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Bank Soal
Bank Soal
A 50-year-old woman came with chief complain chest pain with onset less than 2
hours. There was a history of infarct myocardium, from physical finding we
found blood pressure 160/90 mmHg. Cardiac marker that had increased in this
patient was:
A. Troponin-I
B. Myoglobin*
C. CK-MB
D. LDH
E. CK
2. A 15 years old woman comes to hospital with chief complaint swelling and pain
in knee joint with fever, tachycardia since 2 weeks ago. Physical findings are
within normal limit, except body temperature 38 oC. laboratory result shows
leucocytes 20.000/mm3. To establish the diagnose, we need to test :
A. LDH
B. SGOT
C. ASTO*
D. CK-MB mass
E. Troponin I
3. For the case above, we still need another additional laboratory test :
A. CRP*
B. LDH
C. SGOT
D. Myoglobin
E. CK-MB mass
4. A 64 years old man with severe hypertension, comes to ER with chief complaint
dyspneu with chest pain since 2-3 hours ago. The blood pressure is 190/110
mmHg, heart rate 180/min, irregular, breathing rate 35/min, ronchi is positive in
basal of lungs, there is cardiomegaly and lungs obstruction. Which lab test may
confirm the diagnose ?
A. CRP
B. CK-MB
C. NT-ProBNP*
D. Troponin T
E. Troponin I
5. A 48 years old female had mitrale septum valve surgery and a patch made of
Teflon was used. This condition often causes intravascular hemolysis. Therefore,
we need monitoring test. Monitoring test, we need is :
A. D-Dimer
B. Ferritin
C. Fibrinogen
D. Prothrombin time*
E. Fe serum
6. A 66 years old man comes to hospital with chief complaint dyspneu, especially
while exercising, has coughing, tachycardia. The patient has hypertension history.
From physical finding, we find systole murmur, and 3 th heart sound (S3 gallop).
The less sensitive test to confirm this disorder is :
A. BNP*
B. NT-ProBNP
C. Troponin T
D. Troponin I
E. Myoglobin
7. A 50-year-old man came to emergency unit with chief complain left chest pain
spreading to the left arm since 4 hours before and this was the first attack. The
pain onset was more than 20 minutes without chest trauma history. From ECG we
found ST elevation in V1-V3. After sublingual isosorbid dinitrate was given, the
pain still occurred. Laboratory test which is sensitive recommended to this case:
A. CK-MB activity
B. CK-MB mass*
C. Troponin-T
D. Troponin-I
E. NT-proBNP
8. A 55-year-old woman came to hospital with intermittent typical angina pectoris
since 3 days before. Pain episode duration was 5 minutes. Physical finding and
ECG were normal. There was diabetes mellitus history. Laboratory test
recommended to establish acute coronary syndrome was:
A. SGOT
B. Total-CK
C. CK-MB*
D. LDH
E. LDL
9. A 30 years old woman had mitral stenosis history. After balloning valvulotomy,
she got mitral reguirtation. One months after that, she feel fever which could not
be cured by antibiotic. Laboratory test that should recommended to her was:
A. hsCRP
B. ASTO*
C. Leucocyte
D. Rh F
E. LED
10. A pre-menopause woman come to laboratory to check whether she has risk
factors for cardiovascular disease. Laboratory test that should performed to her
was :
A. LDH
B. SGOT
C. Lipid profile*
D. Alkaline phosphatase
E. Gram staining
11. Myoglobin released from damaged muscle colors the urine dark red in
myocardial infarction, this condition as known :
A. anemia
B. myoglobinuria*
C. thalasemia
D. proteinuria
E. glycinemia
12. Assay of serum enzyme are more sensitive for myocardial injury such as SGOT
enzyme, this enzyme as a member of class :
A. transferase*
B. lyase
C. hydrolase
D. isomerase
E. ligase
13. SGOT enzyme react ans catalyze :
A. oxidations and reductions
B. the hydrolysis cleavage of C-C; C-O; C-N; P-O bonds
C. transfer of groups from a donor molecule to an acceptor molecule*
D. geometric or structural changes within a single molecule
E. the joining together of two molecules, coupled to the hydrolysis of a
pyrophosphoryl group in ATP
14. LDH isoenzyme of serum catalyze reaction of lactate to form pyruvate with
coenzyme :
A. FMN
B. FAD
C. NADH
D. NAD*
E. Coenzyme A
15. When ATP is rapidly being utilized as a source of energy for muscular
contractions, one molecule permits its concentration to be maintained, the
molecule is
A. ATP
B. GTP
C. ADP
D. Ion phosphate
E. Phosphagen*
16. The major lipid of mitochondria membrane in myocard is:
A. lysophospholipid
B. lecithin
C. lysolecithin
D. cardiolipin*
E. phospholipid
17. Lipid peroxidation is a source of free radicals to tissue damage and it may be
cause of :
A. Atherosclerosis*
B. Rhabdomyolisis
C. Cardimyopati
D. Heart failure
E. Thromboembolism
18. Major source of high energy ATP for myocard contraction are come from :
A. glycolysis aerob*
B. glycolysis anaerob
C. gluconeogenesis
D. lipolysis
E. lipogenesis
19. Thrombin is made from final common pathway of clotting involved activation
of :
A. fibrin
B. ion calcium
C. prothrombin
D. Hageman factor
E. Proconvertin
20. A 59-year-old male with congestive heart failure caused by prolonged
hypertension was admitted in the hospital. He was than given steroid digitalis.
What specific test would you request from the Biochemistry laboratory?
A. CK-MB
B. LDH-H4
C. C-Troponin
D. Homocysteine
E. Atrial Natriuretic Peptide*
21. A 48-year old woman comes to ER with complaint of back pain that refer to her
chest for 5 min. It occurs in 3 hours ago. She feel weak with nausea. She has a
history of uncontrolled hipertension. In physical examination, her BP 170/100
mm Hg, HR 100/min, RR 28/min. ECG shows sinus ritme. A radiologic
photograph shows cardiomegali and aorta dilatation. Which one of the following
parts is to be correlated with her complaints?
A. Aorta
B. Aorta valves*
C. Pericardium
D. Myocardium
E. Pulmonary artery
22. What nervus is involved in her back pain ?
A. Nervus axillaris
B. Nervus phrenicus
C. Nervus subscapularis
D. Nervus splanchnicus thoracicus
E. Ramus cardiacus inferior dextra N.X*
23. What structures are connected by Ligamentum arteriosum botalli?
A. Ascendens Aorta with R. sinister of Pulmonary artery
B. Arcus Aorta with R. Dekster of Pulmonary artery
C. Arcus Aorta with R. Sinister of Pulmonary artery*
D. Descendens Aorta with R. Sinister of Pulmonary artery
E. Ascendens Aorta with R. Dekster of Pulmonary artery
24. The exact location of breast is
A. Subfascial (covered byFascia)
B. Under M. Pectoralis Major
C. Subkutan (under skin)*
D. Between Costa III and VII ventral
E. In linea medioclavicularis of ICS V
25. Which of the following structures is belong to Apertura Thoracalis Superior?
A. Corpus of Vertebra Thoracalis XII
B. Processus Xyphoideus
C. Manubrium Sterni*
D. Cartilaginis costa II
E. Scapula
26. Blood transported by the pulmonary veins returns to the :
A. Left atrium*
B. Right atrium
C. Right ventricle
D. Left ventricle
E. Truncus Pulmonary
27. The following muscle which form the profunda layer of chest wall is :
A. M. Pectoralis Minor
B. M. subcostalis*
C. M. Intercostalis internus
D. M. Latissimus dorsi
E. M. Rhomboideus minor
28. The type of blood vessel that involved in leucocyte extravasation during
inflammation is :
A. Arteries
B. Arterioles
C. Venules
D. Capillaries
E. Spinchter pre capillary*
29. A 58-year old woman comes to hospital with chest pain and dyspnea during
activity. In physical examination, her BP is 170/100 mmHg and ronchi in basal
area of lungs. Chest X-ray shows cardiomegaly. ECG reveals inferior ischemia
and echocardiography shows Left Ventricle Hypertrophy (LVH). The following
statements that related with normally condition human is:
A. The endocardium of right atrium is thinner than left atrium
B. The endocardium of left ventricle is thicker than myocardium
C. The myocardium of right ventricle is thicker than left ventricle
D. The myocardium of left ventricle is thicker than right ventricle*
E. Both of myocardium of right and left ventricleis the same in thickness.
30. A man 59 years old has echocardiography result which shows left ventricle
hypertrophy (LVH). Which one of the following structure doesn't belong to left
ventricle ?
A. M. papillaris anterior
B. Chorda tendinae
C. Trabecula carnae
D. Mitralis valves
E. Tricuspidalis valves*
31. The following of histology characteristic that shows in normally coronary artery
is?
A. Adipose cells in tunica intima
B. No adipose cells in tunica intima*
C. Adipose cells in tunica media
D. Adipose cells in tunica adventitia
E. No adipose cells in tunica adventitia
32. The inner layer of a blood vessel wall, characterised by a simple squamous
endothelium supported by a thin layer of connective tissue, is the:
A. adventitia.
B. external elastic lamina.
C. media.
D. internal elastic lamina.
E. Intima*
33. The sino-atrial (SA) node, the atrio-ventricular (AV) node, and the Purkinje
fibers of the myocardium all consist of specialized:
A. Endothelial cells.
B. Fibroblasts.
C. Nerve cells.
D. Smooth muscle cells.
E. Cardiac muscle cells.*
34. The most abundant tissue element forming the media of small, muscular arteries
is:
A. cardiac muscle
B. smooth muscle*
C. collagen fibers
D. elastic fibers
E. cartilago
35. The muscular layer of blood vessels is called :
A. tunica intima
B. tunica media*
C. tunica adventitia
D. mesotelium
E. endothelium
36. Vasa vasorum are :
A. blood vessels of myocardium
B. nerves that supply blood vessels
C. nerves of the heart
D. blood vessels within the wall of blood vessels*
E. blood vessels of endocardium
37. Which of the following features is a normal component of epicardium but NOT
of endocardium?
A. adipocytes*
B. collagen
C. elastin
D. fibroblasts
E. simple squamous epithelial tissue
38. Intercalated discs :
A. include desmosomes
B. are found at the boundary between adjacent cardiac muscle cells.
C. Include gap junctions
D. may appear as dark or light bands by light microscopy.
E. All of above*
39. Where is the myocardium the thickest?
A. right atria
B. left atria
C. right ventricle
D. left ventricle*
E. both right and left ventricle
40. His bundle is located in :
A. right atria
B. left atria
C. inter-atrial septum
D. inter-ventriculare septum*
E. atrioventriculare septum
41. A 30-year old schoolteacher is known to be a strict disiplinarian in the classroom.
She has angina pectoris of 6 month’ duration. On physical examination, her BP is
135/85 mmHg. She is 168 cm tall and weights 82 kg. Coronary angiography
shows 75% narrowing of the anterior descending branch of the left coronary
artery. Angioplasty with stent placement is performed. Which of the following is
the major risk factor associated with these findings?
A. Obesity
B. Type A personality
C. Diabetes mellitus*
D. Sedentary lifestyle
E. Age
42. A 30-year old woman has smoked one pack of cigarettes per day since she was
teenager. She has had painful thromboses of the superficial veins of the lower
lega for 1 month and episodes during which her fingers become blue and cold.
Over the next year, she develops chronic, poorly healing ulcerations of her feet.
One toe becomes gangrenous and is amputated. Histologically, there is an acute
and chronic vasculitis involving medium-sized arteries. Which of the following is
the most appropriate next step in treating this patient?
A. Hemodialysis
B. Smoking cessation*
C. Corticosteroid therapy
D. Antibiotic therapy for syphilis
E. Insulin therapy
43. A 25-year old man dies suddenly and unexpectedly. At autopsy his heart is
enlarged from right ventricular dilatation. The left ventricle is normal. There is no
atherosclerosis, sectioning of the myocardium shows marked thinning of the right
ventricle, and microscopic findings include extensive myocardial fatty infiltration
and fibrosis, but no inflammation. Which of the following is the most likely cause
for his sudden death?
A. Cardiomyopathy*
B. Chagas disease
C. Hypertension
D. Long QT syndrome
E. Radiation therapy
44. A 68-year old woman has had increasing dyspnea for the past year. On physical
examination, her blood pressure is 140/90 mmHg. No murmurs or gallops are
heard. A chest radiograph shows prominent borders on the left and right sides of
the heart. Laboratory studies show serum glucose of 81 mg/dl, creatinine of 1,6
mg/dl, total cholesterol of 326 mg/dl, triglyceride of 169 mg/dl. Which of the
following pharmacologic agents is most likely to be beneficial for this patient?
A. Amiodarone
B. Glyburide
C. Nitroglycerine
D. Propanolol
E. Simvastatin*
45. A 50-year old man has sudden onset of severe substernal chest pain that radiates
to the neck. On physical examination, he is afebril, but has tachycardia,
hyperventilation, and hypotension. No cardiac murmurs are heard on
auscultation. Emergent coronary angiography shows a thrombotic occlusion of
the left circumflex and anterior descending arteries. Which of the following
complications of this disease is most likely to occur within 1 hour of these
events?
A. ventricular fibrillation*
B. pericarditis
C. myocardial ruptur
D. ventricular aneurysm
E. thromboembolism
46. A 19-year old man has had a low grade fever for 3 weeks. On physical
examination, his temperature is 38.3oC, pulse is 104/min, respirations are 28/min,
and blood pressure is 95/60 mmHg. A tender spleen tip is palpable. There are
splinter hemorrhages under the fingernails and tender hemorrhagic nodules on the
palms and soles. A heart murmur is heard on auscultation. Which of the
following infectious agents is most likely to be cultured from this patient’s blood?
A. Viridans streptococci*
B. Trypanozoma cruzi
C. Coxsackievirus B
D. Candida albicans
E. Mycobacterium tuberculosis
47. A 27-year old woman has had a fever for 5 days. On physical examination, her
temperature is 38.2oC, pulse is 100/min, respirations are 19/min, and blood
pressure is 90/60 mmHg. A cardiac murmur is heard on auscultation. The
sensorium is clouded, but there are no focal neurologic deficits. Laboratory
findings include hemoglobin 13.1 g/dl; platelet count 233.300/mm 3; and WBC
count 19.200/mm3. Blood cultures are positive for Staphylococcus aureus.
Urinalysis shows hematuria. An echocardiogram shows a 1.5 cm vegetation on
the mitral valve. Which of the following conditions is this patient most likely to
develop?
A. cerebral arterial aneurysm*
B. dilated cardiomyopathy
C. abcess of the left upper lobe
D. polyarteritis nodosa
E. polycystic kidneys
48. A 49-year old is feeling well when he visits his physician for a routine health
maintanance examination for the first time in 20 years. On physical examination,
his vital signs are temperature, 37oC; pulse, 73/min, respirations, 14/min; and
blood pressure, 155/95 mmHg. He has had no serious medical problems and takes
no medications. Which of the following is most likely to be the primary factor in
this patient’s hypertension?
A. increased cathecolamine secretion
B. renal retention of excess sodium*
C. gene defects in aldosteron metabolism
D. renal artery stenosis
E. increased production of ANP
49. For the past 3 weeks, a 70-year old woman has been bedridden while
reduperating from a bout of viral pneumonia complicated by bacterial
pneumonia. Physical examination now shows some swelling and tenderness of
the right leg, which worsens when she raises or moves the leg. Which of the
following terms best describes the condition involoving the patient’s right leg?
A. lymphedema
B. disseminated intravascular coagulation
C. trombophlebitis*
D. tromboangiitis obliterans
E. varicose veins
50. A 61-year old man had a myocardial infarction 1 year ago, which was the first
major illness in his life. He now wants to prevent another myocardial infarction
and is advised to begin a program of exercise and to change his diet. A reduction
on the level of which of the following serum laboratory findings 1 year later
would best indicate the success of this diet and exercise regimen?
A. cholesterol*
B. glucose
C. potassium
D. renin
E. calcium
51. A 55-year old man comes to hospital with high fever. In physical examination,
his temperature is 39oC and lymph nodes in the anterior of the neck are palpable,
there is pansistolic murmur in mitral area. No signs of infection in his skin. No
history of digestive and urogenital infections. Which of the following
microbiologic examination is likely to be recommended for this patient?
A. Blood culture*
B. Nasal swab
C. Skin swab
D. Serologic test
E. Faeces studies
52. A 55-year old man comes to hospital with high fever. In physical examination,
his temperature is 39oC and lymph nodes in the anterior of the neck are palpable,
there is pansistolic murmur in mitral area. No signs of infection in his skin. No
history of digestive and urogenital infections. In Echocardiography, it shows
vegetations in mitral valves. What is the most like cause of the infection of mitral
valves in this patient?
A. Human Herpes Virus dan Varicella Zoster Virus
B. Staphylococcus dan streptococcus*
C. Virus Coxsackie A dan Coxsackie B
D. Mycoplasma
E. Chlamydia
53. A 55-year old man comes to hospital with high fever. In physical examination,
his temperature is 39oC and lymph nodes in the anterior of the neck are palpable,
there is pansistolic murmur in mitral area. No signs of infection in his skin. No
history of digestive and urogenital infections. In Mannitol Salt Agar (MSA)
culture, it was found Staphylococcus aureus. Which one of test results is could
distinguish between Staphylococcus aureus another types of staphylococcus?
A. Catalase positive
B. Facultative anaerobe
C. Coagulase positive*
D. Anaerobic glucose fermentation
E. All strains produce golden pigment
54. A 30-year old woman comes to clinic with fever and chest pain. Her temperature
is 38,8oC , haemoglobin is 9, and leucocytes count is 12.000/ml. In physical
examination, it was found arthritis’s symptom and subcutaneous nodules, ECG
with atrial fibrillation. In the last two weeks, she complaint of fever and sore
throat. Which one of the following test is likely to examined in this patient?
A. Blood culture*
B. Synovial fluid culture
C. Nasal swab
D. Skin swab
E. Serologic test
55. A 55-year old man comes to hospital with high fever. In physical examination,
his temperature is 39oC and lymph nodes in the anterior of the neck are palpable,
there is pansistolic murmur in mitral area. No signs of infection in his skin. No
history of digestive and urogenital infections. In Mannitol Salt Agar (MSA)
culture, it was found Staphylococcus aureus. Which one of the following
characteristic is belong to Staphylococcus aureus?
A. Smooth colony
B. Irregular-formed colony
C. Baccilus bacteria
D. Pink-coloured in gram staining
E. Its cell wall contains teichoic acid*
A 34-year old man come to hospital with chief complain of chest pain since 3 days
ago. There is a history of fever. The result of Ro thorax and laboratory test are
normal. In culture of his blood, it reveals a significant bacterial colonies.