Kpbi 2010 Answer Respi System

FINALS RESPI KPBI 2010
1. A 70 years old nursing home patient refused the influenza vaccine and subsequently developed influenza.
She died of acute pneumonia 1 week after contracting the flu. The bacteria that cause of acute post
influenza pneumonia is gram negative rods and doesn’t grow on blood agar nor Mac COnkey agar. What is
the possible cause of the disease?
A. Legionella
B. Listeria
C. Staphylococcus aureus
D. Klebsiella
E. E.coli
2. An infant seen in ER, present with fever and persistent cough. Physical manifestation and a chest x ray
suggest pneumonia. Which of the following is most likely the cause of infection?
A. Rotavirus
B. Adenovirus
C. Coxsackie virus
D. Respiratory syncytial virus
E. Rhinovirus
3. Coronaviruses are recognized by club-shaped projections that are 20 nm long and resemble solar coronas.
These viruses be a major agent of common cold, especially in older children and adult are characterized
by:
A. The virion is known to contain B fragment of RNA
B. The virion is positive sense single stranded RNA
C. Grow well in usual cultured cell lines
D. Non enveloped virus
E. Agglutinate human RBC
4. Which virus is leading cause of the croup syndrome, bronchiolitis, and pneumonia in young children that
contain RNA in a nucleocapsid encased within an enveloped and when infecting mammalians cells in
culture, will hemabsorb RBC?
A. Groub B Coxsackievirus
B. Rotavirus
C. Parainfluenza virus
D. Adenovirus
E. Rhinovirus
5. Rhinovirus is the major cause of common cold that primarily transmitted by contact of contaminated
hands, fingers or formites with the conjuctiva or nasal epithelium. Which is the characteristic of the virus?
A. Members of paramyxoviridae
B. Member of orthomyxoviridae
C. gHas a positive sense single stranded RNA
D. Has a negative sense single stranded RNA
E. It is an enveloped virus
6. Excluding influenza virus, which one of the following viruses is the most common cause of acute
respiratory disease?
A. Cytomegaloviruses
B. Rotavirus
C. Varicella zoster virus
D. Adenovirus
E. Papillomavirus
7. This virus Is a single stranded RNA Orthomyxovirus. In the developed countries, annual vaccination is
necessary because of antigenic drift and shift.
A. Measles virus
B. Influenza virus
C. Respiratory syncytial virus
D. Parainfluenza virus
E. Adenovirus
8. A 62 year old man, who had influenza a week earlier reported to the ER with 38.5 °C fever and shaking
chills, a productive cough with yellowish sputum, and chest pain. CBC revealed 30,000mm³ WBC,
predominantly PMN. The result of sputum culture revealed H.influenza. The virulence of H.Influenza, the
most likely target would be:
A. Exotoxin liberator( no endotoxin)
B. Endotoxin assembly
C. Flagella synthesis
D. Capsule formation
E. IgA protease synthesis
9. What media should be used to inoculate sputum specimen from that pt to grow H. Influenza?
A. Blood agar( doesnt grow)
B. Lowenstein Jensen agar
C. Mac Conkey agar
D. Chocolate agar
E. Loeffler media
10. A 21 year old college student, complained of malaise, fever and harsh cough but not of muscle ache and
pains. An x-ray revealed a diffuse interstitial pneumonia in left lobe of lung. The WBC count is normal.
Student has been ill for a week.The bacteria has a characteristic that doesn’t have cell wall. What's the
Etiologic agent?
A. Mycoplasma pneumonia( no cell wall!)
B. Chlamydophilia pneumonia
C. Staphylococcus aureus
D. Legionella pneumophilia
E. Streptococcus pneumonia
11. A 25 years old man known to have AIDS developed a gradual onset of malaise and anorexia. An AFB is
identified microscopically. M TB found is found in the sputum of the patient with Tb. After digestion of the
sputum, isolation is best accomplished:
A. Sheep blood agar
B. Loffler medium
C. Thayer Martin agar
D. Thiosulfate citrate bile salts sacrose medium
E. Lowenstein- Jensen medium.
12. What is the important characteristic of the cell wall structure of AFB?
A. Has a high content of lipopolysaccharide
B. Outer membrane contain lipoteichoic acid
C. Has not peptidoglycan,so that the bacteria resistant to antibiotic
D. The presence of mycolic acid and lipoarabinomanan ( LAM)
E. Has polysaccharide capsule as attribute of pathogenicity
13. The structure of Tb that potentiate the toxicity and promote intracellular survival by inhibition
phagosome-lysosome fusion in the macrophage is:
A. mycolic acid
B. wax
C. sulfatide
D. Lipopolysaccaride
E. lipotheioic acid (s. pneumonia)
14. A 29 year old with previous rhinorrhea, pharyngitis and cough visits his doctor with a 39°C of fever which
appear abruptly after a sudden shaking chill episode. He has chest pain and productive cough. X ray shows
diffuse lobar consodilation of the right lung. Sample from sputum was cultured and the bacteria was
identified as Streptococcus pneumonia. What is thepositive test to identify this bacteria from colony on
blood agar
A. Beta hemolysis (alpha )
B. sensitive to optochin
C. v and x factor (h.influenza)
D. resistance to novobiacin
E. Catalans positive
15. Which is the following statement about respiratory tract mycosis is CORRECT?
A. group of superficial mycosis
B. only cause by opportunistic fungi
C. the true pathogenic fungi dimorphic fungi
D. cannot be diagnosis by lab exam
E. also called as dermatophytosis
16. A 37 year old man presents to the office for the evaluation of a cough and fever. He has had these
symptoms for about a week. His pulmonary examination is notable for some faint expiratory, wheezing,
and crackles in the left upper lung field. A culture from respiratory specimen grows on Sabaouraud Agar
represent a rough walled of round microconidia and tear shaped microconidia. What is the cause of this
disease?
A. Histoplasma capsulatum
B. Coccidioidesimmitis
C. Aspergillusfumigatus
D. Cryptococcus neoformans
E. Paracoccidioidesimmitis
17. A 65 year old man with diabetes and difficulty in breathing was asked by pulmonologist to go to micro lab
for microbiological examination of sputum. The sputum examination was thick and bloody. The colony
yield heavy growth of a lactose positive, non motile, gram negative rod with large capsule. Which of the
following bacteria with those characteristic is to be the cause of the pulmonary problem?
A. Enterobacteraerogenes( small capsule)
B. Klebsiellapneumoniae
C. Mycoplasmapneumoniae
D. Chlamydophilapneumoniae
E. Legionella pneumonia
18. A 11year old girl came home from school because she had a high fever and complained had difficulty
swallowing any food. Her parents noted that several children from her school had reported sore throat
recently. Throat swab was taken for culture, the bacteria was gram + cocci in chains, yields clear B
hemolysis on blood agar, sensitive bacitrasin. Of the organisms list below, which one is the bacteria that
cause the disease?
A.Staphylococcus aureues
B.Staphylococcus saprophyticus
C.Streptococcus pyogens
D.Streptococcus pneumonia
E.Streptococcus viridans
19. Gaseous exchange between pulmonary airway & pulmonary blood happens during:
A. Inhalation, because the alveoli retract during exhalation
B. Inhalation, because at this time the oxygen level of the airway is still high
C. Inhalation, because at this time the alveolar surface area is greatly expanding
D. Exhalation, because at this time the alveolar air pressure reaches its peak
E. Exhalation and inhalation, because at this time alveoli do not appreciably change is size
20. 20.Whats da effect of 2-3-Diphosphoglycerate(2-3-DPG) on affinity between Oxygen n Hb?
A.Increase it, because oxygen needed to synthesize 2,3-DPG
B.2,3-DPG has no effect in the affinity between O2 and Hb
C.Decreases it, because 2-3-DPG replaced the oxygen at the Hb molecule
D.Decreases it, because 2-3-DPG stimulates the changing of Hb shape
E.Decreases it, beacause 2-3-DPG stabilize hemoglobin in the T deoxyhemoglobin form
21. Which of these factors can increase the affinity between O2 and hemoglobin?
A. Increase Co2 tension
B. Increase of body temperature
C. Increase hydrogen ion level
D. Increase of erythrocyte glycolysis
E. Increase of O2 atmospheric pressure
22. If the PO2 of the blood that enter the lung is 40mmHg and PO2 of the alveoli air is 104mmHg, there PO2
of blood that leave the lung must be:
A. More than 104mmHg, because O2 move from the higher pressure to lower pressure
B. 104mmHg, because the blood uptake of O2 is a diffusion process
C. Between 40 to 104mmHg, because not all blood vessel of the lung is used during breathing
D. Between 40 to 104mmHg, because blood from pulmonary veins is diluted by blood from bronchial
veins
E. Between 40 to 104mmHg, because the blood passes the lung only in a short time so there is not
enough time to saturate it completely.
Choose one of the most appropriate answers from these options below:
A. respiratory acidosis
B. metabolic acidosis
C. respiratory alkalosis
D. metabolic alkalosis
E. normal pH
23. Mostly can be happened in the presence of excess CO2 in inspired air A
24. Happened in healthy person that participate a 10km marathon. B
25. Hyperventilation due to panic syndrome C

26. Decreased alveolar ventilation in emphysema due to COPD A
27. Which of the following related about bronchioles

A. major site of gas exchange
B. contain no smooth muscle in wall therefore significantly reduces airway resistance
C. contribute to more than 50% of resistance to flow in the lower respiratory tract
D. contain fibroblast which secrete highly proteinaceous fluid
E. differ from bronchi which contain cartilage in their wall
28. Which of the following statements related to mucosal lymphoid tissue in the respiratory tract?
A. non capsulated lymphoid tissue
B. mostly b-lymphocytes
C. activated lymphocyte will not home bachy to respiratory mucosa
D. within the upper respiratory tract make up the waldeyer’s ring
E. It is a major site of monocyte activation in the airways
29. Which one of the following statements related to emphysema?

A. Diffusion O2 is decreased due to destruction of lung parenchyma
B. Over 10% of cases have ≤2 anti trypsin deficiency
C. Surface for gas exchange is increased
D. Reducing airway resistance
E. Patient develop of fibrotic lungs
30. A newborn infant was observed choking and continues coughing. There was excessive amount of mucus
secretion and saliva. In the infant mouth and the infant experienced considerable difficulty in breathing.
Which one of the congenital anomaly was occur?
A. Olygohydramnion of the lung development
B. Tracheal stenosis
C. Tracheoesophageal fistula
D. Oesophageal fistula
E. Tracheal diverticulum
31. Which one the embryological most common location of this defect?
A. Superior part esophagus and trachea
B. Inferior part esophagus near tracheal bifurcation
C. In the middle part esophagus and tracheal
D. Upper part of trachea
E. Upper part of esophagus
32. A premature infant developed rapid shallow respiration shortly after died was diagnosed Respiratory
Distress Syndrome. Which can usually cause RD’s?
A. Incapable type 1 alveolar producing hyaline protein
B. Incapable type 2 alveolar producing surfactant
C. Suggested prolonged extra uterine asphexhyxia
D. Occur in premature infant undle
E. Incapable lung function
33. The role of human sinuses is very significant in daily life. Which of the following statement is correct
regarding embryological development of 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 frontal bone, forming a frontal sinus on each side
D. Paranasal sinuses form from outgrowth of the walls of nasal placode

E. The maxillary sinuses are present at birth
34. the exchange of gases between alveolar capillary blood and alveolar cavity is the process of
A. paracellular diffusion.
B. simple diffusion
C. facilitated diffusion
D. active transport
E. antiport transport system
35. splanchic mesoderm in the respiratory system will develop into which of the following component?
A. bone
B. epithelium cells
C. striated muscle cells
D. glands
E. connective tissue
36. which of the epithelium cells lining the respiratory portion of the respiratory tract?
A. ciliated pseudostratified epithelium
B. simple columnar
C. simple cuboidal
D. stratified squamous
E. simple squamous
37. in the lamina propria,there are number of cartilages.The larger cartilages are hyaline cartilages and the
smaller cartilage are elastic cartilage.Which tube it is ?
A. larynx
B. trachea
C. primary bronchi
D. secondary bronchi
E. bronchioles
38. First part of respiratory system

A. Bronchi
B. Bronchioles
C. Terminal bronchioles
D. respiratory bronchioles
E. alveolar duct
39. The intralobular airways have neither cartilage nor glands in their mucosa. In the larger part the epitelium
is ciliated pseudostratified columnar. Which of the following is most likely the tube?
A. Bronchi
B. Bronchioles
C. Alveolar duct
D. Terminal bronchioles
E. respiratory bronchioles
40. The smallest portion of this respiratory tract is lined by cuboidal epithelium and contains Clara cells. Which
of the following is most likely the tube?
A. respiratory bronchioles
B. Terminal bronchioles
C. Alveolar duct
D. Alveolar sac
E. Alveoli
41. Tonsils are located in the lateral wall of the oral part of the pharynx. Which of the following epithelial cells that
covered external surface of tonsils
A. Stratified squamous epithelium

B. Stratified columnar epithelium
C. Stratified cuboidal
D. Simple columnar
E. Respiratory epithelium
A 17 year old man was brought to emergency department due to sport injury. he was guarding the goalpost when
suddenly the ball was kicked right in his face's direction and he couldn't avoid it. His nose was bleeding profusely
and bent. After the doctor performed maneuver to his nose, the shape returned to normal
42. which of the following structure most likely cause the difference in his nose shape
A. Septal cartilage
B. Alar cartilage
C. Cribiform cartilage
D. Vomer bone
E. Nasal bone
43. Which of the following artery most likely cause the bleeding?
A. Ophthalmic artery
B. Internal carotid artery
C. Superior ethmoidal artery
D. Sphenopalatine artery
E. Facial artery
44. 2 year old girl was 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 lodged bead?
A. Between nasal septum and nasal conchae

B. Between the middle and inferior conchae
C. In the sphenoethmoidal reces
D. Passed the choanae
E. In the vestibule
45. A 20 year old man has been diagnosed with sinusitis and asked his physician why there is nasal discharge during
the night but not during the day.
Which of the following is the most suitable explaination
A. Disruption of drainage due to mastification

B. Location of the ostia within the nasal passage

C. The sinus most likely affected is the maxillary sinus
D. Diurnal mucous production increases at night
E. Location of the ostia within the Eustachian tube
46. Which of the sentences below is TRUE regarding the sphenoid sinus?
A. It is located in the body of sphenoid, directly inferior to sella tursica

B. It is located on the greater wing of sphenoid. The sinuses separated by sella tursica
C. It is drainage located in the middle meatus, in the groove of semilunar meatus
D. It has multiple cells, collectively called the sphenoidal bullae
E. It is supplied by the sphenoidal artery
47. A 20 year old male come to you complaining of purulent nasal discharge for 2 weeks.He stated that the
discharge is foul smelling, and most particularly, disrupting during bed time. Upon transillumination examination,
you found that the glow decreased on both sides.
The sentence below is TRUE regarding the affected sinus above:
A. The frontal sinus. Located in the frontal bone. Innervated by branches of CN VI
B. The maxillary sinus. It's base forms the inferior part,of the lateral wall of the nasal cavity
C. The ethmoid sinus. It's anterior cells drains into the middle nasal meatus via semilunar hiatus
D. The sphenoid sinus. It's ostia located higher than the antrum, making drainage is only possible in certain position
E. The frontal sinus. Formed during childhood. Supplied by branches from ophthalmic artery
48. A 30 year old female had complaints of uncomfortable feeling in the ear and decrease hearing right after her
plane landed
What structure is responsible to relieve the complaint above?
A. The tensor veli palatini muscle that pulls the opening of pharyngotympanic tube in middle ear
B. The levator veli palatini muscle that pulls the opening of pharyngotympanic tube in middle ear
C. The tensor veli palatini muscle that pulls the opening of pharyngotympanic tube in nasopharynx
D. The levator veli palatini muscle that pulls the opening of pharyngotympanic tube in nasopharynx
E. The tensor tympanic muscle that pulls the opening of pharyngotympanic tube in middle ear
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 tongue
Why was there a temporary loss of taste sensation?
A. Compression of greater 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)
50. A 8 years old girl was brought to the clinic because of decrease hearing. Her parents said that for the last 2
weeks she’s 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?

A. Ascending pharyngeal artery
B. Ascending palatine artery
C. Descending palatine artery
D. Superior laryngeal artery
E. Tonsilar branch of facial artery
51. A group of medical student was observing respiratory tract on dissected cadaver. Upon observing the neck, they
found a structure anterior to the esophagus on the level of C3-C6 vertebrae.
A. Shaped like a signet ring with it’s band facing anterior side
B. The largest cartilage. Paired on either halves of the posterior part of laryngeal inlet
C. Located between the bases of the arytenoids cartilage 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 median plane to form the laryngeal
prominence
E. A heart shaped cartilage covered with mucous membrane. Situated posterior to the root of the tongue
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 contraction
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 symptom?
A. The vagus nerve
B. The recurrent laryngeal nerve
C. The inferior vagal ganglion
D. The superior laryngeal nerve
E. The glossopharyngeal nerve
54) A 44 year old man was brought to the emergency department complaining that he accidentally 'inhaled'
peanut. Upon radiological exam on the chest, the peanut was found slightly upward on the right side of the chest.
Why foreign body would most likely lodge there?
A. Because the caliber of the right main bronchus is largely 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 the left main bronchus is compressed by the passing aorta
E. Because the carina was very sensitive and usually initiate cough reflex
55. A 37 year old man brought to the ER because of rapid and breathing difficulty. His family brought him to the
hospital directly after he fell from the 5m pole in the Independence Day game. The doctor examined him and found
out that his trachea was deviated.
Which is the most appropriate sentence regarding the wind pipe?

A. Extend from the base of the pharynx into the posterior mediastinum
B. Has full cartilages to keep its lumen open
C. Innervated by the branch of CN XI
D. Started at level C6 vertebrae to T4-T5 IV disc
E. Lies posterior to the esophagus
56. A 17 year old male was brought to emergency department because of severe breathlessness. Moments before
his symptoms occur, he had fallen from a tree after attempting to rescue his lost cat. After underwent primary
survey and needle thoracostomy, thorough physical examination was performed. He was diagnosed with tension
pneumothorax and fractured 3rd-4th ribs.
Which sentence is correct?
A. Intercostal arteries is less likely to be source of bleeding compared to branches of pulmonary artery
B. Pain is more likely caused by the tear in the visceral pleura, carried by the branches of Vagus nerve
C. The tear in the pleura caused air to enter the potential pleural cavity, making its pressure to fall below
atmospheric pressure, thus making breathing impossible
D. Fractured ribs most likely punctured the visceral pleura that lined the inner aspect of thoracic cavity
E. Needle thoracostomy should be done rightly above the rib to avoid the nerve and blood supply that runs
inferiorly to the ribs
57. Which of these sentences is CORRECT ?
A. The lungs has 3 lobes on the right, 2 lobes on the left. Each of the lobes divided by the horizontal fissure
B. The lungs located in thoracic cavity, the heart carved the right lung into having cardiac notch
C. The lungs are innervated by branches of vagus nerve, thus making it highly sensitive to pain
D. The lungs has 3 borders and 3 surfaces. It’s costal surface is concave and indented with the ribs shape,
while its mediastinal and diaphragm surfaces is convex
E. The lung attach to its root, at the hilum. The structure that passes thru are pulmonary artery and veins,
the main bronchi, bronchial veins, and lymphatics.
58. A 65 year old woman come to you with complains of difficulty of breathing. The complain has been going on
for a month an getting worst by the night when she’s lying down.
You suspected that she has pulmonary edema.
In orde to confirm your hypotheses, you need to listen to her breath sound. Where should you place your
stethoscope to hear the loudest for the breath sound anomaly?
A. On posterior chest, between the vertebrae and scapula, at the level of T5

B. On posterior chest, at the tip border of scapula, at the level of T10
C. On anterior chest, between the clavicle and the ridge of trapezius
D. On anterior chest at the level of 2nd ICS on the midclavicular line
E. On anterior left chest at the level of 4th ICS, right above the heart
59. You are a 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 then move slightly lateral to either sides.
What would most likely be found?
A. Another bony prominence, a mark of xyphoid process

B. A bulk of mass from overused external intercostal muscles
C. A groove widening 2nd ICS
D. A round prominence marked by darker skin appearance, the nipples
E. Another bony prominence, mark the costo-sternal joint
60. On cadaver dissection, you found intersecting muscle in anterior thorax. The muscle attached from lower end of
one rib to upper part of rib below it.
What is the characteristic of external intercostal muscle?
A. Most actively involved in expiration

B. They elevate the sternum during inspiration
C. They run inferolaterally towards the sides of the thorax
D. Together with internal intercostal occupy ICS, with external intercostal lying deeper than the internal
E. They occupy the ICS from the tubercles of the ribs posteriorly to the costochondral junctions anteriorly
61) The relaxed expiration does'nt depend on muscle work
BECAUSE
Main action on expiration occurs from elastic recoils of lung and relaxation of diaphragm.
What is the correct relationship between the two sentence above?
A. Both sentences are correct with causal relationship
B. Both sentences are correct with no causal relationship
C. The first sentence is correct while the second is false
D. The first sentence is false while the second is correct
E. Both sentences are false
62) In a 65 years old woman with difficulty breathing , the total lung capacity and functional residual capacity are
lower than the normal and FEV1/FVC is slightly higher than normal. What is the most probably the mechanism that
happen on that condition?
A. Decreased pulmonary blood flow
B. Decreased strength of the chest wall muscles
C. Increased airway resistance
D. Increased lung elastic recoil
E. Increased chest wall elastic recoil
63.A patient has decrease total lung capacity and decrease residual volume.Functional residual capacity is
normal.What is the most probably mechanism that happen?
A decrease pulmonary blood flow
B increase airway resistance
C decrease strength of muscle of respiration
D increase chest wall elastic recoil
E increase lung elastic recoil
64 A chest Xray of patient with left sided heart failure indicate pulmonary edema.What is most probably additional
examination that would reveil in this patient?
A decrease pulmonary artery pressure
B decrease pulmonary lymph flow
C increase pulmonary venous pressure
D normal arterial oxygen partial pressure
E normal vital capacity
65 A newborn infant with a deficiency of pulmonary surfactant probably will need to utilize the muscle to have an
adequate respiration .Which of the following muscle to accomplish the condition ?
A Diaphragm (D), internal intercoastal ( II), scalene (S) , Sternocleidomastoid (ST), rectus abdominis (RA)
B D , II , S , ST
C D, external intercostal (EI), II,RA
D D, EI,S,RA
E D, EI,S,ST
66. in a patient wif diff in breathing, TLC N FRC are greatr thn normal, FVC n FeV1/FVC are lower thn normal.
Mechanism…?
a) decrease lung compliance
b) decrease pulmry lymph flow
c) increase air flow resistnce
D) dcrease chest wall compliance
67. a womn 68yrs old wif pulmnry fibrosis wif a chief complain dyspnea while performing activities..
Pulmonary testing.. which lab diagnosis..
a) Decrease diffusion capacity of lung
b) Increase residual volume
c) Dcrease fev1/fvc
d) Increase lung compliance
e) Increase airway resistance corrected fr lung volume
68. A 125 lb, 40 year old woman with a history of nasal polyps and aspirin sensitivity since childhood presents to ER
with status asthmaticus and hypercapnic respiratory failure. She requires immediate intubation and is placed on
mechanical ventilator on FiO2 of 40%, a control rate of 15 breaths/min and tidal volume of 500ml.How much is her
approximate alveolar ventilation?
A. 375 mL/min
B. 3500 mL/min
C. 5250 mL/min
D. 5625 mL/min
E. 7500 mL/min
69. A 68 yo male with COPD entered ER complaining os shortness of breath. His RR was 35 per min and labored. He
had productive cough and rales heard over lung field. The patient had rather ashen complexion and his nail beds
gave clear evidence of cyanosis. An arterial blood sample was obtained and CXR was ordered. The patient was then
placed on an O2 mask delivering 40%O2. One half hour later, the patient found unresponsive. His complexion had
changed to flushed pink with no trace of cyanosis. His respiration was quiet at rate of 6 per min and tidal volume of
300mL. Repeat arterial blood gases showed that his arterial PC02 had increased from 55 to 70mmHg.
What is the most probable mechanism that happen to this patient?
A. Alveolar hypoventilation
B. Hypoxic pulmonary vasoconstriction
C. Increased firing of carotid body receptors
D. Elimination of the hypercapnic drive
E. Oxygen toxicity
70. Oxygen carying capacity in whole blood is:

A. department on the alveolar PO2
B. the amount of O2 dissolved in the blood
C. the sum of dissolved O2 plus the amount bound to haemoglobin
D. the sum of dissolved O2 plus the amount O2 bound to haemoglobin under saturating comdition
E. limited by 02 diffusion
71. The lung function test of a patient show a markedly reduced FEV1 sec and functional residual capacity of 4.2L.
Which of the following statement that most likely cause of the reduced FEV1 sec?
A. weak expiratory muscle
B. small diameter airway
C. pulmonary congestion
D. pulmonary fibrosis
E. dynamic compression of airway
72. Mr. Smith complains of shortness of breath and difficulty with moderate exercise, Pulmonary function tets
indicate a reduced FRC and his FEV1 sec was 2.6 L (78%). His forced vital capacity was 3.1L (70%) what is the most
likely cause of mr.Smiths problem?
A. weak expiratory muscle
B. small diameter airway
C. dynamic compression of airway
D. pulmonary fibrosis
E. pulmonary congestion
73. A 36 year old woman undergoes chemotherapy with bleomycin for an ovarian germ cell cancer. She develops
mild pulmonary fibrosis secondary to the chemotherapy. Which agent diffusion across the alveoli-pulmonary
capillary barrier would be most likely to be affected by her disease?
A. CO
B. CO2
C. N2O
D. O2
74.32 years old man has poisoned with carbon monoxide.What is the Po2 in the arterial blood of the patient?
*picture not clear*
D. reduced from normal because of the CO bound to hemoglobin
75.What factor can inhibit o2 binding hemoglobin in the pulmonary capillary?

The answers not clear in the picture…
D. shift to more acidic pH that is found in venous blood
76. 42 weeks baby got delivered by c-sec. mechanism dat probably took place at first diaphragmatic respiration?
A. PaO2 increase
B. pulmonary capillary resistance increase
C. pulmonary capillary hydrostatic pressure increase
D systemic vascular resistance decrease
E. All of the fetal vascular channel functional close
77. 23 yrs girl present with a sign of hypoxia. Arterial blood gas shows that the PO2 is normal but arterial O2
saturation reduced. Condition?
A. Anaemia
B. a loss of V/Q ratio
C. carbon monoxide poisoning
D. hypoventilation
E. right to left shunt
78. A 70 year old man admitted with CC shortness of breath, cough and yellowish sputum. History of DM +. PE : RR
36/min T 38°C BP130/80mmHg, rhonchi +/-, wheezing -/-, blood glucose 276mg/dl, CXR: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 filled with fluid due to increased hydrostatic pressure
B. the total surface area of respiratory membrane decreased
C> the ventilation and perfusion ratio is consequently increased
D. the content of CO2 in the blood will be decreased
E. the physiologic dead space also become decrease
79. A result of BAG of 25 yo pneumothorax shows: PH 6.971, pCo2: 71.4mmHg, pO2: 97.4mmHg, HCO: 32.1 mEq,
BE: +2.8, O2 saturation 56.4%. These findings suggest homeostasis in preserving gas exchange to fullfill metabolism
demand. Related to the case above, in the normal condition on the other hand, the negative pressure in the pleural
space is allowed through which of the following factor?
A. strong and continuous alveolar epithelium
B. pumping of fluid from pleural space by lymphatics
C. collection of large amounts of fluid in the pleural space
D.hydrostatic pressure at the capillary
E. osmotic forces at the alveolar membrane of the lungs
80. refer to picture below
Related to the case above, which of the following describes most accurately about the functions of the respiratory
passageways?
A. All passageways have cartilage to keep them from collapsing
B. All the passageways are surrounded by smooth muscle
C. In obstructive diseases all the passageways are constrcited
D. The greatest amount of resistance to airflow occurs in alveoli
E. In disease conditions, the smaller bronchioles determine resistance
81. Related to the case above, which of the following describes most accurately about the cough reflex ?
A. Afferent nerve is mediated to through trigeminal nerve

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 82 to 83, refer to the scenario below:
82. Which of the following is the most appropriate regiment for this patient ?
A. 2 HRZE
B. 2 (HRZE)S
C. 2 HRZ / 4 (HR)3
D. 2 (HRZE)S / HRZE
E. 2 (HRZE)S / (HRZE) / 5 (HR)3E3
83. Which of the following anti-TB drugs should be avoided in this patient ?
A. Isoniazid
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. Streptomycin
A 27 y.o woman, came to PUSKESMAS with hemaptoe. She said that she had been diagnosed lung TB few months
before her pregnancy. She said that she had 1 month of continuation phase thrapy using R and H before she
stopped her treatment by herself because she afraid it might harm her foetus.
One week ago, she delivered a healthy baby
84. Which of the following is the most appropriate regiment for her initial phase ?
A. RHZ
B. 4 RH
C. 5 (HR)3E3
D. 2 RHZES
E. 2 (HRZE)S/ (HRZE)
85. A 48 y.o man was diagnosed pharyngitis acute and was given Erythromycin, ibuprofen and bromhexim by
another doctor since 2 days ago. Today he is complaint with diarrhoea and vomiting since yesterday. His medication
has already used up.
Which of the following is the most appropriate reduce for his complaint ?
A. Change ibuprofen
B. Change bromhexim
C. Change erythromycin
D. Give antacid
E. Continue the medication with additional drug for his complaint
86. A 38 y.o man who presents to the Emergency dept. for an acute visit due to shortness of breath. He reports
feeling especially short of breath since this afternoon after he took propranolol for his palpitation. He got that drug
from another doctor in a clinic this morning.
You give him theophylline 300mg 2x1.
If the patient has a liver dysfunction, why you should change the treatment ?
A. Toxicity potency
B. Reduction of efficacy
C. Increasing of clearance
D. Progression of liver disease
E. Shortened duration of action
For each statements below choose the most appropriate drug from the following list:
A. Inhaled cromolyn
B. Inhaled salbutamol
C. Oral or IV methylprednisolone
D. Inhaled ipratropium bromide
E. Intravenous propranolol
87. the most appropriate drug gains rapidly bronchodilator B
88. The drug that most likely to provide sustained resolution of the patient’s inflammation symptoms C
89. A drug contraindicated in this patient
For each statements below choose the most appropriate drug from the following list:
A. INH
B. Rimfampisin
C. PZA
D. Ethambutol
90. The drug interacts with the β subunit bacterial DNA dependent RNA polymerase and thereby
inhibits RNA synthesis B
91. The drug reacts with pyridoxine which can cause deficiency of this vitamin A
92. The drug inhibits the metabolism of phenytoin A
93. The drug may caused red-green color blindness D
94. The drug crosses inflamed meninges C
95. A 30 y.o man complained dyspnea and fever. His symptoms became severe that his family brought him to the
emergency room. Physical examination revealed RR was 32x/min, PR was 112 bpm, temp 40 ‘C and BP was 130/80
mmHg with crackles in the inferior lobe of left pulmo. Others were within normal limit. Hb 12g/dl, WBC
27.000/mm3. Chest x-ray showed inferior left lobe infiltrate. He had history of penicillin and cephalosporin allergy.
The doctor decided the patient could go home after the dyspnea treated.
Which of the following drug of choice for this patient ?
A. Oral cefuroxime
B. Oral azithromycin
C. IV azithromycin
D. IV beta lactam + oral azithromycin
E. IV beta lactam + IV azithromycin
96. A 4 year old boy present to ER with stridor, cough, and slightly hard to breath. PE revealed RR was 42x/min,PR
was 102 beats per min, temp 38°C and suprasternal retraction. Others was within normal limit. He had history of
penicillin and cephalosporin allergy. Which of the following drug is the most appropriate for this patient?
A. erythromycin 1x/day
B. erythromycin 2x/day
C. azithromycin 3x/day
D. clarithromycin 1x/day
E. clarithromycin 3x/day
97. A 15 year old girl came to the primary health care with problem difficulty in breathing. The problem occurred
after she cleaned her room this morning. IN PE, found wheezing during expiration. What do you think the etiology
for her problem?
A. fungus
B. dust mite
C. viral
D. bacteria
E. microflora
98. One way to eradicate is:
A. maintaining humidity above 50%

B. exposing them to temperature above 30°C
C. using abate powder
D. regularly cleaning and washing
E. sweep the carpet
99. The statement which is wrong related with 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
100. Media for Mycobacterium Tuberculosis
A. Mac Conkey
B. Horse blood agar
C. Loeffler agar
D. Lowenstein agar
E. Kligler agar
101 Staining for M. tuberculosis
A. Gram staining
B. Neisser staning
C. Ziehl-neelsen staining
D. Gemsa staining
E. Negative stanning
102 Criteria for reporting the level of M tuberculosis according to IUATLD in staining:
A. Report (+) if we find >10 AFB/100 HPF

B. Report 3 (+) if we find >10 AFB/HPF
C. Report (+) if we find 1-10 AFB/100 HPF
D. Report negative if we find only 9 AFB/100 HPF
E. Report 2 (+) if we find >10 AFB/ HPF
103. A 3 yo develops H. Influenza. Culture of the nasopharyngeal swab specimen in blood agar with X and V factor.
Which is the morphology of this stain?
A. Gram positive cocci

B. Gram negative basicilli
C. Diplococci gram postive
D. Diplococci gram negative
E. Cant stain by gram staining
104)For growth,the influenza in blood agar with x and v factor,v factor contains:
A. Folic A
B. Nicontinamide Adenin Dinucleotide
C. Bacitrasin
D. Heme
E. Nicotinic acid
105) A 27 y.o boy lives with his grandfather that has cronic bloody cough since the last 4 months.The boy has poor
weight gain,loss of appetide,prolonged fever and moderate malnutrition.WOTF diagnostic examination is likely to
result correct diagnosis of this boy?
A. A.Bronchoscopy
B. B.Tuberculin skin test and chest x ray
C. C.Tuberculin skin test
D. D.Chest x ray
E. E.ESR
106)16 month y.o boy with history of weight loss,recurrent low grade fever,with tuberculin skin test 15 mm,and the
chest x ray show enlargement of hilarlympnode,the nutritional status was moderate malnutrition.The most likely
diagnosis:
A. A.Lymphadenitis TB
B. B.Latent TB infection
C. C.Pulmonary TB
D. D.Miliary TB
E. E.Pneumonic type TB
107.13 months old boy.with chief complain,weight loss and 3 weeks cough.Neck lymph node
enlargement.tuberculin test reactive.x ray infiltration in bilateral peripheral.appropiate treatment?
A. isoniazid prophylaxis
B. isoniazid rifampin for 6 months'
C. isoniazid rifampin for 2 months
D. isoniazid rifampin pyrazinde for 6 months
E. isoniazid rifampin pyrazinde for 2 months and isonizide and rifampin for 4 months
108.3 years old boy without any clinical manifestation of tb.chest x ray normal.tuberculin test reactive.His father
diagnosed as tb positive with acid bacilli in sputum.Prophylaxis for the child
A. isoniazid and rifampin for 2 months
B. isoniazid and rifampin fr 3 months
C. isoniazid for 6 months
D. isoniazid for 9 months
E. isoniazid for 12 months
109. which o the following is the component of scoring system in Indonesia for TB NTP?
A. fever >1 week

B. cough >2 weeks
C. positive tuberculin test
D. positive contact with other child diagnosed TB
E. palpable neck lymph node of 0.5cm
For questions 110-111

A 7 month old baby was brought to pedriatric ER with the CC of difficulty breathing since the last 3 days. The PE are
tachypnea, chest indrawing, crackles, fever. CXR:patchy infiltrate in the bilateral hemithorax
110. what is the diagnosis"
F. lobar pneumonia
G. bronchopneumonia
H. bronchiolitis
I. bronchitis
J. laryngotracheabronchitis
111. Initial treatment?
A. oral cefixime
B. oral macrolide
C. IV cefotaxim
D. IV gentamycin
E. IV ampicilin
112. A 11 year old girl came to paediatric ER RSHS with a chief complaint of difficulty of breathing and cough since
the last 3 hours. Physical examination revealed wheezing, patient prefer sitting position, respiratory rate was 45per
minute.what is the diagnosis of this patient?
A. Mild asthma exacerbation

B. Moderate asthma exacerbation
A. Severe asthma exacerbation
C. impending respiratory failure
D. respiratory failure
113.what is the initial management of this patient?
A. inhaled corticosteroid
B. inhaled epinenephrine
C. inhaled SABA
D. inhaled LABA
E. inhaled anticholinergic
114. Which of the following structure the inspiratory stridor most likely would be expected to lie with lesion?
A. adenoid area
B. lower one third of trachea
C. right main stem bronchus
D. nasal area
E. glottic area
115. Medical management for this condition is :

A. Not frequently effective
B. Directed toward more resistant bacteria
C. Usually targeted toward bacteria and broad spectrum is not warranted
D. Universal
E.
116. A 50 year old nan complains of dyspnea,especially when he walked in a rush. His complaint abouy 30 pack per
year cigarette since he was 17 years old. His body weight is 55kg and height is 175cm. Which of the following most
likely his condition?
A. He need more energy to smoking
B. He need more energy to the increased work of breath
C. He need more energy to preserve fat mass
D. He need more energy to preserve viscersl fat mass
E. He need more energy to preserve subcutaneous fat mass
117. From the case above, what is the nutrition recommendation?

A. Add folic acid more than RDA
B. Add vitamin C more than RDA
C. Add vitamin A more than RDA
D. Add vitamin B more than RDA
E. Add vitamin B12
35 years old came to your clinic complaining cough and dyspnea. He is known as a heavy smoker. During physical
examination, it is found that his BP: 120/80, pulse rate 120x/min, resp.rate 30x/min and temp 38.2 C. Chest
examination: inspection barrel shape chest was found. Blood gas analysis results pH 7.28, PaCO2 50, PCO2 60, Sat
O2 90%.
118. Which of the following energy intake is the most appropriate.
A. Increasing energy needs with 65% calories from carbohydrate and 20% calories from fat
B. Increasing energy needs with 60% calories from carbohydrate and 25% calories from fat
C. Increasing energy needs with 50% calories from carbohydrate and 35% calories from fat
D. Increasing energy needs with 65% calories from carbohydrate and 35% calories from fat
E. Increasing energy needs with 70% calories from carbohydrate and 30% calories from fat
119. Which is the most appropriate statement due to substrate metabolism use
A. Respiratory Quotient for Carbohydrate is 0.7, protein 1 and fat 0.8

B. Respiratory Quotient for Carbohydrate is 1, protein 0.8 and fat 0.7
C. Respiratory Quotient for Carbohydrate is 0.7, protein 0.8 and fat 1

D. Respiratory Quotient for Carbohydrate is 0.8, protein 0.7 and fat 1
E. Respiratory Quotient for Carbohydrate is 0.7, protein 1 and fat 0.7
120. Which of the following is the most appropriate due to substrate metabolism use?
A. Respiratory Quotient (RQ) is the ratio of the volume of oxygen expired to the volume of carbon dioxide
inspired.
B. Respiratory Quotient (RQ) is the ratio of the volume of oxygen inspired to the volume of carbon dioxide
expired.
C. Respiratory Quotient (RQ) is the ratio of the volume of carbon dioxide inspired to the volume of oxygen
expired.
D. Respiratory Quotient (RQ) is the ratio of the volume of carbon dioxide expired to the volume of oxygen
inspired.
E. RQ is the ratio of volume of carbon dioxi… question incomplete from question booklet?
Que 121 and 122
A 45 y/o man complains productive cough and dyspnea.The dyspnea and cough were worsening with thick greenish
sputum and fever also by noisy breathing.His BMI was 17.5 kg/m3
121) Which is the most likely feeding strategies to prevent aspiration?
A. Resting before meals promoting oral intake,eating large portion of dense nutrient food and proper sitting
posture during eating.
B. Deep nutrient dense food and proper sitting posture .
C. Resting before meal promoting parenteral route intake,eating small portion of nutrient dense food and
proper sitting posture during eating.
D. Deep breathing during meal, promoting oral intake , eating small portion of nutrient dense food and
proper sitting posture during eating.
E. Resting before meal, promoting oral intake , eating small portion of nutrient dense food and proper sitting
posture during eating.
122)Which of the following the most accurate nutrient intake?
A. A.Caloric need ranging from 94 to 164% of predicted range and protein need ranging from 1.2 to 1.7g/kg
of body weight.
B. Caloric need ranging from 80 to 90% of predicted range and protein need ranging from 0.6 to 0.8g/kg of
body weight.
C. . Caloric need ranging from 80 to 100% of predicted range and protein need ranging from 0.8 to 1g/kg of
body weight
D. Caloric need ranging from 60 to 90% of predicted range and protein need ranging from 0.5 to 0.8g/kg of
body weight
E. Caloric need ranging from 90 to 110% of predicted range and protein need ranging from 1.6 to 0.8g/kg of
body weight
123. WOTF is the most common organism causing acute otitis media?
A. Haemophillus influenza
B. Moraxella catarrhalis
C. Streptococcus pneumonia
D. Staphylococcus aureus
E. Klebsiella pneumonia
124. WOTF is middle ear contain?
A. The auriculotemporalis nerve

B. The glossopharyngeal nerve
C. Semicircular canal
D. The Corda tympani
E. Utriculus
125. A 47 y.o man's chief complaints are chronic nasal obstruction, repeated sinus infection. He complains of
intermitten facial pain and pressure over cheecks, thick postnasal drip and epitaxis. Exmination of his nose shows
inferior turbinate hyperthrophy and yellowish thick discharge from each middle meatus. The Kiesselback plexus is
supplied by eah of the following arteries except which one?
A. Shenopalatine.
B. inferior labial
C. greater palatine.
D. Superior labial.
E. anterior ethemoid.
126.A 30 y.o womancame to your clinic with chief complain of yellowish nasal secretion from both nostrils for
almost 5 months. The complain accompanied with sometimes blocked nose and feel the nasal secretion come
down to the oropharyngeal area. From anterior rhinoscopy you found : yellowih nasal secretion came out from
ostium maxillary sinus with mucosal edema and also post nasal drip.
What are the appropriate and latest diagnostic tools to see every aspects of this disease?
A. Posterior rhinoscopy ans CT scan.

B. Transillumination and sinus paranasal radiologic projection.
C. CT scan and transillumination
D. Nasal endosopy and CT scan.
E. Water's and Caldwell position radiology.
127. What is the latest surgery for this disease?
A. Caldwell Luc operation

B. Endoscopic sinus surgery
C. Anthrostomy Washed out
D. ethmoidectomy intra anthral
E. turbinectomy reduction
128. a 40 yr old man came with chief complaint swelling at neck region since4days ago..accompanied with fever
and pain on swallowing.from PE u found swelling at the submandibular,sublingual,submental region.the tongue of
the patient is elevated and inspiratory stridor.
what is the appropriate diagnosis of this patient?
A. peritonsilar abscess
B. retropharyngeal abscess
C. parapharyngeal abscess
D. ludwig angina
E. danger space infection
129. What is the initial step in managing this condition?
A. tracheostomy
B. broad spectrum antibiotic
C. incision and drainage
D. Surgery
E. Palliative
130. A. 25-year-old woman, admitted to the hospital with chief complains of bloody sputum. Two years before, she
had treatment with RHEZ, but she did not complete the therapy. She had only 9 weeks therapy. Which category is
the case?
a. relapse
b. treatment failure
c. treatment after interruption (after default)
d. chronic case
e. new case
131) A 62 years old man comes 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 15 years old and he
stopped smoking 2 years ago. His chest x ray showed hyperinflation, flattened diaphragm, no infiltrate was found.
Spirometric result showed FEV1/FVC 60% and FEV1 45% predicted, ECG tracing was normal. The physical
examination which would not be found
A. Crackles
B. Prolonged of expiratory time
C. Wheezing during auscultation
D. Hypersonor on percussion
E. Purse lip breathing
132) A 20 year old man came to your clinic with chief complain of cough and sputum for more than 5 weeks. The
complaints were accompanied by chest wall pain, low grade fever and night sweating. He had taken antibiotic, but
showed no improvement. Two specimens of sputum of FAB show positive. One year ago, he had history of TB
treatment for 2 months, and discontinued this drug because he felt better and cures. Chest x ray showed lesion in
upper parts of right lung. Which of the following is the Gold standard to assess the respiratory failure?
A. Blood gas analysis

B. Chest x ray
C. Spirometry
D. CT scan thorax
E. Pulmonary angiography
133. 65 yr old male with sstage 3 COPD and woman 23 yr old with asthma bronchial moderate persistent. Both
took corticosteroid while woman gained improvement but man did not.why
A. gender difference
B. age difference
C. spirometry diff
D. Risk factor diff
E. inflammatory cell and mediator diff
134.exercise recommended in asthma is??

A. deep breathing exercise
B. chest expansion breathing exercise
C. diaphragmatic strengthening exercise
D. strengthening muscles of the extremities
E. aerobic exercise
135. 65y.o Increasing SOB, complains cough n increase sputum. Smoke since 15yo. Xray- hyperinflation, no infiltrate
found. Spirometry- fev1/fev 60% n fev1 45%. Ecg norm. WOTF treatment is not recommended for this patients
disease
A. Rehabilitation
B. bronchodilator
C. inhaled corticosteroid
D. long term o2
E. influenza vaccination
136. 67yo, cough wit whitish sputum. Spirometry- fev1/fvc 65% n fev1 82%. Besides avoid frm risk factor n
influenza vaccination, other med?
A. A.inhaled regular LABA

B. B.ICS
C. C.rehab
D. D.regular oral methylxanthyn
E. E.inhaled SABA as needed
137. suffering pulmo tb. In 2nd month intensive treatment. 3 days ago gt visual disturbance. Wic drug caused?
A. A.rifampicin
B. B.pyrazinamide
C. C.ethambutol
D. D.isoniazide
E. E.combination of isoniazide n rifampicin
138. 18 year old previously healthy medical student shortness of breath. Also complained of fever and yellowish
thick sputum. PE: asymmetrical chest. Right hemithorax tactile fremitus increase, dull on percussion and crackles
heard
A. Community acquired pneumonia
B. Acute exacerbation of asthma bronchial
C. Empyema
D. Acute exa. Of COPD
E. healthcare associated pneumonia
139. 47 year old farmer cough with sputum since 2 months. Previously diagnosed of lung TB and declared cured.
Antituberculosis regimen:
A. HRZE
B. HRZES
C. HRZ
D. RZES
E. HZE Ciprofloxacin
140. 67 year old. Complains of shortness of breath. PE: Hypersonic and wheeze. Spirometry after bronchodilator
FEV/FEC 56% ; FEV1 42% predicted.
A. COPD stage II
B. COPD stage III
C. Moderate persistent asthma bronchial
D. Severe persistent asthma bronchial
E. Mild asthma bronchial
141. Ms. Elsa is a 17 yo high school student who came to you due to shortness of breath. She usually feels her
shortness of breath between midnight to early morning and she feels this about 3 times in a week accompanied by
cough. Sometimes she is absent from school because of her symptoms.
On chest examinations, you only heard wheeze and others were within normal limit. The most likely diagnosis is:
A. COPD stage I
B. COPD stage II
C. Mild persistent bronchial asthma
D. Severe persistent bronchial asthma
E. Moderate persistent bronchial asthma
142. a 67 yo complained of 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 factors and
influenza vaccination, other medication for him is:
A. Inhaled regular long lasting beta2 agonist
B. Inhaled corticosteroid
C. Rehabilitation
D. Regular oral methylxanthyn
E. Inhaled short acting beta2 agonist as needed
143. a 72 years old known for years as a COPD patient. Recently his pulmonologist recommend him to add long
term oxygen therapy in the treatment. The indication for long term oxygen therapy are
A. PA O2 below 55mmHg or Sat below 88% with or without hypercapnia
B. PA O2 below 65mmHg or Sat below 88% with or without hypercapnia
C. PA O2 below 60 mmHg without evidence of pulmonary hypertension
D. PA O2 below 60mmHg without evidence of polycythemia

E. PA O2 below 65mmHg without evidence of pulmonary hypertension
144. Mr Haton Girsang had been diagnosed as pulmonary TB patient since a month ago and he received rifampicin,
ethambutol, INH and pyrazinamide. 2 days ago he complained that he had visual disturbance. Which drug is the
most likey the cause?
A. INH
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. combination of above drugs
145. anoxic condition which is important in forensic medicine is:
A. anemic hypoxia
B. metabolic hypotoxic anemia
C. stagnant hypoxia
D. hypoxic hypoxia
E. extracellular hypotoxic hypoxia
146. mechanical asphyxia is
A. stagnant hypoxia
B. hystotoxic hypoxia
C. anemic hypoxia
D. substrate hypoxia
E. hypoxic hpoxia
147. in cases of sea water drowning, it is found:
A. haemodilution
B. Na plasma increase
C. Haemolysis
D. K plasma increase
E. Ventricular fibrillation
148. in internal examination of drowning cases, it is found:

A. Cutis anseria
B. Cadaveric spasm
C. Washerwoman hands
D. Tardieu spots
E. Pseudo foam
149. the common cause of death in fresh water drowning?
A. Asphyxia
B. ventricular defribrillation
C. vagal inhibition
D. laryngeal spasm
E. cardiac arrest
150. a previously fit infant of 4 mnts old is found unexpectedly dead in her cot one mrg. A post morterm exm is
performed. The pathologist reports increase thickness and extension of pulmonary artery muscle. What does
finding indicate?
A. cardiopulmonary is likely
B. death was cause by asphyxiation
C. death was due to epilepsy
D. the child would developed hypertension in adult life.
E. there was chronic hypoxia before death
151. on a frontal chest film, there is the lung apex retracts towards the hilum, the sharp white line of visceral pleura
is visible, separated from the chest wall by a radiolucent pleural space, which is … lung markings:
A. Pneumothorax
B. Giant bulla
C. Pulmonary emphysema
D. Giant emphysema
E. Pleural effusion
152. a 20 yo male complained of persistent nasal discharge. This nasal discharge was yellowish and thick. Past
history, he had nasal itchy and nasal obstruction when the weather was cold.
On water’s film, there is clouding in right maxillary sinus.

Which of the following is the most likely diagnosis?
A. Tumor of right maxillary sinus
B. Right hematosinus
C. Acute sinusitis
D. Chronic sinusitis
E. Mucocele
153.on posteroanterior chest film, there is a cavity in the apical parts of the left upper lobe, the wall of the cavity is
thick and is surrounded by patchy consolidation.
Which of the following is best feature has been described?
A. Lung abscess
B. Pulmonary cyst
C. Mycetamo in cavity
D. Cavitating tumor
E. The cavity of Tb
for questions 154 to 155 , refer to scenario below:
… girl admitted in pediatric clinic with chief complain of difficulty of breathing (dyspnea) since … ago. This
complaint was accompanied by cough and high fever. In anteroposterior chest X-ray, there is homogenous lung
opacification with air bronchograms in the lateral segment of the lung.
154. the segmental homogenous lung opacification with air bronchogram is
A. An atelectasis
B. A pleural effusion
C. A pneumonia
D. A schwarte
E. A bronchopneumonia
155. the disease begins as a localized infection of
A. Terminal air spaces
B. Terminal bronchioles
C. Respiratory bronchioles
D. Acinus
E. Interstitial
156. a 10 yo girl admitted to pediatric clinic with a chief complaint of difficulty of breathing (dyspnea) since 7 days
ago. This complaint was accompanied by cough and high fever. In anteroposterior chest X-ray, there is a
homogenous lung opacification with air bronchograms in the lateral segment of the lung. The lateral segment of
the lung is located in:
A. upper lobe of right lung
B. upper lobe of left lung
C. middle lobe of right lung
D. lower lobe of left lung
E. lower lobe of right lung
for questions 157 to 158 , refer to scenario below:
A 25 yo female comes to pulmonary clinic. The patient is coughing more than 3wks and accompanied by the
production of purulent sputum, night sweats, weight loss, anorexia, general malaise and weakness.
157. what is the basic standard radiography for any patient presenting with a cough more than 3wks?
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 decubitus film
B. A posteroanterior chest film
C. A lateral chest film
D. An anteroposterior chest film
E. An apical lordotic film
159. in posteroanterior chest X-ray, there is only calcification in the apex of left lung. It is not clear if there are
patchy consolidations in the apex of both lungs because the clavicles and the ribs overlap with the apex of both
lungs.
What is the best radiograph for showing the presence of minimal patchy consolidation in the apex of the lung?
A. An oblique chest film
B. A left lateral decubitus film
C. An apical lordotic film
D. An anteroposterior chest film
E. A lateral chest film
160. mrs. X , a 28 yo woman came to PHC with 10 days history of nasal discharge. The discharge is yellow greenish,
thick, blood tinged also accompanied with decreased of smelling sensation, nasal blockage, fever and headache. 3
days ago, she felt pain and fullness in the left ear with mild decreased of hearing. PE result: discharge from the nose
and bulging tympanic membrane.
Which of the following is the best pathogenesis of discharge in this patient?
A. The ostium obstruction causes the vasodilation and ciliary and mucus glands dysfunction
B. Enlargement of concha part in the nose
C. Eustachian tube dysfunction caused by secondary infection
D. Viral infection causes vasoconstriction and destruct the mucus gland directly
E. The URT infection resulting in Eustachian tube dysfunction and improved bacterial adherence to the URT
mucosa
161. Which of the following is the best pathogenesis of bulging tymphanic membrane in this patient?
A. the ostium obstruction causes vasodilation and ciliary and mucus gland dysfunction.
B. enlargement of concha part in the nose.
C. altered regulation of middle ear pressure and formation of negative pressure in the middle ear.
D.viral infection causes vasoconstriction and destruct the mucous gland directly.
E. the upper respiratory tract infection resulting in Eustachian tube dysfunction and adherence to the upper
respiratory tract mucosa.
162. A 9 y.o boy came to your private practice with breathlessness as a chief complaint. This symptom was
accompanied by wheezing since last 1 hour. These symptoms has occurred about 2 hrs after helping his mother
cleaned his bedroom. He had his first asthma attack when he was 6. His father been diagnosed 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 supepithelial vagal receptors
to irritants.
C. inhibiting cyclooxygenase pathway of arachidonic acid metabolism without affecting the lipoxygenase route thus
tipping the balance toward elaboration of the bronchoconstrictor leukotrienes.
D a marked increase in the goblet cells of small airways small bronchi and bronchioles leading to excessice mucus
production that contributes airway obstruction.
E. the destructive effect of high protease activity in subjects with low antiprotease activity and also the oxidant –
antioxidant imbalance.
A 65 yo man thick and was brought to the emergency department of hasan sadikin hospital with the chief
complaint of dyspnea which was worsening since 2 days ago. Since 3 days before the patient had flu made his
dyspnea and cough worsened with thick and greenish sputum, fever and also by noisy breathing. Physical
examination result: chest: barrel shaped, lung: hypersonor and extremities: clubbing fingers was noted either
edema nor cyanosis was found.
163. which of the following is the best pathogenesis in this patient?

antibodies.
to irritants.
C. inhibiting cyclooxygenase pathway of arachidonic acid metabolism without affecting the lipoxygenase route thus
tipping the balance toward elaboration of the bronchoconstrictor leukotrienes.
164. which of the following is the best microscopic finding in this patient?
A. large alveoli separated by thin septa with only focal inflammation centriacinar fibrosis
B. chronic inflammation of the airways predominantly lymphocytes and enlargement of the mucus secreting glands
of the trachea and bronchi
C. occlusion of bronchi and bronchioles by thick tenacious mucus plugs.
D. the bronchi and bronchioles are sufficiently dilated that they can be followed almost to the pleural surfaces.
E.sub-basement membrane fibrous.
A 35 yo woman single parent came to primary healthcare with productive cough and occasionally bloody sputum
since 3 wks ago. For about 1 mth she had night sweats and body weakness, lose of appetite and mild fever. 3 yrs
ago she had history of TB treatment for 2 mths but she discontinued the drug. she lost 3 kg of her body weight. Lab
result micro: 3x sputum smear. AFB : +2 / +3 / +2. Chest infiltrate at the apex of the right lung with cavity.
165. which of the following is the best pathogenesis in this patient?

antibodies.
to irritants.
C. role of the blockage of phagolysome. Interferon gamma and delayed hypersensitivity.
166.which of the following is the best microscopic finding in this patient?

A. diffuse infiltration of PMN and bloody tissue
B. congestion of cells with exudates and caseous necrosis
C. granulomatous inflammation contain datia langhans and central necrosis
D. diffuse infiltration of mononuclear cell and epitheloid cell
E. consolidation and hapatization of prenchymal tissue of the lung.
167. a 10 m.o boy admiited to pediatric emergency room with the difficulty of breathing and suffers from fecer
since the last 2 days as his chief complaint. This complaint has been preceeded by common cold since 4 days ago.
Lab results HB (11.3g/dl) WBC (21.700mm) thrombocyte(210,00mm)
diff count -/2/4/68/25/1. Blood smear (toxic granule in neutrophil) chest x-ray bilateral infiltrate.
which of the following is the best pathogenesis in this patient?
A. consolidation of acute fibrinosuppurative inflammation in patchy infiltrate.
B.TH2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce IgE and other
antibodies.
C. virus-induced inflammation of the respiratory mucosa lowers the threshold of the supepithelial vagal receptors
to irritants.
D. role of the blockage of phagolysome. Interferon gamma and delayed hypersensitivity.
E. a marked increase in the goblet cells of small airways small bronchi and bronchioles leading to excessice mucus
A 30y.o male came to the outpatient clinic hasan sadikin general hospital because of chronic nasal congestion.
Rhinoscopy revealed gelatinous grayish white tissue with smooth and shiny surface fill in the right and left nasal
cavity. The biopsy was performed and the microscopic appearance showed in the picture below.
168. what is the most appropriate terminology for 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 the most commonly seen
microscopically in the above nasal mass.
A. lymphocytes
B.plasma cells
C. neutrophils
D.bsaophils
E.eosinophils.
A 23yo male came to the hospital because of epistaxis since 2days ago he also complaint nasal blocked since 1mth
ago. Rhinosocpy and pharyngoscopy revealed a reddish ulcerative mass in the choanae and nasopharynx posterior.
Biopsy of the nasal and nasopharnyx was performed macroscopic and microscopic appearance as below..
170. what is the most appropriate terminology describing the disease in the nasal and nasophayrnx of above
patient?
A. chronic inflammation
B.polyp
C.papilloma
D.angiofibroma
E.carcinoma
171. which of the following agent that is closely related to the pathogenesis of the above disease?
A. pollen
B. house mites
C. Epstein barr virus
D.human papilloma virus
E. HIV
For question 172 and 173:
A 54 yo man came to outpatient clinic because of productive cough since 2 months ago, accompanied with low
grade fever. He said that his sputum was yellow green sometimes with blood streak. PE showed no significant
finding. CXR and microscopic appearance:
172: what is the disease that occurs in the above picture:
A. pneumonia
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. Datia Langerhan cells
D. caseous necrosis
E. tumour cells
174. what is the disease that occurs in above patient?
A. pneumonia
B. Pulmonary TB
C. emphysema
D. lung carcinoma
E. COPD
175. What structures are pointed by the white arrows in above case?>
A. extravasated erythrocytes
B. alveoli destruction
C. Datia Langerhan cells
D. caseous necrosis
E. tumour cells

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FINALS RESPI KPBI 2010

E. Has polysaccharide capsule as attribute of pathogenicity

25. Hyperventilation due to panic syndrome C

27. Which of the following related about bronchioles

29. Which one of the following statements related to emphysema?

D. Paranasal sinuses form from outgrowth of the walls of nasal placode

38. First part of respiratory system

A. Stratified squamous epithelium

A. Between nasal septum and nasal conchae

Which of the following is the most suitable explaination

A. Disruption of drainage due to mastification

B. Location of the ostia within the nasal passage

A. It is located in the body of sphenoid, directly inferior to sella tursica

Which structure should be closely monitored In order to prevent complication?

Which is the most appropriate sentence regarding the wind pipe?

Which sentence is correct?

57. Which of these sentences is CORRECT ?

You suspected that she has pulmonary edema.

A. On posterior chest, between the vertebrae and scapula, at the level of T5

What would most likely be found?

A. Another bony prominence, a mark of xyphoid process

What is the characteristic of external intercostal muscle?

A. Most actively involved in expiration

70. Oxygen carying capacity in whole blood is:

75.What factor can inhibit o2 binding hemoglobin in the pulmonary capillary?

80. refer to picture below

A. Afferent nerve is mediated to through trigeminal nerve

For questions 82 to 83, refer to the scenario below:

One week ago, she delivered a healthy baby

You give him theophylline 300mg 2x1.

87. the most appropriate drug gains rapidly bronchodilator B

89. A drug contraindicated in this patient

92. The drug inhibits the metabolism of phenytoin A

93. The drug may caused red-green color blindness D

94. The drug crosses inflamed meninges C

Which of the following drug of choice for this patient ?

98. One way to eradicate is:

A. maintaining humidity above 50%

99. The statement which is wrong related with etiology is:

A. survive in all climate but mostly in humid condition

101 Staining for M. tuberculosis

A. Report (+) if we find >10 AFB/100 HPF

A. Gram positive cocci

A. fever >1 week

For questions 110-111

110. what is the diagnosis"

111. Initial treatment?

A. Mild asthma exacerbation

113.what is the initial management of this patient?

115. Medical management for this condition is :

117. From the case above, what is the nutrition recommendation?

118. Which of the following energy intake is the most appropriate.

A. Respiratory Quotient for Carbohydrate is 0.7, protein 1 and fat 0.8

C. Respiratory Quotient for Carbohydrate is 0.7, protein 0.8 and fat 1

121) Which is the most likely feeding strategies to prevent aspiration?

122)Which of the following the most accurate nutrient intake?

124. WOTF is middle ear contain?

A. The auriculotemporalis nerve

A. Posterior rhinoscopy ans CT scan.

127. What is the latest surgery for this disease?

A. Caldwell Luc operation

129. What is the initial step in managing this condition?

A. Blood gas analysis