SOAL-SOAL MIKRO MID

1. Singkatnya,,seorang bapak batuk2 dan berkeringat dimalam hari, oleh dokter dianjurkan pemeriksaan dahak : A. p-s-p B. s-p-s C. p-s-s D. s-s-p E. s-p-p 2. Postulat Koch (soal ngulang) 3. Vaginal trush example of . . . Flora normal a.translokasi b.cross infection c. Overgrowth d. Distruction e. Natural change Vaginal thrush= vaginal yeast infection, caused by Candida albicans
It is a type of fungal infection - a yeast infection - caused most commonly by the fungus Candida albicans (in over 90% of cases). Although C. albicans is part of the normal flora that lives in the mouth, throat, intestine and vagina, it may become pathogenic and cause symptoms such as vaginal discharge and pruritis (itchiness) of the vulva. This occurs when the normal environment of the vagina changes as a result of several precipitating factors such as pregnancy, use of antibiotics, diabetes mellitus, HIV, chronic debilitating disease etc which in turn allows the fungus to multiply to abnormal levels and causes the signs and symptoms of vaginal thrush.

4. Which of the following result from translocation of normal flora to a normally sterile site ? a. Dental cavities b. Peritonitis c. Gastroenteritis d. Conjunctivitis e. Upper respiratory tract infection Steril: lower respiratory tract, peritoneum
Normal Flora of the Conjunctiva A variety of bacteria may be cultivated from the normal conjunctiva, but the number of organisms is usually small. Staphylococcus epidermidis and certain coryneforms (Propionibacterium acnes) are dominant. Staphylococcus aureus, some streptococci, Haemophilus sp. and Neisseria sp. are occasionally found. The conjunctiva is kept moist and healthy by the continuous secretions from the lachrymal glands. Blinking wipes the conjunctiva every few seconds mechanically washing away foreign objects including bacteria. Lachrymal secretions (tears) also contain bactericidal substances including lysozyme. There is little or no opportunity for microorganisms to colonize the conjunctiva without special mechanisms to attach to the epithelial surfaces and some ability to withstand attack by lysozyme. Pathogens which do infect the conjunctiva (e.g. Neisseria gonorrhoeae and Chlamydia trachomatis) are thought to be able to specifically attach to the conjunctival epithelium. Newborn infants may be especially prone to bacterial attachment. Since Chlamydia and Neisseria might be present on the cervical and vaginal epithelium of an infected mother, silver nitrate or an antibiotic may be put into the newborn's eyes to avoid infection after passage through the birth canal.

Seorang anak 9th (BB 25kg) batuk diagnosa : community acquired pneumonia dokter meresep amoxili, dosis harian : 25-50 mg/kg BB /hari 5. Frekuensi pemberian antibiotik yang benar: a. amoxilin 3x250 b. 1x750 c. 250/8jam d. 750/24jam e. 1500/48jam

6. Berdasarkan hub daya bunuh dgn konsentrasi obat antibiotik: amoksilin ....... termasuk : a. time dependent b.comcentration dependent c. time &conc dependnt d. distributor dep e. elimination dependent Time-dependent killing: beta-lactams (penicillins, cephalosporins, carbapenems, monobactams), clindamycin, macrolides (erythromycin, clarithromycin), oxazolidinones (linezolid) Concentration dependent killing: aminoglycosides and quinolones 7. Ciri clostridium tetani (soal ngulang) 8. antibodies function to: a. directly destroy foreign organ grafty b. mark invading organism for destruction c. kill intracelluler virus d. promote cytokinen synthesis e. stimulate T cell growth 9. Terapi antibiotik yg diberikan sblm keluarnya hasil kultur dan didasarkan pengetahuan dan pola kuman yg ada di RS disebut sbg : a. Terapi antibiotik profilaksin b. definitif c. empirik d. a+b e. a+c Empiric therapy :Initiation of treatment prior to determination of a firm diagnosis Definitive therapy: Organism and susceptibilities are known Prophylaxis: Prevent initial or recurrent infection 10. which one is the best choice for blood culture? a. culture after antibiotic injection, b. culture immediately before antibiotic injection, c. culture before and after antibiotic injection, d. culture 2 days before antibiotic injection,e. culture and injection at the same time 11. Hasil kultur darah pasien MRSA antibiotik nya adl : a. amoxilin b. gentamycin c. cefotaxin d. cerfriaxone e. Vancomycin Staphylococcus aureus Common cause of nosocomial infections

Becoming increasingly resistant In past 50 years most strains acquired resistance to penicillin Due to acquisition of penicillinase genes Until recently most infections could be treated with methicillin (penicillinase resistant penicillin) Many strains have become resistant MRSA methicillin resistant Staphylococcus aureus MRSA many of these strains still susceptible to vancomycin Some hospitals identified VISA VISA vancomycin intermediate Staphylococcus aureus
12. Diantara antibiotik berikut yg bekerja menghambat dinding sel : a.Penicillin b. chloromphenicol c.quinolone d.ami..cin e. Eryteomycin Chloramphenicol, amikacin, erythromycine: sintesis protein Quinolone: DNA/RNA 13. Seseorang terkena Athlete's foot after medication. What Term of this infection? A. Nosocomial inf. B. Exogenous inf. C. Endogenous inf. D. Iatrogen inf. Iatrogenic refers to any disease or complication of treatment inflicted (unwittingly) by a physician or surgeon. It can range from a trivial rash induced by prescribing a drug to which a patient is allergic, to major errors such as

operations on the wrong side. The general estimate is that abou 10-15% of all admissions to hospitals are the result of iatrogenic illness. nosocomial refers, as said here, to illnesses, usually infections contracted whilst a patient is in hospital and can vary from catching a cold from the patient in the next bed to serious infections often acquired by airborne spread. It has the same origins in Greek, nosos = disease, as Nosology (classification of) etc. 14. Media kultur dengan pH tinggi bisa untuk bakteri... a.Staphylococcus aureus b.Streptococcus pneumoniae c.H. influenzae d.Vibrio cholerae e.Neisseria meningitidis Most human pathogens are neutrophiles, i.e., the have optimal pHs which bracket pH An exception is Vibrio cholerae which is a alkaliphile 15. PCR: sensitive, cepat 16. INFECTION IS: A.Bacteria enters the human body B.Infection always followed by inflammation C.Infection has meaning same with an Inflammation D.To be clinically overt, it needs a sufficient infection doses E.The diagnosis must need a microbiology examination 17. Mikroba yang dibasmi pada sterilisasi ? 18. Stetoskop agar aman bagaimana? 19. Plasma membrane fungi mengandung: ergosterol 20. Sterilisasi alat bedah minor ? Untuk kit minor surgery sterilisasipanas: yaitudenganmenggunaakanuappadasuhu 121oC dalamtekanan 106 kPaselama 20 menit (autoclave); dalam oven selama 1 jam padasuhu 171oC; rebus pada air mendidihselama 20 menit (Disinfeksitingkattinggi). Sterilisasikimia: yaitudenganmerendampadalarutanformaldehid 8% selam 24 jam; larutanglutardehidselam 8-10 jam; clorin 0,5% selam 10 menit (air pelarutnyamendidih); Hidrogenperoksida 6% selama 20 menit. Saran: cukupdirebusdalam air mendidihselam 20 menitpraktis, tidakmahal, tidakkorosif.
21. Pada pengecatan dapat dilaporkan a. bentuk b. sifat pengecatan c. sifat anaerob/aerob d. a+b benar e. semua benar 22. cara ngambil darah yg benar pada orng yg sesak napas? a. mll iv setelah disinfeksi b ga blh repalpasi c tdk perlu diinfeksi lg abis repalpasi d ab e abc Daerah tindakan tidak boleh disentuh lagi dengan tangan (repalpasi) ! ! 23. cara ngambil urine pd kateter 24. orng yg pd punggungnya bintik2 putih? Tinea versicolor -> Malassezia furfur 25. khasnya no.24? Spaghetti meatballs appearance 26. orng yg ad kemerahan melebar? dermatidis(?) 27. antibiotik untuk MRSA antibiotik yang menghambat pembentukan dinding sel vancomycin

28. Pernyataan yang benar mengenai Healthcare Associated infection adalah .. Hospital Acquired Infection HealthcareAssociated Infection: Infeksi yg terjadi selama proses perawatan di RS ataufasilitas perawatan kesehatan lainnya, yg tidakdidapatkan atau tidak dalam masa inkubasi saatdatang. Termasuk: infeksi yang didapatkan di RS tetapi baruterlihat setelah dipulangkan Juga termasuk: infeksi yg terjadi pada pekerjakesehatan 29. Mikrobiologi klinik a. penyebab infeksi adalah mikroba saja b. sistem imun untuk melawan infeksi 30. Morfologi Clostridium tetani : a. bentuk batang b. berspora c. gram positif 31. Yang tidak memiliki enzim katalase dan super peroksidase: clostridium tetani Karena Clostridium anaerob obligat 32. Hal penting pada penanganan dan pengambilan bahan untuk pemeriksaan mikrobiologi: bila sudah diberi antimikroba, beri keterangan pada formulir permintaan 33. Pengambilan sampling telinga 34. Cat untuk Corynebacterium diphteri: Neisser Cat untuk Clostridium tetani: a. carbol gelantin violet, b. lugol, c. alcohol 70% d. a dan b benar e. a,b,c benar Pengecatan giemsa 35. Obat antifungi yang menghambat pembentukan ergosterol: azoles Pengobatan fungi: Penghambat biosintesis ergosterol : azoles, allylamine, morpholine

Membentuk komplek dg ergosterol: polyenes Menghambat sintesis DNA dan RNA : 5-fluorocytosine Menghambat mitosis sel: griseofulvin 36. Jamur encapsulated yeast like yang penetrasi ke otak: Cryptococcus neoformans 37. Di sekitar mammae ada bercak kemerahan, bentuk mikroskopis coccus gram positif, jamurnya Candida albicans 38. Oral thrush pada bayi yang berasal dari flora normal vagina ibu: Candida albicans 39. Ikatan virus pada jaringan karena: a. receptor virus pada sel, b. kemampuan sel untuk replikasi virus Viral affinity for specific body tissues (tropism) is determined by: 1. cell receptors for virus, 2. cell transcription factors that recognize viral promoters and enhancer sequences, 3. ability of the cell to support virus replication, 4. physical barriers, 5. local temperature, pH, and oxygen tension enzymes and nonspecific factors in body secretions, and 6. digestive enzymes and bile in the gastrointestinal tract that may inactivate some viruses 40. Virus bersifat self limiting disease menyebabkan infeksi kronis A. HIV B. hepatitis B C. Hepatitis C D. A dan B E. A B C 41. HOST AGENT RELATIONSHIP AND INFECTION WHEN OCCURED: A.Bacteria stronger than the human body B.The human body stronger than bacteria

C.Bacterial flora has protective role D.Innate immunity has functions as primary defence system E.Adaptive immunity has function less specific than innate immunity 42. HOW TO COLLECT SPECIMENS ? A.Specimen must be taken from the site of infection B.Pathogenesis of infection will guidance specimen collection C.The concept of normal flora must be always bear in mind D.Must consider a time of infection E.Must be transport it to laboratory immediately 43. Yang benar mengenai organisasi sel prokariot ? A. Tidak terdapat operon B. Kromosom gen terdapat di dalam inti C. Gen pada kromosom prokariot lebih banyak dari pada manusia D. Pada prokariot gen terdapat pada DNA-kromosom dan DNA-plasmid E.Jumlah Interon pada prokariot banyak sehingga memerlukan splicing 44. Yang dimaksud seleksi dalam resisten antibiotic: bakteri yang sensitive mati, bakteri yang resisten dominan 45. Bakteriocidal: host defense cannot be replied upon to control pathogen, MBC=MIC 46. Biosavety dan biosecurity adalah bagian dari PPI pada lokasi a.komunitas b.instalasi rawat inap c.puskesmas d.laboratorium e.instalasi rawat jalan 47. Yg diharapkan pd pengecatan M.tb.. A. Batang B. Merah C. Spora di ujung D. A+B E. A+B+C 48. what is pandemic? A pandemic (from Greek pan "all" + demos "people") is an epidemic of infectious disease that has spread through human populations across a large region; for instance multiple continents, or even worldwide. 49. Sv
PRE 1. Uji tbc yg spesifisitas nya tinggi A. Kultur B. Tes tuberkulin C. Pengecatan BTA D. Foto thorax E. Dah lah, pokoknya pilihnya A aja haha 2. susu formula yang dinyatakan IPB bla bla bla. enterobacter sakazakii merupakan : (soal ngulang) 3. untuk membedakan staphylococcus aureus dg staphylococcus yg lain A. hyaluronidase B. koagulase C. katalase D. opthochin E.novobiocin 4. kandungan pada m.tuberculosa yang sesuai tes tuberkulin: protein 5. Material pengecatan untuk mencari Chlamydia sp. A.immunofluorecens B.Giemsa C.Neisser D.A+B benar E.A+B+C benar Immunofluorescence staining was significantly more sensitive than Giemsa staining for detecting chlamydial inclusions 6. bagian clamydia yg infeksiusa.inclusion body. b.enteral.... body c. inisial body d. a & b e. a, b & c

Chlamydiae replicate intracellularly in what is called an inclusion--a membrane bound structure. This inclusion is able to avoid lysosomal fusion and degradation. Thus, the metabolically inactive elementary body form of chlamydia is able to become the reticulate body. The multiplying reticulate bodies then become elementary bodies again and burst out of the host cell to continue the infection cycle. Since Chlamydiae are obligate intracellular parasites, they cannot be cultured outside of host cells, leading to many difficulties in research 7. membedakan staphylococcus dan streptococcus dengan tes : catalase 8. ciri Bacillus : kuman bentuk batang, gram positif, berspora 9. common source of enterobacter sakazakii : a. can be detected in the gut of healthy human bla bla b. can be isolated from wide variety food c. can be isolated from hospital d. ab benar e. abc benar Common source The bacterium can be detected in the gut of healthy humans. It can also be found in the gut of animals as well as in the environment. Enterobactersakazakii can be isolated from a wide variety of foods. The only food that has been identified with illness is reconstituted milk-based powdered infant formula. 10. kemungkinan besar menjadi kronis adalah infeksi oleh: virus hepatitis A/B/C/D/E 11. C.trachomatis dapat mnyebabkan ... a. salpingitis b. uretritis c.servisitis d.ab benar e.abc benar Sexually transmitted urethritis, cervicitis, proctitis, and pharyngitis not due to gonorrhea are caused predominantly by chlamydiae and infrequently by mycoplasmas or Ureaplasma sp. Chlamydiae may also cause salpingitis, epididymitis, perihepatitis, neonatal conjunctivitis, and infant pneumonia. 12. enterobacter sakazakii infection is a foodborne pathogen which : a. has been associated with sporadic cases of meningitis bla blab. particular risk is children <1 yo c. in most cases the infection has been linked to milk based powdered bla bla d. ab benar e. abc benar 13. susu formula terkontaminasi dgn cara : a. kontaminasi intrinsik b. proses psteurisasi c. kontaminasi eksternal d. ab benar e. abc benar There are two main routes by which E. sakazakii can enter reconstituted infant formula: A) Through intrinsic contamination: -through the raw material used for producing the formula -through contamination of the formula or other dry ingredients after pasteurisation b) Through external contamination: -During reconstitution and handling. 14. kasus, diare cair dan disertai darah. semakin parah krn toxic megacolon. diagnosis a. tifoid dgn perforasi usus b. chronic ulcus duodeni c. c. difficile-associated-diarrhea d. ab benar e. abc benar 15. tanda khas kasus toxic megacolon a. bloody diarrhea and pseudomembranous colitis b. HUS c. perforasi usus dan sepsis d. ab benar e. abc benar 16. diagnosis mikrobiologi u/ C.difficile paling tepat a. deteksi toxin a dan b b. kultur c. pem mikros d. ab benar e. abc benar 17. bagian dari M. tubersulosis yang bisa melindungi dirinya dari makrofag a. exotoxin b. endotoxin c. cord factor d. m protein e. Kapsul It is a surface glycolipid which blocks macrophage activation by IFN-, induces secretion of TNF and causes Mycobacterium tuberculosis to form cords in vitro. This is the main virulence factor for the mycobacterium tuberculosis that makes it resistance to anti-tuberculosis medications.

18. Yang benar mengenai intoksikasi makanan A. Bakteri masuk bersama makanan B. bakteri bersama makanan multiplikasi di usus C. Keracunan setelah 1-6 jam D. AB benar E. ABC benar

Infection :A foodborne disease is when a person eats food containing harmful microorganisms, which then grow in the intestinal tract and cause illness. Some bacteria, all viruses, and all parasites cause foodborne illness via infection. The foodborne bacteria that cause infection are: Salmonella spp., Listeria monocytogenes, Campylobacter jejuni, Vibrio parahaemolyticus, Vibrio vulnificus, and Yersinia enterocolitica. The most common viral agents that cause foodborne disease are: Hepatitis A, norovirus, and rotavirus. The most common foodborne parasites are: Trichinella spiralis, Anisakis simplex, Giaria duodenalis, Toxoplasma gondii, Cryptosporidium parvum , and Cyclospora cayetanensis. Intoxication: An intoxication results when a person eats food containing toxins that cause illness. Toxins are produced by harmful microorganisms, the result of a chemical contamination, or are naturally part of a plant or seafood. Some bacteria cause an intoxication. Viruses and parasites do not cause foodborne intoxication. The foodborne bacteria that cause intoxication are: Clostridium botulinum, Staphylococcus aureus, Clostridium perfringens , and Bacillus cereus. Chemicals that can cause an intoxication include cleaning products, sanitizers, pesticides and metals (lead, copper, brass, zinc, antimony, and cadmium). Seafood toxins include ciguatera toxin, scombroid toxin, shellfish toxins, and systemic fish toxins. Plants and mushrooms can also cause an intoxication. Toxin-mediated infection: A toxin-mediated infection is when a person eats food containing harmful bacteria. While in the intestinal tract, the bacteria produce toxins that cause illness. Some bacteria cause toxin-mediated infection. Viruses and parasites do not cause a toxin-mediated infection. The foodborne bacteria that cause toxin-mediated infection are: Shigella spp. And Shiga toxinproducing Escherichia coli. SOURCE: American Public Health Association. 2000. Control of Communicable Diseases Manual. J. Chin, Editor. Washington, DC. 624 pp
If symptoms occur within 16 hours after eating the food, it suggests that it is caused by a bacterial toxin or a chemical rather than live bacteria

19. ibu ibu mau melahirkan. riwayat hepatitis b. sebagai dokter apa yanganda lakukan ? a. merujuk ke SpOg b. merujuk ke lupa? c. merujuk ke bidan d lupa e. tetap menolong persalinan dgn memperhatikan prinsip pencegahan 20. agar tidak terjadi penularan vertical, dapat dilakukan a. vaksin bla bla 12 jam b. vaksin 0-1-6 bulan c. terapi antiviral pada ibu d. ab benar e. abc benar

If I am pregnant and have hepatitis B, how can I protect my baby?

If you test positive for hepatitis B, then your newborn must be given two shots immediately in the delivery room:

first dose of the hepatitis B vaccine one dose of the Hepatitis B Immune Globulin (HBIG).

If these two medications are given correctly within the first 12 hours of life, a newborn has more than a 90% chance of being protected against a lifelong hepatitis B infection. You must make sure your baby receives the second and third dose of the hepatitis B vaccine at one and six months of age to ensure complete protection.
21. semisal anda tetap menolong persalinan, apa yang harus anda lakukan ? a. imunisasi aktif b. memakai sarung tangan pjg c. lupa d. ab benar e. abc benar 22. Sifat Chlamydia sp A. Obligat intra sel B. punya DNA C. Punya RNA D. Ab benar E. abc bena 23. hasil pemeriksaan dikatakan negatif hepatitis B jika didapatkan hasil? Positif kalau HbsAg + 24. Kasus riwayat kecelakaan, luka di telapak kaki dan pus di tibia dextra. Mulut tidak bisa terbuka. Diagnosisnya a. C. Tetani b. C. Botulinum cde. dan spesies clostridium lainnya Kejang otot: mula mula pada daerah luka dan infeksi, otot otot rahang (trismus, rahang terkunci, lock jaw) mulut tidak dapat dibuka 25. pemberian antibiotik pada kasus diare, kurang dianjurkan karena : a. self-limiting disease b. kebanyakan disebabkan virus c. kemungkinan karena parasit d. ab benar e. abc benar 26. Kasus pernah jatuh, menginjak sebuah benda, terdapat kejang: C.tetani 27. Pemberian obat lini pertama pada penderita tuberculosis: rifampisin, isoniazid, pirazinamid, etambutol, dan streptomisin 28. membedakan staphylococcus epidermidis dan staphylococcus saprophyticus: a. opotorchin b. bacitracin c. novobiasin d. ab benar e. abc benar 29. termasuk food poisoning adalah a. b cereus b. stp. aureus c. cl. botulinum d. ab benar e. abc benar 30. BTA 12-14/lap pandang menurut IUATLD a. 12-14 b. pos 1 c. pos 2 d. pos 3 e. pos 4 Penilaian menurut IUATLD (International Union Against Tuberculose Lung Diseases) Negatif : Tidak dijumpai adanya BTA. Positif : Ditemukan 1-9 BTA/100 LP. Positif 1 : Ditemukan 10-90 BTA/100 LP. Positif 2 : Ditemukan 1-10 BTA/1 LP. Positif 3 : Ditemukan lebih dari 10 BTA/1 LP. 31. Pembiakan media bakteri mycobacterium timbul biakan kurang dari 7 hari. a. m. tuberculosa bcd. spesies mycobacterium lainnya, e. mycobacterium non tuberculosa Rapidly growing 6.3.1 Mycobacterium chelonae clade

6.3.2 Mycobacterium fortuitum clade 6.3.3 Mycobacterium parafortuitum clade

6.3.4 Mycobacterium vaccae clade

32. media lowenstein jensen terbuat dari ? Malachite green

Mycobacterium tuberculosis on Lwenstein-Jensen medium after 6 weeks of cultivation, 37C. Typical eugonic growth on Lwenstein-Jensen medium: buff to yellow, rough wrinkled colonies. The green color of the medium is due to the presence of malachite green which is one of the selective agents to prevent growth of most other contaminants

33. Dokter yang membantu persalinan ibu dengan penyakit hepatitis b. A. Menggunakan sarung tangan panjang anti bocor B. Menggunakan masker N95 menghindari bioaerosol C. Melakukan imunisasi aktif sebelum melakukan persalinan D. AB benar E. ABc benar 34. c. ptisis bisa ditanamkan pada a. kuning telur berembrio b. abdominal tikus c. kultur jaringan d. ab benar e. abc benar 35. Laki2 26th, keluar nanah dari kaki. Pemeriksaan fisik: luka dg pus pada tibia dx. Pemeriksaan lab mikro: koloni bulat, hemolisis +, katalase +, koagulase +.diagnosis: Staphylococcus aureus 36. Hasil pengecatan gram jawaban no.35 37. untuk memastikan penyebab penyakit diatas (soal anak SD nyeri ulu hati, teman2nya juga bla bla bla) harus periksa? a. kadar ALT/AST darah b. kadar bilirubin dire-indirek darah c. kadar alkaline fosfatase darah d. anti HBS e. anti HAV IgM diagnosis: hepatitis A 38. Spesimen terbaik untuk kultur pada pasien demam tifoid... A. Darah/aspirasi sumsum tulang, B. Tinja, C. Urine, D. A&B, E. A,B,C benar 39. Pemeriksaan non invasif utk diagnosis bakteri penyebab gastritis&ulcus pepticum... A. Kultur dari bahan mukosa gaster, B.pemeriksaan histopatologi, C.pemeriksaan mikroskopis dari bahan mukosa gaster, D.deteksi IgG&IgA, E.endoskopi 40. MDR untuk M tuberkulosis minimal : a.isoniazid (kalo ga salah) b.Rifampisin c.Quinolone (kalo ga salah) d.ab bener e.abc benar MDR: Multiple Drug Resistance -> resisten terhadap first line drug, menggunakan second line drug 41. Terapi dan pencegahan AAD : A. Antibiotik metronidazole dan pada kasus berat kombinasi dengan vancomisin B. bijak menggunakan antibiotik C. Contact precauntion & hypochlorite based for surface desinfection D. Vaksin aktif s. thypii E. abc benar 42. Terapi C.ptettusi dengan a. Penisillin b. Tetrasiklin c.eritromisin d. A dan B bnar e. A,B,C benar tetracycline and its derivatives are generally an effective treatment for Chlamydia 43. Tubex tes untuk mendeteksi adanya... a.IgM b.IgG c.IgM dan IgG d.lupa e.lupa Widal Test : IgM dan IgG 44. Keracunan makanan karena staphylococcus akibat produksi.. Enterotoksin 45. penyebab keracunan krna makanan kaleng c.botulinum c.perfringens c.... 46. Yang benar tentang Salmonella typhi: mean infective dose 10^3, pilihan lain lupa 47. Yang menyebabkan H.pylori dapat tinggal di mukosa gaster adalah: mempunyai enzim urease sehingga dpt menghasilkan ammonia u/ menetralkan asam lambung, flagella, adhesin

To colonize the stomach, H. pylori must survive the acidic pH of the lumen and use its flagella to burrow into the mucus to reach its niche, close to the stomach's epithelial cell layer.[23] Many bacteria can be found deep in the mucus, which is continuously secreted by mucus-secreting cells and removed on the luminal side. To avoid being carried into the lumen, H. pylori senses the pH gradient within the mucus layer by chemotaxis and swims away from the acidic contents of the lumen towards the more neutral pH environment of the epithelial cell surface.[24]H. pylori is also found on the inner surface of the stomach epithelial cells and occasionally inside epithelial cells. [25] It produces adhesins which bind to membrane-associated lipids and carbohydrates and help it adhere to epithelial cells. For example, the adhesin BabA binds to the Lewis b antigen displayed on the surface of stomach epithelial cells. [26]H. pylori produces large amounts of the enzyme urease, molecules of which are localized inside and outside of the bacterium. Urease breaks down urea (which is normally secreted into the stomach) to carbon dioxide and ammonia. The ammonia is converted to ammonium by accepting a proton (H+), which neutralizes gastric acid. The survival of H. pylori in the acidic stomach is dependent on urease. The ammonia produced is toxic to the epithelial cells, and, along with the other products of H. pyloriincluding proteases, vacuolating cytotoxin A (VacA), and certain phospholipases, damages those cells.[27] 48. Soal tentang probiotic yang ngulang 49. Tes tuberkulin + mengindikasikan:

Tes Mantoux dinyatakan positif apabila diameter indurasi > 10 mm. Kemungkinan yang perlu dipikirkan pada anak dengan hasil tersebut: 1. Terinfeksi tuberkulosis secara alamiah 2. Infeksi TB mencakup infeksi TB laten, sakit TB aktif, atau pasca terapi TB. 3. Pernah mendapat imunisasi BCG (pada anak dengan usia kurang dari 5 tahun) 4. Pada pasien usia kurang dari 5 tahun dengan riwayat vaksinasi BCG kecurigaan ke arah infeksi alamiah TB bila hasil uji Mantoux > 15 mm. 5. Infeksi mikobakterium atipik Meskipun demikian, hasil uji Mantoux > 5 mm dapat dipertimbangkan positif pada pasien tertentu seperti : a. Pasien dengan infeksi HIV b. Pasien dengan transplantasi organ atau mendapat imunosupresan jangka panjang seperti pasien keganasan atau sindrom nefrotik
50. Cara pengambilan sampel di conjunctiva yang terinfeksi Chlamydia trachomatis adalah kerokan epitel Bila dicurigai adanya Chlamidia, lakukan kerokan epitel conjungtiva Giemsa.