Respiratory System Perfecten

1. A 70 yo nursing home patient refused the influenza vaccine and subsequently developed influenza. She died of acute pneumonia 1 week after contracting the flu. The bacteria that cause of acute post influenza pneumonia is gram rods and doesnt grow on blood agar nor Mac Conkey agar. What is the possibly cause of this disease?A. LegionellaB. ListeriaC. S. aureusD. KlebsiellaE. Eschericia coli

2. An infant, seen in ER, presents with fever and persistent cough. PE and CXR showed Pneumonia. Which of the following is most likely the cause of this infection?A. RotavirusB. AdenovirusC. CoxsackievirusD. RSVE. Rhinovirus

3. Coronaviruses are recognized by club-shaped surface projections that are 20 nm long and resemble solar coronas. These viruses be a major agent of the common cold, especially in older children and adults are characterized by : bikin respi infection-SARS, enterica. The virion is known to contain 8 fragment of RNAb. The virion is positive sense single stranded RNAc. Grow well in the usual cultured cell linesd. Non enveloped virus (mestinya enveloped di luar-punya 3 protein SpikeEnvelopeMembrane, crown like appearancee. Agglutinate human red blood cells (punya hemaglutinin esterase, bisa yang ini juga katanya)

4. Which virus is the leading cause of croup syndrome, bronchiolitis, and pneumonia in young children that contain RNA in nucleocapsid encased within an envelope, and, when infecting mammalian cells in culture, will hemabsorbreb blood cells?A. Group B coxsackievirusB.RotavirusC.Parainfluenza virus (Cuma 1 kapsul atau genomenya lupa, kalau influenza ada fragment) bikin croup pneumoni sama brochiolitisD.adenovirusE.rhinovirus

5. Rhinovirus is a major cause of the common cold that primarily transmitted by contact of contaminated hands, fingers, or fomites with the conjunctiva or nasal epithelium. Which is the characteristic of this virus?A. Member of paramyxoviridae(parainfluenza sama RSV)B. Member of Orthomyxoviridae (influenza)C. Has a positive sense single stranded RNA( coronaviridae, picornaviridae-coxaci sama rhino)D. Has a negative sense single stranded RNA (orthomyxoviridae, paramyxo, bunyaviridae)E. It is an enveloped virus (coronavirus) SLIDE DOKTER TITI SEMUA

6.Excluding influenza virus, which one of the following viruses is a common cause of acute respiratory disease? Yang lainnya gak ada di slida dr titiA.cytomegalovirusB.rotavirusC.varicella-zoster virus D.adenovirus(double stranded dna)E.papillomavirus

7. This virus is a single-stranded RNA orthomyxovirus. In the developed countries vaccination is necessary because of antigenic drift and shift.A. Measles virusB. Influenza virusC. RSVD. Parainfluenza virusE. Adenovirus (DNA)

8. A 62 yo male who had influenza a week earlier reported to the emergency room with a 38,5oC fever and shaking chills, a productive cough with a yellowish sputum, and chest pain. CBC revealed 30.000/mm3 WBC, predominantly PMN. The result of sputum culture revealed H.influenza. The virulence of H.influenza, the most likely target would be :A. Exotoxin liberatorB. Endotoxin assemblyC. Flagella synthesisD. Capsule formationE. IgA protease synthesis(di slidenya dr titi ada dua duanya)

9. What media that should be used to inoculate sputum specimen from that patient above to grow H. Influenza? Slide dr titiA. Blood agarB. Lowenstein jensen mediaC. Mac Conkey agarD. Chocolate agarE. Loeffler media

10. A 21 yo college student complained of malaise, low-grade fever, and harsh cough, but not of muscle aches and pains. An xray revealed a diffuse interstitial pneumonia in the left lobes of the lung. The WBC count was normal. The student has been ill for a week. The bacteria have a characteristic that doesnt have cell wall. Based on the information given, what is the etiologic agent that causes the disease? Di slide, katanya lack of cell wall, paling kecil paling simple butuh kolesterol, pathogen hanya pada mucus membraneA. Mycoplasma pneumoniaB. Chlamydia pneumoniaC. Staph aureusD. Legionella pneumophilaE. Streptococcus pneumonia

11. A 25 yo man known to have AIDS developed a gradual onset of malaise and anorexia. An acid fast bacilli from sputum is identified microscopically. M. tuberculosis can be found in the sputum of patients with tuberculosis. After digestion of the sputum, isolation is best accomplished using bisa juga ogawa dan middlebrookA. Sheep blood agarB. Loffler's mediaC. Thayer-martin D. Thiosulfate citrate bile salts sucrose mediumE. Lwensteinjensen medium

12. What is theimportant characteristic of cell wall structure of acid fast bacilli? patpatA. Has a high content of lipopolysaccharideB. Outer membrane contain lipotechoic acid (s.pneumoni)C. Has no peptidoglycan, so that, bacteria resistent to antibioticD. The presence of mycolic acid and lipoarabinomananE. Has polysaccaride capsule as attribute of pathogenicity

13. The structure of M. tuberculosis that potentiate the toxicity and promote intracellular survival by inhibit the phagosome-lysosome fusion in the macrophage is (ada 2,sulfatide sama cord trehalose micolate-inhibit nuthrophil dan granulomatous formation)A. Mycolic acidB. Wax DC. SulfatideD. LipopolysacarideE. Lipoteichoic acid

14. A 25 yo male with previous rhinnorhea, pharyngitis cough, visit the doctor with a 39* fever which appears abruptly after a sudden shaking chill episode. He has a chest pain and productive cough. X-ray shows diffuse lobar consolidation of the right lung. Sample from sputum was cultured, and the bacteria isolated was Streptococcus pneumonia. What is the positive test to identify this bacterium from colony on blood agar?A. Beta hemolysis on blood agar (gabhs-pyogens)B. Sensitive to optochin bisa sama inulinC. Require ofX & V factor (h.influenza)D. Resistent to novobiocin (stapylococcus saphropyticus)E. Catalase positive(stapylococci)

15. Which of the following statement about respiratory tract mycosis is correct? ADA DI SLIDE LAGIIIIIIIIIIIII (mycosis = penyakit karena jamur)A. A group of superficial mycosis (dia deep)B. Only caused by opportunistic fungi (mestinya gak only)C. The true pathogenic fungi is is dimorphic fungiD. Cannot be diagnosed by laboratory examination (sebenernya bisa) gak ada di slideE. Also called dermatophytosis

16. A 37 yo man presence to the office for the evaluation of cough and fever. He has had these symptoms for about a week. His pulmonary examination is notable for some taint expiratory wheezing and crackles in the left upper lung field. A culture from respiratory specimen grows on saburoudagarrepresent a rough walled of round macroconidia and microconidia. A. HistoplasmacapsulatumB. Coccidioidesimitis (arthroconidia)C. Aspergilusfumigatus (hifa, rarely have conidia-asexual fungal spore)D. Cryptococcus neformans (pseudohifa)E. Paracoccidioidesimitis

17. A 65 yo patient with diabetes and difficulty in breathing was asked by pulmoologist to go to microbiology laboratory for microbiological examination of sputum. The sputum specimen was thick and bloody. The colony yield heavy growth of a lactose positive, non motile, gram negative rodwith large capsule.mWhich of the following bacteria with those characteristic is to be the cause of the pulmonary problemA. Enterobacterpneumonia (lower respi tract)B. Klebsiellapneumonia (URT,endocarditis, CNS)C. Mycoplasma pneumonia (gak punya capsule)D. Clamydophiapneumonia (virus like, small obligate parasitic)E. Legionella pneumophila (gram -, rod, katalase positive)

18. An 11 yo girl came home from school because she had a high fever and complained of difficulty of swallowing any food. Her parents noted that several children from her school had reported sore throats recently. Throat swab was taken for culture, the bacteria was gram positive cocci in chain, yields clear, sharp beta hemolysis on blood agar, sensitive to bacitracin.Of the organisms list below, which one is the bacteria that cause the disease?A. Staphylococcus aureusB. Staphylococcus saprophyticusC. Streptococcus pyogenesD. Streptococcus pneumoniaeE. Streptococcus viridans

19. Gas exchange between pulmonary airways and pulmonary blood happen duringA. Inhalation, because the alveoli retract during exhalation B. Inhalation, because at this time oxygen level of the airways is still highC. Inhalation, because at this time the alveolar surface area is greatly expandingD. Inhalation, because at this time the alveolar air pressure reacheas its peakE. Exhalation and inhalation, because at this time the alveoli do not appreaciably change in size

20. What is the effect of 2,3 DPG to the affinity between oxygen and hemoglobin? supaya rbc bisa masuk body tissueA. Increase it, because oxygen is needed to synthesize 2,3 DPG (decrease)B. 2,3 DPG has no effect on the affinity between oxygen and hemoglobinC. Decrease it, because 2,3 DPG replace O2 at the hemoglobin molecule (ngubah hbnya)D. Decrease it, because 2,3 DPG stimulates the changing of hemoglobin shapeE. Decrease it, because 2,3 DPG stabilize hemoglobin in the T (deoxyhemoglobin) form

21. Which of the factors can increase the affinity between O2 and hemoglobin?PO2, DPG, PH,PCO2A. increase of CO2 tensionB. increase of body temperatureC. increase of hydrogen ion levelD. increase of erythrocyte glycolysisE. increase of O2 atmosphere pressure22. If the PO2 of blood that enter the lung is 40 mmHg and PO2 of the alveoli air is 104 mmHg, then PO2 of blood that leave the lung must be:A. more than 104 mmHg because O2 move from the higher pressure to the lower pressureB. 104 mmHg, because the blood uptake of O2 is aiffusion processC. between 40 to 104 mmHg, because not all blood vessel of the lung is used during breathingD. Between 40 to 104 mmHg, because blood from pulmonary veins is diluted by blood from bronchial veinsE. Between 40 to 104 mmHg, because the blood passes the lung only in a short time so there is not enough time to saturate it completelyChoose one of the most appropriate answers from these options below :A. Respiratory acidosisB. Metabolic acidosis bisa karena Diabetes, hypercholeremic, lactic acidC. Respiratory alkalosisD. Metabolic alkalosisE. Normal blood P H23. Mostly can be happened in the presence of excess CO2 in inspired airA

24. Happened in healthy person that participate a 10 kilometers marathon B

25. Hyperventilation due to panic syndromeC

26. Decreased alveolar ventilation in emphysema due to COPDA

27. Which of the following statements related about bronchioles?A. are a major site of gas exchangeB. contain no smooth muscle in their walls therefore significantly reduce air way resistanceC. contribute to more than 50% of resistance to flow in their lower respiratory tractD. contain of fibroblast which secrete highly proteinaceous fluidE. differ from bronchi which contain cartilage in their wall28. Which of the following statements related to mucosal lymphoid tissue in the respiratory tract? A. non capsulated lymphoid tissueB. mostly lymphocytesC. activated lymphocytes will not home bachy to respiratory mucosaD. within the upper respiratory tract make up waldeyers ringE. it is a major site of monocytes activation in the airways29. Which of the following statements related to emphysema?A. diffusion of O2 is decreased due to destruction of the lung parenchymaB. over 10% of cases have 2 antithrypsin deficiency C. surface for gas exchange is increased D. reducing airway resistance E. patient develop of febroticf lung30. A newborn infant was observed choking and continues coughing. There was and excessive amount of mucus secretion and saliva in the infant mouth and the infant experienced considerable difficulty in breathing. Which one of the congenital anomaly was occur?A. Olygohydramnion of the lung developmentB. Tracheal StenosisC. Tracheooesophageal FistulaD. Oesophageal agenesisE. Tracheal difeticulum31. which one the embryological most common locations of this defect?A. Superior part esophagus and tracheaB. Inferior part oesophagus near tracheal difurcationC. In the middle part oesopgush and trachealD. Upper part of tracheaE. Upper part of oesophagus (langeman)32. premature infant developed rapid shallow respiration shortly after died was diagnose respiratory distress syndromeWhich one usually cause RDS? Karena surfactantA. Incapable type 1 alveolar producing hyaline proteinB. Incapable type 2 alveolar producing surfactantC. Suggested prolonged extra uterine asphixhyaD. Occur in premature infant undleE. Incapable the lung function33. the role of the human sinuses is very significant in daily life. Which od the following statement is the correct embryological development of the sinusesA. Paranasal sinuses develop during late fetal lifeB. The maxillary sinuses grow rapidly and fully developed before all the permanent teeth have eruptedC. The two most posterior ethmoidal cells grow into the frontal bone, forming a frontal sinus on each sideD. Paranasal sinuses form from outgrowth of the walls of the nasal placodeE. The maxillary sinuses are present at birthsamaethmoid34. the exchange of gases between alveolar capillary blood and alveolar cavity is a process of: oxygen simple diffusion, kalau lewat membrane (basal membrane) namanya paracellular transportA. Paracellular diffusionB. Simple diffusionC. Active transportD. Facilitated diffusionE. Antiport transport system35. thesplanchic mesoderm in the respiratory system will develop which of the following component cartilago sama muscleA. BoneB. Epithelium tissueC. Striated muscle tissueD. GlandsE. Connective tissue36. which of the following type of epithelium cells lining most of the respiratory portion of the respiratory system?A. Ciliated psedostratified columnarB. Simple columnarC. Simple cuboidalD. Stratified squamousE. Simple squamous37. within the lamina proprialia a number of cartilages. The large cartilages are hyaline, and the smaller cartilages are elastic. Which of the following is most likely tube?A. LarynxB. TracheaC. Primary bronchiD. Secondary bronchiE. Bronchioles38. the first part of respiratory portion of respiratory system:A. BronchiB. BronchiolesC. Terminal bronchiolesD. Respiratory bronchiolesE. Alveolar ducts39. thisintralobular airways have neither cartilage nor glands in their mucosa. In the larger part the epithelium is ciliated psedostratified columnar. Which of the following is most likely tube?A. BronchiB. BronchiolesC. Alveolar ductD. Terminal bronchiolesE. Respiratory bronchioles40. the smaller portion of this respiratory track is lined by cuboidal epithelium and contains Clara cells. Which of the following is most likely tube?A. Respiratory bronchiolesB. Terminal bronchioleC. Alveolar ductD. Alveolar sacE. Alveoli 41. These tonsils are located in the lateral walls of the oral part of the pharynx. Which of the following epithelial cells that covered external surface of these tonsils? Karena di orala. stratified squamous epithelium non keratinizedb. stratified columnar epitheliumc. stratified cuboidal epitheliumd. simple columnar epitheliume. respiratory epithelium

For question number 42 and 43, refer to the scenario below :A 17 years old man was brought to the emergency department due to sports injury. He was guarding the goalpost when suddenly the ball was kicked right in his faces direction and he couldnt avoid it. His nose was bleeding profusely, and bent. After the doctor performed maneuver to his nose, the shaped return to normal.

42. Which of the following structure most likely cause the difference in his nose shape?a. the septal cartilageb. the alar cartilagec. the cribiform cartilaged. the vomer cartilagee. the nasal bone

43. Which of the following artery most likely cause the bleeding? Posterior bleeding karena profuselya. opthalamic arteryb. internal carotid arteryc. superior ethmoidal arteryd. sphenopalatine arterye. facial artery

44. A 2 year old girl brought to the emergency department by her parents. They said that their daughter had been playing with beads, and one of the beads was stuck inside her nose. They had tried to take it out, but was unsuccessful. They asked you for assistance.Where is the most possible location of the logged bead? a/ba. between nasal septum and the conchaeb. between the middle and inferior conchaec. in the sphenoethmoidal recessd. passed the choanaee. in the vestibule

45. A 20 year old man has been diagnosed with sinusitis and asks her physician why there is nasal discharge during the night but not during the day.Which of the following is the most suitable explanation?a. Disruption of drainage due to masticationb. Location of the ostia within the nasal passagec. The sinus most likely affected is the maxillary sinusd. Diurnal mucus production increases at nighte. Location of the ostia within the eusthacian tube

46. Which of the sentences below is TRUE regarding the sphenoid sinus?a. it is located in the body of sphenoid, directly inferior sellaturcicab. it is located on the greater wing of sphenoid. The sinuses separated by the sellaturcica (frontal, seperatenya gaks ama itu juga)c. it is drainage located in the middle meatus, in the groove of semilunar hiatus (maxillary sinus)d. it has multiple cells, collectively called the sphenoidal bullae (gak punya bullae)e. it is supplied by the sphenoidal artery (harusnya ethmoidal)

47. A 20 year old male come to you complaining of purulent nasal discharge for 2 weeks. He stated that the discharge is foul smelling, and most particularly disrupting during bed time.Upon transilluminationexamination, you found the glow decreased inn both sides. The sentence below is TRUE regarding the affected sinus above:a. The frontal sinus. Located in the frontal bone, innervated by branches of CN V1 (keliatannya dikit)b. The maxillary sinus. Its base forms the inferior part of the lateral wall of nasal cavityc. The ethmoid sinus. Its anterior cells drains into the middle nasal meatus via the semilunar hiatus.d. The sphenoid sinus. Itsostia located higher that the antrum, making drainage only possible in certain position.e. The frontal sinus. Formed during childhood. Supplied by branches from opthalamic artery.

48. A 30 years old female had complaints of uncomfortable feeling in the ear and decrease hearing right after her plane landed. Push = levator, pull=tensor (moore)What structure is responsible to relieve the complaint above?a. The tensor velipalatini muscle that pulls the opening of pharyngotimpanic tube in middle earb. The levatorvelipalatini muscle that pulls the opening of pharyngotimpanic tube in middle earc. The tensor velipalatini muscle that pulls the opening of pharyngotimpanic tube in nasopharynxd. The levatorvelipalatini muscle that pulls the opening of pharyngotimpanic tube in nasopharynxe. The tensor tympanic muscle that pulls the opening of pharyngotimpanic tube in middle ear

49. A 15 years old boy status post tonsillectomy for recurrent tonsillitis complicated by increased intraoperative bleeding and temporary loss of taste sensation from the posterior one third of the tounge.Why was there a temporary loss of taste sensation?a. Compression of grater palatine nerveb. Compression of pterygopalatine nervec. Compression of glossopharyngeal nerve (CN IX)d. Compression of medial pterygoid (CN V3)e. Compression of vagus nerve (CN X)

50. An 8 year old girl was brought to the clinic because of the decrease hearing. Her parents said that for the last 2 weeks shes been breathing through her mouth. This is her third time visiting doctor for the same complain for the year.The ENT doctor told suggested to performs adenoidectomy and tonsillectomy.Which structure should be closely monitored in order to prevent complication? (moore box biru) yang sering= large external phalatinea. Ascending pharyngeal arteryb. Ascending palatine arteryc. Descending palatine arteryd. Superior laryngeal arterye. Tonsilar branch of facial artery (tonsillectomy), katanyakalau adenoidectomy itu yang a

51. A group of medical student was observing respiratory tract on a dissected cadaver. Upon observing the neck, they found a structure anterior to the esophagus on the level of C3-C6 vertebrae.Which one of the following is the characteristic of thyroid cartilage?a. Shaped like a signet ring with its band facing anterior side (cricoid)b. The largest cartilage. Paired on either halves of the posterior part of laryngeal inlet (mestinya single)c. Located between the bases of the arytenoid cartilages and the superolateral surfaces of the lamina of the cricoid cartilaged. The inferior two thirds of its two plate-like laminae fuse anteriorly in the in the median plane to form the laryngeal prominence e. A heart-shaped cartilage cartilage covered with mucous membrane. Situated posterior to the root of the tongue (epiglotis)

52. From the sentence below, which one is true regarding the larynx?a. Infraglottic cavity lies inferior to the laryngeal inlet, superior to the vocal apparatusb. Laryngeal vestibule is another name for laryngeal ventricle. Located between the vestibular folds and the vocal folds c. The movement of vocal apparatus is a result of intrinsic laryngeal muscle contractionsd. Supplied by the laryngeal artery that arises directly from external carotid arterye. Innervated only by superior laryngeal nerve. A branch of vagus nerve (CN X)

53. A 25-year-old woman complaining of losing her voice after she had surgery that removed her thyroid glands.What structure is most likely affected in the surgery and cause the above symptoms?a. The vagus nerveb. The recurrent laryngeal nervec. The inferior vagal gangliond. The superior laryngeal nervee. The glossopharyngealnerve

54. A 44-year-old man was brought to the emergency department complaining that he accidentally nhaled peanut. Upon radiological examination of the chest, the peanut was found slightly upward on the right side of the chest.Why foreign bodies would most likely lodged there?a. Beacaue the caliber of the right main bronchus is larger than the tracheab. Because the right main bronchus is relatively steeper while the left one has more horizontal coursec. Because the right main bronchus has 3 secondary branchesd. Because teh left main bronchus is compressed by the passing aortae. Because the carina was very sensitive and usually initiate cough reflex

55. A 37-year-old man brought to the ER because of rapid and breathing difficulty. His family brought him to the hospital directly after he fell from 5 m pole in the independence day game. The doctor examined him, and found his trachea was deviated.Which is the most appropriate sentence regarding the windpipe?a. Extends from the base of the pharynx into the posterior mediastinumb. Has full ring cartilages to keep its lumen openc. Innervated by the branch of CN XId. Started at level C6 vertebrae to T4-T5 IV disce. Lies posterior to the esophagus

56. A 17-year-old male was brought to the emergency department because of severe breathlessness. Moments before his symptoms occurs, he had fallen from the tree after attempting to rescue his lost cat. After underwent primary survey and needle thoracostomy through physical examination was performed. He was diagnosed with tension pneumothorax and fractured 3rd-4th ribs.a. Intercostal arteries is less likely to be source of bleeding compared to branches of pulmonary arteryb. Pain is more likely caused by the tear in the visceral pleura, carried by the branches of vagus nervec. The tear in the pleura caused air to enter the potential pleural cavity, making its pressure fall below atmospheric pressure, thus making breathing impossibled. Fractured ribs most likely punctured the visceral pleura that lined the inner aspect of thoracic cavitye. Needle thoracostomy should be done rightly above the rib to avoid the nerve and blood supply that runs inferiorly to the ribs

57. Which of these sentences is correct? Nociceptive barengan sama symphatetica. The lungs has 3 lobes on the right and 2 lobes on the left. Each of the lobes divided by the horizontal fissure b. The lung located in the thoracic cavity. The heart carved the right lung into having cardiac notchc. The lungs are innervated by branches of vagus nerve, thus making it highly sensitive to paind. The lung has 3 borders and 3 surfaces. Its costal surface is concave and indented with ribs shape, while its mediastinal and diaphragma surface is convex e. The lung attach to its root, at the hilum. The structure that passes through are pulmonary artery & veins, the main bronchi, bronchial veins, and lymphatics

58. A 65-year-old women come to you with complains of difficulty of breathing. The complain has been going on for a month and getting worse by the night when shes lying down. You suspected that she has pulmonary edema.In order to confirm your hypotheses, you need to listen to her breath sound. Where should you place your stethoscope to hear the loudest for the breath sound anomaly?a. On posterior chest, between the vertebrae and the scapula, at the level of T5b. On posterior chest, at the tip border of scapula at the level of T10c. On anterior chest, between the clavicle and the ridge of trapeziusd. On anterior chest at the level of 2nd ICS on the midclavicular linee. On anterior left chest at the level of 4th ICS, right above the heart

59. You are medical intern at a public hospital. You were following your supervisor as he make rounds at hospital wards. Your supervisor is performing physical examination on the chest of a 60-year-old man with COPD. He was palpating the notch below the neck, in the middle of upper thorax, and then proceed 5 cm below. He said he found bony prominence and them move slightly lateral to either side.What would most likely to be found?a. Another bony prominence, a mark of xyphoid processb. A bulk of mass from overused external intercostal musclec. A groove, widening 2nd intercostal spaced. A round prominence marked by darker skin appearance, the nipplese. Another bony prominence, mark the costo-sternal joint

60. On cadaver dissection, you found intersecting muscle in the anterior part of the thorax. The muscle attached from lower end of one rib, to the upper part of the ribs below it.What is the characteristic of external intercostal muscle? Ex: expirasia. Most actively involved in expirationb. They elevate the sternum during inspirationc. They run inferolaterally towards the sides of the thoraxd. Together with the internal intercostal occupy the intercostal space, with external intercostal lying deeper than the internal e. They occupy the intercostal spaces from the tubercles of the ribs posteriorly to the costochondral junctions anteriorly

61. The relaxed expiration doesnt depend on muscle work BECAUSE Main action on expiration occurs from elastic recoils of the lung and relaxation of diaphragm.What is the correct relationship between the two sentences above?a. Both sentences are correct with causal relationshipb. Both sentences are correct but no causal relationshipc. The first sentence is correct while the second is falsed. The first sentence is false while the second is correcte. Both sentence are false62. In a 65 years old woman with difficulty breathing, the total lung capacity and functional residual capacity and functional residual capacity are lower than normal and FEV1/FVC slightlyhigher than normal. Whats the most probably mechanism that happen on that condition?a. Decreased pulmonary blood flowb. Decreased strength of the chest wall musclec. Increased airways resistance : soalnya air trapping, jadiresidunyameningkat, d. Increased lung elastic recoil e. Increased chest wall elastic recoil63. A patient has reduced total lung capacity and increased residual volume. Functional residual capacity is normal. Whats the most probably mechanism that happen on that condition?a. Decreased pulmonary blood flowb. Increased airways resistance c. Decreased strength of the chest wall muscle of respirationd. Increased chest wall elastic recoile. Increased lung elastic recoil64. A chest x-ray of patient with left-sided heart failure indicates pulmonary edema. Whats the most probably additional examination that would reveal in this patient?a. Decreased pulmonary artery pressureb. Decreased pulmonary lymph flowc. Increased pulmonary venous pressured. Normal arterial oxygen partial pressuree. Normal vital capacityObstruktif :contohnyaasma, tapimasuknyamasihbisamasihbagus, CumakeluarkeluarnyasusahRestriktif :gabisamengembang, jadigabisamasukgabisakeluar. Fibrosis gtu, myasthenia gravis, gabisangembang.65. A newborn infant with a deficiency of pulmonary surfactant probably will need to utilize the muscle to have an adequate respiration. Which of the following muscle to accomplish that condition? (inspirasi supaya alveoli gak kolaps)a. Diaphragm, internal intercostal, scalene, sternomastoidsb. Diaphragm, internal intercostal, scalene, sternomastoids, rectus abdominisc. Diaphragm, internal intercostal, external intercostal, sternomastoidsd. Diaphragm, external intercostal, scalene, rectus abdominise. Diaphragm, external intercostal, scalene, sternomastoids66. In a patient with difficulty breathing, total lung capacity and functional residual capacity are greater than normal, and forced vital capacity (FVC) and FEV1/FVC are lower than normal. Whats the most probably mechanism that happen on that condition?a. Decreased lung complianceb. Decreased strength of the chest wall musclec. Increased chest wall compliance d. Increased airways resistencee. Decreased chest wall compliance67. A 68 yo woman with pulmonary fibrosis, who presents with a complaint of increase dyspnea while performing activities of daily living is referred for pulmonary function testing. Which is the following laboratory values is consistent when her diagnosis?Restriktifyaniiihhh (ekspansi alveoli turun, lung volume capacity turun, menurunkan ventilation sama oxygenation, effort breathing naik) restrictive FEC turun, FEV=obstruksia. Decreased diffusing capacity of the lungb. Increased residual volumec. Decreased FEV1/FVCd. Increased lung compliancee. Increased airways resistence corrected for lung volume68. A 125-lb, 40 yo woman with a history of nasal polyps and aspirin sensitivity since childhood presents to the ED with status asthmaticus and hypercapnic respiratory failure. She requires immediate intubation and is placed on mechanical ventilator on a FiO2 of 40% a control rate of 15 breaths/min and tidal volume of 500 mL. How much is her approximate alveolar ventilation?15 x 350 = 5250a. 375 mL/minb. 3500 mL/minc. 5250 mL/mind. 5625 mL/mine. 7500 mL/min69. A 68-year old male with chronic obstructive pulmonary disease entered the EmergencyDepartment complaining of shortness of breath. His resspirations were 35 per minute and labored. He had a productive cough and rales were heard over lung fields. The patient had a rather ashen complexion and his nail beds gave clear evidence of cyanosis. An arterial blood sample was obtained and chest x-ray was ordered. The patient was then placed on an O2 mask delivering 40% O2. One half hour later, the patient found unresponsive. His complexion had changed to flushed pink with no trace of cyanosis. His respiraton were quiet at rate of 6 per minute and a tidal volume of 300 mL. Repeat arterial blood gases showed that his arterial PCO2 had increased from 55 to 70 mmHg.What is the most probably mechanism that happen on that patient?a. Alveolar hypoventilationb. Hypoxic pulmonary vasoconstrictionc. Increased firing of carotid body chemoreceptorsd. Elimination of the hypercapnic drivee. Oxygen toxicity70. oxygen-carrying capacity of whole blood is:a. department on the alveolar PO2b. the amount of O2 dissolved in the bloodc. the sum of the dissolved O2 plus the amount bound to hemoglobind. the sum of the dissolved O2 plus the amount of O2 bound to hemoglobin under saturating conditionssoalnyakaitandengan po2 dan sat o2. Jadiharus tau seberapajenuhhbsamaoksigene. Limited by O2 diffusion71. the lung function test of a patient show a markedly reduced FEV1 sec and functional residual capacity of 4.2 L. Which is the following statement that the most likely cause of the reduced FEV1sec?a. weak respirator muscleb. small diameter Airwaysc. pulmonary congestiond. pulmonary fibrosise. dynamic compression of Airways

72. Mr.Smith complains of short of breath and dfficulty with moderate exercise. Pulmonary function test indicate a reduced FRC, and his FEV1 sec was 2.6 L (78%). His Force vital capacity was 3.1 L (70%). What is the most likely cause of Mr.Smith problem?a. weak respirator muscleb. small diameter Airwaysc. dynamic compression of Airwaysd. pulmonary fibrosise. pulmonary congestion

73. a 36 y.o woman undergoes chemotherapy with bleomycin for an ovarriann germ cell cancer. She develops mild pulmonary fibrosis to the chemotherapy. Which agents diffusion across the alveoli-pulmonary capillary Barrier would be most likely to be afffected by her disease?Krnkoefisiendifusi O2 jauhlebihrendah, terus moa obatnyamembutuhkanoksigen, terusada fibrosis lagi, jadimakinparaha.COb.CO2C.N2OD.O2

74. the 25 y.o woman poisoned with carbon monoxide. The carbon monoxide can bind with hemoglobin and affected the oxygen binding capacity. What is the condition that decreased PO2 in the arteial nblood of this patient?a. dependent on alveolar PO2b. dependen on the amount of CO2 bound to hemoglobinc. increased from normal because of dissociated ooxygen from hemoglobind. reduced from normal because of the CO bound to hemoglobin

75. which factor that can inhibit O2 binding to hb in the pulmonary capillary?a. CO2 dissociation from hbb. diffusion of CO2 from pulmonary cappilary to alveolarc. reduction of bicarbonate wit H+d shift to more acidic pH that it found invenous blood

76. a 47 week gestation infant is develop respiratory. What is the most probably mechanism that will occurs with his First diaphhragmatic respiration?a. paO2 increaseb. pulmonary vaskular resistance is increasec. pulmonary cappilary hydrostatic pressure increasedd. syystematic vascular resistance decreasee. all of the fetal vascular channel functional Close

77. a 24 y.o present with sigi of hypoxia. Arterial blood gases reveal that the PaO2 is normal but the arterial O2 saturation is reduced. Which is the most likely cause of this patient condition?a. anemiab. a low V/Q ratioc. carbon monoxide poisoningd. hypoventilatione. righ to left Shunt

78. a 70 y.o man admitted with chief complaint shortness of breath, cough, and yellowish sputum. History DM +, physical examination: RR 30x/min, T:38.0 C, BP: 130/80 mmHg, ronchi +/-, wheezing -/-, blood glucose 276 mg/dL, chest x-ray: infiltrate + . There is no history of hospitalization previously. Which of the following describes most accurately about physiological peculiarities found in the case above?a. the alveoli are filled with fluid due to increased hydrostatic pressureb. the total surface area of respirator membran is decreasedc. the content of carbon dioxide in the blood will be decreasedd. the physiologic dead space also become decrease

79. a result of ABG analysis of 25 y.o pneumothorax patient: pH:6.971, pCO2:71.4 mmHg, pO2: 97.4 mmHg, HCO3:32.1 mEq, BE: +2.8, O2 saturation 96.4%. these findings suggest homeostasis in preserving gas exchange to fulfill metabolism demand. Related to the case above, in the normal condition on the other hand, the negative pressure in the pleura space is allowed through which of the following factor?a. strong and continuous alveolar epitheliumb. pumping of fluid from pleura space by lympathicsc. collection of large amounts of fluida in the pleura spaced. hydrostatic pressures at the capillarye. osmotic Force at the alveolar membran of the lungs

80. once you were on duty in emergency rol a 5 y.o girl patient was taken by her prents with chief complaint stridor since 2 days ago. Her parents also complained about sore throat, fever difficulty on swallowing and breathing. Three was no cough and she was unable to control her own saliva and began to drool.Result from the physical examination are:The child sat upright in a bent-forward position. The jaw was open and drooling was frequently present. She presented a hot potato voice, suprasternal retraction and inspirator stridor.Radiological findings:From sofa tissue neck radiograph: thumb sign appearance, chest x ray: within normal limit. Related to thhe case above, which of the following decribes most accurately about the functions of the respirator passageways? EPIGLOTITISa.all passageways have cartilage to keep them from collapsingb. all of the passageways are surrounded by smooth musclesc. in obstructive diseases all of the passageways are constrictedd. the greatest amount of resistance to airflow occurs in alveoli (di upper)e. in disease condition, the smaller bronchiles determine resistance

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

For questions number 82 83: A 36yo man came to clinic to control his pulmonary TB. He felt better, but still uncomfortable with the red sweat. He also failed to get driving license because he could not pass the Ishihara blind test. He felt strange because he always passed this kind of exam before. He is a public transport driver. He is currently in the 4th week of 1st category TB therapy.

82. WOTF is the most appropriate regiment for this patient? Karena ada masalah mata jadi gak pake Ethambutola. 2HRZEb. 2(HRZE)Sc. 2HRZ/4(HR)3d. 2(HRZE)S/HRZEe. 2(HRZE)S/HRZE/4(HR)3

83. WOTF should be avoided in this patient?a. Isoniazidb. Rifampicinc. Ethambutold. Pyrazinamidee. Streptomycin

84. A 27yo woman came to primary health care with hemoptoe. She was diagnosed with lung TB a few months before her pregnancy. She said she had 1 month of continuation phase therapy using R and H before stopping the treatment because she was afraid it might harm her fetus. One week ago, she delivered a healthy baby.WOTF is the most appropriate regiment for her initial phase? Cat 2a. RHZb. 4RHc. 5(HR)3E3d. 2RHZESe. 2(HRZE)S/(HRZE)

85. A 48yo man was diagnosed with acute pharyngitis and was given erythromycin, ibuprofen, and bromhexim by another doctor two days ago. Yet, he complains of diarrhea and vomiting that he has been suffering since yesterday. His medication has already been used up.WOTF is/ the most appropriate thing to deal with his complaint?a. Change ibuprofenb. Change bromheximc. Change erythromycind. Give antacide. Continue the medication wit additional drug for his complaint

86. A 38yo man was presented to the ER due to shortness of breath. He has been feeling that symptom since this afternoon after he took propranolol for his palpitation. He got the drug from another doctor in a clinic this morning. You give him theophylline 300 mg 2x1. If the patient has a liver dysfunction, why should you change the treatment?a. Toxicity potencyb. Reduction of efficacyc. Increasing of clearanced. Progression of liver diseasee. Shortened duration of action

For number 87 to 89:A 60yo man with history of smoking for > 20 years (2 packs a day) complained of cough, dyspnea, and wheezing. His symptoms have become severe that his family brought him to the ER. PE revealed diaphoresis, dyspnea, tachycardia, and tachypnea. RR 30/min, PR 112 bpm, BP 130/60 mmHg.For each statement below, choose the most appropriate drug from the following list:a. inhaled cromolynb. inhaled salbutamolc. oral/IV methylprednisoloned. inhaled ipraptropium bromide (brochodilator)e. IV propanolol

87. the most appropriate drug as a rapid bronchodilatorB

88. the most likely drug to provide sustained resolution of the inflammatory symptoms C

89. a contraindicated drug for this patientE

For number 90 94:a. INH (isoniazid)b. Rifampicinc. PZAd. Ethambutol

90. This drug interacts with the -subunit bacterial DNA-dependent RNA polymerase and thereby inhibit synthesis of RNA B

For question 90-94A 36 yo woman came to your clinic complained that he had prolong cough, night swear, body weakness, loss of appetite and mild fever since two month ago. After taking history, physical examination and preliminary investigation, he is diagnosed with pulmonary TB. He is then placed on a four drug regiment consisting of INH, rifampisin, PZA, and ethambutol. For each of statement below choose the most appropriate drug from the following list:A. INHB. RifampicinC. PZAEthambutol

90. The drug interacts with the beta subunit bacterial DNA dependent RNA polymerase and therapy inhibits RNA synthesis B

91. The drug reacts with pyridoxine (B6) which can cause deficiency of this vitaminA

92. The drug inhibit the metabolism of phenytoin (anticonvulsant) A

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

94. The drug crosses inflamed meninges C

95. A 30 yo man complained dyspnea and fever. His symptoms became severe that his family brought him to the emergency room. Physical examination revealed respiratory rate was 32x/min, pulse rate was 112 beats per minute, temperature 40C, and blood pressure was 130/80 mmHg, with crackles in the inferior lobe of left pulmo. Others were within normal limit, Hb 12 g/dl, WBC 27.000/mm3. Chest x-ray showed inferior left lob infiltrate. He had history of penicillin and cephalosphorin allergy. The doctor which of the following drug of choice for this patient?A. Oral cefuroximeB. Oral azithromycinC. IV azithromycin 50sD. IV beta lactam + oral azithromycinE. IV beta lactam + IV azithromycin

96. A 4 yo boy present to emergency room with stridor, cough and slightly hard to breath. Physical examination revealed respiratory rate was 42x/min, pulse rate was 102 bpm, temperature 18C and suprasternal retraction. Others was within normal limit. Hb 12 g/dl, WBC 7000/mm3.Chest x-ray within normal limit. He had history of penicillin and cephalosphorin allergy. Which of the following drug the most appropriate for this patient?A. Erythromycin 1x/day (divide 2)B. Erythromycin 2x/dayC. Azithromycin 3x/dayD. Clarithromycin 1x/dayE. Clarithromycin 3x/day

97. A 15 yo girls came to the primary health care with problem difficulty in breathing. The problem occurred after she cleaned her room this morning. In physical examination, found wheexing during expiration. What do you think the etiology for her problem?A. FunggusB. Dust miteC. ViralD. BacteriaE. Microflora

98. The statement which is wrong related with the etiology is:A. Survive in all climate but mostly in humid conditionB. Well survive in carpetC. Prefer outdoor environmentD. Consume minute particle in organic matterE. Can be found in high altitude

99. One way to eradicate is:A. Maintaining humidity above 50%B. Exposing them to temperature above 30CC. Using abate powderD. Regularly cleaning and washingE. Sweep the carpet

100. A 60 yo man has a 5 month history of progressive weakness and a weight los of 13 kg along with intermittent fever, chills and a chronic cough production of yellow sputum. Culture of the sputum is positive for Mycobacteriom tuberculosis. Media for M. tuberculosis is:A. Mac ConkeyB. Horse Blood AgarC. Loeffler AgarD. Lowenstein JensenE. Kligler Agar

101. Staining for M Tuberculosis?A. Gram stainingB. Neisser stainingC. Ziehl Nelson stainingD. Giemsa stainingE. Negative staining

102. Criteria for reporting the level of M Tuberculosis according to IUALTD in staining:A. 1(+) if find >10 AFB/100 HPFB. 3(+) if find >10 AFB/HPFC. 1(+) if find 1-10 AFB/100 HPFD. (-) if find only 9 AFB/100 HPFE. 2(+) if find >10 AFB/HPF

103. 3 y.o develops Haemophilus influenza. Culture of nasopharynx swab specimen in blood agar with X and V factor. What is the morphology of this strain?A. Gram (+) cocciB. Gram (-) bacilliC. Diplococci gram (+)D. Diplococci gram (-)E. Cant stain by gram staining

104. For growth, H. influenza in blood agar with X and V factor. V factor contains:A. Folic acidB. Nicotinamide adenine dinucleotide : inimah XC. BacitrasinD. HemeE. Nicotinic acid

105. 2 y.o boy lives with his grandpa that has a chronic bloody cough since the last 4 months. The boy has poor weight gain, loss appetite, prolonged fever, and moderate malnutrition. Wotf diagnostic examination is likely to result in the correct diagnosis of this boy?A. BronchoscopyB. Tuberculin skin test and chest X rayC. Tuberculin skin test onlyD. Chest X ray onlyE. ESR

106. 16 month old girl with the 3 months history of weight loss, recurrent low grade fever with the tuberculin skin test 15 mm, and the chest X ray shows an enlargement of the hilar lymph node, the nutritional status was moderate malnutrition. The most likely diagnosis of this patient is:A. Lymphadenitis TBB. Latent TB infectionC. Pulmonary TBD. Miliary TBE. Pneumonic type TB

107. 13 month old boy came to pediatric clinic with chief complaint of a poor weight gain and a 3 weeks cough. Physical findings are moderate malnutrition, enlargement of the neck lymph node (confluent), looks tired. Tuberculin skin test was reactive with diameter of induration 17 mm, the chest X ray showed an infiltrate in bilateral perihilar. The appropriate treatment of this patient is:A. INH prophylaxisB. INH, rifampicin for 6 monthsC. INH, rifampin for 2 monthsD. INH, rifampicin, pyrazinamide for 6 monthsE. INH, rifampicin, pyrazinamide for the first 2 months and INH, rifampicin for the following 4 months

108. 3 y.o boy without any clinical manifestations of TB, chest X ray examination within normal limit, tuberculin skin test was reactive. His father has been diagnosed as pulmonary TB with positive AFB in sputum. The appropriate prophylaxis management of this child is:A. INH and rifampicin for 2 monthsB. INH and rifampicin for 3 monthsC. INH for 6 monthsD. INH for 9 monthsE. INH for 12 months

109. The following answer is the component of scoring system for pediatric TB in Indonesias national TB program (NTP):A. Fever more than 1 week (2w)B. Cough more than 2 weeks (3w)C. (+) reaction of tuberculinD. (+) contact with other child diagnosed TBE. Palpable neck lymph node of 0.5 cm (1cm)

7 month old baby was brought to pediatric emergency with the chief complaint of difficulty in breathing since the last 3 days. The physical findings are tachypnea, chest indrawing, crackles, fever. Chest X ray showed a patchy infiltrate in the bilateral hemithorax.

110. the most likely diagnosis in this patient is:A. Lobar pneumoniaB. BronchopneumoniaC. BronchiolitisD. BronchitisE. Laryngotracheobronchitis

111. In case above, what is the initial management? (pokoknya IV) severe=benzil penicilin-panicillin=indrawing, very severe=clora, kalaugak mempan pake gentaa. Oral amphycillinb. oral macrolidec. IV gentamycind. IV amphycilline. IV ampicillin

112. An 11 y.o. gorl came to pediatric ER RSHS with a chief complaint of difficulty breathing and cough since the last 3 hours. Physical exam found wheezing, patient prefer in sitting position RR was 45/mnt. The most appropriate diagnosis of this patient is : severe=rest RR, PR, wheezinga. Mild asthma exacerbation : walking, can lie downb. Moderate asthma exacerbation : talking, infant = difficulty breathing, prefer sittingc. severe asthma exacerbation : hunchbreathingd. impending respi failuree. respi failure

113. initial management of the above case :a. inhaled corticosteroidb. inhaled ephinephrinec. inhaled SABAd. inhaled LABAe. inhaled anticholinergic

For question number 114 to 115, refer to scenario below :A 4-y.o. boy were taken by his parents to the emergency room with stidor since 2 days ago which becoming worse in time. The chief complaint was accompanied by sore throat, fever, that increasing gradually, difficulty of swallowing and breathing. On PE : fully alert, BP 95/60 mmHg, PR 110bpm, RR 42x/mnt, T 39.5 degree celcius. The child upright in a bent-forward position. The jaw was open and drooling was frequently present. He has a hot potatoe voice, supasternal retraction and inspiratory stridor. Lab test shows leukocytosis and from soft tissue neck. Radiograph seen thumb sign appearance

114. WOTF structure that inspiratory stridor most likely would be expected to lie with lesion?a. adenoid areab. lower one-third of the tracheac. right main stem bronchusd. nasal areae. glottic area : biphasic daninspratory stridor (sebenernya inspiratory stridor di sub glotic)

115. Medical management for this condition isa. not frequently effectiveb. directed toward more resistant bacteriac. usually targeted toward spesific bacteria and broad spectrum coverage is not warrantedd. universally effectivee. best provided with IV therapy

For questions number 116 to 117, refer to scenario below:A 50-y.o. man complaints dypnea, when he walks in arush. Complaints accompanied with cough and whitish sputum for the last 5 years. He is a heavy smoker, with a history of smoking about 30 pack/year cigarettes since he was 17 y.o. PE found CVS within normal limits. His body weight is 55 kg and height is 175 cm.

116. WOTF is the most likely condition?a. he needs more energy due to smokingb. he needs more energy due to increased work of breathingc. he needs more energy due to preserving fat massd. he needs more energy due to preserving visceral fat masse. he needs more energy due to preserving subcutaneous fat mass

117. what is teh most appropriate nutrition recommended?a. additional folic acid above Recommended Dietary Allowance (RDA) is necessaryb. additional vitamin C above Recommended Dietary Allowance (RDA) is necessaryc. Additional vitamin A above Recommended Dietary Allowance (RDA) is necessaryd. Additional vitamin B above Recommended Dietary Allowance (RDA) is necessarye. Additional vitamin B12 above Recommended Dietary Allowance (RDA) is necessary

For number 118 to 119, refer to the scenario below :A 35 y.o. came to your clinic complaining cough and dyspnea. He is known as a heavy smoker. During PE BP 120/80 mmHg, PR 120x/min, RR 30x/min, T 38.2 degree celcius, chest exam : barrel chest. BGA : pH 7.28, PaCO2 60, SaO2 90%

118.WOTF energy intake is the most appropriate ?a. Increasing energy needs with 65% calories from carbohydrate and 20% calories from fatb. Increasing energy needs with 60% calories from carbohydrate and 25% calories from fatc. Increasing energy needs with 50% calories from carbohydrate and 35% calories from fatd. Increasing energy needs with 65% calories from carbohydrate and 35% calories from fate. Increasing energy needs with 70% calories from carbohydrate and 30% calories from fat

119. Which of the most appropriate statement due to substrate metabolism use? RQ=buat BMRa. Respiratory Quotient (RQ) for carbo is 0.7, protein 1, and fat 0,8b. Respiratory Quotient (RQ) for carbo is 1, protein 0.8, and fat 0.7c. Respiratory Quotient (RQ) for carbo is 0.7, protein 0.8, and fat 1d. Respiratory Quotient (RQ) for carbo is 0.8, protein 0.7, and fat 1e. Respiratory Quotient (RQ) for carbo is 0.7, protein 1, and fat 0,7

120. WOTF statement is the most appropriate a. Respiratory Quotient (RQ) is the ratio of the volume of O2 expired to the volume of CO2 inspiredb. Respiratory Quotient (RQ) is the ratio of the volume of O2 inspired to the volume of CO2 expiredc. Respiratory Quotient (RQ) is the ratio of the volume of CO2 inspired to the volume O2 expiredd. Respiratory Quotient (RQ) is the ratio of the volume of CO2 expired to the volume of O2 inspirede. Respiratory Quotient (RQ) is the ratio of the volume of CO2

121. Which food intake method to avoid aspiration?a. Rest before eat meals, oral route, large portion of nutrient-dense food, proper sitting positionb. Deep nutrient food, proper sitting positionc. Rest before eat meals, parenteral route, small portion of nutrient-dense food, proper sitting positiond. Deep breathing during eat, oral route, small portion of nutrient-dense food, proper sitting positione. Rest before eat meals, oral route, small portion of nutrient-dense food, proper sitting position

122. Which of the following statement that most accurate nutrient intake?A. Caloric needs ranging from 94% to 164% of predicted range and protein needs ranging from 1,2 to 1,7 g/kg of body weightB. Caloric needs ranging from 80% to 90% of predicted range and protein needs ranging from 0,6 to 0,8 g/kg of body weightC. Caloric needs ranging from 80% to 100% of predicted range and protein needs ranging from 0,8 to 1 g/kg of body weightD. Caloric needs ranging from 60% to 90% of predicted range and protein needs ranging from 0,5 to 0,8 g/kg of body weightE. Caloric needs ranging from 90% to 110% of predicted range and protein needs ranging from 1,6 to 0,8 g/kg of body weight123. A 3 yo boy arrived in an emergency department with a 3-day history of left ear pain and a 5-day of common cold, fever. He has been seen by his primary care physician the day before and started on amoxicillin (40 mg/kg/day) divided three times a day 1 tea spoon. The patient had a history of recurrent otitis media requiring four to five courses of antibiotics per year since birth. Physical examination revealed alert boy with temperature of 39 C. Otoscopy shows tympanic membrane hyperemic on the left side.Which of the following is the most common organism causing acute otitis media? C, a, tp yg sering cA. Haemophillus influenzaB. Moraxella catarrhalisC. Streptococcus pneumoniaeD. Staphylococcus aureusE. Klebsiellapneumoniae124. Which of the following is middle ear contain? Abce dalem, A. Auriculotemporalis nerveB. Glossopharyngeal nerveC. SemicircularcanalD. The corda tympaniE. Utriculus

125. Plexus kiesselbachkecuali: +spenoidalA. SphenopalatineB. Inferior labialC. Greater palatineD. Superior labialE. Anterior ethmoid

126. Kasusrinosinusitis, what are the appropriate and latest diagnostic tools to see every aspects of this disease?A. Poste rhinoscopy and ct scanB. Translumination and sinus paranasal radiologic projectionC. Ct scan and transilluminationD. Nasal endoscopy and ct scanE. Water's and caldwell position radiology

127. What is the latest surgery for this disease?

A. Caldwell lucoperation : chronic maxillary sinusitis (19 century)B. Endoscopic sinus surgeryC. Anthrostomy washed outD. Ethmoidectomy intra anthralE. Turbinectomy reduction

128. Swelling in sublingual, submandibular, and submental, elevated tongue, and inspiratory stridor. Diagnosis:A. Peritonsilar abscessB. Retropharyngeal abscessC. Parapharyngeal abscessD. Ludwig anginaE. Danger space infection

129. What is the initial step in this condition ?A. TracheostomyB. Broad Spectrum Antibiotic :soalnya kata cipongdiamasihbengkak doing, belomada pus dllC. Incicion and drainageD. SurgeryE. Palliative

130. A 25 years old woman with chief complain bloody sputum. Two years ago has been treated by RHEZ, but only 8 week. What category of this patient?A. RelapseB. Treatment failureC. Treatment after interuption (after default)D. New caseE. Chronic case

131. A 62 years old man come to your clinic because he is concern about increasing shortness of breath. He complaint about cough and increased sputum production for the last 5 years. He smoked since of 15 years old and he stopped smoking since 2 years ago. His chest xray showed hyperinflation, flattened diaphragm, no infiltrate was found. Spirometricresult showed FEV1/VC 60% and FEV1 45% predicted, ECG tracing was normal.The PE which would not be found :A. CracklesB. Prolonged expiratory timeC. Wheezing during auscultationD. Hypersonor on percussionE. Purse-lip breathing132. A 20 years old man come to your clinic with chief complaint of cough and sputum more than 5 weeks. The complaints were accompanied by chest wall pain, low grade of fever and night sweating. He had taken antibiotic, but showed no improvement. Two specimens o sputum of FAB show positive. One year ago he had history of TB treatment for 2 months, and discontinued this drug because of felt better and cured. Chest x-ray showed lesion in upper parts of right lung. Which of the following is the Gold standard to assess respiratory failure ?A. BGAB. Chest x rayC. SpirometryD. CT scan thoraxE. Pulmonary angiography

133. A 65 years old male with COPD stage III and a woman 23 year old with asthma bronchial moderate persistent. Both were taken inhalation corticosterois. While the women gain improvement from this therapy the man is not. Possible explanation for this is : tnf a = alfa A. Gender difference between themB. Diference in ageC. Difference in spirometri resultD. Difference in risk factorsE. Difference in inflammatory cell and mediators

134. Exercise which is recommended in asthma is :A. Deep breathing exerciseB. Chest expansion breathing exerciseC. Strengthening diaphragmatic exerciseD. Strengthening muscles of extremitiesE. Aerobic exercise135. A 65 year old man comes to your clinic because he is concern about increasing shortness of breath. He complains about cough and increases sputum production for the last 5 years. He started to smoke at age 15 year old. His chest xray shows hyperinflation, no infiltrate founded. Spirometry result shown FEV1/FVC 60% and FEV1 45% predicted, ECG is normal.Which of the following treatment is NOT recommended for stage of this patients disease?A. RehabilitationB. BronchodilatorC. ICSD. Long term O2E. Influenza Vaaccination136. A man, 67 years old, complained cough with whitish sputum since about 2 years ago. His spirometer examination showed FEV1/FVC ratio was 65% and FEV1 is 82% from predicted value. Beside avoidance from risk factor and influenza vaccination, other medication for him is :a. Inhaled regular long acting 2 agonistb. Inhaled corticosteroid c. Rehabilitation d. Regular oral methylxanthyne. Inhaled short acting 2 agonist as needed

137. A male patient is suffering pulmonary tuberculosis. He is now in the second month of intensive phase of the treatment. Three days ago he began to develop vision disturbance. Which one of these drug is the most likely caused?a. Rifampicinb. Pyrazinamidec. Ethambutold. Isoniazidee. Combination ofisoniazide and rifampicin

138.Perry, an 18 years old previously healthy medical student come to you with difficulty in breathing. He began to feel this symptom 3 days ago. He also complained high fever, cough with yellow thick sputum. On physical examination chest movement was asymmetric, right hemithorax : tactile fremitus was increased and dullness on percussion and crackles was heard.The diagnosis of this medical student :a. Community acquired pneumoniab. Acute exacerbation of asthma exacerbationc. Empyemad. Acute exacerbation of copde. Health care associated pneumonia139. Mr. Sarpini, a 47-years old farmer complained cough for almost 2 months. Acid Fast Bacilis was found in his sputum smear. Two years ago he had been treated for lung tuberculosis and his doctorsdeclaired that he was cured.The current anti tuberculosis regiment for Mr. Sarpiniis :a. Streptomycin, INH, rifampicin, ethambutolb. Rifampicin, INH, ethambutol, pyrazinamide, streptomycinc. Rifampicin, INH, pyrazinamided. Rifampicin, streptomycin, ethambutol, pyrazinamidee. INH, pyrazinamide, ethambutol, ciprofloxacin140. Mr. PrakashPadukone is a 65-year old man, come to you with shortness of breath and cough with productive and thick sputum. On chest examination ypu found hypersonor and wheeze. Spirometri after bronchodilator showed FEV1/FVC was 56% and FEV1 was 42% of predicted value.Your diagnosis will be :a. COPD stage IIb. COPD stage IIIc. Moderate persistent Asthma bronchiald. Severe persistent asthma bronchiale. Mild asthma bronchial 141. Ms. Elsa is a 17 yo high school students came to you due to shortness of breath. She usually feels her SOB between midnight to early morning and she feels this about 3 times a week and sometimes accompanied with cough. Sometimes she was absent from school because of her symptoms.On chest examination you only heatd wheeze and others were within normal limits. The most likely diagnosis is :A. COPD stage IB. COPD stage IIC. Mild persistent asthma bronchialD. Severe persistent asthma bronchialE. Moderate persistent asthma bronchial142. A 67 yo complained cough with whitish sputum since about 2 years ago. His spirometer examination showed FEV1/FVC ratio was 65% and FEV1 is 82% fromm predicted value. Beside avoidance from ris factors and influenza vaccination, other medication for him is :A. Inhaled regular long acting 2 agonistB. Inhaled corticosteroidC. RehabilitationD. Regular oral methlxanthymE. Inhaled short acting 2 agonist is needed143. A 72 yo, known for years as a COPD patient. Recently his pulmonologist recommend him to add long term oxygen therapy in the treatment. The indications for long term oxygen therapy are :A. Pa02 below 55 mmHg or Sat below 88% with or without hypercapnia (GOLD)B. Pa02 below 65 mmHg or Sat below 88% with or without hypercapniaC. Pa02 below 60 mmHg without evidence of pulmonary hypertensionD. Pa02 below 60 mmHg without evidence of polycythemiaE. Pa02 below 65 mmHg without evidence of pulmonary hypertension144. Mr. X had been diagnosed as pulmonary TB patient since 4 month ago. And he received rifampicin, ethambutol, INH and pyrazinamide. 2 days ago he complained that he had vision disturbance. Which drug is the most likely cause?A. IMA (mungkinmaksudnya INH)B. RifampicinC. EthambutolD. PyrazinamideE. Combination of above drugs145. Anoxic condition which is important in Forencic Medicine is :A. Anemic hypoxiaB. Metabolic hystotoxic anoxiaC. Stagnant hypoxiaD. Hypoxic hypoxiaE. Extra cellular hystotoxic hypoxia146. Mechanical asphyxia s :A. Stagnant hypoxiaB. Hystotoxic hypoxiaC. Anemic hypoxiaD. Substrate hystotoxic hypoxiaE. Hypoxic hypoxa147. In cases of sea water drowning it is found : (slide asphyxia) air tawar=KA. HemodilutionB. Na Plasm increaseC. HemolysisD. K Plasm increaseE. Ventricular fibrillation148. In internal examination of drowning cases it is found :A. Cutis AnserinaB. Cadaveric SpasmC. Washerwoman hands (mati di luar)D. Tandieu Spot (slide) ptechie pleura epicardium dan timusE. Pseudo Foam149. The common cause of death in fresh water drowning is :A. AsphyxiaB. Ventricular defibrillatonC. Laryngeal spasmD. Vagal inhibitionE. Cardiac Arrest150. A ..infant of 4 months old is found unexpectedly dead in her cot one morning. A examination is performed. The pathologist report increased thickness and extension of pulmonary artery muscle.What does this finding indicate?A. Cardiomyopathy is likelyB. Death was caused by asphyxiationC. Death was due to epilepsyD. The child would have developed hypertension in adult lifeE. There was chronic hypoxia before death151. On a frontal chest film, there is the lung apex retracts toward the hilum, the sharp white line of visceral pleura is visible, separated from the chest wall by a radiolucent pleural space, which is devo----lung markings: (slide radiology)A. PneumothoraxB. Giant bullaeC. Pulmonary emphysemaD. Giant emphysemaE. Pleural effusion

152. A 20yo male, complained of persistent nasal discharge, this nasal discharge was yellowish and thick. Past history, he had nasal itchy and nasal obstruction whe the weather was cold. On waters film there is clouding in right maxillary sinus.Which of the following is the most likely diagnosis?A. Tumour of right maxillary sinusB. Right hematiosinusC. Acute sinusitisD. Chronic sinusitisE. Mucocele

153. On posteroanterior chest film, there is a cavity in apical parts of the left upper lobe, the wall of the cavity is thick and is surrounded by patchy consolidation. WOTF is best feature has been described?A. Lung abcessB. Pulmonary cystC. Mycetoma in a cavityD. Cavitating tumorE. The cavity of pulmonary tuberculosis

Question number 154-155x-year-old girl admitted to pediatric clinic with a chief complaint of difficulty of breathing since x-hours agp. This complaint was accompanied by cough and high fever. In anteroposterior chest x-ray, there is homogenous lung opacification with air bronchogram in the lateral segment of the lung.

154. The segmental homogenous lung opacification with air bronchogram is:A. An atelectasisB. A pleural effusionC.A pneumoniaD.A schwarteE. A bronchopneumonia (kalau patchy)

155. This disease begins as a localized infection of:A. Terminal air spacesB. Terminal bronchiolesC. Respiratory bronchiolesD. Acinus-alveolar duc-alveolar sacE. Interstitial

156. A 10yo girl chief complaint dyspnea sice 7 days ago. This complaint was accompanied by cough and high fever. In Anteroposterior chest xray there is homogenous lung opacification with air bronchogram in the lateral segm]ent of te lung. The lateral segment of the lung is located in?A. Upper lobe of the right lungB. Upper lobe of the left lungC. Middle lobe of the right lungD. Lower lobe of the left lungE. Lower lobe of the right lung

For question number 157-158A 25yo female comes with cough more than 3 weeks and accompanied by the production of purulent sputum, night sweat, weight loss, anorexia, general malaise, and weakness.

157. What is the basic standard radiograph for any patient presenting with a cough more than 3 weeks?A. A posteroanterior chest filmB. An oblique chest filmC. A left lateral decubitus filmD. An apical lordotic filmE. An anteroposterior chest film

158. What is the best radiograph for showing the presence of a small pleural effusion?A. A lateral edcubitus filmB. A posteroanterior chest filmC. A lateral chest filmD. Aanteroposterior chest filmE. An apical lordotic film

159. In the posteroanterior chest Xray,there is only calcification in the apex of the lung. It is no clear if there are patchy consolidation in the apex of both lungs,because the clavicle and the ribs overlaps with the apex of both lungs. What is the best radiograph for showing the precence of minimal patchy consolidation in the apex of the lung?A. An oblique chest filmB. A left lateral decubitusC.An apical lordotic filmD. An anteroposterior chest filmE. A lateral chest film

160. Mrs. X 28th 10 day history of nasal discharge. Discharge is yellow-greenish, thick, blood tinged, also accompanied with decrease of smelling sensation,nasalblockage,fever and headache. Three days ago she felt pain and fullness on the left ear with mild increase of hearing. PE result discharge from the nose and bulging of tympanic membrane. WOTF is the best pathogenesis of discharge in this patient?A. The ostium obstruction causes the vasodilatation and cilliary and mucus glands dysfunctionB. Enlargement of concha part in the noseC. Eustachian tube disfunction caused by secondary infectionD. Viral infection cause vasoconstriction and destruct the mucous gland directlyE. The upper respiratory tract infection resulting in Eustachian tube dysfunction and improved bacterial adherence to the URT mucosa

161. Which of the following is the best pathogenesis of bulging tympanic membrane in this patient?a. The ostium obstruction causes the vasodilatation and ciliary and mucous gland dysfunctionb. Enlargement of concha part in the nosec. Altered regulation of middle ear pressure and formation of negative pressure in middle eard. Viral infection causes vasoconstriction and destruct the mucous gland directlye. The upper respiratory tract infection resulting in Eustachian tube dysfunction and improved bacterial adherence to the upper respiratory tract mucosa

162. A 9 year old boy come to your private practice with breathlessness as a chief complaint. The symptom was accompanied by wheezing since last 1 hour. These symptoms had occured about two hours after helping his mother cleaned the bedroom. He had his first asthma attack when he was six years within the last two months he also experienced 1-2 times night cough.His father had been diagnoed as having asthma and the symptoms had relieved since he had taken controller medication. Which of the following is the best pathogenesis in this patient? a. TH2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce Ige and other antibodiesb. Virus induced inflammation of the respiratory mucosa lowers the threshold of the subepithelial vagal receptors to irritantsc. Inhibiting the cyclooxigenase pathway of arachidonic acid metabolism without affecting the lipooxygenase route, thus lipping the balance toward elaboration of the bronchoconstorleukotrienesd. A marked increase in goblet cells of small airwayssmall bronchi and bronchiolesleading to excessive mucus production that contributes to airway obstructione. The destuctive effect of high protease activity in subjects with low antiprotease activity and also the oxidant-antioxidant imbalance

For questions number 163-163 refer to scenario belowA 65 year old man was brought to the Emergency department of HasanSadikin Hospital with the chief complaint of dyspnea which was worsening since two days before. Since three days before the patient had flu that made his dyspnea and cough worsened with thick and greenish sputum, fever, and also by noisy breathing. PE : Chest : barrel shaped chest, lung hypersonor and extrimities : Clubbing fingers was noted; neither edema nor cyanosis was found

163. Which of the following is the best pathogenesis in this patient?a. TH2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce Ige and other antibodiesb. Virus induced inflammation of the respiratory mucosa lowers the threshold of the subepithelial vagal receptors to irritantsc. Inhibiting the cyclooxigenase pathway of arachidonic acid metabolism without affecting the lipooxygenase route, thus lipping the balance toward elaboration of the bronchoconstorleukotrienesd. A marked increase in goblet cells of small airwayssmall bronchi and bronchiolesleading to excessive mucus production that contributes to airway obstructione. The destuctive effect of high protease activity in subjects with low antiprotease activity and also the oxidant-antioxidant imbalance

164. Which of the following is the best for microscopic finding in that patient?a. Large alveoli separated by thin septa with only focal centraacinal fibrosisb. Chronic inflammation of the airways (predominantly lymphocytes) and enlargemenr of the mucus-secreting glands of the trachea and bronchic. Occlusion of bronchi and bronchioles are sufficiently dilated that they can be followed almost to the pleural surfaced. The bronchi and bronchioles are sufficiently dilated that they can e. Sub-basement membrane fibrosis

165. Which of the following is the best pathogenesis in this patient?a. TH2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce Ige and other antibodiesb. Virus induced inflammation of the respiratory mucosa lowers the threshold of the subepithelial vagal receptors to irritantsc. Role of blockage of phagolysosom, interferon gamma, and delayed hypersensitivityd. A marked increase in goblet cells of small airwayssmall bronchi and bronchiolesleading to excessive mucus production that contributes to airway obstructione. The destructive effect of high protease activity in subjects with low antiprotease activity and also the oxidant-antioxidant imbalance

166. Which of the following is the best of microscopic finding in this patient?a. Diffuse infiltration of polymono nuclear cell and bloody tissue b. Congestion of cells with exudat and caseous necrosisc. Granulomatous inflammation contain of datialanghans and central necrosisd. Diffuse infiltration of mononuclear cell and epitheloid celle. Consolidation and hepatization of parenchymal tissue of the lung

167. A-10 month-old-boy admitted to Pediatric Emergency Roon with difficulty of breathing and suffers from fever since the last 2 days as his chief complaint. This complaint had been preceded by common cold since 4 days ago. Laboratory results :Hb 11.4 g/dl , Hematocrit 37%, WBC 21.700/mm3 , Thrombocyte 210.000/mm3Differential count -/2/4/68/25/1.Blood smear shows toxic granule in neutrophilChest X-Ray showed bilateral infiltrate Which of the following is the best pathogenesis for this patient.a. Consolidation of acute fibrinosupurrative inflammation in patchy infiltrateb. TH2 cells secrete cytokines that promote allergic inflammation and stimulate B cells to produce Ige and other antibodiesc. Virus induced inflammation of the respiratory mucosa lowers the threshold of the subepithelial vagal receptors to irritantsd. Role of blockage of phagolysosom, interferon gamma, and delayed hypersensitivitye. A marked increase in goblet cells of small airwayssmall bronchi and bronchiolesleading to excessive mucus production that contributes to airway obstruction

For questions number 168-169, refer to scenario below :A year old male came to the outpatient clinic HasanSadikin General Hospital because of chronic nasal congestion. Rhinoscopy revealed gelatinous grayish-white tissue with smooth and shiny surface fill in the right and left nasal cavity. The biopsy was performed and the microscopic appereance showed the picture below.

168. What is the most appropriate terminology of the nasal mass in this patient?a. Chronic rhinitis b. Nasal polypc. Inverted papillomad. Angiofibromae. Nasopharyngeal carcinoma

169. According to the pathogenesis of the disease, which inflammatory cells are most commonly seen microscopically in above nasal mass?a. Lymphocytesb. Plasma cellsc. neutophilsd. Basophilse. EosinophilsFor questions number 170-171A 23 year old male came to the hospital because of epistaxis since 2 days ago. He also complained nasal thickened since 1 month ago. Rhinoscopy and nasopharyngoscopy revealed a reddish ulcerative mass in the choanae and nasopharynx posterior. Biopsy of the nasal and nasophaynx was performed, macroscopic, and microscopic appereance of the mass was shown as below picture.

170. what is the appropriate terminology describing the disease in the nasal and nasopharynx of above patient?a. chronic inflammationb. palypc. papillomad. angiofibromae. carcinoma171. which of the following agent that is closelu related to the pathogenesis of above disease?a. polenb. Hause mitesc. Epstein Barr virusd. Human papilloma viruse. Human immunodeficiency virus

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

b. Pulmonary TBc. Emphysemad. Lung carcinomae. COPD173. What structures are pointed by the white arrows in above case?a. Extravasated erythrocytesb. Alveoli destructionc. DatiaLanghans cellsd. Caseous necrosise. Tumour cells

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

174. What is the disease that occurs in above patient?a. pneumoniab. Pulmonary TBc. Emphysemad. Lung carcinomae. COPD175. What structures are pointed by the white arrows in above case?a. Extravasated erythrocytesb. Alveoli destructionc. DatiaLanghans cellsd. Caseous necrosise. Tumour cells

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