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Respiratory System Perfecten

1. A 70 yo 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 rods and doesnt grow on blood agar nor
Mac Conkey agar. What is the possibly cause of this disease?
A. Legionella
B. Listeria
C. S. aureus
D. Klebsiella
E. Eschericia coli
2. An infant, seen in ER, presents with fever and persistent cough. PE and
CXR showed Pneumonia. Which of the following is most likely the cause of
this infection?
A. Rotavirus
B. Adenovirus
C. Coxsackievirus
D. RSV
E. Rhinovirus
3. Coronaviruses are recognized by club-shaped surface projections that
are 20 nm long and resemble solar coronas. These viruses be a major
agent of the common cold, especially in older children and adults are
characterized by : bikin respi infection-SARS, enteric
a. The virion is known to contain 8 fragment of RNA
b. The virion is positive sense single stranded RNA
c. Grow well in the usual cultured cell lines
d. Non enveloped virus (mestinya enveloped di luar-punya 3 protein
SpikeEnvelopeMembrane, crown like appearance
e. Agglutinate human red blood cells (punya hemaglutinin esterase, bisa
yang ini juga katanya)
4. Which virus is the leading cause of croup syndrome, bronchiolitis, and
pneumonia in young children that contain RNA in nucleocapsid encased
within an envelope, and, when infecting mammalian cells in culture, will
hemabsorbreb blood cells?
A. Group B coxsackievirus
B.Rotavirus
C.Parainfluenza virus (Cuma 1 kapsul atau genomenya lupa, kalau
influenza ada fragment) bikin croup pneumoni sama brochiolitis
D.adenovirus
E.rhinovirus

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5. Rhinovirus is a major cause of the common cold that primarily


transmitted by contact of contaminated hands, fingers, or fomites with the
conjunctiva or nasal epithelium. Which is the characteristic of this virus?
A. Member of paramyxoviridae(parainfluenza sama RSV)
B. Member of Orthomyxoviridae (influenza)
C. Has a positive sense single stranded RNA( coronaviridae,
picornaviridae-coxaci sama rhino)
D. Has a negative sense single stranded RNA (orthomyxoviridae,
paramyxo, bunyaviridae)
E. It is an enveloped virus (coronavirus) SLIDE DOKTER TITI SEMUA
6.Excluding influenza virus, which one of the following viruses is a
common cause of acute respiratory disease? Yang lainnya gak ada di slida
dr titi
A.cytomegalovirus
B.rotavirus
C.varicella-zoster virus
D.adenovirus(double stranded dna)
E.papillomavirus
7. This virus is a single-stranded RNA orthomyxovirus. In the developed
countries vaccination is necessary because of antigenic drift and shift.
A. Measles virus
B. Influenza virus
C. RSV
D. Parainfluenza virus
E. Adenovirus (DNA)
8. A 62 yo male who had influenza a week earlier reported to the
emergency room with a 38,5oC fever and shaking chills, a productive
cough with a yellowish sputum, and chest pain. CBC revealed 30.000/mm 3
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
B. Endotoxin assembly
C. Flagella synthesis
D. Capsule formation
E. IgA protease synthesis(di slidenya dr titi ada dua duanya)
9. What media that should be used to inoculate sputum specimen from
that patient above to grow H. Influenza? Slide dr titi
A. Blood agar
B. Lowenstein jensen media
C. Mac Conkey agar
D. Chocolate agar
E. Loeffler media

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10. A 21 yo college student complained of malaise, low-grade fever, and


harsh cough, but not of muscle aches and pains. An xray revealed a
diffuse interstitial pneumonia in the left lobes of the lung. The WBC count
was normal. The student has been ill for a week. The bacteria have a
characteristic that doesnt have cell wall. Based on the information
given, what is the etiologic agent that causes the disease? Di slide,
katanya lack of cell wall, paling kecil paling simple butuh kolesterol,
pathogen hanya pada mucus membrane
A. Mycoplasma pneumonia
B. Chlamydia pneumonia
C. Staph aureus
D. Legionella pneumophila
E. Streptococcus pneumonia
11. A 25 yo man known to have AIDS developed a gradual onset of
malaise and anorexia. An acid fast bacilli from sputum is identified
microscopically. M. tuberculosis can be found in the sputum of patients
with tuberculosis. After digestion of the sputum, isolation is best
accomplished using bisa juga ogawa dan middlebrook
A. Sheep blood agar
B. Loffler's media
C. Thayer-martin
D. Thiosulfate citrate bile salts sucrose medium
E. Lwensteinjensen medium
12. What is theimportant characteristic of cell wall structure of acid
fast bacilli? patpat
A. Has a high content of lipopolysaccharide
B. Outer membrane contain lipotechoic acid (s.pneumoni)
C. Has no peptidoglycan, so that, bacteria resistent to antibiotic
D. The presence of mycolic acid and lipoarabinomanan
E. Has polysaccaride capsule as attribute of pathogenicity
13. The structure of M. tuberculosis that potentiate the toxicity and
promote intracellular survival by inhibit the phagosome-lysosome fusion in
the macrophage is (ada 2,sulfatide sama cord trehalose micolate-inhibit
nuthrophil dan granulomatous formation)
A. Mycolic acid
B. Wax D
C. Sulfatide
D. Lipopolysacaride
E. Lipoteichoic acid
14. A 25 yo male with previous rhinnorhea, pharyngitis cough, visit the
doctor with a 39* fever which appears abruptly after a sudden shaking
chill episode. He has a chest pain and productive cough. X-ray shows

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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.

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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

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D. Between 40 to 104 mmHg, because blood from pulmonary veins is


diluted by blood from bronchial veins
E. Between 40 to 104 mmHg, 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 bisa karena Diabetes, hypercholeremic, lactic
acid
C. Respiratory alkalosis
D. Metabolic alkalosis
E. Normal blood P H
23. Mostly can be happened in the presence of excess CO 2 in inspired airA
24. Happened in healthy person that participate a 10 kilometers marathon
B
25. Hyperventilation due to panic syndromeC
26. Decreased alveolar ventilation in emphysema due to COPDA
27. Which of the following statements related about bronchioles?
A. are a major site of gas exchange
B. contain no smooth muscle in their walls therefore significantly
reduce air way resistance
C. contribute to more than 50% of resistance to flow in their lower
respiratory tract
D. contain of 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 lymphocytes
C. activated lymphocytes will not home bachy to respiratory mucosa
D. within the upper respiratory tract make up waldeyers ring
E. it is a major site of monocytes activation in the airways
29. Which of the following statements related to emphysema?
A. diffusion of O2 is decreased due to destruction of the lung
parenchyma
B. over 10% of cases have 2 antithrypsin deficiency
C. surface for gas exchange is increased
D. reducing airway resistance
E. patient develop of febroticf lung
30. A newborn infant was observed choking and continues coughing.
There was and excessive amount of mucus secretion and saliva in the
infant mouth and the infant experienced considerable difficulty in
breathing.

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Which one of the congenital anomaly was occur?


A. Olygohydramnion of the lung development
B. Tracheal Stenosis
C. Tracheooesophageal Fistula
D. Oesophageal agenesis
E. Tracheal difeticulum
31. which one the embryological most common locations of this defect?
A. Superior part esophagus and trachea
B. Inferior part oesophagus near tracheal difurcation
C. In the middle part oesopgush and tracheal
D. Upper part of trachea
E. Upper part of oesophagus (langeman)
32. premature infant developed rapid shallow respiration shortly after died
was diagnose respiratory distress syndrome
Which one usually cause RDS? Karena surfactant
A. Incapable type 1 alveolar producing hyaline protein
B. Incapable type 2 alveolar producing surfactant
C. Suggested prolonged extra uterine asphixhya
D. Occur in premature infant undle
E. Incapable the lung function
33. the role of the human sinuses is very significant in daily life. Which od
the following statement is the correct embryological development of the
sinuses
A. Paranasal sinuses develop during late fetal life
B. The maxillary sinuses grow rapidly and fully developed before all
the permanent teeth have erupted
C. The two most posterior ethmoidal cells grow into the frontal bone,
forming a frontal sinus on each side
D. Paranasal sinuses form from outgrowth of the walls of the nasal
placode
E. The maxillary sinuses are present at birthsamaethmoid
34. the exchange of gases between alveolar capillary blood and alveolar
cavity is a process of: oxygen simple diffusion, kalau lewat membrane
(basal membrane) namanya paracellular transport
A. Paracellular diffusion
B. Simple diffusion
C. Active transport
D. Facilitated diffusion
E. Antiport transport system
35. thesplanchic mesoderm in the respiratory system will develop which of
the following component cartilago sama muscle
A. Bone
B. Epithelium tissue
C. Striated muscle tissue
D. Glands
E. Connective tissue

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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

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For question number 42 and 43, refer to the scenario below :


A 17 years old man was brought to the emergency department due to
sports injury. He was guarding the goalpost when suddenly the ball was
kicked right in his faces direction and he couldnt avoid it. His nose was
bleeding profusely, and bent. After the doctor performed maneuver to
his nose, the shaped return to normal.
42. Which of the following structure most likely cause the difference in his
nose shape?
a. the septal cartilage
b. the alar cartilage
c. the cribiform cartilage
d. the vomer cartilage
e. the nasal bone
43. Which of the following artery most likely cause the bleeding? Posterior
bleeding karena profusely
a. opthalamic artery
b. internal carotid artery
c. superior ethmoidal artery
d. sphenopalatine artery
e. facial artery
44. A 2 year old girl brought to the emergency department by her parents.
They said that their daughter had been playing with beads, and one of the
beads was stuck inside her nose. They had tried to take it out, but was
unsuccessful. They asked you for assistance.
Where is the most possible location of the logged bead? a/b
a. between nasal septum and the conchae
b. between the middle and inferior conchae
c. in the sphenoethmoidal recess
d. passed the choanae
e. in the vestibule
45. A 20 year old man has been diagnosed with sinusitis and asks her
physician why there is nasal discharge during the night but not during the
day.
Which of the following is the most suitable explanation?
a. Disruption of drainage due to mastication
b. Location of the ostia within the nasal passage
c. The sinus most likely affected is the maxillary sinus
d. Diurnal mucus production increases at night
e. Location of the ostia within the eusthacian tube
46. Which of the sentences below is TRUE regarding the sphenoid sinus?
a. it is located in the body of sphenoid, directly inferior sellaturcica
b. it is located on the greater wing of sphenoid. The sinuses separated by
the sellaturcica (frontal, seperatenya gaks ama itu juga)

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c. it is drainage located in the middle meatus, in the groove of semilunar


hiatus (maxillary sinus)
d. it has multiple cells, collectively called the sphenoidal bullae (gak punya
bullae)
e. it is supplied by the sphenoidal artery (harusnya ethmoidal)
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 transilluminationexamination, you found the glow decreased inn
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 V1 (keliatannya dikit)
b. The maxillary sinus. Its base forms the inferior part of the lateral
wall of nasal cavity
c. The ethmoid sinus. Its anterior cells drains into the middle nasal
meatus via the semilunar hiatus.
d. The sphenoid sinus. Itsostia located higher that the antrum, making
drainage only possible in certain position.
e. The frontal sinus. Formed during childhood. Supplied by branches
from opthalamic artery.
48. A 30 years old female had complaints of uncomfortable feeling in the
ear and decrease hearing right after her plane landed. Push = levator,
pull=tensor (moore)
What structure is responsible to relieve the complaint above?
a. The tensor velipalatini muscle that pulls the opening of
pharyngotimpanic tube in middle ear
b. The levatorvelipalatini muscle that pulls the opening of
pharyngotimpanic tube in middle ear
c. The tensor velipalatini muscle that pulls the opening of
pharyngotimpanic tube in nasopharynx
d. The levatorvelipalatini muscle that pulls the opening of
pharyngotimpanic tube in nasopharynx
e. The tensor tympanic muscle that pulls the opening of
pharyngotimpanic 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 tounge.
Why was there a temporary loss of taste sensation?
a. Compression of grater palatine nerve
b. Compression of pterygopalatine nerve
c. Compression of glossopharyngeal nerve (CN IX)
d. Compression of medial pterygoid (CN V3)
e. Compression of vagus nerve (CN X)

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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

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54.

A 44-year-old man was brought to the emergency department


complaining that he accidentally nhaled peanut. Upon radiological
examination of the chest, the peanut was found slightly upward on the
right side of the chest.
Why foreign bodies would most likely lodged there?
a. Beacaue the caliber of the right main bronchus is larger than the trachea
b.Because the right main bronchus is relatively steeper while the left one
has more horizontal course
c. Because the right main bronchus has 3 secondary branches
d.Because teh left main bronchus is compressed by the passing aorta
e.Because the carina was very sensitive and usually initiate cough reflex
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
5 m pole in the independence day game. The doctor examined him, and
found his trachea was deviated.
Which is the most appropriate sentence regarding the windpipe?
a.Extends from the base of the pharynx into the posterior mediastinum
b.Has full ring 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 the emergency department because


of severe breathlessness. Moments before his symptoms occurs, he had
fallen from the tree after attempting to rescue his lost cat. After
underwent primary survey and needle thoracostomy through physical
examination was performed. He was diagnosed with tension
pneumothorax and fractured 3rd-4th ribs.
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 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? Nociceptive barengan sama
symphatetic
a.The lungs has 3 lobes on the right and 2 lobes on the left. Each of the
lobes divided by the horizontal fissure
b. The lung located in the thoracic cavity. The heart carved the right lung
into having cardiac notch

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c. The lungs are innervated by branches of vagus nerve, thus making it


highly sensitive to pain
d.The lung has 3 borders and 3 surfaces. Its costal surface is concave and
indented with ribs shape, while its mediastinal and diaphragma surface
is convex
e.The lung attach to its root, at the hilum. The structure that passes through
are pulmonary artery & veins, the main bronchi, bronchial veins, and
lymphatics
58.A 65-year-old women come to you with complains of difficulty of
breathing. The complain has been going on for a month and getting
worse by the night when shes lying down. You suspected that she has
pulmonary edema.
In order 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 the 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 medical intern at a public hospital. You were following your
supervisor as he make rounds at hospital wards. Your supervisor is
performing physical examination on the chest of a 60-year-old man with
COPD. He was palpating the notch below the neck, in the middle of upper
thorax, and then proceed 5 cm below. He said he found bony prominence
and them move slightly lateral to either side.
What would most likely to be found?
a.Another bony prominence, a mark of xyphoid process
b.A bulk of mass from overused external intercostal muscle
c. A groove, widening 2nd intercostal space
d.A round prominence marked by darker skin appearance, the nipples
e.Another bony prominence, mark the costo-sternal joint
60. On cadaver dissection, you found intersecting muscle in the anterior
part of the thorax. The muscle attached from lower end of one rib, to the
upper part of the ribs below it.
What is the characteristic of external intercostal muscle? Ex: expirasi
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 the internal intercostal occupy the intercostal space, with
external intercostal lying deeper than the internal
e.They occupy the intercostal spaces from the tubercles of the ribs
posteriorly to the costochondral junctions anteriorly

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61.

The relaxed expiration doesnt depend on muscle work BECAUSE


Main action on expiration occurs from elastic recoils of the lung and
relaxation of diaphragm.
What is the correct relationship between the two sentences above?
a. Both sentences are correct with causal relationship
b. Both sentences are correct but 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 sentence are false

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,

Restriktif :gabisamengembang, jadigabisamasukgabisakeluar. Fibrosis


gtu, myasthenia gravis, gabisangembang.
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 that condition? (inspirasi supaya
alveoli gak kolaps)
a. Diaphragm, internal intercostal, scalene, sternomastoids

Orang hebatadalahorang yang Melakukan Hal biasasecaraluarbiasa

b. Diaphragm,
abdominis
c. Diaphragm,
d. Diaphragm,
e. Diaphragm,

internal intercostal, scalene, sternomastoids, rectus


internal intercostal, external intercostal, sternomastoids
external intercostal, scalene, rectus abdominis
external intercostal, scalene, sternomastoids

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

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complexion had changed to flushed pink with no trace of cyanosis. His


respiraton were quiet at rate of 6 per minute and a tidal volume of 300
mL. Repeat arterial blood gases showed that his arterial PCO 2 had
increased from 55 to 70 mmHg.
What is the most probably mechanism that happen on that patient?
a. Alveolar hypoventilation
b. Hypoxic pulmonary vasoconstriction
c. Increased firing of carotid body chemoreceptors
d. Elimination of the hypercapnic drive
e. Oxygen toxicity
70. oxygen-carrying capacity of whole blood is:
a. department on the alveolar PO2
b. the amount of O2 dissolved in the blood
c. the sum of the dissolved O2 plus the amount bound to hemoglobin
d. the sum of the dissolved O2 plus the amount of O2 bound to
hemoglobin under saturating conditionssoalnyakaitandengan po2 dan sat
o2. Jadiharus tau seberapajenuhhbsamaoksigen
e. Limited by O2 diffusion
71. the lung function test of a patient show a markedly reduced FEV1 sec
and functional residual capacity of 4.2 L. Which is the following statement
that the most likely cause of the reduced FEV1sec?
a. weak respirator muscle
b. small diameter Airways
c. pulmonary congestion
d. pulmonary fibrosis
e. dynamic compression of Airways
72. Mr.Smith complains of short of breath and dfficulty with moderate
exercise. Pulmonary function test indicate a reduced FRC, and his FEV1 sec
was 2.6 L (78%). His Force vital capacity was 3.1 L (70%). What is the
most likely cause of Mr.Smith problem?
a. weak respirator muscle
b. small diameter Airways
c. dynamic compression of Airways
d. pulmonary fibrosis
e. pulmonary congestion
73. a 36 y.o woman undergoes chemotherapy with bleomycin for an
ovarriann germ cell cancer. She develops mild pulmonary fibrosis to the
chemotherapy. Which agents diffusion across the alveoli-pulmonary
capillary Barrier would be most likely to be afffected by her disease?
Krnkoefisiendifusi
O2
jauhlebihrendah,
terus
moa
obatnyamembutuhkanoksigen, terusada fibrosis lagi, jadimakinparah
a.CO
b.CO2
C.N2O
D.O2

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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

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79. a result of ABG analysis of 25 y.o pneumothorax patient: pH:6.971,


pCO2:71.4 mmHg, pO2: 97.4 mmHg, HCO3:32.1 mEq, BE: +2.8, O2
saturation 96.4%. these findings suggest homeostasis in preserving gas
exchange to fulfill metabolism demand. Related to the case above, in the
normal condition on the other hand, the negative pressure in the pleura
space is allowed through which of the following factor?
a. strong and continuous alveolar epithelium
b. pumping of fluid from pleura space by lympathics
c. collection of large amounts of fluida in the pleura space
d. hydrostatic pressures at the capillary
e. osmotic Force at the alveolar membran of the lungs
80. once you were on duty in emergency rol a 5 y.o girl patient was taken
by her prents with chief complaint stridor since 2 days ago. Her parents
also complained about sore throat, fever difficulty on swallowing and
breathing. Three was no cough and she was unable to control her own
saliva and began to drool.
Result from the physical examination are:
The child sat upright in a bent-forward position. The jaw was open and
drooling was frequently present. She presented a hot potato voice,
suprasternal retraction and inspirator stridor.
Radiological findings:
From sofa tissue neck radiograph: thumb sign appearance, chest x ray:
within normal limit. Related to thhe case above, which of the following
decribes most accurately about the functions of the respirator
passageways? EPIGLOTITIS
a.all passageways have cartilage to keep them from collapsing
b. all of the passageways are surrounded by smooth muscles
c. in obstructive diseases all of the passageways are constricted
d. the greatest amount of resistance to airflow occurs in alveoli (di upper)
e. in disease condition, the smaller bronchiles determine resistance

81. Related to the case above (80), WOTF describes most accurately about
the cough reflex?ef: recurrent, vagus, corticospinal, ....
a. afferent nerve is mediated through trigeminal nerve, gloso, sup laryng
b. the effect is the opening of glottis, followed by closing
c. initially air is rapidly inspired
d. both thoracal and abdominal muscles relax
e. the bronchi and trachea are dilated
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.

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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

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d. Progression of liver disease


e. Shortened duration of action
For number 87 to 89:
A 60yo man with history of smoking for > 20 years (2 packs a day)
complained of cough, dyspnea, and wheezing. His symptoms have
become severe that his family brought him to the ER. PE revealed
diaphoresis, dyspnea, tachycardia, and tachypnea. RR 30/min, PR 112
bpm, BP 130/60 mmHg.
For each statement below, choose the most appropriate drug from the
following list:
a. inhaled cromolyn
b. inhaled salbutamol
c. oral/IV methylprednisolone
d. inhaled ipraptropium bromide (brochodilator)
e. IV propanolol
87. the most appropriate drug as a rapid bronchodilatorB
88. the most likely drug to provide sustained resolution
inflammatory symptoms C

of the

89. a contraindicated drug for this patientE


For number 90 94:
a. INH (isoniazid)
b. Rifampicin
c. PZA
d. Ethambutol
90. This drug interacts with the -subunit bacterial DNA-dependent RNA
polymerase and thereby inhibit synthesis of RNA B
For question 90-94
A 36 yo woman came to your clinic complained that he had prolong cough,
night swear, body weakness, loss of appetite and mild fever since two
month ago. After taking history, physical examination and preliminary
investigation, he is diagnosed with pulmonary TB. He is then placed on a
four drug regiment consisting of INH, rifampisin, PZA, and ethambutol. For
each of statement below choose the most appropriate drug from the
following list:
A. INH
B. Rifampicin
C. PZA
Ethambutol
90. The drug interacts with the beta subunit bacterial DNA dependent RNA
polymerase and therapy inhibits RNA synthesis B

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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

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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

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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

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C. INH for 6 months


D. INH for 9 months
E. INH for 12 months
109. The following answer is the component of scoring system for
pediatric TB in Indonesias national TB program (NTP):
A. Fever more than 1 week (2w)
B. Cough more than 2 weeks (3w)
C. (+) reaction of tuberculin
D. (+) contact with other child diagnosed TB
E. Palpable neck lymph node of 0.5 cm (1cm)
7 month old baby was brought to pediatric emergency with the chief
complaint of difficulty in breathing since the last 3 days. The physical
findings are tachypnea, chest indrawing, crackles, fever. Chest X ray
showed a patchy infiltrate in the bilateral hemithorax.
110. the most likely diagnosis in this patient is:
A. Lobar pneumonia
B. Bronchopneumonia
C. Bronchiolitis
D. Bronchitis
E. Laryngotracheobronchitis
111. In case above, what is the initial management? (pokoknya IV)
severe=benzil penicilin-panicillin=indrawing, very severe=clora, kalaugak
mempan pake genta
a. Oral amphycillin
b. oral macrolide
c. IV gentamycin
d. IV amphycillin
e. IV ampicillin
112. An 11 y.o. gorl came to pediatric ER RSHS with a chief complaint of
difficulty breathing and cough since the last 3 hours. Physical exam found
wheezing, patient prefer in sitting position RR was 45/mnt. The most
appropriate diagnosis of this patient is : severe=rest
RR, PR, wheezing
a. Mild asthma exacerbation : walking, can lie down
b. Moderate asthma exacerbation : talking, infant = difficulty breathing,
prefer sitting
c. severe asthma exacerbation : hunchbreathing
d. impending respi failure
e. respi failure
113. initial management of the above case :
a. inhaled corticosteroid

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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

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117. what is teh most appropriate nutrition recommended?


a. additional folic acid above Recommended Dietary Allowance (RDA)
necessary
b. additional vitamin C above Recommended Dietary Allowance (RDA)
necessary
c. Additional vitamin A above Recommended Dietary Allowance (RDA)
necessary
d. Additional vitamin B above Recommended Dietary Allowance (RDA)
necessary
e. Additional vitamin B12 above Recommended Dietary Allowance (RDA)
necessary

is
is
is
is
is

For number 118 to 119, refer to the scenario below :


A 35 y.o. came to your clinic complaining cough and dyspnea. He is known
as a heavy smoker. During PE BP 120/80 mmHg, PR 120x/min, RR 30x/min,
T 38.2 degree celcius, chest exam : barrel chest. BGA : pH 7.28, PaCO2 60,
SaO2 90%
118.WOTF energy intake is the most appropriate ?
a. Increasing energy needs with 65% calories from
calories from fat
b. Increasing energy needs with 60% calories from
calories from fat
c. Increasing energy needs with 50% calories from
calories from fat
d. Increasing energy needs with 65% calories from
calories from fat
e. Increasing energy needs with 70% calories from
calories from fat

carbohydrate and 20%


carbohydrate and 25%
carbohydrate and 35%
carbohydrate and 35%
carbohydrate and 30%

119. Which of the most appropriate statement due to substrate


metabolism use? RQ=buat BMR
a. Respiratory Quotient (RQ) for carbo is 0.7, protein 1, and fat 0,8
b. Respiratory Quotient (RQ) for carbo is 1, protein 0.8, and fat 0.7
c. Respiratory Quotient (RQ) for carbo is 0.7, protein 0.8, and fat 1
d. Respiratory Quotient (RQ) for carbo is 0.8, protein 0.7, and fat 1
e. Respiratory Quotient (RQ) for carbo is 0.7, protein 1, and fat 0,7
120. WOTF statement is the most appropriate
a. Respiratory Quotient (RQ) is the ratio of the volume of O2 expired to the
volume of CO2 inspired
b. Respiratory Quotient (RQ) is the ratio of the volume of O2 inspired to
the volume of CO2 expired
c. Respiratory Quotient (RQ) is the ratio of the volume of CO2 inspired to
the volume O2 expired
d. Respiratory Quotient (RQ) is the ratio of the volume of CO2 expired to
the volume of O2 inspired

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e. Respiratory Quotient (RQ) is the ratio of the volume of CO2


121. Which food intake method to avoid aspiration?
a. Rest before eat meals, oral route, large portion of nutrient-dense food,
proper sitting position
b. Deep nutrient food, proper sitting position
c. Rest before eat meals, parenteral route, small portion of nutrient-dense
food, proper sitting position
d. Deep breathing during eat, oral route, small portion of nutrient-dense
food, proper sitting position
e. Rest before eat meals, oral route, small portion of nutrient-dense food,
proper sitting position
122. Which of the following statement that most accurate nutrient intake?
A. Caloric needs ranging from 94% to 164% of predicted range and
protein needs ranging from 1,2 to 1,7 g/kg of body weight
B. Caloric needs ranging from 80% to 90% of predicted range and
protein needs ranging from 0,6 to 0,8 g/kg of body weight
C. Caloric needs ranging from 80% to 100% of predicted range and
protein needs ranging from 0,8 to 1 g/kg of body weight
D. Caloric needs ranging from 60% to 90% of predicted range and
protein needs ranging from 0,5 to 0,8 g/kg of body weight
E. Caloric needs ranging from 90% to 110% of predicted range and
protein needs ranging from 1,6 to 0,8 g/kg of body weight
123. A 3 yo boy arrived in an emergency department with a 3-day history
of left ear pain and a 5-day of common cold, fever. He has been seen by
his primary care physician the day before and started on amoxicillin (40
mg/kg/day) divided three times a day 1 tea spoon. The patient had a
history of recurrent otitis media requiring four to five courses of antibiotics
per year since birth. Physical examination revealed alert boy with
temperature of 39 C. Otoscopy shows tympanic membrane hyperemic on
the left side.
Which of the following is the most common organism causing acute otitis
media? C, a, tp yg sering c
A. Haemophillus influenza
B. Moraxella catarrhalis
C. Streptococcus pneumoniae
D. Staphylococcus aureus
E. Klebsiellapneumoniae
124. Which of the following is middle ear contain? Abce dalem,
A. Auriculotemporalis nerve
B. Glossopharyngeal nerve
C. Semicircularcanal
D. The corda tympani
E. Utriculus

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125. Plexus kiesselbachkecuali: +spenoidal


A. Sphenopalatine
B. Inferior labial
C. Greater palatine
D. Superior labial
E. Anterior ethmoid
126. Kasusrinosinusitis, what are the appropriate and latest diagnostic
tools to see every aspects of this disease?
A. Poste rhinoscopy and ct scan
B. Translumination and sinus paranasal radiologic projection
C. Ct scan and transillumination
D. Nasal endoscopy and ct scan
E. Water's and caldwell position radiology
127. What is the latest surgery for this disease?
A. Caldwell lucoperation : chronic maxillary sinusitis (19 century)
B. Endoscopic sinus surgery
C. Anthrostomy washed out
D. Ethmoidectomy intra anthral
E. Turbinectomy reduction
128. Swelling in sublingual, submandibular, and submental, elevated
tongue, and inspiratory stridor. Diagnosis:
A. Peritonsilar abscess
B. Retropharyngeal abscess
C. Parapharyngeal abscess
D. Ludwig angina
E. Danger space infection
129. What is the initial step in this condition ?
A. Tracheostomy
B. Broad Spectrum Antibiotic :soalnya kata cipongdiamasihbengkak doing,
belomada pus dll
C. Incicion and drainage
D. Surgery
E. Palliative
130. A 25 years old woman with chief complain bloody sputum. Two years
ago has been treated by RHEZ, but only 8 week. What category of this
patient?
A. Relapse
B. Treatment failure
C. Treatment after interuption (after default)
D. New case
E. Chronic case

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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

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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 :

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a.
b.
c.
d.

Streptomycin, INH, rifampicin, ethambutol


Rifampicin, INH, ethambutol, pyrazinamide, streptomycin
Rifampicin, INH, pyrazinamide
Rifampicin, streptomycin, ethambutol, pyrazinamide
e. INH, pyrazinamide, ethambutol, ciprofloxacin

140. Mr. PrakashPadukone is a 65-year old man, come to you with


shortness of breath and cough with productive and thick sputum. On
chest examination ypu found hypersonor and wheeze. Spirometri after
bronchodilator showed FEV1/FVC was 56% and FEV1 was 42% of
predicted value.
Your diagnosis will be :
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 students came to you due to shortness
of breath. She usually feels her SOB between midnight to early morning
and she feels this about 3 times a week and sometimes accompanied with
cough. Sometimes she was absent from school because of her symptoms.
On chest examination you only heatd wheeze and others were within
normal limits. The most likely diagnosis is :
A. COPD stage I
B. COPD stage II
C. Mild persistent asthma bronchial
D. Severe persistent asthma bronchial
E. Moderate persistent asthma bronchial
142. A 67 yo complained cough with whitish sputum since about 2 years
ago. His spirometer examination showed FEV1/FVC ratio was 65% and
FEV1 is 82% fromm predicted value. Beside avoidance from ris factors and
influenza vaccination, other medication for him is :
A. Inhaled regular long acting 2 agonist
B. Inhaled corticosteroid
C. Rehabilitation
D. Regular oral methlxanthym
E. Inhaled short acting 2 agonist is needed
143. A 72 yo, known for years as a COPD patient. Recently his
pulmonologist recommend him to add long term oxygen therapy in the
treatment.
The indications for long term oxygen therapy are :
A. Pa02 below 55 mmHg or Sat below 88% with or without hypercapnia
(GOLD)
B. Pa02 below 65 mmHg or Sat below 88% with or without hypercapnia
C. Pa02 below 60 mmHg without evidence of pulmonary hypertension
D. Pa02 below 60 mmHg without evidence of polycythemia
E. Pa02 below 65 mmHg without evidence of pulmonary hypertension

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144. Mr. X had been diagnosed as pulmonary TB patient since 4 month


ago. And he received rifampicin, ethambutol, INH and pyrazinamide. 2
days ago he complained that he had vision disturbance. Which drug is the
most likely cause?
A. IMA (mungkinmaksudnya INH)
B. Rifampicin
C. Ethambutol
D. Pyrazinamide
E. Combination of above drugs
145. Anoxic condition which is important in Forencic Medicine is :
A. Anemic hypoxia
B. Metabolic hystotoxic anoxia
C. Stagnant hypoxia
D. Hypoxic hypoxia
E. Extra cellular hystotoxic hypoxia
146. Mechanical asphyxia s :
A. Stagnant hypoxia
B. Hystotoxic hypoxia
C. Anemic hypoxia
D. Substrate hystotoxic hypoxia
E. Hypoxic hypoxa
147. In cases of sea water drowning it is found : (slide asphyxia) air
tawar=K
A. Hemodilution
B. Na Plasm increase
C. Hemolysis
D. K Plasm increase
E. Ventricular fibrillation
148. In internal examination of drowning cases it is found :
A. Cutis Anserina
B. Cadaveric Spasm
C. Washerwoman hands (mati di luar)
D. Tandieu Spot (slide) ptechie pleura epicardium dan timus
E. Pseudo Foam
149. The common cause of death in fresh water drowning is :
A. Asphyxia
B. Ventricular defibrillaton
C. Laryngeal spasm
D. Vagal inhibition
E. Cardiac Arrest
150. A ..infant of 4 months old is found unexpectedly dead in her cot one
morning. A examination is performed. The pathologist report increased
thickness and extension of pulmonary artery muscle.
What does this finding indicate?
A. Cardiomyopathy is likely
B. Death was caused by asphyxiation

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C. Death was due to epilepsy


D. The child would have developed hypertension in adult life
E. There was chronic hypoxia before death
151. On a frontal chest film, there is the lung apex retracts toward the
hilum, the sharp white line of visceral pleura is visible, separated from
the chest wall by a radiolucent pleural space, which is devo----lung
markings: (slide radiology)
A. Pneumothorax
B. Giant bullae
C. Pulmonary emphysema
D. Giant emphysema
E. Pleural effusion
152. A 20yo male, complained of persistent nasal discharge, this nasal
discharge was yellowish and thick. Past history, he had nasal itchy and
nasal obstruction whe the weather was cold. On waters film there is
clouding in right maxillary sinus.
Which of the following is the most likely diagnosis?
A. Tumour of right maxillary sinus
B. Right hematiosinus
C. Acute sinusitis
D. Chronic sinusitis
E. Mucocele
153. On posteroanterior chest film, there is a cavity in apical parts of
the left upper lobe, the wall of the cavity is thick and is surrounded by
patchy consolidation. WOTF is best feature has been described?
A. Lung abcess
B. Pulmonary cyst
C. Mycetoma in a cavity
D. Cavitating tumor
E. The cavity of pulmonary tuberculosis
Question number 154-155
x-year-old girl admitted to pediatric clinic with a chief complaint of
difficulty of breathing since x-hours agp. This complaint was
accompanied by cough and high fever. In anteroposterior chest x-ray,
there is homogenous lung opacification with air bronchogram 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

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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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A. An oblique chest film


B. A left lateral decubitus
C.An apical lordotic film
D. An anteroposterior chest film
E. A lateral chest film
160. Mrs. X 28th 10 day history of nasal discharge. Discharge is yellowgreenish, thick, blood tinged, also accompanied with decrease of
smelling sensation,nasalblockage,fever and headache. Three days ago
she felt pain and fullness on the left ear with mild increase of hearing.
PE result discharge from the nose and bulging of tympanic membrane.
WOTF is the best pathogenesis of discharge in this patient?
A. The ostium obstruction causes the vasodilatation and cilliary and
mucus glands dysfunction
B. Enlargement of concha part in the nose
C. Eustachian tube disfunction caused by secondary infection
D. Viral infection cause vasoconstriction and destruct the mucous gland
directly
E. The upper respiratory tract 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 tympanic
membrane in this patient?
a. The ostium obstruction causes the vasodilatation and ciliary and
mucous gland dysfunction
b. Enlargement of concha part in the nose
c. Altered regulation of middle ear pressure and formation of negative
pressure in 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 improved bacterial adherence to the upper respiratory
tract mucosa
162. A 9 year old boy come to your private practice with breathlessness as
a chief complaint. The symptom was accompanied by wheezing since last
1 hour. These symptoms had occured about two hours after helping his
mother cleaned the bedroom. He had his first asthma attack when he was
six years within the last two months he also experienced 1-2 times night
cough.
His father had been diagnoed as having asthma and the symptoms had
relieved since he had taken controller medication. Which of the following is
the best pathogenesis in this patient?
a. TH2 cells secrete cytokines that promote allergic inflammation and
stimulate B cells to produce Ige and other antibodies
b. Virus induced inflammation of the respiratory mucosa lowers the
threshold of the subepithelial vagal receptors to irritants
c. Inhibiting the cyclooxigenase pathway of arachidonic acid metabolism
without affecting the lipooxygenase route, thus lipping the balance toward
elaboration of the bronchoconstorleukotrienes

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d. A marked increase in goblet cells of small airwayssmall bronchi and


bronchiolesleading to excessive mucus production that contributes to
airway obstruction
e. The destuctive effect of high protease activity in subjects with low
antiprotease activity and also the oxidant-antioxidant imbalance
For questions number 163-163 refer to scenario below
A 65 year old man was brought to the Emergency department of
HasanSadikin Hospital with the chief complaint of dyspnea which was
worsening since two days before.
Since three days before the patient had flu that made his dyspnea and
cough worsened with thick and greenish sputum, fever, and also by noisy
breathing. PE : Chest : barrel shaped chest, lung hypersonor and
extrimities : Clubbing fingers was noted; neither edema nor cyanosis was
found
163. Which of the following is the best pathogenesis in this patient?
a. TH2 cells secrete cytokines that promote allergic inflammation and
stimulate B cells to produce Ige and other antibodies
b. Virus induced inflammation of the respiratory mucosa lowers the
threshold of the subepithelial vagal receptors to irritants
c. Inhibiting the cyclooxigenase pathway of arachidonic acid metabolism
without affecting the lipooxygenase route, thus lipping the balance toward
elaboration of the bronchoconstorleukotrienes
d. A marked increase in goblet cells of small airwayssmall bronchi and
bronchiolesleading to excessive mucus production that contributes to
airway obstruction
e. The destuctive effect of high protease activity in subjects with low
antiprotease activity and also the oxidant-antioxidant imbalance
164. Which of the following is the best for microscopic finding in that
patient?
a. Large alveoli separated by thin septa with only focal centraacinal
fibrosis
b. Chronic inflammation of the airways (predominantly lymphocytes) and
enlargemenr of the mucus-secreting glands of the trachea and bronchi
c. Occlusion of bronchi and bronchioles are sufficiently dilated that they
can be followed almost to the pleural surface
d. The bronchi and bronchioles are sufficiently dilated that they can
e. Sub-basement membrane fibrosis
165. Which of the following is the best pathogenesis in this patient?
a. TH2 cells secrete cytokines that promote allergic inflammation and
stimulate B cells to produce Ige and other antibodies
b. Virus induced inflammation of the respiratory mucosa lowers the
threshold of the subepithelial vagal receptors to irritants
c. Role of blockage of phagolysosom, interferon gamma, and delayed
hypersensitivity
d. A marked increase in goblet cells of small airwayssmall bronchi and
bronchiolesleading to excessive mucus production that contributes to
airway obstruction
e. The destructive effect of high protease activity in subjects with low
antiprotease activity and also the oxidant-antioxidant imbalance

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166. Which of the following is the best of microscopic finding in this


patient?
a. Diffuse infiltration of polymono nuclear cell and bloody tissue
b. Congestion of cells with exudat and caseous necrosis
c. Granulomatous inflammation contain of datialanghans and central
necrosis
d. Diffuse infiltration of mononuclear cell and epitheloid cell
e. Consolidation and hepatization of parenchymal tissue of the lung
167. A-10 month-old-boy admitted to Pediatric Emergency Roon with
difficulty of breathing and suffers from fever since the last 2 days as his
chief complaint. This complaint had been preceded by common cold since
4 days ago. Laboratory results :
Hb 11.4 g/dl , Hematocrit 37%, WBC 21.700/mm3 , Thrombocyte
210.000/mm3
Differential count -/2/4/68/25/1.
Blood smear shows toxic granule in neutrophil
Chest X-Ray showed bilateral infiltrate
Which of the following is the best pathogenesis for this patient.
a. Consolidation of acute fibrinosupurrative 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 subepithelial vagal receptors to irritants
d. Role of blockage of phagolysosom, interferon gamma, and delayed
hypersensitivity
e. A marked increase in goblet cells of small airwayssmall bronchi and
bronchiolesleading to excessive mucus production that contributes to
airway obstruction
For questions number 168-169, refer to scenario below :
A year old male came to the outpatient clinic HasanSadikin 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
appereance showed the picture below.

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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.

170. what is the appropriate terminology describing the disease in the


nasal and nasopharynx of above patient?
a. chronic inflammation
b. palyp
c. papilloma
d. angiofibroma
e. carcinoma
171. which of the following agent that is closelu related to the
pathogenesis of above disease?
a. polen
b. Hause mites
c. Epstein Barr virus

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d. Human papilloma virus


e. Human immunodeficiency virus

172. what is the disease that occurs in above patient?


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. DatiaLanghans cells
d. Caseous necrosis
e. Tumour cells
174-175
A 45yo male come to out patient clinic because of dyspne, fever and
productive cough since 7 days ago. He said that his sputum was yellow
green sometimes with blood streak. PE showed fever, takipnea,
tachycardia, and crackles in his left chest. Macroscopic and microscopic
appearance of his lung were shown as below picture.

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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. DatiaLanghans cells
d. Caseous necrosis
e. Tumour cells

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