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MDE RESPIRATORY SYSTEM BATCH 2008

1. Comparing to the oxygen partial pressure in alveoli. Which one is true about pulmonary veins oxygen partial pressure
a. Lower because it contains blood from right chamber of heart
b. The same because its transport is simple diffusion
c. higher because its transport by active transport
d. higher because its large and thin surface
e.higher because its transport is so fast
2. Faktor yang meningkatkan afinitas oksigen terhadap Hb? (Rendy S.) shunt to the left
e. blood O2 level increased
3. Which of the following mediates predominantly the respiratory regulation of central nervous system mechanism?
a. The level of blood ph
b. The level of O2
c. The level of blood CO2
d. The level of blood 2,3 bpg
e. The body temperature
4. Can lung act in regulating acid base balance?
a. No, because the main function of lung is to exchange gases
b. Yes, because the lung has the ability to excrete and preserve H+
c. yes, because the lung has the ability to excrete and preserve H2O
d. Yes, because the lung has the ability to excrete n preserve CO2
e. yes, because the lung has the ability to prevent us from inhaling acid
5. What is approximate amount of inspiratory reserve volume in normal man at rest?
a. 2200 ml
d. 500 ml
b. 1500 ml
e. 1200 ml
c. 3100 ml
6. Wotf is responsible for the movement from the alveoli into the blood in the pulmo capiller?
a. active transport
b. filtration
c. second active transport
d. facilitated diffusion
e. passive transport
7. True "airway resistance"
a. > jika paru2 diremove, inflate ketika dikasih saline
b. > asma
c. > paraplegik pasien
d. Not effect on work of breath
e. Berkontribusi pada 80% work of breath
8. Which of the following relax the bronchial smooth muscle?
a. Leukotriene
d. cool air
b. Vip
e. Sulfur dioxide
c. Acetylcholine
9. The most form of CO2 transported in blood?
a. Dissolve in plasma
b. In corbamino compound formed from plasma protein
c. In carbamino compound formed from hb
d. bound to Cl
e. HCO310. Greatest effect on ability to transport O2 is
a. Capacity blood to dissolve O2
b. Jumlah hb di darah
c. Ph plasma

d. CO2 content of RBC


e. Temperature blood
11.
a.
b.
c.
d.
e.

At inspiratory, event yang terjadi ?


Intraabdominal pressure turun
Venous return increase
HR turun
Intrapleural pressure turun
Muscle abdominalis contracts

12. Air in the lung subdivided into


A. 3 vol 4 capacities
B. 5 vol 5 cap
C. 4 vol 4 cap
D. 4 vol 5 cap
E. 5 vol 6 cap
13.
a.
b.
c.
d.
e.

IV lactic acid dapat meningkatkan pernafasan akibat rangsangan ke reseptor di..?


Medulla oblongata
Carotid body
Lung parenchyme
Aortic
Trachea dan large bronchi

14.
a.
b.
c.
d.
e.

In which the following conditions is CO2 retention most likely occur ?


Climbing high mountain
Ventilatory failure
CO
Lung failure
Hysterical hyperventilation

15. Child 2 y.o.datang ke THT clini dgn kelujan hearing loss sejak 2 minggu yang lalu. Tanpa otalgia, otorrhea ataupun
febrile. Otosopy menunjukkan right ear normal, left ear, tympanic membran intact namun terlihat adanya buble
sign di tympanic cavity.
a. External otitis
b. Acute otitis media
c. Chronic otitis media
d. Serous otitis media
e. Malignant external otitis
16.
a.
b.
c.
d.
e.

Pasien dengan buble sign yang sudah ditreatment dengan obat tp tidak berhasil. Apa yg dilakukan kemudian,,
Myringotomy
Myringoplasty
Mastoidectomy
Tympanoplasty
Hearing aid

17. in the past two weeks, an 8 y.o boy suffered from blockage of the nose with purulent rhinorrhea, facial pain, and
sometimes epistaxis. from rhinoscopy anterior there was hyperemic nasal mucosa, with mucopurulent discharge. no
mases or anatomical pathologies were found. blood clot was found in anterior nasal septum. oropharyngeal exam
reveal post nasal drip.
medical management for this condition is:
a. not frequently effective
b. directed toward more resistant bacteria
c. usually targeted toward specific bacteria and broad spectrum
d. universally effective
e. best provided with IV therapy
18. What muscle actively open the eustachian tube ?

a.
b.
c.
d.
e.

M. Tensor veli palatine


M. Levator veli palatine
M. Salphyngopheryngeus
M.lateral pterygoid
M. Medial pterygoid

19.
a.
b.
c.
d.

Drainage nasolacrimal duct..


Common meatus
Superior meatus
Middle meatus
Inferior meatus

20.
a.
b.
c.
d.
e.

Kiesselbach plexuse, little area tersusun dari superior labial artery dan..
Pharyngeal artery
Anterior ethmoid
Posterior ethmoid
Descending palatine
Sphenopalatine

21. 21 y.o male pain and difficulty in swallowing since 2 days ago. Pain mnyebar ke left ear,can only eat liquid. Kesulitan
dalam mmbuka mulut,enlarged le ft tnsil,deviated uvula to right. Diagnosis?
A. Ludwig's angina
b. Parapharyngeal abcess
c. Tonsillar hypertrophicans
d. Peritonsillar abcess
e. Retropharyngeal abcess
22. the strap muscles of neck are enveloped in:
a. deep layer of deep cervical fascia
b. middle layer of deep cervical fascia
c. superficial layer of deep cervical fascia
d. superficial cervical fascia
e. carotid sheath
23. The lateral pharyngeal space divided into 2 compartment by?
A. Cranial nerve 2
B. Carotid artery
C. Deep larynx of deep cervical fascia
D. Styloid process
E. Jugular artery
24. The most common place of infection of lateral pharyngeal space is from the :
A. Soft palate
d. Neck
B. Mastoid
e. Floor of the mouth
C. Tonsil
25. 12 yrs old male has dirty gray membrane on tonsils pillars and uvula. Removal attempts caused bleeding. There is
positive marked clinically lymphadenopathy. The fluorescent study is positive. What is the diagnosis?
A. Vincent angina
B.
C.
D. Diphteri
E. Infectious mononucleosis
26. 5 years old, pneumonia, alergi penicillin & cephalosporin. Obat yg cocok?
A. Azithromycin
B. Amoxicillin + clavulanate, krn tahan thdp beta-lactamase

C. Cefadroxil
D. Erythromycin, krn efektif melawan gram positif dan immunologic characteristic berbeda dgn beta-lactam
E.
(duh maaf ya yg ini ga lngkap, ga bs nyatet duduknya depan dosen >.< )
For question 27-28:
A male patient is given antibiotic on enteric coated form. Because of his difficulty at swallowing drugs, it is divided into
small pieces. He had a good compliance in taking the drugs. A few days after, there is no improve on clinical features. He
said that he got additional symptoms including nausea & diarrhea.
27. What is the most possible cause of treatment failure in this case?
A. Microorganism is resistant to antibiotic consumed
B. The patient also have allergy agains this antibiotic
C. The antibiotic was inactivated cause by drug
D. The antibiotic was innapropriate against the organism
E. The antibiotic's absorption is interfered by gastric acid
28. The most appropriate management for the abdominal symptoms?
A. Substitute the antibiotic used
B. Add antiemetic and anti diarrhea
C. Continue the antibiotic used but do not crush the drugs
D. Stop the antibiotic use and consider additio of antibiotic for GIT
E. Take the antibiotic after meal
Soal no. 29-30
Seorang ibu baru melahirkan bayi, dia telah mengkonsumsi OAT sejak lama tapi kemudian dihentikan 1 bln yang lalu.
29. Appropriate planning for mother?
A. Stop breastfeeding; lanjutkan pengobatan sampai 6 bln
B. Continues breastfeeding; beri pengobatan baru ( 2HREZ/HREZ/5HRE)
C. Stop breastfeeding; beri pengobatan baru
D. Continues breastfeeding; beri pengobatan 5HRE
E. Stop breastfeeding; beri pengobatan 5HRE
30. Appropriate planning for baby?
A. Beri full TB treatment
B. Beri INH untuk pencegahan, dan jauhkan dari ibu sampai 2mgg pengobatan
C. Vaksin BCG
D. Vaksin BCG dan pencegahan (INH) after TB role out
31. Gilang
32. A 56 yo man was diagnosed of End State Renal Disease since 2 years ago. He had to have blood hemodialysis once a
week. Because of his 2 times positive sputum smear of MTB, his doctor said that he have to get R, H, Z, E, S.
Fortunately, his liver function is normal. If the doctor does not adjust the regimen dosage for him because of his past
clinical history, which one is the most possible symptom that could happen?
a. Nephropathy because of streptomycin
b. Hyperuricemia because of isoniazid
c. Peripheral neuropathy because of pyrazinamide accumulation
d. Retrobulbar neuritis because of ethambutol
e. Hepatotoxicity because of Rifampicin
33. 45 yo man administrated ART, recently diagnosed TB
a. 2HRZE/4HR, STOP ART
B. 2HRZE/4H3R3, STOP ART

C. 2HREZES/HRZE/4H3R3, CONTINUE ART


D. 2HRZE/4HR, CONTINIE ART
E. 2HRZE/4H3R3,CONTINUE ART
Gambar2 yang gangguan development trachea-esophagus.
34. Bella
35. Which of the following structure is match with the statement the air cant pass the gastric and esophagus?
36. H-type tracheoesophageal itu yg mana? (pilihannya berupa gambar)
37. isolated esophageal atresia yang mana?
38. Ecky
39. components of the blood air barrier in the lung are derived from wotf?
a. ectoderm only
b. visceral mesoderm only
c. visceral mesokderm and ectoderm
d. ectoderm adn endoderm
e. visceral mesoderm and endoderm
40. The laryngotracheal tube initially is in open communication with the primitive foregut. WOTF structures is
responsible for separating this two structure?
A. Laryngotracheal groove
B. Posterior esophageal folds
C. Laryngotracheal diverticulum
D. Tracheosophageal septum
E. Bronchopulmonary segment
41. Collapse of bronchial caused by failure of bronchial cartilage development are indicator of WOTF congenital
malformation:
A. Congenital bronchial cyst
B. Congenital neonatal emphysema
C. Tracheoesophageal fistula
D. HMD
E. Pulmo hipoplasia
42. 27yo,man,smoking,sudden onset chill fever, temp 28,5'C, cough, left-sided pleurutic chest pain. xray= focal
consolidation in left lower lobe
organisme likely =
a. s.pneumonia
b. h.influenza
c. m.catarrhis
d. m.pneumonia
e. s.aureus
43. Which of the following statement is correct about wall layers of the larynx?
a. It has elastic and hyaline cartilage
b. Lined by simple columnar epithelium
c. Has sebaceous gland
d. Not a component of skeletal muscle
e. Has sweat gland
44. WOTF differentiate streptococcus and staphylococcus:
A. Gram reactivation
B. Cell diameter
C. Cell morphology
D. Catalase

E. Acid fast staining


45. Staining untuk C. Diphteri:
A. Gram stain
B. Ziehl Nielsen
C. Burri gins

d. Giemsa
e. Neisser

46. Intracellular bacterial parasite:


A. S. pyogenes
B. Klebsiella pneumoniae
C. Clostridium perfringens
D. M. Tb
E. S. Pneumoniae
47. Which is true about Legionella pneumoniae:
A. Gram positive rod
B. Intracellular paracite bacteria
C. It produce no toxin
D. It is associated with room air conditioner
E. It can infect tissue human bodies
48. Mycobacterium yang dapat menyebabkan tuberculosis:
Ans: M. Bovis
49. WOTF most likely cultivation for M. Tb:
A. Mac conkey agar
B. Loeffler agar
C. Lowenstein jensen agar
D. Chocholate agar
E. BCYE agar
50. What are the organism that have a heavy encapsulated capsule and frequently cause pneumonia in debilitated
patient?
A. S. pneumoniae
B. Klebsiella pneumoniae
C. M. Tb
D. S. aureus
E. Legionella penumoniae
51.
a.
b.
c.
d.
e.

in diagnosis of pertusis, bordetella is most likely isolated from?


Blood culture during bacteriemic phase of disease
Joint fluid
Nasopharyngeal swab cultured on bordet-bengou medium
Abscess on skin
Spinal fluid

a.
b.
c.
d.
e.

s.pneumonia can escape phagocytic clearance by which mechanism?


Capsulated-mediated inhibition of phagocytosis
Inhibition of phagosome-lysosome fusion
Inhibition of opsonization mediated by protein A
Lysis of phagosome & replication in cytoplasm
Replication in fused phagosome-lysosome

52.

53.

handry

54.
a.
b.
c.

use to differ streptococcus pneumonia & s.viridans?


bacitracin
d. Coagulation
optochin
e. Oxidase
catalase

55.
a.
b.
c.

which of following situation is caused by increase of pCO2 in arterial blood that causes
chemoreceptor stimulate the respiratory center?
Decrease RR
d. hypercapnia
Increase RR
e. Hypoxia
Hypocapnia

a.
b.
c.
d.
e.

52 yo, smoker male comes to rshs having diff breathing. pO2 45mmhg. Then his pCO2 become 37
mmhg & ph 7.4. WOTF most likely condition?
Doesnt have respi problem
Respiratory acidosis
Hypoxia, unlikely acidosis
Respiratory alkalosis
Hypoxia, alkalosis

56.

57.

b.
c.
d.
e.
58.
a.
b.
c.
d.
e.
59.

17 yo,female, hyperventilating (freq,deep,sighing respiration to sustained,obvious,rapid,deep


breathing) fell unconscious. An attending physician diagnosed her condition as hyperventilation syndrome
caused by anxiety & mental stress. He successfully treated her by rebreathing expired CO2 from paper bag & she
completely recovered. What happened to the acid-base balance in her body?
a.
Increase rate of respiration due to hyperventilation cause the lung to remove
more O2 from the blood than normal & will decrease pO2 & increase the blood ph
Plasma O2 is considered an acid & HCO3 its conjugated base
Decrease of acid relative to the level of its conjugated base causes decrease
in ph
Respiratory alkalosis
The process of acid-base balance is acidosis
46 yo, male, high urea & creatinin. Acid-base disorder?
Respi acidosis due to CO2 retention
Acidosis cause overproduction acid
Metabolic acidosis cause impaired excretion acid
Respiratory alkalosis due to CO2 retention
Metabolic alkalosis due to overproduction base
pilihannya : (Puti)

a.
b.
c.
d.
60.
a.
b.
c.
d.
e.

shallow breathing
Kusmauls breathing
Deep breathing
Slow breathing
55 yo,man, hard to breath,smoke or 30 years 16 pack/day, rr 30. BGA?
Ph decrease
Sat o2 increase
Ph increase
Po2 increase
Pco2 increase

61. 17 yo girl experienced deep frequent sighing respiration to sustained obvious, rapid, deep breathing, feel
unconscious on floor. Attending physician diagnosed her send caused by her anxiety & mental stress. He successfully
treated her with rebreathing expired CO2 from paper bag in improving her condition by neutralized the blood pH?
a. Accumulation of CO2 decreased blood pH (Respiratory Acidosis)
b. Accumulation of O2, normalized pO2, decrease blood pH
c. Accumulation HCO3-, normalized pHCO3-, increased pH
d. Accumulation H+, normalized pHCO3-, increased pH
e. Accumulation OH-, normalized pOH-, increased pH
62. Prolonged alveolar hyperventilation can cause?
a. Metabolic acidosis
b. Metabolic alkalosis

c. Respiratory acidosis
d. Respiratory alkalosis
e. No change in blood pH
63. Why is gas exchange at respiratory membrane are efficient?
a. The difference in partial pressure are substansial
b. The gas are lipid soluble
c. The total surface area is large
d. The gas are protein soluble
e. The gas are lipid & protein soluble
64. For any partial pressure of O2 which of the following statement are correlated with condition of 2,3 BPG increase?
a. The amount of O2 release from Hb decrease
b. The amount of O2 release from Hb increase (shunt to the right)
c. The amount of CO2 release from Hb increase
d. The amount of CO2 carried by Hb increase
e. The amount of O2 and Hb unaffected
65. Mutiara Retno Anjani (lagi sakit, lupa nyari back up nya..maaf ( )
66. Throat specimen from 3 y.o. boy with pharyngitis. Throat swabs are mostly used for :
A. Group A Streptococcus
B. N. diphthteria
C. Coli
D. Staphylococcus aureus
E. Pseudomonas aeruginosa
67. Suryo Indah W. (soalnya ketinggalan di jantinangor, nanti nyusul diupload)
68. Eosinofil naik di kasus?
a. Tb
d. Malaria
b. Parasit
e. Amobeasis
c. Hepatitis
69. An adult woman patient always complains about had difficulty of breathing. The doctor says that she has asthmatic
bronchitis and need to perform laboratory test to evaluate ventilation status of the lung by blood gas analysis. In her
condition of ventilation disturbance cause of respiratory acidosis. The result of BGA are:
a. Increase pH, increase pCO2, increase HCO3b. Decrease pH, decrease pCO2, decrease HCO3c. Decrease pH, increase pCO2, HCO3- in normal level
d. Increase pH, decrease pCO2, decrease HCO3e. Decrease pH, decrease pCO2, increase HCO370. Characteristic of exudates?
a. Total protein < 3 g/dl
b. WBC count > 1000/mm3
c. Specific gravity < 1,016
d. Cholesterol < 60 mg/dl
e. Rivalta test (+)
71. Diff count OMA dengan?
a. thin blood film/smear
b. bone marrow film
c. thick blood film

d. gram/ziehl neelsen
e. papanicolau
72. 32 yo man, chief complaint: dyspnea, fever, never experience before, no family history. BP 130/80 mmHg, HR 90X,
RR 36X, temp 390. Pneumococcus, hypersensitivity B-lactam. He got antibiotic but few hour after feel abdominal
discomfort. What is the antibiotic? Beri Macrolide !
a. azythromycin
b. cefalodroxyl
c. clarithromycin
d. clindamycin
e. erythromycin
73. 10-15 m, nucleus bilobed, granules coarse and orange red cytoplasm abundant and pale pink tan. What cell?
a. basophil
b. eosinophil
c. Neutrophil
d. Lymphocyte
e. Monocyte
74. Khairunisa
75. Jumlah eosinofil akan meningkat pada kondisi? alergi, infeksi parasit(Ligai)
76. Factor that interfere BGA in heavy smoker?
a. false hi pCO2 because hi pCO2 valu
b. false low pH level because of low pH level
c. false low O2 because of low O2 value
d. false hi O2 saturated
e. false hi base excess
77. Male. Complain of tachypnea, slight fever. Wheezing and decrease body weight despite of the regular eating habit.
Past history: ever taken TB medication but stopped after he felt better. Whats the medication he should take?
a. category I
b. category II
c. category III
d. dont give medication until the culture result come out
78. Seorang pasien 20 yo datang ke klinik dengan keluhan utama chronic cough and sputum. Diikuti dengan ada chest
wall pain, low grade fever, night sweating. Makan antibiotik tapi tidak ada perubahan. Two specimen AFB +.
Setahun yang lalu didiagnosis TB dengan pengobatan berhenti setelah 2 bulan, dan merasa baik. Dari chest x-ray,
ada koloni upper lobe. Tipe kasus?
a. new case
b. relapse
c. treatment failure
d. after default
79. 64 yo, complaint dyspnea especially when walked in rushed for several hundred meters and cough with whitish
sputum for the last 2 years. He is current smoker, smoked for 36 packs/year clove cigarrette (kretek) since he was 20
yo.
He comes form low socio-economic. His father has allergy. Which one represent the chronic inflammation?
a. Lymphocyte CD4+ dominant
b. eosinophil dominant
c. neutrophil dominant
d. reversible airflow limitation
e. Excellent response to glucocorticoid
80. 65 years old man, increasing shortess of breath. cough and sputum production for the last 5
years. Smoke since age 15. chest x-ray: hyperinflation, no sign of infiltrate found. spirometry:
FEV1/FVC 60%. FEV1: 45%. Predicted ECG normal. If this patient has pneumothorax, which of the
following will be found:
If he has spontaneous pneumothorax, which is the following is the diagnosis?
a. Primary pneumothorax
b. secondary pneumothorax (akibat COPD)

c. tension pneumothorax
d. iatrogenic pneumothorax
81. A 65-years old man with COPD stage III and women23-years old with asthma bronchial moderate persistent. Both
were taken inhalation corticosteroid. While women gains improvement from this therapy, the man is not. What is
possible explanation for this?
A. Difference gender between them
B. Different in age
C. Different in spirometry result
D. Different in risk factor
E. Different in inflammatory cell & mediator
82. 22-years old woman, intermittent wheezing in response to exercise presents to emergency room with shortness of
breath. Her attack occurred during aerobic class. She is obvious difficulty breathing & diffuse wheezes on
pulmonary exam. 02 saturation is 95% by pulse oxymetry.
WOTF condition occurs as results of air trapping?
A. Airway obstruction during inhalation & subsequent alveolar collapse
B. Increase lung compliance because inflammation
C. Collapse of congested bronchioles during exhalation
D. Shunting of ventilation of the right lung fields
E. Increase mismatch ventilation
83. 65-years old, dyspnea, spirometry exam FEV/FVC 57%, FEV 30% of the predictive value after bronchodilator
treatment. Which PE may be appear?
A. Pleural friction rub
B. Bronchial breath sound
C. Broncophony
D. Narrow intercostals space
E. Hypersonor in percussion
84. 20-y.o woman, ER, dyspnea, start 1,5 jam because she nervous in the gym class. Suddenly hard breath with
wheezing breath. WOTF exam statement?
A. Bronchial provocation test are essential for diagnosis
B. FEV1 after bronchodilation
C. TLC is decreased
D. Residual volume maybe increased
E. Skin prick test are usually negative in extrinsic asthma
85. Not influence clinical feature TB?
A. Tropism of specific tissue
B. Malnutrition
C. Immunization BCG
D. Coexisting another disease
E. Genetic
86. 62-y.o, shortness of breathing, cough, increase of sputum for 5 years. Chest X-ray: hyperinflation, no infiltration.
FEV1/FVC 60% & FEV1 45%. ECG normal.
Type of pneumothorax if suspected as DD?
A. Primary pneumothorax
B. Secondary pneumothorax
C. Endogenous pneumothorax
D. Tension pneumothorax
E. Iatrogenic pneumothorax
87. 17-y.o. AFB+, treated with category 1, after 9 days he developed jaundice & vomit. Which drugs cause that
condition?
A. R, H, Z (Rimfam, Isoniazid, Pyrazinamide)
B. R, H, E
C. Z, E, S
D. S, R, E
E. H, S, Z

88. 30-y.o man came to clinic with chief complaint cough & sputum > 6 weeks. Complaints accompanied by decrease
body weight in spite of regular eating habits, low grade fever, and night sweating. Which of the following factor
that has no role in management in this patient?
A. Species & virulence of mycobacterium
B. Immunity of host to mycobacterium
C. Adherence of patient to regiment ATD
D. Interaction between host & drug
E. Prevalence of organ involvement
89. What is the most common cause of massive hemoptysis in Indonesia?
A. Bronchiectasis
B. Lung cancer
C. Tuberculosis
D. Necrotizing pneumonia
E. Lung abscess
90. A 70-y.o man admitted with chief complaint of shortness of breath, yellowish sputum. History of DM. PE shows RR
30x/min, T: 380C, BP: 130/80, rhonchi +/-, wheezing +, blood glucose 276 mg/dL, chest x-ray: infiltration. No
history hospitalization.
If he come with respiratory failure, what is gold standard for diagnosis?
A. Chest x-ray
B. Spirometry
C. BGA
D. Pulse oxymetry
E. Pulse angiogram
91. Diberi Amoxicilyn 500 mg diminum 3x sehari untuk 7 hari setelah makan, tulis resepnya.
c. R/ Amoxicillin tab 500 mg No. XXI S.3.d.d tab I a.c
d. R/ Amoxicillin tab 500 mg No. XXI S.3.d.d tab I p.c
92. Obstructive lung disease
a. Lower energy consumption & hypometabolic state
b. Lower energy consumption & hypermetabolic state
c. Normal energy consumption
d. Higher energy consumption & hypometabolic state
e. Higher energy consumption & hypermetabolic state
93. A 35 y.o is a heavy smoker. He came to your clinic with cough & dyspnea. His BP: 120/80 mmHg, Pulse rate:
120x/m, Respiration rate: 30x/m, and temperature: 38,2o C. Chest examination: from inspection was found barrel
shaped chest. From blood gas analysis:pH: 7.28, PaCO2: 50, PCO2: 60, Sat O2: 90%. Which of the following
statement is the most appropriate due to substrate metabolism use?
a. Respiratory Quotient (RQ) is the ratio of the volume of oxygen expired to the volume of carbon dioxide inspired
b. Respiratory Quotient (RQ) is the ratio of the volume of oxygen inspired to the volume of carbon dioxide expired
c. Respiratory Quotient (RQ) is the ratio of the volume of carbon dioxide inspired to the volume of oxygen expired
d. Respiratory Quotient (RQ) is the ratio of the volume of carbon dioxide expired to the volume of oxygen
inspired
e. Respiratory Quotient (RQ) is the ratio of the volume of carbon dioxide inspired to the volume of carbon dioxide
inspired
94. A 50 yo man complains dyspnea, especially when he walks in rush. His complains are accompanied with cough and
whitish sputum for the last five years. He is a heavy smoker, with a history of smoking about 30 pack-year cigarettes
since he was 17 year old. During physical examination, it is found that the cardiovascular is within normal limits. His
body weight is 55 kg and his height is 175 cm.
Which of the following is the most likely condition?
a. He needs more energy due to smoking
b. He needs more energy due to the increased work of breathing
c. He needs more energy due to preserving fat mass

d.
e.

He needs more energy due to preserving visceral fat mass


He needs more energy due to preserving subcutaneous fat mass

95. A 35 yo came to your clinic complaining cough and dyspnea. He is known as a heavy smoker. During physical
examination it is found that his BP: 120/80 mmHg, pulse rate: 120x/m, respiration rate: 30 x/m, and temperature:
38.2o C. Chest examination: from inspection barrel shaped chest was found. Blood gas analysis result: pH: 7.28,
PaCO2 : 50, PCO2: 60, Sat O2: 90%.
Which of the following energy intake is the most appropriate?
a. Increasing energy needs with 65% calories from carbohydrate and 20% calories from fat
b. Increasing energy needs with 60% calories from carbohydrate and 25% calories from fat
c. Increasing energy needs with 50% calories from carbohydrate and 35% calories from fat
d. Increasing energy needs with 65% calories from carbohydrate and 35% calories from fat
e. Increasing energy needs with 70% calories from carbohydrate and 30% calories from fat
96. Which parasite is most apt to be diagnosed by examination of sputum specimens?
a. Schistosoma mansoni
b. Metagonimus yokogawai
c. Paragonimus westermani
d. Schistosoma japonicum
e. Fasciolopsis buski
97. A 22-month-age boy brought to the emergency room with chief complaint shortness of breath. Inspection of the chest
showed retraction of the chest wall.
Which of the following muscle pulls the rib cage downward during expiration?
a. External intercostals
b. Abdominal recti
c. Sternocleidomastoid
d. Anterior serrate
e. Scaleni
98. A 70 yo man, admitted with chief complaint shortness of breath, cough, and yellowish sputum. History diabetes
mellitus +. Physical examination: respiratory rate 30 x/m, T: 38o 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 physical peculiarities found in case above?
a. The alveoli are filled with fluid due to increased hydrostatic pressure
b. The total surface area of respiratory membrane is decreased
c. The ventilation and perfusion ratio is consequently increased
d. The content of carbon dioxide in the blood will be decreased
e. The physiologic dead space also become decrease
99. A result of arterial blood gas analysis of 25 yo pneumothorax patient: pH: 6.971, pCO 2: 71.4 mmHg, pO2: 97.4
mmHg, HCO3-: 32.1 mEq (naik), 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 pleural space is
allowed through which of the following factor?
a. Strong and continous alveolar epithelium
b. Pumping of fluid from the pleural space by lympathics
c. Collection of large amounts of fluid in the pleural space
d. Hydrostatic pressure at the capillary
e. Osmotic forces at the alveolar membrane of the lungs
100. Related to case above, which of the following describes most accurately about the cough reflex?
a. Afferent nerve is mediated through trigeminal nerve (sneez reflex)
b. The effect is the opening of epiglottis followed by closing
c. Initially air is rapidly inspired
d. Both thoracal and abdominal muscles relax
e. The bronchi and trachea are dilated

101. A 55 yo male patient is admitted to the E.R with difficulty in breathing. According to his family, he has been
smoking for 30 years and consumed 16 cigarettes every day. His breathing difficulty has last for 1 year and
becoming worst. He never went to health center before. Physical examination result shows blood pressure 140/90
mmHg, heart rate 100 x/m and respiration rate 30 x/m: swallow breathing.
In term of oxygen saturation, it is strongly related to the pO2 and O2 delivery to the tissue. Which of the following
describes most accurately about the factors influencing the process?
a. Decrease of pH will lead to the shift of the curve to the right
b. Decrease CO2 in the blood will shift the curve to the right
c. Increase temperature will shift the curve to the left
d. Increase BPG will shift the curve to the left
e. Exercise will shift the curve to the left
102. A 70 yo man admitted with chief complain shortness of breath, cough and yellowish sputum. History diabetes
mellitus +. Physical examination: respiratory rate 30 x/m, T: 38oC, 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 physical peculiarities found in the case above?
a. Alveolar macrophage effectively combated the infection process
b. The smooth muscles on the wall constrict many smaller airways
c. The obstruction will cause air entrapment in the alveoli
d. Bronchial obstruction will decrease airway resistance
e. The pathological process increase the lung diffusing capacity
103. A result of arterial blood gas analysis of 25 yo pneomothoraz 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, ventilation process is somewhat disturbed. Which of the following breathing work is
mostly possibly involved in that situation?
a. Compliance work in increased
b. Tissue resistance work is increased
c. Airway resistance work is increased
d. Tissue resistance work is decreased
e. Airway resistance work is decreased
104. Once you were on duty in emergency room a 5 yo girl patient was taken by her parents with chief complaint stridor
since 2 days ago. Her parents also complained about sore throat, fever, difficulty on swallowing and breathing. There
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 inspiratory stridor.
Radiological findings:
From soft tissue neck radiograph: thumb sign appearance (epiglottitis). Chest X-ray: within normal limit.
Related to the case above, which of the following describes most accurately about the function of the respiratory
passageaways?
a. All passageways have cartilage to keep them from collapsing
b. All of the passageways are surrounded by smooth muscle
c. In obstructive disease all of the passageways are constricted
d. The greatest amount of resistance to airflow occurs in alveoli
e. In disease conditions, the smaller bronchioles determine resistance
105. WOTF is true about Maximum Expiratory Flow (MEF)?
a. MEF is much greater when the lungs are empty
b. in the enlarged lungs, the bronchi are completely collapse
c. beyond MEF, additional forces will no more increase in flow
d. further expiratory force may dilate the alveoli and the bronchus
e. compressing the chest cage tends to expands the bronchus
106. Decrease of MEF?

a. normal FEV1
b. normal FVC
c. increased FEV1/FVC ratio
d. increased FEV1
e. decreased FEV1
107. most important function of nose?
a. its warming effect is endowed by filtration process of nose
b. air conditioning of URT
c. the filtration procrss involves tubular precipitation by hair
d. the entrapped particles transported to trachea
e. filter the particle smaller than 1 micrometer
108. 45 yo woman presents with fever and cough. She has had no past medical problem and was well until about 3 days
ago. PE is remarkable for temperature of 39o C and the presence of diffuse rales on chest exam. WBC count is
elevated with left-shifted differential. Chest X-ray reveals patchy bilateral infiltrates. She is unable to produce
sputum. She has resting hypoxaemia and required hospital admission. What is the mechanism of cough happened in
this patient?
a. 2,5 L air is expired
b. abdominal pressure increased
c. alveoli pressure increased
d. afferent nerve impulse through the vagus nerve
e. automatic sequence triggered by fever
109. Rehab COPD acute stage?
Ans: breathing control
110. what is the characteristic of death by vagal reflex from strangulation case?
a. cyanosis
b. tardieu spot
c. bleeding at neck muscle
d. pulmo edema
e. pseudoform
111. In internal exam of drowning cases, its found?
a. Cutis anserine
b. Cadaveric spasm
c. Washerwoman hands
d. Tardieu spot
e. Pseudo foam
112. In cases of sea water drowning, is found ?
a. Hemodilution
b. Kadar plasma natrium meningkat
c. Kadar plasma kalium mmenurun
d. Hemolisis
e. Ventricular fibrillation
For Question 113-114 :
Brotoseno, 3 yo has been suffered asthma since 8 months old. In the last year his asthma exacerbate >2x/month.
Nocturnal symptom >1x/week. His activity and sleep were disturbed.
113. Classification severity asthma?
a. Mild intermitten
b. Mild persistent
c. Moderate persistent
d. Severe persistent
e. Chronic Asthma

114. Management for severe exacerbation asthma ?


a. Inhaled LABA
b. inhaled SABA
c. inhaled SABA + inhaled ipratropium bromide (IB)
d. inhaled SABA + inhlaled IB + ICS
e. inhaled SABA + inhaled IB + systemic corticosteroid
For Question for 115-118 :
5 y.o male presented to emergency Department with a history of breathlessness since 5 hours ago. This symptom
associated with cough and cold which has been occurring for a week at night and morning time. He had been treat by GP
with antibiotic, cold and cough remedies without any improvement. During the last year those symptomps appeared
recurrently. On PE he appeared alert, dyspneic, afebrile, chest intercostals and subcostal reatraction were noted,
prolonged expiration was noted, no expiratory nor crackles were heard. No abnormality was found in other examination
115. Which of the following diagnosis is most likely to this patient ?
a. Moderate acute asthma attack
b. Mild acute asthma attack
c. Persistent asthma
d. Frequent episodic asthma
e. Acute asthma attack (frequent episodic asthma)
116. Which of the following initial management in the most appropriate for this patient?
a. nebulized salbutamol
b. nebulized ipratropium bromide
c. Pressured metered dose inhaler salbutamol
d. nebulized terbutalline
e. IV aminophyline
117. After giving 2x of one medication chosen above which was shown partial improvement, which of the following
diagnosis is most likely to this patient?
a. Moderate acute astma attack (Frequent Episodic Asthma/FEA)
b. Mild FEA
c. Severe FEA
d. FEA
e. Persistent Asthma
118. (Angga)
119.An 8yo boy comes to your clinic with exacerbation of asthma as his chief complain. What is the most appropriate
drug for him?
A. Terbutaline syrup
B. Inhaled ipraprotium bromide
C. Inhaled glucocorticoid
D. Inhaled salbutamol
E. IV aminophyline
120. 12 y.o girl suffered from moderate persistent asthma. What is the most appropriate drug for her?
a. Terbutalline syrup
b. Inhaled glucocorticoid
c. Inhaled beta-2 agonist
d. Critize oral . (?)
e. Oral theophylline

121. Yusas
122. Asmi,9yo gitl has been suffered from asthma since 6yo. In the last year her asthma exacerbate once a
while,nocturnal symptom less then once a week. Between episodes,she has normal lung function. Medication?
A. Rapid acting inhaled beta-1-agonist as needed
B. Daily low dose inhaled corticosteroid
C. Daily medium dose inhaled corticosteroid
D. Daily high dose inhaled corticosteroid
E. Daily medium dose inhaled corticosteroid plus oral glucocorticoid
123. 5mo boy,laryngomalacia,frequently had aspiration when he got milk. Last 3 days--> pneumonia. Most common
etiologic pathogen of this patient age&adolescent?
A. S pneumonia
B. S aureus
C. Pseudomonas aeruginosa
D. E coli
E. M pneumonia
124. 22 yo female w/ history of intermittent wheezing in response to exercise present to emergency room w/
shortness of breath. Her attack occured during aerobic class. At this point she is having obvious difficulty
breathing & has diffuse wheeze on pulmonary exam. Oxygen saturation 95% by pulse oxymetry. WOTF is most
effective treatment at this point?
a. IV amynophyline
b. inhaled cromolyn sodium
c. inhaled albuterol (SABA)
d. IV hydrocortisone
e. inhaled beclometasone
125. A boy has admitted to RSHS with dyspnea as a chief complaint. Sub bronchial sound in the upper part of the
right thorax was found. Chest xray: consolidation of 2 upperlobe. What is classification of this disease?
A. CAP interstitial
B. CAP lobar
C. CAP bronchopneumonia
D. HAP lobar
E. HAP bronchopneumonia
126. 5 mo baby, dtg ke ER.Komplain: fever 10 days. No seizure Cough 2 weeks No BCG vaccine Treatment: antibiotik
not improve X-ray: snow flakes appearance Hepatomegali. Diagnosis?
A. tb meningitis
B. miliary tb
C. sepsis
D. pneumonia
E. acute bronkitis.
127. On a frontal chest film,the apex of the lung retracts toward of visceral pleura is visible,separated from chest wall
by a radiolucent space devoid of lung markings..
A. Pneumothorax
B. Giant bulla
C. Giant emphysema
D. E. Pleural effusion
128. Radiography of sphenoidal sinus:
A. Lateral
B. Caldwell
C. Waters
D. Rhese
E. Stanver

129. a 10yo girl dyspnea since 7days ago. AP chest xray: homogenous lung opacification with air bronchograms in the
lateral segment of the lung. The segmental homogenous lung opacification with air bronchograms is :
A. Atelectasis
B. Pneumonia
C. Bronchopneumonia
D. Pleural effusion
E. Schwarte
130. A 20 y.o. Girl , chief complaint: dyspnea since 7 days ago accompanied by cough & fever.
In PA chest x-ray: The left costophrenic angle is blinded by a fairly well defined & concave upper edge
homogeneous opacity.
It is caused by:
A. Atelectasis
B. Pneumonia
C. Bronchopneumoni
D. Pleura effusion
E. Schwarte
131. 25 y.o patient comes to pulmo clinic. The patient is cough > 3 weeks and accompanied by the production of
purulent sputum, night sweats, weight loss, anorexia, general malaise, weakness. X ray to see small pleural effusion
A. Lateral chest film
B. Oblique chest film
C. lateral decubitus position
D. Apical lordotic
E. Anteroposterior chest
132. Posterior anterior chest xray revealed cavity in apex of left upper lobe, wall cavity is thick and surrounded by patchy
consolidation. What is it?
A. Lung abscess
B. Pulmonary cyst
C. Mycetoma in cavity
D. Cavity tumor
E. Cavity of pulmonary TB
133. 25 y.o patient comes to pulmo clinic. The patient is cough > 3 weeks and accompanied by the production of purulent
sputum, night sweats, weight loss, anorexia, general malaise, weakness. What is the basic standard radiograph for
any patient presenting with cough >3 weeks.
A. Posteroanterior chest film
B. Oblique chest film
C. Left lateral decubitus
D. Apical lordotic
E. Anteroposterior chest
134. Persistent nasal discharge, yellowish, thick, past history: nasal itchy and obstruction in cold weather, water's film:
clouding right maxillary sinus. Diagnosis?
A. Tumor right max sinus,
b. Right hematosinua,
c. Acute sinusitis
d. Chronic sinusitis
e. Mucocele
135. A doctor prescribed an anti tuberculosis drug. What medicine caused red orange urine?
A. Rifampicyn
b. Ethambuthol

c. Pyrazinamide
d.Isoniazid
e.streptomycin
136. A patient 30 y.o. Receive anti TB treatment and he has pain in right big toe swollen & low grade fever and
diagnosed gouty arthritis and high uric acid in blood. Treatment used?
A. Isoniazid
B. Rifampin
C. Pyrazinamide
D. Cycloserine
E. Streptomycin
137. 25 years old man could not obtain lisence driver because poor performance in red green color vision discrimination.
No family history color vision. He was taking 4 drugs regimen for tuberculosis. Which anti TB drug responsible?
a. Rifampin
b. Pyrazinamide
c. Ethambutol
d. Isoniazid
e. Streptomycin
Clinical situation for 138-139
15 y.o girls taken to the clinic by her mom with chief complaint 1 day history of right ear discharge. Discharge is
yellow,thick,odorless, also pain and aural fullness on right ear with febrile. after doctor perform pe and lab, she was
diagnosed acute right otitis media stage suppuration. She receive erythromycin as treatment.
138. Why erithromycin is a drug of choice of this patient? Because it is effective:
a. Against aerobic
b. Against anaerobic
c. Against gram positive
d. Against gram negative
e. Against all bacteria
139. The treatment is change from erythromicin to azytromicin. She has gastritis and consume antacid to relieve the
gastritis. What will happen in this situation ?
A. Antacid reduce bioavailibility of azytromicin
B. Azytromicin alters bioavailibility of antacid
C. Antacid delay absortion & reduce peak serum concentration
D. Azytromicin delay absorption & reduce peak serum concentration
E. Azytromicin delay excretion & reduce peak serum concentration
140. Streptomycin is very important in life threatening condition of tb. What is the side effect of streptomycin ?
gangguan hearing (Ototoxicity)
141. A 20 y/o ,am with asthma present with complaints of cough and chest tightness, ehich have been accuring daily,
requiring him to inhale a Beta receptor agonist. He notes waking up from sleep approximately three times per weeks with
similar symptoms. If he is taking sympathomimetic agent and inhaled corticoste...roids to improve his asthma control,
which of the following new generation of long acting -selective agonist to aim of his therapy?
a. Metaproterenol
b. Pirbuterol
c. Albuterol
d. Terbutalin
e. Salmeterol
142. 32 y o male came to clinic with chief complaint dyspneu and fever, HT: never suffered same experience before., no
history of the same disease in the family. Hipersensitif thd beta laktam antibiotik, so doctor give another antibiotik.
PE BP: 130/80, HR: 90bpm, temp : 39, RR : 36x, microbial culture: pneumococcus. Few hour after taking drugs
had abdominal discomfort. Wotf MOST POSSIBLE antibiotic taken??

a. azithromycin
b. cefadroxyl.
c. clarithromicyn
d. clindamycin
e. erythromycin

For question number 143 to 144, refer to scenario below:


A 20 y/o woman came to the doctor with dyspnea and fever. She has been had this condition for the last 2 days and now
its became worsen. She is noted as betalactam hypersensitive patient.
In physical examination found RR 36x/minutes, temperature 38.6oC, epigastric and intercostals retractions; vesicular
breathing sound and crackles was found by auscultation.
Laboratory result showed WBC 18.000/mm. Blood culture: Streptococcus pneumonia
143. What is the most likely appropriate drug?
a. Amoxicyllin
b. Ceftriaxone
c. Azitromicin
d. Netilmicin
e. Vancomycin
144. What is the most appropriate drug for her if she comes from low society?
a. Erythromycin
b. Cefoperazone
c. Azithromicin
d. Vancomycin
e. Spiramycin
145. The presence of fluid in the thoracic cage reduces ventilation capacity.
Thoracocentesis procedure to remove the fluid is best accomplished by inserting needle:
a. Adjacent to the sternum in the second intercostals space
b. Adjacent to the sternum in the fifth intercostals space
c. In the midclavicular line in the fifth intercostals space
d. In the midaxillary line in the seventh intercostals space
e. In the twelfth intercostals space adjacent to vertebral column

146. During thoracocentesis procedure,the physician must be careful to avoid the intercostals neurovascular bundle,
which is particularly susceptible to injury from a fractured rib because it lies:
a. Behind the superior border of the rib
b. Beneath the inferior border of the rib
c. Between external and internal intercostals layers
d. directly behind the midpoint of the rib.
e. halfway between two adjacent ribs

147. Two elderly persons, both were diagnosed as having pleurisy, were comparing their cases. One had left latera;
thoracic pain, whereas other had left neck and shoulder pain. They went to the point of reviewing the academic
qualifications of their respective physicians. Assuming the diagnosis was correct, the explanation for these differences in
pain distribution is that pleura in innervated by:

a. Cervical sphlanchnic and thoracic sphlanchnic nerves


b. Intercostal and phrenic nerves (visceral)
c. Parasympathetic and symphatetic nerves
d. Phrenic and vagus nerves
e, Vagus and intercostals nerves

148. purulent drainage from sup. Nasal meatus come from which sinus?
a. ethmoid
b. frontal
c. sphenoid
d. maxilla
e. sphenoethmoid

149. during PE of pt with facial ache, ottolaryngoligist noted drainage into left middle meatus when patien lying inthe
right side. Most likely infection:
a. anterior ethmoid sinus
b. frontal sinus
c. maxillary sinus
d. nasolacrimal duct
e. maxillary sphenoid sinus
150. a 15 y.o boy eating a fish and in advertently has a bone caught in his throat, complaint significant pain above the
vocal cord. WOTF responsible carrying the sensation for this pain?
a. superior laryngeal nerve
b. recurrent laryngeal nerve
c. spinal accessory nerve
d. hypoglossal nerve
e. maxillary nerve

151. 33 years old women underwent partial thyroidectomy. She is noted to have some hoarseness of voicess 1 month
later. What of the allowing is the most likely explanation.
a. Endotracheal tube trauma to vocal cords
b. Injury to cricoid cartilage

c.
d.
e.

Injury thyroid cartilage


Injury to recurrent laryngeal nerve
Injury to arythenoid cartilage

152. A guy admitted to ER. He aspirated peanut. Bronchoscopy perormed. Which side is the peanut probably located?
a. Right lower lobe
b. Let lower lobe
c. Right upper segmental bronchus
d. Left upper segmental bronchus
e. Acini
153. a 28 years old neuroanatomi graduate student noted pain at the bridge of his nose and had been told that he had sinus
infection. He was speculating about the afferent nerve supply from this area. What o the following is the most
accurate description of sensory nerve innervation?
a. Branches of CN III
b. Branches of CN IV
c. Branches of CN V
d. Branches of CN VII
e. Branches of CN IX
154. a 5 years old complain severe pain for right ear due to acute otitis media. Which of the following nerve is the
most likely to be responsible in carrying sensation pain of timpanic membrane?
a. CN V
b. CN VII
c. CN VIII
d. CN IX
e. CN X
155. when a person is standing upright, the gravity pulls the pleural fluid. What is the lowest level of the fluids drains
to during that situation?
a. Costomediastinal recess
b. Costodiaphragmatic recess
c. Obligue fissure
d. Horizontal fissure
156. 24 years old medical student diagnosed having sinusitis and ask his physician why he experienced a nasal drainage
during night but not day. What you explanation?
a. Location ostia within sinus
b. Location ostia within nasal passage
c. Disruption of drainage due to mastoid
d. Diurnal mucus production increase at night
e. Locatin of ostia within eustachian tube
157. 55 years old anemic dan hypotension due to anterior epistaxis . which of major artery?
a. Ethmoidal artery
b. Sphenopalatine artery
c. Superior labial artery
d. Greater palatine artery
e. Alveoar superiar artery
158. 18 years old woman come to clinic with chief complaint anterior epistaxis, on going bleeding on right nostrill.
Which of the following most likely source of bleeding?
a. Anterior nasal septum
b. Posterior nasal septum
c. Anterior turbinate
d. Posterior turbinate
e. Nasal septum

159. these closed cavities, there are in the frontal, maxillary, ethmoid, and sphenoid bones. These cavities
communicate with the nasal cavity. Which of the following epithelial tissue is the most likely lined the mucous layer
of these cavities?
a. Stratified squamous non keratinized epithelium
b. Stratified squamous keratinized epithelium
c. Stratified columnar epithelium
d. Pseudostratified columnar epithelium (epithel sinus)
e. Stratified cuboidal epithelium
160. below the epiglottis, the mucosa o larynx form 2 pairs of fold, the upper pair and the lower pair. Which of the
following epithelial tissues most likely lined the mucous layer of the lower pair fold?
a. Stratified squamous non keratinized epithelium
b. Stratified squamous keratinized epithelium
c. Stratified columnar epithelium
d. Pseudostratified columnar epithelium
e. Stratified cuboidal epithelium
161. This single conducting portion of respi system is lined with respi epithelium. In the lamina propria are 16-20 C
shaped ring of hyaline cartilage. WOTF is most likely portion?
a. nasal cavity
b. nasopharynx
c. larynx
d. trachea
e. bronchiole
162. In the larger portions of this conducting respiratory system, the hyaline cartilage rings completely encircle the
lumen. As the diameter decreases, the cartilage rings are replaced with isolated plate. WOTF is the most likely
portion?
A. larynx
B. trachea
C. bronchi
D. bronchioles
E. terminal bronchioles
163. Bagian tsb tidak ada cartilage maupun gland. Ada clara cell. Sel apa yang melapisi? Terminal Bronchiole
a. simple squamous
b. simple cuboidal
c. simple columnar
d. pseudostratified cuboidal
e. pseudostratified columnar
164-165
A 25 y.o. woman got traffic accident while driving his car 2 days ago and had been amputated (right lower limb)
yesterday. Few hours post operation his condition was decreased & finally she died.
164. Which of the following is the most likely cause of death.
a. fat embolism
b. air embolism
c. fluid embolism
d. thromboembolism
e. amnion embolism
165. Post mortal autopsy reported a pulmo embolism. WOTF is the most common source pulmo emboli.
a. Hypogastric vein
b. SVC
c. deep veins of the thigh
d. axillary vein
e. jugular vein
166. 64 y.o. man come to respiratory clinic with difficulty in breathing since yesterday, had chronic history of asthma
bronchiole, from PE: temp 39, Pulse 115 bpm, radiology: barrel chest, leukocyte: 15000. WOTF is the etiology?

a. diffuse interstitial lung fibrosis


b. portal hypertension
c. lymphoid hyperplasia
d. medial hypertrophy of pulmo artery vessel
e. chronic pneumoconisiosis
167. Most common cause of bacterial pneumonia
a. pneumocystic carinii
b. S aureus
c. E coli
d. S pneumonia
e. pseudomonas aeruginosa
168. A 42-year-old black woman presents with shortness of breath. She is a non smoker. A diffuse interstitial pattern
with small parenchymal nodules is seen on chest radiograph, as well as massively enlarged hilar lymph nodes.
Biopsy was performed.
Which of the following is the most likely microscopic feature from transbronchial biopsy of the lung?
a. Loss of alveolar walls with minimal changes in the airways
b. Non caseating granulomata
c. Many neutrophils in alveoli with edema
d. Type II pneumocyte proliferation with chronic interstitial inflammation & intranuclear viral inclusions
e. An increased mucus
169. A 70-year-old male, who was a heavy smoker, complained of blood tinged sputum. A chest X-ray & CT
demonstrated a large hilar mass with retraction of mediastinum. He also complained of headaches. A work up
showed nodules in the brain. A transbronchial biopsy was performed. The biopsy consistence with malignancy.
Which of the following is the most likely diagnosis?
a. Lymphoma
b. Squamous cell carcinoma
c. Adenocarcinoma
d. Small cell carcinoma
e. Malignant mesothelioma
170. A 54-year-old suffered lung cancer since 6 months ago, came to hospital with chief complaint of low vision and
enlargement of the eye-ball. Physical examination revealed ptosis, miosis, hemianhidrosis.
Which of the following site is the most likely tumor location?
a. Inferior pulmonary lobule
b. Superior pulmonary sulcus lesions
c. Peripheral pulmonary lesions
d. Terminal lobules pulmonary lesions
e. Central lobules pulmonary lesions
171. A 70-year-old suffered lung cancer since 6 months ago, came to hospital with chief complaint of low vision and
enlargement of the eye-ball. Physical examination revealed ptosis, miosis, hemianhidrosis.
Which of the following conditions is the most likely to have?
a. Tuberculosis
b. Bronchogenic pneumonia
c. Bronchiectasis
d. Bronchogenic carcinoma
e. Emphysema
172. Patient who inhales his left lower bridge consisting of two teeth and completely obstruct his right lower lobe main
bronchus. Wise but stubborn, he refuses surgical intervention for 2 weeks. By that time a right lower lobotomy is
necessery.
The LEAST likely pathological finding in light of the history?
a. Atelectasis
b. Emphysema
c. Empyema
d. Bronchiectasis
e. Bronchopneumonia

173. A 45-year-old man develops severe shortness of breath after automobile accident. He is thought to have adult
respiratory distress syndrome. Histo finding most characteristic of the first lesion?
a. Mucous plug
b. Hemosiderin laden macrophage
c. Multinucleated giant cell
d. Abcess
e. Hyalin membrane
174. A 45-year-old man smoked 2 packs of cigarettes/day for 20 years. For the past years, he has had a chronic cough
with abundant mucoid expectoration. Several episodes or respiratory tract infection, developed difficulty of
breathing, wheezing, & consumed salbutamol.
Which of the following is the most likely microscopic feature?
a. Alveolis are vary size. Some of them show enlargement & sinusoidal
b. Enlargement bronchiolus terminalis caused by loss of elastin protein
c. Bronchus until alveoli should be normal
d. Air entraped in alveoli
e. (gak sempet nyatet)
175. A 67-year-old man has had long standing smoker, and for 5 years show the symptom breathless when exercise,
cough > 3 / month with productive sputum. PE: RR 30x/minute, barrel shaped chest, wheeze & crackles.
Which of the following is the most likely pathological finding?
a. Trachea-brochioles enlarge in internal diameter, inflammatory cell infiltrate the surface epithelium, and enlarge
mucus secreting gland
b. Trachea-brochioles smaller in internal diameter, inflammatory cell infiltrate the surface epithel, and hyperplasia &
hypertrophy mucus gland
c. Destruction of lung parenchyme in COPD caused constriction & destruction of respiratory bronchioles
d. Pulmonary vascular change are characterized by thinning of vessel wall, thickening of the intima followed by
decrease in smooth muscle
e. Increasing collagen content and scar tissue in respiratory tract caused by narrows the lumen and imbalance of
endogenous proteinase & anti-proteinase in the lung