2. Result of hearing test on the left ear of the boy?
A. conductive hearing loss
B. sensorineural hearing loss
C. mixed hearing loss
D. no hearing loss
3. A 38 y.o. woman. Symptoms : headache, facial pain, nasal purulent drainage, persisted 3 weeks following upper respiratory infection. PE : head and neck normal except nasal exam showing septum ildly deviated to the left. Nasal endoscopy : inflammatory changes with edema & purulent from both left and right middle meatus. Initial treatment?
9. A 4 months old child. Stridor for 2 months. His mom said that his condition improves in prone position. Diagnosis?
C. vocal cord paralysis
D. subglottic stenosis
E. foreign body aspiration
10. Inspiratory stridor is caused by obstruction in?
11. Origin of infection in lateral pharyngeal space?
A. soft palate
E. floor of mouth
12. A 10 y.o. boy came to ENT clinic with CC of decrease in hearingon the left ear since 2 weeks ago. This condition is not accompanied by pain in the ear, febrile, or otorrhea. From the otoscopy right ear normal, on the left ear there is normal acoustic canal with intact tympanic membrane and there is bubble sign in the tympanic cavity. The most likely diagnosis?
A. external otitis
B. acute OM
C. chronic OM
D. serous OM
E. malignant otitis externa
18. Biopsy lymph node : caseous necrosis , granulomatous, Datia langhans cell.
A. non-hodgkin lymphoma
B. hodgkin lymphoma
20. Nutrition for COPD?
A. adequate protein, ↑ lipid, adequate CH
B. 20% protein, 25% lipid, 55% CH
C. 10% protein, 50% lipid, 40% CH
D. adequate protein, ↑ lipid, ↓ CH
E. 15% protein, 30% lipid, 55% CH
23. WOTF will protect against lung tissues destruction in COPD?
25. Respon pasien terhadap dyspnea di atas adalah
C. kussmaul breathing
E. shallow breathing
A 29 y.o. man. SOB, cough, yellowish sputum. History of DM. PE : RR 30x/min, T 38oC, BP 130/80 mmHg, rhonchi (+), wheezing (-), blood glucose 276 mg/dL, chest x-ray infiltrate (+).
29. WOTF is the metabolism of the lung in the patient?
A. ↑ production of glucose in the lungs as the major site of blood glucose production
B. ↑ lung compliance
C. involved in removal of serotonin, prostaglandin, and leukotriens
D. type I cells produce surfactant
E. ↑ pH in lungs
34. PaO2 45 mmHg, PaCO2 37.5 mmHg, pH 7.4. Condition?
A. baik2 saja
B. respiratory acidosis
C. hypoxia tapi tidak acidosis
D. respiratory alkalosis
E. hypoxia tapi tidak alkalosis
44. WOTF disease is caused by this anomaly?
45. Premature baby girl, D/ : RDS. WOTF appropriate with her condition?
A. surfactant increase surface tension between air-alveolar septa
B. terminal saccular phase begins at 18 weeks
C. surfactant is produced by type ! cell
D. sufficient surfactant 24-26 weeks
E. the baby has sufficient surfactant since terminal saccular period
48. A 20 y.o. male has asthma experience nocturnal symptoms 4x/week, daily symptoms 3x/week. Category?
A. mild intermittent asthma
B. moderate asthma
C. severe asthma
D. status asthmatic
52. Gejala TB à antibiotic but no improvement. Past history : treatment TB 6 month, completed and cured. Patient status :
A. new patient
E. transfer in
62. Criteria for hospital acquired pneumonia
A. >24 hours after admission
B. >36 hours after admission
C. > 48 hours after admission
D. >60 hours after admission
E. >72 hours after admission
68. A 29 y.o. HIV patient was brought to the hospital with a week long history of fever, SOB, dry cough. Exam revealed fever and mild tachypnea. Sputum specimen was taken and the result of microscopic exam with india ink show yeast cell with capsule surrounding the cell. WOTF pathogens?
A. Cryptococcus neoformans
B. Blastomyces dermtitidis
C. Pneumocystis jirovecii
D. Histoplasma capsulatum
E. Aspergillus fumigatus
70. A 47 yo.o. male farmer complained cough for almost 2 months. AFB was found in sputum smear. Two years ago he had been treated for lung TB and his doctors declared that he was cured. Which of the following antiTB regiment is the most appropriate for this case?
A. streptomycin, INH, rifampin, ethambutol
B. rifampin, INH, ethabutol, pyrazinamide, streptomycin
C. rifampin, pyrazinamide, INH
D. rifampin, streptomycin, ethambutol, pyrazinamide
E. INH, pyrazinamide, ethambutol, ciprofloxacin
71. Ms Elsa 17 y.o. female, a high school student, came to you due to SOB. She usually feels her SOB between midnight to early morning and she feels about 3x a week and sometimes accompanied with cough. Sometims she was absent from school because of her symptoms. On chest exam you only heard wheeze and others were WNL. Which is the diagnosis?
A. COPD stage I
B. COPD stage II
C. mild persistent asthma bronchial
D. severe persistent asthma bronchial
E. moderate persistent asthma bronchial
72. A 65 y.o. man with COPD stage III and a 23 y.o. woman with asthma bronchial moderate persistent. Both were take inhalational corticosteroid. While the woman gains improvemet from this therapy the man is not. Possible explanation?
A. gender difference
B. difference in age
C. difference in spirometri result
D. difference in risk factors
E. difference in inflammatory cells and mediators
73. A 20 y.o. male complained of persistent nasal discharge. This nasal discharge was yellowish and thick. Past history, he had nasal itchy and nasal obstruction when the weather is cold. On water’s film, there’s clouding in maxillary sinus. WOTF is most likely diagnosis?
A. tumor of right maxillary sinus
B. right hematosinus
C. acute sinusitis
D. chronic sinusitis
74. On PA chest film, there is a cavity in the apical parts of left upper lobe, the wall of cavity is thick and surrounded by patchy consolidation.WOTF is best feature that has been described?
A. lung abscess
B. pulmonary cyst
C. mycetoma in a caity
D. cavitating tumor
E. the cavity of pulmonary TB
For question no. 75-76 refer t the clinical scenario below
A 10 y.o. girl admitted to peaditric clinic with CC difficulty of breathing (dyspnea) since 7 days ago. This complaint was accompanied by cough and high fever. In AP chest x ray, there is a homogenous lung opacification with air bronchograms in the lateral segment of the lung.
75. The segmenta homogenous lung opacification with air bronchograms is
A. an atelectasis
B. a pleural effusion
C. a pneumonia
D. a schwarte
E. a bronchopneumonia
76. This disease begin as a localized infection of
A. terminal air spaces
B. terminal bronchioles
C. respiratory bronchioles
For question number 77-78, refer to the clinical scenario below
A 25 y.o. female comes to pulmonbary clinic. The patient is coughing more than 3 weeks and accompanied by the production of purulent sputum, night sweats, weight loss, anorexia, general malaise, and weakness.
77. What is the basic standard radiograph for any patient presenting with a cough more than 3 weeks?
A. PA chest film
B. oblique chest film
C. left lateral decubitus film
D. apical lordotic film
E. AP chest film
78. What is the best radiograph for showing the presence of small pleural effusion?
A. lateral decubitus film
B. PA chest film
C. lateral chest film
D. AP film
E. apical lordotic film
79. In PA chest x-ray, there is only calcification on the apex of left lung. It is not clear if there are patchy consolidation in the apex of both lungs, because the clavicles and the ribs overlap with the apex of both lungs. What is the best radiograph for showing the presence of minimal patchy consolidation in the apex of the lungs?
A. oblique chest film
B. left lateral decubitus film
C. apical lordotic film
D. Ap chest film
E. lateral chest film
80. WOTF statements is related to acute exacerbation of asthma?
A. mucous secretion is ↓
B. the peak expiratory flow is ↑
C. the forced expiratory volume in one second is ↓
D. there is no mucosal edema in the airway
E. bacterial infection may be act as trigger
81. Lobar consolidation with positive air bronchograms can be found in?
B. pleural effusion
82. This cavity is divided by the cartilage and bone septum into 2 bilaterally symmetric cavities that open to the exterior through the nares. Each cavity consists of 2 chambers, anterior and posterior. WOTF statements is correct about anterior portion of this cavity?
A. lined by simple cuboidal epithelium
B. has goblet cells
C. has sweat bodies
D. no sweat glands
E. has sebaceous gland
83. A 20 y.o. male come to the doctor because of facial pain since 3 days ago. He als complains head ache and nasal obstruction. Water x-ray shows air-fluid level at roght maxillary sinuses. WOTF statements is correct about structure that involved in this case?
A. stratified squamous non keratinized epithelium
B. stratified squamous keratinized epithelium
C. stratified columnar epithelium
D. pseudostratified columnar epithelium
E. stratified cuboidal epithelium
84. This irregular space lies in the interior of the temporal bone. It communicates anteriorly with the pharynx via the auditory tube and posteriorly with the mastoid process. WOTF specialized tissue is most likely lined the mucous layer of this space?
A. stratified squamous epithelium
B. pseudostratified columnar epithelium
C. stratified columnar epithelium
D. simple squamous epithelium
E. simple cuboidal epithelium
89. Lung is covered by 2 layers, inner thorax and outer lung. Between 2 layers, it is lined by lubricating film. What is the epithelial tissue lining this part?
A. simple squamous
B. simple cuboidal
C. stratified squamous
D. pseudostratified columnar
E. stratified columnar
93. A 30 y.o. man get trauma, bleeding from the nose for 30 minutes. Anterior pack did not help.
A. anterior epistaxis
B. posterior epistaxis
C. trauma at nose
D. trauma at maxillary
103. inhaled a peanut, nyangkut di?
A. left bronchus
B. left segmental bronchus
C. right bronchus
D. right lower segmental bronchus
E. right upper segmental bronchus
114. A 20 y.o. man came to ER department with SOB, shoulder blades and fatigue suddenly when he was watching television. He also looks pale. Chest x-ray revelaed a 55% pneumothorax of the right lung due to rupture of bleb on the surface of the lung. WOTF statements is the most appropriate for his condition?
A. the chest wall on the affected site recoils inward
B. the V/Q ratio on the affected site is higher than normal
C. the mediastinum shifts further to the right with each inspiration
D. the intrapleural pressure in the affected area is equal with atmospheric pressure
E. there is a hyperventilation of the affected lung
115. A 60 y.o. man have dyspnea. The diffusing capacity of the lung is increased. WOTF conditions best accounts for an increase in diffusing capacity?
A. fibrotic lung disease
B. pulmonary embolism
D. pulmonary hypertension
116. A 20 y.o. medical students doing weight training and jogging. WOTF statement is most appropriate?
A. ↓ pulmonary blood flow due to ↓cardiac output
B. ↑ diffusing capacity due to hyperventilation
C. ↑ airway resistance due to hyperventilation
D. ↑ pulmonary vessels resistance due to ↑ pulmonary blood flow
E. ↑ diffusing capacity due to ↑ pulmonary blood flow
117. WOTF is higher at total lung capacity than it is at residual volume?
A. airway resistance
B. lung compliance
C. alveolar pressure
D. anatomical dead space
E. intrapleural pressure
118. An arterial blood gases result from a patient with comatose revelaed hypercapnia. WOTF is the most likely cause of the high arterial pCO2?
A. prolonged hypoxia
B. depression of respiratory center
C. ↑ alveolar ventilation
D. ↓ metabolic activity
E. obstruction process of expiration
119. A 20 y.o. man came to his family doctor because he has cough without sputum for the last 2 weeks. WOTF most likely happened in this young man?
A. foreign matter irritate nasal pathway
B. the chemistry corrosive matter destroy the alveoli
C. he inspired 2.5 L air while he was cough
D. afferent nerve impuls through vagus nerve
E. automatic sequence triggered by strong compression of the lung
120. A 16 y.o. woman with recurrent SOB accompanied with cough and wheezing. Her parents has history of asthma. She is already taking bronchodilator agent for her condition. The doctor said taht she should do some aerobic exercise as part of her treatment. WOTF statement that most be affected if she has regular aerobic exercise?
A. tidal volume
B. residual volume
C. forced expiratory volume
D. residual capacity
E. inspiratory capacity
121. A 70 y.o. woman with SOB is referred for pulmonary function testing, including lung volumes, flow volume curves, and lung compliance. WOTF statements best characterizes pulmonary compliance?
A. it is equivalent to ΔP/ΔV
B. it is inversely related to the elastic recoil properties of the lung
C. it decreases with advancing age
D. it increases when there is a deficiency of surfactant
E. it increases in patients with pulmonary edema
122. A marathon athlete undergoes pulmonary exercise prior to next exercise program. WOTF occurs during anaerobic exercise?
A. ↓ of blood lactate lead to ↓ of blood pH
B. ↑ of blood lactate due to proportional ↑ of alveolar ventilation
C. ↑ of blood lactate lead to ↓ in blood pH
D. ↑ of oxygen consumption lead to hyperventilation
E. ↓ of blood pH due to increase of alveolar ventilation
123. A patient with congestive heart failure, orthopnea, and paroxysmal nocturnal dyspnea is referred for pulmonary function testing in the supine and upright position. WOTF is higher at the apex of the lung than at the base when a person is upright?
B. blood flow
C. V/Q ratio
E. lung compliance
124. A young lady becomes very anxious and increase her rate of ventilation. If her rate of CO2 production remains constant WOTF will decrease?
A. ↓ PaCO2
B. ↑ PaO2
C. ↑ V/Q
D. ↓ PaO2
E. ↓ kPO2
125. A child has SOB with cyanosis. WOTF statements that most likely for this child condition?
A. excessive amount of deoxygenated Hb
B. excessive profound hypoxemia
C. excessive demand of oxygen
D. excessive amount of carbondioxide
E. excessive amount of carbaminoxide
126. A professional athlete undergoes exercise program to exceed his anaerobic threshold. WOTF is increased as a result of the exercise program?
A. ↑ stimulation to brainstem to ↑ alveolar ventilation
B. ↑ alveolar ventilation resulting in ↑ of PaO2
C. ↑ alveolar ventilation resulting in ↓ of PaCO2
D. ↑ aerobic respiration resulting in ↑ blood lactate
E. ↑ oxygen demand resulting in ↑ of respiratory rate
127. A 34 y.o. man came to the PHC due to cough with bloody sputum. The symptom was felt for the last 3 months, it became worst now. He has consulted to a doctor and he was given 4 drugs which should be taken for 6 months but he stopped taking it just after 2 weeks. What is the most appropriate reason for this long period treatment?
A. microorganism is AFB
B. microorganism is survive in a dormant state
C. microorganism has thick and complicated wall
D. the patient was default the treatment
E. the patient is categorize I
128. A 23 y.o. man came to the doctor complaining poor performance in red-green color vision discrimination leading to fail in getting drive license. On further history taking, he is taking a four regiment drug for pulmonary TB. What is the most likely drug hw took?
129. A 38 y.o. man TB patient is given oral antiTB drug. One week later he complained that his urine color become reddish. What is the most likely drug he took?
121. A 70 years old woman come into the clinic with shortness of breath. A pulmonary function test was ordered to measure lung compliance. volume, etc. Which of the test is true about lung compliance?
B. inversely proportionated with elastic recoil of lungs
C. ↓ with ↑ age
D. ↑ when there is deficinency of surfactant
133. WOTF is macrolides?
139. Azythromycin digunakan 1x sehari. Alasannya?
B. T ½ lebih lama
149. PCO2 ↑, apa yang terjadi?
A. respiratory alkalosis
B. respiratory acidosis
C. metabolic acidosis
D. metabolic alkalosis
155. A 45 y.o woman history : episode wheezing and cough, selalu diawali dengan minor common cold dan muncul saat hujan. Ibunya juga memiliki gejala yang sama. CBC dan IgE normal. Mekanisme kasus?
A. Akumulasi mast cell di airspace following viral infection
B. Emigrasi eosinophil into bronchi
C. Bronchial hyperresponsiveness induced by viral inflammation
D. sekresi IL4 dan 5 oleh antiviral T cell
E. hyperresponsiveness karena inhlasi spora aspergillosis
157. Kasus pertussis. True about the microorganism?
A. grow on Mac Conkey agar
B. gram (-) rod
D. non fastidious bacteria
E. culture from sputum
158. Characteristic of RSV?
A. RNA double stranded
B. causing pneumonia in children
D. multinucleated giant cell
165. Kasus : anak-anak wheezing. Bukan penyebabnya?
189. A 8 months old boy. RR 61x/min, T 38.9oC, crackles on auscultation. What is the microorganism that causing this condition?
Male, 21 y.o., ER 3 menit setelah inject heroin. O2 saturation 70%, BGA : PaO2 40 mmHg, PaCO2 60 mmHg, pH 7.2. Cause of hypoxemia?
A. ventilation-perfusion mismatch
B. intrapulmonary shunting
C. alveolar hypoventilation
D. inpaired diffuse O2
E. abnormal de saturation