SOAL UJIAN PRE TEST MODUL EMERGENCY GROUP D, MARET 2010 1.

Female 42 years old, highly suspicious of multiple ribs fractures of the right hemithorax and patient perform dyspnea with respiratory rate 32x/m. According to the treatment of tension pneumothorax, which one of the following statement is worsening her condition, exept a. Perform needle thoracostomy b. Gentle pressure in the fracture to help breathingSakit kali, ko dipijit2? c. Perform 0.5 lbs load to the selected multiple fracturesapaan nih ngaco, mau nambah parah fracturenya kali ya? apalagi kalo ditindih uci d. Give the IV morphine 0,05-0,1 mg/Kg BW immediatelybisa2 depresi nafas malah e. Give the IV morphine 0,1-0,2 mg/Kg BW immediatelybisa2 depresi nafas juga 2. During initial assessment the best way to predict the outcome of the patient a. Immediately perform primary and secondary survey simultaneous b. Check the A,B,C randomly?????aga2 ngaco jawabanya c. Always re evaluate our primary survey??? Mungkin g sih jawabanya ini? Gatau de d. Give the definitive therapy on the scene of trauma happenedga mungkin banget, kalo g ada gmn? e. Within secondary survey give the adjunct therapy of primary surveyknp g pas di primary aja? 3. Taking history of an accident, here are we listed all of them:

a. b. c. d. e.

last beverages last meal allergitic past illness exposure ini harusnya di primary survey, sisanya penting untuk menentukan kelainan apa yang mendasari kegawat daruratan.

4. Statement "... and fingers in all orifices" shoulde we perform during a. end of primary survey b. middle of primary survey c. secondary survey d. immediately after secondary survey e. beginning of primary survey 5. Female 26yo, is a victim of flood . Her nuchal head area is hit by flooding handle bar of motorbike. This patient is highly suspicious for cervical compromise. The trauma team will evacuate from to the ambulance. C-pine control should be omitted during: a. Evacuate from initial place to the scope-stretcher b. log roll procedure c. first initial assessment until the inside of the ambulance d. move patients from the scopestretcher to the ambulance e. first initial assessment until definitive cervical collar omitted 6. Within secondary survey, these steps are correct, except a. head to toe examination b. full neurological examination ga yakin c. examination using tip of the finger backwards all orifice d. asking AMPLE to the witness and victim e. complete physical examination 7. ABCDE of initial assessment in abbreviated from: A. Airway-Breath SoundCirculation-Drug-Exposure B. Airway-BreathingCirculation-DrugEnvironment

C. Airway-Breathing-Circulus Blood-Drug-Exposure D. Airway-BreathingCirculation-DisabilityEnvironment E. Airway-BreathingCirculation-Drug-Exposure 8. During initial assessment, the most important thing that we must perform during airway assessment is: A. Cervical spine bend B. Smallest size of cervical color C. Cervical spine control D. Cervical spine palpitation E. Cervical spine hematoma assessment 9. During assessment of E in initial assessment, the most important step that suitable for multiple trauma patient is: A. Prevent blood loss B. Prevent airway obstructed by tongue using OPA C. Prevent hypothermia D. Prevent missed diagnose by expose all of wear E. Prevent emergency hypertension Answer : C. Prevent hypothermia (prevent blood loss kyknya uda dari Circulation) 10.A female patient, 50 year-old regarding a suicide trial by jumping toward deep river from wooden bridge. The bridge is about 4.75 m from the river. This woman can be evacuate from the water 2 minutes after she drown into the water by a fish farmer. Condition after ??minutes, as she arrived in the emergency department, she is slightly delirium, AB clear, BP 70/55 mmHg, GCS 14, her dress full of water plant and mud. During this primary survey which component of adjunct can be omitted? A. Echocardiography B. Electromyography C. Head and neck CT scan D. Electrocardiography

E. Lipid profile of blood serum 11.A patient has a BP of 210/140 accompanied by severe headache, nausea and vomiting. Which category of hypertension BEST describes this presentation A. Hypertensive emergency B. Hypertensive urgency C. Uncomplicated hypertension D. Transient hypertension E. Chronic hypertension 12.Which of the following is the most common cause of upper GI Bleeding? A. Esophageal varices B. Mallory Weiss tear C. PUD D. Erosive gastritis E. Arteriovenous malformations 13. A patient presents with what appears to be massive lower GI hemorrhage. Which one of the following is the LEAST likely etiology? a. Diverticulosis b. Angiodysplasia c. Gastric varises d. Duodenal ulcer e. Hemorrhoids 14. All of the following statements regarding platelet abnormalities are TRUE EXCEPT a. Bleeding complications may arise if platelets are _50.000/L_ b. Patients are at risk for spontaneous bleeding if platelet counts are _10.000/L_ c. When platelets drop below 10.000/L, the patient should receive a platelet transfusion d. Patients with ITP respond well to platelet transfusion e. Each unit of platelets transfused should raise the platelet count by about 10.000/L

15. All of the following pathways occur as diabetic ketoacidosis develops, except : a. hyperglycemia glycosuria dehydration and loss of electrolyte (betul) b. hyperglycemia cell dehydration altered level of consciousness (betul) c. insulin and glucagon deficiency increased hepatic gluconeogenesis d. lipolisis ketosis acidosis f. muscle breakdown azotemia loss of sodium ? 16. Strategies for the management of uncomplicated COPD include all of the following, EXCEPT: a. broad- spectrum antibiotics (limit evidence based in COPD) b. cromolyn sodium c. glucocorticoid therapy d. anticholinergics (betul as a short acting) e. beta- adrenergics agonists (juga short-acting) 17. Which one below is true about DSS: a. alert for hypotension as the earliest sign of DSS (betul) b. dengue virus serotype DEN-4 is the most common cause of DSS c. commonly, DSS is occur on the 4th and 5th day (betul) d. none of the above e. all of the above. 18. DSS treatment should be done properly, which one below is the right treatment: a. Thrombocyte transfusion is one of the fluid for replacement therapy b. PRC transfusion is given if Hb < 10g/dl c. Corticosteroid is one of the most important treatment d. Thrombocyte transfusion is indicated in thrombocyte < 10.000/mm3 with echymosis e. In DSS, doesnt have to use central vein catheter 19.Factor contributing except: to DSS,

a. Dengue virus serotype b. Nutritional and immunological condition of the patient c. Secondary infection by the same serotype d. Co morbidities with another infectious disease e. None of the above 20.Diagnostic examination in DSS: a. Dengue Serologic Examination is the best on the 3rd day of fever b. Widal examination to eliminate Typhoid fever is the best on the 3rd day of fever c. The most important Peripheral Complete Blood Count examination in DSS is thrombocyte count d. Blood Gas Analysis is the most sensitive tool to detect pleural effusion in DSS e. None of the above 21.Tools to diagnose thrombosis, EXCEPT: a. USG b. INR c. D-Dimer d. Lung angiography e. Venography 22.Dyspnea is: a. Inadequate breathing b. Difficult to breathe c. Respiratory disorder d. Respiratory failure e. None of the above 23. One of the signs of dyspnea in children is: A. Respiratory rate 32 times/minute B. Chest pain C. Pale D. Chest wall retraction E. Cold sweat 24. The best additional examination to determine the severity of dyspnea is: A. Blood gas analysis

B. Chest x-ray C. Lung function test D. Peripheral blood count examination E. Pulse oxymetry Answer: A 25. Disease that didn t cause acute dyspnea is: A. Pneumonia B. Bronchiolitis C. Acute laryngitis D. Acute bronchiolitis E. Suffocation Answer: C 26. Heart disease that often cause acute repiratory failure: a. MI b. Heart tamponade c. CHF d. Congenital Heart Disease klo cyanotic congenital heart disease si bisa (right-to-left shunt) e. Severe hypertension aka klo mpe bikin pulmonary hypertension br bisa bikin acute resp failure Answers: E 27. Frequent and durable dyspneu in children can be found in: a. TB b. Chronic interstitial lung disease c. chronic sinusitis d. chronic tonsillitis e. all of the above Answers: B 28. Sign of respiratory failure: a. tachypneu b. cyanotic c. tachycardia d. Seizure klo ad severe hypoxemia e. All of the above 29. Dyspnea in babies or children often accompanied by clinical symptoms/sign: a. Grunting b. Cyanosis c. Apathy d. Stridor/wheezing e. All of the above (E) 30. Additional examination result didnt found in respiratory failure: a. Hypoxemia

b. Hypercapnia c. Alkalosis d. Acidemia e. Acidosis (C) tapi gw gak yakin,.. T.T nyari jg ga ketemu,.. Soalnya kyaknya semua bisa 31. Action that should be done to patient with dyspnea: a. Clear the airway, assess breathing, assess circulation, act according to initial assessment b. Assess breathing, give oxygen, give infusion c. Clear the airway, assess circulation, do cardiopulmonary resuscitation d. Assess breathing, assess circulation, give infusion e. None of the above (A) 32. the aim of fluid resuscitation : a. normalize Blood pressure b. normalize heart rate c. urine target more than 0,5 ml/kgBB/hour d. repair perfusion and oxygenation e. normalize RR 33. conventional parameter used in fluid resuscitation: a. Blood pressure b. heart rate c. urine production d. central venous pressure e. all of the above 34. in unstable hemodynamic condition, fast resuscitation can be given: a. 10ml/kgbb in 60 mins b. 10/20ml/kgbb in 60-90 mins c. 20/40ml/kgbb in 20 minutes d. 20/40ml/kgbb in 2 hours e. none of the above answer : C 35. Modern parameter used in fluid resuscitation: a. oxygen delivery b. lactate serum c. base deficit d. mixed venous oxygen saturation

e. all the above 36. Complication of fluid resuscitation: a. lung edema b. bleeding disorder c. electrolyte balance disorder d. acid base balance disorder e. all the above 37. In patient with shortness of breath due to pleural effusion, the most likely appearance of chest radiography is: a. Avascular radiolucency with pleural shift b. Heterogenous opacity without pleural shift c. Homogenous radio opacity with pleural shift d. Consolidation with airbronchogram e. Cavity with air-fluid level 38. A young patient came to ER with chest pain on the right side. The appropriate projection for chest radiography is: a. AP b. PA c. PA and right lateral d. AP and left lateral e. AP, PA, and right-left lateral 39. Male patient with chest pain everytime he takes a deep breath. Chest radiograph may show: a. pleural fibrosis b. airway obstruction c. increased vascular markings d. compression fracture of the vertebrae e. pneumomediastinum

c. homogenous area like ascites d. deformity of lumbar vertebrae answer : 41. A 30 years old female with acute abdominal pain in right lower quadrant, possible an acute appendicitis. The most suitable radiological examination is a. histerosalphingography b. barium enema c. intravenous urography d. pelvic CT-scan e. SPECT- CT 42. Snake venom can cause: a. Neurotoxicity b. Coagulopathy c. Nephrotoxicity d. A, B and C correct e. A and B correct (D) di literature ga spesifik dibilang ttg yg nefrotoksik. Kalo yg a,b, jelas disebut + sistemik involvement... Jadi ya kalo ga D/E 43. Male, 50 years old, came to emergency unit with swelling in the front neck accompanied by shortness of breath. When he swallowed, the swelling moves up. What should you prepare? a. Insert IV line b. Chest X-ray c. Cervical photo d. Tumor staging e. All of the above (C) 44. According to no. 43, emergency action that should be done: a. WSD insertion b. Needle thoracostomy c. Thyroidectomy d. Tracheostomy e. All of the above (D) 45. Not included as emergency in oncology field: a. Cava Superior Vein syndrome b. Increased intracranial pressure c. Spinal cord compression d. Metabolic disorder e. Thyroid tumor (E)

pleura yang mngandung nerve adalah yang parietal. ketika terjadi pengembangan paru praktis ada gesekan oleh surfaktan dengan adanya fibrosis gesekan oleh surfaktan tidak terjadi
40. a 2 years old infant was taken to ER due to repeated vomiting. Based on the initial assessment, the physician-onduty suspected GI obstruction. The possible feature of plain abdominal radiograph in that case a. bilateral kidney stone b. bowel air distribution not reaching distal are/rectum

46. Action that should be done to patient with Vena Cava Syndrome: a. Biopsy to determine the type of tumor b. Chest x-ray c. Radiation d. Tracheotomy e. All of the above 47. Clinical manifestation that does not find in septic condition a. Hyperglycemia b. Disseminated Intravascular Coagulation c. Polyuria d. Hypothermia e. Tachycardia 48. Aflatoxin is produced by: a. Staphylococcus aureus b. Salmonella c. Candida albicans d. Shigella e. Aspergillus 49. Substance that can cause food intoxication symptoms because of Staphylococcus aures: a. Exotoxin b. Endotoxin c. Cyanide d. Aflatoxin e. Alkaloid 50. Jamur cendawan intoxication because of its content, which is: a. Fungicide b. Pesticide c. Muscarine d. Solanine e. Tyramine is