Beruflich Dokumente
Kultur Dokumente
diffuse lobar consolidation of the right lung. Sample from sputum was
cultured, and the bacteria isolated was Streptococcus pneumonia.
What is the positive test to identify this bacterium from colony on blood
agar?
A. Beta hemolysis on blood agar (gabhs-pyogens)
B. Sensitive to optochin bisa sama inulin
C. Require of X & V factor (h.influenza)
D. Resistent to novobiocin (stapylococcus saphropyticus)
E. Catalase positive(stapylococci)
15. Which of the following statement about respiratory tract mycosis is
correct? ADA DI SLIDE LAGIIIIIIIIIIIII (mycosis = penyakit karena jamur)
A. A group of superficial mycosis (dia deep)
B. Only caused by opportunistic fungi (mestinya gak only)
C. The true pathogenic fungi is is dimorphic fungi
D. Cannot be diagnosed by laboratory examination (sebenernya bisa) gak
ada di slide
E. Also called dermatophytosis
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
17. A 65 yo patient with diabetes and difficulty in breathing was asked by
pulmoologist to go to microbiology laboratory for microbiological
examination of sputum. The sputum specimen was thick and bloody. The
colony yield heavy growth of a lactose positive, non motile, gram
negative rodwith large capsule.m
Which of the following bacteria with those characteristic is to be the cause
of the pulmonary problem
A. Enterobacterpneumonia (lower respi tract)
B. Klebsiellapneumonia (URT,endocarditis, CNS)
C. Mycoplasma pneumonia (gak punya capsule)
D. Clamydophiapneumonia (virus like, small obligate parasitic)
E. Legionella pneumophila (gram -, rod, katalase positive)
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.
Throat swab was taken for culture, the bacteria was gram positive cocci in
chain, yields clear, sharp beta hemolysis on blood agar, sensitive to
bacitracin.
Of the organisms list below, which one is the bacteria that cause the
disease?
A. Staphylococcus aureus
B. Staphylococcus saprophyticus
C. Streptococcus pyogenes
D. Streptococcus pneumoniae
E. Streptococcus viridans
19. Gas exchange between pulmonary airways and pulmonary blood
happen during
A. Inhalation, because the alveoli retract during exhalation
B. Inhalation, because at this time oxygen level of the airways is still high
C. Inhalation, because at this time the alveolar surface area is
greatly expanding
D. Inhalation, because at this time the alveolar air pressure reacheas its
peak
E. Exhalation and inhalation, because at this time the alveoli do not
appreaciably change in size
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
36. which of the following type of epithelium cells lining most of the
respiratory portion of the respiratory system?
A. Ciliated psedostratified columnar
B. Simple columnar
C. Simple cuboidal
D. Stratified squamous
E. Simple squamous
37. within the lamina proprialia a number of cartilages. The large
cartilages are hyaline, and the smaller cartilages are elastic. Which of the
following is most likely tube?
A. Larynx
B. Trachea
C. Primary bronchi
D. Secondary bronchi
E. Bronchioles
38. the first part of respiratory portion of respiratory system:
A. Bronchi
B. Bronchioles
C. Terminal bronchioles
D. Respiratory bronchioles
E. Alveolar ducts
39. thisintralobular airways have neither cartilage nor glands in their
mucosa. In the larger part the epithelium is ciliated psedostratified
columnar. Which of the following is most likely tube?
A. Bronchi
B. Bronchioles
C. Alveolar duct
D. Terminal bronchioles
E. Respiratory bronchioles
40. the smaller portion of this respiratory track is lined by cuboidal
epithelium and contains Clara cells. Which of the following is most likely
tube?
A. Respiratory bronchioles
B. Terminal bronchiole
C. Alveolar duct
D. Alveolar sac
E. Alveoli
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
50. An 8 year old girl was brought to the clinic because of the decrease
hearing. Her parents said that for the last 2 weeks shes been breathing
through her mouth. This is her third time visiting doctor for the same
complain for the year.
The ENT doctor told suggested to performs adenoidectomy and
tonsillectomy.
Which structure should be closely monitored in order to prevent
complication? (moore box biru) yang sering= large external phalatine
a. Ascending pharyngeal artery
b. Ascending palatine artery
c. Descending palatine artery
d. Superior laryngeal artery
e. Tonsilar branch of facial
artery (tonsillectomy), katanyakalau
adenoidectomy itu yang a
51.A group of medical student was observing respiratory tract on a
dissected cadaver. Upon observing the neck, they found a structure
anterior to the esophagus on the level of C3-C6 vertebrae.
Which one of the following is the characteristic of thyroid cartilage?
a. Shaped like a signet ring with its band facing anterior side (cricoid)
b. The largest cartilage. Paired on either halves of the posterior part of
laryngeal inlet (mestinya single)
c. Located between the bases of the arytenoid cartilages and the
superolateral surfaces of the lamina of the cricoid cartilage
d. The inferior two thirds of its two plate-like laminae fuse anteriorly in the
in the median plane to form the laryngeal prominence
e. A heart-shaped cartilage cartilage covered with mucous membrane.
Situated posterior to the root of the tongue (epiglotis)
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
1
1
54.
1
3
61.
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
64. A chest x-ray of patient with left-sided heart failure indicates
pulmonary edema. Whats the most probably additional examination
that would reveal in this patient?
a. Decreased pulmonary artery pressure
b. Decreased pulmonary lymph flow
c. Increased pulmonary venous pressure
d. Normal arterial oxygen partial pressure
e. Normal vital capacity
Obstruktif
:contohnyaasma,
Cumakeluarkeluarnyasusah
tapimasuknyamasihbisamasihbagus,
b. Diaphragm,
abdominis
c. Diaphragm,
d. Diaphragm,
e. Diaphragm,
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
67. A 68 yo woman with pulmonary fibrosis, who presents with a
complaint of increase dyspnea while performing activities of daily living
is referred for pulmonary function testing. Which is the following
laboratory
values
is
consistent
when
her
diagnosis?
Restriktifyaniiihhh (ekspansi alveoli turun, lung volume
capacity turun, menurunkan ventilation sama oxygenation,
effort breathing naik) restrictive FEC turun, FEV=obstruksi
a. Decreased diffusing capacity of the lung
b. Increased residual volume
c. Decreased FEV1/FVC
d. Increased lung compliance
e. Increased airways resistence corrected for lung volume
68. A 125-lb, 40 yo woman with a history of nasal polyps and aspirin
sensitivity since childhood presents to the ED with status asthmaticus
and hypercapnic respiratory failure. She requires immediate intubation
and is placed on mechanical ventilator on a FiO2 of 40% a control rate
of 15 breaths/min and tidal volume of 500 mL. How much is her
approximate alveolar ventilation?
15 x 350 = 5250
a. 375 mL/min
b. 3500 mL/min
c. 5250 mL/min
d. 5625 mL/min
e. 7500 mL/min
69. A 68-year old male with chronic obstructive pulmonary disease
entered the EmergencyDepartment complaining of shortness of
breath. His resspirations were 35 per minute and labored. He had a
productive cough and rales were heard over lung fields. The patient
had a rather ashen complexion and his nail beds gave clear evidence
of cyanosis. An arterial blood sample was obtained and chest x-ray
was ordered. The patient was then placed on an O 2 mask delivering
40% O2. One half hour later, the patient found unresponsive. His
1
5
74. the 25 y.o woman poisoned with carbon monoxide. The carbon
monoxide can bind with hemoglobin and affected the oxygen binding
capacity. What is the condition that decreased PO2 in the arteial nblood of
this patient?
a. dependent on alveolar PO2
b. dependen on the amount of CO2 bound to hemoglobin
c. increased from normal because of dissociated ooxygen from hemoglobin
d. reduced from normal because of the CO bound to hemoglobin
75. which factor that can inhibit O2 binding to hb in the pulmonary
capillary?
a. CO2 dissociation from hb
b. diffusion of CO2 from pulmonary cappilary to alveolar
c. reduction of bicarbonate wit H+
d shift to more acidic pH that it found invenous blood
76. a 47 week gestation infant is develop respiratory. What is the most
probably mechanism that will occurs with his First diaphhragmatic
respiration?
a. paO2 increase
b. pulmonary vaskular resistance is increase
c. pulmonary cappilary hydrostatic pressure increased
d. syystematic vascular resistance decrease
e. all of the fetal vascular channel functional Close
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
78. a 70 y.o man admitted with chief complaint shortness of breath,
cough, and yellowish sputum. History DM +, physical examination: RR
30x/min, T:38.0 C, BP: 130/80 mmHg, ronchi +/-, wheezing -/-, blood
glucose 276 mg/dL, chest x-ray: infiltrate + . There is no history of
hospitalization previously. Which of the following describes most
accurately about physiological peculiarities found in the case above?
a. the alveoli are filled with fluid due to increased hydrostatic pressure
b. the total surface area of respirator membran is decreased
c. the content of carbon dioxide in the blood will be decreased
d. the physiologic dead space also become decrease
1
7
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
For questions number 82 83:
A 36yo man came to clinic to control his pulmonary TB. He felt better, but
still uncomfortable with the red sweat. He also failed to get driving license
because he could not pass the Ishihara blind test. He felt strange because
he always passed this kind of exam before. He is a public transport driver.
He is currently in the 4th week of 1st category TB therapy.
82. WOTF is the most appropriate regiment for this patient? Karena ada
masalah mata jadi gak pake Ethambutol
a. 2HRZE
b. 2(HRZE)S
c. 2HRZ/4(HR)3
d. 2(HRZE)S/HRZE
e. 2(HRZE)S/HRZE/4(HR)3
83. WOTF should be avoided in this patient?
a. Isoniazid
b. Rifampicin
c. Ethambutol
d. Pyrazinamide
e. Streptomycin
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
86. A 38yo man was presented to the ER due to shortness of breath. He
has been feeling that symptom since this afternoon after he took
propranolol for his palpitation. He got the drug from another doctor in a
clinic this morning. You give him theophylline 300 mg 2x1. If the patient
has a liver dysfunction, why should you change the treatment?
a. Toxicity potency
b. Reduction of efficacy
c. Increasing of clearance
1
9
of the
91. The drug reacts with pyridoxine (B6) which can cause deficiency of this
vitaminA
92. The drug inhibit the metabolism of phenytoin (anticonvulsant) A
93. The drug may caused red-green color blindness D
94. The drug crosses inflamed meninges C
95. A 30 yo man complained dyspnea and fever. His symptoms became
severe that his family brought him to the emergency room. Physical
examination revealed respiratory rate was 32x/min, pulse rate was 112
beats per minute, temperature 40C, and blood pressure was 130/80
mmHg, with crackles in the inferior lobe of left pulmo. Others were within
normal limit, Hb 12 g/dl, WBC 27.000/mm3. Chest x-ray showed inferior
left lob infiltrate. He had history of penicillin and cephalosphorin allergy.
The doctor which of the following drug of choice for this patient?
A. Oral cefuroxime
B. Oral azithromycin
C. IV azithromycin 50s
D. IV beta lactam + oral azithromycin
E. IV beta lactam + IV azithromycin
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
2
1
98. The statement which is wrong related with the etiology is:
A. Survive in all climate but mostly in humid condition
B. Well survive in carpet
C. Prefer outdoor environment
D. Consume minute particle in organic matter
E. Can be found in high altitude
99. One way to eradicate is:
A. Maintaining humidity above 50%
B. Exposing them to temperature above 30C
C. Using abate powder
D. Regularly cleaning and washing
E. Sweep the carpet
100. A 60 yo man has a 5 month history of progressive weakness and a
weight los of 13 kg along with intermittent fever, chills and a chronic
cough production of yellow sputum. Culture of the sputum is positive for
Mycobacteriom tuberculosis. Media for M. tuberculosis is:
A. Mac Conkey
B. Horse Blood Agar
C. Loeffler Agar
D. Lowenstein Jensen
E. Kligler Agar
101. Staining for M Tuberculosis?
A. Gram staining
B. Neisser staining
C. Ziehl Nelson staining
D. Giemsa staining
E. Negative staining
102. Criteria for reporting the level of M Tuberculosis according to IUALTD
in staining:
A. 1(+) if find >10 AFB/100 HPF
B. 3(+) if find >10 AFB/HPF
C. 1(+) if find 1-10 AFB/100 HPF
D. (-) if find only 9 AFB/100 HPF
E. 2(+) if find >10 AFB/HPF
103. 3 y.o develops Haemophilus influenza. Culture of nasopharynx swab
specimen in blood agar with X and V factor. What is the morphology of this
strain?
A. Gram (+) cocci
B. Gram (-) bacilli
C. Diplococci gram (+)
D. Diplococci gram (-)
E. Cant stain by gram staining
104. For growth, H. influenza in blood agar with X and V factor. V factor
contains:
A. Folic acid
B. Nicotinamide adenine dinucleotide : inimah X
C. Bacitrasin
D. Heme
E. Nicotinic acid
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
2
3
b. inhaled ephinephrine
c. inhaled SABA
d. inhaled LABA
e. inhaled anticholinergic
For question number 114 to 115, refer to scenario below :
A 4-y.o. boy were taken by his parents to the emergency room with stidor
since 2 days ago which becoming worse in time. The chief complaint was
accompanied by sore throat, fever, that increasing gradually, difficulty of
swallowing and breathing. On PE : fully alert, BP 95/60 mmHg, PR 110bpm,
RR 42x/mnt, T 39.5 degree celcius. The child upright in a bent-forward
position. The jaw was open and drooling was frequently present. He has a
hot potatoe voice, supasternal retraction and inspiratory stridor. Lab test
shows leukocytosis and from soft tissue neck. Radiograph seen thumb
sign appearance
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)
115. Medical management for this condition is
a. not frequently effective
b. directed toward more resistant bacteria
c. usually targeted toward spesific bacteria and broad spectrum coverage
is not warranted
d. universally effective
e. best provided with IV therapy
For questions number 116 to 117, refer to scenario below:
A 50-y.o. man complaints dypnea, when he walks in arush. Complaints
accompanied with cough and whitish sputum for the last 5 years. He is a
heavy smoker, with a history of smoking about 30 pack/year cigarettes
since he was 17 y.o. PE found CVS within normal limits. His body weight is
55 kg and height is 175 cm.
116. WOTF is the most likely condition?
a. he needs more energy due to smoking
b. he needs more energy due to increased work of breathing
c. he needs more energy due to preserving fat mass
d. he needs more energy due to preserving visceral fat mass
e. he needs more energy due to preserving subcutaneous fat mass
2
5
is
is
is
is
is
2
7
131. A 62 years old man come to your clinic because he is concern about
increasing shortness of breath. He complaint about cough and increased
sputum production for the last 5 years. He smoked since of 15 years old
and he stopped smoking since 2 years ago. His chest xray showed
hyperinflation, flattened diaphragm,
no infiltrate was found.
Spirometricresult showed FEV1/VC 60% and FEV1 45% predicted, ECG
tracing was normal.
The PE which would not be found :
A. Crackles
B. Prolonged expiratory time
C. Wheezing during auscultation
D. Hypersonor on percussion
E. Purse-lip breathing
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
134. Exercise which is recommended in asthma is :
A. Deep breathing exercise
B. Chest expansion breathing exercise
C. Strengthening diaphragmatic exercise
D. Strengthening muscles of extremities
E. Aerobic exercise
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
2
9
sputum production for the last 5 years. He started to smoke at age 15 year
old. His chest xray shows hyperinflation, no infiltrate founded. Spirometry
result shown FEV1/FVC 60% and FEV1 45% predicted, ECG is normal.
Which of the following treatment is NOT recommended for stage of this
patients disease?
A. Rehabilitation
B. Bronchodilator
C. ICS
D. Long term O2
E. Influenza Vaaccination
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
137. A male patient is suffering pulmonary tuberculosis. He is now in the
second month of intensive phase of the treatment. Three days ago he
began to develop vision disturbance. Which one of these drug is the
most likely caused?
a. Rifampicin
b. Pyrazinamide
c. Ethambutol
d. Isoniazide
e. Combination ofisoniazide and rifampicin
138.Perry, an 18 years old previously healthy medical student come to you
with difficulty in breathing. He began to feel this symptom 3 days ago.
He also complained high fever, cough with yellow thick sputum. On
physical examination chest movement was asymmetric, right
hemithorax : tactile fremitus was increased and dullness on percussion
and crackles was heard.
The diagnosis of this medical student :
a. Community acquired pneumonia
b. Acute exacerbation of asthma exacerbation
c. Empyema
d. Acute exacerbation of copd
e. Health care associated pneumonia
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 :
a.
b.
c.
d.
3
1
3
3
D.A schwarte
E. A bronchopneumonia (kalau patchy)
155. This disease begins as a localized infection of:
A. Terminal air spaces
B. Terminal bronchioles
C. Respiratory bronchioles
D. Acinus-alveolar duc-alveolar sac
E. Interstitial
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
For question number 157-158
A 25yo female comes with cough more than 3 weeks and accompanied
by the production of purulent sputum, night sweat, weight loss,
anorexia, general malaise, and weakness.
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
159. In the posteroanterior chest Xray,there is only calcification in the
apex of the lung. It is no clear if there are patchy consolidation in the
apex of both lungs,because the clavicle and the ribs overlaps with the
apex of both lungs. What is the best radiograph for showing the
precence of minimal patchy consolidation in the apex of the lung?
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168. What is the most appropriate terminology of the nasal mass in this
patient?
a. Chronic rhinitis
b. Nasal polyp
c. Inverted papilloma
d. Angiofibroma
e. Nasopharyngeal carcinoma
169. According to the pathogenesis of the disease, which inflammatory
cells are most commonly seen microscopically in above nasal mass?
a. Lymphocytes
b. Plasma cells
c. neutophils
d. Basophils
e. Eosinophils
For questions number 170-171
A 23 year old male came to the hospital because of epistaxis since 2 days
ago. He also complained nasal thickened since 1 month ago. Rhinoscopy
and nasopharyngoscopy revealed a reddish ulcerative mass in the
choanae and nasopharynx posterior. Biopsy of the nasal and nasophaynx
was performed, macroscopic, and microscopic appereance of the mass
was shown as below picture.
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