KEMENTERIAN PENDIDIKAN NASIONALUNIVERSITAS HASANUDDINFAKULTAS KEDOKTERAN

SISTEM GASTROENTEROHEPATOLOGI (GEH)Sekretariat: Bagian Bedah Fakultas Kedokteran UNHAS

Jl. Perintis Kemerdekaan Kampus Tamalarea Km. 10 Makassar 90245Telp. 081543060855 Fax. 0411-586296. Email: geh.fkunhas@gmail.com

REMEDI AL TEST ACADEMIC PHASE 2012/2013

Friday, October 5th, 2012

Location : GA 306 FKUH LT. 3

Time : 10.00 – 11.40 (100 minutes)

Test code : 1

INSTRUCTION:A. Choose the best answer (A, B, C, D, or E) B. Some questions can have just 4 four choices (A, B, C, and D)C. For some questions with options 1, 2, 3, and 4: choose A if 1, 2, and 3 are correct; B if

1 and 3 are correct; C if 2 and 4 are correct; D if only 4 is correct; E if all statements are correct

Choose the best answer (A, B, C, D, or E)

1. 46-year-old farmer woman was brought by ambulance to the hospital in acute distress with symptoms of severe pain in the right upper abdominal region. In the past she has had repeated attacks of severe pain in the right upper quadrant of the abdomen, frequently following a heavy meal. She suffers from indigestion and “gas pain on her stomach”, particularly after eating fatty foods and eggs. What is the organ that might be suffering in this patient ?A. Stomach B. Duodenum C. Liver D. Gall bladder E. Ascending Colon

2. A 24-year-old woman was admitted to the hospital with jaundice since the last 7 days. She also reported the darkening of her urine for 3 days before admission. On X-ray examination without contrast, there are seen multiple calcified stones in the right upper quadrant. According to the above scenario, which one of the biliary system involve.A. Liver B. Gall bladder C. Pancreatic ductD. Common bile duct E. Common hepatic duct

3. Our throat divides into two separate tubes: the windpipe and the gullet. What prevents food from entering the windpipe?A. The uvula B. The tongue C. The trachea D. The epiglottis E.The oesophagus

4. Where does the partly-digested food (in liquid form) go after it leaves the stomach?A. The gullet B. The appendix C. The small intestine D. The large intestine E. The Sigmoid colon

5. A 20 year-old boy, came to the clinic department complaining ofpain at right lower quadrant abdomen from sleep last night. This chief complaint is associated with with nausea and episodes of vomiting. The patient also reports that he has chills.What is the organ/structure might be suffering in this patient?A. Appendix vermiformis B. Oesophagus (abdominal part) C. DuodenumD. Stomach E. Pancreas

6. What are the organs that located retroperitoneal (lay behind peritoneum)?A. Ileum, jejunum B. Transverse and sigmoid colonC. Ascending and descending colon D. Abdominal part of oesophagusE. Both right and left lobe of liver

7. Mouth or oral cavity divided into two area, vestibule and oral cavity proper. Which of the following statement is correct due to vestibule?A. Space behind alveolar processes B. Space between cheeks and alveolar processesC. Hard and soft palate as roof D. Large space in the oral cavityE. Tongue located in this area

8 . The following statement is not in gaster :A. Simple cylindris epitheliumB. Fovea gastricaeC. Crypt lieberkhunD. Simplex tubular glandE. Rugae

9. The appendices epiloicae :A. AppendixB. EsophagusC. GasterD. Small intestineE. Large intestine

10. The following statement is not in vesica felea :A. Simple cylindris epitheliumB. A thin submucosaC. Sinus Rochitansky AschoffD. Capillaries in lamina propiaE. The serosa is covered by mesothelium

11. The centrum of liver lobules is :A. Portal areaB. Portal veinC. Central veinD. SinusoidE. Trigonum Kiernan

For questions no. 12 – 14 with options 1, 2, 3, and 4: Choose

A. if 1, 2, and 3 are correct; B . if 1 and 3 are correct; C . if 2 and 4 are correct; D . if only 4 is correct; E . if all statements are correct

12. The characteristics of large intestine are:1. Many goblet cells2. Small villi

3. Crypt Lieberkuhn4. Small plica circularis

13. The characteristic mucosa of small intestine are:1. Villi2. Crypt Lieberkuhn

3. Plica Circularis Kerkringi4. Rugae

14. The Acinus Hepar:1. Rappaport cs2. Divided in 3 zone

3. Rhomboid4. Trigonum of Kiernan

Choose the best answer (A, B, C, D, or E)

15. A 40-year-old policeman presents with the chief complaint of intermittent midepigastric pain that is relieved by antacids or eating. Gastric analysis reveals that basal and maximal acid output exceed normal values. The gastric acid hypersecretion can be explained by an increase in the plasma concentration of which of the following?A. Gastrin B. Histamine C. SomatostatinD. Secretin E. Enterogastrone

16. A patient presents with a chronic cough. The patient also reports substernal burning pain that is most pronounced after ingestion of coffee, chocolate, french fries, and alcohol. Which of the following is the most likely cause of gastroesophageal reflux disease (GERD) in this patient?A. Hiatal hernia B. Delayed gastric emptyingC. Decreased esophageal motilityD. Decreased lower esophageal sphincter toneE. Decreased upper esophageal sphincter tone

17. A 28-year-old male presents to the emergency room with a 48-hour bout of diarrhea with steatorrhea. Which of the following best accounts for the appearance of excess fat in the stool?A. Delayed gastric emptying B. Decreased bile salt pool sizeC. Decreased gastric acid secretionD. Decreased gastric accommodation E. Decreased secretion of intrinsic factor

18. After secretion of trypsinogen into the duodenum, the enzyme is converted into its active form, trypsin, by which of the following?A. Enteropeptidase B. Carboxypeptidase C. Pancreatic lipaseD. Chymotrypsin E. An alkaline pH

19. Which of the following is the major mechanisms for absorption of protein from the small intestine?A. Na+ - H+ exchange B. Cotransport with sodium C. Electrogenic transportD. Neutral NaCl absorption E. Solvent drag

20. A young mother calls the pediatrician because she is concerned that her infant defecates after every meal. Which of the following is the cause of these normal bowel movements in newborns?A. The gastroileal reflex B. The gastrocolic reflex C. Peristaltic rushesD. The intestino-intestinal reflex E. The defecation reflex

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21. An 18-year-old male with pernicious anemia lacks intrinsic factor, which is necessary for the absorption of cyanocobalamin. Intrincsic factor is produced by:A. Oxyntic cell B. Parietal cell C. G cell D. D cell E. S cell

22. Which one of the following factors is possible to stimulate gastrin secretion?A. HCl B. Secretin C. Calcitonin D. VIP E. Nutrient proteins

23. Which one of the following hormones to stimulate the contraction of the gall bladder?A. Gastrin B. Glucagon C. Cholecystokinin D. Enterocrine E. Secretin

24. Which one of the following enzymes is exoenzyme?A. Pepsin B. Trypsin C. ElastaseD. α-amylase E. Carboxypeptidase

25. Which one of the following is needed to convert biliverdin to bilirubin?A. NADP+ + O2 B. Carbonmonoxide C. Heme oxygenase D. Bilverdin reductase E. UDP-glucuronyl transferase

26. Bile salts is primarily derived from:A. Trigliserides B. Phopholipids C. HemeproteinsD. Cholesterols E. Globin

27. Hepatitis D virus is a defective virus that can replicate only in cell which already infected with which of the following viruses?A. HIVB. Hepatitis G VirusC. Hepatitis A VirusD. Hepatitis B VirusE. Herpes Simplex Virus.

For Question no. 28 – 29 Woman 31 years old is brought in after vomiting in a large amount. She is dizzy and complains an abdominal cramp and looks ill. This is her first such illness. She has just finished her fried rice lunch in a canteen around 30 minutes ago.

28. What did likely happen to the woman? a. Dyspepsiab. Cholerac. Salmonellosisd. Food intoxicatione. Food infection

29. What was likely the cause of the case above?a. Bacillus cereusb. Campylobacter jejunic. Salmonella typhiid. Vibrio choleraee. Clostridium perfringens

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For Question no. 3 0 - 3 1 A 23 years old man presents with fever that lasting since a week ago, the febrile is intermittent and often occur in the evening preceded by shivering. He also complains an abdominal cramp and diarrhea a couple days ago. Today he has just vomiting twice. 30. If the blood specimen of the patient is taken to microbiology laboratory reveal a gram

negative rod bacterium, with negative lactose and positive H2S in biochemistry test, what is the possible bacterium infected him?a. Shigella flexnerib. Salmonella typhiic. Escherichia colid. Bacillus cereuse. Clostridium botulinum

31. What is the characteristic of that bacterium?a. Aerobeb. Non-motile c. Food borne bacteriumd. Can be also cultured from urine in first week of disease e. Has ability to cross the gastric acid barrier in a small amount

For Question no. 3 2 - 3 3 A 15 years old boy presents to the hospital with extremities flaccid paralysis since 2 hours ago. This is the first episode of paralysis for him. He has no history of neurologic disease, and never taken certain drugs for a long period. A day ago he ate a canned fish.

32. What is likely the cause of the disease?a. Shigella flexnerib. Salmonella typhiic. Escherichia colid. Bacillus cereuse. Clostridium botulinum

33. What is the best diagnostic test taken to make sure the diagnosis?a. Gram stainingb. Biochemistry testc. Cultured of blood sampled. Electroencephalographye. PCR based assays

34. The following properties of Hepatitis A virus is :A. Incubation period HAV 2 - 6 weeks.B. Replicates in the nucleus of infected cellC. Mortality rate : more than 1 %D. Replicative cycle different to that replicative cycle of polio virusE. HAV infection of culture cells produced cytoplasmic effect.

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35. HBV is also called as the helper virus for HDV, because:A. HDV does have the genes for its envelope protein.B. HDV requires an established Hepatitis B virus infection to be able to replicate.C. HDV can replicate in cells also infected with HEV or HCV.D. HDV uses HbcAg as its envelope protein.E. Hepatitis D virus is can replicate on its own.

For Question no. 36 - 42 Patient, male 57 yo, was hospitalized a few days ago. Symptoms: fatigue, fever(subfebrile), anorexia. Physical examinations: jaundice, pale, pruritus. Laboratory tests: RBC: 3.100.100/cmm, WBC: 9.100/cmm, Plt: 210.000/cmm, Hb: 8,5 gr/dl, Hct: 31%, AST: 100 U/l, ALT: 360 U/l, Total bilirubin: 8mg, Blood glucose: 100mg/dl, Urine: Bilirubinuria (++).

36. Differential Diagnosis: 1. Viral hepatitis2. DHF3. Hemolytic anemia4. CKD

37. Alanine Amino Transferase (ALT)= 360 U/l (High)1. Chronic hepatitis2. Mononucleosis3. Cholecyctitis4. Myocard infarct

38. Total bilirubin= 8,0 mg/dl1. Fatty liver degeneration2. Chirosis toxication (Alcoholic ingestion)3. Ductus biliaris occlusion4. Acute viral hepatitis, cholestatic type

39. Jaundice, etiology1. Bacterial infection2. Parasitic infection(falciparum)3. Haemorrhargic disease4. Haemolytic anemia

40. Bilirubin indirect1. Water soluble2. Bilirubin proteinat3. Conjugated bilirubin4. Serum bilirubin

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41. Laboratory tests to make a diagnosis of hepatitis B ;1. HBsAg2. ALT(20-50x upper limit)3. Anti-HBs4. AFP

42. Vaccination of hepatitis B&C for all case :1. Basic vaccination: anytime2. Booster I (Second dosage): 1-2 months after basic3. Booster II (Third dosage): 4-6 months after basic4. Booster III: Very important dosage

For question no. 43 – 44 : A 25-year-old man come to health centre with diarrhea. He states that his stool was mixed with blood and mucus. Examination of his stool reveals parasite with characteristics as follow: irregular shaped, ectoplasm sharply separated from endoplasm, has one nucleus with a small central compact karyosome, and endoplasm contain red blood cell.43. Which one of the following organisms is the most likely found in this man’s stool?

A. Trophozoite of Giardia lamblia B. Trophozoite of Entamoeba coliC. Trophozoite of Endolimax nana D. Trophozoite of Balantidium coliE. Trophozoite of Entamoema histolytica

44. What is the best diagnosis for the case above?A. Giardiasis B. Amebiasis C. ShigellosisD. Isosporiasis E. Balantidiasis

For question no. 45 – 46 : A 7-years-old girl presents to health centre with diarrhea. Examination of her stool reveals fat granules and parasite with characteristics as follow: bilaterally symetric, pear-shaped, rounded on anterior part, pointed on posterior part, has two nuclei in the anterior, four flagella, and two axostlyes.

45. Which one of the following organisms is the most likely found in this girl’s stool?A. Trophozoite of Entamoeba hystolitica B. Trophozoite of Balantidium coliC. Trophozoite of Entamoeba coli D. Trophozoite of Giardia lambliaE. Oocyst of Isospora belli

46. What is the best diagnosis for the case above?A. Giardiasis B. Amebiasis C. ShigellosisD. Isosporiasis E. Balantidiasis

For question no. 47 – 48:A 45-year-old woman hospitalized due to difficulty in swallowing. A tumor in her oesophagus located at near the stomach-oesophageal junction was found by endoscopic examination. 47. Type of tumor that could be found mostly at that location is:

A. Adenocarcinoma B. Basal Cell CarcinomaC. Squomous Cell Carcinoma D. Undifferentiated Carcinoma.E. Adenosquamous Carcinoma

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48. The tumor occurred at that location initiated by metaplastic change and displatic change due to the present of chronic irritation by stomach acid reflux. The distal part of esophagus that metaplastic change occurred is called: A. Atresia esophagus B. Stricture esophagus C. Varices esophagusD. Barret esophagus E. Burkitt esophagus

For question no. 49– 5 0 : A 30-year-old woman came to doctor with frequent epigastric pain. The doctor diagnose her as a chronic gastritis patient. Because she suffered from the disease in long period, the doctor worried about the possibility of cancer development, and he asked her to visit a gastroenterologist to know the actual cause of the disease.

49. Among the possible cause of the disease (chronic gastritis) which one of them having highest possibility to develop stomach cancer:

A. Gastric outlet obstruction B. Chronic functional dyspepsiaC. Chronic infection by Helicobacter pyloriD. Chronic chemical gastritis caused by bile refluxE. Chronic autoimmune gastritis of parietal cells by antibody

50. The endoscopic examination followed by biopsy of the gastric lesion was performed at the gastroenterology department. The pathologic examination of biopsy specimens found the cause of the chronic gastritis having a very high risk to develop stomach cancer, and the pathologist reports the present of intestinal metaplasia and dysplasia of the stomach epithelial. The conclusion is:

A. Chronic gastritis is not severe.B. Chronic gastritis is severe and stomach cancer already present.C. Chronic gastritis is severe but don’t worry for development of stomach cancerD. Chronic gastritis is severe and high risk for the development of stomach cancer

A 61-year-old woman came to doctor with hematemesis, melena, and frequent epigastric pain. She showed sign of anemia with 4 gr% of hemoglobin level. By endoscopic examination the diagnosis was ulcer in the stomach.

51. The incorrect statement about stomach ulcer is: A. Peptic ulcer in the stomach never cause perforation B. Ulcer penetration in acute ulcer reaches muscular layerC. The most cause of ulcer of stomach is Helicobacter PyloriD. Term erosion is used if the ulcer penetration limited on mucous layerE. The ulcer may couse massive bleeding if ulcer affected a big blood vessel

52. 37 years old woman, visit her doctor, complaining of epigastric pain, doctor ‘s Diagnosis, she is suffering gastritis. Doctor gives her Proton Pump Inhibitor(PPI), The drug is :A. Simetidine 150 mg B. Ranitidine 200 mg C. Omoperazole 20 mg,D. Domperidon 10 mg E. Sucralfat 500 mg

53. A man age 21 years old,vertigo and gaster discomfort . The doctor chooses drug that action Inhibit nausea and vomiting. Side action of this drug at central and perifer of body.

A. Domperidon B. Loperamid C. Metoclopramid D. Cisapride E. Hyocianin

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54. Man 45 years old ,tourist, abdominal pain and diarrhea without bloody stool. Doctor praescribes 3 drugs . one of those drug is anti diarrhea classified narcotic. This drug is:

A. Kodein B. Norit C. pektin D. Loperamid E, Attapulgide

55. Woman 35 years old ,consume drug for treat his menstruation pain from dispensary. Complain mydriasis and retensi urinary . This is side effect of : A. Anti spasmodic B Analgetik C.AntasidaD. Non steroid antiinflamation drug E. Antibiotik

56. One patien ( 40) comes to his doctor ,his case internal haemoroid. The doctor praescribes drug per rectal( suppositoria). One component of that drug is steroid anti inflamasi. That drug is A. Benzocain B. Prednisolon C. Dimenhidrinat D. Lidocain E. Diphenhidramine

57. Lipotropic drug is :A. Simvastatin, B, Gemfibrosil C.Cholin D. Fenofibrate E.Pravastatin .

For question no. 58 - 6 0 A 62-year-old man presents to the emergency department (ED) with a chief complaint of waking up with abdominal pain. He states that over the past week he has had intermittent, gaslike epigastric pain and a sensation "like I need to burp". It is now radiating in a bandlike pattern throughout the patient's upper abdomen and to his back. The patient has mild nausea but has not vomited. He has not experienced any chills or fever, and he denies having any diarrhea. No chest pain, shortness of breath, or palpitations are noted. He has no chronic medical conditions and does not take any medications like nonsteroidal anti-inflammatory drugs (NSAIDs). 58. What is the cause of the patient's abdominal pain?

A. Gastroesophageal reflux diseaseB. CholecystitisC. Acute pancreatitisD. Peptic ulcerE. Gastric Tumor

59. Which of the following is the most common cause of the above patient's condition?A. Helicobacter pylori infectionB. NSAIDsC. SmokingD. AlcoholE. Chronic steroid use

For question no. 60 - 61 Three month later, the patient comes again because of melena, from history taking he was suffering from rematoid arthritis and using prednisone with non-steroid anti inflammatory drugs (NSAIDs) for a past few years. Upper GI tract reveal as peptic ulcer . 60. The pathomechanism of gastroduodenal injury related to NSAIDs:

A. Indirect accumulation of NSAID in epitel gastroduodenal causing inflammation and later giving necrosis with epitelial haemorrhagic

B. Inhibition of cyclo-oxygenase receptor with direct accumulation of NSAIDC. Direct accumulation causing inflmmation, decreased of prostaglandin and neutrofil

formation D. Direct inhibition of cyclo-oxygenase receptor causing increased of prostaglandin and

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decreasing neutrofil formation with indirect accumulation of NSAID E. Indirect inhibition of cyclo-oxygenase receptor causing prostaglandin decrease and

neutrofil formation increase with direct accumulation of NSAIDs

61. Recommendation for this patients to avoid the complication, such as:A. Discontinue NSAIDs and ulcerogenic drugB. Using PPI while NSAIDs continue or change to COX-2 selective inhibitorsC. Identify high risk patient : age > 60 y.o, prior GI bleed, high dose NSAID, concurrents

steroid D. A and C choiceE. B and D choice

For question no. 62-64A 45-year-old presents to you, he has experienced the gradual onset of rectal bleeding over the past 3 months. He first noticed it with wiping, but it has become more overt with blood associated with passing bowel movements. His stool frequency has increased to approximately 4-5 trips to the toilet daily. He is experiencing an urgent sensation to defecate just before going to the toilet. He has no other health issues. Physical examination shows anemia, eritema nodusum, mild abdominal distention and pain in left lower hipochondrium. 62. According to anamnesis and physical examination, suspicious diagnosis of this patient is :

A. DysentriB. Diverticulosis C. Irritable bowel syndromeD. Colitis infectionE. Inflammatory bowel disease

63. Simple diagnostic procedure as a doctor in primary health care:A. Rectal examinationB. Endoscopy of lower GI tract C. Colon in Loop D. Ultrasonography of abdomen E. Take serologic laboratory study

64. Long term complication of this patient disease should always to take attention:A. Toxic megacolon B. Bleeding and perforationC. CachexiaD. Impairement the quality of life E. Colorectal cancer

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For question no. 65 - 66 A 25 years old male patient complain with nausea, vomiting, artralgia, anorexia and malaise within 2 weeks. After 7 days, patient have dark yellow urine and according his friends, yellow eyes was appear on his eyes recently.Physical examination reveal : sclera icteric and light pain palpable in upper hypochondrium dextra; laboratory : Billirubin total 16,8 mg%, Billirubin direk 8,5 mg%, SGOT=250 U/L, SGPT=400 U/L.

65. Temporary diagnosis of this patient:A. Cholestatic disease C. Acute HepatitisB. Chronic Liver Disease D. Acute Pancreatitis E. Acute Cholecystitis

66. Which of the following tests is used to screen patients for evidence of HBV infection?A. Hepatitis B surface antigen (HBsAg)B. Hepatitis B surface antibody (anti-HBs)C. Hepatitis B core antibody (anti-HBc)D. Hepatitis B envelope antigen (HBeAg)E. Hepatitis B envelope antibody (anti-HBe)

For question no. 67 - 68 A 56 years old female patient enter to hospital with abdominal distention, edema in foot within 3 months. Bleeding with dark blood are find in mouth and anal. Physical examination: sclera icteric, conjungtiva, anemis, eritema palmaris, shifting dulness , edema tibial and pretibial. Laboratory findings: Bill total = 20.5 mg%, SGOT= 59 U/L, SGPT=65 U/L, protein total=5,2 gr/dl, albumin=2.0 gr/dl.67. Diagnosis according anamnesis, physical examination and laboratory are:

A. Ascites C. Compensated Liver CirrhosisB. Chronic liver disease D. Decompensated Liver Cirrhosis

E. Acute hepatitis

68. Complication can occur according diagnosis of the patient:1. Variceal Bleeding 3. Hepatorenal syndrome2. Spontaneous Bacterial Peritonitis 4. Hepatic Encephalopathy

For question no. 69 – 71 : A boy, 6 years of age complained abdominal pain, especially at right lower quadrant. It had been felt since 3 days ago and become severe now until the right leg was pain. The child had fever and sometimes vomiting. Micturation were in normal limit and bowel movement were less today.69. According to find the etiology of abdominal pain, the first step is to look for:

A. Nutritional status B. Gender C. History of medicine beforeD. Age E. Other complaining signs

70. If there is Rovsing’s sign in physical examination, the possibility of diagnosis is:A. Urinary tract infection B. Gastritis C. DiverticulitisD. Appendicitis E. Constipation

71. The diagnostic adjunct must be done at first step is:A. BNO B. Colon in loop C. Abdominal USG D. Complete blood count E. IVP

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For question no. 72 – 76 : A girl, 2 years of age had watery stool yesterday with less waste, she can drink less water but get vomit. Her general condition was nervous. The girl has well nutrition. 72. The girl possibly suffer from:

A. Severe dehydration diarrhea B. Mild-moderate dehydration acute diarrheaC. Acute diarrhea D. Chronic diarrheaE. Persistent diarrhea

73. The most possible cause of her diarrhea is:A. Salmonella B. Virus C. Shigella D. Worm E. Fungi

74. The first line management for this condition is:A. Anti-bacterial B. Anti-virus C. Breast milkD. Oral rehydration solution E. Anti-diarrhea

75. The main problem of neonatal jaundice:    A. Physiologic Jaundice   B. Breast milk Jaundice    C. Jaundice caused by dehydration   D. Jaundice caused by immaturity of liver

function    E. Obstructive Jaundice

76. Physiological jaundice:    A. Direct hyperbilirubinemia     B. Direct and indirect hyperbilirubinemia    C. Normal indirect bilirubin     D. Caused by abnormality of the biliary tract    E. Disappear completely

For question no. 77 - 79 Patient, 2 years old, female. Admitted to the hospital with a bulge (swelling) in the groin which at times may extend into the right scrotum. The bulge may appear and then disappear with some regularity, especially during straining, crying,or coughing.There is no vomiting and no abdominal distention. Rectal toucher in normal limite.

77. What is the Clinical diagnosis?a. Inguinal Hernia Reponible Dextrab. Hydrocele uncommunicantes Dextrac. Femoralis Hernia Dextrad. Ca Testis Dextrae. Orchitis Dextra

78. Differential Diagnosis For this case with use transiluminasi test positiveis:a. Incarcerata herniab. Strangulata herniac. Iguinalis herniad. Hydrocelee. Ca Testis

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79. The treatment for this case is :a. Herniotomyb. Hidrocelectomyc. Orchidectomyd. Concervativee. Orchidopexi

For question no. 80 - 82 Patient, 2 month years old,male. Admitted to the hospital (policlinic of pediatric surgery) with a bulge (swelling) in umbilical region, There is no changing color of skin in bulging area, others physical examination is normal limite.The bulge may appearduring straining, crying,or coughing.There is no vomiting and no abdominal distention.80. What is the diagnose?

a. Umbilical Fistelb. Umbilical Herniac. Omphaloceled. Umbilical Granulomae. Ductus Omphalomesentricus persisten

81. The correct answer for this case treatment is.a. Firstulectomyb. Directly operate (Cito)c. Observe until age 3 to 4 yearsd. Incidence of incarcerata is highere. Exicision Granuloma

82. Surgical management of this case is:a. Laparotomy explorationb. Wide excision of granuloma c. Fistulectomyd. Repair Omphalocelee. Repair Hernia Umbilical

83. Seorang wanita muda berumur 19 tahun, mengeluh nyeri perut tiba-tiba pada abdomen kanan bawah. Pemeriksaan fisik abdomen ditemukan adanya nyeri pada kwadran kanan bawah. Pada colok dubur juga didapatkan adanya nyeri. Suhu tubuh 37,30 C, leukosit 10.000/mm3. Diagnosis yang paling mungkin adalah :A. Penyakit Inflamasi PelvikB. Infeksi traktus urinariusC. Appendisitis EpiploikaD. Ruptur Folikel GraafE. Appendisitis Akut

84. Pada anak anak proses penyakit yang di salah diagnosiskan dengan appendisitis akut adalah :

A. Lymphadenitis mesenteric akutB. Enteritis regional akutC. Gastroenteritis akutD. Pyelonephritis akut

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E. Intususepsi85. Penyebab utama cholesistitis akut adalah

A. Infeksi KlebsiellaB. Infeksi SalmonellaC. Batu empedu multipleD. Infeksi Escherichia ColiE. Obtruksi duktus sistikus

86. Seorang laki-laki berumur 75 tahun, masuk Rumah sakit dengan ikterus obstruksi yang dialami sejak 2 minggu terakhir. Prosedur awal terbaik dalam menentukan penyebab ikterus obstruksi adalahA. CT scanningB. UltrasonographyC. Radionuclide scanningD. Percutaneus transhepatic cholangiography (PTC)E. Endoscopic retrograde cholangiopancreatography (ERCP)

87. Wanita, 45 th masuk rumah sakit dengan ikterus obstruksi yang dialami sejak 3 bulan lalu, pada pemeriksaan MRCP dan ERCP ( gambar diatas menunjukkan bayangan radiopak pada distal duktus sistikus yang menekan common bile duck sehingga aliran empedu terhambat, diagnosis penyakit ini dikenal dengan A. PankreatitisB. CholesistitisC. Mirizzi syndromeD. Mallory Wheiss syndromeE. Penyakit Obstruktif menahun

For question no. 88 - 90 Laki-laki umur 60 tahun datang ke rumah sakit dengan keluhan tidak bisa buang air besar. Dialami sejak 5 hari yang lalu. Sebelumnya penderita mengeluh sering sakit perut. Para foto polos abdomen ditemukan gambaran friemaan-Dahl dan dengan pemeriksaan barium terdapat gambaran Birk beak appearance.88. Kemungkinan diagnosa penderita ini :

a. Perforasi gasterb. Appendisitis acutc. Diverticulitisd. Volvulus sigmoid

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e. Chron’s disease89. Penanganan pada penderita ini, kecuali :

a. Konservatifb. Pemasangan NGTc. Pemasangan katetherd. Operasi laparatomie. Sigmoidektomi

90. Pada kasus di atas yang merupakan kontra indikasi tindakan :a. Terapi entheral feedingb. Terapi parentheral feedingc. Puasad. Pasang NGTe. Foto polos abdomen

91. Man, 28 years old, with BMI 25.7 kg/m2, waist circumference 95 cm came to clinic because of heart burn especially after have a meal.What do you suggest to him for nutrition intake? A. Have a soft meal B. Have a small portion of meal but frequentlyC. Have a coffe after having a meal D. Have a meal early as possibleE. Have a cold meal

92. Man, 48 years old, come to private clinic because of bloating and pain in the abdomen. To maintain the mucous intestinal, what nutrient shoud be given to this man?A. Arginine B. Probiotic C. Proline D. Glutamine E. Prebiotic

93. College student, 22 years old, always complaining for pain in the epigastric area. Now he loses his weight about 2 kg since 2 months ago. What do you suggest for him about his intake to prevent another weight loss? A. Avoid high protein food B. Avoid high carbohydrate foodC. Have probiotic D. Have immunonutrition supplementE. Have high fiber food

94. Woman, 60 years old have a tumour in her stomach. Now, she has jejunal tube feeding. Food should be given as slowly as it can. If she has abdominal fullness and crampy. What is the sign stand for? A. Re-feeding syndrome B. Untolerance syndromeC. Chron’s syndrome D. Dumping syndromeE. Tolerance syndrome

95. Woman, 38 years old, come to emergency room because of pain in the epigastric and radiating to the back. What is nutrition management for this woman?A. Stop oral intake B. Give liquid dietC. Give fish oil supplement D. Give small portion and frequent meal

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E. Give curcumine supplement

96. The routine position of plain abdominal radiography in case of acute abdomen is:A. Supine-erect-right lateral decubitus B. Supine-erect-left lateral decubitusC. Supine-prone-erect D. Supine-prone-lateral decubitusE. Supine-prone-erect-lateral decubitus

97. A 44-year-old housewife is admitted to the ward with nausea and pain especially over the right upper abdominal. She has a history of fever and medication. In physical exam is unremarkable. The most appropriate investigation for this patient is ?A. MRI B. USG C. MRCP D. CT Scan E. Plain photo

98. A 60 years-old man with melena. Which of the following radiologic examination you recommend to be performed?A. Sialography B. Barium enema C. Follow throughD. Bronchography E. Gastroduodenography

99. A 45 years-old man with hematemesis melena. Esophagogram showing “ cobble-stone appearance” . The most likely diagnosis is A. Achalasia B. Varices C. Tumor D. Diverticle E. Polyp

100. A women 65 years-old was referred to radiology department for gastroduodenography with the clinical history of haematemesis. Gastroduodenogram showed persistent filling defect with irregular border along the wall of stomach body. The most likely diagnosis is:A. Ulcer B. Diverticle C.Gastritis D. Polyp E. Malignant tumor

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