You observed your patient’s daily temperature. On the 1st day of hospitalization, his temperature ranged from 37 to 39 degree Celcius. On the 2nd day, his temperature ranged from 37.3 to 38.5 degree Celcius. And on the 3rd day, his temperature’s range was 37.2 to 39.5 degree Celcius. You conclude that your patient’s fever type is:

A 26 year old male patient came to emergency room with severe pain VAS 8 in swallowing since 2 days ago, he has eating difficulty and unable to swallow anything since yesterday, 2 weeks ago he had history of sore throat VAS 3. He had history of multiple sore throat in the past. Physical examination sounds muffle voice (+), poor oral hygiene, halithosis, and hypersalivation. Throat examination as shown in picture. What is the Probable diagnosis?

Fifty year old female came to your outpatient clinic with a complaint of severe exhaustion worsening since one month prior. She felt a lack of energy and disturbances in her sleep, she also easily feel cold and develop some weight gain despite lessening appetite. She recently underwent a procedure to remove her thyroid gland because of an enlargement. Physical examination revealed an obese woman with non pitting edema on her extremity. Dry and thin skin, compounded with brittle and coarse hair. What laboratory pattern would explain the disorder found in this patient?

Fifty two years old female patient came to your outpatient clinic and complained about severe exhaustion since one year prior. She was continually exhausted to the point that she was in bed up to 18 hours a day. Some days just walking to the shops around the corner from where she lives would render her incapable of doing anything else for the day. She also complained about sleep disturbances, joint and muscle pain and impairment in her concentration ability. Physical examination revealed nothing of significant, except several myofascial trigger points in her neck and back. What is the most likely diagnosis in this patient?

The microscopic appearance from biopsy a mass in the right breast of a-65 year old woman reveals a ductal cell carcinoma. Then, her malignant tumor is analyzed to determine the presence and amount of Estrogen and Progesteron Receptor. What is assessed through this procedure?

Ms. Siti, a 20 years old female present with acute redness in the right eye, associated with pain. It was noted when She wakes up in the morning. She already had several episodes of red eyes. Visual acuity revealed 20/20 in both eye. The redness is blanching after phenilephrine instillation. What is the most possible diagnosis?

A girl, 16 months age, come with wheezing since this morning. She gets cough since 3 days ago. She started to difficult to drink since she got wheezing. On her physical examination: body temperatur 37.7C, respiratory rate 74x/mnt (20-30) with nasal flaring and chest indrawing. Wheezing is heard all over the chest wall. What is your working diagnosis?

A 45-year-old obese woman with cholelithiasis presents to the emergency room complaining of nausea and vomiting for 2 days, along with severe continuous midabdominal pain. She has a low-grade fever and the ER physician finds that she has a slightly elevated WBC count (12,000). What is the most likely diagnosis?

Female, 61 y.o. came with complaint lack of strength or feeling of inability to carry out daily tasks, which became more intense at the end of the day, and usually improves after a period of sleep. What interview that should be done?

You ran a laboratory check up for your fever patient. Your patient is 7 years old, and the result is as

follows:

Hb 10,9 g/dL

Leukocyte 3500 /mm3

Thrombocyte 175.000 /mm3

From this result, there is a high possibility that the fever cause by:

Sarah, a 15-months-old girl was referred from a Posyandu to your clinic because of poor weight gain since she was 6 months old. From further history taking you got the information that she has wrong feeding practice and lack of quantity of daily intake. No history of previous illness. She looks thin, without any other significant physical findings. Her mother have a record of Sarah’s weight in her KMS (Kartu Menuju Sehat). After plotting to WHO growth chart, you got the chart as shown below: Can you state Sarah as failure to thrive?

Male, 58 y.o. came to general physician with complaints of early satiety each time he ate, accompanied with bloating and epigastric pain for the last 3 months. He experienced 5 kilograms weight loss since 3 months, but he did not complain about blood in his faeces. He had this symptoms one year ago but it had resolved. What kind of action would you suggest?

A 35 year old woman works as a keyboard operator and must type for 6 hours/day. Over the course of a few months she has developed pain in her wrist, as well as some paresthesias on her left thumb, index and middle finger especially when she type for hours. Her symptoms are most likely from injury to which of the following nerves?

Budi, a 7-year-old boy developed itchy eyes and swollen lids after playing tennis in the garden. Because his mother had hay fever, the boy's symptoms were also presumed to be an allergy to grass pollen. After several episodes of increasing severity, medical help was sought. He was skin tested; a wheal-and-flare reaction appeared 5-15min after prick testing with extracts of grass pollens, cat fur and house dust mite. According to case above (Budi), what can be found in his Ophthalmological examination?

A 23 y.o woman come to clinic with chief complain painful and enlarged left breast since 4 days ago. The patient is lactating her first son, which was born 10 days ago. She also felt progressive painful lump in the left breast, accompanied with low-grade fever not more than 38 C. She never seek any medical attention so she never take any medication. The clinical picture was given : Outer circle indicates the red, painful area. Inner circle indicates the painful lump. What is clinical diagnosis for the patient?

A 40 year old female came to OPD with complaint of low back pain that spread along lateral aspect of her leg to the back of her right foot since a week ago. There was no history of trauma, diabetes or hypertension. Physical examination found the patient was slightly obese but other result still unremarkable. What structure do you consider involved in this case that contribute to the pain?

A man came to emergency department having a gunshot wound on his back. He felt numbness on his right leg that has risen to his upper abdomen. He also could not move his left leg but still able to move his right leg. On physical examination he was unable to feel pain but still able to feel vibration in his right leg. According to case above, what pathway involved in his inability to feel vibration?

A 12 year old boy came to clinic with complain watery diarrhea five times a day since 3 days ago. What the most condition will happens to this boys?

A 5 years old boy suffered from pain on his right ear. According to his mother, he had suffered from rhinnorhea and cough for 2 weeks. Since 3 days ago he has had a fever. Yesterday he complained that his right ear was awfully pain with pain score 7 so that he was crying all the day, but at night the pain was slightly relieved and now the pain score only 4. This morning yellow fluid came out from his right ear. Which of the following results will you find in the physical examination?

A 38-year-old previously healthy woman has had a cough with fever for 3 days. A chest radiograph reveals infiltrates in the right lower lobe. A sputum culture grows Streptococcus pneumoniae. What is the drug of choice for this patient?

A 45 year old male came with easily tired since 2 months. He was on Tuberculosis treatment since 4 months. The hemoglobin level was 8.4 g/dL (normal: 14-18 g/dL), MCV 82 (normal: 80-100 fl), MCH 28 (normal: 26-34 pg), the reticulocyte count 2.5% (normal: 0,5-1%). There is no history of bleeding. The blood smear showed burr cells. The ferritin level was normal. What is the pathophysiology of his problem?

A 19 year old man is involved in a street fight in which he is attack with a lead pipe. A particularly forceful blow hits his left elbow. Blunt trauma to the elbow may lead to development of which of the following?

A 60 years old man is being treated for pulmonal tuberculosis with isoniazid and rifampin. To avoid additional signs of neuropathy, which of the following agents should be administered along with these antibiotics?

A 18 year old boy came with jaundice since 1 week and fatigue since 3 weeks. No fever. The hemoglobin was 9.2 gram/dl with indirect bilirubin increased. The platelet was 350 thousand. From abdominal ultrasound there was several cholelithiasis. What is his problem?

A 5 year old girl came to the emergency room with chief complaint of shortness of breath, stridor, and fever. According to patient’s mother, she has cough since a week ago, mucoid sputum, and she started to show swallowing difficulty since 2 days ago. General physical examination the patient looks weak, Sat.02 95%, HR 148 bpm, RR 36 bpm, S 38.5 C, Physical examination shown as the picture: What is the etiology of upper airway obstruction in this patient?

A 34 year old male came with fatigue since 1 month. He was on TB treatment for 5 months. Hemoglobin level is 8.2 g/dl MCV 78 MCH 27. The serum Iron was normal. The blood smear showed many lymphocytes. What is his problem?

A 45 year male present with general edema whole of the body. Physical examination: Blood Pressure and pulse: in normal limit, extremity edema ++, Heart and lung normal, Abdomen: liver and spleen: not palpable. What is the most important laboratory examination?

An 8-year-old girl comes to your office complaining of worsening throat pain for 2 days, moderate to high grade fever. She is barely able to eat food this morning because of pain. No one else is ill at home, but several of her friends at school have the same complain. On physical examination you note her temperature of 39⁰C, no injection of conjunctiva, clear nares, and oropharynx with a swollen and erythematous vulva, palatal petechiae, and enlarged erythematous tonsils. She has tender anterior cervical lymphadenopathy, right greater than left, with diameter approximately 1 cm. Her lungs are clear bilaterally and no rash. What is the most likely diagnosis?

A 10 months old boy presented with a two-days history of watery diarrhea. There is also some vomiting and fever 2 days before the diarrhea. Over the previous 24 hours the child had had watery diarrhea every 2 hours. Urination was infrequent. His 4 years-old sister had a non-bloody diarrhea last week. What is the most likely etiology for diarrhea in this patient?

A 56 year old man, came to your private practice complaining fatigue and itch all over his body for 1 month. Lab examination revealed: Hb 9.00 gr/dL Leukocyte: 6000 / ml Platelet: 325.000 / ml. IgE: Negative, Eosinophyl: in normal limit What is the most possible condition?

A 4 month-old baby is brought to the emergency room with two-day history of watery diarrhea and vomiting. On examination the child is lethargic, his heart rate is 150 beats/minute with weak pulse. He has sunken eyes and depressed anterior fontanelle. He is unable to drink. What is the proper initial management for this patient?

Patient 65 year old man presents with acute large bowel obstruction, rectal bleeding and change in bowel habit. What is the most likely cause?

A 45 years old man complaint about pain on his right calf every time after playing tennis. On physical examination, there is no discoloration, no deformity and no swelling. There is mild tenderness on gastrocnemius muscle. Which part of the muscle is the most probable affected?

Ms. Siti, a 20 years old female present with acute redness in the right eye, associated with pain. It was noted when She wakes up in the morning. She already had several episodes of red eyes. Visual acuity revealed 20/20 in both eye. The redness is blanching after phenilephrine instillation. According to the case above (Ms. Siti), what is the most underlying possible mechanism of this case?

A 35-year-old woman notices a 2 cm solid and moveable mass in her right breast on latero inferior quadrant. A fine-needle aspirate of this mass shows fibroblast cells proliferation intra and extracanlicular between proliferation of ductal glandular epithelial, and no malignant cells to be present. What is the best diagnosis for this case?

A three week-old male infant presents with a two day history of projectile vomiting. The vomit isnot bile stained. On physical examination the infant is 200 g below his birth weight and appears dehydrated. What is the most likely diagnosis?

A 57-year-old woman has experienced an increasing feeling of fullness in her neck along with a 3-kg weight loss over the past 3 months. On physical examination, there is a firm, fixed mass in a 3 × 5 cm area in the right side of the neck. A CT scan shows a solid infiltrating mass in the region of the right lobe of the thyroid gland. A biopsy of the mass is performed and the microscopic appearance is shown in the figure. All areas of the tumor have similar morphology. Which of the following terms best describes this neoplasm?

A 40-year-old female presents with pain in her surrounding eye since 2 days ago. In the examination revealed hyperemic conjunctival, edema corneal, mid dilatation pupil, flat anterior chamber, unidentified funduscopy, IOP 50 mmHg. What is your possible diagnosis?

A four-year-old girl presented to an outpatient clinic after two days of vomiting. She had already had a high fever for three days, and started to experience nausea and vomiting on fever day two. She vomited digested food or yellow fluid 3 times a day, accompanied by mild abdominal pain in epigastric region but no diarrhea. Today her body temperature was a little bit lower and she showed no signs of dehydration, but she generally looked weak and lethargic. What is your priority examination to explore the etiology of her vomiting?

A 70 years old man came to your office with chief complain decrease of hearing ability. To find degree of his hearing loss what examination do you need?

A 18 year old female came to you after underwent medical check-up. The hemoglobin level was 10.5 g/dL (normal 12-16 g/dL), MCV 65 fl (normal: 80-100 fl), MCH 20 pg (normal: 26-34 pg). From the blood smear there were target cells. What happened in the case above?

A man came to emergency department having a gunshot wound on his back. He felt numbness on his right leg that has risen to his upper abdomen. He also could not move his left leg but still able to move his right leg. On physical examination he was unable to feel pain but still able to feel vibration in his right leg. What myelopathy syndrome does this man have?

A 12-year-old girl went camping. Two days after returning from camping, the girl noticed itchy, red, indurated linear streaks on her left forearm. What is a likely explanation for the girl’s signs and symptoms?

Bono, a two year-old boy is brought in by his mother, who says her son has had a runny nose and cough for well over a week. She complains that he always seems to have a cold and is concerned that his hearing may be affected. You explain that often, with respiratory infections, the Eustachian tube does not function properly. Which one of the following is a consequence of a blocked Eustachian tube, and would contribute to the boy 's reduced hearing in this case?

After playing roller coaster, a 15-year-old girl had nausea, vomiting, and dizziness. Which receptor most likely involved the afferent pathway in developing her vomiting symptoms?

A 63 years old female patient came to your practice and complained she was decrease her body weight 3 kg in one month. Laboratory result: Fasting blood glucoe: 99 mg/dL, Two hours post prandial blood glucose 210 mg/dL. What is the most possible diagnosis?

A 43 year old man presents to your clinic with the complaining of fatigue and paresthesias. He is vegetarian. His examination reveals pallor, an absence of hepatosplenomegaly, normal muscle strength throughout, and loss of position sensation and vibration sensation distally. Increased MCV and MCH, teardrop cell +. What is the probable cause of anemia in this patient?

A 23 year old male came to your clinic with chief complaint of hoarseness voice, excess throat mucus , cough after and during eating, sensation of lump in the throat, and sometimes he felt stomach acid coming up. The symptoms got worsened as he started to work as barista in a coffee shop 1 month ago, the complaint showed during the day and worse at night, sometimes he woke up at night due to chocking and coughing. Therapy you need to prescribe for this patient?

A 40 year old man present with complain diplopia until 4 weeks ago. In examination the patient cannot move his right eye to lateral. What kind of nerve involve in this case?