Multiple Choice Questions

SKIN AND SPECIAL SENSE

FK UPH 2014
Friday, 12 May 17
13.40 – selesai
[Missed questions : 0 numbers]

1. Pasien lai-laki, berusia 65 tahun, datang dengan keluhan desquama dan redness di tubuhnya.
Awalnya muncul di dada kemudian ke ekstremitas trus ke seluruh tubuh. PF ditemukan adanya
distress dan severe dehydration. Life threatening complication yang bakal terjadi?
A. Acute Kidney Injury
B. High output cardiac failure
C. Seizure
D. Skin malignancy
E. Anaphylatic shock
Erythroderma : > 90% area tubuh, pasien biasa menggigil, ada squama (reaksi penyakit kulit sblmnya
lg akut atau skuama), dehidrasi (vasodilate)
Kalau SJS ada triase: lesi kulit, konjungtiva, oral mucousa atau genitalia

2. A 10 years old boy came with itching more intense at night in wrist, axilla, sela-sela jari. His
friends also experience the same. Diagnosis? Scabies
A.
B. Sarcoptes scabiei hominis
Obat: Permetrin

3. 45 y o carpenter came to dv clinic with an ulcer on his neck under the jawline, it was a single
raised bump, enlarge, soft, swollen without pain. There were also small bumps in a row around
his neck which he considered as something common since he had cough for 6 months. On
examination large abscess on his neck under right jawline extruded pus and caseous material,
granulate base, livid surrounding, serpiginous, and lymph node enlargement surrounding his
neck. What is the best treatment for this condition? Dx: Tb cutis dari Tb Paru
A. 2Rhze/4rh
B. Rifampicin 600mg, clofazimine 300mg dapsone 100mg and clofazimine 50mg dapsone
100mg everyday for 1 year
C. Benzathin penicillin g 2,4 m units IM every week, total 7,2 m units
D. Amox 500mg 3x
E. Wide excision + radiotheraphy

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 Tx: sama tp kl ekstra paru obatnya setahun

4. Ms. Ani always go to the beach to get sun exposure. She does not afraid to uv radiation since
she tanned skin. What is the protect mechanism of tanned skin to uv? Melanin
A. keratohyaline granules will dissipate or scatter of 99,9% of uv radiation
B. lamellated granule will dissipate or scatter of 99,9% of uv radiation
C. melanin pigment will dissipate or scatter of 99,9% of uv radiation
D. strat. corneum will dissipate or scatter of 99,9% of uv radiation
E. keratinocyte cell will dissipate or scatter of 99,9% of uv radiation

5. A 30-years-old came to DV clinic with red, thick, scaly patches itchy on the knee, elbow and
her body. Doctor found erythematous plaque with sharp border in different shapes and sizes
with thick scale. Both Auspitz sign and candle grease sign are positive. What is the most likely
diagnosis of this patient's condition? Auspitz (dikopek berdarah) & Fenomena tetesan lilin
sering nya di sendi-sendi
A. Seborrhoeic dermatitis
B. Psoriasis vulgaris
C. Pytiriasis rosea
D. Parapsoriasis
E. Erythroderma

6. Agus was riding motorcycle. He fucked up and fell down and got lacerated. He got cream
antibiotic. What is the primary defense from infection? Epidermis paling luar soalnya
A. Epidermis is the primary barrier against infection.
B. Dermis is the primary barrier against infection.
C. Hypodermis is the primary barrier against infection.
D. Subcutaneous is the primary barrier against infection.
E. Desmosome is the primary barrier against infection.

7. A 80 years old female, come to dermatology clinic with chief complaint of skin irritation and
itch at the scalp. On anamnesis doctor found that she was abandoned with poor hygenic without
any family. On Physical examination found numerous lice in scalp and hair with microscopic
nits. What is the best treatment for her? Pediculosis capitis 0.5-1 % bisa jg Permetrin
A. Ketoconazol shampoo 2%
B. Malathion lotion 1%
C. Precipitated sulfur 20%
D. Hydrocortisone 1 %

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 E. Mel’s yep Mometasone Furomate 0,1 %

8. 17 y/o girl came to DV Clinic with skin rash on her back, chest, arm and thigh since one week
ago, which was not very itchy. On examination the doctor found many small pink or red, flaky,
oval shaped erythematous rash appearing on the torso following the rib line like a christmas
tree, and the upper arms and thighs, with herald patch positive. What is the most likely
diagnosis? Herald patch, Christmas tree, Oval shape erythematous
A. Seborrhoeic dermatitis
B. Eritroderma
C. Psoriasis vulgaris
D. Pityriasis rosea
E. Parapsoriasis

9. A 5 years old girl come to the doctor with her mother with chief complaint erythema all over
body. Doctor diagnosis : varicella. What is the sign of primary lesion of varicella to support the
diagnosis? Bisa macem2 sebelum akhirnya jd krusta
B. papule, macule, vesicle, pustule.
E. pustule, ulcer, crusting, hypotrofi scar.

10. Whay layer that is not found in thin skin?

A. stratum corneum
B. stratum granulosum
C. stratum basale
D. stratum lusidum
E. stratum spinosum

11. Perbedaan Reticullar dermis yang tidak ada pada Papillary dermis?
A. Capillary
B. Dense Irregular Connective Tissue
C. Meissner
D. Sweat Gland
E. Type I collagen fiber

12. A 5 m.o baby boy was bought to the dermatolgy clinc by his mother with chief complain of
exzema on both of his cheek since 1 week ago along with itch the mother said that his son
always try rub his skin & become iritable at night. This symptoms have been experienced by
the boy since 2 month old intermittenly. Both of his parents have history of asthma & alergic

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 rhinitis. What topical therapy should be used for this patient? Karena anak kecil yg paling
lemah
A. Betamethasone velerate 0,1%cream
B. Desoximethasone 0,25% cream
C. Clibetasol propionate 0,05% cream
D. Hydrocortisone 1% cream
E. Diflucortolone valerate 0,1% cream

13. Pada soal 12, anak tersebut akan memakai kortikosteroid topikal pada jangka panjang, apa
efeknya? Atrophy, striae, acnei form, hypertrichosis, hypopigmentation, secondary infection &
allergy
A. Hyperpigmentation
B. Skin atrophy
C. Tachypilaksis
D. Hyperkeratosis
E. Suppresion on HPA Axis

14. Pelepasan epidermis. Test apa epidermiolysis? Kalo ada blister ngecek mobilitas atau engga.
A. Darrier sign
B. Auspitz sign
C.
D. Nicolsky sign
E. Dermatoglyphs

15. A 40 years old woman comes to dermatology clinic with complaint of dissemenated pustular
lesion. She was referred to the hospital due to UTI and was given ciprofloxacin 2 weeks before.
On the 7th day she developed pruritic erythematous maculopapular rash affecting the abdomen,
neck, and skin folds. The next day she developed disseminated pustular lesion. Temperature
was 38oC. On the gram stain there is no bacteria. Diagnosis? Gara2 abis minum obat jadi
pustul2 seperti pioderma
A. Folliculitis
B. Pustular psoriasis
C. AGEP (Acute Generalized ______)
D. Acneiform eruption
E. Subcorneal pustular dermatosis

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16. A 25 y.o. woman with history of sexual intercourse 1 month ago. Ada ulser di vagina, tidak
diobati hilang sendiri. Kemudian, ada redspot di badan yang tidak gatal. VDRL 1/80.
Diagnosis? Sifilis secondary karena hilang sendiri trs ada red spot di dalam.
A. sifilis
B. GO
C. Ulcus molle
D. varicella
E. LGV

17. A 40 years old women cames with complains of greyish maldorous discharge from vagina. She
has no sexual intercouse since husband died. Recently She is feel depressed. Diagnosis?
Greyish malodorous discharge (minor STD)
A. Syphillis
B. Gonorrhea
C. Herpes genitalis
D. Candidiasis
E. Bacterial vaginosis

18. A 25 years old male, working as Driver, came with prurituc erythematous wheal since 1 day
ago. Lesion appears an hour after he ate shrimps. Whcih antihistamin drug with minimal
sedative effect? BACA ANTI HISTAMIN
A. Chlorpheniramine
B. Diphenhydramine
C. Hydroxyzine
D. Cyrohepatadine
E. Cetirizine

19. 32 year-old women presented with pruritic cutaneous lesion since 1 week ago. She did
gardening as a hobby and reported to change the manure in potted plants recently, about 3-4
weeks of complaint. She has no pets. PF revealed cutaneous erythematous with elevated lesion
of 2 mm in width and 7 cm in long. Possible diagnosis? Serpiginousa
A. Enterobiasis
B. Cutaneous Larva Migrans
C. Cutaneous Filiriasis
D. Ascariasis
E. Hookworm infection

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20. A 17-year-old male presents to a clinic complaining of severe sunburn to his face and forearms.
He was playing soccer ball outdoors for less than one hour on a sunny day before noticing the
sunburn. His past medical history is significant for acne vulgaris, which he is taking
medication for. Physical examination reveals numerous comedones, papules, and pustules on
his face, neck, and chest. There is significant scarring from previous episodes of acne.
Confluent areas of erythema, warmth, and edema are evident on the patient’s face and
forearms.
Which of the following medications is the most likely causative agent of the sunburn?
Doxycyclin bikin skin sensitive to sunlight
A. Benzoyl peroxide
B. Erythromycin
C. Clindamycin
D. Doxycycline
E. Acid salicylic

21. orang di cek IgM dan IgG positif dengue dan platelet count menurun, gambar dermatology?
A. Petechiae
B. Gumma (sifilis tersier)
C. Telengatacsia
D. Vesicle

22. 45 tahun wanita ada pruritic outbreak 0,3-0,5cm vesikel di permukaan ekstensor tangan kanan.
Punch biopsy 3mm dilakukan dan diperiksa mikroskop ada epidermal bullae (just above the
basal layer). Best diagnosis? Epidermal bullae.
A. Bullous pemphigoud -> DEJ
B. Pemphigous vulgaris
C. Acuta eczematous dermatitis
D. Impetigo
E. Urticaria

23. Receptor dr cold receptor :

A.merkel unencapsulated modified free nerve ending skin receptor (sentuhan mekanis)
B. Encapsulated free nerve ending (KRAUSSE)
C. Pacinian corpuscle skin receptor (Tekanan)
D. Unencapsulated free nerve ending (SALAH)
E. Ruffini corpuscle skin receptor (Panas)

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24. A 8 years old son was brought to clinic with itching in fossa cubiti and poplitea. In PF, pruritic
rash in fossa cubital. Mother said same thing happen to her husband and relaps
chronically with asthma.Which is increase in lab? Atopik Dermatitis
A. IgA
B. IgE
C. IgG
D. IgM
E. IgG dan IgM

25. Laki laki 31 tahun datang dengan keluhan lesi kemerahan yang sakit dengan raised border. Dia
ada demam & involvement of dermal lymphatic juga. Dermatologic exam reveal intensely
erythematous, indurated plaque with sharply demarcated border. Streptococcus b hemolytic
merupakan etiology penyakitnya. Diagnosis yang paling mungkin? Infeksi di dermis extend ke
dermal lymphtic. Plaque sharply demarcated border.
A. Impetigo crustosa
B. Furuncle
C. Ektima
D. Erysipelas
E. Folliculitis

26. A 14-year old female presents to the pediatrician complaining of discoloration of her toenails,
which makes it impossible to wear sandals. She says that months ago, she first notice the big
toes of both feet were affected, and that the yellowish brown discoloration began with the distal
tips of her toenails and spread proximally to involve entirely of the nail. On physical
examination, the nail plats of all ten toes are heaped up and irregular. Brownish discoloration is
evident. Dermatophytic hyphae and arthrospores are visible upon KOH examination of scraping
from the nail bed. What is most effective treatment regimen for this girl’s condition? Tinea
unguium
A. Bacitracin
B. Permethrin
C. Ketoconazole topical
D. Gliseovulvin

27. A 32-year-old comes to a dermatologist for the evaluation of a rash over her knees. She
first noticed the rash two weeks ago on the front of her knees. She denies any
associated symptoms of itching or joint pains. No significant past medical history.

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 contraceptive. She takes oral medication regularly. Physical examination, symmetric,
erythematous plaques with well-defined margins are observed over the anterior aspect of
both knees. The plaques are covered with thick, silvery scales. Which of the following is
the most appropriate initial treatment? Psoriasis
A. Topical application of hydrocortisone 1% cream
B. Topical application of betamethasone 0.05% cream
C. Short course of 60 mg oral prednisone every day for two weeks
D. Phototherapy with ultraviolet-B radiation
E. Low-dose methotrexate daily for two weeks

28. 20 year old woman reported came to dermatology clinic reported redness and itchy on her
scalp, 2 days after having hair dyed. Dermatology examination showed erythematous lesions on
her head and hair lesions. What the likely diagnosis of this patient? DKA
A. Seborrhoic dermatitis
B. Allergen contact dermatitis
C. Psoriasis
D. Atopic dermatitis
E. Irritant contact dermatitis

29. A 25 years old man comes to the doctor because of painful boils in his beard area since 2 days
ago. On skin examination: pustule with hair in the center of pustule. Skin scrapping test on
lesion: gram positive grape-like cocci. What is the possible diagnosis?
A. Furuncle (necrotizing folliculitis)
B. Carbuncle (kumpulan furuncle)
C. Foliculitis
D. Impetigo
E. Acne Vulgaris

30. Org goreng pempek keciprat minyak luka. Fase2 penyembuhan?

Epidermis healing process:
A. Inflammatory phase – Proliferative phase – Maturation phase
B. Inflammatory phase – Granulation phase – Maturation phase
C. Inflammatory phase – Maturation phase – Granulation phase

31. A 25-year-old woman presented with some itch on the scalp that started 3 month ago.
She always cover her hair with a scarf every day from 9 am to 5 pm and worked at

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 the parking lot. On examination there’s some annular patch which covered with white-
gray fine scales. What is your most likely diagnosis ?
A. Psoriasis
B. Seborrheic dermatitis
C. Pediculosis capitis
D. Kerion celsi
E. Gray patch ring worm

32. 30 th laki2 ada hipopigmen di deket bibir. Ayahnya juga gitu

A. Albino
B. Melasma
C. Post inflam hipopigmen
D. Vitiligo
E. Ptiriasis alba

33. 20 years old man came to clinic with blurred vision on both eyes. After physical examination,
his refraction status is S+1.50 for right eye and S+1.00 for left eye. Before using spectacles,
where the image would be in the eye?
A. In front of retina
B. At retina
C. At the back of retina
D. Infinite
E. At cornea

34. Man 67 thn, blurred vision since 2 years ago. No pain/red/trauma. Visual acuity right : 6/20
left: 6/24. IOP right:35 left:32. Cup disc ratio 0,8. Mechanism of blurred vision?
A. Image located in front of retina
B. Lens haziness
C. Optic nerve neuropathy
D. Rupture of the retinal vessel
E. Neovascularisation

35. A 70 years old man blurred vision in his right eye. physical examination showed hazy lens, iris
bowed frontal, IOP 40, drugs relative contraindication:
A. timolol
B. acetazolamid
C. atropine sulfat

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 D. latanoprost
E. prednisone

36. A man comes to the ER after trafic accident. He had no decrease consciousness and had
moderate head injury. A week after the accident he has diplopia and hirschberg test shown the
left eye 15° esotropia. Probably he has paralysis of which cranial nerve?
A. Optic nerve
B. Trochlear nerve
C. Trigeminal nerve
D. Abduscens nerve
E. Vestibulocochlear nerve

37. Upon further examination, he is found to have lagopthalmus of his left eye, causing his eyes to
be watery. What is the most likely involved structure?
A. M. Levator palpebrae
B. M. Muller
C. M. Orbicularis occuli
D. M. Cilliary

38. 50 yo man came to eye clinic with complain of hitting chair while walking his house. After
confrontation test, it was revealed that he got reduction in visual field loss in nasal side of both
eyes. The most probable site to cause this deficit is…
A. Edinger-wesphal nuclei
B. Cortical association
C. Optical radiasm
D. Optic chiasm
E. Macular degeneration

39. 20 years old woman presents with redness in the eye, associated with pain. It was noted when
she woke up in the morning. She already had several episodes of red eye. Visual acuity
revealed 20/20 in both eyes. The redness is blanching with phenilephrine instillation. What is
the most possible underlying mechanism of this case?
A. Possible mechanical trauma
B. Connective tissue disorder
C. Alteration in aqueous outflow
D. Infection by herpetic virus
E. UV exposure

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40. 9y.o. female came with nasal left pain with fever 4 days prior to presentation. Her left eye was
red swollen, seemed to be worsening. She also stated it had been more difficult to open her left
eye, and diplopia in her all gazes. PE revealed proptosis on her left eye and visus 20/20 on both
eyes: most likely diagnosis?
A. Optic tumor
B. Pseudotumor
C. Thyroid eye disease
D. Optic celullitis
E. Hordeulum

41. 51 y.o male has dry and red eyes. He has history of palpitation and mild tremor. He has
horizontal binocular diplopia on extreme gaze. He was not bothered by the diplopia. Complaint
of "starring eye". Physical examination: restriction in upper ocular motility and exophthalmus.
What is the next initial diagnostic test?
A. Orbital CT scan imaging
B. Hirschberg test
C. Schirmer and ferning test
D. Complete Blood Count
E. Hertel exophthalmometer

42. A 25 years old man come to Emergency Unit Siloam LV with chief complain of redness of
right eye since 5 hours ago, after hit by a tennis ball. Visual acuity both eyes is 6/6.
What is the possible diagnosis for the right eyes ?
A. Palpebral laceration
B. Corneal laceration
C. Ablatio retina
D. Subconjunctiva bleeding
E. Vitreous hemorrhage

43. Management case above :

A. Verban + mydiatrics
B. Inform consent bahwa akan hilang sendiri
C. Topical antibiotics & analgesics meds
D. Observation karena emergency
E. suture conjunctiva

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44. 55 year old female with blurry vision gradually for 1 year. No pain or redness. Her blood
glucose level was always higher than 210 mg/dl and her blood pressure was 130/80. Her visual
accuity 6/60 on both eyes. Anterior chamber was normal and lens was clear. What possible
finding is found in funduscopy?
A. Retinal exudate
B.
C. Cotton wool appearance
D. Keratin prescipitate
E. Cherry red spot

45. A 15 y/o teenager was brought to test his color vision. It was revealed he had red-green
deficiency. Which part of the retina is most likely to be affected?
A. Muller cells
B. Cone cells
C. Rod cells
D. Bipolar cells
E. Retinal pigment epithelium cells

46. 63 y.o. female came to doctor with blurred vision since 3 months ago. No hypertension no
trauma, no red eye no pain. Visus 2 meter hand counting. Lens look hazy. What diagnostic test?
A. Anel test
B. Hisburg test
C.
D. Shadow test
E. Fluoresen test

47. A 75 years old comes to ER with complaining sudden blurred vision with pain, headache,
nausea, vomit. Opthal examination revealed redness, corneal edema, flat anterior chamber,
midriatic pupil. IOP 60 mmHg, what is the possible definitive treatment?
A. Trabeculotomy
B. Trabeculoplasty
C. Goniotomy
D. Iridectomy
E. Iridoplasty

48. A 54 years old woman came with itching and watery eyes. On PE, there is lump in eyelid
margin, cornea and lens clear. What is the appropiate diagnosis?

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 A. Nasolacrimal duct obstruction
B. Eyelid tumor
C. Trichiasis
D. Chronic Corneal Inflammation
E. Conjungtivitis

49. 57 years old women, right eye blurred, sore eyes, the color of the rainbow, nausea,
vomiting. Previously, the normal right eye visual aquity : 2/60, pressure : N + 3,
hyperemic, corneal edema, pupillary midriasis, shallow chamber. Diagnosis?
A. open angle glaucoma
B. Acute closed angle glaucoma
C. absolute glaucoma
D. secondary glaucoma
E. chronic glaucoma

49. A 40 years old woman present with pain in her surrounding eye since 2 days ago. In
examination revealed hyperemic conjungtiva, edema cornea, mid dilatation pupil, flat anterior
chamber, unidentified funduscopy. IOP 50 mmHg. What is your possible diagnosis?
A. Acute close angle glaucoma
B. Primary open angle glaucoma
C. Indocyclitic
D. Uveitis
E. Keratitis

50. 25 y.o. man comes to the hospital because of blurred vision in his left eye after being hit by a
tennis ball. It was red and painful, visual acuity 6/48. Eyelid hematoma, subconjuctival
hemorrhage, chemosis, corneal edema, normal iris, clear lens, hazy fundus reflex. What is your
further examination?
A. Autorefractometry
B. Keratometry
C. Perimetry
D. Tonometry
E. Biometry

51. A 70 years old female, visual acuity RE : hand movement, LE : 6/40. What is hand movement
visual acuity?
A. It can only seeing waving hand.

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 B. It can read finger 1 meter distance
C. It can read finger 3 metes distance
D. It can only see light
E. She can see nothing.

52. Male, farmer, splashed by mud. His eyes become red, visual acuity 6/30, there is round
infiltrates in cornea, diagnosis?
A. Corneal ulcer
B. Numular keratitis
C. Dendritic keratitis
D. Puctate keratitis puctata

53. A 10 years old boy came to the clinic complaining right ear hearing declined since 2 weeks ago.
On examination found tuning fork can only be heard when placed on the mastoid process.
Which reaction is most likely to occur when tuning fork placed on the middle of the head?
A. Left ear heard sound weaker than right ear
B. Left ear heard sound louder than right ear
C . Right ear heard sound louder than left ear
D. Both ear hear sound the same
E. Both ear does not hear sound.

54. 8 y.o. girl come to the clinic with complaining about her right ear feel full, like water filling
since 1 day ago. Physical Examination right ear tympanic membrane intact, retraction +, there
is clear fluid shadow and air bubbles. Left ear normal, patient got cough and colds since 3 days
ago. Based on patophysiology of middle ear infection, what is the main cause?
A. Upper respiration tract infection
B. Tube eustachius dysfunction
C. Feeding time sleep position
D. Maxillofacial abnormalities
E. Tonsiloadenoid hypertrophy

55. A 12y.o. boy comes to Siloam Hospital with complaints hearing in the right ear decreased since
3 days ago. PE reveals left ear is normal, right ear : retraction on tympany membrane.
Audiometry reveals there is a gap 35 dB, where BC and AC 10 dB and 45 dB. Diagnosis?
A. Mild sensory neural deafness
B. Moderate sensory neural deafness
C. mild conduction deafness

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 D. moderate conduction deafness
E. Mixed deafness

56. Weber result from the previous number?

A. Right elongation
B. Left elongation
C. Right lateralization
E. Left lateralization

57. A 28 years old man came with decreasing hearing in the left ear, waktu kecil pernah menderita
otorea. Keluhan lainnya ada runny nose, nasal congestion, cough, trouble tasting in left tongue,
ear exam normal, ada pus dari telinga tengah, dan ada perforasi. Diagnosis?
A. Labyrinithis
B. Sinusitis
C. Petrosis
D. Chorda Tympani parese
E. Retro-auricular fistule

58. On audiometry, result: AD: (AC=10; BC=5). AS: (AC=65; BC=30). Based on the audiometry
what is the level of hearing of both ears?
A. AD normal, AC normal level hearing
B. AD normal, AC conductive deafness
C. AD normal, AC mixed deafness
D. AD normal, AC heavy conductive deafness
E. AD normal, AC severe neural deafness

59. A 34 y.o. man was brought to emergency department after being falling from ladder and hit his
head. The patient complain that he cannot smell anything after the accident (anosmia). Where is
the location of brain that he get anosmia?
A. Frontal
B. Parietale
C. Temporale
D. Amygdala
E. Hypothalamus

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60. 72 years old woman came to your clinic with chief complain of hearing loss especially in the
crowd. Ear examination right and left are normal. Audiometry : AC AD/S 56dB. BC AD/S
45dB. Especially in high notes. Apa letak lesi di cochlea?
A. Reissner membrane
B. Tectorial membrane
C. Striae Vascularis
D. Optic Capsule
E. Spiral Limbus

61. The organ of corti lies on which of the following structures?

A. Spiral limbus
B. Tectorial membrane
C. Vestibular membrane
D. Basillar membrane
E. Spiral ligament

62. 21 y.o. man loss of taste and apetite. Doctor explain about physiology of taste. Which statement
is correct?
A. Sweet and bitter taste depolarizes through G protein
B. Sour and salty through Na+ ions
C. Salty tastebud less sensitive to acid (NO Salty Tastebuds)
D. Taste bud less sensitive to bitter taste of sucrose
E. Salty and sour taste depolarizes through H+ ions

63. A 57 y.o. male came with complain spinning sensation with vomiting and nausea. Also
complain tinnitus and hearing loss. Ear Otoskopic examination normal. Diagnosis?
A. Non vestibular vertigo
B. Central vertigo
C. BPPV
D. Meniere disease
E. Cerebellar vertigo

64. 6 year old boy with fever 38, myalgia, pain when swallowing, sneeze and cough. Physical exam
: enlarged lymph node, pharynx hiperemis, T1/T1, no rash in skin.
A. Corynobacterium Diphteria
B. RSV
C. Haemophilus influenzae

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 D. Paramyxovirus
E. Strepto b hemolitik

65. A 7-year-old girl often felt pain while pulling her left ear. The pain worsened at nap time and
night. It occurred for 5 days. Sometimes odor discharge came from her left ear. She also
complained headache, fever, cough, nausea, and decreased hearing. Her mother took her to the
doctor. An otoscopic examination revealed the tympanic membrane was erythema and bulging.
Why is the tympanic membrane bulging?
A. An occlusion in the Eustachian tube
B. Retraction of the tympanic membrane
C. Protrusion of vessels over the tympanic membrane
D. Purulent exudate in the middle ear

66. Laki2 15 tahun, keluhan tidak bisa nafas dari hidung kiri sejak 1 tahun lalu. Disertai dengan
mimisan masiv dari lubang hidung kiri, terasa mengalir dari tenggorokan. Ada pilek dengan
ingus encer. Tidak ada demam dan penurunan BB. Pada rhinoscopy tdp konka eutrofil, septum
nasal ditengah, ada masa warna keputihan di rongga posterior yg mudah berdarah. Diagnosis?
A. Polip
B. Antrokoaral polip
C. Nasal scc
D. Angiofibroma nasofaring
E. Septum deviasi

67. 8 y.o. girl come to the clinic with complaining about her right ear feel full, like water filling
since 1 day ago. Physical Examination right ear tympanic membrane intact, retraction +, there
is clear fluid shadow and air bubbles. Left ear normal, patient got cough and colds since 3 days
ago. Based on patophysiology of middle ear infection, what is the main cause?
A. Upper respiration tract infection
B. Tube eustachius dysfunction
C. Feeding time sleep position
D. Maxillofacial abnormalities
E. Tonsiloadenoid hypertrophy

68. A 30 years old woman comes to the emergency room complaining spinning. The symptoms
provoked by change of head position. There was latency, fatigability, and habitual symptoms.
What is the pathology that happened to this patient?
A. Tumor of brainstem

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 B. Ischemia of cerebellum
C. Labirynth occlusion
D. Distention of endolymphatic compartement of inner ear
E. Free floating otocania within semicircular canal

69. 5 y.o dateng ke dokter, krn snoring sama sleep deviation. Ternyata dia napas lewat mulut dan
ada abnormalities face, terus ada recurrent episode upper respi infection and effusion otitis
media. Diagnosis?
A. Chronoc tonsilitis
B. Adenoid hyperplasia
C. Diphtery tonsilitis
D. Acute pharingitis
E. TB pharingitis

70. Patient a 54 years old man come to ED with massive nosebleed. the bleeding could be seen
through the bakc of the mouth. The source of bleeding could not easily be found. The patient
have history of hypertension. What is the appropriate treatment?
A. Anterior nasal packing
B. Anterior and Posterior nasal packing
C. Nose pressure
D. Posterior head tilt
E. Ice pack

71. A 72 year old man after having a stroke was suspected to have hearing loss. To determine
whether or not the patient have hearing loss, which test should be conducted?
A. impedans tympanometry
B. tonal decay test
C. ABLB
D. pure tone audiometry
E. BERA

72. Cwe usia 5 th dtg ke klinik dg keluhan telinga kanan keluar cairan sejak 10 hari lalu. Punya
riwayat batuk pilek 7 hari lalu. Telinga kanan sakit tapi merasa lebih baik sjk cairan keluar.
Diagnosis?
A. Kronik supuratif OM
B. Acute Otitis Media
C. Otitis Eksterna

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 D. Serous Otitis Media
E. Bullous meningitis

73. A 25 years old girl comes to ENT Clinic with a chief complaint of runny nose, reduced
smelling and nasal congestion, green discharge for 6 mo and she took flu medications for that.
On examination using nasal antroscope found hypotropied of nasal septae media and inferior
with green discharge and crustae. What is the diagnosis?
A. Rhinitis Sicca
B. Rhinitis Allergy
C. Rhinitis Hormonal
D. Rhinitis medicamentosa
E. Rhinitis atropied

74. 38 years old woman come to Outpatient clinic with nasal block since 6 months. Anterior
rhinoscopy reveal polyp mass ampir ke semua nasal cavity. What are patophysiology of this
disease?
A. Acute infection in nasal and sinus cavity.
B. Chronic infection in nasal and sinus cavity.
C. Acute inflammation in nasal and sinus cavity.
D. Chronic inflammation in nasal and sinus cavity.
E. Foreign body in nasal cavity.

75. A 20 years old presents with nasal block and purulent discharge. There is facial pain and
headache. Inferior concha membesar. The most common etiology?
A. Allergy
B. Infection
C. Trauma
D. Foreign Body
E. Dust (?)

76. What is the cause of the disease of the patient above?

A. Bacteria in the nasal cavity
B. Fungus in the nasal cavity
C. Blood in the nasal cavity
D. Mucocilliary dysfunction
E. Edema of the inferior turbinate

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77. Chronic Rhinosinusitis terus hyposmia. Pathophysiology of hyposmia?
A. Too many secret in meatus media
B. Edema of the inferior turbinate
C.
D. Mucocilliary dysfunction
E.

78. From the case above (Orang kena chronic rhinosinusitis terus hyposmia),He feels better when
he sniff. What is the mechanism?
A. More odor come into the nose
B. Faster air to the lungs
C. The olfactory nerve been more active
D. More air turbulence in the nose
E. If we sniff, nose become clean

79. 3A 17 y.o. patient come to a dental clinic with a painful jaw and can't open his mouth. He feel a
pressure from the lower second molar and come from the back. On the intraoral examination,
found swelling and pain from behind the second molar. What is the etiology of the disease?
A. Impacted wisdom tooth
B. Viral infection
C. Infection of the gum
D.
E. Food Allergy

80. Male, 55 tahun, ada ulcerative inhomogen lession yang membesar dalam 6 bulan. Dia meroko
12 batang per hari, minum alkohol. PF : multiple lymph node enlarged. Terdapat penurunan
berat badan progresif. Diagnosis?
A. Parotitis
B. Fibroma
C. Herpes Zoster
D. Herpes Simplex
E. Squamous Cell Carninoma

81. A patient came with swelling on the lower jaw. Intraoral examination: multiple caries and radix
on posterior mandible. History of uncontrolled diabetes. Pus from gum and submandibula.
What is the diagnosis?
A. Cyst

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 B. Periocoronitis
C. Ameloblastoma
D. Mandibular tumor
E. Submandibular Abscess

82. 17 years old patient came to dentist with his mother because he feels unhappy about dark-
brown colored on all of his tooth. From past medical history, her mother was using antibiotics
during pregnancy. What antibiotics that caused symptom above?
A. Amphicillin
B. Clindamycin
C. Tetracyclin
D. Azithromycin
E. Cephalosporine

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