug is most appropriate that can cause this situation?
A. Domperidone
B. Metoclopramide (crosses BBB)
C. Ondansetrone
D. Omeprazole
E. Sucralfate

56. For months, 60 years old woman had experience burning substernal pain after meal.
Endoscopy biopsy revealed Barret's oesophagus.
A. Chronic Esophagitis
B. Ulcerative esophagitis
C. Columnar Metaplasia
D. Squamous Metaplasia
E. Benign neoplasm

57. A 30-year old women suffers gastric pain and burning sensation all the time and relieved
by food and antacid. Radiology showed ulcer at pylorus part of stomach. The doctor thinks
that may be cause infection. Most convenient test for infection?
A. Endoscopy-guide biopsy
B. Microscopic culture
C. Rapid urease test
D. Urea breath (Non-invasive)
E. CLO-slide test
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58. A/An 8-year-old boy had difficulty in swallowing. Endoscopic exam reveals that there was
an abnormal relaxation of lower esophageal sphincter. Pathological examination shows
aganglionosis. What is the diagnostic?
A. Stricture
B. Paralysis
C. Primary Achalasia
D. Secondary Achalasia (Chagas' Disease)
E. Esophagitis

59. A 55 years old male with a long history of duodenal ulcers was seen in ER after vomiting
blood and exhibiting severe hypovolemic shock. Assuming the ulcers had perforated the
posterior wall of the first part of duodenum, which artery most likely to have been eroded?
A. Splenic artery
B. Right gastric artery
C. Gastroduodenal artery
D. Right epiploica artery
E. Hepatic propia artery

60. A girl, 20 months, came with diarrhea since 2 days ago. She suffered from severe vomiting
4 days ago for about 2 days. The vomit was the resolving but followed with watery stools 5-8
times in a day. She started to get fever since yesterday but still able to drink a lot. What might
be the most possible cause of diarrhea?
A. bacteria
B. protozoa
C. Rotavirus
D. Coronavirus
E. Adenovirus

62. A 51-year-old man comes to your private practice with a history of mid epigastric upper
abdominal pain that diminished by eating or taking antacid tablets. He drinks 2-3 glasses of
beer every night, also taking 2-3 tablets of aspirin frequently for his stress related headache.
PE reveals no evidence for blood in the stool. You advised him to replace the aspirin with
acetaminophen and stop his drinking of beer; you give him a prescription of famotidine 20 mg
bid.
Which of the following is the mechanism of action of famotidine?
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A. Eradication of H. pylori
B. Increase gaster motility
C. Inhibit acid secretion
D. Naturalized gastric acid
E. Protect gastric mucosa

63. 58 year old lady who has intermittent cramping abdominal pain continuous for 2 weeks.
The abdominal radiograph shows no free air and none of the bowel sound indentified. The
colonoscopy shows patchy areas on the mucosa erythema and necrosis at ascending and
descending colon. What is the diagnosis from the finding?
A. Acute Appendicitis
B. Ischemia Colitis
C. Amoebiasis colon
D. Adenocarcinoma
E. Crohn's disease

64. A 25 years old female comes to the clinic with chief complaint of diarrhea form that 1 week
duration. The diarrhea is watery with blood and mucous. Microscopic examination shows
protozoan with pseudopodia. Which of the following is the most likely diagnosis?
A. Minuta stage of Entamoeba histolytica
B. Vegetative stage of Entamoeba histolytica
C. Cystic stage of Entamoeba histolytica
D. Vegetative stage of Entamoeba coli
E. Cystic stage of Entamoeba coli

65. Of the following, which one is the most likely mode by which this disease (upper clinical
case) as acquired?
A. Ingestion of the larvae on the organism in contaminated food
B. Ingestion of the egg on the organism in contaminated food
C. Ingestion of the cystic on the organism in contaminated food
D. Drinking unboiled water supply
E. Penetration of the skin by the organism while

66. Cewe, punya anak 2, ada lump di antara iliac crest dan tubercle pubis. Diagnosis?
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A. Femoral hernia
B. Inguinal hernia

67. A 44 year old lady has had increasing nausea, vomit, colicky for the past week. The USG
showed some stones in the gallbladder. Operation was done. Which of the following specific
changes is most likely found in the gallbladder wall?
A. Atrofi mukosa epitel
B. Chronic inflammation
C. Acute inflammation
D. Sinus Rokitansky-Aschoff
E. Irregular area of fibrosis

70. Ranitidine buat apa?

Buat block H ion dengan ngeblock H2 receptor

71. A 62 year old woman lost 11 kg in 3 months accompanied w/ loss of appetite, fatigue and
decreased sexual interest. She has no history of depression. What is the most likely diagnosis?
(Lihat soal berikutnya)
A. Rectal Ca
B. Hypochondriasis
C. Bullimia
D. Masked Depression

72. Blood tap done, what is the the expected result?

A. Increased CEA (Carcinoembryonic Antigen)
B. Increase ureum and creatinin
C. Increase Ca -125
D. Increased natrium
E. Increased kalium

74. Therapy H. pylori -> Omeprazole, Clarithromycin, Amoxicillin (OCA)

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