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CVS Perfecten

1. A 9yo boy presents with complaints of numbness and tingling in


both feet. Examination reveals no pulse in the femoral artery,
increased blood pressure in the arteries of the upper extremity, and
enlarged intercostal veins. Which of the following congenital heart
diseases would be suspected?
A. PDA
B. Pre ductal coarctation of the aorta
C. ToF
D. Double aortic arch
E. Post ductal coarctation of the aorta

2. A 6 week-old infant has a pulmonary infundibular stenosis, a large


defect of the IV septum and the aorta arises directly above the
septal defect from both ventricular cavities and hypertrophy of the
right ventricular wall. The infant is cyanosis.
Which of the following congenital heart diseases is the most likely to
be present?
A. PDA
B. VSD
C. ToF
D. Dextrocardia
E. Coarctation of the aorta

3. A condition in which the aortic lumen below the origin of the left
subclavian artery is signifiant narrowed. The aortic narrowing is
primarily an abnormality in the media of the aorta followed by
intima proliferations.
Which of the following congenital heart disease is the most likely
above?
A. Aortic valvular stenosis
B. Aortic valvular atresia
C. Probe patency of the oval foramen
D. Coarctation of the aorta
E. Interrupted aortic arch

4. A condition in which the conotruncal septum fails to follow its


normal coarse and runs straight down, as a consequence, the aorta
originates from the right ventricle, and the pulmonary artery
originates from the left ventricle. It is usually accompanied by an
open ductus arteriosus.
Which of the following congenital heart diseases is the most likely to
be present?
A. Persistent truncus arteriosus
B. VSD
C. ToF
D. Transposition of the great vessels
E. PDA

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5. After birth, when lung circulation begins and pressure in the left
atrium increases, the valve of the oval foramen is pressed against
the septum secundum, obliterating the oval foramen and separating
the right and left atria. In about 20% of cases, fusion of the septum
primum and septum secundum is incomplete, and a narrow oblique
cleft remains between the two atria.
Which of the following condition is the most likely to be present?
A. ASD
B. Transposition of the great vessels
C. Persistent truncus arteriosus
D. Probe patency of the oval foramen
E. Premature closure of the oval foramen

6. The aortic arches are embedded in the mesenchyme of the


branchial arches and terminate in the dorsal aortae. With the
formation of the successive branchial arches, the aortic sac
contributes a branch to each new arch, thus giving rise to a total of
six pairs of aortic arches.
The dorsal aortas and the aortic arches perform transformation into
definitive blood vessels.
Which of the following aortic arch is most likely transform into the
ductus arteriosus during intra uterine life?
A. Left 2nd aortic arch
B. 1st aortic arch
C. Left 4th aortic arch
D. The distal part of left 6th aortic arch
E. The distal part of left 4th aortic arch

7. The oval foramen normally closes during after birth, when lung
circulation begins, and pressure in the left atrium increases.
Occasionally, the oval foramen closes during prenatal life. This
abnormality, leads to massive hypertrophy of the right atrium and
ventricle and underdevelopment of the left side of the heart. Death
usually occurs shortly after birth. Which of the following condition is
the most likely to be present?
A. Oval foramen in premature infant
B. Probe patency of the oval foramen
C. ASD
D. Transposition of the great vessels
E. Premature closure of the oval foramen

8. The changing of macrophages to become foam cells in the


atherogenesis process is mostly due to?
A. Ageing of the macrophages
B. Mutation of the macrophages genes
C. Injury of the macrophages by free radicals
D. Unlimited uptake of mLDL by the macrophages
E. Increased level fat synthesis inside the macrophages

9. Synthesis of scavenger receptors in the atherogenesis process is


caused by :

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A. The changing of monocytes to become macrophages
B. Growth factors produced by injured endothelial cells
C. Decreased level of cholesterol in the macrophages
D. Increase level of mLDL around the macrophages
E. Increase level of free radicals around the macrophages

10.Which of the cells below are mostly responsible for the appearance
of more extracellular matrix inside the atheroma plaque?
A. Smooth muscle cells
B. Endothelial cells
C. Macrophages
D. Monocytes
E. Foam cells

11. A 50 yo man suffered from left chest pain after playing badminton
vigorously. Which examination from the list below that could tell
wether the pain was coming from cardiac problem or chest
muscleproblem?
A. Complete blood count
B. Creatin kinase profile
C. Troponin level
D. Lipid profile
E. Chest X-ray

12. Bile acid binding resins can be used as anti hyperlipidemic agents
because this resins
A. Act as an HMG-coAreductase inhibitor
B. Stimulate the degradation of cholesterol in the liver
C. Stimulate the liver to excrete more cholesterol into the bile
D. Bind the acid hence decrease its ability to stimulate cholesterol
synthesis
E. Inhibit bile acid reabsorption thus more cholesterol are needed to
synthesize new bile acids

For questions number 13-15


A 40 yo man complained of severe pain in precordium after having an
emotional upset that radiated to the left mandible. He took some pills
sublingually and the pain disappeared within 3 minutes. PE and ECG after
attack of pain were normai. Lab revealed ; Cholesterol total : 245 mg/dl,
HDL : 30 mg/dl, LDL : 150 mg/dl, Triglyceride 215 mg/dl. He was diagnosed
as Ischemic Heart Disease.

13. To reduce the cholesterol level, the doctor suggested him to


A. Take simvastatin every night
B. Exercise and consume a lot of vegetables
C. Consume trans fatty acids
D. Take low dose aspirin
E. High protein diet and low salt diet

14. The most possibility of having high triglyceride level is because of

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A. Lack of apoprotein B48
B. Lack of apoprotein B100
C. Lack of apoprotein CII
D. Lack of apoprotein CIII
E. Lack of apoprotein E

15. Factor that mostly causes high level of LDL is


A. Lack of lipoprotein lipase
B. Lack of Acyl CoA Cholesterol Acyl Transferase
C. Lack of Lecithin Cholesterol Acyl Transferase
D. Defective of Apo E receptor in the liver
E. Defective of LDL receptor in the extra hepatic tissues

For questions number 16-17


A 54 yo male complained of sudden onset of severe left anterior chest
pain, radiating to the left arm that was not relieved by nitro glycerine
tablets. The patient was markedly short of breath. On auscultation, diffuse
wheezing and crepitate rales bilaterally. Heart sounds were soft and no
murmurs were heard. The skin was cold and clammy. He was oligouric.
Lab cholesterol level was 285 mg/dl. He was diagnosed as acute
pulmonary edema due to myocardial infarction.

16. This patient is most likely to have


A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
E. Bronchiectasis

17. To reduce the cholesterol level, the doctor gave atorvastatin once
daily. The mechanism of this drug is
A. To activate HMG CoA synthase
B. To activate HMG CoA reductase
C. To inhibit Thiolase
D. To inhibit synthesis of HMG CoA
E. To inhibit synthesis of mevalonate

18. Which of the following statements regarding Mitral Stenosis (MS) is


TRUE?
A. The pressure gradient between the left atrium and the left ventricle
decrease with increased heart rate
B. Auscultation in the left mid clavascular line fifth intercostal space
the murmur occurs in diastolic phase
C. Infective endocarditis is a common complication of pure MS.
D. Auscultation in the left mid clavascular line fifth intercostal space
the murmur occurs in systolic phase
E. Shortly after the event of acute rheumatic fever the patient shows
symptomatic MS

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19. Which of the following statements regarding chronic Aortic
Regurgitation (AR) is TRUE?
A. Cardiac muscle cells do not degenerate
B. Clinical heart failure is generally a results of left ventricular diastolic
dysfunction
C. Increased pulse pressure with cresscendo-decresscendo murmur
D. Increased pulse pressure with pansystolic murmur
E. The jugular venous pressure is usually abnormal

20. Which of the following statements regarding acute coronary syndrome


is TRUE?
A. Diagnosis of acute coronary syndrome is based on history physical
exam, ECG, cardiac enzymes
B. Plaque future and subsequent formation of thrombus this can be
either occlusive
C. Progression of obstructive coronary atherosclerosis disease
D. The spectrum of clinical conditions that range from unstable angina
to non ST elevation myocardial infarction and ST segment elevation
myocardial infarction
E. All of the above

20. which of the following


a. diagnosis of acute coronary syndrome is based on history physical
examination, ECG, cardiac enzyme
b. plague future and subsequent formation of thrombus this can be
either occlusive
c. progression of obstructive coronary atherosclerosis disease
d. the spectrum of clinical condition that range from unstable angina
to non ST elevation myocardial infarction and ST segment elevation
myocardial infarction
e. all of above

21. a 61 years old woman is brought into the emergency departement.


She pain between her shoulders Complain of light headedness and
nausea. The cardiologist reviews her 12 lead ECG. Which shows a Sinus
bradycardia at 54 bpm with ST segment elevation in lead V1 until V4. The
patient is classification as having which of the following?
a. STEMI anteroseptal wall
b. STEMI interolateral wall
c. Stable angina
d. Unstable angina
e. Pericarditis

22. preload of heart is the best defined as


a. end systolic wall tension
b. shortening of muscle fiber
c. function of length of muscle fiber
d. aortic impedance

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e. pulmonary artery impedance

for question number 23-24, refer to


a 60 year old male smoker long standing hypertension present to the
emergency departement with dyspnea since one week. He has been
increasingly dyspneic since 3 years on examination his blood pressure
110/70 mmHg heart rate 112 bpm and respiratory rate 32x/minute. Most
rales are heard over the lungs. A left pericardial heave is found and S3
gallop heard over the apex cordis. His liver is 4 cm below the costal arc
with a positive hepatojugular reflux

23. the most important examination to establish the diagnosis of this


patient is one of the following
a. CXR and ECG
b. CXR and liver function test
c. lung function test
d. cardiac marker/enzymes
e. BGA

24. choose one condition below which may relate to development of


dyspnea in this patient:
a. reduced contractility of the myocardium
b. low compliance of the left ventricle
c. diastolic dysfunction of the left ventricle
d. reduced shortening of muscle fiber
e. reduced end left ventricular systolic wall

25. a 71 years old man develops palpitation and dizziness. His blood
pressure is 80/50 mmHg and his pulse is Regular at 170/min. His ECG
monitor shows a saw-toothed patterns (see figure below)

Which of the following procedures is most appropiate in converting him


backto sinus rhythm?
a. Gagging procedures
b. Valsava maneuver
c. Eyeball compression
d. Carotid sinus pressure
e. Electrical cardioversion

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26. what is the most common sustained arrythmia seen in the clinical
practice?
a. atrial fibrilation
b. ventricular tachycardia
c. paroxysmal supraventricular tachycardia (PSVT)
d. premature atrial contraction
e. ventricular fibrilation

27. which of the following statement concerning natural history


a. acute idiopathic pericarditis is not a self limited disease and significant
complication
b. antibiotic should be initiated as soon as the diagnosis is confirmed
c. complication of acute pericarditis are effusion, tamponade and
constrictive pericarditis
d. ten milligram of colchicines daily is much better than steroid
e. in young man it is reasonable to test for SLE as apart of the initial
evaluation.

28. which of the following ECG changes is typical for acute pericarditis?
a. inverted T waves followed by elevated ST segment
b. localized convex ST segment elevation
c. concave ST segment elevation
d. frequent premature ventricular contractions
e. prolonged PR interval

for question number 29-34


after examine a 55 year old woman in hospital, the doctor in charge
thought that woman suffer from sub acute bacterial endocarditis and send
blood sample to microbiology labolatorium.
29. what kind of best media for blood sample according to the diagnosis?
a. mac conkey agar
b. blood agar
c. sabouraud agar
d. chocolate agar
e. thayer martin agar

30. what is the common bacterial the common bacteria cause of this
disease?
a. staphylococcus aureus
b. staphylococcus viridan
c. staphylococcus apidermidis
d. streptococcus beta
e. staphylococcus saprophyticus

31. According to the cause of disease, what colony morphology appear of


this bacteria in media cultur?
a. Pin point, transparent around colony

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b. Pin point, greenish around colony
c. Pin point, non hemolysis
d. Size about 3 mm, non hemolysis
e. Size about 3 mm hemolysis

32. To confirm significant infective endocarditis, the doctor has to send


blood sample. How many samples have to be sent to confirm infective
endocarditis significancy?
a. 1 sample
b. 2 samples
c. 3 samples
d. 4 samples
e. 5 samples

33. what the best test to confirm Staphylococcus aureus as the pathogenic
bacteria?
a. Positive test to inulin fermentation
b. Color of colony are yellow
c. Sensitivity to Bacitracin
d. Negative test of Manitol fermentation
e. Positive test of DNA test

34. Streptococcus pneumonia and Streptococcus viridians have greenish


color around their colony. What test to differ of both bacteria?
a. DNA-test
b. Inulin-test
c. Sensitivity test to optochin
d. Colony size in blood agar
e. Manitol test

For questions number 35 to 39, refer to scenario below:


A 60-years-old man got heart attack. He was treated with digoxin and
captropril orally, and must be given furosemide 40 mg/6 hours IV
immediately.
35. Which of the following is the most likely the function of digoxin?
a. Stimulate 1 and 2 receptors in the heart and vascular smooth
muscle
b. Inhibiting myocardial pump Na+, K+, ATPase
c. Inactivates adenyl cyclase
d. Inactivates Na+ channel
e. Inhibits Ca2+ channel

36. Which of the factors below that can increase toxicity of digoxin?
a. Depletion of K+ by furosemide
b. Depletion of Na+ by furosemide
c. Hyperkalemia
d. Hypocalcemia
e. Hypercalcemia

37. Which of the following is the most appropriate prescription for the
Captopril
a. R/ Captopril 25 mg tab. No XXX
S p.r.n. tab I 1 h.p.c.
b. R/ Captopril 25 tab. No XXX

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S 2x1 tab 2 h.a.c.
c. R/ Tab. Captopril 25 mg tab. No. XXX
S.t.d.d. I tab.
d. R/ Captopril 25 mg tab. No. XXX
S.b.d.d. tab. I 1.h.a.c.
e. R/ Captopril tab. No. XXX
S.2.d.d. I 1 h.p.c
38. Which of the following is the most appropriate prescription for the
Furosemide IV?
a. R/ Furosemide 40 mg IV / 8 hours No. I
S.s.d.d. I
b. R/ Furosemide 40 mg/2 ml Amp. No. III
S.l.m.m.
c. R/ Furosemide 40 mg IV No. Amp. III
S.t.d.d. I
d. R/ Furosemide 40 mg No. Amp. III
S.t.d.d. I
e. R/ Furosemide 40 mg IV No. I
S.p.r.n
39. Which of the following is the most appropriate note that must be
written in prescription immediately?
a. ITER
b. CITO
c. PRO INJ.
d. HORA SOMNI
e. PRO RE NATA

For the questions number 40 to 41, refer to scenario below


When you are in the primary health center. A 46 year old man was bring
result of laboratory examination that contain of total cholesterol 312
mg/dl.LDL cholesterol 170 mg/dl.And HDL cholesterol 24 mg/dl. He afraid
this result can make an illness.
40.What kind of meals can increase dyslipidernia?
A. Low fruit intake
B. High caffeine intake
C. High carbohydrate intake
D. High calorie intake
E. Low alcohol intake

41.What dictary factor that increase risk of dyslipidernia development?


A. High SF A intake
B. Low physical activity
C. Balance water intake
D. High fiber intake
E. Moderate daily activity

42.The changes of blood lipid level can be influenced by specific food


sources, this kind cholesterol content:
A. Vegetable oil
B. Coffe cream
C. Coconut milk

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D. Peanut
E. Animal skin

43.Sedentary lifestyle and high energy source intake contribute to higher


risk factor for endotel inflammation due to atherosclerosis with myorcadial
infarction as comorbidity.To reducing risk of coronary heart disease and
lipid disorders:
A. Reduce fat intake balance fat composition between SAFA,MAFA and
PUFA
B. Reduce protein intake and substitute lipoproteins for saturated fat
C. Fat intake and substitute trans-fat for saturated fat
D. Reduce carbohydrate intake and substitute complex carbohydrate
for sample carbohydrate
E. Reduce protein intake and substitute with vegetables

44.Lifestyle change with healthy food intake descrease risk factor coronary
heart desease. Many recommendation of nutritional supportive therapy
promise the improvement of metabolic condition. Diet recommendation to
decrease risk factor such as dyslipidernia include:
A. Eat 6 servings of fruit per day
B. Eat 4-5 servings of vegetable and fruit per day and lean protein
sources
C. Eat 2-3 servings of dairy food per day
D. Eat meat and low fiber grains
E. All of the above

45.Limitation of salt intake in heart failure needed for normalize water and
electrolyte balance.The regulation of fluid imbalance that result in cardiac
edema , this condition need restriction of specific mineral because its
ineral influence to fluid balance.
A. Potassium
B. Magnesium
C. Calcium
D. Selenium
E. Sodium

46.Metabolic disorder , a state of insulin resistance is commonly present in


dylipidemic patient. Treatment for insulin resistance must direct toward:
A. Without caloric restriction
B. Increased weight training activity and caloric restriction
C. Use drugsdesigned generally to reduce insulin resistance
D. Moderate fiber intake
E. Increase high intensity training

For question number 47 to 48 , refer to scenario below:

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A 50 year old male came to primary health care with chief complain
discomfort in his left chest. The doctor ask many question related to risk
factor of heart problem as working diagnosis.
47.If the cholesterol level 250 mg/dl. LDL 140 mg/dl and normal
triglyceride level. The nutritional supportive theraphy of this patient is:
A. Decrease only animal food sources in his diets
B. Decrease liquid composition in his diets without the others
C. Low cholesterol food sources
D. Decrease total calorie and improve nutrient composition
E. Decrease total calorie and give supplementation

48.Intake of fiber can reduce blood cholesterol in the way:


A. Break down cholesterol in blood
B. Increase enzyme to remove cholesterol
C. Bind cholesterol in blood and remove it through bile acid
D. Decrease enzyme forming cholesterol
E. Bind cholesterol in intestine

49.Normal blood cholesterol can be achieved with a good lifestyle , and


maintain a normal body weight it should be:
A. Normal between 18.5 to 23.5 kg/m 2
B. Normal between 18.0 to 22.9
C. Normal between 18.5 to 22.9
D. Obese: above 30
E. Obese: above 25

50. A 45 year old male came to to primary health care with chief complain
weakness. The doctor
Asks many question related to risk factor of heart problem as working
diagnosis. If the HDL level was 25 mg/dl and and the BMI was 31.2 kg/m 2,
some of these state may contribute:
A. Genetic vulnerability
B. Previously too many intake of food
C. Usually in sedentary lifestyle
D. Physiologycal and psychological stress
E. All are possible

For questions number 51 to 52, refer to


A 20-year-old G1 P0 woman has a screening ultrasound performed at 18
weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal
kidney, liver, head, and extremities appear normal. However, the fetus has
a heart with a membranous ventricular septal defect, overriding aorta, and
marked pulmonic atresia.
51.If the baby were to be live born, which of the most possible sign on the
baby that we have to worry about?
a. Systemic hypertension
b. Weak lower extremity pulses

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c. Clubbing of digits
d. Cyanosis
e. Telangiectasias
52.If the baby were to be born, what is the most possible mechanism on
the babys heart
a. Decrease oxygen demand
b. Left to right shunt
c. Right to left shunt
d. Decrease oxygen supply
e. Normal cardiac cycle

For questions number 53 to 56, refer to scenario below:


A 60-year-old man comes to emergency department with the chief
complain sudden onset of substernal chest pain. The pain persists for
three hours. He becomes shortness of breath and diaphoresis. On physical
examination found that his blood pressure 135/95 mmHg, temperature:
37,50C, respiratory rate 26/ minute. A chest radiograph shows a slightly
enlarged heart and mild pulmonary edema. An ECG shows ST segment
elevation in anterior leads V1-6
53. Which of the following serum laboratory test findings is most likely to
be present in this man?
a. Urea nitrogen of 110 mg/dL
b. Sodium of 115 mmol/L
c. ALT of 876 U/L
d. HDL cholesterol of 55 mg/dL
e. Troponin I of 32 ng/mL

54.What is the most possible mechanism occur to the patient?


a. Decreased coronary artery pressure
b. Increased myocardial oxygen demand
c. Increased myocardial oxygen supply
d. Decreased myocardial oxygen supply
e. Increased coronary artery pressure

55.Base on ECG interpretation, what is the possible diagnosis of this man?


a. Ischemic on inferior
b. AMI on inferior wall
c. Old myocardial infarct on anterior wall
d. AMI in lateral wall
e. AMI on anterior wall

56.Which of the following will require the smallest increase in oxygen


consumption by the heart?
a. Generating an increase in left ventricular pressure
b. Severe hypertension
c. Aortic stenosis
d. Generating an increase in stroke volume

For questions number 57 to 59, refer to scenario below:


A-60-year-old man came to your clinic with the chief complain ulcer at his
thumb of toe. He also feels numbness and pain. He has been smoking
since 15 years. He smokes two packs of cigarette a day.

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57.What is the possible mechanism of hos disease?
a. Antigen-antibody reaction
b. Imbalance on oxygen supply and demand
c. Obstruction on distal microcirculation
d. Atherosclerosis
e. Vasodilatation

58.What is the most possible cause of his disease?


a. Superoxide dismutase
b. Reactive oxygen species
c. Allergic reaction
d. Infection
e. Plaque formation

59.Which of the following


a. Vessels has the largest effect on totalArteries
b. Arterioles
c. Capillaries
d. Venules
e. Veins

For questions number 60 to 62, refer to scenarion below:


A 50-year-old man admitted to the emergency department with a chief
complaint severe dyspnea. That condition make you unable to ask him
questions. His wife explains that her husband has dyspnea on exertion
accompanied by weakness during a month ago. She also said that her
husband feels sharp pain when he takes a deep breath, coughing and
swallowing, but he was ignored to see a doctor. He has history lung
tuberculosis a year ago but he refused to take the medication. From vital
sign found that his general condition is severely ill, blood pressure is 85/60
mmHg with pulsus paradoxus, respiratory rate is 36 bpm, pulse rate is 115
bpm, and temperature: 38.00C. From physical examination found that he
elevated jugular venous pressure, kussmaul sign was observed, the
precordium is quiet without palpable apex beat. On auscultation found
muffled heart sound from chest x-ray shows enlarged cardiopericardial
silhouette without lung congestion.
60.What is further examination that is most likely to be present in this
man?
a. USG
b. ECG
c. Echocardigraphy
d. Troponin
e. Angiography

61. what is possible mechanism of his disease?


a. atherosclerosis
b. infection of mypcardium
c. imbalance on o2 supply and demand
d. antigen-antibody reaction
e. pericardial effusion

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62. what is principal management of his disease?
a. antibiotic for his lung tuberculosis
b. diuretic
c. decompression
d. oxygen therapy
e. digoxin

a 30 yo female was admitted to the emergency room with palpitation. The


palpitation started one day before admission, which was felt as rapid and
irregular heart beat. She had also complaint of shortness of breath in the
last few weeks, which worsened to dyspnea even at rest, after the
palpitation occurred. She was hospitalizes two months ago, due to
dyspnea on mild exertion accompanied with easy fatigability and
shortness of breath
Three month ago she was hospitalizes because of heart disease and
discharge after ten days, at home, she continued to take her medication a
small white tablet which increase her urination, but she refused to follow
up. From the physical exam found her pulse was irregularly irregular,
unequal, with a rate of 128 bpm.
her heart was enlarged, S1 was variable with normal S2, and no
discernible cardiac murmur. The heart beat was irregularly irregular with a
rate of 150 bpm. The electrolytes exam showed sodium concentration of
133 mEq/L and potassium concentration of 2.5 mEq/L. hypoxemia, with a
normal ph was found in the blood gas analysis
63. base on her conditions, what is the most possible factor that can
trigger her chief complaints ?
a. septal defect
b. infection on the cardiac wall
c. compression on cardiac muscle
d. ischemic on cardiac muscle
e. electrolyte imbalance

64. base on her conditions, what is the most possible interpretation that
you can find on ECG exam
a. atrial fluter
b. ventricular flutter
c. ventricular tachycardia
d. atrial fibrillation
e. AV complate block

65. sodium enters the cell during the upstroke of the action potential.
What is the major mechanism for removing Na from the cell?
a. it passively diffuse out of the cell
b. it is extruded via an ATP-independent Na-Ca pump
c. it is extruded via an ATP-dependent Na-Ca pump
d. it is extruded via an ATP independent Na-K pump
e. it is extruded via an ATP dependent Na-K pump

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66. a 40 yo man suffered from high blood cholesterol level the sum of his
uncontrolled dietary Cholesterol intake and cellular synthesis, and that
make him vulnerable of the developing of atheroslerotic Plaque resulting
in obstraction of his blood vessels.
Which lipoprotein mostly transports cholesterol from his liver to his heart?
a. plasma albumin
b. chilomicron
c. vldl
d. ldl
e. hdl

67. a 75 yo woman present with fatigue, edema, and shortness of breath.


Her physician prescribe a diuretic and a positive inotropic agent. Which of
the following changes is primarily responsible for the improvement in her
condition?
a. a reduction in heart rate
b. a reduction in heart size
c. an increase in ventricular end diastolic pressure
d. an increase in wall thickness
e. an increase in cardiac excitability

68. a 24 years old woman undergoes an annual physical exam for


participation on the athletic team at her college. While auscultating her
heart sound, the sport medicine physician instructs the women to take in a
deep inspiration. During this maneuver, he detects splinting of the second
heart sound. which of the following mechanism underlying this finding?
a. a decrease in heart rate
b. an increase left ventricular stroke volume
c. delayed closing of the aortic valve
d. delayed opening of the mitral valve
e. delayed closing of the pulmonic valve

69. a 67 yo man who has difficulty breathing when he exercise malan


appointment to see physician. Auscultation reveals a holosystolic murmur
leading to the diagnosis of mitral regurgutation. which of the following
laboratory finding is most likely to be present?
a. a decreased arterial pressure
b. an increased pulse pressure
c. an increased a wave
d. a decreased cardiac output
e. a decreased left ventricular preload

70. during a exercise, the cardiac output of a trained athlete may increase
to 1.5 liter per minute. The stroke volume is 90 ml. which of the following
heart rate is needed to compensate the increase the cardiac output?
a. 145 beats/minute
b. 155 beats/minute
c. 165 beats/minute
d. 175 beats/minute
e. 185 beats/minute

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71. the thoracic cage bound the thorax and separates it from the
superiorly, and the abdomen inferiorly. What is the structure that allows
structure from the neck enter the thorax?
a. the clavicle
b. thoracic cage
c. the intercostal spaces
d. the superior thoracic aperture
e. the inferior thotracic aperture

72. a thoracic surgeon is doing thoracocentesis procedure. The patient had


been complaining of dyspnea and pain in the chest during coughing or
sneezing. From x-ray, it was concluded that the patient has pleural
effusion. Which cavity is the thoracic surgeon is attempting to reach by
doing thoracocentesis?
a. pleural cavity
b. the superior mediastinum
c. the middle mediastinum
d. the superior mediastinum
e. the peritoneal cavity

For question number 73 and 74, refer to scenario below:


A group of 3rd year was observing the middle part of cadavers thorax.
They were trying to identify the midway between T4-T5, and draw an
imaginary line to the sternal angle.
73. which border are they trying to identify?
a. border between superior mediastinum and inferior mediastinum
b. border between superior mediastinum and middle mediastinum
c. border between middle mediastinum and posterior mediastinum
d. border between neck and mediastinum
e. border between anterior and superior mediastinum

74. what organ will they above the imaginary line?


a.bifurcation of the trachea, part of esofagus, ascending aorta
b. thymus, ascending aorta, IVC
c. part of esophagus, trachea, arch of the aorta
d. SVC, ascending aorta, thymus
e. arch of the aorta, IVC, part of esophagus

75. the heart is covered by fibroserous layer that protect its outermost
surface
Because
The pericardium anchors to the diapraghm by the pericardiiophrenic
ligament
a. The first sentence is TRUE, the second sentence is TRUE , both has
CAUSAL RELATIONSHIP

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b. The first sentence is TRUE, the second sentence is TRUE , both has
NO CAUSAL RELATIONSHIP
c. The first sentence is TRUE, the second sentence is FALSE
d. The first sentence is FALSE, the second sentence is TRUE
e. The first sentence is FALSE, the second sentence is FALSE

76. the pericardium is an enclosed sac covering the heart, During which of
the sentence below is true?
a. the transverse sinus is found at the anterior of the heart
b. the oblique sinus is a blind pouch
c. the transverse sinus separated left and right arterial outlet
d. the oblique sinus is accessible by sliding one finger between the venous
and arterial outlet
e. the oblique and transverse sinus has a passage that connect them

77. a 49 year old man complained of palpitation. He had history of


hypertension since 4 years ago. On thorax examination, you found the
point of maximal impulse is at the level of 5th intercostal space 2 cm to
left of the left midclavicular line. Which part of the heart do you actually
assess by doing examination?
a. the apex, formed mostly by left ventricle
b. the apex, formed the superior border of the heart
c. the base, formed mostly by left atrium
d. the base, part of the heart that contact closest with anterior thoracic
cavity
e. the entire surface of the heart, formed mostly from the hearts ventricle

78. a 27 year old man came in to the emergency roo after falling on the
construction site where he had been working. A sharp wooden stick
pierced his chest. Radiography examination revealed that stick barely
pierced the right side of his heart. While the other examination revealed
that his heart is uncompromised, which structure might severe from the
accident?
a. the left lung
b. the aorta
c. the trachea
d. the esophagus
e. the vena cava

For question number 79 and 80, refer to scenario below:


A 2 year old girl came to the clinic with swelling in the leg and abdomen as
chief complaint. Her mother explained that at 8 months old, she was taken
to a doctor because of bluish lips and fingertips. She was diagnosed with
congenital heart disease. Her parents refuse operative treatment then,
and chose conservative treatment.

79. if her medical record stated that she has Tetralogy of Fallot, where
would you look for murmur?

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a. at the left midclavicular line, 5th ICS level
b. at the right midclavicular line, 2th ICS level
c. at the left parasternal line, 3rd or 4th ICS level
d. at the left parasternal line, 2nd ICS level
e. at the right midclavicular line, 5th ICS level

80. which i f the following sentence below has the correct feature of right
atrium?
a. has opening from 4 pulmonar vein in its posterior wall
b. its inferior has irregular muscle elevation, the trabecula carnae
c. it forms most of the base of the heart
d. has a sulcus terminalis which lies on the interatrial septum as remnants
of oval foramen
e. has rough muscular anterior wall composed of pectinate muscle

81) It has thick walls and fine meshwork of trabeculae carnae, with two
papillary muscles. Which structure that has description on above
sentence?
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle
e. The interventricular septum

82) A 56-year-old man came to the outpatient clinic because of having


syncope for the last several days. From ECG, it was revealed that the
P-wave is multiple and irregular before a QRS-complex followed. Where
is the location of the structure that most likely causes his
abnormalities?
a. Located in the posteroinferior region of interatrial septum, near the
opening of coronary sinus
b. Located between the atrial and ventricular myocardium, passes
from the atrial part through the insulating fibrous skeleton of the
heart, along the membranous part of the IVS
c. Located anterolaterally, deep to epicardium at the junction of SVC
and RA. Near the superior end of sulcus terminalis
d. Located in the subendocardial layer of the ventricle wall
e. Located in the ventricular wall

For questions number 83 to 85, refer to scenario below:


A 55-year-old woman brought to the emergency room after having chest
tightness for the last hour. She has been having the complaint in the last 6
months, but only lasted 10 to 20 minutes. Her ECG revealed myocardial
infarct in the lead V1 V2.
83) Which artery is most likely clogged in this patient
a. Right marginal artery
b. Circumflex artery
c. Anterior interventricular artery
d. Posterior interventricular artery

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e. Right coronary artery
84) What is the origin of the above artery
a. Great cardiac artery
b. Small cardiac artery
c. Anterior descending artery
d. Left coronary artery
e. Right coronary artery
85) Which of the vein below most likely drains blood from the affected
area?
a. Great cardiac vein
b. Small cardiac vein
c. Middle cardiac vein
d. Right coronary vein
e. Left coronary vein
86) The tight sensation is transmitted through the cardiac plexus. Which
is the origin of the sympathetic trunk that supplies this?
a. Presynaptic fibers from lumbar segment of spinal cord
b. Postsynaptic fibers from thoracic segment of spinal cord
c. Vagus of the cranial nerve
d. Presynaptic fibers from the thoracic segment of spinal cord
e. Postsynaptic fibers from the lumbar segment of spinal cord
87) Where would the right pulmonary artery be found?
a. Anterior to the ascending aorta and the SVC
b. Posterior to the ascending aorta and the SVC
c. Anterior to the ascending aorta and posterior to the SVC
d. Posterior to the descending aorta and the SVC
e. Posterior to the ascending aorta and the SVC
88) Which of these arteries below is branched directly from the
abdominal aorta?
a. Hepatic artery
b. Splenic artery
c. Superior mesenteric artery
d. External iliac artery
e. Intercostal artery

For questions number 89 to 90, refer to the scenario below:


A 27-year-old woman came to the outpatient clinic because of the
varicosities in her leg, From examination, you see varicose vein and blow
out in the lateral side of her right leg, starting from around the ankle, up to
around her knee.
89) Which of the vein is most likely incompetent?
a. Femoral vein
b. Popliteal vein
c. Great saphenous vein
d. Small saphenous vein
e. Perforator vein

90.Which one of the sentences below follows the correct lymphatic


flow?
a. From the head, upper limb, right thorax, right lower limb, to the
right lymphatic duct

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b. From the right head, right upper limb, right thorax, right
abdomen, right lower limb, to the right lymphatic duct
c. From the left head, left upper limb, left thorax, left abdomen,
left lower limb to lymphatic duct
d. From the head, upper limb, left thorax, left lower limb, to
thoracic duct
e. From the left head, left upper limb, left thorax, abdomen, lower
limb, to thoracic duct
91.A 58-years old man present to hospital with squeezing chest pain.
The pain began abruptly spreading to the left hand and has lasted
for 2 hours. The intensity of the pain increase during inspiration and
with body movement on physical exam found a third and fourth
heart sound, systolic murmurs, paradoxical splitting of the second
heart sound. ECG showed ST segment elevation. The patient will be
given nitroglycerin sublingual.
What is the most important condition should be detected as
precaution?
a. Hypotension
b. Bradycardia
c. Blurred vision
d. Nausea
e. Diarrhea
92.A 70 year old man came to hospital for routine his condition. He has
brought to emergency room following a shortness of breath 2 hours
ago and the doctor found several sign of ventricular tachycardia,
since then he has been given verapamil.
What is the condition should be monitored regularly?
a. Lupus related syndrome
b. Kidney function test
c. Peripheral edema
d. Trombo-test
e. TSH
93.A 65 year old man was brought to the doctor due to shortness of
breath. He notice a shortness of breath when climbing 1 flight of
stairs and he frequently awake at night due to a sensation of lack
of air for the last year.
Physical examination revealed: BP 120/60 mmHg, HR 96 bpm, RR
28x/min, laterally apex beat, gallop rhythm, heart murmur,
hepatomegaly, pretibial pitting edema, other in normal limits. One
of prescription drug was captopril.
What is the most expected effect of drug besides decreasing blood
pressure?
a. Countering heart murmur
b. Reduce pretibial edema
c. Myocardial remodeling
d. Decrease heart rate
e. Relief dypsnea
94.A 67 year old man was brought to the doctor due to shortness of
breath. He notice a shortness of breath when climbing 1 flight of
stairs and he frequently awake at night due to a sensation of lack
of air for the last 6 months. Physical examination revealed: BP

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120/60 mmHg, HR 96 bpm, RR 20x/min, laterally apex beat, gallop
rhythm, heart murmur, hepatomegaly, pretibial pitting edema,
other in normal limits. The doctor gave her initial dose of digoxin,
continue with 1/3 of initial dose for maintenance dose.
Why should maintenance dose is mush lower than the initial dose?
a. Avoid drug interaction
b. Wide drug distribution
c. The long drug half life
d. Active excreted drug
e. High protein binding
95.A 2 years girl was brought to the ER with circum oral and finger tip
cyanosis. She frequently has to squat after running. Since she was
one YO, she often has circum oral and finger tip cyanosis, especially
after crying. She underwent an echocardiography examination when
she was 1,5 YO. She was advice to have a heart catheterization
followed by surgery to correct her heart problem. But her parents
do not have the needed finances to pay for the procedure. In the
meantime she has been treated with propranolol.
What is the role of that drug?
a. Constrict infundibular of pulmonary artery
b. Increase right ventricular pressure
c. Positive chronotropic
d. Positive inotropic
e. Positive domotropic
96.A 50 years old man was admitted to the hospital because fever,
shortness of breath, and weight loss. Chills, sweats, and anorexia
started 6 weeks prior to admission. The doctor in charge also found
a heart murmur during examination, and he thought the patient
suffers from endocarditis.
What is the most common agent causes such disease?
a. Staphylococcus epidermidis
b. Staphylococcus aureus
c. Streptococcus alfa hemolyticus
d. Streptococcus beta hemolyticus
e. Streptococcus gamma hemolyticus
97.To confirm etiologic agent of infective endocarditis, blood culture
must be obtain form the suspected patient.
How many blood cultures obtain in such case?
a. One blood culture
b. Two blood culture
c. Three blood culture
d. Four blood culture
e. Five blood culture
98.Blood culture of suspected sub-acute infective endocarditis patient
performs on blood agar and after incubation in 37 oC in 24 hour,
grew some bacterial colony.
What is the colony morphology of such bacteria?
a. Colony 0 to 3 mm, non haemolysis
b. Colony 0 to 3 mm, haemolysis
c. Pin point colony, non haemolysis
d. Pin point colony, alfa haemolysis
e. Pin point colony, beta haemolysis

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99.There is an agent of infective endocarditis, which can be confirmed
only by one blood culture obtain from the suspected patient. What
is the name of this agent?
a. Hemophilus influenza
b. Streptococcus pyogenes
c. Staphylococcus aureus
d. Klebsiella pneumonic
e. Coxiella burnetii
100. The bacteria could produce such diease through an intact
endothelium?
a. Hemophilus influenza
b. Actinobacillus
c. Cardiobacterium
d. Eikenella
e. Staphylococcus

101. The substance as bactrerial product responsible or facilitate this


bacteria produce such disease on intact endocardium:
a. soluble coagulase
b. clumping factor
c. hyaluronidase
d. DNA-ase
e. none of all above

102. Alfa streptococcus and streptococcus pneumonia very similar each


other, and some test must perform to confirm these bacteria.
Which of the test has the same result for those bacteria?
a. Gram stain
b. Colony on blood agar
c. Optochin test
d. Inulin fermentation
e. Bile solubility

103. A 15-year old boy admitted to hospital because of fever and joint
involvement. After examination, the doctor in charge found the
manifestation of rheumatic fever, such as migratory polyarthritis, carditis,
subcutaneous nodule, and erythema marginatum.
What is the agent most likely responsible in such disease?
a. Streptococcus alfa hemolytic
b. Streptococcus beta hemolytic group A
c. Staphylococcus saphrophiticus
d. Haemophilus influenza
e. Coxiella burnetii

104. Some laboratory test carried out to confirm the etiology precursor of
rheumatic fever. No single test is pathognomonic, but diagnosis base on
Jones criteria requires evident of recent infection of certain bacteria.
Which of the result of this test confirm involvement such becteria?
a. increase in WBC count
b. increase in ESR
c. positive C reactive protein

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d. increase anti streptolysin O titer
e. prolong PR interval in ECG

For question number 105 to 109, refer to option given below


All about cell in the circulatory system are:
a. endothelial cell
b. smooth muscle cell
c. cardiac muscle cell
d. pericyte
e. purkinje cell

Which of the following statement corresponded with the cell?


105. it has calmodulin for binding ion calcium
106. it production of nitric oxide
107. it has A band and I band
108. it located outside the capillary
109. it as the conduction system

For question number 110 to 111, refer to scenario below:


A loud first heart sound with fixed and widely split second heart sound at
the upper left sterna border that does not change with respiration was
noted in 9-year-old girl. Otherwise she is asymptomatic and active.
110. what is the most likely diagnosis?
a. mitral valve prolapsed
b. Ventricular septal defect
c. isolated tricuspid regurgitation
d. tetralogy of fallot
e. atrial septal defect.

111. What is the next procedure needed to confirm the diagnosis?


a. ECG
b. CT scan
c. Echo
d. Cardiac cathetherization
e. Chest X-ray

112. A 7-month-old male baby was brought to clinic with cyanosis on


fingertips and mouth. On auscultation noted S1 was normal but s2 was
single. A long 3/6 ejection systolic murmur is best heard at the
middle and upper left sternal borders. CXR show concave segment
of main pulmonary artery and decreased of pulmo vascular markings.
What is the most likely diagnosis?
a. Ventricular septal defect
b. Truncusarteriosus
c. TOF
d. Persistent ductus arteriosus
e. Pulmo stenosis

For question number 113-114, refer to this following scenario.

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A 3-months-old female baby, diagnosed as TOF, was brought to the
hospital because increasing cyanosis w/ rapid and deep respiration,
irritability and prolonged crying. There was no fever, cough, or cold.
On auscultation s1 was normal. However intensity of s2 was decreased
and no audible of heart murmur
113. What is the condition happening?
a. Hypoxic spell
b. Heart failure
c. Respiratory failure
d. Metabolic acidosis
e. Breat holding spell
114. A five yo girl presents w/ fever for 8 days, anorexia, night
sweats, a new heart murmur splenomegaly, joint pains, and history
of having her teeth cleaned by dentist 1 month prior to this visit.
What is the most likely diagnosis?
a. Kawasaki disease
b. Juvenile rheumatoid arthritis
c. Acute rheumatic fever
d. Infective endocarditis
e. Systemic Lupus Erythomatosus

For questions 115-116, refer to scenario below


A 10 y.o boy, a star in a soccer team, had sore throat since two weeks
diagnosed rheumatic fever.
115. WOTF criteria must commonly found?
a. athralgia
b. carditis
c. Erythema marginatum
d. chorea
e. subcutaneous nodule

116. WOTF treatment, is the secondary prophylaxis for case above?


a.Benzathine Penicilline G every 4 weeks
b. Corticosteroid 2mg/Kg /day
c. Cephadroxil oral 2 x 500 mg for completed 10 days
d. Salicylates oral 4 x 250 mg everyday
e. Amox oral 4 x 250 mg everyday

For question 117-118, refer to scenario below


A 4-month-old male baby came to your clinic with failure to thrive and
recurrent respiratory infections as chief complaint. On PE, baby
looked pink and his breathing was faster without chest recession.
A 3/6 continuous murmur was best heard at upper lelft sternal
border and bounding pulsation on all extremities
117. What is the most likely diagnosis of this baby?
a. aortic stenosis
b. ventricular septal defect
c. atrial septal duct

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d. pulmonary stenosis
e. patent ductusarteriosus

118. What is the next step should be taken for case above?
a. commence anti-failure
b. surgical catheter correction of the defect
c. life-long endocarditis prophylaxis for at risk procedure
d. repeating exam at the edge of 12 months
e. reassuring the parents

119. You are called to see a 2-hour-old male with cyanosis and
tachypnea. Oxygen saturation is 80% while breathing room air and
the RR is 60 BPM with BP od 80/50 mmHg. The baby is cyanotic and
there are no audible murmurs. The rest of the exam is unremarkable.
The baby is placed in on anFiO2 of 1.0 by head hood and arterial
blood gases reveal PaO2 to be 90 mmHg
What is most likely etiology of the hypoxemia?
a. Methemoglobinemia
b. Cyanotic congenital heart disease
c. Sepsis
d. Lung disease
e. Arterovenous fistula

120. One mont-old baby is seen after turning blue when feeding.
Auscultation of the heart reveals a harsh grade III systolic ejection
murmur over the pulmonic area that radiates to the back. Arterial
blood gas shows normal pH, PaCO2, and PaO2 at rest. The ECG
demonstrates right axis deviation and right ventricular hyperthropy.
The chest x-ray film reveals a large heart with a reduced main
pulmonary artery segment.
WOTF congenital heart disorders is consistent with these findings?
a. Atrial Septal Defect
b. Coarctation of the aorta
c. Tetralogy of Fallot
d. Patent ductusarteriosus
e. Ventricular septal defect

121. You are caring for a now 5 day old infant born after 28 weeks of
gestation. On physical examination you note bounding pulses and a harsh
washing machine murmur. The patient has also had an increasing
oxygen requirement. You order an echocardiogram and diagnose a patent
ductus arteriosus which of the following therapies may correct
this problem?
a. Dopamine infusion
b. 100% oxygen administration
c. Indomethacin (prostaglandin synthesis inhibitor)
d. Prostaglandin infusion
e. Corticosteroid

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122. A 50 year old gentleman has been complaining of chest discomfort
when climbing one flight of strairs since 1 month ago. A positive
ischemic response was detected from the ECG stress test done a
week ago. What is the most possible mechanism underlying the patient
symptom?
a. Coronary atherosclerotic plaque rupture
b. Significant reduction in myocardial blood supply
c. Increased myocardial oxygen demand
d. Spasm of the coronary artery
e. Necrosis of myocites

123. A 50 year old gentleman experienced chest discomfort when


walking 50 meters at normal place for the time. The ECG showed
significant T-wave inversion in lead II, III, and avF. Two troponin
test, measured hour-interval, showed negative results. What was the
most appropriate diagnosis of this 50 years old gentleman?
a. Non-ST-elevation myocard infarction
b. Prinzmetal angina
c. Stable angina
d. Unstable angina
e. Non-cardiac chest pain

124. A 50 year gentleman who hospitalized for unstable angina has a


heart rate of 104 bpm. The patient has neither symptoms nor sign of
heart failure. His physician put him on an oral beta-blocker.In this
setting, beta-adrenergic blockade elicit a beneficial effect because it:
a. Reduce myocardial oxygen extraction
b. Reduce oxygen content
c. Reduce double product
d. Reduce vasodilatation of coronary arterioles
e. Reduce stroke volume

125. A gentleman who was hypertensive, experienced acute heart failure


with pulmonary rales. His blood pressure was 230/130 mmHg. The
echocardiogram showed concentric left ventricular hypertrophy,
normal size of the left ventricle chamber, and normal ejection fraction.
Which is te following condition that may relate to the development of
acute heart failure in this patient?
a. reduced contractility of myocardium
b. low compliance of the left ventricle
c. systolic dysfunction of the ventricle
d. reduced shortening of muscle fiber
e. reduced end-left ventricular systolic wall tension

126. a patient with acute myocardial infarction came to the ER with


accompanied symptom and sign of shortness of breath, wet rales in
the lower half of the lung fields and S3 gallop. Which of the following
is the killip classification for this patient?
a. killip class I
b. killip class II

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c. killip class III
d. killip class IV
e. killip class V
127. 60 year old man comes to hasan sadikin hospital with complaint in
swelling in both legs. The swelling has been occurred since a month
ago. In the past 2 year he tired easily when walking 10 m but still
be able to sleep supine.Patients had been treated in R. ICCU of a heart
attack 3 years ago with irregularlu follow up. Since 4 months ago
the patient taked medication only when there are complaints. On
physical examination found: CM, BP 100/60 mmHg. HR=N (100/min),
Shallow, afebrile, full JVP, HJR (+), heart enlarge to the left, S1 S2 (-)
S3 (+) ronchi (-) liver palpable 5 finger BPX. Spleen not palpable. Lateral
side dullness +. Extremities: pretibial edema +/+. Investigations
showed: ECG sinus tachycardia with old infarction in the anterior wall.
CXR: enlarged heart accompanied by signs of visible lung dam. For
the above case, leg edema occurs due to:
a. pneumonia lobaris
b. left and right HF
c. left HF
d. left HF and pneumonia
e. right HF

128. a 50 year old man arrived in the emergency room with complaints
of left chest feels heavy when the patient is resting, complaints
continue to be felt until arrival at hospital. Complaints like these
have often felt, but before not too great. ECG at presentation in the
emergency room showed ST segment depression but no ST segment
elevation. No T wave inversion. Lab examination of blood showed no
abnormalities in cardiac markers. Further examination is necessary in
patient above?
A. coronary angiography
B. CT scans of coronary
C. Holter monitor
D. Treadmill exercise
E. Echocardiography

129. a 55 years old male come to clinic. He is known had dypertension,


dyslipidemia, and smoking, since the last 10 months the patient
complained of retrosternal area chest pain, tingling, arising when
activity, duration od pain a few minutes. On physical exam found bp:
140/90, HR: normal, RR: 18, JVP: normal, s1 s2 normal, s3 -, s4 -, no
pulmonary abnormalities. ECG shows no change for axis -300 and biphasic
p wave in v1 with SV2+ RV5 = 42 mm. what is the ECG interpretation?
a. LVH
b. LVH, LAE
c. LVH, RVH
d. RVH, RAE
e. left and right atrial enlargement

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130. a 25 years old man had complaints of shortness of breath since
3 weeks ago. On physical exam: ictus cordis palpable in ICS 5, left
midclavicular line. The first and second heart sound is normal, no
additional heart sound. There was a diastolic murmur in ICS 2, right
parasternal line. What is the valve abnormality that causes that state?
a. mitral valve regurgitation
b. pulmonary valve regurgitation
c. tricuspid valve regurgitation
d. aortic valve regurgitation
e. mitral valve prolapse

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131. What does the ECG above illustrate?
a. First-degree atrioventricular (AV) block
b. Type-1 second-degree AV block
c. Type II second-degree AV block
d. Third-degree AV block at the AV node level
e. Third-degree AV block at the infranodal level

132. A .... (ga terlalu keliatan, tapi kayanya 70) year old man presents to
general hospital because of altered mental status. His medical .......
congestive heart failure. On the past hospital day, he is agitated and pull
out his intra venous line and has been seen a big monkey there are none.
Which of the following danger is best used to treat delirium?
a. CPZ
b. Lithium
c. Haloperidol
d. Amobarbital
e. Physostigmin salycilate

133. A 65 year old man is admitted to a general hospitals emergency with


chief complaint sleep disturbance, feelings of worthlessness, and
depressive. Six months ago he has coronary by pass surgery. Which of the
following anti depressant should be used cautiously in cardiac patients due
to increased risk?
a. Suicide
b. Withdrawal
c. Hypotension
d. Conduction side effect
e. Drug dependence

134. A 59 years ole man presenst to ED room complaint of insomnia,


depressant. He has a past medical history including myocardial infarction,
atrial fibrillation, and a coronary by pass graft. Which anti depressant class
would you most want to avoid?
a. Serotonin selective reuptake inhibitor (SSRI)

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b. Neuroadrenergic serotonin selective reuptake inhibitor (NSSRI)
c. Trycyclic acid
d. Tetracyclic
e. Noradrenergic dopaminergic

135. Mrs. AM, a 75 years old woman presents to the Emergency


department with left chest pain and ....... arm pain of 6 hours
duration. Her chief complaint also accompanied with vomit. Physical
examination shows BP 110/80 mmHg, pulse 72 bpm, respiration 22x/min,
and chest examination are unremarkable. ECG examination shows mild
non specific ST changes.
Which of the cardiac markers that will be suitable for Mrs. AM disease?
a.Creatinine kinase - MM
b. Creatinine kinase MB
c. Creatinine kinase BB
d.Myoglobulin
e.Total Creatinine Kinase

136. Eight hour after Mrs. AM chest pain, the blood was drawn and
taken to the laboratory for several examinations. The labpratory results as
followed : Hb 12.5 gr/dL (12-16 gr/dL), Hct 36% (36-48%), Leukocyte
7000/mm3 (5000-10000/mm3), Thrombocyte count 220.000/mm3
(150.000-300.000/mm3), CKMB 6 ng/mL (normal : <5 ng/m), LDH 50
U/L (normal : 140-280 U/L).
What is your interpretation of Mrs. AM laboratory result?
a. Unstable angina pectoris
b. Acute myocardial infarction
c. Stable angona pectoris
d. Atypical chest pain
e. Typical chest infarction

137. Mr. TS, 50 years old man had sufferd for hypertension for last 5
years. To maintain the hypertension and other related cardiac disease ,
you as his doctor were given antihypertension drug and aspirin.
Aspirin was known as anti platelet drug to inhibit the thrombus
formation.
What kind of laboratory examination that you suggest to Mr. TS as
monitoring of aspirin therapy?
a.Prothrombin time
b.Activated partial thromboplastin time
c. Thrombocyte
d.Fibrinogen
e.D-Dimer

138. A 45-year old man presents to the Emergency department with


crushing chest pain of 6 hours duration. EkG shows S-T elevation
and new Q waves. Laboratory results show Troponin I : 10.00 ng/mL
(normal : < 0.15 ng/mL) and CK-MB 15.00 ng/mL (normal : <
5ng/mL). The patien was diagnosed as S-T elevation myocardial
infarction and undergo with some medication in ICCU. 24 hours after

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chest pain, the troponin I and CK-MB was re-examined and the result was
Troponin I : 20.00ng/mL and CK-MB : 7.00 ng/mL.
Based on laboratory result about Troponin I and CK-MB, which of the
following statement are true?
a. CK-MB is specific for cardiac muscle injury and can differentiate from
other smooth muscle injury.
b. Both CK-MB and troponin have peak concentration at 12-24 hours
c. Troponin is specific for cardiac muscle and not elevated with
skeletal muscle damage or in renal failure
d. CK-MB may not be elevated in chronic renal failure
e. Troponin may be mildly elevated in chronic renal failure

139. 55-year old man presents to the Emergency Departmen following a


car accident with several muscle trauma and fracture. Tha patient
getting blacked out while driving the car and now has chest pain
as well as wall tenderness. ECG examination is normal. The
laboratory results (12 hours after event) shows as below :
CK : 10.000 ng/mL (normal 50-350 ng/mL), CK-MB : 150 ng/mL
(normal : <0.5 ng/mL), Troponin : 0.17 ng/mL (normal : <0.15
ng/mL)
What is the possibility interpretation of this man condition?
a. Acute myocardial infarction
b. Unstable angina pectoris
c. Acute myocardial infarction with muscle trauma
d. Unstable angina pectoris with muscle trauma
e. Muscle trauma without cardiac event

140. a 40-year old man came with present chief complaint chest pain
for 2 hours and clinically diagnosed as acute myocardial infarction.
Troponin was chosen as diagnostic markers to determine the acute
myocardial infarction. How many subform of troponin that availabe as
diagnostic test?
a. Tropoin has 2 subform : Troponin I and Troponin C
b. Troponin has 3 subform : Troponin C, Troponin I and Troponin T
c. Troponin has 2 subform : Troponin I and Troponin T
d. Troponin has only 1 subform : Troponin I
e. Troponin has only 1 subform : Troponin T

141. when you are working at emergency departement, you find a patient
with clinical manifestation acute myocardial infarction. You ordered the
troponin T parameter as your guide to diagnose the patient. Then the
laboratory result of troponin T show as qualitative and quantitative result.
What is the meaning of qualitative result of card iac Troponin T?
a) The troponin T will be reported as concentration in ng/mL
b) The troponin T will be reported as positive and negative only
c) The troponin T will be reported as positive or negative and also
concentration in ng/mL
d) The troponin T will be reported as high/low mark with concentration
in ng/ml
e) The troponin T will be reported range concentrartion in ng/Ml

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142. this laboratory result is taken from 53 years old women with typical
chest pain of cardiac infraction
TotAL CK CK-MB Troponin T
(N:50-350 (N: < 5 (N : < 0.15
ng/ML) ng/mL) ng/mL)
On 230 3.5 0.16
admission
6 hours later 470 18.5 4.00
12 hours 750 39.8 12.00
later
24 hours 450 12.0 25.00
later

Which of these following statement is CORRECT?


a. CKMB is as spesific as total CK
b. CKMB is spesific for myocardium and skeletal muscle
c. Troponin T is more spesific than CKMB
d. Total CK elevated longer than Troponin T more than 24 hours
e. Elevation is total CK also as predictor of mortality for cardiac
infarction

143. A 30 year-old male patient is presented to the emergency


departement with chest pain that started 20 minutes ago. Upon emergy
room arrival, the phlebotomist draws blood for electrolytes and cardiac
markers. The cardiac marker result as follows :
Total CK CK-MB Troponin I Myoglobulin
(N: 50-350 (N: < 5 (N: < 0.5 (N: 0.90
ng/mL) ng/mL) ng/mL) ng/mL)
On admission 150 5 0.4 60
4 hours later 200 8 0.9 170
12 hours 150 29 3.5 140
later

Which cardiac muscle is considered the ideal early marker?


A. Myoglobulin
B. Total CK
C. CK-MB
D. Troponin I
E. CK-MB and Troponin I

144.A. 30 years old male patient is presented to the emergency


departement with chest pain that started 45 minutes ago. Upon
emergency room arrival, the phlebotomist draws blood for electrolytes and
cardiac markers. The cardiac marker result as follows :
Total CK CK-MB Troponin I Myoglobulin
(N: 50-350 (N: < 5 (N: < 0.5 (N: 0.90
ng/mL) ng/mL) ng/mL) ng/mL)
On admission 170 5 0.3 70
4 hours later 220 7 0.8 180
12 hours 180 27 3.8 150
later

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The interpretation of labolatory result is :
a. Highly suggestive of acute myocardiac infarction
b. Low suggestive of acute myocardiac infarction
c. Normal
d. The laboratory result can describe AMI because lack of into......
e. Other cardiac event beside acute myocardiac infarction

145. In a clinical study of TOF ( tetralogy of fallot ), patients are


examined before surgery to determine predictors observed on
echocardiography that correlate with the severity of disease and the
need for more careful monitoring. A subset of patients is found to have
more severe congestive heart failure, poor exercise tolerance and
decreased arterial oxygen saturation levels. Which of the following is
most likely to predict a worse clinical presentation of these patients ?
a. size of left ventricle
b. diameter of tricuspid valve
c. degree of pulmonary stenosis
d. presence of atrial septal defect
e. size of ventricular septal defect

For questions number 146 to 148, refer to scenario below :


A 27 years old man was found dead at home by the apartment manager,
who had been called by the decedents employer because of failure to
report to work for past 3 days. An external examination by the medical
examiner showed splinter hemorrhages under fingernails and no signs of
trauma. The autopsy was done and the tissue sample from tricuspidal
valve was sent for histopathological examination. The microscopic
appearance of the valve shown in the figure below :

146. Which of the following laboratory finding is most likely to provide


evidence of the cause of disease ?
a. Positive ANCA determination
b. Elevated antistreptolysin O type
c. High double stranded DNA autoantibody titer
d. Positive blood culture for Staphylococcus aureus
e. Increased creatine kinase MB fraction ( CK-MB )

147. Which of the following structure is pointed by the blue arrow ?


a. Fibrin
b. Vegetation

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c. Dead myocytes
d. Mononuclear cells
e. Polimorphonuclear cells

148. Which of the following structure is pointed by white stars ?


a. Fibrin
b. Vegetation
c. Dead myocytes
d. Mononuclear cells
e. Polimorphonuclear cells

For questions number 149 to 150, refer to scenario below :


A 45 year old man experiences crushing substernal chest pain after
arriving at work one morning. Over the next 4 hours that pain persists and
begins to radiate to his left arm. He becomes diaphoretic and shortness of
breath, but he waits until the end of his 8-hour shift to go to the hospital
149. Which of the following microscopic ( light microscope ) change that
most likely appear in this patients myocardium at the time he arrives
at the hospital ?
a. No histopathological changes can be seen
b. Beginning coagulation necrosis, edema and hemorrhage
c. Coagulation necrosis with loss of nuclei and striations & interstitial
infiltrate of neutrophils
d. Well-established granulation tissue with new blood vessels &
collagen deposition
e. Increased collagen deposition with decreased cellularity

150. Which of the following microscopic ( light microscope ) change that


is most likely appear in this patients myocardium before the pain
radiate to his left arm ?
a. No histopathological changes can be seen
b. Beginning coagulation necrosis, edema and hemorrhage
c. Coagulation necrosis with loss of nuclei and striations & interstitial
infiltrate of neutrophils
d. Well-established granulation tissue with new blood vessels &
collagen deposition
e. Increased collagen deposition with decreased cellularity

151. a 1 yo boy is brought to the physician for routine health maintenance


examination. The physiscian notes a lesion his cheek (shown in below
picture). The parents state that this lesion has been present since infancy.
The lesion is excised and its microscopic appearance is shown in the
figure. Which of the following is the most likely diagnosis?
a. Kaposi sarcoma
b. angiosarcoma
c. lymphangoma
d. telangiectasia
e. hemangioma
152. a 34 yo heavy smoker man came to outpatient clinic because of
gangrene in his left foot (as shown in below picture) 1 month earlier he

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often feel pain and cold at his left foot. Which of the following statement is
most appropriate with Ardis disease?
a. the disease mainly affected male 20-35 yo, mostly affected large
arteries
b. the disease mainly affected male 20-35 yo, blood vessel
calcification (+)
c. the disease mainly affected male 20-35 yo, blood vessel
calcification (-)
d. mostly affected large arteries, blood vessel calcification (-)
e. mostly affected small arteries, blood vessel calcification (+)
153. a 4 yo girl had a little bright red spot in her forehead. The size is 4
milimetres, and slightly elevated from the surface of the skin, covered with
intact epithelium. The lesion was excised and pathological examination
showed a capillary hemangioma. Which one of these appearance shows
microscopic features of capillary hemangioma?
a. the mass is sharply defined, but not encapsulated
b. the capillaries walls consist of smooth muscle proliferation
c. a dilated irregular and angulated blood vessel
d. there are branching vascular channels separated by specialized
stromal cell
e. a closely packed aggregates of thin walled capillaries
154. a 50 yo male experiences episodes of severe substernal chest pain
every time he performs any task requiring moderate exercise. These
become more frequent and severe in the past year, but they can be
relieved by use of sublingual nitroglycerin. Which of the following cardiac
lesions is probably present?
a. rheumatic mitral stenosis
b. serous pericarditits
c. restrictive cardiomyopathy
d. calcific aortic stenosis
e. atherosclerotic narrowing of coronary arteries
155. a 12 yo male complained with a sore throat and fever. Throat culture
was positive for beta-hemolytic streptococcus. Two weeks later patient
developed a reddish rash. On examination the pediatrician noticed a
murmur of mitral regurgitation and roles over both of the lungs. which of
the following changes occurs in the heart found in microscopic
examination?
a. fibrosis of mitral valve with fusion of communisures
b. constrictive pericarditis
c. the endocardial surface is often thickened, particularly above the
posterior mitral leaflet
d. deposits of calcium and scanty inflammatory infiltrate in the
pericardium
e. pathognomonic lesion is the Aschoff bodies in the myocardium
156. a 30 yo male smoker presents with gangrene of his extrimities. Which
one of the following histologic findings from a biopsy of the blood vessel
supplying this area would be most common for this patient?

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a. granulomatous inflammation with giant cells
b. fibrinoid necrosis with overlying thrombosis
c. focal aneurysmal dilatation
d. fragmentation of neutrophils
e. thrombosis with microabceses
157. a 35 yo male who was a heavy smoker came to outpatient clinic
because of pain. Physical examination showed gangrenous ulcer in his left
finger, digiti II-IV. histopathological consistent with Buegers disease.
Which of the following histopathologic change is the most likely occur in
this patient?
a. microabcesses and thrombus in medium size and small arteries
b. microabcesses and thrombus in medium size and small veins
c. microabcesses and thrombus in large arteries
d. microabcesses and thrombus large veins
e. microabcesses and thrombus in capillaries
158. classical sign of Tetralogy of Fallot on chest X-ray
a. decreased pulmonary vascular markings, hypertrophy of right
ventricle
b. increased pulmonary vascular marking, hypertrophy of right
ventricle
c. decreased pulmonary vascular markings, hyperplasia of right
ventricle
d. normal pulmonary vascular markings, hyperplasia of left ventricle
e. increased pulmonary vascular markings, hypertrophy of left
ventricle
159. radiological appearances of left atrial enlargement on PA projection of
chest X-ray are:
a. double contour appearance, prominence of 1/3 inferior portion of
posterior aspect of the heart esophagus displaced to right
b. double contour appearance, prominence of 1/3 midportion of
posterior aspect of the heart, esophagus displaced to right
c. double contour appearance, prominence of 1/3 midportion of
posterior aspect of the heart displaced to left
d. double contour appearance, prominence of 1/3 superior portion
of posterior aspect of the heart, esophagus displaced to right
e. double contour appearance, prominence of 1/3 inferior portion of
posterior aspectof the heart, esophagus is not displaced
160. which one of the following statements is correct in the clinical
application of Myocardial Perfusion Imaging (MPI)?
a. MPI evaluates coronary arteries directly
b. MPI cannot separate high-risk from low-risk patients
c. MPI act as a gate-keeper for referral to angiography test
d. MPI has lower sensitivity compared to tread-mill test for CAD
e. coronary arteries can be visualized with MPI

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161. A 4 year old girl is cyanotoc and dyspnea, has oligaemia of
pulmonary vasculatures, lucency of both lungs, rounded apex and the size
of the heart is normal
Which of the following is the most likely diagnosis?
a. Trilogi of Fallot
b. Tetralogy of Fallot
c. Pulmonary stenosis
d. TAPVR
e. Pulmonary atresia

162. Which of the following examination accurately can detect left atrial
enlargement of the heart?
a. Magnetic Resonance Imaging
b. PA projection of chest X ray
c. Lateral projection of chest X ray
d. Oblique projection of chest X ray
e. Cardiac analysis of chest X ray

For question number 163 and 164, refer to scenario below :


Mrs. Brown, 45 years old man was found lying on the bathroom floor at
6:00 am, unawake, and was rushed to the hospital. Dr Greem examined
her vital signs and declared her dead. Her medical record showed that
Mrs. Brown suffered from hypertension for years. Her husband told Dr.
Green that last time she was seen alive wast at 12.00 am last night before
she was going to bed. Dr. Green has a doubt because he found two round
bruises on her neck, just below her left and right jaw
163. To make sure whether Mrs. Brown is dead or not, the doctor should
examine her pulse, respiration and :
a. Ventilation
b. Pupil reflex
c. Babinsky reflex
d. Electro Encephalogram
e. Peripheral nerve reflex

164. What do you think Dr. Green should do in this situation?


a. Ask the family to bring her home
b. Write a death certificate
c. Suggest an autopsy
d. Consult her family doctor
e. Ask the family what they want to do

For questions number 165 and 166, refer to scenario below :


Mrs. Brown, 45 years old man was found lying on the bathroom floor at
6:00 am, unawake, and was rushed to the hospital. Dr Greem examined
her vital signs and declared her dead. Her medical record showed that
Mrs. Brown suffered from hypertension for years. Her husband told Dr.
Green that last time she was seen alive wast at 12.00 am last night before

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she was going to bed. Dr. Green has a doubt because he found two round
bruises on her neck, just below her left and right jaw
165. What kind of objective examination the doctor has to do to estimate
the time of death?
a. Post morterm rigidity
b. The size of the pupils
c. Electro Encephalogram
d. The color of the bruises
e. Information from

166. What do you think about Mrs. Browns cause of death?


a. Heart attack
b. Heart insufficiency
c. Cannot be established yet
d. Rupture of Berry aneurysm
e. Intra cerebral haemorrhage

For questions number 167 and 168, refer to scenario below :


Mr. Smith, 45 years old, a truck driver, was suddenly dead minutes after
he felt down in the bathroom. The doctor found no significant sign of
massive bleeding. There was no history of severe illness of heart problem
before Mr. Smiths grandfather was dead because ruptured aneurysm at
the age 75. Many years ago Mr. Smiths sister was dead right after giving
birth to a baby without significant bleeding. The doctor considers Mr.
Smiths death was caused by ruptured aneurysm of pulmonary embolism.
167. The mechanism of death related with pulmonary embolism is :
a. Blockage of pulmonary artery by atherosclerosis
b. Airway obstruction in the bronchioles
c. Rupture of aneurysm of the aorta
d. Hypertension of the pulmonary artery
e. Rupture of thrombus on deep vein thrombosis

168. The mechanism of death in rupture of brain aneurysm is :


a. Trans tentorial herniation
b. Neurogenic shock
c. Cytoskeleton destruction
d. Hypovolemic shick
e. Bleeding from Willis circle

169. The type of aneurysm which can cause massive bleeding when
ruptured is :
a. Congenital aneurysm
b. Berry aneurysm
c. Charcot-Bouchard aneurysm
d. Aortic aneurysm
e. Atheromatous aneurysm

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170. The mechanism which causes the brain very sensitive to injury is :
a. Vascular auto-regulation
b. Ca2+ enters the neuron
c. Blood brain barrier
d. Thrombus formation
e. Free radicals production

For questions number 171 to 172, refer to scenario below:


During your shift in the hospitals Emergency Room, you received a
patient, Mr. Doe, 55 years old, brought by his daughter and son in law.
Your examination showed that Mr. Doe was already dead (Dead on Arrival).
His daughter, Ms. Milly told you that Mr. Doe was found lying on the floor
in his bedroom. Mr. Doe was in medication for his hypertension, prescribed
by his family doctor.
171. what should be the best thing to do afterwards?
A. Send Mr. Doe and family home
B. Report to the police for investigation
C. Consult the forensic doctor for autopsy
D. Write a death certificate to declare his death
E. Contact the family doctor for Mr. Does record

172. You can declare Mr. Doe dead when you found:
A. Cessarion of circulation
B. Cessation of brain cortex function
C. Stoppage of spontaneous breathing
D. Complete stoppage of circulation and respiration
E. Stoppage of circulation, respiration, and brainstem
For questions number 173 to 174, refer to scenario belpw:
A 22 year-old woman was suddenly dead minutes after she delivered her
first baby. Doctor checked on to find any sign of bleeding, but found
nothing significantly. During the delivery, her blood pressure was slightly
increased up to 150/100 mmHg. Nevertheless, her prenatal care record
showed that her blood pressure was normal and no history of
hypertension. Her aunt was also dead in the same kind situation. The
doctor suspected that she had ruptured aneurysm
173. Which of the following is the most appropriate mechanism that
closely related with this aneurysm?
A. Deep vein thrombosis
B. Catecholamine release
C. Cerebral vasodilatation
D. Thromboembolism
E. Varicose vein

174. What is the most common mechanism of death in above condition?


A. Brain infarction
B. Neurogenic shock
C. Irreversible shock

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D. Hypovolemic shock
E. Herniation of the brain

175. A 60-year old man was found lying on the floor at 7:00 am, unawake,
and rushed to the hospital. Dr. Green declared him Death on Arrival. His
wife told him that her husband was often suffered from chest pain within
the last two years. The last time he was seen alive was at 9:00 last night
while he was going to bed
When brain death of this patient is would be established?
A. The doctor saw flat EEG
B. Babinsky reflex was negative
C. Pupils reflex ceased irreversibly
D. Death of tissue at cellular levels
E. Vital sign apparently discontinue

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