Traumatology 111. man 30y/o. naik sepeda motor tanpa helm dan bertabrakan dengan pohon. Saat kejadian, penderita pingsan. Pada saat dibawa, bisa bicara tapi nda ingat kejadiannya. Pada saat diRS kesadaran menurun.Neurologic examination : he could not open his eyes spontan, tapi dengan rangsang nyeri. Moaning with irregular words, his leg was flexed with pain stimuli.Left pupil bigger than right. Seen hematoma at his face and bleeding from his nose.

1. Symptoms decrease consciousness occurred after patient awake was ….a) cushing syndromeb) monro kelly’s syndromec) lucid intervald) cushing syndromee) severe head injury.

2. The symptom above was caused by ….a) spinal cord injuryb) blood accumulationc) secondary brain injuryd) concussion was occurred at the beginning and then hematoma accumulate occurred slowlye) normal response was occur

3. The symptoms above was commonly found in…a) intracerebral hematomab) epidural hematomac) subdural hematomad) intraventicular hematomae) central contussion

4. BP 160/100 mmHg, HR 50 x/minute was sign of …a) body response to the stress traumab) sign of neurogenic shockc) sign of hemorrhagic shockd) decreased intracranial pressuree) increased of intracranial pressure

5. the sign was called …a) cushing’s responseb) monro kelly’s doctrinec) cushing’s syndromed) lucid intervale) severe head injury

6. the sign above was body reaction for …a) decreased ICPb) increased ICPc) maintain pressure of brain perfusiond) increased CSF stream to the spinal chambere) decreased CSF stream to the spinal chamber

7. There was periorbital ecchymosis at the patient which is sign of ….a) Fracture of anterior cranial base

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b) Fracture of basis cranii mediac) Fracture of basis cranii posteriord) Facial traumae) Fracture of bilateral zygoma

8. The sign above was contraindication for …a) Examination of plan skull radiologyb) Examination of CT scanc) Apply nasogastric tubed) Apply nasogastric through the mouthe) Apply orotracheal intubation

9. GCS in patient was ….a) E3V3M4b) E2V3M4c) E3V4M2d) E2V3M2e) E2V2M4

10. There was possibility to the patient that the hematoma was occur at ….a) Left hemisphereb) Right hemispherec) Cerebellumd) Intraventriculare) bifrontal

11. laki-laki, 24 tahun, masuk UGD karena kecelakaan lalu lintas. Tidak dapat menggerakkan kedua tungkai pasca kecelakaan. Ditemukan jejas pada kedua paha tanpa deformitas dan jejas pada epichondrium kiri, penderita juga merasakan nyeri pada bahu kiri tapi tanpa jejas.Important examination …

a) reflex physiologisb) reflex pathologisc) rectal touchéd) labe) light touch and pin prick test.

12. in this patient, the bulbocavernosus reflex is (+), which is mean ….a) Complete spinal cord injuryb) LMN injuryc) UMN injuryd) Severe destruction of bone componentse) Mild destruction of bone components

13. spinal cord injury at level of ….a) upper cervicalb) lower cervicalc) thoracald) lumbale) conus medularis

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14. first day reflex bulbocavernosus (-) and in the third day. Sacral Spare sign (+).What is the diagnosis …

a) upper motor neuron complete spinal cord injuryb) lower motor neuron incomplete spinal cord injuryc) peripheral nerve injuryd) neurogenic shocke) UMN incomplete injury

15. in the second day, the patient has hypovolemic shock. BP 80/40. Hb 6 gr/dl.Your suspicion is ….

a) Aorta traumab) Kidney traumac) Duodenum traumad) Pelvis traumae) Spleen trauma

16. Principal management of spinal trauma ….a) life savingb) prevent secondary injuryc) stabilizationd) alignmente) transportation

17. Vacuum mattress is contraindicated in ….a) Pelvic fractureb) Multiple fracture in lower extremityc) Severe thoracic traumad) Head traumae) Spinal trauma

18. Conditions below include UMN trauma, except ….a) Brown sequared syndromeb) Anterior cordc) Posterior cordd) Conus medularise) Cauda equine syndrome

19. Condition below can lead to hypovolemic shock, except ….a) Headb) thoraxc) pelvicd) abdominale) femur

20. Conditions below related to brown-squared syndrome, except ….a) MOI : stab woundb) Lateral mass fracturec) Total transaction of spinal cordd) Decrease or loss motor power while normal pain and temperature sensation on the affected

side.

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e) Normal motor power while decreases pain and temperature sensation on normal side.21. 65 y/o woman, feels numbness and tingling on index and thumb finger esp night since 2 years ago. Weakness when holding things, but still can do housework. Wasting thenar muscle (-). No palpable tumor, no scar. No tenderness, same temperature with the other hands. Possible diagnose ….

a) Ulnar vessels and nerve problemb) Carpal tumor syndromec) Median nerve problem because cookingd) Ulnar nerve injurye) Radial nerve disruption because of trauma

22. what are the risk factor …a) Osteoporosisb) Osteoporoticc) Synovium atrophyd) Osteophytee) Tendon atrophy

23. Treatment for this case …a) Antibiotic injectionb) Wrist splintc) Diverse transversal carpal ligamentd) Open surgerye) Endoscopic release

24. if patient get thenar muscle atrophy. Treatment …

a) Steroid injectionb) NSAIDc) Rest and NSAIDd) Wrist splinte) Open surgical division

25. 35 y/o man, has traffic accident come to hospital with knee ecchymosis. Hip joint slightly flexion, adduction, internal rotation.

a) …b) …c) Anterior hip dislocationd) Posterior hip dislocatione) …

26. what is the additional sign …a) Leg length discripancyb) Unlimited range movementc) Galeazzi sign (-)d) Head of femur protrude inguinale) Head of femur protrude lateral

27. What is the management for this patient …a) Traction countertraction

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b) Mich maneuverc) Kotcher maneuverd) Stimson techniquee) Pravin technique

28. The effect of different treatment of children in neck femoral fracture ….a) Vessel in the lig. Teresb) Vessel in the retinaculac) Intraosseus vesseld) ..e) ..

29. man, working at construction, hit by machine.What’s possible diagnosis …

a) Open fracture proximal at phalanx halluxb) Fracture median phalanx 1st toesc) Fracture distal phalanx 1st toes.

30. treatment …a) Buddy tapping, rest and immobilizationb) …c) …d) Buddy tapping and antibiotice) …

31. in X ray result, communitive fracture at interphalangeal joint.Appropriate treatment ….

a)b) Kischer wirec) Buddy tappingd) Castinge) Splinting

32. 28 y/o man play badminton and do jumping smash. Can’t dorsiflexion.a) …b) …c) …d) Achilles tendon rupturee) …

33. what is the injury mechanism from the patient problem? a) violent plantarflexion of flexi foot as in the fall from heightb) direct trauma at 1st digitc) twisting mechanism at the interphalanges of the halluxd) weightbearing foot because extended kneee) sudden unexpected plantarflexion on the ankle joint

34. what is the treatment for case above? a) ...b) kessler techniquec) debridement

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d) castinge) splinting

35. a patient shallow laceration (<1cm) in renal. what is injury grade according

    American association of Trauma Scale?a) Ib) IIc) IIId) IVe) V

36. which of the following is neither relative nor an absolute indication for open repair of bladder injury ….

a) Significant extraperitoneal bladder rupture in a patient scheduled to undergo laparotomy for associated intra abdominal injuries by the general surgery team.

b) Significant extra peritoneal bladder rupture in a patient scheduled for open anterior repair of pelvic fracture by the orthopaedic surgery team

c) Significant extra peritoneal bladder rupture and a concern by the urology team that the complication rate of conservative treatment are unacceptably high.

d) Intraperitoneal bladder rupturee) “pie in the sky” bladder

37. in the blunt trauma patient with the pelvic fracture in whom no urine returned to catheter placement. What is the best method to evaluate urethral injury …

a) Retrograde urethrographyb) CT with intravenous contrast material and clamping of the urethral catheter.c) Flexible cystoscopy in the operating roomd) Percutaneous antegrade cryptographye) Use the urethral sound

38. There are distinct clinical and physiological difference between high flow and low flow priapism. Which of the following statement are true ….

a) Priapism of 12 or more hours after intracavernosus pharmacotherapy is generally high flowb) Low flow is generally painful after 6 hours.c) A corporal aspirate of dark blood that is hyperbaric and epidotic is classic low flow priapismd) Trauma after penile or straddle injury more often leads to ischemic rather than arterial

priapisme) The least invasive way of diagnosing low flow priapism is with phalloarteriography.

39. On the best physical finding indicative of torsio of the spermatic cord is …a) High riding testisb) Absence of the cremasteric reflexc) Transverse lie of the testisd) Absent Doppler sounde) Inflammatory hydrocele

40. After manual detorsion of spermatic cord.

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which of the following is appropriate management?a) Color Doppler USG Examinationb) Radionuclide Scanc) Doppler Examination of the testis and spermatic cordd) Discharge of the patient and arrangement of an office re-evaluation in 1 weeke) Immediate scrotal exploration 41. The blood in hematocele is contained in which of the following …

a) The tunica albugineab) Tunica vaginalisc) Colles fasciad) Scarpa’s fasciae) Camper’s fascia

42. Male 19 years old come with pain and oedema at the right testicle, 2hours ago after bed time. Physical examination show there was edema at the right testicle and slightly arises from normal position and pain on palpation.The most probably diagnosis for this conditionis:

a) Right acute orchitisb) Right testicle torsionc) Testicle Hydrocele infectiond) Acute tuberculous epididimitise) Incarserata inguinal hernia

43. The examination to establish the diagnosis are …a) Angel and phren signb) Bag of wormc) Transillumination positive testd) Valsalva maeuvere) String pearl/ rosario on epidydimis

44. Management for this case …a) orchidectomyb) reposition and orchidopexy bilateralc) berkmann-winkelmann operationd) tuberculostatic and vasectomye) herniotomy

45. 3 hours old baby prolonged delivery by fetopelvic proposition. Apgar score 6/8. Body weight, 4200 gr, length 51 cm. Bulging center of the head suture. no moro reflex at left side.Diagnosis?

a) caput succedenumb) subgaleal hematomac) cephal hematomad) subarachnoid hematomae) epidural hematoma

46. what make in this patient no moro reflex …a) Brachial palsy type erbb) Brachial palsy type klumpkeec) Clavicle fracture

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d) B+Ce) A+B+C

47. if this case is brachial palsy injury type klumpkee. What could you find in your physical examination ….

a) grasp reflex is usually presentb) clawing handc) there is “waiter’s tip” handd) in adductione) in pronation and internally rotated

48. According to fetal body weight, the cause of birth injuries is ….a) Abnormal presentationb) LBW + prematurityc) Fetal macrosomiad) Large fetal heade) Fetal anomalies

49. long term deficit …a) Progressive deformity b) Muscle atrophyc) Limb contractured) Impaired growth of limbe) All correct

50. a term baby girl, weight 2200gr, premature rupture membrane, put in warmed .. was given resuscitation for 10 minute with apgar score 4/5/7. Temperature 36.1⁰ CStage hypothermia ….

a) Mild b) Moderatec) Severed) Cold stresse) A+D

51. Causes of hypothermia in this baby …a) Pretermb) Small for gestational agec) Prolonged resuscitationd) B+Ce) A+B+C

52. Estimated temperature after treatment ….a) 36.5-37.5b) 36.5-37.1c) 36.6-37.1d) 36.6-37.6e) 37.0-37.5

53. female 64 y/o decrease consciousness, no history of fever nor hypertension, vital sign normal except tachycardia, no meningeal sign, light reflex (+) and has severe diarrhea and vomiting since 3 days ago.what is the cause of decrease consciousness in this patient …

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a) Hypoglycemiab) Electrolyte imbalancec) ..d) ..e) …

54. For management, what IV we should give …a) Dextrose 40%b) Dextrose 5%c) NaCl 0.9%d) KaEn…e) Mannitol 20 %

55. 45y/o woman decrese consciousness, weakness extremities, cold sweating, no fever no head trauma, diabetic (take insulin) mild hypertension. PE: BP: 140/90 HR: 90/min GCS E2M5V3, Na 140 K 3.5 glucose random 50mg%Cause of decrease of consciousness ….

a) Hypoglycaemiab) ..c) hypertensiond) electrolyte imbalancee) cerebrovascular

56. based on the scenario above, what the possible diagnose …a) brain deathb) wernick encephalopathyc) metabolic encephalopathyd) hypertension encephalopathye) diencephalic coma

57. 3 y/o boy admitted because of fever 3 days ago. There was vomiting 5x and poor drinking child. History of gum bleeding 1 day ago. Pemfis : unmeasurable pulse, unpalpable pulse, cold extremities.Lab : hematocryte 45%, platelet count 80000.Diagnosis …

a) DHF Ib) DHF IIc) DHF IIId) DHF IVe) Dengue fever

58. initial therapy …a) RL/ RA 100-200 cc 10-15 minutesb) Crystalloid 5cc/KgBW/hourc) Crystalloid 10cc/kgBW/hourd) Crystalloid 20cc/kgBW/hour

59. case invaginasi.In physical examination we found …

a) Cupping sign

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b) Pseudoportioc) Target signd) Doughnut signe) ..

60. 3 y/o baby vomit 5x/day. Watery stool >10 x/ day. Irritable, sunken eyes, dry mouth, pulse 152x/min, BR 48x/min, BP 70/40 mmHG, very slowly skin pinch.Score …

a) 13b) 14c) 15d) 16e) 17

61. A 5 days old baby was brought by her mother to the hospital with vomiting of >10x/day & watery stool of >5x/day without mucous nor blood. There is shunken fontanella. The baby's weight is 3000g & her birth weight is 3500g. What is the diagnosis?

a) Very severe dehydrationb) Severe dehydrationc) Moderate dehydrationd) Mild dehydratione) No dehydration

62. treatment for case …a) RL 24 hoursb) RA 24 hoursc) RL 8 hoursd) RA 24 hours

63. (lupa kes tp cerita dia lebih kurang mcm ni la) ada seorang ibu yg sangat sedih kerana dia mendapati anak dia tak bernafas. Lalu dibawalah ibu itu ke UGD dengan penuh linangan air mata. Doktor mendapati bahawa anak itu telah meninggal. Yang peliknya, tidak ditemukan tanda2 respiratory distress. Dokter tu pon buat la autopsy, lalu tidak jua ditemukan kelainan di situ. pening punya pasal (mybe malas nak pikir dah kot) di pon ckp la baby ni meninggal sebab "Sudden Infant Dead Syndrome"?Cause of SIDS …

a) Hypothermiab) Put back in bedc) Breast feedingd) Rebreathing asphyxiae) Neonatum asphyxia

64. 65. man, unconsciouss, unresponsive.What’s the diagnosis …

a) Deliriumb) Vegetative statec) Lock on syndrome

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d) Drowsinesse) coma

66. what’s GCS in this patient …a) 3-7b) …c) …d) …e) …

67. follow up for patient's brainstem function? I. pupil reflex

II. corneal reflexIII. oculocephalic reflexIV. gag reflex

68. the position has chyne stoke respiration type due to …a) Brain cortical functionb) High intracranial pressurec) Brain hematomad) Brain stem hematomae) Brain stem death

69. 70.I, II, III correct → AI, III correct → BII, IV correct → CAll correct →D71. 50 y/o man come with blurred right eye. 3 hours ago he had accident and got head injury. What’s the correct statement of lens displacement …

I. Slit exam → no lensII. Pain on the right eye

III. Distance vision 1/60 cor S+1.00 D= 6/75IV. Near vision →not disturbed

72. found in lens subluxation I. Decrease vision

II. AstigmatismIII. Monocular diplopiaIV. Iridodenesis

73. treatment for this caseI. Extracapsular surgery with …

II. Intracapsular surgery with …III. Extracapsular with IOLIV. Intracapsular with IOL

74. Ectopia lentis complicationI. Dislocation to anterior chamber

II. Pupillary block

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III. Dislocation to posterior chamberIV. Cataract

75. causes of lens dislocation …I. Blunt injury

II. AccidentIII. Congenital ( marfan syndrome)IV. Perforans (perforation)

76. the disease of foreign bodies in nasal cavity cause by flies meggots …a) Nasal mitosisb) Nasal meiosisc) Nasal maggotsd) Nasal myasise) Nasal worms

77. Appropriate tracheal stoma position for elective tracheostomy is …a) 1-2b) 2-3c) 3-4d) 4-5e) 5-6

78. Rapid killing for foreign body at external auditory canal, except …a) Glyserin oilb) Coconut oilc) Paraffin solutiond) Kayu putih oile) Fried oil

79. Strong indication for elective tracheostomy, according the Jackson’s dyspnea grading is …a) Ib) IIc) IIId) IVe) V

80. The complication may occur from inappropriate treated septal hematoma are …I. Septal perforation

II. Septal abscessIII. Saddle noseIV. Conceal atrophy

81. The cardinal sign’s of menierre disease ….I. Tinnitus

II. Sensory neural hearingIII. VertigoIV. Severe pain

82. the statement below are related to the posterior nasal bleed, except …a) Woodruff’s plexusb) Belloc’s tampon

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c) Sphenopalatine arteryd) Superior labial arterye) Large in diameter vascular involvement

83. the statement below are situation which need urgent procedure, except …a) Coins of esophageal foreign bodiesb) Café coronaryc) Uncontrolled nasal bleedd) Diphterie of the larynxe) Grade lil Jackson dyspnoe

84. rapid killing for foreign body at external auditory canal, except …a) Glyserin oilb) Coconut oilc) Paraffin solutiond) Kayu putih oile) Fried oil

85. mostly blood supplies in the nasal cavity from external carotid arteryBecauseOnly blood ethmoidal arteries are branches from internal carotid artery86. Kasus Glaukomaalat untuk mengukur tekanan intraocular …

a) …b) Tonometerc) ..d) …e) ..

87. alat untuk melihat scar pada trabecular meshwork …a) Gonioscopyb) …c) ..d) Ant OCTe) Bio..

88. 89. diagnosis …

a) Glaucoma resses angleb) Pigmented glaucomac) Neovascular glaucomad) …e) …

90. there’s scar In trabecular meshwork more half.Treatment of this case are …

a. Trabeculoctomyb. Baerveld shuntc. Iridectomyd. A + B

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e. A+B+C91. perempuan datang ditemani oleh suaminya. Keluhan …Sebagai seorang dokter apa yang harus qta lakukan …

a) Memberi informed consent pada suaminya bahwa istrinya akan diobservasib) …c) …d) …e) ..

92. her mother has bleeding pervaginam (klo gak salah).TD 80/60, pulse 110 x/rate, respiration 20 x/ menit.The examination we do, except ….

a. …., Leopold, fetal heart rateb. Setting IV line, ukur output dan inputc. Inspeculo examinationd. Vagina examinatione. Ultrasonography

93. perdarahan vagina, no pain, heal 5/5, no contraction.Diagnosis …

a. Placenta previab. Abruption placentac. …d. …e. Vasa previa

94. pada abrutio placenta, etiologic yang paling sering ..a) Infeksib) External rotationc) Trauma abdomend) Short umbilical corde) hypoxia

95. patient, datang tiba-tiba mengalami penurunan penglihatan, dan mengeluh floaters, photophobia, ….has history of high myopiawhat’s the diagnosis ….

a) Central vena occlusionb) Central artery occlusionc) Branch vena occlusiond) ..e) Retinal detachment

96. 69 y/o man has sudden visual loss, segment anterior normal. Milky white appearance, red cherry spot.Diagnosis …

a) Central vena occlusionb) Central artery occlusionc) Branch vena occlusion

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d) ..e) Rhegmatous retina

97. cotton wool spot, red fovea spot.Diagnosis …

a) Central vena occlusionb) Central artery occlusionc) Branch vena occlusiond) Branch artery occlusione) Rhegmatous retina

98. 60 y/o woman sudden inferonasal vision loss. Control visual acuity 6/6. If patient diagnose with rheugmatous retina detachment. Possible location of retinal detachment …

a) superotemporal retina, involved macula b) superotemporal retina, macula still intactc) inferonasal retina, involved maculad) inferonasal retina, macula still intact.e) superior retina.

99. a man come to ophthalmology outpatient clinic with bloody appearance of his eye, which occur suddenly 2 days before. Ophthalmology showed conjunctival hiperemia with clear cornea.This patient is likely to have ….

a) Hyperemiab) Conjunctival chemosisc) Subconjunctival bleedingd) Corneal edemae) Conjunctivitis

100. cause of that case except …a) Vascular disorderb) Ocular traumac) Unknownd) Infectione) Prev. hypertension

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