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FINAL GIS PERFECTEN 1. A 57 yo man was brought to the clinic due to his slurred speech. His family stated that the condition started in the morning upon waking up, and followed by weakness in his right arm. From the neurological examination, it is revealed that he got CN XII paralysis and right hemiparesis. Which of these muscles below did not affected by the paralysis? A. Superior longitudinal muscle B. Inferior longitudinal muscle C. Palatoglossus muscle-> CN VII D. Genioglossus muscle E. Hyoglossus muscle 2. A 3 yo girl brought to the emergency department. Her parents stated that she was playing with marble and swallowed them. Upon chest X-ray, the foreign body was found logged in the center of the thorax, midway between root of the neck and diaphragm. Where the foreign object would most possibly logged in this case? A. In the cervical constriction, at the pharyngoesophageal junction. Compressed by cricopharyngeal muscle B. At thoracic constriction, compressed by the arc of aorta and left main bronchus C. At esophageal hiatus when it passes the diaphragm D. At diaphragmatic constriction where it passes through the internal esophageal spinchter E. At abdominal constriction where it passes through the cardia For no 3-4: A 36 yo man came to your practice complaining of abdominal pain and nausea. The pain grows more intense these part 2 days. He said that he has been under a lot of stress, so he often skipped meal, and had a lot of coffe to help him concentrate. 3. From these sentences below, which one best describe the organ involve? A. It is the expanded part of the alimentary tract between esophagus and small intestine, has two curvature, an covered by peritoneum B. It is muscular tube 25 cm long, has 3 constriction along its course, passing through 3 different compartments, and is not covered by peritoneum -> esofagus C. The organ has two curvature. The lesser curvature connects it to the liver. The greater curvature connects it to the colon. Its posterior aspect directly in touch with the spleen. D. It is the terminal part of alimentary tract, has a large caliber, its longitudinal muscle make sacculation appearance. Its transverse part attached to greater omentum. -> colon E. The organ has four part. Cardia, connects it to the heart, fundus, the dilateated superior part, (body?) between fundus and pyloric, pylorus, the funnel shapped region 4. Which of these sentences below are true regarding the organ arterial supply? A. The left and right gastro-omental arteries are forming anastomosis in the lesser curvature -> greater B. The left and right gastro-omental arteries are forming anastomosis in the pyloric antrum C. The left and right gastric arteries are forming anastomosis in the greater curvature -> lesser D. The anterior and posterior gastric arteries are forming anastomosis in the grater curvature E. The right and left gastric arteries are forming anastomosis in the lesser curvature 5. A 57 yo man was brought to the emergency department because he vomited blood since a . hours. His family said that the blood was bright red. He was diagnose with liver cirrhosis since . ago. What other condition should you examine in the case of portal hypertension? A. Caput medusa, where the anastomosis between central vein and portal vein occurs -> periumbilical B. Esophageal varices, where the anastomosis between left gastric vein and the inferior mesenteris vein occurs -> azygous dan left gastric C. Hemorrhoid, where the anastomosis between anterior

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rectal vein and inferior rectal vein> sup dan mid&inf rectal D. Caput medusa, where the anastomosis between paraumbilical vein and epigastric vein E. Hemorrhoid, where the anastomosis between superior rectal vein and the pudendal vein 6. Which statement below is correct regarding the first part of the small intestine? A. The organ was completely covered by peritoneum and connested through mesentery -> hanya superior yang tercover B. The organ in C shaped and has part: anterior, superior, descending, horizontal C. The organ span between the pyloric sphincter and the duodenojejunal junction. It warps around the head of pancreas D. It is the longest part of the small intestine. Its descending part has major papilla which is an opening of major pancreatic duct E. The organ is mostly fixed and has no peritoneal convering, has arterial supply only form the branch of celiac trunk -> disuplai SMA juga 7. A 32 yo man was found lying on the street with blood coming from his abdomen. He was a victim of a robbery and got stabbed. As you examined the wound, you found that the injury was quite large, some organ was protruding from inside, covered by blood. If the wound was located on the left lower abdominal close to the umbilical, what is the organ and arteri bleeding you probably see? A. ileum, bleeding fromabdominal wall arteries and branches of SMA B. jejunum bleeding from inferior costal arteries and branches of SMA C. ileum, bleeding from inferior costal arteries and branches celiac trunk D. descending colon, bleeding from abdominal wall arteri and branches of IMA E. jejunum, bleeding from abdominal wall arteri and branches of IMA 8. a 23 yo woman complaining of severe abdominal pain since 6 hours ago. Pain starts in epigastric and moved to right lower part abdomen. She also had fever and loss apetite. PE: tenderness, rebound tenderness on MC Burney point, she has difficulty straightening her right leg and (+) psoas sign. Where would you find the organ in most people? A. Right lower quadrant, project from cecum inferiorly toward pelvic brim -> pelvic B. From its orifice in caecum, extend superoposteriorly toward right colic flexure -> retrocecal C. Extend posterolaterally, crossed ileocecal junction D. In junction of ileum and caecum, project anterioriorly toward abdominal wall E. From its orifices in cecum, extend anteosuperiorly toward rectus abdominis 9. What are distinctive characteristic of large intestine? A. larger diameter, covered by movable peritoneum, internal surface has extensive pili for absoption B. larger diameter, has specialized longitudinal muscle, internal surface has extensive mucosal fold C. larger diameter, teniae coli caused sacculation, internal surface has extensice mucosal fold D. larger diameter, haustra is dynamic structure depends on its contraction, its internal surface has smooth appearance E. larger diameter, teniae coli caused formation of haustra, internal surface has smooth appearance 10. a 45 yo man complain rectal bleeding when he has his bowel movement this morning. This is his fifth time having same complaint over last 2 month. This time, bleeding followed by something came out of anus, but quickly went back in on its own. Didnt feel any pain. Source problem? -> internal hemorrhoid A. Dilataton of superior and middle rectal vein lies on mucosal layer of rectum B. Dilatation of superior and middle rectal vein lies on submucosal layer of rectum

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D. Ligamentum teres/ round ligament 17. This part of gallbladder is wide end of the E. Ligamentumvenosum organ, projects from the inferior of the liver and is usually located at the tip of the right 14. This part is posterosuperior extension 9th costal cartilage in teh CML. of subhepatic space, lying betweenWhich of the following is most likely part? right of visceral surface of liver and A. Fundus right kidney and suprarenal gland. B. Body This part is gravity-dependent part of C. Neck peritoneal cavity in supine position, D. Infundibulum fluid draining from omental bursa E. Cystic duct 11. This ligament is fibrous remnant of flows into this part. Wotf? fetal dustus venosus, which shunted A. Subphrenic recess 18. This portion is the expanded part of the blood from umbilical vein to IVC, short B. Hepatorenal recess gland that is embraced by the C-shaped circuiting the liver. WOTF is most C. Lesser omentum curve of the duodenum to the right of the likely ligament? D. Greater omentum superior mesenteric vessels. It firmly attaches A. Coronary ligament E. Bare area to the medial aspect of the descending and B. Falciform ligament horizontal parts of the duodenum. C. Triangular ligament 15. This part extend to right, between IVCWhich of the following is most likely portion? D. Ligamentumteres -> and portal hepatis, connecting A. Head of the pancreas E. Ligamentumvenosum caudate, and right lobes. Wotf? B. Neck of the pancreas F. Round ligament -> remnant A. Right Sagital fissures C. Body of the pancreas umbillical vein B. Left lobe D. Tail of the pancreas C. Quadrate lobe E. Uncinate process 12. This part, enclosing portal triad from D. Caudate process liver to lesser curvature of stomach E. Papillary process 19. This part is located superior to the middle and the first 2 cm of superior part of of the inguinal ligament and lateral to the duodenum. Wotf? 16. On the left side of the descending part of inferior epigastric artery, is the beginning of A. Diaphragmatic surface duodenum, the bile duct comes into contact an evaginatin in the transversalis fascia, B. Visceral surface with the main pancreatic duct. These ducts forming an opening like the entrance to a C. Lesser omentum run oblique through the wall of this part of cave. D. Greater omentum duodenum, where they unite to form this Which of the following is most likely part? E. Peritoneum portion. A. Internal inguinal ring / deep Which of the following is most likely portion? B. Middle inguinal ring 13. This ligament is fibrous remnant of A. Cystic duct C. Superficial inguinal ring umbilical, which carried well B. Common hepatic duct D. Internal spermatic fascia oxygenated and nutrient-rich blood C. Sphincter of the bile duct E. External spermatic fascia from placenta to fetus. Wotf? D. Major duodenal papilla A. Coronary ligament E. Hepatopancreatic ampulla / ampula of 20. The omental bursa communicates with B. Falciform ligament Vater the greater peritoneal sac through this C. Triangular ligament portion, situated posterior to the free edge of
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C. Dilatation of middle and inferior rectal vein lies on mucosal layer of rectum D. Dilatation of middle and inferior rectal vein lies on submucosal layer of rectum E. Dilatation of superior and middle pudendal vein lies on subcutaneous layer of anal skin

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the lesser omentum. This portion can be located by running a finger along the gallbladder to the free edge of the lesser omentum. Which of the following is most likely portion? A. Lesser omentum B. Greater omentum C. Omental foramen D. Peritoneal fold E. Peritoneal recess months. Which of the following is most likely A. Lamina propia cells that has the role to those complain? B. Muscularis mucosa A. Chief cells C. Muscularis external -> Auerbach B. Mucous neck cells D. Mucosa C. Oxyntic cells/parietal cell -> HCl E. Serosa D. Enteroedocrine cells E. Regeneratif cells 27. This portion of the bile duct system is located in the portal spaces and lined by 24. The mucosa of this region os the cuboidal epithelium or columnar epithelium alimentary canal is lined by simple columnar and has distinct connective tissue sheath. epithelium with goblet cells. The submucosa Which of the following is most likely portion? 21. A pathologist will examine the section of is composed of dense, irregular fibroelastic A. Bile canaliculus alimentary tract on GERD patient, his connective tissue and houses Brunners B. Bile ductules objective is to identify the esophagus glands. Which of the following is most likely C. Bile duct structure. Which of the following is most likely region? D. Hepatic duct specific appearance due to his objective? A. Stomach E. Common bile duct A. Has both skeletal and smooth muscle B. Duodenum B. Simple columnar epithelial --> C. Jejenum 28. This region of the alimentary canal has stratified squamous D. Ileum aricher supply of lymphoid follicle, less crypts C. Crypt of liberkun E. Caecum of Lieberkuhn, no taeniae. The mucosa is D. Mucosa and submucosa make the fold lined by simple columnar epithelium with structure 25. A 4-year-old boy brought by his parent to goblet cells. Which of the following is most E. Could be found peyerispathces the hospital with watery diarrhea without likely region? blood since 3 days ago. The complaint A. Ascending colon 22. All the region of his part of the alimentary accompanied by low grade fever. Which of B. Transverse colon canal display longitudinal folds of the mucosa the following is most likely part of the organ C. Descending colon and submucosa which disappear in the disturbed in that patient? D. Appendix maximal distention. They are lined by a A. Crypt of liberkun E. Caecum simple columnar epithelium and goblet cells. B. Peyeris patches Which of the following is most likely region? C. Bruners gland 29. Each exocrine acinus of the pancreas is A. Stomach D. Villi drained by initial part of exocrine duct with its B. Small intestine E. Submucosa gland initial cells, the centroacinar cells inserted C. Colon into the acinar lumen. Which of the following D. Rectum 26. A 5-year-old baby brought by her parents is most likely epithelial cell that lined this part E. Anal canal to emergency unit in Hasan Sadikin Hospital of exocrine duct? Acinar -> pyramidal, with the chief complaint was constipation centriacinar -> cuboid 23. A 35-year-old female was diagnosed as since 3 days ago. From imaging examination A. Simple squamous chronic gastritis, she always complain result showed megacolon. Which of the B. Simple cuboid epigastric pain. She has had numerous following is most likely location of the C. Simple columnar episodes nausea and vomiting in past 3 structure that causes of that disease? D. Stratified cuboid
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E. Stratified columnar 30. This hollow, pear shaped organ attached to the lower surface of the liver. The main function of this organ is to store bile and concentrate it by absorbing its water. Which of the following is most likely epithelial cell For questions number 33 to 35, refer to types that lined the mucous layer of this opstions given belows: 37. Substrate secreted by this organ will organ? A. Duodenal obstruction digest protein at random. B A. Simple squamous B. Diaphragma atresia 38. Proenzyme secreted by this organ will be B. Simple cuboid C. Gastroschisis -> herniasi abdominal activated by enterokinase. E C. Simple columnar, no goblet cell content mll abdominal wall 39. Digestion of certain nutrient in this organ D. Stratified columnar with goblet cell D. Congenital ophalocele -> masuk ke is done intraluminary and intracellularly. C E. Stratified columnar umbillical cordnya, dilapisi selaput 40. Instead of breaking protein molecules into amnion a smaller one, an enzyme secreted by this 31. A newborn baby girl has has meconium in organ will coagulate protein molecules. B her vagina after undergo physical 33. Defect near the median plane of ventral (renin: protein susu-> casein) examination. The doctor also found that abdominal. C 41. The main substrate of digestie enzyme she has no anal opening. 34. Failure of intestine to return to the secreted by this organ is carbohydrate. A Which of the following birth defect is most abdominal cavity. D 42. Proteosa and pepton is the most product likely? 35. Failuer of midgut loop to complete of protein degradation of this organ. B A. Imperforated anus rotation. A B. Imperforated vagina For question number 43 to 48, refer to C. Imperforated vagina anus 36. A newborn baby boy have ABO options given below: D. Imperforated anus with rectovaginal incompatibility. He is rushed to emergency A. Na+ dependent cotransport fistula due to decrease consciousness level. He is B. Na+ independent facilitated diffusion E. Anorectal atresia incomplete then diagnosed as Kernicterus. His indirect C. H+ dependent cotransport bilirubin level highly increase. D. Anion exchange 32. A newborn baby girl has meconium in her What is the characteristic of indirect E. Endocytosis vagina after undergo physical bilirubin that most likely caused the baby F. Paracelluler route examination. The doctor also found that condition? she has no anal opening. A. Water insoluble 43. In fetus and neonatal, protein can be Which of the following development B. Enter the blood brain barrier taken into the small intestine cells by this process that most likely? C. Albumin-binding route. E A. Opening of foregut to shift posteriorly D. Conjugated in the liver 44. Short peptides are absorbed by this route. of cloaca E. Degradated from erythrocyte A B. Opening of hindgut to shift anteriorly 45. Glucose and galactose are absorbed by of cloaca For questions number 37 to 42, refer to this route. A C. Inferior of vagina form from posterior opstions given belows: 46. glycerol and fatty acids are absorbed by part of the urogenital A. Salivatory gland this route. E
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D. Posterior of vagina form from posterior part of urogenital E. Failure of the urorectal septum -> di female, uroctal septum memisahkan rectum dgn urogenital

B. C. D. E. F. G.

Stomach Small Intestine Large Intestine Pancreas Liver Gall bladder

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47. bicarbonate in the stomach are absorbed b. Gliserol c. Hypotensive nonrelaxed esophageal by this route d c. Fatty acids sphincter 48. a 47 years old man suffered from d. Cholesterol d. Hypotensive relaxed esophageal anorexia, weakness, headache for 3 days and e. Chylomicron sphincter then these symptomes dissapeared followed51. what is the following process most likely e. Normotensive nonrelaxed esophageal by right upeer quadrant abdominal underlie this condition? sphincter discomfort, darkening of urine, yellowish of a. Hyperglycemia condition lead to54. what are the major neurotransmitter that tint eyes. Physical examination revealed a ketoacidosis involved in this case? -> imhibisi relaksasi large and tender liver. Laboratory b. High lipid diet directly breakdown into spinchter examinationre revealed IgM anti-HAV (+) and keton bodies a. Histamin, acetylcholine, vasoactive the doctor diagnosed him as Acute Hepatitis c. High lipid diet undergo intestinal polipeptide A. gluconeogenesis process b. Dopamine, epinephrine, nitric oxide What is the most probable laboratory result d. Fat will be stored into adipose tissue c. Epinephrine, nitric oxide, vasoactive that elevated due to this case? e. Amino acids will be breakdown into intestinal polipeptide a. Direct bilirubin urea d. Acetylcholine, nitric oxide, vasoactive b. Indirect bilirubin intestinal polipeptide c. Direct and indirect bilirubin For questions number 52 to 55 refer to e. Adenosine, histamin, acetylcholine d. Urobilinogen scenario below: 55. what is the most responsible nerve plexus A 45 years old woman come to the due to this disorder? Questions number 49 to 51, refer to emergency department with the chief a. Posterior vagal nerve scenario below: complain of dysphagia. She can only eat b. Anterior vagal nerve A 7 years old boy lives in rural area of Papua. porridge for the last 3 months. She also c. Meissners plexus -> lebih ke sekresi He suffered from chronic diarrhea for the lastlooses weight. The doctor performs barium kelemjar di submukosa 6 months. He also suffered from severeswallow and esophageal manometry and d. Sciatic plexus malnutrition marasmus kwarshiorkor. diagnoses her as Achalasia. -> paralitik e. Auerbachs plexus 49. what should be given first in to manage esofagus nutrient problem this case? 52. what part of gastrointestinal sphincterFor questions number 56 to 57, refer to a. carbohydrate that most likely disturbed in this patient? scenario below: b. protein a. Lower esophageal sphincter A 60-year-old man came to the emergency c. fat b. Upper esophageal sphincter department with the chief complain of d. mineral c. Sphincter of Oddi abdominal colic since 12 hours ago. He e. vitamins d. Precapillary sphincter couldnt drink anything and vomited all the 50. his parents give him meat curry. In the e. Pyloric sphincter food he had swallowed. He cannot defecate next day, the child became very weak and he 53. what is the basic mechanism involve in nor flatus. On the physical examination the is taken to the hospital. The doctor examines this disorder? doctor found that the BP was 80/60 mmHg, him and performs laboratory examination and a. Hypertensive relaxed esophagealHR: 130 x/bpm, RR: 32 x/mnt, tense abdomen then he diagnosed him ketoacidosis. sphincter with pain and meteorismus. On the DRE, the What is the high lipid will breakdown into in b. Hypertensive nonrelaxed esophagealsphincter was normal, the ampula was this case? sphincter collapse, no mass touched, and there was a. Ketonbodies blood on the hand-gloves. The doctor
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diagnoses him as a total ileus obstructive and tachipneu. On abdominal showed a. One bundle consist of approximately with severe dehydration and performs andistended abdomen, bowel sound decreases. 100 parallel fibers emergency surgery. The doctor diagnosed him as acute b. The smooth muscle is excited by 56. what is the valve that involves to prevent pancreatitis with complication of ileus continual slow, intrinsic electrical backflow of fecal contents from the colon into paralytics. activity the small intestine? This valve can resist What is the basic mechanism of complication c. Every single muscle in the GI system pressure of at least 50 to 60 centimeters of in this case? contract rhythmically water. a. Obstruction in the mesenteric artery d. In gastrointestinal smooth muscle a. Houstons valve b. Drug complication fibers, Ca channels are fast to open -> b. Intestinal valve c. Electrolyte imbalance la,a c. Small intestine valve d. Inflamation of the peritoneum due to e. There is no electrical peacemakers for d. Ileocecal valve infection -> peritoneocolic reflex smooth muscle -> Kajal e. Ileal valve e. Surgery complication 57. the complication of ileus obstructive total 59. what is the enzyme that mostly involved 62. A patient with diabetes mellitus presents is dehydration. The basic mechanism of thisin this disease that it is active in the lumen of with gastroesophageal reflux diseaseaccompanying gas........ Which of the complication is due to the pancreatic duct? following condition most likely occured with a. Antiperistaltic reflux from the small a. Trypsin thiscondition? intestine causes intestinal juices to b. Amylase A. Solid food empty more rapidly than liquids flow backward into the stomach, and c. Mucin within the gastric juices are vomited along with the d. Lysozyme B. Meals containing fat empty faster than stomach secretions e. Amylase b. Chemoreceptor trigger zone in the60. the ultrasonography of the abdomencarbohydrate rich food brain medulla is activated that lead torevealed a gallstone. The doctor assumesC. Hyperosmolaliy of duodenal contents severe vomit that this is the cause of the pancreatitis. initiates a decrease in gastric emptying c. Squeezing action of the muscles of the Which duct that the gallstone seemed toD. Acidification of the antrum increases abdomen associated withblock that can lead to pancreatitis in this gastric emptying simullaneous contraction of thecase? E. Vagal stimulation decreases receptive stomach wall a. Common bile duct relaxation in the upper portion of the stomach d. Excessive distention os irritation od b. Ampulla of Vater the duodenum provides an especially c. Cystic duct 63. A 27-year-old female medical resident strong stimulus for vomiting d. Common hepatic duct student with irritable bowel syndrome (IBS) e. Obstruction of the large intestine can e. Hepatic duct has an alterationin intestinal motility resulting finally causes rupture of the intestine 61. gastrointestinal motility works as we in fluctuating constioation in diarrhea. Her consume food every day. It motility depends condition has worsened in thepast month as 58. a 40-year-old man came to theon its smooth muscle that contract the date she has scheduled for her licensure emergency department with the chiefsimultaneously. For it purpose theexamination approaches. Which of complaint of abdominal pain with severegastrointestinal smooth muscle function as athefollowing statements about small intestinal vomiting for the last 3 days. He also had fever syncytium. motility that most likely occured in this case? with with constipation. The physical What is the most correct answer due to the A. Contractile frequency is constant from examination revealed tachycardia, febrile,smooth muscle in the GI tract: duodenum to terminal ileum
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B. Peristalsis is the only contractile activity that occurs during feeding C. Migrating motor complexes occur during the digestive period D. Vagotomy abolishes contractile activity during the digestive period E. Contractile activity is initiated in response to bowel wall distention Which of the following sodiumreabsorptive pathway is inhibited by the bacteria's enerotoxin? A. Sodium-glucose-coupled cotransport B. Electroneural NaCl transport C. Electrogenic sodium diffussion D. Sodium-hydrogen countertransport E. Sodium-bile salt cotransport For question number 70 to 72, refer to scenario below: A 40-year-old woman suffers from watery diarrhea for 2 months. Her condition is very weak.....examination (Hb) shows 5 gr%. Stool examination is also done. She had a story travelling to Danau ....

67. A 37-year-old male presents with 64. A 57-year-old man undergoes resection of dehydration and hypokalemic metabolic 70. What species could b the etiology for her acidosis. This acid-baseand electrolyte the distal 100 cm of the terminal ileum as disease? disorder can occur with excess fluid loss from A. Schistosomaintercalatum part of treatmentCrohn's disease. Which of which of the following organ? the following substance theat cannot be B. Schistosomamekongi -> thailand A. Stomach absorbed in this patient? C. Schistosomamansoni -> amerika B. Ileum A. Iron D. Schistisomahaematobium -> afrika B. Folate C. Colon E. Schistosomajaponicum -> banyak di Asia D. Pancreas C. Lactose -> jejunum E. Liver D. Bile salt dan B12 71. What is the habitat for the species? E. Protein A. Intestine 68. A 49-year-old man undergoes vagotomy B. Hepar for his peptic ulcer disease. As a result, which C. Lung 65. A 42-year-old salesman presents with chief complaint of intermittent midepigastric of thefollowing gastrointestinal motor D. Blood activities will be affected most? pain that isrelieved by antacids or eating. E. Brain A. Secondary esophageal peristalsis Gastric analysis reveals that basal and maximal acid output exceed normalvalues. B. Distention-induced intestinal segmentation 72. What is the diagnostic stadium for the C. Orad stomach acoommodation The gastric acid hypersecretion can be species? explained by an increase in the plasma D. Caudad stomach peristalsis A. Egg E. Migrating motor complexes concentration ofwhich of the following? B. Miracidium A. Somatostatin C. Cercaria -> infektif 69. A 42-year-old male develops a gatric B. Histamine D. Metacercaria carcinoma affecting the proximal third of his E. Adult C. Gastrin stomach....Scheduled for a partial D. Secretin gastrectomy of the affecting region. Which of 73. A 55-year-old man suffer from watery E. Enterogastrone the following processes will primarily affect by diarrhea since 1 week ago. His body weight this procedure? 66. A 27-year-old female comes to the decrease..... eatingundercooked pork meet. emergency room because of a 2-day bout of A. Accommodation The stool examination is taken. What is the profuse waterydiarrhea. Physical examination B. Peristalsis larva for the species? -> T. Solium reveals dry lips and oropharynx. The patient C. Retropulsion A. Cysticercusbovis -> sapi D. Segmentation is diagnosed with acutesecretory diarrhea B. Cystiercus cellulosae and dehydration, likely due toEscherichia coli. E. Trituration C. Cercaria
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D. Metacercaria E. Miracidium disease since 2 years ago, which sometimes released by taking antacid drugs. In crowded kampong where drinking water is very 74. A 30-year-old woman suffers from limited. To establish the diagnosis , what kind diarrhea with abdominal pain since 6 days of laboratory examination do you suggest to ago. The ....examination shows no sign of perform? acute abdomen. The stool examination is A. Stool microscopy taken and show (no?) mucus. Sheusually eats B. Blood culture for Helicobacter pylori beef meet in undercooked condition. What is c. Helicobacter pylori antigen detection in the true characteristic of this species? -> T. stool Saginata D. Urease test from blood A. Scolex has no sucker -> 4 sucker E. Urea breath test B. Has no rostellum and hook For questions number 77 to 78 C. Uterus not branches 27 years old man complain of fatigue and D. Has no porus genitalis yellow tint of eyes since three days ago and E. The egg has no embryophore the urine was dark yellow since one week ago. He was known to have suffered from 75. A forty four year old fat woman infection liver disease by hepatitis B Virus. complained of fever and right upper 77. which of the following result can be found abdominal pain for three days.The pain in massive destruction of the liver tissue due becomes severe and intensified, and was not to chronic liver disease such as hepatic relieved by taking pain relief pills. Her eyes cirrhosis by above virus? lookyellowish since five days before. She A. Low serum albumin level often complains of right upper abdominal B. Low serum creatinine levels pain that was radiated tothe back and C. Low serum glucose levels preceded by nausea and abdominal D. Low serum amylase levels discomfort, several hours after having a meal. E. Low serum lipase levels Her doctortold her that she suffered from 78. What is the serologic marker of hepatitis pancreatitis. To establish the diagnosis, what B virus infection that indicates contagious kind of laboratoryexamination do you suggest (infektif) condition of this infection? to perform? A. HbcAg A. SGOT (AST) and SGPT (ALT) B. HbeAg -> replikatif B. Amylase dan lipase C. HBV DNA C. Gamma GT dan ALP D. Hbc Antibody D. AFP dan HBDH E. Hbs Antibody E. Total cholesterol dan triglycerides 79. a Forty seven years old man complained of abdominal discomfort with nausea and 76. A 55 year old man came to your vomiting. His urine becomes darker and his outpatient clinic with upper abdominal pain is eyes and skin look yellowish since two weeks his chief complain . He suffered from this before. Since one year ago he often
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complained of right upper abdominal pain that was radiated to the back and preceded by nausea and abdominal discomfort . He was diagnosed had an obstructive jaundice by the doctor . On his macroscopic examination of the stool look acholis. What kind of of undigested food that had found in the microscopic examinations of the stool? A. Fat B. Carbohydrate C. Vegetable fibers D. Muscle fibers E. Connective tissue fibers 80. A 10 month old baby girl is diagnosed acute diarrhea by the doctor in pediatric EMG Unit Hasan Sadikin Hospital Bandung. Her laboratory result are blood glucose 115 mg/dl (Normal value 100 mg/dl), stool : clinitest positive. Which of the following is the most likely solution needed for above examination? A. Sudan IIIb-> fat B. Sudan IV C. Acetic acid glacial -> protein D. Acetic glacial E. Lugol 81. Why fecal occult blood (FOB) is necessary used as a screening procedure for early detection of colorectal carcinoma? Because in early stage of colorectal carcinoma : A. No visible sign of bleeding in the stool B. Slight visible sign of bleeding in the stool C. Moderate sign of bleeding in the stool D. Visible sign of bleeding in the stool E. Massive bleeding in the stool For questions no 82-83 Mira a 10 month old baby girl was diagnosed Acute diarrhea by the doctor in pediatric EMG Unit dr Hasan Sadikin Hospital Bandung. The

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important of her laboratory results are blood symptoms. She had tachycardia, high glucose 115 mg/dl (Normal value 100 mg/dl), respiratory rates, low blood pressure , stool : clinitest is positive disappeared liver dullness, diffused abdominal pain and loss of bowel sound. 82. From the result of stool examination, 85. According to the information above the what is Mira problem? diagnosis is : A. Mlabsorption of carbohydrate A. Acute peritonitis B. Malabsorption of protein B. Gastric ulcers C. Malabsorption of fat C. Duodenal ulcers D. Malabsorption of vitamin D. Acute pancreatitis E. Malabsorption of mineral E. Peptic Ulcer 86. What is the causes of this condition? 83. For that examination , what solution do A. Perforated peptic ulcer you need? B. Acute pancreatitis A. Sudan III C. Acute cholecystitis B. Sudan IV D. Chronic Pancreatitis C. Acetic acid glacial E. Acute cholangitis D. Acetic glacial 87. What is your suggestion the E. Lugol examination? 84. Mr Y a sixty year old man comes to OPD A. Abdominal plain photo (erect) unit Dr Hasan Sadikin Bandung hospital with B. Esophago-gastro-duodenography chief complain is chronic diarrhea. He was C. Upper abdominal endoscopy diagnosed suspect colorectal carcinoma by D. Abdominal ultrasound doctor. The result of stool examination : E. Barrium enema erythrocyte 3-5/upf , leukocyte 1-2/upf, mucus negative, egg warm negative. Why For questions no 88-90 Fecal Occult Blood Test (FOB) is necessary A 55 years old male came ER with used as a screening procedure for early hematemesis. He had history of chronic detection of colorectal carcinoma? In early hepatitis B, Abdominal enlargement and stage of colorectal carcinoma : edema. Physical examination findings were A. Slight visible sign of bleeding in the stool hemorrhagic shock, jaundice, spider B. Moderate sign of bleeding in the stool angiomata and ascites. C. No visible sign bleeding in the stool D. Visible sign of bleeding in the stool 88. What is the main etiology of this E. Massive bleeding in the stool condition? A. Rupture of esophageal varyx For questions no 85-87 B. Duodenal ulcer bleeding A 55 years old female came to ER with C. Pharingitis diffused abdominal pain for one day. She had D. Mild portal hypertensive gastropathy history pain killer consumption, ulcer like E. Esophagitis
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89. What will you do as first action in the emergency room? A. Endoscopy B. Check airways C. Ultra sound examination D. Nasogastric tube insertion E. Male a laboratory examination 90. What is the drug that could stop bleeding in this patient? A. Ranitidine B. Omeprazole C. Propanolol D. Somatostatin (ocreotide) -> vasokonstriktor E. Sucralfate For questions number 91 to 93, refer to information given below: A 55 years old male came to ER with abdominal pain (RUQ), febris and jaundice, dark yellow 91. what does diagnosis for him ?-> charcot a. acute cholecystitis b. acute hepatitis c. acute cholangitis d. liver cirrhosis e. acute pancreatitis 92. what is the name of the triad of this case? a. charchot b. hippocratic c. raynauld d. kusmauld e. pancreatic 93.what is the antimocrobial of choice? a. amoxycillin b. ampicillin c. amikacin d. ciprofloxacin

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e. gentamycin ALT :765 U/ml, AST:680 U/ml. HAV IgMpain, nausea, vomitting, and diarrhea. She for question number 94 to 96 refer to antibody (+), HbcIgM antibody (-), Hbelooks dehydrated and her temperature is information given below: antigen (+), HbcIgG antibody (+). Which of 101F. On further asking, she states that she 25 years old female came to clinic due tothe following is the most likely diagnosis for noted streaks of blood in her stool one day epigastric pain on and off since 3 months ago. this patient : back. Her stool culture shows gram negative, Clinic and laboratory results were normal. She a. acute hepatitis B and acute hepatitis A straight rods, unable to ferment lactose. took H2RA and antacid but not improving. b. chronic hepatitis A and acute hepatitisWhich organism is the most likely etiological Physical examination was normal. B agent in this patient? 94. what will you suggest to this patient c. acute hepatitis A and carrier hepatitis a. Salmonella typhi a. endoscopy examination B b. E.coli b. giving PPI first (empirical anti d. window period of hepatitis B and acute c. Vibrio cholerae secretory therapy) hepatitis A d. Shigella dysenteriae c. abdominal CT scan e. acute hepatitis A and chronic hepatitis e. Campylobacter jejuni d. giving sucralfate B 101. A 14 years old lorry driver presented e. abdominal ultrasound with vomiting and severe diarrhoea but with 95. two weeks after the patient comes again 98. if the problem is gastric emptying, whatno fever. The stool was watery. He admitted with the same symptom. What will you dowill you do to this patient? to having eaten a road-side food stall while he next: a. giving double dose PPI was in a city in the tropics. Which of the a. endoscopy examination with biopsy b. add on promotility agents following organism most likely cause his for H.pylori c. dietary educations -> porsi kecil,illness? b. H pylori test only rendah lemak. a. Vibrio cholerae c. abdominal ultrasound d. add on antimotility agents b. e.coli d. increasing PPI dose e. add on mucoprotective agents c. Salmonella typhi e. additional promotility agents d. listeria monocytogenes 99. a 64 year old man undergoes CEA e. shigella flexneii 96. no evidence of structural disease on surveillance for cancer because his brother 102. you are a primary care physician. A 28 endoscopy, H.pylori positiveand wasand father (blabla) of the colon. He should be years old man, Mr.ian rushton comes to your eradicated co... symptom persist. What will informed that : surgery. He has been feeling off-colour for a you do to this patient : a. CEA highly sensitive for diagnosis -> week or two, with anorexia, nausea, and a. giving SRRI and promotility agents ga sensitif malaise. Now he has low grade jaundice with b. increase PPI dose b. if CEA is elevated preoperatively, itdark coloured urine and pale stools. You send c. PPI standard dose with promotility implies unresectable disease a blood sample to the laboratory for a agents c. increase in CEA after resection mayhepatitis screen and the results state that IgM d. abdominal CT scan indicate tumor recurrence antibody to hepatitis A virus was detected. e. abdominal ultrasound d. CEA is highly spesific for the presence Whic of the scenario below is most likely to 97.twenty years old boy went to the clinic of colon cancer have resulted in ians infection? because he has elevated live enzymes and e. CEA is present in normal adult a. through sharing needles when HbsAg (+). Physical examination no injecting ilegal drugs abnormalities are found. The result of100. A 29 year old woman comes to the b. through sexual intercourse with an laboratory tesing :CBC within normal limits.clinical OPD complaining of severe abdominal infected individual
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c. through eating undercooked meat The bacteria responsible for such disease is? well many days before. She had d. through drinking sewagea. Clostridium difficile experience acute onset of vomiting, contaminated water b. Campilobacter jejuni following by multiple episode of diarrhea. e. through transfusion with blood from an c. H.pylori She refused to eat and drink a little. After infected individual d. E.coli careful examination, the doctor in charge e. Enterobacter thought that the baby suffer from viral 103. rotavirus type A infection commonly gastroenteritis cause by Rotavirus. occurs among : Untuk soal 106-107 : Other microorganism that cause watery a. fetuses A 41 y.o man was brought to hospital with 3 diarrhea is : b. elderly people day history of shaking chills, high fever, a. Shigella dysentriae c. infant and young children headache, abdominal pain, and weakness. b. Entamoeba hystolitica d. teenagers Since 2 days earlier he also complaining of c. EHEC e. adults constipation. After conduct careful d. Vibrio cholera 104. a nurse develops clinical symptoms examination to the patient, the doctors e. None of all above consistent with hepatitis. Sge recalls sticking working diagnosis is typhoid fever. ToUntuk nomer 109-112 : herself with a needle approximately 4 months confirm this, the doctor in charge ask forGastrointestinal tract infections : before after drawing blood from a patient. culture examination to the laboratory. A. Salmonella typhi Serologic test for HbsAg, antibodies to HbsAg, B. Shigella dysentriae and hepatitis A virus (HAV) are all negative, 106. C. Enterotoxigenic E. coli however she is positive for IgM core antibody The best specimen for culture in the 1st week D. Vibrio cholera . which of the following is the most of such disease is : E. Entamoeba coli appropriate for that nurse? a. Stools F. Entamoeba hystolitica a. she does not have hepatitis B b. Urine G. Giardia lambia b. she has hepatitis A c. Rose Spot H. Balantidium Coli c. she is in the late stages of hepatitis B d. Blood infection e. None of all above 109. d. she in the window period A 12 y.o child presents in a refugee health e. she has hepatitis C 107. clinic with history of watery diarrhea for What is selected medium use to culture such the last 2 days. He reports that he has 105. a 54 yo woman admitted to a clinic bacteria? passed stools 6-8 times which are watery complaining of abdominal pain that had been a. Blood agar and white in color. questioning he reports worsening for the past 2 weeks. She stated b. Nutrient agar that he frequently consumes food and that it often improved immediately after c. SS agar drink brought from roadside vendors. D meal or taking antacid. She also noted d. Mac Conkey Agar occasional heartburn, but denied fever, e. EMB agar 110. nausea, vomiting, or diarrhea. The patient A 30 y.o male works on a pig farm. He was a school teacher who worked under 108. presents to his local doctor with history of stressful conditions. After carefulA 9 m.o baby girl was brought to the ER of a slimy diarrhea more than 2 months examinations, the doctor in charge thought hospital because of vomiting, watery duration. Over the course of the last two that this patient suffer from peptic ulcer. diarrhea, and fever. The baby had been weeks he has noticed the presence of
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afebris. Abdominal examination : pain at b. Ranitidine iv epigastric area,ascites ( ), caput med ( ). c. Sucralfate Hemoglobin 7 gr/dl, WBC 5.400/mm3, d. Tra......... acid thormbocyte 212.000/mm3, creatinine 2.0 e. Vit. K iv 111. mg/dl, ureum 110 mg/dl. Untuk no 116-117 : A 26 y.o woman comes to medical clinic with What is the most possible diagnosis for A 43 y.o man has complain nausea and a seven day history of fever especially at this patient? vomiting since 1 day prior to admission. He night. She has just returned from a 2 a. Rupture of esophageal varices also has fever 4 days ago. On physical week holiday at the coast and tells the b. Bleeding portal hypertensionexamination she looks quiet ill, fever, slightly doctor that she took no precaution........... gastropathy jaundice, epigastric tenderness and about she eat there. She also had c. Bleeding peptic ulcer decreased bowel sound. diarrhea and abdominal discomfort. On d. Bleeding erosive gastropathy The laboratory test Hb 16 g/dL, L physical examination her BP was 110/70, e. Uremic gastropathy 18.000/mm3, PCV 50%, thrombocyte HR 60 bpm, RR 20/min, temperatureUntuk no 114-115 : 150.000/mm3, blood glucose 228 mg/dl, 39,30C and obvious tongue tremor wereA 62 y.o woman comes to emergency room amilase 800 U/L, lipase 550 U/L, SGOT 110 noted. H due to bloody vomiting an dark-tarry tarry U/L, SGPT 112 U/L stool 5 hours before admission. She had 112. history of epigastric pain. She is used to drink 116. A 22 y.o woman returned from a rural area oftraditional remedy to relief pain on her knee Which is the most likely clinical diagnosis of Papua after 2 week voluntary work comesfor the last 2 month. Examination result BP this patient? to a clinic with a history of bloody and 90/60 mmHg, pulse 116/min, RR 20/min, a. Acute cholangitis slimy diarrhea for the last 5 days. She temperature afebris. Hemoglobin 7 gr/dl, b. Acute hepatitis experiences................movement thanWBC 5.400/mm3, thormbocyte 212.000/mm3, c. Acute pancreatitis usual within each day. She alsocreatinine 2.0 mg/dl, ureum 110 mg/dl. d. Acute cholecystitis experiences stomach cramp and e. Acute gastritis pain...........stool. she reports no fever or 114. any other symptoms. There is aslight What is the first step treatment for this 117. lower quadran abdomen...............on her patient? What is the most possible etiology of this examination. She is found to be a little bit a. Endoscopy emergency a. Cholelithiasis dehydrated. b. Intravenous administration H2 b. Alcohol intake antagonist c. Pancreatic divi..........m 113. c. Rescucitation using NaCl 0.9%--> d. Hypercalcemia A 62 y.o woman come to emergency room initial kl PR naik dan BP turun e. Diabetes mellitus due to bloody vomiting and dark-tarry d. Transfussion with Packed Red Cell Untuk soal no. 118-119 stool....hours before admission. She had e. Nasogastric tube insertion A 24 y.o male come to emergency room due history of epigastric pain. She is used to to fever and jaundice. He has histoy of colic drink traditional remedy to relief pain on115. abdomen prior to admission. On physical her knee for the last 2 month. What is the best choice of drug for this examination : awake, BP 100/60 mmHg, PR Examination result BP 90/60 mmHg, patient? 116/min, RR 24/min, temperature 39 0C. Right pulse 116/min, RR 20/min, temperature a. Proton pump inhibitor upper quadran tenderness, with normal bowel
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blood. Laboratory examination of the stools shows multiple cystic organism with macronuclei. G

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sound. Hb 14 gr/dL, WBC 20.400/mm3, 121. Which of the following is the most defecation and the blood becoming thrombocyte 212.000/mm3, SGOT 70 U/L, likely correct statement concerning mixed with mucus and small in size. SGPT 85 U/L, total serum bilirubin 8.5 mg/dl management for this patient? Tenesmus is not complained. There with conjugated bilirubin 6.2 mg/dl, Alkaline a. Nasogastric tube can relief was no previous history of prolapsed phosphatase 300 U/ml, GGTT 275 U/ml, DC : abdominal distention in this mass from the anal while straining. 0/5/70/4/17 patient DRE revealsgood sphincter tone, an b. Rectal biopsy should immediately irregular, hard, and circumscribed 118. be performed to make definite mass on the mucosa with distance of Which is the most likely clinical diagnosis of diagnosis 5cm from anal .. there is some fresh this patient? c. CT scan abdomen is the most blood on the glove. Abdominal exam a. Acute abdomen accurate diagnosis for this case has not shown distended abdomen b. Acute hepatitis d. Abdominal X-ray and barium and mass. On proctoscopy there is a c. Acute cholangitis enema must be performed after circumscribed mass lesion with blood d. Acute pancreatitis acute condition is managed and mucus on the center of the mass. e. Acute cholecystitis e. Rectal biopsy can be performed in What is the most likely diagnosis of acute state this patient? 119. a. Rectal cancer To confirm the diagnosis, what is the fors 122. A 9 month old baby girl brought to b. Prolapsed internal hemorrhoid imaging study? emergency unit Hasan Sadikin Hospital c. Rctal polyp a. Abdominal ultrasound with bloody and ... stool. One day d. Rectal adenoma b. CT scan of abdomen before the baby seems restless and e. Rectal .....? c. Plain abdominal x-ray crying loudly (this condition repeated d. MRCP periodically) vomiting is also occur. 124. A 2 months old baby boy is brought to e. ERCP There is no history of fever. you (GP) beecase the mother notice an Untuk no. 120-121 On physical finding there is palpable on and off scrotal lumps. On PE the A 2 m.o baby boy was brought to ER with mass at epigastrium, no portio-like lump is not exist and positive abdominal distension, vomiting and no appearance on DRE. transillumination. defecation since 4... ago. There is history of Which of the following is the most What is the most likely diagnosis of delayed passage of meconium and recurrent likely diagnosis? this patients? obstipation. There also history of excretory a. Ameba dysentry a. Hydrocele diarrhea. b. Intussusception b. Inguinal hernia 120. c. Haemorrhoid c. Testicular torsion Which of the following is the most likely d. Ulcerative colitis d. Inguinal lymphadenopathy diagnosis? e. Perforated meckels diverticulum e. Hydrocele and inguinal hernia a. .................... b. acute diarrhea 123. A 56-year-old male presents to the 125. A 2 month old baby boy was brought c. enterocolitis clinic with the complaint of rectal to ER with abdominal distention, d. hirschprung disease bleeding. It has been suffered for ... vomiting, and no defecation since 4 e. ulcerative colitis months and since a month ago he also days ago. There is history of delayed has been complaining os difficulty in passage of meconeum and recurrent
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obstipation. There also history of explosive diarrhea. Which of the following statement is the best statement related to condition in this patient? a. Enterocolitis is manifested by fever and obstipation b. Classic clinical manifestation are fever, abdominal distention, and frequent diarrhea c. Typical barium enema studies shows four zone of intestinal column d. Ganglionic segment on barium enema represented by dilated proximal intestinal segment e. Pathological findings of HD is hypotrophic of neuron fibers For question number 126-128, refer to scenario below: An 18 old month baby brought by his parent with chief complaint of fever since 7 days before. He lost his appetite during the illness, and decrease his body weight. The child is still conciousness. PE showed moderate film, severe wasted, no sign of dehydration and edema. His body weight was 6.6 kg. Body heigh 76 cm. According to WHO Growth Chart Standard his WFH <-3 SD. Lab finding showed glucose level was40 mg/dl, Na 140 mEq/L, K 3.5 mEq/L 126. What is the nutritional status in this patient? a. Normal b. Mild malnutrition c. Moderate malnutrition d. Severe malnutrition marasmic type e. Severe malnutrition kwarshiorkor type 127. What is the treatment for this patient? Hipoglikemi, hipotermia, hidrasi a. Glucose 10% b. Formula milk c. ORS d. Ringer Lactate e. Natrium chloride 131. An 8 month old child is hospitalized because of vomiting and screaming episodes for 12 hours. During the episodes, the infant draws up his legs as if having abdominal pain. PE reveals a sausage shaped mass in the right upper quadrant. Temperature is 38 C. WBC count is 18.000/mm3. -> intususepsi What would be your next step in management? f. Lumbar puncture g. Exploratory laparotomy h. Blood culture i. Abdominal ultrasound j. IV anibiotics A 7 years old boy was exposed to hepatitis 1 year ago. The mother asks your opinion about possibility of this exposure turning into chronic hepatitis. When counseling her, you will explain that the virus most likely to result in chronic hepatitis is? a. Epstein barr b. Hepatitis A c. Hepatitis B d. Hepatitis D e. Hepatitis E A 15-months old girl developed emesis and intermittent abdominal pain since yesterday, with several smell partialy formed stool. His parent was nor overly concerned because he seemed fine between the pain episodes. Today, however, he has persistent bilious emesis and he had several bloody stools. Examination reveals a lethargic child in mild distress, tachycardia, and

128. If evidence of diarrhea occurs in this patient, what is management for fluid and electrolyte replacement? a. Oral rehydration solution b. Breastfeeding c. Resomal d. Ringer Lactate e. Nothing peroral (?) For question number 129-130, refer to 132. scenario below : You are visiting a post delivery mother in parturient room with his healthy baby boy. She is expecting for exclusive breastfeeding. You explain to her about physiology of lactation for successful breastfeeding. 129. What is the reflex that can be interferred by psychological condition? a. Prolactin reflex b. Oxytocin reflex c. Rooting reflex d. Suckling reflex e. Swallowing reflex 133. 130. What is the advantage of this activity for baby? a. High protein levels b. High lactose c. High casein d. High fat e. High calcium

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fever. He has diffusely tender on the c. IV administration Ringer C. Ileal atresia right lower abdomen with a vague Lactate solution D. Colonic atresia tubular mass. What is the most likely d. Oral rehydration salt E. Functional immaturity of the colon diagnosis. e. Antibiotic administration a. Intussusception 136. Barium enema examination on 70 y.o 139. A 70 year old male present with acute b. Meckels diverticulum man w/ a history of changing bowel habit, onset of abominal pain with peritonitis post c. Perforated duodenal ulcer rectal bleeding, and abdominal painfilling ERCP for biliary ... placement. Amylase, d. Abdominal wall hematoma defect (apple core) and shouldered margins inlipase, AST, ALT,ALP, Total Bilirubin CBC, WBC e. Cholecystitis and billiary colic the recto sigmoid. WOTF is the most possible are normal. He is hypokalemia, with a BP of For question number 134 to 135, refer to plain-film finding for above case? 80/50, RR is 30 bpm, no fever. On PE, there is scenario below : A. Meteorism marked rebound tenderness and guarding A 4 month-old baby boy presents to B. Paralytic ileus throughout the abdomen. The following emergency unit of pediatric departement C. Small bowel obstruction radiograph were performed. Ehat is most with profuse and watery bloody diarrhea D. Large bowel obstruction likely radiological diagnosis? since 3 days ago. He also had vomiting E. Pneumoperitoneum A. Massive ascites and low grade fever for the past 2 days. B. Cholecystitis On physycal examination, he looks 137. On chest x-ray an air-fluid level is seen C. Intraperitoneal Air restless, irritable, and drink eagerly. His in the upper esophagus of a middle-aged D. Abdominal aortic aneurysm eyes and fontanelle are sunken and skin man. The gastric bubble is either absent or goes back slowly. His body weight is 5 very small. A barium meal shown a smooth 140. A 36 Y.o female presents to int. medicine kg. Vital signs : temperature 37,6 C, tappering of the lower esophagus .......... department w/ chief complain abdominal pain heart rate 176 and BP 90/50 mmHg. appearence at the esophagogastric junction at epigastrium or paraumbilical region, 134. What is the most likely diagnosis to a point of obstruction with a diffuse especially after taking meal. From USG for this patient? dilatation of esophagus above this level. finding, there aremultiple hyperechoic w/ a. Acute diarrhea without Which most likely diagnosis? acoustic shadow in gall bladder and biliary dehydration A. Chalasia duct. What is the most likely diagnosis from b. Acute diarrhea, some B. Achalasia USG finding? dehydration C. Scleroderma A. Acute pancreatitis c. Acute diarrhea, severe D. Esophageal spasm B. Chronic pancreatitis dehydration E. Pseudoesophagus C. Cholelithiasis w/ cholecystitis d. Acute diarrhea, hypovolemic D. Cholelithiasis w/ choledocholithiasis shock 138. An abdominal radiograph of neonatal E. Acute cholangitis e. Acute diarrhea, septic shock boy with abdominal distension and failure to pass meconium within the first 48 h of life For 141-143 135. Which of the following is te most shows multiple air-fluid level in moderately When you are in clinic an 18 y.o girl was appropriate initial step in managing dilated loops of bowel. Barium enema admitted w/ pain in upper abdomen. This the patient? examination shows an inversion of the recto complain occurred after she ate some spicy a. Anti diarrheal agent sigmoid index. What is the diagnosis? food. She often complains this abdominal pain b. Fasting and antiemetic drug A. Hirschprungs disease for 3 years.Her PE : tenderness at middle and B. Meconeum ileus left upper quadrant (+). Lab : normal
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145. The patient is diagnosed by viral HepB,. 141. Why spicy food cause abdominal pain ? The giving of fat should be : A. Allow H. pylori to breed A. Not more than 10% B. Increase gastric juice B. Betweeen 10-20% C. Increase gastric acid C. 25% D. Attack gastric wall D. 35% E. Allow H. pylori adhesion E. Enough of essential fatty acid which is 20% 142. What diet can reduce the risk of For 146-148 complication ? After 15 years, the woman whom infected by A. Dairy product diet hepatitis B , complains bloody vomit, B. High meat diet ....swelling and... C. High fibre diet PE : shifting dullness. D. High fat diet 146. What is the coaus of fluid accumulation E. High protein diet in her body ? A. Protein depletion 143. The patient should take a wall balance B. Oliguria diet in a small frequent portion. What is the C. Accumulation of sodium reason ? D. Protein leakage A. To kill H.pylori effectively E. Plenty drink B. To raise nutritional status 147. The nutritional treatment should be : C. To reduce acidity A. High potassium intake D. To cover gastric wall B. High calorie E. To maintain the gut health C. High water intake D. Plenty calorie and protein For 144-145 E. Iron supplementation A 42 y.o woman come to hospital w/ yellowish 148. What is the common change in mineral skin. She also complains weak and sometimes metabolism ? epigastric pain for 3 weeks. Her PE : icteric in A. Decrease of sodium conjunctiva, tenderness at right upper B. Decrease of calcium quadrant abdominal (+) liver palpable C. Decrease of chloride hardened edge 2 cm bac, 2 cm bpx, w/o D. Decrease of potassium shifting dullness in abdomen area. E. Decrwease of phosphate 144. Assesment her nutritional status will be 149. A Mr. B 50 yo man is diagnosed w/ affected by : chronic HBV infection since 25 yo he was a A. The virulence of the virus drug abuse. He has lost his appetite B. The enlargement of the liver andkeeps loosing his weight. The doctor C. The colour of the skin should give the nutritional intake : D. The surface of the liver A. Increase energy intake/ large meal E. The change of metabolism B. Increase carbohydrate intake
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C. Give more simple carbohydrate composition D. Balance ratio b/w protein and lipid E. Increase energy intake w/ small frequent meal 150. Decrease food intake is a common in each person w/ hepatic disease but actually energy needs may be increased or decreased. Its crucial to remember that energy balance. This aspect isnt correction factor to calculate energy intake in hepatic disease : A. Thermogenic effect of food B. Stress factor C. Age D. Gender E. Lactic acid level 151. Before the appropriate nutrition therapy can be implemented, a nutritional assessment must be performed to determine the extent and cause of malnutrition. The best alternative to perform a nutritional assessment in liver disease is : a. Objective parameters b. Quisioner question c. SGA parameter d. Combine of objective and SGA parameter e. Clinical assessment 152. Protein is the most controversial nutrient in liver failure. Sufficient protein is necessary to maintain or restore body strength, as well as to promote immune function. How to give the protein for the patient? a. Above 0,8 g/kg BW b. In situation of stress in liver failure need less of.(fotonya kepotong) c. Increase branch chain amino acid food resource..

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inflammatory agent induce ulceration. Which e. K HCO3 of the following is the right statement of misoprostol? 160. Which of the following has adverse a. Blocks cholinergic receptor effects transient metabolic alkalosis? b. Blocks H2 histamine receptor a. CaCO3 153. Ms.Gina, 29 years old is diagnosed c. Stimulates prostaglandin receptor b. Al(OH)3 Peptic Ulcer. She is given Omeprazol by her d. Activated protein kinase c. Mg(OH)2 doctor. e. Blocks proton pump d. NaHCO3 Which of the following is the right answer for e. K HCO3 Omeprazol? 157. Which of the following has both acid a. Antacid inhibitory and mucosal protective properties? 161. Which of the following is used as b. Anticholinergic agent a. Misoprostol adjuncts to the H2 histamin receptors c. H2 receptor blocker b. Sucralfate blockers? d. Protein pump inhibitor c. Bismuth -> proteksi aja a. Famotidine e. Prostaglandin analog d. Antacid b. Pirenzepine e. Pirenzepine c. Sucralfate 154. What is inhibited by Omeprazol? d. Omeprazole a. Adenosine monophosphatase 158. Mrs.Dewi, 45 years old woman is e. Antacid b. The gastric ATP ase diagnosed gastritis and get antacid as the c. Cholinergic treatment. At the same she also get 162. Which of the following is mucosal d. Histamine tetracyclines for her other disease. Which of protective agents? e. Prostaglandin the following is the right statement? a. Famotidine a. Antacid should given at the same time b. Pirenzepine 155. Histamine has a powerful effect on the with tetracycline c. Sucralfate secretory cells of the stomach, stimulating b. Antacid affects the absorption of d. Omeprazole acid secretion. It does by binding to H2 tetracycline e. Antacid receptor on the parietal cells of the stomach, c. Antacid decreasing intragastric pH 163. A pathologist will examine the section of thereby inhibiting a cyclic AMP-mediated d. Antacid should be taken as longterm alimentary tract on GERD patient. His cascade of activity. Which of the following medication for renal insufficiency objective is to identified the esophagus drugs competitively block the H2 histamine patient structure. The patient got GERD for several receptor? e. Antacid is weak acid that react with years. The pathologist saw the changes in a. Misoprostol gastric hydrochloride to form a salt squamous epithelial layer became columnar b. Pirenzepine and water type of epithelial. What is the terminology of c. Sucralfate the changes in that epithelial layer? d. Bismuth 159. Which of the following is systemic a. Carcinoma e. Ranitidine antacid? b. Adenoma a. CaCO3 c. Metaplasia 156. Misoprostol, a methylester with b. Al(OH)3 d. Anaplasia antisecretory and cytoprotective properties c. Mg(OH)2 e. Neoplasia has been approved for the prevention of antid. NaHCO3
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d. Increase aromatic amino acid food resources e. Choose ammoniogenic amino acid food resources

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164. What is the best diagnosis for this patient based on pathological examination? a. Neoplasia of stomach b. Barret esophagus c. Gastric polyp d. MALT e. Gastric adenoma b. Fibrosis of the muscular layer c. Destruction of epithelial layer until serosa layer with PMN cells d. Atrophic of epithelial layer e. Proliferation of seromucosa gland describe of the microscopic finding of the specimen from this patient? a. Dilation of the vessel below the epithelial layer b. Fibrosis of muscular layer c. Infiltration of inflammation cells d. Proliferation of the epithelial layer with the atypical cells e. There is no ganglion in the gut

167. What is the best diagnosis for this patient based on the pathological 165. A 46-year-old woman with no prior examination? medical history was admitted to a local a. Appendicitis hospital due to progressively increasing upper b. Chronic appendicitis 170. The pathologist gave the diagnosis as abdominal discomfort for some weeks, lately c. Acute appendicitis internal and external hemorrhoid. Which of associated with jaundice. No weight loss was d. Acute perforated appendicitis the best finding from microscopic feature reported. No mass was palpable at the e. Chronic perforated appendicitis from this patient? physical examination. Ultrasound showed a a. Dilated vessel with columnar epithelial gallbladder hydrops with gallstone in the 168. A 2-month-old baby boy was brought to cells gallbladder and bilateral dilation of ER with abdominal distension, vomiting, and b. Dilated vessel with squamous intrahepatic bile ducts, performed operation no defecation since 4 days ago. There is epithelial cells (cholecystectomy). Which of the following is history of delayed passage of meconeum and c. Thrombus in the vessel the microscopic finding in the specimen from recurrent obstipation. There also history of d. There are blood clots and necrotic cholecystectomy? explosive diarrhea. Biopsy of the gus was tissue a. Aschoff bodies performed. Which of the following is the best e. Columnar and squamous epithelial b. Invasiveness of the epithelial layer describe of the microscopic finding from this layer was found c. Crypt patient? d. Rokitansky aschoff a. Fibrosis of the muscular layer 171. A 55-year-old man came to the out e. Proliferation of lymphoid follicle b. Destruction of epithelial layer patient clinic with the chief complaint of c. There are ganglions in aurbach plexus yellow eye and dark color urine. He ever got 166. A 34-year-old man came to emergency d. Absent of ganglion in meisner plexus hematemesis in several years ago, and was unit with the chief complaint right lower e. Hyperplasia of the ganglion diagnosed as hepatitis. The doctor did the quadrant pain. The complaint accompanied biopsy. Which of the following is the best by low grade fever, vomiting, and obstipation. 169. A 57-year-old man came to out patient microscopic finding in this patient? From physical examination showed rebound clinic with chief complaint the blood drips a. Bridging necrosis tenderness. He was diagnosed as especially after he has his bowel open. He has b. Fibrosis periportal appendicitis, and appendectomy was had such a bleeding four times since two c. Necrosis of the hepatocyte performed and the specimen was sent to years ago and sometimes it accompanied by d. Hepatocyte was enlargement pathology department. Which of the following the piles coming out from the anus that could e. Infiltration of PMN cells is the best describe of the microscopic finding be pushed back into the anus by fingers. The in the specimen from that patient? doctor gave the suggestion to get the 172. A 24-year-old man was admitted to the a. Hyperplasia of lymphoid tissue with operation of the piles and the operation was hospital through the emergency room with infiltration of mononuclear cell done. Which of the following is the best hematemesis and melena. No history of
Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )

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icterus, Injecting Drug Usage or use of 173. Related to the diagnosis of this patient, NSAIDS. He was pale but in stable which microscopic finding will revealed in the hemodynamic conditions. There was slight A area of this colon? hepatomegaly and a huge spleen of Schuffner a. Normal ganglion 6 was detected. Which is the most likely b. Aganglion etiology of GI bleeding in this case? c. Hypoganglion a. Esophageal varices d. Hyperganglion b. Gastric telangiectasis e. Ganglioneuroma c. Gastric Henoch-Schoend (maaf foto ngeblur) 174. Related to the diagnosis of this patient, d. Erosive hemorrhagic gas which microscopic finding will revealed in the e. Peptic ulceration B area of this colon? a. Normal ganglion For questions number 173 to 174, refer b. Aganglion What is the most appropriate diagnosis of this to scenario below : c. Hypoganglion patient? A 2-month-old baby boy admitted to the d. Hyperganglion a. Chronic calculouscholecystitis hospital because of abdominal distention. His e. Ganglioneuroma b. Chronic acalculouscholecystitis mother said that the baby had chronic c. Acute calculouscholecystitis constipation since he was born, physical 175. A 45-year-old female admitted to the d. Acute acalculouscholecystitis examination revealed very distended hospital because of colicky pain in the right e. Cholelithiasis abdomen, the x ray showed enlargement of upper quadrant, this symptom accompanied the descending colon filled with gases and by nausea, vomiting, and fatty food radioopaque material. Transanalpullthrough intolerance. USG of the liver and gallbladder operation was performed and the showed gallstone and enlargement of the macroscopic finding in descending colon was gallbladder. Cholecystectomy was performed shown in picture below. and the specimen samples were sent to the pathology laboratory. The macroscopic and microscopic findings were showed in the picture below.

Ilmu lebih utama dari harta, karena ilmu menjaga kamu, sementara harta kamulah yang menjaganya. (Ali bin Abi Thalib )