tag:blogger.com,1999:blog-38105809679669782662024-02-19T08:09:13.800-08:00Departemen Akademik FK UNPAD 2007superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.comBlogger148125tag:blogger.com,1999:blog-3810580967966978266.post-42214967868388087332011-06-22T07:13:00.000-07:002011-06-22T07:14:32.873-07:00MDE GIS 2011<p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">1. You deliver a newborn baby girl that has an umbilical hernia with part of another organ attached to it’s inner surface. What portion of the GIT is most likely to be attached to inner surface of the umbilical hernia?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. anal canal<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. appendix<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. cecum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. ileum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. stomach<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">2. Where is the anatomic location of gallbladder?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. between left and caudate lobe liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. between right and quadrate lobe liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. ligament falciform<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">5. Lateral umbilical fold and inner abdominal wall is formed by?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">6. Omental bursa is continuous with?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">8. Saraf yang mempersarafi abdominal wall yang mencegah direct inguinal hernia?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C subcostal nerve<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. 10th intercostal nerve<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">9. Mucosal necrosis of rectum will not result from occlusion of inferior mesenteric artery. Why?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. arterial supply to rectum<span style="mso-spacerun:yes"> </span>is from anastomosis connection from SMA<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. arterial supply to rectum is from left colic artery with anastomoses to branches of internal iliac artery<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. IMA does not supply the rectum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. principal branch of external iliac artery is major supply for rectum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. middle rectal artery, a branch of internal iliac artery, supplies rectum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">10. A 55 y.o. woman came with red bright blood vomit. Liver was palpated 5 cm below right costal margin. She was an alcoholic. The most possible diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. peptic ulcer<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. gastric ulcer<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. gastric telangiectasia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. cirrhosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">12. Pathology within abdominal organ can occasionally cause referred pain in shoulder & neck region, C3-C5, because the diaphragm receives motor and afferent innervation from this level as a result of its cranioembriologic development. WOTF abdominal organ cause unilateral shoulder/neck pain?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. liver, left pain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. gallbladder, right pain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. pancreas, right pain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. spleen, right pain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. appendix, left pain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">15. A surgeon enterong the abdominal cavity through the abdominal wall will take care to avoid injury to the vessels and nerves within the wall. The main portion of this vessels and nerves will be found immediately deep to the?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. skin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. superficial fascia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. external abdominal oblique muscle<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. internal abdominal oblique muscle<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. transversus abdominis muscle<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">16. As a surgeon performing an appendectomy, you encounter an artery and vein in the superficial fascia of the lower abdominal wall. These vessels most likeli the?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. superior epigastric artery<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. superficial circumflex artery and vein<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. intercostal artery and vein<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. inferior epigastric artery and vein<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. superior epigastric artery and vein<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">17. During surgery, you must incise the anterior rectus sheath between the xiphoid process and the umbilicus. In this region the sheath is derived from the aponeurosis of the?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. external abdominal oblique only<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. internal abdominal oblique only<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. external and internal abdominal oblique<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. internal oblique and tranversus abdominis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. transversus abdominis only<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">18. During laparoscopic procedure, you observe the inferior epigastric vessels ascending on the posterior surface of the rectus abdominalis muscle. They suddenly disappear from view by passing superior to the?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. falx inguinalis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. linea semilunaris<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. falciform ligament<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. arcuate line<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. transversalis fascia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">19. As a physician examining the inguinal region of a patient, the inguinal ligament will be key landmark. This structure feature is derived from WOTF?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. superfical fascia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. fascia lata of the thigh<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. aponeurosis of the external abdominal muscle<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. aponeurosis of the internal abdominal muscle<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. aponeurosis of the transversus abdominis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">20. You are in the process of repairing a direct inguinal hernia. WOTF anatomical realtions will you find during the surgery?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. the hernia will enter deep inguinal ring<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. the hernia will enter the femoral ring<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. the hernia will lie lateral to the inferior epigastric vessels<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. the hernia will lie medial to the inferior epigastric vessels<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. the hernia will lie inferior to the inguinal ligament<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">21. A 30 y.o. female present with heartburn and abdominal pain after taking a meal. Endoscopic result : ulcer at the alimentary canal area which has villi and Brunner’s gland at the submucosa. WOTF organ is mist likely as ulcer location?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. duodenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. jejunum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. ileum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. cecum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. rectum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">22. The lumen of this alimentary canal is usually collapsed and open only during the process of swallowing and convey the masticated fod from oral pharynx to the stomach. WOTF epithelial tissue is most likely lined this mucous layer of this canal?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. stratified cuboidal epithelium<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. stratified columnar epithelium<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. pseudostratified columnar epithelium<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. keratinized stratified squamous epithelium<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. non keratinized stratified squamous epithelium <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">23. A biopsy from patient with inflammatory bowel disease shows a part of mucous membrane longitudinal folds, called colums of morgagni of large intestine. WOTF is most likely portion?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. doudenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. cecum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. rectum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. anus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">24. This organ temporarily holds ingested food, adding mucus, HCL, and enzyme pepsinogen. Muscular contraction of this organ blend this components into a viscous mixture called chyme. WOTF is correct about wall layer of this organ?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. consist of mucosa, submucosa, muscularis, and serosa<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. consist of mucosa, submucosa, muscularis, and adventitia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. consist of mucosa, muscularis, adventitia, and serosa<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. consist of mucosa, muscularis, perimuscularis, and serosa<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. consist of mucosa, muscularis, perimuscularis, and adventitia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">25. These cells have round, basally located nuclei and cytoplasm is eosinophilic. These cells manufacture HCL and intrinsic factor into the lumen of the stomach. WOTF cells is most likely cells?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. surface lining cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. mucous nek cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. DNES cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. chief cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. parietal cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">26. These cells which are derived from monocyte precursors, have main function to metabolize erythrocyte, digest Hb, and destroys bacteria. WOTF is most likely location of these cells?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. duodenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. pancreas<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. cecum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. appendix<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">27. The inflammation of this cecum diverticulum is caused by obstruction of the lumen, accompanied by swelling and severe pain in the lower right quadrant of the abdomen. WOTF is correct about microscopic structure of this organ?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. contains mucosal vertical folds<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. contains shallow crypts of Lieberkuhn<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. contains hemorrhoidal plexus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. contains taenia coli<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. contains plicae circularis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">28. This hollow, pear shaped organ attached to the lower surface of the liver. It main function is to store and concentrate bile and to release stored bile in response to CCK. WOTF following tissue is most likely lined the mucous layer of this organ?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. simple squamous epithelial tissue<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. simple cuboidal epithelial tissue<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. simple columnar epithelial tissue<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. transitional epithelial tissue<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. stratified squamous epithelial tissue<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">29. The muscular layer of this part of alimentary canal is composed of smooth mucle fibers oriented in 3 main directions. The external layer is longitudinal, the middle layer is circular, and the internal layer is oblique. WOTF is most likely canal?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. esophagus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. stmach<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. small interintine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. appendix<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. cecum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">30. The main functions of this gland is to produce digestive enzymes and to secrete hormones. The presence of centroacinar cells in the center of the acinus is distinguishing characteristics of this gland. WOTF is most likely gland?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. Brunner’s gland<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. pancreas<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. gastric gland<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. parotid gland<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">31. A 27 y.o. female medical student wth irritable bowel syndrome (IBS) has an alteration in intestinal motility resulting in fluctuating constipation and diarrhea. Her condotion has worsened in the past month as the date she has scheduled for minor thesis examination. WOTF statement about small intestine motiliy is correct?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. contactule frequency is constant from duodenum to terminal ileum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. peristalsis is the only contractile activity that occurs during feeding<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. migrating motor complexes occur during digestive period<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. vagotomy abolishes contractile activity during the digestive period<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. contractile activty is initiated in response to boel wall distention<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">32. A 42 y.o. salesman presents with chief complaint of internittent misepigastric pain taht is relieved by antacids or eating. Gastric analysis reveals that basal and maximal acid output exceed normal values. WOTF subtances can cause gastric acid hypersecretion?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. somatostatin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. histamine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. gastrin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. secretin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. enterogastrone<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">33. A 27 y.o. female comes to ER because of 2 day profuse watery diarrhea. Physical exam reveals dry lips and oropharynx. This patient is diagnosed with acute secretory diarrhea and dehydration, likely due <i style="mso-bidi-font-style:normal">to Escherichia coli</i>. WOTF sodium reabsorption pathway is inhibited by the enterotoxin?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. sodium-glucose coupled cotransport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. electroneutral NaCl cotransport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. electrogenic sodium diffusion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. sodium-hydrogen cotransport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. sodium-bile salt cotransport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify;text-indent:.5in"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">34. </span><span style="font-size:9.0pt;font-family: "Arial","sans-serif";mso-fareast-font-family:"Times New Roman";mso-ansi-language: EN-US;mso-fareast-language:IN">A </span><span lang="IN" style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">37 yo male present with dehydration&hypokalemi with metabolic acidosis WOTF that excess fluid loss can </span><span style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:IN">c</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">ause acid base & electrolyte disorder? </span><span style="font-size:9.0pt;font-family:"Arial","sans-serif"; mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language: IN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">A</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">. </span><span style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">s</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">tomach</span><span style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">B</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">. </span><span style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">i</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">leum</span><span style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">C. c</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">olo</span><span style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">n<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">D. </span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-fareast-language:IN">pancreas</span><span style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:IN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:IN">E. liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">35. A 68 y.o. woman with rheumatoid arthritis, who has been taking NSAIDs for the past 10 years, complaints of burning epigastric pain that is relieved by antacids, but worsened with food. Her doctos discontinues the NSAIDs and starts her on cimetidine. WOTF is true regarding the pharmacological blockade of histamine H<sub>2</sub>-receptors in the gastric mucosa?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. it inhibits both gastrin- and acetylcholine mediated secretion of acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. it inhibits gastrin-induced but meal-induced secretion of acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. i has no effect on either gastrin-induced and meal-induced secretion of acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. it prevents activation of adenyl cyclase by gastrin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. it causes an increase in potassium transport by gastric parietal (oxyntic) cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">36. A 37 y.o. with AIDS presents with a fever, anorexia, weight loss, and GI vleeding. Physical exam reveals a palpavbel abdominal mass. Endoscopy and biopsy reveal a small bowel malignancy, indicating surgical resection. WOTF most likely result in a decrease due to segment removal?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. basal acid output<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. maximal acid output<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. gastric emptying of fluids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. gastric emptying of solids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. pancreatic enzyme secretion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">37. A 33 y.o woman complains of abdominal cramps and bloating that are relieved by defecation. Subsequent clinical evaluation reveals an increased maximal acid output, decreased serumcalcium and iron concentrations, and microcytic anemia. Inflammation in which area of the GI tract best explains these findings?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. stomach<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. duodenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. jejunum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. ileum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">38. Gastric emptying studies performed on a 49 y.o. female reveal a time to one-half emptying of liquids is 18 min (normal 20 min) and a time to one-half emptying of solids is 150 min (normal 120 min). WOTF best explains the data?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. increased amplitude of antral contraction<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. decreased orad stomach compliance<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. pyloric stenosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. sectionaing of the vagus nerves to the stomach<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. inflammation of the proximal small intestine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">39. A 57 y.o. female undergoes resection of the terminal ileum as a pert of trwatment of her chronic IBD. Removal of the terminal ileum will most likely result in WOTF?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. increased bile acid concentration<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. decreased glucose absorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. increased water content of the feces<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. decreased fat absorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. increased fat absorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">40. A 67 y.o. male with a history of alcohol abse present to the ER with severe epigastruc pain, hypotension, abdominal distention, and diarrhea with steatorrhea. Serum amylase and lipase are found to be greater than normal, leading to a diagnosis of panceratitis. The steatorrhea can be accounted for by a decrease in the intraluminal concentration of which following pancreatic enzyme?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. amylase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. trypsin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. chymotrypsin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. lipase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. colipase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">41. A patient’s abdominal pain is subdued after eating. WOTF is true regarding contraction of gallbladder following meal?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. it is inhibited by fat rich meal<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. it is inhibited by the presence of amino acid in duodenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. it is stimulated by atropine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. it occurs in response to CCK<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. it occurs simultaneously with the contraction of sphincter of Oddi<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">42. A 70 y.o. woman presents with abdominal pain, microcytic anemia, and weight loss. Colonoscopy biopsy confirms colon cancer. WOTF statement about the colon is correct?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. absorption of Na in colon is under hormonal (aldosterone) control<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. bile acids enhance absorption of water from the colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. net absorptionof HCO<sub>3</sub><sup>-</sup> occurs in colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. net absorptionof K<sup>+</sup> occurs in colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. the luminal potential in colon is positive<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">43. An 18 y.o. college student reports that she experiences severe abdominal bloating and diarrhea within 1 hour of consuming dairy products. A subsequent H<sub>2</sub>-breath is abnormal. The diarrhea and bloating can be best explained by WOTF?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. a deficiency in brush border enzyme lactase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. carbohydrate induced secretory diarrhea<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. decreased intestinal surface area<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. decreased carbohydrate absorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. a decrease in pancreatic secretion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">44. A patient with alcoholic cirrhosis comes in vomiting blood. After stabilizing him with IV fluids, the next step should be administration of an agonist/analog that can inbhibit gastric acid secretion and visceral blood flow. WOTF is most likely agent?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">A. gastrin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">B. somatostatin <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">C. histamine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">D. pepsin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN">E. acetylcholine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-fareast-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">45. A patient has vomiting and severe watery diarrhea after eating fish sushi, IV fluid and electrolyte</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-ansi-language: EN-US"> </span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">replacement was started and stool specimen was taken,which came back positive for <i style="mso-bidi-font-style:normal">Vibrio cholerae</i>.</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-ansi-language:EN-US"> </span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">Which of the following statement bst describe water and electrolyte</span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-ansi-language: EN-US"> </span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">absorption in GI tract?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. most water and electrolyte come from ingested fluid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. the small intestine and colon have similar absorptive capacities<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. osmotic equilibrium of chyme occurs in the stomach<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. the majority of absorption occurs in jejunum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. cholera toxin inhibits sodium coupled nutrient transport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">46. An 18 y.o. female dcides to get a tattoo for her birthday. Two months later she present with fever, right upper quadrant pain, nausea, vomiting, and jaundice. WOTF lab value would most likely be found in a patient with infectious hepatitis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. an increase in plasma alkaline phospatase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. an increase in plasma bile acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. an increase in both direct and indirect plasma bilirubin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. an increase in direct and a decrease in indirect plasma bilirubin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. a decrease in both direct and indirect plasma bilirubin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">For questions number 47-49 refer to the scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A beggar patient had an acute onset of diarrhea and abdominal pain. The diarrhea worsened and he became weak and unable to walk. He was admitted to the hospital. Physical exam revealed the following BP 50/60 mmHg, pulse :<span style="mso-spacerun:yes"> </span>130/min. Lab : Hct and total serum protein was increased. Serum sodium level was normal. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">47. WOTF statement that is the most appropriate explanation about elevated serum protein and Hct?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. red cells and plasma protein become more diluted because they are ECF<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. red cells and plasma protein become more concentrated because they are not lost<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. red cells and plasma protein become more diluted because they are not move to intracellular<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. red cells and plasma protein become more concentrated because they are lost<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. red cells and plasma protein become more concentrated because they are ICF<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">48. Why is the blood pressure low and heart rate high?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. decrease blood volume </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings;mso-ascii-font-family: Arial;mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type: symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol; mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif""> decrease cardiac output </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings; mso-ascii-font-family:Arial;mso-hansi-font-family:Arial;mso-bidi-font-family: Arial;mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif""> increase heart rate<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. sympathetic discharge in response to to the elevated heart rate<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. parasympathetic discharge in response to to the elevated heart rate<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. increase Hct </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings;mso-ascii-font-family:Arial; mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type:symbol; mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family: Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family: "Arial","sans-serif""> decrease cardiac output </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings;mso-ascii-font-family:Arial; mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type:symbol; mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family: Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family: "Arial","sans-serif""> increase heart rate<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. increase heart rate </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings;mso-ascii-font-family: Arial;mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type: symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol; mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif""> decrease cardiac output </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings; mso-ascii-font-family:Arial;mso-hansi-font-family:Arial;mso-bidi-font-family: Arial;mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif""> decrease blood pressure<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">49. If the patient was given NaCl rehydration and oral water rehydration, WOTF statement taht can explain the fall in serum sodium?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. sodium serum is diluted<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. water continues to loss<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. serum sodium is concentrated<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. only water is given replacement<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. sodium serum is increased<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">50. A 63. y.o. female is diagnosed with an intractable duodenal ulcer. After consultation with a surgeon, it is recommended that she undergoes a parietal cell vagotomy. Subsequently the patient experiences nausea and vomiting after ingestion of mixed meal. WOTF best explains her symptoms?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. increased gastric emptying of solids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. decreased gastric emptying of solids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. increased gastric emptying of liquids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. decreased gastric emptying of liquids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. increased gastric emptying of liquids and solids<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">51. A 75 y.o. man comes with swallowing difficulty for the past 1 month. He ia a chain smoker for the last 50 years. Endoscopy examination reveals an ilcerative mid-esophageal, 3 cm mass that partially occludes the esophageal lumen. He undergoes esophagetomy. What is the most likely pathological appearance?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. multinucleated cell eith intranuclear inclusion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. squamous cell carcinoma<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. dense collagenous scar<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. adenocarcinoma<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. thrombosed vascular channels<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">For questions number 52-53 refer to clinical scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A 56 y.o. female come with hematemesis since 2 days ago. She has episodic epigastric pain, nausea and vomiting since 1 month ago. She takes NSAID for her chronic arthritis since 2 years ago.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">52. WOTF defense mechanism that most likely failed to protect gastric mucosa in this patient?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. mucus secretion of surface epithelial in duodenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. bicarbonate acid secretion to the surface of the gaster<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. rapid epithelial regenaration of the gaster<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. ptyalin secretion at the gaster<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. regularity of gastric emptying time<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">53. WOTF lesion will gastric biopsy most probably show?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. epithelial dysplasia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. hyperplastic polyp<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. acute gastritis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. adenocarcinoma<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. H. pylori infection<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">54. A 30 y.o. has acute abdominal pain. His abdomen diffusely distended, with absent bowel sounds. He undergoes removal of 20 cm terminal ileum segment within the surgery. The pathologic examination show chronic inflammation with lymphoid aggregates and deep fissure extending into the muscularis is also seen. What is the most likely diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. diverticulitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. Crohn’s disease<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. colitis ulcerative<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. celiac disease<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. enterocolitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">55. Significant passage of meconium fails to occur after a normal birth at term. Three days post partum, the baby vomits all oral feedings. An abdominal ultrasound shows marked colonic dilatation above narrowed region shows an absence of ganglion cells in the muscle wall and submucosa. What is the most likely diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. duodenal atresia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. Hirschprung disease<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. necrotizing enterocolitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. volvulus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. intussuception<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">For questions number 56-57 refer to scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A biopsy result from a 58 y.o. man with ascites shows cirrhosis hepatic appearances.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">56. What is the most important histopathological finding in the biopsy?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. hepatocyte injury with balooning degeneration<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. bridging fibrosis in lobulus and portal tract<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. massive infiltration of eosinophil and plasma cell<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. fatty liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. ground glass appearances of hepatocyte<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">57. he has a history of having blood transfusion 20 years ago. WOTF virus is the most possible etiologic agent in his disease?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. HAV and HEV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. HBC and HCV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. HBV and HAV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. HCV and HEV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. HAV and HBV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">For number 58-59, refer to scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A 45 y.o. woman had abdominal cramp and diarrhea since 3 weeks ago. Stool specimen : blood, mucous, but no egg/ parasite. Symptoms periodic for the last 10 years. Colonoscopy revealed diffuse uninterrupted mucosal inflammation, superficial ulceration extending from rectum to ascending colon. Histopathology : diffuse, predominated lymphocyte infiltrate to lamina propria. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">58. Diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. Crohn disease<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. Fat malabsorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. ulcerative colitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. ischemic colitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">59. Complication of the disease?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. carcinoma colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. carcinoid of rectum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. fat malabsorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. pseudomonal colitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. lymphoma malignant <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">For question number 61-62, refer to clinical scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A 17 y.o. man came to the hospital due to right lower abdominal pain. The doctor diagnosed that he had an acute appendicitis.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">61. WOTF statement is appropriate for acute appendicitis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. macroscopically the appendix is pale and atrophic<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. microsopically the mucosa and serosa is infiltrated by PMN cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. feces is usuallu found within the appendix<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. blood smear shows monocytosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. macroscopically the appendix is shrunked<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">62. What is the most common etiology of acute appendicitis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. worm<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. bilestone<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. fecalith<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. bacteria<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. tumor<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">65. A 20 y.o. male came to hospital with chief complain of yellowish skin & eyes. Doctor suspect hepatitis viral infection. Which enzyme most effective to detect this disease?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. ALP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. leucine aminopeptidase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. acid phosphatase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. GGT<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. serum glutamate pyruvate transaminase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">68. WOTF condition we can find decreased ALP?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. obstructive jaundice<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. hemolytic jaundice<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. hyperparathyroidism<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. hyperthyroidism<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. hypophosphatemia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">69. Jaundice, fever, icteric<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. acute hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. chronic hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. cirroshis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. hepatic carcinoma<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. biliary obstruction<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">70. Patient with fever. Lab : increased unconjugated bilirubin. Diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. malaria<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. choledocholithiasis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. acute hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. chronic hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. drug induced hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><span style="mso-spacerun:yes"> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">71. Urin urobilinogen will increase in patient with obstructive jaundice if there is an infection. Where is the infection in this case?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. proximal obstruction<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. distal obstruction<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. duodenum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. jejunum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">72. Orang yang dijadwalkan untuk gallbladder surgery. Bilirubin total 2.5 (normal <1), bilirubin direct 0.75 (normal <0.3). Kelainannya?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. prehepatic (?)<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. hepatic<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. posthepatic (obstruction)<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. prehepatic (RBC destruction)<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">75. Result of severe BGA, severe vomiting. pH 7.5, pCO2 55 mmHg, HCO<sub>3</sub><sup>-</sup> 40 mmHg.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. metabolic acidosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. respiratory acidosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. metabolic alkalosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. respiratory alkalosis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">76. Examining feces from 2 y.o. boy who has acute bloody diarrhea. WOTF aspect that has inaccurate result?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. stool stored at room temperature 24 hours before testing<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. stool collected in small container<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. stool collected in container contaminated with urine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. stool collected in filling lid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. stool stored at room temperature 2 hours before testing<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">77. A 40 y.o. man taking OTC drug medication for gastric reflux reported passing frequent black stool. FOB (-). Possible non-pathological cause?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. gastric reflux medication containing bismuth may produce black stool<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. gastric reflux medication containing iodine may produce black stool<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. gastric reflux medication containing colchicine may produce black stool<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. gastric reflux medication containing rauwolfia may produce black stool<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. gastric reflux medication containing barium may produce black stool<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">80. Seorang laki-laki 34 tahun, copious diarrhea dan abdominal cramp sejak 2 hari yang lalu. Diare 10-12 kali. Diare no blood dengan mucus. Bagaimana mekanisme yang terjadi?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. adhesion heat labile toxin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. stimulus adenyl cyclase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. stimulus guanylate cyclase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. adhere and endocytosis bacteria<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. destruction of mature enterocyte<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">For number 83-84 refer to scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A 6 month old baby had diarrhea. Temp 37.1<sup>o</sup>C, no blood/mucus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">83. Etiology?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. rotavirus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. adenovirus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. salmonella<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. norwalk<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. necrotizing enterocolitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">84. Characteristic of the etiology?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">87. People who attend party got sick, with vomiting, fever, headache. Consume beans, cheese cake shrimp. A 26 y.o. 2 month pregnant womanhad miscarriage ane day later. Lab test : gram (+) β-hemolytic short, rod shaped, spore forming in coleslaw. What is the cause?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. S. aureus <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. L. monocytogenes<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. C. perfringens<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. C. botulinum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. Salmonella<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">88. Boil hand, out of refrigerator, eat mayonnaise, sandwich.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. S. aureus enterotoxin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. coagulase S. aureus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. S. aureus leukocidin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. C. perfringens toxin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. penicillinase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">89. Symptoms of C. botulinum caused by food poisoning include double vision, inability to speak, and respiratory paralysis. WOTF is consistent with the symptoms?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. invasion of the gut epithelium by C. botulinum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. secretion of enterotoxin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. endotoxin shock<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. ingestion of neurotoxin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. activation of cAMP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">92. PAtoent has all GI symptoms infection with Hepatitis A. History of drinking contaminated water source. Test for HAV IgG & HAV IgM (-). Which is the cause of infection?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. HAV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. HBV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. HCV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. HDV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. HEV<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">93. Kecenderungan mendapatkan penyakit opportunistic?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. TBC paru pada medical student<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. TBC paru pada chemotherapy leukemia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">95. A newborn baby has extrusion of abdominal content on her umbilical region ata right lateral side. What is her abnormality?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. omphalocele<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. volvulus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. gastroschisis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">98. Barium enema </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings;mso-ascii-font-family:Arial; mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type:symbol; mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family: Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family: "Arial","sans-serif""> funnel shape appearance. What is the embryological basic?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">102. The primordium of which structure is located in septum transversum?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. dorsal pancreas<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. lung<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. liver<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. thymus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. spleen<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">103. Location of Meckel diverticulum is usually at?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. jejunum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. ileum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. asceding colon / descending colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. cecum<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. transverse colon<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">104. A 20 y.o. patient complains abdominal pain. Pain is releved with antacid. Mechanism?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. HCl stimulated by histamine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">105. You’re eating chocolate for snack. WOTF mechanism assure this chocholate final product absorbed in the small intestine?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. simple diffusion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. Na<sup>+</sup> dependent co-transport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. H<sup>+</sup> dependent co-transport<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. Na<sup>+</sup> independent facilitated diffusion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. H<sup>+</sup> independent facilitated diffusion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">106. A young researcher assessing gallstone composition by its primary bile acid in bole. WOTF subtances that can be found?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. deoxychlic acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. lithocolic acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. cholic acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. bilirubin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. biliverdin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">109. Umat muslim berpuasa selama 12 jam, kadar glukosa dalam tubuh tetap normal. Selama puasa subtansi apa yang diubah sehingga kadar glukosa darah teteap normal?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. acetone<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. ketone bodies<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. fatty acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">110. A poor beggar is starvation but still alert. WOTF substances can be alternative fuel for the brain?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. galactose<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. glycerol<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. fatty acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. ketone bodies<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. amino acid</span><span style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">114. If Rh (-) has Rh (+) fetus, there will be Rh factor antibody days after infant is born. Therefore infant would get jaundice and CNS damage. WOTF enzyme is predominantly affected?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. Heme oxygenase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. Bilirubin reductase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. Bilirubin degydrogenase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. SGOT<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. UDP-glucose dehydrogenase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">115. Female, acute abdominal pain in RUQ & pain in back after consuming meal of fried chicken and cheese coated french fries. The appropriate mechanism for bile synthesis in gallbladder?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. primary bile is synthesized by liver synthesis from cholic-deoxycholic acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. secondary bile is produced by conjugation of primary bile + glycin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. 7-dehydroxilation produce secondary bile acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. daily bile secretion equal to bile synthesis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. conjugated bile interact with lipid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">116. Epigastic pain, didn’t relieved by eating. Take stomach pill for 1 month. Associated with the disease?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. gastric acid + pepsin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. gastric acid + pepsinogen<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. gastric acid + trypsin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. gastric acid + renin<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. gastric acid + amylase<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">123. decrease protein </span><span lang="IN" style="font-size:9.0pt;font-family:Wingdings;mso-ascii-font-family: Arial;mso-hansi-font-family:Arial;mso-bidi-font-family:Arial;mso-char-type: symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol; mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif""> untuk decrease nitrogen<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">125. Antacid characteristic?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. weak acid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. increase acid production in stomach<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. with HCl form salt and water<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">126. What is the effects of drug interaction between antacid and other medication?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. antacid can influence the metabolism of other drugs<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. antacid concentration is increased by other drugs<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. antacid decrease intragastric pH acidity hence influence other drugs absorption<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. antacid must be given within 2 hours with other drugs<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. long use antacid for kidney insufficiency<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">128. How does ranitidine work?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. stimulate base secretion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. exhibit competitive inhibitor at parietal cell<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. decrease base secretion<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. increase parietal cell AMP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. have little 1st metabolism & bioavailability almost 100%<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">129. Obat yang mengakibatkan impotence dan gynecomastia pada pria dan galctorrhea pada wanita?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. ranitidine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. nizatidine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. famotidine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. antacid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. cimetidine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">130. Ranitidine?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. it may cause tachycardia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. it may cause hypertension<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. it doesn’t bind to cytochrome P450<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. it doesn’t compete with other drugs<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">132. How omeprazole administered in our body?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. active drug<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. inactive drug<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. active prodrug<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. inactive prodrug<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. acid labile prodrug<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">133. Omeprazole + diazepam?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. omperazole hambat diazepam<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. diazepam hambat omeprazole<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. omeprazole tidak mempengaruhi<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. diazepam tidak mempengaruhi<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">134. Obat yang bioavailability nya paling tinggi?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. omeprazole<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. ansoprazole<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. rabeprazole<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. pantoprazole<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">136. Pernyataan yang benar tentang sucralfate?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. well absorbed<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. tidak dipengaruhi absorpsinya<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. salt that sulfatized...<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">138. What is the MOA of misoprostol?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. inhibit acidity & mucosal protective<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">140. A 53 y.o. woman dysphagia on chemotherapy for leukemia. Examination with?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. videofluoroscopy<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. monometry<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. endoscopy<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. scintigraphy<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. USG<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">141. Laki-laki, 49 tahun, minum cairan pembesih toilet untuk bunuh diri. Initial management?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. endoscopy dalam 12-24 jam<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. broadspectrum AB<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. corticosteroid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. milk<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">142. A 50 y.o. man comes to radiology department due to barium examination. During swallowing barium found that a peristaltic and dilation oesofagus with failure to relax LES. WOTF disorder that most likely for this condition?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. scleroderma<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. presbiesofagus<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. diffuse esophageal spasm<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. barret esophagitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. achalasia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">143. Tes untuk mendeteksi esophageal reflux?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. Bernstein test<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. Smith test<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">144. A 53 y.o. woman came to ENT clinic with complaint of intermittent swallowing difficulty. She was diagnosed as achalasia. Most likely found on HT?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. heart burn, epigastric & retrosternal pain after eat, husky voice, vomit<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. slowly progressive intermittent dysphagia, regurgitation, aspiration<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. dysphagia especially to raw food, heart burn<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. intermittent dysphagia, sheer emotional, chest pain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. spontaneous regurgitation, dysphagia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">149. USG : multiple gastric ulcer. Berdasarkan klasifikasi Forres, komplikasi yang paling sering adalah?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. GI bleeding<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. peritonitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">151. A 43 y.o. female complains vomit 1 day prior to admission. Fever 4 days ago. PE : ill, fever, slightly jaundice, epigastric tenderness, decreased bowel sound.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span style="font-size:9.0pt;font-family:"Arial","sans-serif"; mso-ansi-language:EN-US">For 154-156 refer to scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A 24 y.o. male came to ER with fever, jaundice. History of colic abdomen 3 days ago. PE : awake, BP 100/60, PR 116x/min, RR 24x/min, temp 39<sup>o</sup>C. RUQ tenderness, normal bowel sound. Hb 14 gr/dl, WBC 20.400/mm<sup>3</sup>, PLT 212.000/mm<sup>3</sup>. Total serum bilirubin 8.5 mg/dl, conjugated bilirubin 6.2 mg/dl, SGOT 70 U/L, SGPT 85 U/L, ALP 300 U/ml, GGT 275 U/ml. Diff count 0/7/49/4/12. </span><span style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">154. </span><span lang="IN" style="font-size:9.0pt;font-family:"Arial","sans-serif"">Diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. acute abdomen<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. acute hepatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. acute cholangitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. acute pancreatitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. acute cholecystitis</span><span style="font-size:9.0pt;font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">155. To confirm diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. USG abdominal<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. CT scan<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. plain abdominal x-ray<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. MRCP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. ERCP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">156. Etiology?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. gallbladder stone<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">157. Imaging: biliary ectasis with tubular structure noted at distal of CBD. The best treatment?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. therapeutic ERCP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. PTBD<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. cholecystectomy<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. antibiotic and antihelminthic<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">159. Perforating peptic ulcer cause?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">163. Female. Rectal bleeding. Mass protrude when defecating. No pain. What is the diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. prolapse internal hemorrhoid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. prolapse external hemorrhoid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. rectal prolapse<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">Inability to defecate, frequent colicky abdominal pain, distended abdomen, no lump in abdominal region.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">164. Diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. acute cholangitis with reynold’s pentad<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. acute cholangitis due to bile duct stone<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. sclerosing cholangitis<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. acute cholangitis due to ascaris<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. Mirrizi syndrome<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><b style="mso-bidi-font-weight: normal"><span style="font-size:9.0pt;font-family:"Arial","sans-serif"; mso-ansi-language:EN-US">For number 166-169, refer to scenario below<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">One month old baby boy came with abdominal distention and constipation since birth. He has history of delayed meconium and his nutrition status is underweight.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">168. Rectal suction biopsy shows the absence of ganglion cell and the presence of hypertonic nerve trunks. WOTF contrast enema finding is typical for this disease?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. string sign<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. funnel shape appearace<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. dilated loop<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. air fluid level<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. cupping sign<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">171. Which of the following about gastroschizis formation theory?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">a. failure of upper abdominal fold formation theory<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">b. failure of lower abdominal fold formation theory<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">c. failure of right umbilical vein degeneration<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">d. right umbilical vein involution theory<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">e. failure of lateral abdominal fold formation<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">176. Non advance radiology?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. plain abdominal x-ray<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. endoscopy<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. CT abdomen<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">D. MRCP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">E. CT angiography<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">181. Sign and symptom class II hemorrhagic shock?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. blood loss 500 ml<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. RR 30-40x/min<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. blood loss 15-30%<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. pulse rate 130 bpm<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. urine production 5-15 ml/min<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">182. Untuk ukur stunting?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">Jawab : height for age<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">183. The best anthropometric index to determine obesity in children?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. height for age<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. mid arm circumference<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. head circumference<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. BMI for age<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. skin fold thickness<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">186. Seorang ibu setiap kali defekasi berdarah, ada massa yang keluar dari anal, tidak sakit.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">A. external hemorrhoid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">B. internal hemorrhoid<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">C. colonic cancer<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">188. What is the definition of nutritional assessment?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">189. What is the definition of nutritional diagnosis?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">190. What is the definition of nutritional intervention?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US">191. What is the definition of nutritional monitoring and evaluation?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span style="font-size:9.0pt; font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">196. Mechanism for ascites in this patient?</span><span style="font-size:9.0pt;font-family:"Arial","sans-serif"; mso-ansi-language:EN-US"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. underfill theory<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. fluidic shift theory<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. infection<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. hyponatremia<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif""><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">What is the 1st imaging study that is needed for etiology of the disease?<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">A. plain abdominal x-ray<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">B. CT scan of abdomen<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">C. ultrasound<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">D. MRCP<o:p></o:p></span></p> <p class="MsoNormal" style="text-align:justify"><span lang="IN" style="font-size: 9.0pt;font-family:"Arial","sans-serif"">E. ERCP</span><span style="font-size: 9.0pt;font-family:"Arial","sans-serif";mso-ansi-language:EN-US"><o:p></o:p></span></p>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com1tag:blogger.com,1999:blog-3810580967966978266.post-3634879553236308732011-06-22T07:12:00.000-07:002011-06-22T07:13:28.112-07:00MDE RESPI 2010<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">2. Result of hearing test on the left ear of the boy?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. conductive hearing loss</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. sensorineural hearing loss</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. mixed hearing loss</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. no hearing loss</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. chlarythromycin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. amoxicillin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. ciprofloxacin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. levofloxacin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. cephalosporin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">9. A 4 months old child. Stridor for 2 months. His mom said that his condition improves in prone position. Diagnosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. laryngocele</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. laryomalacia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. vocal cord paralysis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. subglottic stenosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. foreign body aspiration</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">10. Inspiratory stridor is caused by obstruction in?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. subglottic</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">11. Origin of infection in lateral pharyngeal space?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. soft palate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. mastoid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. tonsil</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. neck</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. floor of mouth</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. external otitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. acute OM</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. chronic OM</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. serous OM</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. malignant otitis externa</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">18. Biopsy lymph node : caseous necrosis , granulomatous, Datia langhans cell.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. non-hodgkin lymphoma<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. hodgkin lymphoma<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. tubercle<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">20. Nutrition for COPD?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. adequate protein, ↑ lipid, adequate CH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. 20% protein, 25% lipid, 55% CH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. 10% protein, 50% lipid, 40% CH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. adequate protein, ↑ lipid, ↓ CH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. 15% protein, 30% lipid, 55% CH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">23. WOTF will protect against lung tissues destruction in COPD?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. epinephrine<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. glucagon<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. cortisol<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. retinol<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. adrenaline<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">25. Respon pasien terhadap dyspnea di atas adalah<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. kussmaul breathing<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. shallow breathing<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A 29 y.o. man. SOB, cough, yellowish sputum. History of DM. PE : RR 30x/min, T 38<sup>o</sup>C, BP 130/80 mmHg, rhonchi (+), wheezing (-), blood glucose 276 mg/dL, chest x-ray infiltrate (+).<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">29. WOTF is the metabolism of the lung in the patient?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> production of glucose in the lungs as the major site of blood glucose production<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> lung compliance<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. involved in removal of serotonin, prostaglandin, and leukotriens<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. type I cells produce surfactant<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> pH in lungs<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">34. PaO<sub>2</sub> 45 mmHg, PaCO<sub>2</sub> 37.5 mmHg, pH 7.4. Condition?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. baik2 saja<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. respiratory acidosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. hypoxia tapi tidak acidosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. respiratory alkalosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. hypoxia tapi tidak alkalosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">44. WOTF disease is caused by this anomaly?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. sinusitis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. pneumonitis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. esophagitis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. gastritis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. candidiasis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">45. Premature baby girl, D/ : RDS. WOTF appropriate with her condition?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. surfactant increase surface tension between air-alveolar septa<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. terminal saccular phase begins at 18 weeks<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. surfactant is produced by type ! cell<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. sufficient surfactant 24-26 weeks<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. the baby has sufficient surfactant since terminal saccular period<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">48. A 20 y.o. male has asthma experience nocturnal symptoms 4x/week, daily symptoms 3x/week. Category?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. mild intermittent asthma<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. moderate asthma<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. severe asthma<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. status asthmatic<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">52. Gejala TB </span><span lang="IN" style="font-family:Wingdings;mso-ascii-font-family:Calibri;mso-ascii-theme-font: minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin; mso-ansi-language:IN;mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="mso-ansi-language:IN"> antibiotic but no improvement. Past history : treatment TB 6 month, completed and cured. Patient status :<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. new patient<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. relapse<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. failure<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. default<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. transfer in<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">62. Criteria for hospital acquired pneumonia<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. >24 hours after admission<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. >36 hours after admission<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. > 48 hours after admission<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. >60 hours after admission<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. >72 hours after admission<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. Cryptococcus neoformans<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. Blastomyces dermtitidis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. Pneumocystis jirovecii<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. Histoplasma capsulatum<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. Aspergillus fumigatus<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. streptomycin, INH, rifampin, ethambutol</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. rifampin, INH, ethabutol, pyrazinamide, streptomycin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. rifampin, pyrazinamide, INH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. rifampin, streptomycin, ethambutol, <span lang="IN" style="mso-ansi-language:IN">p</span>yrazinamide</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. INH, pyrazinamide, ethambutol, ciprofloxacin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. COPD stage I</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. COPD stage II</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. mild persistent asthma bronchial</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. severe persistent asthma bronchial</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. moderate persistent asthma bronchial</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. gender difference</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. difference in age</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. difference in spirometri result</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. difference in risk factors</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. difference in inflammatory cells and mediators</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. tumor of right maxillary sinus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. right hematosinus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. acute sinusitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. chronic sinusitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. mucocele</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. lung abscess</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. pulmonary cyst</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. mycetoma in a caity</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. cavitating tumor</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. the cavity of pulmonary TB</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">For question no. 75-76 refer t the clinical scenario below</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">75. The segmenta homogenous lung opacification with air bronchograms is</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. an atelectasis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. a pleural effusion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. a pneumonia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. a schwarte</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. a bronchopneumonia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">76. This disease begin as a localized infection of</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. terminal air spaces</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. terminal bronchioles</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. respiratory bronchioles</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. acinus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. interstitial</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">For question number 77-78, refer to the clinical scenario below</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">77. What is the basic standard radiograph for any patient presenting with a cough more than 3 weeks?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. PA chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. oblique chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. left lateral decubitus film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. apical lordotic film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. AP chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">78. What is the best radiograph for showing the presence of small pleural effusion?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. lateral decubitus film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. PA chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. lateral chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. AP film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. apical lordotic film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. oblique chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. left lateral decubitus film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. apical lordotic film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. Ap chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. lateral chest film</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">80. WOTF statements is rel<span lang="IN" style="mso-ansi-language:IN">a</span>ted to acute exacerbation of asthma?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. mucous secretion is ↓</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. the peak expiratory flow is ↑</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. the forced expiratory volume in one second is ↓</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. there is no mucosal edema in the airway</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. bacterial infection may be act as trigger</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">81. Lobar consolidation with positive air bronchograms can be found in?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. pneumonia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. pleural effusion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. atelectasis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. bronchopneumonia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. schwarte</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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 statement<span lang="IN" style="mso-ansi-language: IN">s</span> is correct about anterior portion of this cavity?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. lined by simple cuboidal epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. has goblet cells</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. has sweat bodies</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. no sweat glands</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. has sebaceous gland</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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 statement<span lang="IN" style="mso-ansi-language:IN">s</span> is correct about structure that involved in this case?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. stratified squamous non keratinized epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. stratified squamous keratinized epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. stratified columnar epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. pseudostratified columnar epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. stratified cuboidal epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. stratified squamous epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. pseudostratified columnar epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. stratified columnar epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. simple squamous epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. simple cuboidal epithelium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. simple squamous</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. simple cuboidal</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. stratified squamous</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. pseudostratified columnar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. stratified columnar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">93. A 30 y.o. man get trauma, bleeding from the nose for 30 minutes. Anterior pack did not help.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. anterior epistaxis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. posterior epistaxis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. trauma at nose<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. trauma at maxillary<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">103. inhaled a peanut, nyangkut di?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. left bronchus<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. left segmental bronchus<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. right bronchus<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. right lower segmental bronchus<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. right upper segmental bronchus<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. the chest wall on the affected site recoils inward<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. the V/Q ratio on the affected site is higher than normal<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. the mediastinum shifts further to the right with each inspiration<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. the intrapleural pressure in the affected area is equal with atmospheric pressure<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. there is a hyperventilation of the affected lung<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. fibrotic lung disease<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. pulmonary embolism<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. hyperventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. pulmonary hypertension<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. polycythemia<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">116. A 20 y.o. medical students doing weight training and jogging. WOTF statement is most appropriate?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> pulmonary blood flow due to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN">cardiac output<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> diffusing capacity due to hyperventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> airway resistance due to hyperventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> pulmonary vessels resistance due to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> pulmonary blood flow<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> diffusing capacity due to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> pulmonary blood flow<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">117. WOTF is higher at total lung capacity than it is at residual volume?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. airway resistance<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. lung compliance<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. alveolar pressure<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. anatomical dead space<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. intrapleural pressure<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">118. An arterial blood gases result from a patient with comatose revelaed hypercapnia. WOTF is the most likely cause of the high arterial pCO<sub>2</sub>?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. prolonged hypoxia<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. depression of respiratory center<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> alveolar ventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> metabolic activity<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. obstruction process of expiration<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. foreign matter irritate nasal pathway<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. the chemistry corrosive matter destroy the alveoli<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. he inspired 2.5 L air while he was cough<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. afferent nerve impuls through vagus nerve<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. automatic sequence triggered by strong compression of the lung<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. tidal volume<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. residual volume<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. forced expiratory volume<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. residual capacity<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. inspiratory capacity<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. it is equivalent to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language: IN">Δ</span><span lang="IN" style="mso-ansi-language:IN">P/</span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language: IN">Δ</span><span lang="IN" style="mso-ansi-language:IN">V<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. it is inversely related to the elastic recoil properties of the lung<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. it decreases with advancing age<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. it increases when there is a deficiency of surfactant<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. it increases in patients with pulmonary edema<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">122. A marathon athlete undergoes pulmonary exercise prior to next exercise program. WOTF occurs during anaerobic exercise?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> of blood lactate lead to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> of blood pH<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> of blood lactate due to proportional </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> of alveolar ventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> of blood lactate lead to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> in blood pH<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> of oxygen consumption lead to hyperventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> of blood pH due to increase of alveolar ventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. ventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. blood flow<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. V/Q ratio<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. PaCO<sub>2</sub><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. lung compliance<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">124. A young lady becomes very anxious and increase her rate of ventilation. If her rate of CO<sub>2</sub> production remains constant WOTF will decrease?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> PaCO<sub>2</sub><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> PaO<sub>2</sub><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> V/Q<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> PaO<sub>2</sub><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> kPO<sub>2</sub><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">125. A child has SOB with cyanosis. WOTF statements that most likely for this child condition?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. excessive amount of deoxygenated Hb<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. excessive profound hypoxemia<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. excessive demand of oxygen<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. excessive amount of carbondioxide<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. excessive amount of carbaminoxide<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">126. A professional athlete undergoes exercise program to exceed his anaerobic threshold. WOTF is increased as a result of the exercise program?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> stimulation to brainstem to </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> alveolar ventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> alveolar ventilation resulting in </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> of PaO2<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> alveolar ventilation resulting in </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> of PaCO2<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> aerobic respiration resulting in </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin; mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> blood lactate<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑ oxygen demand resulting in ↑ of respiratory rate</span><span lang="IN" style="mso-ansi-language: IN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. microorganism is AFB<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. microorganism is survive in a dormant state<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. microorganism has thick and complicated wall<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. the patient was default the treatment<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. the patient is categorize I<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. ethambutol<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. isoniazid<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. pyrazinamide<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. rifampin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. streptomycin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. INH<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. rifampin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. streptomycin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. pyrazinamide<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. streptomycin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">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?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">Δ</span><span lang="IN" style="mso-ansi-language:IN">P/</span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">Δ</span><span lang="IN" style="mso-ansi-language:IN">V<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. inversely proportionated with elastic recoil of lungs<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↓</span><span lang="IN" style="mso-ansi-language:IN"> with </span><span lang="IN" style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language: IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> age<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN"> when there is deficinency of surfactant<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">133. WOTF is macrolides?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">139. Azythromycin digunakan 1x sehari. Alasannya?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. T ½ lebih lama<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">149. PCO2 </span><span lang="IN" style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin;mso-ansi-language:IN">↑</span><span lang="IN" style="mso-ansi-language:IN">, apa yang terjadi?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. respiratory alkalosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. respiratory acidosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. metabolic acidosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. metabolic alkalosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">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?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. Akumulasi mast cell di airspace following viral infection</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B. Emigrasi eosinophil into bronchi</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C. Bronchial hyperresponsiveness induced by viral inflammation</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D. sekresi IL4 dan 5 oleh antiviral T cell</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E. hyperresponsiveness karena inhlasi spora aspergillosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">157. Kasus pertussis. True about the microorganism?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. grow on Mac Conkey agar<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. gram (-) rod<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. non fastidious bacteria<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. culture from sputum<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">158. Characteristic of RSV?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. RNA double stranded</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. causing pneumonia in children<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. multinucleated giant cell<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">165. Kasus : anak-anak wheezing. Bukan penyebabnya?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">A. rotavirus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">B.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">C.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">D.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">174. Cough?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal">189. A 8 months old boy. RR 61x/min, T 38.9<sup>o</sup>C, crackles on auscultation. What is the microorganism that causing this condition?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">Male, 21 y.o., ER 3 menit setelah inject heroin. O<sub>2</sub> saturation 70%, BGA : PaO<sub>2</sub> 40 mmHg, PaCO<sub>2</sub> 60 mmHg, pH 7.2. Cause of hypoxemia?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">A. ventilation-perfusion mismatch<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">B. intrapulmonary shunting<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">C. alveolar hypoventilation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">D. inpaired diffuse O<sub>2</sub><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;text-justify:inter-ideograph;line-height:normal"><span lang="IN" style="mso-ansi-language:IN">E. abnormal de saturation<o:p></o:p></span></p>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-16549703123497682102011-06-19T01:35:00.000-07:002011-06-19T01:36:02.685-07:00MDE TROPMED 2011<div>3. 2 years old boy, 10 kg, visit emergency departement. History : 4 day high fever,spontaneous ptechiae, without vomiting. Lab Platelet 88.000/ml Ht 36%; further examination platelet 66.000/ml Ht 48%. Management?</div><div>A. Orally since there is no vomit</div><div>B. 750 cc/24h parenteral and adjust when needed</div><div>C. 1000cc/24h parenteral and adjust when needed</div><div>D. 1250cc/24h parenteral and adjust when needed</div><div>E. 1500cc/24h parenteral and adjust when needed</div><div><br /></div><div>4. Diagnosis of typhoid fever is confirmed by culturing salmonella strain. WOTF is correct statement?</div><div>A. (+) blood culture in 40-60% patient during 2nd week of illness</div><div>B. most stool culture (+) during 1st week of illness</div><div>C. most urine culture (+) during 1st week of illness</div><div>D. bone marrow culture is less sensitive</div><div>E. bone marrow culture is the most sensitive since it less influenced by prior antimicrobial therapy</div><div><br /></div><div>9. A girl with lobar pneumonia with high fever for 3 days. remission of fever < 1 C</div><div>A. Continuous</div><div>B. Saddle-back</div><div>C. Intermittent</div><div>D. Remittent</div><div>E. Relapsing</div><div><br /></div><div>14. soalnya lupa, pokoknya mendiskripsikan penyakit DBD, pertanyaan : causative agent nya?</div><div>a.lupa</div><div>b.lupa</div><div>c.lupa</div><div>d.lupa</div><div>e.single stranded RNA positive --> ini kayaknya jawabannya</div><div><br /></div><div>19. 9 months old infant, bodyweight 7 kg, receive corticosteroid, sudah dapat vaksinasi BCG waktu umur 1 bulan. dikasih imunisasi apa sekarang ?</div><div>A. Measles, DTP</div><div>B. Measles, DTaP</div><div>C. Measles, hepatitis</div><div>D. DTP, OPV</div><div>E. DTP, hepatitis B</div><div><br /></div><div>22. Lesi kulit dipunggung, hypopigmentation. Diagnosis?</div><div>Ans : tinea versicolor</div><div><br /></div><div>25. pasien usia 38 tahun kena leprosy. nerve di elbow medial terhadap epycondile mengalami perbesaran. apa yang terjadi? a. drop wrist</div><div>b. claw thumb</div><div>c. claw hand</div><div>d. drop hand</div><div>e. claw finger</div><div><br /></div><div>29. 31 year old woman comes with her daughter. complant : discrete papular itchy lesion with pinpoint blue color on its top, located at neck and axilla. diagnosis ?</div><div>A. Pediculosis capitis</div><div>B. Pediculosis corporis</div><div>C. Pediculosis pubis</div><div>D. Scabies</div><div>E. Insect bite</div><div><br /></div><div>For questions 38 and 39</div><div>4 months old baby boy comes with skin patch at neck, ibunya juga memiliki skin lesion yang sama di breast. PE : numular eritropapulosquamous patches with active borders, clear area at middle. di rumah pelihara kucing</div><div><br /></div><div>38. Gambaran mikroskopis skin scrapingnya seperti apa ?</div><div>A. Epithel, long septate-branched hyphae, round spores</div><div>B. Epithel, long septate-branched hyphae, arthrospores</div><div>C. Epithel, short hyphae, round sometimes oval spores</div><div>D. Epithel, budding cells, round spores, germ tubes</div><div>E. Epithel, short hyphae, arthrospores, germ tubes</div><div><br /></div><div>39. tipe funginya ?</div><div>A. zoophilic</div><div>B. Geophilic</div><div>C. Anthropophilic</div><div>D. Hydrophilic</div><div>E. Keratinophilic</div><div><br /></div><div>42. Trichrome stain indicated the presence of intestinal pathogenic protozoa.</div><div>WOTF statement is correct for lifecycle of all intestinan pathogenic protozoa</div><div>A. Infective stage occured in soil</div><div>B. Encystation in lower ileum</div><div>C. The most frequent primary sites are caecum and rectosigmoid</div><div>E. Cysts and trophozoites may be found in liquid feces</div><div><br /></div><div>Options for 47-50</div><div>A. Entamoeba dispar</div><div>B. Entamoeba coli</div><div>C. Giardia lamblia</div><div>D. Trichomonas hominis</div><div>E. Entamoeba histolytica</div><div><br /></div><div>47. amoeboid trophozoite with cytoplasmic pseudopodia and fine granular cytoplasm</div><div>48. eccentric karyosome</div><div>49. ellipsoidal cyst</div><div><br /></div><div>For question number 51 until 53, refer to this option:</div><div>A. Negative</div><div>B. Primary Infection</div><div>C. Secondary Infection</div><div>D. Invalid</div><div>E. Primary and secondary infection</div><div><br /></div><div>51. C-Line and M-Line are pink color</div><div>52. C-Line, M-Line, and G-Line are pink color</div><div>53. C-Line, M-Line, and G-Line are white color</div><div><br /></div><div>58. A 14 y.o. girl typhoid fever. Salmonella antigen harus meningkat berapa kali dari acute sera ke convalescence sera?</div><div>A. 1/2x</div><div>B. 1x</div><div>C. 2x</div><div>D. 3x</div><div>E. 4x</div><div><br /></div><div>61. The doctor in charge gives her chloramphenicol. WOTF is the adverse effect of the drug?</div><div>A. Aplastic anemia</div><div>B. Hypotension</div><div>C. Weakness</div><div>D. Malaise</div><div>E. Dizziness</div><div><br /></div><div>71. Which statement is TRUE about cerebrospinal fluid?</div><div>A. Lumbar puncture may be drawn at L3-L4 intervertebrae level</div><div>B. CSF is formed at choroid plexus within the ventricle</div><div>C. Choroid plexus only occur along the inferior horn of the lateral ventricle</div><div>D. CSF flows through the ventricle and enter arachnoid space</div><div>E. CSF drains into the venous system when the venous pressure greater than CSF pressure</div><div><br /></div><div>72. jenis epitel yang melapisi sisi dalam dari lapisan meningen terluar adalah..</div><div>(pokoknya optionnya ada yang simple squamous, simple cuboidal, simple columnar, truz gw lupa apa lagi:)))</div><div><br /></div><div>88. Pasien datang ke RS dengan demam tiba2 mencapai 39 derajat C, sakit kepala dan jaundice 3 hari yang lalu. Memiliki riwayat pekerjaan bekerja di gudang yang banyak tikus.</div><div>Penyebab organisme?</div><div>A. Acromonas hydrophila</div><div>B. Mycobacterium marinum</div><div>C. Streptococcus pyogenes</div><div>D. Leptospira interrogans</div><div>E. Vibrio Vuilnifiens</div><div><br /></div><div>89. Which of the following is the characteristic of this microorganism? (Leptospira)A. Rods with microgranular form</div><div>B. Spirochetes gram negative</div><div>C. Rods gram positive</div><div>D. Cocci gram positive</div><div>E. Spirochetes with hooked ends</div><div><br /></div><div>A. P. falciparum</div><div>B. P. vivax</div><div>C. P ovale</div><div>D. P. malariae</div><div>95. Schuffner stipple on routine blood examination</div><div><br /></div><div>102. Pemeriksaan mikroskopis pada pasien malaria menunjukkan adanya sel darah merah dengan ukuran normal, "no stippling", "multiple ring-form", dan pada beberapa sel darah merah terdapat trofozoit yang berkembang yang berbentuk "band". Etiologi apa yang paling mungkin?</div><div>A. Plasmodium malariae</div><div>B. Plasmodium vivax</div><div>C. Plasmodium falciparum</div><div>D. Mixed infection (Plasmodium malariae & Plasmodium vivax)</div><div>E. Mixed infection (Plasmodium falciparum & Plasmodium malariae)</div><div><br /></div><div>108. Classification of patient with sepsis</div><div>A. Hospitalized in ICU and undergo mechanic ventilation</div><div>B. Fever with core temperature more than 38.8'C</div><div>C. Hypothermia with core temperature less than 36'C and tachypnea</div><div>D. Increase circulating imflamatory mediators</div><div>E. Combination of infection with Systemic Inflamatory Response Syndrome</div><div><br /></div><div>109. Correct statement about plasmodium ?</div><div>A. agent does not develop or multiply inside vector</div><div>B. agent multiply inside vector</div><div>C. agent grow and multiply inside vector</div><div>D. agent develop but not multiply inside vector</div><div>E. agent grow inside vector</div><div><br /></div><div>115. Drug nteraction chlorapenicol and phenytoin?</div><div>A. half life phenytoin increase</div><div>B. serum concentration phenytoin increase</div><div>C. half life phenytoin decrease</div><div>D. chlorampenicol doesn’t inhibit hepatic microsomal enzyme</div><div>E. serum concentration of both increase</div><div><br /></div><div>118. WOTF characteristic of Dapson?</div><div>A. it inhibits protein synthesis</div><div>B. resistance can emerge if very high doses are given</div><div>C. the combination of dapsone, rifampin and clofazimine is not iniatially recomended</div><div>D. Dapsone is well tolerated</div><div>E. Dapsone can not be given to renal failure patient</div><div><br /></div><div>122. Indikasi pemberian clofazimin?</div><div><br /></div><div>125. Side effect permethrin</div><div>A. unpleasant odor </div><div>B. staining</div><div>C. pruritus </div><div>D. itching </div><div>E. nonirritating</div><div><br /></div><div>129. MOA acyclovir?</div><div>Maaf jawabnnya lupa T___________T</div><div><br /></div><div>130. Pharmakokinetic spesification of acyclovir:</div><div>a. biovailability is affected by food</div><div>b. it is cleared by glomerular filtration</div><div>c. it is not cleared by tubular secretion</div><div>d. it is not cleared by hemolysis</div><div>e. it is cleared by peritoneal hemolysis</div><div><br /></div><div>136. Manakah diantara obat di bawah ini yg menghambat sistesis ergosterol?</div><div>a. Allylamine</div><div>b. Polyene</div><div>c. triazole</div><div>d. Inidazole</div><div><br /></div><div>142. A 40 year old woman came to the doctor due to high grade intermittent fever for a week. Typically it was started by chills, followed by high fever and sweating. She also had headachen myalgia, nausea, and vomiting. The patient has just come back from the P.falciparum endemic area.</div><div>Which of the most appropriate combination antimalaria should be added to amodiaquine?</div><div>A. Quinine</div><div>B. Mefloquine</div><div>C. Artesunate</div><div>D. Doxicycline</div><div>E. Chloroquine</div><div><br /></div><div>148. Scaling patch di punggung</div><div>A. seborrheic dermatitis</div><div>B. pityriasis versicolor</div><div>C. pityriasis rosea</div><div>D. psoriasis</div><div>E. lepra</div><div><br /></div><div>157. Clue that suggests anaerobic infection:</div><div>A. + in facultative anaerobic culture</div><div>B. Special cotton swab</div><div>C. Foul-smelling discharge</div><div>D. Infect mucosal area</div><div>E. Grow on McConkey agar</div><div><br /></div><div>For question 161-162</div><div>A 60 year old female complains about red patches, papules, and blisters on a red base at the right side of her face, neck, and upper chest since 3 days ago. She also feels discomfort, pain, numbness, and varies from superficial itching, tingling, and burning sensation in the involved area.</div><div>161. What is the source of her infection?</div><div>A. Aerosolized droplets of the causative agent</div><div>B. Contaminated food or water</div><div>C. Sexual activity</div><div>D. Puncture with contaminated needle</div><div>E. Endogenous reactivation of an earlier infection</div><div><br /></div><div>163. Diagnosis : diphtheria. Stain?</div><div>A. gram stain</div><div>B. Ziehl-Neelsen</div><div>C. Neisser</div><div>D. Burr-gins</div><div>E. negative staining…</div><div>164. Viruses can be isolated in the embryonated egg into appropriate region. Which part of the embrionated egg for incubation of herpes virus?a. Amniotic cavity</div><div>b. Allantoic cavity</div><div>c. yolk sac</div><div>d. intraembryonal</div><div>e. chorioallantoic membrane </div><div><br /></div><div>168. A 26 year old obese female presents to the clinic with scaly erythematous patches on the grain. Skin scrapping in taken from the lesion, for microscopic examination.</div><div>How is morphologic pattern of the etiologic agent of that case when you observe using KOH solution?</div><div>A. Spaghetti & meatballs appearance</div><div>B. Long branches septate hyphae & arthrospore</div><div>C. Pseudohyphae</div><div>D. Long branches non septate hyphae</div><div>E. Yeast cells with budding</div><div><br /></div><div>171. 27 years old athletic male. White patch of skin mainly on axilla, back, trunk. No itching. Multiple hypopigmented macules covered by fine scales. Woods lamp : positive yellow fluorescence. Diagnosis : tinea versicolor.</div><div>WOTF fungus cause disease?</div><div>A. Microsporum canis</div><div>B. Malassezia furfur</div><div>C. Trichophyton beigelii</div><div>D. Epidermophyton werneckii</div><div>E. Epidermophyton floccosum</div><div><br /></div><div>178. A 27 y.o. businessman experienced high fever, serius retroorbital headache, severe joint and back pain for 5 days. Rash appear on his palm and sole that lasted for 2 days. At the same time, his 5 y.o. son experienced mild flu like symptom, collapse after 2-5 days. There were petechiae on his forhead, ecchymosis elsewhere. What is the structure of the virus that aused this disease?</div><div>A. double stranded RNA</div><div>B. double stranded DNA</div><div>C. positive sense single stranded RNA</div><div>D. negative sense single stranded RNA</div><div>E. single stranded RNA</div><div><br /></div><div>A. Biologic control</div><div>B. Environmental control</div><div>C. Vector control</div><div>D. Vector survey</div><div>E.</div><div>195. Alteration in breeding site of vectr</div><div><br /></div><div>Itraconazole adalah?</div><div>A. phenylallamines</div><div>B. triazole</div><div>C. imidazole</div><div>D. allyamines</div><div>E. beta-3-glucose synthase inhibitor</div><div><br /></div>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-61015915841537687562011-06-19T01:17:00.000-07:002011-06-19T01:18:41.964-07:00MDE GUS 2011<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">3. Calcium metabolism is also regulated by kidney because of vit D3 has to be catalyzed by WOTF kidney enzyme?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. vit D3 phosphorylase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. vit D3 transferase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. vit D3 hydroxylase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. vit D3 kinase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. vit D3 synthetase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A 50 y.o. woma with 5 year history of uncontrolled hypertension <span style="font-family:Wingdings;mso-ascii-font-family:Calibri;mso-ascii-theme-font: minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin; mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type: symbol;mso-symbol-font-family:Wingdings">à</span></span> theray with thiazide diuretic and <span style="mso-bidi-font-family:Calibri;mso-bidi-theme-font: minor-latin">β</span>-blocker <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> evaluated because of proteinuria during routine yearly medical visit.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">PE : height 167 cm, weight 91 kg, BP 170/100 mmHg, trace pedal edema</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Lab : serum creatinine 1.7 mg/dL, BUN 27 mg/dL, creatinine clearance 97 mL/min</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Urinalysis : pH 5, protein +3, specific gravity 1.018, no glucose, occasional coarse granules</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">4. According to the condition of the patient, WOTF pathway is true for her condition?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. glycolysis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. glycogenolysis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. gluconeogenesis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. glycogenesis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. lipogenesis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">9. Gross appearance of malignant nephrosclerosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. broad U shaped cortical scars overlying dilated calyces in renal poles</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. depressed cortical areas overlying necrotic papillae of varying stages</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. multiple small petechial hemorrhages on the surface</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. multiple small white areas on the surface</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. wedge shaped pale cortical scars</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">12. A 7 y.o. male come to the hospital with gross hematuria in the morning & disappear in the afternoon. HE had history of throat infection 2 weeks earlier. According to the clinical statements above, what is the most possible cause of the boys’ hematuria?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. increase globulin in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Hb in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. leucocyte in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. abnormal number of RBC in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. increase protein in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">16. Na+ reaborption in the tubule cells membrane is a/an … process.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. simple diffusion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. facilitated diffusion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. active transport</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. endocytosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. paracellular transport</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">18. The forst morning urine is the specimen of choice for routine analysis because?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. it has a high volume</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. it is produced while the body in resting state</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. more concentrated resulting in better detection of abnormalities</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. more dilute preventing flase (-) reaction</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. more concentrated preventing false (-)</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">19. Best preservation in urine sediments?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. boric acid + hydrochloric acid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. formalin + boric acid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. formalin + freezing</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. chloroform + refrigeration</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. chloroform + freezing</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">21. Lubang yang terdapat pada endotel glomerulus adalah?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. filtration membrane</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. fenestrae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. filtration slit</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. glomerulus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. </p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">22. Paisen uncontrolled hypertension, diberi new diuretic target to Na+ reasorption site from basolateral surface of renal epithelial cells. Proses yang dipengaruhi oleh obat tersebut?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Na-glucose</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Na-K</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Na-H</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. solven drug</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. facilitated diffusion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">23. A patient have persistent diarrhea for the last 7 days. WOTF will increased?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. filtration load of HCO3-</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. NH3 synthesis by proximal tubule</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. H+ secretion by diatal nephron</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. anion gap</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. production of new HCO3- by distal nephron</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">27. DM <span style="font-family:Wingdings;mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font: minor-latin;mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> glukosa di urin sebagai konsekuensi proses apa di PCT?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. saturasi Na/glucose tranporter</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. inhibisi Na/K ATPase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. saturasi NA/H cotransport</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. stimulasi glucose secretion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. stimulasi glycogen breakdown</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">29. A 25 y.o. man has generalized edema prominent in the periorbital regions early in the morning & hypertension. The microscopic feature of kidney shows diffuse thickening of glomerular capillary wall & mesangial proliferation. The following statement is correct for capillary portion of the renal corpuscle?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Bowman’s capsule</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. fenestrae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. podocytes</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. glomerulus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. renal column</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">31. Cell that has long primary process and great number of secondary foot process?<br />A. macula densa</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. mesangial cell</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. podocyte</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. juxtaglomerular</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">32. This portion is collection of cortical kidney’s tissue found between the medullary pyramids. WOTF structure is most likely?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. corpuscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. medullary ray</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. renal columns of Bertin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. interlobular cortex</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. renal sinus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">33. WOTF contain mesangial cell?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. renal corpuscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. thick ascending limb</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. DCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">34. Structure most commonly found in conical pyramid region?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. DCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. loop of henle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. renal corpuscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. afferent arteriole</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">40. Iv infusion of 1L of WOTF will be the largest to increase ECF?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. distilled water</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. hypotonic NaCl</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. isotonic NaCl</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. hypertonic NaCl</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. hypertonic ureum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">42. Decreased BP caused by captopril is result from?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. decreasing of angiotensin I level</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. decreasing of angiotensin II level</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. decreasing of bradykinin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. blocking angiotensin II receptor</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. decreasing plasma renin level</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">43. Non pharmacological treatment of hypertension?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Jawaban : reduce body weight</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">44. The target organ damaged in hypertensive patient is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. prostate hypertrophy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. leukosituria</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. atherosclerosis plaque</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. vein narrowing</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. liver enlargement</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">47. GFR increased <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> PCT reabsorption of salt and water increased by glomerotubular balance, include :</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. increase peritubular capillary hydrostatic pressure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. decrease peritubular sodium concentration</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. increase peritubular oncotic pressure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. increase proximal tuble flow</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. increase peritubular capillary flow</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">50. Apa proses yang terjadi pada penicillin di PCT?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Jawaban : sekresi</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">52. The origin of collecting duct in the kidney?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Jawaban :<span style="mso-spacerun:yes"> </span>ureter bud</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">53. WOTF is correct for development of bladder?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. developed from hind gut</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. originated from endoderm</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. shaped from mesoderm</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. shaped from urogenital sinus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. originates from allantois</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">54. ARPKD. What is the embryological basis of this congenital anomaly?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. dysmorphology during development of renal system</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. failure of ureteric bud derivates to join the tubule</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. division of the mesonephric diverticulum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. failure of mesenchymal cells to migrate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. the poles of the kidney are fixed</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">55. Anak menderita polycystic di ginjal. Nama penyakit?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">JAwaban : ARPKD</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">57. Penyebab double ureter?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. splitting of metanephric bud</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. development of ureteric bud</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. splitting of ureteric bud</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. non-dysfunctional of ureteric bud and metanephros blastema</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. splitting of mesonephric bud</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">59. A 40 y.o. woman with essential hypertension complaining headache, flushing after taking her medicine. Besides, recently she got bad experience in sense of taste. What is the most possible antihypertensive agent she takes?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. ACE-inhibitors</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. <span style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin">α</span>-blocker</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. <span style="mso-bidi-font-family:Calibri;mso-bidi-theme-font:minor-latin">β</span>-blocker</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. diuretics</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. vasodilator</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">61. AN increase of WBC in urine is called?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. pyelonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. custitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. urethrtis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. pyuria</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">62. A 6 y.o. had a throat infection three weeks ago. Presently, he has hematuria, oliguria, mild hypertension. On microscopic feature of kidney : proliferation of endothelial and mesangial cells and also shows neutrophil an mnocyte infiltration. WOTF diagnosis is the most possible for the patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. acute post streptococcal glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. crescentic glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Goodpasture’s syndrome</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. idiopathic rapidly progressive glomeruloneprhitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Heyman nephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">63. Lab results from a 5 y.o. boy with swelling of his whole body : urine color light yellow, appearance : cloudy, pH 6, nitrite (-), urobilinogen (+), blood (-); serum : urea 20 mg/dl, creatinine 0.8 mg/dl. OWTF conditions is the most possible color of the urine?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. the nephron excretion of blood borne</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. the glomerulus excretion of blood borne</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. the glomerulus excretion of albumin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. the nephron excretion of albumin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. the glomerulus excretion of ureum </p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">64. The formation of crystal in the urine sample depend on pH of urine. Low acidity urine sample (low pH) can form several crystals such as?<br />A. uric crystals, sodium urates</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. triple phosphate, calcium phosphate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. calcium carbonate, ammonium biurate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. cystine, cholesterol, leucine, thyrocine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. bilirubin, sulfonamides</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">65. WOTF is most likely to cause a false positive dry reagent strip test for protein?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. urine of high specific graity</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. highly buffered alkali urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. bence-jones proteinuria</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. salicylates in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. acidic in urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">66. A 40 y.o. male has abdominal discomfort. A mass found on palpation of upper right abdominal. The microscopic featue of kidney shows cysts rising from the tubules throughout the nephron. WOTF diagnosis is the most possible for this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. autosomal dominant PKD</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. cystic disease of renal medulla</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. acquired cystic disease</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. simple cyst disease</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. autosomal recessive PKD</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">67. A 30 y.o. man has general edma promeinent in preorbital regions early in the morning and hypertension. The microscopic feature of kidneys shows diffuse thickening of glomerular capillary wall and mesangial proliferation. WOTF is the most possible diagnosis for this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. minimal change disease</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. focal segmental glomerulosclerosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. membranoproliferative glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. IgA nephropathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. chronic glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">68.<span style="mso-spacerun:yes"> </span>A 30 y.o. man medical lab technician recovering from hepatitis B develops hematuria, proteinuria, and red cell cast and oval fat bodies identified by microscopic exam of urine. WOTF statements describes the changes of the kidney in this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. no deposits of antibodies</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. IgG linier fluorescence along the glomerular basement membrane</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. granular deposits of antibodies in the GBM</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. diffuse GBM thickening by subepithelial immune deposits</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. nodular hyaline glomerulosclerosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">For question no 69-71</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A 60 y.o. man works in asbes factory. On the microscopic feature of bladder biopsy shows papillary from and highest anaplastic.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">69. WOTF diagnosis is the most possible for this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. transitional cell papilloma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. TCC grade I</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. TCC grade II</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. TCC grade III</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. squamous cell carcinoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">70. Approximately <span style="mso-spacerun:yes"> </span>90% epithelial bladder malignancy is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. carcinoma in situ</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. adenocarcinoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. transitional</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. squamous</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. undifferentiated</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">71. What is the diagnostic tool for early staging of bladder cancer?</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">A. BNO-IVP</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">B. USG + biopsy</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">C. sectio alta + biopsy</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">D. cytoscopy + IVP</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">E. cytoscopy + transurethral resection</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">72. A 50 y.o. male with painless hematuria undergoes bladder biopsy. ON the microscopic features shows atypical epithelial surface. What is the most possible diagnosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. transitional cell carcinoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. TCC</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. squamous cell carcinoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. adenocarcinoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. mixed carcinoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">73. A 25 y.o. man has general edma promeinent in preorbital regions early in the morning and hypertension. The microscopic feature of kidneys shows diffuse thickening of glomerular capillary wall and mesangial proliferation. WOTF is the most possible diagnosis for this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. focal segmental glomerulosclerosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. membranoproliferative glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. membranous glomerulopathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. minimal change disease</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. IgA nephropathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">74. A 4 y.o. boy has an abdominal mass, hematuria, and flank pain. Microscopic feature of kidney shows nest of primitive blastema sheet intertwine with mesenchymal abortive glomeruli. What is the most possible diagnosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. cystic renal dysplasia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Wilm’s tumor</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. neuroblastoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. teratoma</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. hamartoma</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">For number 75-76</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A 60 y.o. man has early and terminal dysuria. A nodule in anterior location is found on DRE. Prostate cut section shows gritty and firm. Micriscopic feature shows numerous small acini lying ‘back to back’.</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">75. The most reliable method of diagnosing prostatic carcinoma?</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">A. <span style="mso-spacerun:yes"> </span>prostate acid phospatase</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">B. PSA</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">C. prostate ultrasound</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">D. transrectal biopsy</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">E. MRI</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">76. Indication of prostate biopsy is?</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">A. PSA level between 4-10 ng/dl</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">B. PSA level below $ ng/dl</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">C. nodule on DRE of prostate</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">D. PSA density below 0.15</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">E. prostate weight > 60 gr</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">87. A 9 y.o boy <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> difficult to urinate. There was constricting preputial ring and non-retractable foreskin. WOTF condition most likely occurred accompanying disease above?</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">A. balanoposthitis</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">B. urethritis</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">C. cystitis</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">D. pyeloneprhitis</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal">E. nephritis</p> <p class="MsoNormal" style="margin-top:0in;margin-right:0in;margin-bottom:0in; margin-left:.5in;margin-bottom:.0001pt;text-indent:-.5in;line-height:normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">88. Most common urinary retention in older men?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. carcinoma prostate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. BPH</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. chronic prostatitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. urethral stricture</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. prostatic abscess</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">89. A 5 y.o. female, best method for urine collection?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. urine bag collector</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. midstream urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. urine catheter</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. suprapubic puncture</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. fresh urine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A 7 y.o., dark cola colored urine, voiding 2x/24h. Facial puffiness, no swelling at hands or feet. Headache, blurry vision.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">PE : compos mentis, edema anasarca, BP 180/120, PR 100x/min, T 36.9<sup>o</sup>C</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Lab : Hb 10.6 gr/dL, serum ureum 45 mg/dL, serum creatinine 1.3 mg/dL, WBC 9600/mm<sup>3</sup></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Urinalysis : dark cola colored, protein +2, many erythrocyte, leucocyte 8-10 HPF</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">92. WOTF is the criteria to make the diagnosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. hypoalbuminemia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. hypocholesterolemia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. hematuria</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. hypertension</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. renal insufficiency</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">95. What is the most common complication of this disease?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. infection</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. heart failure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. encephalopathy hypertension</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. lung edema</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. chronic renal failure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">97. WOTF drug is first line for this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. diuretics</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. antibiotics</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. steroid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. lovamisol</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. ACE inhibitor</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">100. Wanita, 18 y.o., arthralgia 6 bulan dengan intermittent fever. BP 165/110, WBC 3200/<span style="mso-bidi-font-family:Calibri;mso-bidi-theme-font: minor-latin">µ</span>L, Hb 10.8, PLT 74000/<span style="mso-bidi-font-family: Calibri;mso-bidi-theme-font:minor-latin">µ</span>L, proteinuria 3.8 gr/day, pleural effusion. Diagnosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. chronic pyeloneprhitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. amyloidosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. lupus nephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Alport’s syndrome</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. membranous glomerulonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">111. A man has spinal cord injury 3 months ago. He has problem with micturition. The level of the lesion is T12. What urodynamic problem that he has?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. urine retention</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. urine incontinence</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. overflow incontinence</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. hyperactive of bladder</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. incompetence of urethral sphincter</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">118. A 57 y.o. male have chief complain of difficulty voiding and have BPH. WOTF prostatic lobe is it likely are possible?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. middle lobe</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. anterior lobe</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. posterior lobe</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. lateral lobe</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. superior lobe</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">121. A 40 y.o. male come with complain… X-ray : artery closed with this muscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. psoas muscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. serratus uscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. obturator muscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. external oblique muscle</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. </p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">129. You have a patient who has renal failure. While he is currently on dialysis, he is hoping to receive a new transplanted kidney. He asks you if they are going to remove one of his bad kidneys & put the new transplanted kidney back in the same place. Wou tell him WOTF?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. right kidney <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> removed, more inferior, and easier to remove</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. left kidney <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> removed, easier to move descending colon</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. keep both kidneys, new one <span style="font-family:Wingdings; mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family: Calibri;mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> left posterior waal,inferior to left kidney</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. new <span style="font-family:Wingdings;mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font: minor-latin;mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> in iliac fossa in greater pelvis, attach to iliac vessels, connect to bladder</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. left kidney <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> removed, more inferior and easier</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">132. Both autonomic and vascular system need to function properly successful male sexual function. WOTF statement concerning erction, emission, and ejaculation in the males is correct?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. contraction of internal urethral sphincter is under control of parasympathetic nervous system</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. parasympathetic nerves stimulate closure of helical artery</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. sympathetic neuron stimulate helicine artery to dulate and increase blood flow to corpora cavernosum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. parasympathetic innervations stimulate emission of seminal fluid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. contraction of bulbospongiosus muscle impede drainage of blood from corpus spongiosum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">136. A 65 y.o. woman came with metabolic acidosis. There is history of DM & hypertension. She refused to take medicine and change her lifestyle.What is the mechanism of kidney ot prevent serious condition?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. reabsorb H+</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. excrete HCO3-</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. neutralize excess acid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. neutralize excess base</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">140. Pasien DM + hypertension. WOTF caused the leakage of a protein?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. increase capillary hydrostatic pressure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. decrease capillary hydrostatic pressure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. inhibition of protein kinase C</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. glycating of end product</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. decrease colloid osmotic pressure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">141. What is the component of bipyramid crystal?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. calcium oxalate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. cystine</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. calcium phosphate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. uric acid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. struvite</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">142. WOTF material that inhibit crystal formation?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. mangan</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. citrate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. bicarbonate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. potassium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. sodium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">143. Enlargement of prostate. Enzyme that catalyze the enlargement?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Jawaban : 5<span style="mso-bidi-font-family:Calibri;mso-bidi-theme-font: minor-latin">α</span>-reductase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">148. NH3?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. impermeable to epithel</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. titrable acid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. synthesized in DCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. menurunkan HCO3-</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. meningkat di respiratory acidosis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">149.<span style="mso-spacerun:yes"> </span>A patient with hypertension is given a K+ sparing diuretic. The amount of potassium excreted by the kidney will decrease if WOTF occur?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. distal tubular flow increase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. circulating aldosterone increase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. dietary intake of potassium increase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. natrium reabsorption by the distal nephron increase</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. the excretion of organic ion decreases</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">153. A patient with CHF is given loop diuretic : furosemide, K sparing diuretics, and spironolactone. WOTF comparisons between distal nephron and PCT?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. DCT is more permeable to H+ than PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. DCT is less responsive to aldosterone than PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. DCT has more negative intraluminal potential than PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. DCT secretes less K+ than PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. DCT secretes more H+ than PCT</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">154. An elderly woman present with spiking fever, shaking chills, nausea, CVA (+) tenderness. Urine cultures are (+), she is hospitalized for pyelonephritis.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">158. Malnutrition in CKD karena?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. hypercatabolism of protein, carbohydrate, lipid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. abnormalities in lipid metabolism</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. uremic syndrome caused by hypercatabolism of protein, carbohydrate, lipid</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">160. What kind of food should be limited in a patient with kidney stone?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. soft drink, vit C, high protein, high calcium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. soft drink, high cholesterol, high vit C, high selenium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. soft drink, low cholesterol, low protein, low calcium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. soft drink, junk food, high natrium, high kalium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. soft drinks, high natrium, high cholesterol, high lipid, high natrium, high kalium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">161. When you are at ER at HAsan Sadikin hospital, A 25 y.o. was admitted to the hospal with the complains of small producing urine. This complains occurred prior to massive diarrhoeas and vomiting. It all started five days before admitted to the hospital. What is the main goal of nutrition recommendation with acute kidney injury?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. to minimize the protein catabolism cause dby the underlying disease</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. to prevent anorexia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. to minimize uremic syndrome</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. to prevent progressivity of renal failure</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. to prevent vomit and diarrhea</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">162. A 34 y.o came to STI clinic with chief complain of dysuria and yellowish urethral discharge since 3 days ago. The rest of the culture revealed that the bacterium is N. gonorrhoeae. The virulence factor that play a role in adherence of the bacteria on the mucosa is?<br />A. lipopolysaccharide</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. capsule</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. flagella</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. peptidoglycan</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. pili</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">163. A 30 y.o. male patient was seen by emergency service and reported a 2 week history of penile ukcer. He noted that this ulcer did not hurt. WOTF conclusions/actions is most valid?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. draw bloof dor a herpes antibody test</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. perform a dark feld exam of the lesion</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. prescribe acyclovir for primary genital herpes</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. even if treated, the lesion will remain for months</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. failure to treat the patient will have no untoward effect, as this is a self limiting infection</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">164. N. gonorrhoeae is a fastidious bacterium that should be isolated from sites often contaminated with normal flora. The best medium for isolation is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. sheep blood agar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Loeffler medium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Thayer-Martin agar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Loewenstein-Jensen medium</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Mac Conkey agar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">165. A 42 y.o. man who has a penile ulcer appears in STI clinic. The base of ulcer is soft and [ainful with suppuration. Microscopic gram stain shows gram (-) rods with school of fish arrangement. The bacteria is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Neisseria gonorrhoeae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Haemophilus ducreyi</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Mycoplasma hominis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Ureaplasma urelyticum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Treponema pallidum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">166. A 24 y.o. sexually active woman develops vaginal discharge, left lower quadrant pain, and fever. On pelvic exam there is tenderness in the left adnexa. Gram staining from cervical discharge reveals low number of leukocyte cells, no gram (-) diplococci. No bacteria grow on selective media for N. gonorrhoeae. The most possible cause of the symptom is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Haemophilus ducreyi</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Treponema pallidum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Gardnerella vaginalis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Chlamydia trachomatis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Pseudomonas aeruginosa</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">167. A 33 y.o. woman referred to STI clinic because of vaginal discharge. She has history of sxual contact with several male partner. Microbiological exam reveals that the cause of this symptom is Mycoplasma homini. How is the characteristic of this bacterium?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. growth in an anatomic site where anaerobic organism thirive</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. the absence of bactria cell wall</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. cannot culture on the artificial media.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. the absence of cilia on the surface of the host cell</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. gram (-) rods morphology</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">168. A 60 yo. Man has experienced some frequent, urging, and painful urination. DRE revelaed enlargement of the prostate and he has a history of several catheterization. Culture of the urine on Mac Conkey agar reveals non-lactose fermenter colonies without evidence of swarming and gram stain shows gram (-) rods. WOTF organisms us to be the cause of those symptom?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Pseudomonas aeruginosa</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Proteus mirabilis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Escherichia coli</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Haemophilus ducreyi</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Chlamydia trachomatis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">169. A 30 y.o. female appear with symptoms of dysuria, frequency, and urgency since 2 days ago. She has also been suffering from fever and cills. Urine culture is performed which grow 10<sup>5</sup> CFU/ml of E.coli. How is the characteristic of this bacterium?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. non-lactose fermenter</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. cannot grow on Mac Conkey agar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. gram (-) diplococcic</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. gram (-) rods, lactose fermenter</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. obligate intracellular</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">170. An adolescent female came to the clinic because of a new and unusual vaginal discharge. She has recently become sexually active and had two new partners during previous minth. A purulent discharge was seen from endocervical canal. WOTF statements about this case is most correct?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. the endocervical specimen should be analyzed for HAemophilus ducreyi</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. wet mount preparation of endocervical specimen showed clue cells</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. gram staining of endocervical specimen would show Chlamydia trachomatis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. the possibilities infection caused by Chlamydia trachomatis or N. gonorrhoeae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. dark field microscopy of endocervical specimen showed spiral bacteria</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">171. A 25 y.o. young female goes to health center after 2 days increasing pain during urination. Her urine is cloudy and shows microscopic evidence of erythrocyte and pyuria. Urine culture grows colonies of gram (+) cocci, catalase (+), coagulase (-). Her relevant past medical history is significant ofr no previous urinary tract infection. Which organism is ost likely responsible for this infection?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Enterococcus faecalis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Streptococcus pyogenes</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Staphylococcus saprophyticus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. NEisseria gonorrhoeae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Escherichia coli</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">172. A 37 y.o. woman with a history of UTI comes to the ER with burning on urination along with frequency and urgency. She says her urine smells like ammonia. The cause of her UTI is likely to be?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Enterobacter aerogenes</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Proteus mirabilis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Citrobacter freundii</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Escherichia coli</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Serratia marsescens</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">173. A 65 y.o. male hospitalized for 7 days as indication of diabetic nephropathy and catheter inserted because of problem I urination. Within this period developed UTI. The most common opportunist pathogen bacteria that cause the infection is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Proteus vulgaris</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Serratia marsescens</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Staphylococcus aureus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Enterococcus faecalis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Escherichia coli</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">174. A 6 y.o. boy came to the hospital with gross hematuria as the chief complain. There was eyelids swelling in the morning and disappeared in the afternoon. He has history of throat infection two weeks earlier. The causative agent that cause the diasease is?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Streptococcus pneumonia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Staphylococcus aureus</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Streptococcus agalactiae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Streptococcus pyogenes</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Staphylococcus epidermidis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">175. Pseudomonas aeruginosa is an opportunist pathogen as one of the cause of UTI. WOTF statements about P. aeruginosa is correct?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. typically susceptible to penicillin G</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. readily grown in anaerobic condition</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. able to penetrate intact normal human tissue</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. gram (-) rods, lactise fermenter</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. have fimbriae which promote attachment to epithelial cells</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">176. A 50 y.o. man develops UTI. Gram (-) rods from urne ulture grow on Mac Conkey agar produce large sticky, lactose fermenter colonies, does not have flagella. This bacteria is second only to E. coli as a urinary tract pathogen. What bacterium those cause infection of this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. Enterobacter aerogenes</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B, Klebsiella penumoniae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Pseudomonas aeruginosa</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Proteus mirabilis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Serratia marsescens</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">177. The pus of STD that has fishy odor is caused by?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. N. gonorrhoeae</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. Treponema pallidum</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. Gardnerella vaginalis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. Trichomonas vaginalis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. Candida albicans</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">178. Diagnostic test for Treponema pallidum?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. gram stain</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. culture in Loefler agar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. ZN stain</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. TPHA</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. culture in LJ agar</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">179. To differentiate Staphylococcus epidermidis and S. saprophyticus we can use test?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. bacitracin disc</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. DNAse test</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. novobiocin disc</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. catalase test</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. coagulase test</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">180. Differentiate colonies of S. aureus with colonies of E. coli in blood agar?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. color of colonies</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. lactose fermentate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. size of colonies</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. color of halo around colonies</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. non hemolytic</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">181. A 40 y.o. male is consulted to the nuclear medicine for kidney function exam due to chronic kidney failure. What is the most appropriate examination of this patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. effective renal plasma flow</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. glomerular filtration rate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. renal scintigraphy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. renal arterial flow rate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. conventional renography</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">182. A 40 y.o. male is consulted to the nuclear medicine for kidney function exam due to nephropathy diabeticum. What is the most appropriate examination for this condition?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. effective renal plasma flow</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. glomerular filtration rate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. renal scintigraphy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. renal arterial flow rate</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. conventional renography</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">183. A 45 y.o. ale come with possibility of renovascular hypertension based on the history of uncontrolled hypertension. USG Doppler examination shows impairment at left kidney renal blood flow. Patient then consulted to nuclear medicine for captopril renography. What is the most possible result?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. renovascular hypertension, if captopril renogram show decreased left kidney function, while in the captopril renogram is normal.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. renovascular hypertension, if conventional renogram show decreased left kidney function, while in the conventional renogram is normal.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. renovascular hypertension not exist, if both captopril and conventional renogram are not normal</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. renovascular hypertension not exist, if captopril renogram show improvement in left kidney function, while conventional renogram shows abnormality.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. renovascular hypertension, if both show improvement of left kidney </p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">184.A 25 y.o. male came with scrotal pain. From PE found inflammation sign at the right scrotum. You consulted this patient to the nuclear medicine. What is the most appropriate exam?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. scrotal scintigraphy for differentiate testis torsion with orchitis epidydymitis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. scrotal cintigraphy for identifying UTI source</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. bladder scintigraphy to differentiate UTI with vesicolithiasis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. ureteral scintigraphy to determine urethritis as etiology of scrotal inflammation</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. penis scintigraphy to determine any priapismus or hypospadia as etiology of UTI</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">185. A 65 y.o. male with scrotal malignancy. His PSA serum is increasing significantly compared with last month result. X-ray pelvis show abnormality at pelvic bones. PAsien then consulted to nuclear medicine. What is the most appropriate exam</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. conventional renogram, to evaluate the blood flow to renal</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. GFR to determine each kidney function</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. kidney scintigraphy to fin sign of acute pyelonephritis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. malignancy prostate scintigraphy localization to find any sequel and recurrency</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. bone scintigraphy to find any metastase to the bone</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">186. A 60 y.o. came to the outpatient clinic for follow up. He noted as hypertensive and type 2 DM for the last 2 years. On PE found : BP 160/90, no other abnormality on PE and lab exam. The doctor prescribed oral antidiabetic and ACE inhibitor. What is theadvantage og this antihypertensive agent for the patient?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. it decreases blood glucose level</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. it delays diabetic nephropathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. it prevents RAAS stimulation</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. it decreases peripheral resistance</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. it prevents vascular remodeling</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">187. WOTF is the prototype of ACE inhibitor?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. valsartan</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. atenolol</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. captopril</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. hydralazin</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. diltiazem</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">188. A 62 y.o. man came to the doctor for routine follow up. BP was 160/90, HR 76 bpm. Random blood glucose level was 140mg/dl. He is given nifedipine. What is the most possible side effect of the drug?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. decrease blood glucose level</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. orthostatic hypotension</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. cardiac depressant</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. hyperkalemia</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. palpitation</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">189. What is nifedipine?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. beta blocker</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. alpha 1 selective blocker</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. vasodilator</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. calcium channel blocker</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. diuretic</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">191. A 65 y.o. woman. BP 200/120 <span style="font-family:Wingdings; mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family: Calibri;mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> given direct vasodilator <span style="font-family:Wingdings;mso-ascii-font-family: Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;mso-char-type:symbol;mso-symbol-font-family: Wingdings"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span> BP increase. Mechanism of drug?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. decreased peripheral resistance</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. inhibit RAAS</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. decreased CO</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. increased venous return</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. chronotropic negative</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Woman, dysuria, no flank pain, no tenderness, pemeriksaan lain within normal limit but many WBC. Other examination needed for diagnostic tool is urine microscopic exam of?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. protein</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. casts</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. bacteria</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. </p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Hypertension, proteinuria, height 167, weight 91, BP 170/100, edema, creatinine clearance turun, BUN turun. Urinalysis : pH 5, prot +3, no glucose, occasional course granular cast. Diagnosis?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. nephropathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. neuropathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. retinopathy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. nephrolithiasis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. nephrovesicolithiasis</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">Struktur yang mebagi perineum jadi anal triangle dan genitourinary triangle?</p>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-87593251773370018402011-05-10T02:37:00.001-07:002011-05-10T05:32:20.736-07:00FINAL PHOP VIII<p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><b></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.caring for whole spectrum age groups </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B.holistic approach </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C.emphasis on preventive medicine </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.patient centered care </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E.conducting home visit</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>1. The family physician should recognize the contribution of social & psychosocial problems in treating the patient..</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>2. Good communication and relationship between doctor and patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>3. the family should emphasis on care for family in every stage of life cycle</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>4-7</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.dedicated to the person</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B.understand the context of illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C.all contact with patient and opportunity for prevention and health education</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.the practice as a population at risk</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E.live in community/a part of the complex of family relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F.does community networking</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>G.subjective aspect of medicine (sensitivity to feelings,emotional)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>4. deploy resources from the community for the benefit of the people in community</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>5. This principle means that if one of their patients who haven't been immunizedshould be as much as a concern as one who is attending for well baby care.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>6. self-reflective</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>7.the family physician's is not limited by type of health problem physician is available for any health problem in a person.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>8. Continuity care for the patient and the family is very important. Continuity is the sense of overall direct and coordinative responsibility for the different medical needs of the patient over time. It can be done by keeping good medical records. What dimension of this continuity of care is based on Hennen’s Five Dimentions of Continuity?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. interpersonal</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Chronological</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Interdisciplinary</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Informational</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Geographical</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>9. Research has shown young widowers have 12x increased than comparable married people for TB. This is one of 6 main effects of health to family members :</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Family affects morbidity and mortality</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. family is important in recovery from illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Infectious diseases spreads in families</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Genetic influences</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Family is crucial in child development</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>10. Which is the activity that included in the assessment of GRR?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. smoking cessation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. screening and case finding</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. reduction of serum cholesterol</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. coping ability</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. nutrition education</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>genogram utk soal no 14 dan 15</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><img src="http://photos-f.ak.fbcdn.net/hphotos-ak-snc6/225824_2046872332834_1275194285_2442000_1413716_a.jpg" _mce_src="http://photos-f.ak.fbcdn.net/hphotos-ak-snc6/225824_2046872332834_1275194285_2442000_1413716_a.jpg" fbid="2046872332834" hmac="AQCXAkHXxu9TL8pJ" style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; " /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><img src="http://photos-h.ak.fbcdn.net/hphotos-ak-snc6/227191_2046876652942_1275194285_2442008_5954225_a.jpg" _mce_src="http://photos-h.ak.fbcdn.net/hphotos-ak-snc6/227191_2046876652942_1275194285_2442008_5954225_a.jpg" fbid="2046876652942" hmac="AQBcGbVVf5viczPO" style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; " /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>11. Berdasarkan Duvall, Sule termasuk dalam stage apa?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a. childbearing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b. pre-school</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c. teenager</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d. middle-aged</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e. launching the adult</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>12. Based on the stage, what is the development task for Sule's family?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. establishing postparental interests and careers as growing parents</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. having adjusting to and encouraging the development of toddlers</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. adapting to the critical needs and interests of preschool chldren in stimulating, growth promoting ways</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. fitting into the community of school age families in constructive ways</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. maintaining kin ties with older and younger generations</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>13. If Sule's family success in this stage (no 11), they will enter to the next stage. What is the next stage?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. preschool children</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. teenager</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. launching young adult</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. middle aged</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. aging family members</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>14. Berdasarkan Duvall, Parto termasuk dalam stage apa?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a. childbearing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b. pre-school</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c. teenager</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d. aging-family members</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e. middle-age</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>15. Family illness trajectory based on Sule's family genogram?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. onset of illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. reaction to diagnosis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. major therapeutic effect</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. early adjustment to outcome</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. adjustment to permanent disability</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>16. What is the reaction of family members on this stage (no. 15)?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. convince the doctor that something is wrong</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. shck & overwhelming anxiety</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. uncertainity about the outcome</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. feel the second crisis occur because of permanency and disability</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. not emotional equipped to undertake some forms of therapy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>17. What is the role of family doctor on this stage (no. 15)?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. alert to the potential problems of the illnes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. ease the patient and family's anxiety & concern</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. responsible for making a clinical judgment about the amount of information the patient can absorb</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. anticipate the second crisis of adaptation to permanency of the outcome</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. encourage to clear the nature of illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>18. Experiencing her father's disease, Wati has the feeling of being vulnerable to her father's disease. For Wati's conditon, which is the best procedure of investigating the meaning of illness?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. semantic illness network</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. the patient's explanatory model</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. health belief model</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. the family member's meaning of illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. transtheoretical model</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 19-21</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. developmental task</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. thinking family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. functional family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. dysfunctional family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. family life cycle</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>19. Family members are encourages to develop their own life goals and emotional independence while staying connected with the family as a whole</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>20. Being sensitive to unmentioned family stress that often lies behind depression and somatic symptoms</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>21. Family members are involved in the nurturing of children from birth to maturity</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 22-24</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. family dynamic</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. family genogram</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. family tree</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. family map</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. BATHE rechnique</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>22. It helps to draw out the quiet patient and provide structure of when to move on to talkactive patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>23. It helps the attending physician to diagnose the disease and dis-ease of the patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>24. It helps to rule out the family relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>25. What is the family structure of Sule's family?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Nuclear family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Extended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Blended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>26. What is the family history of Azis?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. His grandmother from father's side had myocard infarct</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. His grandmother from father's side had hypertension</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. His grandmother from mother's side had allergy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. His mother has obesity</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. His mother has depression</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>27. True from Sule's family genogram?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Sule-Wati : close relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Sule-Wati : conflict relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Sule-Parto : distance relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Sule-Parto : close relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Sule-Wati : distance relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><img src="http://photos-e.ak.fbcdn.net/hphotos-ak-snc6/223375_2046878892998_1275194285_2442010_1967133_a.jpg" _mce_src="http://photos-e.ak.fbcdn.net/hphotos-ak-snc6/223375_2046878892998_1275194285_2442010_1967133_a.jpg" fbid="2046878892998" hmac="AQBZxY-xcRKDB8eR" style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; " /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>28. What is the family structure of Yoyo's family?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Nuclear family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Extended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Blended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>29. WOTF is correct?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Yoyo separated from 1st wife</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Yoyo & Marni have dizygotic twins</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Jihan has abortion</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Jihan is pregnant</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Yoyo has unmarried relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>30. Who is the index patient in the genogram?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Primus</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Jihan</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Yoyo</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Toto</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Warni</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 31-34</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. frail elderly</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. homeostenosis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. homeostasis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. terminal end</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. mental status assessment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. functional status assessment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>G. social status assessment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>31. To assess decision making capacity</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>32. In the absence of disease, this process should not cause symptoms or impose restrictions on ADL</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>33. Increased risk of disability abd death from minor external causes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>34. This assessment can be an indicator of possible caregiver stress</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>35. what is the consequence of age related physiologic change of eye in the elderly?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. blindness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Presbiopy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Lens opacification</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. decresasing of accomodation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. miopi</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>36. A 84 y.o. women comes with her family with terminal stage of breast cancer and bone metastasis. What will you do as a family physician?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. continue chemotherapy treatment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. give her pain killer</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. sent her to other hospital for next treatment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. no other management</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>37. what is the goal for patient’s management?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. cure the patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. prevent other complication</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. focus on quality of life</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. prepare for breavement process</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>38. The care for this patient should relief the total suffering. Her family physician must manage patient in the context of the family. Her need must belanced against family’s need. What is care given by the family physician?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. psychosocial care</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. physical care</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. psychological care</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. symptom control</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>39. in caring terminal patient, family physician must be able to cope with dying patients emotions and reaction, especially in the first stage of dying. What is the first stage of dying?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Acceptance</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. anger</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. bargaining</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Denial</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Depresion</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>40. WOTF is correct about palliative care?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. hospital is the only place for palliative care</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. cure is not possible</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. more concern about quantity rather than quality</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 41-43</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. primary prevention</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. secondary prevention</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. tertiary prevention</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. risk avoidance</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. risk reduction</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>41. Management of established disease, in order to minimalize the disabilities</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>42. identify those with high risk to modify the risk factors</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>43. early detection</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>soal no. 44-46</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. DPT</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Hep A</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Measles</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Hib</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Pneumococcal</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. Tetanus</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>44. Should be given to Warna (12 y.o.)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>45. Contraindicated for Jihan (pregnant)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>46. This immunization is given in two doses</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>soal no. 47-49</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. B6</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Thiamin</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Fluoride</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Erythromycin oinment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Folic acid</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. Hormone replacement therapy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>47. Given to Jihan to prevent neural tube defect</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>48. Will be given to Jihan's future baby</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>49. Given to Marni (hipertensi, 54 thn)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 50-52</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Mammography</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Pap smear</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Fecal occult blood</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Sigmoidoscopy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Vision, hearing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. Lead screening</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>50. The screening should be performed by Marni every 1-3 years until age 65, and stop if normal</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>51. Performed annually to find the risk of colon cancer</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>52. Warni should perform this screening</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 53-57</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. formal consultation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. informal consultation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. interval referral</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. collateral referral</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. cross referral</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. split referral</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>53. In referring the patients for surgery, if the patients develop a respiratory infection following thes surgery, the surgeon can ask for family physician's advice in dealing with that respiratory problem.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>54. Dr. Amin intends to ask for the second opinion and he writes the letter for his colleague including all patient's significant problem,state the physician's main findings the inverstigation that have been carried out,all medication, and the purpose of consultation.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>55. Mr. David is referred by dr. Henry because of his prostate cancer. For better care, it is essential taht after referral only a surgeon should prescribe treatment.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>56. The responsibility of patient is divided more or less evenly between two or more physician.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>57. Mrs. Ani is referred by dr. Nadia for long-term treatment of glaucoma. Dr. Nadia retains overall responsibility, but refers the patient only for care SOME SPECIFIC PROBLEM. Jadi jawabannya yang D - Collateral referral</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 58-60</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. planning</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. organizing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. leading</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. control</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>58. This is the process of influencing staff to meet predetermined objectives.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>59. This is a process of ensuring that things happen according to plan and taking corrective actions where necessary.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>60. This is a process of getting activities, people, materials structured to meet organizational objectives.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>61. Leadership is the process whereby one person influences the thoughts and behaviours of others. WOTF sentence is the most correct for personal leadership style according to theory X?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. theory x is more effective than theory Y</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. theory X have positive assumption</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. managers may be motivating</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. usually task oriented</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. more self responsibility</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>62. WOTF sentence is the most correct example for effective leadership depends on group needs?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. the leader should seek to discover what each member wants from the group objectives or he will lose the confidence of the group</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. a leader must be seen to strive to achieve group</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. measures for meeting individual needs are coaching, counseling, motivating, and staff development</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. team spirit and morale are very important</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. the needs may be satisfied through planning, allocating duties, giving targets to individuals, and setting standards</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>63. Manager has three skills set are conceptual, human, and technical. WOTF sentence is most likely for technical skills?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. skills in managing things rather than people and are often learned through on the job training programmes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. perceiving how the parts of the organization link together in structure and processes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. involved in working with people, often as a member of a group</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. involved people in decision making</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. to motivate people to contribute their best to get work done</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>64. Urutan dari proses menejemen untuk dokter keluarga?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>--> objektif --> practice population --> assess kebutuhan dan sumber daya --> alokasi --> penentuan kebijakan (policy or health care) --> evaluasi</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>65. WOTF sentence most likely step about practice population ...</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. more specific to prevention and manage disease</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. preservation of doctor-patient relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. The List is compiled by going through the practice records and entering all patients who have need the prac</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.The resources include the physical plan, communication system, physician, staff, the attached personel, hospital and community resources</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. various of health care according to need and demand of population and scarcuty of resources (prevention, promotion, curative, rehabilitation)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>66. WOTF sentence most likely step assessment of need, demand, and resources...</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. more specific to prevention and manage disease</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. preservation of doctor-patient relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. The List is compiled by going through the practice records and entering all patients who have need the prac</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.The resources include the physical plan, communication system, physician, staff, the attached personel, hospital and community resources</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. various of health care according to need and demand of population and scarcuty of resources (prevention, promotion, curative, rehabilitation)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>67. Disadvantages of group practice? d.potential conflict</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>68. WOTF sentence is the most correct to evaluate input in evaluation of performance?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. disease pattern</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. resources</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. total patients</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. patient satisfaction</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. audit of records</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>69. Managers has 3 clusters of role : leadership role, informational role, decisional role. WOTF is the leadership role?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Monitor</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Figurehead</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Disseminator</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Spokesman</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Entrepreneurship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>70. decisional role?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Monitor</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Figurehead</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Disseminator</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Spokesman</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Entrepreneurship</b></p><p></p>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-45185589291151246692011-05-10T02:37:00.000-07:002011-05-10T05:25:37.377-07:00FINAL PHOP VIII<p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><b></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><b></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.caring for whole spectrum age groups </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B.holistic approach </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C.emphasis on preventive medicine </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.patient centered care </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E.conducting home visit</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>1. The family physician should recognize the contribution of social & psychosocial problems in treating the patient..</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>2. Good communication and relationship between doctor and patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>3. the family should emphasis on care for family in every stage of life cycle</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>4-7</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.dedicated to the person</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B.understand the context of illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C.all contact with patient and opportunity for prevention and health education</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.the practice as a population at risk</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E.live in community/a part of the complex of family relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F.does community networking</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>G.subjective aspect of medicine (sensitivity to feelings,emotional)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>4. deploy resources from the community for the benefit of the people in community</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>5. This principle means that if one of their patients who haven't been immunizedshould be as much as a concern as one who is attending for well baby care.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>6. self-reflective</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>7.the family physician's is not limited by type of health problem physician is available for any health problem in a person.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>8.continuity care for the patient and the family is very important .continuity is overall,direct and coordinative responsibility for the different medical need of the time.it can be done by keeping good medrec .what dimension of this care based on the HENNEN'S FIVE DIMENTION OF CONTINUITY</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.INTERPERSONAL</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B.CHRONOLOGICAL</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C.INTERDISCIPLINARY</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.INFORMATIONAL</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E.GEOGRAFICAL</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>9. Research has shown young widowers have 12x increased than comparable married people for TB. This is one of 6 main effects of health to family members :</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Family affects morbidity and mortality</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. family is important in recovery from illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Infectious diseases spreads in families</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Genetic influences</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Family is crucial in child development</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>10. Which is the activity that included in the assessment of GRR?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. smoking cessation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. screening and case finding</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. reduction of serum cholesterol</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. coping ability</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. nutrition education</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>genogram utk soal no 14 dan 15</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><img src="http://photos-c.ak.fbcdn.net/hphotos-ak-ash4/227605_2019810652404_1158047676_32424330_1729171_a.jpg" _mce_src="http://photos-c.ak.fbcdn.net/hphotos-ak-ash4/227605_2019810652404_1158047676_32424330_1729171_a.jpg" fbid="2019810652404" hmac="AQCuIkvHpMXg_cvV" style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; " /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>1-. Berdasarkan Duvall, Sule termasuk dalam stage apa?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a. childbearing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b. pre-school</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c. teenager</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d. middle-aged</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e. launching the adult</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>1-. Peran orang tua dalam fase di atas? (liat soal sebelumnya?)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a.ikut dalam mendorong pertumbuhan toodler</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b.ikut dalam pertumbuhan anak pre-school</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c.fitting in kin environment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d.make relationshio with younger and older generation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e.make postparental interest</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>1-. Jika ia berhasil fase ini, maka Sule akan memasukin fase?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a. pre-school</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b. school age</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c.launching the adult</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d.middle aged</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e.aging family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>14. Berdasarkan Duvall, Parto termasuk dalam stage apa?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a. childbearing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b. pre-school</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c. teenager</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d. aging-family members</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e. middle-age</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>15. Family illness trajectory based on Sule's family genogram?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. onset of illness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. reaction to diagnosis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. major therapeutic effect</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. early adjustment to outcome</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. adjustment to permanent disability</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>16. What is the role of family doctor on this stage (no. 15)?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. alert to the potential problems of the illnes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. encourage to clear the nature</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. responsible to clinical judgment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. </b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>a. functional family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>b.dysfunctional family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>c.family life cycle</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>d.thinking family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>e.developmental task</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>19. membiarkan anak, remaja dan dewasa berkembang sesuai keinginannya namun tetap dekat dengan keluarganya</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>20. tidak etis untuk tidak menyebutkan gejala stress yang terlihat dalam gejala symptomatik dan depresi</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>21. peran anggota keluarga dalam membimbing anak dari lahir sampai matur</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. family dynamic</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. family genogram</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. family tree</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. family map</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. BATHE rechnique</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>22. It helps to draw out the quiet patient and provide structure of when to move on to talkactive patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>23. It helps the attending physician to diagnose the disease and dis-ease of the patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>24. It helps to rule out the family relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>25. Family Sule</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Nuclear family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Extended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Blended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>27. True from Sule's family genogram?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Sule-Wati : close relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Sule-Parto : distance relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Sule-Parto : close relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Sule-Wati : distance relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Sule-Wati : conflict relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>28. Family Yoyo</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Nuclear family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Extended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Blended family</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>29. WOTF is correct?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Yoyo separated from 1st wife</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Yoyo & Marni have dizygotic twins</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Jihan has abortion</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Jihan is pregnant</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Yoyo has unmarried relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. terminal end</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. frail elderly</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. homeostasis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. homeostenosis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. assessment of mental status</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. assessment of functional status</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>G. assessment of social status</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>33. Increased risk of disability abd death from minor external causes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>34. normalnya, proses penuaan tidak mengakibatkan kelainan patologis</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>35. what is the consequence of age related physiologic change of eye in the elderly?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. blindness</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Presbiopy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Lens opacification</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. decresasing of accomodation</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. miopi</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>36. A 84 y.o. women comes with her family with terminal stage of breast cancer and bone metastasis. What will you do as a family physician?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. continue chemotherapy treatment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. give her pain killer</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. sent her to other hospital for next treatment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. no other management</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>37. what is the goal for patient’s management?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. cure the patient</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. prevent other complication</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. focus on quality of life</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. prepare for breavement process</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>39. in caring terminal patient, family physician must be able to cope with dying patients emotions and reaction, especially in the first stage of dying. What is the first stage of dying?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Acceptance</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. anger</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. bargaining</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Denial</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Depresion</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>40. WOTF is correct about palliative care?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. hospital is the only place for palliative care</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. cure is not possible</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. more concern about quantity rather than quality</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 41-43</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. primary prevention</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. secondary prevention</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. tertiary prevention</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. risk avoidance</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. risk reduction</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>41. Management of established disease, in order to minimalize the disabilities</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>42. identify those with high risk to modify the risk factors</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>43. early detection</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>soal no. 44-46</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. DPT</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Hep A</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Measles</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Hib</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Pneumococcal</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. Tetanus</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>44. Should be given to Warna (12 y.o.)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>45. Contraindicated for Jihan (pregnant)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>46. This immunization is given in two doses</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>soal no. 47-49</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. B6</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Thiamin</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Fluoride</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Erythromycin oinment</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Folic acid</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>F. Hormone replacement therapy</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>47. Given to Jihan to prevent neural tube defect</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>48. Will be given to Jihan's future baby</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>49. Given to Marni (hipertensi, 54 thn)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>54. Dr. Amin intends to ask for the second opinion and he writes the letter for his colleague including all patient's significant problem,state the physician's main findings the inverstigation that have been carried out,all medication, and the purpose of consultation.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>55. Mr. David is referred by dr. Henry because of his prostate cancer. For better care, it is essential taht after referral only a surgeon should prescribe treatment.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>56. The responsibility of patient is divided more or less evenly between two or more physician.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>57. Mrs. Ani is referred by dr. Nadia for long-term treatment of glaucoma. Dr. Nadia retains overall responsibility, but refers the patient only for care SOME SPECIFIC PROBLEM. Jadi jawabannya yang D - Collateral referral</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><strong style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; ">For number 58-60</strong></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. planning</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. organizing</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. leading</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. control</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>58. This is the process of influencing staff to meet predetermined objectives.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>59. This is a process of ensuring that things happen according to plan and taking corrective actions where necessary.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>60. This is a process of getting activities, people, materials structured to meet organizational objectives.</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>61. Leadership is the process whereby one person influences the thoughts and behaviours of others. WOTF sentence is the most correct for personal leadership style according to theory X?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. theory x is more effective than theory Y</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. theory X have positive assumption</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. managers may be motivating</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. usually task oriented</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. more self responsibility</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>62. WOTF sentence is the most correct example for effective leadership depends on group needs?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. the leader should seek to discover what each member wants from the group objectives or he will lose the confidence of the group</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. a leader must be seen to strive to achieve group</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. measures for meeting individual needs are coaching, counseling, motivating, and staff development</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. team spirit and morale are very important</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. the needs may be satisfied through planning, allocating duties, giving targets to individuals, and setting standards</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>63. Manager has three skills set are conceptual, human, and technical. WOTF sentence is most likely for technical skills?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. skills in managing things rather than people and are often learned through on the job training programmes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. perceiving how the parts of the organization link together in structure and processes</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. involved in working with people, often as a member of a group</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. involved people in decision making</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. to motivate people to contribute their best to get work done</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>64. Urutan dari proses menejemen untuk dokter keluarga?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>--> objektif --> practice population --> assess kebutuhan dan sumber daya --> alokasi --> penentuan kebijakan (policy or health care) --> evaluasi</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>65. WOTF sentence most likely step about practice population ...</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. more specific to prevention and manage disease</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. preservation of doctor-patient relationship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. The List is compiled by going through the practice records and entering all patients who have need the prac</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.The resources include the physical plan, communication system, physician, staff, the attached personel, hospital and community resources</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. various of health care according to need and demand of population and scarcuty of resources (prevention, promotion, curative, rehabilitation)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>66. WOTF sentence most likely step assessment of need, demand, and resources...</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. more specific to prevention and manage disease-->Formulation objective</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. preservation of doctor-patient relationship-->Formulation objective</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. The List is compiled by going through the practice records and entering all patients who have need the prac-->Practice population</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D.The resources include the physical plan, communication system, physician, staff, the attached personel, hospital and community resources</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. various of health care according to need and demand of population and scarcuty of resources (prevention, promotion, curative, rehabilitation)-->Formulation policies/health care</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>Jawaban : D (Slidemanagement clinic no.31)</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>67. Disadvantages of gropu practice d.potensial conflict</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>69. Managers has 3 clusters of role : leadership role, informational role, decisional role. WOTF is the leadership role?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Monitor</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Figurehead</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Disseminator</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Spokesman</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Entrepreneurship</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b><br /></b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>70. decisional role?</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>A. Monitor</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>B. Figurehead</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>C. Disseminator</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>D. Spokesman</b></p><p style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 16px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-weight: normal; "><b>E. Entrepreneurship</b></p><p></p><p></p>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-13834818271840173452011-05-06T23:11:00.000-07:002011-05-06T23:12:20.622-07:00MDE PHOP IV<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >2. Important science about chemical hazards?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >A. ergonomic</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >B. toxicology</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >C. epidemiology</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >D.</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >E.</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >3. <span lang="IN" style="mso-ansi-language:IN">To solve the problem in occupational health, it needs many factors. What is the important study to solve the problem in occupational or ocupational related disease?<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. epidemiology<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. toxicology<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. law<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. ergonomic<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. environmental engineering<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >4<span lang="IN" style="mso-ansi-language:IN">. The best way to prevent oneself from nosocomial infection is<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. doing exercise regularly<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. have a balanced diet<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. follow medical procedure<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. using masker and gloves in hospital<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. examining patient from a safe distance<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >9. A young doctor work as PTT in remote area. What kind of hazard it is?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >A. physical burden</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >B. mental burden</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >C. social burden</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >D. expenses biology</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >E. psychological burden</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >12. Definition of health care waste?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. pharmaceutical<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. pathological<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. infectious<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. highy infectious<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. <o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >14. highly infectious culture from lab</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >15. human tissue<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" ><span lang="IN" style="mso-ansi-language:IN">17. Gas cylinder </span><span lang="IN"><span style="mso-char-type:symbol;mso-symbol-font-family:Wingdings">à</span></span><span lang="IN" style="mso-ansi-language:IN"> pressured containers<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >19. What is the main risk with infection in hospital?<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. body fluid<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. hospital waste management<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. sharp contamination<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. hospital waste of handling inadequate<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >21. Yang termasuk physical hazard di RS adalah?<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. HIV<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. gas sisa anestesi<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. static posture<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >21. Yang termasuk physical hazard di rumah sakit?<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. HIV<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. gas sisa anestesi<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. static posture<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >22. Disease yang didapat saat kerja yang hazardnya adalah biological? nosocomial<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >25. Peningkatan angka kejadian tapi tidak separah epidemic? Outbreak</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >27. Peningkatan insidensi penyakit di atas perkiraan? Epidemic</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >28. Disease caused by work or work environment? Occupational disease<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. physical<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. chemical<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. biological<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. ergonomic<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. psychosocial<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >29. repetitive motion<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >30. lack of control over work<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >31. pesticides<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >32. improper desigened tools<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >33. radiation<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >34. The most important thing to identify medical problems related to occupation? <o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. occupational history<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. history taking<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. physical exam<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. chest x-ray<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. pulmonary functional test<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. environmental psychosocial<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. physical<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. environmental chemical<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. social support<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. interindividual relationship<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >38. low wage<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >40. job turn over<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >Endogenous infection in nosocomial is caused by?<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. direct infection<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. indirect infection<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. transmission of agent from patient to patient<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. microbial agent acquired in hospital<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. patient’s own flora<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >41. Stressor at workplace<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. relationship at work<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. support to engage personal interest<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. dual career status<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D. air quality<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E. lack of promotional opportunity<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >44. UU perlindungan keselamatan kerja? UU no 14 tahun 1949</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >48. Apa yang dmaksud dengan accident pro nenes?<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >A. penyakit yang berkaitan dengan sinar UV<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >B. idem tapi x-ray<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >C. perilaku tidak patuh pada peraturan keselamatan kerja<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >D.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >E.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p><span class="Apple-style-span" > </span></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span class="Apple-style-span" >50. Yang termasuk golongan penyakit Sick Building Syndrome? ISPA</span></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >53. Labor union-helath care professional relationship?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >A. advocate safety issue</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >B. </span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >C.</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >D. to know medical info</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >E.</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >A. government role</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >B. management control</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >C. legislative control</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >D. engineering control</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >E. medical control</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >58. Implementing regulation or laws of health</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >61. Working with tractors or other farm equipment such as motor vehicle and sharp tools for cutting or pruning can cuse following health hazard in agriculture?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >A. musculoskeletal disorder</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >B. respiratory disorder</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >C. traumatic inury</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >D. toxification</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >E. dermatitis</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p><span class="Apple-style-span" > </span></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >63. Combination of ailment associated with individual’s place of work or residence is known as?</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >A. musculoskeletal disorder</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >B. nosocomial infection</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >C. respiratory disorder</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" >D. occupational injury</span></p> <span style="line-height: 115%; "><span class="Apple-style-span" >E. sick building syndrome</span></span>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-24885816905088489342011-05-06T23:10:00.000-07:002011-05-06T23:11:05.752-07:00MDE BHP VIII<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">2. A young doctor reluctantly examined a poor patient. Bioethical issue?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. beneficence</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. nonmaleficence</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. justice</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. autonomy</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E.</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span style="mso-spacerun:yes"> </span>9. Seorang mahasiswa FK butuh biaya untuk menyelesaikan studinya. Untuk itu dia mendonorkan ginjalnya kepada yang membutuhkan agar mendapatkan uang. Isu etika?</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">A. humanitarianism</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. financial</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. religious</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. medical</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. socio cultural</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">19. The principle to reward those who has given benefit to society in the past has disadvantage which is?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">A. favors tose who have better prognosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">B. treating people only when prognosis deteriorates<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">C. prefer younger people than those which is the sickest<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">D. favors wealthy, powerful, and well connected people<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">E. ignores needs to those who will become sick in the future<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">21. Pengobatan sick people first<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">A. disaster triage<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">B. emergency<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">C. kidney transplantation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">D.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">E.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN"><span style="mso-spacerun:yes"> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">23. Giving limited drug to stadium II instead of stadium IV patient is according to<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">A. Benefits who had the least chance<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">B. Aids people who suffer more<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">C. Limited resipiens information neede<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">D. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">E. benefits who had more chance to life<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">25. Ginjal yang diberikan kepada prisoner 25 y.o. instead a 80 y.o. retired general menggunakan prinsip etika dari?<br />A. it favor well-connected people</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">B. it ignores the sense of social justice</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">C. best prognosis (highest life expectance)</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">D. it doesn’t benefit the greatest number of people</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal">E. it ignores to aids those who are suffering</p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">28. Dalam pemilihan pasien yang masuk UGD atau tidak berpegang pada prinsip?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">A. Benefit the greatest number<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">B. Aids the suffering right now<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">C. Prognosis or life<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">D.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span lang="IN" style="mso-ansi-language:IN">E. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">29. Doctor who are involved in a disaster medical team should choose the sickest to be treated first,which is based on the principle?<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">A. reciprocity<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">B. rule of rescue<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">C. save more lives<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">D. social usefulness<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">E. first come-first output<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">Lottery can be ethically used in<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">A. disaster relief<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">B. school vaccination<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">C. antibiotic allocation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">D. emergency<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span lang="IN" style="mso-ansi-language:IN">E. ICU occupant<o:p></o:p></span></p>superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-83438355159406238822011-01-12T22:36:00.000-08:002011-01-12T23:08:09.865-08:00Info Skripsi: Surat PengantarTeman2 2007,, ini ada email dari dr.Yulia tentang surat pengantar skripsi kita:<br /><br /><br />Sehubungan dengan akan dibuatnya surat pengantar penelitian minor thesis, sementara perubahan judul banyak yang belum dilaporkan, maka bersama ini saya minta kesediaan setiap ketua kelompok untuk mencocokan/mendata ulang dan mengirimkan kembali kepada saya (dalam bentuk excel) data dari masing-masing anggota kelompoknya (1file/kelompok lab CRP). Mohon dikirimkan via ysofiatin@yahoo.com, paling lambat hari Minggu, 16 Jan 2011 pukul 21.00, agar surat pengantar perijinan bisa segera diselesaikan.<br /><br />Catatan: semua mahasiswa HARUS mendapat surat pengantar perijinan/penelitian, meskipun penelitian akan dilakukan terhadap mahasiswa FK UNPAD sendiri. Di dalam file excel terlampir,<br />1. sudah ada daftar nama, judul dan pembimbing, mohon dicek apakah sudah benar. Kalau masih ada yang salah, mohon ditulis pada kolom Judul ganti/Pb ganti<br />2. ada pula kolom Perijinan. Isilah kolom lokasi penelitian sesuai dengan dropbox, lalu nama lokasinya, bisa nama bagian, nama desa, nama sekolah, nama laboratorium.<br /><br />Terimakasih atas kerjasamanya<br /><br />Contoh Tabel:<br /><div style="text-align: left;"><img style="width: 527px; height: 106px;" src="data:image/jpeg;base64,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alt="" /><br /></div><br /><br />link daftar judul skripsi angkatan 2007:<br />http://www.4shared.com/file/P3Ke5iyh/penggantian_judul_dan_pembimbi.htmlsuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-52288127579806058612011-01-12T01:14:00.000-08:002011-01-12T05:50:19.716-08:00FINAL BHP VII4. WOTF steps in developing new drugs derived from traditional medicine?<br />A. identification of aims of the research<br />B. identification of the plants species<br />C. research of post marketing of drugs<br /><span style="font-weight:bold;">D. clinical research with appropriate laboratory animal</span><br />E. research of development of plant<br /><br />7. to be marketed a product of jamu must be first:<br />A. converted into a medical drug<br />B. prescribed by doctors<br />C. advertised as jamu<br />D. labeled as jamu<br /><span style="font-weight:bold;">E. audited for safety</span><br /><br />8. the advantages of jamu compared to modern drugs due to the characteristic….<br />A. does not cause side effects<br />B. cultural background<br />C.<br />D.<br /><span style="font-weight:bold;">E. natural sources</span><br /><br />9. what ethical issue rose when medical doctors become model in jamu advertisement<br />A. altruism<br />B. excellence<br />C. confidentiality<br />D. public health issue<br /><span style="font-weight:bold;">E. decision making issue</span><br /><br />10. what ethical issue rose when pharmaceutical company give free drugs sample to medical doctors?<br />A. public health issue<br />B. professionalism issue<br /><span style="font-weight:bold;">C. decision making issue</span><br />D. informed consent issue<br />E. conflict of interest issue<br /><br />11. What ethical issue rise when pharmaceutical company give material fee to doctor prescribing their drugs?<br />A. Interdisciplinary issue<br />B. Decision making issue<br />C. Truth telling issue<br />D. Public health issue<br /><span style="font-weight:bold;">E. Conflict of interest issue</span><br /><br />13. On what condition a medical doctor may prescribe jamu?<br />A. There is no known side effect<br />B. It is produced in modernized factory<br />C. Other medical doctors use it for patient<br />D. History shows people use the jamu safely<br /><span style="font-weight:bold;">E. It has been standardized into phytopharmaca</span><br /><br />14.The step of jamu standardization which is the same with modern drug standardization is:<br />A. Standardazation of marketing<br />B. Monitoring of local farmers in the population<br /><span style="font-weight:bold;">C. Studies through preclinical and clinical trial</span><br />D. Educating the local farmer in plantation technology<br />E. Standardization of plant, land, plantation andharvesting<br /><br />15. So far, why there is only few Indonesian traditional medicine studied by researcher?<br />A. Researcher must concentrate more on modern drugs<br />B. The research should be conducted abroad<br />C. Traditional medicines cannot be prescribed by doctors<br /><span style="font-weight:bold;">D. The cost of the drug development is high</span><br />E. It does not need to be studied further as modern drugs do<br /><br />16. The step of clinical trial which use healthy human as subjects is:<br />A. Phase 0<br /><span style="font-weight:bold;">B. Phase 1</span><br />C. Phase 2<br />D. Phase 3<br />E. phase 4<br /><br />18. what is d phase when traditional medicine compared with placebo?<br />A- pre-clinical trial<br />B- phase 0 in clinical trial<br />C- phase I in clinical trial<br /><span style="font-weight:bold;">D- phase II in clinical trial</span><br />E- phase III in clinical trial<br /><br />19. The phase when jamu is being tested to find its active ingredient in it is:<br /><span style="font-weight:bold;">A. preclinical trial</span><br />B. Phase 0 <br />C. Phase 1 <br />D. Phase 2 <br />E. Phase 3 <br /><br />20. The characteristic of clinical trial which is different from pre- clinical trials is:<br />A. To use animal as subject<br /><span style="font-weight:bold;">B. To use human as subject</span><br />C. To search for the safe dose<br />D. To investigate the drug in vitro<br />E. To investigate the active ingredients<br /><br />21. When a hospital used drugs only from certain company that has connection with hospital owner<br /><span style="font-weight:bold;">A. Interdisciplinary team issu</span>e<br />B. Conflict of interest issue<br />C. Decision making issue<br />D. Public health issue<br />E. Truth telling issue<br /><br />22. A mode of sponsorship from pharmaceutical is ethical?<br />A. Scholarship to medical students<br />B. Gift for hospital’s purchasing office<br />C. Renovation doctor’s waiting room<br />D. Fee for the doctors who prescribe their drugs<br />E. Travel expense for doctors attending seminar<br /><br />23. The ethical way to spread information about new drug is through:<br />A. Brochures of public<br />B. Article on newspaper<br /><span style="font-weight:bold;">C. Article journal or seminar</span><br />D. TV interview on researchers<br />E. Advertisement involving doctor as model<br /><br />24. Direct impact to the patient when pharmaceutical company pays the doctor after prescribing their drugs?<br />A. No direct effect<br />B. Increase price of drug<br />C. Uncontrolled adverse effect<br /><span style="font-weight:bold;">D. Hinders patient autonomy</span><br />E. Influence patient preference<br /><br />25. What is the most important consideration by a doctor in choosing the treatment<br />A. Best treatment according to research<br />B. Most efficient treatment in history<br />C. Hospital standard procedure<br />D. Most expensive treatment<br /><span style="font-weight:bold;">E. Patients best interest</span><br /><br />27. Millennium Development Goal: which one is closely related to community nutrition?<br /><span style="font-weight:bold;">A. Goal 1:Prevent extreme poor and hunger</span><br />B. Goal 2:Achieve universal primary education<br />C. Goal 3:Gender equality and woman empowerment<br />D. Goal 4ecrease child mortality<br />E. Goal 5:Improve maternal health<br /><br />28. The cheapest protein source is?<br />A. Chicken<br />B. Eggs<br />C. Milk<br /><span style="font-weight:bold;">D. Plants</span><br />E. Fish<br /><br />29. How to measure hunger according to MDG?<br />A. The proportion of the family based on worker<br />B. The proportion of people living on less than $1 a day<br />C. The level of poorest quintile in national consumption<br /><span style="font-weight:bold;">D. The prevalence of underweight children under 5 years old</span><br />E. By calculating the poverty gap ratio (incidence X depth poverty)<br /><br />31. In which aspects of MDG's Goal 1 (Eradicate extreme poverty and hunger) relates to Goal 5 (Improve maternal health)?<br />A. Malnutrition often happen in women<br />B. Healthy women can work to get better income<br />C. Carrier women often have malnutrition children<br />D. Healthy women can prevent malnutrition in children<br />E. Malnutrition is common cause of death in women<br /><br />32. It is a duty for doctors to support this target of MDG’s Goal 1 (Eradicate extreme poverty and hunger)<br /> A. To halve the proportion of people living on less than $1 per day<br />B. To achieve descent employment for women, men and young people<br />C. To share of poorest quintile in national consumption<br /><span style="font-weight:bold;">D. To halve the prevalence of underweight children under 5 years</span><br />E. To halve poverty gap ratio (incidence X depth of poverty)<br /><br /><br /><br />Yang dibold kemungkinan besar adalah jawabannya,klo ga ada brarti masih bingung.klo ada yg mau jawab silahkan komen ya...:Dsuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com2tag:blogger.com,1999:blog-3810580967966978266.post-16099534038061559262010-10-09T09:46:00.000-07:002010-10-09T09:53:07.803-07:00judul skripsi bermasalahdari dokter kurnia, ini daftar NPM mahasiswa yang judulnya 'bermasalah'<br />tolong untuk bertemu dr Yulia atau dr Lola hari Senin 11 Okt 2010 pukul 8-9 atau pk 12-13<br />terimakasih.<br /><br />NPM dan judulnya:<br /><br />130110060059 hubungan antara kejadian anemia dan metode persalinan ibu hamil di rumah sakit hasan sadikin tahun 2006 sampai dengan 2009<br /><br />130110060131 analisa kesesuaian lama puasa antara instruksi anesthesi dan kenyataan pada pasien yang dilakukan operasi elektif di rumah sakit hasan sadikin<br /><br />130110063065 Antibacterial activity of black cumin seed (Nigella sativa) against Stapylococcus aureus and shigella flexneri<br /><br />130110070009 Hubungan Diare pada Balita dengan Kebersihan Botol Susu<br /><br />130110070012 Derajat gangguan cemas pada wanita infertil yang mengikuti program bayi tabung di Poliklinik Aster RSHS<br /><br />130110070021 Deteksi Mikroba Patogen pada Uang Kertas yang Layak Pakai<br /><br />130110070040 Interpolasi Kurva Antropometri Bayi Baru Lahir Menurut <br />Alisjahbana pada Klasifikasi Bayi Baru Lahir di Rumah Sakit Hasan Sadikin Bandung<br /><br />130110070042 Gambaran Deskriptif Penyakit pada Remaja yang Berkunjung ke Puskesmas Selama Satu Tahun<br /><br />130110070045 146 Charctistic of glaucoma patient in cicendo Eye Hospital<br /><br />130110070053 Terapi Akupunktur dalam Bidang Kesehatan<br /><br />130110070055 Pola Kedatangan Pasien alergi di Poli Sub Bagian Alergi <br />Poliklinik Ilmu Kulit dan Kelamin Rumah Sakit Hasan Sadikin Dihubungkan dengan Kelembaban Udara dan Perubahan Musim<br /><br />130110070060 Hubungan antara kejadian atopic dermatitis dengan sejarah riwayat asma dilihat dari berbagai variabel<br /><br />130110070069 EFEK ANTELMINTIK INFUSA BIJI PEPAYA (Carica Papaya) TERHADAP CACING Ascaris suum SECARA IN VITRO<br /><br />130110070070 Efek infusa buah kurma terhadap kenaikan trombosit pada mencit<br /><br />130110070085 Hubungan jumlah jam belajar terhadap kekuatan memori mahasiswa UNPAD dengan GPA 3.51-4<br /><br />130110070096 "faktor-faktor yang mempengaruhi pola pencarian pengobatan di tingkat keluarga di kecamatan jatinangor<br />"<br />130110070105 Pola Pertolongan Persalinan antara Tenaga Tradisional (paraji) dengan Tenaga Medis Profesional (dokter/bidan) pada Masyarakat<br /><br />130110070108 Pengaruh program desa siaga terhadap penurunan angka kematian ibu di jawa barat (IKM)<br /><br />130110070116 Proporsi informasi kesehatan di media cetak misalnya koran<br /><br />130110070118 Komunikasi dokter-pasien: sebuah studi observasional<br /><br />130110070119 Tingkat Pengetahuan Kesehatan Reproduksi Remaja SMA di Kecamatan Jatinangor. (IKM)<br /><br />130110070123 Gambaran Peminatan Bidang Profesi Mahasiswa Fakultas Kedokteran Universitas Padjadjaran Angkatan 2007<br /><br />130110070125 Efek sari buah kurma terhadap jumlah trombosit pada mencit<br /><br />130110070126 hubungan tingkat addiksi kafein dengan QOL pada mahasiswa UNPAD periode 2007-2010<br /><br />130110070129 hubungan berat lahir dan usia lahir dengan kasus icterus neonatorum di RSUD Majalaya periode 2009-2010<br /><br />130110070136 Korelasi antara kuantitas dan kualitas tidur terhadap atensi dilihat dari indikator indeks prestasi akademik mahasiswa fakultas kedokteran unpad<br /><br />130110070147 Hubungan tingkat kecemasan terhadap timbulnya acne vulgaris pada siswa SMA kelas 12 menjelang UN<br /><br />130110070159 Pengaruh depresi terhadap status imun pasien HIV di klinik Teratai RSHS<br /><br />130110070162 Efek Angkak (Monascus purpureus)terhadap Peningkatan Jumlah Trombosit pada Mencit<br /><br />130110070166 Gambaran Deskriptif Penyakit pada Balita yang Berkunjung ke Puskesmas Selama Satu Tahun<br /><br />130110070174 Korelasi atopic dermatitis dengan alergi rhinitis<br /><br />130110070177 Hubungan antara pemberian ASI dengan kecerdasan anak pada siswa SD di Jatinangor<br /><br />130110070180 Tingkat pengetahuan warga Desa Sayang terhadap pencegahan diabetes melitus tipe 2 (Ilmu kesehatan masyarakat)<br /><br />130110073007 The Calming Effect of Chamomile Tea<br /><br />130110073034 The effectiveness of honey as an antibiotic compares to vancomycin towards Staphylococcus aureus<br /><br />130110073036 Karakteristik sitologi efusi pleura yang disebabkan tuberkulosis<br /><br />130110073038 effect of exercise (jogging) on short term memory among fkup batch 2007 students<br /><br />130110073063 Efek antibakteri infusa Pegagan(Centella asiatica) terhadap Staphylococcus Aureus dan Pseudomonas Aeruginosa secara in vitro<br /><br />130110073066 mengukur tingkat stress pada pasien rehabilitasi kecacatan menetap<br /><br />130110073068 effectiveness of the usage of cross bristles tooth brush when brushing teeth towards lowering the amount of hemolytic streptococcus in saliva<br /><br />130110073070 Gambaran Fungsi Paru dan mahasiswa FK Unpad yang merokok<br /><br />130110073072 Comparison of renal function between students exercise regularly and non regularly among FK UNPAD 2007 students (prof.purba)<br /><br />130110073075 The comparison of psychological stress among KPBI students in FKU, FKG and Pharmacy faculty in UNPAD, Jatinangor<br /><br />130110073089 Perbandingan penggunaan kopi dan madu terhadap penyembuhan luka bakar<br /><br />130110073090 Relationship between anxiety level and eating pattern of medical students comparing during exams and without exams in FK UNPAD 2010/2011<br /><br />130110073111 The Comparison between Female and Male Siamese Fighting Fish's (Betta Spledens) ability as the biological predator for Aedes Aegypti's larvae in preventing Dengue Hemorrhagic Fever.<br /><br />13011008-A024 Pengaruh Phillantus nururi terhadap expresi gen massh2 pada usus halus tikus mencitsuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-55322511915219425052010-08-04T02:25:00.001-07:002010-08-04T02:26:47.820-07:00COMPRE PHOP I 2009Akademik 2007 – Soal Compre PHOP I<br /><br />1. Prioritas utama pada alokasi biaya kesehatan yang bersumber dari pemerintah adalah pada kegiatan :<br />A. Pelayanan kuratif tersier bagi keluarga miskin<br />B. Pelayanan kesehatan yang bersifat private goods dari RS pemerintah<br />C. Pelayanan kesehatan yang bersifat public goods<br />D. Pelayanan kuratif bagi keluarga miskin dari puskesmas maupun di RS sesuai dengan kebutuhan<br />E. Pelayanan kesehatan primer<br /><br />2. Konsep asuransi kesehatan?<br />“Pengalihan resiko sakit dari perorangan ke kelompok.”<br /><br />3. Yang termasuk ke dalam unsur-unsur asuransi :<br />A. Pembayaran premi<br />B. Ahli waris dari tertanggung<br />C. Adanya pengumpulan dana dari kelompok tertentu<br />D. Badan asuransi sebagai pemberi pelayanan kesehatan<br />E. Penyedia jasa pelayanan<br /><br />7. Yang dimaksud dengan manajer ?<br />A. Memiliki keterampilan tertentu, yang bertanggung jawab atas kelancaran proses manajerial<br />B. Seseorang yang memiliki jiwa kepemimpinan<br />C. Berani, inovatif, kreativitas tinggi<br />D. Seseorang dengan posisi tertinggi pada organisasi, keterampilan teknis tinggi<br />E. Seseorang dengan posisi tertinggi pada organisasi, keterampilan konsep tinggi<br /><br />7. Makna D dalam SKDN?<br />A. Seluruh bayi yang berada di wilayah kerja Puskesmas<br />B. Seluruh bayi yang memiliki KMS<br />C. Seluruh bayi yang datang pada saat penimbangan<br />D. Seluruh bayi yang berat badannya naik pada bulan tersebut<br />E. Seluruh bayi yang ditimbang bulan tersebut<br /><br />9. Unsur pokok pada sistem kesehatan berdasarkan SKN 2004?<br />A. Organisasi pendanaan kesehatan<br />B. Mutu pelayanan<br />C. Perbekalan kesehatan<br />D. Organisasi pelayanan kesehatan<br />E. Subsistem manajemen kesehatan<br /><br />11. Faktor-faktor yang mempengaruhi sikap & perilaku seseorang?<br />A. Gaya kepemimpinan<br />B. Gaya memcahkan masalah<br />C. Kemampuan untuk menjadi pengikut<br />D. Motivasi<br />E. Kebutuhan akan pengakuan diri<br /><br />12. Yang mempengaruhi gaya kepemimpinan seseorang :<br />A. Gaya pemecahan masalah<br />B. Lokus kontrol pemimpin<br />C. Sifat kreativitas dan inovatif<br />D. Sikap dan perilaku pekerja yang berada di bawah kepemimpinannya <br />E. Kemampuan untuk terus belajar<br /><br />12. Termasuk POA dalam langkah perencanaan?<br />A. Identifikasi masalah<br />B. Penetapan masalah<br />C. Analisis masalah potensial<br />D. Pengalokasian sumber daya<br />E. Penetapan rencana evaluasi<br />14. Kemampuan mendengar yang efektif?<br /><br />18. Aspek dalam menentukan prioritas masalah?<br />A. Tujuan organisasi<br />B. Keterkaitan antar masalah<br />C. Perencanaan yang sudah disusun<br />D. Umpan balik<br />E. Masalah potensial<br /><br />19. POA?<br />A. Identifikasi masalah<br />B. Analisis masalah potensial<br />C. Alokasi sumber daya<br />D. Rencana evaluasi<br />E. ?<br /><br />19. Perencanaan merupakan salah satu proses pada siklus manajemen. Adapun fungsi perencanaan pada siklus manajemen adalah :<br />A. Untuk menetapkan tujuan<br />B. Untuk menghilangkan ketidakpastian<br />C. Sebagai dasar untuk memotivasi anggota organisasi<br />D. Untuk memperkirakan kebutuhan SDM saja<br />E. Sebagai dasar untuk melakukan analisis yang sistematik<br /><br />22. Pencapaian keselarasan usaha individu dalam rangka mencapai tujuan & sasaran kelompok merupakan salah satu dari definisi :<br />A. Organisasi<br />B. Pengorganisasian<br />C. Pengawasan<br />D. Pengendalian<br />E. Koordinasi<br /><br />24. Rentang kendali ideal organisasi modern (sama) ?<br /><br />25. Acceptance of theory authority?<br />D. Bawahan menolak wewenang di luar zona penerimaan<br /><br />26. Pengawasan dilakukan dengan baik apabila meliputi aspek :<br />A. Ada obyek, pengawas, standar<br />B. Pengawas, obyek, metode<br />C. Obyek, metode<br />D. Metode, obyek, proses<br />E. Obyek, proses<br /><br />29. Salah satu unsur pokok pada sistem kesehatan berdasarkan SKN 2004?<br />A. Organisasi pendanaan kesehatan<br />B. Mutu pelayanan<br />C. Perbekalan kesehatan<br />D. Organisasi pelayanan kesehatan<br />E. Subsistem manajemen kesehatan<br /><br />33. Pendidikan kesehatan menurut Blum :<br />A. 45%<br />B. 30%<br />C. 20%<br />D. 10%<br />E. 5%<br /><br />34. Environmental menurut IFTF :<br />A. 10%<br />B. 20%<br />C. ?<br />D. 50%<br />E. ?<br /><br />35. Manakah yang termasuk 4 elemen dalam penilaian resiko?<br />A. Penilaian lingkungan fisik<br />B. Penilaian lingkungan ekonomi<br />C. Penilaian lingkungan biologi<br />D. Penilaian lingkungan paparan<br />E. Pengaruh media massa<br /><br />(No.39-51 : original text from “Comprehensive Test of PHOP I 3rd Year Program 09-10 (Class A) – Page 6 of 12”)<br />39. Manakah yang termasuk Re Emerging Disease ?<br />A. Avian Influenza<br />B. Malaria<br />C. Kusta<br />D. Typhoid<br />E. Filariasis<br /><br />Untuk pertanyaan No.40 sampai dengan No.44 lihat pilihan berikut :<br />A. Reservoir<br />B. Transmission<br />C. Portal of entry<br />D. Portal of exit<br />E. Pathogen<br />F. Establishment of disease in new host<br /><br />Berbagai macam cara pencegahan dan kontrol yang bisa dilakukan supaya tidak terjadi sakit. Cocokanlah pernyataan di atas dengan soal di bawah ini :<br />40. Disinfectans<br />41. Immunizations<br />42. Drug treatment<br />43. Hair nets<br />44. Gowns<br /><br />Pertanyaan No.45 sampai dengan No.47 lihat pilihan berikut :<br />A. Acute Communicable Disease<br />B. Acute Non-Communicable Disease<br />C. Chronic Communicable Disease<br />D. Chronic Non-Communicable Disease<br /><br />45. Pneumonia<br />46. Gout<br />47. Pertusis<br /><br />Untuk pertanyaan No.48 sampai dengan No.50 lihat pilihan berikut :<br />A. Basic Science Era<br />B. Empirical Health Era<br />C. Public Health Era<br />D. Clinical Science Era<br /><br />Tahapan-tahapan perkembangan dunia kedokteran yang tertera di atas cocokan dengan soal di bawah ini :<br />48. Usaha pelayanan semata-mata terhadap gejala klinik<br />49. Causal Treatment<br />50. Lahir beberapa pionir dalam bidang kedokteran<br /><br />51. Yang merupakan upaya perbaikan gizi keluarga (UPGK) adalah :<br />A. Upaya untuk meningkatkan status gizi masyarakat yang dilaksanakan oleh puskesmas<br />B. Upaya untuk meningkatkan gizi masyarakat dengan melakukan koordinasi lintas sektoral<br />C. Upaya perbaikan gizi yang bertujuan untuk mencapai kadarzi<br />D. Upaya untuk meningkatkan gizi masyarakat yang dilakukan melalui kegiatan pada institusi<br />E. Upaya perbaikan gizi masyarakat yang dikerjakan di tingkat posyandu<br /><br />57. Deklarasi Alma Ata, agar pembangunan sosial & ekonomi dapat terus berlangsung, aspek-aspek penting yang esensial:<br />A. ?<br />B. Mengurangi kesenjangan kaya-miskin<br />C. Promosi kesehatan & memperbaiki kualitas<br />D. Promosi kesehatan<br />E. Meningkatkan pendapatan masyarakat suatu negara<br /><br />58. Konsep Puskesmas berdasarkan Kep. Menkes 128 ?<br /><br />59. ???????<br />A. Melibatkan masyarakat dalam pembangunan kesehatan oleh puskesmas di wilayah kerjanya<br />B. ?<br />C. ?<br />D. ?<br />E. ?<br /><br />68. Tujuan dari pemeriksaan dahak SPS pada pasien suspect TB adalah :<br />A. Untuk menilai keberhasilan pengobatan paru<br />B. Untuk menjaring kasus TB paru<br />C. Untuk menentukan jenis OAT yang akan diberikan<br />D. Untuk menentukan apakah penjaringan aktif perlu dilakukan<br />E. Untuk menentukan klasifikasi penyakit<br /><br />70. Pemeriksaan antenatal K4?<br />A. Pemberian tablet Fe<br />B. Pemberian 90 tablet Fe<br />C. TT 2x<br />D. Pengukuran lingkar lengan atas<br />E. Tablet Fe 30<br /><br />71. Maternal Mortality Ratio?<br />A. Jumlah ibu hamil yang meninggal per 1.000 kelahiran hidup<br />B. Jumlah ibu hamil yang meninggal per 10.000 kelahiran hidup<br />C. Jumlah ibu hamil yang meninggal per 100.000 kelahiran hidup<br />D. Jumlah ibu hamil yang meninggal per 100.000 wanita usia 15-49<br />E. Jumlah ibu hamil yang meninggal per seluruh wanita usia subur yang meninggal<br /><br />76. Informasi dalam siklus manajemen berperan dalam tahap?<br /><br />Untuk pertanyaan No. 92 sampai dengan No.?? cocokaln dengan pilihan di bawah ini :<br />A. Socioeconomic Distal Cause<br />B. Proximal Cause<br />C. Physiology & Pathophysiological Cause<br />D. Outcome<br />E. Sequelae<br /><br />92. Chronic vascular disease<br /><br />97. To motivate then to … additional resources?<br />B. Advocacy to highest …superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-86455609426044695272010-06-30T09:02:00.000-07:002010-06-30T09:03:13.067-07:00MDE CVS 20101. Anterior tibial artery?<br />2. Most common site of DVT<br />3. as a pathologist, you must examine av bundle histologically. In which of the following tissue sample will you find the av bundle?<br /><br />4. artery to the AV node arise from?<br />a. circumflex artery<br />b. RCA<br />c. right marginal<br />d. anterior interventricular<br />e. posterior interventricular<br /><br />14. Congenital heart disease karena kegagalan arteriopulmonary septum tumbuh secara spiral?<br />a. left atrium<br />b. right strium<br />c. interatrial septum<br />d. muscular interventricular septum<br />e. membranous interventricular septum<br /><br />untuk no 21-25: GAMBAR lapisan pembuluh darah arteri-vena<br />21. Endothelium<br />22. Internal elastic lamina<br />23. muscular layer<br />24. external elastic lamina<br />25. tunica adventitia<br /><br />Untuk nomor 26-<br />26.endocardium mitral valve<br />27. endocardium ventricle<br />28. subendocardium<br /><br />a.LDH<br />b.SGOT<br />c. DGBH<br />d. CKMB<br />e. Troponin<br />31.this test can assist in diagnosing reinfarction<br />32. this test is characteristically for qualitative test<br />33. remain 12th day post infarct<br />36. mass exam is better than activity exam<br /><br />A. Mg<br />B. Na<br />C. Ca<br />D. Potassium<br />E. Cl<br />41. Fisiologis Ca antagonis<br />42. Jumlah yang banyak pada mineral ini dapat menyebabkan kontraksi otot<br />43. Paling banyak di extracellular<br />44. Coenzim<br />45. Kation paling banyak di intracellular<br /><br />a. low sensitivity<br />b.low specificity<br />c. high sensitivity<br />d. high specificity<br />e. high sensitivity and high specificity<br />46. it is used as a screening test<br />47. it is used as a diagnostic test<br />48. if the result is negative, there is no disease<br />49. if the result is positive, there is a disease<br />50. it is only theoretical test<br /><br />51. One of WHO diagnostic criteria for AMI<br />a. ECG<br />b. treadmill<br />c. X-Ray<br />d. Echocardiography<br />e. Cardiac perfusion<br /><br />a. ECG<br />b. Treadmill<br />c. Chest X-Ray<br />d. Echocardiography<br />e. Cardiac perfusion scan<br />53. Check size of myocard damage<br />54. Test if ECG is failed to show abnormality<br />55. Measure size of heart<br /><br />68. If HR = 90 bpm, EDV = 150, CO = 6.3 L/min, ESV ?<br />a. unknown<br />b. 220<br />c. 200<br />d. 80<br />e. 60<br /><br />70. 1st heart sound<br />a. ventricular filling<br />b. closure aortic & pulmonary valve<br />c. vibration ventricular wall on systole<br />d. closure mitral & tricuspid valves<br />e. retrograde vena cava<br /><br />71. 4th heart sound<br /><br />104. heart auscultastion of ASD<br />a. wide split &fixed S2<br />B. narrow split S2<br />c. loud split S2<br />d. paradoxical split<br />e. normally splitting S2<br /><br />124. A 24 y.o man goes to the atletic field. HE runs for 1 hour. Physiologic CVS changes?<br />a. decrease pulmonary arterial resistance<br />b. increase pulmonary arterial pressure<br />c. increase total peripheral resistance<br />d. decrease diastolic pressure<br />e. increase SV<br /><br />128. symptom of large VSD?<br />Ans : poor feeding, rapid breathing<br /><br />129. Cause of subacute IE?<br />a. S. epidermidis<br />b. S. Viridans<br />c. S. aureus<br /><br />132. The most important cause of secondary pulmonary hypertension is…<br />a. chirosis of liver<br />b. scleroderma<br />c. pulmonary thromboembolism<br />d. COPD<br />e. Schistosomiasis<br /><br />133. 31 years old woman come to ER: progressive dyspnea, no fever over 1 week. She has delivered spontaneously 4th baby 5 weeks ago. No health problem before except mild hypertension. Diagnosis dyspnea :<br />a. Dilated cardiomyopathy<br />b. Restrictive cardiomyopathy<br />c. Hypertrophy cardiomyopathy<br />d. Pulmonary embolism<br />e. Pulmonary infarction<br /><br />136. Pasien dating ke ER dengan keluhan dyspnea on moderate activity. Ada thrill di apex. P2 accentuated. Diagnosis?<br />a. mitral regurgitation<br />b. mitral stenosis<br />c. aortic regurgitation<br />d. aortic stenosis<br />e. tricuspid stenosis<br /><br />139. unstable angina is characterized by…<br />a. angina after exercise<br />b. angina relieve by sublingual nitrate<br />c. angina <10 minutes<br />d. first onset angina<br />e. angina relieved by rest<br /><br />141. Thrombolytic paling tepat diberikan pada pasien?<br />a. ST depression<br />b. new bundle branch block<br />c. T inverted<br />d. non diagnose change<br />e. blocked atrioventricular<br /><br />142. A patient w/ symptoms of AMI has ST segment depression of 2 mm on the ECG lead I&AVL, this may reflect<br />a. inferior wall infarction<br />b. anterior wall infarction<br />c. anteroseptal wall infarction<br />d. high lateral wall infarction<br />e. anterolateral wall infarction<br /><br />145. Spironolactone<br />a. IV administration<br />d. water soluble potassium interfensi<br />e. reducing CHF<br /><br />146. function of risk stratification in CAD?<br />a. looking for risk stratification<br />b. choosing 1st or secaondary prevention<br />c.<br />d.choosing appropriate treatment<br />e.<br /><br />147. What is the following patient of heart failure who needs β-adrenergic bloacker<br />a. ?<br />b. class III NYCA heart failure<br />c. sinus rhythm + rate = 40 bpm<br />d. advance heart block<br />e. patient depression<br /><br />151. MoA amiodarone<br />a. blocking Na channel<br />b. blocking Ca channel<br />c. blocking K channel<br /><br />152. Acute pericarditis…<br /><br />153. ER chest pain+fever ; pericardial friction rub; ↑ WBC + ESR<br />Acute pericarditis presentation?<br />a. pain onset crescendo<br />b. more comfortable in recumbence<br />c. abnormal S3 & S4<br />d. Pulmonary congestion in sever pericarditis<br />e. Rubs last hours to days<br /><br />156. WOTF statement is true about physical finding in acute pericarditis?<br />a. Acute pericarditis produces retrosternal pain.<br />b. Pericardial friction rub is the hallmark of acute pericarditis.<br />c. Pericardial pain is almost always relieved by lying down.<br />d. Most pericardial friction rub are louder during expiration.<br />e. The friction rub is best heard while the patient is lying down.<br /><br />157. PE cardiac tamponade:<br />a. arterial hypotension, wide pulse pressure<br />b.prominent basal rales and dyspnea<br />c. a rapid X descent, pulsus paradoxus, arterial hypotension<br />d. rapid X and Y descent, tachycardia<br />e. normal JVP, pulsus alternans<br />159. Pathophysiology of constrictive pericarditis :<br />a. Increased cardiac index of consequence of impaired filling<br />b. Normal EF and contraction<br />c. Ventricular filling occurs in every early diastole<br />d. Isovolumetric relaxation → increased period<br />e. …? Venous return during diastole ↑??<br /><br />160. WTOF statement about pericardiocentesis is TRUE…<br />a. An anti-inflammatory agent is recommended prior to pericardiocentesis<br />b. Surgical intervention (pericardial window) usually better than percutaneous pericardiocentesis<br />c. size of effusion is well correlated w/ probability of successfully obtaining pericardial fluid<br />d. IV hydration should be initiated before threatened tamponade is diagnosed<br />e. pericardiocentesis especially useful in which a loculated effusion is present<br /><br />162. patient present w/ systemic embolic event 1mo after MV replacement. For the past 1 week experience febrile. Blood culture, what organism?<br />a. S.viridans<br />B. S. aureus<br />c. Staphilococcus epidermidis<br />d. E. fecalis<br />e. Candida albicans<br /><br />168. Thrombolytic therapy Is primarily indicated to patients with AMI whose ECG shows:<br />a. ST elevation<br />b. ST depression<br />c. T wave inversion<br />d. Pathologic Q wave<br />e. any ECG changes<br /><br />171. definitive diagnosis CAD<br />a. coronary angiography<br />b. resting ECG<br />c. Exercise ECG<br />d. Cardiac enzyme<br />e. Echocardiography<br /><br />172. factor most important in pulmonary hypertension in COPD<br />a. Loss small vessel inmost vascular regions<br />b. emphysema & lung destruction<br />c. pulmoany vasculature constriction due to hypoxia<br />d. ↑ CO from polycythemia<br />e. ↑ blood viscosity secondary to hypoxia<br /><br />175. in the training phase a rehabilitation program following MI, a conditioning program is used to increase the physical work capacity. This conditioning program is one..<br />a. passively<br />b. passive active<br />c. assistive<br />d. actively<br />e. active resistive<br /><br />176. in the training phase, target HR fot exercise training is:<br />a. 55-65% of maximal HR<br />b. 65-75% of maximal HR<br />c. 75-85% of maximal HR<br />d. 85-95% of maximal HR<br />e. 95-100% of maximal HR<br /><br />194. Cardiac phenotypic changes result to alteration of cardiac cells metabolic rates, such as :<br />a. decrease calcium removal<br />b. increase cardiac contractility<br />c. decrease cardiac relaxation<br />d. decrease perfusion pressure<br />e. increase stiffness of the heart<br /><br />?. Gangguan genetic metabolism mucopolysaccharides menyebabkan…<br />a. CHD<br />b. VHD<br />c. RHD<br /><br />? Pulmonary vasodilator? Nitric Oxidesuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com1tag:blogger.com,1999:blog-3810580967966978266.post-43892518262877383952010-06-17T06:51:00.000-07:002010-06-17T08:42:03.393-07:00MDE CVS 2009MDE CVS 2009<br />Nb : tmen2,nie ada bbrp jawaban yang fotokopiannya beda sendiri. Yang ada tanda tanya artinya ga yakin. Sori ya ga pake alasan,soalnya ngerjainnya buru2,klo bisa dicek sendiri sekalian belajar juga...:) klo masih banyak kekurangan mohon dimaafkan...-__-<br /><br />1. D<br />2. E<br />3. C<br />4. D<br />5. C (sebenernya tepatnya letak mitral valve di posterior sternum costal 4)<br />6. E<br />7. D<br />8. E<br />9. C<br />10. D<br />11. E<br />12. B<br />13. C<br />14. E<br />15. A<br />16. ??? (mungkin low level HDL atau high level LDL)<br />17. B (ga ada soalnya tapi mungkin nanya ttg AST/ALT,liat di soal yg buku)<br />18. ??? (angkanya ga jelas,tapi cara ngitungnya CKMB/CK total. Satuannya jgn lupa disamain dulu 1 IU = 0.025 microgram)<br />19. C<br />20. B<br />21. C<br />22. B<br />23. A<br />24. D<br />25. B<br />26. D<br />27. C<br />28. E<br />29. F<br />30. E<br />31. C<br />32. C<br />33. C<br />34. A???<br />35. C<br />36. E<br />37. E<br />38. A<br />39 D<br />40. C<br />41. B<br />42. A<br />43. D<br />44. C???<br />45. E<br />46. D<br />47. D<br />48. A/C/D???<br />49. B???<br />50. E<br />51. A<br />52. D???<br />53. C<br />54. A???<br />55. C<br />56. D<br />57. B<br />58. E<br />59. B<br />60. D???<br />61. E<br />62. C/E<br />64. C<br />67. A<br />68. ??? (harusnya diffuse ST elevation & PR segment depression)<br />69. D???<br />71. C<br />73. C<br />74. C<br />75. B???<br />77. E<br />79. ???<br />80. D???<br />81. D<br />83. D<br />86. B<br />87. B <br />88. A<br />89. A<br />90. C<br />91. D<br />92. D<br />93. B<br />94. C<br />95. B<br />96. E<br />97. C<br />98. E<br />99. D<br />100. B<br />101. A/B<br />102. opening K+<br />103. D<br />104. B<br />105. E<br />106. A<br />107. A<br />108. C<br />109. A<br />110. A<br />111. B<br />112. A<br />118. C???<br />119. B???<br />120. A<br />121. B<br />124. D<br />125. B<br />126. A<br />127. D??<br />128. D<br />129. C<br />130. E<br />132. A<br />133. C<br />134. D<br />135. D<br />136. E<br />137. D<br />138. C<br />139. D<br />140. C<br />141. B<br />142. C???<br />143. C???<br />144. A<br />145. ???<br />157. B<br />158. A???<br />159. C<br />160. B<br />161. A<br />162. D<br />163. B<br />164. C<br />165. E<br />166. D<br />167. A<br />168. A???<br />169. B???<br />170. E???<br />171. D???<br />172. C???<br />173. ???<br />174. C???<br />175. C<br />176. E???<br />187. B<br />188. C<br />189. A<br />190. B<br />191. C???<br />192. D<br />193. B<br />194. B<br />195. B<br />196. D<br />197. B<br />198. E<br />199. D<br />200. Bsuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-14521268900364469962010-06-16T05:21:00.001-07:002010-06-16T22:33:17.460-07:00MDE CVS 20051. Jawaban : B. Secundum defect<br />Alasan : Nelson hlm 1506<br />2. Jawaban : A. Widely fixed & split S2<br />Alasan : Nelson hlm 1506<br />3. Jawaban : D. The ductus arteriosus normally diverts 80% of RV output<br />Alasan : Lilly hlm 379<br />4. Jawaban : ???<br />Alasan : Kemungkinan A,soalnya opsi lain ga mungkin<br />5. Jawaban : B. VSDs may be associated with coarctation of aorta<br />Alasan : Nelson hlm 1508<br />6. Jawaban : ???<br />Alasan :<br />7. Jawaban : ???<br />Alasan :<br />8. Jawaban : C. TOF<br />Alasan : Lilly hlm 390-391<br />9. Jawaban : E. Premature closure of foramen ovale<br />Alasan : foramen ovale harusnya menutup setelah lahir bukan pada saat prenatal life<br />10. Jawaban : D. Coarctation of aorta<br />Alasan :Lilly hlm 389<br />11. Jawaban : D. TGA<br />Alasan : Lilly hlm 393<br />12. Jawaban : A. Atrial septal defect<br />Alasan : Lilly hlm 380-381<br />13. Jawaban : B. Hypoplasia of endocardial cushion <br />Alasan : Lilly hlm 380-381<br />14. Jawaban : D. The diatal part of 6th aortic arch<br />Alasan : Moore embryology hlm 361-365<br />15. Jawaban : A. Aortic regurgitation<br />Alasan : Lilly hlm 42<br />16. Jawaban : <br />Alasan : Most cases of congenital heart disease were thought to be multifactorial and result from a combination of genetic predisposition and environmental stimulus (nelson) <br />17. Jawaban : D. Arteries <br />Alasan : stretch receptor ada di aorta dan carotid sinus<br />18. Jawaban : C. Closure of foramen ovale due to increase pressure at left atrium<br />Alasan : yang lain kurang tepat<br />19. Jawaban : B. Period of isovolumic (isometric) contraction<br />Alasan : guyton hlm 107<br />20. Jawaban : D. Higher frequency<br />Alasan : Lilly hlm 32-33<br /><br />21. d. TOF: aorta overriding, RV hypertrophy, VSD, pulmonary artery stenosis<br />22. A. berikut statement dari emedicine tentang VSD: “A measurement of LA and left ventricular (LV) diameters provides semiquantitative information about shunt volume. The size of the defect is often expressed in terms of the size of the aortic root. Defects that approximate the size of the aortic root are classified as large, those one third to two thirds of the diameter of the aorta are classified as moderate, and those less than one third of the aortic root diameter are classified as small”,<br />Pada defect lain, pada pemeriksaan defect, tidak ditemukan hubungan dengan aorta.<br />23. D. pada VSD terjadi shifting left to right peningkatan volume yang ada di RV pulmonary left atrium enlargement<br />Juga terdapat systemic insufficiency kalo VSD besar stimulate Left ventricular enlargement. Jadi tidak ada keterlibatan right atrium<br />24. e. gambaran PDA adalah leftright shunt dengan adanya left side chambers enlargement dengan adanya prominent pulmonary vascular marking.<br />25. a. CTR: infant >= 50%; dewasa < 50%<br />26.<br />27.<br />28. bingung. S.Aureus dan S.viridans merupakan leading cause dari endocarditis pada pada pediatric pasien. S.aureus lebih sering pada kejadian tanpa adanya underlying disease, sedangkan s.viridans terjadi lebih sering setelah melakukan dental procedure.. jadi jawabannya antara a/b, tergantung nanti soal mintanya apa..<br />29.C. untuk prophylaxis antibiotic digunakan penicillin, tapi kalo alergi diaganti cephalixin or clindamycin or azithromycin<br />30. e. bisa karena infectious microorganism, autoimmune mediated cytotoxicit, cytokine damage. Tapi yang paling sering adalah virus (enterovirus ssRNA that include coxsackie virus dan echovirus)<br />31. b. komplikasi dari myocarditis adalah : - fatal heart failure dan arrythmia <br /> - myocardial dysfunction<br />32. C<br />33.?<br />34. D. etio dari subacute endocarditis yang saya dapat adalah bakteri gram negative HACEK dan S.viridans.. tapi S.viridans memiliki angka kejadian 50-60% dari subacute endocarditis<br />39. B. polyarthritis : >=75%; carditis = 40-60%; chorea = 5-36%; erythema marginatum lalu subcutaneous nodule prevelansi hanya angka satuan persen.<br />40. C. based on major dan minor criteria, paling sering untuk muncul dan memperkuat diagnosis RF adalah major. Maka itu salicylate untuk relieve dari arthritis. Fever dapar diminish tanpa antipyretic therapy dalam 1 minggu atau low grade fever persisten selama 2 minggu.<br />61. D<br />62. C<br />63. A<br />64. D<br />65. B (ga yakin,sori)<br />66. A<br />67. C<br />68. ga ada soalnya<br />69. C<br />70. D<br />71. D<br />72. ga tau,sori<br />73. C<br />74. D<br />75. A<br />76. A<br />77. ga tau,sori<br />78. D<br />79. D<br />80. D<br /><br />161. Of the following statement regarding the ECG of a patient with history of coronary artery disease below is true, except<br /> A. sinus rhythm with 1st degree AV block<br /> B. myocardial infarction, age undetermined<br /> C. pair of PVCs<br /> D. ventricular tachycardia<br /> Jawab: A<br /> Pembahasan:<br />Dari gambar EKG, terlihat jelas bahwa pasien mengalami tachyarrhythmia (jarak kompleks R ke R berikutnya sempit).<br />Karena QRS kompleks-nya lebar, maka bisa kita simpulkan bahwa ini adalah ventricular tachyarrhythmia.<br />Lihat di bagian tengah hingga akhir gambaran EKG, bentuk gelombangnya monomorphic. Maka bisa disimpulkan ini adalah monomorphic ventricular tachycardia. Monomorphic VT biasa terjadi karena adanya abnormalitas struktural yang mendukung terbentuknya suatu reentry circuit, biasanya karena ada myocardial scar karena old infarct atau cardiomyopathy. Secara definisi, VT adalah “a series of three or more VPB/PVCs”.<br />Jadi option B, C, D benar.<br />Option A salah karena 1st degree AV block termanifestasi sebagai bradyarrhythmia dengan pemanjangan PR interval.<br /><br />162. From the features of ECG of a patient in his 5th day in the CCU below, which statement is not?<br /> A. normal sinus rhythm<br /> B. recent myocardial infarction<br /> C. a possible left ventricular aneurysm<br /> D. PACs with trigeminy pattern<br /> E. non-compensatory pause<br /> Jawab: B<br /> Pembahasan:<br /> Dari gambar, terlihat:<br />1. Ada PAB/PAC (gelombang EKG yang kedua ke yang pertama jaraknya lebih sempit daripada jarak gelombang EKG yang kedua ke yang ketiga).<br />2. Ada elevasi ST segmen<br />Maka,<br />Opsi A salah, ada PAC bukan sinus rhythm.<br />Opsi B benar, ada elevasi segmen ST new/recent myocardial infarction<br />Opsi C salah, LV aneurysm biasanya ditunjukkan dengan gambaran sustained VT.<br />Opsi D tidak bisa dinilai, karena trigeminy berarti ada satu PAC dalam setiap 3 beat. Gambar tidak cukup panjang untuk menilai ini.<br />Opsi E salah, tidak terlihat pause.<br /><br />163. All the statement below regarding the features of ECG of a 52-year-old male patient with chest pain and hypoventilation are true, except<br /> A. sinus rhythm with 3rd degree AV block<br /> B. 2nd degree AV block type 1<br /> C. functional escape rhythm<br /> D. acute inferior wall myocardial infarction<br /> E. reciprocal ST-T changes at 1, aVL, V1-V4<br /> Jawab: ?? Tidak ada gambaran EKG-nya!<br /> Pembahasan opsi:<br /> Opsi A: sinus rhythm with 3rd degree AV block secara definisi salah. 3rd degree AV block terjadi jika ada “complete failure of conduction between the atria and ventricles”, berarti depolarisasi atrium (gelombang P) dan depolarisasi ventrikel (kompleks QRS) akan berjalan sendiri-sendiri. Sementara, salah satu syarat sinus rhythm adalah gelombang P yang selalu diikuti kompleks QRS.<br /> Opsi B: 2nd degree AV block type 1 ciri-cirinya ada prolongation dari interval PR dari beat ke beat hingga pada satu titik, impulse dari atrium tidak dikonduksikan ke ventrikel (gelombang P tanpa kompleks QRS), lalu siklus berulang.<br /> Opsi C: functional escape rhythm ada gambaran PAC (PAB) atau PVB (PVC).<br /> Opsi D: acute inferior wall MI mungkin saja benar, karena pasien sedang mengalami chest pain.<br /> Opsi E: reciprocal ST-T changes pada lead I, aVL (lateral) dan V1-V4 (anterior) berarti MI-nya terjadi pada dinding inferior? Sama dengan opsi D.<br /><br />164. Which of the following statement regarding ventricular arrhythmia in the ECG below is true<br /> A. VCs multifocal, with R-on-T phenomenon, atrial fibrillation<br /> B. VCs multifocal, with R-on-T phenomenon, paired PVC, atrial fibrillation<br /> C. VCs multifocal, with R-on-T phenomenon, paired PVC<br /> D. VCs multifocal, with R-on-T phenomenon, non-sustained ventricular tachycardia<br /> E. VCs multifocal, with R-on-T phenomenon, paired PVC, non-sustained ventricular tachycardia<br /> Jawab: jawaban 2006: C <br /><br />165. Which of the following statement regarding the features in the ECG below is true?<br /> A. atrial flutter with ventricular facing bea<br /> B. atrial flutter with consecutive PVCs<br /> C. atrial fibrillation<br /> Jawab: C (sepertinya, karena P wave-nya tidak jelas)<br /><br />166. Which of the following statement regarding atrioventricular block is not true?<br /> A. 2nd degree AV block type I is usually located at the AV nodal level<br /> B. 2nd degree AV block type II is usually located at the intranodal level<br /> C. asymptomatic patients with a 3rd degree AV block at the AV nodal level should have permanent pacing<br /> D. the slight variation in the patients in sinus rhythm and 3rd degree AV block<br /> E. pacing is not indicated in patients with 1st degree AV block<br /> Jawab: C<br /> Pembahasan:<br /> Atrioventricular Block<br />1. First Degree AV Block<br />• The impairment of conduction is usually within the AV node itself.<br />• During first-degree AV block, every atrial impulse conducts to the ventricles and a regular ventricular rate is produced, but the PR interval exceeds 0.20 second in adults. <br />• Clinically important PR interval prolongation can result from a conduction delay in the AV node (A-H interval), in the His-Purkinje system (H-V interval), or at both sites. <br />2. Second Degree AV Block<br />• Mobitz Type I block is usually as a result of intermittent impairment in AV node itself, while Type II block is usually due to that in His-Purkinje system.<br />• Blocking of some atrial impulses conducted to the ventricle at a time when physiological interference is not involved constitutes second-degree AV block.<br />• The nonconducted P wave can be intermittent or frequent, at regular or irregular intervals, and can be preceded by fixed or lengthening PR intervals. <br />• Electrocardiographically, typical type I second-degree AV block is characterized by progressive PR prolongation culminating in a nonconducted P wave , whereas in type II second-degree AV block, the PR interval remains constant prior to the blocked P wave <br />3. 3rd Degree AV Block<br />• Third degree or complete AV block occurs when no atrial activity is conducted to the ventricles and therefore the atria and ventricles are controlled by independent pacemakers complete AV dissociation.<br />• The atrial pacemaker can be sinus or ectopic (tachycardia, flutter, or fibrillation) or can result from an AV junctional focus occurring above the block with retrograde atrial conduction. The ventricular focus is usually located just below the region of the block, which can be above or below the His bundle bifurcation.<br />• Complete AV block can result from block at the level of the AV node (usually congenital), within the bundle of His, or distal to it in the Purkinje system (usually acquired).<br /><br /> Management AV block:<br />• Drugs cannot be relied on to increase the heart rate for more than several hours to several days in patients with symptomatic heart block without producing significant side effects<br />• temporary or permanent pacemaker insertion is indicated for patients with symptomatic bradyarrhythmias<br />• For short-term therapy, when the block is likely to be evanescent but still requires treatment or until adequate pacing therapy can be established, vagolytic agents such as atropine are useful for patients who have AV nodal disturbances, whereas catecholamines such as isoproterenol can be used transiently to treat patients who have heart block at any site.<br />• For symptomatic AV block or high-grade AV block (e.g., infrahisian, type II AV block, third-degree heart block not caused by congenital AV block), permanent pacemaker placement is the treatment of choice<br /><br /> Dari pembahasan di atas, maka<br /> Opsi A benar.<br /> Opsi B benar.<br />Opsi C salah (3rd degree AV block pada AV nodal level biasanya congenital, jadi tidak perlu pacemaker, apalagi jika asymptomatic).<br /> Opsi D ??<br /> Opsi E benar.<br /><br />167. Which of the following statements regarding electrical abnormalities in the heart and sudden cardiac death is true?<br /> A. arrhythmic events in patients with long QT syndromes I are often triggered by auditory stimuli<br /> B. the risk of sudden death in Wolff-Parkinson-White Syndrome is high and often occurs in otherwise healthy individuals<br /> C. patients with idiopathic polymorphic ventricular tachycardia have a good prognosis<br /> D. younger patients who survived SCD have a higher incidence of idiopathic ventricular fibrillation<br /> E. most cases of idiopathic ventricular tachycardia originate from the left ventricular outflow tract<br /> Jawab: paling mungkin sih B<br /> Pembahasan:<br /> Opsi A: Long QT syndrome I Di Braunwald disebutkan, pada LQTS, “Patients should undergo prolonged electrocardiographic recording with various stresses designed to evoke ventricular arrhythmias, such as auditory stimuli, psychological stress, cold pressor stimulation, and exercise.” arrhythmic events bisa ditrigger oleh auditory stimuli.<br /> Opsi B: Wolf-Parkinson-White Syndrome the anomalous pathways of conduction, bundles of Kent in the Wolff-Parkinson-White syndrome and Mahaim fibers, are commonly associated with nonlethal arrhythmias. However, when the anomalous pathways of conduction have short refractory periods, the occurrence of atrial fibrillation may allow the initiation of VF during very rapid conduction across the bypass tract .<br /> Opsi C dan E: idiopathic polymorphic VT polymorphic VT (seperti torsades de pointes) biasanya akan berdegenerasi menjadi VF yang sering menjadi penyebab sudden cardiac death. Jadi, prognosisnya buruk. Opsi E juga kemungkinan salah karena VT tidak mungkin berasal dari outflow tract LV (dekat aorta).<br /> Opsi D: sudden cardiac death.. g nemu.<br /><br />168. As anti-arrhythmic agent, the mechanism of action of amiodarone is<br /> A. blocking Na channel<br /> B. blocking Ca channel<br /> C. blocking K channel<br /> D. sympatholytic action<br /> E. inhibiting Na-K ATP-ase<br /> Jawab: A<br /> Pembahasan:<br /> AMIODARONE<br /> Effects:<br />• Acute effects include prolong action potential duration of ventricular muscle but shorten the action potential duration of Purkinje fibers. They also reduce sinus and junctional discharge rates and prolong AV nodal conduction time.<br />• Chronically, amiodarone prolongs action potential duration and refractoriness of all cardiac fibers without affecting resting membrane potential.<br />• Hemodynamically, amiodarone is a peripheral and coronary vasodilator. It decreases heart rate, systemic vascular resistance, LV contractile force. However, because it is able to control the arrhythmia, it does not reduce ejection fraction nor cardiac output.<br /> Mechanism of action:<br />1. It blocks the inactivated sodium channel, therefore reducing maximum conduction velocity.<br />2. It increases resistance to passive current flow.<br />3. It antagonizes alpha and beta receptor noncompetitively<br />4. It blocks conversion of thyroxine (T4) to triiodothyronine (T3)<br /> Sumber: Braunwald<br /><br />169. Which of the following is the best therapy to relieve symptom in acute pericarditis?<br /> A. oral antisteroidal anti-inflammatory agents and colchicines<br /> B. oral antisteroidal anti-inflammatory agents and indomethacine<br /> C. oral antistreoidal anti-inflammatory agents and corticosteroid<br /> D. corticosteroid: colchicines and indomethacine<br /> E. corticosteroid<br /> Jawab: A<br /> Pembahasan:<br /> Management Acute Pericarditis<br /> Management dari pericarditis bertujuan:<br />- Deteksi etiologi yang memiliki implikasi terhadap management (misal, jadi harus ganti antibiotic)<br />- Deteksi effusion dan other echocardiographic abnormalities<br />- Meringankan symptom<br />- Treatment yang sesuai dengan etiologi yang spesifik<br />Acute idiopathic pericarditis merupakan self-limited disease tanpa komplikasi yang significan dan tanpa reccurence pada 70-90% pasien. Jika lab menunjukkan idiopathic acute pericarditis, maka NSAID (biasanya ibuprofen 600-800 mg p.o. tdd) hingga 2 minggu jika nyeri dada sudah tidak dirasakan lagi.<br />Jika pasien tidak merespon dengan baik pada awal pemberian NSAID, maka sebaiknya diopname untuk observasi dan tes tambahan.<br />Jika pasien merespon secara lambat, maka diperlukan tambahan analgesic narcotic dan/atau colchicines atau prednisone.<br />Pada pasien yang mengalami RECURRENT acute idiopathic pericarditis (15-30% dari pasien yang merespon secara memuaskan thd management yang disebutkan di atas), perlu dilakukan evaluasi untuk kemungkinan penyakit autoimmune, dan kadang (jarang) diperlukan biopsi pericardium. Pada kelompok pasien ini, diberikan lagi NSAID selama 2 minggu, lalu diberikan colchicines prophylaxis. Jika pasien tidak membaik, maka diberikan short course of prednisone ketika terasa gejala, namun ini tidak dilakukan secara kronis. Pericardiotomy bisa juga dilakukan, tapi hanya efektif pada sebagian kecil pasien.<br /> Sumber: Braunwald<br /><br />170. A 30-year-old man came to ER with fever and chest pain. On physical examination, pericardial friction rub was heard. Laboratory finding revealed elevated WBC and ESR. Which of the following is a typical presentation of acute pericarditis?<br /> A. the onset of pain is usually crescendo<br /> B. the patient feels more comfortable in recumbence<br /> C. abnormal S3 and S4<br /> D. pulmonary congestion may be present in severe pericarditis<br /> E. rub can last hours to days<br /> Jawab: A<br /> Pembahasan:<br /> ACUTE PERICARDITIS<br /> Sign and symptom:<br />6. Chest pain (pasien hampir selalu datang dengan keluhan ini), nyerinya severe. Kualitasnya rapid onset, terletak substernal (bisa juga pada dada kiri atau epigastrium kiri), dan biasa beradiasi ke lengan kiri atau ke trapezius ridge. Nyeri akan membaik jika duduk membungkuk dan akan memburuk jika berbaring.<br />7. Dyspnea<br />8. Fever<br />9. Cough<br />10. Hiccoughs (hiccups)<br />Pemeriksaan Fisik:<br />4. Pasien terlihat uncomfortable, anxious<br />5. Vital signs: low-grade fever, sinus tachycardia<br />6. Auskultasi jantung: ada friction rub yang terdiri atas 3 komponen. Komponen pertama terjadi pada ventricular systole, lalu pada early diastolic filling, dan pada atrial contraction. Bunyinya mirip suara berjalan pada crunchy snow. Rub paling terdengar pada lower left sternal border hingga cardiac apex, dan paling keras jika posisi pasien duduk membungkuk. Rub-nya dinamis, kadang muncul kadang menghilang.<br /> Sumber: Braunwald<br /> Dari Lilly disebutkan, onset dari chest pain biasanya crescendo.<br /> Opsi A benar<br /> Opsi B salah, pasien memburuk jika berbaring<br /> Opsi C salah, tidak ada S3 dan S4<br /> Opsi D salah, tidak ada pulmonary congestion<br /> Opsi E salah, karena rub intermittent.<br /><br />171. Which of the following ECG changes are typical for acute pericarditis?<br /> A. inverted T waves while ST segment still elevated<br /> B. localized convex ST segment elevation<br /> C. diffuse concave ST segment elevation<br /> D. frequent PVCs<br /> E. first degree AV block<br /> Jawab: C<br /> Pembahasan:<br /> Electrocardiogram pada acute pericarditis menunjukkan temuan-temuan sbb:<br />4. Diffuse ST segment elevation (merupakan classic finding dalam perikarditis akut).<br />5. Depresi segmen PR merupakan manifestasi yang lebih awal, biasanya terjadi sebelum ada rub maupun elevasi segmen ST<br />6. Sangat jarang terjadi elevasi ST yang berprogresi ke depresi segmen ST disertai inversi gelombang T.<br /> Sumber: Braunwald<br /><br />172. Which of the following statement is true?<br /> A. Acute pericarditis produces dull retrosternal pain<br /> B. Pericardial friction rub is the hallmark of acute pericarditis<br /> C. The stethoscope bell should be placed firmly on the chest wall<br /> D. Most pericardial friction rubs are louder during expiration<br /> E. ASA 650 mg, q3-4th is the drug of choice in recurrent pericarditis<br /> Jawab: B<br /> Pembahasan:<br /> Lihat pembahasan no. 169-170<br /> Opsi A salah, pada acute pericarditis, nyeri dada berkualitas sharp<br /> Opsi C salah, tidak disebutkan bahwa pericardial rub hanya terdengar jika menggunakan bell.<br /> Opsi D salah, pericardial friction rub bisa ada dan menghilang secara tiba-tiba (intermittent).<br />Opsi E tidak sepenuhnya benar, pada recurrent pericarditis, harus diberikan prophylaxis berupa colchicines juga.<br />Opsi B benar, karena friction rub paling parah terdengar saat fase pericarditis. Saat fase effusion, friction rub makin melemah. Karena itu, friction rub adalah hallmark dari pericarditis.<br /><br />173. Which of the following regarding the physical examination of cardiac tamponade is true?<br /> A. Elevation of pericardial pressure, pulsus paradoxus, and arterial hypertension<br /> B. Basal rales are typically present<br /> C. There is rapid x descent, pulsus paradoxus, and arterial hypotension<br /> D. There are rapid x and y descent in the jugular venous pulse<br /> E. There are normal jugular venous pressure and pulsus alternans<br /> Jawab: C<br /> Pembahasan:<br /> Patofisiologi Cardiac Tamponade (CT)<br /> CT dicirikan dengan suatu continuum yang dimulai dari efusi pericardium tanpa efek yang jelas yang berlanjut ke circulatory collapse. Ini tergantung pada tekanan di pericardium (yg meningkat karena efusi) dan kemampuan jantung untuk mengkompensasi peningkatan tekanan tersebut.<br /> Volume cairan di pericardium biasanya hanya sedikit, jadi peningkatan jumlah cairan yang rapid, walaupun dalam jumlah kecil, dapat dengan cepat meningkatkan tekanan pericardium dan berpengaruh pada fungsi jantung. Sebaliknya, slowly accumulating effusion, walaupun jumlahnya besar, dapat ditolerir dengan baik.<br /> Kompensasi jantung bergantung terutama pada respon sympathetic untuk meningkatkan heart rate dan kontraktilitas. Pada pasien yang meminum beta-blocker, maka respon ini minimal dan kompensasi jantung tidak maksimal.<br /> Seiring dengan menumpuknya cairan pada pericardial cavity, akan terjadi peningkatan tekanan diastolic pada ruang-ruang jantung sehingga tekanannya sama dengan tekanan pad pericardial cavity (fenomena ini disebut equalization). Karena meningkatnya tekanan, maka volume darah di jantung akan berkurang (preload berkurang), menyebabkan berkurangnya stroke volume. Karena jantung kanan dindingnya lebih tipis dan kurang bisa beradaptasi terhadap peningkatan tekanan, maka peningkatan tekanan di jantung kanan lebih cepat daripada di jantung kiri (namun pada akhirnya akan mencapai tekanan yg sama, yakni tekanan pericardial cavity).<br /> Kelainan hemodinamik lainnya:<br />3. Loss of y descent of RA (or systemic venous) pressure (without loss of x descent)<br />Ini didasarkan pada konsep bahwa, pada severe CT, total heart volume tetap (tidak berkurang maupun bertambah, tidak dipengaruhi oleh kontraksi-relaksasi). Karena itu, darah hanya bisa mengalir ke jantung saat darah (yang tadinya ada di jantung) dipompa keluar. Karena itu, y descent, yang menggambarkan penurunan tekanan atrium setelah atrium berkontraksi, tidak tergambarkan.<br />4. Paradoxical pulse<br />Paradoxical pulse menggambarkan berkurangnya tekanan arteri sistemik secara abnormal (>10 mmHg) saat inspirasi. Pada CT (dan secara fisiologis), terjadi peningkatan systemic venous return saat inspirasi (sehingga systemic venous pressure berkurang). Ketika total volume jantung tetap, maka peningkatan venous return ini akan menyebabkan interventricular septum untuk shift to the left saat inspirasi, sehingga membuat LV menjadi sempit, dan stroke volume (LV pressure) berkurang secara abnormal. Karena itu, tekanan arteri sistemik pun berkurang saat inspirasi.<br /> Diagnosis Cardiac Tamponade<br />f. Anamnesis: pasien mengeluhkan dyspnea, kadang ada pericardial pain atau discomfort, yang akan membaik jika duduk membungkuk (sitting and leaning forward). Terdapat pula gejala-gejala yang berkaitan dengan berkurangnya cardiac output, seperti fatigue, weakness, dizziness.<br />g. Physical examination: Beck’s triad (hypotension, muffled heart sounds, elevated jugular venous pressure), tachypnea, diaphoresis, cool extremities, peripheral cyanosis, depressed sensorium, yawning. Terdapat pulsus paradoxus. Cardiac impulse tidak ada atau berkurang. Terdapat friction rub.<br />h. Radiography: = pericardial effusion<br />i. Electrocardiography: = pericardial effusion<br />j. Echocardiography: lucent separation between parietal and visceral pericardium is circumferential (usually). Ada collapse dari RV pada saat early diastole dan collapse pada RA pada saat ventricular diastole (kalau tidak ada collapse, biasanya menunjukkan effusion, bukan tamponade).<br /><br />174. Which of the following statement is NOT true about pathophysiology of cardiac tamponade?<br /> A. Cardiac tamponade occurs when intracardial pressure is equal to RA and RV diastolic pressure<br /> B. In the presence of hypovolemia, cardiac tamponade may be more difficult to detect<br /> C. Equalization of intrapericardial and ventricular filling pressure may lead initially to a small increase in stroke volume<br /> D. Sinus bradycardia may occur during severe cardiac tamponade<br /> E. Hemodynamic deterioration during tamponade is dependent upon atria; compression during diastole<br /> Jawab: C<br /> Pembahasan:<br /> Lihat patofisiologi cardiac tamponade (CT) di no. 173 <br /><br />175. Which of the following statement about bacterial pericarditis is NOT true?<br /> A. Uremic pericarditis may predispose to the development of purulent bacterial pericarditis<br /> B. Direct extension into pericardium of bacterial pneumonia accounts for the majority of cases of purulent pericarditis<br /> C. Bacterial pericarditis is most often an acute fulminant illness that develops over a few days<br /> D. Long term survival after purulent bacterial pericarditis remains poor despite the availability of antibacterial therapy<br /> E. High concentration of antibiotics may be achieved in pericardial fluid<br /> Jawab: A<br /> Pembahasan:<br /> BACTERIAL PERICARDITIS<br />1. Etiologi<br />Bacterial pericarditis is usually characterized by a purulent effusion. Direct extension from pneumonia or empyema accounts for a majority of cases. The most common agents are staphylococci, pneumococci, and streptococci. Hematogenous spread during bacteremia and contiguous spread after thoracic surgery or trauma are also important mechanisms. Hospital-acquired, penicillin-resistant staphylococcal pericarditis following thoracic surgery has been increasing. Anaerobic organisms are also increasing in frequency. Concomitant infection in the mediastinum, head, or neck is commonly associated with anaerobes.<br />2. Clinical Features<br />The clinical presentation of bacterial pericarditis is usually high-grade fever with shaking chills and tachycardia, but these may be absent in debilitated patients. Patients may complain of dyspnea and chest pain. A pericardial friction rub is present in the majority. Bacterial pericarditis can take a fulminant course with rapid development of tamponade and may be unsuspected because associated illnesses such as severe pneumonia or mediastinitis following thoracic surgery dominate the clinical picture.<br />3. Management<br />Suspected or proven bacterial pericarditis should be considered a medical emergency, and prompt closed pericardiocentesis or surgical drainage performed. We recommend at least 3 to 4 days of subsequent catheter drainage. The actual length is dependent on the volume and nature (i.e., purulence) of the fluid. Fluid should be Gram stained and cultured for aerobic and anaerobic bacteria with appropriate antibiotic sensitivity testing. Fungal and tuberculosis staining and cultures should also be performed. Blood, sputum, urine, and recent surgical wounds should all be cultured. Broad-spectrum antibiotics should be started promptly and then modified according to culture results. Anaerobic coverage is critical when pericarditis associated with head and neck infections is suspected.<br />4. Prognosis<br />The prognosis of bacterial pericarditis is generally poor, with survival in the range of 30 percent even in modern series<br /> <br /> KLASIFIKASI PERICARDITIS (menurut Lilly)<br />A. Infectious<br />1. Idiopathic and viral pericarditis<br />2. Tuberculous pericarditis<br />3. Nontuberculous bacterial pericarditis (purulent pericarditis)<br />B. Non-Infectious<br />1. Pericarditis following myocardial infarction<br />2. Uremic pericarditis<br />3. Neoplastic pericarditis<br />4. Radiation-induced pericarditis<br />5. Pericarditis associated with connective tissue diseases<br />6. Drug-induced pericarditis<br /><br /> Opsi A salah, karena uremic pericarditis adalah salah satu jenis pericarditis noninfectious.<br /> Opsi B benar (lihat pembahasan)<br /> Opsi C benar (lihat pembahasan)<br /> Opsi D benar (lihat pembahasan)<br /> Opsi E g nemu, tapi sepertinya benar.<br /><br />176. Streptococcus sp. Cause endocarditis in about 70% of cases. Streptococcus viridans are the most common pathogens, followed by enterococci. The procedure to detect this organism is obtaining blood for?<br /> A. Bacterial culture<br /> B. Microscopic observed<br /> C. Specific IgG detection<br /> D. Immune detection<br /> E. Hemolytic test<br /> Jawab: A<br /> Pada endocarditis, criteria yang dipakai adalah Duke’s criteria, dimana salah satu major criterianya adalah positive blood culture. Hanya Coxiella burnetti yang boleh didemonstrasikan melalui IgG titer.<br /> Major criteria:<br /> Positive blood culture<br /> Typical microorganism for infective endocarditis from two separate blood cultures <br />Viridans streptococci, Streptococcus bovis, HACEK group or<br /> Staphylococcus aureus or community-acquired enterococci in the absence of a primary focus, or <br />Persistently positive blood culture, defined as recovery of a microorganism consistent with infective endocarditis from: <br /> Blood cultures (≥2) drawn more than 12 hr apart, or <br /> All of three or a majority of four or more separate blood cultures, with first and last drawn at least 1 hr apart <br />Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800<br /><br />177. Which method is correct to detect a streptococcus in rheumatic fever?<br /> A. Bacterial culture and identification<br /> B. Antistreptolysin O Test<br /> C. Bacteracin test<br /> D. Lancefield test<br /> E. M. protein test<br /> Jawab: B<br /> Pembahasan: cukup jelas :-)<br /><br />179. Group A streptococcus, which causes rheumatic fever characterized by one of the following mechanism?<br /> A. it produces an erythrogenic toxin<br /> B. it causes beta hemolysis<br /> C. its pathogenicity is by the M protein<br /> D. it causes anti streptolysion O production<br /> E. it produces a hemolysin that dissolves red blood cells<br /> Jawab: C<br /> Pembahasan:<br /> Opsi B, C, D, E benar, tetapi yang berkaitan dengan mekanisme yang menyebabkan rheumatic fever adalah M protein yang secara struktural banyak memiliki kemiripan dengan protein-protein di tubuh.<br /><br /><br />180. Transient bacteremia is common after minor surgical procedures and bacteria can colonize and multiply in cardiac endothelium. The organism causing endocarditis is all of the following, except …<br /> A. Streptococcus viridans<br /> B. Staphylococcus aureus<br /> C. Staphylococcus epidermidis<br /> D. Escherichia coli<br /> E. Clostridium tetani<br /> Jawab: B<br /> Pembahasan: cukup jelas ya..superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-45438972598733911832010-06-16T05:20:00.000-07:002010-06-16T22:32:05.214-07:00MDE CVS 20061. Jawaban : C. Long absolute rafractory period<br />Alasan : guyton hlm 105<br />2. Jawaban : AV sulcus<br />Alasan : Moore hlm 158 tabel<br />3. Jawaban : E. Mital valve<br />Alasan : komponen S1 terdiri atas mitral dan tricuspid dengan mitral mendahului triscuspid (Lilly hlm 32)<br />4. Jawaban : D. Chordae tendinae<br />Alasan : Chordae tendinae menhubungkan papillary muscles dengan cusp dari valve<br />5. Jawaban :<br />Alasan :<br />6. Jawaban : ???<br />Alasan : Lilly hlm 320 angiotensin 1 diubah membtutuhkan renin,jadi klo renin ↑ ↑ angiotensin 1. Di hlm 319 estrogen ↑ angiotensinogen, jadi klo ada opsinya pilih renin,klo ga ada mungkin estrogen<br />7. Jawaban : E. Elevation of arterial presure<br />Alasan : harusnya decrease of arterial pressure<br />8. Jawaban : C. Cardiac ventricles<br />Alasan : slide minilecture biokimia<br />9. Jawaban : D. Local hormone<br />Alasan : slide minilecture biokimia<br />10. Jawaban : C. Angiotensinase<br />Alasan : angiotensinase berfungsi untuk mendegradasi angiotensin II sebenernya ga yakin juga da pengaruhnya ada apa ga,tapi enzim ini jarang disebut...^_^ <br />11. Jawaban : B. Ailmentary system<br />Alasan : Lilly hlm 312<br />12. Jawaban : C. C-type natriuretic peptide<br />Alasan : ga ditemukan di sirkulasi (slide minilecture biokimia)<br />13. Jawaban : B. Endothelin <br />Alasan : slide minilecture biokimia<br />14. Jawaban : D. Decreased perfusion pressure<br />Alasan : Jurnal tentang cardiac remodelling<br />15. Jawaban : E. Hypertrophy of cardiac cells<br />Alasan : Jurnal tentang cardiac remodelling<br />16. Jawaban : D. Calcium binding protein<br />Alasan : Jurnal tentang cardiac remodelling<br />17. Jawaban : B. CKMB<br />Alasan : cardiac enzyme utama adalah CKMB dan troponin<br />18. Jawaban : ???<br />Alasan : di Moore yang disebut-sebut tentang heart tube,tapi kalau mentok2 mungkin yang A<br />19. Jawaban : ???<br />Alasan : soalnya kurang lengkap, tapikayaknya sih E soalnya jantung berasal dari splanchnic mesoderm<br />20. Jawaban : E<br />Alasan : karena berasal dari existing layer, kalau dari blood island namanya vasculogenesis<br />21. c. lange embriologi, di atas subbab pembentukan rongga jantung<br />22. b. note: arch V tidak pernah terbentuk<br />23. B. <br />-3rd aortic arch carotid communis<br />- 4th kiri part of arch aorta<br />- 4th kanan prox subclavia kanan<br />- 5th ga kebentuk<br />- 6th lengkung pulmonal kiri-kanan membentuk arch pulmonal<br />24. b. lange embriologi di subbab perubahan-perubahan saat lahir<br />25. e<br />26. B<br />27. a. di braunwald hal 157, PR interval terdapat delayed (di AV node) dari atrial depolarization dan ventricle depolarization dengan gambaran isoelectric (reduced amplitude)<br />28. C. karena punya hiperpolarisasi voltage akhir lebih positif dibandingkan dengan berkas listrik jantung yang lain sehingga automatisasinya paling cepat.<br />29. d<br />30. e.<br />31. CO = (EDV-ESV) x HR note = EDV-ESV adalah stroke volume<br /> 96 = (EDV-ESV) x 70<br /> 137mL = EDV-ESV<br /> 137 + 106 = EDV<br /> 243 ml = EDV<br />32. MAP = 1/3 systole + 2/3 diastole<br /> 100 = 1/3 S + 2/3. 90<br /> 40 = 1/3 S<br />120 = systole<br />Pulse pressure = Systole – Diastole<br /> 120- 90<br /> 30 mmHg<br />33. nilai normal: MAP = 70-105 mmHg; 2-6 mmHg; RVP systole: 15-25 mmHg; RVP diastole: 0-8 mmHg, LAP: 6-12 mmHg<br /> RAP = right atrial pressure ; RVP: Right Ventricular pressure; MAP: mean arterial pressure<br />34. c. masukin rumus no 31<br />35.C. autonomic neural di jantung (termasuk vagal nerve) punya pola iinnervasi “sidedness”. Right Vagus nerves affecting sinus node dibandingkan AV node (slows sinus node discharde), sedangkan Left autonomic nerves affecting AV node more than sinus node (prolonges AV nodal conduction time and refractoriness).. tapi statement berikutnya: negative dromotropic response of the heart to vagal stimulation result hyperpolarization of the AV nodal cells.<br />36. D<br />37. D. kalo sound ke 2 dari penutupan semilunar valve<br />38. s4 terjadi karena ventricular compliance yang jelek sehingga terjadi atrial contraction yg menimbulkan s4 tersebut dan terdengar pada akhir atrial filling phase of ventricular diastole<br />39. e.<br />40. d. Within physiologic range, the larger ventricular volume during diastole, the more the fibers are stretched before stimulation, the greater the force of the next contraction<br />61. D<br />62. B<br />63. ga tau,sori<br />64. C<br />65. B<br />66. D<br />67. C<br />68. A<br />69. C<br />70. B<br />71. E<br />72. A (iv,im,parenteral,rectal,ophthalmic,topical,epidural,intraspinal,injection) dan B (ventricular a.)<br />73. D dan E<br />74. D<br />75. A <br />76. C (adenosine is an endogenous nucleoside.administered IV, it is the most effective drug for the rapid termination of reentrant PSVT-lily 430)<br />77. A<br />78. C<br />79. B<br />80. D<br /><br />163. The key indication for considering a diagnosis of the COPD are the following EXCEPT:<br /> A. chronic cough present intermittently<br /> B. chronic sputum production<br /> C. progressive dyspnea on exertion<br /> D. left heart failure<br /> E. history of exposure cooking smoke<br /> Jawab: D dan E. <br /> Pembahasan:<br /> Key Indicators for Considering a Diagnosis of Chronic Obstructive Pulmonary Disease (COPD):<br />1. Chronic cough that is present intermittently or everyday or that is often present throughout the day. Merely nocturnal cough is seldom.<br />2. Chronic sputum production, any pattern<br />3. Dyspnea that is progressive, persistent, described as “increased effort to breathe”, “heaviness”, “air hunger”, “gasping”, worsen on exercise, and worsen during respiration<br />4. History of exposure to risk factors, such as tobacco smoke, occupational dusts, and chemicals.<br /> A, B, C adalah key indication untuk diagnosis (point 1, 2, 3)<br /> D benar karena COPD berkaitan dengan right heart failure, bukan left.<br />E benar karena cooking smoke bukan termasuk faktor risiko COPD.<br /><br />164. The following are the definitions of COPD, except<br /> A. cystic fibrosis and asthma<br /> B. smoking is the major risk factor<br /> C. irreversible air flow obstruction<br /> D. bronchitis and emphysema<br /> E. limited reversible air flow obstruction by bronchodilator<br /> Jawab: A<br />Menurut expert panel dari American Thoracic Society, European Thoracic Society, British Thoracic Society, dan Global Initiative for Chronic Obstructive Lung Disease (GOLD), keypoint dalam definisi COPD adalah sbb:<br />1. Irreversible airflow obstruction<br />2. Although limited reversibility of airflow obstruction in response to bronchodilators is common, it does not preclude bronchodilator treatment.<br />3. Neither asthma with complete reversibility nor chronic airflow obstruction caused by diagnosable conditions such as cystic fibrosis, obliterative bronchiolitis, or panbronchiolitis is included in the definition of COPD.<br />4. Tobacco smoking is the major, but not only, risk factor for COPD.<br />5. The cause of irreversible airflow obstruction in patients with COPD is the presence in the lungs of bronchiolitis or small airway disease and emphysema, which are present to a variable mix among patients.<br /> Dari point no. 3, jelas, cystic fibrosis dan asthma bukan definisi COPD. <br /><br />165. Oxygen therapy improves survival in COPD by following, except<br /> A. it corrects pulmonary vasoconstriction<br /> B. it increases right ventricular stroke volume<br /> C. it improves oxygen delivery to the heart<br /> D. it prevents tachyarrythmia<br /> E. it corrects hypoxemia<br /> Jawab: D<br /> Pembahasan:<br />Dengan low-flow supplemental oxygen, maka hypoxemia pada COPD akan dengan mudah dikoreksi.<br />Pada patofisiologi COPD, diketahui bahwa hypoxemia dapat menyebabkan remodeling dari arteri pulmonalis, yang akan menyebabkan vasokonsitriksi. Vasokonstriksi arteri pulmonalis menyebabkan pulmonary hypertension, sehingga meningkatkan afterload dari RV, menyebabkan berkurangnya stroke volume RV.<br />Hypoxemia, secara definisi, adalah konsentrasi oksigen yang kurang dari normal pada darah. Ketika ini dikoreksi dengan oksigen, maka konsentrasi oksigen meningkat, termasuk konsentrasi oksigen pada darah yang mengalir ke jantung.<br />Jadi, opsi A, B, C, E memang merupakan efek dari oxygen therapy.<br /><br />166. The physical signs of pulmonary hypertension includes all of the following, except<br /> A. signs of pulmonary edema<br /> B. left parasternal heave<br /> C. systolic pulsation in 2nd …<br /> D. ejection click and …<br /> E. closely-split S2, loud pulmonary sound<br /> Jawab: A<br /> Pembahasan:<br /> Diagnsosis pulmonary hypertension adalah sbb:<br />1. History Taking<br />Pasien biasa datang dengan keluhan dyspnea on effort.<br />Jika RV failure telah terjadi, akan didapatkan edema pada tungkai bawah.<br />Pada penyakit yang parah, pasien bisa mengalami angina karena RV mengalami hipertrofi yang prominen sehingga mengurangi aliran darah pada coronary artery.<br />Cardiac output yang berkurang dapat menyebabkan gejala seperti syncope atau near syncope.<br />Pasien juga mengalami gejala LV diastolic dysfunction seperti orthopnea, paroxysmal nocturnal dyspnea.<br />Jika pasien memiliki penyakit paru-paru, maka akan didapati coughing.<br />Hemoptysis bisa didapati jika pasien mengalami hypertension pulmonal karena thromboembolism atau mitral stenosis.<br />2. Physical Examination<br />a. Gelombang a yang besar pada jugular venous pulse<br />b. Peningkatan JVP<br />c. Left parasternal (RV) heave<br />d. Systolic pulsation pada ICS 2 karena arteri pulmonalis yang tegang mengalami dilatasi<br />e. a closely split second heart sound with a loud pulmonic component<br />f. Ejection click, flow murmur pada ICS 2<br />g. S4 di daerah RV<br />h. Tanda-tanda RV (hepatomegaly, peripheral edema, ascites)<br />i. Cyanosis (jika cardiac output sangat berkurang dan ada vasokonstriksi sistemik)<br />j. Ortner syndrome (paralysis left recurrent laryngeal nerve karena kompresi dari pulmonary artery)<br /> Sumber: Braunwald<br /><br />167. Which of the following statement regarding pulmonary hypertension is TRUE<br /> A. The ECG is the most reliable tool in diagnosing obstructed artery disease<br /> B. The gold standard method for diagnosing pulmonary hypertension is echocardiogram<br /> C. the degree of pulmonary hypertension is usually less severe in chronic lung disease<br /> D. autonomic innervations of the vascular …<br /> E. pulmonary congestion and edema are the hallmark of pulmonary hypertension<br /> Jawab: C<br /> Pembahasan:<br /> Kita lihat per option…<br /> Opsi A, tentang ECG:<br />“The detection of right ventricular hypertrophy on the electrocardiogram is highly specific but has a low sensitivity. It usually exhibits RA & RV enlargement, T wave inversion in anterior precordial leads. These are less pronounced in COPD patients because of the modest degree of pulmonary hypertension and because of the effects of hyperinflation.”<br />Low sensitivity, high specificity jadi kurang reliable dalam mendiagnosis obstruksi untuk pulmonary hypertension.<br />Opsi B, tentang echocardiogram:<br />“Echocardiography demonstrates enlargement of RA and RV, normal or small LV, and thickened IV septum. There is abnormal septal motion due to RV pressure overload. Detection of RVH is limited by ability of echocardiograph to differentiate RV wall from surrounding structure. RV dysfunction is also difficult to quantitate echocardiographically.”<br />Jadi jelas echocardiogram bukan gold standard.<br />Di paragraph ini yang tentang ECG (opsi A), disebutkan juga bahwa pada pasien COPD, pulmonary hypertension-nya modest (tidak parah), berarti opsi C benar.<br />Opsi D kurang lengkap.<br />Opsi E salah, karena pada pulmonary hypertension, yang menjadi concern adalah RV failure yang menyebabkan congesti vena sistemik dan edema pada liver atau pedis. Sementara, pulmonary congestion dan edema adalah karakteristik dari LV failure.<br /><br />168. During normal pregnancy, systemic vascular resistance falls due to the following<br /> A. increased heat production<br /> B. incrased innervations<br /> C. increased prostaglandin synthesis<br /> D. low … circulation<br /> Jawab: C<br /> Pembahasan:<br /> Perubahan hemodinamik pada kehamilan:<br />1. Berkurangnya resistensi vaskular sistemik maupun vaskular pulmonal. Ini disebabkan beberapa hal:<br />a. Cardiac natriuretic peptide<br />ANP dan BNP diproduksi oleh cardiomyocyte, dan akan meningkatkan natriuresis dan diuresis. Selain itu, ANP dan BNP akan meningkatkan relaksasi otot polos vaskular.<br />b. Prostaglandin<br />PGI2 (prostacyclin) banyak disintesis di akhir kehamilan. Ini akan meningkatkan resistensi endothel terhadap angiotensin, sehingga meskipun kadar angiotensin meningkat, endothel tidak responsive terhadap angiotensin.<br />c. Progesterone<br />Efeknya berhubungan dengan efek prostacyclin yang dijelaskan di atas.<br />2. Venous occlusion<br />Uterus yang membesar akan menekan vena-vena pada pelvis dan inferior vena cava. Karena itu, tekanan pada vena-vena tsb. meningkat. Peningkatan tekananan ini ditransmisikan ke vena di tungkai bawah dan daerah anogenital. Manifestasinya adalah edema pada tungkai bawah, varicose vein, hemorrhoid, dan peningkatan risiko deep vein thrombosis.<br />3. Supine hypotension<br />Karena uterus yang membesar akan menekan IVC, maka venous return berkurang. Ini akan mengurangi cardiac output dan pada sebagian kecil wanita (10%), akan menyebabkan arterial hypotension yang signifikan.<br />4. Peningkatan volume darah<br />Peningkatan aktivitas RAA system akan meningkatkan volume darah. <br />5. Peningkatan cardiac output<br />Cardiac output meningkat karena adanya peningkatan plasma volume (preload meningkat) dan penurunan resistensi vaskular sistemik (afterload berkurang). Namun, stroke volume relatif konstan, jadi peningkatan cardiac output lebih dikarenakan peningkatan heart rate. Peningkatan heart rate juga bisa dikarenakan hypotension.<br /><br />169. The severe hypotension syndrome of pregnancy fulfills the following, except<br /> A. it is associated with decreased blood pressure<br /> B. it is due to acute occlusion of the IVC<br /> C. increased heart rate is a frequent finding<br /> D. it is rarely associated with cardiac standard<br /> Jawab: D<br /> Pembahasan: <br />Berdasar penjelasan di no. 169, maka A, B, dan C berhubungan dengan hypotension of pregnancy.<br /><br />170. The most prominent cardiocirculatory change during pregnancy is<br /> A. increase in systolic blood pressure<br /> B. increase in heart rate<br /> C. increase in left ventricular ejection fraction<br /> D. increase in cardiac output<br /> E. decrease in systemic vascular resistance<br /> Jawab: D<br /> Pembahasan:<br /> Cardiac output meningkat 30%, karena:<br /> Resistensi perifer berkurang<br /> Uterine blood flow meningkat<br /> Blood volume meningkat 40-45%<br /> Heart rate meningkat 10-20%<br /> Blood pressure tetap atau berkurang<br /> Resistensi vaskular pulmonal berkurang<br /> Tekanan vena sistemik meningkat<br /> Sumber: Braunwald <br /><br />For no. 171 – 173, refer to clinical scenario below<br />… y.o. woman came to the emergency department complaining of shortness of breath for one week. She was 6 month pregnant with her 5th child. Her former pregnancies are uneventful. Physical examination revealed she was dyspneic with an enlarged heart. A third heart sound was heard, systolic murmur over the tricuspid and mitral areas were heard.<br /><br />171. ECG change in the woman may include all the following, except<br /> A. 1st degree AV block<br /> B. <br /> C. Atrial premature beat<br /> D. Ventricular premature beat<br /> E. Peripheral …<br /> Jawab: A<br /> Pembahasan:<br />Kalau di kasus yang kita pelajari, paling dekat dengan kasus no. 171 ini adalah peripartum cardiomyopathy (PPCM), namun per definisi, seharusnya ibu ini tidak digolongkan sebagai penderita PPCM.<br />PPCM is a dilated cardiomyopathy (DCM), documented with echocardiographic left ventricular dysfunction occurring in the last month of pregnancy or within 5 months of pregnancy.<br />Pada DCM, perubahan EKG yang terjadi adalah sbb, namun ini tidak spesifik.<br />1. Sinus tachycardia<br />2. Poor R wave progression<br />3. Interventricular conduction delay<br />4. LBBB<br />5. Wide QRS complex indicator of poor prognosis<br />6. Pathological anterior Q wave if patients have substantial LV fibrosis<br />7. Nonspecific ST segment and T wave abnormalities<br />8. Nonsustained ventricular tachycardia<br />9. Persistent supraventricular or ventricular arrhythmia<br />Atrial dan ventricular premature beat termasuk kategori no. 9<br /><br />172. The most frequent clinical course in this prevention would be<br /> A. congenital recovery of cardiac function<br /> B. development of chronic heart failure<br /> C. ventricular fibrillation and sudden death<br /> D. no … or to depression with prolonged …<br /> E. further clinical deterioration<br /> Jawab: B<br /> Pembahasan: Kurang jelas maksud pertanyaannya. Tapi dari 2006, pembahasannya begini:<br /> Goal of therapy in DCM:<br />1. To relieve symptom<br />2. To prevent complications<br />3. To improve long-term survival<br />Opsi A salah, karena DCM bukan kelainan congenital (pada kasus ini, terutama)<br />Opsi B benar, karena paling sering, DCM akan berakibat pada perkembangan gagal jantung<br />Opsi C benar, tapi bukan yang paling sering<br />Opsi E belum tentu, karena jika dikontrol dengan obat-obatan, gejala klinis bisa membaik.<br /><br />173. The management for this patient do not include the following<br /> A. diuretics<br /> B. digitalis<br /> C. hydralazine<br /> D. ACE inhibitor<br /> E.<br /> Jawab: D<br />Untuk pasien DCM yang sedang dalam keadaan hamil, ACE inhibitor dan ARB dikontraindikasikan karena dapat menyebabkan congenital malformation. Biasanya, pasien diberi kombinasi hydralazine dan nitrates sebagai vasodilator.<br /><br />174. Postpartum hemodynamic change do not include one of the following condition<br /> A. Increase in venous return<br /> B. decrease in cardiac output<br /> C. Rise in heart rate<br /> D. low ventricular filling pressure<br /> E.<br /> Jawab: B<br /> Pembahasan:<br /> Perubahan hemodinamik postpartum:<br /> Blood volume kembali normal<br />Cardiac output masih terelevasi hingga 48 jam karena peningkatan stroke volume yang disebabkan peningkatan venous return.<br />Sumber: Williams’ Obstetrics<br /><br />175. Mitral stenosis in a pregnant woman is not associated with one of the following, except<br /> A. Worsening in functional cardiac status<br /> B. Occurrence of atrial fibrillation<br /> C. Increased prematurity of newborn<br /> D. Increased maternal mortality<br /> E. Fetal growth retardation<br /> Jawab: B<br /> Mitral stenosis tends to worsen during pregnancy because of the increase in cardiac output coupled with the increase in heart rate; this shortens the diastolic filling time and exaggerates the mitral valve gradient. The onset of atrial fibrillation may precipitate acute pulmonary edema. A study of Canadian women has reported no maternal death, but 35 percent of pregnancies were associated with cardiac complications.<br /><br />176. If lymphedema occurs in a patient, the most important fact that the patient has to know is<br /> A. The problem is best treated with conservative therapy<br /> B. The problem is treated with anticoagulants<br /> C. The problem must be treated by antibiotics<br /> D. The problem is treated by …<br /> E. The problem is solved by surgical removal of the …<br /> Jawab: A<br /> Pembahasan:<br />Lymphedema is a condition of localized fluid retention caused by a compromised lymphatic system. Treatment for lymphedema varies according to the severity of edema and the degree of fibrosis of affected limb, including:<br />1. Bed rest and lymphedema sling<br />2. Compression<br />3. Manual decongestive massage<br />4. Isometric exercise<br />5. Home program (bandaging, elevation, exercise, skin care)<br /><br />177. In rehabilitation program after acute myocardial infarction, a patient can … program<br /> A. 2-4 days after AMI<br /> B. 6-9 days after AMI<br /> C. 1 month after AMI<br /> D. 3-4 months after AMI<br /> E. 4-9 months after AMI<br /> Jawab: E<br />Cardiac rehabilitation program setelah MI dibagi menjadi 3-4 fase, tergantung status klinis pasien:<br />1. Phase I<br />Inpatient rehabilitation, usually lasting for the duration of hospitalization.<br />It emphasizes a gradual, progressive approach to exercise and an education program that helps the patient understand the disease process, the rehabilitation process, and the initial preventive efforts to slow the progression of disease.<br />In the US, it is oftend directed by Physical Therapy Department or a dedicated cardiac rehabilitation staff.<br />2. Phase II<br />Multifaceted outpatient rehabilitation, lasting 2-3 months.<br />Emphasizes safe physical activity to improve conditioning with continued behavior modification aimed at smoking cessation, weight loss, healthy eating, and other factors to reduce disease risk. Initiate an exercise prescription.<br />This refers to physician-supervised outpatient program. Patient exercise 3 times weekly for 3 months. The physician will monitor the electrocardiographic findings of the patient during exercise.<br />3. Phase III<br />Supervised rehabilitation, lasting 6-12 mo. <br />Establishes a prescription for safe exercise that can be performed at home or in a community service facility, such as a senior center or YMCA, and continues to emphasize risk factor reduction.<br />This phase refers to non-ECG monitored, medically-supervised, maintenance programme and is usually provided by the same facilities that provide phase II programs.<br />4. Phase IV<br />Maintenance, indefinite.<br /><br /> Exercise yang Dianjurkan:<br />a. Aerobic exercise<br />- Secara umum, pasien diharapkan berolahraga minimal 3x seminggu @ minimal 20 menit. Targetnya adalah mencapai 70-85% peak HR.<br />- Dengan asymptomatic ischemia, pasien diharapkan berolahraga dengan frekuensi dan durasi yang sama, namun targetnya adalah 70-85% peak HR.<br />- Dengan angina, pasien diharapkan berolahraga dengan frekuensi dan durasi yang sama, namun targetnya adalah 70-85% ischemic HR atau onset dari angina.<br />- Dengan claudication, pasien diharapkan berolahraga minimal 3x seminggu @ minimal 30 menit. Targetnya adalah berjalan untuk mendapatkan toleransi rasa nyeri.<br />- Pasien CAD yang sudah dipasang stent atau melakukan angioplasty dan pasien gagal jantung kelas NYHA I-III melakukan exercise yang sama dgn pasien CAD secara umum.<br />b. Resistance exercise<br />Dilakukan 2-3 x seminggu, dengan 12-15 repetisi. Intensitasnya adalah mencapai 30-50% repetition maximal weight.<br /><br /> Pasien boleh tidak ikut program lagi (masuk phase IV) setelah 6-12 bulan. Jadi, jawabnya E <br /><br />178. Which of the following regarding exercise in maintenance phase of rehabilitation in CAD is<br /> TRUE<br /> A. an improvement from aerobic exercise of certain muscle cells will met the needs of<br /> Vocational or avocational activities<br /> B. continuous ECG monitoring should always be used as it has shown to provide added safety during supervised exercise<br /> C. during exercise, patient can monitor their HR by using carotid pulse<br /> D. there are complications with exercise testing in elderly patients<br /> E. the treadmill or bicycle exercise programs can meet all patients’ need<br /> Jawab: A (jawaban 2006)<br /><br />179. In the training phase of a rehabilitation program, a condition program is the physical capacity. The reconditioning program is done …<br /> A. passive<br /> B. passive-assistive<br /> C. assistive<br /> D. active<br /> E. active-ressistive<br /> Jawab: D (jawaban 2006)<br /><br />180. In the training phase, the target heart rate for exercise training usually is …<br /> A. 55-63% of the maximum heart rate<br /> B. 65-75% of the maximum heart rate<br /> C. 60-85% of the maximum heart rate<br /> D. 85-95% of the maximum heart rate<br /> E. 95-100% of the maximum heart rate<br /> Jawab: C<br /> Lihat penjelasan no. 177superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-24586437463217603692010-06-16T05:17:00.001-07:002010-06-16T22:31:28.417-07:00MDE CVS 20071. Jawaban : A. Congenital heart disease<br />Alasan : udah jelas lah ya dari lahir<br />2. Jawaban : A. 1%<br />Alasan : About 0.8 percent of live births are complicated by a cardiovascular malformation (Braunwald ch 61) mendekati 1 % ^_^<br />3. Jawaban : E. Closure of neural folds<br />Alasan : Langman sub bab formation and position of heart tube<br />4. Jawaban : B. Septum secundum<br />Alasan : ASD paling sering terjadi pada foramen ovale bekas daerah septum secundum (Lilly hlm 380)<br />5. Jawaban : D. VSD<br />Alasan : Moore embyology hlm 312<br />7. Jawaban : A. Loud & high pitched<br />Alasan : Lilly hlm 383<br />8. Jawaban : <br />Alasan :<br />9. Jawaban : D. Size of the heart <br />Alasan : Slide minilecture radiology<br />10. Jawaban : B. TOF<br />Alasan : Langman bab 11<br />11. Jawaban : B. TOF<br />Alasan : Lilly hlm 393<br />12. Jawaban : C. 3rd aortic arch<br />Alasan : Moore embryology hlm 318<br />13. Jawaban : B. Apex of the heart upward<br />Alasan : moore embryology hlm 301<br />14. Jawaban : ???<br />Alasan harusnya jawabannya foramen ovale (bukan fossa ovale) tapi klo ga ada opsinya mentok2 pilih B aja...<br />15. Jawaban : C. Descending aorta<br />Alasan : Lilly hlm 384<br />16. Jawaban : E. Blood culture<br />Alasan : blood culture termasuk majojr criteria di modified duke criteria (Lilly hlm 222)<br />17. Jawaban : E. Staphylococcus aureus<br />Alasan : Lilly hlm 219<br />18. Jawaban : B. Staphylococcus aureus<br />Alasan : sama dengan no 17<br />20. Jawaban : C. TGA<br />Alasan : Braunwald hlm 1714 <br /><br />21. D. komplikasi endocarditis infective:<br />- glomerulonephritis<br />- CHF karena desturuksi dan rupture dari valve<br />- embolic stroke, purulent meningitis, dan cerebritis dengan microabses<br />Sedangkan TOF merupakan kelainan congenital<br />22. braunwald hal 1728. Cardiac surgery in patients with infective endocarditis<br />Indications<br />- Moderate to severe congestive heart failure cause by valve dysfunction<br />- Unstable prosthesis, prosthesis orifice obstructed<br />- Uncontrolled infection despite optimal antimicrobial therapy<br />- Unavailable effective antimicrobial therapy: endocarditis caused by fungi, Brucellae, pseudomonas aeurginosa<br />- Staphiloccocus aureus PVE with intracardiac complication<br />- Relapse of PVE after optimal therapy<br />- Fistula to pericardial sac<br />Relative Indication<br />- Perivalvular extension of infection, intracardiac fistula, myocardial abscess with persistent fever<br />- Poorly responsive S.aureus NVE<br />- Relapse of NVE after optimal antimicrobial therapy<br />- Culture negative NVE or PVE with persistent fever<br />- Large (>10mm) diameter hypermobile vegetation (with or without prior arterial embolism)<br />- Endocarditis caused by highly antibiotic-resistant enetrococci<br />Jadi jawabannya antara c/d<br />23. d. <br />a. rheumatic fever = terdapat polyarthralgia dan adanya riwayat dari pharyngitis<br />b. Kawasaki disease = terdapat perubahan pada mucosa (strawberry tongue), bilateral conjunctivae infection, cervical lymphadenopathy<br />c. scarlet fever = diawali pharyngitis myalgia, petechiae, rash, tapi tanpa manifest ke jantung<br />24.c treatment sebenernya adalah mengeradicate penyebab IE dengan pemberian antibiotic.. tapi setelah itu, apabila pasien akan melakukan dental procedure, diberikan antibiotic prophylaxis.<br />25. E. option lain bisa sebagai komplikasi jika penyakit yang bersangkutan tidak ditreatment dan option C bisa sebagai manifestasinya..<br />Sedangkan option E, harusnya ditreatment bukan hanya (pada akhirnya ke) ventricle rate, tapi first medication itu dari anti arrhythmic drug adalah mentreat abnormalitas dari conduction system, dengan (dua diantaranya) menormalisasikan action potential rate, mencegat reentrant pathway dsb dari Seluruh pathway, sehingga terjadi normalisasi arus listrik normalisasi rhythm yg berefek nantinya ke ventricular rate.<br />26. RHD.. major criteria : ada 2, minor : 1, + positif adanya GABHS infection ( 2 major or 1 major +2 minor dengan positif GABHS infection)<br />27. E. dari pathological jantung, dapat ditemukan aschoff bodies, bisa terdapat di endo, myo, atau epicardium<br />28. C. janeway lesion small erythematous/ hemorrhagic macular non tender lesion on the palms and soles (sebagai tanda septic embolic signs)<br />29. d<br />30. C. untuk cek gabhs involvement throat culture ato dengan titer antibody streptococcal termasuk antistreptolysin O, anti deoxyribonuclease-B, antihyaluronidase, dan streprozyme.<br />31. b<br />32. b. penicillin inhibit sintesis cell wall<br />33.e. manifestasi dari RF : terjadi stenosis berupa penebalan atau kalsifikasi pada leaflet atau subleaflet yang berakibat reducing motion of leaflet, tapi gambaran echonya ya penebalan itu..<br />Terjadi regurgitasi karena melibatkan chorda tendinae (pemendekan excessive atau rupture) atau melibatkan leaflet berupa perforasi pada leaflet. Note: apabila terjadi rupture chordate baru terjadi leaflet prolaps<br />34. a<br />35. a polyarthritis : >=75%; carditis = 40-60%; chorea = 5-36%; erythema marginatum lalu subcutaneous nodule<br />36. a. salisilat punya pengaruh yang efektif pada inflamasi sendi, tapi untuk jantungnya diberikan corticosteroid<br />37. b. merupakan involuntary, irregular movement, fibirlatory muscle movement of tongue, characteristic spooning with external rotation of the hands and abolition of the movement with sleep.<br />40. a. adanya MS suara tutupnya jadi kecil dan paling jelas dari mitral iu adalah di apex, sehingga yang terdengar jelas hanya s2.. terkadang bisa terdapat opening snap sebagai tanda kekakuan dari leaflet.<br />61. E<br />62. A<br />63. D<br />64. E<br />65. ga ada soal<br />66. ga ada soal<br />67. A<br />68. A<br />69. ga ada soal<br />70. ga ada soal<br />71. C<br />72. D<br />73. A<br />74. C<br />75. D<br />76. B<br />77. E<br />78. ga tau, sori<br />79. B<br />80. E (kayanya)<br /><br />161. Ciri-ciri pericardial effusion …<br /> A. boot shape<br /> B. <br /> C. tear drop<br /> D. globular<br /> E. <br /> Jawab: D<br /> Pembahasan:<br /> Pada efusi pericardial tingkat sedang, siluet jantung pada radiography masih terlihat normal.<br /> Pada efusi yang lebih besar, siluet jantung pada gambaran anteroposterior akan terlihat bulat (atau globular) dan mirip botol. Pada gambaran lateral akan terlihat pericardial fat pad sign (yaitu suatu lucency linear di antara dinding thorax dan permukaan anterior jantung, menunjukkan adanya pemisahan antara parietal pericardial fat dengan epicardium oleh cairan). Paru-paru terlihat oligemic (vaskular markings-nya sedikit meningkat.<br /> Sumber: Braunwald<br /><br />162. 60-year-old male presents with fever and chest pain. Physical examination shows pericardial friction rub. Laboratory examination shows increased white blood cell count and ESR.<br /> Diagnosis: acute pericarditis<br /><br />163. Typical presentation of the disease …<br /> A. onset of pain crescendo<br /> B. more comfortable in recumbent<br /> C. abnormal S3 and S4<br /> D. pulmonary congestion in severe pericarditis<br /> E. rub can last hours to days<br /> Jawab: A<br /> Pembahasan:<br /> Soal no. 163 ini marupakan lanjutan soal no. 162, jadi masih membahas tentang acute pericarditis.<br /> Sign and symptom:<br />1. Chest pain (pasien hampir selalu datang dengan keluhan ini), nyerinya severe. Kualitasnya rapid onset, terletak substernal (bisa juga pada dada kiri atau epigastrium kiri), dan biasa beradiasi ke lengan kiri atau ke trapezius ridge. Nyeri akan membaik jika duduk membungkuk dan akan memburuk jika berbaring.<br />2. Dyspnea<br />3. Fever<br />4. Cough<br />5. Hiccoughs (hiccups)<br />Pemeriksaan Fisik:<br />1. Pasien terlihat uncomfortable, anxious<br />2. Vital signs: low-grade fever, sinus tachycardia<br />3. Auskultasi jantung: ada friction rub yang terdiri atas 3 komponen. Komponen pertama terjadi pada ventricular systole, lalu pada early diastolic filling, dan pada atrial contraction. Bunyinya mirip suara berjalan pada crunchy snow. Rub paling terdengar pada lower left sternal border hingga cardiac apex, dan paling keras jika posisi pasien duduk membungkuk. Rub-nya dinamis, kadang muncul kadang menghilang.<br /> Sumber: Braunwald<br /> Dari Lilly disebutkan, onset dari chest pain biasanya crescendo.<br /><br />164. Typical ECG changes…<br /> A. inverted T wave with elevated ST segment<br /> B. localized ST segment elevation<br /> C. diffuse concave ST segment elevation<br /> D. frequent PVCs<br /> E. 1st degree AV block<br /> Jawab: C<br /> Pembahasan:<br /> Electrocardiogram pada acute pericarditis menunjukkan temuan-temuan sbb:<br />1. Diffuse ST segment elevation (merupakan classic finding dalam perikarditis akut).<br />2. Depresi segmen PR merupakan manifestasi yang lebih awal, biasanya terjadi sebelum ada rub maupun elevasi segmen ST<br />3. Sangat jarang terjadi elevasi ST yang berprogresi ke depresi segmen ST disertai inversi gelombang T.<br /> Sumber: Braunwald<br /><br />165. The following is true regarding the disease<br /> A. the majority of cases are caused by …<br /> B. TB pericarditis usually present with acute symptom<br /> C. in most cases, it is associated with pericarditis<br /> D. large pericardial effusion may occur with no symptom of pericarditis<br /> E. Dressler syndrome used to be more common after viral infection<br /> Jawab: D, evaluasi lagi opsi A dan C<br /> Pembahasan:<br /> Opsi A, belum tahu, karena tidak komplit<br /> Opsi B salah, karena TB pericarditis biasanya presentasinya kronis<br /> Opsi C g tahu, karena kurang jelas<br /> Opsi D benar, efusi pericardial bisa dipresentasikan dengan nyeri dada maupun asymptomatic.<br /> Opsi E salah, karena Dressler syndrome biasa terjadi setelah myocardial infarction, dan diduga merupakan penyakit autoimmune.<br /><br />166. Chest radiograph, TRUE:<br /> A. acute pericarditis: …<br /> B. moderate pericardial effusion: …<br /> C. the pericardial fat pad signs a hallmark sign in acute pericarditis<br /> D. abnormal cardiac silhouette may be seen in …<br /> E. … congestion is a signal of the presence of acute pericarditis<br /> Jawab: ??<br /> Pembahasan:<br /> Opsinya g komplit!<br /> Opsi A: pada acute pericarditis, radiography thorax biasanya normal<br /> Opsi B: pada moderate effusion, radiography biasanya masih normal<br /> Opsi C: pericardial fat pad sign merupakan ciri pericardial effusion, bukan pericarditis akut<br /> Opsi D: abnormal cardiac silhouette biasanya terjadi pada pericardial effusion (berupa bottle-like appearance)<br /> Opsi E: (mungkin pulmonary) congestion kadang menandakan acute pericarditis, tergantung etiologinya. Tetapi, jika idiopathic, biasanya tidak disertai congestion.<br /><br />167. Regarding of the lab, which of the following area statement is true?<br /> A. pericardial effusion appears as a hyperechoic separation between 2 pericardial layers<br /> B. in acute idiopathic pericarditis, the ESR is normal<br /> C. electrical alternant of the QRS complex is a characteristic sign in cardiac tamponade<br /> D. elevation of cardiac markers is present in cardiac tamponade<br /> E. diffuse ST segment elevation followed by Q wave is found in acute pericarditis<br /> Jawab: B<br /> Pembahasan:<br />1. Diagnosis Acute Pericarditis<br />a. Anamnesis: chest pain, dyspnea, fever, cough, hiccups<br />b. Physical examination: low-grade fever, sinus tachycardia, pericardial friction rub yang terdengar lebih keras saat inspirasi<br />c. Lab: modest elevation of WBC count, lymphocytosis pada idiopathic acute pericarditis, ESR is no more than modestly elevated pada idiopathic acute pericarditis<br />d. Radiography: pada idiopathic acute pericarditis, cenderung normal. Pada neoplasm, terlihat lymphadenopathy. Pulmonary infiltrates sering ditemukan pada tuberculous pericarditis. Jika disertai pericardial effusion, maka akan terlihat globular.<br />e. Electrocardiogram: diffuse ST segment elevation<br />f. Echocardiography: normal<br />2. Diagnosis Pericardial Effusion<br />a. Anamnesis: kadang mengeluhkan pericardial pain (seperti pericarditis) atau discomfort, tapi bisa juga asymptomatic.<br />b. Physical examination: normal jika efusinya sedikit/sedang. Namun, jika efusinya banyak, auskultasi akan menunjukkan muffled heart sounds. Cardiac impulse akan sulit dipalpasi. Ada tubular breath sounds jika bronchi mengalami kompresi oleh pericardium.<br />c. Radiography: globular, bottle-like<br />d. Electrocardiography: reduced voltage of QRS complex dan electrical alternans (amplitude kompleks QRS yang bervariasi, tinggi-rendah).<br />e. Echocardiogaphy: lucent separation between parietal and visceral pericardium, and the effusions can be regional and/or loculated<br />3. Diagnosis Cardiac Tamponade<br />a. Anamnesis: pasien mengeluhkan dyspnea, kadang ada pericardial pain atau discomfort, yang akan membaik jika duduk membungkuk (sitting and leaning forward). Terdapat pula gejala-gejala yang berkaitan dengan berkurangnya cardiac output, seperti fatigue, weakness, dizziness.<br />b. Physical examination: Beck’s triad (hypotension, muffled heart sounds, elevated jugular venous pressure), tachypnea, diaphoresis, cool extremities, peripheral cyanosis, depressed sensorium, yawning. Terdapat pulsus paradoxus. Cardiac impulse tidak ada atau berkurang. Terdapat friction rub.<br />c. Radiography: = pericardial effusion<br />d. Electrocardiography: = pericardial effusion<br />e. Echocardiography: lucent separation between parietal and visceral pericardium is circumferential (usually). Ada collapse dari RV pada saat early diastole dan collapse pada RA pada saat ventricular diastole (kalau tidak ada collapse, biasanya menunjukkan effusion, bukan tamponade).<br /> Sumber: Braunwald<br /><br />168. Which of the following statement is ECG changes typical of this disease (masih membicarakan pericarditis yang no. 162!)<br /> A. ST segment elevation in all leads<br /> B. deeply-inverted T waves resembling myocardial injury<br /> C. localized convex ST segment elevation<br /> D. frequent premature ventricular complex<br /> E. prolonged PR interval<br /> Jawab: A<br /> Pembahasan: lihat no. 167<br /><br />169. Management<br /> A. treatment is not necessary in acute idiopathic pericarditis since it is a self-limiting disease<br /> B. high dose of steroid recommended and great better outcome than NSAID<br /> C. high dose of ibuprofen is drug of choice in pericarditis<br /> D. narcotic analgesic and aspirin recommended in …<br /> E. some cases … factors response after NSAID followed by surgical treatment<br /> Jawab: C<br /> Pembahasan:<br /> Management dari pericarditis bertujuan:<br />- Deteksi etiologi yang memiliki implikasi terhadap management (misal, jadi harus ganti antibiotic)<br />- Deteksi effusion dan other echocardiographic abnormalities<br />- Meringankan symptom<br />- Treatment yang sesuai dengan etiologi yang spesifik<br />Acute idiopathic pericarditis merupakan self-limited disease tanpa komplikasi yang significan dan tanpa reccurence pada 70-90% pasien. Jika lab menunjukkan idiopathic acute pericarditis, maka NSAID (biasanya ibuprofen 600-800 mg p.o. tdd) hingga 2 minggu jika nyeri dada sudah tidak dirasakan lagi.<br />Jika pasien tidak merespon dengan baik pada awal pemberian NSAID, maka sebaiknya diopname untuk observasi dan tes tambahan.<br />Jika pasien merespon secara lambat, maka diperlukan tambahan analgesic narcotic dan/atau colchicines atau prednisone.<br />Pada pasien yang mengalami RECURRENT acute idiopathic pericarditis (15-30% dari pasien yang merespon secara memuaskan thd management yang disebutkan di atas), perlu dilakukan evaluasi untuk kemungkinan penyakit autoimmune, dan kadang (jarang) diperlukan biopsi pericardium. Pada kelompok pasien ini, diberikan lagi NSAID selama 2 minggu, lalu diberikan colchicines prophylaxis. Jika pasien tidak membaik, maka diberikan short course of prednisone ketika terasa gejala, namun ini tidak dilakukan secara kronis. Pericardiotomy bisa juga dilakukan, tapi hanya efektif pada sebagian kecil pasien.<br />Sumber: Braunwald<br /><br />170. Sign and symptom<br /> A. produce dull retrosternal pain<br /> B. pain is severe and often sharp in acute pericarditis<br /> C. pericardial friction rub is hallmark of chronic pericarditis<br /> D. most pericardial friction rub are louder during expiration<br /> E. relieved by lying down and taking deep breath<br /> Jawab: B<br /> Pembahasan: lihat no. 167<br /><br />171. Which of the following statement is true regarding physical examination of cardiac tamponade?<br /> A. arterial hypotension and increased JVP<br /> B. prominent basal rales and dyspnea are the hallmark<br /> C. decline in blood pressure during expiration<br /> D. PMI can be seen easily<br /> E. Kusmaull sign is a hallmark<br /> Jawab: A<br /> Pembahasan: lihat no. 167<br /><br />172. Which of the following statement is true about pathophysiology of cardiac tamponade (CT)?<br /> A. CT occurs when intrapericardial pressure is not equal to RA and RV diastolic pressure<br /> B. In the presence of hypovolemia, CT may be more difficult to detect<br /> C. Equalization of intrapericardial and ventricular filling pressure may lead to a small increase RV<br /> D. Atrial fibrillation may occur during severe CT<br /> E. Hemodynamic deterioration during tamponade is caused by RV failure<br /> Jawab: E<br /> Pembahasan:<br /> Patofisiologi Cardiac Tamponade (CT)<br /> CT dicirikan dengan suatu continuum yang dimulai dari efusi pericardium tanpa efek yang jelas yang berlanjut ke circulatory collapse. Ini tergantung pada tekanan di pericardium (yg meningkat karena efusi) dan kemampuan jantung untuk mengkompensasi peningkatan tekanan tersebut.<br /> Volume cairan di pericardium biasanya hanya sedikit, jadi peningkatan jumlah cairan yang rapid, walaupun dalam jumlah kecil, dapat dengan cepat meningkatkan tekanan pericardium dan berpengaruh pada fungsi jantung. Sebaliknya, slowly accumulating effusion, walaupun jumlahnya besar, dapat ditolerir dengan baik.<br /> Kompensasi jantung bergantung terutama pada respon sympathetic untuk meningkatkan heart rate dan kontraktilitas. Pada pasien yang meminum beta-blocker, maka respon ini minimal dan kompensasi jantung tidak maksimal.<br /> Seiring dengan menumpuknya cairan pada pericardial cavity, akan terjadi peningkatan tekanan diastolic pada ruang-ruang jantung sehingga tekanannya sama dengan tekanan pad pericardial cavity (fenomena ini disebut equalization). Karena meningkatnya tekanan, maka volume darah di jantung akan berkurang (preload berkurang), menyebabkan berkurangnya stroke volume. Karena jantung kanan dindingnya lebih tipis dan kurang bisa beradaptasi terhadap peningkatan tekanan, maka peningkatan tekanan di jantung kanan lebih cepat daripada di jantung kiri (namun pada akhirnya akan mencapai tekanan yg sama, yakni tekanan pericardial cavity).<br /> Kelainan hemodinamik lainnya:<br />1. Loss of y descent of RA (or systemic venous) pressure<br />Ini didasarkan pada konsep bahwa, pada severe CT, total heart volume tetap (tidak berkurang maupun bertambah, tidak dipengaruhi oleh kontraksi-relaksasi). Karena itu, darah hanya bisa mengalir ke jantung saat darah (yang tadinya ada di jantung) dipompa keluar. Karena itu, y descent, yang menggambarkan penurunan tekanan atrium setelah atrium berkontraksi, tidak tergambarkan.<br />2. Paradoxical pulse<br />Paradoxical pulse menggambarkan berkurangnya tekanan arteri sistemik secara abnormal (>10 mmHg) saat inspirasi. Pada CT (dan secara fisiologis), terjadi peningkatan systemic venous return saat inspirasi (sehingga systemic venous pressure berkurang). Ketika total volume jantung tetap, maka peningkatan venous return ini akan menyebabkan interventricular septum untuk shift to the left saat inspirasi, sehingga membuat LV menjadi sempit, dan stroke volume (LV pressure) berkurang secara abnormal. Karena itu, tekanan arteri sistemik pun berkurang saat inspirasi.<br /> Jadi,<br />Opsi A salah, karena terjadi ekualisasi tekanan antara pericardial cavity dengan seluruh chamber jantung.<br />Opsi C salah, karena ekualisasi tekanan tidak meningkatkan volume RV, malah menguranginya. Ekualisasi tekanan meningkatkan tekanan RV hingga sama dengan tekanan pericardial cavity (yang tentunya sangat tinggi, mengingat ini adalah tamponade)<br />Opsi D salah, karena atrial fibrillation justru cenderung terjadi jika ada pembesaran atrium (substrat meningkat, lebih banyak jalur re-entry terbentuk, sehingga risiko terjadi AF meningkat). Pada CT, volume jantung tidak membesar.<br />Opsi E salah, karena cardiac tamponade menyebabkan berkurangnya cardiac output, sehingga lebih perubahan hemodinamis sistemik lebih disebabkan kegagalan LV, bukan RV.<br />Opsi B, jawaban yang paling mungkin; walaupun hypotension adalah salah satu tanda CT (lihat no. 167).<br /><br />179. Which of the following is the most likely diagnosis?<br /> A. chronic bronchitis and liver cirrhosis<br /> B. congestive heart failure<br /> C. alpha 1 antitrypsin deficiency<br /> D. cor pulmonale<br /> E. pericardial effusion<br /> Jawab: ???<br /> Tidak ada case…<br /><br />180. Pulmonary circulation is similar to the systemic circulation in which of the following aspects?<br /> A. The volume of blood in veins is similar in both system<br /> B. The arteries serve as more important blood volume reservoirs in both system<br /> C. The artery in both system are about the same length<br /> D. <br /> E.<br /> Jawab: A<br /> Pembahasan:<br /> Opsi B salah, karena yang menjadi reservoir darah adalah vena.<br /> Opsi C salah, karena arteri sistemik lebih panjang daripada arteri pulmonalis.<br /> Jawaban yang paling mungkin dari 3 pilihan itu adalah A, namun jika di soal nanti ada pilihan D & E, cek lagi. Karena, pada vena sistemik, volume darah lebih besar (karena dia adalah reservoir) daripada vena pulmonalis.superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-67580937471156344612010-06-16T05:12:00.000-07:002010-06-16T22:30:45.815-07:00MDE CVS 20081. Jawaban : D. Mesoderm<br />Alasan : keseluruhan jantung dibentuk dari splanchnic mesoderm (Moore embryology hlm 286)<br />2. Jawaban : E. Carniocaudal folding of the embryo<br />Alasan : Moore embryology hlm 292<br />3. Jawaban : C. Right ventricle<br />Alasan : bisa dilihat di gambaran anatomi jantung right ventricle ada di anterior surface (Moore anatomy hlm 146)<br />4. Jawaban : D. Membranous VSD<br />Alasan : Moore embyology hlm 312<br />5. Jawaban : E. TGA<br />Alasan : pada TGA letak aorta dan pulmonary trunk jadi terbalik (Moore embryology hlm 314)<br />6. Jawaban : A. CKMB<br />Alasan : kelainan pada jantung yang biasanya diperiksa adalah CKMB dan cardiac specific troponin <br />7. Jawaban : A. Apolipoprotein A1<br />Alasan : Apo-A1 adalah penyusun utama HDL semakin ↑ HDL semakin ↓ risk for CAD yang ditanya : inverse/berbanding terbalik (harusnya Harper ada tapi males buka buku jadi dari inet...^_^)<br />8. Jawaban : B. AST peak in 24-48 hours after AMI and return to normal in 4-6 days<br />Alasan : Mild to moderate increases may be seen with vigorous excercise and muscle injury or in conditions such as acute pancreatitis and heart attacks<br />9. Jawaban : B. Troponin<br />Alasan : sama dengan no 6<br />10. Jawaban : B. Ckmb levels are normal in cases of cardiac ischemia<br />Alasan : CKMB akan naik bila terjadi infarct (penjelasan waktu lab act + Lilly hlm 183)<br />11. Jawaban : C. LDH pericardial fluid/serum ratio > 0.6<br />Alasan : ciri exudate pericardial protein/serum >0.5 atau pericardial LDH/serum > 0.6 (Lilly hlm 344)<br />12. Jawaban : B. Therapy of amiodarone<br />Alasan : untuk menjaga stabilitas meskipun sudah sinus rhytm tetap perlu diberikan antiarrhytmia amiodaron ↓ sinud firing (Lilly 296, 428)<br />13. Jawaban : B. Loud 1st heart sound<br />Alasan : Lilly hlm 202<br />14. Jawaban : C. Janeway lesion<br />Alasan : Lilly hlm 220<br />15. Jawaban : E. Mitral Regurgitation<br />Alasan : MR bisa disebabkan oleh rupture chordae tendinae akibat blunt chest trauma (Baraunwald ch 62)<br />16. Jawaban : ???<br />Alasan : It is a consequence of shortening, rigidity, deformity, and retraction of one or both mitral valve cusps and is associated with shortening and fusion of the chordae tendineae and papillary muscles (Braunwald ch 61) ini dr Braunwald tapi ga ada pilihan spesifik, kayaknya sih B<br />17. Jawaban : A. Thickening of chordae / leaflets<br />Alasan : Lilly hlm 199<br />18. Jawaban : B. Pulmonary hypertension<br />Alasan : Lilly hlm 216<br />19. Jawaban : E. Pericardial friction rub<br />Alasan : chest pain saat posisi tidur dan hilang saat duduk tanda pericarditis (Lily hlm 337)<br />20. Jawaban : C. Coagulation<br />Alasan : Lilly hlm 177<br /><br />21. C<br />Risk factor yang paling tinggi menyebabkan mortalitas: rokok, DM, alcohol, obesity<br />22. A <br />23. A<br />* 4-12 hours – 1-3 days = terjadi neutrophilic infiltrates<br />* 3-7 days – 7-10 days = well developed macrophage<br />* 10-14 days – 2-8 weeks = fibrous tissue formation<br />25. C. sebenernya bingung karena dari semua sumber, aschoff bodies itu bisa melibatkan semua lapisan cardium.. tapi kalo kita belajar dari tutorial, komplikasi tersering dari RHD tu kan valve stenosis ato regurgitant (dlm case ini diduga mitral involvement = karena ada dyspnea) jadi mikirnya kalo kena disitu, berarti lapisan endocardium..<br />26. A. Aschoff bodies = swollen eosinophilic collagen yang dikelilingi T lymphocyte<br />27. C.. uda jelas ya.<br />28. C<br />29. A. di robin hal 216,,epitheloid cells itu merupakan manifestasi dari hypersensitivity type 4 karena non degradable product seperti tubercle bacilli. Disekitarnya dikelilingi oleh collar lymphocyte.<br />30. b<br />31. C. pada orang DM, terdapat abnormalitas fungsi metabolism lipid juga dan enzim pemecah seperti Lipoprotein lipase.. hasilnya menunjukan increasing LDL dan VLDL, decreasing HDL, dsb.<br />32.d.<br />33. B. statin merupakan obat HMG CoA reductase..<br />34. E. berdasarkan alur produksi hormonal.. reninANG 1 ANG2 Aldosteron<br />35. B. salah satu indicator dari pelepasan renin adalah penurunan perfusi dan tekanan darah ke ginjal yang dalam hal ini bisa karena penurunan BP.. tapi jika BP sudah mendapat batas, maka terjadi feedback negative ke ginjal untuk stop produksi dari RAA system.<br />36.<br />37. D.<br />38. B. efeknya oleh Endothelin isoform 1 (ET-1), dan endothelin ini juga bisa dihasilkan selain oleh endothelium, juga oleh cardiac myocyte.<br />39.<br />40.?<br />61. -<br />62. -<br />63. -<br />64. B<br />65.-<br />66. E<br />67. C<br />68. B<br />69. B<br />70. B<br />71. A<br />72. A<br />73. D<br />74. B<br />75. B<br />76. -<br />77.-<br />78. D<br />79. A<br />80. C<br />81. C. anterior interventricular branch of coronary artery<br />Distribution of anterior IV branch: right and left ventricle and anterior two third of IVS<br />Moore,158<br /><br />82. C. Left side in midclavicular line in the 5th ICS<br />Auscultation area of mitral valve is 5LICS(5th left intercostals space)<br />Moore, 168<br /><br />83. E. in the wall of the RA near the opening of the superior vena cava<br />Normal heart rate controlled by SA node. This is location of SA node<br />Moore, 162<br /><br />84. C. activate guanilate cyclase<br />Lily, 414<br /><br />85. B. Captopril<br />The drug to prevent ventricular remodeling process: captoril. Karena obat ini akan menghambat produksi aldosterone sehingga efek bahayanya bisa terhindari. Efek buruk dari aldosterone adalah provoking hypertrophy and fibrosisi within myocardium<br /><br />86. A. decreased potassium level<br />MOA Furosemide adalah loop diuretic yaitu menghambat NKCC2, the luminal Na/K/Cl transporter in thick ascending limb of Henle’s loop.<br />Transporter ini normalnya akan menyerap Na,K,dan Cl searah dari lumen ke sel-sel ascending limb,sekaligus menyerap air. Ketika traspoter ini dihambat tidak ada penyerapan air(dan Na,Cl, serta K)pembuangan K tinggihypokalemia<br />(katzung 10th,243)<br /><br />87. D. Captoril<br />Kontra Indikasi Captopril:. <br />-Penderita yang hipersensitif terhadap captopril atau penghambat ACE lainnya (misalnya pasien mengalami angioedema selama pengobatan dengan penghambat ACE lainnya)<br />-Wanita hamil atau yang berpotensi hamil.<br />-Wanita menyusui <br />-Gagal ginjal <br /><br />88. B. Increased of bradykinin level<br />Ingat penjelasan salah seorang dokter waktu lecture. Untuk mekanisme lebih jelasnya baca lagi ya<br /><br />89. C. Digoxynpositive inotropic drug<br />90. B. Heparinanticoagulant effect<br />91. <br />92. E. Nifedipineblockage of Ca channel<br />93. D. Propanololcompetitive B-antagonist<br />94. E. Pulsatile arterial trauma<br /><br />96. E. Thromboangitis Obliterans<br />Ciri khas: Heavy smoker dan painful ulcer in distal extremities<br />Lily, 361<br /><br />97. C. Ischemia <br />Thromboangitis obliteran muncul dengan Triad Symptom:<br />-Distal arterial occlusionmenghasilkan claudication,yaitu exertional limb fatigue and pain cause by ischemia(inadequate supply to of blood to affected muscle) <br />-Raynold’s phenomenon<br />-Migrating superficial vein thrombophlebitis<br />Lily,361<br /><br />98. E. Phlebitis<br />Lihat penjelasan nomor 97<br /><br />99. D. Hemosiderin deposit<br /><br />100. E. Angiography<br />Left arm hypertension and claudication in her limb masalah pada pembuluh darah extremitas pemeriksaannya adalah angiography <br /><br />100)E claudication is a classic symptom of exertional limb fatigue and pain.usually occur in peripheral aterial disease(PAD),which may result in chronic occlusive arterial disease,with progressive stenosis & obstruction of blood flow.evaluation : duplex USG-assess the extent of arterial stenoses & corresponding reduction in blood flow.other imaging-MRA,CT-angiography-are obtained when revascularization procedure are planned (lilly;4th ed,pg 356-359) <br /><br />101)E Tuberculous pericardial effusions are typically exudative and characterized by a high protein content and increased leukocyte count, with a predominance of lymphocytes and monocytes.(American Heart Association-Circulation. 2005;112:3608-3616).<br />Nontuberculous bacterial(suppurative) pericarditis-fluid is a turbid exudates characterized by PMN leukocytes,increased LDH & decreased glucose.(braunwald;6th ed;pg 1854)<br /><br />102)<br /><br />103)A ECG pattern-diffuse ST segment elevation in most of ECG leads,usually with exception of aVR & V1.PR segment depression in several leads is often evident,reflecting abnormal atrial repolarization related to atrial epicardial inflammation.(lilly;4th ed;pg 338)<br /><br />104) B most frequent symptoms of acute pericarditis are chest pain & fever-pain may be severe..pain typically sharp & pleuritic & positional(sitting & leaning forward often lessen the discomfort).dyspnea is common during acute pericarditis but is not exertional & probably result from a reluctance of patient to breath deeply because of pleuric pain.(lilly,4th ed;pg 337)<br /><br />105)<br /><br />106)A idiopathic/viral pericarditis is a self limited disease-runs in course in 1-3weeks-management-rest,analgesic & NSAIDs.recurrent pericardial pain-oral corticosteroid.(lilly,4th ed;pg 339)<br /><br />107)E an intravenous drip containing isotonic saline or dextrose in water can be used to deliver supporting therapy (braunwald,6th ed,pg 1840)<br /><br />108)may be B or CECG,always nonspecifically abnormal,T wave-low/flat/have general /local inversion.QRS n T wave voltage may be normal or reduced,interatrial block is common-P waves wider than 100ms n usually notched.<br />Constriction (especially chronic) may present deceptively as congestice failure,pleural effusion,RA thrombosis,even hepatic coma.CP resembles ,but is not HF;venous congestion resembles right-sided HF with appropriate compensatory response.<br />All cardiac diastolic pressures are nearly equilibrated as in cardiac temponade (braunwald,6th ed,pg 1850-1852)<br /><br />109)<br /><br />110) C ELECTROCARDIOGRAPHY-In acute pericarditis, the ECG typically shows ST-segment elevation in all leads, with an upward concavity of the elevation (so-called “smiling face”). The PR segment is depressed. Unlike myocardial infarction, there is no reciprocal change, and T waves are not inverted.12–15<br />In this situation, the differential diagnosis includes acute myocardial infarction and normal-variant repolarization abnormality. It is particularly important to distinguish pericarditis from acute myocardial infarction, because thrombolytic therapy could have disastrous effects in patients with pericarditis. Characteristic features of acute pericarditis, acute myocardial infarction, and early repolarization are summarized in Table 3. Examples illustrating the ECG differentiation of the three conditions are provided in Figure 2.16<br /><br />Electrocardiographic Differentiation of Pericarditis<br />________________________________________<br />Acute pericarditis Acute myocardial infarction Early repolarization<br />ST-segment elevation in many leads, with no ST-segment depression Upward concave ST-segment elevation No T-wave inversion in leads with ST-segment elevation PR-segment depression Q waves during evolution ST-segment elevation in anatomically contiguous leads, with possible reciprocal ST-segment depression Upward convex ST-segment elevation T-wave inversion in leads with ST-segment elevation as myocardial infarction evolves No PR-segment depression May have Q waves during evolution ST-segment elevation in middle and left precordial leads, but may be widespread Upward convex ST-segment elevation May have T-wave inversion in leads with ST-segment elevation No PR-segment depression No Q waves<br /><br /> <br />A. Acute pericarditis. The ST segment (long arrows) is elevated in all leads (universal elevation in contrast to the focal elevation in acute myocardial infarction), with no reciprocal change. The ST-segment elevation shows upward concavity (so-called "smiling face"). The PR interval (short arrow) is depressed because of inflammatory changes involving the atrial wall. <br /> <br />B. Acute myocardial infarction. The ST segment (long arrow) is elevated in leads II, III, and aVF, and depressed (short arrow) in leads I, aVL, and V1, V2, and V3 (focal elevation in segment of injury, with reciprocal ST-segment depression). The ST elevation is convex upward (tomb shape or so-called "sad face"). <br /> <br />C. Early repolarization. ST-segment elevation (long arrow) is present in all leads, with no reciprocal depression. Peaked T waves (short arrow) are seen in the middle precordial leads. No Q waves are present<br />In cardiac tamponade, the ECG shows electrical alternans as the heart “floats” in relation to the recording leads. Chronic constrictive pericarditis presents with low voltage of the QRS complex and diffuse flattening or inversion of the T waves. Atrial fibrillation occurs in one third of patients with pericardial disease. <br />LABORATORY TESTS<br />Laboratory studies are useful for excluding other possible causes of symptoms and clarifying the underlying cause of pericarditis. Testing is individualized but frequently includes a complete blood cell count (CBC), an erythrocyte sedimentation rate (ESR), cardiac enzyme levels, and serum chemistries. Non-specific elevations in the CBC and ESR are common in patients with pericarditis. (American Academy of Family Physicians)<br />111)A a sharp early diastolic thrust is common especially in chronic constriction,corresponding to ventricular rapid filling.it coincides with loud,often palpable,abnorlmal S3,which sometimes has a ‘knocking’ quality.CP resembles,but is not HF.(braunwald,6th ed,pg 1851-1852)<br />112)A hypothesis-COPD,diagnosis:chest radiograph,ECG,echoCG,MRI,CT scan,radionuclide ventriculography(braunwald,6th ed,pg 1938)<br /><br />113)B dilation of RV gives the heart a globular appearance,but right ventricular hypertrophy or dilation is not easily discernible on a plain chest radiograph.pulmonary arterial hypertension in patient with COPD has been shown to be related to width of right descending pulmonary artery.although there are numerous disorders that fall under the heading of COPD,the 2 largest components are emphysema and chronic bronchitis.(braunwald,6th ed,pg 1938-1939)<br /><br />114)D management goals in COPD are ameliorate air flow obstruction and improve symptos,toavoid 2ndry complications,to maintain functional capacity & to improve the quality of life.drugs:anticholinergics,beta-blocker agonist,rheophylline,corticosteroids,digitalis,vasodilators,NO,ACE inhibitors,noninvasive ventilation(braunwald,6th ed,1941-1943)<br /><br />115)<br /><br />116)C PAH in COPD is due to multiple factors,include pulmonary vasoconstriction caused by alveola hypoxia,academia,and hypercarbia;the mechanical effects of high lung volume on pulmonary vessels;the loss of small vessels in vascular bed in regions of emphysema & lung destruction;ang increased of CO n blood viscosity from polycythemia secondary to hypoxia.of these causes,hypoxia is undoubtedly the most important & is associated with pathological changes that occur characteristically in peripheral pulmonary arterial bed.(braunwald,6th ed,pg 1940) <br /><br />117)D pulmonary thromboembolism,as a single event or as repeated events,rarely leads to development of chronic pulmonary hypertension(braunwald,6th ed,pg 1949)<br /><br />118)D vasodilators produced by endothelium include NO,prostacyclin,& EDHF(LILLY,4TH ED,144)<br /><br />119)A lec note<br /><br />120)C lecture note(cardiac rehabilitation)<br /><br />161. Which of the following is the most likely diagnosis?<br /> A. VSD<br /> B. ASD<br /> C. Aortic stenosis<br /> D. Tricuspid regurgitation<br /> E. Mitral valve prolapsed<br /> Jawab: E<br /> Pembahasan:<br /> Karakteristik bunyi jantung pada penyakit-penyakit di atas adalah sbb:<br /> Ventricular septal defect: harsh systolic murmur, middiastolic rumble<br /> Atrial septal defect: RV heave, widened-splitted S2, middiastolic murmur at left lower sterna border<br /> Aortic stenosis: coarse late-peaking systolic ejection murmur, parvus-tardus carotid pulse, S4, attenuated S2<br /> Tricuspid regurgitation: systolic murmur at lower left sterna border which is augmented by inspiration<br /> Mitral valve prolapse: midsystolic click, late systolic murmur<br /><br />162. Which of the following is the most appropriate management for the patient?<br /> A. Cardiac catheterization<br /> B. Penicillin prophylaxis for dental procedure<br /> C. Avoidance of strenuous activity<br /> D. Beta blocker<br /> E. Digitalis<br /> Jawab: B<br /> Pembahasan:<br /> Mitral valve prolapse secara umum kondisinya benign sehingga kebanyakan pasien akan asymptomatic untuk sebagian besar masa hidupnya.<br /> Komplikasi utama adalah endocarditis. Sehingga opsi B adalah jawaban paling tepat.<br /><br />163. The heart disease that is present at the time of birth is known as …<br /> A. congenital heart disease<br /> B. cardiogenic shock<br /> C. cardiovascular disease<br /> D. coronary heart disease<br /> E. acquired heart disease<br /> Jawab: A <br /> Pembahasan: jelas :-)<br /><br />164. A 45-year-old man is admitted to the hospital with low grade fever, night sweat, fatigability, malaise, weight loss, and valvular insufficiency. There is also erythematous subcutaneous nodules about the tips of the digits and hemorrhagic retinal lesion. After examining the patient, the doctor in charge thought that the man suffered from subacute bacterial endocarditis. What is the common cause of the disease?<br /> A. Staphylococcus aureus<br /> B. Staphylococcus epidermidis<br /> C. Streptococcus viridans<br /> D. Streptococcus non hemolyticus<br /> E. Streptococcus gamma haemolyticus<br /> Jawab: C<br /> Pembahasan:<br /> Etiologi utama acute infective endocarditis adalah Staphylococcus aureus.<br /> Etiologi utama subacute infective endocarditis adalah Streptococcus viridans, enterococci, fastidious gram negative bacteria. Yang ada di pilihan hanya Streptococcus viridans.<br /><br />165. Blood culture of suspected subacute infective endocarditis patients is performed on blood agar and after incubation in 37 C for 24 hours, growth of some bacterial colony is observed. What is the colony morphology of such bacteria?<br /> A. Diameter is 3 mm, non hemolytic<br /> B. Diameter is 3 mm, hemolytic<br /> C. Pinpoint colony, non hemolytic<br /> D. Pinpoint colony, alpha hemolytic<br /> E. Pinpoint colony, beta hemolytic<br /> Jawab: D<br /> Pembahasan:<br /> Kemungkinan besar, bakteri yang ditemukan pada kultur adalah Streptococcus viridans (karena subacute infective endocarditis). Bakteri ini termasuk golongan alpha-hemolytic. Jadi jawabnya D.<br /><br />166. To confirm an infective endocarditis, the doctor usually must have three positive blood cultures of the patient. From three blood samples drawn from three different venipuncture, except for a certain bacterium, only one positive sample is needed. What is the name of the bacterium?<br /> A. Mycobacterium tuberculosis<br /> B. Pseudomonas aeruginosa<br /> C. Streptococcus pneumonia<br /> D. Coxiella burnetti<br /> E. Eikenela corrodens<br /> Jawab: D<br /> Pembahasan:<br /> Criteria for Diagnosis of Infective Endocarditis<br /> Major Criteria<br /> Positive blood culture<br /> Typical microorganism for infective endocarditis from two separate blood cultures <br />Viridans streptococci, Streptococcus bovis, HACEK group or<br /> Staphylococcus aureus or community-acquired enterococci in the absence of a primary focus, or <br />Persistently positive blood culture, defined as recovery of a microorganism consistent with infective endocarditis from: <br /> Blood cultures (≥2) drawn more than 12 hr apart, or <br /> All of three or a majority of four or more separate blood cultures, with first and last drawn at least 1 hr apart <br />Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800<br /> Evidence of endocardial involvement<br /> Positive echocardiogram (TEE advised for PVE or complicated infective endocarditis) <br /> Oscillating intracardiac mass, on valve or supporting structures, or in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomical explanation, or <br /> Abscess, or <br /> New partial dehiscence of prosthetic valve, or <br /> New valvular regurgitation (increase or change in preexisting murmur not sufficient) <br /> Minor Criteria <br /> Predisposition: predisposing heart condition or intravenous drug use <br /> Fever ≥38.0°C (100.4°F) <br /> Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions <br /> Immunological phenomena: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor <br /> Microbiological evidence: positive blood culture but not meeting major criterion as noted previously or serologic evidence of active infection with organism consistent with infective endocarditis <br /> Sumber: Braunwald hal. 1718<br /><br />For question no. 167-168, see the scenario below<br />Most of the bacteria adhere to the damaged endothelium and cause endocarditis. There is also a kind of bacteria that can cause endocarditis on intact endothelium.<br /><br />167. What is the name of such bacteria?<br /> A. Coxiella burnetti<br /> B. Haemophilus influenza<br /> C. Streptococcus alpha hemolyticus<br /> D. Pseudomonas aeruginosa<br /> E. Staphylococcus aureus<br /> Jawab: E<br /> Pembahasan:<br /> Mekanisme terjadinya endocarditis pada endothelium utuh (intact) adalah sbb:<br />1. Pada orang yang tua (elderly), terjadi proses degenerasi pada katup, sehingga ada inflamasi. Inflamasi ini akan menginduksi terbentuknya berbagai adhesion molecules yang dapat membantu pelekatan leukosit ke katup; namun juga dapat membantu pelekatan mikroorganisme ke katup.<br />2. Pada intravenous drug users (IDU), hal yang sama terjadi.<br />Mikroorganisme yang mampu berlekatan dengan adhesion molecule yang diekspresikan adalah Staphylococcus aureus, karena bakteri ini memiliki microbial surface components recognizing adhesive matrix molecules (MSCRAMMs). Selain itu, S. aureus memiliki keunikan mampu membuat sel endothel menginternalisasi S. aureus sehingga di dalam sel endothel, S. aureus dapat melakukan multiplikasi. Akibatnya, sel endothel akan mengalami kematian, sehingga tidak lagi intact. Ketika endothel tidak lagi intact, sementara bakteri sudah berkumpul di sekitarnya, maka terjadi endocarditis.<br /> Sumber Braunwald hal 1719<br /><br />168. What is the bacterial product that facilitate bacteria adherence to the endothelium of the endocardium?<br /> A. LPS<br /> B. Hyaluronidase<br /> C. Hemolysin<br /> D. Clumping factors<br /> E. Streptokinase<br /> Jawab: D<br /> Pembahasan:<br /> Secara kolektif, molekul-molekul pada permukaan bakteri yang dapat membantu perlekatan ke endothelium disebut dengan microbial surface components recognizing adhesive matrix molecules (MSCRAMMs). Molekul ini ada beberapa jenis:<br />1. Glucan atau dextran, diproduksi oleh Streptococci. Fungsinya memediasi penempelan dengan fibrin, katup yang terluka, dan memfasilitasi perkembangan endocarditis.<br />2. Fim A protein, diproduksi oleh Streptococcus parasanguis, membantu penempelan dengan fibrin dan memfasilitasi perkembangan endocarditis.<br />3. Fibronectin receptor, diproduksi oleh Staphylococcus aureus, Streptococcus viridans, Streptococcus Group A, C, dan G, Enterococi, Streptococcus pneumonia, dan Candida albicans. Receptor ini akan berikatan dengan Fibronectin yg secara alami diekspresikan oleh sel endothel. Pelekatan akan memediasi pembentukan endocarditis.<br />4. Clumping factor, diproduksi oleh Staphylococcus aureus, akan memediasi penempelan bakteri ke thrombi yang dibentuk, dan, pada eksperimen, ke katup aorticus.<br />5. Glycocalyx dan slime (lendir) di permukaan S. epidermidis tidak membantu pelekatan, namun dapat membuat S. epidermidis lebih virulen dan menghindari host defense.<br />Sumber: Braunwald<br /><br />169. A 15-year-old boy is admitted to the hospital because of fever, malaise, and migratory polyarthritis. After examining the patient, the doctor in charge suspected that the boy suffered from rheumatic fever. What is the bacteria most likely responsible for such disease?<br /> A. Staphylococcus epidermidis<br /> B. Staphylococcus aureus positive coagulase<br /> C. Streptococcus beta haemolyticus group A<br /> D. Streptococcus alpha haemolyticus<br /> E. Haemophilus influenza<br /> Jawab: C<br /> Pembahasan:<br /> Cukup jelas. Etiologi dari rheumatic fever adalah group A beta-hemolytic streptococci (GABHS).<br /> <br />170. A doctor in charge in Cardiology Ward performs pericardiocentesis to a patient suspected of chronic infective pericarditis and takes out some bloody fluid. What bacteria is the most likely cause?<br /> A. Pseudomonas aeruginosa<br /> B. Mycobacterium tuberculosis<br /> C. Streptococcus pneumonia<br /> D. Haemophilus influenza<br /> E. Staphylococcus aureus<br /> Jawab: B<br /> Pembahasan:<br /> Pilihan-pilihan lainnya adalah bacterial pericarditis, yang kemungkinan menunjukkan pus pada pericardial fluid-nya.<br /><br /><br /><br /><br />For question number 171 and 172, refer to the scenario below<br />A 62-year-old man comes to your clinic with exercise-induced angina. His serum cholesterol is 277 mg/dL, LDL 157, HDL 43, and triglyceride 170. He is overweight and has two risk factors for CAD. On cardiac catheterization, there is occlusion of left anterior descending and the origin of right coronary artery.<br /><br />171. Which of the following process cause the disease above?<br /> A. adventitial proliferation<br /> B. injury to endothelium<br /> C. formation of an intimal plaque<br /> D. proliferation of smooth muscle cells<br /> E. attraction of platelet to collagen microfibrils<br /> Jawab: C<br /> Pembahasan:<br /> Berdasarkan keluhan (exercise-induced angina), anamnesis (2 faktor risiko untuk CAD), pemeriksaan fisik dan lab (overweight, hypercholesterolemia, dyslipidemia, hyperlipidemia), maka pasien mengalami CAD.<br /> Pada CAD, terbentuk atherosclerosis pada dinding arteri koroner pada jantung. Proses pembentukannya diawali oleh kerusakan pada endothelium yang menyebabkan LDL dapat masuk ke dalam jaringan subintima. Ketika LDL masuk, ia akan dimodifikasi menjadi modified LDL melalui proses oksidasi atau glikasi. Modified LDL akan menginduksi pembentukan reseptor scavenger pada leukosit yang masuk ke dalam tunica intima sehingga leukosit akan meng-engulf modified LDL. Engulfment ini akan mengubah leukosit (macrophage) menjadi foam cells. Foam cells sendiri mampu mensekresikan cytokine dan growth factor. Cytokine akan menginduksi migrasi sel otot polos dari tunica media ke intima. Growth factor akan menginduksi proliferasi sel otot polos tsb. Sel otot polos akan mensekresikan extracellular matrix (ECM). Proliferasi sel otot polos dan sekresi ECM akan menyebabkan penebalan lokal dari dinding pembuluh darah, menyebabkan oklusi.<br /> Jadi, kesimpulannya, proses yang menyebabkan CAD adalah pembentukan plaque pada tunica intima.<br /> Opsi yang lain tidak cukup untuk secara mandiri menyebabkan CAD.<br /><br />172. Which of the type of arteries involved in the above condition?<br /> A. Conducting<br /> B. Distributing<br /> C. Arterioles<br /> D. Metarterioles<br /> E. Capillaries<br /> Jawab: B<br /> Pembahasan:<br /> Histologi Arteri<br /> Arteri ada 3 macam:<br />1. Elastic/conducting artery<br />a. Diameter > 1 cm<br />b. Contoh: aorta, bracicephalic artery, common carotid artery, subclavian artery, pulmonary artery, common iliac artery<br />c. Fungsi utamanya adalah membantu mendorong darah ketika ventricle sedang relaksasi.<br />d. Tunica intima terdiri atas endothel, basal membrane, dan internal elastic lamina yang tidak utuh.<br />e. Tunica media terdiri atas smooth muscle, banyak elastic fibers, dan external elastic lamina yang tipis.<br />f. Tunica adventitia terdiri atas collagen dan elastic fibers.<br />2. Muscular/distributing artery<br />a. Diameter 0.1 – 1 cm<br />b. Contoh: brachial artery, radial artery<br />c. Fungsi utamanya untuk menentukan kecepatan aliran darah karena kemampuan konstriksi dan dilatasinya sangat tinggi<br />d. Tunica intima terdiri atas sel endothel, basal membrane, dan internal elastic lamina yang tipis<br />e. Tunica media terdiri atas banyak smooth muscle cells, sedikit elastic fibers, dan external elastic lamina yang tebal<br />f. Tunica adventitia terdiri atas collagen fiber dan elastic fibers.<br />3. Arteriole<br />a. Diameter 10-100 μm<br />b. Tunica intima terdiri atas endothel, basal membrane, dan internal elastic lamina<br />c. Tunica media terdiri atas smooth muscle cells, sedikit elastic fibers, tanpa external elastic lamina.<br />d. Tunica adventitia terdiri atas collagen dan elastic fibers.<br />Arteri koroner memiliki diameter < 1 cm, namun masih dapat terlihat jelas. Selain itu, kemampuan vasokonstriksi dan dilatasinya tinggi, sehingga termasuk muscular/distributing artery.<br /><br />173. A 45-year-old woman came with painful, tender, cord-like structure with associated redness and swelling as chief complaint. Which of the following normal structures from damaged organ above?<br /> A. Tunica intima has pericytes<br /> B. Tunica intima has thick internal elastic lamina<br /> C. Tunica media has reticular and elastic fibers<br /> D. Tunica media has thick external elastic lamina<br /> E. Tunica adventitia has smooth muscle cells<br /> Jawab: kurang tahu, tapi kalau di buku 2006, dijawab D<br /> Pembahasan:<br /> Pembahasan 2006 juga:<br /> Kemungkinan besar, arteri yang dimaksud adalah arteri muscular karena berada di antara jantung dan organ yang akan divaskularisasi.<br /> Opsi A salah, karena pericyte hanya dimiliki oleh kapiler<br /> Opsi B salah, karena tunica intima dari muscular artery memiliki internal elastic lamina yang tipis.<br /> Opsi C salah, karena tunica media dari muscular artery hanya dibentuk oleh elastic fiber dan otot polos.<br /> Opsi E salah, karena (di vaskular jenis apa pun) adventitia hanya terdiri atas collagen dan elastin<br /> Opsi D benar, karena pada muscular artery, tunica medianya memiliki external elastic lamina yang tebal.<br /> <br />For question number 177 and 178, refer to the options below.<br />A. Decrease pulmonary vascular markings<br />B. Hilar alveolar infiltrats and widening of hilum<br />C. Cephalization<br />D. Revised comma sign<br /><br />177. A man with a history of cardiac enlargement was confined for 7 days. Today, he is complaining of dyspnea again and chest X-ray reveals pulmonary congestion.<br /><br />178. A middle-aged man smoker admitted to the hospital due to setting or worst chest pain. Based on x-ray, doctors’ conclusion was pulmonary edema.<br /><br /> Pembahasan tentang radiografi (dari jawaban 2006, maaf saya g nemu..):<br />- Decreased pulmonary vascular markings disebabkan oleh penurunan aliran darah pada arteri pulmonalis, biasanya karena ada block pada arteri tersebut. Contoh penyakitnya adalah pulmonary stenosis, TOF (karena ada pulmonary stenosis), pulmonary atresia.<br />- Hilar alveolar infiltrates disebabkan adanya alveolar edema karena congestive heart failure.<br />- Cephalization adalah redistribusi aliran darah dari vena pulmonalis untuk paru-paru lobus inferior ke lobus yang superior (normalnya, lobus yang inferior mendapat lebih banyak aliran). Ini biasa ditemukan pada congestion juga, namun tipe congestion yang lebih berat daripada hilar alveolar infiltrate.<br />Pada no. 177, jawabnya kemungkinan C, karena pada kasus ada cardiac enlargement, yang mengindikasikan gagal jantung confestif yang sudah lebih parah.<br />Pada no. 178, jawabnya kemungkinan B, karena ada pulmonary edema yang belum terlalu parah.<br /><br />For number 179 and 183, refer to the options below.<br />A. MRI<br />B. CT scan<br />C. Nuclear medicine<br />D. Echocardiography<br />E. Conventional radiography of the chest<br /><br />179. Abnormal of the costa sternum<br />180. Evaluation of hemodynamics of the heart<br /> <br /> Pembahasan modalitas imaging untuk jantung (dari 2006 juga):<br /> MRI digunakan untuk melihat jaringan lunak (darah maupun jaringan) pada berbagai bidang.<br /> CT scan digunakan untuk melihat jaringan pada sumbu melintang tubuh.<br /> Nuclear medicine berkaitan dengan penyuntikan zat radioaktif (kontras) untuk melihat uptake dari jaringan yang ditarget. Pada jantung, bisa digunakan untuk melihat fungsi myocardium.<br /> Echocardiography paling baik digunakan untuk meng-assess fungsi jantung. Biasa melihat fungsi hemodinamik jantung jika dikombinasikan dengan Doppler, bisa melihat pergerakan katup, kontraksi jantung, dll.<br /> Radiography thorax dapat melihat siluet jantung dan paru, vaskular markings, serta tulang-tulang pada thorax.<br /> Jadi, jawaban no. 179 adalah E dan jawaban no. 180 adalah D.superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com1tag:blogger.com,1999:blog-3810580967966978266.post-15648477592707029962010-06-12T23:11:00.002-07:002010-06-12T23:17:45.645-07:00MIDTERM 2010 (CRP-BHP-PHOP)Soal CRP<br />17. Geometrical model for population projection?<br /><br />36. (Soal tentang twinning med student) What info do you need to decide if this is an oubreak?<br /><br />West Java diarrhea case per 100.000 people approximately 150<br />Sukarasa 2005 : 154 cases, 2006 : 145 cases, 2007 : 150 cases<br />Sukawangi 2005 : 120 cases, 2006 : 60 cases, 2007 : 100 cases<br />Sukadana 2005 : 100 cases, 2006 : 110 cases, 2007 : 150 cases<br />Sukaresik 2005 : 175 cases, 2006 : 164 cases, 2007 : 109 cases<br />Sukarame 2005 : 100 cases, 2006 : 130 cases, 2007 : 200 cases<br />40. Diarrhea outbreak in 2007?<br />A. Sukarasa<br />B. Sukawangi<br />C. Sukadana<br />D. Sukaresik<br />E. Sukarame<br /><br />58. Most appropriate for epidemic curve?<br />A. Line chart<br />B. Bar chart<br />C. Histogram<br />D. Pie chart<br />E. Scatter chart<br /><br />61. Public health sureillance include which activities?<br />A. Data minimalization<br />B. Data collection<br />C. Data presentation<br />D. Data reporting<br />E. Disease control<br /><br />78. If you already have BMI data, the appropriate command in Epi info to answer “What percentage of the...” is<br />A. READ BMI_1 ASSIGN BMI_1 FREQ BMI_1<br />B. RECODE BMI_1 ASSIGN BMI_1 FREQ BMI_1<br />C. RECODE BMI_1 FREQ BMI_1 ASSIGN BMI_1<br />D. DEFINE BMI_1 RECODE BMI_1 FREQ BMI_1<br />e. DEFINE BMI_1 RECODE BMI_1 FREQ BMI_1<br /><br />Soal BHP<br />2. The doctor gives transfusion to the patient without doing cross match. Bertentangan dengan prinsip apa?<br />A. nonmaleficence<br />B. beneficence<br />C. justice<br />D. autonomy<br />E. integrity<br /><br />3. A 36 y.o male diagnosed having AML that is incurable, the treatment is only symptomatic by giving blood transfusion if the symptom getting worse. Which ia the most appropriate action done by the doctor?<br />A. Explain the condition & let him decide the treatment<br />B. Explain the condition & decide the treatment<br />C. Tell the patient not to worry about his condition<br />D. Not tell the diagnosis & refer the patient to other doctor<br />E. Not tell diagnosis, but to family<br /><br />17. Anak leukemia. Dokter menyarankan transplantasi bone marrow. Tapi pasien menolak dan rencana dibatalkan. Ethic yang dilakukan dokter?<br />A. Beneficence<br />B. Autonomy<br />C. Non maleficence<br />D. Justice<br /><br />Soal PHOP<br />11. UV can cause cataract<br /><br />14. UV can cause cataract<br /><br />17. Usualy found in batteries, solder, or drinking water if pipes are used. Accumulation in bone.<br /><br />nb : sori ya ga lengkap,emang ga pada ngumpulin waktu itu,nampak gara2 sama ama soal yg waktu 08...:)superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-76640870424015972272010-06-12T23:11:00.001-07:002010-06-12T23:24:28.783-07:00FINAL PHOP II 2010MDE FINAL PHOP 2<br /><br />Frenz, ini soal Final PHOP kemaren… Urutan soalnya ngacak, tapi semuanya lengkap 40” nya hehe…<br />Trus jawabannya tolong dicek-ricek lagi yah…<br />Gudlak semuanya!<br /><br />These are the answers for questions number 1-4 :<br />A. CO<br />B. SO2<br />C. Particle<br />D. O3<br />E. NO<br /><br />1. Molecules that bind to Hb 200-300 times stronger than Hb O2 bound. (Ans: CO)<br />2. After several days, people become tolerant, but persons with asthma may still develop airflow obstruction. (Ans: O3)<br />3. Causing acid rain, which causing London Fog. (Ans: SO2)<br />4. Source from fireplace and tobacco smoking. (Ans: ga yakin -> NO / particle)<br /><br />5. Gas can cause chemical asphyxiant? (Ans: hydrogen cyanide )<br /><br />These are the answers for questions number 6-10 :<br />a. waterborne disease<br />b. water privation disease<br />c. water-based disease<br />d. water related disease<br />e. water dispersed infection<br /><br />6. Disease like malaria, dengue, yellow fever, and Japanese encephalitis are include in… (Ans : -related)<br />7. Disease that affected more by quantity rather than quality. (Ans : -privation)<br />8. Arise from the contamination of water by human or animal feces or urine infected by pathogenic viruses or bacteria… (Ans : -borne)<br />9. Water provides the habitat for intermediate host organism to pass their life cycle... (Ans : -based)<br />10. Pathogen proliferate in fresh water and enter to the body from respiratory tract? (Ans : -dispersed)<br /><br />11. Which is the following is a chemical that can combine with hemoglobin and form methemoglobin?<br />a. arsenic<br />b. fluoride<br />c. iodine<br />d. nitrates<br />e. cyanides<br />Ans : D<br /><br />12. Which is the following substance which in lack condition can cause thyroid gland enlargement?<br />a. arsenic<br />b. fluoride<br />c. iodine<br />d. nitrates<br />e. cyanides<br />Ans : C<br /><br />13. Zat yang digunakan untuk pengolahan air : :<br />a. chlorine & arsenic<br />b. ? & arsenic<br />c. chlorine & cyanide<br />d. ? & cyanide<br />e. aluminium & iron<br />Ans : kemungkinan Al & Fe (E), soalnya masa mau dikasih sianida & arsen…<br /><br />14. Proses pencemaran air secara tidak langsung dari pencemaran udara disebut …<br />a. eutrophication<br />b. algae<br />c. acidification <br />Ans: kemungkinan acidification (C), makanya ada acid rain akibat polusi udara…<br />Eutrophication = dorongan terhadap pertumbuhan organism yang berlebihan sehingga merugikan organism lain dalm ekosisitemyang sama akibat pasokan gizi secara berlebihan. (Dorland) <br /><br />15. Penyebab diare akibat virus pada anak-anak …<br />a. rotavirus<br />b. hepatitis a<br />c. hepatitis b<br />Ans : A<br /><br />These are the answers for questions number 16-20 :<br />The hierarchy of control based on ALARA is below :<br />a. Elimination<br />b. Subtitution<br />c. Engineering controls<br />d. Administration controls<br />e. Personal protective equipment<br /><br />16. Synthetic pyrethroid insecticides instead of organophoshates. (Ans : substitution )<br />17. Permits for high-risk tasks. (Ans : administration)<br />18. Removal of asbestos from buildings. (Ans : elimination)<br />19. Enclosing the process & increasing ventilation to get rid of steam & hot air. (Ans : engineering)<br />20. Rotation job. (Ans: administration)<br /><br />21. What is index that indicates distribution of such vector aedes aegypty surveillance?<br />a. Breateau Index<br />b. Water Index<br />c. Container index<br />d. Mosquito Index<br />e. ?<br />Ans: A<br />According to the WHO definition, this index is the number of positive containers (i.e. containing _Aedes aegypti_ larvae) per 100 premises inspected. That is number of positive containers for Aedes aegypti per 100 houses is represented as Breteau index. When it is 50 or more then the risk of transmission is high and when it is 5 then risk of transmission is low. (internet)<br /><br />22. The insecticide that classified as organochlorine?<br />a. abate<br />b. malathion<br />c. DDT<br />Ans : C<br /><br />23. Penemuan jenis insektisida pertama untuk vector-borne control termasuk dalam kelas?<br />a. natural<br />b. organochlorine<br />c. organophosphate<br />d. carbamate<br />e. fumigants<br />Ans: B, yang dimaksud di sini adalah DDT.<br /><br />24. Which is the following sentence is advantage of larvicidal application ?<br />a. Cost effectively<br />b. The operation carried out in long time<br />c. Maybe toxic to human<br />d. Some larvacidal may harm other organism<br />e. Many effective larvicide is widely available<br />Ans : E<br /><br />25. Alasan memilih insecticide untuk metode residual wall spraying :<br />a. Technically simple methods<br />b. No need trained personnel<br />c. Cheaper<br />d. Technical involvement of the community<br />e. Requiring high investment for a limited period<br />Ans : D.<br /><br />26. What is the early vector control program?<br />a. The use of treated mosquito net<br />b. The use of mosquito net<br />c. The use of carbamate<br />d. The use of insecticide vaporizer<br />e. The use of protective clothing<br />Ans : B<br /><br />27. DDT is no longer use because of…<br />a. Short life<br />b. Non highly toxic<br />c. Merusak lingkungan <br />d. Biodegradable<br />e. Expensive<br />Ans : C<br /><br />28. Which is classified as natural repellent? (Ans : pyrethrum)<br /><br />29. Community control … ?<br />a. membasmi breeding in and around house<br />b. use self protection<br />c. wall spraying<br />Ans : C (kalo ga salah sih ada option wall spraying…)<br /><br />30. Aedes mosquito play a role in what disease?<br />a. Japanese encephalitis<br />b. Malaria<br />c. Dengue Hemorrhagic Fever<br />d. Schistosomiasis<br />e. Trypanosomiasis<br />Ans : C<br /><br />31. Warfare yang dilakukan oleh kaum lemah yang terbatas sumber dayanya, terhadap kaum yang lebih dominan/kuat, serangannya periodik dan tidak terduga, daripada serangan langsung…<br />a. Biological warfare<br />b. Chemical warfare<br />c. Nuclear warfare<br />d. ? <br />e. Guerilla warfare<br />Ans : E<br /><br />32. Sinar ultra violet yang menyebabkan kerusakan kulit dan tanning?<br />a. UV-A<br />b. UV-B<br />c. UV-C<br />d. UV-A dan UV-B<br />e. UV-A dan UV-C<br />Ans : kemungkinan D, karena UV-B jelas merusak kulit, UV-A membantu si UV-B (kata Dorland), UV-C ga nyampe ke bumi…<br /><br />33. Which of the following is the right gas of greenhouse gas?<br />a. Carbon dioxide<br />b. Carbon monoxide<br />c. Sulfur dioxide<br />d. Volatile organic compound<br />e. Ozone<br />Ans : A<br /><br />34. Characteristic of technological disaster? (no idea … T_T)<br />a. responsibility usually without agent<br />b. objective magnitude of loss usually great<br />c. perceived magnitude of loss is usually maximized<br />d. nature of disaster is clean & unavoidable<br />e. community support for those affected is usually non-judgmental<br /><br />35. Effect of ozone depletion?<br />a. Immunological<br />b. GI tract<br />c. Urogenital<br />d. Reproductive<br />e. Respiratory<br />Ans : A<br /><br />These are the answers for questions number 36-40 :<br />a. pathological waste<br />b. infectious waste<br />c. pharmaceutical waste<br />d. radioactive waste<br />e. chemical containing heavy metal waste<br /><br />36. Body waste (Ans : A)<br />37. Feces (Ans : B)<br />38. Expired drugs (Ans : C)<br />39. Waste from drug industry (Ans : D)<br />40. Broken thermometer (Ans : E)superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-56600446445530359592010-04-17T00:26:00.000-07:002010-06-13T21:28:14.051-07:00MDE DMS 2010MDE DMS 2010 (BATCH 2007)<br /><br />1. During insertion of an IV cannula in the median cubital vein, a patient suddenly lost his feeling on the radial side of the forearm. Which of the following nerve is the most likely injured for this case?<br />a. musculocutaneus N<br />b. superficial radial N<br />c. lateral antebrachial cutaneus N<br />d. medial antebrachial cutaneus N<br />e. posterior antebrachial cutaneus N<br /><br />2. A saphenous cut down is a surgical procedure that involves cutting through the skin locate the greater saphenous vein. Best way to find that vessel ?<br />a. Anterior to the medial malleolus<br />b. Through the saphenous opening<br />c. Anterior to medial epicondyle<br />d. Tributaries to the posterior tibial vein<br />e. Subcutaneous branches of the posterior tibial artery<br />3. An elderly woman presented with severe pain beneath her left eye, radiating into lower eye lid, lateral side of the nose and upper lip. WOTF nerve is most likely appropriate?<br />a. supratrochelar<br />b. infraorbital<br />c. zygomatic<br />d. buccal<br />e. mental<br /><br />4.which of the following muscle can produce the expression of grimace?<br />a. platysma<br />b. buccinators<br />c. zygomatic major<br />d. levator anguli oris<br />e. levator labii superioris<br /><br />5. muscle yang disupply oleh medeial pterygoid nerve:<br />a. tensor velli palatine<br />b. levator velli palatine<br />c. palatopharyngeus<br />d. palatoglossus<br />e. uvula<br /><br />6. Triangle superior ansa cervicalis separated with hypoglossal nerve?<br />7. Muscle to elevate tongue?<br />a. medial pterygoid<br />b. lateral pterygoid<br />c. buccinators<br />d. temporalis<br />e. masseter<br /><br />8. Dislocation of jaw spasm. Which muscle injured?<br /><br />9. Severe neck injury in C6. Left transverse process is fractured. Artery injured ?<br />a. Common carotid<br />b. Internal carotid<br />c. Vertebral<br />d. Costocervical<br />e. Inferior thyroid<br />10. Conus medullaris terletak di ?<br />a. T8-T10<br />b. T10-T12<br />c. L2-L3<br />d. L5-S1<br />e. S2-S4<br />11. After ramming the points of his shoulder into a practice dummy, a football player suffered a severe shoulder aeparation. The one that give the joint its greatest strength and stability?<br />A. supraspinatus tendon<br />B. coracoacromal ligament<br />C. coracoclavicular ligament<br />D. acromioclavicular ligament<br /><br />12.Shoulder dislocation is always clue to injured rotator cuff muscle. Some muscle rotator the arm medially.Which nerve innervate?<br />a.Supraclavicular<br />b.Thoracodorsal<br />c.Subscapular<br />d.Subclavian<br />e.Axillary<br /><br />13. axillary nerve injured. Otot apa yang terkena?<br /><br />14. lubricants in synovial fluid?<br /><br />16.The action of group contrictor pharyngeal muscle is to contrict the pharingeal cavity.Which of the following nerves is the most likely innervate that muscles?<br />a.Glossopharyngeal nerve<br />b.Spinal accessory nerve<br />c.Symphatetic trunk<br />d.Hypoglossal nerve<br />e.Vagus nerve<br /> <br />17.Irrigation of maxillary sinus through its opening is a supportive measure to accelerate the resolution of maxillary sinus infection.<br />Which of the following nasal spaces is the most likely approach to the sinus opening?<br />a. Choana<br />b. Inferior meatus<br />c. Middle meatus<br />d. Superior meatus<br />e. Sphenoethmoidal recess<br /> <br />18.A Six-year-old,whose medical history include a rather difficult birth, has a pemanently tilted head posture,with the right ear near the right shoulder and face turned upward and to the left.Which of the following muscles was very likely damaged during birth?<br />a.Sternocleidomastoid<br />b.Anterior scalene<br />c.Omohyoid<br />d.Trapezius<br />e.Platysma<br /> <br />19.A.patient who has sustained a fracture at the base of cranium following a fall from a height, might have nerve injury.The fracture located at the foramen ovale.<br />Which of the following nerves that enter the foramina is the most likely injured?<br />a. Facial<br />b. Abduscen<br />c. Maxillary<br />d. Occulomotor<br />e. Mandibular<br /> <br />20.During an industrial accident, a sheet metal lacerates the anterior surface of a worker wrist at the junction pf his wrist and hand.Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb.Which of the following nerves is most likely injured?<br />a.Lateral antebrachial cutaneus<br />b.Medial antebrachial cutaneus<br />c.Median<br />d.Radial<br />e.Ulnar<br /> <br />21.A 50-year-old male patient says that he has pain in his groin and uppert thigh.Upon examination, you palpate a lump located below the inguinal ligament lateral to it’s attachment to the pubic tubercle.You suspect that this may be a hernia.<br />Which of the following is the structure that passes through the hernia?<br />a. Femoral canal<br />b. Obturator canal<br />c. Adductor hiatus<br />d. Deep inguinal ring<br />e. Superficial ingunal ring<br /><br />For 22-24<br /> The skeletal system develops from mesenchyme, which is derived from the mesodermal germ layer and from neural crest.match the description below with the appropiate skeletal abnormality.<br />a. Scoliosis<br />b. Syndactily<br />c. Spina bifida<br />d. Acromegaly<br />e. Achondroplasia<br />22.This result from imperfect fusion or non-union of the vertebral arches<br />23.This is a conditiont have two succesive vertebrae fuse asymetrically or have half a vertebrae missing.<br />24.This is an abnormality of conversion of cartilage into bone, primarily affecting the epiphyses of long bones, in which epiphyseal growth is retarded.<br /> <br />25.Pattern of muscle formation are controlled by connective tisssue into which myoblasts migrate.<br />Which of the following pattern of muscle formation are directed by connective tissue elements derived from neural crest cells?<br />a. In the head<br />b. In the limbs<br />c. In tthe body wall<br />d. In the cervical region<br />e. In the occipital region<br /> <br />26.Pharyngeal apparatus contributes greatly to the formation of the head and neck.It consists of pharyngeal arches,-pouch,-grooves,and-membrane.<br />WOTF cartilage of the ear derived from pharyngeal arch 2?<br />a. Incus<br />b. Stapes<br />c. Maleus<br />d. Stapedius<br />e. Tensor tympany<br /> <br />27.If skeletal muscle is stimulated by the threshold stimulation,WOTF condition will occur?<br />a.Depolarization<br />b.Repolarization<br />c.Polarization<br />d.Hyperpolarization<br />e.Nothing happend<br /> <br />For no 28-33<br />a. Keratin alfa<br />b. Collagen<br />c. Elastin<br />d. Hyaluronic acid<br />e. Myosin<br />f. Actin<br />28.These molecules produce high tensile strength without stretch<br />29.These molecules produce two way stretch with elasticity<br />30.These molecules are the constituent of almost the entire dry weight of the hair.<br />31.The synthesis of these molecules requires vitamin C<br />32.These molecules serve as lubricants in synovial of joint<br /><br />33.An 18-year old woman with chief complaint of papules on face and back, her diagnosis is acne vulgaris for lesion of the face and doctor plans to give for systemic treatment: Tetracycline 500 mg cap.orally 3 times a aday 1 hour before meal for 5 day.<br />Which of the following is the most likely prescription for the patient.<br />a. R/Tetracycline cap 500 mg No.V<br />S.t.d.d. cap.1.1 h.p.c<br />b. R/Tetracycline 500 mg cap No.XV<br /> S.t.d.d. cap.1 1 h.a.c<br />c. R/Tetracycline cap No.XV<br /> S.t.d.d. cap.1 1 h.p.c<br />d. R/Tetracycline cap No.XV 500 mg<br /> S.t.d.d. 3 cap. 1 h.p.c.<br />E. R/Tetracycline cap.500 mg<br /> S.t.d.d. cap. 1 h.a.c.<br /><br />35.The doctor also gives erythromycin 2% cream, quantity of tube 20 gr, number of tube 1, twice daily. Whivh of the following is the most likely prescription for the patient?<br />a. R/ Erythromycin 2 % cream tube 20 gr. No.1.<br /> S.b. d.d.part.dol.applic<br />b. R/ Erythromycin cream tube 1, 20 g.<br /> S.t. d.d.part.dol.applic.<br />c. R/ 2 % Erythromycin cream 20 g tube 1<br /> S.b.d.d.part.dol.applic.<br />d. R/ Erythromycin cream 20 g. 2%<br /> S d.d.part.dol.applic.<br />e. R/ Erythromycin 20 g. No.tube.1<br /> S. b.d.d.part.dol.applic.<br /><br />36. A 60 year old has moderate hypertension controlled with HCT 12.5 mg once daily and Losartan 50 mg once daily. He is prescribed Rofecoxib 50 mg once daily to control osteoarthritis pain. After 3 months of this therapy, his BP begins to rise. This increase in blood pressure is most likely due to:<br />a. Arteriolar contraction in the peripheral circulation caused by inhibition of COX-1 by rofecoxib.<br />b. weight gain caused by rofecoxib’s ability to decrease basal metabolic rate<br />c. Increased Excretion of HCT due to increased renal blood flow by rofecoxib<br />d. Inhibition of COX-2 by rofecoxib which leads to decreased renal blood flow<br />e. Increased metabolism of Losartan due to induction of CYP2C9 by rofecoxib<br /><br />37. A 60 year old man with a history of echzema and heavy alcohol use begins taking ibuprofen to control hip and knee pain due to osteoarthrititis. Over the course of 10 months as the pain worsens, he increase her dosage to high level (600 mg four times daily). What toxicity is most likely to occur?<br />a. Abnormal heart rythmes<br />b. murotizing fasciitis<br />c.confusion and ataxia<br />d. eosinophilia<br />e. Gastric ulceration<br /><br />38. A patient with coronary artery disease is particularly challenging anesthesia, since alteration in vascular responsiveness and myocardial function may put them at risk. In this respecet which statement correctly describes the cardiovascular action of agents that should be taken into account when planning anesthesia for such patients?<br />a. all halogenated hydrocarbon inhalation anesthetics sensitize the myocardium to cathecolamine induce cardiac arrhythmias<br />b.halogenated hydrocarbon inhalation agents reduce cardiac output equally well<br />c. sevoflurane directly stimulates symphatetic action<br />d. reflex symphatetic stimulation is a mayor component of halotane’s cardiovascular profile<br />e. several halogenated hydrocarbon produce vascular relaxation to renal blood pressure<br /><br />39. Remifentanil has recently gained popularity as a high dose opioid anesthesia because:<br />a. it induce anesthesia in patient faster than any other drug<br />b. phenylperidine type opioids release histamine from mast cells<br />c. it is metabolize by non specific esterase in red cells and other tissue<br />d. it has long duration of action following IV infusion<br />e. It does not produce chest wall rigidity<br /><br />40. which of hypothtetical anesthetic would you expect anesthetic partial pressure to be achieved relatively quickly?<br />a. an agent that is highly soluble in blood and other body tissue<br />b. an agent with a low minimum alveolar concentration<br />c. an agent with a high Oswald solubility coefficient<br />d. an agent whose rate of rise of partial pressure in the lung is influenced minimally by uptake into the blood, supplied as a gas rather than ???<br />e. an agent supplied as a gas rather than one supplied as a volatile liquid<br /><br />41. which of the following opiods has analgesically active metabolite? <br />a. Naloxone<br />b. Meferidine<br />c. Propoxyphene<br />d. Codein<br />e. Nelmefene<br /><br />42. which of the following statement about relecoxib is true?<br />a. it irreversible acetylates the COX-2 enzymes<br />b. inhibits both the inducible and constitutive COX-2 Enzyme<br />c. it produce no GI bleeding<br />d. it is indicated only for the disease , osteoarthritis<br />e. it increases healing of GI ulcers<br /><br />43. morphine produces an analgesic effect due to:<br />a. a block of potassium efflux from a neuron<br />b. an increase in C-AMP accumulation in a neuron<br />c. a decrease in intracellular Ca in a neuron<br />d. interaction with a G-protein in the neuron<br />e. an increase in calcium channel phosphorylation in the neuron<br /><br />44. K-opioid receptor activation is a required to observe:<br />a. Respiratory depression<br />b. bradycardia<br />c. myosis<br />d. mydriasis<br />e. hypocapnia<br /><br />45. which of the following statements about fentanyl paths is true?<br />a. they produce no respiratory depression<br />b. they no produce no anesthesia and analgesia<br />c. they no produce constipation<br />d. they can be use during pregnancy<br />e. they cannot be used in ambulatory patients<br /><br />46. a patient has been receiving 5 fluorouracil as a palliative for adebocarcinoma. You suspect that the patient has become resistant to the treatment. You want to understand the most likely cause of the resistance before you select another agent. Which of the following is the most likely cause?<br />a. drug transport into cells is decreased<br />b. P-glycoprotein is increased<br />c. the tumor can no longer activate the lung<br />d. the tumor is detoxifying the drug more rapidly<br />e. the tumor has developed an increase in metallothionein content<br /><br />47. damage to the peripheral nerve motor neuron in the somatic nerves system produce:<br />a. high voltage and short duration potential<br />b. high voltage and long duration potential<br />c. low voltage and short duration potential<br />d. low voltage and long duration potential<br />e. silent potential<br /><br />48. the period between muscle twitch IS relaxation period and during this period the one of the very important mechanism is such as follow:<br />a. sarcomeres shorten as result of myosin cross bridge cycling<br />b. Tension is reduced, muscle returns to original length<br />c. sarcolema and T-tubules depolarize<br />d. Ca released to cytosol<br /><br />49. detachment of the cross bridges from actin is directly triggered by:<br />a. depolarization of plasma membrane<br />b. attachement of ATP to myosin head<br />c. repolarization of T-tubules<br />d. hydrolysis of ATP<br />e. calcium ions<br /><br />50. prolongation of contraction with high frequency is called:<br />a. treppe<br />b. twitch<br />c. summation<br />d. complete tetanic contraction<br />e. incomplete tetanic contraction<br /><br />51. the sac like region of the sarcoplasmic reticulum that serve as specialized reservoir of calcium ions is:<br />a. Triad<br />b. T-tubule<br />c. Myofibril<br />d. Terminal cisternae<br />e. Sarcoplasmic reticulum<br /><br />52. select its correct definition on the term below for short, rapid contraction/relaxation cycles due to high frequency of stimulation:<br />a. treppe<br />b. fatigue<br />c. complete tetanus<br />d. incomplete tetanus<br />e. temporal summation<br /><br />53. when movement causes someone gets fatigue rapidly, it is resulting from:<br />a. red muscle type of skeletal muscle<br />b. dystrophy muscular progressive<br />c. anterior motoneuron disorder<br />d. peripheral neuropathy<br />e. myasthenia gravis<br /><br />For question number 54 to 56, refer to options below<br />Choose in correct name to each participant in the sliding filament theory:<br />Troponin<br />Tropomyosin<br />Myosin<br />Actin<br />ATP<br />54. has a binding site of ATP<br />55. responsible for disconnecting the cross bridge<br />56. has a binding site for calcium<br /><br />57. a man came to emergency room RSHS with difficulty to lift right arm maximally. According to physical diagnostic M.deltoideus seem to be atrophy and according to EMG tracing during resting state found fibrillation potentials. What is the cause of the M.Deltoideus become atrophy?<br />a.myasthenia gravis<br />b. peripheral neurophaty<br />c. spinal motor neuron disorder<br />d. dystrophy muscular progressive<br /><br />For question number 59 to 60, refer to scenario below:<br />A 17 year old girl come to emergency room with complained of burn injury to her body. From anamnesis, her parents said one hour before admission to the hospital, she was in the kitchen, suddenly their stove exploded. so her hair, face, and clothes were burned. She is alert, with blood pressure is 110/70 mmHg, pulse 100 times per minute, respiratory rate: 28-30 times per minute, with temperature in 370 C. there is hiperemis and blister of her skin on face, neck, and chest. And also her eyebrow and eyelash is burned.<br />59. How much percentage of areas affected in her body according to rule of nine and the degree of burn injury?<br />a. first degree, ± 14 %<br />b. first degree, ± 18 %<br />c. second degree, ± 14 %<br />d. second degree, ± 18 %<br />e. third degree, ± 18 %<br /><br />60. what is the first complication ffrom this case if she was treated not properly?<br />a. shock.<br />b. airway problem<br />c.hypoproteinemia<br />d. respiratory acidosis<br />e. electrolyte imbalance<br /><br />For question number 61 to 62, refer to scenario below<br /> A 25 year old come to ER with BP: 70/40 mmHg, pulse 120 bpm, RR: 26-28 times per minute and still conscious. From anamnesis, when he was riding a motorcycle with a helmet in high velocity, he collided with a car from opposite direction. There is deformity of his right thigh and leg, wound on anterior side of middle third of thigh with bone exposed. The pelvic is not stable in the examination.<br />61. what should you do first to this patient if he came to ER when you are in charge?<br />a. Reduction the bone and then immobilize it with splintage<br />b. do the primary & secondary survey stimultantly<br />c. close the wound with moist gauze<br />d. binding the pelvis with the sheet<br />e. resuscitate the circulation<br /><br />62. which radiographs are required in the initial assessment of the patient?<br />a. AP & lateral view of thigh and leg<br />b. lateral view of neck, AP view of the chest, AP view of pelvis<br />c. AP & lateral view of pelvis, AP & lateral view of thigh and leg<br />d. AP view of the chest, an AP view of pelvis, AP & lateral view of thigh and leg<br />e. lateral view of neck, AP view of the chest, an AP view of pelvis, AP & lateral view of thigh and leg<br /><br />For question number 63 to 64, refer to scenario below<br />A 30 year old man comes to the hospital because of an accident. When he was walking on the street, he was collided by a motor cycle from his right side. He complains about pain in his right thigh & leg, and also his right forearm. He’s alert, with vital sign in normal range. There is deformity on his right thigh, leg, and forearm with wound and bone exposed on right leg. From the X-ray is found the bone discontiunuity of middle third of radius-ulna and thigh, bone discontinuity of distal third of tibia-fibula.<br /><br />63. what is the suitable first action for this patient?<br />a. surgical debridement in operating room <br />b. open reduction and external fixation<br />c. open reduction with internal fixation<br />d. irrigation for wound<br />e. splint the fracture<br /><br />64. if there are hypesthesia of his right foot, what should we suspect to?<br />a. rupture of the spinal nerve<br />b. compartment syndrome<br />c. inferior aorta rupture<br />d. neurogenic shock<br />e. muscle rupture<br /><br />65. the sequence of “5P” sign of compartment syndrome is…<br />a. pale, pain, paralysis, paraesthesia, pulselessness<br />b. pain, pale, paraesthesia, pulselessness, paralysis<br />c. paraesthesia, pain, pale, pulselessness, paralysis<br />d. pain, pale, pulselessness, paraesthesia, paralysis<br />e. pale, pain, paraesthesia, pulselessness, paralysis<br /><br />66.a 34 year old man comes to your hospital with chief complaint of purulent discharge from his right upper leg for the last 6 months. There was a history of open fracture of right proximal tibia 15 years ago and undergo open reduction and internal fixation. The implant is not removed until now. The patient still able to stand and walk. There is history of fever. From laboratory findings, you found leucocytoses, elevated ESR, and CRP quantitative. From radiological findings, you found sclerotic, lytic lesion and new bone formation on right proximal tibia. What is the most possible diagnose for this patient?<br />a. cellulitis<br />b. osteosarcoma<br />c. septic arthrititis<br />d. osteomyelitis<br />e. non union of tibial fracture<br /><br />67. A 27 year old man comes to our clinic with chief complaint of fluctuate lump on his right inguinal. There is a history of chronic back pain radiating to his right lower leg, accompanied with night sweating and decrease of body weight. There is no history of trauma before. From lab findings, you found elevated ESR. What is the most possible diagnosis for this patient?<br />a. malignancy of pelvic organ<br />b. TB spondylitis<br />c. scrotal hematoma<br />d. lympahadenopathy<br />e. inguinal hernia<br /><br />68. An 11 year old young athlete girl under heavy training for a marathon, experiences pain on his ankle after the 4th week training. Tenderness is found in her lateral malleolus which relieved by rest. The most likely diagnosis is:<br />a. calcaneal spur<br />b. Achilles tendinitis<br />c. fasciitis plantaris<br />d.osteoarthritis of ankle joint<br />e. stress fracture of distal fibula<br /><br />69. a 30 year old man sustained an acute injury to his left shoulder while lifting weights. He reports pain with abduction and external of the shoulder and he has weakness with the internal rotation. Inspection shows loss of contour of the axillary fold. The most likely injured structure is:<br />a. deltoid muscle<br />b.supraspinatus muscle<br />c. pectoralis major<br />d. biceps tendon <br />e. teres minor muscle<br /><br />70. a tennis player complaints of acute weakness of abduction after hand serving with his raquets. The most likely injured structure is:<br />a. trapezius muscle<br />b. teres minor muscle<br />c. infraspinatus muscle<br />d. supraspinatus muscle<br />e. brachial plexus injury<br /><br />71. A 20 year old man, falls onto outstretch hand, and complaints of pain on his right shoulder, on PE, the patient support the arm with the opposite hand, lateral outline shoulder flattened, a bulge felt just below the clavicle. The most possible of this kind injury is…<br />a. posterior dislocation of shoulder<br />b. inferior dislocation of shoulder<br />c. anterior dislocation of shoulder<br />d. superior dislocation of shoulder<br />e. clavicle fracture<br /><br />72. a 20 year old man came to allergic clinic with runny nose as the chief complaint which he had already experienced since 4 years old. He also been complaining nasal blockage, itchy nose, sneezing,especially after dust inhaling. His occupation is a bus driver. PE reveals facies adenoid, allergic shiners, enlargement of inferior and mmiddle turbinate with a boggy, pale, and bluish mucosa. Laboratory studies show IgE serum 600 IU/mL. which is the most likely diagnose for this case?<br />a. allergic rhinitis<br />b. atrophic rhinitis<br />c. vasomotor rhinitis<br />d. occupational rhinitis<br />e. drug induce rhinitis<br /><br />73. a 5 year old boy come to ENT clinic with runny nose as chief complaint since he was 3 years old. He also suffered nasal blockage, itchy, sneezing especially when he inhaled dust. On PE there was allergic shiners, Dennie-Morgan fold, pale, and bluish nasal mucosa. Lab result showed IgE serum 600 IU/mL. which of the following is the most frequent comorbidity on the pharynx in the PE?<br />a. Pale mucosa<br />b. post nasal drip<br />c.pseudomembran<br />d. hyperemic mucosa<br />e. cobblestone appearance<br /><br />74. a 21 year old afebrile man sees you for a headache. You notice he has an infected cholesteatoma in the right ear. You immediately investigate to find out if he has an obvious complication. To do this you immediately:<br />a. look ay his eyes with ophthalmoscope<br />b. senf him for a CT scan<br />c. send him for MRI scan<br />d. test his deep tendon reflex<br />e. have him count backward by sevens<br /><br />75. you treated a 5 year old girl 2 weeks ago with an obvious bilateral acute suppurative otitis media. She improved immediately and was doing well; then her mother called you today and said the child having a little pain in the left ear again. You should suspect:<br />a. persistent otitis media<br />b. recurrent otitis media<br />c. sigmoid sinus thrombophlebitis<br />d. extradural abscess<br />e. mastoiditis<br /><br />For question number 76 to 77, refer to scenario below<br />Mrs.M is 35 years old, come to ENT clinic with off and on nasal bleeding (not massive) since 2 years ago.<br />76. what is the most frequent lymph node location in nasopharynx tumor?<br />a. level I<br />b. level II<br />c. level III<br />d. level IV<br />e. level V<br /><br />77. if diagnosis of this case is angiofibroma, which statement is appropriates?<br />a. angiofibroma only happened in female<br />b. bleeding in angiofibroma usually only slight<br />c. only happened in old male<br />d. usually happened in young male<br />e. angiofibroma metastasis quite often<br /><br />78. in nasopharynx CA intracranial infiltration/ extension most frequently through..<br />a. foramen magnum<br />b. foramen ovale<br />c. foramen spinosum<br />d. foramen lacerum<br />e. foramen jugulare<br /><br />79. The most frequent intracranial nerve damage that happened in patient with nasopharynx CA is:<br />a. IX<br />b. X<br />c. V<br />d. VI<br />e. VII<br /><br />80. In making diagnosis of nasopharyngeal angiofibroma by clinical examination, which factor is important?<br />a. soft mass in nasopharynx<br />b. neck mass associated with mass in nasopharynx<br />c. hard mass in nasopharynx in 15 years old girl<br />d. hard mass in nasopharynx in 17 year old boy<br />e. mild epistaxis<br /><br />81. in nasopharynx CA, extension of tumor into skull base causing N.VI paralysis is through:<br />a. foramen rotundum<br />b. foramen ovale<br />c. foramen magnum<br />d. foramen lacerum<br />e. foramen spinosum<br /><br />82. Nasopharynx CA can cause vocal cord paralysis if it destroys<br />a. N.V<br />b. N.VI<br />c. N.X<br />d. N.XII<br />e. N.IX<br /><br />83. area 4 in neck metastasis is:<br />a. jugular superior<br />b. submental<br />c. mid jugular<br />d. lower jugular<br />e. posterior triangle of the neck<br /><br />86. A 45 year old man is hospitalized with diagnosis 2nd-3rd grade burn injury covering 25% of body surface, including neck, shoulders, chest, and left thigh. At risk of contracture development. Prevent musculoskeletal complication?<br />a. Shoulder abduction 90°, external rotation, neck extension, hip abduction, external rotation<br />b. Shoulder abduction 90°, external rotation, neck flexion, hip abduction, external rotation<br />c. Shoulder abduction 90°, external rotation, neck extension, hip abduction, no external rotation<br />d. Shoulder abduction 90°, internal rotation, neck flexion, hip abduction, no external rotation<br />e. Shoulder abduction 90°, internal rotation, neck extension, hip abduction, no external rotation<br />87. Burn injury 45 year old by flame, both hands. Functional problem should be thinked. Appropriate for this condition?<br />A. communication<br />B. mobilization<br />C. vocational activity<br />D. avocational activity<br />E. psychosocial<br /><br />88.TB spondylitis , at risk ulcer development. What is the predisposing factor?<br />a. thick skin<br />b. water mattress<br />c. upright position<br />d. sensory impairment<br />e. always change position<br /><br />88(?). Patient in rehab, at risk of pressure sores. Predisposing factors?<br />89.A. 55 years old woman complain about painon her both knee.She can’t stand or walk. She can’t do reguler social gathering.<br />From a field of medical rehabilitation, what is her main problem?<br />a.Communation<br />b.Mobility<br />c.Self care activities<br />d.Vocational activities<br />e.Avocational<br />92.What do you suggest with the goal of preventing of second disabilies and handicapped.<br />a.Taking anagesic<br />b.Range of motion exercise<br />c.Endurance extremities for lower extremities muscle<br />d.Doing high impact aerobic exercise<br />e.Take part in community activities<br /> <br />93.Secondary disabilities?<br />a.Osteomyelitis/ osteoatritis<br />b.Isolation from community<br />c.Contractute of knee<br />d.Physchosocial<br /> <br />94. Type of bone (tibia)…<br /> a. dense<br /> b. woven<br /> c. immature<br /> d. spongy<br /> e. cancellous<br /><br />95. Which cell that involved in bone remodelling ?<br />a. Osteoblast<br />b. Osteon<br />c. Osteoclast<br />d. Osteocytes<br />96.Fracture pada 1/3 tibia.What type of basic tissue?<br />e. a.Nerve’ c.Connective tissue<br />f. b.Muscle d.Cartilage<br /><br />98. Outer layer dari muscle?<br />A. sarcoplasma<br />B. sarcolemma<br />C. endomysium<br />D. perimysium<br />E. epimysium<br />100. a cross section muscle. How many thin filament surround each thick filament?<br />a.2<br />b.3<br />c.4<br />d.5<br />e.6<br /><br />101.18 year old girl came to clinic with acne since 3 weeks ago.What is type of gland is associated with her problem?<br />a.Apocrine c.Holocrine e.Sitokrine<br />b.Eccrine d.Paracrine<br /> <br />For question number 104 to 109, refer to scenario below:<br />After heavy rain & thunderstorm on a mountain, a flood over flow over a river, causing a boat with with 3 passengers turned upside down. 1 week later, decomposed bodies are recovered on the riverbank, 2 male, 2 female, 1 boy, an adult skeleton, and a femur are recovered. Only 3 families claimed of losing their family member. Mrs.X and her daughter claimed the lost of Mr.X, a female reported her brother, Mr.Y. Mr.Z asked for Mrs.Z, his 3 months pregnant wife. All families brought the photographs of their loved ones.<br /><br />104. Mrs. Z is better to be identified with this method…<br />a. autopsy<br />b. nuclear DNA<br />c. Y chromosome<br />d. mitochondrial DNA<br />e. photo superimposed <br /><br />105.An easy and reliable method to estimate the boys’ age<br />a.Epiphiseal plate c.Weight e.Teeth<br />b.Skull circumference d.Height<br /> <br />106.The best professional to identify the skeleton is..<br />a.A dentist<br />b.An orthopedist<br />c.A paleontologist<br />d.A forensis pathologist<br />e.A physical antropologist<br />107. We can conclude positive identification based on DNA examination of victims if probability of identity least reach?<br />A. 100 %<br />B. 99,99 %<br />C. 99,85 %<br />D. 99 %<br />E. 98,5 %<br /><br />109. Mitochondria DNA for forensic examination…<br />a. non mendellian mode of inheritance<br />b. inherited through maternal lineage<br />c. exist in non nucleated cell<br />d. non copy number <br /><br />110. WOTF is the manifestation from brain stem death?<br />a. No pulsation<br />b. No breath<br />c. No pupil reflex<br /><br />111. The doctor found Mrs. X is not breathing, pale, no pulse, purple, and stiff. What causes the skin purple?<br />a. erythrocyte in the lower body<br />b. high un-oxygenated Hb<br />c. low ATP<br />b.Perubahan epithelial kulit <br /><br />112.muscke stiffness is caused by..<br />a.high level of CO2<br />b. coagulation of muscle protein<br />c. high level of calcium in muscle<br />d. inability myosin to detach from actin<br /><br />113. Apa yang seharusnya dilakukan dokter umum pada mayat wanita yang meninggal karena stroke (nature)?<br />A. do cardipulmonary resuscitation<br />B. consult to forensic doctor<br />C. report to police<br />D. tulis surat kematian<br />E. embalm Mrs. X<br /><br />114. Exercising muscle actually consists of cyclic attachment and detachment of which of the following structure ?<br />a. Globular head region of myosin to F-actin<br />b. Globular head region of myosin to G-actin<br />c. Helix (tail) region of myosin to F-actin<br />d. Helix (tail) region of myosin to G-actin<br />e. G-actin to F-actin<br />116. thick scalling on elbow & knee + mild itching + reddish. Diagnose?<br />a. psoriasis<br />b. erythroderma<br />c. sunburn<br />d. lichen planus<br />e. dermatitis<br /><br />For question number 117 to 118, refer to scenario below:<br />A 60 y.o man came to the hospital with breathing difficulty and poor conditions. He said his weight loss about 10 kg in last 3 months. Cough without sputum occurred. Last month, PE was found normal vital sign, anemic conjunctivae; lung auscultation: ronchi (+) in left chest. In left extremity the doctor found 3 black nodules 2x3x1 cm in diameter, painless , wall border, left inguinal lymph node just palpable.<br /><br />117. what is the possible diagnose for this man?<br />a. keratoacanthoma<br />b. melanoma maligna<br />c. basal cell carcinoma<br />d. epidermoid CA<br />e. squamous cell CA<br /><br />118. Black nodule occure due to?<br />a. hemorrhagic crust<br />b. increase of melanocyte<br />c. inflammation<br />d. necrotic tissue<br />e. disturbance of lymph system<br /><br /><br />121. A 45 years old man came to the clinic with chief complaint chillness and redness. It spreads to most of his body since 6 months ago. From PE there are no lesions on his elbow and knee area. What is the predilection site area?<br /> a. sun exposure area<br /> b. traumatic area<br /> c. flexor area<br /> d. extensor area<br /> e. neck area<br /><br />122. 17 year old female, red pimples on cheek. Lesion : comedo, papule, pustule on forehead, jaw, cheek. Diagnosis?<br />A. common acne<br />B. cica...? acne<br />C. conglobata acne<br />D. comedone acne<br />E. papule-pustule acne<br />124. 30 y.o. female, long history of sexual and non-other specific complaints that shown no evidence of verifiable disease. Patient has a long history of doctor shopping. On interview, she complains of back and chest pains, dyspareunia and excessive menstrual bleeding. She also points out that “no body been able to figure out why I can’t feel anything on the back side of my arm”. Past history: multiple surgeries for abdominal complains, no findings. “I’ve always been sickly, most of my life”<br />a. pain disorder<br />b. malingering<br />c. hysterical personality disorder<br />d. somatization<br />e. major depressive disorder<br /><br />125. a 56 year old man come to clinic with hoarseness for the last 6 months with slightly dyspnea. On PE revealed more than 1 of his vocal cord having tumor with impair mobility & 4 cm neck node in his mid jugular. No node could be detected in other part of the body. Which of the following is the most likely “T”?<br />a. T1<br />b. T1s<br />c. T2<br />d. T3<br />e. T4<br /> <br />127. lab test spondylitis TB, menunjukan:<br />a. ESR 12/20<br />b. ESR 60/90<br /><br />128. running for long time will decreased ATP, molecule is used an immediate source of energy…<br />a. fatty acid<br />b. keton bodies<br />c. muscle protein<br />d. oxygen<br />e. creatinine phosphate<br /><br />129. in osteomyelitis, the radiological feature of sequester is:<br />a. radioopaque surrounded by luscent shadow<br />b. radioluscent surrounded by radioopaque shadow<br />c. cannot be seen on radiology photos<br />d. solid radioopaque appearance<br />e. wide radioluscent appearance<br /><br />130. what is the most possible diagnosis for lesion at epiphyse with soap bubble appearance?<br />a. osteoma<br />b. osteosarcoma<br />c. osteochondroma<br />d. giant cell tumor<br />e. multiple myeloma<br /><br />131. a 19 year old male, came to hospital with pain at the back and unable to walk as a chief complaint. He is complained about persistent pain since 3 months ago, and concomitantly unable to walk since 1 week ago. He also complained about night sweat, loss of appetite as well as loss of body weight. He looks so skinny and both of his lower limb muscle are wasted. Laboratory revealed elevated ESR and low Hb, otherwise are normal. Vertebral X-ray revealed compression fracture at T12, with kyphotic deformity. Which of the following is the most frequent site of skeletal tuberculosis?<br />a. the ribs<br />b. the spine<br />c. the clavicles<br />d. the skull<br />e. the hip<br /><br />132. the radiological feature of tuberculous spondylitis are:<br />a. destruction of vertebrae bodies<br />b. paravertebral abscess always exist<br />c. destruction of pedicles<br />d. on chest X-ray photo, there is always lung tuberculosis<br />e.used to affect cervical vertebras<br /><br />133. a positive tuberculine skin test indicates:<br />a. no immunity to M.tuberculosis infection<br />b. active pulmonary tuberculosis<br />c. active non tuberculosis mycobacterium infection<br />d. prior exposure to M.tuberculosis<br />e. prior immunity to M. tuberculosis infections<br /><br />134. the following bacteria is a gram negative cocci:<br />a. Staphylococcus aureus<br />b. Streptococcus pneumoniae<br />c. Staphylococcus epidermidi<br />d. Neisseria gonorrhoe<br />e. Haemophilus influenza<br /><br />135. The primary stain of the acid fast stain procedure is:<br />a. methylene blue<br />b. carbol fuschin<br />c. acid alcohol<br />d. crystal violet<br />e. safranin<br /><br />136. A 9 year old boy came to a dentist for a routine dental examination. The dentist found that he has caries at most of his teeth. The dentist also notes that his oral hygiene is poor, as a possible cause of the caries. The other cause of caries is a bacterial multiplication at oral cavity. Bacteria responsible for this condition:<br />a. Streptococcus haemolyticus<br />b. streptococcus mutants<br />c. staphylococcus epidermidis<br />d. staphylococcus aureus<br />e. staphylococcus haemolyticus<br />137. a 42 year old man has visited the ophthalmologist. He complained about watery discharge from both eyes, which become puffy and red. What is the most likely microorganism cause his condition?<br />a. bacteria<br />b. virus<br />c. arthropoda<br />d. fungi<br />e.protozoa<br />138. gram stain is probably the most important and widely uses microbiological differential stain. Reagents that use in gram staining procedure are crystal violet, gram’s iodine, safranin, ethyl alcohol 95 %, and water as well. Which of the following part of bacterial cell that makes the difference?<br />a. cytoplasm of the bacteria<br />b.cytoplasmic membrane<br />c. periplasm<br />d. peptidoglycan layer<br />e. lipopolysaccharida layer<br /><br />139. the acid fast stain is a differential staining method, is used to distinguish certain bacteria that contain a high content of mycolic acid in their wall. Which of the following is the most primary stain in this staining method?<br />a.methylene blue<br />b. carbol fuschin<br />c. malachite green<br />d. safranin<br />e. acid alcohol<br /><br />140. a 19 year old male came to health center because of pain, redness, and tenderness of the eye lid margin and then followed by a small, round, and tender area of indurations. He also felt a foreign body sensation, lacrimation, and photophobia. The doctor in charge diagnosed the disease as styes. In the gram staining preparation, those bacteria appear as:<br />a. gram +, coccus, in chain<br />b.gram +, coccus, in cluster<br />c. gram +, coccus, in pair<br />d. gram -, coccus, in pair<br />e. gram -, rod, in chain<br /><br />141. some bacteria produce an internal structure known as endoscope. This structure is produce by the vegetative cells by process called sporogenesis. Which of the following is the most likely bacteria produce such structure?<br />a. Mycobacterium tuberculosis<br />b. Chlamydia trachomatis<br />c. Pseudomonas aeruginosa<br />d. Clostridium tetani<br />e. Proteus vulgaris<br /><br />142. which of the following is the function of the skin?<br />a. production of vitamin C<br />b. production of vitamin B<br />c. production of melatonin<br />d. secretion of hormones<br />e. Vitamin D metabolism<br /><br />143. which one of the following statements is mainly for the fracture repair?<br />a. osteoprogenitor cell in outer circumferential lamellae<br />b. osteoprogenitor cell in inner circumferential lamellae<br />c. osteoprogenitor cell in interstitial lamellae<br />d. osteoprogenitor cell in harvesian system<br />e. osteoprogenitor cell in endosteum<br /><br />144. formation of the bony callus in repair is followed by:<br />a. hematoma formation in the middle of callus<br />b. fibrpcartilaginous callus formation after the bone remodeling<br />c. bone remodeling to convert woven bone to compact bone<br />d. formation of granulation tissue to compact bone<br />e. protein release from the callus<br /><br />147. sel apakah yang berperan dalam growth & bone repair?<br />a. osteoprogenitor sel di periosteum<br />b. osteoblast sel di periosteum<br />c. osteoclast sel di periosteum<br />d. osteocyte sel di periosteum<br />e. fibrocyte sel di periosteum<br /><br />148. What is the MOST effective treatment of milliaria?<br />a. put the person in hot environment<br />b. put the person in cool environment<br />c. put the person in non air conditioned room<br />d. avoid using rotating fan<br />e. avoid bathing<br /><br />149. Psoriasis is a disease with…<br />a. Mycobacterium tb infection<br />b. Skin lesion usually on sun exposure area<br />c. Caused by<br />d. Psoriasis usually uncommon<br />e. Salah satu komplikasinya erythroderma<br /><br />151. Found erythematous macule<br />A. change skin thickness<br />B. change skin surface<br />C. color<br />D. humidity<br />E. texture<br /><br />152. What is likely to cause the case (erythroderma)<br />A. psoriasis vulgaris<br />B. eczema<br />C. seborrheic dermatitis<br />D. erythema multiforme<br /><br />153. a girl 17 y.o., punya pimples di both of her cheeks. Dia jarang pakai kosmetik. PE menunjukan papules, comedones, pustules. Diagnose?<br />a. common acne<br />b. conglobata acne<br />c. comedone acne<br />d. papullo-pustule acne<br /><br />154. 19 years old boys is hospitalized. Anamnesis from his mother revealed he had pimplies 3 days ago, and he was given cream from his friend. PE: decrease consciousness, BP: 120/90, HR: 100 BPM, RR: 24, Temp: 40.30 C. Red papules (+), stiff neck (+). Which of this treatment is suitable for him?<br />a. on the ward<br />b. on the ward with special caution<br />c. ICU<br />d. isolation room<br />e. isolation room in ICU<br /><br />155. Shake lotion mixture from…<br />a. Powder and lotion<br />b. Powder and tincture<br /><br />158. a 45 y.o man complains of chronic cough for the last 2 months. Doctor give PPD 5TU test and result confirm he got TB. Principle of this test?<br />a. hypersensitivity<br />b. humoral mediated sensitivity<br />c. erythema & induration caused by neutrophil<br />d. CD4+ T lymphocyte isn’t involved<br />e. skin reaction requires 24-48 Hours to develop following antigen challenge <br /><br />159. a 30 year old male is suffering exfoliative dermatitis. What lab result do you expect?<br />a.neutrophilia<br />b. high level of IgM<br />c. hyperalbuminemia<br />d. (+) nitrogen balance<br />e. anemia<br /><br />160. 25 year old man came to clinic, chief complaint reddish plaque, plaque, pruritus on entire body + chillness since 1 months ago, started on knees, elbow, and buttock. Lesion have large scalling that exfoliated profusely. Microscopic findings from skin biopsy : epithelial hyperplasia, hyperkeratosis, parakeratosis, spongiosis. What is the diagnose?<br />a. erythema multiforme<br />b. lupus vulgaris<br />c. psoriasis vulgaris<br />d. bullous pemphigus<br />e. pemphigus vulgaris<br /><br />161. Hyperpigmentation without any sunlight protection,growth hyperplastic in solid arrangement<br />A. epidermoid cancer<br />B. BCC<br />C. melanoma malignant<br />D. nevus dermal<br />E. lentigo<br />162. 25 years old woman, good healthy, underwent extraction of impacted 3rd molar teeth. In the evening, she developed fever. 2 days later swelling of bilateral submandible. Her tongue was elevated, dyspnea, paroxysm with evidence of respiratory paralysis. Which of the following spaces involved in this case?<br />a. sublingual, submandibular<br />b.sublingual, submental<br />c. sublingual, submandibular, submental<br />d. submandibular, submucus<br />e. submentalis, buccalis<br /><br />163. a 28.y.o woman admitted to hospital complaining of pain and firm massive mass swelling in lower right jaw. Radiographic feature: large multioculer cyst contained with unerrupted mandible 3rd molar. Body temp: Normal. Microscopically there is islands of cells which were growing through stroma. Diagnose?<br />a. Ludwigg angina<br />b.ameloblastoma<br />c. mandible osteosarcoma<br />d. odontoma<br />e. sory lupa..<br /><br />164. in the dental clinic at OPD of hospital X, you see a young lady at her twenties already seated on a dental chair. Result of her examination:<br />- general condition: conscious, pale, body temperature 390C<br />- extraoral : edema of tissue along the lower jaw area up to the chin forming a bull neck appearance.<br />- the neck area is hard and tense as a massive board, as well as shiny and reddish.<br />- intraoral : tongue is noticed pushed upward and trismus was clearly detected. Deep caries of the 3rd mandible molar was obvious. A complete history of treatment of the tooth was never been achieved.<br />For caries to occur, the following factors must exist:<br />a. susceptible host and microorganism<br />b. susceptible host, microorganism, and time<br />c. susceptible host, microorganism, time, and substrate<br />d. susceptible host, microorganism, time, substrate, and saliva<br />e. susceptible host, microorganism, time, substrate, saliva, and demineralization of the tooth structure<br /><br />165. 40 y.o. man, teeth mobility at anterior lower jaw Since past 4 months. Pain (-), gum easily bleed esp. when brushing teeth. Clinical exam: many plaque and calculus, supragingival, subgingival, gingival recession at anterior region. Radiological :alveolar bone loss. Diagnose?<br />a. Chronic gingivitis<br />b. chronic periodontitis<br />c.ANUG<br />d. juvenile periodontitis<br />e.periodontitis abscess <br /><br /><br />168. A 15 y.o. female has a black wart on his upper lips as large as corn seed since 10 years ago. Histopathological examination of the tumor shows plump cells under the squamous epithelial cells. Some of the cells contain melanin. Which of the following diagnosis is the most likely?<br />a. blue nevus<br />b. nevus sebaceous<br />c. compound nevus<br />d. junction nevus<br />e. intradermal nevus<br /><br />169. Vertebral deformity, vertebral destruction. WBC infiltration. Necrosis : epitheloid langhans cell. Apakah itu? Spondylitis TB.<br />170. A 25 y.o. woman is 5 months pregnant had swelling at her gum at frontal region of the upper jaw since 3 months ago. The swelling was as big as a green pea. This is a reactive lesion of gingival composed of stratified squamous epithelium granulatum tissue and chronic inflammatory infiltrate. What is the diagnose?<br />a. mucocele<br />b. oral thrush<br />c. epulis granulomatosa<br />d. aphtuous ulcer<br />e. leukoplagia<br /><br /><br />172. soalnya lupa… tapi carcinoma yang ada gambaran histopatologis pallisading nuclei..<br />a. BCC<br />b. SCC<br />c. malignant melanoma<br />d. nevus pigmentosus<br />e. vervucuous vulgaris<br /><br />174. which of the following statement is Strongyloid stercoralis life cycle?<br />a.<br />b. skin penetration-lung-adult in intestine-egg-rhabditiform-filariform-autoinfection, direct and indirect developmental external environmental.<br />c.<br />d.<br />e.<br /><br />177. 35 y.o. farmer suffered from snake bites on his right foot. Two hours later the wounds swollen and bleeding and is difficult to stop. He also experience double vision and difficulty to close his eye lids. Which of thee following is the life threatening condition as neurological complication?<br />a. renal failure<br />b. respiratory failure<br />c. hypovolemic shock<br />d. cardiogenic shock<br />e. compartment syndrome<br /><br />181. 35 y.o. former suffered from a snake bite on his right foot also experience double vision & difficult open eyelid mechanism.. kenapa bisa kaya gitu?<br />a. paralysis CN<br />b. destruction CN<br />c. demyelination CN<br />d. blockade NMJ<br />e. rhabdomyelisis<br /><br />182.pasien 2 tahun dengan cleft lift and palate.Trdap hypernasal voice dan articulation disturbance.disability in this patient? Speeh disturbance<br /><br />183. The best wound closure is by:<br />a. spontaneous closure<br />b. secondary closure<br />c. primary closure<br />d. delayed primary closure<br />e. epithelialization<br /><br />185)burn-head & neck;half of right arm,chest & abdomen,fully right thigh<br /> A)degree 2 – 32% D)degree 2-3 – 45%<br /> B)degree 2 – 46% E)degree 2 – 48% <br /> C)degree 2-3 – 38%<br /><br />186)10y.o,asymmetry of shoulder,diagnosis-idiopathic scoliosis,thoracolumbar area,25 degree,when do you treat scoliosis of spine with braces : <br /> A)patient is still growing D)when complication to other organ<br /> B)patient reaches adulthood E)patient has many complain<br /> C)when spine unbalance<br /><br />187)the most possible diagnosis for lesion at epiphysis with soap bubble appearance:<br /> A)osteoma D)giant<br /> B)osteosarcoma E)multiple myeloma<br /> C)osteochondroma <br /><br />188)male come to emergency 2 hours after burn injury,burn at face,neck,whole right arm abdomen,chest & inguinal,how long burn at whole right arm can heal?<br /> A)2-3 weeks D)10 weeks<br /> B)>3 weeks E)1 week<br /> C) >3 months<br /><br />189)1 y.o girl,comes to outpatient clinic with the red spot in the left upper eyes.the diameter is 3 cm,soft elevated from the skin,compressible,popular lesion with sharp border.it was a pin point red spot at birth.which is most likely diagnosis of the patient : <br /> A)port wine stain D)cavernous hemangioma<br /> B)strawberry hemangioma E)mixed hemangioma <br /> C)nevi flammers <br />190.Farmer with corneal ulcer on right eye.We want to determine the etiology of ulcer scrapping. We give natamycin.<br />Microorganisme yang paling sering ditemukan?<br />a. Gram rod<br />b. Gram – coccus<br />c. Hyphae<br />d. Tropozoid<br />e. Cyts<br /> <br />191. a 20 year old had motor vehicle accident.He complaint about pain and sweeling.Ada blurred vision.Ophthalmic exam: reduce tension eyeball as well as shallow anterior chamber.<br />Pemeriksaan apa yang tepat untuk pemeriksaan mata?<br />a.flourescin test<br />b.Schrimer test<br />c.Seidel test<br />d.Shellen test<br />e.Anell test<br /><br />192. Management corneal ulcer?<br />193. Optic lens origin?<br />195. Ion fundamental basis for local anasthetic for dental procedure?<br />196.Vasontrictor yang sering digunakan untuk menghambat penyerapan/penyerapan anesthesia?<br />a.Coccain c.Dopamin e......<br />b.Epinephrine d.....<br /><br />198. Regiment anti TB? <br />199. a 19.y.o girl, have an accident. She has fracture in her Radius. Callus dalam bone healing terbentuk dalam fase apa?<br /><br />200. a 19 y.o. man come to health center because of pain, redness, & tenderness of the eyelid margin and then followed by small, round, and tender area of indurations. He also felt a foreign body sensation, lacrimation, & photophobia. The doctor in charge diagnose the disease as styes. Which of the following is the most etiologic agent?<br />a. streptococcus mutants<br />b. streptococcus pyogens<br />c. staphylococcus aureus<br />d. neisseria gonorrheae<br />e. pseudomonas aeruginosa<br /><br />?? seorang pemain bola tertendang pada bagian kaki anteriornya,, terbentuk hematoma pada anterior compartmennya,, gejala klinis yang dapat timbul:<br />a. loss sensory of foot<br />b.?<br />c.?<br />d.?<br />e.foot dropsuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-20811127351755655812010-04-17T00:23:00.000-07:002010-04-17T00:24:36.061-07:00MDE HIS 20101. the special type of lymphatic capillaries in the small intestine are called?<br />a. lacteals<br />b. rugae<br />c. pylorus<br />d. fundus<br />e. corpus<br /><br />2. tempat maturasi T-cell? thymus<br /><br />4. thymus produces hormones that stimulate lymphocyte maturation.. what is the hormone?<br />a. oxytocine<br />b. thymocyine<br />c. calcitonine<br />d. progesterone<br />e. esterogen<br /><br />5. jalur lymphatic vessels<br />a. afferent-sinus-efferent<br /><br />9. Which of the following is the most presence in SLE ?<br />A. hyperreactivity B cell<br />B. hyperreactivity T cell<br />C. hyperreactivity B and T cell<br />D. hyperreactivity stem cell<br />E. hyperreactivity thrombocyte<br /><br />10. WOTF most likely cause of SLE?<br />a. complement fixation factor<br />b. anti DNA ab factor<br />c. immune complex factor<br />d. autoantibody factor<br />e. coagulation factor<br /><br />12.part of immunoglobulin molecule that bind to its antigen is called region (VH & VL) because it has a variability in its:<br />a. molecular weight<br />b. amino acid sequence<br />c. …(ga jelas tulisannya)<br />d. number of polymeration<br />e. antigen recognition ability<br /><br />for number 13-17<br />a. G6PD<br />b. Methemoglobin reductase<br />c. ALA synthase<br />d. Phosphoglycerate mutase<br />e. NADH oxidase<br />13. deficiency of this enzyme reduce NADPH level inside RBC causing hemolytic anemia<br />14. deficiency this enzyme will maintain heme FE in that reducing from fe2+<br />15. product of their enzyme is important in regularly that binding of O2 to Hb<br />16. this enzyme is the key to regulating enzyme in controlling heme biosynthesis<br />17. this enzyme plays a key role in producing potent microbial agent inside active leukocyte<br /><br />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?<br />a. sodium citrate<br />b. sodium oxalate<br />c. sodium heparin<br />d. ….heparin<br />e. EDTA<br /><br />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?<br />a. bleeding time<br />b. clotting time<br />c. rumple leede test<br />d. substitution test<br />e. platelet aggregation test<br /><br />22. A 5 y.o. boy,epistaxis,prolonged aPTT,yang lain normal. Ada history pada male family member. What is the diagnosis?<br /><br />23. tujuan torniquete test?<br />a. ability of capillary to resist pressure<br />b. ability of platelet to resist pressure<br />c. ability of capillary to resist heat<br />d. ability of platelet to resist heat<br />e. ability of platelet and capillary to resist pressure<br /><br />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?<br />a. plasma potassium naik<br />b. plasma sodium naik<br />c. plasma Hb turun<br />d. 2,3 DPG naik<br />e. pH naik<br /><br />25. WBC = 15.000, apa itu?<br />a. leukocytosis<br />b. leucopenia<br /><br />26. bagaimana rumus mencari MCV?<br /><br />27. jika kadar Hb = 10, Ht = 31%, maka berapa nilai MCHC?<br /><br />28. Mary’s CBC Hb: low, MCV: 67 fL, possible morphology RBC hypochromic microcytic<br /><br />29. a 5 year, fever, red dots on his extremities. Platelet count 50.000. term?<br />a. thrombocytopenia<br />b. thrombocytosis<br />c. thromboasthenia<br />d. thrombopathia<br />e. thrombosis<br /><br />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…<br />a. normocytic-normochromic anemia<br />b. microcytic-normochromic anemia<br />c.microcytic-hypochromic anemia<br />d. normocytic-hypochromic anemia<br />e. macrocytic-normochromic anemia<br /><br />32. fever, mild sore throat, easy bruising, gingival bleeding. Hb , RBC , PLT, WBC, diff count: blast: 73%, promyelocyte: 10%, myelocyte: 10%, lymphocyte: 7%. Diagnosis?<br />a. AML<br />b. acute myelomonoblastic leukemia<br />c. ALL<br />d. CML<br />e. CLL<br /><br />33. anak 7 thn, lymphadenopathy, spleenomegaly. Blast 78%, neutrofil 3%, limfosit 24%. Diagnosis?<br />a. AML<br />b. ALL<br />c. CLL<br />d. CML<br />e. burkitt’s lymphoma<br /><br />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?<br />a. superantigen activation of CD4+ T cells<br />b. CD8+ cell mediated cytolysis of keratinocyte in the skin<br />c. CD4+ cell mediated delayed type hypersensitivity to poison ivy<br />d. complement activation by antibody-antigen immune complex in the skin<br />e. activation of IgE coated mast cell induce release of histamine<br /><br />37. increased HbA2 found in..<br />a. IDA<br />b. sideroblastic<br />c. megaloblastic<br />d. aplastic<br />e. thalasemia<br /><br />39. in hemolytic anemia, there will be?<br /><br />40. in aplastic anemia you will find:<br />a. pancytopenia<br />b. polychromasia<br />c. poikylocytosis<br />d. anisocytosis<br />e. normoblastosis<br /><br />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:<br />Hb :13.2 g/dl (N:12-16)<br />RBC : 4.52 million/mm3 (N :3.8-5.2 million/mm3)<br />PCV : 38.2% (N:36-46)<br />Platelet : 10.000 (N: 150000-440000)<br />WBC : 5300 (N:4000-11000)<br />MCV 82.30 (N: 80-100)<br />MCH : 29.7 pg/dl (N: 26-34)<br />MCHC : 35.9% (N 31-37%)<br /> Diff count : PMN: 47%, lymphocyte : 39%, monocyte :14% <br />Result of blood smear exam:<br />RBC morphology : normocytic, normochromic<br />WBC morphology : within normal limit<br />PLT morphology : appear increased in size<br />Result of coagulation test<br /> APTT : 24.8 sec (N: 23-34)<br />TT : 15.8 sec (N: 13-18)<br />What is the most likely diagnosis?<br />a. Secondary thrombocytopenia<br />b. Thrombotic thrombocytopenic purpura<br />c. Dengue hemorrhagic fever<br />d. Immune thrombocytopenic purpura<br />e. Drug induce thrombocytopenia<br />42. which PE result is causing a blood donor rejection?<br />a. weight of 55 kg<br />b. pulse of 75 bpm<br />c. temperature of 36.50 C<br />d. diastolic pressure of 110 mmHg<br />e. Hb of 13.5 g/dl<br /><br />43. what would be result of group A blood given to a group O patient?<br />a. non immune transfusion reaction<br />b. immediate hemolytic transfusion reaction<br />c. delayed hemolytic transfusion reaction<br />d. immediate non immune transfusion reaction<br />e. delayed non immune transfusion reaction<br /><br />44. a patient with present a platelet count of 350 x 10?./L and bleeding time of 12 minutes. These result most probably suggest:<br />a. decreased platelet production<br />b. defective platelet function<br />c. increased platelet production<br />d. increased platelet destructive<br />e. decreased platelet destructive<br /><br />45. neutrophilic granulocyte development occurs in bone marrow. Which is the following stages development of that cell?<br />a. promyelocyte, myeloblast, myelocyte, metamyelocyte, band, and segmented neutrophils<br /> b. myeloblast, promyelocyte, myelocyte, metamyelocyte, band, and segmented neutrophils<br />c. myeloblast, myelocyte, promyelocyte,metamyelocyte, band, and segmented neutrophils<br />d. myeloblast, promyelocyte, metamyelocyte,myelocyte, band, and segmented neutrophils<br />e. segmented neutrophils, band, metamyelocyte, promyelocyte, myelocyte, and myeloblast,<br /><br />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?<br />a. Hb, Leukocyte, platelet<br />b. Hb, Leukocyte, Differential counting<br />c. leukocyte, platelet, and differential counting<br />d. leukocyte, erythrocyte, platelet<br />e. Hb, leukocyte, erythrocyte<br /><br />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.<br />What is the most possible diagnosis in this case?<br />a. Acute lymphoblastic leukemia<br />b. Chronic lymphoblastic leukemia<br />c. Acute lymphocytic leukemia<br />d. Acute myeloblastic leukemia<br />e. Acute myelocytic leukemia<br /><br />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?<br />a. IgA<br />b. IgD<br />c. IgE<br />d. IgM<br />e. IgG<br /><br />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?<br />a. face, especially cheeks<br />b. scalp<br />c. diaper area<br />d. extensor area of the extremities<br />e. flexural fold of the extremities<br /><br />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?<br />a. intra epidermal blister<br />b. sub epidermal blister<br />c. infrabasal blister<br />d. infradermal blister<br />e. intradermal blister<br /><br />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?<br />a. type I hypersensitivity<br />b. type II hypersensitivity<br />c. type III hypersensitivity<br />d. type IV hypersensitivity<br />e. autoimmunity<br /><br />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?<br />a. urinalisis: bilirubin (+)<br />b. Hb : 16 gr/dl<br />c. SGOT/SGPT 50/60<br />d. leukosit 2000/mm3<br />e. urinalysis: urobilinogen (+)<br /><br />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?<br />a. exenthematous eruption<br />b. pustular eruption<br />c. fixed drug eruption<br />d. bulous eruption<br />e. drug induced lichenoid<br /><br />57. most important cell in hypersensitivity type IV?<br /><br />58. 24 y.o. man complain : crust, hyperemic nasal mucus.. total body surface affected 35%. What is the diagnose? TEN<br /><br />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?<br />a. contact urticaria<br />b. irritant contact dermatitis<br />c. atopic dermatitis<br />d. allergic contact dermatitis<br />e. seborrheic dermatitis<br /><br />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?<br />a. sebrrhoic dermatitis<br />b. nummular dermatitis<br />c. acrodermatitis<br />d. atopic dermatitis<br />e. stasis dermatitis<br /><br />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?<br />a. liver<br />b. spleen<br />c. palatine tonsil<br />d. thymus gland<br />e. payer patche<br /><br />64. a developing erythrocyte + neutrophil in RBM may be differentiated from one another by presence of:<br />a. golgi apparatus<br />b. granule<br />c. mitochondria<br />d. peroxisome<br />e. RER<br /><br />66. antigen specific binding that occurs in graft rejection as result from..<br />a. T-Cell<br />b. plasma cell<br />c. monocyte<br />d…..<br />e. …<br /><br />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?<br />a.iron deficiency anemia<br />b. hemolytic anemia<br />c. aplastic anemia<br />d. pernicious anemia<br />e. sideroblastic anemia<br /><br />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?<br />a. myelofibrosis with myeloid metaplasia<br />b. chronic granulocytic leukemia<br />c. lymphocytic chronic leukemia<br />d. polycytemia vera rubra<br />e. multiple myeloma<br /><br />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?<br />a. elimination the cause<br />b. avoid certain diet<br />c. while blood transfusion<br />d. vitamin supplementation<br />e. hematinic agent therapy<br /><br />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?<br />a. chest X-ray<br />b. lymph node biopsy<br />c. abdominal CT scan<br />d. neck ultrasonography<br />e. peripheral blood smear<br /><br />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?<br />a. moist hand<br />b. brittle hair<br />c. clubbing finger<br />d. hepatomegaly<br />e. splenomegaly<br /><br />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?<br />a. VDRL<br />b. anti nuclear antibody<br />c. Rheumatoid factor<br />d. Anti ds-DNA<br />e. Anti ss-DNA<br /><br />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?<br />a. quantitative platelet disorder<br />b. qualitative platelet disorder<br />c. coagulation disorder<br />d. thrombosis disorder<br />e. vascular disorder<br /><br />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?<br />a. liver enzyme level<br />b. creatinine level<br />c. LDH level<br />d. uric acid level<br />e. Hb level<br /><br />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?<br />a. pathology findings like with IgA dermatitis<br />b. microscopically: there is basal cell vacuolization but without lymphocyte infiltration<br />c. immunofluoresence studies no granular band of immunoglobulin and complements<br />d. microscopically there are epidermis atrophy with hydrophic generation<br />e. hyperkeratosis and parakeratosis usually can fined in the microscopic findings<br /><br /> for question 76 to 77, refer to scenario below:<br />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<br />76. if his bone marrow smear shows cellular hypoplasia, which of the following is the most likely to predict the prognosis of his disease?<br />a. Hb<br />b. Ht<br />c. RBC count<br />d. WBC count<br />e. PLT count<br /><br />77. if his bone marrow smear shows cellular hypoplasia and he needs blood transfusion, what kind of transfusion would you give to this patient?<br />a. fresh whole blood<br />b. packed red cell<br />c. washed red cell<br />d. platelet concentrate<br />e. fresh frozen plasma<br /> <br />for question number 78-79, refer to scenario below:<br />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<br />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?<br />a. acute myeloblastic leukemia- M0<br />b. acute myeloblastic leukemia- M1<br />c. acute myeloblastic leukemia- M2<br />d. acute myeloblastic leukemia- M3<br />e. acute myeloblastic leukemia- M4<br /><br />79. what is the next appropriate step in making diagnosis?<br />a. cytochemistry<br />b. cytogenetic<br />c. immunophenotyping<br />d. absolute values<br />e. peripheral smear<br /><br />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?<br />a. Hepatitis C virus<br />b. Hepatitis B virus<br />c. Ebstein Barr virus<br />d. Human papiloma virus<br />e. HTLV-1<br /><br />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?<br />a. intracranial bleeding<br />b. DIC<br />c. Gastrointestinal bleeding<br />d. menomethorrhargi<br />e. joint bleeding<br /><br />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?<br />a. blood transfusion<br />b. splenectomy<br />c. corticosteroid<br />d. immunoglobulin<br />e. radiotherapy<br /><br />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?<br />a. antibiotic<br />b. cytostatic<br />c. tuberculostatic<br />d. operation<br />e. radiation<br /><br />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?<br />a. vascular disorder<br />b. thrombosis disorder<br />c. coagulation disorder<br />d. qualitative platelet disorder<br />e. quantitative platelet disorder<br /><br />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:<br />a. Erythropoietic hypoplasia<br />b. granulopoietic hypoplasia<br />c. thrombopoietic hypoplasia<br />d. giant stab cell<br />e. giant platelet<br /><br />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:<br />a. chronic myelocytic leukemia<br />b. chronic lymphocytic leukemia<br />c. multiple myeloma<br />d. myelofibrosis<br />e. leukemoid reaction<br /><br />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?<br />a. curable with radiotherapy<br />b. curable with chemotherapy<br />c. curable with chemoradiation<br />d. curable with immunotherapy<br />e. curable with antibiotics<br /><br />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?<br />a. conjunctivitis<br />b. gingivitis<br />c. arthrititis<br />d. stomatitis<br />e. glossitis<br /><br />89. which statement is true for arterial thrombosis?<br />a. long term use if oral contraceptive pill<br />b. stasis in blood vessel<br />c. begin with endothelial injury<br />d. deficiency of natural inhibitor is the basic process<br />e. deficiency of plasminogen activator inhibitor I (PAI-1)<br /><br />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?<br />a. inflammation<br />b. infection<br />c. metastases malignancy<br />d. lymphnode malignancy<br />e. autoimmune<br /><br />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?<br />a. non hodgkin’s malignant lymphoma stadium II<br />b. non hodgkin’s malignant lymphoma stadium III<br />c. hodgkin’s lymphoma stadium, stadium III<br />d. hodgkin’s lymphoma stadium II<br />e. non hodgkin’s malignant lymphoma stadium IV<br /><br />96.gen untuk replikasi HIV? …<br />a. gp120<br />b. tat<br />c. gp41<br />d. p11<br /><br />104. the highest concentration of immunoglobulin that secreted by gut…<br />a. IgG<br />b. IgA<br />c. IgM<br />d. IgD<br />e. IgE<br /><br />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?<br />a. intradermal test<br />b. patch test<br />c. prick test<br />d. radioallergosorbent test<br />e. skin end point titration test <br /><br />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?<br />a. fungal rhinitis<br />b. allergic rhinitis<br />c. vasomotor rhinitis<br />d. occupational rhinitis<br />e. medicamentosa rhinitis<br /><br />111.which Ig that has a role in allergic rhinitis?<br />a. IgG<br />b. IgA<br />c. IgD<br />d. IgE<br />e. IgM<br /><br />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?<br />a. bradikinin<br />b. esterogen<br />c. leukotrien<br />d. prostaglandin<br />e. progesterone<br /><br />113. 90% of ATP needed by RBC is generated by :<br />A. Hexose monophospate shunt<br />B. Kreb’s cycle<br />C. Leukering-rappaport pathway<br />D. Embden-meyerhof glycolytic pathway<br />E. MetHb reductase pathway<br /><br />115. the clinical manifestation that distinguish pernicious anemia from folic acid anemia with the presence of..<br />a. neurologic abnormalities<br />b. fatigue<br />c. weakness<br />d. shortness of bresth<br />e. slight jaundice<br /><br />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?<br />a. 0,18 ml 1:1000<br />b. 0,36 ml 1:1000<br />c. 3,6 ml 1:1000<br />d. 0,18 ml 1:1000<br />e. 0,36 ml 1:1000<br /><br />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?<br />a. glucocorticoid<br />b. NSAID<br />c. Cyclosporin<br />d. immunoglobulin<br />e. cyclosulphate<br /><br />119. anak kecil, habis makan shrimp angioedema dan gatal2. Obat yang cocok? <br /> antihistamine<br />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?<br />a. type I<br />b. type II<br />c. type III<br />d. type IV<br />e. type I-IV<br /><br />122. kinds of urticaria that immediately appear after vigorous swimming at seawater in the beach, at high noon on hot summer day, except:<br />a. heat urticaria<br />b. solar urticaria<br />c. cholinergic urticaria<br />d. psychogenic urticaria<br />e. aquagenic urticaria<br /><br />123. lymphoid organ yang perkembangannya tidak dipengaruhi antigen…<br />a. spleen<br />b. thymus<br />c. bone marrow<br />d. bursa equivalent<br />e. yolk sac<br /><br />124. in which hypersensitivity determination plasma/serum tryptase is helpful?<br />a. DD IgE mediated and non IgE mediated type I<br />b. diagnose type I hypersensitivity<br />c. diagnose type II hypersensitivity<br />d. diagnose type III hypersensitivity<br />e. diagnose type IV hypersensitivity<br /><br />125. which of the following antibody, involve in atopic disease?<br /> ans: IgE<br /><br />126. 12 y.o. boy follow skin prick test. The purpose of the test is to identified….<br />a. IgE mediated type I hypersensitivity<br />b. non IgE mediated type I hypersensitivity<br />c. IgE & non IgE type I hypersensitivity<br />d. type II hypersensitivity<br />e. type III hypersensitivity<br /><br />128. diagnosis thalasemia trait is frequently misdiagnosed with…<br />a. IDA<br />b. aplsatic anemia<br />c. megaloblastic anemia<br />d. autoimmune hemolytic anemia<br />e. sideroblastic anemia<br /><br />129. what is the right indicating to do ceasarian section operation in HIV pregnant mother?<br />e. transversal transmission preventing<br /><br />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..<br />a. anti HIV-1<br />b. HIV p-24<br />c. HIV RNA<br />d. HIV DNA<br />e. culture<br /><br />132. antibody yang dapat ditransfer dari ibu ke janin melalui transplacental?<br />a. IgE<br />b. IgA<br />c. IgG<br />d. IgD<br />e. IgM<br /><br />133. characteristic of cutaneous lesion of NLE:<br />a. facial<br />b. acral<br />c. extensor<br />d. diffuse<br />e. photo distribution<br /><br />138. which of the following clinical manifestation is permanent in NLE?<br />a. congenital heart block<br />b. cutaneous lesion<br />c. pulmonary involvement<br />d. neurology involvement<br />e. thrombocytopenia<br /><br />142. appropriate treatment for IDA<br />a. blood transfusion<br />b. multivitamin intake<br />c. oral ferrous sulfate<br />d. intramuscular iron dextrant<br />e. an iron fortified cereal<br /><br />146. WOTF agent would be the most likely to dampen the immune response in organ transplantation and autoimmune disease…<br />a. levimasole<br />b. thalidomide<br />c. serolimus<br />d. IFN<br />e. IL-2<br /><br />154. WOTF is the site of action of corticosteroid in allergic reaction?<br />a.<br />b. inhibiting IgE class switching on plasma cells<br />c. inhibiting interaction on mast cell<br />d. inhibiting phospolipase-A2 liberated arachidonic acid<br />e. inhibiting leukotriene binding its receptor on eosinophils<br /><br />156. drugs that need intrinsic factor for its absorption?<br />a. pyridoxine<br />b. folic acid<br />c. cyanocobalamine<br />d. riboflavin<br />e. Iron<br /><br />158. moleku yang membantu absorbs non heme Fe..<br />a. vit C<br />b. vit B12<br />c. Vit B6<br />d. Vit D<br />e. Vit A<br /><br />159. which of the following drug yang punya efek ke numbness and weakness?<br />a. vit b12<br />b….<br />c. pyridoxine<br />d….<br />e…..<br /><br />163. which of the following statement is correct about phenothiazine?<br />a. produce marked sedation<br />b. produce marked adverse GI bleeding<br />c. may cause increase appetite weight gain<br />d. also act as antitussive<br />e. only marketed as sleeping aid<br /><br />164. which of the following statement is regarding the effect of H1 receptor antagonist is true?<br />a. poor absorbed after oral administration<br />b. have limited use in allergic bronchospasm<br />c. all have muscarinic-cholinergic antagonis activity<br />d. not induce microsomal enzymes<br />e. cause increase in appetite<br /><br />165. Mengenai alegy dan hypersensitivity<br />a. delayed reaction occurs in asthma<br />b. histamine play role in bronchospasm<br />c. hay fever, other than histamine lead to nose irritation<br />d. red flare and hives in urticaria karena mixture toxic leukotrient<br />e. anaphylaxis : localized reaction in vascular system<br /><br />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?<br />a.<br />b.<br />c. suspension for thrombocyte<br />d.<br />e.<br /><br />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..<br />a. factor I deficiency<br />b. factor V deficiency<br />c. factor VII deficiency<br />d. factor VIII deficiency<br />e. factor XIII deficiency<br /><br />170. ……. Neurological examination show tetraparesis, stocking glove paresethesia and decreased physiologic reflex. Lumbar puncture is done. What is the result?<br />a. increased glucose with normal cell<br />b. increased glucose with increased protein<br />c. decreased protein with normal cell<br />d. decreased protein with decreased glucose<br />e. decreased protein with increased glucose<br /><br />171. which is the most possible cause of this case…<br />a. H.influenza<br />b. campylobacter jejuni<br />c. CMV<br />d. salmonella thypii<br />e. Herpes zoster<br /><br />174. which of the following has been the mainstay treatment for this patient (SJS)<br />a. glucocorticoid<br />b. NSAID<br />c. cyclosporine<br />d. immunoglobulin<br />e. cyclophospamide<br /><br />177. red eye, pain, easy tearing. Peripheral corneal ulcer. Treatment..<br />a. oral antibiotic<br />b. anti fungal<br />c. topical corticosteroid<br />d.antihistamin<br />e. topical antibiotic<br /><br />179. male, 50 y.o. chief complain red eye,pain, excessive tearing, objective exam : peripheral corneal ulcer. Main treatment?<br />A. oral antibiotic<br />B. antifungal<br />C. topical corticosteroid<br />D. antihistamine<br />E. topical antibiotic<br /><br />184. immunoglobulin paling terpengaruh untuk melindungi tubuh seperti contohnya toxic infection : dipteri?<br />A .IgG<br />b. IgM<br />c. IgA<br />d. IgD<br />e. IgE<br /><br />189. 54 y.o. woman terkena rhinitis. Dia menggunakan nasal spray. Obat tersebut dapat menyebabkan apa?<br />a.<br />b. rebound phenomenon<br />c. mulberry rhinitis<br />d.<br />e.<br /><br />199. bleeding time which of the following option is markedly prolonged?<br />a. VIII deficiency<br />b. Taking high dose of aspirin<br />c. malabsorption of vit.k<br />d. abnormal liver function<br />e. ….superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-8399752334020897902010-03-11T05:36:00.001-08:002010-03-12T03:31:08.624-08:00MDE HIS 2008For number 1-3, refer to clinical scenario below<br />28 y.o woman with heavy periods & fatigue comes to thr outpatient dept. These complaints occur since 3 months ago. Her conjunctivae are anemic. There is koilonychia without hepatosplenomegaly on physical examination. Lab findings : Hb 8.0 g/dl, WBC 5000/m3, thrombocyte 475.000/mm3<br />1. What is the most possible findings on the physical exam?<br />A. icteric sclerae<br />B. gum hypertrophy<br />C. atrophy of lingual papilae<br />D. lymphadenopathy on the neck<br />E. mass on the abdomen<br />Jawaban : C<br />Alasan : koilonychia salah satu tanda iron deficiency anemia. A tanda hemolytic anemia. B&D tanda AML. E tanda hepatosplenomegaly, tidak ada di kasus (Wintrobe ch 28)<br /><br />2. Which of the following cells in erythropoiesis is dominant on her BM smear?<br />A. pronormoblast<br />B. basophilic normoblast<br />C. polychromatophilic normoblast<br />D. acidophilic normoblast<br />E. reticulocyte<br />Jawaban : E?<br />Alasan : sebenernya jawabannya “lack of stainable iron in reticuloendothelial cells”, tapi ga ada di pilihan. <br /><br />3. What is the first to treat the patient?<br />A. blood transfusion<br />B. iron therapy<br />C. folate therapy<br />D. cobalamine therapy<br />E. eliminate the cause<br />Jawaban : B<br />Alasan : 1st choice treatment untuk IDA adalah mengembalikan kadar Fe. A indikasi Hb <7mg/dl. C&D manifestasi klinis berbeda. (Wintrobe ch 28)<br /><br />For number 4-5 refer to clinical scenario below<br />A 25 y.o woman admitted to hispital with complaints of fatigue & increased shortness of breath with exercise. The patient appeared pale and was tachycardia. Results of lab tests included HB 5.6 gr/dL, WBC 10.000/mm3, RBC 4.5x106, MCV 68.6 fL, MCH 16pg, MCHC 23%. Examination of perpheral blood smear revealed microcytic, hypochromic, and minimal anisopoikilocytosis.<br />4. Which of the folowing process is the most likely for the patient?<br />A. excess Hb synthesis<br />B. vit B12 deficiency<br />C. A quantitative defect in Hb synthesis<br />D. A qualitative defect in globin protein chains<br />E. folate deficiency<br />Jawaban : C<br />Alasan :peripheral blood smear menunjukkan IDA (Harmening hlm 103)<br /><br />5. Which of the following test may useful in confirming the diagnosis?<br />A. measurement of serum Fe dan TIBC<br />B. Hb electrophoresis<br />C. vit B12 deficiency<br />D. chromosome analysis<br />E. flow cytometry<br />Jawaban : A<br />Alasan : kasus di atas adalah IDA, jadi pemeriksaan selanjutnya adalah pengukuran serum Fe dan TIBC (Harmening hlm 103-106)<br /><br />6. A 12 month old boy presents to your office with a chief complaint of pallor. He has inadequate nutritional intake. On physical exam : pale conjunctivae, no liver & spleen enlargement. Lab : WBC 8100/m3, Hb 7.2 gr/dL, PLT 250.000/mm3. Peripheral blood smear : microcytosis, hypochromia. <br />What is the most likely etiology of this anemia?<br />A. vit B12 deficiency<br />B. folic acid deficiency<br />C. iron deficiency<br />D. beta globin deficiency<br />E. G6PD deficiency<br />Jawaban : C<br />Alasan: microcytosis, hypochromia ciri IDA<br /><br />7. What kind of peripheral blood smear appearances will be found?<br />A. Hypochromic, microcytic, anisopoikilocytosis with abundant of pencil cells<br />B. Hypochromic, microcytic, anisopoikilocytosis with abundant of target cells<br />C. Normochromic, normocytic, anisopoikilocytosis with abundant of target cells<br />D. Normochromic, normocytic, anisopoikilocytosis with abundant of pencil cells<br />E. Normochromic, macrocytic, anisopoikilocytosis with abundant of target cells<br />Jawaban : B<br />Alasan : ciri IDA (Harmening hlm 108 tabel 6-13)<br /><br />8. What kind of lab exam will be found ?<br />A. Low serum Fe level, low TIBC, low transferrin saturation<br />B. Low serum Fe level, increased TIBC, low transferrin saturation<br />C. Low serum Fe level, low TIBC, increased transferrin saturation<br />D. Increased serum Fe level, increased TIBC, increased transferrin saturation<br />E. Increased serum Fe level, increased TIBC, increased ferritin saturation<br />Jawaban : C<br />Alasan : Harmening hlm 108 tabel 6-13<br /><br />9. What is the most appropriate recommended treatment for this patient?<br />A. Multivitamin<br />B. Blood transfusion<br />C. Oral ferrous sulphate<br />D. An iron fortified cereal<br />E. Intramuscular iron dextran<br />Jawaban : C<br />Alasan : untuk memperbaiki status iron dalam serum<br /><br />10. A 32 y.o. woman was referred to your hospital for evaluating her low level of Hb. She looks pale and on physical exam you found papillae atrophy of her tongue and dry skin. Which of the following is most likely epithelium damaged for her tongue?<br />A. Simple stratified keratinized<br />B. simple stratified nonkeratinized<br />C. simple squamous<br />D. simple cuboidal<br />E. simple ciliated columnar<br />Jawaban : B<br />Alasan : lidah termasuk simple stratified nonkeratinized<br /><br />For number 11&12, refer to clinical scenario below<br />A 24 y.o woman presents to the hospital with multiple bruises on her arms. This symptoms occurs since 2 days ago. There is no recent illness or problems with bleeding or bruising in the past and she takes no medication. On exams, there are several purpuric lesion on each of her forearms. There is no adenopathy or organomegaly.<br />11. What is the 1st lab study would you order to investigate this?<br />A. Complete blood count (CBC)<br />B. bleeding time (BT)<br />C. Clotting time (CT)<br />D. Prothrombin time (PT)<br />E. activated partial thromboplastin time (aPTT)<br />Jawaban : A<br />Alasan : bruising kelainan hemostasis. Oleh karena itu perlu dicek terlebih dahulu jumlah keseluruhan dari sel darah melalui CBC (Harmening hlm 517)<br /><br />12. IF the PLT count is low which will be prolonged?<br />A. CT<br />B. BT<br />C. thrombin time (TT)<br />D. PT<br />E. aPTT<br />Jawaban : B<br />Alasan : BT evaluasi PLT dan fungsi vaskular untuk membentuk PLT plug (Labman HIS)<br /><br />13. A 4 m.o. boy was brought to the ER dept by his parents. The boy hsa bleeding from his arm after his hepatitis immunization. There was history of bleeding in the male family members. The ab shows normal CBC, BT 2 min(N:1-3min), aPTT 70sec (N:24-45), PT 12sec (N:10-14), TT 14 sec (N:11-15).<br />What is the other test will be suggested?<br />A. bone marrow smear<br />B. Cytokimia<br />C. Factor assay<br />D. Lupus anticoagulant<br />E. Hb electrophoresis<br />Jawaban : C<br />Alasan : bleeding kelainan hemostasis, history of bleeding in male family member penyakit genetik, BT & CBC normal bukan kelainan PLT ata vaskular, PT normal extrinsic dan common pathway normal, TT normal common pathway normal, aPTT prolonged kelainan pada intrinsic pathway perlu factor assay (Wintrobe figure 51.8)<br /><br />14. A 3 y.o. boy is referred to pediatric dept with fever as chief complaint which occur since 5 days ago. At the hospital, doctor performed Rumple leede test on him.<br />Which of the following ability is measured by this test?<br />A. the capillaries to resist pressure<br />B. the PLT to resist pressure<br />C. the capillaries to resist heat<br />D. the PLT to resist heat<br />E. the fibrinogen to resist heat<br />Jawaban : A<br />Alasan : a test in which the increased bleeding tendency characteristic of various disorders (as scarlet fever and thrombocytopenia) is indicated by the formation of multiple petechiae on the forearm following application of a tourniquet to the upper arm<br /><br />For number 15-16 refer to this scenario below<br />A 50 y.o man present with pain in the right calf. He states that his mother had pulmonary emboli. Lab findings : aPTT 70 sec (N:24-25), PT 12 sec (N:10-14), ACA-IgG 80gpl. A Doppler ultrasound reveals a deep vein thrombosis.<br />15. What is the diagnosis of this case?<br />A. Factor V Leiden<br />B. antithrombin III deficiency<br />C. antiphospholipid syndrome<br />D. protein C deficiency<br />E. protein S deficiency<br />Jawaban : C<br />Alasan : DVT, pulmonary emboli (di kasus ada family member) tanda APS (Harmening ch 27)<br /><br />16. What is the additional test will be suggested?<br />A. Factor assay<br />B. Lupus anticoagulant assay<br />C. TPHA<br />D. ASTO<br />E. blood smear<br />Jawaban : B<br />Alasan : APS biasanya disebabkan oleh lupus anticoagulant atau anticardiolipin antibodies (Harmening ch 27)<br /><br />For number 17-18 refer to the scenario below<br />A 3 y.o. boy is referred to the hematology dept with a chief complaint of bruising of his right thigh. He also noted that there were red dots on his extremities since 2 days ago. Lab results : Hb 12.8 gr/dL, Hct 38.5%, WBC 6000/mm,. Peripheral blood smear shows giant PLT and normal morphology of red and white blood cell lines.<br />17. What is the cause of the bleeding?<br />A. fibrinolysis disorder<br />B. vascular disorder<br />C. coagulation disorder<br />D. Quantitative PLT disorder<br />E. Qualitative PLT disorder<br />Jawaban : D<br />Alasan : giant PLT menandakan kompensasi jumlah PLT yang kurang<br /><br />18. What is most likely appearance of the bone marrow smear of this patient?<br />A. large promegakaryocyte<br />B. large megakaryoblast<br />C. small promegakaryocyte<br />D. megakaryocyte with PLT formation<br />E. megakaryocyte without PLT formation<br />Jawaban : D<br />Alasan : megakaryocyte with increased or normal number (Harmening hlm 474-475)<br /><br />19. What is PLT receptor for von Willebrand factor?<br />A. glycoprotein Ia<br />B. glycoprotein Ib<br />C. glycoprotein IIa<br />D. glycoprotein Iib<br />E. glycoprotein III<br />Jawaban : B<br />Alasan : primary receptor for vWF is GpIb (Harmening ch 23)<br /><br />20. A 12 y.o boy was brought to the emergency dept by his parents. The boy suffered from hemarthrosis. There was a history of bleeding in the male family members. The lab results shows normal CBC. What is the appearance of lab results on this patient?<br />A. PT prolonged, aPTT normal<br />B. CT normal, BT normal<br />C. BT prolonged, CT normal<br />D. PT normal, aPTT prolonged<br />E. PT normal, aPTT normal<br />Jawaban :<br />Alasan :<br />21.D. kasus kita kan ITP, untuk treatment dari penyakit autoimun, maka kita harus berikan obat imunosupressan.. di sini kortikosteroid. (wintrobe: ITP-Treatment)<br />22.B. keadaan ini kita curiga ke hemophilia, jadi untuk memastikan apakah ini hemophilia atau bukan, maka kita melakukan melakukan assay dari factor VIII<br />23. C. sudah terlihat dengan jelas dengan aptt yang prolonged. Bukan von willebrand, karena biasanya von willebrand yang turun sering diikuti dengan bleeding time yang naik .<br />24.D Hemophillia jelas ya dari hasil pemeriksaan dan eksklusi dari option yang ada.<br />25. E. cryoprecipitate itu mengandung factor VIII ag dan c, Faktor XIII,dan fibrinogen, & dengan orang hemophilia tipe A, akan mendapatkan transfuse ini. Apabila dalam keadaan severe hemophilia, maka akan diberikan purified factor yang bersangkutan.<br />26. D. dalam hal ini dengan prolonged aptt dan pt dan normal fibrinogen, yang terjadi kemungkinan adalah vit k deficiency. DIC, biasanya diikuti dengan penurunan kadar fibrinogen.<br />27. D. Vit K<br />28. C. di Nelson ebook, untuk treatment vit-k deficiency ya diberikan vit-K karena vit-k sudah jadi specific antidote. Jadi kalo masih berdarah yang kita takutkan adalah keadaan hypovolemic . jadi mikirnya diberikan fresh frozen plasma.<br />29.E. Unperturbed EC possess procoagulant activities that promote coagulation after vascular injury or perturbation. However, in the absence of initiating stimuli, these activities remain latent and do not contribute to thrombosis. Major prothrombotic activities of resting EC include binding sites (receptors) for coagulation zymogens or proteases [factor XII, factor XI, factors X and Xa, factors IX and IXa , and thrombin] and cofactor proteins [high-molecular-weight kininogen , factor VIIIa , and factor Va] and synthesis and expression of factor V and von Willebrand factor. –wintrobe chapter 22 endothelium angiogenesis and regulation hemostasis.<br />30. A. kalo option E itu biasanya dengan gejala yang purpura, petechiae dll yang mencirikan masalah pada kapiler.<br />31.c. vWF bisa dilakukan assay untuk mendeteksi kadarnya secara terpisah dari FVIII-vWF complex.<br />32. B. DDAVP therapy of choice for vWD (type 1) dan hemophilia A minor. DDAVP mengakibatkan transient increase of VIIIc and VIIIag<br />33. C<br />34. E. sebenernya ga dapet dimana2, tapi dari buku wintrobe, Williams, dan Hoffman serta robin bilangnya bahwa CLL bisa mengarah transformasi ke prolymphocytic leukemia apabila di blood smearnya banyak prolymphocyte (sekitar >56%) dan mixed type (10-56%), ga ada keterangan dari bone marrow. Tapi kecurigaan saya itu adanya statement “B-cell dengan prolymphocytoid transformation), jadi kemungkinan jawabannya adalah E.<br />35.A. jelas primarynya jumlah trombosit yang dibawah 150rb<br />36.B<br />37.D, karena ga ada tanda2 lymphadenopathy<br />38. C<br />39.D. kecurigaannya adalah CLL karena ada keterlibatan hematopoietic cells di bone marrow dan lymphadenopathy. Jadi untuk kofirmasi setelah peripheral blood smear, kita smear ke tempat yg dicurigai, yaitu bone marrow.<br />40.b.<br />41. Jawaban : E. Stage IV<br />Penjelasan :<br />Penyakit yang dimaksud adalah CLL (Chronic Lymphocytic Leukemia).<br />Staging menurut Rai System :<br />0 : lymphocytosis in peripheral blood & bone marrow<br />I : + lymphadenopathy<br />II : + splenomegaly<br />III : + anemia<br />IV : + thrombocytopenia<br />(Harmening, 310)<br /><br />42. Jawaban : B/C/E(?) tapi akademik 2006 jawab A. hyperkalemia<br />Penjelasan :<br />Salah satu hasil lab CLL adalah hypogammaglobulinemia (Harmening, 302).<br />Dari beberapa sumber internet ada yang mengikutsertakan hyperkalemia (B), hyperuricemia (E), & hypernatremia (C).<br /><br />43. Jawaban : A. Increased sensitivity of hematopoietic stem cell to erythropoietin<br />Penjelasan :<br />Penyakit yang dimaksud adalah PV (Polycythemia Vera) ->soalnya ga lengkap.<br />“Erythroid progenitors are extremely sensitive to low levels of EPO supplied by serum that is inherently present in the basic culture medium.” (Harmening, 342)<br /><br />44. Jawaban : A. Phlebotomy<br />Penjelasan :<br />Komplikasi utama dari PV adalah thrombosis akibat hiperviskositas darah & transisi PV menjadi MPD. Tujuan utama terapi adalah reduksi massa total RBC. Untuk itu dapat dilakukan terapi phlebotomy & cytotoxic myelosupressive agent. (Harmening, 346-347)<br /><br />45. Jawaban : C.(?) tapi akademik 2006 jawab E. polycythemia, burned out, leukemic phase<br />Penjelasan :<br />“As previously mentioned, PV progress through several stages. In active erythrocytic phase, RBC can be maintained at satisfactory level. Many patients enter anemia period, and this spent phase (=burned out phase, from internet) ia associated with transformation to myelofibrosis. Presence of teardrop RBC on peripheral heralds transition PV to IMF.” (Harmening, 348)<br />Saya cenderung jawab C. erythrocte, burned out, myelofibrosis.<br /><br />46. Jawaban : D. Lymphocytic lymphoma well-differentiated<br />Penjelasan :<br />“This pattern is diffuse & no lymphoid follicles are identified. The lymph node is replaced by an infiltrate of small (mature-appearing) neoplastic lymphocytes.” (Labman Pathology Anatomy)<br /><br />47. Jawaban : A. Diffuse large B-cell lymphoma <br />Penjelasan :<br />“The malignant lymphocytes here are very large with moderately abundant cytoplasm, & the nuclei are round to ovoid with prominent nucleoli & occasional mitoses. Demonstration of CD-19 & CD-20 antigens would classify it as B-cell origin.” (Labman Pathology Anatomy)<br /><br />48. ga ada soalnya…<br /><br />49. ga ada soalnya…<br /><br />50. Jawaban : C. Follicular lymphoma<br />Penjelasan :<br />“These lymphomas (-> follicular center lymphomas) are composed predominantly (more than 50%) of large cleaved cell (large cebtrocytes) & large non-cleaved (centroblast) cell. (Harmening, 405).<br /> <br />51. ga ada soalnya…<br /><br />52. Jawaban : B. Epstein-Barr virus<br />Penjelasan :<br />Penyakit yang dimaksud adalah Burkitt’s lymphoma.<br />Ciri-cirinya : “Apoptosis is also very high & a starry-sky pattern of tingible-body macrophages is usually evident owing to phagocytosis of the apoptotic debris.” (Harmening, 413)<br />“The endemic & immunodeficiency-related cases are also assiciated with a high frequency of tumor cell incorporated EBV genomes.” (Harmening, 414)<br /><br />53. ga ada soalnya…<br /><br />54. ga ada soalnya…<br /><br />55. Jawaban : A. Afferent lymphatics, medullary sinuses, hilus, efferent lymphatics<br />Penjelasan :<br />Struktur lymph node :<br />Lymphatic vessel : afferent vessel -> sub-capsular sinuses -> trabecular sinuses -> medullary sinuses -> hilum -> efferent vessel. (Labman Histology & Junquiera)<br /><br />56. Jawaban : B/C(?) tapi akademik 2006 jawab D.HTLV-1<br />Penjelasan :<br />Penyakit yang dimaksud adalah Hodgkin’s lymphoma.<br />Karena ada non-painful lymph node swelling (Harmening, 402) dan gejalanya sesuai dengan klasifikasi Ann-Arbor (Harmening, 403).<br />Salah satu kemungkinan etiologinya adalah RNA-tumor-virus & EBV (Epstein-Barr virus). Kemungkinan lain adalah cytomegalovirus (B) & herpes virus 6 (C). (Harmening, 398-399).<br />HTLV-1 ditemukan pada non-Hodgkin’s lymphoma (Harmening, 416). <br /><br />57. Jawaban : C. A nucleated Reed-Sternberg cell with large, inclusion nucleoli, & abundant cytoplasm is surrounded by mature lymphocytes<br />Penjelasan :<br />“The cytologic hallmark of Hodgkin’s lymphoma is the presence of unusual giant cell, the Reed-Sternberg cell. Features : large size, abundant acidophilic cytoplasm, multinucleated / polylobulated nucleus, & gigantic inclusion-like nucleoli.” (Harmening, 399)<br /><br />58. Jawaban : D. Stage III B<br />Penjelasan :<br />Berdasarkan Ann-Arbor Staging :<br />I : involvement of single lymph node region / localized single extralymphatic site (IE)<br />II : involvement of 2/more lymph node regions at the same side of diaphragm / associated extralymphatic site (IIE)<br />III : involvement of lymph node regions on both side of diaphragm / associated extralymphatic site (IIIE)<br />IV : disseminated (multifocal) involvement of extralymphatic site & associated lymph nodes<br />Tambahan : A = asymptomatic, B = symptomatic (weight loss >10% in 6 months, fever >38°C, night sweat)<br />(Harmening, 403)<br />Pada kasus ini bilateral cervical & inguinal lymphadenopathy (=stage III) & ada symptom weight loss, fever, night sweat (=B).<br /><br />59. Jawaban : B. Radiation<br />Penjelasan : <br />“Current modalities for the therapy of Hodgkin’s lymphoma are radiation, chemotherapy, or combination.” (Harmening, 403)<br /><br />60. Jawaban : A G6PD-deficiency<br />Penjelasan :<br />Tabel 10-2 (Harmening, 159) chloramphenicol bisa menyebabkan G6PD deficiency.<br />Gejalanya anemia normochromic normocytic, back pain, hemoglobinuria & jaundice. (Harmening, 159)<br /><br />61. E. Severe anemia (Hb < 7g/dl)<br />62. D. Karena : 8 mo, mild icterus, hepatosplenomegaly, decreased Hb, RDW increased, microcytosis, hypochromic<br />63. D jelas<br />64. D. WRBC = RBC, depleted of plasma, platelets, and leukocytes which can be deleterious to the recipient. Indication : for patients with antibodies to IgA or IgE immunoglobulins or thalassemic patients.<br />Packed red cell = RBC + small amounts of plasma with anticoagulant.<br /><br />65. B. Semua sign n symptoms mengarah pada hemolytic anemia<br />66. A. Sign symptoms mengarah pada megaloblastic anemia ( terutama : malnourished). Di peripheral blood smear ditemukan : pancytopenia, macro-ovalocytes, hypersegmented neutrophils<br />67. B. Semua ciri2 pasien kita mengarah pada thalassemia. Peripheral blood smear : microcytic, hypochromic, >>> target cells (Harmening 196)<br />68. C (liat no 64)<br />69. B. Pasien kita terkena Megaloblastic anemia (increased MCV, weakness, fatigue,shortness of breath). Hb may be Normal to Low, absolute reticulocyte count is decreased. Pathogenesis : the defective nuclear maturation caused by a decrease in TTP synthesis from UMP. This deficiency interferes with nuclear maturation, DNA replication, and cell division.<br />70. C. Alasan diperkuat krn multiple Auer rod were seen.<br />71. D. Pasien kita anemia, leukocytosis,thrombocytopenia. Sepertinya dia kena leukemia.<br />72. B. Aplastic anemia : CBC shows pancytopenia, often with anemia being the most notable. The anemia is usually normochromic normocytic (Harmening 133)<br />73. B. Pasiennya mengalami pancytopenia (bukan leukemia), tapi aplastic. <br />74. C. Transfusion transmitted diseases : Hepatitis B, Hepatitis C, HIV, HTLV-1, CMV, HGV, Malaria, Babesiosis, Leishmaniasis, Lyme Disease, Chagas Disease - Chagas' Disease TTV, Creutzfeldt-Jakob CJD, KS and HHV-8, Toxoplasmosis, Cryoglobulinemia, Bacterial Contamination of Blood Products <br />75. C. Each unit of PRBCs is expected to raise circulating Hb by 1g/dl.<br />76. C. Disturbed cell = platelet (don’t have nuclear in mature cell, function : hemostasis, have OCS)<br />77. gtww..sorii<br />78. A.Adults = posterior superior iliac crest (most commonly), sternum (avoided in children), anterior superior iliac crest, spinal processes / vertebral bodies. Newborns and infant = upper end of the tibial bone. Jadi kalo diliat dr optionnya, maka jwbnnya A (Harmening 43)<br />79. D. Jelas,merupakan treatmenu utk IDA<br />80. B. Ferric iron is typically converted into ferrous state by the ACID of the stomach. (Harmening 101)<br />81. A.Folic Acid<br />That is important in synthesis of nucleid acid. It is interdependent with vit B12. Both of this are required for rapidly dividing cells. Deficiency of folic acid can cause megaliblastic anemia and also use for prevent neural tube defect (spine bifida)<br />82. E. Cyanocobalamine<br />It is the other name of vit B12. Necessary for synthesis of nuceid acid, maintenance of myelin production in nervous system and proper function od folic acid. Deficiency of vit B12 affect near all body tissue,particularly those cell containing rapidly dividing cell. So,deficiency of these vitamin also caue anemia,anemia megaloblastic. Loss of myelin cause decrease function of nervous system. The symptoms are paraesthesia,decrease of tendon reflex,and others. <br />83. A. Blood Transfusion<br />The diagnose of this patient is Iron Deficiency Anemia. So,the proper treatment (from the options) is blood transfusion. Blood transfusion is needed to do to treat the patient with Iron Deficiency Anemia if Hb decrease under 6 g/dl.<br />84. B. Urokinase<br />It is the enzyme endogenously produced by kidney present in blood and urine that is capable of breking up blood clots. It is activated plasminogen directly to plasmin,which dissolves blood clots. <br />85. the question is not complete<br />87. A. Decrese of basophilic color<br />The changes of RBC maturation,particularly in cytoplasma is from basophilic to red cytoplasma because of increase of HB. <br />88. C. Yolc sac - liver and spleen – red bone marrow<br /> See harmening page 9<br />89. B. Briliant cresyl blue staining<br /> See harmening page 80<br />90. C. Tissue hypoxia<br /> See harmening page 15<br />91. B. Pelger-huetanomaly<br /> Netrophil that has a bilobus nuclei or monolobed/round<br />93. B. ITP<br /> More closed diagnose from the option is ITP<br />96. <br />98. <br />99. mechanism of action of allopurinol<br /> Inhibitor to enzyme xanthin oxidase in uric acid production to treat of gout.<br /><br />101)<br /><br />102) ANS : D<br /> EXP : tonsil incompletely encapsulated,each tonsil has 10-20 ep.invaginations that penetrate the tonsil deeply,forming crypts,whose lumen contain desquamated ep.cells,live & dead lymphocytes & bacteria (basic histology,junqueira,11th ed,pg 263-264)<br /><br />103)<br /><br />107)<br /><br />108)<br /><br />110) ANS : D<br /> EXP : cytolytic T lymphocytes (CTLs) respond to antigen recognition by killing the antigen-bearing cell.these cells are usually CD8 & recognize antigen in the context of MHC class 1 molecules. (medical immunology,lange,10th ed,pg 141-142)<br /><br />111) ANS : C<br /> EXP : Thalidomide is very harmful to the fetus. Therefore, thalidomide should be avoided during pregnancy. Men and women who are taking thalidomide should use appropriate methods of birth control. Moreover, women of childbearing age should practice two forms of birth control concurrently. Men taking thalidomide should not donate sperm, and thalidomide users should not donate blood since the recipients of the sperm and blood may receive small amounts of thalidomide. <br />NURSING MOTHERS: It is not known whether thalidomide is excreted in breast milk. <br />SIDE EFFECTS: The most common side effects are drowsiness, dizziness, low blood pressure, weakness, rash and increased sensitivity to sunlight. Thalidomide also causes nerve damage and a decrease in white blood cells. Symptoms of nerve damage are tingling, numbness and pain in the feet or hands. (MedicineNet.com)<br /><br /><br />112)<br /><br />113) ANS : E<br /> EXP : corticosteroidadvantages :<br />• Promote normal intermediary metabolism<br />• Increase resistance to stress – high glucosegive high energyincrease resistance to stress(exp;trauma,fright,infection)<br />• Alter blood cell levels in plasma – cause decrease in eosinophils,basophils, monocytes & lymphocytes by redistributing them from the circulation to lymphoid tissue;increase blood levels of erythrocytes,hb,platelets PMN<br />• Anti-inflammatory action – exact mech.not fully understood.however,the lowering & inhition of peripheral lymphocytes & macrophages is known to play a role.interference in mast cell degranulation results in decreased histamine & capillary permeability.<br />• Affect other components of endocrine system<br />• Effects on other systems<br />(Lippincott,pharmacology,3rd ed,308-309)<br /><br />114) ANS : C<br /> EXP : dexamethasone=corticosteroids group;corticosteroid eye drops to control acute severe allergic conjunctivitis should be used very sparingly fro brief periods only,with careful monitoring by an ophtgalmologist (medical immunology,lange,10th ed,358) <br /><br /><br /><br /><br />115) ANS : C<br /> EXP : side effects of glucocorticoidhyperglycemia may develop & lead to DM,other side-osteoporosis,increase risk of infection & classic Cushing-like syndrome (pharmacology,Lippincott,3rd ed,pg 312)<br /><br />116)<br /><br />117) ANS : A<br /> EXP : pemphigus vulgaris – skin biopsy shows a suprabasal intraepidermal blister with loss of cohesion of keratinocytes(acantholysis);blisters that most commonly affect the scalp,chest,umbilicus,body folds;direct immunofluorescence reveals the deposition of IgG in virtually all patients & complement components (mostly C3) on epidermal cell surface forming a honeycomb pattern in 50% of all patients. (medical immunology,lange,10th ed,pg 504-505) <br /><br />118) ANS : D<br /> EXP : refer to explanation of the answer above<br /><br />119) ANS : E <br /> EXP : refer to explanation of the ans no. 117<br /><br />120) ANS : B<br /> EXP : <br /><br />121. Which of the following is the best place in-patient care ?<br /> a. burn unit room<br /> b. recovery room<br /> c. high care unit room<br /> d. standard in-patient room<br /> e. intensive care unit room<br />Ans.<br />a/e<br />Since the age of 4, an 8 yo girl has been suffering sneezing, watery rhinorrhea, nasal blockage resulting in nasal voice, severe itch in her nose and throat, accompanied with red, watery, severe itching eyes without fever. It recurs everytime she is in the rice stock ham, rice, and ricefields, especially in harvest time. The eye’s topical glucocorticoid treatment, need monitoring of an ophthalmologist, due to defective cell mediated immunity.<br />122. Which of the following is the most unlikely sign of PE ?<br /> a. allergic salute<br /> b. Dennie-Morgan folds<br /> c. facial twitching or grimacing<br /> d. hyperemic nasal mucous<br /> e. transverse nasal crease <br />Ans.<br />d<br />PE pada allergic rhinitis :<br />- facial twitching or grimacing<br />- allergic salute<br />- dennie-morgan folds<br />- transverse nasal crease<br />123. The eye’s topical glucocorticoid treatment, needs monitoring of an ophthalmologist, due to defective cell mediated immunity. Which one of the following needs to be detected early by ophthalmologist ?<br />a. cataract<br />b. corneal ulcer<br />c. glaucoma<br />d. herpes simplex virus infection<br />e. sight threatening side effect<br />Ans.<br />c<br />Topical glucocorticoid therapy frequently intraocular pressure in normal eyes and exacerbates intraocular hypertension in patient with antecedent glaucoma. Intraocular pressure should be monitored when glucocorticoid are applied to the eye for more than 2 weeks.<br />A 4 months old baby girl comes to clinic with rash skin on her cheeks, which spare the perioral skin. It appears first as typical dryness (1 week ago) developing into red scaly plaques since 4 days ago. On the first day of life, she was given cow’s milk formula and was exclusively breastfed there after. Since 8 days ago cow’s milk formula containing porridge was added to her daily feeding. Her brother (5 yo) will wheeze and her mother sneeze after exposure to dust.<br />124. Which one of the following is the most likely diagnosis ?<br /> a. contact dermatitis<br /> b. irritant dermatitis<br /> c. atopic dermatitis<br /> d. Steven Johnson’s Syndrome<br /> e. Streptococcal skin scalded syndrome<br />Ans.<br />c<br />Terjadi akibat konsumsi susu sapi.<br />125. Which one of the following is the most likely cause of this baby’s disease ?<br /> a. house dust<br /> b. house dust mite<br /> c. wheat<br /> d. cow’s milk<br /> e. breast milk<br />Ans.<br />d<br />Telah diberikan selama 8 hari.<br />20 yo with runny nose as chief complaint. It occurs since he was 4 yo. There is also nasal blockage, itchy-nose, sneezing especially after dust inhalation. He wotks as bus driver. PE : facies adenoid and allergic shinners, enlargement inferior and middle turbinate with a boggy, pale, and bluish mucosa. Lab : IgE levels : 600 IU/ml<br />129. Runny nose. Major substance release ?<br />Ans.<br />IgE<br />130. for the above case, what is the most suitable H. I. Antihistamine for this patient ?<br /> a. ceftrizine hydrochloride<br />b. chlorpheniramine maleat<br />c. promethazine hydrochloride<br />d. tripehennamite hydrochloride<br />e. diphenhydramine hydrochloride<br />Ans.<br />a<br />Sesuai dengan case. Efek samping pada CNS rendah.<br />132. A 32 yo mother who was 32 weeks pregnant (G1P0A0) came to allergic clinic with a runny nose and stuffy nose as a chief complaint. This nose problem was firstly notice in 2nd trimester. PE reveal allergic shinners, enlarged inferior turbinate and watery-clear mucus. Lab : IgE serum 340 IU/ml. Which of the following substance beside histamine might cause the nose problem to this patient ?<br /> a. estrogen<br /> b. bradykinin<br /> c. prostaglandin<br /> d. progesterone<br /> e. leukotrienes<br />Ans. <br />e<br />Menampakkan late phase mediator yang memiliki efek sama dengan histamine namun lebih potent.<br />137. 5 yo boy comes to ENT clinic. Runny nose since 3 yo, also suffered nasal blockage, itchy, and sneezing especially when inhaled dust. Lab : IgE serum 600 IU/ml. Most frequent co-morbidity on pharynx in PE ?<br /> a. pale mucosa<br /> b. post nasal drip<br /> c. pseudomembrane<br /> d. hyperemic mucosa<br /> e. cobblestone appearance<br />Ans.<br />b<br />terjadi akibat produksi mucus .<br />139. During christmast dinner, female is hospitalized because of tight throat and shortness of breath after eating shrimp. What is the diagnosis ?<br /> a. choking <br /> b. anaphylactic shock<br /> c. shrimp in throat<br /> d. laryngeal edema<br /> e. asthma<br />Ans.<br />b<br />141. 5 yo went to Pangandaran. Swimming vigorously in sea water at high noon which spread multiple pruritic papules, develop immediately, small which 1-3 mm diameter surrounded with excessive ... What type of urticaria is she having ?<br /> a. aquagenic urticaria<br /> b. cholinergic urticaria<br /> c. heat urticaria<br /> d. psychogenic urticaria<br /> e. solar urticaria<br />Ans.<br />b<br />Cholinergic urticaria is a disease of unknown cause in which small (1-3 mm) wheals with prominent surrounding flare appear after exercise, heat, or emotional stress. <br />161. From case 160. Permanent symptom in NLE<br />A. Cutaneous lesion<br />B. Congenital heart block<br />C. Pulmonary involvement<br />D. Neurologic involvement<br />E. Thrombocytosis<br />Jawab : B<br /><br />162. Major cause of death to chronic corticosteroid administration ?<br />A. Infection<br />B. Nephritis<br />C. CNS disease<br />D. Pulmonary hemorrhage<br />E. Myocardial infarction<br />Jawab : A<br />Kenapa bukan E ? Karena kelainan jantung yang bisa disebabkan oleh corticosteroid adalah heart failure (terutama congestive heart failure), bukan myocardial infarction (= heart attack).<br /><br />163. IV drug user, Anti-HIV (+), CD4 = 66, shortness of breath, bilateral infiltrate of lung. Which is true ?<br />A. Risk of multiple opportunistic infection<br />B. Risk of myocardial infarction<br />C. Risk of autoimmune disease<br />D. Risk of hematological disease<br />E. Risk of drug allergy<br />Jawab : A<br /><br />164. 30 y.o. male had symptom of anemia, diagnosed as megaloblastic anemia. Drug avoided through …<br />A. Oral<br />B. Intravenous<br />C. Intravascular<br />D. Subcutaneous<br />E. Intracutaneous<br />Jawab : B<br />Penyebab megaloblastic anemia adalah defisiensi vitamin B12 atau asam folat. Untuk vitamin B12, bisa diberikan secara per oral atau intramuscular atau subcutaneous. Untuk asam folat, biasa diberikan secara oral.<br /><br />165. Patient with malar rash, photosensitivity, atrophic lesion at periauricular, ANA (+), dsDNA (-), no protein in urine. Diagnosis ?<br />A. DLE<br />B. SLE<br />C. CLE<br />D. Acute SLE<br />E. Acute CLE<br />Jawab : E<br />Dari criteria SLE, yang terpenuhi hanya 3, yakni malar rash, photosensitivity, dan ANA (+), sehingga belum memenuhi diagnosis SLE (minimal 4 dari 11 kriteria). Jadi jelas termasuk CLE. Mengapa acute, bukan subacute atau chronic ? Bentuk lesi khas acute adalah malar rash, subacute lesi khasnya annular dan hyperkeratotic, chronic : discoid/DLE.<br /><br />166. 45 y.o. female has rheumatoid arthritis for 6 years and has been treated with NSAIDs and, sometimes, corticosteroids for severe exacerbation. She feels the disease gets worsen. Due to acute exacerbation, she is treated with methotrexate. What is MoA of the last drug ?<br />Jawab :<br />Methotrexate adalah first choice untuk disease-modifying antirheumatic drugs (DMARDs). MoA-nya menginhibisi aminoimidazolecarboxamide ribonucleotide (AICAR) transformylase dan thymidylate synthetase dan efek sekunder (bukan utama) ke dyhidrofolate reductase dan penghambatan chemotaxis dari PMN. Penghambatan enzim-enzim ini menyebabkan berkurangnya sintesis thymidylate, purine nucleotide, dan serine dan methionine. Sehingga menyebabkan intervensi thd pembentukan DNA, RNA, dan protein sel.<br /><br />167. –<br /><br /><br />168. Patient present with polyarthritis around small joint of hand and feet. According to Americal College of Rheumatology for rheumatoid arthritis ?<br />A. Systemic symptom<br />B. Swan neck appearance<br />C. Rheumatoid nodules<br />D. Oligoarthritis<br />E. Osteosclerosis<br />Jawab : maaf, saya kurang tahu maksud pertanyaannya >.<<br />Kriteria diagnosis untuk RA dari American College of Rheumatology (minimal 4 terpenuhi diagnosis RA) :<br />1. Morning stiffness > 1 hour for at least 6 weeks<br />2. Arthritis and soft tissue swelling of >3 of 14 joints/joint groups, present for at least 6 weeks<br />3. Arthritis of hand joints, present for at least 6 weeks<br />4. Symmetric arthritis, present for at least 6 weeks<br />5. Subcutaneous nodules in specific places<br />6. Rheumatoid factor at level above 95th percentile<br />7. Radiological changes suggestive of joint erosions<br /><br />169. –<br /><br />170. Histopathology for above case :<br /><br />171. Chief complaint : difficulty of breathing<br />3 weeks ago, had diarrhea and febrile.<br />General practitioner gave antibiotic and antidiarrhea, these drugs decrease the symptoms.<br />2 weeks ago, felt numbness and weakness in both extremities, which become worse.<br />PE : alert, RR 14/min, temperature 36.7<br />Neurological exam : symmetrical and bilateral tetraplegic, flaccid, gloves & stocking anesthetic.<br />Physiologic reflex absent<br />Oxygen saturation is decreased<br />CSF analysis : cytoalbuminic dissociation<br />Which of the following type of hypersensitivity is the most likely occur in this case ?<br />A. 1<br />B. 2<br />C. 3<br />D. 4<br />E. 1 – 4<br />Jawab : D<br />Dari chief complain “difficulty of breathing”, riwayat adanya infeksi gastrointestinal sebelumnya, hasil pemeriksaan neurologis yang menunjukkan adanya ascending paralysis, sepertinya ini adalah Guillain-Barre Syndrome, yang disebabkan reaksi hypersensitivity tipe 4.<br /><br />172. –<br /><br />173. HIV antibodies positive since 5 years<br />CD4 = 65<br />Difficulty in breathing.<br />Which one is true ?<br />A. High risk for infection<br />B. High risk for myocardial infection (infarction mgkn maksudnya)<br />C. High risk for hematologic disease<br />D. High risk for drug allergy<br />Jawab : A<br /><br />174. Which of the following causes that can proceed to respiratory failure in this case ?<br />A. Ascending paralysis<br />B. Descending paralysis<br />C. Uncal herniation<br />D. Rostrocaudal herniation<br />E. Transtentorial herniation<br />Jawab : kalau ini kasus GBS, jawabnya A.<br /><br />175. –<br /><br />176. –<br /><br />177. Appropriate tools to confirm diagnostic for baby’s HIV infection state ?<br />A. HIV DNA PCR<br />B. HIV RNA PCR<br />C. HIV culture<br />D. HIV p24 Ag ex<br />E. Anti-HIV-1<br />Jawab : B<br /><br />178. Based on Indonesian Medical, what is appropriate drug for treatment for neonatal HIV infection ?<br />A. AZT + 3TC + NVP, 6 weeks<br />B. AZT + 3TC + ZDV, 6 weeks<br />C. AZT + ZDV<br />D. AZT + ZDV<br />E. Antimycotic<br />Jawab : A<br />untuk terapi AIDS, diperlukan gabungan 2 NRTI + 1 NNRTI atau 1 protease inhibitor. AZT dan 3TC termasuk NRTI, NVP termasuk NNRT, ZDV termasuk NRTI.<br /><br />179. Which one of the following is mediator of early phase of mast cell degranulation ?<br />A. Prostaglandin<br />B. Leukotriene<br />C. PAF<br />D. Tryptase<br />E. IL-4<br />Jawab : D<br />Degranulasi mast cell menyebabkan pengeluaran histamine, heparin, dan tryptase pada fase awal (karena ketiga substansi itu ada di preformed granule). Di fase lambat, arachidonic acid, leukotriene, prostaglandin, cytokine, TNF, dan IL dilepaskan.<br /><br />180. Which of the following molecule is opsonin that facilitates efficient phagocytosis of microbes by neutrophil and macrophage ?<br />A. IgA<br />B. IgG<br />C. IgE<br />D. CRP<br />E. IF<br />Jawab : B<br />Tabel 2-10 Lange Medical Immunology hal. 36 menyebutkan, opsonin dari macrophage salah satunya adalah immunoglobulin, especially IgG<br /><br />181.8 months old boy, mild icterus, mycrocytosis, hypocromia, anisopoikilicytosis, polychromasia, basophilic stippling.Most appropiate condition<br /><br />a. moderate anemia+splenomegali<br />b. moderate anemia+ hepatosplenomegali<br />c. severe anemia+ hepatomegali<br />d. severe anemia+ splenomegali<br />e. severe anemia+ hepatosplenomegali<br /><br /><br />182.which of following is present to facilitate efficient phagocytosis of microbe by neutrophil and macrophage<br />a.IgA d.CRP<br />b.IgG e.IF<br />c.IgE<br /><br />Alasan: IgG protect against bacteria and virus by enhancing phagocytosis, neutralizing toxins, and triggering complement system.<br /><br />183. a man diagnosed with AIDS 5 years ago.CD4+ count decreased.What is big risk<br />a.he is at risk getting oppurtunistic infection<br />b.he is at risk of getting trauma<br />c.he is at big risk of getting malformation<br />d.he is at risk of getting inflamation<br /><br />Alasan: CD4+ cell ato helper T-cell berperan dalam proses imun system sehingga saat kadarnya rendah maka proses imun system juga akan menurun sehingga resiko terinfeksi tinggi.<br /><br />184.63 year female has symetrical sweeling of proximal phalanges joints and small subcutaneus nodules over extensor surface on her arm. She report had pain and stiffness is most pronounced on arising in morning.which of following laboratory test result is typical in of patient disease?<br />a.positive IgM specific to streptococcal antigen<br />b.positive IgG specific to streptococcal<br />c.positive anti-double stranded DNA<br />d.positive rheumatoid factor<br />e.positive ASLO<br /><br />Alasan:diagnosis kasus diatas ialah rheumatoid karena terdapat symetrical swelling in join kecil dan subcutaneus nodul uang disebut rheumatoid nodule dan pada RA rasa sakit terjadi saat bangun pagi dan improve throughtout of the day<br />Dimana ciri RA ialah: presence rheumatoid factorbin serum and synovial fluid, infiltartion lymphocyte and activated macrophage into involved synovium, dan local production TNF- alpha dan other proinflamatory cytokines in inflamed synovium.<br /><br />185.SLE is the diseasse of autoimmune origin.Which of following act as antigen from the production of antibodies in the case<br />a.snRNP (small nuclear ribonucleoprotein)<br />b.Mrna<br />c.rRNA (ribosomal ribonucleic acid)<br />d.cDNA (circular deoxyribonucleic acid)<br />e.dsDNA (double stranded DNA)<br /><br />alasan: high titer of anti-ds-DNA antibodies are characterized of SLE.in contrast, anti ss-DNA are not specific and can be found in other autoimune disease ( RA, cronic active hepatitis dsb)\ <br /><br />186.lihat soalny di buku kumpulan soal<br />a.hair fall d.difficult concentration<br />b.skin rash e.symetrical polyarticular inflamation<br />c.systemic symptom<br /><br />alasan: main problem / chief complain ialah keluhan yang mebuat seseorang datang beribat ke dokter.<br /><br />187.one morning, as a medical student, you are observing in rheumatology clinic of hasan sadikin general hospital, a 20 years old woman presented with symetrical painful and swollen joints including proximal interphalanges (PIPs).metacarpophalanges (MCPs), wrist,knee and ankles. The other symptom were fever and subcutaneus nodules.Which of the following is thhe most likely diagnosis in this case<br />a.SLE d.artritis reactive<br />b.Rheumatoid artritis e.osteomyelitis<br />c.spondyloartritis alasan : lihat pembahasan no 184<br /><br />188.patient with symetric polyartritis particularly off small joints of the hands and feet should be checked for rheumatoid factor.which of the following symptom were included in the american college of rheumatology duagnostic criteria for rheumatoid artritis<br />a.systemic symptom d.oligoartritis<br />b.swan neck deformities e.osteoslerosis<br />c.rheumatoid nodule<br /><br />Alasan: most characteristic feature of hand in RA are<br />- ulnar deviation (boutonniere) deformity = flexion of proximal interphalanges joint and hyperextention of distal interphalanges joint resulting from volar slippage of lateral band of superficial extensor tendons.<br />- swan neck deformities (hyperextention of proximal interphalange joint and <br />- flexion of distal interphalange joints resulting from contarcture of intinsic muscle of the hand)<br />189.a young man, 24 years old had a history back pain and stiffness especially in the morning, over the past 3 months and relieved by increased avtivity or anti-inflamatory medication.he did not have constitutional complaints of fever or weight loss.in addition for the last months he has sweeling and stiffness in his knees and unable to walk.rheumatology finding: legs,knees,and ankles were inflamed and swollen, spine: schober test (+).what is the differential diagnosis in this patient<br />A.gouty artritis and osteoartritis<br />b.rheumatoid artritis and spondyloartritis<br />c.septic artritis and rheumatoid artritis <br />d.osteoartritis and rheumatoid artritis<br />e.SLE and spondyloartritis<br /><br />Alasan: diagnosis kasus diatas ialah RA karna ada stiffness saat pagi hari dan spondyloartritis karna ada schober test (+) yang umumnya pada sacroiliac joint, spine and large periperal joints.yang ditanya adalah differential diagnosis<br /><br />190.48 year old business man had history of mild hypertention.usually he had no symptoms and for the hypertension he has had hydochlorothiazole theraphy for 3 days.he wake up in the night with painful and warm in hiss feet.one hour later his symptom become worst, warm and redness.he called the doctor and received analgesic.what kind of drugs can induce the acute attack of gouty artritis<br />a.low dose aspirin d.paracetamol<br />b.allupurinol e.prednisone<br />c.hydrochlorothiazide<br /><br />alasan: drugs (including diuretics ex hydrochlothiazide and cyclosporine A), and chronic ethanol (especially beer and hard liquor) can induce GA.asprin juga bisa mengakibatkan GA tapi tidak saat low dose.<br /><br />192.an 18 year old in room full of people who are coughing and sneezing.the influenza viral particle that she inhales attach to respiratory epithalium and viral transformation reduce the class I MHC molecules on these epithelial cells.which of the following cell that respond to destroy the infected cells.<br />a.neutrophile d.NK cells<br />b.monocyte e.dendritic cell<br />c.CD4 cells <br /><br />alasan: infected target cell by viral> fragment dipecah dan diikat ke permukaan sel oleh MHC> cytotoxic CD4 > melekat ke MHC> CD4 release cytotoxic substance cause death infected cell by release perforin dan granzyme.<br /><br />193.in rsponse with mucobacterium tuberculosis, agranuloma forms in the lung. Within the granulooma ae cell expressing class II MHC antigens.these cell liberate cytokines that promote fibroblastic production in colagen within granulomma.WOTF blood leucocyte are in the mechanism<br />a.neutrophle d.NK cells<br />b.monocyte e.basophile<br />c.B cell<br /><br />Alasan: MHC II diekspresi oleh APC (dendritic cell, macrophage, dan B cell)<br /><br />194.a 43 year old male presents several flaccid lesion with crusts on his back.patology anatomy diagnosis from the biopsy which obtained from the lesion was pemphigius folaceus.Which of the most appropiate histopatologic appereance for the case above<br />a.spongiosis within epidermis<br />b.superficial perivascular lymphocytic infiltrate<br />c.intraepidermal blister with acantholitic<br />d.dermal and epidermal edema and mast cell degranulation<br />e.subcorneal blister with acantholitic cells.<br /><br />Alasan: microscopic pada pemphigius folaceus ialh subcorneal clister is apparent with acantholysis.<br /><br />196.Gouty artritis that is caused by overproduction of uric acid.which of the following is a precursor of uric acid<br />a.pyrimidine d.thymine<br />b.purine e.uracil<br />c.cytosine<br /><br />alasan: uric acid produced by xanthine oxidase from xanthine and hypoxanthine, which in true produced from purine.<br /><br />197.allupurinol is compound used to trear gout.which of the follwing is the mechanism of action of the dug above<br />a.inhibit degradation of guanosine to guanine<br />b.inhibits degradation of guanine to xanthine<br />c.increase excretion of hypoxanthine<br />d.activates degradation of uric acid to allantoin<br />e.inhibit degradation of hypoxanthine to xanthine<br /><br />alasan: allopurinol inhibit synthesis xanthine oxidase and prevent synthesis of urate from hypoxanthine and xanthine (xanthine oxidase: ubah degradasi xypoxanthine menjadi xanthine)<br /><br />198.according to the origin and physiologic process of ejaculation, antigenicity of the semen is divided into antigens derived from testes, epididymis and spermatozoa and antigen derived from the secretions of reproductive accesory glands.WOTF is most likely the sperm coating antigen originated from seminal plasma:<br />a.trasferrin d.albumin<br />b.acid phosphatase e.globulin<br />c.scaferrin<br /><br />199.breakdown of normal protective mechanism, ex the blood testis barier, appear to be the major factor cause of antigen leakage causing antisperm antibody (ASA) formation.ASA may cause fertility by which of the following ways<br />a.interfering with spermmatozoa production<br />b.interfering with spermatozoa capacitation<br />c.reducing the amount of spermatozoa<br />d.reducing the mobility of spermatozoa<br />e.agglutinating and immobilizing the spermatozoa<br /><br />200.WBC have been found found to carry numerous different antigen in HLA system.the presence of a particular region on leucocyte means that a corrsponding alleles is the present in genotype making up that person.which of the followinh is most likely explanation pf HLA symptom<br /><br />a. objective of transplantation<br />b. antigens in the HLA system are controlled by cromosome 8<br />c. alleles of the genotype maybe homoxygous and heteroxygous<br />d. alleles of the genotype are always homozygous<br />e. alleles of the genotype are always heterozygous<br /><br />alasan: the succes of organ or tissue tranplantation depends on histocompability –that is, the tissue histocompability between donor and the recipient.tissue typing (histocompability testing) is done before any organ transplant.antigen of HLA system are controlled by cromosome 6.superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-12021258051768491432010-03-11T05:35:00.001-08:002010-03-12T03:31:41.061-08:00MDE HIS 2007-21. Jawaban : C<br />Alasan : soal kurang lengkap, klo hanya segini harusnya bisa semua. Tapi klo ada hemarthrosis (bleeding in joint) biasanya karena masalah koagulasi.<br /><br />2. Jawaban : A<br />Alasan : ada thrombocytopenia sedangkan blood count lain normal, ada sejarah bleeding (Harmening hlm 474)<br /><br />3. Jawaban : C<br />Alasan : Hb nomal 12-16 (women), WBC 4800-10800, PLT 150000-350000 (tabel Harmening)<br /><br />4. Jawaban : A<br />Alasan : gejala paling sering pada ITP adalah bleeding, dan yang paling berbahaya bila terjadi di intrakranial<br /><br />5. Jawaban : C/D<br />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)<br /><br />6. Jawaban : C<br />Alasan : BM smear peningkatan jumlah megakaryocyte (harmening hlm 444)<br /><br />7. Jawaban : A<br />Alasan : Harmening hlm 444<br /><br />8. Jawaban : C<br />Alasan : dari SS mungkin yang bterjadi adalah Hodgkin’s lymphoma<br /><br />9. Jawaban : A<br />Alasan : diagnosis untuk keganasan pada lymph (node) dilakukan melalui biopsy <br /><br />10. Jawaban : D<br />Alasan : Robbins hlm 688<br /><br />11. Jawaban : B<br />Alasan : kebanyakan pasien ditreatment dengan chemotherapy (cytostatic)<br /><br />12. Jawaban : E<br />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<br /><br />13. Jawaban : IDA<br />Alasan : sign & symptom cocok dgn IDA<br /><br />14. Jawaban : Acidophilic normoblast<br />Alasan : sebenernya jawabannya “lack of stainable iron in reticuloendothelial cells”, tapi ga ada di pilihan.<br /><br />15. Jawaban : Hemorrhagic disease of newborn<br />Alasan : prolonged PT dan aPTT kelainan pada intrinsic dan extrinsic pathway multiple coagulation factor disorder<br /><br />16. Jawaban : A/B<br />Alasan : PLT count normal kemungkinana kelainan di faktor koagulasi (Harmening hlm 465-466)<br /><br />17. Jawaban : E<br />Alasan : nampak soalnya salah, harusnya PLT count berkurang, jadi diagnosisnya ITP<br /><br />18. Jawaban : B<br />Alasan : ada faktor genetis (pada male family member) dan peningkatan aPTT kelainan proses koagulasi (secondary hemostasis)<br /><br />19. Jawaban : C<br />Alasan : prolnged aPTT, hemarthrosis, history of bleeding in male family member (Harmening hlm 501)<br /><br />20. Jawaban : D<br />Alasan : hemophilia A kelainan faktor VIII<br /><br />21. E. jelas ya, liat penjelasan no 24 tahun 2007-1<br />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<br />Note: DIC itu mempunyai manifestasi yang unik, tergantung dari manifestasi mana yang dominan, bisa manifestasi pendarahan atau manifestasi thrombotic.<br />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..<br />24.B. karena abnormal response dari mast cell dari compensatory cholinergic in thermoregulation.<br />25.?<br />26.?<br />27?<br />28?<br />29. E. jelas ada tanda2 hemolytic anemia pale yang disertai icterus, splenomegaly (SII) <br />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.<br />31. jika optionnya seperti ini, diagnosis pastinya melalui Hb electrophoresis.<br />33.??<br />38. D.kalo granulocyte hyperpigmentation itu ga ada.adanya adalah hypersegmentation yang muncul pada megaloblastic anemia.<br />39. D. robbins hal 676<br />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…<br />41. Jawaban : E. cryoprecipitate<br />Pembahasan :<br />Penyakitnya adalah hemophilia, karena ada riwayat bleeding pada keluarga laki-laki & APTT turun.<br />“Cryoprecipitate = a concentrated source of coagulation fator VIII.” (Harmening, glossary 699)<br />“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)<br />“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)<br />Yawda kasih cryo- aja, daripada yang laen lebih ga nyambung, ya ngga?? <br /><br />42. Jawaban : C. scafferin<br />Pembahasan :<br />“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)<br /><br />43. Jawaban : B. BCB staining<br />Pembahasan :<br />“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)<br />“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)<br /><br />44. Jawaban : (?) akademik 2006 jawab A. increase potassium<br />Pembahasan :<br /><br />45. Jawaban : (?) akademik 2006 jawab A. whole blood<br />Pembahasan :<br /><br />46. Jawaban : pronormoblast / rubriblast<br />Pembahasan :<br />Youngest RBC -> pronormoblast / rubriblast (Harmening, 10, tabel 1-6, 13)<br /><br />47. Jawaban : myeloblast – promyelocyte – N.myelocyte – N.metamyelocyte – N.band – N.segmented <br />Pembahasan :<br />Stage of neutrophil development (Harmening, tabel 1-7, 17)<br /><br />48. Jawaban : B. leukocyte, Hb, diff.count<br />Pembahasan :<br />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.<br /><br />49. Jawaban : A. microcytic, hypochromic anemia<br />Pembahasan :<br />(Harmening, tabel4-3, 77)<br />MCV (80-100 fL) -> turun, microcytic<br />MCH (22-31 pg)<br />MCHC (32-36%) -> turun, hypochromic<br />Pada kasus, ketiganya turun, maka microcytic hypochromic anemia.<br /><br />50. Jawaban : B. iron deficiency anemia<br />Pembahasan :<br />MCV, MCH, MCHC turun -> microcytic hypochromic anemia.<br />A. megaloblastic anemia -> macrocytic normochromic<br />B. IDA -> microcytic hypochromic (V)<br />C. hemolytic anemia -> normocytic normochromic<br />D. aplastic anemia -> normocytic normochromic<br />E. pernicious anemia = megaloblastic<br />(Harmening, tabel 4-3, 77)<br /><br />51. Jawaban : B. normoblast with marked nucleus<br />Pembahasan :<br />“IDA –> the bone marrow revealed a mild to moderate increase in erythroid progenitors (normoblasts).” (Robbins, 646)<br /><br />52 – 53. ga ada soalnya...<br /><br />54. Jawaban : E. bullous pemphigoid<br />Pembahasan :<br />“Bullous pemphigoid –> a bullous autoimmune disease usually in eldery. <br />Lesion = pruritic papular / urticarial lesion with large tense bullae, subepidermal blister with eosinophils.<br />Mechanism = interaction of antibody with bullous pemphigoid antigen (BPAG12) at hemidesmosome of basal keratinocyte.” (Fitzpatrick pocket, 112)<br /><br />55. ga ada soalnya...<br /><br />56. Jawaban : A. abnormal synthesis of globin chain<br />Pembahasan :<br />“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)<br /><br />57. Jawaban : C packed red cell<br />Pembahasan :<br />Karena terdapat defek pada pembentukan rantai globin dari Hb, dari RBC. Maka transfusi yang sesuai adalah packed red cell.<br /><br />58. Jawaban : E. aplastic anemia<br />Pembahasan :<br />“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)<br /><br />59. Jawaban : (?) <br />Pembahasan :<br />Penyakitnya adalah IDA, karena serum iron & ferritin turun.Terapi dengan iron replacement.<br />“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)<br /><br />60. ga ada soalnya...<br /><br />61. D<br />62. C. Tanda2 dari pasien ini mengarah ke IDA. Lab result dari pasien yg mengidap IDA adalah decreased serum ferritin, increased TIBC<br />63. E. seperti case IDA kita (no hepatosplenomegaly)<br />64. D<br />65. C<br />66. A.<br />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.<br />68. C. Pasien kita terkena leukemic tipe AML (dewasa), khususnya AML M3<br />69. B.<br />70. ga nyambung soalnya<br />71. A<br />73. E<br />74.C<br />75. C<br />78. A<br />79. D <br />80. ga jelas soalnya<br />100) A<br />101) C<br />102) A<br />103) D<br />104) D<br />105) <br />106) A<br />107) E<br />108) C<br />109) A<br />110) D<br />111) C<br />112) D<br />124. which of the following is the characteristic of rhinorrhea ?<br />Ans.<br />-<br />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 ?<br />Ans.<br />B. Exocrine<br />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 ?<br />Ans.<br />A. Pars papillaris<br />128. a 24 years old male, IV drug user, lab result shows HIV (+). Which of the following cell killed by the virus ?<br />Ans.<br />C. CD4+ T lymphocyte<br />132. which of the following cells is mediated in transmitting this virus to CD4+ and T lymphocytes ?<br />Ans.<br />?<br />133. which of the following target cell will be killed by cytotoxic T cell induced by viral infection ?<br />Ans.<br />B. Infected by virus and identical at class I MHC loci at cytotoxic T cell<br />134. after binding to its specific antigen, a B lymphocyte may switch which of the following component ?<br />Ans.<br />B. Immunoglobulin heavy chain class<br />135. which of the following must be exposed on the surface of APC that activate T helper ?<br />Ans.<br />D. Class II antigen<br />136. which of the following class immunoglobulin is present in highest concentration in the blood of human newborn ?<br />Ans.<br />A. IgG <br />137. which of the following statement is the most likely is the macrophage during an antibody response ?<br />Ans.<br />D. Processing antigen and presenting it<br />139. MoA of allopurinol ?<br />Ans.<br />Allopurinol inhibits xanthineoxidase and prevents the synthesis of urate from hypoxanthine and xanthine.<br />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.<br />140. which of the following is the most likely diagnosis ?<br />Ans.<br />D. SLE<br /><br />190.A.Prevent rather than reversing histamin action on target tissue<br /><br />193.E.Agglutinating and immobilizing the spermatozoa<br /><br />196.B.Competitive inhibitor of histamine, by reversible binding of H1 receptor.<br /><br />197.D.Topical Antihistamin<br /><br />198.B.NSAID<br /><br />199.C.IgA<br /><br />200.D.Polyclonal antibody generate by injection of human thymocyte in animal<br /><br />Pembahasan bisa dilihat di MDE 2007-1superstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0tag:blogger.com,1999:blog-3810580967966978266.post-76145893851939612332010-03-11T05:34:00.000-08:002010-03-12T03:29:58.072-08:00MDE HIS 2007-11. Male, 14 y.o : joint bleeding. Ada history bleeding. Hemarthrosis. Hb 14gr/dL. WBC 8000. PLT 225.000. How can you explain this problem?<br />A. quantitative PLT disorder<br />B. qualitative PLT disorder<br />C. coagulation disorder<br />D. thrombotic disorder<br />E. vascular disorder<br />Jawaban : C<br />Alasan : karakteristik coagulation disorder : hemarthrosis dan hematoma. A, B, E primary hemostasis disorder PLT ↓qualitative & ↑quantitative, vasculat defect. (Harmening hlm 471-472)<br /><br />2. Lab test apa untuk konfirmasi diagnosis?<br /><br />3. Diagnosis?<br />A. ITP<br />B. henoch S purpura<br />C. von Willebrand disease<br />D. DIC<br />E. Acute leukemia<br />Jawaban : C<br />Alasan : kelainan koagulasi dengan SS di atas paling mungkin vWF disease<br /><br />4. Character of cell in IDA?<br />Jawaban : hypochromic, microcytic RBC<br /><br />5. Abnormalities PLT di atas disebabkan oleh?<br />Jawaban : ITP<br /><br />6. Most appropriate statement of the case?<br />A. mostly will have spontaneous remission<br />B. mostly will need splenectomy<br />C. mostly will need IV Ig<br />D. about half respond to corticosteroid<br />E. about half will change to leukemia<br />Jawaban : D<br />Alasan : Patients with ITP are initially treated with corticosteroid to rapidly increase PLT and improve hemostasis (Harmening hlm 475)<br /><br />7. Cells that will increase in bone marrw smear as a compensation in this case?<br />A. thrombocyte<br />B. reticulocyte<br />C. magakaryocyte<br />D. myeloblast<br />E. normoblast<br />Jawaban : C<br />Alasan : jumlah PLT ↓ dikompensasi dengan bentuk dan ukuran yang besar dikarenakan pembentukan yang belum sempurna<br /><br />8. In primary hemostasis, what mediates the PLT adhesion to expose collagen within the endothelium of the vessel wall?<br />A. GpIb<br />B. fibrinogen<br />C. plasmin<br />D. PDGF<br />E. kinin<br />Jawaban : A<br />Alasan : Harmening bab introduction to hemostasis<br /><br />50 y.o. male, bilateral painless mass in the neck, fever, night sweat, weight loss (60-50). PE : bilateral subclavicular and cervical lymphadenopathy diameter 1-3, rubbery, non-tender, hepatosplenomegaly (-)<br />9. Which is the cause of lymphadenopathy?<br />A. Inflammation<br />B. Infection<br />C. Metastasis malignancy<br />D. Lymph node<br />E. Autoimmune<br />Jawaban : C<br />Alasan : ada mass, fever, night sweat, weight loss kemungkinan besar ada keganasan<br /><br />10. The most appropriate exam :<br />A. lymph node biopsy<br />B. Abdomen USG<br />C. LDH<br />D. Bone marrow aspiration<br />E. PBS<br />Jawaban : A<br />Alasan : untuk memeriksa jenis jaringan lymph yang terkena diperlukan biopsy<br /><br />11. Clinical stage :<br />A. IA<br />B. IB<br />C. IIA<br />D. IIB<br />E. IIIA<br />Jawaban : D<br />Alasan : dengan ciri2 di atas kemungkinan kasus yang terjadi adalah hodgkin lymphoma. Klasifikasi :<br />• Stage I is involvement of a single lymph node region (I) or single extralymphatic site (Ie); <br />• Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe); <br />• Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes); <br />• Stage IV is disseminated involvement of one or more extralymphatic organs<br />The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage. For localized extranodal extension from mass of nodes that does not advance the stage, subscript 'E' is added.<br /><br />12. Which is the most appropriate source of the most cause of lymph adenopathy?<br />A. Head<br />B. Oral cavity<br />C. Thorax<br />D. Inguinal<br />E. Inferior extremity<br />Jawaban : A<br />Alasan : Cervical adenopathy is a common feature of many viral/bacterial infections<br /><br />13. What is the positive factor to determine prognosis?<br />A. Liver enzyme level<br />B. Creatine level<br />C. LDH level<br />D. Uric acid level<br />E. Hb level<br />Jawaban :<br />Alasan : The adverse prognostic factors identified in the international study are:<br />• Age >= 45 years<br />• Stage IV disease<br />• Hemoglobin < 10.5 g/dl<br />• Lymphocyte count < 600/µl or < 8%<br />• Male<br />• Albumin < 4.0 g/dl<br />• White blood count >= 15,000/µl<br /><br />Female, 33 y.o. fatigue, shortness of breath with exercise, heavy menstrual bleeding for several years, increase TIBC, decrease ferritin and transferrin<br />14. Diagnosis?<br />A. Thalassemia<br />B. Acquired hemolytic anemia<br />C. Pernicious anemia<br />D. Aplastic anemia<br />E. Iron deficinecy anemia<br />Jawaban : E<br />Alasan : karena ada increase TIBC, decrease ferritin and transferrin<br /><br />15. What cell that will be difficult to found in bone marrow smear?<br />A. Basophilic normoblast<br />B. Polychromatophilic normoblast<br />C. Acidophilic normoblast<br />D. Reticulocyte<br />E. Pronormoblast<br />Jawaban : E?<br />Alasan : sebenernya jawabannya “lack of stainable iron in reticuloendothelial cells”, tapi ga ada di pilihan.<br /><br />16. A 18 y.o. female acute onset of bruising & rash for 3 days, had...approx. 2 weeks ago, no fever, no history bleeding, no hepatomegaly. Diffuse petechial rash on trunk & extremities. Lab : Hb 11.5, Hct 36, WBC 6000, PLT 15.000/mm3, PT/PTT normal. Diagnosis?<br />A. Hemophilia<br />B. von Willebrand disease<br />C. ITP<br />D. Hemorrhagic disease for newborn<br />E. DIC<br />Jawaban : C<br />Alasan : PLT <30.000, ada petechiae (Harmening hlm 474)<br /><br />17. A 5 y.o. male, RS akibat pneumococcal sepsis selama 3 hari, diffuse petechiae purpura, venipuncture bleeding, hypotension, adn shock. PLT and fibrinogen decrease. Characteristic :<br />A. ↑ PLT<br />B. ↑ plasma fibrinogen<br />C. ↑ factor VIII<br />D. ↑ tPA<br />E. ↑ D-dimer<br />Jawaban : E<br />Alasan : penurunan fibrinogen menandakan banyak pemecahan fibrinogen akan menghasilkan D-dimer (Harmening hlm 463)<br /><br />18. a previous healthy baby unconscious for the 3rd day of life. CT scan : intrasranial bleeding. Lab : HB 11, WBC 6000, PLT 117.500, PT dan aPTT ↑, BP normal.<br />A. ↓ PLT<br />B. ↓ fibrinogen<br />C. ↓ AHF<br />D. ↓ factor II, VII, IX, X<br />E. ↓ nature inhibitor of coagulation<br />Jawaban : D<br />Alasan : peningkatan PT gangguan extrinsic/common pathway. Peningkatan aPTT gangguan intrinsic/common pathway. Kemungkinan mengalami gangguan multifactor.<br /><br />19. Diagnosis :<br />A. Hemophilia<br />B. DIC<br />C. Hemorrhagic disease in newborn<br />D. congenital hypofibrinogenemia<br />E. von Willebrand disease<br />Jawaban : C<br />Alasan : gangguan koagulasi akibat kurangnya vit K untuk pembentukan faktor koagulasi (Wintrobe ch )60<br /><br />20. Vitamin yang dibutuhkan?<br />A. Vit A<br />B. Vit B<br />C. Vit K<br />Jawaban : C<br />Alasan : vit K merupakan vit yang dibutuhkan untuk pembentukan faktor koagulasi.<br />21.C. dibuktikan dengan adanya low Hb, HCT, MCV,MCH, dan retikulosit tanpa adanya tanda2 hemolitik anemia (hepatosplenomegaly, jaundice, increasing bilirubin). Pada anak kecil, salah satu penyebab dari Fe deficiency adalah malnutrisi atau infeksi parasit yang dibuktikan dengan adanya underweight..<br />22. Penampakan yang muncul apabila seseorang terkena IDA yaitu<br />Peripheral blood smear : microcytic,hypochrome, aniso-poikilocytosis, terdapat pencil shape, juga terdapat target cell<br />Bone marrow smear : mild-moderate erythrocytosis, decrease-depleted dari sideroblastic cells appearance, bahkan bisa sampai nuclear distortion, nuclear budding, karyohexis, dan nuclear fragmentation of normoblastic cells<br />23. ans: aplastic: dengan adanya tanda2 pancytopenia di bone marrow dan peripheral : anemia (fatigue, pallor, RBC count rendah), leukocytopenia (rentan terjadi infeksi => fever), thrombocytopenia (petechiae, ecchymoses, gum bleeding).<br />24. ans: E. hemophilia A karena depleted dari factor VIIc, oleh karena itu, treatment yang tepat ialah cryoprecipitate (mengandung factor VIIIc, VIIIag, fibrinogen, dan XIII) atau purified factor VIII.<br />25.?? Ga ngerti.. sorii<br />26. A. pendarahan hypovolemic condition.. berdasarkan wintrobe pada bab transfusion medicine, keadaan hypovolemic ditangani dengan transfuse whole blood.<br />27. A. yang menjadi key wordnya adalah deep blue scanty dengan no granule yang merupakan cirri dari normoblastic cell.. jika dilihat dari option yang berwarna biru itu pronormoblast dan normoblast basophilic.. tapi warna dari pronormoblast adalah dark/royal blue, sedangkan warna normoblast basophil adalah basophil, lebih terang dari pronormoblast.<br />28.?<br />29. selama acute inflammation : CBC, CRP / ESR.<br />30.A. gambarannya ialah MCV rendah = microcytic, MCHC rendah = hypochrome.<br />31.B. gambarannya mengarah Fe deficiency.<br />-Megalloblastic = MCV biasanya naik<br />-Hemolytic anemia = MCV,MCH turun, MCHC turun(hereditary spherocytocyte naik) tapi ada peningkatan dari RBC dan reticulocyte count serta ada tanda2 seperti jaundice,splenomegaly<br />-Aplastic = jumlah WBC dan platelet juga turun<br />-Pernicious anemia = gambaran megalloblastic.<br />32. B. liat penjelasan no 22<br />33. C. adanya peningkatan yang besar dari blast cell golongan myeloid. Jadi jelas merupakan AML.<br />34. seharusnya sih tipe FAB M3, karena ditandai dengan adanya abundant auer rod di leukemic cells (faggot cells) dan adanya tanda hemorrhagic manifestation dari DIC.<br />35.A. adanya tanda2 anemia : pale dan hb turun, increasing destruction dari RBC berupa splenomegaly, dan adanya kompensasi anemia, yaitu peningkatan retikulosit kecurigaan hemolytic anemia (kalo deficient B12, tanda2nya bisa kaya di atas tapi retikulositnya turun). Lalu gambaran anisopoikylocytosis, polychromasia, large target cell merupakan gambaran yang bisa terjadi pada sickle cell anemia dan thlasemia (sickle cell trait punya gambaran yang normal di apus darah tepi). Lalu pasien kita ini sudah berumur 5 tahun, padahal thalasemia itu termanifest pada 1st year of life. Jadi jawaban adalah A.<br />36. soalnya seperti tadi. ANS: A. untuk mendiagnosis dari sickle cell, lab exam selanjutnya ialah electrophoresis. Hasil yang diharapkan adalah adanya peningkatan dari HbS sehingga hasil electrophoresisnya terhadap HbS men jadi lebih nyata.<br />37. A. jelas ya..<br />38.A. pilihan treatment untuk sickle cell anemia ialah chronic transfusion, hydroxyurea, dan bone marrow transplantation. Yang ditransfusi untuk kasus sickle cell anemia adalah normal red cell. Jadi pilihan ke arah packed red cell (PRC)<br />39.C.<br />40. ??<br />41. Jawaban : D. decrease serum ferritin<br />Pembahasan :<br />Merupakan ciri-ciri Iron Deficiency Anemia (IDA).<br />Hasil lab : decrease serum ferritin level, derease serum iron level, increase TIBC (Harmening, 104)<br /><br />42. Jawaban : C. vitamin C<br />Pembahasan :<br />Menurut internet, vitamin C memang membantu absorbsi non-heme iron.<br /><br />43. Jawaban : A. vitamin B12<br />Pembahasan :<br />Clinical manifestation of vit.B deficiency:<br />-peripheral nerve : paresthesia, areflexia, symmetric tingling.<br />-posterior spinal columns : clumsiness, incoordinate gait.<br />-lateral spinal columns : weakness & stiffness of limbs, memory impairment, depression.<br />(Harmening, 119)<br /><br />44. Jawaban : (?) akademik 2006 jawab D. gum hypertrophy <br />Pembahasan :<br />“Classic symptoms of vit B12 deficiency include weakness, glossitis, paresthesia.” (Harmening, 118)<br /><br />45. Jawaban : B hemolytic<br />Pembahasan :<br />Subiteric sclera -> banyak bilirubin di darah -> banyak pemecahan RBC (hemolytic) -> splenomegaly (kerja berat, tempat pemecahan RBC)<br /><br />46. Jawaban : E. glossitis<br />Pembahasan :<br />Merupakan penyakit anemia megaloblastik, karena ada ciri-ciri weakness, numbness, hypersegmented neutrophil (Harmening115,119). Maka PE-nya kemungkinan terdapat glossitis (Harmening, 118)<br /><br />47. Jawaban : E. hyperativity of macrophage cell<br />Pembahasan :<br />Penyakitnya anemia hemolitik, karena yellow skin.<br />“Each day 1% of old RBC in circulation are taken out by a system of fixed macrophages in the body known as the reticuloendothelial system (RES). Although RES cells are located in various organs and throughout te body, those of spleen, called littoral cells, are the most sensitive detectors of RBC abnormalities.” (Harmening, 70)<br /><br />48. Jawaban : C. gaster<br />Pembahasan :<br />Penyakitnya anemia megaloblastik, karena ada giant stab/band cell (Harmening, tabel 7-1,115).<br />Kemungkinan penyebabnya berasal dari gaster. “Pernicious anemia = vit B12 deficiency anemia. Caused by deficiency of IF. IF is secreted by gastic parietal cell, and in this case there is parietal cell atrophy.” (Harmening, 117)<br /><br />49. Jawaban : (?) akademik 2006 jawab A. Hodgkin lymphoma<br />Pembahasan :<br />Penyakit yang histopatologinya ada “rossete-like formation” = ?<br /><br />50. Jawaban : B. chronic lymphocytic leukemia<br />Pembahasan :<br />WBC sangat meningkat -> keganasan.<br />Periphreal blood, mature lymphocyte meningkat -> chronic lymphocytic leukemia /CLL (Harmening, tabel 16-2, 275)<br /><br />51. Jawaban : C. observe<br />Pembahasan :<br />Klasifikasi Rai-Binet untuk CLL (Harmening, tabel17-5, 310).<br />Pada kasus ada splenomegali, jadi masuk stage II. Treatmentnya observation, karena pada kasus ini asymptomatic (Harmening, tabel17-6, 311)<br /><br />52. Jawaban : (?) akademik 2006 jawab A. B-prolymphoid transf well diff.<br />Pembahasan :<br />“CLL is most frequent neoplasm of B lymphocyte.” (Harmening, 302)<br />“Photomicrogaph of bone marrow aspirate smear from CLL patient. Note monotonous appearance of mature-appearing lymphocytes with condensed nuclear chromatin.” (Harmening, fig 17-2, 303)<br />A. pro- vs mature = ?<br /><br />53-60. ga ada soalnya... <br /><br /><br />83. <br />84. <br />85. B. G6PD<br />Sulfamethoxazole has side effect that cause deficiency of glucose 6 phosphate. Deficiency of this enzyme can cause breakdown of RBC (hemolisys)<br />86. C. Normochromic normocytic<br /> Hemolityc blood smear<br />87. <br />88. B. Type B child<br />89. D. Father Rr<br />90. C. Palatine tonsil<br />The lymphoid tissue in palatine tonsils forms a band that contains free lymphocytes and lymphoid nodules, generally with germinal centers . Deeply invaginated mucosal surface is the characteristic of these tonsil. Each tonsil has 10–20 epithelial invaginations that penetrate the tonsil deeply, forming crypts, whose lumens contain desquamated epithelial cells, live and dead lymphocytes, and bacteria. (jonquera,bab palatine tonsil)<br />95. E. 0,3 in 1:1000<br />Ephinephrine is injected intramuscularly or subcutaneously in dose 0,2-0,5 ml/kg BW for adults and 0,1 ml/kg BW for children to treatment treat anaphylaxis reaction.It is in aqueous 1:1000 solution.<br />96. B. irreversible shock<br /> The most frequent cause of death in the case of anaphylaxis<br />97. D. IgG<br /> IgG is the autoantibody of SLE so it can cross placenta<br />98. D. between 12-16 week of gestation<br />99. A. congenital heart block<br />100. A. infection<br /> One of effext of steroid administration is immunosuppressant. It is increase the r isk of infection.<br /><br />100) D<br />103) A<br />104) B<br />105) A<br />106)<br />107) A<br />108) hypersensitivity type 1<br />109) A<br />110) B<br />111) <br />112)<br />113)Ig E (+) = atopy<br />114) B<br />115) A<br />116) <br />117)<br />118) D (I think)<br />119) C<br />120) A<br />126. a girl 6 year old wheal with certain blanching after eating shrimp. Have allergy cold, no food allergy before. What skin layer appears abnormal ?<br />Ans.<br />D. Pars papillaris<br />127. a 25 years old man came to hospital with a sign of inflammation in his left leg. Which of the following vessels is most likely abnormal ?<br />Ans.<br />C. Capillary<br />128. a 20 years old IV drugs user came into the internal medicine department for general check up. Lab finding shows that he has HIV. Which is most likely cell killed by above virus ?<br />Ans.<br />C. CD4+ T lymphocyte<br />129. most likely characteristic above virus ?<br />Ans.<br />C. Have single stranded RNA<br />130. what gene is likely needed for replication for above virus ?<br />Ans.<br />B. Tat<br />133. following target cell will be killed by cytotoxic T cell induced by viral infection ?<br />Ans.<br />B. Infected by virus and identical at class I MHC loci of the cytotoxic T cell<br />134. after binding to its specific antigen, B lymphocytes may switch t which of the following component ?<br />Ans.<br />C. Variable region of the Ig heavy chain<br />135. which one of the following must be expressed on the surface of APC that activate T helper cells ?<br />Ans.<br />D. Class II MHC antigen<br />136. which of the following class of immunoglobulin is present in highest concentration in the blood of a newborn ?<br />Ans.<br />A. IgG<br />137. which of the following statement is the response of macrophage for antibody reaction ?<br />Ans.<br />A. Lysing virus infected cell<br />138. male 47 years old, chief complaint right toe swelling. In middle night : pricking, stiffness on his right toe. One hour later more painful. Few hours later swelling red and painful. He has tight hypertension, easy socializing with his friends. He is also overweight. Diagnosis ?<br />Ans.<br />A. Gouty arthritis<br />141. which of the following criteria include the ACR diagnostic criteria for her disease ?<br />Ans.<br />B. Increase ANA titer and positive anti dsDNA<br /><br />For questions number 161 – 163, see the case below :<br />25-year-old woman, red, itchy, circumscribed patches with central blanching on her body, swollen lips, and itchy tongue after consumption of methampirone. BP 80/60. RR 24/min. Temperature 37.5°C. PR 130/min<br /><br />161. Which of the following mediator most likely inhibiting the process causing the above condition ?<br />A. PGI2<br />B. PGE2<br />C. PGD2<br />D. PGF2<br />E. TXA2<br />Jawab : E<br />Hipersensitivitas tipe I. Gejala-gejalanya disebabkan oleh mediator-mediator yang menyebabkan vasodilatasi dan peningkatan permeabilitas vascular. Thromboxane (vasokonstriktor) dapat menyebabkan penghambatan.<br /><br />162. What is the enzyme responsible ?<br />A. Adenylate cyclase<br />B. Guanylate cyclase<br />C. Thymidine cyclase<br />D. Uridine cyclase<br />E. Cystosine cyclase<br />?<br /><br />163. Which mediator is inhibited on this phase ?<br />A. Histamine<br />B. Leukotriene<br />C. Prostaglandin<br />D. Prostacyclin<br />E. Thromboxane<br />Jawab : E<br /><br />164. Chief complain : runny nose. He started sneezing after he cleaned books. Family history : sibling has urticaria. Father has rhinitis. What is the antibody responsible ?<br />A. IgG<br />B. IgA<br />C. IgE<br />D. IgM<br />E. IgD<br />Jawab : C<br />Allergic rhinitis IgE-mediated <br /><br />165. Malar rash especially on photosensitivity area, caused by immune complex. What type of hypersensitivity responsible ?<br />A. I<br />B. II<br />C. III<br />D. IV<br />E. All above<br />Jawab : C<br />Kata kuncinya adalah “immune complex”, apalagi sign and symptom merujuk ke lupus. Jadi, hypersensitivity type III.<br /><br />166. A 7-year-old girl suffered from multiple rashes on her face and symmetrical macule rashes on her feet and trunk. She also complained itchy redness and patches on her elbow and knee fold. Both parents have intermittent asthma, and her sister has unexplained urticaria. Which immunology abnormality that most commonly occurs ?<br />A. Decrease IgE<br />B. Decrease basophilic histamine release<br />C. Decrease IL-13 by TH1<br />D. Increase IFN gamma by TH-2<br />E. Increase soluble IL-2 receptor<br />Jawab : C<br />Diagnosisnya adalah psoriasis. Psoriasis adalah penyakit autoimmune yang dimediasi oleh T-cell. Di Robbins (hal. 1257) disebutkan, pada psoriasis, terdapat cytokine “soup” yang didominasi oleh TH1 cytokines seperti IL-12, IFN-γ, dan TNF-α. (catatan : TH2 cytokine : IL-4 dan IL-13). Seperti kita tahu, TH1 dan TH2 cytokine (maupun selnya) cenderung timpang dalam keadaan tertentu, misalnya jika keadaan hypersensitivity type I (e.g. allergic rhinitis), maka yg dominan adalah TH2 dengan konsekuensi supresi oleh TH1.<br />Maka karena pada psoriasis yang dominan adalah TH1, terjadi supresi TH2 cytokine (yakni IL-13).<br /><br />See the case below :<br />9-year-old boy came to ophthalmology department whith a chief complain of itching, blepharospasm, photophobia, and copious mucoid discharge. Visual acuity is within normal limit. The slit examination revealed cobblestone in superior tarsal conjunctivae.<br /><br />167. The most likely diagnosis is :<br />A. Vernal conjunctivitis<br />B. Atopic conjunctivitis<br />C. Acute conjunctivitis<br />D. Flictenuralis conjunctivitis<br />E. Follicle conjunctivitis<br />Jawab : A<br />Kata “cobblestone in superior tarsal conjunctivae” menunjukkan vernal conjunctivitis (Lange Immunology hal. 527).<br /><br />168. Which type of hypersensitivity can cause this reaction :<br />A. Type I and II<br />B. Type I and III<br />C. Type I and IV<br />D. Type II and III<br />E. Type II and IV<br />Jawab : A<br />Di Lange (hal. 527) disebutkan vernal conjunctivitis adalah atopic disease, jadi termasuk tipe I. Selain itu, dia dikategorikan juga di bawah “antibody-mediated disease”, jadi masuk tipe II juga. Memang immunologic pathogenesisnya belum terlalu jelas.<br /><br />169. A 40-year-old lady complained decrease of her vision since 3 days ago. She was also diagnosed as TB patient. On clinical exam, there is ciliary injection, anterior chamber …, keratic precipitate. What is the most likely diagnosis ?<br />A. Acute uveitis<br />B. Vitritis<br />C. Choroiditis<br />D. Endophthalmitis<br />E. Pars planitis<br />Jawab : A<br />Uveitis dikarakteristikkan dengan adanya keratotic precipitate (berupa WBC) pada endothelium. Selain itu, ada ciliary injection (tapi tidak spesifik untuk uveitis).<br /><br />170. The drug for acute uveitis ?<br />Cycloplegics (block nerve impulse to ciliary muscles, therefore easing pain) dan topical steroid.<br /><br />171. 50-year-old man, red, and painful eyes with excessive tears. Examination results : peripheral corneal ulcer, negative fluorescence. What is the most likely diagnosis ?<br />A. Bacterial ulcer<br />B. Herpetic ulcer<br />C. Geographian ulcer<br />D. Fungal ulcer<br />E. Maroon ulcer<br />?<br /><br />See the case below :<br />A 20-year-old man. Weakness worst and numbness. 10 days ago, he had fever, diarrhea, and was healed by treatment. PE : dyspnea. Neurologic exam : tetraparesis, glove-stocking hypesthesia and decreased physiological reflex.<br /><br />172. What is the finding in blood ?<br />A. Increase glucose with normal protein<br />B. Increase glucose with normal cell<br />C. Increase glucose with normal glucose<br />?<br /><br />173. What microbe can cause this case ?<br />A. H. influenza<br />B. Campylobacter jejuni<br />C. Cytomegalovirus<br />D. S. typhii<br />E. Herpes zoster<br />Jawab : B<br />Guillain-Barre Syndrome bisa disebabkan Campylobacter jejuni, HIV, EBV, cytomegalovirus. Tapi karena didahului gastrointestinal infection (diare yang disembuhkan dengan treatment), maka B lebih tepat.<br /><br />174. What is the possible cause of dyspnea ?<br />A. Ascending paralysis<br />B. Metabolic acidosis<br />C. Pulmonary distress<br />D. Laryngeal spasm<br />E. Metabolic alkalosis<br />Jawab : A<br />Guillain-Barre Syndrome dikarakteristikkan dengan adanya ascending paralysis dari ekstremitas bagian distal. Salah satu komplikasinya adalah respiratory failure.<br /><br />175. Neurophysiological examination as an additional for this case :<br />A. EEG<br />B. EMG<br />C. NCS<br />D. Evoked potential<br />E. TCD<br />Jawab : NCS atau EMG<br />Di fase awal, NCS (nerve conduction studies) akan menunjukkan adanya prolonged distal motor latencies dan prolonged/absent F waves. Setelah 4-6 minggu, EMG menunjukkan adanya denervasi otot.<br /><br />176. Drugs of choice for this case :<br />A. Corticosteroid<br />B. Immunoglobulin<br />C. Plasmapharesis<br />D. Neurotrophic<br />E. Neuroprotected<br />Jawab : B<br />Treatmentnya berupa plasmapharesis dan immunoglobulin IV. Karena pertanyaannya “drugs” of choice, jadi jawabnya B.<br /><br />177. –<br />178. –<br />179. –<br />180. –<br /><br />182.D.Intraepidermal blister with acantholitic cell<br /><br />Alasan: Microscopic pada pemphigus vulgaris ialah: an intraepidermal blister is present containing acantholytic cells.There is marked intracellular edema and eosinophilic spongiosis.<br /><br />189.C.Decrease cAMP dependent protein kinase<br /><br />Alasan: dengan penurunan cAMP dependent protein kinase akan mengakibatkan peningkatan cAMP yang akan menghambat degranulasi.<br /><br />190.A.preventing rather than reversing histamin’s action on target tissue<br /><br />Alasan: MOA of anti-histamin in prevent effect H1 receptor activation through reversible, competitive inhibition of histamine by binding to H1-receptor.As a result,antihistamin work best in preventing rather than reversing the action of histamine.<br /><br />192.C.Scofferin<br /><br />193.E.Agglutination and immobilizing spermatozoa<br /><br />Alasan: ASA (Anti Spermatozoa Antibody) akan attract to sperm yang mengkibatkan reducing mortality dan make clump together so difficult form sperm to fertilize an egg.<br /><br />194.A.Object of transplatation<br /><br />Alasan: The succes of an organ or tissue transplant depends on histocompability-that is, the tissue compability between the donor and the recipient.<br /><br />195.E.Loratadine<br /><br />Alasan: dari keseluruh obsi hanya loratadine yang termasuk second generation (yang lain termasuk first generation) dimana second genertaion lebih baik daripada first generation karena tidak mengakibatkan CNS side effect.<br /><br />197.B.NSAID<br /><br />Alasan: pada treatment RA, NSAID merupakan first line treatment sedangkan cytotoxic agent seperti MTX dan cyclophosphamide dan corticosteroid merupakan second line.<br /><br />198.C.Topical Antihistamin<br /><br />Alasan: Pada pasein ini mengalami hypersensitivity type I sehingga treatment paling cocok ialah permberian anti-histamin<br /><br />199.B.IgA<br /><br />Alasan: IgA merupakan antibody yang banyak dijumpai di cairan tubuh (secret) seperti air liur, keringat, air mata, vaginal secret dsb<br /><br />200.D.Polyclonal antibody generated by repeated rejection of human tymocyte into animalssuperstar2007http://www.blogger.com/profile/04904168271951431017noreply@blogger.com0