Multiple Choice Questions

GASTROINTESTINAL SYSTEM
FK UPH 2014
Friday, 12 Feb. 16
08.10 – 10.50

Soal 1-3
1. 63-year-old man comes to the ER with complaint yellow in eyes since 1 month ago. He
feels unwell since 2 month ago and his has weight loss. He is slightly fever and nausea.
Physical Examination shows sclera icteric, liver was not palpable, but the spleen was
palpable. Lab test shows Hb 11, WBC 4900, platelet 80000, SGPT 60,SGOT 75, Total
bilirubin 4, Direct bilirubin 3.1, HBsAg (+), AFP 450. What is the best assist to
diagnostic this patient?
A. Endoscopy
B. Plain X-ray
C. Ultrasound
D. CT scan with contrast

2. Which complication may be found in the case above?

A. Septic Shock
B. Chronic Diarrhea
C. Hematemesis
D. Renal Failure
E. Heart Failure

3. A blood tap is taken on this patient. What most likely to show?

A. Decreased potassium
B. Decreased Globulin
C. Increased CEA
D. Increased Sodium
E. Increased PT and INR

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4. A 56 years old businessman came to the emergency department after having an event of
coffee blood vomiting. He has a history of coronary heart disease and he regularly takes
aspirin, as prescribed by his doctor, in order to treat the disease. During an endoscopy,
the doctor discovers an ulcer on the epithelium of his lesser curvature, near the pylorus
part, of the luminal side of his stomach. Which artery would most likely ruptures as a
result of the progression of the disease?
A. Right gastroepiploic artery
B. Left gastroepiploic artery
C. Right gastric artery
D. Left gastric artery
E. Gastroduodenal artery

Soal no 5-6
5. 50-year-old female present to your office for evaluation of dysphagia for 6 months. She
usually drinks 5-6 beers per day, love spicy food; she smokes daily 30 packs-years,
intermittent heartburn symptoms. She takes Hydrochlorothiazide for her hypertension.
She has Chronic Cough. Physical Examination was normal. On endoscopy, distal
esophageal stricture was found. On biopsy, benign mucosal with chronic inflammation
of H. Pylori was negative. What is the etiology of the stricture?
A. Alcohol
B. Tobacco smoke
C. Spicy food
D. Gastroesophageal Reflux
E. Hydrochlorothiazide

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

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

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Soal no7-8
7. A 30 years old woman suffer with gastric pain and burning sensation all the time and
relieved by food and antacids. Family doctor asks her to get endoscopic examination
and found ulcer in the surface of gastric mucosa.
The pathogen that may cause the disease above is :
A. Enteroaggregative E. Coli
B. Helicobacter pylori
C. Yersinia enterolitica
D. Campylobacter jejuni
E. Vibrio parahaemolyticus

8. Which swallowing reflex was most likely to be altered on the disease above?
A. Glottic closure
B. Inhibition of respiration
C. Peristaltic ring contraction of esophageal muscle
D. Relaxation of lower esophageal sphincter
E. Contraction of pharyngeal muscles that pushes bolus into the esophagus

9. 65-year-old woman presents with abdominal pain, night sweat, and early satiety.
Physical Examination shows multiple enlarged lymph nodes in supraclavicular and
mass in epigastric region. Hb 7 g/dL, WBC normal. What is the gold standard for
diagnose and treatment this patient?
A. Upper GI X-Ray D. Upper endoscopy with biopsy
B. Peripheral Blood Smear E. USG with contrast
C. CT scan of abdomen

10. A 42-year-old man come to you with history of epigastric pain for 6 months, constant
in nature especially after meal. He has tarry stool for last 2 months. He feel lack of
energy and look pale on physical examination. What organ may be affected?
A. Jejunum
B. Gaster
C. Pancreas
D. Appendix
E. Gallbladder

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11. A 42 year old came to ER with mild fever, fatigue, nausea, vomiting from 5 days ago.
Acholic stool and darken urine were present, the sclera and skin looked yellow. Liver
was palpable 2 cm below arcus costae and tender. Spleen was enlarged. What
mechanism cause the darken urine?
A. Increase unconjugated bilirubin an filtered by glomerulus
B. RBC destruction and filtered to the kidney
C. Inflammation reaction of kidney
D. Increased conjugated bilirubin plasma because soluble in water
E. Increased conjugated bilirubin and filtered by glomerulus.

12. 1-month-old baby present with diarrhea since 2 days before admission. He has watery
diarrhea fir 4-6 times per day with no blood, no mucus, acid smell, not bulky, not oily.
His mother complained that the baby has rash around his buttock. What substance
that’s not properly absorbed in the case above?
A. Fats
B. Protein
C. Carbohydrate
D. Vitamin
E. Mineral

13. 65-year-old woman presents with abdominal pain, night sweat, and early satiety.
Physical Examination shows multiple enlarged lymph nodes in supraclavicular and
mass in epigastric region. Hb 7 g/dL, WBC normal. What is the gold standard for
diagnose and treatment this patient?
A. Upper GI X-Ray
B. Peripheral Blood Smear
C. CT scan of abdomen
D. Upper endoscopy with biopsy
E. USG with contrast

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14. A 35 year old woman recently traveled to Aceh one week pasca tsunami. She
developed diarrhea causing hypovolemic shock, and metabolic acidosis. Her symptoms
started abruptly, with watery diarrhea followed by vomiting. She had no fever and
denies abdominal pain. What is the most likely organism responsible for her disease?
A. Staphylococcus aureus
B. Shigella dysentriae
C. Vibrio Cholerae
D. Salmonella Typhii
E. Escherichia coli

15. What is the important bacterial factor from the case above?
A. Lipopolysaccharides
B. IgA Protease
C. R antigen
D. H antigen (S. typhii)
E. K antigen (S. typhii)

16. A 2-day-old infant was treated in NICU after complicated birth. Suddenly the baby’s
condition worsens and according to the pediatrician needs a central line, so the doctor
inserts an intravenous catheter on the baby’s umbilical cord. Which of the following
was the remnant of the structure manipulated by the doctor?
A. Gastrohepatic ligament
B. Anterior coronary ligament
C. Posterior coronary ligament
D. Round ligament
E. Falciform ligament

17. Which of the following statements about histologically distinguish small intestine from
large intestine?
A. The small intestine have plicae circularis kerkringi
B. The large intestine have peyer's patch
C. The small intestine have relative more goblet cell
D. The large intestine almost as long as the small intestine
E. The small intestine have taenia coli

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18. A patient comes to your clinic with severe abdominal pain and a ‘burning’ sensation in
the upper abdomen. Endoscopy reveals several benign ulcers in the anthral mucosa of
the stomach. Which of the following drugs is most likely to provide the fastest relief of
the discomfort with just a single dose?
A. Omeprazol
B. Misoprostol
C. Propantheline
D. Antacid
E. Belladonna alkaloids

19. Microscopic of liver biopsy of a 50 year old man with long history of chronic alcohol
consumption:
A. Hydrophic Degeneration
B. Fatty Changes
C. (lupa)
D. nutmeg liver
E. Cirrhosis Hepatis

20. Which of these that distinguishes pyloric and gastric glands?

A. Pyloric glands have more parietal cells
B. Gastric glands do not contain enteroendocrine cells
C. Pyloric glands contain serous secretory
D. Pyloric glands mucosa extend to submucosa layer
E. Gastric glands only contain one type cells

21. The USG of 42 years old lady shows several stones in the gallbladder. An operation
was performed. What pathological findings that likely could be found in the gall
bladder wall?
A. Atrophy of mucosa epithelial
B. Chronic inflammatory cells
C. Acute inflammatory cells
D. Sinus rokkitansky
E. Irregular area of fibrosis

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Soal 22-23
22. 43 years old woman came to the clinic with complain of yellows eye and pruritis. Five
days ago she suffered right upper abdominal colic pain for hour after eating in padang
restaurant that afternoon. Now the colic pain has gone for two days. What substance
most likely increased in the serum?
A. Unconjugated billirubin
B. Albumin
C. Globulin
D. CCK
E. Conjugated bilirubin

23. Which structure is the most likely to altered in this case?

A. Ductus pancreaticus
B. Ascending duodenum
C. Ductus hepaticus communis
D. Ductus cysticus
E. Ductus choledocus

24. Hepatocellularcarninoma, possible substance as the causes?

A. Alfatoxin
B. Aspartam
C. Acetyl Salicylate
D. lupa
E. lupa

25. Female 24 years old, come with keluhan vomitting black tarry blood and has history of
epigastric pain after meals. Doctor performs gastric lavage and prescribe Antacid and
Sucralfate via nasogastric tube. Mechanism of the medicine?
A. Depressed vomit center in the brainstem
B. Increase peristaltic movement
C. Coating gastric necrotic tissue.
D. Block proton pump
E. Block H2 receptor

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26. A 5 years old boy comes to you with complaint of diarrhea with blood and mucus. On
two occasion, his mother noted "insides were coming out of his rectum". On stool
examination, there is parasites egg. What is the most likely cause?
A. Entamoeba Histolytica
B. Balantidium Coli
C. Trichuris Trichiura
D. Fasciolopsis Buski
E. B. Hominis

Soal 27-28
27. A-10-month-old boy brought to the emergency department by his mother with
abdominal pain and vomiting in the recent 2 hour. The boy was brought to a
pediatrician yesterday because of diarrhea; the last stool was like red-currant-jelly and
has stopped since the boy suffers the pain. On the examination there is distended and
tender abdomen, a palpable mass with sausage like appearance on right side of
abdomen, and increased bowel sound.
Which of the following findings may be seen on the plain abdominal photos?
A. Air distribution in the sigmoid colon
B. Free air under the diaphragm
C. Enlargement of liver
D. Thickening of the wall of appendix
E. Dilated small bowel with air fluid level

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

29. A 42 year old alcoholic man came into your clinic with severe epigastric pain. The pain
comes abruptly 30minutes after meal, he also vomit 2 times on that period. On physical
exam you’ve got blood pressure 80/60 mmHg , heart rate 132x/min, respiratory rate
28x/min, temperature 37,4C, tenderness and guarding on left upper quadrant, and

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 diminished bowel sound. Lab result returns with serum amylase 1000 (53-153) and
serum lipase 4500(10-150). RBS 250mg/dL (<200mg/dL).
What is the basic pathologic mechanism of the condition above?
A. Infection
B. Malignancy
C. Autodigestion
D. Obstruction
E. Perforation

30. Hypovolemic shock in acute pancreatitis is caused by?

A. Fluid loss due to vomit
B. Fluid loss due to diarrhea
C. Blood loss to intestinal lumen
D. Blood loss to peritoneal cavity (?)
E. Sequestration of fluid to the third space.

31. Man come 2 months with intermittent abdominal pain. Dull and gnawing ache. Pain
relieved when eating food and drink milk. PF: fit and healthy man, but abdominal mild
epogastric tenderness. 6mpnths piroxicam for his osteoarthritis.
What protective factor of mucosal that impaired?
A. Mucus
B. Bicarbonate
C. Mucosal Bifosfat
D. Prostaglandin
E. Cell renewal

32. 55 year old man came to the doctor with no history of any medications to check for
lower gastrointestinal cancer. He has no family history of abdominal cancer. What
procedure will you suggest?
A. 3 test of fecal blood
B. Abdominal ultrasonography
C. Colonoscopy
D. CT scan
E. Barium Enema

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33. A 65 years old male has positive stool occult blood on routine rectal examination, he is
iron anemia. A colonoscopy reveals a mass 4 cm in diameter in right colon. The
condition that most likely to present is
A. Lymphoma Malignant
B. Leiomyoma
C. Adenocarcinoma / Adenosarcoma (?)
D. Squamous Carcinoma
E. Carcinoid Tumor

34. A 60-year-old male, come to the Siloam Hospital with a chief complain of bloody
vomiting. The blood was red and fresh. The patient also tells that his stool was dark. At
physical examination, there are palmar erythema, spider navy, and ascites at the
abdomen. The USG show a nodule on the right lobule of the hepar. Which of the
following test that can help you diagnose?
A. Alfa feto protein
B. CA 19-9
C. CA 153
D. PS
E. CEA

35. 58 years old man goes to ER because of black and tarry stool. He regularly drink herbal
medicine in powder form that he buy from the traditional market. No history of liver
disease. What is the reason for his black stool?
A. Erosive gastropathy
B. Encephalopathy
C. Gastric carcinoma
D. Peptic ulcer
E. Perforated esophageal varices

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36. 46 years old female complaining blood in her stool 5 days ago. She had hemorrhoids
since 5 years ago when giving birth to her 5th child. With regard to the blood supply of
the rectum and anus:
A. The veins do not correspond to the arteries.
B. The anal canal is the site of portosystemic anastomoses.
C. It is principally from the inferior rectal artery.
D. The vessel do not supply the full thickness of the anal wall.

37. A 15-year-old junior high school was stabbed in the abdomen. Under laparotomy ,
the Inferior mesenteric artery was ruptured. What may be found when you do surgery?
A. The descending branch of the left colic supplies the sigmoid colon only.
B. There are very few anastomoses between its branches.
C. Inferior mesenteric artery ends at superior rectal artery.
D. Inferior mesenteric artery rise from the aorta at the level of vertebral lumbar 2.

38. 22 years old female with icteric sclera and abdominal discomfort came to general
practitioner. Physical examination revealed hepatomegaly tenderness. Serology
examination igM HAV is positive. Which following characteristic increase risk of
fulminant hepatic failure?
A. She is pregnant
B. She is patient of chronic HCV infection
C. She had post exposure Hepatitis A during infancy
D. She is patient of chronic renal failure
E. She has previously exposure HBV and develops anti Hbs

39. In a diagnostic procedure ERCP evaluate the biliary system and pancreas. A diber optic
of the endoscope inserted through what sphincter?
A. Sphincter of Oddy
B. Cardiac sphincter
C. Pyloric sphincter
D. Ileocecal valve
E. Ureter valve

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

41. While examining a tissue of the GI tract, you notice many lymphoid nodules,
surrounding a relative small lumen. No intestinal villi are seen. Which of the following
part of the gi tract are you examining?
A. duodenum
B. Jejunum
C. Ileum
D. Colon
E. Appendix

42. A 62-year-old man with chief complains nausea, vomiting, and epigastric pain. He was
given stomach medication, three hours later, he had dyskinesia and rigidity (extra
pyramidal symptoms). Which of the following drug is the most appropriate that can
cause this situation?
A. domperidone
B. metoclopramide
C. ondansetrone
D. omeprazole
E. sucralfate

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43. The 18 old male presents with intermittent abdominal pain, no bloody diarrhea. The
diarrheas wake him from sleep. The few occasions, he had fever, nausea, and vomiting.
PE: normal. Patient describes his work as being stressful. He had an oral aphthous ulcer
and poorly localized lower abdominal to mid abdominal tenderness without peritoneal
signs. Anal and rectal examination is normal. Fecal occult blood (-), there are stool
leukocytes. The sigmoidoscopy (normal). Hb 11.5 and Ht 34 %.
A. Acute appendicitis
B. Crohn disease
C. Colon cancer
D. IBS
E. Ulcerative colitis

44. Barret’s Esophagus

A. Chronic Esophagitis
B. Ulcerative esophagitis
C. Columnar Metaplasia
D. Squamous Metaplasia
E. Benign neoplasm

Soal 45-46
45. Thomas W, 45 years old, suddenly experiences pain in his epigastric and spread to his
back. His abdomen looks puff up. His physician supposes that he has suffered acute
pancreatitis.
What kind of pancreatic enzyme that needs enterokinase for activation?
A. Chemotrypsinogen
B. Procarboxylpeptidase
C. Proelastase
D. Trypsinogen
E. Ribonuclease

46. What Secretin stimulates by present of acid from stomach?

Secretin stimulates the secretion of NaHCO3 by the pancreas

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

48. A 8-year-old boy had difficulty in swallowing. Endoscopic exam reveals that there was
an abnormal relaxation of lower esophageal sphincter. Pathological examination shows
aganglionosis. What is the diagnostic?
A. Stricture
B. Paralysis
C. Primary Achalasia
D. Secondary Achalasia
E. Esophagitis

49. A 55 year old man with a long history of duodenal ulcer was seen in emergency room
after vomiting blood and exhibiting severe hypovolemic shock. Assuming the ulcer had
perforated the posterior wall of the first part of duodenum, which artery is most likely
to have been eroded?
A. Splenic artery
B. Right gastric artery
C. Gastroduodenal artery
D. Right Gastroepiploic artery
E. Hepatic artery

Page 14 of 22
50. A girl, 20 months, came with diarrhea since 2 days ago. She suffered from severe
vomiting 4 days ago for about 2 days. The vomit was the resolving but followed with
watery stools 5-8 times in a day. She started to get fever since yesterday but still able to
drink a lot. What might be the most possible cause of diarrhea?
A. bacteria
B. protozoa
C. Rotavirus
D. Coronavirus
E. Adenovirus

51. A 45- year old man was admitted to the emergency department complaining of severe
pain in the right lower quadrant of the anterior abdominal wall. He had repeatedly
vomited, and his temperature and pulse rate were elevated. On examination, the
muscles of the lower part of the anterior abdominal wall in the right lower quadrant
showed tenderness at the MC Burney point. You are at surgery for removal, but the
organ is not visible.
What position of this organ is likely to be?
A. Paracecal
B. Paracolic
C. Retrocecal
D. Ileocecal
E. Retrocolic

52. A 51 y.o man comes to your private practice with a history of mid epigastric upper
abdominal pain that diminished by eating and taking antacid. He drinks alcohol every
night, also taking aspirin related for his stress and headache. PE reveals no evidence for
blood in the stool. You advise him to replace his aspirin with acetaminophen and stop
drinking alcohol. You gave him prescription of famotidine 20 mg BID. Which is the
mechanism of famotidine?
A. eradication of H.pylori
B. increase of motility
C. inhibit acid secretion
D. neutralized gastric acid
E. protect gastric mucus

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53. A 58-year-old who has history of intermittent cramping abdominal pain for continuous
2 weeks visited an ER. An abdominal radiograph showed no free air and none of bowel
sound is identified. Colonoscopy showed patchy area on mucosa erythema and necrosis
in ascending and descending colon but no polyps or mass are identified. What is the
best diagnostic for the patient?
A. Acute pancreatitis
B. Ischemia colitis
C. Amoebiasis colon
D. Adenocarninoma
E. Crohn’s Disease

54. A 48-year-old female comes to the ER with complaint of 24 hours of epigastric pain,
nausea, and vomiting after eating a large meal at a restaurant. There is Right Upper
Quadrant pain on the day before. Her temperature is 38,5oC and her pulse is 100. Her
physical examination is unremarkable. There is epigastric tenderness on palpation, no
bowel sounds, no rebound tenderness and guarding. Her laboratory tests showed
amylase 1980 (53-153) and lipase 2500 (10-150).
What is the most likely diagnosis of this patient?
A. Acute Gastroenteritis
B. Acute gallstone pancreatitis
C. Drug-induce pancreatitis
D. Acute cholecystitis
E. Acute cholangitis

55. What is the next test? Ultrasound (?)

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

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57. Of the following, which one is the most likely mode by which this disease (upper
clinical case) as acquired?
A. ingestion of the larvae on the organism in contaminated food
B. ingestion of the egg on the organism in contaminated food
C. ingestion of the cystic on the organism in contaminated food
D. drinking unboiled water supply
E. penetration of the skin by the organism while walking bare-footed

58. A 55-year-old Woman has a bulge in her groin. On physical examination found a lump
in line between anterior iliac crest and pubic tubercle. Can be seen when the patient
stand or lying down, but may be reduced by manipulation. What diagnostic?
A.
B. Femoral Hernia
C. Inguinal Hernia
D.
E.

59. Guaiac Test (+) = Perforated Duodenal Ulcer (?)

60. What is the first initial radiographic examination?

A. Supine and upright abdominal X-ray
B. Upright abdominal and left lateral decubitus X-ray
C. Upper and Lower Endoscopy
D. Full abdomen CT with contrast
E. USG with inner/lower thoracic USG

61. A 44-year-old lady has had increased nausea, vomit, colicky pain for the past week.
The USG showed several stones in the gallbladder. An operation was performed.
Which of the following specific changes in the gallbladder could possibly be found?
A. Atrophy of mucosa epithelial
B. Chronic inflammatory cells
C. Acute inflammatory cells
D. Sinus rokkitansky
E. Irregular area of fibrosis

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62. 78 years old man came with osteoarthritis which doesn't relieved by paracetamol.
Treatment with NSAID is suggested. He also has peptic ulcer. Which class of drugs
when given with NSAID is the most effective in preventing the recurrence esophageal
GI ulceration?
A. Anti-Muscarinic
B. Bismuth chelates ("lupa" tri"lupa" bismuchetate)
C. Dopamine antagonist (meto clopramide)
D. Proton pump inhibitor (Lansoprazole)
E. Simple antacid (aluminum hydroxide)

63. A baby was born at 9. There is no problem in birth. 24 hours later the midwife said that
he vomits with yellow color vomiting every time he drink. What is the diagnosis?
A. Duodenal atresia
B. GE fistules
C. Hirschsprung disease
D. Pylorus stenosis
E. Volvulus gaster

64. 67-year-old woman underwent right colon cancer surgery. T1N3M0 was obtained from
her biopsy. Every 4 months she checks up regularly. 1 year later she found her CEA
was increased. What organ is the most common location of metastasis?
A. Bone
B. Brain
C. Liver
D. Lung
E. Surgery Scar

65. 57 years old man presents with burning sensation in chest and shoulder. He like
drinking alcohol 40 units in past weekends and this thing aggravated symptoms. He go
to pharmacologist and was given Ranitidine. What is the mechanism of ranitidine?
A. Depressed vomit center in the brainstem
B. Increase peristaltic movement
C. Coating gastric necrotic tissue.
D. Block proton pump
E. Block H2 receptor

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66. A 62 year old woman is admitted to the ward because of 11kg weight loss over the last
3 months. She also reports persistent poor appetite, insomnia, fatigue, and decreased
sexual interest. She had no depressed affect. Extensive medical examination is
inremarkable.
Which of the following is the most possible diagnosis?
A. Rectal ca
B. Somatisation disease
C. Hypochondriasis
D. Bulimia nervosa
E. Marked depression

67. What is the conventional methods for the diagnosis of H. Pylori?

A. Endoscopy with biopsy D. Urea Breath Test
B. ELISA E. Stool Test
C. Rapid Urease Test

Soal 68-70
68. Wanita usia 70 Tahun. Datang dengan keluhan konstipasi sejak 3 hari. pasien mengeluh
ada altered bowel habit sejak 6 bulan yg lalu dan muntah2 sejak 3 hari, stool kecil2 dan
tercampur darah. PF: distensi abdomen dan metallic sound di seluruh regio abdomen,
bising usus meningkat, tenderness di LLQ. Apa kemugkinan diagnosis pasien?
a. Infective collitis
b. mucosal edema dan inflam
c. Diverculitis
d. Colonic cancer

69. The, the patient do plain abdominal photo. What is the likely finding?
A. Massive fluid within intraabdominal cavity
B. Free air sacs in sub diaphragm
C. Dilated small bowel and right colon with no gas in left lower abdominal area.
D. Much fecaloma and fluid within intraabdominal cavity
E. Loss of pre..fat and ...

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70. Blood tap were done, what is the expected result?
A. Increased CEA
B. Increased ureum & creatinin
C. Increased Ca-125
D. Increased Natrium
E. Increased Kalium

Soal 71-73
71. 25 year old women 4 days ago felt right lower quadrant pain suddenly. But on
yesterday night, the pain has spread to whole abdomen. On physical examination the
whole abdomen is tender to palpation. Liver normal no ascites. Hb 8 mg/dl. Wbc
11.000.
What is your most likely Diagnosis?
Acute bacterial peritonitis due to appendicitis

72. Peritoneal tap was taken, what is the most likely fluid?
A. Clear fluid with monocytes
B. Turbid fluid with lymphocytes
C. Turbid fluid with leukocytes
D. Red fluid with erythrocytes
E. Turbid fluid with plasma cells

73. Immediate culture of the fluid was performed, what is the most likely organism that
will show?
A. Staphylococcus aureus
B. Streptococcus Hemolytic B
C. E. Coli
D. Mycobacterium tuberculosis
E. Sterile (no growth)

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74. What is the best medication for Helicobacter pylori?
A. Ranitidine, metronidazole, chlaritomycin
B. Bismuth, Metronidazole, Tetracycline
C. Omeprazole, amoxicillin, metronidazole
D. Omeprazole, Amoxicillin, Clarithromycin
E. Omeprazole, Amoxicillin, Metronidazole

75. Anak diare. What are losses in diarrhea?

A. Electrolyte, Mineral, Glucose
B. Nutrient, Glucose, Mineral
C. Nutrient, Mineral, Electrolyte
D. Electrolyte, Mineral, Water
E. Water, Electrolite, Nutrient

76. Parasympathetic nerve : Cranial Nerve X

77. A 35-year-old man comes after got into a fight with thief. He was stabbed in the Left
Upper Quadrant below Costae 10-11. What organ may be injured?
A. Liver
B. Pancreas
C. Duodenum
E. Spleen

78. Posisi Appendix : Right inguinal

79. A 17-year-old boy presents with abdominal pain for 1 hour after doing some exercise in
school. He go to the hospital and the doctor then got that the pain is coming from the
abdominal muscle cramp. What does the muscle which the pain come from?
A. M. Rectus abdominis
B. M. psoas
C. M. Obturatorius
D. M. Quadratus
E. M. Iliacus

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80. A 50-years-old woman come to general practitioner and was diagnosed with stones in
gallbladder. The gallbladder must be removed. Gallbladder is located in
A. Right Lumbar
B. Left Lumbar
C. Right Hypochondriac
D. Left Hypochondriac
E. Hypogastric

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