​DERMATOMUSCULOSKELETAL SUMMATIVE 1 What is the most likely diagnosis?

(FMUI 2018) A. Dislocation of erect glenohumeral join

B. Dislocation of anterior scapula-thoracic joint
DISCLAIMER: C. Dislocation of posterior glenohumeral joint
D. Dislocation of anterior glenohumeral joint
1. This is a supplement for your study. DO NOT blindly
E. Dislocation of anterior acriomioclavicular joint
memorize the answers.
2. Use this with discretion. Keep this within FMUI, try not to
Ini dari pembahasan sitasi regu:
leave a hard copy
dislokasi anterior itu abduksi+eksorotasi sementara kalau posterior
3. There is no guarantee that the answers are 100% correct
adduksi+endorotasi
because it has not been quality checked by a trusted
personnel (we all still learning too bruv).
2. Which of the following is a reactive metabolite of acetaminophen
4. The department of citations wishes you ALL THE BEST!
that in high levels can cause liver toxicity?
A. N-acetyl-transferase
Layout:​ Fikar
B. N-acetly-p-benzoquinoneime (NAPQ1)
Answers:
C. N-para benzo quinone
RED: ​Nisa gee
D. N-acetyl cysteine
Tosca​: ​Ran (sebuah disclaimer: gw pikunan jadi cmiiw)
E. Para amino salicilate
PINK:​ ​Net
GREEN​: your Gdrive manager :)
Metabolism of Acetaminophen will produce
Purple ​: Ayu
N-Acetyl-P-Benxoquinone(NAPQ1), which in large dose may
Biru :​ ilja
cause liver toxicity. Therefore there is a lot of case of
acetaminophen toxicity. However, the enzyme that metabolize
1. A 25-year-old man came to the emergency unit with chief
Acetaminophen into NAPQ1 is higher in European people, so the
complain of pain on the right shoulder after failing from 3m
case of Acetaminophen toxicity is higher in them.
height. His shoulder hit the floor. He felt pain VAS 5-6 and
could not move his right upper extremity. Shortly after that,
he was brought to the hospital. After clinical examination,
3. A-21-year-old man injured his left arm in a car accident.
the doctor found deformities in extension, abduction, and
Radiographic examination revealed a fracture of medial epicondyle
exorotation.
of the humerus which injured the nerve.
Which of the following statements most consistent to the fracture? D. The Z line beco​me closer to each other
A. Inability to flex distal interphalangeal joint of his left index E. The H band has no change
finger Jujur w baru ngeh bahwa jawabannya ada dua
B. Flexion on the left wrist is drastically decrease Flexion: contraction of the muscle
C. Feel sensation on his left palm Kalo contraction,
D. Inability to flex the distal interphalangeal joint of his left index 1. Individual thick and thin filaments ​don’t ​shorten
finger 2. But they’re brought closer together (UWUU) by sliding
E. Inability to adduct to the left thumb filament mechanism, jadi​ two Z disks are brought closer
together
4. Mrs. M, 55 years old, admitted to the clinic because of pain 3. I band becomes narrower
around her hip in the past 2 months. There is no history of trauma 4. H band is extinguished
around her hip. She said that her mother has a history of 5. Width of ​A band remains the same
spontaneous fracture. Mrs. M has a sedentary lifestyle and never Ini gambar biar lebih gampang bayanginnya:
doing exercise. She does not drink milk because she does not like
it. Anthropometric measurement showed her weight was 55kg
height 155cm.
What kind of food/drink should be avoided by Mrs.M?
A. Tofu
B. Coffee
C. Cheese
D. Milk
E. Salted fish

5. Satrio, a healthy 25-year-old medical student, perform biceps curl

(flexion of the elbow) using 3-kg dumbbell.
6. A 24-year-old patient came to the emergency room because he
Which of the following statements is suitable for the changes in
had suffered an open wound on his head as a result of being hit by
sarcomere in above condition?
an unknown person. The patient reports the incident to the police.
A. The I band become longer
In this case, from whom will the police investigator authorized to
B. The A band has no change in length
request an expert opinion?
C. The sarcomere become longer
 A. Hospital security guard E. Increase muscle length before onset of contraction
B. The patient himself as a victim
C. The doctor factors affecting muscle tension:
D. Eye witness from the crime scene 1. Frequency of Stimulation
E. The suspect or perpetrator 2. Number of motor units recruited
Competence medical workers, including DOCTOR are the one who 3. Degree of muscle stretch
can make Visum et Repertum
9. Which of the following is the benefit of radiographic examination
7. Mrs. N, 70 years old, has been suffering from bone pain due to in osteoarthritis?
osteoporosis. A. Rule out fracture
How is the appearance of active bone-cells in this condition? B. Treat the patient
A. Big, multinucleated, wandering cells C. Detect pathophysiology
B. Round cells with small nuclei, which have cytoplasmic D. Reduce pain
process E. Detect risk factor
C. Cells with flattened nuclei, located at the inner layer of
periosteum 10. A 52-year=old woman presented with intense pain, warmth, and
D. Cells located in the lacunae, buried in the bone matrix redness in the first toe on her left foot. Examination of fluid withdarn
E. Cells with round nuclei, located at the periphery of bone from the inflamed joint revelaed crystals of uric acid. Her serum
trabeculae concentration of uric acid was elevated.
Osteoporosis itu kan osteoclast activity lebih dari osteoblast activity. Which of the following drugs could be used to decrease this
Berarti yang active bone-cells itu osteoclastnya krn doi lebih active. woman’s rate of production of uric acid?
Osteoclast itu big, multinucleated, di pinggir2 trabeculae/bone A. Aspirin ​-> cox-1 inhibitor, anti platelet aggregation
matrix. B. Indometachin ​-> mainly inhibit cox-1, high risk of gi toxicity
C. Colchicine ​-> anti-inflammatory treatment for gout
8. Which of the following statements can increase the ability of a D. Allopurinol
muscle fiber to generate muscle tension? E. Probenecid ​-> contoh uricosuric agent, dia increase the
A. Recruitment of large motor unit excretion of uric acid
B. Increase motor unit recruitment
C. Increase size of muscle Allopurinol inhibits the activity of xanthine oxidase, which converts
D. Increase muscle activity purin into uric acid.

11. A 25-year-old woman cannot walk properly due to injury of
common peroneal nerve.
Which of the following statements is most likely possible to explain
this condition?
A. There is no heel strike
B. Inability of pelvic flexion on swing phase
C. Excessive knee extension on paralyzed leg
D. The center of gravity falls on paralyzed leg
E. Excessive pelvic tilt on paralyzed leg
common peroneal/fibular nerve itu innervate m. biceps femoris (flex
the knee), innervate m. fibularis longus&brevis (buat eversion)
sama m. tibialis anterior (dorsiflexion). nah kalo gaada dorsiflexion
gaada heel strike jd namanya foot drop
12. A 12-year old boy sustained an open fracture of his right lower
leg. On the physical examination the lower tibia and fibula can be
seen protruding from the lower leg. The fracture was set by external
manipulation and the skin wound was sutured. A year later, he still
has pain and also a draining sinus tract has developed.
Which condition is the most suitable for this patient?
A. Osteonecrosis
B. Osteopetrosis
C. Osteoporosis
D. Osteomyelitis
E. Osteoarthritis
13. Which of the following NSAID can be used for acute gout
arthritis, which inhibit the migration of PMN?
A. Colchicine
B. Acetaminophen
C. Sodium Diclofenac
D. Ibuprofen
E. Naproxen
Itu di no 10, colchicine buat anti-inflammatory gout treatment.
Mechanisms of actions nya itu si colchicine inhibits PMN migration.
Ada juga NSAIDs lain buat gout itu indomethacin sama
phenylbutazone. Dua2nya itu buat inhibit urate crystal phagocytosis
by mononuclear phagocytes.
Acetaminophen technically bukan NSAIDs. Buat analgesic.
Diclofenac NSAIDs tp hepatotoxic.
Ibuprofen paling love, least side effect (less fluid retention, less GI
toxicity compared to salicylic acid/aspirin). Di children bisa buat
antipyretic juga (proris namanya).
Naproxen —> GI bleeding higher than ibuprofen
14. An 80-year-old man with history of joint arhtritis came to the
hospital with a complaint of shoulder stiffness and pain. A
radiograph of the shoulder joint reveals significant degenerative
arthritis with bone spurs and calcification. There is a large enough
spur located on the infraglenoid tubercle. The doctor worried about
the function of the muscle that originiates on this bony feature.
Which of the following function would be tested on the patient to
determine if the muscle in this case still fully functional?
A. Flexion of the elbow join
B. Flexion of shoulder join
 C. Extension of elbow join it. Anthropometric measurement showed her weight was 55kg and
D. Extension of shoulder join height 155cm.
E. Lateral rotation of shoulder joint Before what age is the primary prevention of this case should be
done?
yang origonya di infraglenoid tubercle itu tricep brachii. jadi A. 10 years
fungsinya buat extension of elbow joint B. 40 years
C. 20 years
15. A soccer athlete got a bumped injury. Physical examination by a D. 50 years
physician revealed injury of cartilage of left knee joint. He concerns E. 30 years
about declining in his future performance. Ini tuh berhubungan sama peak bone mass gasih. Seinget gw kalo
Which cartilage characteristic is related to his concern? di lecture 2, itu peak bone mass nya di 16-25yo. Tapi di lecture nutri
A. Cartilage has avascular feature peak bone mass perempuan di 30 yo. Kalo peak bone massnya
B. Cartilage is received nutrition from diffusion only kurang, pas tua nnt jadi osteoporosis. Kalo peak bone massnya
C. The cartilage has flexible feature normal, nnt pas tua osteopenia doang.
D. Cartilage required for bone ossification
E. Cartilage composers of organic ad in-organic material 18. A 67-year-old woman came to outpatient clinic because of pain
on her right knee for the past 6 months. There was also crepitation
16. Which of the following is considered an autoimmune rheumatic on both knees. Physical examination reveals body height 155 cm,
disease? body weight 82 kg. No sign of redness and warmth of both of the
A. Trigger finger knee. Routine laboratory examination within normal limits.
B. Gouty arthritis From the data, what is your suspected diagnosis?
C. Systemic lupus erythematosus Select one:
D. Osteoarthritis A. Goutry Arthritis
E. Septic arthritis B. Osteoarthritis
C. Systemic Lupus Erythematosus
17. Mrs. M, 55 years old, admitted to the clinic because of pain D. Ankylosing Spondylitis
around her hip in the past 2 months. There is no history of trauma E. Rheumatoid Arthritis
around her hip. She said that her mother has a history of
spontanoues fracture. Mrs. M has a sedentary lifestyle and never no sign of redness warmth -> gaada inflammation, terus lab exam
doing exercise. She does not drink milk because she does not like jg normal berarti bukan autoimmune
19. Inflammation is a complex tissue reaction that includes the 22. A 20-year-old man had closed fracture of the shaft right tibia
release of cytokines, leukotrienes, prostaglandins, and peptides. minimal displaced. Closed reduction and immobilization with plaster
Prostaglandins involved in inflammatory proccess are typically of Paris (gips) had been done. After some period of time, doctor
produced from arachidonic acid by which of the following enzymes? concluded the clinical union already took place.
A. Cyclooxygenase-1 Which of the following statements is appropriate with clinical union
B. Cyclooxygenase-2 phase?
C. Lipoxygenase A. Patient can do weight bearing and the plain radiography still
D. Gluthathione S-transferase shows fracture line
E. Phospholipase-A2 B. Patient can do weight bearing and the plain radiography
shows no fracture line
arachidonic acid produce two enzymes, cox-1 or housekeeping C. Patient cannot do weight bearing because of pain
enzyme (ini buat yg regulate GI mucosal integrity, platelet D. Patient can do weight bearing but he feels pain
aggregation, renal function) and cox-2 for inflammation E. Patient cannot do weight bearing because the plain
radiography still shows fracture line
20. In the pathogenesis of rheumatoid arhritis, which part of the joint
will be initially attack? 23. A 21-year-old man injured his left arm in a car accident.
A. Cartilage Radiographic examination revealed a fracture of the medial
B. Joint capsul epicondyle of the humerus which injured the nerve.
C. Bursa Which of the following muscle is most likely paralyzed as a result of
D. Synovia this accident
E. Ligament A. Abductor pollicis longus
B. Extensor pollicis longus
21. A 25-year-old man is performing biceps curl. Which of the C. Opponens pollicis
following muscle acts as stabilizer? D. Adductor pollicis
A. Latissimus dorsi E. Abductor pollicis brevis
B. Biceps brachii
C. Teres minor adductor pollicis is innervated by the ulnar nerve. Abductor pollicis
D. Deltoid and opponens pollicis is innervated by median nerve.
E. Triceps brachii
24. A 12-year-old boy came with rapidly enlarging mass in the lower
limb over 1-month duration. Physical examination found a mass in 26. Movement can be loosely classified into three categories: reflex
the lower limb, immobile , no discoloration compared to surrounding movement, voluntary movement, and rhythmic movement. Which of
skin, and no ulceration is seen in the lower limb. History of fever the following statements is TRUE for reflex movement?
was denied. After lower limb conventional radiography was A. The stimulus can be external or at will
done,the patient was diagnosed with proximal tibial B. Require integration at cerebral cortex
epimetadiaphyseal bone tumor, suspected malignancy. C. Can be improved with practice
Which of the following is TRUE regarding the lower limb MRI in this D. Help to maintain body posture
patient E. Walking is one of the examples
A. It cannot be used to assess bone marrow extension of the
mass 27. Which of the following will be high in fast-twitch muscle fiber?
B. It is not indicated in this patient A. Mitochondria content
C. It can be used to evaluate soft tissue extension and B. Resistance to fatigue
neurovascular involvement C. Oxidative phosphorylation capacity
D. It can be subtituted by 3 phase bone scans D. Number of capillaries
E. It can show joint effusion E. Myosin-ATPase activity ​(according to the NCBI this is the
answer, CMIIW (hae))
25. A 22-year-old football player comes to emergency room with
knee swelling and pain after trauma 2 hours previously. From
physical examination, there is a sign of anterior cruciate ligament
rupture.
What is the most appropriate radiological modality to establish
diagnosis in this patient/?
A. Knee MRI
B. Bone scintigraphy
C. Knee CT Scan
D. Knee radiography
E. Knee ultrasound
Dalam muskuloskeletal, MRI berfungsi untuk melihat bagian
persendian seperti cairan sinovial,​ ligamen​ dan kartilago.
28. A 24-year-old patient came to the emergency room because he A. Femoral nerve
had suffered an open wound on his head as a result of being hit by B. Sciatic nerve
an unknown person. The patient came to the hospital with a visum C. Femoral vein
et repertum request letter from the police. D. Popliteal artery
What information will be in the visum et repertum? E. Femoral artery
A. The identity of the perpetrator
B. Past medical history of the patient 32. A football player sustained a knee injury after being kicked by a
C. Medical examination result rival player from the ​lateral side ​that affected the posterolateral
D. Patient’s empolyment status/type of patient’s work aspect of his knee. Physical examination result does not indicate a
E. Object that causing the injury displacement of tibia to anterior aspect. Radiology examination
suggest a ligament injury.
29. What is the structure that held the myofibril in its bundle and Which ligament is most likely damaged?
keeps the stability of myofibril in muscle fiber? A. Anterior cruciate ligament
A. Nebulin -> elastic, stabilize/align actin B. Patellar ligament
B. Alpha-actinin -> hold the thin filament to the z-disk C. Posterior cruciate ligament
C. Titin -> largest protein, provide elasticity (supaya myosin D. Tibial collateral ligament
bisa stretch and recoil) and stabilize myosin E. Fibular collateral ligament
D. Dystrophin -> attach groups of myofibrils to the cytoplasmic Kalo yg kena tendangnya di lateral side, yg kena nya ya the other
aspect of the sarcolemma side which is medial side yang disana ada Tibial collateral
E. Vimentin -> hold myofibrils to each other ligament/medial collateral ligament (beda nama aja itu, padahal it’s
the same thing). Kalo kena tendang dari anterior, brarti yang
30. Which of the following is the most suitable definition of sprain? rupture posterior collateral ligament.
A. Complete tear of muscle
B. Extreme stretching of muscle 33. A 65-year-old woman is diagnosed with Osteroarthritis. Whis
C. Complete tear of ligament woman known to have GERD.
D. Extreme stretching of ligament What is the most suitable NSAID for this woman?
E. Extreme stretching of tendon A. Mefanemic Acid
B. Piroxicam
31. What is the structure that could be injured in fracture of the shaft C. Celecoxib ​-> lowest risk for gi toxicity
of the femur? D. Ketorolac
 E. Naproxen D. Pulsivelessness
E. Pain
34. Mrs. M, 55 years old, admitted to the clinic because of pain
around her hip in the past 2 months. There is no history of trauma 36. What kind of protein that is released by bone matrix at the end
around her hip. She said that her mother has a history of of resorption phase to recruit osteoblast in the reabsorbed area?
spontaneous fracture. Mrs. M has a sedentary lifestyle and never A. IL-6
doing exercise. She does not drink milk because she does not like B. IGF
it. Anthropometric measurement showed her weight was 55 kg and C. IL-1
height 155 cm. D. TNF
To avoid fracture like her mother, what is the recommended E. BMPs
consumption of calcium in food?
A. 800 mg/day TGF-B sama FGF jg bisa attract osteoblast yak
B. 1300 mg/day
C. 1000 mg/day 37. Mrs. R, 50 years old was admitted to the clinic because of the
D. 1500 mg/day pain in her knee. The pain gets worse for the past 6 months. Mrs. R
E. 1200 mg/day currently is not working and has a sedentary lifestyle.
Quick pembahasan: Anthropometric measurements showed her weight was 80 kg and
For adolesence in puberty they need 1300 mg/day her height were 160 cm. She often consumes organ meat and
For 19-50 years old, 1000 mg/day sugar sweetened beverage as her daily menu. As recommended by
For >50 yo, 1200 mg/day her friend, she often took pain killer herb medicine (jamu) that she
Ga tau kenapa kemaren gue ngafalin ini, ternyata berguna coi. bought in the street shop.
To help Mrs. R reduce the symptoms, what is needed to be
35. A 25-year-old patient had a closed segmental comminutive increased in her food sources?
fracture of the proximal tibial with suspected compartment A. Calcium
syndrome. B. Omega 6
Which of the following is the early clinical sign of compartment C. Vitamin D
syndrome? D. Omega 3
A. Paresthesia E. Omega 9
B. Pale
C. Paralysis
jadi orangnya sakit OA trs kl dr lecture ada riset yg blg kl omge 3 itu
punya anti-inflammatory effect jadi bs dicoba buat org yg OA
40. A 30-year-old male came to the emergency unit after falling
from 3 meters high. He fell with an outstrecthed hand with the
38. Mrs. R, 50 years old was admitted to the clinic because of the forearmd in excessive pronation. The doctor found deformity at the
pain on her knee. The pain gets worse for the past 6 months. Mrs. forearm and asked for a radiological examination.
R currently is not working and has a​ sedentary lifestyle.
Anthropometric measurement showed her weight was 80 kg and
her height were 160 cm. She often consumes organ meat and
sugar sweetened beverage as her daily menu. As recommended by
her friend, she often took pain killer herb medicine (jamu) that she
bought in the street shop.
What is the most possible etiology in this case?
A. Excessive physical activity
What is the most likely diagnosis?
B. Consumption of pain killer
A. Fracture and dislocation Galeazzi
C. Consumption of organ meat
B. Fracture and dislocation Colles
D. Overweight and obesity
C. Fracture and dislocation Smith
E. Less calcium intake
D. Fracture and dislocation Shenton
E. Fracture and dislocation Monteggia
39. A 50-year-old male came with fever and pain on his right foot
big toe for the past 24 hours. Laboratory test found lekocytosis,
monteggia -> fracture of the ulna and dislocation of the radius
hyperuricemia and hyperlipidemia. Radiological examination of his
galeazzi -> ​fracture of the distal third of the radius with dislocation
join showed “punched-out lesion” in juxta-articular area of the bone.
of the distal radioulnar joint.
Synovial fluid found urate cyrstal and neutrophils.
What is the most appropriate diagnosis for this case?
A. Reactive bone
B. Rheumatoid nodule
C. Pannus
D. Tophus
E. Osteophye
41. A 25-year-old, 3 months pregnant woman admitted to the clinic
with the chief complaint of fever and hadache.
What is the most safe drug to be given to the woman.
A. Sodium diclofenac
B. Ketorolac
C. Acetaminophen
D. Mefenamic acid

42. A 20-year-old man had a motor accident and was brought to the
emergency room due to pain below his knee. Radiography
examination revealed a fracture of the neck of fibula which also From the radiography result, what is the most likely diagnosis?
injured the nerves. (common peroneal nerves) A. Central dislocation of hip joint
Which of the following movements is most likely affected B. Fracture and dislocation left hip joint
A. Inability of flexion of the toes C. Subluxation of left hip joint
B. Weakness of ankle eversion D. Fracture of left femoral neck
C. Weakness of ankle inversion E. Dislocation of left hip joint
D. Weakness of extension of the first toe
E. Weakness of ankle extension (foot drop, probably the 44. The bone remodelling has several phases.
answer(haekal)) An increase of RANK expression on the osteoclast’s surface
happened in which phase?
43. A 25-year-old man came to the emergency unit after a traffic A. Rest phase
accident. When the traffic accident happened, he rode a car with B. Mineralization phase
speed around 60 km/hour and hit a tree. He could not move his left C. Resorption phase
lower extremity due to pain. The doctor found a deformity of lower D. Active phase
leg and performed a radiological examination. E. Formation phase

45. A 35-year-old man came to the emergency unit after he had a

motor cycle accident (speed 50 km/hour) 24 hours previously. A
wound 3 cm in size and deformity at lower leg was found by the
doctor after physical examination had been done. 47. A 22-year-old sportsman performed a long jump and he landed
What is the most likely clinical diagnosis of the patient? very hand on the soles of his feet againts the ground which resulted
A. Open fracture of the right tibia and fibula grade I in a fracture of the head of talus.
B. Open fracture of the right tibia and fibula grade IIIA Which of following structure is unable to function normally?
C. Open fracture of the right tibia and fibula grade II A. Lateral longitudinal arch
D. Open fracture of the right tibia and fibula grade IIIB B. Tendon of fibularis longus
E. Open fracture of the right tibia and fibula grade III C. Transverse arch
Open fracture kl udah lebih dr 8 jam didiemin lgsg msk ke grade III, D. Medial longitudinal arch
di soalnya seinget gue dia ngmg kl udh lebih dr 24 jam trs kl buat E. Long plantar ligament
masuk ke grade IIIA/B/C itu baru butuh info yg lebih detail lg tp
karna no further information ttg gmn vascularisasinya dll jadi 48. The doctor on duty put a split for a patient with fracture. What is
yaudah grade III the aim of putting a splint for fracture of tibia and fibula?
A. To prevent neurovascular structures
46. A 15-year-old girl came to a clinic with back pain for the past 3 B. To decrease in pain
months. The girl previously has been diagnosed with pulmonary C. To improve fracture healing
tuberculosis and treated with antituberculous drugs. Kyphotic D. To fixate fracture
deformity was found on physical examination. E. To reduce a fracture
What radiogical examination modality should be chosen as the first
evalution of this patient? 49. Which of these following statements is related to parathyroid
A. Bone scintigraphy function in human body?
B. Thoracal radiography A. It decreases calcium and phosphate release in bone
C. Thoracal ultrasound B. It has direct effect on increasing calcium absorption in
D. Thoracal CT scan intestine stimulated by Vitamin D activity
E. Thoracal MRI C. It has intracellular receptor
ini aga tricky karna kan sbnrnya kt udh tau kl itu pasti spondylitis D. It decreases blood calcium level
tuberculosis dari riwayat tbnya jd sbnrnya bs lgsg pake MRI buat E. It decreases calcium reabsorption in kidney
liat extension of the damage soft tissuenya tapi ttp kt harus pake For option B, the transport of calcium and phosphate from the
X-ray biasa dulu buat mastiin dia bener gak TB spondylitis atau intestine into blood serum are solely done by active vit D (1,25
mungkin cuman scoliosis gt kan bs hehe OH2)
 C. Malunion
50. Which of the following muscles is the most significant for D. Nonunion
forward propulsion? E. Disuse atrophy
A. Tibialis anterior
B. Extensor digitorum longus 53. As a medical doctor you are assessing gait pattern of a patient
C. Quadriceps femoris with Trendelenburg gait.
D. Triceps surae Which of the following statements describe the gait pattern of this
E. Flexor digitorum longus man?
A. During swing phase, flexion of the hip is increasing
51. In bone remodeling, what cells that play role in secretion of B. Base of support is decreasing
bone matrix (osteoid)? C. During stance phase, lateral displacement of the hip is
A. Osteoblasts increasing
B. Fibroblasts D. The trunk is tilted to the swing leg
C. Osteoprogenitor cell E. During swing phase, pelvic tilt on swing leg is increasing
D. Nest cells
E. Osteoclasts 54. A 24-year-old patient came to the emergency room because he
had suffered an open wound on his head as a result of being hit by
52. A 55-year-old woman had severe wound on the right thight an unknown person.
pafter hit by a motorcycle from the right direction. He fell down and Which of the following is the correct statement regarding the case?
was unable to walk and had pain with VAS 6. Soon after that, he A. Patient must go to the police before an examination by a
was brought to the hospital and got some examination. He was doctor
diagnosed with an open fracture of the shaft right femur grade IIIA B. Doctor write Pro Justitia on the medical certificate
underwent debridement, open reduction and internal fixation C. Visum et repertum can be given by the doctor to the patient
surgery. Six months after surgery, plain radiography showed D. Doctor write about the name of the object causing the injury
sclerosis and round on both the end of the bone fragment (at the on the conclusion of visum et repertum
proximal and distal). E. Doctor write about the degree or severity or qualification of
Which of the following statements is appropriate with fracture the injury on the conclusion of visum et repertum
healing complication in this case?
A. Delayed union
B. Fracture disease
55. Which of the following statements describe the main A. Certificate of Expert
mechanism of action of Corticosteroid as an anti-inflammatory B. Certificate of Health ​(ex: surat keterangan sakit)
agent? C. Letter of Agreement
A. Inhibition of phagocyte activation D. Visum et Repertum
B. Antiapoptotic E. Patient Medical Resumes
C. Inhibit cyclooxygenase (both isofrom COX-1 and COX-2)
D. Inhibit phospholipase A2 59. The mineralization process is formed after the osteoid
E. Inhibit lipoxygenase formation.
Which of the following that play a significant role in the
56. What is the predilection site of joint is mostly intially attacked in mineralization process?
Gouty Arthritis and called Podagra? A. Ostroprotegenin
A. Shoulder B. Osteocyte
B. Big toe C. Osteocalcin
C. Ankle D. Osteoblast
D. Knee E. Osteopontine
E. Heel
60. Which of these following NSAID could irreversibly inhibit the
57. Where is the location of Heberden’s node in osteoarthritis? synthesis of thromboxane?
A. Knee A. Ibuprofen
B. Elbow B. Mefanemic Acid
C. Proximal interphalangeal -> bouchard’s node C. Aspirin
D. Wrist D. Acetaminophen
E. Distal interphalangeal E. Ketorolac

61. What is the template that humerus bone tissue developed on?
58. A 24-year-old patient came to the emergency room because he A. Mesenchymal connective tissue
had suffered an open wound on his head as a result of being hit by B. Elastic cartilage
an unknown person. The patient has not yet made a report to the C. Hyaline cartilage
police. What is the correct document given by the doctor to the D. Spongy bone
patient when the patient is discharged? E. Fibrocartilage

62. A 4-year-old boy is brought to ER by his mother. The boy has a
complain of right elbow pain. Upon examination, doctor notes
swelling of the joint along with severe tenderness upon palpation of
the radial head region. Motor function and sensation remain normal.
The boy told the doctor that the pain began after he was holding
one of each of his parent’s hand and swinging in between them.
What is the most likely diagnosis based on that case?
A. Radialn tuberosity avulsion
B. Lateral epicondylitis
C. Dislocation of radial head from the anular lig
D. Dislocation of the olecranon from the olecranon fossa
E. Radial nerve compression
63. A 55-year-old woman slips and falls on the bathroom floor. As a
result, she has a posterior dislocation of the hip joint and fracture of
the neck of femur. She experiences weakness when abducting and
medial rotating the thigh after this accident.
Which of following muscles is most likely injured?
A. Quadratus femoris
B. Glutaeus minimus
C. Obturator internus
D. Piriformis
E. Glutaeus maximus
64. Lalu Muhammad Zohri is an Indonesian track and field sprinter.
He is the first Indonesian and the only Asian to win any medal at the
IAAF World U20 Championships by taking home a Gold medal in
the 100 m. He is the current holder of the Indonesian 100m and
200m national records.
Which of the following are suitable histological characteristic of
muscle fibers for the athlete as Lalu Muhammad Zohri?
A. It is dominantly composed by the muscle fiber with large
diameter, less amount of myoglobin and small number of
capillaries
B. It is dominantly composed by the muscle fiber with large
diameter, less amount of myoglobin and many numbers of
capillaries.
C. It is dominantly composed by the muscle fiber with small
diameter, large amount of myoglobin and many capillaries
D. It is dominantly composed by the muscle fiber with small
diameter, less amount of myoglobin and small number of
capillaries
E. It is dominantly composed by the muscle fiber with large
diameter, large amount of myoglobin and many numbers of
capillaries
65. A 45-years-old male complained of increasing pain on his right
hip. He has a history of taking corticosteroid for about 6 months due
to his other ilness, without doctor supervision. Radiological
examination showed a fracture of his caput femoris with irregular
density in spongious bone. The patient have Avascular
Osteonecrosis.
Which of the following conditions is most suitable for the
microscopic appearance in this condition?
A. The cortex is thinned and haversian system widened
B. The bone contains intraosseous abcess
C. The bony trabeculae is thinned
D. The bone showed mosaic pattern
E. The dead bone showed empty lacuna

66. A 40-year-old female come to a doctor with deformed, bent and
swollen hand fingers. From anamnesis she said that she already
has this condition for about 2 years. Physical examination found a
very stiff fingers with unmovable interphalangeal joints. Laboratory
test revealed ​antibody to dsDNA.
Which of the following diagnosis is the most appropriate?
A. Ankylosing arthritis
B. Rheumatoid arthritis
C. Osteomyelitis
D. Gout
E. Osteoarthritis
67. A 24-year-old patient came to the emergency room because he
had suffered an open wound on his head as a result of being hit by
an unknown person. The patient came to the hospital with visum et
repertum request letter from the police.
Who will be received the Visum et Repertum from the doctor?
A. Police investigator
B. The person authorized by the patient
C. The attorney
D. The patient
E. Insurance company
68. Which of the following hormones play a role in calcium
homeostasis?
a. 1,25(OH)2-D3 (Calcitriol), adrenocorticoid
b. Parathyroid hormone (PTH), adrenocorticoid
c. Calcitonin (CT), adrenocorticoid
d. Thyroid hormone, adrenocorticoid
e. Parathyroid hormone (PTH), Calcitonin (CT)
69. Mrs. M, 55 years old, admitted to the clinic because of pain
around her hip in the past 2 months. There is no history of trauma
around her hip. She said that her mother has a history of
spontaneous fracture​. Mrs. M has a sedentary lifestyle and never
doing exercise. She ​does not drink milk​ because she does not like
it. Anthropometric measurement showed her weight was 55 kg and
height 155 cm.
What is the most possible diagnose for Mrs. M?
A. Rheumatoid arthritis
B. Osteoporosis
C. Fracture of the hip
D. Osteoarthritis
E. Gout
Spontaneous fracture occurs due to thin bone mass caused by low
peak bone mass gained during 0-30 year old which can be done
through the consumption of high calcium food and beverages such
as milk, cheese
70. A 58-year-old female has experience pain in her right knee and
hip over 3 years. She notices that her join is stiff in the morning and
the pain gets worse towards the end of the day. Histopathology
examination result as shown in the picture.
 A. It is only secreted when blood calcium levels is low
B. When secreted allow for movement of calcium in bone by
increasing the number of osteoclasts
C. Decreases the calcium reabsorption in intestine
D. Increase the urine calcium output

A. Osteoarthritis
B. Osteomyelitis
C. Osteoporosis
D. Rheumatoid arthritis
E. Systemic Lupus Erthytomatosus

ini gambar OA karna dia nunjukin adanya fibrilation of the articular

cartilage kalau RA itu cirinya ada pannus
71. A 9-year-old boy come to the ER with an open wound. Shortly
after that, it shown that he got swelling and fever. From the
radiographic examination found there is a formation of new bone
and necrotic bone.
What is the new bone called?
A. Involucrum
B. Brodie’s -> hollow part of the bone, mainly can be seen in
osteomyelitis
C. Sequester -> dead necrotic bone
72. Which of the following calcitriol metabolism is true?
Calcitriol, or 1,25 dihydroxycholecalciferol is active form of vitamin
D. It has functions to increase blood calcium level which happens
only if the blood calcium level is low. Once activated, it induces
several events to happen which results in increase of blood calcium
such as:
- Increase reabsorption of calcium & decrease secretion of
calcium in the kidney
- Increase active transport of Ca2+ dan PO43- from intestine
into blood serum
73. Fibrocartilage has special structure mixed between dense
regular connective tissue & cartilage. Combines tensile strength,
firmness, durability of tendon with resistance to compression of
cartilage
A. Symphysis pubis
B. Epiglottis -> Elastin cartilage
C. Hip joint
D. External ear -> Hyaline cartilage

74. Which shows cross bridge position when muscle fiber relax &
intracellular ATP is within normal level?
A. High energy form, myosin head bind to actin A. Synovitis
B. High energy form, ATP bind to myosin head B. Pannus
C. Low energy form, myosin head bind to actin C. Rheumatoid nodules
D. High energy form, ADP & Pi bind to myosin head
E. Low energy form, actin and myosin detach from each other 77. What is usually found in ankylosis spondylitis?
A. Alopecia
75. 10 years old boy come to the clinic with severe pain on his right B. Discoid rash
wrist. On his tendon extensor pollicis longus and abductor pollicis C. Oral Ulcer
longus cannot be moved. It seems there is bone fracture. Which D. Mallar Rash -> SLE
bone is fractured? E. ​Bamboo Spine
A. Trapezoid
B. Hamatum 78. What is the pathogenesis of Rheumatoid Arthritis?
C. Distal of radius A. Infiltration of CD4 of T cells immune system
D. Scaphoid B. DHRIT HELPS THIS ONE ADA DI SITASI TAHUN LALU
E. Trapezioum
79. Cytokine inhibits osteoclast activity?
76. In the picture of rheumatoid arthritis can be seen A. IL-1
B. IL-6
C. OPG
D. Osteoprotegerin Ligand
E. IL-4
80. 19 y.o guy had motorcycle accident. Goes to the ER, fractured
the humerus and damage the axillary nerve. Which part of the
humerus is possibly broken?
a. Anatomical neck
b. Caput of humerus
c. Surgical neck