MDE HIS 2006

Kamis, 11 Maret 2010

1. Jawaban : C

Alasan : Hb, Hct ↓ à anemia, MCV ↓ à microcytic, MCHC ↓ à hypochromic

2. Jawaban : B

Alasan : diagnosis à IDA (harmening hlm 104)

3. Jawaban : A

Alasan : promyelocyte&myelocyte à myeloblastic, immature cells à acute leukimia (AML)

4. Jawaban : D

Alasan : blast ↑, PMN ↓, lymphocyte N. ALL lebih sering pada anak-anak.

5. Jawaban : E

Alasan : hasil lab merujuk pada CML

6. Jawaban : C

Alasan : kemungkinan yang btrjadi adalah contact dermatitis (hypersensistivity tipe 4)

7. Jawaban : B

Alasan : ELISA menggunakan enzim dan substrat dari enxim tsb yang akan memberi warna pada antigen

8. Jawaban : D

Alasan : salah satu tes untuk SLE adalah tes anti dsDNA

9. Jawaban : A

Alasan : poison ivy à contact dermatitis à hypersensitivity tipe 4 àT cell berperan

10. Jawaban : E

Alasan : 15 minutes à acute phase reaction à A, B, C, D benar. E à late phase reaction

11. Jawaban : C

Alasan : kemungkinan diagnosis adalah Hodgkin’s lymphoma

12. Jawaban : A

Alasan : diagnosis untuk keganasan pada lymph (node) dilakukan melalui biopsy

13. Jawaban : C

Alasan : Robbins hlm 688

14. Jawaban : B

Alasan : kebanyakan pasien ditreatment dengan chemotherapy (cytostatic)

15. Jawaban : E

Alasan : adverse prognostic factors identified in the international study are: Age >= 45 years, Stage IV disease, Hemoglobin <>, Lymphocyte count <>, Male, Albumin <>, White blood count >= 15,000/µl

16. Jawaban : A

Alasan : petechiae, ecchymosis, PLT ↓ (Harmening hlm 474)

17. Jawaban : B

Alasan : Harmening hlm 475

18. Jawaban : B

Alasan : Harmening hlm 475

19. Jawaban : B

Alasan : Harmening hlm 475

20. Jawaban : D

Alasan : Harmening hlm 475

21.C. jelas ya, setelah kita tahu kadar Hb, kita tahu keadaan RBCnya secara blood chemistry dan komponen2 yang terlibat yang diindikasikan (serum iron, TIBC, dll), lalu kita liat morfologinya RBC dengan smear

22. B. IDA juga bisa bermanifest ke lapisan kulit (spoon nail, atrophy tongue, brittle hair)

23. C. Wintrobe bilangnya 3-6 months, tapi Harisson bilangnya 6-12 bulan karena di harisson itu prinsip treatment adalah hilangkan anemia dan increase and relieve iron storage 0,5-1 mg.

24.D. kalo liat dari wintrobe dan harisson, respon therapy itu diliat dari

- symptom yang relieve

- increase back of reticulocyte ke jumlah normal

- Hb naik ke arah normal

- kadar EPO yang turun

- Fe absorption turun

Tapi kalo diliat dari prinsip treatmentnya harisson yang melihat sampai adanya iron storage, maka melihat keberhasilannya ya kita lihat storagenya berupa feritin.

25. A. EPO masih punya efek untuk “menghiperplasiakan” sel erythroid precussor pronormoblast yang CFU-E, yang masih sensitive terhadap EPO.(compare: Sedangkan yang BFU-E itu sensitive terhadap Interleukin)

26. B.

27. D. jelas ya, AML-M3 itu dicirikan dengan promyelocyte dominant, adanya faggot cell dengan adanya manifestasi DIC , bisa berupa thrombosisnya atau hemorhagicnya. Di sini kebetulan manifestasinya berupa hemorrhagic.

28. D. di sini kecurigaan kea rah deficiency dari vit b12. Etionya berupa:

- dietary : kurang banyak vit b12-nya

- needednya meningkat è pada wanita hamil

- absorption : infeksi, kelainan congenital pada GI tract, adanya autoimun (cthnya yang ganggu parietal cell bwt release IF), hereditary deficiency release dari IF,neoplasia, gangguan release IF gasterektomy, dll. Ngeliat dari kasus, achlohydria ini merupakan salah satu etiologi dari absentnya release substance dari sel2 parietal yang juga release IF.

29.D. anemia apalstik treatmentnya berupa supportive dan transplantion of bone marrow.

30.C. pada spherocyte, ditandai dengan adanya kenaikan MCHC dan osmotic fragility test yang meningkat karena ketidakmampuan cytoskeleton RBC untuk mempertahankan bentuk dan resistensi tekanan osmosis

31. A. karena makin banyak tersintesisnya Hb, warna cytoplasmanya jadi makin jadi merah.

32. normal maturasi RBC:

- perubahan warna kea rah acidophil karena increasing dari kadar Hb

- chromatin condensed, loss nucleoili, loss nucleus

- decrease of mitochondria

33. B. azurophillic granule itu ada di tahap progranulocyte, kalo uda mature, granulocyte itu akan mengandung specific granule. Di lecture note, maturasi abnormal pada WBC bisahypersegmen nuclei dan persisten azurophillic granule di cytoplasm.

34. D.

35. C. ngeliat optionnya, ini mengarah ke WBC maturation. Jadi yang jelas adalah C.

36. E. karena adanya defect di rantai beta, maka akan adanya mekanisme kompensasi berupa switching rantai beta ke rantai gamma dan delta, sehingga membentuk rantai Hb 2 alfa + 2 gamma atau 2 delta. Sehingga yang meningkat masing2 adalah HbF (dengan gamma) dan HbA2 (dengan delta)

37. B. jelas ya..

38. C. karena adanya penurunan jumlah RBC maka mekanisme yang terjadi adalah reaksi kompensasi berupa peningkatan retikulosit.

39. A. aplastic anemia berupa pancytopenia (penurunan sel2 hematopoietic) di perifer dan hypoccellular pada bone marrow.

40. D. ada di harmening

41. Jawaban : B. eosinophils

Pembahasan :

Jelas ya... eosinophil naik saat keadaan alergi & infeksi parasit.

42. Jawaban : D. basophils

Pembahasan :

“Mast cell granules, in addition to all other substances that are present in the granules of basophils, contain serotonin & proteolytic enzymes.” (Harmening, 42)

43. Jawaban : A. sternum

Pembahasan :

“The sites for bone marrow studies in adults are most commonly the posterior superior iliac crest, occasionally the sternum, and very rarely anterior superior iliac crest & spinal process of vertebral bodies.” (Harmening, 43)

44. Jawaban : A. T-lymphocyte

Pembahasan :

“The incidence of acute GVHD (graft-versus-host disease) can be reduced by depleting the donor marrow of the cell responsible for the GVHD reaction, namely T-lymphocyte.” (Harmening, 324)

45. Jawaban : B. mast cell

Pembahasan :

Anaphylactic shock terjadi karena pelepasan histamin secara masif & sistemik dari mast cell yang mengalami degranulasi akibat menempelnya antigen spesifik dengan antibodi yang menempel pada permukaan mast cell.

46. Jawaban : C. causing the histamine ...

Pembahasan :

Penjelasan sama dengan nomor 45...

47. Jawaban : D. hemophilia

Pembahasan :

Terdapat hematoma. Hasil lab, BT normal, PT normal, APTT prolong.

Penyakitnya hemophilia A. (Harmening, tabel 25-1, 496)

48. Jawaban : D. deficiency of factor VIII

Pembahasan :

Hemophilia A terjadi akibat defisiensi faktor VIII. (Harmening, tabel 25-1, 496)

49. Jawaban : D. defect of secondary hemostasis

Pembahasan :

“Secondary hemostasis involves the enzymatic activation of coagulation proteins to produce fibrin from fibrinogen, thereby stabilizing the fragile clot.” (Harmening, 442).

Hemophilia A terjadi akibat defisiensi faktor koagulasi VIII -> defek pada secondary hemostasis.

50. Jawaban : D. deficiency of factor VIII

Pembahasan :

Penjelasan sama dengan nomor 48,

51. Jawaban : D. defect of secondary hemostasis

Pembahasan :

Penjelasan sama dengan nomor 49,

52. Jawaban : A. cryoprecipitate

Pembahasan :

Penyakitnya adalah hemophilia.

“Cryoprecipitate = a concentrated source of coagulation fator VIII.” (Harmening, glossary 699)

“Although cryoprecipitate is a rich source of FVIII, it is not the product of choice beause of the high incidence of parenteral transmitted HIV.” (Harmening, 502)

“Fresh Frozen Plasma = a frozen plasma product contains all clotting factors. It is useful for clotting factors deficiency other than hemophilia A, vWB disease, hypofibrinogenemia.” (Harmening, glossary 701)

Yawda kasih cryoprecipitate aja, daripada yang laen lebih ga nyambung, ya ngga??

53. Jawaban : E. hemarthroses

Pembahasan :

“Hemarthrosis is a primary symptom of hemophilia involving knees, elbows, ankles, shoulders, hips, wrists.” (Harmening, 501)

54. Jawaban : B. defect of platelet production

Pembahasan :

D & E salah karena PT & APTT normal,berarti tidak ada kelainan pada fungsi faktor koagulasi (intrinsik & ekstrinsik). Petechiae adalah karakteristik abnormality of vessel or the platelets, and are exceedingly rare in coagulation disorders. Dan dari kasus, jelas jumlah plateletnya sangat turun. Maka defek produksi platelet yang mungkin.

55. Jawaban : B. immune thrombocytic purpura

Pembahasan :

“Platelets undergo premature destruction as a result of autoantibody. Antiplatelet antibody can also bind to precursor bone marrow megakaryocyte. Tha bone marrow is characterized by increased or normal number of megakaryocyte.” (Harmening, 474)

56. Jawaban : D. defect in factor coagulation

Pembahasan :

Prolong PT -> defect in factor coagulation (common pathway & extrinsic)

Prolong APTT -> defect in factor coagulation (common pathway & intrinsic)

57. Jawaban : C. vitamin K deficiency

Pembahasan :

“Acquired deficiencies of the vitamin K-dependent coagulation factors are relatively common because the body does not contain appreciable stores of vitamin K.” (Harmening, 655)

58. Jawaban : C. fresh frozen plasma

Pembahasan :

“Fresh Frozen Plasma = a frozen plasma product contains all clotting factors. It is useful for clotting factors deficiency other than hemophilia A, vWB disease, hypofibrinogenemia.” (Harmening, glossary 701)

59. Jawaban : B. polycythemia vera rubra

Pembahasan :

Coffee ground vomit = muntahan yang mengandung darah yang berubah gelap bercampur dengan isi lambung akibat pengumpulan darah dalam lambung. (Dorland)

“Elevation of the RBC count, Hb, and Ht are the most important findings in PV.” (Harmening, 343)

“GI disorders associated with PV include peptic ulcer, and possibly, massive hemorrhages from varices in the esophagus, stomach, or bowel.” (Harmening, 342)

60. Jawaban : C.normal O2 saturation, erythrocyte mass over 36 ml/kg, high serum vit.B12

Pembahasan :

“The arterial O2 saturation is normal in most patients with PV.” (Harmening, 344)

“Absolute erythocytosis is present in men with values at least 36 mL/kg, and in women with at least 32 mL/kg.” (Harmening, 343)

“Increased serum vitamin B12 or vitamin B12-binding proteins.” (Harmening, tabel 18-8, 345)

A. salah low B12 / B. salah low O2 / D. salah pada kasus male / E. salah high O2.

61. sori gtw

62. A

63. D

64. D

65. A (mungkin yg dimaksud diagnosis of CML depends on…)

66. sorii gtw

67. sori gtw

68. E

69. B

70. C

71. E

72. B

73. C

74. A

75. B

76. C

77. B

78. D

79. B

80. C

100) B

101) A

102) A

103) C

104)

105) D

106) C

107) C

108) A

111) A

112) E

113) C

114) E

115) C

116) A

117) E

118) A

119) D

120) D

121. how is the mechanism of action of antihistamine ?

Ans.

-

122. which of the following is the characteristic for the first generation of antihistamine ?

Ans.

B. Cross blood brain barrier

123. how does the antihistamine works best in allergic disease ?

Ans.

B. Reversing rather than preventing histamine’s actions on target tissue

124. which of the following can be given simulaneously with antihistamine, metabolized through hepatic cytochrome P450 pathway ?

Ans.

?

125. when might corticosteroids be NOT beneficial at all in the management of anaphylaxis ?

Ans.

?

126. where exactly is the site of action of glucocorticoids in allergic inflammation ?

Ans.

?

127. cytokines that release by macrophage and have role in maturation of T helper cell is ?

Ans.

B. IL-12

128. the highest concentration of immunoglobulin that can be found in gut secretion is ?

Ans.

B. igA

129. antigen that come from human body substance and has ability to induce immune response to human body self is called ?

Ans.

C. Autologous antigen

130. the role of class I MHC in immune response is presenting antigen from ?

Ans.

A. Infected cell to Tc cell

131. viral receptor of HIV on human cell is ?

Ans.

D. CD4

132. the most important defense body mechanism in infection of HIV is ?

Ans.

D. Cell mediated immunity

133. one of the following statement of HIV characteristics is not true ?

Ans.

E. Grouped in unenveloped virus

134. antigen binding site of immunoglobulin are build by ?

Ans.

E. N-terminal of H&L chains

135. if the amount of IgM can be detected from sera of neonatus, it indicates ?

Ans.

C. Intrauterine infectious disease

136. which of the following human body cells does NOT have class I MHC on its surface ?

Ans.

?

137. one of the following is TRUE regarding Discoid Lupus Erythematous (DLE) ?

Ans.

A. Patient’s with systemic lupus erythematous (SLE) can develop DLE-like skin patches

138. the lupus band test has correlation with ?

Ans.

B. Discoid Lupus Erythematous

139. microscopic studies on biopsy of DLE show ?

Ans.

C. Epidermal atrophy

140. one of the following pathologic finding is most likely associated with systemic lupus erythematous (SLE) ?

Ans.

A. Glomerular deposition of immune complex

181.The presence of iron deficiency anemia to iron therapy is influenced by?

A.The type of iron compound

B.Sex

C.Dose interval

D.Ability of patient to absorb medicinal iron

E.Age

Alasan:

Failure of iron therapy dapat diakibatkan oleh: incorrect diagnosis, complicating illness, failure of patient to take prescribed medication, inadequate prescription (dose form), and malabsorbtion of iron.

182.The drug that has effect of myelinization process in peripheral nerve

A.Iron

B.Cobalt

C.Folic Acid

D.Cyanocobalamin

E.Riboflavin

Alasan: Pada keadaan Megaloblastic anemia (deficiency B12) biasanya disertai gangguan neuropsyciatric dimana B12 berperan dalam mencegah degenerasi peripheral nerve, posterior colum dan lateral colum.

183.The majority of iron in the body is found in

A.Myeloglobin

B.Enzyme

C.Hemoglobin

D.Storage iron

E.Hemosiderine

Alasan: 2/3 iron berupa hemoglobin iron sedangkan 1/3 berupa tissue iron dan proporsi kecil berupa plasma dan transport iron.

184.The most common cause of nutritional anemia in human being is

A.Iron deficiency

B.Riboflavin deficiency

C.Pyridoxine deficiency

D.Vit- B12 deficiency

E.Folic acid deficiency

Alasan: pada wanita sering terjadi IDA khususnya saat menstruasi begitu juga pada pria , kasus IDA juga sering dijumpai.

185.Substance know to facilitate absorption of non-heme iron

A.Vit A

B.Vit E

C.Vit C

D.Vit D

E.Vit K

Alasan: Absorbis acid (Vit C) dan succinate acid increase absorbtion of ferrous iron.

186.The drug which has effect such as paresthesia of hand and feet, dimunation of vibration, and resultant unsteadiness.

A.Vit B12

B.Iron

C.Cupprum

D.Pyridoxin

E.Cobalt

Alasan: lihat pembahasan no 183.

187.Soalny lihat di buku soal ya (panjang banget)

What is the most likely diagnosis:

  1. Secondary trombocytopenia
  2. Thrombotic trombocytopenia purpura
  3. Dengue hemorhagic fever
  4. Immune trombocytopenic purpura
  5. Drug induced trombocytopenia.

188.Which pysical examination result can cause a blood donor rejected

A.Weight 55 kg

B.Pulse 75 bpm

C.Temperature 36.5 c

D.Diastolic 110 mg

E.Hb 13.5 g/dl

189.what transmitted disease test shold be performed on blood that will transfused to donor.

A.Malaria,HBSag, VDRL, and ebstein barr virus

B.Ebstein barr virus, VDRL,HBSag, and cytomegalovirus

C.HIV, HBSag, HCV, and malaria

D.HLV,HCV,HBSag and VDRL

Alasan: seluruh type penyakit tersebut sering diperiksa saat akan transfusi darah sedangkan VDRL tidak dilakukan karena VDRL tidak ditransmisi melalui darah melainkan STI

190.What blood type is possible for an offspring of AO dan BO person

a.AB,A or B

b.A or B

c.AB,A.B or O

d.AB or o

e.O

Alasan: IAIO + IBIO > IAIB (AB), IAIO (A), IOIB (B), IOIO (O)

191.What would be the result of group A blood given to group O pasien

A.non immune transfusion reaction

b.immediate hemolytic transfusion reaction

c.delayed hemolytic transfusion reaction

d.immediate non immune transfusio reaction

e.delayed non immune trasfusion reaction

Alasan: apabila darah A diberi ke darah O akan terjadi agglutinasi dimana proses ini melibatkan proses immune cytotoxic (hemolytic) transfusion reaction. Kejadian ini termasuk type hypersensitivity type 2

192.A patien with hypofibrinogenemia.What component is the best choice for transfusion

a.granulocyte

b.cryoprecipitate

c.FFP

d.platelet concentrate

e.PRC (Packed Red Cell)

Alasan: Cryoprecipitate kaya akan FC VIII dan fibrinogen

193.a male cancer patient with hemoglobin of 6 g/dl was admitted to the hospital with acute abdominal pain.Small bowel resection was indicated,the attending physician wanted to raise the patien’s Hb to 12 g/dl before surgery.How many units of RBCs would most likely to be required to accomplish this?

a.eight

b.seven

c.six

d.five

e.four

Alasan: 1 PRC dapat meningkatkan 1 g/dl Hb dan 3-4 Ht

194.What is characteristic finding seen in the peripheral smear patien with multiple myeloma

a.microcytic hypocromic cells

b.intracellular inclusion bodies

c.rouleux

d.hypersegmented neutropil

e.teardrop cell

Alasan: Pada multiple myeloma terdapat high level serum M protein yang mengakibatkan red cell in smear of peripheral blood to stick to one another in linear array yang disebut roulex formation

195.What are the lab finding in polycytemic vera

b. peningkatan Ht,RBC, granulocyte and platelet

Alasan: polycytemic vera ialah hematopoietic stem cell disorder characterized by accelerated erytropoiesis ,proliferasi myeloid dan megakaryocytic element of bone marrow.

196.a patient present with platelet count of 1500/L and bleeding time of 12 minutes.these result probably suggest

a.penurunan platelet production

b.penurunan platelet function

c.peningkatan platelet production

d.peningkatan platelet destruction

e.penurunan platelet destruction

Alasan: pada kasus tersebut pasien mengalami prolonge bleeding time (N=30 Second- 2 minute) dimana akibat produksi platelet yang rendah (N=150.000-450.000)

197.Which coagulation disorder decreased activity of factor VIIIC,vf:Ag,VWF and cause prolong bleeding time test?

a.hypoprothrombinemia

b.von willebrand disease

c.hemophilia A

d.hemophilia B

e.parahemophila

198.The factor that efect that has normal APTT and a prolonged PT is

a.hypoprothrombinemia

b.Von willebrand’s disease

c.hemophilia A

d.hemophilia B

e.decreased platelet destruction

Alasan : b,c,d slah karena yang terjadi adalah normal PT dan prolonged APTT sedangkan e salah karena PT dan APTT nya normal

Karena PT untuk melihat kadar factor I,II,V,VII, dan X sedangkan APTT untuk melihat kadar factor I,II,V,VIII,IX,X,XI,XII

199.whIch of the following process in involved in alternative pathway of the complement

a.induced by binding IgGI and CI

b.induced by antigen-antigen IgG2 complex

c.induced by activation of C4

d.induced by microbial cell suface

e.induced by activation by C2

200.whuch of the following cytokines play important role in synovitis?

a.INF Gamma

b.IL-12

c.TNF-alpha

d.IL-2

E.IL-4

Alasan: pada synovitis melibatkan 3 cytokines major yakni TNF-alpha,IL-12 dan IFN-gamma namun proporsinya TNF-alpha > IL-12 > IFN-gamma

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