Soal Ujian Utama Alimentary B

UPPER ALIMENTARY

Dr. Martinus (3)

A 42-year-old male stressed-out executive has a 6-months history of constant upper abdominal pain and heart burn for the past year that was relieved by over-the-counter antacids. His stools have become dark and tarry, which at examination, have occult blood. Most likely diagnosis: peptic ulcer disease (case for questions no.1-3).

  1. Gastric content exiting a posterior perforation of the stomach wall will accumulate in the:

    1. Left paracolic gutter

    2. Left paravertebral gutter

    3. Right paravertebral gutter

    4. *Omental bursa

    5. Hepatorenal recess

  1. The following statement concerning the peritoneal cavity is correct:

    1. A potential space of capillary thinness between parietal peritoneum and abdomen wall

    2. The content of this cavity are the small and large intestine

    3. Contains 500cc peritoneal fluid

    4. *there is a communication pathway in females to the exterior body

    5. consist of the greater sac only

  1. The following statements are correct for abdominal cavity, except:

    1. Is the location of most digestive organs and ureter, the spleen, and the kidneys.

    2. Separated superiorly from the thoracic cavity by the diaphragm

    3. Continuous inferiorly with the pelvic cavity

    4. *the posterior wall are the lumbar+sacral vertebrae and their intervertebral discs

    5. Their internal surface lined with the parietal peritoneum.

Dr. Sugiritama (2)

  1. Which of the following statements is correct about histological structure of esophagus?

    1. Mucosa is lined by keratinized stratified squamous epithelium

    2. Esophageal cardiac glands is located in the submucosa layer

    3. Muscularis externa of the upper third of the esophagus is composed by smooth muscle

    4. Muscularis externa of the lowest third of the esophagus is composed by skeletal muscle

    5. Esophageal gland proper is located in submucosa layer*

  1. The following statements are correct about histological structure of cardiac mucosa, except:

    1. The lamina propria contains simple tubular cardiac glands

    2. The predominant cell on the cardiac glands is parietal cells*

    3. The gastric pits is more shallow than fundic

    4. There is no chief cells on the cardiac glands

    5. The terminal portion of cardiac gland is coiled

Dr. Suwetra (3)

  1. Generally, a normal alimentary function is regulated by :

    1. enzyme

    2. feed-back mechanism

    3. motoric nerve

    4. intramural plexus

    5. thyroxin

  1. Peristaltic always move from oral to anal, because it follow the role of :

    1. All or None

    2. Boyle

    3. Laplace

    4. Newton

    5. Receptive Relaxation and Low of Gut

  1. Protein digestion in stomach is done by enzyme:

    1. ptyalin

    2. pepsin

    3. trypsin

    4. chymotrypsin

    5. renin

Dr. Desak (2)

9. A 60-year-old patient presents with a history of increasing frequency of passage of feces. On questioning, he tells you that the stools are pale in colour, are passed in copious amount and difficult to flush away. Does this suggest:

  1. Dissacharidae deficiency

  2. Malabsorption of fat

  3. The absence of secreted HCl in the stomach

  4. Lactose intolerance

  5. Impairment of galactose absorption

10. There are many organs that involved in digestion process and each of them has specific function. To absorp of fluid and electrollytes is the function of:

  1. Stomach

  2. Pancreas

  3. Gallbladder

  4. Small bowel

  5. Large bowel

Dr. Mustika (2)

11. Patien 50 years old man comes to hospital because of profuse hematemesis. He also has weakness, anemia and decrease body weight in one year.Laboratory examination shows disturbances in lever function test ,IgG for Viral Hep.C positive. The most commont causes causes of profuse Hematemesis is :

    1. Esophageal Carcinoma

    2. Barrett Esophagus

    3. Esophageal Varices

    4. Acute Gastritis

    5. Peptic Ulcers (C)

12. Which one of these statement is not a morphologic feature of pleomorphic adenoma of salivary gland. :

    1. Cystous

    2. Epithelial cells

    3. Intermingled with myxoid connective tissue.

    4. Myoepithelial derivation

    5. Encaptulated. (A)

Dr. Elys (2)

13. A boy came with chief complain about pain when swallowing and also pain at his neck. One day before admission he had history about choking and swallowed a fish bone.You suspicious about trapped fish bone at the esophagus.What kind of initial imaging examination that you advice?

    1. Plain photo cervical*

    2. Plain photo thoracal

    3. Plain photo abdominal

    4. Pharyngoesofagography

    5. UGI study

14. Radiological appearance of achalasia is :

      1. Fillling defect of the esophagus

      2. Iregularitas of the esophageal wall

      3. Dilatation of the proximal esophagus and narrowing of the distal esophagus with beak-likeappearance*

      4. Worm-like impression along the esophageal wall.

      5. Esophageal diverticle

Prof Aman (2)

15. Antacid that cause side effect diarrhea is:

  1. Aluminum hydroxide

  2. Calcium carbonate

  3. Sodium carbonate

  4. Magnesium hydroxide*

  5. Combination of Magnesium/Aluminum hydroxide

16. These are the likely side effects of metoclopramid if used in long period of time, EXCEPT:

    1. Parkinsonism

    2. Galactorrhea

    3. Hyperprolactinemia

    4. Arrhythmia *

E. Tardive dyskinesia

Drg Agung (2)

15 years old boy complained about spontaneous pain at his right upper molar since last night when he was sleeping. Clinical finding shows there is an untreated deep cavity on the surface of that tooth.

17. Suspected diagnosis for that condition:

  1. Pulp Irritation

  2. Pulp Hyperaemia

  3. Pulpitis*

  4. Superficial Caries

  5. Chronic Periodontitis

18. Preferred medicines which can be prescribed to the patient before being admitted to the Dental Department:

  1. Analgesic

  2. Antibiotic

  3. Anti inflammation

  4. Combination between option A and B*

  5. Combination between option B and C

Dr Dewa Arta (2)

19. A 2 year old boy came with bad general condition, vesicles are found in gingival area. The boy is also complained convulse and high fever, what is the diagnosis of this patient:

    1. Oral candidiasis

    2. Primary Herpes simplex*

    3. Secondary Herpes simplex

    4. Recurrent Stomatitis apthous

    5. Ginggivitis

20. A 35 year old woman come with chief complain about pain to swallow. On the physical examination, vesicles are found on the oral base and mandible gingival area. What is the possible diagnosis of this patient?

    1. Primary herpes simplex

    2. Secondary herpes simplex

    3. Oral candidiasis

    4. Herpes zoster*

    5. Recurrent Stomatitis apthous

Dr. Sagung putri (2)

21. A 3 year old boy, come with his parent to Sanglah hospital. His chief complaint is difficulty when swallowing, after accidentaly swallow Rp. 50,- when he played with his friend 2 hours ago. Others complaint that immediately follow the case are:

    1. Pain when swallowing (ordinophagia)

    2. Vomitting*

    3. Cough

    4. Hoarse

    5. Shortness of breath

22. A 19 year old girl come with chief complaint pain when swallowing and vomiting after consume toilet cleanse solution, in suicide attempt because of broke with her boyfriend. The complications that can be occurred after the recovery phase if the management were not optimum are:

    1. Stricture of oesophagus*

    2. Tumour of oesophagus

    3. Fistula trachea oesophagus

    4. Diticulum

    5. All are correct

Prof Wibawa (2)

Dr. Suryadarma (3)

Dr. Karyana (2)

  1. A 1-year-old-boy was brought to a polyclinic by his parents because of diarrhea that he had suffered for 2 days. The frequency was 4-5 times a day, every time the volume was approximately 25 mL, without blood or mucus, and not accompanied with vomiting. The findings in physical examination were: body weight 10 kg, large fontanelle was flat, the skin went back immediately when pinched.

Based on the clinical data above, other symptoms that might be found are:

    1. He looked irritable, sunken eyes, dry oral mucous

    2. No tears when crying, looked thirsty, increased breathing frequency

    3. Poor feeding, decreased activity, decreased urine volume

    4. Normal activity, last urination was 2 hours before, pulse 100 times per minute

    5. Unconscious, fast and deep breathing, skin pinching went back very slowly

  1. If the dehydration status has been defined in case no.1, the fluid therapy given:

    1. 75 ml of ORS after each loose stool

    2. 100 ml of ORS after each loose stool

    3. 125 ml of ORS after each loose stool

    4. Infused with RL 700 ml in 4 hours

    5. Infused with RL 1000 ml in 4 hours

LOWER ALIMENTARY

Dr. Martinus (2)

An 18-year-old man complains of 12-hour abdominal pain that is initially periumbilical and then migrates to the Right Lower Quadrant (RLQ). He has some nausea and a low grade fever. The abdomen is tender in the RLQ and right lateral region. The urinalysis is normal.

Most likely diagnosis: Acute appendicitis. You are at surgery for the removal of a suspected appendicitis, but the appendix is not visible. The appendix is likely to be:

  1. Anticecal

  2. Paracecal

  3. Paracolic

  4. *Retrocecal

  5. Retrocolic

A patient experiencing infraumbilical (pubic) pain is likely to have a disorder of the:

    1. Appendix

    2. Ascending colon

    3. Ileum

    4. Stomach

    5. *Sigmoid colon

Dr. Suwetra (2)

Defecation reflex in normal adult:

    1. Occur 5 times

    2. Stimulated, if feces insert into the rectum

    3. Cannot be postpone

    4. Started if ascending colon is filled

    5. Can be fascilitated by atropin injection

Ileocaecal emptying is faster in the present of infection of :

  1. Small intestine

  2. Appendix

  3. Kidney

  4. Colon

  5. Ureter

Dr. Sri Wiryawan (2)

  1. Choose the best description of the duodenum.

    1. Mucosa with crypts and villi; epithelium with scattered goblet cells; lamina propria with occasional lymph nodules; submucosa unspecialized.

    2. Mucosa with crypts but no villi; epithelium with scattered goblet cells; lamina propria with occasional lymph nodules; submucosa unspecialized.

    3. Mucosa with both crypts and villi; epithelium with scattered goblet cells; lamina propria with occasional lymph nodules; submucosa with mucous glands. (*)

    4. Mucosa with both crypts and villi; epithelium with scattered goblet cells; lamina propria packed with mucous glands; submucosa with numerous lymph nodules.

    5. Mucosa with crypts but no villi; epithelium with scattered goblet cells; lamina propria with occasional lymph nodules; submucosa with mucous glands.

  1. Choose the best description of the appendix.

    1. Mucosa with short tubular invaginations but no villi; epithelium lacking goblet cells; lamina propria packed with lymphoid tissue containing numerous germinal centers.

    2. Mucosa lacking both tubular invaginations and villi; epithelium with many goblet cells; lamina propria unspecialized, without lymphoid tissue.

    3. Mucosa lacking both tubular invaginations and villi; epithelium lacking goblet cells; lamina propria packed with lymphoid tissue containing numerous germinal centers.

    4. Mucosa with short tubular invaginations but no villi; epithelium with many goblet cells; lamina propria unspecialized, without lymphoid tissue.

    5. Mucosa with short tubular invaginations but no villi; epithelium with many goblet cells; lamina propria packed with lymphoid tissue containing numerous germinal centers.(*)

Dr. Mustika (2)

Patient 25 years old man come to a private doctor with cramps,tenesmus,and colicky lower abdominal pain,he also has chronic relapsing diarrhea ,melena ,weakness and decrease body weight .On physical examination the patient look pale, abdominal mass cant found with palpation,and the hemoglobine is 6,5 gr% .The patient also has migratory polyarthritis and then referred to Sanglah hospital for further examination. Which one is the the most likely diagnosis between these diseases:

    1. Malabsorbtion syndrome

    2. Infectious Enterocolitis

    3. Amoebic dysentery

    4. Crohn Disease

    5. Ulcerative colitis {E}

In colorectal cancer, dietary factors receiving the most attention, which one of these is not the most likely:

A.A low content of unabsorbable vegetable fiber

B.Low fat content

C.High content refined carbohydrate

D.Decreased intake of vitamin A,C and E

E.Nitrites derived from nitrates (found in food and drinking water) (B)

Dr. Elys (2)

A 58 year-old man came with chief complaint about bloody stool since this last 3 months. He also complained about changes in bowel habit. His faeces caliber became smaller and more hard than usual. His body weight also decreased until 15 kilograms in this 2 months. He also felt pain at the left lower abdomen. On the physical examination, you find a mass at his left lower abdomen. What kind of initial imaging examination that you advice for this patient?

    1. UGI study

    2. BOF*

    3. Barium enema

    4. Barium follows through.

    5. CT scan abdomen

Large bowel carcinoma usually giving radiological appearance :

  1. Diverticle

  2. Dissapearing of the haustrae along the large bowel.

  3. Filling defect annular type*

  4. Polyp

  5. Generalized irregularity of the entire colon

Prof Aman (2)

Mechanism of action of laxative castor oil, cascara, senna, phenolphthalein is:

    1. Irritate and stimulate large bowel wall*

    2. Forming a bulky, emollient gel

    3. Soften stool material

    4. Lubricate fecal material

    5. Inhibit peristalsis

To become active as anti inflammatory this drug is converted to 5-Amino Salicylic Acid, and effectively for the treatment of Colitis Ulcerative. This drug is:

  1. Sulfasalazine*

  2. Infliximab

  3. Glucocorticoid

  4. Methotrexate

  5. Azathioprine

Dr. Purwadi (3)

Dr. Sudartana (2)

A 45 year old male, comes with chief complaints malaise, decrease of appetite, body weight loss 6 kg in 1 month and diarrhea for 6 weeks. On physical examination BP : 110/70 mmHg, HR: 88 x/mnt, eyes (sclera) : anemis +/+. RT : tumours are not papable.

The management of this patients are:

    1. Right Hemicolektomy

    2. Left Hemicolektomy

    3. Low anterior resection

    4. Colostomy

    5. Radiotherapy + chemotherapy

According to TNM system, the meaning of T4 on Colorectal carcinoma is:

    1. Tumour are limited to sub mucosa

    2. Tumour are reach the serous of the bowel

    3. Tumour are reach the muscularis layer of the bowel

    4. Tumours are spread beyond the serous

    5. All are wrong

Dr. Sudartana (4)

A 35 year old female comes with chief complaints pain in the anal, especially when defecate, and also bleeding from anus. The bloods are not so copious and just stick on toilet tissue.

The most possible diagnosis of this patient is:

    1. Internal Haemorrhoid

    2. Perianal Fistula

    3. Perianal Abscess

    4. Fissure ani

    5. Tumour of rectum

The examination that can be used to determine the cause of the complaint of this patient is:

      1. Fistulografi

      2. Transrectal Ultrasonografi

      3. Tonografi

      4. Barium in loop

      5. Rectal Toucher

The most common cause of Perianal Fistula is:

  1. Anal infection

  2. Chrohn disease

  3. Ulcerative colitis

  4. Trauma

  5. Diverticulosis

Working diagnisis of internal Haemorrhoid can be determine with:

  1. Rectal toucher

  2. Proctoscopy

  3. Sondase

  4. Fistulografi

  5. Transrectal USG

Dr. Darma putra (4)

A 18 year old girl, comes to emergency room with chief complain pain on right lower quadrant of abdomen and nausea. About 3 hours ago she suddenly felt pain in the epigastric region. On the physical examination, the general condition of the patients is good. BP 110/80 mm Hg, HR 76X/m, axilla temperature 370 C. Pressed pain and resistance of abdominal muscle are found on the right lower of the abdomen.

The examination that need to be done do dismiss the possibility of ureter stone in this patient is:

    1. Routine blood examination

    2. Urine sediment

    3. Rectal touch

    4. Abdominal plian photo

    5. Renal function examination

If there were no disorders found on the ginecologic and urologic examination, the most possible diagnosis of this patient is:

  1. Acute Appendicitis

  2. Acute Cholesistitis

  3. Ileitis terminalis

  4. Diverticulitis ( of Meckel)

  5. Entherocolitis

A 6 moth old boy is carried by his mother to hospital, present history defecate with blood. According to his mother, a night before, the baby suddenly cried and screams. The baby stop cried, but cried again, and its happen since that time. In the morning his stools mixed with blood. On the physical examination, the baby in good nutrient status, moderate dehydration, distension of the abdomen with increasing peristaltic. On rectal touch, there were blood with bright red colour and slime on the glove. Rectal temperature 380 C, heart rate and respiration rate are increasing.

What examinations that will you do to determine the diagnosis of this patient?

    1. USG

    2. Abdomen plain photo

    3. Barium in loop

    4. Blood routine examination

    5. Stool routine examination

Complication that can be occurred to this patient is:

  1. Dehydration

  2. Balance disorders

  3. Gangrene of the pinched bowel segment

  4. Peritonitis

  5. All are correct

Dr. Suryadarma (2)

Dr. Purwadi (2)

Dr. Sudartana (4)

A 55 year old male come with chief complaint tumour on the right scrotum that still exist since 8 hours before admission to the hospital. There are no abdominal pain, flatus and defecate are normal, difficulty in urinating, sometimes he need to . in order to push the urine comes out.

The most possible diagnosis of this patient is:

    1. Hidrocele dextra

    2. Hernia inguinalis medialis dextra irreponibilis

    3. Hernia inguinalis lateralis dextra irreponobilis

    4. Torsio testis dextra

    5. Tumor testis dextra

Management of this patient is:

  1. Emergency Surgery

  2. Manual reposition

  3. Medicamentosa

  4. Supporting devise

  5. All are correct

This statement are correct about femoralis hernia, EXCEPT:

      1. Female more frequent than male

      2. Often become incarserta

      3. Come out from foramen ovale

      4. Often become Richter hernia

      5. The highest incident on fat women

The indication of surgery of Umbilicalis hernia is:

  1. If the diameter of hernia < 2 cm

  2. If the diameter of hernia> 3 cm

  3. If the diameter of hernia ring > 2 cm

  4. If the diameter of hernia ring < 2 cm

  5. There are signs of infection

HEPATOBILIARY SYSTEM

Dr. Suarya (2)

Location or tophography of the liver, is/are correct:

    1. All lobes located in right superior quadrant.

    2. All lobes located in right hypochondriac region.

    3. Part of the liver located in thoracic cavity.

    4. Covering by part of the thoracic wall.

    5. Part of the liver pass over right costal arc in normal adult.

These structures pass through to the hepatic porta, Except:

      1. Bile duct/ductus choledochus.

      2. Lymphatic vessels.

      3. Portal vein.

      4. Hepatic artery.

      5. Nerves fiber for the liver.

dr. Mayun (1)

The feature of the portal lobule is :

  1. Central vein as it central axis

  2. It has three zones for metabolism

  3. It boundared by central veins of three classic lobules *

  4. It has hexagonal in shape

  5. It is same with classic lobule

dr. Suwetra (2)

Gall blader emptying is caused by :

    1. Enterogastron secreted in duodenum

    2. Cholecystokinin secreted in duodenum

    3. The present of carbohydrate digestion product in small intestine

    4. Chyme too acid

    5. The present of peristaltic in ileum

In enterohepatic cycle, bile SALT is reabsorbed in :

  1. Duodenum

  2. Jejunum

  3. Ileum

  4. Ascending colon

  5. Appendix

Dr. Desak Wihandani (2)

Which of the following porphyrin derivates is conjugated, reacts directly and is a major component of bile?

  1. Biliverdin

  2. Bilirubin diglucoronide

  3. Stercobilin

  4. Urobilin

  5. Heme

Which of the following prophyrins gives stools their characteristic color?

  1. Biliverdin

  2. Urobilinogen

  3. Bilirubin

  4. Stercobilin

  5. Heme

Dr. Mahendradewi (2)

A 50 year old man came to the hospital with chief complain massive hematemesis. In anamnesis, his wife told that her husband almost always drink alcohol every day since about he was 35 year old. He also felt fatigue, decrease apetite and body weight. Physical examination show hepatosplenomegaly, ascites, dilated blood vessels around umbilical and chest. The possible diagnosis of this patient is :

  1. hepatic steatosis

  2. alcoholic hepatitis

  3. alcoholic cirrhosis*

  4. hepatocellular carcinoma

  5. cholangiocarcinoma

The most common form of malignancy in the gallbladder is :

  1. metastatic carcinoma

  2. angiosarcoma

  3. adenocarcinoma*

  4. fibrolamellar carcinoma

  5. squamous cell carcinoma

Dr. Elysanti (2)

A 55 year-old man come with chief complain about icterus at his eye and skin since 2 weeks ago, and now, it become worst (progressive). He also complain about decreased of body weight drastically in this last month. You suspicious about biliary obstruction that caused by mass of the pancreatic head. Initial imaging examination that is relatively inexpensive and safe that you will advice for this patient :

  1. BOF

  2. Abdominal ultrasound

  3. Abdominal CT scan *

  4. Abdominal MRI .

  5. Radioisotop scanning

Imaging that can be used for making diagnosis of liver cirrhosis with portal hypertension is :

  1. USG *

  2. MRI

  3. BOF

  4. Isotop scanning

  5. Angiography hepatic

Dr. Wiradewi (2)

On Hepatic cirrhosis, those condition can be occurred, EXCEPT:

    1. Increase of ALT

    2. Decrease of albumin

    3. Increase of Bilirubin

    4. Decrease of globulin

    5. Increase of ALP

If a patient comes with chief complaint yellow eyes (icterus), other than physical examination, laboratory examination that you advised is:

    1. Direct Bilirubin

    2. Indirect Bilirubin

    3. Stercobiline urine

    4. SGOT

    5. SGPT

Prof. Wibawa (2)

dr. Sanjaya (2)

A 7 years old boy come to doctor with due to complain of nausea, fatigue, fever and yellowish sclera. his friends were suffer the same symptoms.

The patient have 3 siblings: 4 month old twins, and 5 years old

Who is the most needed for vaccination ?

      1. His 4 months old siblings

      2. His 5 years old sibling*

      3. His mother

      4. His father

      5. His parents

The definitive diagnosis for this patient based on:

  1. Anti HAV Ig M*

  2. Anti HAV IgG

  3. Elevation of SGOT and SGPT

  4. Elevation of bilirubine level

  5. Elevation of the alkali phosphatase

Prof Wibawa (4)

Dr. Suryadarma (4)

Dr. Suryadarma (2)

Dr. Purwadi (2)

Dr. Purwadi (4)

Interactive lectures (3)

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