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 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 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?

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?

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?

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?

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 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 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 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 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 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 three week-old male infant presents with a two day history of projectile vomiting. The vomit is not bile stained. On physical examination the infant is 200 g below his birth weight and appears dehydrated. What is the most likely diagnosis?

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?

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 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?

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 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?

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. Ig E: Negative, Eosinophyl: in normal limit What is the most possible condition?

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?

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 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?

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 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 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 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 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 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 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 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 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 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 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 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?

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 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?

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?

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?

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:

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?

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?

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?

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?

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?

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?

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?

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?

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:

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. What is the most likely diagnosis?

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 the next diagnostic assessment for the patient  to prove the clinical diagnosis?

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 the possible further complication she could have when the natural history of the disease occurred without medical intervention ?

A 55 year old Alcoholic American male came to International hospital with frequent slept since 5 weeks. The hemoglobin level 7.6 gram/dl. MCV 105 MCH 33. Blood smear showed hypersegmented neutrophil. What is his problem?

Male, 18 y.o. came to emergency unit with complaint of yellowish eyes. He also experienced nausea and vomiting, and dark colored urine. His friend experienced the same symptoms one week ago. What kind of laboratory examinations would you recommend?

Female, 28 y.o. came to general physician with complaints of early satiety each time she ate, accompanied with bloating and epigastric pain for the last 3 months. She experienced no weight loss, and she did not complain about blood in her faeces. She had this symptoms one year ago but it had resolved. What kind of action would you suggest?

An 8-month-old boy was brought to the emergency department after vomiting profusely for a day. He vomited more than ten times a day, after every feeding. He looked lethargic and tachycardic, with a normal respiratory rate. On physical examination, there were apparent sunken fontanelles, eyes, and dry lips. What is your most priority action for this patient?

A 12 week-old boy presents to his GP with rash in both buttocks. The rash is red, extensive and involves the skin creases and scrotum. The base of the rash is erythematous with a superadded white scale that can be scraped off. There are satellite lesions. He is a bottle fed baby who wears disposable nappies and there is no family history of atopy. Which of the following is the most likely diagnosis?

A 3 months old baby boy was brought to clinic due to rashes over his cheeks and elbows since a week ago. He was exclusively breastfed since birth. Perinatal history was unremarkable. From the detailed history, his mother ate shrimp and squid almost every day for a week since 2 weeks ago and his cloths were washed using a liquid detergent since birth. Family history revealed that his 6 year old eldest brother was diagnosed as intermittent asthma. Physical finding showed dry skin with erythematous, popular diffuse orders, bizarre shape with erosion and crust over the elbows and cheeks. What is the most likely diagnosis for this case?

A pair of young mother and father came to Eye clinic bring their baby boy of 2 days old. The baby’s eyes look swelling and were closed tightly hard. When the doctor tries to open his lids, there is yellowish secret come out profusedly from the eyes. In laboratory finding to the conjunctival swab, there is Diplococcus Gram Negative, intra and extra cellular. What of this following is most likely diagnosis?

A 60 years old man come to general practitioner with complain of Polyuria, polidypsia and polyphagia If you suspected Patient suffering NIDDM. What kind examination do you need?

A 37 year old man was complaining of chronic bilateral pain above and around her eyes. He had history of rhinitis allergy since 2 years ago. These complaints only accompanied with nasal congestion and post-nasal drip. Which of the following examination is the most appropriate to establish the diagnosis?

A 32 year old man came to Medical Check Up for screening according recruitment for Pilot. Physical examination: In normal limit. The laboratory result: TSH: 0,45 mU/L (N: 0,5–4,7), FT4: 2,5 nmol/L (N: 0,8–2,7 ng/dL), FT3: 4,9 pg/mL (N: 1,4–4,4 pg/ml). Another laboratory result in normal limit. What is the most possible diagnosis?

A male complaints a triangular tissue in his right eye. There were no blurred and redness. In examination revealed fibrovascular tissue in his nasal conjunctival entered 2 mm in corneal parts. What is your possible diagnosis?

A 36 year old female come to your clinic with chief complaint of sore throat. She also has fever since 3 days ago. This morning she complained sudden loss of smelling sensation and difficulty to identify taste, 5 days ago she started having body ache. She works daily in the office because her job cant be done with ‘Work from home method’. A week ago her office mate also had the same complaint. No history of head trauma. What is the Probable diagnosis of this patient?

A 5-year-old girl was admitted at the hospital due to difficulty of breathing. Five days prior she has productive cough associated with intermittent moderate to high grade fever, clear to mucopurulent rhinorrhea, post tussive vomiting, and decrease appetite. On physical examination she was lethargic, with respiratory distress, respiratory rate 50x/minute, heart rate of 120x/minute, temperature of 39°C, nasal flaring, chest indrawing, retractions, crackles is heard on both lung field, and no murmur. The WBC count was elevated and predominance of granulocytes. Chest radiographs showed consolidation in the right lower lobe. What is the treatment of choice for this patient?

Raisya, a 2-years-old girl has been referred to you for poor weight gain. Her body weight is between -2SD and -3SD z-score weight-for-age and weight-for-length WHO growth chart, while her height is between +2 and -2SD height-for-age WHO growth chart. There is no complain about her development. What is the status of nutrition of Raisya based on the the WHO growth chart?

A 58 years old woman, came to Medical Check Up for regular examination. Physical diagnosis in normal limit. Laboratory result: Blood Ca: 12,5 (N: 9–10,5 mg/dL), Blood Phosphorus: 2,5 (N: 3–4,5 mg/dL) Alkali phospatase: 135 (N :30–120 U/L), AST: 32 U/L (N: < 35 U/L), ALT 34 U/L (N: < 40U/L), Gamma glutamyl transferase: 70 U /L (N: 1–94). Another lab examination in normal limit. What is the most possible diagnosis?

A 52 year old man came with nausea and vomiting since 1 week ago. There also symptom coffee ground stools. He has diagnosed uncontrolled diabetes since 23 years ago. He also told having hypertension since 5 years. There is history of passing stone and nephrolithiasis 8 years ago. What is the most probable diagnosis?

Rachmat, a 48 years old driver came to your office with chief complain right upper abdominal pain and history of bloody diarrhea 1 weeks ago. Physical examination revealed no fever, no icteric and tender hepatomegaly. Laboratory examination revealed anemia (Hb 9 g/dL), normal transaminase enzim, slight increase in direct bilirubin (1,8 mg/dl). What is the most likely diagnosis?

A 50 years old woman, came to General Practitioner complaining palpitation, excessive sweating, and loss of body weight 4 kg in a month, she had increased frequency of defecation. In Physical examination: BP: 135/85, Pulse 110 X/minute. She look confuse and tremor. According data above what is the most important laboratory examination?

A 33 year old man came to Private Clinic with complain hematuria and dysuria since 3 days ago. History of trauma: negative. In physical examination: No fever, he feel pain when the physician percussion in right flank, another examination in normal limit. What your working diagnosis for this patient?

A 67 year-old man presents to the Emergency Department with acute right-sided loin pain and macroscopic haematuria. His past history includes hypertension and occasional gout. A plain abdominal x-ray shows no opacities but an intravenous urogram shows hold-up of contrast at the right pelviureteric junction. What is the most likely diagnosis?

A seven years old child is seen at the Emergency Department for a left acute ear and periauricular throbbing pain persisting for the last 3 days with otorrhea, fever and progressive hearing loss. She had an ear ache with an upper respiratory tract infection 2 weeks ago which resolved spontaneously. On physical examination, the child looks ill with an oral temperature of 39.5°C. There is a profuse creamy discharge from her left ear canal with tenderness, redness and edema on her left retroauricular region. Her right ear, chest and throat are normal. Which one of the following diagnosis is the most likely?

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. According to case above. What is your drug of choice in the management of this pain?

35 years old male came to hospital with redness in his right eye. He also complaint photophobia, blurred vision. Visual acuity 6/9, ciliary injection (+), Keratic precipitate (+), tyndal effect (+), Pupilary reflex decreased. What is your diagnosis?

A 48 year old male patient comes to a private practice because of black stool since 3 days ago. He had abdominal discomfort since 1 month ago. He had no weight loss. He says he never use pain killer. On physical examination, the patient’s conjunctiva look pale, but other examination reveals normal. What is the next step the doctor should do?

A 1-year-old boy came to the emergency department with persistent vomiting since yesterday. After completing workups and evaluations, the doctor decided to do an emergency abdominal surgery on her. These manifestations were most probably found on her physical examinations, except

A 26 years old pregnant woman present to your office, worrying about her laboratory result. From a screening laboratory examination she is known to have positive HBsAg. She already took another rlaboratory examination according to hepatitis B and the result is: negative HBeAg, normal ALT and low HBV DNA. What phase of chronic hepatitis B she is?

Over the past year, a 30-year old alchoholic man has developed bilateral breast enlargement which is symmetric and painless. He is not obese. Microscopic examination after surgery reveals gynecomastia. What is the most possible underlying condition of his breast?

A 47 years old man, fell from 2 meters height. He dropped on his back, and after he started to felt radiating pain followed by weakness on his both legs. Physical examination showed motor strength of right/left leg 4/2, an absent reflex, and loss of anal reflex. What is your diagnosis in this patient?

A 1-month-old boy was brought to outpatient clinic because of recurrent forceful vomiting after feeding. The baby looked hungry and dehydrated. His body weight according to his height was < -3 SD. In physical examination, there was an abdominal palpable mass in the right upper quadrant and notable peristaltic wave while feeding. What is your working diagnosis of this patient?

A 38 year old male came to OPD with complaint of low back pain and numbness that spread along an area as shown below. What reflex do you expect to be changed in this patient?

Male, 48 y.o. came to emergency unit with complaint of yellowish eyes. He also experienced nausea and vomiting, and dark colored urine. He was an intravenous drug user about 20 years ago. What kind of laboratory examinations would you recommend?

A 11 year old girl, come to physician with decrease of hearing since 1 week ago. In examination : Outer ear canal: normal limit, ear drum: intake. Test Rinne -. Weber: right laterisation. According the data above what is your diagnosis?

A 58-year-old man presented with a 1-month history of an expanding mass in the left side of his neck and neurologic symptoms. His left-sided otalgia, headache, and odynophagia were initially treated as a temporomandibular joint disorder. He developed hoarseness, a dry cough, left-sided facial numbness, and a rapidly expanding mass in the left side of his neck (4.3 × 3.4 cm on a computed tomographic [CT] scan) and then left-sided ptosis and diplopia. Microscopic examination shows the findings in the figure. What is the most likely diagnosis?

A 31 year-old male unemployment came to clinic with a chief complaint of his eyes that became yellow since 2 weeks ago. He also had dark colored urine, low grade fever, weakness and feeling of nausea. He could not eat as much as he could and sometimes he vomited, his body weight decreased. He had history of intravenous drugs abuse, and unsafe sexual intercourse, but no history of blood transfusion. He had been vaccinated with Hepatitis B. From his complaints, what is the most probable diagnosis?

Bowo, a 28 years old government employee came to emergency department with high fever since 4 days prior. He also complain headache, retroorbita pain, abdominal pain, nausea and rash over his feet. From physical examination his weight is 60 kgs, tachycardia, fever and epigastric pain. His laboratory result revealed Hb 16,5 g/dL (12-14 g/dL), Ht 52% (37-42%), Leucocyte 1100/mm3 (5000-10000/mm3), thrombocyte 38.000/mm3 (150.000-400.000/mm3). What is the most appropriate treatment for this patient ?

Pasya, 6 month-old baby is brought to the emergency room with 1-days profuse watery diarrhea. He is eager to drink, with some vomiting after he drank. On examination he looked irritable, has slight fever (37,9oC), with normal vital sign. He has sunken eyes and depressed anterior fontanelle. His last urine is 6 hours ago with dark yellow color. What is the status of dehydration if this patient?

A boy age 4 years presents to your office with pale since 1 year. There is no other complain. His brother got blood transfusion frequently. Physical examination revealed slight hepatomegaly and splenomegaly (Schuffner II). His MCV 70 (80-100fL). Blood smear revealed target cell. What is most likely diagnosis?

A man came with a lump on his right anterior neck. On physical examination the lump was moved upward when the patient swallowed. The structure that a doctor must clearly identify to avoid hoarseness post-operation is:

Two years old child brought to your clinic with complaint of fever and cough. On physical examination, you note an intercostal retraction. The most common cause of this disease in children this age is:

A 36 year old male came with fatigue since 8 weeks. He often felt night sweats and gum bleed. The hemoglobin level was 8.1 gram/dl. The reticulocyte count was decreased. The blood smear showed normocytic anemia, leucopenia, and thrombocytopenia. What is the pathogenesis of his problem?

A 25-year-old male is admitted to the hospital for unexplained high fever and diarrhea over the last week. He returned 4 months ago from a 1-month trip to Kalimantan. He states that he took doxycycline weekly as prescribed (without missing any doses) prior to his trip, during his trip, and for 4 weeks after he returned. What is the most appropriate first step diagnostic test?

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 the next question you want to ask the patient?

A 5 year old child came to primary health care with complaint of recurrent sore throat. He refuse to eat rice to pain in swallowing, he also has cough, fever and runny nose. He has history of recurrent tonsilitis every month during the last 1 year. His mother also complaine the children has been snoring every night, and seems unable to focus and a bit ‘hyperactive’. The patient looks mouth breathing and typical of adenoid facial. What is the complications of the child ?

A 33 year old male came with fatigue since 3 months. The hemoglobin 7.5 gram/dl. The abdominal ultrasound showed contracted kidney. The blood smear showed macrocytic anemia and hyper-segmented neutrophil. What is the pathogenesis of decreasing hemoglobin?

A 64 years old man came to Clinic complaining abdominal distention and edema over both of his leg. Physical Examination revealed: BP, RR, Temp, Pulse: Normal. Heart and Lung: Normal. Abdomen: Ascites: + (positive), Liver and Spleen: not palpable. Inferior extremities: edema. Laboratory result: AST: normal, ALT: normal, AFT: very high, Anti HCV: +, HBsAg: +, serum albumin: low, serum globulin: increase. What is most possible diagnosis?

A 64-year-old man presents to you with new onset of “racoon-eyes.” His left eye can’t move out laterally and he has a chronic mild headache that he attributes to eyestrain. Which orbital bone is most likely to fracture with blunt trauma to the eye?

A 27-year-old woman discovers a lump in her left breast. On physical examination, a 2-cm, discrete, freely movable mass beneath the nipple is palpable. Microscopic examination shows the findings in the figure. What is the most likely diagnosis?

A 67 year old man came with epigastric pain since 3 hour before admission. He looked dyspnoe. He was diagnosed having long standing uncontrolled diabetes and hypertension; and lastly he was diagnosed with early chronic kidney disease. He is heavy smoker. What is the most appropriate first step examination?

Patient 35 years old come with low back pain, what is the best diagnosis for this patient?

A 55 year-old male came to out patient clinic in Puskesmas with a complaint of general weakness. He had experienced this weakness for one year, and he had no spirit to do his activities and difficulties concentrating, pain when swallowing, pain in his muscle and headache. Patient did not complain, any psychiatric problems. Physical examination and laboratory examination revealed normal results. What is you diagnosis?

Patient 57 years old fall from high place, what is the best diagnosis for this patient?

Patient female 56 years old, come with severe abdominal pain, tender and distended abdomen, what abnormality can be seen in this case?

A 23 year old female came with fatigue since l month. She has history of menorrhagia before. The conjunctiva was pale and atrophy tongue. The hemoglobin level was 8.5 (normal: 12-16 g/dL), MCV 70 fl (normal: 80-100 fl), MCH 18 pg (normal: 26-34 pg). The ferritin serum decreased and TIBC was increased. What is the mechanism under this patient disease?

A 26 years old man came to your clinic with chief complain gross hematuria. From physical examination his BP 160/100 mmHg, edema in lower extremitas, liver and spleen unpalpable. Urinalisis revealed proteinuria +3, RBC full, cast (+). What is the most likely diagnosis?

1. A 23 year old female came with fatigue since 1 month. She has history of menorrhagia before. The conjunctiva was pale and atrophy tongue. The hemoglobin level was 8.5 (normal: 12-16 g/dL), MCV 70 fl (normal: 80-100 fl), MCH 18 pg (normal: 26-34 pg). The ferritin serum decreased and TIBC was increased. What is the mechanism under this patient disease?

1. A 35 year-old male came to out patient clinic in Puskesmas with a complaint of burning sensation in his epigastrium. He experienced this sensation in 1–2 hours after taking meal, especially after dinner. He felt fullness in his stomach that made him burp and sometimes there was a feeling of acid on his mouth. He did not experience weight loss. What will you do to this patient as general practitioner?

A febrile child in your care complain of shivering. In this condition, what other thing predictably happen in the child’s body?

1. A 70 year old man develops pain and burning over the right side of his face. Within a few days, a vesiculopapular rash in the distribution of the first division of the fifth nerve appears. The vesicles become encrusted and the burning associated with the rash abates. Within 1 month the rash largely resolved but the man is left with a dull ache over the area of the rash that is periodically punctuated by shooting pains. What is the most likely diagnosis?

1. A-50-year old woman palpates a 0,5 cm irregular nodule, hyperpigmented, sometimes itching but no pain in her left breast quadrant latero inferior. The biopsy is performed, histopathology reveals mycosis Fungioides. What is the best therapy for her disease?

1. A newlywed woman presents to your office, asking for suggestion. Her husband recently diagnosed as chronic active hepatitis B. She already took a laboratory examination according to hepatitis B and the result is: HBsAg negative, Anti HBs negative, transaminase enzyme within normal limit. Which is the best suggestion for her?

1. A 24-year-old man presented with a 5-month history of slowly enlarging, bilateral, nonpainful cervical masses. Examination revealed a 3 × 2-cm, level 4, right cervical mass and a 3 × 3-cm, level 3, left cervical mass. Both masses were firm, mobile, nontender, and without overlying skin changes. The rest of the head and neck examination revealed no abnormalities other than poor dentition. Microscopic examination shows the findings in the figure. Which of the following infectious agents is most likely to produce these findings?

1. A 33 year old male came with fatigue since 3 months. Laboratory result: Anti HCV (+), ALT and AST: Normal, Ureum and Creatinin: Normal. What the next examination do you need for this patient:

A 7-year-old male presents to your clinic for evaluation due to difficulty of breathing. His mom reports yesterday he began having shortness of breath, cough, and occasional wheeze. The patient has wheezed once before when he was 6 months old and diagnosed with RSV. On physical examination, he is in moderate respiratory distress. His oxygen saturation is 94% on room air, with a respiratory rate of 45. Other vital signs are normal. His lung exam is notable for diffuse expiratory wheezing, obvious retractions and nasal flaring. What is the most likely cause of this patient’s respiratory distress?

56 year-old woman had been treated without success for post-nasal drip syndrome. She had had a non-productive cough for 2 ½ years. While she complained of a post-nasal drip, she denied throat clearing, allergies, wheeze and shortness of breath. She had never smoked, and her home and work environments could not be implicated in her cough. She was taking no medicines, specifically no angiotensin converting enzyme (ACE) inhibitors. Her physical examination was normal. Chest x-rays normal. What would you suggest for this patient?

A 16 years old boy came to your office with chief complain fever since 4 days prior. He also complain headache, retroorbita pain, myalgias and nausea. 1 week ago his neighbour was admitted to hospital due to dengue fever. What is the next examination you suggest for this patient?

A 23-year-old woman came to the internal medicine department with signs of dehydration, fever and tachycardia. On physical examination, there was exophtalmus and lump in the front of her neck. What is the possible diagnosis for this patient?