MDE HIS 2010

1. the special type of lymphatic capillaries in the small intestine are called?
a. lacteals
b. rugae
c. pylorus
d. fundus
e. corpus

2. tempat maturasi T-cell? thymus

4. thymus produces hormones that stimulate lymphocyte maturation.. what is the hormone?
a. oxytocine
b. thymocyine
c. calcitonine
d. progesterone
e. esterogen

5. jalur lymphatic vessels
a. afferent-sinus-efferent

9. Which of the following is the most presence in SLE ?
A. hyperreactivity B cell
B. hyperreactivity T cell
C. hyperreactivity B and T cell
D. hyperreactivity stem cell
E. hyperreactivity thrombocyte

10. WOTF most likely cause of SLE?
a. complement fixation factor
b. anti DNA ab factor
c. immune complex factor
d. autoantibody factor
e. coagulation factor

12.part of immunoglobulin molecule that bind to its antigen is called region (VH & VL) because it has a variability in its:
a. molecular weight
b. amino acid sequence
c. …(ga jelas tulisannya)
d. number of polymeration
e. antigen recognition ability

for number 13-17
a. G6PD
b. Methemoglobin reductase
c. ALA synthase
d. Phosphoglycerate mutase
e. NADH oxidase
13. deficiency of this enzyme reduce NADPH level inside RBC causing hemolytic anemia
14. deficiency this enzyme will maintain heme FE in that reducing from fe2+
15. product of their enzyme is important in regularly that binding of O2 to Hb
16. this enzyme is the key to regulating enzyme in controlling heme biosynthesis
17. this enzyme plays a key role in producing potent microbial agent inside active leukocyte

18. 5 years old boy ke RSHS karena bleeding from nostril. Doctor perform hemostasis test, most common anticoagulant yang digunakan dalam pemeriksaan lab kasus di atas?
a. sodium citrate
b. sodium oxalate
c. sodium heparin
d. ….heparin
e. EDTA

21. the clinical laboratory staff performed PT & APTT on 8 years old boy come with prolonged bleeding after circumcisition, and the resul are: PT 12 sec (N:10-14), APTT: 67 sec (N:25-40). What is the additional test will be suggested?
a. bleeding time
b. clotting time
c. rumple leede test
d. substitution test
e. platelet aggregation test

22. A 5 y.o. boy,epistaxis,prolonged aPTT,yang lain normal. Ada history pada male family member. What is the diagnosis?

23. tujuan torniquete test?
a. ability of capillary to resist pressure
b. ability of platelet to resist pressure
c. ability of capillary to resist heat
d. ability of platelet to resist heat
e. ability of platelet and capillary to resist pressure

24. because of the severe bleeding during delivery of her baby, the doctor gave blood transfusion of a whole blood which was taken 5 days before. What is biochemical change during storage of the blood?
a. plasma potassium naik
b. plasma sodium naik
c. plasma Hb turun
d. 2,3 DPG naik
e. pH naik

25. WBC = 15.000, apa itu?
a. leukocytosis
b. leucopenia

26. bagaimana rumus mencari MCV?

27. jika kadar Hb = 10, Ht = 31%, maka berapa nilai MCHC?

28. Mary’s CBC  Hb: low, MCV: 67 fL, possible morphology RBC  hypochromic microcytic

29. a 5 year, fever, red dots on his extremities. Platelet count 50.000. term?
a. thrombocytopenia
b. thrombocytosis
c. thromboasthenia
d. thrombopathia
e. thrombosis

30. 21 y.o. woman, chronic fatigue, prolonged mens, conjunctivae anemic. Lab test: Hb: 8,3; RBC: 4,15x109; WBC: 4800, MCH:23, PCV: 26%, PLT: 374rb, MCV: 67 fL, MCHC: 29, reticulocyte: 0,5. Diagnosis…
a. normocytic-normochromic anemia
b. microcytic-normochromic anemia
c.microcytic-hypochromic anemia
d. normocytic-hypochromic anemia
e. macrocytic-normochromic anemia

32. fever, mild sore throat, easy bruising, gingival bleeding. Hb , RBC , PLT, WBC, diff count: blast: 73%, promyelocyte: 10%, myelocyte: 10%, lymphocyte: 7%. Diagnosis?
a. AML
b. acute myelomonoblastic leukemia
c. ALL
d. CML
e. CLL

33. anak 7 thn, lymphadenopathy, spleenomegaly. Blast 78%, neutrofil 3%, limfosit 24%. Diagnosis?
a. AML
b. ALL
c. CLL
d. CML
e. burkitt’s lymphoma

35. a 15 y.o. girl experiences flushing, pruritus, and urticaria, which began during a class trip to the local botanical garden. She is restless and uncomfortable and describes a sensation of burning in her skin. Which of the following is the best characterized her condition?
a. superantigen activation of CD4+ T cells
b. CD8+ cell mediated cytolysis of keratinocyte in the skin
c. CD4+ cell mediated delayed type hypersensitivity to poison ivy
d. complement activation by antibody-antigen immune complex in the skin
e. activation of IgE coated mast cell induce release of histamine

37. increased HbA2 found in..
a. IDA
b. sideroblastic
c. megaloblastic
d. aplastic
e. thalasemia

39. in hemolytic anemia, there will be?

40. in aplastic anemia you will find:
a. pancytopenia
b. polychromasia
c. poikylocytosis
d. anisocytosis
e. normoblastosis

41. an 11 year old male presented in ER with persistent epistaxis. Mother stated he was never sick before in his entire life. No history of recent viral infection, no family history of bleeding disorder and no organomegaly. Result blood test:
Hb :13.2 g/dl (N:12-16)
RBC : 4.52 million/mm3 (N :3.8-5.2 million/mm3)
PCV : 38.2% (N:36-46)
Platelet : 10.000 (N: 150000-440000)
WBC : 5300 (N:4000-11000)
MCV 82.30 (N: 80-100)
MCH : 29.7 pg/dl (N: 26-34)
MCHC : 35.9% (N 31-37%)
Diff count : PMN: 47%, lymphocyte : 39%, monocyte :14%
Result of blood smear exam:
RBC morphology : normocytic, normochromic
WBC morphology : within normal limit
PLT morphology : appear increased in size
Result of coagulation test
APTT : 24.8 sec (N: 23-34)
TT : 15.8 sec (N: 13-18)
What is the most likely diagnosis?
a. Secondary thrombocytopenia
b. Thrombotic thrombocytopenic purpura
c. Dengue hemorrhagic fever
d. Immune thrombocytopenic purpura
e. Drug induce thrombocytopenia
42. which PE result is causing a blood donor rejection?
a. weight of 55 kg
b. pulse of 75 bpm
c. temperature of 36.50 C
d. diastolic pressure of 110 mmHg
e. Hb of 13.5 g/dl

43. what would be result of group A blood given to a group O patient?
a. non immune transfusion reaction
b. immediate hemolytic transfusion reaction
c. delayed hemolytic transfusion reaction
d. immediate non immune transfusion reaction
e. delayed non immune transfusion reaction

44. a patient with present a platelet count of 350 x 10?./L and bleeding time of 12 minutes. These result most probably suggest:
a. decreased platelet production
b. defective platelet function
c. increased platelet production
d. increased platelet destructive
e. decreased platelet destructive

45. neutrophilic granulocyte development occurs in bone marrow. Which is the following stages development of that cell?
a. promyelocyte, myeloblast, myelocyte, metamyelocyte, band, and segmented neutrophils
b. myeloblast, promyelocyte, myelocyte, metamyelocyte, band, and segmented neutrophils
c. myeloblast, myelocyte, promyelocyte,metamyelocyte, band, and segmented neutrophils
d. myeloblast, promyelocyte, metamyelocyte,myelocyte, band, and segmented neutrophils
e. segmented neutrophils, band, metamyelocyte, promyelocyte, myelocyte, and myeloblast,

46. A 40 year old man with an acute inflammation is reffered to Hasan Sadikin Hospital, which is the following laboratory test useful in this case?
a. Hb, Leukocyte, platelet
b. Hb, Leukocyte, Differential counting
c. leukocyte, platelet, and differential counting
d. leukocyte, erythrocyte, platelet
e. Hb, leukocyte, erythrocyte

47. a 20 year old man had been complaining of fatigue. She look pale and has come some unexplained large bruises. Hepatomegaly was present, but lymphadenopathy was absent. A routine CBC reveals: Hb 10g/dl, WBC: 110.000/ mm3, platelet: 35.000/ mm3, the differential count as follows : blast cell 53%, promyelocyte 12%, myelocyte 8%, metamyelocyte 6%, band 4%, segmented neutrophils 10%, lymphocyte 7%, auer rod was seen in many blast.
What is the most possible diagnosis in this case?
a. Acute lymphoblastic leukemia
b. Chronic lymphoblastic leukemia
c. Acute lymphocytic leukemia
d. Acute myeloblastic leukemia
e. Acute myelocytic leukemia

48. A 25 year old woman has suffered wheals in her arms, trunk, and chest two hours after she ate prawn. She feels severe itching and stinging. The clinical manifestation is more severe when she scratched the lesion. Which of the following substances is the most likely involved?
a. IgA
b. IgD
c. IgE
d. IgM
e. IgG

49. an 11 year old boy come to dermatology outpatient with chief complaint itchy skin rashes on both elbows. He also complained about dry skin on limbs. His mother has a history of allergy to seafood and cat dander. The dermatological status reveal erythematous papules, scales, and lichenification on both elbows. Which of the following is the most common predilection of this case?
a. face, especially cheeks
b. scalp
c. diaper area
d. extensor area of the extremities
e. flexural fold of the extremities

50. a 45 year old man has had recurrent blister on his body since 1 year ago. No itchy. Nickolsky sign positive. No history drug allergy. His skin lesion improved with corticosteroid. Which of the following is the most likely finding on histopatological of his skin?
a. intra epidermal blister
b. sub epidermal blister
c. infrabasal blister
d. infradermal blister
e. intradermal blister

51. a nurse that works at operation room comes to dermatovenerologist with chief complaint rash and papules at her hands that felt itchy and stinging. The complaint occurs after she used a new brand gloves. She has history of sneezing and running nose in the morning. The dermatological status reveal erythematous macules and papules on her both hands. Which of the following is the most mechanism that plays role in the pathogenesis in this case?
a. type I hypersensitivity
b. type II hypersensitivity
c. type III hypersensitivity
d. type IV hypersensitivity
e. autoimmunity

52. A 15 year old boy has occasional fever, malar rash, athralgia. He looks pale and weakness. The malar rash is not itchy which became more severe on sun exposure. Which of the following laboratory findings is the most likely to be abnormal?
a. urinalisis: bilirubin (+)
b. Hb : 16 gr/dl
c. SGOT/SGPT 50/60
d. leukosit 2000/mm3
e. urinalysis: urobilinogen (+)

54. 54 y.o.male, chief complaint: burning stinging dusky red macule on lip and genitalia. Appear after taking ibuproven 6 months ago. Dermatological status: rounded erythematosus, hyperpigmentia macule on lip and genitalia. Diagnose?
a. exenthematous eruption
b. pustular eruption
c. fixed drug eruption
d. bulous eruption
e. drug induced lichenoid

57. most important cell in hypersensitivity type IV?

58. 24 y.o. man complain : crust, hyperemic nasal mucus.. total body surface affected 35%. What is the diagnose?  TEN

59. 25 y.o. female comes to hospital with chief complaint of redness, itchy oatches and some blister on her neck. For a week she has redness itchy patches and small blister on her neck, color area which spread rapidly involving upper chest. 2 weeks ago, using imitation neckless. 6 months ago suffered redness itchy patches on wrist after using new bracelet. PE dan lab normal. Patch test positive 3 to nickel. Diagnosis?
a. contact urticaria
b. irritant contact dermatitis
c. atopic dermatitis
d. allergic contact dermatitis
e. seborrheic dermatitis

61. a y.o boy come to the hospital with chief complaint redness, itchy patches on both knees and elbows. He also has rhinitis and a history of redness itchy patches on cheeks when he was 2 years old. PE within normal limit. Lab result: IgE total 500. What is the most likely diagnosis?
a. sebrrhoic dermatitis
b. nummular dermatitis
c. acrodermatitis
d. atopic dermatitis
e. stasis dermatitis

63. a histosection show an organ with large amount of lymph tissue including nodules with germinal centers and deeply in vaginated mucosal surface formed by stratified but poorly defined epitel?
a. liver
b. spleen
c. palatine tonsil
d. thymus gland
e. payer patche

64. a developing erythrocyte + neutrophil in RBM may be differentiated from one another by presence of:
a. golgi apparatus
b. granule
c. mitochondria
d. peroxisome
e. RER

66. antigen specific binding that occurs in graft rejection as result from..
a. T-Cell
b. plasma cell
c. monocyte
d…..
e. …

67. a 25 y.o.man is being evaluated for his anemia. On PE the doctor finds his sclera are subicteric and his spleen is enlarged (Schuffner II). What is the most possible of this patient?
a.iron deficiency anemia
b. hemolytic anemia
c. aplastic anemia
d. pernicious anemia
e. sideroblastic anemia

68. a 60 y.o. woman presented to the physician with easy satiety and fullnesss in her abdomen. Her spleen was enlarged (scuffner II). Lab test showed Hb: 17.5 g/dl, Ht 54%, WBC 30.000/ mm3, PLT 600.000/ mm3. Which of the following is the most possible diagnosis of her problem?
a. myelofibrosis with myeloid metaplasia
b. chronic granulocytic leukemia
c. lymphocytic chronic leukemia
d. polycytemia vera rubra
e. multiple myeloma

69. a 35 y.o woman comes to your clinic with a chief complaint of physical weakness since 2 months ago. She looks pale and on physical examination you find papilla atrophy of her tongue and spoon nail. What is the most important factor in managing this patient?
a. elimination the cause
b. avoid certain diet
c. while blood transfusion
d. vitamin supplementation
e. hematinic agent therapy

70. a 20 y.o. male present with a chief complaint of unilateral painless masses in the right neck region of 3 months duration. He has weight loss from 40 kg to 35 kg over a 3 month-interval. He has no fever and no diameter, rubbery, non tender and mobile. He has no splenomegaly. What is the most appropriate examination to diagnose this patient?
a. chest X-ray
b. lymph node biopsy
c. abdominal CT scan
d. neck ultrasonography
e. peripheral blood smear

71. a 40 y.o male is referred to an internist by a surgeon for an evaluation of anemia. The patient will undergo operation for his internal hemorrhoid and the laboratory screening before operation shows that his Hb level is 8 g/dl. The internist finds that the patient’s conjunctivae are pale and there is papilla atrophy of his tongue and spoon nail. What is another most possible findings on physical examination of this patient?
a. moist hand
b. brittle hair
c. clubbing finger
d. hepatomegaly
e. splenomegaly

72. a 20 y.o woman comes to your private practice with swelling and stiffness as chief complaint. Over the past month she has been extremely tired and unable to keep up with her coursework. She falls asleep in classes and has found some difficulty with concentration. Recently, she has felt feverish, but has not bothered to take her temperature. She comments that her hair seems to be falling out after brushing or washing her hair. PE revealed a raised, warm rash on her cheeks and small ulceration on the hard palate. Mild tender synovitis are found in both wrist as well as in the second and third metacarpointerphalangeal joints of both hands. A small effusion is present in the left knee. Test principal diagnostic result specific for this condition is a high titer of an autoantibodies against. Which of the following the most appropriate serologic test for this patient?
a. VDRL
b. anti nuclear antibody
c. Rheumatoid factor
d. Anti ds-DNA
e. Anti ss-DNA

73. a 14 year old male complains of spontaneous joint bleeding on his left leg. There was history of bleeding after circumcision when he was 7 year old. PE reveals hemarthrosis, no other obvious bleeding. Lab findings show Hb 14 g/dl, WBC 8000/ml, PLT 225.000/ml. which of the following is the most likely explanation of his problem?
a. quantitative platelet disorder
b. qualitative platelet disorder
c. coagulation disorder
d. thrombosis disorder
e. vascular disorder

74. a 50 y.o male presents with a chief complaint of bilateral painless masses in the neck region of 6 months duration. He also has fever, night sweat and weight loss from 60 to 50 kg over a 6 month interval. On PE, the patient found to have bilateral supraclavicular and cervical lymphadenopathy, diameter 2-3 cm, rubbery, non tender and mobile. He has no splenomegaly. What is the most possible factor to determine the prognosis in this case?
a. liver enzyme level
b. creatinine level
c. LDH level
d. uric acid level
e. Hb level

75. 72. a 20 y.o woman comes to your private practice with swelling and stiffness as chief complaint. Over the past month she has been extremely tired and unable to keep up with her coursework. She falls asleep in classes and has found some difficulty with concentration. Recently, she has felt feverish, but has not bothered to take her temperature. She comments that her hair seems to be falling out after brushing or washing her hair. PE revealed a raised, warm rash on her cheeks and small ulceration on the hard palate. Mild tender synovitis are found in both wrist as well as in the second and third metacarpointerphalangeal joints of both hands. A small effusion is present in the left knee. Which of the following appearance should be expected on histopatological examination if biopsy was taken from the skin lesion?
a. pathology findings like with IgA dermatitis
b. microscopically: there is basal cell vacuolization but without lymphocyte infiltration
c. immunofluoresence studies no granular band of immunoglobulin and complements
d. microscopically there are epidermis atrophy with hydrophic generation
e. hyperkeratosis and parakeratosis usually can fined in the microscopic findings

for question 76 to 77, refer to scenario below:
a 24 year old man comes to the physician because of spontaneous gum bleeding since 2 days before. He has also been complaining fatigue and dizziness since a month ago and has been feeling a little feverish in the evening for two weeks. He looks pale, gingival bleeding is noted. There are no lymphadenopathies nor liver and spleen enlargement. Kab result show: Hb: 7 g/dl, Ht: 18 %, WBC: 2500/mm3, PLT 35.000/mm3
76. if his bone marrow smear shows cellular hypoplasia, which of the following is the most likely to predict the prognosis of his disease?
a. Hb
b. Ht
c. RBC count
d. WBC count
e. PLT count

77. if his bone marrow smear shows cellular hypoplasia and he needs blood transfusion, what kind of transfusion would you give to this patient?
a. fresh whole blood
b. packed red cell
c. washed red cell
d. platelet concentrate
e. fresh frozen plasma

for question number 78-79, refer to scenario below:
a 40 y.o. man is admitted to the ward with anemia. He has history of fever for a month, and gum bleeding occasionally. Lab result: Hb : 6 g/dl, wbc: 60.000/mm3, PLT: 57.000/mm3
78. if his bone marrow shows poorly differentiated blast more than 30% of the cells, with auer rod in the cytoplasm, what is the diagnose of the patient?
a. acute myeloblastic leukemia- M0
b. acute myeloblastic leukemia- M1
c. acute myeloblastic leukemia- M2
d. acute myeloblastic leukemia- M3
e. acute myeloblastic leukemia- M4

79. what is the next appropriate step in making diagnosis?
a. cytochemistry
b. cytogenetic
c. immunophenotyping
d. absolute values
e. peripheral smear

80. a 20 y.o. man presents with chief complaint of unilateral painless masses in the right neck region of 3 months duration. He has weight loss from 44 to 35 kg over a 3 month interval. He has no fever and no night sweat. On PE, the patient has three right cervical lymphadenopathies, 3-4 cm in diameter, rubbery, non-tender, and mobile. He has no splenomegaly. Which of the following viral is the most likely cause of the lymphadenopathy?
a. Hepatitis C virus
b. Hepatitis B virus
c. Ebstein Barr virus
d. Human papiloma virus
e. HTLV-1

81. a 20 y.o. female complains of easy bruising of the arm and legs for several months. She also has recurrent bleeding from the nose and heavy menstrual bleeding since 2 weeks. Physical examination reveals echymoses and petechiae on the thighs and forearm, no other obvious bleeding. Laboratory findings show Hb 13 g/dl, WBC 4000/ mm3, PLT 25.000/ mm3. what is the most life threatening complication in this case?
a. intracranial bleeding
b. DIC
c. Gastrointestinal bleeding
d. menomethorrhargi
e. joint bleeding

82. a a 20 y.o.woman is screened to asses her complaint of weakness. The vital signs are normal. She looks pale and her sclera are slight jaundice. There are also mild hepatosplenomegaly. Her liver enzyme are normal, with total bilirubin 3.2 mg/dl and direct bilirubin 1.1 mg/dl.if direct and indirect coombs’ test are positive, what is the best treatment for this patient?
a. blood transfusion
b. splenectomy
c. corticosteroid
d. immunoglobulin
e. radiotherapy

83. a 50. Y.o female presents with painless neck swelling. She notes fevers, night sweats for the last 6 months. No history of bleeding. On PE you note a 4 cm left anterior cervical lymph node, multiple right anterior right cervical lymph nodes, no palpable axillary lymph node, 2-3 cm and a 3 cm right inguinal lymph node. They are non tender and mobile. The oropharynx is clear. She has hepatosplenomegaly. What is the most appropriate treatment of this patient?
a. antibiotic
b. cytostatic
c. tuberculostatic
d. operation
e. radiation

84. a 14 y.o. male complains of pain and swelling on his right knee. There is a history of the same symptom with his younger brother. PE reveals hemarthrosis on his right knee, no anemia. Lab findings show Hb 14 g/dl, WBC 8000/ mm3, PLT 225.000/ mm3 BT 1 minute (N: 1-3), prothrombin time in normal limit, APTT 70 sec (N: control 35 sec). which of the following is the most likely explanation of his problem?
a. vascular disorder
b. thrombosis disorder
c. coagulation disorder
d. qualitative platelet disorder
e. quantitative platelet disorder

85. a 50 y.o. man has had progressive weakness and dyspnea with exertion for 3 months. He appears malnourished and the conjunctivae are pale, and there are scattered petechiae. Lab studies shows: Hb: 6 g/dl, WBC: 3500/ mm3 with hypersegmented neutrophils, PLT 60.000/ mm3, MCV 115 fL, Reticulocyte count: 0.5%. the bone marrow smear of this patient shows:
a. Erythropoietic hypoplasia
b. granulopoietic hypoplasia
c. thrombopoietic hypoplasia
d. giant stab cell
e. giant platelet

86. a 55 y.o woman is hospitalized with anemia. She has enlarged cervical lymph nodes and splenomegaly (Schuffner III). Lab result: 6 gr/dl, WBC 60.000/ mm3, PLT 57.000/ mm3. the peripheral blood lymphocyte count is 40.000/ mm3. the most likely diagnosis of this patient:
a. chronic myelocytic leukemia
b. chronic lymphocytic leukemia
c. multiple myeloma
d. myelofibrosis
e. leukemoid reaction

87. a 15 y.o boy is brought to the physician by his mother due to masses on his right neck. He has also been fatigue since a month. The physician notes that his conjunctivae are anemic and there are lymph nodes palpated on his right neck, 1-3 cm in diameter, rubbery and not painful. There are also hepatosplenomegaly and bruising on his leg. Lab result shows : Hb 8gr/dl, WBC 3000/ mm3 PLT 60.000 /mm3, the peripheral smears shows pancytopenia and smudge cells. If his bone marrow shows blast more than 30% of the cells, within 1-2 nucleoli, what is the prognosis of his disease?
a. curable with radiotherapy
b. curable with chemotherapy
c. curable with chemoradiation
d. curable with immunotherapy
e. curable with antibiotics

88. a 55 y.o woman has had progressive weakness and numbness on her extremities. Lab studies shows: Hb 8gr/dl, WBC: 4500/ mm3 with hypersegmented neutrophils, PLT: 150.000/ mm3, MCV: 125 fL, reticulocyte count: 1 %. Which is the most possible abnormality found on the PE?
a. conjunctivitis
b. gingivitis
c. arthrititis
d. stomatitis
e. glossitis

89. which statement is true for arterial thrombosis?
a. long term use if oral contraceptive pill
b. stasis in blood vessel
c. begin with endothelial injury
d. deficiency of natural inhibitor is the basic process
e. deficiency of plasminogen activator inhibitor I (PAI-1)

90. 50 y.o female, chief complaint of bilateral painless masses in the neck region of 6 months duration. He also has fever, night sweat and weight loss (60kg 50kg) over 6 months interval. PE : bilateral supraclavicular and cervical lymphadenopathy. Diameter 2-3 cm, rubbery, non tender and mobile, no hepatospleenomegaly. Which of the following is the most likely cause of the lymphadenopathy?
a. inflammation
b. infection
c. metastases malignancy
d. lymphnode malignancy
e. autoimmune

93. if biopsy of the lymph node reveals no reed Stenberg cells and abdominal ultrasound shows paraaortic lymph node enlargement, which of the following is the most likely diagnosis?
a. non hodgkin’s malignant lymphoma stadium II
b. non hodgkin’s malignant lymphoma stadium III
c. hodgkin’s lymphoma stadium, stadium III
d. hodgkin’s lymphoma stadium II
e. non hodgkin’s malignant lymphoma stadium IV

96.gen untuk replikasi HIV? …
a. gp120
b. tat
c. gp41
d. p11

104. the highest concentration of immunoglobulin that secreted by gut…
a. IgG
b. IgA
c. IgM
d. IgD
e. IgE

106. 35 y.o woman: allergic rhinitis, sneezing, nasal obstruction, and impaired QOL. Which of the following test is the safest and sensitive for her?
a. intradermal test
b. patch test
c. prick test
d. radioallergosorbent test
e. skin end point titration test

108. 33 years old man came to ENT clinic with bilateral nasal obstruction followed by on and off runny nose for 6 months. The symptom is worst in the morning and cold temperature. No fever, headache, no nasal itching. PE : boggy edematous in lateral wall nose, septum, and especially in turbinates. Lab test are normal. Which of the following is most appropriate diagnose of this case?
a. fungal rhinitis
b. allergic rhinitis
c. vasomotor rhinitis
d. occupational rhinitis
e. medicamentosa rhinitis

111.which Ig that has a role in allergic rhinitis?
a. IgG
b. IgA
c. IgD
d. IgE
e. IgM

112. seorang wanita 24 tahun, hamil 32 minggu datang ke klinik alergi chief complaint  runny nose dan nasal stiffing. PE: enlarge inferior turbinate, watery mucous, ada latar belakang keluarga alergi dan asma. Which of the following substance beside histamine that make nasal problem?
a. bradikinin
b. esterogen
c. leukotrien
d. prostaglandin
e. progesterone

113. 90% of ATP needed by RBC is generated by :
A. Hexose monophospate shunt
B. Kreb’s cycle
C. Leukering-rappaport pathway
D. Embden-meyerhof glycolytic pathway
E. MetHb reductase pathway

115. the clinical manifestation that distinguish pernicious anemia from folic acid anemia with the presence of..
a. neurologic abnormalities
b. fatigue
c. weakness
d. shortness of bresth
e. slight jaundice

117. following hospital admission with loss of consciousness and hypotension after an antibiotic injection of primary health center. A 6 y.o. girl, atopic with 18 kg BW was given aqueous epinephrine subcutaneous. Dosisnya?
a. 0,18 ml 1:1000
b. 0,36 ml 1:1000
c. 3,6 ml 1:1000
d. 0,18 ml 1:1000
e. 0,36 ml 1:1000

118. 7 y.o. boy come to the clinic after taking acetylsalycilat acid. He come with symmetric blistering around arms and legs, painful ulcer, hemorrhage in lip and mucous and conjunctiva ulcer involving in cornea. Total skin lesion less than 10% BSA. What is thee best treatment for this disease?
a. glucocorticoid
b. NSAID
c. Cyclosporin
d. immunoglobulin
e. cyclosulphate

119. anak kecil, habis makan shrimp  angioedema dan gatal2. Obat yang cocok?
 antihistamine
121. following administration with loss of consciousness and hypotension, a 7 y.o. girl, body weight 22 kg was given injection aqueous epinephrine. Which of the following was the hypersensitivity cause?
a. type I
b. type II
c. type III
d. type IV
e. type I-IV

122. kinds of urticaria that immediately appear after vigorous swimming at seawater in the beach, at high noon on hot summer day, except:
a. heat urticaria
b. solar urticaria
c. cholinergic urticaria
d. psychogenic urticaria
e. aquagenic urticaria

123. lymphoid organ yang perkembangannya tidak dipengaruhi antigen…
a. spleen
b. thymus
c. bone marrow
d. bursa equivalent
e. yolk sac

124. in which hypersensitivity determination plasma/serum tryptase is helpful?
a. DD IgE mediated and non IgE mediated type I
b. diagnose type I hypersensitivity
c. diagnose type II hypersensitivity
d. diagnose type III hypersensitivity
e. diagnose type IV hypersensitivity

125. which of the following antibody, involve in atopic disease?
 ans: IgE

126. 12 y.o. boy follow skin prick test. The purpose of the test is to identified….
a. IgE mediated type I hypersensitivity
b. non IgE mediated type I hypersensitivity
c. IgE & non IgE type I hypersensitivity
d. type II hypersensitivity
e. type III hypersensitivity

128. diagnosis thalasemia trait is frequently misdiagnosed with…
a. IDA
b. aplsatic anemia
c. megaloblastic anemia
d. autoimmune hemolytic anemia
e. sideroblastic anemia

129. what is the right indicating to do ceasarian section operation in HIV pregnant mother?
e. transversal transmission preventing

130. bayi lahir normal, 3 kg dari ibu yang menderita HIV. Dilahirkan secara cesar pada minggu 38 kehamilan. Pendekatan diagnosis untuk konfirmasi bayi itu sudah terinfeksi HIV atau belum..
a. anti HIV-1
b. HIV p-24
c. HIV RNA
d. HIV DNA
e. culture

132. antibody yang dapat ditransfer dari ibu ke janin melalui transplacental?
a. IgE
b. IgA
c. IgG
d. IgD
e. IgM

133. characteristic of cutaneous lesion of NLE:
a. facial
b. acral
c. extensor
d. diffuse
e. photo distribution

138. which of the following clinical manifestation is permanent in NLE?
a. congenital heart block
b. cutaneous lesion
c. pulmonary involvement
d. neurology involvement
e. thrombocytopenia

142. appropriate treatment for IDA
a. blood transfusion
b. multivitamin intake
c. oral ferrous sulfate
d. intramuscular iron dextrant
e. an iron fortified cereal

146. WOTF agent would be the most likely to dampen the immune response in organ transplantation and autoimmune disease…
a. levimasole
b. thalidomide
c. serolimus
d. IFN
e. IL-2

154. WOTF is the site of action of corticosteroid in allergic reaction?
a.
b. inhibiting IgE class switching on plasma cells
c. inhibiting interaction on mast cell
d. inhibiting phospolipase-A2 liberated arachidonic acid
e. inhibiting leukotriene binding its receptor on eosinophils

156. drugs that need intrinsic factor for its absorption?
a. pyridoxine
b. folic acid
c. cyanocobalamine
d. riboflavin
e. Iron

158. moleku yang membantu absorbs non heme Fe..
a. vit C
b. vit B12
c. Vit B6
d. Vit D
e. Vit A

159. which of the following drug yang punya efek ke numbness and weakness?
a. vit b12
b….
c. pyridoxine
d….
e…..

163. which of the following statement is correct about phenothiazine?
a. produce marked sedation
b. produce marked adverse GI bleeding
c. may cause increase appetite weight gain
d. also act as antitussive
e. only marketed as sleeping aid

164. which of the following statement is regarding the effect of H1 receptor antagonist is true?
a. poor absorbed after oral administration
b. have limited use in allergic bronchospasm
c. all have muscarinic-cholinergic antagonis activity
d. not induce microsomal enzymes
e. cause increase in appetite

165. Mengenai alegy dan hypersensitivity
a. delayed reaction occurs in asthma
b. histamine play role in bronchospasm
c. hay fever, other than histamine lead to nose irritation
d. red flare and hives in urticaria karena mixture toxic leukotrient
e. anaphylaxis : localized reaction in vascular system

166. girl 5 y.o., chief complaint rash di trunk dan extremities, easy brushing, no fever, no history bleeding, PE no splenomegaly. Lab : Hb,Hct, WBC  normal, platelet 15.000. treatment for this patient?
a.
b.
c. suspension for thrombocyte
d.
e.

168. 4 y.o boy, chief complaint: bruishing on his right knee and joint pain, there are palpable bruises on the right thigh and hemarthrosis on the right knee. Lab: Hb: 12.8, HCT: 38.5%, WBC: 9000, platelet: 220.000, BT 3 min, PT: 11 sec, APTT: 98 sec. his brother has same history. WOTF lab result is supposed to be abnormal in this patient..
a. factor I deficiency
b. factor V deficiency
c. factor VII deficiency
d. factor VIII deficiency
e. factor XIII deficiency

170. ……. Neurological examination show tetraparesis, stocking glove paresethesia and decreased physiologic reflex. Lumbar puncture is done. What is the result?
a. increased glucose with normal cell
b. increased glucose with increased protein
c. decreased protein with normal cell
d. decreased protein with decreased glucose
e. decreased protein with increased glucose

171. which is the most possible cause of this case…
a. H.influenza
b. campylobacter jejuni
c. CMV
d. salmonella thypii
e. Herpes zoster

174. which of the following has been the mainstay treatment for this patient (SJS)
a. glucocorticoid
b. NSAID
c. cyclosporine
d. immunoglobulin
e. cyclophospamide

177. red eye, pain, easy tearing. Peripheral corneal ulcer. Treatment..
a. oral antibiotic
b. anti fungal
c. topical corticosteroid
d.antihistamin
e. topical antibiotic

179. male, 50 y.o. chief complain red eye,pain, excessive tearing, objective exam : peripheral corneal ulcer. Main treatment?
A. oral antibiotic
B. antifungal
C. topical corticosteroid
D. antihistamine
E. topical antibiotic

184. immunoglobulin paling terpengaruh untuk melindungi tubuh seperti contohnya toxic infection : dipteri?
A .IgG
b. IgM
c. IgA
d. IgD
e. IgE

189. 54 y.o. woman terkena rhinitis. Dia menggunakan nasal spray. Obat tersebut dapat menyebabkan apa?
a.
b. rebound phenomenon
c. mulberry rhinitis
d.
e.

199. bleeding time which of the following option is markedly prolonged?
a. VIII deficiency
b. Taking high dose of aspirin
c. malabsorption of vit.k
d. abnormal liver function
e. ….