Formative Test

TROPICAL MEDICINE

Ikatlah ilmu dengan menuliskannya. ( Ali bin Abi

Thalib )
For question number 1 - 4, refer to the scenario below:
Sammy, a 17 year old girl present with 9 days of fever which was recurrent in the first 7 days and sustained in
the last two days. The fever accompanied with malaise, anorexia, myalgia, frontal headache, and abdominal
pain. She frequent eats at side walk restaurant surrounding her school. On physical examination reveal acutely
ill, relative bradycardia, high fever, abdominal ditended with hepatosplenomegaly and rose spot on lower chest
and upper abdomen. CBC revealed leucopenia with aneosinophilia on differential counting. Working diagnosis
of the patient is typhoid fever and treated with Chloramphenicol, blood culture was drawn. Five days later the
blood culture reveals Salmonella typhi.

1. Which of the following is the antimicrobial activity used for this patient?
a. A bactericidal broad spectrum
b. A potent inhibitor of microbial lipid synthesis
c. It inhibits the peptidyl transferase step of protein synthesis
d. It binds reversibly to the 30S sub unit of the bacterial ribosome
e. It is active against aerobic gram positive and negative organism only

2. What is the most serious side effect of the drug?

a. Megaloblastic anemia
b. Aplastic anemia
c. Hemolytic anemia
d. Iron deficiency anemia
e. Sideroblastic anemia

3. If the patient also consumed phenytoin, which of the following is the drug interaction that most likely
happened?
a. Half life of phenytoin is prolonged
b. The serum concentration of phenytoin are increased
c. Half life of phenytoin is prolonged
d. Chloramphenicol does not inhibit hepatic microsomal enzymes
e. Both serum concentration are increased

4. The blood culture showed that the Salmonella typhi is resistant to chloramphenicol, and the fever hasn't
resolved yet. The doctor decides to change the antibiotic which has mechanism mostly as bactericidal in normal
dose.
Which of the following antibiotics the doctor will give?
a. Trimetroptim-sulfametoxazol
b. Tetracycline
c. Azithromycin
d. Chlarithromycin
e. Erythromycin

5. A 30 y.o man came with 5 days fever accompanied by headache, myalgia, GI disturbances. His wife has the
same symptom and diagnosed as S.typhi and his wida titer 1/640. Treatment with trimeptophrim-
sulfametoxazol. What is the drug side effect that most likely occurred in this case?
A. Aplastic anemia
B. Leucopenia
C. Thrombocytopenia
D. Agranulocytopenia
E. Leukemia

6. Indonesia Minister of Health decided to use dapson as mass treatment for leprosy, although many studies
show that this drug increase in resistance.
Which of the following is the most likely reason for that condition?
a. It inhibits protein synthesis
b. Resistance can emerge if very high doses are given
c. Minimal renal side effect
d. Dapsone is well tolerated
e. Dapsone can not be given to pregnant women

7. A 25 year old male patient presents to dermato-venerological outpatient clinic with anesthetic
hypopigmentation macule and paresthetic on his left hand. After taking history, physical examination, and
preliminary investigation are done, he is diagnosed with tuberculoid leprosy, with neuritis left ulnar nerve later.
He is treated with rifampicin 600 mg once in a month and dapson 100 mg daily. After treatment the patient
develops some hemolytic problems.
Which of the following is the reason for that condition?
a. Gastrointestinal intolerance
b. G6PD
c. Methemoglobinemia
d. Erythema nodosum
e. Lipolysis

8. Leprosy patient is given dapson 50mg for maintenance. WOTF drug distribution within human body?
A. Body fluids and brain
B. Tissue and nerves
C. Body fluids and tissue
D. CNS and PNS
E. Skin and nerves

9. WHO classified leprosy as paucibacillar and multibacillar. Phenazine dye is given for multibacillar leprosy
patients as alternative to dapsone.
What is the specific characteristic of this alternative drug?
a. Involve RNA binding
b. Excreted in urine
c. Stored in reticuloendothelial tissues
d. Fast release
e. The serum half life is short

For question number 10 - 11, refer to the scenario below:

Shelly, a 30 year old 32-34 weeks pregnant woman present with 11 days of fever which was recurrent in the
first 8 days and sustained in the last three days. The fever accompanied with malaise, anorexia, myalgia, frontal
headache, and abdominal pain. She frequent eats at side walk restaurant surrounding her workplace. On
physical examination reveals acutely ill, relative bradycardia, high fever, abdominal distended with
hepatosplenomegaly, and rose spot on lower chest and upper abdomen. Her CBC revealed normal range results.
Working diagnosis of the patient is typhoid fever.

10. Which is the most appropriate drug prescription?

a. Chloramphenicol cap 250 mg S4 d.d caps II a.c.
b. Chloramphenicol cap 250 mg S4 d.d caps I a.c.
c. Chloramphenicol cap 250 mg S4 d.d caps I p.c.
d. Chloramphenicol cap 250 mg S4 d.d caps II p.c.
e. Chloramphenicol cap 500 mg S4 d.d caps II p.c.

11. The doctor decided to give the 2000 mg chlorampenicol treatment for 14 days. How many antimicrobial
capsule should be prescribed to this patient ?
a. Chlorampenicol caps 500 mg No. LVI
b. Chlorampenicol caps 250 mg No. LVI
c. Chlorampenicol caps 500 mg No. XXVIII
d. Chlorampenicol caps 500 mg No. XIV
e. Chlorampenicol caps 500 mg No. LII

12. A 32 years old woman came with chief complain painless erythematous plaque on her left cheek and her
right elbow. She also feels numbness on both her hands. From physical examination there were losses of her
eyebrows. From dermatological examination there were erythematous plaque with elevated border and from
neurological examination there were enlargement of both side in articularis magnus and in ulnaris.
What will we expect to be found from histologic examination ?
a. Tubercle
b. Foam cells
c. Langerhans cells
d. Caseous necrosis
e. Multinucleated giant cells

13. A 12 years old boy admitted to emergency room because of high fever for 3 days, normal episode for one
day and then today the temperature raise again. He also suffers of headache and got some ptechiae in his
forearm. The result of serologi test was IgM negative, IgG positive. Control in test strip was positive. Diagnosis
of this patient is?
a.Dengue hemorrhagic fever primary infection
b. Dengue hemorrhagic fever secondary infection
c. Dengue hemorrhagic fever possible secondary infection
d. Dengue hemorrhagic fever mixed infection
e. Dengue hemorrhagic fever possible primary infection

14. A 36 years old man presented to ER with jaundice in the last 3 days. Symptoms started 7 days before with
gradually onset of fever with muscle ache especially in the calves, headache and nausea. If we suspect this
patient to have leptospirosis, what is definitive laboratory examination to confirm the diagnosis in the serovar
level ?
a. Macroscopic inhibition test
b. Slide peroxidase test
c. Microscopic agglutination test
d. Tube agglutination test
e. Coagulation test

For question number 15-17

A 12 years old boy presents to ER with high fever last for 5 days accompanied by headache, myalgia, and
epigastric pain. The body temperature range from 38.6-39.4 celcius. It occurs all day and night. On day 3, body
temperature decreased but, on the next day elevated again. Physical examination revealed high fever,
hepatomegaly, pleural effusion, petechiae, and positive tourniquet test. Lab findings revealed Hb content 15.8 g
% , WBC 3,400/mm3. Hematocrite 48% and platelet count 80,000/mm3. H.I titer antibody dengue virus on
acute serum is more than 1/2560.

15. What laboratory parameter should be performed in series (serial) for management of the patient ?
a. Erythrocyte count and BSR
b. trombocyte count and hematocrite
c. Leukocyte count and hemoglobin
d. Differential count and morphology
e. Lymphocyte count and haemostatic

16. WOTF is best explanation for an increase of hematocrite >20% of normal level in this patient?
a. immunological response
b. plasma leakage
c. antigen-antibody reaction
d. bone marrow depletion
e. haemorrhage state

17. WOTF will be found from serologic assays using rapid immunochromatography of Dengue kit of that
patient?
a. control neative, IgM negative, IgG positive
b. Control positive, IgM negative, IgG negative
c. Control negative, IgM negative, IgG negative
d. Control positive, IgM positive, IgG negative
e. Control positive, IgM positive, IgG positive

18. Beside detection of antibody as an evidence of response to Dengue virus infection, the antigen of the virus
also can be detected by WOTF?
a. Dengue NS-1 Elisa
b. Dengue Mac Elisa for IgG/IgM
c. Dengue blot
d. Dengue DNA detection
e. Dengue immunochromatography

19. A 15 yo boy presented with fever for 7 days with chills, headache, nausea, and abdominal discomfort.
PE: T 38,5 degree celcius wit relative bradycardia. Lab result show leucopenia. A typhoid fever diagnosis is
made. Widal test is perform in the first day of admission. The next Widal test is best done at?
a. 2-4 days after the first Widal test.
b. 1-2 weeks after the first Widal test.
c. 3-4 weeks after the first Widal test.
d. 4-5 weeks after the first Widal test.
e. >6 weeks after the first Widal test.

For question number 20-21

Mrs. Siti, 50 yo, was brought to RSHS with chief complaint decreased level of consciousness. She has history
of fever within these 2 days, with headache and vomiting, but no significant complaints of increased intracranial
pressure. No seizure.
On PE she was delirium,HR 110x/ minute, RR 30x/minute, T 39,4 degree celcius.
Neurological exam: neck stiffness, Brudzinski I (+), no papiledema.
Dermatological exam: purpura and ecchymosis in her extremities.
She just came back from Saudi Arabia for an umrah pilgrimage in the last 2 weeks.

20. What is the most possible diagnosis of the patient?

a. stroke
b. brain tumor
c. encephalitis
d. viral meningitis
e. acute bacterial meningitis

21. What is the most appropriate examination to confirm the diagnosis?

a. EEG
b. Head CT Scan
c. Head MRI
d. Lumbar puncture
e. Schedel X-ray

22. a 40 yo man, a gardener, came with chief complain hypopigmented macule on his right upper arm since 6
months ago. Since 1 months ago he felt stiffness and numbness on his right arm. There was no family with same
symptom, but some of is neighbor has a history of painless erythematous or hypopigmented patches on the
body. From dermatological status there was a hypopigmented macule with 2x3 cm in diameter, and dry. From
neurological examination there was enlargement of right nervus ulnaris and hypesthesia on his right arm.
What is the appropriate treatment for this patient condition?
a. dapsone
b. prednison
c. methampirone
d. mefenamic acid
e. acetyl salicylic acid

23. a 35 yo man develops high fever two weeks after the big float occurred in his house. He also complains
jaundice, red eye, fatigue, and severe headache. From PE reveals hepatomegaly.
WOTF is the most suitable medium culture for above causative microbe? (leptospirosis)
a. Feelay Gorman Blood
b. Saboraud Glucose Agar
c. Egg yolk agar
d. Fletcher Semisolid agar
e. Eosin metylen blue agar

24. a 27yo man was admitted to hospital because of sudden onset of fever to 39 degree celcius headache and
jaundice in the last 3 days. The patient had history of working in a warehouse where there were many rats, and
exposed to polluted water. Blood test done shortly after admission indicted renal function abnormality, elevated
bilirubin and liver function test. (lepto)
WOTF is the characteristic of this microorganism?
a. red with microgranular form
b. spirochetes gram negative
c. red gram positive
d. cocci gram positive
e. spirochetes with hooked ends

25. Choose the most likely parasite for the following description.
is the definitive host and Anopheles barbirotris is intermediate host. (B.timori)
a. Brugia
b. Wuchereria brancofti
c.
d.
e. Brugia malayi

26. What is the anaerobic bacterium that cause antibiotic associated diarrhea and also pseudomembranous
colitis
a. Clostridium pefringens
b. C. botulinum
c. C. difficile
d. Propion bacterium sp.
e. Prevotella sp.

27. Public health intervention to prevent typhoid include the provision of safe water supply. What is the
indication for safe water supply in the extent of bacteriological parameter?
a. The presence of colored organic matter associated with the soil humus fraction
b. The number of Salmonella typhii
c. The growth of microorganisms & may increase taste, odor, color, & corrosion problems.
d. Thermotolerant coliform bacteria

28. The etiology of Scabies has the following characteristic:

a. Only the female species of all stages sucks blood
b. Produce itch of the skin at scalp and pubic area
c. Lateral lobes has no function as motor organ
d. One of the stage has 4 pairs of leg
e. The eggs are glued to the hair shaft

29. A 65-year-old man develops an abscess on the back of his neck. Culture yields grape-like clusters with large,
group, and golden-yellow colonies.
What is characteristic of the isolate?
a. Grow on Mac Conkey agar
b. Gram negative cocci
c. Catalase negative
d. Coagulase positive
e. Resistant to Novobiocin

For question number 30 - 33, refer to the scenario below:

A 34-year-old male, from Bandung city, present to the clinic with the chief complaint of fever for 15 days. The
fever start by low grade fever, and then step ladder fever, followed by continues high fever, relative bradycardia,
and tongue tremor.

30. Which is proper laboratory examination below?

a. IgM anti dengue
b. Widal test
c. IgG anti leptospira
d. Thick blood smear
e. Urine profile

31. Lab result of that patients: tubx T (+). What is the possible dignosis?
A. Dhf
B. Leptospirosis
C. Typhoid fever
D. Filariasis
E. Malaria

32. What is the possible complication after 2 weeks?

A. Intestinal perforation
B. Hyperglycemia
C. Lung oedema
D. Skin hemorrhage
E. Hypertension

33. Best is the best prevention?

A. Improving sanitation
B. Provide clean towel
C. Health Epidemiology survey
D. Improving personality
E. Education for family members

34. 7 days ago a 54y.o. woman developed a tight shoulder abscess. The doctor took the specimen from the
location of infection and performed culture on the media followed by identification. The result showed that the
organism was staphylococcus sp. based on the following criteria:
A. Produce betalactamase
B. Encapsulated
C. Catalase
D. Gram negatif diplpcocci
E. Produce alfa hemolysis

35. A 21y.o.girl is admitted to the hospital because of fever, headache, weakness, and anorexia. Ten days prior to
admission she had diarrhea illness that lasted about 36hours. She has been constipated for the last 3 days. what
is the best specimen for culture to detect the causative agent of the disease?
A. CSF
B. Blood
C. Stool
D. Urine
E. Bone marrow

36. A 39 yr old man presents to you with a 10 days history of headache, fever , chills, sweats and myalgia. PE :
fever 40C, a rapid pulse rate and generalized sweating. Blood examination with thin blood smear revealed
intra-eythrocytic microorganism with typical banana shape. Which of the following statement described the
causing agent ?
A. Female Anopheles sp. is the intermediate host
B. Intra erythrocytic cycle occur in every day
C. Infects yound red blood cell
D. Gametocyte is the infective stage
E. Hepatoyte is the hipnozoit phase takes place

37. This activity used to determine changes in the geographical distribution and density of the vector, evaluate
controlled programmes, obtain relative measurement of the vector population over time and facilities
appropriate and timely decision regarding intervention. This activity is known as ?
A. Biological control
B. Environmental management
C. Vector Surveilance
D. Vector control
E. Larvae eradication

38. Because of increasing resistance to the commonly used insecticides among important vector species, this
alternative effort can be taken such as involving the alteration of the breeding sites of the vectors. This effort
known as :
A. Biological control
B. Environmental management
C. Vector Surveilance
D. Vector control
E. Larvae eradication

For number 39-42

The followings are the prevention strategies
A. The usage of open defecation as a excreta disposal
B. Screening and treating promptly for other family members
C. Improvement of water supply sanitation
D. Animal vaccination
E. Doxicyclin 200 mg single dose
F. All household and other intimate contacts of a case should be given ciprofloxacin
G. Using shoes or slipper to prevent injury
H. Distribution of medicines in endemic communities

39. This is a second level of prevention strategy for Leprosy B

40. This is a prevention strategy for Filariasis H
41. this is a third level of prevention strategy for leprosy G
42. this is a prevention strategy for meningitis caused by Neiserria meningitides F

For question number 43-44

A 19 yo girl present to policlinic when you are in charge, suffering of 11days of fever which was recurrent in
the first 7 days and sustained in the last four days. The fever accompanied with malaise, anorexia, myalgia,
frontal headache, and abdominal pain. CBC revealed Hb content 12.1 g/dl and leucopenia wit aneosinophilia on
differential counting. Widal test titer is high.

43. what is the possible diagnosis?

a. dengue fever
b. leptospirosis
c. malaria
d. filariasis
e. typhoid fever

44. what is the drug of choice of this disease?

a. ciprofloxacin
b. chlorampenicol
c. cephalosporin
d. streptomycin
e. kanamycin

45. male 37yo, preents to a hospital with jaundice in the last 4 days. Symptoms started 7 days before, wit
gradually onset fever, accompanied by muscle ache especially in the calves, headache and nausea. PE revealed
severe ill patient with tachycardia, and fever. Conjunctiva was icteric with suffusion. Lab findings revealed
thrombocytopenia, leukocyte count of 21,800/mm3, plasma creatinine concentration of 9.60 mg%, ureum 261
mg%, protein urine +++

Which is proper lab exam below?

a. Microscopic agglutination test
b. IgM anti Dengue
c. Widal test
d. Thick blood smear
e. IgM anti Salmonella
46. Male, 25yo of native in Soreang, Bandung, West Java, went to Primary Health Care because of scrotal
swelling of 3 years duration. About 3 years prior to the visit, the patient noted the onset of painless small size
scrotal size scrotal swelling on the right side. The patient had no other complaints and no other past medical
history. Some of his neighbours have the same condition, with floor swelling. Other PE were within normal
limits. Lab finding positive skin prick test. Which is proper lab exam below? (lepro)
a. Microscopic agglutination test
b. IgM anti Dengue
c. Widal test
d. IgM anti leptospira
e. Thin and thick blood film smears

47. a 51 yo woman is diagnosed with Plasmodium falciparum malaria after returning from Sulawesi. Her
parasitemia is 6, hematocrit is 21%, bilirubin is 7,8 mg/dL, and creatinine is 2,7 mg/dl. She is still making 60 ml
of urine per hour. WOTF regiment is recommended?
a. IV Cephalosporin
b. IV Artesunate
c. IV Metronidazole
d. Oral Metronidazole
e. Oral Mebendazole

48. Male, 32 yo, from Bandung city, present to the clinic with the chief complaint of fever for 6 days. The fever
is high grade, intermittent every each two day. Typically it is started by chills, followed by high fever and
sweating. He went to Papua province one month ago and stayed there for 4 weeks. PE revealed alert, pale, and
hepatosplenomegaly. All stadium of Plasmodium falciparum were found on blood smear examination.
WOTF statement is true regarding the etiology?
a. not causes more severe disease in pregnancy
b. associated with recurrent relapses after initial treatment
c. causing less than 20% parasitemia
d. not associated with thrombocytopenia
e. the only cause of cerebral malaria

For questions number 49-51

A 36yo woman, from Bandung city, present to the clinic with the chief complaint of fever for 5 days. The fever
is high grade, intermittent every each two days. Typically it is started by chills, followed by high fever and
sweating. She went to Borneo two months ago and stayed there for 6 weeks. Plasmodium vivax were found on
blood smear examination.

49. WOTF statement is true regarding the etiology?

a. anemia is rare complication
b. may be complicated by jaundice
c. the only cause of cerebral malaria
d. not sensitive to chloroquine
e. cannot co-exist with falciparum malaria in the same patient

50. The patient then got medicine, and you have quinine only in your clinic. What is the most likely true to this
drug?
a. it is gametocidal for mature gametocytes of Plasmodium falciparum
b. not active against schizonts of Plasmodium malariae
c. resistance occurs in Plasmodium falciparum
d. in the CSF level are much higer than serum levels
e. it can cause hyperglycemia

51. what is the effective prevention of this disease?

a. mass use of Fansidar chemoprophylaxis
b. use of mosquito nets
c. vaccination
d. vitamin
e. body lotion
52. brain tissue is obtained at autopsy from a person who dead of rabies.
What procedures could be used to confirm the presence of rabies virus-infected cells in the brain tissue?
a. Negri inclusion bodies and the presence of viral proteins by immunofluorescence.
b. detection of rising titers of antibody between acute and convalescent stages of infection.
c. virus isolation in chorioallantoic membrane of embryonated egg.
d. hemagglutination inhibition (HI) tests when the disease manifested
e. rapid culture techniques whereby viral antigens are detected 2 to 4 days after inoculation.

53. serology is one of the diagnostic methods in virology.

What is the criterion for diagnosing primary infection in viral disease?
a. two fold or more increase in titer of IgG or total antibody between acute and convalescent sera.
b. four fold or more increase in titer of IgG or total antibody between acute and convalescent sera.
c. a single low titer of IgG (or total antibody)
d. absence or slight increase in IgM
e. presence of IgG antibody

54. Female 24-year-old, from Bandung city, present to the clinic with the chief complaint of fever for 3 days.
The fever start suddenly with high grade fever. He had never gone to the East Indonesian province or to the
beach area. Physical examination revealed alert, high grade fever, tachycardia, and myalgia. The neighbor seem
have same condition with her. Laboratory: thrombocyte: 65,000/mm3.
Which is proper laboratory examination below?
a. Tubex T
b. NS 1
c. Anti leptospira
d. Widal test
e. IgM and Dengue.

55. A 5-year-old boy was brought to the hospital with fever for 10 days. He has went to several clinics and had
received symptomatic treatments with paracetamol and erytromycia. His mother denied any gastrointestinal
symptom. Physical examination: Temperature: 39,5C., mild anemia, hepatosplenomegaly.
Laboratory investigations: Hb 9,0 g/dL (decrease), ESR = 75 mm/hr (slightly increase). Other in normal lmit.
Widal: day 1 of admission (day 11 of fever): O titer 1:80, H titer 1:160, day 12 of admission: O titer 1:320, H
titer 1:320.
On day 6 of admission the culture which was taken on day 1 of admission revealed Gram negative rod.

Which one of this following statement is true?

a. patients already treated with antibiotics does not effect Widal test ----
b. the best sample for culture taken on day 1 of admission in this patient is urine
c. patients who have received vaccines against Salmonella may give false negative reactions in Widal test.
d. the best sample for culture taken on day 1 of admission in this patient is stool
e. patients already treated with antibiotics does not effect culture rest.

56. Virus-infected cells often develop morphologic changes referred to as cytopathic effect. Which one of the
following statements best describe the cytopathic effects of viruses on host cells ?
A. Cause morphological changes of the cells
B. Often associated with changes in mithocondrial membranes
C. Can be seen using the Gram staining
D. Rarely associated with cell death
E. Can only be seen with an electron microscope

57. A 9-month old infant, 7 kg body weight, has been giving corticosteroid therapy 15 mg per day for 2 weeks.
This infant is brought to your clinic for routine immunization; he had only BCG immunization at 1 month old
Which of the following immunization should be administered at this time ?
A. Measles virus vaccine and DTP
B. Measles virus vaccine and DTaP
C. Measles virus vaccine and Hepatitis
D. DTP and Oral Polio Vaccine (OPV)
E. DTP and Hepatitis B
For question number 58 until 59 refer to the scenario below
Miss R died after being hospitalized for 4 days and she was diagnosed as suffering from Avian Influenza. You
were informed beforehand that in the area where she lived, there were cases of death of poultry. However, you
believe that the area had never been an endemic area, and there had never been any case from there.

58. Will you consider that this might be an act of bioterrorism ? Why ?
A. Yes, because it happened not in the endemic area and it never happened there
B. No, because avian influenza is not an unusual disease and it can happen anywhere
C. Yes, because all microorganism can be used as bioterrorism agent
D. No, because it is impossible to obtain the virus
E. Yes, because avian influenza virus is an ideal bioterrorism agent

59. What will you do to the body if there is no staff in mortuary who can manage infectious dead body ?
A. Send the body for cremation, since it is most recommended by the WHO
B. Embalm, so that the body will be sterilized, then bathe the body with hypochlorite solution
C. Bathe the body with hypochlorite solution
D. Bathe the body with soap and water, then give the deceased to the family
E. Bathe the body with soap and water and put the deceased in the tight-sealed coffin

60. A 5-years-old girl is bought into the hospital for evaluation of a sore throat and fever, which she has had for
about 4 days. She is the daughter of parents of low economic status, she has not had much medical care in her
life, and her immunization status is unknown. On examination of her pharynx reveals tonsillar and pharyngeal
edema with the presence of a gray membrane coating of the tonsil, this extends over the uvula and soft palate.
You immediately consult to pediatrician and diagnose as diphtheria. What is the name of special staining for
identifying the specific characteristic of bacteria that cause the disease ?
A. Ziehl-Neelsen staining
B. Gram staining
C. Neisser staining
D. Burri-Gins staining
E. Negative staining

For question number 61 until 64 refer to rhe scenario below :

Male 31-years old of age, present to clinic with complaint of shortness of breath since 3 days ago. It
accompanied by fever, muscle ache, nasuea, and headache. He is chicken breeder in poultry. Physical
examination : very severe ill, blood pressure 100/60mm Hg, respiratoy rate 32x/min, temperature 41.3 O C.
laboratory : Leukocyte 12.000 mm3, hematocryte 55%, trombocyte 95.000 mm3
61. Wht is the best initial treatment for the patient ?
A. Oxygen pernasal
B. Normal saline physiologis
C. Antiseptic
D. Colloid solution
E. Antibiotic

62. What is the possible diagnosis ?

A. Typhoid fever
B. Urinary tract infection
C. Dengue fever
D. Avian influenza
E. Leptospirosis

63. What is the possible aetiology of the disease ?

A. H1 N1
B. H5 N1
C. H3 N3
D. H1 N5
E. H5 N3
 64. What is the best medicine for this patient ?
A. Herbs medicine from China
B. Herbs medicine from Indonesia
C. Oseltamivir
D. Acyclovir
E. Gancyclovir

65. Larva stage has only one row comb scale in the nineth of abdominal segment, and adult stage doesnt have
lyre in mesonolum. Which of the following is the most likely mosquito ?
A. Anopheles barbirostris
B. Aedes albopticus
C. Aedes aegypti has lyre
D. Culex fatigans
E. Anoptheles maculates

66. The following manifesttion is very rare presenting features of severe malaria in children
A. Multiple convulsions
B. Hypoglycemia
C. Renal failure
D. Sever anemia
E. Lactic acidosis

67. A 27 yo male came to PHC with left leg swelling for the last 5 years. He lives in an endemic area of
filariasis. He also diagnosed with left leg elephantiasis. What is the main method to control lymphatic filariasis?
F.

A. Mosquito control
B. Physiotherapy
C. Health education
D. Mass chemotherapy
E. Jygiene and sanitation

For question 68-69

Nurhasanah a 19 yo girl came with her mother to PHC. They live in epidemic area of filariasis. She heard that
everyone should take some drugs for the disease prevention. The doctor gave Nurhasanah and her mother
dietylcarbamazine citrate (DEC) and albendazole

68. what is the most reasonable factor why the goverment chooses this type of combination for mass therapy?
a. the drugs are effective the microfilarial rate
b. relatively safe with minimal side effect
c. single dose therapy
d. white therapeutic range with low cost
e. cheap and easy to access

69. The after Nurhasanah took the drugs, she developed a mild fever, nausea, and headache. What is the most
likely explanation to this kind of symptom?
a. side effect of the drugs ---
b. interaction between DEC and albendazole
c. idiosyncratic
d. alergic reaction
e. immune response due to adult filaria worm death

70. there are millon of cases of Leprosy Hansens disease worldwide. But predominently in tropical countries in
Asia and Africa. The clinical spectrum of Hansens disease is best characterize by peripheral neuritis. How is
the morphology of bacteria that cause the disease?
a. gram negative rods
b. acid fast bacilli
c. gram positive nonsporming rods
d. gram negative cocci
e. gram positive spore forming rods.

71. A 8 y.o boy have severe sore throat. A gray exudate was found over the tonsil and pharynx. Differential
diagnosis of this symptims include group a streptococci and diphtheriae.

The cause is:

a. Gram (-) cocci
b.gram (+) cocci
c.catalase positive gram positive arrange in clister
d.a club shape gram (+) rod
e.a gram (+) sporeforming rod

72. a 27 yo male living in village was admitted to the hospital because of sudden onset of fever to 39 degree
celcius, jaundice, and headache. He has a history of often swimming in the river and many rats surrounding this
area.

What media can be used for isolation of the bacteria that cause this disease?
a. Loeffler media
b. Fletcher semisolid media
c. Louwenstein Jensen media
d. Thayer-Martin agar
e. Cannot be grown in artificial media

73. a 23 yo man develop a perirectal abscess. This is drained surgically. A specimen is cultured and grows
anaerobic bacteria. What is the most likely sign for anaerobic bacteria as etiology?
a. positive in condition facultative anaerobic culture
b. special cotton swab can be used for specimen collection
c. foul smelling discharge
d. infect to mucosal area
e. can be grown on Mac Conkey agar

74. Culex quinquefasicatus may act as factor of the worm with nocturnal periodicity. What is the most likely
worm
A. Brugia timori
B. Wuchereria bancrofti
C. Loa loa
D. Oncocerca folvulus
E. Brugia malayi

75. What is the current routine methods for finding the etiology from the skin?
a. using cellophane tape method
b. inserting needle into the tunnel of the skin
c. injecting black Indian ink into the burrow to identify the canaliculi
d. examining skin scrapping microscopically
e. use physical examination to examine the eruption on the skin

76. serology is one of the diagnostic methods in virology. A criterion for diagnosing primary infection in viral
disease is:
a. 2 fold or more increase in titer IgG or total antibody between acute and convalescent sera
b. 4 fold or more increase in titer IgG or total antibody between acute and convalescent sera
c. a single low titer of IgG for total antibody
d. absence or slight increase in light
e. presence of IgG antibody

77. your patient is a 13yo boy with a chief complaint of high fever for 3 days. Her mother tells you that her sons
has bleeding from his nose, a symptom of headache and some red spots in her forearm. Laboratory examination
shows thrombocytopenia.
WOTF is the characteristic of virus causing the disease?
a. transmitted by arthropod vectors
b. usually resistant to other
c. usually cause symptomatic infection
d. closely related to parvovirus
e. cannot grow in a cell culture

78. A 1 month old healthy infant is brought to the PHC Clinic for routine examination. The infant has never had
immunization before.
WOTF immunization should be administered?
a. BCG, DTP, OPV
b. BCG, OPV, Hep B
c. BCG, DTP, Hep B
d. DTaP, OPV, Hep B
e. DTaP, IPV, Hep B

79. A 22 yo mother come to the PHC to have her son vaccine. The schedule is for DTP vaccine.
What does DTP vaccine consist of?
a. Diphteria, pertussis, and tetanus toxoid
b. Diphteria and pertusis toxoid, inactivated tetanus bacteria
c. Diphteria, tetanus and pertusis live bacteria
d. Diphteria, tetanus and pertusis inactivated bacteria
e. Diphteria and tetanus toxoid, and inactivated pertusis bacteria

80. A fisrt semester student from Bekasi presented himself to the clinic because of painful and swollen left leg.
Lab exam from blood smear with Giemsa Stain revealed a number of microfilariae. The doctor diagnose him as
ymphatic Filariasis.
WOTF statement is correct related for diagnosis?
a. morphological appearance from adult stage is very important to diagnose Lymphatic filariasis
b. clinical manifestation is not important for diagnosing Lymphatic filariasis
c. microfilariae is the diagnostic stage and always revealed beside erythrocyte
d. Lab exam for lymphatic filariasis not only with microscopic exam
e. Periodicity from species filariae is not important for diagnosing Lymphatic filariasis

81. A 39-year-old man present at the emergency room with a 10 days history of headache, fever, chills, sweat,
and myalgia. Physical examination reveals a fever of 40 degree Celcius, a rapid pulse rate and generalized
sweating. Blood examination with thin blood smear revealed intraerythrocyte microorganism. Doctor diagnose
him as having Malaria tropica.
Which of the following stages of parasite is most likely to be found from a peripheral blood sample of this
patient? (slide malaria)
A. Amuboid
B. Schizont mature
C. Gametocyte
D. Macrogamet
E. Schizont immature

82. Microscopic examination of a thin blood smear from a patient suspected of having malaria with numerous
normal size erythrocyte without stippling but with ring stages, many wih multiple ring stages and appliqued
forms. Several erythrocyte show developing trophozoites that are spread accross the erythrocyte in a band
pattern. Which of the following is the most likely cause of infection?
A. Mixed infection Plasmodium falciparum and Plasmodium vivax
B. Plasmodium malariae
C. Plasmodium falciparum
D. Mixed infection Pl. malariae and Pl. vivax
E. Mixed infection Pl. falciparum and Pl. malariae

83. A 27-year-old athlete male visited the Dermatology clinic with the complaint of a white patch of his skin
mainly on the axilla, back, and the trunk. There was no itching. Dermatological examination revealed multiple
hypopigmented macules covered by fine scales. Woods lamp examination showed positive yellow flourescense.
He was diagnosed as tinea versicolor. Which of the following fungus is the cause of this disease?
A. Microsporum canis
B. Malassezia furfur
C. Trichophyton beigelli
D. Epidermophyton werneckti
E. Epidermophyton fluccosum

84. A 36-year-old man presented to ER with jaundice in the last 3 days. Symptom started 7 days before with
gradually onset of fever with muscle ache especially in the calves, headache, and nausea. What laboratory
examination do you want to perform to establish the diagnosis?
A. Blood ureum, creatinin, and CBC
B. Blood alkali phosphatase and glucose
C. Blood creatinin, lipid, and haemoglobin
D. Blood glucose and CBC
E. Blood cholesterol and ureum

85. Which of the following is the most important step to prevent nosocomial infection?
A. Gloving
B. Gowning
C. Hand washing
D. Room cleaning
E. Maskering

86. Siti, a 17 yo female was admitted to the hospital due to 14 days of fever accompanied by malaise chills,
headache, and constipation. Blood count showed leukopenia and blood antibody for Salmonellatyphi was
positive. On 2nd day of hospitalization she complained severe abdominal pain. She was diagnosed to have
peritonitis due to ileal perforation. The emergency surgery was undertaken and the tissue sample from
perforation areas was sent to Pathology Department. What is the most closely associated histopathology
finding?
A. Granuloma
B. Molluscum bodies
C. Koilocitosis
D. Erytrophage
E. Eosinofil

87. You observed a 40 yo man begging on a street. He had clawing of the fourth and fifth digits with loss of
distal parts of the digits of both hands, strongly leprosy
Which of the following regarding causative agent is true?
A. it is susceptible to isoniazid and
B. It grows in parts of the body that are cooler than 370 C
C. It can be cultured in the laboratory using middlebrook 7H11 medium
D. It is seen in high numbers in biopsies of tuberculoid leprosy
E. It commonly infects people live surrounding armadilos

88. During the febrile phase of DHF, a patient with history febrile convulsion should be given:
A. Salicylic acis 10 mg/kg BW
B. Ibuprofen 10 mg/kg BW
C. Pyramidin 10-15 mg/kg BW
D. Acetaminophen 10-15 mg/kg BW
E. Metampiron 10 mg/kg BW
89. A 12 yo boy presents to ER with high fever for the last 5 days accompanied by headache, myalgia and
epigastric pain. The body temperature is range from 38.6 to 39.40C, occurs all day and night. On the 3rd day the
body temperature decreased but on the next day elevated again. Physical examination revealed high fever,
petechiae, and positive tourniquet test. Laboratory findings revealed HB 15.8 g/dl, WBC 3,400/ mm3.
Hematocrit level 48%, and platelet count 80,000/mm3. The result of rapid test for Dengue infection is C-line
and M-line are pink color.
A. Negative
B. Primary infection
C. Secondary infection
D. Invalid
E. Primary and secondary infection

90. A 21 yo women presented with an acute febrile illness. Her symptoms started 4 days ago, with sudden onset
of continuous higher fever (> 390C), dizziness, and nausea. She also developed a generalized macular rash.
Laboratory for dengue serology show a negative anti-dengue IgM and positive IgG antibodies
Based on the serology result what is the possible diagnosis of this patient
What is the term for lesion arrangement in this patient?
A. Acute primary dengue infection
B. Acute secondary dengue infection
C. Past dengue infection
D. Chronic dengue infection
E. Undefineable

91. A two year old boy, 10 kg, visit emergency department with 4 days of high fever,spontaneously ptechiae
without vomitting, lab result shows platelet count 88000 and hematocrite value 36% . Further examination
revealed platelet count 66000 and hemAtocrite 48% . The fluid replacement should be given:
A. Orally since there is no vomit
B. 250 cc 24 hours parenteral and adjust when needed
C. 1000 cc 24 hours parenteral and adjust when needed
D. 1250 cc 24 hours parenteral and adjust when needed
E. 1500 cc 24 hours parenteral and adjust when needed

92. A patient suspected with tick-borne disease experiencing sudden onset of fever with chills, headache,and
backpain. The high fever continous for 5 days and followed by afebrile phase for 1 week, and followed again by
another similar cycle. what type of fever does this patient has?
A.continuous
B.saddle back
C.intermittent
D.remittent
E.Relapsing

93. Dede visit the hospital with fever as chief complaint, he experiencing high fever for 3 days, and a gap of
reduced fever for 1 day followed, by additional high fever for 2 days , what type of fever does this patient has?
A.continuous
B.saddle back
C.intermittent
D.remittent
E.Relapsing

94. Mia, experiencing fever for 2 weeks. The fever occur every 3 days and preceeded by chills, and followed by
sweating. After that fever subsided reach the normal body temperature,what type of fever does this patient has?
A.continuous
B.saddle back
C.intermittent
D.remittent
E.Relapsing

95. Tia, experiencing fever for 14 days ,during the first week the fever is not too high, the highest temperature
was found in the late evening and during night, in the morning, fever slightly reduced but not reached the
normal body temperature. what type of fever does this patient has?
A.continuous
B.saddle back
C.intermittent
D.remittent
E.Relapsing

96. A 14-years-old girl has a mild sore throat, low grade fever, and a diffuse maculopapular rash. Physical
examination reveals midl tenderness and marked swelling on her posterior cervical and occipital lymph nodes.
Four days after the onset of her illness, the rash has vanished. The most likely diagnosis of her condition is:
a. Rubeola
b. Scarlatina
c. Rubella
d. Erythema infectiosum
e. Henoch Schonlein purpura

97. A patient, 6-year-old boy, body weight 20kg, with high fever last for 6 days revealed hematocrit value of
48% and platelet count of 87.000/mm, he got lactated Ringer solution intra venously 60cc/kg body weight/hour
since he experienced vomiting. Six hours later haematocrit value was 37% and platelet count was 57.000/mm.
What is your working diagnosis?
a. A Dengue fever
b. Dengue haemorrhagic fever grade I
c. Dengue haemorrhagic fever grade 3
d. Silent Infection of Dengue Virus infection
e. Undifferentiated fever

98. A 22-year-old woman is diagnosed as struma diffuse toxic. Her vital sign is BP 120/80 mmHg, HR 120
x/mnt, RR: 32x/mnt, T: 40.9C.
a. Increased basal metabolic rate
b. Lesion that involves the temperature regulating centers
c. Infection
d. Idiopathic

99. A 15-month-old boy is brought to the office by his very concerned mother who that he has a high grade
fever which doesnt come down even with double doses of acetaminophen and a cold water bath. He has had
fever for 24 hours. His temperature has been measured as high as 40.8 degrees. His mother aand grandmother
have given acetaminophen as directed on the package. When his fever remained over 40 degrees, they gave a
second dose one hour after the first during every 4 hour period over the past day. Last dose was 1 hour prior to
your exam. He has also been placed in a cold water bath but he objectives forcefully that it lasted only 5
minutes. Despite the fever he has been playing with his toys but has refuse solid foods. He has had some juice.
He has urinated slightly less often than usual. He has not vomiting and had one normal formed stool today, and
does not appear to be in pain although he is more fussy that usual and he appears tired. His mother notes that he
is getting a new molar. His past medical history, family history and review of systems are unremarkable.
Exam: Vital sign: T 40.7C, HR 185, RR 24, BP 95/56, Oxygen Saturation 99%. He is alert and sitting on the
exam table playing with a toy car. His movement appear jerky. He cries immediately touch with a stetoschope
and vigorously resist examination. The physical exam is unmarkable except for the fever and tachycardia.

What is the false statement according to the case

a. There is a strong correlation between heigh of fever and the severity of infection or whether or bacteria
b. A temperature rise is accomplished by increasing heat generation primarily through shivering, decreasing heat
dissipation by shunting blood a way from the skin surface
c. Fatal liver damage from unintentional over dose of acetaminophen for fever has been reported
d. If patient appear to be very uncomfortable from fever it is reasonable to administer antipyretic

100. fever producing substances are divided into two categories: those produced outside the body (exogenous
pyrogens), and those produced inside the body (endogenous pyrogens). Which of the following statement is
FALSE due to this statement?
a. exogenous pyrogens are usually microorganisms
b. endogenous pyrogens are host cell derived cytokines.
c. the secretion of endogenous pyrogens is induced by both exogenous pyrogens and many endogenous
molecules.
d. the most prominent currently recognized pyrogenic pro-inflammatory cytokines include IL-1, TNF alpha,
and interferon gamma.
e. the initial cytokine mediated rise of core temperature is the only facet of the febrile response.

101. A 21-years-old female came with two days fever. Her vital sign revealed blood pressure 110/80 mmHg, heart rate 104
bpm, temperature 38oC, respiration rate 28/ minute. Which of the following that most likely for her vital sign condition?
a. increasing temperature lead to increase cardiac output
b. infection process lead to respiratory alkalosis
c. fever cause excitement of sympathetic system
d. stimulated pacemaker cells by increase temperature
e. cytotoxic of infectious agent increase metabolic process

102. A group of investigator was studying fever mechanism due to viral infection. They injected some substance from viral
and measure the febrile activator level on each mouse. Which of the febrile factor that most likely found in this research?
a. TNF
b. Endotoxin
c. Antigen antibody complex
d. INF
e. CD8

105. a 26-year-old woman presents to her physician with a 3-day history of arthritis
in her knee, fever, and dermatitis. The dermatitis consists of several pustular lesions
on her extremities. The patient admits that she has had multiple sexual encounters
over the past year and that none of her partner used protection. A sample of her knee
joint fluid is sent to the lab along with two sets of blood cultures. A gram stain of the
joint fluid reveals moderate white blood cells and few Gram-negative diplococci. The
following day, a pure culture of the organism in below is obtained only on a chocolate
agar plate. The isolate is an oxidase positive, Catalase positive, gram-negative
diplococcus. In addition, the organism produces acid from glucose from maltose,
sucrose, lactose or fructose.

What is the identity of the isolate?

a. neisseria gonorrhoeae
b. moraxella catarrhalis
c. neisseria meningitides
d. neisseria lactamica
e. neisseria sicca

106. Which body compartment is directly proportional to basal metabolic rate?

a. Body fat
b. Extracellular volume
c. Clean body mass (cell mass)
d. Plasma volume
e. Total body mass

107. What two components of energy input and/or output should you attempt to modify in a person who overweight or
obese?
a. Basal energy expenditure and food intake
b. Food intake and physical work
c. Food intake and specific dynamic action
d. Physical work and specific dynamic action
e. None of these can or should be modified

108. What would be the implication for dietary regulation of blood glucose if the glycemic index (white bread = 100) of
Food A were 80, Food B were 60, and Food C were 35?
a. Food A would have the least effect on blood glucose concentration
b. Food C is probably a simple sugar
c. Food C might be a good choice for avoiding a dramatic increase blood glucose if it were not high in fat
d. Food B would probably be the healthiest overall choice because it holds a balanced, intermediate position

109. A 24-years-old student just loves his new bulldog puppy. After approximately 3 months of proud puppy ownership and
smooching, this guy noticed that his moustache began itching and his upper lip was beginning to swell. Over a 1-week
period, his upper lip became swollen and inflamed, and small areas became apparent among the sparse hairs of his
moustache. He visits the dermatologist.
What was the likely cause of this symptom?
a. Microsporum canis
b. Aspergillus niger
c. Malassezia furfur
d. Piedraia hortae
e. Candida albicans

110. A 42-year-old male developed cellulitis on his backs and arms 24 hours after exercise in a gymnasium. Skin swab
were taken from the abraded lesions for microscopy and culture. Gram positive cocci was found and developed clear
hemolytic on sheep blood agar. Katalase test was negative. What possible bacteria cause this disease?
a. Staphylococcus aureus
b. Staphylococcus epidermidis
c. Enterococcus faecium
d. Streptococcus pyrogenes
e. Streptococcus viridans

111. A 6-year-old boy develops a severe sore throat. On examination, grayish exudates (pseudomembrane) is seen over the
tonsil and pharynx. The primary mechanism in the pathogenesis of the disease is due to the bacteria as the causative agent:
a. Have an action of pyrogenic exotoxin as a superantigen
b. increase in intracellular cyclic AMP
c. Produce exotoxin that is responsible for the necrotizing effect
d. have an action of enterotoxin A
e. inactivate of acetylcholine esterase

For questions number 112-113

A 19 yo girl is admitted to the hospital because of fever, headache, weakness, and anorexia. Ten days prior to admission
she had diarrhea illness that lasted about 36 hours. She has been constipated for the last 3 days.

112. what is the best specimen for culture to detect the causative agent of the disease in this period of disease?
a. CSF
b. bone marrow
c. blood
d. stool
e. urine

113. the culture from this patient grows a non lactose fermenting gram negative rod, oxidase negative, and motile.
WOTF is most likely cause of her illness?
a. Shigella sonesi
b. Salmonella typhi
c. Pseudomonas aeruginosa
d. Eschericia coli
e. Enterobacter cloacae

114. A 23yo man develops a perineal abscess. This is drained surgically. A specimen is cultured and grows anaerobic
bacteria.
Clues that suggest infection with anaerobic bacteria include:
a. positive in condition facultative anaerobic culture
b. special cotton swab can be used fro specimen collection
c. foul smelling discharge
d. infect to mucosal area
e. can be grown on Mac Conkey agar

115. 40 y.o. man came to E.R. complaining of 2 days of crampy abdominal pain, weakness, fever, chills, diarrhea, and
followed by 1 day of obstipation. He denied contact with people with similar symptoms but always had his meals from the
street vendors. Which agar do you use to isolate the bacteria from feces?
A. Blood agar
B. Ss agar
C. Thayer martin agar
D. Blood agar
E. Chocolate agar

116. you are a fourth year medical student. 7 y.o. boy presents to you with high fever for 5 days with abrupt onset, the
temperature ranging from 38.5-39 in two days and occur during day and night. On the 3rd day, the fever decreased until
37.5-38 but elevated again with the same temperature like the previous day on the next day. Which is the character of the
virus below?
A. Can not grow in cell culture
B, usually resistant to ether
C. Usually causes symptomatic infection
D. Transmitted by arthropod vectors
E. Closely related to parvovirus

117. 60 y.o. female complaints about red patches with papules and blisters with red base on the right side of her face, nech,
and upper trunk for 3 days. she also feels discomfort, pain, numbness, and varies from superficial itching, tingling, and
burning sensation from the involved area. What is the source of the infection?
A. Aerosol droplets of causative agent
B. Contaminated food or water
C. Sexual activity
D. Puncture with contaminated needle
E. Endogenous reactivation of an earlier infection

118. A 5 y.o, girl is brought to hospital for evaluation of sore throat and fever, which she has had for 4 days. She is from
low social economic family and has not enough medical care throughout her life and her immunization status is unknown.
On PE it revealed that she has edema in the tonsil and pharynx with grey membrane coating the tonsil. This extends toward
the uvula and soft palate. You consult the pediatrician and diagnose this as diptheria. What is the staining used to diagnose
causative agent? Diphtheria?
A. Ziehl-nielsen staining
B. Gram staining
C. Neisser staining
D. Burri-gins staining
E. Negative staining

119. Some viruses can be isolated from embryonated egg into appropriate region. Which part of the embryonated egg can
isolate the herpes virus?
A. Amniotic cavity
B. Allantoic cavity
C. Yolk sac
D. Intraembryonal
E. Chorioallantoic membrane

120. 26 y.o. obese patient presents with scaly erythematous patches on the groin. Skin scraping is taken from the lesion for
microscopic exam. What is the pattern on microscopic exam of the causative agent?
A. Spaghetti and meatball appearance
B. Long branches separate hyphae and arthrospores
C. Pseudohyphae
D. Long branches non-septate hyphae
E. Yeast cells with budding

121. A 25 years old man, suffering 11 days of fever, muscle ache, frontal headache, and constipation. Examination showed
titer O> 1/320. Which of the following pathologic appearance that the most appropriate with this patient?
A. Salmonella infection not cause of classic typhoid fever
B. Small number of organism basically a chronic carrier state
C. The organism cause enlargement of Peyer's patches
D. Liver and spleen always increase in size
E. Bleeding and ulcer isbusually often

122. A 25 years old man, suffering 11 days of fever, muscle ache, frontal headache, and constipation. Examination
showed titer O for typhi > 1/320. Which of the following statement that true regarding this case ?
A. Classic typhoid fever is the fever stabilizes during the four weeks
B. Microscopically: mixed of lymphoid follicle scattered erythrophagocytes
C. Microscopically : mixed inflammatory cell resemble idiopathic ulcerative colitis
D. Salmonella typhii cannot localized the conjunctiva, joint and meningen
E. Neutrophilia and eosinophilia in the peripheral blood

For question number 123-124 refer to the scenario below

A 35 years old man chief complain of fever intermittent every each two days accompanied with shivering and headache.
He just came back from Maluku for duty.
123. Which of the following statement that true regarding these case?
A. Only male anopheles take blood and transmit malaria
B. Plasmodium vivax and ovale infections are often fatal
C. Plasmodium in insect vector ending production of gametocyte
D. Plasmodium falciparum fever often shows as benign quartana malaria
E. Initiated intraerythrocytic asexual cycle merozoites grow to tropozoites

124. Which of the following pathology appearance that most appropiate with this condition?
A. In chronic stage, parasites forming solid masses as brown black malaril pigment called hemo...
B. In the malignant vivax, there is extreme congestion of the pigment reaction in the brain
C. In acute stage, splenic congestion and pigment reaction can be seen within red cells
D. Pigment react with stain for ferrous iron resembles hematin
E. Same pigment also not be found in the hepatocyte cells

125. A 50 years old man has white patches at his chest and upper extremity. There was no itching or pain at the lesion.
Histopathology leprosy examination may be interpreted a granulomatous not develop, but consist of only a few chronic
inflammation.
What is the most appropiate diagnosis?
A. Bordeline tuberculoid leprosy
B. Bordeline lepromatous leprosy
C. Indeterminate leprosy
D. True borderline leprosy
E. Tuberculoid leprosy