SOAL BLOK TROPICAL MEDICINE

Question 9-10 are linked to the following case:

A 31 year old female underwent allogenic bone marrow transplantation for acute myeloid leukemia. In the second month post transplant, she developed high fever, a nonproductive cough and breathlessness. Physical exam showed splenomegaly, and laboratory studies showed anemia, leucopenia, and thrombocytopenia, and abnormal liver function test. Her chest x-ray showed diffuse interstitial pulmonary infiltrates. A bronchoalveolar sample performed infected kidney cells showed owl eye.

1. What is the best treatment for this infection disease?a. Antimicrobial b. Antiviral c. Antitoxin d. Immunosuppressante. Antifungal

2. This females illness could be most easily diagnosed by which of the following tests?a. HSV-1 IgM antibodyb. CMV antigenemiac. HHV-6 IgM antibodyd. Culture of blood in erythroblastic cellse. Monospot test

3. A 45 year old man has chronic otitis media since 2 years ago. He comes to Siloam hospital because he suffers headache since a week ago. The doctor makes some examinations also radiographic examination on his head. The doctor fined a round mass with 3 cm diameter. Which of the most likely cause of the mass?a. Neoplasmab. Aneurismac. Infarctiond. Abcesse. Hemorrhage

A 70 years old man presents to ER with history of seizure. His wife awakened at 05.00 by an odd gurgling noise. Her husbands head was deviated to the left and his left arm was stiffened. After a few moments he had generalized body jerking and was unresponsive. Event lasted 2 minutes but stopped spontaneously. His wife said he seemed drowsy and confused. There was no history of prior seizure. On ER, he was conscious, BP was 140/95 mmHg, HR 96 x/min, RR 20 x/min, Temperature 36, 5 C. The laboratory examination revealed Random Blood Glucose was 610 mg/dl.

4. What is your treatment for case above?a. Diazepam intravenous b. Oral phenytoin c. Ringer lactate infusiond. Insulin subcutane. Dextrose bolus intravenous

5. A 5-year-old girl brought by her mother to a clinic because of a-two-day fever and sore throat. On mouth examination, the doctor finds a leathery grayish white membrane adheres to pharyngeal walls and tonsillar pillars which spread asymmetrically onto the soft palate and uvula. What treatment should be given to the patient?A. Antibiotic and antiviralB. Antiviral and antifungiC. Antitoxin and antifungiD. Antibiotic and antitoxinE. antiviral and antitoxin

6. A 22-year-old woman who just got home from a 2-week voluntary work in rural Papua comes to a clinic with history of bloody and slimy diarrhea since her last five days in Papua. She experiences more than five bowel movements within each day. She also experiences stomach cramp and painful passage of stool. She reports no fever or any other complains. There is a slight lower quadrant abdominal tenderness on her physical examination. She is found to be a little bit dehydrated. What is the most likely organism which causes her condition?a. Entamoeba histolitycab. Vibrio choleraec. Rotavirusd. Salmonella typhie. Escherichia coli

7. The mother of a 4-year-old child notes that her child is sleeping poorly and scratching his anal area. You suspect the child may have pinworms. Which one of the following is the BEST method to make that diagnosis? a. Examine the stool for the presence of eggsb. Examine the stool for the presence of larvaec. Examine a blood smear for the presence of microfilariad. Examine transparent adhesive tape for the presence of eggse. Determine the titer of IgE antibody against the parasites

8. A patient came to the clinic with portal hypertension syndromes. From the interview, the patient was known to consume raw fish regularly. Of the following, the most likely cause of disease is : a. Paragonimiasisb. Clonorchiasisc. Fasciolopsiasisd. Echinococcosise. Fascioliasis

A 40-year-old man came to the clinic with complaints of having fever more than one-week, nausea, and fatigue. He came back from Timika, Papua. On blood smear examination, there are late trophozoites forms, schizonts with 12-24 merozoites, and the infected red cell is enlarged.

9. Of the following, the most likely caused of parasite species is : a. Plasmodium vivaxb. Plasmodium falciparumc. Plasmodium malariaed. Plasmodium ovalee. Plasmodium cynomolgi

A 30-year-old man, having fever for 3 days, with falciparum rings +++ was given CQ3 (chloroquine for 3 days). After 3 days, the patient is still feverish, blood smear examination shows falciparum rings ++++.

10. What is the possible response of CQ?a. Sensitivity (S)b. R I resistance, early recrudescencec. R I resistance, delayed recrudescenced. R II resistance e. R III resistance

11. 52- year old man is brought to the emergency department in an unconscious condition. On examination, he was death form more than one hour. On autopsy of the brain, there is cysts fluid containing protoscoleces with hooklets and many daughter cysts were found. What is the most likely diagnosis of this disease?a. Hydatidosisb. Cysticercosisc. Cerebral malariad. Hstoplasmosise. Toxoplasmosis 12. A female tourist developed gastroenteritis while visiting small town in Indonesia and tried some Indonesian traditional food. The onset of the disease is abrupt with abdominal cramps and watery diarrhea. She had no fever or nausea or vomiting. The symptoms have resolved within 24 hour and no subsequent recurrences. They report the disease to district public health office. The investigation found that one of the food products eaten by this tourist was contaminated by suspected pathogens. What is the suspected pathogen may cause the disease above? a. Salmonella typhib. Shigella dysenteriaec. Enterohemorragic E. colid. Staphylococcus aureuse. Enterotoxigenic E.coli

A 3-year-old boy was brought to emergency unit in Tangerang Hospital with stridor, dyspnea, and croupy cough.

13. What is the most likely pathogenic agent that causes the patients disease? a. Bordetella pertussis b. Haemophilus influenzae c. Coxsackievirus d. B. Parapertussis e. C. diphtheriae

14. A 34 years old man, come to dermatovenereology clinic, complain itchy on his sole. He is a army, that usually exercise at dirty land. Clinical manifestations are burrow 3 cm on his sole, erithema, and papule. What is the treatment for patient above?a. Lindaneb. Gamexanec. Albendazoled. Pirantel pamoate. Antibiotika

15. A migrant worker presents to the emergency room in respiratory distress. He had been spraying parathion in the fields for several days, and today he began to feel sweaty and dizzy. By the time he got to the hospital he was drooling, gasping, and becoming agitated. These symptoms are due to the actions of parathion on which of the following?a. Acetylcholinesteraseb. Muscarinicreceptorsc. Neuronallipidbilayerd. Nicotinicreceptorse. Voltage-gated sodium channels

Question 72-75 are linked to the following case:

At night, a 28-year-old man is brought to the emergency department after his right foot being bitten by an animal, within 1 hour before admission. The patient said that he heard the sound of the animal. He complains of pain in his right foot and there are two bitten marks, surrounded by edema and erythema in the dorsal aspect of his right foot.

16. After 12 hours, the patient complains of severe pain especially when he moves his right leg and his right foot becomes pallor and cold. There are no pulse in the right dorsalis pedis and posterior tibial artery. What is the next management of the case described should be?a. Wide excisionb. Fasciotomy c. Antivenin d. Incision and suctione. Corticosteroids

1. A 40-year-old patient comes with the complaints of uncomfortable stomach & flatulence. From history, the patient was known live in the valley of Napu, Sulawesi and he had a fever frequently. On physical examination, his liver was found enlarged. Which one of the following test can be used to confirm the diagnosis? a. Blood testb. Liver biopsyc. Rectal biopsyd. Stool examinatione. CT scan

19. A 55-year-old warden found a dead muskrat on the bank of a stream. He picks up the animal and buried it. Four days later, he developed a 1.5 cm painful ulcer on the index finger of his right arm, a 1 cm ulcer on his right forehead, and pain in his right axilla. Physical examination also revealed right axillary lymphadenopathy. Which of the following is working diagnosis for this patient?a. Brucellosisb. Pertusisc. Leptospirosisd. Tularemiae. Hydatidosis

20. A 27-year-old man develops acute severe encephalitis that requires hospitalization. Several days before he got that disease, he recognizes that many pigs in his farm were died. Which of the following is most appropriated natural host for the pathogen?a. Arthropod b. Horsec. Batsd. Squirrele. Rats

21. A 48 year old lady came to the outpatient clinic with chief complaint of fatigue and difficulty in concentration for the last 2 weeks. The history taking revealed that she had a balanced diet, no history of chronic disease and had been a heavy smoker for 20 years. On physical exam it was found that she had anaemic conjunctiva with other findings was within normal limit. The laboratory examination showed that she had haemolytic anemia. Based on the information given above, what is the most likely cause for her condition?a. Vitamin K deficiencyb. Copper deficiencyc. Vitamin E deficiency d. Iron deficiencye. Folate deficiency

22. A 40 year old man came to hospital with four times generalized tonic-clonic seizure since two week ago. There was no history of seizure and head trauma. A one year ago, he had business in Papua for six months. During his stay in there, he often consumed under-cooked pork. Brain MRI showed a small cystic with invaginated scolex inside. What of this following is the most likely inside cyst?a. Taenia eggsb. Cycticercosis cellulosec. Cysticercosis bovisd. Taenia solium worme. Taenia saginata worm

A worried mother brings her 18-month-old son to the emergency department because of a rash that developed today. She reports that he has had a runny nose, conjunctivitis, and diarrhea. On physical examination, he appears severely ill, is temperature to 40C for the last 3 days and has diffuse 2 3 mm erythematous rash beginning from the hairline behind the ear and spreading to his face and body. On buccal mucosa, there is a red spot surrounded by white bluish appearance.

23. Of the following, the MOST likely cause of the rash isa. Rubella virusb. Coxsackievirusc. Morbilli virusd. Human herpesvirus 6e. Parvovirus B19

24. A 48-year-old man with acute gastroenteritis has step ladder night fever since 7 days ago. He also has abdominal pain, and constipation. He usually eats uncooked vegetables at street vendor (pedagang kaki lima).Which of the following is most likely to be a constituent of this organism?a. Vi antigenb. Ureasec. Hemolysind. Shiga toxin e. Pili

25. A baby is born with a rash identical. History taking reveals that the mother had a febrile illness during the second trimester of pregnancy. Examination reveals diffuse raised purple skin lesions. There is no pallor, jaundice, or cyanosis. The baby has cataract, a 3/6 systolic heart murmur, and enlargement of both liver and spleen. There is no lymphadenopathy.Of the following, the MOST likely diagnosis is?a. Congenital Toxoplasmosisb. Congenital Rubellac. Congenital Cytomegalovirusd. Congenital Herpes Simplexe. Congenital Varicella

26. A 40-year-old woman presented with a raised redness plaque resemble a doughnut with a raised border that she already had for 1 year, It was no itchy, no pain, not easily bleeding. Sometime she feel weakness on her leg and her slipper left behind while walking. On her legs she developed an anular erythematous sharp border lesion, no scally, shiny surface and enlargement of the popliteal nerve. What kind of laboratory examination results that can help us make a diagnose of the case above?a. Dark field examination b. Gramc. KOH examination d. Ziehl neelson e. Na Cl examination

27. A woman, recently returned from Lampung, complains of having paroxysmal attacks of chills, fever, and sweating; these attacks last a day or two at a time and recur every 36 to 48 h. Examination of a stained blood specimen reveals ringlike and crescent-like forms within red blood cells. The infecting organism most likely isa. Plasmodium falciparumb. Plasmodium vivaxc. Plasmodium ovaled. Plasmodium malariee. Plasmodium brasilianumi

28. A 25-year-old G3 at 39 weeks delivers a small-for-gestational-age infant with chorioretinitis, intracranial calcifications, microcephaly, jaundice, and hepatosplenomegaly. The infant displays poor feeding and tone in the nursery. The patient denies eating any raw or undercooked meat and does not have any cats living at home with her. She works as a nurse in the pediatric intensive care unit at the local hospital. What is the most likely causative agent?a. Cytomegalovirusb. Epstein-Barr virusc. Hepatitis B virusd. Parvoviruse. Yellow fever virus

29. The patient was a 3-year-old girl who was seen by her pediatrician for a routine physical examination. Her mother was concerned about her daughters poor appetite. Physical exammmination revealed that the child was small for her age and had a slightly enlarged liver. Blood was collected for a routine complete blood count, since she had previously been slightly anemic. Her hemoglobin level was within the normal range; however, she did have eosinophilia (20%). The child had no history of travel. When questioned about pets, her mother reported that she spent a great deal of time with her puppy. Of the following, which manifestation of the infection (above case) is known to occur?a. Creeping eruptionb. Biliary cirrhosisc. Cholecystitis d. Pruritus anie. Visceral larva migrans

30. A patient complains of having nail size excrement from his anus. On the stool examination, parasite eggs contains a hexacanth embryo with six hooklets surrounded by radially striated spherical shell, 30 to 40 u in diameter were found, the most likely diagnosis of this patient is :a. Saginata taeniasisb. Solium taeniasisc. Cysticercosisd. Oxyuriasise. Ascariasis 31. A 1 year old girl came to the Puskesmas with swollen gum for a week. From the history taking it was found that she was born normal with normal birth weight, had been breastfed up to now and had a balanced diet with high intake of cooked vegetable and fruit since 6 months old. She had no history of chronic diseases. Her other physical and laboratory examination was normal. Based on the information given above, what is the most likely cause of her complaint?a. Protein deficiency due to prolonged breastfeeding b. Carbohydrate deficiency due to increased calorie needc. Fat soluble vitamin deficiency due to high vegetable/fruit intaked. Water soluble vitamin deficiency due to cooking processe. Mineral deficiency due to competition with high vitamin absorption

32. Approximately 4 hour after eating a meal in restaurant, 3 members of a tourisms group develop a sudden onset of nausea, vomiting, severe abdominal cramps, and diarrhea. Nobody got febrile. Which of the following vaccination is should be given to the traveler?a. Shigella vaccineb. Salmonella vaccinec. Enterobacter vaccined. H. pylori vaccinee. ETEC vaccine

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