MDE DMS 2004Senin, 07 Desember 2009 1. Jawaban:C Alasan : ameloblast berasal dari inner enamel epithelium / ectoderm (moore embryology hlm 449) 2. Jawaban : B Alasan : sama dgn buku 3. Jawaban : C Alasan : agak ga yakin, tapi yang pasti fungsi arrector pili untuk bikin rambut berdiri (goosebump effect) 4. Jawaban : E Alasan : sama dengan buku 5. Jawaban : C / E Alasan : Moore hlm 75 6. Jawaban : E Alasan : sama dengan buku 7. Jawaban : C / D Alasan : sama dengan buku 8. Jawaban : B Alasan : sama dengan buku 9. Jawaban : B Alasan : sama dengan buku 10. Jawaban : A Alasan : sama dengan buku 11. Jawaban : Resemble normal basal cell of epidermis, arise from epidermis or follicular epithelium. Two patterns : multifocal growths and nodular lesions (Robbins hlllm 1243) 12. Jawaban : C Alasan : jaringan lipid ga punya nuclei 13. Jawaban : C Alasan : sama dengan buku 14. Jawaban : A Alasan : sama dengan buku 15. Jawaban : B Alasan : sama dengan buku 16. Jawaban : E Alasan : sama dengan buku 17. Jawaban : B 18. Jawaban : A Alasan : sama dengan buku 19. Jawaban : B Alasan : Moore anatomy hlm 603 20. Jawaban : C Alasan : lab muscle contraction 21. Jawaban : D Alasan : interactive pgysiology bagian skeletal tissue 22. Jawaban : B Alasan : sama dengan buku 23. Jawaban : A 24. Jawaban : C Alasan : sama dengan buku 25. Jawaban : A Alasan : sama dengan buku 26. Jawaban : D Alasan : fascicle fibers yang dikelilingi CT 27. Jawaban : D 28. Jawaban : A Alasan : sama dengan buku 29. Jawaban : A Alasan : sama dengan buku 30. Jawaban : B Alasan : osteoblast pembentukan, osteoclast perombakan 31. Jawaban : A Alasan : sama dengan buku 32. Jawaban : semua benar 33. Jawaban : D Alasan : sama dengan buku 34. Jawaban : D Alasan : sama dengan buku 35. Jawaban : D Alasan : sama dengan buku 36. Jawaban : D Alasan : sama dengan buku 37. Jawaban : D Alasan : sama dengan buku 38. Jawaban : B Alasan : ciri khas TB 39. Jawaban : E Alasan : sama dengan buku 40. Jawaban : A 41. Jawaban : D Alasan : sama dengan buku 42. Jawaban : B Alasan : sama dengan buku 43. Jawaban : B Alasan : tumor marker ada klo ada tumor 44. Jawaban : A Alasan : sama dengan buku 45. Jawaban : E Alasan : case review 07 46. Jawaban : Alasan : B, D benar 47. Jawaban : C Alasan : ada peningkatan ESR 48. Jawaban : A Alasan : slide dermotherapy 49. Jawaban : D Alasan : slide dermotherapy 50. Jawaban : A Alasan : itchy skin lesions; lesions become dark, thick, and leathery with round scaly plaque underneath. The lesions may have well-defined rectangular borders, or present in oval, irregular, or angular shapes; exaggerated skin lines in the lesions; usual locales -- nape of the neck, forearms, area on inside of elbows, wrists, inner thighs, behind the knees, and lower legs 51. Jawaban : A Alasan : perlu sirkulasi udara yg baik 52. Jawaban : B Alasan : sama dengan buku 53. Jawaban : B 54. Jawaban : D Alasan : untuk melihat soft tissue 56 e.GCS. untuk mengetahui seseorang jatuh kea rah shocked atau improvement setelah dilakukan resusitasi adalah: 1. CNS : improvement dari GCS 2. Renal : increase urine output 3. Skin: warm and capillary refill 4. Pulmonary : improved rate and depth 5. Vital sign : return to normal 57.C. (dari hasil eliminasi.. sumber: Chapman orthopaedic surgery 3rd ed) (A) justru high velocity berakibat great tissue damage yang terkena atau yang dileawati oleh peluru (B). penjelasan sama dengan option A jika yg kena langsung ke nerve (D). membutuhkan 2 stage debridement, yaitu initiall debridement (directly), kedua, 48-72 jam setelah initial debridement (E).apabila tidak diremove, maka bisa berakibat adanya abrasi mekanik di daerah sendi. Meski hal itu tidak terjadi, maka resiko adanya infeksi tidak pernah hilang. 58. C.. sudah jelas apabila ada riwayat open fracture di suture dan terjadi gejala2 komplikasi septic kurang dari 24 jam, maka bakteri yang berperan adalah anaerob (dalam hal ini Clostridium welchii). Maka dilihat dari option, yang paling mungkin dari waktu dan gejala yg timbul adalah gangrene. (appley: complication of fracture) 59. volkman’s ischemic = contracture dari muscle fiber karena direplace oleh jaringan fibrosis. Maka penampakan klinisnya adalah weakness of flexor muscle. (Appley: complication of fracture) 60. A. (jalan ceritanya mirip di case kita) 61. ???? (sori pisan ga nemu reffrencenya). 2 joint muscle itu otot yang origo-insersionya melewati 2 sendi, contohnya bicep brachii.. tapi jawaban kayanya mengarah ke C, karena prinsip pergerakan tulang-sendi, tergantung di mana origo-insersionya sehingga menentukan jenis aksi dari otot tersebut. (mohon dikoreksi juga) 72. D. Appley hal 193: in patient over 50 years, bone metastases seen more frequently than all primary malignant bone tumors together. The commonest source is carcinoma of the breast. 74. E . gambarannya berupa loss of trabecular pada X-ray tanpa adanya swelling dari soft tissue sekitar. 75.B. (hasil eliminasi) (A). post menopause condition dianggap sebagai physiologic condition (C). diagnosis pastinya adalah dengan X-Ray (D). manage seharusnya dengan supplement, early exercise, dan Hormone replacement therapy (jika ada keterlibatan dengan hormone = pada post menopausal osteoporosis) 76. B. appley hal 81, gambar 5.5 clinical feature. 77. B. Appley hal 684 80. B. Case review 2006 management dari snake bite 81. C Systemic sign dari snake bite: - hypotension and shock - neurotoksisitas: muntah2, kontraksi frontal, penglihatan kabur,nyeri kepala, paresthesis peroral, otonom hyperexcitation, penurunan kesadaran. Maka jika dihubungkan dengan option, maka jawabannya C 82. ?? soal kurang lengkap 84. D. yang menjadi provide durability barrier adalah collagen. Basal cell provide mitosis process for renewing epidermal cells 85. E. Fitzpatrick ed 6, tidak ada penjelasan mengenai pressure barrier, yang ada adalah mechanical barrier dari mechanical blunt trauma 86. ? 87. b. pertama adalah BCC, kedua squamous cell carcinoma. (lab act PA) 88.? 91. ? 92. impairment: any loss/ abnormality of psychological, physiological or anatomical structure or function Disability : activity limitation that creates a difficulty in the performance, accomplishment, or completion of an activity in the manner or within the range that considered normal in human being. Diliat dari definisi: A 93. D 94. B. 95. B 97. handicap : setiap cacat berupa fisik/mental, congential/acquired yang membatasi/mencegah seseorang berpartisipasi dalam kehidupan normal/ kemampuan bekerja. Maka dari sini, menggambarkan posisi seseorang dalam kehidupan social, jawabannya A 99. B. uda jelas ya.. 100 dan 101. Kurang yakin, karena ga ada sumber buku yang menjelaskan efek dari chronic edema pasca fraktur.tapi, dari analisa, akibat dari edema adalah adanya peningkatan tekanan di dalam fascia sehingga reduce blood perfusion ke otot, akibatnya proses kontraksi jadi lemah. Dengan demikian, muscle weakness + penurunan blood perfusion berakibat muscle wating.. jadi sepertinya D 103. E. joint contracture bisa berasal dari fibrosis di otot, jaringan penunjang otot, atau jaringan penunjang joint sehingga berakibat resistensi terhadap regangan pasif. Dengan demikian lebih mengarah ke jawaban E. 105.? 106. C. case review 2006 tentang Ludwigg’s angina 107. soal kurang lengkap.. 108. ga tau jawabannya yang mana, tapi saya dapet faktor2nya: - poor hygiene - systemic disease - trauma - DM 109. B. dari Labman PA tentang ameloblastoma 110. E. 111. E. gambaran lesinya sesuai dengan penyebaran radix 113. B. karena ada impaired pain sensation dari umbilical ke bawah (T10) 114. B. dibuktikan adanya sensory loss di C5-T1 dan absent tendon2 reflex yang berasal dari sumber yang sama (motoric B.plexus) 116. C. (catatatn kuliah), anthropologist memiliki kemampuan mengidentifikasi bone dan skeletal remains sehingga menyediakan informasi mengenai sex, race, age, dan waktu kematian 117.D, jika istrinya A: IA IA atau IA IO dan suaminya: seperti istrinya atau IB IB atau IB IO 118. B ada di buku mini lecture 120. C. ada di buku mini lecture 122. E. Visum et repertum, melakukan pemeriksaan fisik yang berkenaan dengan kekerasan fisik, kejahatan susila,jenazah, dan psikiatrik. Dasar hukumnya adalah KUHAP pasal 186 dan 187c 123. ga ada jawabannya. (A). jikaterjadi advance lesion berupa ulceration bisa terjadi extensive local tissue destruction (B) lebih sering di male (C) dan (D) Sensitve radiotherapy dengan prognosis yang baik, tp memiliki resiko kerusakan cosmetic dalam waktu 15 tahun ke depan (khususnya pada non elderly people) 126?? 127. B. Hasil dari kultur corneal scrapping merevealed positif terbanyak = pseudomonas aureginosa gram negative 129. C. di Bunga rampai parasitology, CLM ini masuk ke dalam larva nematode. 132. Geographical epidemiology of CLM ? D. Most common occur in USA Demographic Distribution of CLM Endemic in deprived communities. Tropical and subtropical areas, especially southeastern United States, Caribbean, Africa, Central/South America, Southeast Asia. (Fitzpatrick) 133. Gnathostoma spinigerum ? A. Cause cutaneous larva migrans only Visceral larva migrans characterized by persistent hypereosinophilia, hepatomegaly, and frequently pneumonitis (Loeffler's syndrome). Caused by Toxocara canis, T. cati, A. lumbricoides.(Fitzpatrick) 134. People at risk of CLM ? D. Plumber Activities and occupations that pose risk include contact with sand/soil contaminated with animal feces: playing in sandbox, walking barefoot or sitting on beach, working in crawl spaces under houses, gardeners and plumbers, farmers, electricians, carpenters, pest exterminators. (Fitzpatrick) 135. Not pathology of CLM ? E. Larvae burrow in the subcutaneous Third-stage larvae penetrate human skin and migrate up to several centimeters a day, usually between stratum germinativum and stratum corneum. Parasite induces localized eosinophilic inflammatory reaction. Most larvae are unable to develop further or invade deeper tissues and die after days or months. (Fitzpatrick) 136. Larva found in biopsy ? D. Taken just upper of the clinically evident tract Part of the parasite can be seen on biopsy specimens from the advancing point of the lesion(s). (Fitzpatrick) 137. Larva’s complete life cycle ? ? 139. Not true about clinical manifestasion of CLM ? E. Creating tunnel within subcutaneous See no. 135. 141. Diagnostic of CLM ? E. All true (based on clinical evidence, based on tract, larvae rarely found, larvae beyond the serpiginous tract) 142. Best prevention for CLM contamination ? B. Avoid exposed skin with soil Prevention of CLM Avoid direct skin contact with fecally contaminated soil. (Fitzpatrick) 143. Reducing soil contamination by larvae causing CLM ? C. Periodic deworming by cats and dogs Infestation Helminth(s) Comments Cutaneous larva migrans Primarily Ancylostoma braziliense and A. caninum Larvae of dog/cat hookworms 144. Ineffective treatment of CLM ? ? Topical Agents Thiabendazole, ivermectin, albendazole are effective topically. (Fitzpatrick) 147. Strongyloides stercoralis life cycle ? B. Skin penetration-lungs-adult in intestine-egg-rhabditiform+filariform-autoinfection, direct infection, and indirect in external environment. (Pediatric Nelson) 148. Children who are more likely to get CLM ? C. Contact with contaminated soil 149. Pleomorphic adenoma ? ? 150. Not included to the feature of osteosarcoma ? ? 152. Retina is originated from ? D. Optic vesicles As the lens vesicles are developing, the optic vesicles invaginate to form double-walled optic cups. The retina develops from the walls of the optic cup, an outgrowth of the forebrain. (Embryology Moore) 153. A 5 month old baby boy has 4 fingers in one of his hands; 2 of the fingers are fused. During the development of foot and hand, fingers are formed when cell death in the apical ectoderm ridge separates into 5 parts. Baby’s abnormality is called ? D. Syndactyly Cutaneous syndactyly results from failure of the webs to degenerate between two or more digits. (Embryology Moore) 154. Development of the ear begin with ? C. Meatal plug 156. During development of face, secondary palate is formed by outgrowth from ? C. Maxillary prominence The secondary palate begins to develop early in the sixth week from 2 mesenchymal projections that extend from the internal aspects of the maxillary prominences. (Embryology Moore) 157. During development of tibial endochondral bone. Which cells begin to form the cartilaginous model ? A. Chondroblast 158. During development of vertebrae, cells of the sclerotome surrounds the spinal cord and notochord, the notochord regress to form ? C. Nucleus pulposus Between the vertebrae, the notochord expands to form the gelatinous center of the invertebral disc – the nucleus pulposus. (Embryology Moore) 159. Physical abnormalities is asymmetry of back and chest. Radiographic examination, successive vertebrae found asymmetry and one vertebrae is missing. A. Scoliosis Scoliosis; a hemivertebrae results from failure of one of the chondrification centers to appear & subsequent failure of half of the vertebrae to form. (Embryology Moore) 160. In osteomyelitic, the radiographical features of sequestrum ? ? 162. Main features of osteomyelitis in long bones is ? A. Usually derives from metaphysis Apley page 29 163. What is the possible diagnosis of lesion of epiphyseal with soap bubble appearance ? D. Giant cell tumor Apley page 181 164. The most possible diagnosis for infiltration of osteolytic… in play X-ray photo of skull ? ? 165. In metastase of malignancy to columnar vertebralis. The predilection area would be ? ? 166. Radiological features of Colle’s fracture ? A. Fracture at distal radius with post angulation and radial dislocation Apley page 616 169. Specific radiologic signs of maxillary sinusitis ? ? 171. Radiological appearance of osteoporosis ? A. Thin bone cortex, thin trabeculae, diminished in number 172. Radiologic appearance of chronic abscess which is surrounded by marked sclerosis is known as ? B. Brodie’s abscess Apley page 32 175. Sunray or sunburst appearance of periosteal reaction is found in ? C. Osteogenic sarcoma (or osteosarcoma) Apley page 185 177. The primary quasi malignant bone tumor is ? C. Osteosarcoma Apley page 185 178. Radiological features of spondylitis TB ? B. Paravertebral abscess Apley page 44 180. If we saw that the patient had oral cancer T2 N2 it means that ? ? 181. Which part of the cell cycle that the tumor is most radioresistant ? A. G0 185. Most frequent cranial nerve damage that happens in patients of nasopharynx carcinoma ? D. VI The most common deficits are ophthalmoplegia (CN VI), ptosis (CN III), and pain and anesthesia of the supraorbital and superior maxillary regions (CN V1 followed by CN V2). (Pubmed) 186. In nasopharynx carcinoma, intracranial infiltration/extension most frequently through ? D. Foramen lacerum Cavernous sinus invasion occurs because the tumor tracks through the foramen lacerum, which often leads to multiple CN deficits. (Pubmed) 187. To differentiate medullary thyroid carcinoma and other thyroid carcinoma, we use ? A. Calcitonin Calcitonin is the principal biochemical marker in MTC; it is used for detection, staging, postoperative management, and prognosis. (emedicine) 189. A 56 years old man came to ENT clinic, has hoarseness for 6 months with dyspnea. On physical examination it’s found that one of his vocal cord have tumor with immobility. Neck node size… , no other enlargement. What ‘T’ does the patient have ? ? 192. A lady is diagnosed to have tumor. Ther’s a swelling … you detected a lymph node enlargement at mid jugular. No other lymph node enlargement on other area is detected. What is the location of the lymph node enlargement at the neck ? which level ? ? 193. During development of hand and foot, the mesenchyme between prospective digits in the hand and foot plates will break down. If mesenchyme fails to break down, result in abnormality called ? C. Syndactyly Abnormal fusion is usually restricted to the fingers or toes (syndactyly). Normally mesenchyme between prospective digits in the handplates and footplates breaks down. (Langman’s Embryology page 191) 197. Etiological agent for opthalmia neonatorum ? C. Neisseria gonorrhoeae Opthalmia neonatorum due to N. gonorrhoeae usually appears from 1-4 days after birth. (Nelson Pediatrics) 198. In wound healing, increase collagen synthesis and proliferation of blood vessels occur in … A. Fibroplasias phase B. Remodeling phase C. Inflammatory phase D. Coagulation phase E. Bag phase Jawaban : (?) A/B. Pembahasan : Collagen synthesis fibroplasia phase Proliferation of blood vessels / angiogenesis remodelling phase 199. A burn patient … A. No hospitalization required B. Fluid resuscitation C. Urinary catheter D. Skin grafting Jawaban : B. Pembahasan : Treatment utama untuk burn patient secara general fluid resuscitation