CUCU

(HENDRA-NIPAH VIRUS)
1. 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?
a. Arthropod
b. Horse
c. Fruit bats
d. Squirrel
e. Rats

2. A 32-year-old female developed a “flu-like” syndrome with high fever up to 40 0C, 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 biopsi
e. 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 ?
a. Giant cell
b. Limfosit plasma biru
c. Negri bodies
d. Inclusion bodies
e. 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?

a. Tetracycline
b. Aminoglycoside
c. Ciprofloxacin
d. Neomycin
e. Crystalline penicillin G

6. 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

(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?
a. Bacteroides fragillis
b. Leptospira interrogans
c. Bacillus anthracis
d. Pasteurella pestis
e. 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?
a. Spread by contact with blood or other body fluid
b. Transmitted by mosquitoes bite
c. Transmitted to human from rodent excreta
d. Aerosol transmission
e. 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 PO 2 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?

a. Vaccine
b. Antitoxin
c. Antibiotic
d. Antiviral
e. 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?
a. Rota virus
b. Rubella virus
c. Coxsackie virus
d. Hepadnavirus
e. 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?
a. Vi antigen
b. Urease
c. Hemolysin
d. Shiga toxin
e. 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?
a. Blood
b. Kidney
c. Liver
d. Intestine
e. 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 40 0C. 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?
a. Vibrio cholerae
b. Shigella dysentriae
c. Salmonella typhi
d. Entamoeba histolitica
e. Giardia lambia

18. Which of the following specimen is most appropriate for case above?
 a. Feces
b. Blood
c. Urine
d. Throat swab
e. 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?
a. Heart
b. Liver
c. Brain
d. Spleen
e. 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?
a. Schizonts in red cells with 8-12 progeny
b. Rounded gametocytes present
c. Enlarged, somewhat misshapen parasitized red cells
d. Numerous large ovoid parasites in some of the red cells
e. 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?
a. Uncooked vegetables
b. Raw oysters
c. Raw pork
d. Uncooked fish
e. 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?
a. The level of Balantidium coli in swine stool
b. The practice of consuming raw human brains from recently deceased family members
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

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?
a. Mycobcaterium tuberculosis
b. Salmonella typhi
c. Brucella species
d. Pasteurella pestis
e. 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?

a. Brucellosis
b. Pertusis
c. Leptospirosis
d. Tularemia
e. 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 microscopy.

30. Which of the following is your working diagnosis?

a. Syphillis
b. Pertusis
c. Weil’s disease
d. Lyme disease
e. Relapsing fever

31. Which of the following disease is the complication of this disease?

 a. Pulmonary hemorrhage
b. Myopericarditis
c. Aseptic meningitis
d. Osteomyelitis
e. Anemia

32. Which of the following reservoir animal is the source of human infection?
a. Fish
b. Bird
c. Reptile
d. Scallop
e. Rat

33. Which of the following is drug of choice of this disease?

a. Penicillin G
b. Chloramphenicol
c. Erythromycin
d. Gentamycin
e. Rifampin

Question 34-35 are linked to the following case:

(LEPTOSPIROSIS)
A 27-year-old medical student was admitted to hospital because of sudden onset fever up to 39 0C and
headache. Two weeks previously he volunteers cleaning the canal with others. Blood tests done shortly
after admission indicated renal function abnormality and elevated liver function tests. On examination, he
looked so yellow.

34. Which of the following would be most likely to confirm the diagnosis?
a. Testing serum using the rapid plasma reagin (RPR) test
b. Culture the urine on human diploid fibroblast cells
c. Testing serum by darkfield microscopy
d. Testing serum for antileptospiral antibody
e. Culture of CFS on chocolate agar

35. Which of the following is the prevention after exposure?

a. Human vaccine
b. Health education
c. Vector controll
d. Isolation the infected people
e. Antibiotics prophylaxis

Question 36-38 are linked to the following case:

(YAWS)
A young boy had an ulcerating papule on his legs. Later, this lesion destroys the bone of his legs
(gummata), but three are no visceral and nervous system complications. The disease is still endemic in hot
tropical countries, such as Indonesia.

36. Which of the following microorganism is the cause of the disease above?
a. Treponema pertenue
b. Borrelia burgdorferi
c. Leptospira interrogans
d. Spirillum minor
e. Chlamydia trachomatis

37. Which of the following drugs is the drug of choice for the disease above?
a. Tetracycline
b. Penicillin
c. Doxyccycline
d. Vancomycin
e. Clarithromycin

38. Which of the following examination is the most appropriate to diagnosis the disease above?
a. Widal test
b. IgG and IgM of Treponema
c. Dark-field microscope
d. FTA-ABS test and TP-PA test
e. 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?
a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. 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?
a. Shigella vaccine
b. Salmonella vaccine
c. Enterobacter vaccine
d. H Pylori vaccine
e. 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?
a. Morbili
b. Dengue
c. Influenza
d. Coxsackie
e. 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?
a. Prick test
b. Tourniquet test
c. Complete blood test
d. Widal test
e. 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?
a. Trombositosis
b. Leukocytosis
c. Erythrositosis
d. Elevated of hematokrit
e. 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?
a. Vitamin K deficiency
b. Copper deficiency
c. Vitamin E deficiency
d. Iron deficiency
e. 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?
a. Dark green leafy vegetables
b. Pasteurized milk
c. Deep water fishes
d. Boiled eggs
e. 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?
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

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 40 oC. 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 indicated leucopenia.

50. Which criteria of avian influenza is the most appropriate with this patient’s condition?
a. Probable
b. Suspect
c. Confirmed
d. Definitive
e. Absolute

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?
a. Reye syndrome
b. Gray syndrome
c. Down syndrome
d. ADHD
e. Black water fever

54. A 24 year old man, recently returned from Myanmar, presented very unwell febrile. His consciousness
was GCS of 7. His thin blood smear showed malaria falciparum. Which of this following is the best
treatment for this patient?
a. Chloroquine
b. Mefloquine
c. Fansidar
d. Doxycycline
e. Quinine IV

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?
a. Kina
 b. Chloroquine
c. Doxycycline
d. Kuinin
e. 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?
a. Eggs
b. Cycticercosis cellulose
c. Cysticercosis bovis
d. Taenia solium
e. 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 examination was normal. Within a few hours of her admission she was found dead
in her bed during the ward round. After autopsy, the diagnosis was neurocycticercosis. Which of this
following brain’s location is the possible cause of patient’s sudden death?
a. The frontal lobe
b. The temporal lobe
c. The parietal lobe
d. The lateral ventricle
e. The fourth ventricle

dr. ROBERT SOETANDIO

58. You are precepting a resident who has just evaluated a 4-year-old incompletely immunized immigrant
boy who has classic varicella lesions and a history that is consistent with this diagnosis. Of the
following, the MOST accurate statement is that
a. Lesions of both varicella and smallpox follow a 7- to 10-day course from eruption to resolution
b. Lesions of both varicella and smallpox frequently produce deep, pitted scars
c. Varicella lesions appear in stages or crops; smallpox lesions are uniformly in the same Stage of
development
d. Varicella lesions are concentrated on the face; smallpox lesions are concentrated over bony
prominences
e. Varicella lesions are transient vesicles; smallpox lesions are persistent pustules until resolution of
the illness
59. You are working in a refugee camp when a mother brings in her 8-day-old boy. The mother states he
started becoming irritable 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
c. Generalized seizure
d. Tetanus
e. Viral encephalitis

Question 60-61 are linked to the following case:

60. 4. A worried mother brings her 18-month-old son to the emergency department because of a rash that
developed today. She reports that he has had a runny nose, conjunctivitis, and diarrhea. On physical
examination, he appears toxic, is temperature to 104ºF (40°C) for the last 3 days and has diffuse 2- to
3-mm erythematous rush beginning from their face. Of the following, the MOST likely cause of the rash
is
a. Adenovirus
b. Coxsackievirus
c. Measles
d. Human herpesvirus 6
e. Parvovirus B19

61. Case no 4, if the son got worse. What would the complication happened?
a. Osteomylitis
b. Encephalitis
c. Otitis externa
d. Sinusitis
e. Oral thrush

Question 62-63 are linked to the following case:

62. 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
a. Adenovirus infection
b. Coxsackie virus infection
c. Mononucleosis
d. Sinusitis
e. Streptococcal pharyngitis

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?
a. Tonsilitis Folikularis
b. Angina Plaut Vincent
c. Mononucleosis infectiosa
d. Laryngitis Akut
e. 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
a. Tonsilitis Folikularis
b. Bronchiolitis
c. Pertussis
d. Laryngitis Akut
e. 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?
a. Congenital Toxoplasmosis
b. Congenital Rubella
c. Congenital Cytomegalovirus
d. Congenital Malaria
e. 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?
a. TPHA and VDRL
b. Gram preparation
c. KOH preparation
d. Skin scrapping
e. 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 ?
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

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
a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malarie
e. 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?
a. Primaquine
b. Pyrimethamine
c. Quinacrine
d. Chloroquine
e. 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

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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?
a. Salmonella typhi
b. Plasmodium falciparum
c. Vibrio cholera
d. Hepatitis A
e. 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?
a. Epinephrine
b. Antacid
c. Spironolactone
d. Atropine
e. 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. Cysticercosis
d. Sparganosis
e. Dipylidiasis

Question 92-93 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.

103. 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

104. 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

105. 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. The most likely diagnosis is :
a. Malaria viviax
b. Malaria falciparum
c. Malaria malariae
d. Malaria ovale
e. Mix infection of malaria vivax and malaria falciparum

106. Sexual life cycle of malaria parasite take place in :

a. Human liver cell
b. Human spleen cell
c. Human erythrocyte
d. Mosquito body
e. Mosquito proboscis

107. Plasmodium falciparum is the most dangerous species because :

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

Question 97-98 are linked to the following case:

A 30-years-old woman presents abdominal pain and diarrhea for 3 days 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 larvae form of of Strongyloides stercoralis.

108. In condition below adult form of Strongyloides stercoralis 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

109. Refer to the case above; 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

110. 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

111. 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

112. A 3 year old girl came to pediatric outpatient clinic with her parents. Her mother complaint that she
had watery diarrhea since 3 days. This was her 3 rd episode of diarrhea in the last 2 months. Her mother
also noticed that she was delayed in growth and development compared to her siblings. She hardly
gained weight and height since last year. The physical examination showed that her weight and height
was below 5th percentile for girls of her age.
What is the most likely underlying mechanism that caused her repeated episodes of diarrhea?
a. Protein catabolism
b. Reduced food intake
c. Altered lipid metabolism
d. Reduced bactericidal activities

113. 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.
What is the most likely transmission of her infection?
a. Droplet
b. Air borne
c. Fecal-oral
d. Close contact
e. Animal bite
114. A 4-year-old child presents with fever, conjunctivitis, photophobia, posterior cervical adenopathy,
and coryza. 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