HEMATO-ONCO

1. Wanita 36 y.o. difficult to think for 7 month. Prolonged mens for 3 months, no family history, no
bleeding, no other symptoms. Hb 6.5, MCV 60, MCH 24, RBC 5.15, TIBC 550.
A. Hemoglobinopathy
B. Folic acid deficiency
C. Iron deficiency
D. Bleeding
E. Anemia of chronic disease

* MCV dia rendah berarti mikrositik. TiBC normalnya 250-450, brarti dia naik. Berarti besi kurang. Hapalin
ini baik-baik!!!

Anemia

Makrositik Normositik Mikrositik

Non
Megaloblastik Hemolitik Non Hemolitik Thalasemia Alpha
Megaloblastik

Folic Acid
Defesiensi
Alcohol Disease Ekstravaskuler Intravaskuler Aplastik Anemia Thalasemia Beta

Sianokobalamin Mikroangiopathic
Liver Disease HbC Disease IDA ( Early) IDA ( Late )
Defisiensi Anemia

Paroxymal
Diamond Blackfan Makroangiopathic
Orotic Aciduria Nocturnal Anemia On Kronik Keracunan Timbal
Syndroma Anemia
Hemoglobinuria

AIHA Warm and Anemia

Sickle Cell Anemia
Cold Sideroblastik

Hereditary
Infection
Spherocytosis

G6PD Defisiensi

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 2. A 23 years old man came with fatigue for 2 months. He was on TB treatment for 3 months.
Hemoglobin level is 9.2 g/dL, MCV 78, MCH 27. The serum iron was normal. The blood smear
showed many lymphocytes. What is his problem?
A. Hemoglobinopathy
B. Folic acid deficiency
C. Iron deficiency anemia
D. Bleeding
E. Anemia on chronic disease

* Dia ada infeksi kronik, yaitu TB. MCV-nya rendah dikit, masih bisa dipertimbangkan normositik. Bilirubin
tidak naik, berarti bukan hemolitik. Kadar besinya bagus, tidak ada pansitopenia. Berarti anemia on Chronic.

3. N/A

4. Pria 32 years old come to ER with complains of fever, headache, and nausea vomiting since 1 week
ago. He recently came back from travelling to Kupang. In PF: HR 104x/mnt, BP 130/90 ,RR
18x/menit, temperature 38,8, pale conjunctiva, sclera slightly icteric and splenomegaly. His
laboratory shows: HB 9.8, Ht 30%, MCV 88, SGOT 23, SGPT 32. What is most likely diagnosis:
A. Aplastic anemia
B. Hemolytic anemia
C. Anemia et causa liver disease
D. Drug induced anemia
E. Leukemia

* MCV normal, berarti dia normositik. Ada ikterik, ada splenomegaly à Berarti ada hemolitik extravascular.

5. 15 year old boy came with jaundice since 1 week ago, ans jaundice since 3 weeks ago. Lab result
Hb 9.2 g/dL, increase indirect bilirubin and platelet count 350k. Abdominal USG showed
cholelithiasis.
A. Non-immune hemolytic anemia
B. Malnutrition
C. Evan syndrome
D. Anemia of chronic disease

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 E. Iron deficiency anemia

* Bilirubin naik, berarti anemia hemolitik extravascular. Ga ada immunoglobulin diperiksa, berarti bukan
AIHA.

6. 24 years old male came with decrease level of consciousness. Creatinine 8, ureum 78, Hb 6.8,
platelet 67000. Ada schistocyte. Cause of anemia?
A. Microangiopathic Hemolytic Anemia
B. Severe malaria
C. HUS
D. Anemia of chronic disease
E. B12 deficiency

* Schistosit artinya ada mikroangiopathic hemolytic anemia. Bisa TTP, bisa HUS, ureumnya naik (normal 7-
20 mg/dL), berarti jawabannya HUS.

7. A 45-year-old Alcoholic american male came to international hospital with a complain of frequent
slept since 5 months. Hb 7,6. MCV 110. MCH 36. Blood smear shows Hypersegmented neutrophil.
What is the problem?

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 A. Liver disease
B. Folic deficiency
C. Myelodysplastic Syndrome
D. Myelofibrosis
E. Toxic Poisoning

* Hypersegmented neutrophil, temennya Megaloblastic anemia. Selalu ada ovalosit dengan

hypersegmented neutrophil.

8. N / A

9. 35-year-old male painter, came to you with could not do anything since 2 weeks ago. Hb 7.4
gram/dl. MCV 90 MCH 28. He felt night sweat in the last 3 months. In the both leg wash rash.
Reticulocyte count was low. What is the most likely problem of this case?
A. Anemia of chronic disease
B. Aplastic anemia
C. Autoimmune hemolytic anemia
D. Evan's syndrome
E. Nutrient deficiency anemia

* MCV normal, berarti dia normocytic anemia. Gak ada bilirubin naik, berarti dia bisa Non-hemolytic atau
Hemolytic Intrinsic. Berarti bukan C, D, E. Tidak ada petechiae/purpura, berarti bukan Pancytopenia. Berarti
jawabannya A.

10. A 28-year-old mother come with fatigue since 2 month after delivery. There is history of
transfusion during pregnancy. Hb = 8.2 g/dl. MCV = 81. MCH = 28, with increased reticulocyte.
Direct coombs test was negative with negative IgG, IgM and C3. What would we explain about
her condition?
A. Autoimmune hemolytic anemia with warm type
B. Alloimmune hemolytic anemia
C. Autoimmune hemolytic anemia with cold type
D. Paroxysmal cold hemoglobinuria
E. Mixed type of warm and cold type

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 * MCV normal (Normocytic anemia). Coombs test negative IgG, IgM dan C3 (bukan AIHA). Ada riwayat 2
bulan habis lahiran dan ADA TRANSFUSI (Alloimun hemolytic).

11. 65 year old man with chronic renal failure was given EPO. Fungsi erythropoietin buat apa?
A. Maturasi erythrocyte progenitor cell
B. Proliferasi erythrocyte progenitor cell à (Ini udh fix, hafalin ya)

12. Male, 34 year old, painter, datang dengan keluhan could not do anything since 2 weeks ago. MCV
90, MCH 28, reticulocyte low. Night sweats since 3 months ago. Both leg are rash. What is the
probable diagnosis?
A. Anemia on chronic disease à (Sama ini kasusnya kyk yg nomer 9)
B. Aplastic anemia
C. Autoimmune hemolytic anemia
D. Evans syndrome
E. Nutritional deficiency anemia

13. A 67 years old male came with sign of ascites and positive spidar navi. Abdominal ultrasound
showed liver cirrhosis. He felt tired in the last 2 weeks. Occult blood positive. Hemoglobin 8.3 g/dl
MCV 88 MCH 30. Blood smear showed positive pencil cell and hypersegmented neutrophil. What
is the cause of his tired symptom?
A. Anemia in chronic disease
B. Iron deficiency anemia
C. Variceal bleeding
D. Liver cirrhosis
E. Myelodysplastic syndrome

* MCV normal, berarti dia Normocytic. Berarti liver cirrhosis gk bisa, karena dia harusnya Macrocytic Non-
Megaloblastic. Variceal bleeding lebih ke hematemesis, jadi bukan. MDS kan kumpulannya PV, ET sama
myelosclerosis, gak ada disinggung. Tinggal anemia on Chronic atau IDA (early). Tapi karena di soal ada
Pencil Cell, jadi pilih IDA.

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 14. 24 y.o male fatigue & blood smear shows ovalocytes. Hb 7.2. MCV 82. MCH 19. What do you do
to relieve Hb?
A. Give leuko depleted red cells
B. Give Packed Red Cells à (1 kantong PRC, naikin 1 mg/dL Hb)
C. Transfuse Washed Red Cell
D. Whole blood
E. Give erythrocyte apheresis

15. Cewe 34 tahun dateng dengan heart failure. Hb 6, MCV 82, MCH 28, platelet 340k, blood smear
spherocyte & erythrophagocyte reticulocyte naik. No bleed. What is her problem?
A. Anemia on chronic disease
B. Aplastic anemia
C. Evan syndrome
D. AIHA
E. MDS à trombosit normal, Hb-nya turun (berarti bukan PV/ET). MDS itu kayak stadium speedometer
antara (PV, ET, myelosclerosis, AML, CML)

* MCV normal, berarti Normocytic Anemia. Spherocyte berarti arahnya ke Hemolytic extravascular.

16. N/A

17. A 25 year old lady come to a clinic for anemia. She was diagnosed with Autoimmune Hemolytic
Anemia. She has gotten steroid for 2 months. She was cured, but for the last 2 days her fatigue
returns. In laboratory test result, shows Hb 8 g/dL, MCV 110, MCH 32. What is happening to her?
A. Autoimmune hemolytic anemia relaps
B. B12 deficiency
C. Folic acid deficiency
D. Iron deficiency anemia
E. Adrenal insufficiency

* MCV naik, berarti megaloblastic. Steroid bikin folic acid turun.

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18. Woman 22 year old with a history of frequent transfusion for several past year. Hb 7, MCV 82,
MCH 28. Blood smear: ovalocyte. What is the pathogenesis of her problem?
A. Hemoglobin disorder
B. Erythrocyte membrane disorder
C. Erythrocyte enzyme disorder
D. DNA disorder à (karena dialysis sering sering, ada resiko asam folatnya kebuang, makanya DNA-nya
rusak)
E. External destruction

19. 26-year-old male with jaundice and pallor since 2 weeks. Hb 6.4 g/dl, MCV normal, indirect
bilirubin increased, direct coombs test positive, urinalysis normal. what causes his anemia?
A. Destruction of erythrocyte in lien
B. Cytokine action
C. Membrane attack complex
D. Autolysis of red blood cells
E. Immune to erythrocyte progenitor cells

* MCV normal, berarti normocytic. Bilirubin naik berarti Extravascular hemolytic. Extravascular hemolytic
terjadinya di spleen (komponen retikuloendotelial system: liver, spleen, lymph node)

20. Lelaki 53 tahun, fatigue 2 months, USG Abdomen show Contracted Kidney, Blood Smear
Macrocytic and Hypersegmented Neutrofil, Kreatinin 12,5. What is the patogenesis of his anemia?
A. Decrease erythropoietin
B. Frequent HD
C. Loss of blood
D. Uremic syndrome
E. Reduced RBC production

* Macrocytic, berarti dia megaloblastic. Megaloblastic, berarti dia kekurangan folate/sianokobalamin.

Nutrisi bisa kebuang gara-gara HD.

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 21. 35-year-old man with 8 weeks of fatigue. He often felt night sweats and gum bleeding came to
clinic, he looked pallor, indirect bilirubin is increased, MCV and MCH is normal, Hb 8.7, what's the
probable diagnosis?
A. Blood breakdown in lien
B. Antibody to blood progenitor cells
C. B12 deficiency
D. Folate deficiency
E. Blood loss

* MCV MCH normal, artinya normocytic. Indirect bilirubin naik artinya hemolytic extravascular. Berarti
jawabnnya A.

22. 35 year old man came with easily tired since 2 months. Hb 8.2 g/dL, MCV 78, MCH 26. Chest x-ray
showed infiltration in upper left lobe. Feritin 1200. What is the pathogenesis?
A. Decreased absorption of iron
B. Hemoglobinopathy
C. Enzyme defect
D. Hepcidin increased à (pegang aja. Ini hapalan)

* Iron kurang jadi ferritin keluarin karena dia storage. Tapi karena ada infection, iron-nya dipake sama itu
agen et causa infection. Nah tubuh kan udah detect keluarin Fe dari storage, biar gak kebanyakan keluarin
dia negative feedback pake hepcidin.

23. Pasien thalassemia, target cell. Pathogenesisnya?

Denatured of Hb

24. Anak-anak mimisan kalo lagi hectic, apa yang diperiksa?

A. aPTT
B. Clotting time
C. Bleeding Time

* Mimisan itu berarti superfisial bleeding. Superficial bleeding berkaitan dengan ketahanan
vaskuler/thrombocyte à periksa bleeding time.

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 Superficial bleeding time, petechiae, purpura à bleeding time, curiga ketahanan vaskuler rusak atau
trombosit rusak.

Kalo profundal bleeding, hemarthrosis à curiga faktor pembekuan rusak, clotting time.

25. Pasien 33 thn cowo dtg karena orthopnea dan Hb nya 8. Ada folic acid deficiency iron deficiency
sama blood loss. Ferritinnya cmn 5. Treatmentnya mau apa?
FUROSEMIDA
* kalo treatment paling penting yang saat ini harus kita ambil, adalah kita jaga dia jangan sampe meninggal
karena shock. Pilih Furosemide dulu.

26. A 65-year-old man comes with main complaint of shortness of breath. Hb 19.5 g/dL. Tinggal di
gunung agung. JAK-2 negative. Diagnosis?
A. Polycythemia vera
B. Essential thrombocytosis
C. High Altitude Syndrome
D. Dehydration
E. Chronic pulmonary disease

27. A 35-year-old male came with suddenly feel tired the hemoglobin level was 6.5 g/dL. Billirubin
indirect was increased and haptoglobin was decreased. From the Coombs test there is antibody
IGM near the Erythrocyte. what do you do next?
A. Give dexamethasone
B. Transfer with leucodepleted PRC
C. Rituximab
D. Go to top of mountain
E. Take artesurate

28. A 22 yo male come with fatigue and blood smear shows ovalocyte. There is history of blood
transfussion. Lab: hb: 6.4, mcv: 7.3, mch :10. What to do to relieve the hemoglobin?
A. Give red pack cells
B. Transfuse washed red cell

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 C. Leukodepleted red cell
D. Whole blood
E. Erythrocyte apheresis

29. Mr. Raysid 32 year old come to ER with complains of fever, headache, and nausea vomiting since
1 week ago. He recently came back from travelling outside Java island. In PF: HR 104x/minute, BP
130/90, RR 18/minute, temperature 38.8, pale conjunctiva, sclera slightly icteric and
splenomegaly. His laboratory shows: HB 9.8, Ht 30%, MCV 88, SGOT 23, SGPT 32. What is most
likely diagnosis?
A. Aplastic anemia
B. Hemolytic anemia
C. Liver disease
D. Leukemia

30. Seorang anak dengan nutrisi cukup dateng keluhan anemia pallor fatigue dsb, MCV MCH tinggi,
kita order schilling test hasil negatif. Diagnosis?
Folic def anemia

31. Wanita 31 tahun, ada diabetes type 1 dan acute renal failure. Dia fatigue, Hb 6,8, MCV 86. Belum
dialisis. Penyebab anemia nya?
A. Erythrocyte enzyme deficiency
B. Autoimmune hemolytic anemia
C. Microangiopathy hemolysis
D. Erythropoietin deficiency
E. Bleeding

32. 50 y.o headcahe complaining of his vertigo, pruritus. Recently angina pectoris. Leukocyte 12.000,
hematocrit 65%, increased mass of erythrocyte. EPO decresaed, splenomegaly s4. Diagnosis?
A. Endocrine cancer
B. EPO mutation
C. Polycythemia Vera

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 D. CKD
E. CPOD

33. Color pigmentation

Hemosiderin

34. Gastric Ca with Fe deficiency. Dikasih apa?

A. Folic acid 5 mg daily
B. Ferrous Sulfate 200mg 3 times per day
C. Treat gastric Ca
D. B12 50 mg daily
E. PRC transfusion 300 ml

35. A 26 yo male fame with complaint of nausea, fatigue, and vomiting. On PF enlarged spleen S3. Hb
14, WBC 27k, platelet 231k. On blood smear there was all stages of development of leukocytes
and myeloblasts. What is his diagnosis?
A. AML
B. Chronic phase CML
C. Accelerated phase CML
D. Crisis Blast phase CML
E. Hairy Cell Leukemia

36. 50th cowo, leukosit 60k, blood smear banyak small lymphocytes. Possible diagnosis?
A. ALL
B. CML
C. CLL
D. ALL
E. Hodgkin Lymphoma

37. Cewek 28 thun ad malaise fever, nasea(maybe), vomit (mungkin) 4 weeks aho. hb 8.2 wbc 5400.
platelet 123k. dif count 0/0/1/42/31/0. positive blast with pro and metamyelocyte. Diagnonis?

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 A. AML
B. Blast phase CML
C. Crisis phase CML
D. Accelerated phase CML
E. Acute promyelocytic leukemia

38. Pasien datang dengan keluhan jaundice dan pale sejak 2 minggu lalu. Hb 6.4 g/dL. Indirect bilirubin
naik. Direct coombs test positive. Urinalysis normal. What is the mechanism of her anemia?
A. Destruction of erythrocyte in lien
B. Cytokine action
C. Membrane attack complex
D. Autolysis of RBC
E. Immune to erythrocyte progenitor cell

39. Cowo 36 thn, fever 2 weeks, night sweat, reccurent infection. Hb 9.2. Platelet 170k. Blood smear
atypical lymphocyte. What is the diagnosis?
A. Hodgkin lymphoma
B. Non-hodgkin lymphoma
C. Multiple myeloma
D. ALL
E. CLL

40. Lymphadenopathy, ada Reed-Steinberg cell

Hodgkin lymphoma

41. N/A

42. 40 year old male came with malaise, fatigue and nights sweat for 4 weeks. Hb 8.2, leukosit 24k,
platelet 123000. Blood smear shows positive reticulocyte blast. Diff count 0/0/45/23/20/0.
Diagnosis?
A. Acute myeloid leukemia

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 B. Chronic phase CML
C. Accelerated phase CML
D. Crisis blast CML
E. Chronic promyelocytic leukemia

43. A 57 years old male came with bone pain in lumbal area. From the x-ray showed lytic in the bone.
The peripheral blood is normal. Albumin level was 2.5 g/dl with globulin 5.2 g/dl. What is your
next plan?
A. Protein electrophoresis
B. Bone survey
C. Bone scan
D. Urinalysis
E. Blood smear

44. Male 34 y.o came to clinic with fatigue since 5 weeks ago. He also has pain on his shoulder. Mcv
84 mch 28. On blood smear it shows rouleaux formation. What is his diagnosis?
A. Occult malignancy
B. Acute leukemia
C. Multiple myeloma
D. CLL
E. Malaria

45. A 67 years old male came with history of bleeding and anemia with Hb 9 g/dl. The WBC count 86
thousands. Blood smears shows myeloblasts. What is your advice to his family?
A. Supportive care
B. Recommend of leucophoresis
C. Refer to radiation oncologist
D. Ask for bone marrow aspiration
E. Give antibiotics

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 46. 45 tahun. recurrent fever & 6kg weight loss for 5months. microscope: small lymphocyte, eusinofil,
monocyte, ....
A. Lymphadenitis TB
B. Hodgkin lymphoma
C. Non-hodgkin Lmyphoma à (soal tahun lalu ada RS-nya, nah ini gk tau ada atau gk)
D. Burkit lymphoma
E. Langerhans Cell Histiocytosis

47. A 44 years old male came with fever of unknown origin since 6 months. Leukocyte 34000. Diff
count was 0/0/1/45/40/0. There was myeloblast. Diagnosis?
A. AML
B. Accelerated phase CML
C. Crisis phase CML
D. Chronic phase CML
E. Post PV-Acute Myeloid Leukemia

48. A 69 year old man came with enlargement of lien since 4 months. Blood smear shows varieties of
leukocyte development. From the cytogenetics there was mutation in Break cluster region of
Abelson. What is your advice for his treatment?
A. Chlorambucil
B. Imatinib
C. Capecitabine
D. Ponatinib
E. Ruxolitinib

49. 43 years old female : fever, fatigue, purpura in both legs. lab : Hb 8.1, leukocyte 42k, platelet 34k.
no splenomegaly. bone marrow aspiration : hypercellular myeloid blass 24%. diagnosis?
A. AML
B. Accelerated phase of CML
C. Chronic phase of CML
D. CLL

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 E. Hairy cell leukemia

50. CML
t(9,22)

51. 52 yo woman have recurrent headache. Leukosit 12.000, platelet 1.2 juta, spleen membesar. Jak-
2 positive, bone marrow aspiration hyperactive megakaryocytes. What is the possible diagnosis?
A. Polycytemia Vera
B. Myelofibrosis
C. Essential thrombocythemia
D. Reactive thrombosis

* antara PV dan ET (keduanya Jak-2+), diagnosis PV memerlukan Hb (diatas 18.5 utk cowo atau 16.5 utk
cewe) dan biasa soal nya menyebutkan trilineage proliferation pada Bone Marrow Aspirates. Sedangkan
ET diagnosis nya platelet diatas 450rb dengan disingkirkan nya dd lain. Karena tidak ada nilai Hb dan di
Bone Marrow Aspirates cuma hyperactive megakaryocytes maka dipilih ET.

52. A 50 yr old man has headache, vertigo and generalized pruritus. He experience recent onset of
angina pectoris. Ht 65% wbc 12000/mm3. Increased red cell mass. Splenomegaly s3. EPO
decreased. Which of the following is the most likely diagnosis?
A. CKD
B. EPO mutation
C. PV

* menunjukan gejala hyperviscocity, Ht meningkat; WBC meningkat, dikatakan increased red cell mass à
ciri Polycythemia Vera. EPO yang menurun merupakan respon fisiologis.

53. N/A

54. 4 yo boy thalasemmia major. Prolonged transfussion. Treatment of complication of the

treatment?
A. Sulfas ferrous
B. Calcium

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 C. Deferiprone/Desferioxamine
D. Folic acid
E. Phlebotomy

* dikatakan mengalami prolonged transfusion, ditanya penanganan apabila terjadi komplikasi dari
transfusi nya à iron-chelating agents (karena transfusi bisa menyebabkan iron overload).

55. You are called to see 26 years old man came with fever since 2 days. He recently underwent
induction chemotherapy for acute myelogenous leukimia. Yesterday, his absolute neutrophils
count (ANC) was 500/mm^3, and today it is 100/mm^3. He has been anemic and
thrombocytopenic but not required transfusion. This morning, he develop a fever of 39.5 ^oC.
Which of the following would you recommend for this patients at this time?
A. No treatment until culture result are known
B. Lumbar puncture
C. Intravenous Gentamycin & Piperacillin
D. Oral Ciplofloxacin
E. Administration of Granulocyte Colony Stimulating Hormone (G-CSF) and Granulocyte
Macrophages Colony Stimulating Hormone (GM-CSF)

* ANC sudah turun ke 100 (pasien highly susceptible to infections), lalu kemudian sudah muncul gejala fever
à dapat diberikan kombinasi piperacillin (penicillin / beta-lactam antibiotics yang cocok untuk gram-
negative bacteria) dan gentamicin (aminoglycosides, apabila ditambah dengan beta-lactam bisa efektif
mengatasi gram-positive bacteria). Selain itu, gentamicin bisa digunakan untuk mengatasi sepsis (systemic).
Sedangkan untuk cipro biasanya lebih bermanfaat kearah urinary tract infection.

56. 35 years old student come with repeated nose bleeding especially If he in hectic day. Suggest to
evaluate bleed?
A. APTT
B. PT
C. Platelet function
D. Mixing APTT
E. Clotting Time

* karena mucosal bleeding à cek dulu fungsi platelet nya bisa melalui BT, PFA dsb.

21


57. A 21 year old female came with petechiae in both legs for 10 days. Platelet count was decreased
and in peripheral blood smear was found giant cell. What is your diagnosis?
A. Hereditary platelet defect
B. Scurvy disease
C. Zika virus infection
D. Dengue fever
E. Immune thrombocythemia

* ciri-ciri fungsi platelet jelek, dibuktikan dengan trombositopenia, dan ditemukan giant cell à ciri khas dari
Immune / Idiopathic Thrombocytopenic Purpura (terbentuk antibodi terhadap platelet).

58. A 58 year old man has leakage of fluid from surgical site since 1 day. He had surgery for humeri
fracture 4 days ago. BT, PT, aPTT normal. What is his problem?
A. vWF disease
B. Hemophilia B
C. Surgical bleeding
D. Liver disease
E. Factor XIII deficiency

* menunjukan ciri-ciri kesalahan di faktor-faktor koagulasi tetapi tidak ditemukan kelainan pada
pemeriksaan lab sehingga vWF disease, Hem B not likely. Jadi pilihan nya FXIII def karena merupakan fibrin
stabilizing, kalau tidak ada maka fibrin sempat terbentuk tapi tidak kuat.

59. Umur 24 tahun, male, datang gingival bleeding. Bleeding time was normal. INR 5.6. Others within
normal limit. What do you give him?
A. Fresh Frozen Plasma
B. Cryoprecipitate
C. Thrombo-apheresis
D. Thrombocyte concentrates
E. Vitamin K

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 * INR tinggi curiga konsumsi warfarin (vit. K antagonist) atau kelainan pada extrinsic pathway. Sehingga
vit. K sebagai antidote diberikan. Karena vit. K juga diperlukan utk bentuk bbrp factor.

60. N/A

61. Cewe melena. Hb 6 g/dL. Mau transfusi, tapi lg makan obat aspirin & clopidogrel. Clotting time
normal. Maka di transfusinya apa?
A. FFP
B. Cryoprecipitate
C. DDAVP
D. Trombosit

* antara trombosit dan DDAVP. Menurut jurnal antidote untuk aspirin dkk adalah desmopressin (DDAVP),
trombosit less likely karena akan bertolak belakang dengan indikasi pemberian aspirin clopi pasien.

62. A 33-year-old male hemarthrosis dextra, increased aPTT, low factor IX. What do you give to him?
A. Steroid
B. Desmopressin
C. Fresh frozen plasma
D. Factor XI concentrate
E. Vitamin K

* diberikan FFP karena mengandung berbagai macam faktor pembekuan (salah satunya faktor IX).
Mengapa bukan vit. K tetapi faktor IX nya yang kita tambah, karena prinsip utama tx hemophilia adalah
factor replacement therapy.

63. A 45-Year-old came with swelling in the right knee since 1 day. Pain, venectation, and homan sign
wss positif. He had history of operation 3 months ago. What is the next step to diagnosis?
A. D-Dimer
B. Venography
C. Filarial Test
D. Compression Doppler Ultra Sound
E. Lymphegraphy

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 * curiga high risk DVT karena menurut Wells score sudah diatas 2 (lihat penilaian Wells score). Apabila high
risk maka langsung cek Compressed Doppler US. Kalau menurut Wells score masih dibawah 2 (soal
berikutnya) maka masuk nya ke less likely DVT, cek D-dimer dahulu.

64. A 31-year-old with swelling in right arm, no pain, no edema, no venectasis. What will you do next?
A. Venography
B. Compression doppler ultrasound
C. Venography
D. Lymphography
E. D-dimer

65. 21 y/o female with swelling in right arm, no pain, no edema. What is your next step?
A. D-dimer
B. Venography
C. Ultrasound compression doppler
D. Filaria
E. Lymphography

66. 18 years old lady came with gum bleeding two hours ago. It’s also accompanied by petechie over
her both legs. Her blood exam shows platelet counts to be 98.000/mm3. Which binding protein
mediated disorder of her?
A. GP1A
B. GP1B
C. GP2A
D. GP2B
E. GP3B

* menurut internet kalau Bernard-Soulier itu ditandai dengan trombosit turun (karena banyakan
megakaryocytes yang ga ke detect sama mesin). Sedangkan Glanzmann biasanya normal platelet count
and morphology. Karena curiga Bernard-Soulier maka pilih GP1B.

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 67. Anak umur 13 cowo jatoh trs berdarah lututnya. kakeknya juga dlu sama. yg pertama kali di cek
apa?
A. aPTT
B. PT
C. TT
D. CT
E. BT

* pertama kali curiga hemophilia maka cek aPTT.

68. N/A

69. Cewe 24 tahun hematoma, gk ada riwayat serious trauma. No bleeding history before, smua
normal kecuali INR 6.1, diagnosisnya apa?
A. Immune Thrombocytopenia
B. Vitamin K Antagonist overdose
C. Scurvy disease
D. Post operation
E. Hemophilia B

* karena semua lab test normal kecuali INR maka kemungkinan ada overdose vit. K antagonist

70. Cowo 56 tahun liver cirrhosis, datang dengan melena. Kelainan dimana?
A. Increased fibrinolysis
B. Factor VIII deficiency
C. Factor VII deficiency
D. vWF deficiency

* seinget gw ada variceal bleeding à melena. Jadi kemungkinan rusak di faktor koagulasi FVII, seharusnya
kalau ada luka dari luar (variceal bleeding) bisa menginduce FVII jadi FVIIa. Selain itu karena cirrhosis curiga
dia vit. K def (karena vit. K di store di liver seharusnya) à tidak bisa membentuk FVII.

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 71. 54 tahun female, riwayat dengan cervical cancer dengan sekarang ada vaginal bleeding. Hb 7, left
leg swollen. Pada hasil pemeriksaan doppler ada DVT. Which of the best treatment for the
thrombus?
A. Unfraction Heparin IV
B. Fraction Heparin SC
C. Unfraction Heparin SC
D. Oral Warfarin
E. Vena Cava Filter

* diberikan VC filter karena pengencer darah tidak bisa diberikan (karena sedang active bleeding). VC filter
mencegah agar embolus ga masuk ke jantung dan ke paru (pulmo embolism).

72. A 39 years old man noted DVT, without any risk factor. His brother kena PE umur 45 tahun, his
mother ada clot di leg umur 30an. Inherited disorder apa yang orang ini punya?
A. Occult cancer
B. Anti-thrombin III deficiency
C. Factor V Leiden mutation
D. Antiphospholipid antibody syndrome
E. Familial malignancy disorder

* karena selain FV Leiden, AT 3 merupakan hypercoagulable disease yang inherited

73. Healthy woman 26 yo has had redspot on her leg during the last 24 hours. Lab show (lupa).
Peripheral blood smear shows normal morphology, Bone Marrow smear shows megakaryocytic
cell hyperplasia. Diagnosis?
A. Hereditary platelet syndrome
B. Thrombocytopenia gestational
C. ITP
D. Thrombotic thrombocytopenia purpura
E. Hepatitis A infection

* sudah dibahas seperti nomor 57

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 74. 13 y/o girl come to the physician by mother because 2 months of heavy menstrual bleeding. Rpd :
excessive peridontal bleeding while brushinh teeth and easy bruising for 6 years. mother and
brother also like that. PF : patchy ecchymoses on upper and lower extremities. platelet 234000
BT: 17 min, PT : 12s (INR = 1), aPTT : 46s. diagnosis?
A. Proconvertin deficiency
B. Stuart factor deficiency
C. Hageman factor deficiency
D. vWF deficiency
E. Vitamin K deficiency

* platelet count normal tetapi ditemukan BT meningkat, serta aPTT yang naik sedikit à diagnosis
sementara adalah vWF disease.

75. 45 tahun pria datang dengan keluhan gum bleed, epistaxis, ecchomosis sejak 3 hari yang lalu. 2
minggu yang lalu dia mengeluhkan sob dan fever. Pf: bp 110/70 hr 114x rr 26x temperature 35.8,
ecchymosis (+) nosebleed (+) gum bleed (+). Lab: Hb 11 g/dl, leukosit 16500, platelet 30000, PT
CT memanjang, fibrinogen 50, d dimer 400. Diagnosis?
DIC
* (dinilai dari hasil laboratorium yang menunjukan habisnya faktor pembekuan baik itu platelet; PT yang
memanjang; fibrinogen rendah, dsb. Selain itu dinilai dari gejala klinis dimana awalnya berupa gejala
thrombosis baru sekarang muncul gejala bleeding nya).

76. Cowo di shave trs kalo berdarah yg pertama kali mekanisme nya apaa?
A. Vasoconstriction blood vessel à (Vasoconstriction à adhesion à aggregation à clotting)
B. Platelet adhesion
C. Platelet aggregation
D. Clotting

77. 29 years old female ada nose bleed and increased menstrual flow. PF: petechiae, purpura on skin
and extremity. Lab examinations shows normal PT, aPTT, and platelet count, with decrease in cWF
activity. Which of the hemostasis prosess is disrupted?
A. Vasoconstriction

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 B. Platelet adhesion à (mainly kerjanya di adhesion, tapi pada high shear condition juga membantu
aggregation)
C. Platelet aggregation
D. Fibrin polymerization
E. Prothrombin activation

78. 14 years old boy complains of fatigue, nausea. Hb decrease, ureum creatinine increase,
thrombocyte decrease. Blood smear shows schistocyte. Diagnosis?
HUS à (ada schistocyte à hemolytic, urea juga naik kemungkinan HUS)

79. N/A

80. AIDS, leg-nya ada edema, DVT, PT aPTT normal. Problem?

A. Antiphospholipid syndrome
B. Protein C deficiency
C. Factor XIII deficiency
D. Factor VII deficiency
E. Protein S deficiency

* karena cek lab-nya normal, A B dan E harusnya bisa, tapi pasien ada AIDS dan ada korelasi HIV terhadap
increasing prevalence of antiphospholipid syndrome. Kalo ada gangguan di factor VII harusnya aPTT
abnormal. Factor XIII kerjanya kan utuk stabilize clot, jadi kalo deficiency malah harusnya menyebabkan
easy bleeding dan hemorrhage/poor wound healing.

81. A 12-year-old came to Primary Health Care in rural area, with fever for 4 days and epistaxis 2 times
on the 3rd and 4th day. What is simple and first simple examination for this patient?
A. Blood smear
B. Rumple-Leed test à (curiga dengue à rumple leed buat cek petechiae (vascular sama
thrombocyte). Simple dan melihat ini daerah rural ini paling gampang dilakukan pertama)
C. Complete Blood Count
D. Platelet function analysis

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 82. 6 year old boy ke ER, suspect bleeding di right knee joint. First examination apa?
A. BT
B. aPTT à (bleeding di joint (hemarthroses) à kemungkinan besar masalah di coagulation factor)
C. Platelet

83. 47 tahun cewe, fatigue sejak 3 bulan lalu, no fever, hb 6,3 ; platelet 17.000 ; WBC 2400,
reticulocyte increase , hep b , cirrhosis
A.
B. Evan syndrome
C. Nutrient deficiency
D. Enlarge lien
E. Dengue fever with bleeding

* pasien ada HBV infection yang menyebabkan terjadinya cirrhosis. Cirrhosis akan menyebabkan
sequestration komponen-komponen darah ke spleen, sehingga terjadi destruction dari platelets, WBC dan
RBC (hypersplenism))

84. A 36 year old man visit ur private practice and is concerned about having colorectal cancer due to
his family history (uncle & brother) dying from colorectal cancer. He shows no other risk factor
that would lead to him having a colorectal cancer besides his family history. As a general
practitioner medical doctor what advise would you give for him?
A. Do colonoscopy now
B. Wait for colonoscopy until 45 years old
C. Wait for colonoscopy until 50 years old
D. Wait for colonoscopy until 55 years old
E. Do Fecal Occult Blood Testing now

* kalo gak salah kasusnya gak ada family history??

à kalo gk ada, sesuai dengan guideline dilakukannya umur 50

à kalo ada, harusnya dilakukan umur 40 atau 10 tahun lebih muda dari umur saat diagnosis keluarga yang
kena

85. N/A

29


86. Female, Ca mamae, proliferating sustaining signal receptor +, ER PR (-). Target therapy?
Transtuzumab

87. A 61 years old man came to general check up due to fear of his father having cancer. His weight
is decreases. He was a heavy smoker. He has been smoking 2 packs a day for more than 25 years.
What test?
A. No recommendation
B. PET-Scan
C. Cytology sputum
D. Low dose CT-scan à (kata dr. Andree BT screening pake low dose CT-scan (low dose biar gak terlalu
banyak radiasi; kalo x-ray gak bisa screening))
E. Bronchoscopy

88. Cewe, multiple sex partners, heavy smoker

Cek Papsmear

89. A 8 years old boy came with confirm of neuroblastoma. He was given a surgery, chemotherapy,
and radiotherapy. The chemotherapy is cisplastin, CCNS, vincristine. What is the mechanism of
vincristine?
A. Inhibit DNA
B. Inhibit Microtubule formation
C. Inhibit Microtubule disassembly à (paclitaxel)
D. Antimetabolite à (5-FU, Methotrexate, dkk)

90. 55 year old male, metastasis colorectal cancer. Undergone full chemo & targeted therapy. What
type of receptor responsible for metastasis & angiogenesis?
A. EGRF
B. VEGF-receptor
C. Her-2 receptor
D. PD-L1 receptor

30


91. 55 years old male has been diagnosed as metastatic colorectal cancer. he is put on full dose
chemotherapy and targeted therapy. What type of receptor play a role in metastasis and
angiogenesis:
A. EGFR
B. CD-20
C. VEGF
D. HER-2
E. PD-I1

92. Tumor marker pancreatic cancer?

* gak ada pilihan, tapi buat pancreatic cancer biasa tumor marker-nya CA 19-9

93. N/A

94. Laki laki dg Hodgkin lymphoma. Shortly after treatment dia mengalami chronic cough dan susah
untuk bernafas, kulit juga makin gelap, ada minimal myelosupression. Obat yang menyebabkan
efek samping ini?
A. Bleomycin à (side effect bleomycin: yang paling ditakutkan pulmonary fibrosis; selain itu bisa ada
hyperpigmentation, fever, rash, alopecia, little myelosuppression)
B. Dactinomycin
C. Doxorubicin
D. Vinblastine
E. Vincristine

95. Tumor marker cancer mammae?

A. BRCA
B. Tyrosine kinase

96. A 24 years old woman has breast lump at both breast since 1 year ago. The lump increase in size
in 1 year. She find that the lump get bigger at menstrual period. Physical examination: lump 3 cm,

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 supermedial quadrant, painless, no nipple retraction, no dimpling, no peau de orange. She is
afraid of her condition is serious because her aunt is diagnosed with breast cancer 3 years ago.
What is the most probable diagnosis?
A. Fibroadenoma mammae
B. Mammary aberans
C. Fibrocystic disease
D. Paget disease
E. Breast lymphoma

97. 24 years old woman, ada lump di both breast 1 year ago. Ukurannya berubah dari 2 jadi 3 cm
dalam setahun. Makin membesar saat menstruasi. Lump 3 cm in size at superomedial quadrant
and painless. No retraction nipple, no dimpling and peau de orange. Her aunt diagnosed breast
cancer 3 years ago. Diagnosis?
A. FAM
B. Mammary aberans
C. Paget disease
D. Fibrocystic disease
E. Breast lymphoma

98. Starry sky appearance?

A. Follicular lymphoma
B. Mantel cell lymphoma
C. Burkitt’s lymphoma à (khas)
D. Hodgkin lymphoma
E. Non-hodgkin lymphoma

99. Cowo 56 tahun, DRE: prostate slightly bigger, several nodule stony hard not tender, PSA 31
A. MRI Pelvic
B. USG prostate
C. Staging process
D. Trans rectal biopsy à (untuk memastikan diagnosis malignant bukan)

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 E. Prostatectomy

100. A 37 year old woman complain left breast lump. Size of lump 3cm since 4 years ago. No
lump in other breast, lymph node. No lymphadenopathy. She have average cancer risk. Pathology:
proliferation of epithelial and (lupa) cells. Diagnosis?
A. Carcinoma epithelial
B. Lymphoma of breast
C. Carcinoma in situ
D. Fibroadenoma mammae
E. Ductal carcinoma

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