1. A 25 years old woman comes to emergency department, complaint with abdominal pain and vomiting since 1 day. At the physical examination shows the patient looks irritable, apatis, BP 80/50 mmHg, HR 130 x/m, RR 24 X/M, S 38.5o C. At abdominal examination, defance muscular (+), tenderness at all field of abdomen, bowel sound (-).

What is the condition in this patient?

a. Shock obstruction.

b. Shock cardiogenic.

c. Shock neurogenic.

d. Shock hypovolemic.

e. Shock anaphylactic.

2. As the diagnosis above, the first step you must do as the emergency doctor is:

a. Antibiotic infusion

b. Strong analgesic i.v

c. Abdominal plain X-Ray

d. Crystalloid rapid infusion

e. Adrenalin s.c3. After doing that treatment, the hemodynamic of this patient is still unstable. The Patient still have in shock condition. What is the next step you must do?

a. Change infusion fluid with Dextrose 5%.

b. Give vasoactive dopamine drug

c. Antipiretic drug i.v

d. Immediately Laparotomy

e. Antiemetic drug i.v

4. A 25 years old male presents to emergency with suspected closed left femur fracture after motorcycle accident. He looks confused with blood pressure 80/60 mmHg and pulse 110 /min. The doctor splints the fracture and gives large bores rapid crystalloid and colloid infusion but unsuccessful in stabilizing the hemodynamic.

What is the most likely cause of the failure?

a. Inadequate splinting

b. Major artery injury of the left femur

c. Underlying heart disease

d. Ongoing bleeding in other parts of the body

e. No blood transfusion

5. A 35 years old female fall from 5 meters height. She presents with acute abdomen and multiple open fractures on thigh and leg. Emergency laparotomy and temporary external fixation is performed. After 6 days, the doctor wants to perform definitive stabilization of the fracture.

The reasons to wait until 6 days is to

a. Achieve early healing of intraabdominal woundxb. Stabilize hemodynamic

c. Control infection

xd. Avoid immunosuppression period

xe. Reduce inflammatory reaction

6. A 45 years old male presents with multiple injury and unstable hemodynamic after motorcycle accident. The doctor found that the lung is clear, no abdominal defans muscular, stable pelvic and intact extremity

Where is the likely source of the bleeding?

a. Thorax

b. Intra peritoneal

c. Retroperitoneal

d. Intracranial

e. Pelvic cavity

7. A-17-year old woman comes to your private practice with pain on the left knee in which the pain become worse at night for 2 months. Pain is aggravating by activity. There was a history of injury at that knee. Sometime she feels fever and night sweat. The physical examination shows a palpable mass, tender, warm. Range of motion of the left knee is decrease. The radiographic finding shows a sunray appearance on the proximal tibia. Which of the following is the most rational step?a. Establish osteosarcoma as diagnosisb. Give a broad spectrum antibioticc. Prepare for immediate surgeryd. Pain relieve after 2 weeks of treatment as an endpoint

e. Communicate with the patient, risk and benefit of treatment option

8. A-24-year old woman consulted to you that since 3 weeks ago she felt of constant tiredness after delivery of her second child 15 months ago. She is slightly pale, but has normal hemoglobin. Every day she works as a secretary from 8 am to 4 pm, her first child now 3 years old. She has now returned because the tiredness persists and a friend told her that a vitamin injection would do her good. That is what she wants. What would be your treatment objective in this patient?

a. Advise her not to worry, it can resolve soon

b. Advise her to reduce physical/emotional overload

c. Doing a vitamin injection as she wants

d. Gives her the other option of drugs

e. Ask her to do other laboratory examination

9. A 37 year old man came to Emergency & Accident Unit with feeling of apprehension, fear and palpitation, even mounting to feeling of impending death. After being examined by doctor, the results showed that nothing was wrong. After 3 weeks, he got the same feelings, and he had to go to the hospital again. But this time the Emergency staffs were busy, and he was kept to wait. Until about 15-20 minutes he had not been attended to, but his fear and palpitation subsided and became calm by it.

What would you think about the suffering that this person had?

a. Somatization disorder

b. Generalized Anxiety Disorder (GAD)

c. Phobic anxiety disorder

d. Panic disorder

e. Neurotic disorder

10. According to the above case, what would you do to help him?

a. Give some explanation as to the nature of his illness

b. Prescribe drug for this distress

c. Plan for psychoanalytical psychotherapy

d. Advise him to go for Yoga exercise

e. Advise him to go for refreshing

11. Again considering the above case, which of the following medication would suit him well:

a. Diazepam

b. Chlorpromazine

c. Luminal

d. Alprazolam

e. Perphenazine

12. A 45 year old man is having the custom of drinking of beer. After some months, his habit increase into heavier drinks such as wine and then even Whiskey and Vodka. Few more months, he was admitted to a hospital because of an accident where he banged his head when crossing a wooden bar where he fell unconscious for few minutes. He was advised to be hospitalized. On the third day, he began to shake in his hands and tremble the whole body. After being put on some drugs his shaking subsided and he was discharged after being pronounced as recovered from his ailments. What was the reason for his shaking?

a. Dementia

xb. Brain contusion

c. Delirium tremens

d. Blackouts

xe. Stroke

x13. After his discharge from the hospital and returned to work he began to resume his habitual drinking, his wife and family were against this habit of drinking, but he went on disregarding the advice. Even he became irritable and shouted with abusive words against anybody at home even he could beat his wife if she is nagging on. Some time he would throw things and hit his children.

What would you call this episode of hitting family members?

a. Wife battering as a result of alcoholism

b. Alcohol intoxication

c. Marital discord

d. Personality disorder

e. Psychotic disorder

14. If in this family the children who used to be very dutiful at school works and compliant to family discipline, observing father did a very bad example. The eldest son who is rather big boy and physically robust became acting like a big boss against his schoolmates who are smaller and weaker than him. Some time asking them to bring him candies, some time he extorted money from them, otherwise he would threaten to hit them or refusing to be his friends. What is the classification of this behavior Personality disorder

a. A bully

b. Bossy

c. Delinquency

d. Genetic inheritance

e. ADHD

15. A 55 year old man came to emergency with suddenly being unconscious 2 hours before admission after complaining of severe headache and vomit. His GCS was E3M5V3, blood pressure was 190/100 mmHg, HR 90 x/min, RR 16 x/min, temperature 36,7oC. Which of the following examination is the most appropriate to exclude intracranial bleeding?

a. Brain MRI

b. Angiography

c. Brain CT scan

d. Carotid Ultrasound

e. Electroencephalography

16. A 56 year old man was suddenly being confused and unable to move his left extremities 7 hours ago. On examination his blood pressure was 200/100 mmHg, HR 74 x/min irregular. He was disoriented, left hemiplegia with increased tone on left side, and babinsky sign on left side. Lab exam: WBC 12.000/mm3, RBG 190 g/dl. His CT scan showed a large hypointense lesion in the right frontotemporoparietal lobe with significant edema and midline shift. Which of the following is an appropriate treatment?

a. r-TPA

b. Corticosteroids

c. Mannitol

d. Antihypertension

e. Antibiotic

17. For case above, if the ECG showed atrial fibrillation, which of the following examination would be most appropriate for the next step?

a. Brain MRI

b. Brain PET scan

c. Echocardiography

d. Transcranial Doppler

e. Electroencephalography

18. A 17 year old boy is brought to emergency following fall from 4 meters height one hour before admission. On examination he is alert, weakness of his left leg and loss of fine touch on the left with loss of pain and temperature sensation on the right leg at level Th-12 below. This clinical picture is most consistent with which of the following?

a. A posterior cord syndrome

b. An anterior cord syndrome

c. A complete cord syndrome

d. A central cord syndrome

e. A hemisection syndrome

19. Which of the following management is the most appropriate to prevent further damage of spinal cord?

a. Give high dose corticosteroid

b. Trendelenberg position

c. Give mannitol

d. Neuroprotector agent

e. Lumbar corcet

20. A 52 year old man was sent to ER caused by seizure. His wife watched that he suddenly stop his activity, starred, got involuntary movement on his right hand and then spread to lower and upper right arm and finally became convulsion bilaterally. He has infarct in left capsula interna with risk factor diabetes mellitus 3 months before and never gets seizure. In the ER, the result of blood examination in normal limit, except blood glucose was 58 mg/dl.

` Which of the following is most likely diagnosis at that time?

a. Symptomatic epilepsy

b. Pseudo seizures

c. Acute symptomatic seizures.

d. Idiopathic epilepsy

e. Secondary epilepsy

21. According to the case above, what is the type of his attack?

a. Partial seizure

b. Primary generalized seizure

c. Absence seizure

d. Simple partial secondarily generalized seizures

e. Complex partial secondarily generalized seizures

22. A 23 year old man was hospitalized after got head injury. His brain CT Scan showed subdural hematoma and brain contusion in the right temporal region. On the second days before underwent craniectomy, he suffered repeated left partial seizures.

What is your working diagnosis?

a. Symptomatic epilepsy

b. Provoked seizures

c. Reflex seizures

d. Cryptogenic epilepsy

e. Pseudoseizure

23. A PWE(patient with epilepsy)-42 year-old-man was treated with Phenobarbital 150 mg once daily but had bad compliance. During under psychological stress in his office, he get repeated seizures. He brought to nearest hospital and during transportation for 20 minutes he never gain his consciousness and still convulsive.

What is your working diagnosis?

a. Status epilepticus

b. Early phase status epilepticus

c. Acute symptomatic seizures

d. Panic attack

e. Psychological episodic attack

24. A 39 year old woman suffering from breast cancer since a year ago. She has main complaint of headache that sometimes is accompanied with vomit for three weeks. According to her husband, she gets tonic-clonic convulsion this morning. Which is the priority diagnostic procedure you will perform?

a. Brain CT Scan with contrast

b. Brain MRI with contrast

c. EEG

d. Blood examination

e. Mammography

For Number 25-27

A 4 years old boy presents with burn wound on his stomach, hand, tight, and buttocks after her mother accidentally spilled boiled water one hour before. Wound is felt pain, bullae(-). He cried very loud, seems no dyspneu. Fever (-). History of immunization was unknown. The patient never get this accident before. Alergy (-).

At physical examination, patient looks compos mentis, moderate ill. Vital sign is normal. Weight is 12 kg. At thorax examination, chest retraction (-), syanosis at extremity (-), and good perifer perfusion. Localis status of this patient show pink on the wound base, tepi tidak rata, necrotic tissue (+), bullae (-), pus (-), brown/black patchy (-), abses (-). dengan luas 21%.

Laboratory examination shows anemia and mild leucocytosis.

25. What is the degree of that burn trauma on this patient?

a. 1

b. 2

c. 3a

d. 3b

e. 3c

26. What is the best thing you must do for this patient before bring him to the hospital?

a. Give tooth pasta

b. Close with sterile dressing

c. Shower with water for 15 minutes

d. Compress with ice for 15 minutes

e. Give topical antibiotic

27. What is the initial step you must give at hospital?

a. Fluid Infusion Maintenance

b. Give topical antiseptic

c. Antibiotic

d. Parlkland resuscitation infusion

e. Bulectomy

For Number 28-29

A 34-year-old woman just delivered a 4100 g boy after a 15-hour labor, including a 2,5 hour second stage. During the repair of a midline episiotomy, there is a marked increase in the amount of vaginal bleeding.

28. Which of the following is the most common cause of immediate postpartum hemorrhage?

a. Retained placental fragments

b. Uterine atony

c. Cervical laceration

d. Vaginal laceration

e. Disseminated intravascular coagulation

29. Which of the following is the best immediate management of the probable cause of this postpartum hemorrhage?

a. Massage and compression of the uterine fundus

b. Intravenous administration of 20 units of oxytocin

c. Abdominal hysterectomy

d. Uterine artery embolization

e. Hypogastric artery ligation

30. Dedy, 13 year old man brought to Emergency by his mother with seizures and altered consciousness. His mother said that his seizures happen continuously since 45 minutes ago. Two days ago, he also suffers seizure about 40 minute. Physical examination: Temp 39.5C, He was lethargic, BP 120/80 mm Hg, Heart Rate 110 X/minute. Pupils were reactive and no obvious focal deficits. Babinsky sign present bilaterally. Lab examination: Hb 14 mg/dL, Leukocyte 11.000 /mm3, Random glucose: 70 mg/dL, Liver Function Test, Renal function, Electrolyte: in normal limit.

According to your examination which of the following is the most likely diagnosis?

a. Febrile seizure

b. Status epilepticus

c. Cryptogenic seizure

d. Refractory epilepsy

e. Hypoglycemic seizure

31. A 40 years old man presented in Emergency unit (ER) with unconsciousness. His wife finds him in the bath room 2 hours ago and brings him to the hospital. Physical examination: Unconsciousness, no trauma, BP 160/95 mm Hg. What kind of laboratory examination is the most appropriate to find non structural causes of unconsciousness?

a. Na , K , Ureum

b. Na, K, Glucose

c. Na, Glucose, Ureum

d. Na, Cl , Glucose

e. K, Cl, Glucose

32. A 7 years old boy, have injury falls from bicycle and had wound and bleeding at the lower extremity. What is the most appropriate sequent to stop bleeding :

a. Vascular spasm Blood coagulation Platelet plug formation

b. Vascular spasm - Platelet plug formation - Blood coagulation

c. Platelet plug formation - Blood coagulation Vascular spasm

d. Blood coagulation - Vascular spasm - Platelet plug formation

e. Blood coagulation Platelet plug formation Vascular spasm

33. A 60 year old man came to emergency unit with history of chest pain 9 days ago. Which is the most appropriate laboratory examination do you need for this patient?a. CPK serum

b. CK MB serum

c. Troponin I and T

d. SGOT/AST

e. Myoglobin

34. A 31 year old man came to emergency depart with complaint severe pain in abdominal area and frequent vomit since 24 hours ago. In physical examination looks severe pain, pain pressure abdomen (+) in all area. Radio imaging: not find sign of perforation.Whats the most important laboratory examination do you need for make diagnosis?

a. Urinalysis

b. Amylase serum

c. Lipase serum

d. Widal serology

e. Liver function test

35. A 22-year-old female college student is brought into the emergency room by the police, who found her walking back and forth across a busy street, talking to herself. The young woman appears to be oriented with respect to person, place, and time. Her first hospital admission was two months ago for a similar condition. During a psychiatric interview, she has difficulty concentrating, and seems to hear voices A phone call to her sister provides the additional information that the girl dropped out of school three months ago and has been living on the street. Urine toxicology is negative. What is the most likely disorder?a. Schizoaffective

b. Halusination

c. Bipolar delusion

d. Schizophreniform

e. Panic

36. A 45 year old man fell down after complaining severe headache. Vital sign was normal. He was vomits several times after and had meningeal signs. What is the most appropriate investigation needed?

a. Transcranial doppler

b. Laboratory

c. CT scan

d. Cranial X ray

e. Electroencephalography

37. A 20-year female presents with abdominal pain which was initially felt in the centre of abdomen but now felt in the right iliac fossa. She denies any other symptom. Her last menstrual period was 5 days ago. Examination reveals low fever (37.9C) and tender right iliac fossa. Digital rectal examination shows tenderness on 9-12 Clock direction. What is the most likely diagnosis?

a. Acute appendicitis.

b. Mid-cycle pain (Mittelschmerz).

c. Urinary tract infection.

d. Mesenteric lymphadenitis.

e. Intestinal obstruction

38. An unconscious patient with sepsis in the intensive care unit undergoes a 2-hour period of severe hypotension. Blood chemistries taken during the following 48 hours show rising creatine kinase MB fraction (CK-MB), peaking at 5 times the upper limit of normal. ECG findings are equivocal; with some degree of flat S-T segment depression over several leads. Which of the following is the most likely diagnosis?

a. Prinzmetal angina

b. Stable angina

c. Subendochondral infarction

d. Transmural infarction

e. Unstable angina

39. A 74-year-old woman, in otherwise good health, tripped and injured her right leg 2 days previously and has been bedridden since the accident. Two hours ago, she suddenly had shortness of breath and became delirious. On physical examination, her blood pressure is 120/70 mm Hg, heart rate is 110, and respiratory rate is 32 x/min. Pulse oximetry shows an oxygen saturation of 80%.

Which of the following is the most likely diagnosis?

a. Pneumonia

b. Acute cerebral infarction

c. Myocardial infarction

d. Pulmonary infarction

e. Pulmonary thromboembolism

40. A 60 year old woman comes to emergency room, complaining about dyspnea, dizziness, fatigue, lightheadedness and palpitation. After a few second, the patient collapse. ECG shows on Lead II

What is the initial management for this patient?

a. Nitroglycerin sublingual

b. Echocardiograph

c. Heart surgery

d. Dopamin

e. Defibrilator

41. A 61 years old man comes with vomitting, dispepsia and sweating. He feels cool when he plays tennis and fainting for a few minute. He has hypertension and diabetes, no smoking and no hypercholesterolemia.

What is the most likely location of AMI?

a. Inferior

b. Posterior

c. Anterior

d. Lateral

e. Anteroseptal

For Number 42-45

A 60 year-old man, is brought by his friend to ED because of unconsciousness. According to his friend, the patient is a heavy smoker and often to be hospitalized due to shortness of breath. On physical examination, RR: 42x/m, BP: 100/80, Heart rate 120x/m. Blood gas analysis showed pH: 7,20 ( 7,35-7,45); pO2: 50 (>80); pCO2: 82,5 (35-45); HCO3: 28 (22-26); BE +3 (( 2); SpO2: 88% (>95). Routine blood examination: Hb: 17.8; Ht: 51; WBC: 11.000; Platelet 420.000, Natrium: 130 (135-145); Kalium 5 (3.5-4.5). The chest X-ray showed lung hyperinflation.

42. According to those data, what is the most possible cause of the unconsciousness?

a. Severe hypoxemia

b. CO2 narcosis

c. Sepsis

d. Hypokalemia

e. Hyponatremia

43. What is the lung function test might be showed?

a. FEV1/FVC < 70

b. FEV1/FVC > 70

c. FEV1/FVC normal

d. FEV1 > 75

e. FVC > 80

44. If we measure the lung static volume, what is the most possibility result?

a. increased tidal volume

b. increased expiratory respiratory volume

c. increased residual volume

d. decreased functional residual capacity

e. decreased total lung capacity

45. What is the most inflammation cell that plays a role?

a. Macrophage

b. Eosinophil

xc. Neutrophil

d. Mast cell

e. Basophil

For Number 46-47

46. A 32 year old man brought by his wife to mental hospital. The wife complained that since 3 days ago, her husband had disorganized behaviour and speech. In this case, the doctor gives Haloperidol 3 x 5 mg a day. After 2 days, his wife come again and reported that he showed shaking his hand and feet.

What does he suffered from?

a. Acute Dystonia Reaction

b. Akathisia

c. Torticolis

d. Parkinsonism

e. Tardive Diskinesia

47. According to the case above, what medicine should be given to the patient to reduce the symptoms?

a. Metilphenidate

b. Triheksiphenidil

c. Risperidone

d. Chlorpromazine

e. Carbamazepine

For Number 48-50

A 17 year old girl attempted to suicide by drinking one cup of Baygon. Her mother found her diary saying that she really wants to be dead because her boyfriend has another girl and leaved her.

48. What is the most probably diagnosis?

a. Anxiety Disorder

b. Panic Disorder

c. PTSD

d. Schizophrenic

e. Depression

49. According to the cases above, which type of the suicide she has?

a. Suicide Attempt

b. Suicide Gesture

c. Suicide Gamble

d. Suicide Equivalent

e. Suicide Attack

50. What is the classification of suicide for the case above?

a. Euthanasia

b. Murder Suicide

c. Self Injury

d. Attack Suicide

e. Mass Suicide9