MDE HIS 2007-2

1. Jawaban : C
Alasan : soal kurang lengkap, klo hanya segini harusnya bisa semua. Tapi klo ada hemarthrosis (bleeding in joint) biasanya karena masalah koagulasi.

2. Jawaban : A
Alasan : ada thrombocytopenia sedangkan blood count lain normal, ada sejarah bleeding (Harmening hlm 474)

3. Jawaban : C
Alasan : Hb nomal  12-16 (women), WBC  4800-10800, PLT  150000-350000 (tabel Harmening)

4. Jawaban : A
Alasan : gejala paling sering pada ITP adalah bleeding, dan yang paling berbahaya bila terjadi di intrakranial

5. Jawaban : C/D
Alasan : sebenernya di bukunya “most of the case will respond to corticosteroid” jadi masukin yang D juga. Treatment awal diberikan corticosteroid atau IV Ig (wintrobe)

6. Jawaban : C
Alasan : BM smear  peningkatan jumlah megakaryocyte (harmening hlm 444)

7. Jawaban : A
Alasan : Harmening hlm 444

8. Jawaban : C
Alasan : dari SS mungkin yang bterjadi adalah Hodgkin’s lymphoma

9. Jawaban : A
Alasan : diagnosis untuk keganasan pada lymph (node) dilakukan melalui biopsy

10. Jawaban : D
Alasan : Robbins hlm 688

11. Jawaban : B
Alasan : kebanyakan pasien ditreatment dengan chemotherapy (cytostatic)

12. Jawaban : E
Alasan : adverse prognostic factors identified in the international study are: Age >= 45 years, Stage IV disease, Hemoglobin < 10.5 g/dl, Lymphocyte count < 600/µl or < 8%, Male, Albumin < 4.0 g/dl, White blood count >= 15,000/µl

13. Jawaban : IDA
Alasan : sign & symptom cocok dgn IDA

14. Jawaban : Acidophilic normoblast
Alasan : sebenernya jawabannya “lack of stainable iron in reticuloendothelial cells”, tapi ga ada di pilihan.

15. Jawaban : Hemorrhagic disease of newborn
Alasan : prolonged PT dan aPTT  kelainan pada intrinsic dan extrinsic pathway  multiple coagulation factor disorder

16. Jawaban : A/B
Alasan : PLT count normal  kemungkinana kelainan di faktor koagulasi (Harmening hlm 465-466)

17. Jawaban : E
Alasan : nampak soalnya salah, harusnya PLT count berkurang, jadi diagnosisnya ITP

18. Jawaban : B
Alasan : ada faktor genetis (pada male family member) dan peningkatan aPTT  kelainan proses koagulasi (secondary hemostasis)

19. Jawaban : C
Alasan : prolnged aPTT, hemarthrosis, history of bleeding in male family member (Harmening hlm 501)

20. Jawaban : D
Alasan : hemophilia A  kelainan faktor VIII

21. E. jelas ya, liat penjelasan no 24 tahun 2007-1
22. E. pasien kita ini kemungkinan dikarenakan DIC (salah satu etiologynya adalah sepsis)  terjadi peningkatan konsumsi dari faktor2 koagulasi sehingga terjadi depleted dari ketersediaan factor koagulasi; dan peningkatan degradasinya. Terbukti dengan adanya gejala hemorrhagic aktif (purpura dan petechiae yang diffuse dan pendarahan di tmpt injeksi) serta peningkatan APTT n PT dan penurunanthrombocyte dan fibrinogen dengan elevated degradation product D-Dimer. Coba lihat harmening hal 528 tabel 26.4
Note: DIC itu mempunyai manifestasi yang unik, tergantung dari manifestasi mana yang dominan, bisa manifestasi pendarahan atau manifestasi thrombotic.
23. E. PT dan APTT yang meningkat (masalah multiple coagulation factors), dan pasien kita masih berumur 3 hari, kemungkinan besar, hemorhagic disease pada masa breastfed ialah akibat dari deficiency vit K; yang di mana vit K mempengaruhi factor II,VII,IX,X..
24.B. karena abnormal response dari mast cell dari compensatory cholinergic in thermoregulation.
25.?
26.?
27?
28?
29. E. jelas ada tanda2 hemolytic anemia  pale yang disertai icterus, splenomegaly (SII)
30. agak ga jelas. Untuk H.spherocyte  splenectomy; untuk Thalasemia dan Sickle Cell disease  transfusion PRC, hydroxyurea atau bone marrow transplantation. Untuk hemolytic anemia karena autoimmune  dikasih glucocorticoid, tapi… di sini soalnya ga gitu jelas.
31. jika optionnya seperti ini, diagnosis pastinya melalui Hb electrophoresis.
33.??
38. D.kalo granulocyte hyperpigmentation itu ga ada.adanya adalah hypersegmentation yang muncul pada megaloblastic anemia.
39. D. robbins hal 676
40.?? Ini kan pasien uda kita curigai ada hemophilia, test yang dilakukan selanjutnya ialah factor VIII assay untuk memastikan betul bahwa memang ada deficiency di situ.. tapi kalo dibilang substitutional test, ga ketemu itu apa…
41. Jawaban : E. cryoprecipitate
Pembahasan :
Penyakitnya adalah hemophilia, karena ada riwayat bleeding pada keluarga laki-laki & APTT turun.
“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 cryo- aja, daripada yang laen lebih ga nyambung, ya ngga??

42. Jawaban : C. scafferin
Pembahasan :
“At least six sperm-coating antigens have since been identified in human seminal plasma. Only two of these antigens, lactoferrin, also known as scafferin, and the seminal plasma No. 7 antigen (ferrisplan) have been shown to originate in the human seminal vesicles.” (internet)

43. Jawaban : B. BCB staining
Pembahasan :
“When stained with new methylene blue, diffusely basophilic cell reveals ribosomes in granulofilamentous arrangement (or network of strands & ganules) and are classified as reticulocytes.” (Harmening, hlm 13)
“Cytoplasm of reticulocytes stains slightly basophilic with Wright's stain. However, when stained with a supravital-stain such as new methylene blue or brilliant cresyl blue (BCB), precipitated ribrosomal RNA (reticulum) can be demonstrated within the cell.” (internet)

44. Jawaban : (?) akademik 2006 jawab A. increase potassium
Pembahasan :

45. Jawaban : (?) akademik 2006 jawab A. whole blood
Pembahasan :

46. Jawaban : pronormoblast / rubriblast
Pembahasan :
Youngest RBC -> pronormoblast / rubriblast (Harmening, 10, tabel 1-6, 13)

47. Jawaban : myeloblast – promyelocyte – N.myelocyte – N.metamyelocyte – N.band – N.segmented
Pembahasan :
Stage of neutrophil development (Harmening, tabel 1-7, 17)

48. Jawaban : B. leukocyte, Hb, diff.count
Pembahasan :
Inflamasi berkaitan dengan naiknya jumlah sel-sel leukosit, untuk tahu lebih jelas penyebabnya kita lakukan diff.count. Platelet & reticulocyte kurang berkaitan dengan proses inflamasi. Jadi yang paling mungkin B.

49. Jawaban : A. microcytic, hypochromic anemia
Pembahasan :
(Harmening, tabel4-3, 77)
MCV (80-100 fL) -> turun, microcytic
MCH (22-31 pg)
MCHC (32-36%) -> turun, hypochromic
Pada kasus, ketiganya turun, maka microcytic hypochromic anemia.

50. Jawaban : B. iron deficiency anemia
Pembahasan :
MCV, MCH, MCHC turun -> microcytic hypochromic anemia.
A. megaloblastic anemia -> macrocytic normochromic
B. IDA -> microcytic hypochromic (V)
C. hemolytic anemia -> normocytic normochromic
D. aplastic anemia -> normocytic normochromic
E. pernicious anemia = megaloblastic
(Harmening, tabel 4-3, 77)

51. Jawaban : B. normoblast with marked nucleus
Pembahasan :
“IDA –> the bone marrow revealed a mild to moderate increase in erythroid progenitors (normoblasts).” (Robbins, 646)

52 – 53. ga ada soalnya...

54. Jawaban : E. bullous pemphigoid
Pembahasan :
“Bullous pemphigoid –> a bullous autoimmune disease usually in eldery.
Lesion = pruritic papular / urticarial lesion with large tense bullae, subepidermal blister with eosinophils.
Mechanism = interaction of antibody with bullous pemphigoid antigen (BPAG12) at hemidesmosome of basal keratinocyte.” (Fitzpatrick pocket, 112)

55. ga ada soalnya...

56. Jawaban : A. abnormal synthesis of globin chain
Pembahasan :
“In thalassemia, a defect in the rate of production of one of the globin chains causes a decrease in the ammount of normal physiologic Hb produced, resulting in microcytic hypochromic anemia.” (Harmening, 188)

57. Jawaban : C packed red cell
Pembahasan :
Karena terdapat defek pada pembentukan rantai globin dari Hb, dari RBC. Maka transfusi yang sesuai adalah packed red cell.

58. Jawaban : E. aplastic anemia
Pembahasan :
“Aplastic anemia is a disorder characterized by cellular depletion & fatty replacement of bone marrow. Decrease in hematopoietic progenitors laed to diminished production of erythocyte, leukocyte, & platelet and development of peripheral blood cytopenia.” (Harmening, 129)

59. Jawaban : (?)
Pembahasan :
Penyakitnya adalah IDA, karena serum iron & ferritin turun.Terapi dengan iron replacement.
“Iron toxicity (acute) = necrotizing gastroenteritis, vomit, abdominal pain, bloody diarhea, may be followed by shock, lethargy, dyspnea, and in severe cases metabolic acidosis & death. (Katzung, 531)

60. ga ada soalnya...

61. D
62. C. Tanda2 dari pasien ini mengarah ke IDA. Lab result dari pasien yg mengidap IDA adalah decreased serum ferritin, increased TIBC
63. E. seperti case IDA kita (no hepatosplenomegaly)
64. D
65. C
66. A.
67. D. Dari tanda2nya pasien kita terkena leukemia. Kalo brittle hair=anemia; koilonychias=anemia; dry skin=anemia. Nah gum hypertrophy bias terjadi karena infiltrasi dari leukemic clone.
68. C. Pasien kita terkena leukemic tipe AML (dewasa), khususnya AML M3
69. B.
70. ga nyambung soalnya
71. A
73. E
74.C
75. C
78. A
79. D
80. ga jelas soalnya
100) A
101) C
102) A
103) D
104) D
105)
106) A
107) E
108) C
109) A
110) D
111) C
112) D
124. which of the following is the characteristic of rhinorrhea ?
Ans.
-
125. a 24 years old women with runny nose, sneezing in the morning. No cough, headache, fever, anterior rhinoscopy with swelling of mucous which appeared pale or bluish in color, clear discharge, no septum deviation, no polyp and decrease air passage. Which of gland activity should be abnormal ?
Ans.
B. Exocrine
126. a 6 years old girl came to outpatient department of RSHS with chief complaint red, itchy, circumscribed patches on her body. She ate shrimp an hour ago. She’s allergic to cold but has no history of food allergy. Which of the following skin layer is abnormal ?
Ans.
A. Pars papillaris
128. a 24 years old male, IV drug user, lab result shows HIV (+). Which of the following cell killed by the virus ?
Ans.
C. CD4+ T lymphocyte
132. which of the following cells is mediated in transmitting this virus to CD4+ and T lymphocytes ?
Ans.
?
133. which of the following target cell will be killed by cytotoxic T cell induced by viral infection ?
Ans.
B. Infected by virus and identical at class I MHC loci at cytotoxic T cell
134. after binding to its specific antigen, a B lymphocyte may switch which of the following component ?
Ans.
B. Immunoglobulin heavy chain class
135. which of the following must be exposed on the surface of APC that activate T helper ?
Ans.
D. Class II antigen
136. which of the following class immunoglobulin is present in highest concentration in the blood of human newborn ?
Ans.
A. IgG
137. which of the following statement is the most likely is the macrophage during an antibody response ?
Ans.
D. Processing antigen and presenting it
139. MoA of allopurinol ?
Ans.
Allopurinol inhibits xanthineoxidase and prevents the synthesis of urate from hypoxanthine and xanthine.
20 years old woman, swelling and stiffness as chief complain. Over past month, extremely tired and unable to keep up with coursework, fall asleep in classes and difficult to concentrate. Recently felt feverish, but not take her temperature. Hair seems to be falling out after brushing or washing hair. PE : raised and warm rash on cheeks, small ulceration on hard palate and mild tender synovitis at both wrist, 2nd and 3rd interphalangeal joints at both hands. There is small effusion in left knee.
140. which of the following is the most likely diagnosis ?
Ans.
D. SLE

190.A.Prevent rather than reversing histamin action on target tissue

193.E.Agglutinating and immobilizing the spermatozoa

196.B.Competitive inhibitor of histamine, by reversible binding of H1 receptor.

197.D.Topical Antihistamin

198.B.NSAID

199.C.IgA

200.D.Polyclonal antibody generate by injection of human thymocyte in animal

Pembahasan bisa dilihat di MDE 2007-1