Archive for March, 2012


An 82-year-old previously healthy woman with a recent upper respiratory infection presents with generalized weakness, headache, and blurry vision. For the past 2 weeks she has had upper respiratory symptoms that started with a sore throat, nasal congestion, and excessive coughing. She went to her primary care doctor 4 days ago and was diagnosed with sinusitis. She was given a prescription for an antibiotic and took it for 2 days, then stopped. She thereafter had chills, lightheadedness, vomiting, blurry vision, general achiness, and a headache that started abruptly and has not gotten better since. Except for blurry vision, she has not had any other visual symptoms. The blurry vision remains when she closes either eye. She also has eye tenderness with movement and mild photosensitivity. She has no drug allergies. Exam findings include temperature of 102.5°F, nuchal rigidity, and sleepiness. Which of the following is the next most appropriate action in this case?

a. Get a brain MRI, then perform a lumbar puncture

b. Give the patient a prescription for oral azithromycin and let her go home

c. Immediately give intravenous ceftriaxone plus ampicillin

d. Immediately start intravenous acyclovir

e. Obtain cerebrospinal fluid and blood cultures and observe the patient until the results come back

the answer is below…

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A 57-year-old woman is involved in a motor vehicle accident in which she strikes the windshield and is briefly unconscious. She makes a full recovery, except that 3 months later she notices that she cannot taste the food she is eating. This is most likely due to which of the following?

a. Medullary infarction

b. Temporal lobe contusion

c. Sphenoid sinus hemorrhage

d. Phenytoin use to prevent seizures

e. Avulsion of olfactory rootlets

the answer is below…

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Cerita singkat?
Iya.

Hehe… Saya sengaja membagi cerita perjalanan tiga hari dua malam ke Yogyakarta ini menjadi beberapa bagian. Bukan karena terlalu panjang, namun untuk memudahkan bercerita saja.

Segalanya berawal dari munculnya Cahyo Alkantana di Kick Andy. Keinginan yang sejak dulu ingin caving pun jadi bangkit. Kebetulan saya dan sahabat-sahabat saya sedang ada waktu luang dan pun ada tanggal merah di hari jumat. Baiklah, kami putuskan untuk berangkat.

Kami pun mencari sumber informasi. Praba berperan paling banyak dalam trip kami kali ini. Praba mendapat nomor kontak seseorang yang dapat membantu dan menemani kami caving di Gunung Kidul. Namanya mas Cetoel.

Mas Cetoel ini rekan Cahyo Alkantana juga. Namun bila resort Jomblang dimana mas Cahyo sebagai pemiliknya menawarkan caving Goa Jomblang saja, mas Cetoel ini menawarkan caving dua goa dalam dua hari berturut-turut. Salah satunya tentu Goa Jomblang.

Maka kami deal.

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Saya dan Praba di Terminal Arjosari Malang

Kamis malam (22/03) kami-saya, Bayu, dan Praba-berangkat menuju Surabaya dengan bus patas. Kami sampai di Terminal pukul 21.00. Isi perut sejenak lantas kami menunggu bus ekonomi Surabaya-Yogyakarta.

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24 Maret 2012.

Catatan Perjalanan.
Angkringan Jogja.
Lintas ramai kaki lima.
Backpacker.
Adventourer.
Penikmat malam.

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angkringan jogja

Pojokan dekat stasiun.
Lesehan.
Ditemani susu jahe nan menggoda.
Dan kopi joss nan nikmat.

Rinai rintik menyesap.
Menemani ringin sejuk.
Sekaligus hangat.

Malam Mu, bagi kami.
Selepas lelah menyusur Goa.

Yogyakarta.
22.49

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A 32-year-old man from a rural area of southern Africa was recently brought to the United States by some of his family members who had emigrated previously. His family says that he was diagnosed with syphilis at age 16 and has taken penicillin off and on over the years, but never completed the prescribed course. Assuming that he has neurosyphilis, which of the following is true with regard to the classic pupillary defect most likely to be observed?

a. Completely normal (no defect)

b. Reacts poorly to light but accommodates well

c. Accommodates poorly but reacts well to light

d. Is pinpoint and regular in shape

e. Is fixed and dilated

the answer is below…

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A mother brings her daughter in to see you for consultation. The daughter is 17 years old and has not started her period. She is 4 ft 10 in. tall. She has no breast budding. On pelvic examination, she has no pubic hair. By digital examination the patient has a cervix and uterus (emang boleh ya?). The ovaries are not palpable. As part of the workup, serum FSH and LH levels are drawn and both are high. Which of the following is the most likely reason for delayed puberty and sexual infantilism in this patient?

a. Adrenogenital syndrome (testicular feminization)

b. McCune-Albright syndrome

c. Kallman syndrome

d. Gonadal dysgenesis

e. Müllerian agenesis

the answer is below…

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A 28-year-old nulligravid patient complains of bleeding between her periods and increasingly heavy menses. Over the past 9 months she has had two dilation and curettages (D&Cs), which have failed to resolve her symptoms, and oral contraceptives and antiprostaglandins have not decreased the abnormal bleeding. Which of the following options is most appropriate at this time?

a. Perform a hysterectomy

b. Perform hysteroscopy

c. Perform endometrial ablation

d. Treat with a GnRH agonist

e. Start the patient on a high-dose progestational agent

the answer is below…

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During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient?

a. Stress

b. Primary hyperthyroidism

c. Anorexia nervosa

d. Congenital adrenal hyperplasia

e. Polycystic ovarian disease

the answer is below…

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Weits. Bertahan hidup di fakultas kedokteran? Macam mau perang saja ini. Hehe… tapi memang benar. Belajar di fakultas kedokteran itu butuh tips dan trik. Buat apa? Biar bisa lulus? Basi!! Lulus itu mudah. Tapi lulus dan sukses itu beda, bro.

Ingat ketika pertama kali kita menginjakkan kaki di fakultas kedokteran? Wow!!. Berjuta rasanya. Tapi pernah nggak kita merasa tetiba sudah di semester 5.

Ndak terasa ya…”

Atau macam saya ini. Ketika wisuda, “lha semacam baru kemarin saya di-ospek.” Ah. Awet muda memang. Berasa muda selalu. Hehehe… begitulah. Kenapa? Karena hidup kita telah berubah secara dramatis selama kita sekolah di kedokteran. Dan itu tidak kita sadari. Kenapa? (Lagi!)

Karena hidup kita tertelan dalam rutinitas. Terutama saat koass. Hidup normal saja sulit. 24 jam tidak lagi mampu mengakomodasi kebutuhan kita menelan se-abreg data untuk ujian. Ingat modul histologi yang terbagi menjadi empat dan bahkan masing-masing setebal batu bata (lebay) pun ukuran A4 (nangis). Well, bagaimana kita bisa tidur dan makan ya…

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A 19-year-old woman with headaches and visual blurring has prominent bulging of both optic nerve heads with obscuration of all margins of both optic discs. Her physician is reluctant to pursue neurologic studies because the patient is 8 months pregnant and had similar symptoms during the last month of another pregnancy. Her physical and neurologic examinations are otherwise unrevealing. If neuroimaging studies were to be performed on this woman, they probably would reveal which of the following?

a. A subfrontal meningioma

b. Intraventricular blood

c. Slitlike ventricles

d. Transtentorial herniation

e. Metastatic breast carcinoma

the answer is below…

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