Professional Documents
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2. An infant, seen in ER, presents with fever and persistent cough. PE and
CXR showed Pneumonia. Which of the following is most likely the cause of
this infection?
A. Rotavirus
B. Adenovirus
C. Coxsackievirus
D. RSV
E. Rhinovirus
16. A 37 yo man presence to the office for the evaluation of cough and
fever. He has had these symptoms for about a week. His pulmonary
examination is notable for some taint expiratory wheezing and crackles in
the left upper lung field. A culture from respiratory specimen grows on
saburoudagarrepresent a rough walled of round macroconidia and
microconidia.
A. Histoplasmacapsulatum
B. Coccidioidesimitis (arthroconidia)
C. Aspergilusfumigatus (hifa, rarely have conidia-asexual fungal spore)
D. Cryptococcus neformans (pseudohifa)
E. Paracoccidioidesimitis
18. An 11 yo girl came home from school because she had a high fever
and complained of difficulty of swallowing any food. Her parents noted
that several children from her school had reported sore throats recently.
20. What is the effect of 2,3 DPG to the affinity between oxygen and
hemoglobin? supaya rbc bisa masuk body tissue
A. Increase it, because oxygen is needed to synthesize 2,3 DPG (decrease)
B. 2,3 DPG has no effect on the affinity between oxygen and hemoglobin
C. Decrease it, because 2,3 DPG replace O2 at the hemoglobin molecule
(ngubah hbnya)
D. Decrease it, because 2,3 DPG stimulates the changing of hemoglobin
shape
E. Decrease it, because 2,3 DPG stabilize hemoglobin in the T
(deoxyhemoglobin) form
21. Which of the factors can increase the affinity between O 2 and
hemoglobin?PO2, DPG, PH,PCO2
A. increase of CO2 tension
B. increase of body temperature
C. increase of hydrogen ion level
D. increase of erythrocyte glycolysis
E. increase of O2 atmosphere pressure
22. If the PO2 of blood that enter the lung is 40 mmHg and PO 2 of the
alveoli air is 104 mmHg, then PO2 of blood that leave the lung must be:
A. more than 104 mmHg because O 2 move from the higher pressure to
the lower pressure
B. 104 mmHg, because the blood uptake of O 2 is aiffusion process
C. between 40 to 104 mmHg, because not all blood vessel of the lung
is used during breathing
Choose one of the most appropriate answers from these options below :
A. Respiratory acidosis
B. Metabolic acidosis bisa karena Diabetes, hypercholeremic, lactic
acid
C. Respiratory alkalosis
D. Metabolic alkalosis
E. Normal blood P H
31. which one the embryological most common locations of this defect?
A. Superior part esophagus and trachea
B. Inferior part oesophagus near tracheal difurcation
C. In the middle part oesopgush and tracheal
D. Upper part of trachea
E. Upper part of oesophagus (langeman)
32. premature infant developed rapid shallow respiration shortly after died
was diagnose respiratory distress syndrome
Which one usually cause RDS? Karena surfactant
A. Incapable type 1 alveolar producing hyaline protein
B. Incapable type 2 alveolar producing surfactant
C. Suggested prolonged extra uterine asphixhya
D. Occur in premature infant undle
E. Incapable the lung function
33. the role of the human sinuses is very significant in daily life. Which od
the following statement is the correct embryological development of the
sinuses
A. Paranasal sinuses develop during late fetal life
B. The maxillary sinuses grow rapidly and fully developed before all
the permanent teeth have erupted
C. The two most posterior ethmoidal cells grow into the frontal bone,
forming a frontal sinus on each side
D. Paranasal sinuses form from outgrowth of the walls of the nasal
placode
E. The maxillary sinuses are present at birthsamaethmoid
34. the exchange of gases between alveolar capillary blood and alveolar
cavity is a process of: oxygen simple diffusion, kalau lewat membrane
(basal membrane) namanya paracellular transport
A. Paracellular diffusion
B. Simple diffusion
C. Active transport
D. Facilitated diffusion
E. Antiport transport system
41. These tonsils are located in the lateral walls of the oral part of the
pharynx. Which of the following epithelial cells that covered external
surface of these tonsils? Karena di oral
a. stratified squamous epithelium non keratinized
b. stratified columnar epithelium
c. stratified cuboidal epithelium
d. simple columnar epithelium
e. respiratory epithelium
42. Which of the following structure most likely cause the difference in his
nose shape?
a. the septal cartilage
b. the alar cartilage
c. the cribiform cartilage
d. the vomer cartilage
e. the nasal bone
43. Which of the following artery most likely cause the bleeding? Posterior
bleeding karena profusely
a. opthalamic artery
b. internal carotid artery
c. superior ethmoidal artery
d. sphenopalatine artery
e. facial artery
44. A 2 year old girl brought to the emergency department by her parents.
They said that their daughter had been playing with beads, and one of the
beads was stuck inside her nose. They had tried to take it out, but was
unsuccessful. They asked you for assistance.
Where is the most possible location of the logged bead? a/b
a. between nasal septum and the conchae
b. between the middle and inferior conchae
c. in the sphenoethmoidal recess
d. passed the choanae
e. in the vestibule
45. A 20 year old man has been diagnosed with sinusitis and asks her
physician why there is nasal discharge during the night but not during the
day.
Which of the following is the most suitable explanation?
a. Disruption of drainage due to mastication
b. Location of the ostia within the nasal passage
c. The sinus most likely affected is the maxillary sinus
d. Diurnal mucus production increases at night
e. Location of the ostia within the eusthacian tube
46. Which of the sentences below is TRUE regarding the sphenoid sinus?
a. it is located in the body of sphenoid, directly inferior sellaturcica
b. it is located on the greater wing of sphenoid. The sinuses separated by
the sellaturcica (frontal, seperatenya gaks ama itu juga)
49. A 15 years old boy status post tonsillectomy for recurrent tonsillitis
complicated by increased intraoperative bleeding and temporary loss of
taste sensation from the posterior one third of the tounge.
Why was there a temporary loss of taste sensation?
a. Compression of grater palatine nerve
b. Compression of pterygopalatine nerve
c. Compression of glossopharyngeal nerve (CN IX)
d. Compression of medial pterygoid (CN V3)
e. Compression of vagus nerve (CN X)
52. From the sentence below, which one is true regarding the larynx?
a. Infraglottic cavity lies inferior to the laryngeal inlet, superior to the
vocal apparatus
b. Laryngeal vestibule is another name for laryngeal ventricle. Located
between the vestibular folds and the vocal folds
c. The movement of vocal apparatus is a result of intrinsic laryngeal
muscle contractions
d. Supplied by the laryngeal artery that arises directly from external
carotid artery
e. Innervated only by superior laryngeal nerve. A branch of vagus nerve
(CN X)
53. A 25-year-old woman complaining of losing her voice after she had
surgery that removed her thyroid glands.
What structure is most likely affected in the surgery and cause the above
symptoms?
a. The vagus nerve
b. The recurrent laryngeal nerve
c. The inferior vagal ganglion
d. The superior laryngeal nerve
e. The glossopharyngealnerve
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54. A 44-year-old man was brought to the emergency department
complaining that he accidentally nhaled peanut. Upon radiological
examination of the chest, the peanut was found slightly upward on the
right side of the chest.
Why foreign bodies would most likely lodged there?
a. Beacaue the caliber of the right main bronchus is larger than the trachea
b.Because the right main bronchus is relatively steeper while the left one
has more horizontal course
c. Because the right main bronchus has 3 secondary branches
d.Because teh left main bronchus is compressed by the passing aorta
e.Because the carina was very sensitive and usually initiate cough reflex
59. You are medical intern at a public hospital. You were following your
supervisor as he make rounds at hospital wards. Your supervisor is
performing physical examination on the chest of a 60-year-old man with
COPD. He was palpating the notch below the neck, in the middle of upper
thorax, and then proceed 5 cm below. He said he found bony prominence
and them move slightly lateral to either side.
What would most likely to be found?
a.Another bony prominence, a mark of xyphoid process
b.A bulk of mass from overused external intercostal muscle
c. A groove, widening 2nd intercostal space
d.A round prominence marked by darker skin appearance, the nipples
e.Another bony prominence, mark the costo-sternal joint
62. In a 65 years old woman with difficulty breathing, the total lung
capacity and functional residual capacity and functional residual
capacity are lower than normal and FEV1/FVC slightlyhigher than
normal. Whats the most probably mechanism that happen on that
condition?
a. Decreased pulmonary blood flow
b. Decreased strength of the chest wall muscle
c. Increased airways resistance : soalnya air trapping,
jadiresidunyameningkat,
d. Increased lung elastic recoil
e. Increased chest wall elastic recoil
63. A patient has reduced total lung capacity and increased residual
volume. Functional residual capacity is normal. Whats the most
probably mechanism that happen on that condition?
a. Decreased pulmonary blood flow
b. Increased airways resistance
c. Decreased strength of the chest wall muscle of respiration
d. Increased chest wall elastic recoil
e. Increased lung elastic recoil
66. In a patient with difficulty breathing, total lung capacity and functional
residual capacity are greater than normal, and forced vital capacity
(FVC) and FEV1/FVC are lower than normal. Whats the most probably
mechanism that happen on that condition?
a. Decreased lung compliance
b. Decreased strength of the chest wall muscle
c. Increased chest wall compliance
d. Increased airways resistence
e. Decreased chest wall compliance
77. a 24 y.o present with sigi of hypoxia. Arterial blood gases reveal that
the PaO2 is normal but the arterial O2 saturation is reduced. Which
is the most likely cause of this patient condition?
a. anemia
b. a low V/Q ratio
c. carbon monoxide poisoning
d. hypoventilation
e. righ to left Shunt
80. once you were on duty in emergency rol a 5 y.o girl patient was taken
by her prents with chief complaint stridor since 2 days ago. Her parents
also complained about sore throat, fever difficulty on swallowing and
breathing. Three was no cough and she was unable to control her own
saliva and began to drool.
Result from the physical examination are:
The child sat upright in a bent-forward position. The jaw was open and
drooling was frequently present. She presented a hot potato voice,
suprasternal retraction and inspirator stridor.
Radiological findings:
From sofa tissue neck radiograph: thumb sign appearance, chest x ray:
within normal limit. Related to thhe case above, which of the following
decribes most accurately about the functions of the respirator
passageways? EPIGLOTITIS
a.all passageways have cartilage to keep them from collapsing
b. all of the passageways are surrounded by smooth muscles
c. in obstructive diseases all of the passageways are constricted
d. the greatest amount of resistance to airflow occurs in alveoli (di upper)
e. in disease condition, the smaller bronchiles determine resistance
81. Related to the case above (80), WOTF describes most accurately about
the cough reflex?ef: recurrent, vagus, corticospinal, ....
a. afferent nerve is mediated through trigeminal nerve, gloso, sup laryng
b. the effect is the opening of glottis, followed by closing
c. initially air is rapidly inspired
d. both thoracal and abdominal muscles relax
e. the bronchi and trachea are dilated
84. A 27yo woman came to primary health care with hemoptoe. She was
diagnosed with lung TB a few months before her pregnancy. She said she
had 1 month of continuation phase therapy using R and H before stopping
the treatment because she was afraid it might harm her fetus. One week
ago, she delivered a healthy baby.
WOTF is the most appropriate regiment for her initial phase? Cat 2
a. RHZ
b. 4RH
c. 5(HR)3E3
d. 2RHZES
e. 2(HRZE)S/(HRZE)
85. A 48yo man was diagnosed with acute pharyngitis and was given
erythromycin, ibuprofen, and bromhexim by another doctor two days ago.
Yet, he complains of diarrhea and vomiting that he has been suffering
since yesterday. His medication has already been used up.
WOTF is/ the most appropriate thing to deal with his complaint?
a. Change ibuprofen
b. Change bromhexim
c. Change erythromycin
d. Give antacid
e. Continue the medication wit additional drug for his complaint
90. This drug interacts with the -subunit bacterial DNA-dependent RNA
polymerase and thereby inhibit synthesis of RNA B
90. The drug interacts with the beta subunit bacterial DNA dependent RNA
polymerase and therapy inhibits RNA synthesis B
96. A 4 yo boy present to emergency room with stridor, cough and slightly
hard to breath. Physical examination revealed respiratory rate was
42x/min, pulse rate was 102 bpm, temperature 18C and suprasternal
retraction. Others was within normal limit. Hb 12 g/dl, WBC
7000/mm3.Chest x-ray within normal limit. He had history of penicillin and
cephalosphorin allergy. Which of the following drug the most appropriate
for this patient?
A. Erythromycin 1x/day (divide 2)
B. Erythromycin 2x/day
C. Azithromycin 3x/day
D. Clarithromycin 1x/day
E. Clarithromycin 3x/day
97. A 15 yo girls came to the primary health care with problem difficulty in
breathing. The problem occurred after she cleaned her room this morning.
In physical examination, found wheexing during expiration. What do you
think the etiology for her problem?
A. Funggus
B. Dust mite
C. Viral
D. Bacteria
E. Microflora
105. 2 y.o boy lives with his grandpa that has a chronic bloody cough since
the last 4 months. The boy has poor weight gain, loss appetite, prolonged
fever, and moderate malnutrition. Wotf diagnostic examination is likely to
result in the correct diagnosis of this boy?
A. Bronchoscopy
B. Tuberculin skin test and chest X ray
C. Tuberculin skin test only
D. Chest X ray only
E. ESR
106. 16 month old girl with the 3 months history of weight loss, recurrent
low grade fever with the tuberculin skin test 15 mm, and the chest X
ray shows an enlargement of the hilar lymph node, the nutritional status
was moderate malnutrition. The most likely diagnosis of this patient is:
A. Lymphadenitis TB
B. Latent TB infection
C. Pulmonary TB
D. Miliary TB
E. Pneumonic type TB
107. 13 month old boy came to pediatric clinic with chief complaint of a
poor weight gain and a 3 weeks cough. Physical findings are moderate
malnutrition, enlargement of the neck lymph node (confluent), looks tired.
Tuberculin skin test was reactive with diameter of induration 17 mm, the
chest X ray showed an infiltrate in bilateral perihilar. The appropriate
treatment of this patient is:
A. INH prophylaxis
B. INH, rifampicin for 6 months
C. INH, rifampin for 2 months
D. INH, rifampicin, pyrazinamide for 6 months
E. INH, rifampicin, pyrazinamide for the first 2 months and INH,
rifampicin for the following 4 months
108. 3 y.o boy without any clinical manifestations of TB, chest X ray
examination within normal limit, tuberculin skin test was reactive. His
father has been diagnosed as pulmonary TB with positive AFB in sputum.
The appropriate prophylaxis management of this child is:
A. INH and rifampicin for 2 months
B. INH and rifampicin for 3 months
7 month old baby was brought to pediatric emergency with the chief
complaint of difficulty in breathing since the last 3 days. The physical
findings are tachypnea, chest indrawing, crackles, fever. Chest X ray
showed a patchy infiltrate in the bilateral hemithorax.
114. WOTF structure that inspiratory stridor most likely would be expected
to lie with lesion?
a. adenoid area
b. lower one-third of the trachea
c. right main stem bronchus
d. nasal area
e. glottic area : biphasic daninspratory stridor (sebenernya inspiratory
stridor di sub glotic)
122. Which of the following statement that most accurate nutrient intake?
A. Caloric needs ranging from 94% to 164% of predicted range and
protein needs ranging from 1,2 to 1,7 g/kg of body weight
B. Caloric needs ranging from 80% to 90% of predicted range and
protein needs ranging from 0,6 to 0,8 g/kg of body weight
C. Caloric needs ranging from 80% to 100% of predicted range and
protein needs ranging from 0,8 to 1 g/kg of body weight
D. Caloric needs ranging from 60% to 90% of predicted range and
protein needs ranging from 0,5 to 0,8 g/kg of body weight
E. Caloric needs ranging from 90% to 110% of predicted range and
protein needs ranging from 1,6 to 0,8 g/kg of body weight
130. A 25 years old woman with chief complain bloody sputum. Two years
ago has been treated by RHEZ, but only 8 week. What category of this
patient?
A. Relapse
B. Treatment failure
C. Treatment after interuption (after default)
D. New case
E. Chronic case
132. A 20 years old man come to your clinic with chief complaint of cough
and sputum more than 5 weeks. The complaints were accompanied by
chest wall pain, low grade of fever and night sweating. He had taken
antibiotic, but showed no improvement. Two specimens o sputum of FAB
show positive. One year ago he had history of TB treatment for 2 months,
and discontinued this drug because of felt better and cured. Chest x-ray
showed lesion in upper parts of right lung. Which of the following is the
Gold standard to assess respiratory failure ?
A. BGA
B. Chest x ray
C. Spirometry
D. CT scan thorax
E. Pulmonary angiography
133. A 65 years old male with COPD stage III and a woman 23 year old
with asthma bronchial moderate persistent. Both were taken inhalation
corticosterois. While the women gain improvement from this therapy the
man is not. Possible explanation for this is : tnf a = alfa
A. Gender difference between them
B. Diference in age
C. Difference in spirometri result
D. Difference in risk factors
E. Difference in inflammatory cell and mediators
135. A 65 year old man comes to your clinic because he is concern about
increasing shortness of breath. He complains about cough and increases
136. A man, 67 years old, complained cough with whitish sputum since
about 2 years ago. His spirometer examination showed FEV1/FVC ratio
was 65% and FEV1 is 82% from predicted value. Beside avoidance
from risk factor and influenza vaccination, other medication for him is :
a. Inhaled regular long acting 2 agonist
b. Inhaled corticosteroid
c. Rehabilitation
d. Regular oral methylxanthyn
e. Inhaled short acting 2 agonist as needed
139. Mr. Sarpini, a 47-years old farmer complained cough for almost 2
months. Acid Fast Bacilis was found in his sputum smear. Two years ago
he had been treated for lung tuberculosis and his doctorsdeclaired that
he was cured.
The current anti tuberculosis regiment for Mr. Sarpiniis :
141. Ms. Elsa is a 17 yo high school students came to you due to shortness
of breath. She usually feels her SOB between midnight to early morning
and she feels this about 3 times a week and sometimes accompanied with
cough. Sometimes she was absent from school because of her symptoms.
On chest examination you only heatd wheeze and others were within
normal limits. The most likely diagnosis is :
A. COPD stage I
B. COPD stage II
C. Mild persistent asthma bronchial
D. Severe persistent asthma bronchial
E. Moderate persistent asthma bronchial
150. A ..infant of 4 months old is found unexpectedly dead in her cot one
morning. A examination is performed. The pathologist report increased
thickness and extension of pulmonary artery muscle.
What does this finding indicate?
A. Cardiomyopathy is likely
B. Death was caused by asphyxiation
151. On a frontal chest film, there is the lung apex retracts toward the
hilum, the sharp white line of visceral pleura is visible, separated from
the chest wall by a radiolucent pleural space, which is devo----lung
markings: (slide radiology)
A. Pneumothorax
B. Giant bullae
C. Pulmonary emphysema
D. Giant emphysema
E. Pleural effusion
156. A 10yo girl chief complaint dyspnea sice 7 days ago. This
complaint was accompanied by cough and high fever. In
Anteroposterior chest xray there is homogenous lung opacification with
air bronchogram in the lateral segm]ent of te lung. The lateral segment
of the lung is located in?
A. Upper lobe of the right lung
B. Upper lobe of the left lung
C. Middle lobe of the right lung
D. Lower lobe of the left lung
E. Lower lobe of the right lung
157. What is the basic standard radiograph for any patient presenting
with a cough more than 3 weeks?
A. A posteroanterior chest film
B. An oblique chest film
C. A left lateral decubitus film
D. An apical lordotic film
E. An anteroposterior chest film
158. What is the best radiograph for showing the presence of a small
pleural effusion?
A. A lateral edcubitus film
B. A posteroanterior chest film
C. A lateral chest film
D. Aanteroposterior chest film
E. An apical lordotic film
162. A 9 year old boy come to your private practice with breathlessness as
a chief complaint. The symptom was accompanied by wheezing since last
1 hour. These symptoms had occured about two hours after helping his
mother cleaned the bedroom. He had his first asthma attack when he was
six years within the last two months he also experienced 1-2 times night
cough.
His father had been diagnoed as having asthma and the symptoms had
relieved since he had taken controller medication. Which of the following is
the best pathogenesis in this patient?
a. TH2 cells secrete cytokines that promote allergic inflammation and
stimulate B cells to produce Ige and other antibodies
b. Virus induced inflammation of the respiratory mucosa lowers the
threshold of the subepithelial vagal receptors to irritants
c. Inhibiting the cyclooxigenase pathway of arachidonic acid metabolism
without affecting the lipooxygenase route, thus lipping the balance toward
elaboration of the bronchoconstorleukotrienes
164. Which of the following is the best for microscopic finding in that
patient?
a. Large alveoli separated by thin septa with only focal centraacinal
fibrosis
b. Chronic inflammation of the airways (predominantly lymphocytes) and
enlargemenr of the mucus-secreting glands of the trachea and bronchi
c. Occlusion of bronchi and bronchioles are sufficiently dilated that they
can be followed almost to the pleural surface
d. The bronchi and bronchioles are sufficiently dilated that they can
e. Sub-basement membrane fibrosis
b. Pulmonary TB
c. Emphysema
d. Lung carcinoma
e. COPD
173. What structures are pointed by the white arrows in above case?
a. Extravasated erythrocytes
b. Alveoli destruction
c. DatiaLanghans cells
d. Caseous necrosis
e. Tumour cells
174-175
A 45yo male come to out patient clinic because of dyspne, fever and
productive cough since 7 days ago. He said that his sputum was yellow
green sometimes with blood streak. PE showed fever, takipnea,
tachycardia, and crackles in his left chest. Macroscopic and microscopic
appearance of his lung were shown as below picture.