1. You must remove fluid from the pleural cavity of 3.

While performing this procedure, the lower border of

your patient (thora- centesis). You decide to insert the lung will lie at the level of which
the aspiration needle over the top of a rib, into an rib in the MCL?
intercostal space inferior to the lower border of the A. Fifth
lung in the MAL at the end of a normal expiration. B. Sixth
Which of the following is the highest level at which
this procedure might safely be done without injuring C. Seventh
the lung D. Eighth
E. Ninth
A. Fourth intercostal space
B. Fifth intercostal space 4. A 30 years old man with history of heavy smoker.
C. Sixth intercostal space Which of the following respitarory mucosa structure
D. Seventh intercostal space
Observe the figure. There are differences in partial pressure of
gases in each compartment.

6. Why O2 partial pressure (PO2) in alveoli has a great

difference with PO2 in inspired air?
A. O2 is trapped in the dead space
B. O2 is absorped during passing the airway
C. O2 is absorped by the tissues
D. O2 is displaced by other gasses E. O2 react with
Carbon atom

7. Why PCO2 tends to increase from inspired air to venous blood?

A. To make balance with PO2
B. Metabolic process in the cells
C. Decreased Hb content in the blood
D. Hb is already saturated with CO2
E. Plasma is already saturated with O2

E. Eighth intercostal space will be damaged?

A. Simple squamous epithelium
2. While performing this thoracentesis procedure, the B. Stratified squamous epithelium
lowest level of the pleural cavity will lie at the C. Transitional epithelium
level of which rib at the end of expiration in the D. Simple columnar epithelium
MAL? E. Pseudostratified epithelium
A. Seventh
B. Eighth 5. While examining a pulmonary tissue section with a
C. Ninth microscope, you notice a small tube lined with
cuboidal epithelium, with a small sac at its wall.
D. Tenth Which of the following are you describing?
E. Eleventh A. Bronchus
B. Bronchiole
C. Terminal bronchiole
D. Respiratory bronchiole
E. Alveolar duct
E.PH2O is in equilibrium with surrounding H2O
pressure
8. Why is the water vapor partial pressure (PH 2O) in
most of the compartment 47
mmHg?
A. Metabolic process produce H2O
B.O2 and carbon atom react to produce H2O 9. A 11 year old boy brought to the emergency room
C.PO2 tend to decrease Siloam Hospital with chief complaint is that he
D.At 370C water vapor is saturated has been constantly coughing & having trouble
 breathing. These symptoms become progressively Which of the following drug is the most
more severe over past 3 days. Physical exam : appropriate for the patient conditions?
respiratory rate 32X/min, BP 120/80 mmHg, Heart A. Albuterol inhalation
rate 135X/min, Temperature 37.30 C. On B. Beclomethasone inhalation
auscultation: wheezes in bilateral chest area.
1
C. Cromolyn sodium inhalation 13. What will you do to establish the diagnosis?
D. Ipratropium inhalation A. Doing physical examination only
E. Salmeterol inhalation B. Doing physical examination and ordering chest
10. A 7 year old girl was diagnosed had a x-ray
mildmoderate persistent asthma. As a doctor C. Doing physical examination and ordering chest
you’ve consider to give her long term daily therapy x-ray and blood laboratory testing
with an inhaled D. Doing physical examination and ordering chest
Fluticasone + Salmeterol. However, her parents x-ray and sputum smear
insist on oral medication E. Doing physical examination and ordering chest
because it is uncomfortable for her. Which of the x-ray, blood laboratory testing, and sputum
following oral drug is the most appropriate smear
choice for the patient?
A. Atropine 14. What kind of microbiology examination which can
B. Dexamethasone be done for the patient above?
C. Ketotifen A. Sputum smear
D. Montelukast B. Sputum culture
E. Loratadine C. Blood culture
D. Sputum smear and sputum culture
11. Which of the following structures in the lung is likely E. Sputum smear, sputum culture, and blood
to be affected the most in a patient who culture
smoked a pack and a half of cigarettes per day for
25 years and developed centrilobular
emphysema? 15. What is the superiority of sputum smear in the
A. Alveolar sac management of TB?
B. Terminal bronchiole A. It is a widely known microbiology examination
C. Alveolar duct B. It is cheap and easy to be done
D. Respiratory bronchiole C. It is a gold standar examination
E. Capillary D. It is able to diagnose M.tuberculosis
E. It is able to know the resistance pattern of
12. A 50 year old male chain smokerpresent with a 4 M.tuberculosis toward anti tuberculosis drugs
month history of cough and
loss of weight.A radiograph of the chest show s a A 65-year-old female patient has been in the hospital for
solid mass around 3 cm 1 week. She is known for having hypertension and is
,left upper lobe lung mass. Which of the following hospitalized after falling in the bathroom and
pathologic changes is most likely to be found in experiencing left extremities paralysis. On the 6th day in
his lung? the hospital she complains of having cough with
A. Compression atelectases excessive white-yellowish sputum. She also has fever.
B. Obstructive emphysematous
C. Restrictive emphysematous 16. What microbiology examination should be done on
D. Contraction atelectasis the patient?
E. Centrilobular emphysema A. Sputum smear
B. Sputum culture
A 30-year-old male employee in a factory in Tangerang C. Blood culture
come to the public health clinic with cough since 2 D. Sputum smear and sputum culture
weeks ago. He also complains about havingweight loss E. Sputum smear, sputum culture, and blood
and night sweat while sleeping. culture

2
17. This kind of microorganism is the most often cause and worsen for 1 week. She admits that the symptoms
of lower respiration tract infection could not diminish totally and she always suffering
for patients in the hospital: recurrent lower respiratory tract infection over many
A. Mycoplasma months. Chest X ray showed tram tracks and multiple
B. Streptococcus pneumonia ring shadow.
C. Staphylococcus epidermidis
D. Adenovirus 21. Which part of the airway may involved ?
E. RSV A. Carina
B. Main bronchus
18. Microbial pattern of the infectious agents which C. Bronchiolus terminalis
cause lower respiration tract infection in the D. Alveolus
hospitalized patients is different with the pattern in E. Trachea
the community. Which of the following statements
has correlation with the statement above? 22. What is the definite test to establish the
A. Nutritional status of hospitalized patients are diagnosis?
not as good as patients in the community, A. Sputum examination
therefore the patterns are also different.
B. Chest X ray
B. The microorganisms in the hospital setting
usually come from the environment and are C. MRI lung
multi resistant to antibiotics D. CT lung scan
C. Microorganisms which cause lower respiratory E. Spirometry
tract infection in community are still sensitive to
antibiotics
D. The above statement is wrong because Dr Alvin performed spirometry and the result was FEV1
principally the microbial pattern in hospital and 1340 ml, FVC 2250 ml. Prediction value FVC 2398 ml,
in community are the same and prediction value FEV1 1918 ml.
E. The above statement is wrong because
principally microbial pattern is always 23. What is the result of spirometry test?
determined by the disease pattern, not by the A. No restriction, mild obstruction B. No
setting where the patient is being taken care restriction, moderate obstruction
C. Mild restriction, severe obstruction
D. Mild restriction, mild obstruction
A 22-year-old woman works as a secretary in a big E. Moderate restriction, moderate
company. She comes to a clinic with fever since 2 days obstruction
ago. She says that her 5 friends in the same room with
her are also having the same disease.
Mrs Jessy came to your clinic with the chief complain
chronic productive cough for 3 months during 2
19. What possible infection can cause the disease?
consecutive years. From anamnesis and examination,
A. Psittacossis lung tuberculosis, lung carcinoma, bronchiectasis and
B. Specific pneumonia cystic fibrosis have been excluded. From the chest X
C. Tuberculosis ray, you found it clear.
D. Histoplasmosis
E. Legionellosis 24. What might be the morphologic changes in the
airway?
20. How is the route for the above disease? A. Normal ciliated epithelium
A. The patients were exposed to bird with B. Lymphocytes are prominent
infectious agent C. Airway smooth muscle is decreased
B. The patients were in contact with TB patient D. Alveolar attachment is increased
C. The cooling tower system in the building is E. Eosinop hils are decreas
contaminated with infectious agent ed
D. The patients breathe in the infectious agent
which comes from the gastrointestinal tract 25. What is the major source of mucus in sputum?
E. The patients breathe in the dust which contain A. Goblet cells
infectious agent on their way to the office B. Epithelium cells
C. Inflammatory cells
D. Type 1 alveolar cells E. Type 2 alveolar
Mrs Kim, 56 years old, height 160 cm came to
cells
emergency department with chief complain shortness of
breath and productive sputum since a long time ago
3
26. What is the most likely etiology of this kind of
disease?
A. Air pollutant
B. Abnormal host defense
C. Abnormal smooth muscle
D. Genetic
E. Infection
As a doctor, you suggest Mrs Jessy perform pulmonary
rehabilitation and controlled breathing techniques (
pursed lip breathing ) is one of the choice.
27.Why is this kind of rehabilitation suggested to her?
-Increase the abdominal pressure
-Placing the diaphragm in a better position
-Reduced respiratory rate
-Increased FEV1
-Enhanced inspiratory tidal volume
A 67 years old man, has noted worsening cough and
shortness of breath since 5 days ago. He had
productive cough with yellowish-green sputum. He
denies fever and chest pain. When he reached
emergency department, he looked cyanotic. Chest
examination reveals distributed wheezing and coarse
crackles. He worked at wood company for 25 years.
28. What is the most important inflammation cell which?
A. Eosinophils B. Mast cells
C. Neutrophils
D. CD4 T cells
E. Basophils
29. Why this kind of disease causing shortness of
breath?
A. due to diffusion disorder
B. due to perfusion disorder
C. due to the huge of anatomic dead
space
D. due to mismatching of ventilation
perfusion
E. due to imbalance ventilation diffusion
Doctor performed chest X ray for this patient, and the
result showed flattened diaphragm and hyperlucency of
the lung.
30. What is the result of lung volumes measurement?
A. Increased Expiratory Reserve Volume
B. Increased Inspiratory Reserve Volume
C. Increased Inspiratory Capacity
D. Increased Vital Capacity
E. Increased Functional Residual
Capacity
After a few days, the general condition of this patient
getting better and the spirometry was performed.
31 .What is the spirogram might show? A
Decreased Functional Residual
Capacity
B. Decreased Forced Expiration Volume 1
second
C. Increased ratio FEV1/FVC
D. Normal Total Lung Capacity
E. Normal Forced Vital Capacity
Young man, 25 year old complaint that he had coughing
for 3 months, productive sputum and shortness of
breath. He feels weakness From the physical
examination, dr Yani found that the face is edema as
well as the upper extremity. There was venous
distension of the neck and chest wall.
32. What is the vascular that could be obstructed?
A. Hemiazygos Vein
B. Azygos Vein
C. Superior Vena Cava
D. Pulmonary Vein
E. Jugular vein
The results of anatomy pathology showed lymphocyte
rich and there is invasion into capsul. No evidence for
distance metastasis
33. What is the most recommended management for
this patient?
A. Total excision
B. Partial excision
C. Incomplete excision
D. Simple biopsy
E. Fine needle aspiration biopsy
34. Where might be the location of the disease
according to the chest x ray?
A. Superior thoracic opening to the plane
for the sternal angle to the
disc of T4-T5
B. Superior thoracic opening to the
behind of pericardium
C. Upper portion to the in front of
pericardium
D. Upper portion including the
pericardium and its contents
E. Superior thoracic opening to the
pericardium
A 37-year-old male has been hospitalized for 2 days
after being involved in a motor vehicle accident where
he sustained multiple severe injuries, including rib
fractures. He is developing progressive shortness of
breath, and is being maintained on 100% oxygen. He
has no previous medical history or any known lung and
4
heart abnormalities. His family history is not significant.
He does not smoke, drink alcohol, or use any illicit
drugs. A chest x-ray shows diffuse bilateral pulmonary
infiltrates.
35. Which among the following is the most useful
strategy to decrease mortality ?
A. Administration of surfactant
B. Intravenous methyl prednisone
C. Inhaled nitric oxide (NO)
D. Intravenous prostacyclins
E. Mechanical ventilation
36. Which is the high flow of giving oxygen in hospital:
A. Venturi mask
B. Nonrebreathing mask
C. Rebreathing mask
D. Simple mask
E. Nasal cannula
37. Why does the supplemental oxygen causing
hypoventilation?
A. Decreased dead space
B. Decreased pulmonary perfusion
C. Suppression of the hypoxic drive
D. Irritation of nasal mucosa
E. Fatigue of diaphragmatic muscles
A 25-year-old man comes to the emergency
department with complaints of a sudden onset of
shortness of breath. He had history of asthma. On
physical examination, his temperature is 37.2°C
(99F), blood pressure is 142/64 mmHg, heart rate is
110/min, and respiratory rate is 28/min. His oxygen
saturation is 90 % on room air. His lung examination
reveals equal, bilateral air entry with diffuse wheezing
throughout both lung fields. His cardiovascular
examination is unremarkable except for the presence of
sinus tachycardia. His peak expiratory flow rate is 60%
of his personal best, based on his prior admissions.
38. Which of the following is the most appropriate next
step in the management of this patient?
A Routine high dose oral steroids. B
Intravenous corticosteroids. C Aggressive
inhaled β-2 adrenergic agonist D
Intravenous bolus theophylline.
E Intravenous magnesium sulphate
After the treatment, he is now markedly diaphoretic and
has visible suprasternal retractions. He appears
exhausted, confused, and drowsy. His vital signs
reveal a temperature of 37.2C (99F), blood pressure of
90/60 mmHg, heart rate of 106/min, and respiratory rate
of 10/min. The result of BGA : pH 7,25 pCO2 60 ;
pO2 40 ; HCO3 28; BE + 3. Saturation O2 78%.
39. Which of the following is the most appropriate next
step in the management
of this patient?
A Aggressive inhaled beta-2 agonists. B
Intravenous corticosteroids. C Intravenous
theophylline
D Intravenous magnesium sulphate.
E Endotracheal intubation
40. Mr Jono, a heavy smoker complaint that he got
hemoptysis in the morning.
He loose his weight around 5 kg within 1 month
because of lack of appetite.
The result of sputum examination showed that acid
fast bacilli was found. As the doctor, you suggest to
perform chest X ray. What might the result of it?
A Consolidation process on lung parenchyma
B The process could be sharp in margin
C Pleural thickness
D Cavity
E Calcific spread on lung parenchyma
A 12-year old girl has a history of recurrent upper and
lower respiratory infections that began at 3-years of age.
Physical examination reveals a transverse nasal crease;
pale, boggy, grayish-pink nasal mucosa; and infraorbital
edema with dark pigmentation beneath the eyes. The
girl’s respiratory rate is increase, and she is
barrelchested. Expiratory wheezes are noted in all lung
fields. A posteroanterior chest x-ray reveals radiolucency
of the lungs, widening of the intercostals spaces, and
flattening of the diaphragm.
41.Which test result would be expected in this patient?
A. Abnormal sweat chloride test
B. Low C3 complement level
C. Abnormal test of SGOT/SGPT
D. Increase serum immunoglobulin E
(IgE) levels
E. Sputum with gram-positive diplococci
A 30 year-old Male, weighed 50 Kg with height 170 cm,
a heavy smoker and a saxophone player, came to your
office with chest pain. The pain was being felt suddenly
and he also said that he had shortness of breath
afterwards. During the episode, the patient was not doing
any kind of physical activity. Vital signs BP 130/70
mmHg, Pulse 100 x/m, RR 24 x/m. The patient was
gasping for air.
42. What was the most probable diagnosis? A.
Simple pneumothorax.
B. Bronchitis.
C. Acute Respiratory Distress Syndrome.
D. Bronchopleural fistula.
E. Acute Pneumonia.
5
43. What result would you probably get in
physical examination? 47. If the blood of coughing is getting more than
A. Narrowing of intercostal space. 600 cc and Hb< 10 gr% which the blood is
B. Diminished lung sounds. still there, what is the
C. Bronchial lung sounds. procedure do you need to perform
D. Pleural friction rubs. immediately ?
E. Dullness on percussion. A.. Chest X-ray
B.. Bronchoschopy
A 50 year-old Male came to the emergency department, C. Anticoagulan drugs
after having a motorcycle accident 1 hour ago. The D. Lobectomy
patient was riding a motorcycle to his office and then a E. Anti-TB medicine
car struck him from the side. The accident was so severe
thus he was thrown out 7 meters away. The patient got 48. What is the correct dose of the tuberculin-test?
multiple traumas. In triage, primary survey, you find the A. 0,1 cc PPD-5TU intramuscular
patient is having difficulty on breathing. Vital signs : BP B. 0,1 cc PPD-5TU intracutan
100/60 mmHg, P 110 x/m, R 30 x/m. Physical C. 0,1 cc PPD-5TU subcutan
examination shows diminished thoracic movement, D. 0,5 cc PPD-5TU subcutan
widening of intercostal space, hypersonor on percussion,
E. 0,5 cc PPD-5TU intracutan
diminished lung sounds on his left side.

44. What are you going to do to the A 56 year-old man has a complain of breathless and
patient? A. Give 100% oxygen. coughing with a bloody-phlegm since 10 days ago, there
B. Give Ringer Lactate 1000 ml in 30 also decreasing of the body weight 15 kg in the last 2
minutes. month. He is a smoker since 20 years old, 2 boxes of
C. Place an unsealed drainage. cigarette a day, he feels very weak. On physical
D. Do needle decompression. examination, he is conscious, blood pressure is 160/80
E. Do nothing and continue primary mmHg, pulse rate is 80 x/min reguler, Respiratory rate
40 x/min, temperature is 370 C. On chest examination
survey.
there is dull on percussion, vesicular breath sounds
decrease and crackles in the lower lobe of the right lung.
A 35-year-old man comes to emergency room with Labs finding: Hb : 10 gr%, WBC: 9.800
complain of coughing with blood about ¼ cup of glass
since 6 hours before admitted. Reducing 2 kg of body
weight in 1 month, breathless, left chest pain. On 49. Which of the following is the most appropriate for
physical examination, he is conscious, blood pressure working diagnosis ?
is 115/75 mmHg, pulse rate is 89 x/min, regular A. Tuberculosis
temperature is 370 C. The conjunctiva looked pale. On B. Bronchiectasis
chest examination there is sonor on percussion, C. Fungal infection
bronchovesicular breath sounds and crackles at the D. Lung tumor
apex of the right lung. On chest x-ray fibroinfiltrate are E. Asthma bronchial
found on the apex and middle lobes of the right lung.
Laboratories finding : Hb: 10,3 gr%, WBC: 10.400, 50. What is the initial treatment for helping this patient ?
ESR: 55. A. Oxygen
B. Anti fungal
45. What is the definitive examination to establish
C. Antibiotic
the diagnosis?
D. Anti TB
A. Bronchoscopy
E. Bronchodilator
B. CT-Scan Thorax
C. Spirometry
D. Mantoux test 51. What is the most of possible etiology of the
E. Sputum culture of AFB disease?
a. Mycobacteria tuberculosis
b. Candida albicans
46. What is the most diagnosis?
c. Genetic
A. Bronchitis chronic
d. Streptococcus pneumonie
B. Community acquired Pneumonia
e. Hypersensitivity reaction
C. Interstitial lung disease
D. Lung TB
E. Lung cancer

6
A 25 year-old man with cough and breathless. It was
getting worse when he inhales smoke. He often has
sleep disturbance at early in the morning (twice a
week). There is also an allergy of sea food, dust, and
some of antibiotics. On physical examination, the
patient is conscious, blood pressure is 120/80 mmHg,
pulse rate is 124 x/min regular, temperature is 36,80 C.
There is normal chest examination except diffuse
wheezing.
The doctor performed spirometry.
52. Which of the following result is the most
expected from spirometry?
A. FVC decreased
B. MVV decreased
C. FEV1 decreased
D. Residual capacity decreased
E. Inspiratory capacity decreased
53. Which of the following is the most lung
function parameter to check the
obstruction of the air way?
A. Force Ekspiration Volume first second
(FEV1)
B. Force Vital Capacity (FVC)
C. FEV1/FVC
D. Ekspiration Peak Flow
E. MVV
Male, 57 years old came to emergency department with
svere breathless. From the history taking, the doctor
found that COPD was the history of the past illness.
Ten days ago he experienced hemoptysis and chest X
ray showed fungus ball.
54. What is the most likely diagnosis?
A. ABPA
B. Aspergiloma
C. Asthma
D. Invasive candidiasis
E. Tuberculosis
Male, 35 years old was admitted because of fever and
tired for several weeks. Bone marrow biopsy was
performed and the culture showed yeast colonization (
temperature 37°C ) and on the temperature 25°C
filament colonization growth. HIV was positive and CD4
50/ul ( Normal 1000-1500/ul )
55. What is the most likely etiology?
A. Aspergillus fumigatus
B. Cryptococcus neoformans
C. Histoplasma capsulatum
D. Mucor sp
E. Coccidioides immites
Male, 30 years old admitted chief complaint high fever,
breathless and look cyanotic. Laboratorium result
showed that CD4 was very low, ESR 40 mm3/hour and
from the bronchoalveolar lavage there was thick wall
cyst with diameter 5-7 micron
56. What is the working diagnosis of this
patient?
A. Tropical pulmonary eosinophilia
B. Loeffler syndrome
C. Aspergillosis
D. Pneumocystis jiroveci
E. Histoplasmosis
57. What is the treatment of this case?
A. Amphotericin B
B. Voriconazole
C. Sulfamethoxazole-trimethoprim
D. Itraconazole
E. Metronidazole
A 4-month old boy presents to the Puskesmas at
with the complaint of whooping cough with and
fever for 7 days. The child was not immunized yet.
The mother said that 1 week ago there is a child
with same symptoms came to their house.
58. What is the most likely proper to this situation ?
A. Bronchiolitis
B. Pertusis
C. Bronkopneumonia
D. Asthma attack
E. Bronchitis
A 4-year old boy with difficulty in eating and
catching up the body weight come to Puskesmas.
The child has completed the government
immunization program. You mentioned the child as
mild malnourished child. There is history that the
father had bloody sputum cough in his house and
now was treated. Enlargement colli lump was
found. You checked the lab and the results show
Hb 10 g/dL, Leucocytes 8.000/uL, Ht 38 vol%,
trombocytes 315.000 /uL. ESR 35 mm/hour. You
also do the x- ray that there was hillus
lymphadenopathy.
59. How long you have to treat this patient ?
A. 6 months
B. 9 months
C. 12 months D. 18 months
E. 24 months
A 25-year-old male is bought to the emergency
department due to shortness of breath. He had traffic
7
accident 1 hour ago and his chest hit into the steer. He
is conscious, BP 120/70 mmHg, HR 110x/mnt, RR 60. What is the cause of his shortness of breath?
32x/mnt, and temp 36,5oC. From physical examination:
right chest movement on inspiration decrease, tactile a. Airway remodeling
fremitus demonstrastes decrease vibration on the right, b. Bronchoconstriction
percussion is hyperresonant on the right side, and from
c. Loss of pressure gradient
the auscultation reveals no breath sound on the right.
Fingers look cyanotic. d. Airway obstruction
e. Bronchospasm

1. A 50-year-old male chain-smoker presents with a a. Compression atelectases

4 month history of cough and loss of weight. A b. Obstructive emphysematous
chest x-ray shows a 3 cm solid mass, left upper c. Restrictive emphysematous
lobe lung mass. Which of the following d. Contraction atelectasis
pathologic changes is most likely to be found in e. Centrilobular emphysema
his lung?

8
2. A 67-year-old man has noted worsening cough e. Mechanical ventilation
and shortness of breath since 5 days ago. He
has productive cough with yellowish-green 1) 67. A 30 year old man. High fever, breathless,
sputum. He denies fever and chest pain. When cyanotic, CD4 very low, ESR 40mm/hour. Pada
he reached emergency department, he looked BAL thick wall cyst diameter 5-7 micron. a.
cyanotic. Chest examination reveals distributed amphotericin B
wheezing and coarse crackles. He worked at
wood company for 25 years. Why this kind of b. voriconazole
disease causing shortness of breaths? c. sulfatemetroxazole-trimethoprim
a. due to diffusion disorder d. itraconazole
b. due to perfusion disorder e. metronidazole
c. due to the huge of anatomic dead
space 21. A 15 year old teenager has sudden shortness of
d. due to mismatching of ventilation breath. 48 kg, 175 cm. No prior lung problems. SaO2 =
perfusion 89 %. What is the most possible pathophysiology? a.
e. due to imbalance ventilation diffusion allergic reaction
b. rupture of the bleb
3. A 25-year-old man comes to the emergency c. bronchus hyperactivity
department with complaints of a sudden onset d. emotional stress
of shortness of breath. He had history of e. vascular impairment
asthma. On physical examination, his
temperature is 37.2°C (99F), blood pressure is 15. A 23 year old female is a pulmonary TB patient who
142/64 mmHg, heart rate is 110/min, and underwent TB treatment for 2 weeks. During that period,
respiratory rate is 28/min. His oxygen she did not take her medication for 1 week. Now she has
saturation is 90 % on room air. His lung to continue her treatment again. What regimen ? a.
examination reveals equal, bilateral air entry 2RHZE / 4RH
with diffuse wheezing throughout both lung b. 2 RHZES / 4 RHE
fields. His cardiovascular examination is c. 2 RHZE / 4 RHE
unremarkable except for the presence of sinus d. 2 EZS / 4 R3
tachycardia. His peak expiratory flow rate is e. 2 HEZ / 4 R3
60% of his personal best, based on his prior
admissions. Which of the following is the most 35. Crackles on the 7th linea paravertebralis dextra.
appropriate next step in the management of Perform X-ray. What is the location should pay attention ?
this patient? a. apex
a. Routine high dose oral steroids. b. hilus
b. Intravenous corticosteroids. c. aorta
c. Aggressive inhaled β-2 adrenergic d. costophrenicus
agonist
e. cardiophrenicus
d. Intravenous bolus theophylline
e. Intravenous magnesium sulphate 3. A 70 year old male, heavy smoker >20 years.
Diagnosed by lung cancer. Which lymph node is the
4. A 37-year-old male has been hospitalized for 2 most possible site of metastase of lung cancer ? a.
days after being involved in a motor vehicle Tracheobronchial nodes
accident where he sustained multiple severe b. Bronchomediastinal trunks
injuries, including rib fractures. He is c. Para sterna nodes
developing progressive shortness of breath, and d. Branchiocephalic nodes
is being maintained on 100% oxygen. He has
e. Right mediastinal nodes
no previous medical history or any known lung
and heart abnormalities. His family history is
4. When the esophagus transit the diaphragm, it has trouble
not significant. He does not smoke, drink
in the level of thoracal 10. Which of the following structures
alcohol, or use any illicit drugs. A chest x-ray
is influenced in this level ?
shows diffuse bilateral pulmonary infiltrates.
a. Azygos vein
Which among the following is the most useful
strategy to decrease mortality? b. Hemiazygos vein
a. Administration of surfactant c. Vagus nerve (inget esophagus – vagus)
b. Intravenous methyl prednisone d. Greater splanchnic nerve
c. Inhaled nitric oxide (NO) e. Thoracic duct
d. Intravenous prostacyclins

9
9. In a patient with pneumothorax, what finding would
you expect with auscultation of the thorax on the 19. (dari no 18) Bakteri apa yang kena?
affected side ? a. Wheezes a. Influenza virus
b. Rhonchi b. Rhinovirus
c. Absent breath sound c. Mycoplasma pneumonia
d. Crackles d. Necolyzing fungal infection (abses)
e. Amphoric sound
20. Tesnya apa?
10. While examining a tissue from the lungs, you a. bronchoscopy
notice a “tube” lined by respiratory epithelium, b. mantoux test
surrounded by several pieces of hyaline cartilage. c. CT scan
Which of the following parts of the airways are you d. X-Ray ( berawan)
examining ? a. Trachea (bentuk C)
Emfisema = alveoulus colaps pecah (udara item)
b. Bronchus (hyaline cartilage)
Empiema : isinya pus
c. Bronchioles terminalis
Atelektasis: mengecil
d. Bronchioles
Pneumotoraks : kecil ke samping
e. Bronchioles respiratorius
GOLF BALL n Coin lesion: cancer paru
13. A 56 years old male, come with shortness of breath,
21. A 15 year old teenager has sudden shortness of
cyanotic. The doctor finds edema on both lower
breath. 48 kg, 175 cm. No prior lung problems. SaO2 =
extremities. In USG finds fluids in the pericardium
89 %. What is the most possible pathophysiology? a.
space.
allergic reaction
The patient no prior history.
b. rupture of the bleb (clement tinggi = pneumotoraks)
a. FVC increase
c. bronchus hyperactivity
b. FVD decrease
d. emotional stress
c. FEV1 decrease (force expiratory volum 1 secon)
e. vascular impairment
d. FEV1 increase
e. FEV1 / FVC decrease (force vital capacity)
22. A 24 year old girl come to emergency because
shortness of breath. 1 month ago been admitted with the
14. A 36 years old female, tinggi 158cm, berat 35kg. same symptoms. She and her mother have runny nose in
AFB (acid fast bacilus) positive for 3 times test. the morning. What is the inflammatory cell? a. neutrophil
Tuberculin = 4mm. (0-5 : negatif 6-9 rambu2, >9 positif, b. lymphocyte
>15: positif n infektif) c. eosinophil (alergi)
a. secondary infection d. basophil
b. immunocompromised (diagnosis TB, 4 cm) e. monocyte
c. allergic reaction
d. chronic disease 29. Berdasarkan kasus dia atas. Apa gambaran
e. hypersensitivity radiology yang terlihat?
a. cardiomegaly
15. A 23 year old female is a pulmonary TB patient who b. pleural thickening
underwent TB treatment for 2 weeks. During that period, c. diafragma mendatar
she did not take her medication for 1 week. Now she
has to continue her treatment again. What regimen ?
30. Hasil lab apa yang akan meningkat?
Kalo < 1 bulan = kasus baru, a. 2RHZE / 4RH
a. Hemoglobin (o2 turun, hemoglobin turun)
b. 2 RHZES / 4 RHE
b. ALT
c. 2 RHZE / 4 RHE COPDpolicitemiaviskositas
c. Ureum
d. 2 EZS / 4 R3 naik Hipertension
d. Creatinin
e. 2 HEZ / 4 R3
e. Bilirubin
Policitopenia hb dikeluarin bnyk
16. A cured TB came to policlinic. She was declared krna hipoxia
33. On USG, reveal liver nodul.
cured a year ago. Now she is AFB positive. Regimen ?
a. 2RHZE / 4RH a. embolization (pembuluh darah dimampetin untuk
hepatocelular carcinoma)
b. 2 RHZES / 4 RHE (gagal obat, kambuh, berenti obat
b. laser
> 2bulan)
c. surgery
c. 2 RHZE / 4 RHE
d. radiotherapy
d. 2 EZS / 4 R3
e. best supportive care
e. 2 HEZ / 4 R3

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34. Patient in ICU, after orthopedic surgery. Shortness 41. Which of the following is the most appropriate clinical
of breath, hemoptysis, acute sharp knfe chest pain on specimen to find the causative organism?
the right lung. ECG normal. X-ray westermark sign . a. blood
What kind of blood test ? = pulmo emboli (blockage b. sputum
arteri of lung) khas pulmonary embolism c. throat swab
a. Troponin T d. skin wrapping
b. High sensitivity CRP e. wound swab
c. D dimmer (adanya blood cloting)
D. CKMB 42. A 30 year old man, hemoptysis, dyspneu, subfebrile.
e. procalcitonin Dari foto thorax  clouded and a cavity in the right lung.
He is smoker, acid fast smear found positive sputum.
35. Crackles on the 7th linea paravertebralis dextra. PPD negative (mantux). What virulence cause the
Perform X-ray. What is the location should pay attention pathogenesis?
? a. exotoxin
a. apex (atas) b. nuclei
b. hilus…. c. cord factor
c. aorta d. flagellia
d. costophrenicus e. endotoxin
e. cardiophrenicus
53. Chest X-Ray show unclear on the apex area. What is
36. A 47 year old man, cough, weakness 6 months, the position next ? a. AP
getting worse 1 month. Works in coal mine 5 years. b. PA
Xray show coars illustration round opacity. PO 2 <80 c. right lateral
mmHg. Hb = 13. d. left lateral
a. silicosis (tekstil) : silica e. top lordotic….(untuk liat apex)
b. pneumoconiosis
c. asbestosis : asbes 54. A 70 years old male enter the emergency
d. sarcoidosis : berilium department and trauma thorax. Crepitation on the right
e. berryliosis : berilium side. Expect on X-ray?
a. costa fracture
39. pH = 7,35 (normal : 7.25-7.45), PaCO2 = 60 mmHg b. pleural effusion
(35-45)naek, HCO3 = 30 mEq/Lnaek, BE = +3 (base c. flattening diaphragm
excess naek n: -2-+2), Sp O2 = 95%. Which acid base d. cavity
imbalance? e. soliter nodule
a. uncompensated respiratory acidosis
b. compensated respiratory acidosis (normal lg 55. While you accept the Chest X-ray from your patient, you
valuenya found radioopacities with the Ellis D’maiseau (deket
sdh dikompensasi, misalnya basanya) compensasi dr diafragma) in the left side of the lung. What is the most
HCO3 likely the diagnosis?
c. uncompensated metabolic acidosis a. pneumomediastinum
d. compensated metabolic acidosis b. pleural effusion (cairan di pleura)
e. compensated respiratory and metabolic acidosis c. CAP
d. atelectasis
40. A 34 years old woman, cough 6 weeks and lost e. pulmonary thromboembolism
weight 5 kg. Night sweats and subjective fever and felt
fatigue. Coughing blood-tinged sputum. On PE, 56. A 6 year old child come to your private clinic with
abnormal bronchial breath sound. Chest X-ray : a small lethargy (lemas), failure to thrive (tumbuh), lost appetite
cavity in right upper lobe & calcified lung lesion in and sweating while sleep. You perform chest X-ray to
lymph node. Penularan? support diagnosis. What area in the lung would be
a. IV drug use affected ?
b. contact with dirty linens a. costophrenicus sinus
c. exposure to airbone organism b. apex (dewasa)
d. vector transmission c. hilus (anak-anak)
e. open wound transmission d. diaphragm
e. paracardial

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67. A 30 year old man. High fever, breathless,
cyanotic, CD4 very low, ESR 40mm/hour. Pada BAL
thick wall cyst diameter 5-7 micron. = pceumococus
zerovici
a. amphotericin B
b. voriconazole
c. sulfatemetroxazole-trimethoprim (parasit)
d. itraconazole
e. metronidazole
68. A 38 years old female smoker, right chest pain
several months, 6 months before kambuh, but no
treatment. X-ray 2 weeks later = normal. Akut
dyspnea at second day menstruation (katamenial
men’s di paru,paru berdarah). CT scan show
abnormality. a. chest tube
b. corticostreroid
c. antibiotic
d. hormone therapy
e. chemotherapy
69. A 35 year old male, progressive shortness of
breath in 2 days. Non-productive cough for 2 weeks,
low grade fever and night sweats. He lost body weight
about 14 kg this few months. He has been smoking 2
packs per days since high school. Chest X-Ray shows
pulmonary infiltrates. His CD4+ count is 80 cells/mm3 .
What is the hypothesis?
a. metastatic lung cancer
b. friendlander’s pneumonia (klebsiela)
c. pneumocystic pneumonia (CD4 and fever)
d. aspergillosis
e. sarcoidosis
70. A patient is 40 years old. He complained of coughing
for 2 weeks, and he sometimes found blood in the
mucus. He took OTC but didn’t help. He has lost weight
and experienced night sweating. The doctor diagnosed
him with lung infection, and asked to take SPS sputum
for 2 consecutive days. What is the direct examination
that the doctor asked for?
a. gram staining
b. giemza staining
c. papanicolau staining
d. Ziehl-nielsen staining (ijo n biru pewarnaan TBC)
e. KOH staining
COPD NAMA LAENNYA chronic BRONKITIS, emfisema
ada mucus
73. What is the pathophysiology of shortness of
breath according to the case above?
a. laminar airflow
b. turbulence airflow
c. linear activity
d. circular airflow
e. concurrent airflow
74. 4 months old boy : whooping cough, fever for 2 days,
belum imunisasi. 1 weeks ago there’s a child with the same
symptoms came to their house.
a. bronchitis
b. pertusis (WHOOPING COUGH)
c. bronchopneumonia
d. asthma attack
e. bronchitis
75. A 4-year old boy with difficulty in eating and catching up
the body weight come to Puskesmas. The child has
completed the government immunization program. You
mentioned the child as mild malnourished child. There is
history that the father had bloody sputum cough in his house
and now was treated. Enlargement colli lump was found. You
checked the lab and the results show Hb 10 g/dL, Leucocytes
8000/uL, Ht 38 vol%, Trombocytes 315000/uL. ESR 35
mm/hour. You also do the x-ray that there was hillus
lymphadenopathy. How long you have to treat this patient?
A. 6 months
B. 9 months
C. 12 months
D. 18 months
E. 24 months
44. A 50-year-old male chain-smoker presents with a
4 month history of cough and loss of weight. A chest
x-ray shows a 3 cm solid mass, left upper lobe lung
mass. Which of the following pathologic changes is
most likely to be found in his lung?
A. Compression atelectases
B. Obstructive emphysematous
C. Restrictive emphysematous
D. Contraction atelectasis
E. Centrilobular emphysema
45. A 67-year-old man has noted worsening cough and
shortness of breath since 5 days ago. He has
productive cough with yellowish-green sputum. He
denies fever and chest pain. When he reached
emergency department, he looked cyanotic. Chest
examination reveals distributed wheezing and
coarse crackles. He worked at wood company for 25
years. Why this kind of disease causing shortness of
breaths?
A. due to diffusion disorder
B. due to perfusion disorder
C. due to the huge of anatomic dead space
D. due to mismatching of ventilation perfusion
E. due to imbalance ventilation diffusion
46. A 25-year-old man comes to the emergency
department with complaints of a sudden onset of
shortness of breath. He had history of asthma. On
physical examination, his temperature is 37.2°C
(99F), blood pressure is 142/64 mmHg, heart rate is
110/min, and respiratory rate is 28/min. His oxygen
saturation is 90 % on room air. His lung
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 examination reveals equal, bilateral air entry
with diffuse wheezing throughout both lung
fields. His cardiovascular examination is
unremarkable except for the presence of sinus
tachycardia. His peak expiratory flow rate is
60% of his personal best, based on his prior
admissions. Which of the following is the most
appropriate next step in the management of this
patient? (kan lgi serangan asma)
A. Routine high dose oral steroids.
B. Intravenous corticosteroids.
C. Aggressive inhaled β-2 adrenergic
agonist
D. Intravenous bolus theophylline
E. Intravenous magnesium sulphate

47. A 37-year-old male has been hospitalized for 2

days after being involved in a motor vehicle
accident where he sustained multiple severe
injuries, including rib fractures. He is developing
progressive shortness of breath, and is being
maintained on 100% oxygen. He has no
previous medical history or any known lung and
heart abnormalities. His family history is not
significant. He does not smoke, drink alcohol,
or use any illicit drugs. A chest x-ray shows
diffuse bilateral pulmonary infiltrates. Which
among the following is the most useful strategy
to decrease mortality?
A. Administration of surfactant
B. Intravenous methyl prednisone
C. Inhaled nitric oxide (NO)
D. Intravenous prostacyclins
E. Mechanical ventilation

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