1. A man, 50 years, visits the puskesmas routinely every months while taking anti TB drugs.

He follows the DOTS

programme that running in the PUskesmas. The component of DOTS for TB include:
A. Case detection by sputum culture among symptomatic patients
B. Supply of anti-tuberculosis drugs especially Rifampicin and isoniazid
C. Government commitment to participate especially in prepares microscopy equipment.
D. A standard recording and reporting that allows assessment of treatment result
E. Standardized treatment regimen of 8 months, with DOTS for at least the initial 1 months.
2. Mr. B 39 yo. Come to outpatient clinic to continue the anti-TB drugs medication. He has follow the DOTS programme for
2 months. And given treatment of first category. Routinely control every months. Every visit the hospital what is the doctor
should monitoring in mr. B?
a. Bacteriology result
d. Side effect of the drug
b. Radiologic
e. Estimated sediment rate
c. Mantoux test

3. A woman 25 years routinely visit outpatient clinic for taking anti-TB drugs. The doctor give her the therapy anti-TB drug
second category. Probably this patient have this therapy because of :
a. New-smear positive patient
d. Severe concomitant HIV disease
b. New-smear negative patient
e. Extenssive parenchimal involvement
c. Treatment after interruptive
4. A man, 35 years old, admitted to hospital because of SOB,. Prolonged cough for 1 month, night sweating. Past history
illness: ever taken , anti-drug for 6 months, completely, finished 6 months ago. Physical examination BP 110/70mmhg,
pulse rate 120x/min, respiratory rate 28x/min. temperature 37.3 degree celcius, chest x-ray: infiltrate suphilar dextra,
cavity, costophrenicus.. sharp. Laboratory examination : positive result Acid Fast bacilli Smear.
Management?
A. Start anti TB Drugs, 1st category
B. Start anti TB Drugs, 2nd category
C. Start anti TB Drugs, 3rd category
D. Start anti TB Drugs, 4th category
E. Start anti TB Drugs, 5th category

5. A woman 44 years come to outpatient complaint with hemoptysis. After complete exam the doctor establish TB diagnose
and beside to start anti-TB drugs first category. How long the patient should complete the therapy ?
a. 6 months, 4 month for intensive test fase and 2 months for continuation fase.
b. 6 months, 2 month for intensive test fase and 4 months for continuation fase
c. 8 months, 2 month for intensive test fase and 6 months for continuation fase
d. 8 months, 4 month for intensive test fase and 4 months for continuation fase
e. 8 months, 3 month for intensive test fase and 5 months for continuation fase
6. 60 yo. Old man presented with SOB especially in physical active, productive cough and story of smoking. Physical exam
reveals ICS enlargement. Prolonged expiration uncompain with wheezing, increase of jugular venous pressure,
hepatomegali and oedema of lower extremities. What is the possible diagnosis ?
a. Lung tumor and COPD
d. COPD and cord pulmonal
b. COPD and pneumonia
e. Bronchial ashtma and COPD
c. COPD and lung TB
7. Beside the lung inflammation that cause the patological change in COPD ...... also place a importtant rules.
a. Airway remodelling
d. antiinflammation
b. Antiprotease
e. Airway obstruction
c. Antioxidants

8. The main and important educational programme for the above patient is ?
a. Smoking cessation
d. Knowledge above the complication
b. Limitation of physical active
e. Long term oxigen therapy
c. High carbohydrate intake
9. There are several kind of drug that may be used in COPD treatment , namely:
a. Amlodipine
d. Corticosteroid and amlodipine
b. Anti colinergic
e. H2 receptor antagonist
c. Beta 2-agonist and anticolinergic
32 yo. Woman present to Kalabahi general hospital with fever, breathlessness, cough and left sided chest pain, weight loss,
and nite sweating, and history of lung TB 2 years ago. Initial evaluation reveal her to be thin and chronically ill apparing. On
physical exam: HR: 112x/min. RR 24x, Temp. 28Celcius. asymptomatic lung expansion. CXR reveal : left lower lobe
consolidation and moderate size left pleural effusion that layers 10,5% and WBC 1.700 mm3
10. cause of transudat pleural effussion except :
a. Heart failure
d. Lung TB
b. Hypoalbuminemia due to malnutrition e. Lever chirrosis
c. Nefrotic syndrome (NS)
11. If the left side chest pain for this patient result inflammation of pleura parietalis near the costa this pain was delivered
by ?
a. N. Phrenicus
d. N. intercostalis
b. N. Vagus
e. N. splanchnicus
c. N. Recurrent laryngeus
12. All of the following are true on pneumothorax, except :
a. It may be occur spontaneously in apparently fit young adult.
b. When present in the tension form it is medical emergency.
c. It may occur as a complication of asma.
d. Radiography finding is partially lung collaps
e. The Force Vital capacity is increase
13. Cough reflex above patient as same as above other reflex have sensoric and motoric part. This sensoric and motoric
part delivered by:
a. N. Trigeminus
d. N. Laryngeus internus
b. N. Maxillaris
e. N. Laryngeus eksternus
c. N. Facial
14. The management principal of tnsion pneumothorax
a. Observation on emergency room
b. Supplement oxygen alone.
c. Immediately decompression via chest tuce or needle thoracostomy
d. Perform thoracic ct-scan to evaluate need for thoracotomy
e. High dose antibiotic
15. Physical exam result of pneumothorax all of the following is true except :
a. Deviate trachea
d. Asimmetric chest expansion
b. Increased tactil fremitus
e. Diminished breath sound unlaterally
c. Hyperresonance unilateraly

A boy 14 yo. Come to hospital for first time hemoptysis. His suffered from frequent low grade fever. Decreasing body
weight. No recent contact with adult TB patient. His mother suffered from chronic gastritis. Acid fast bacill were found on
his sputum examination.
16. the most likely diagnosis :
a. acute gastritis
d. Post primary lung tuberculosis
b. gastritic tuberculosis
e. Extra pulmonary tuberculosis
c. primary lung tuberculosis
17. adequate therapy include :
a. intensive phase of anti tuberculosis combine with corticosteroid
b. intensive phase of anti tubercuosis combine without corticosteroid
c. antacid combine with anti-TB
d. antacid combine with proton pump inhibitor
e. antacid combine with simetidyn

a baby male 8 aged 2 months and 10 days was admitted to hospital due to rapid breathing and coughing since 3 days ago
no vommiting. On physical ecxam reveal : a body Temp. 38,5Celcius, RR 58x/min, bronchovesicular , without crickles no
chest indrawing . CXR reveal: parahilar and paracardial infiltrates. His father has allergic rhinitis.
18. The most likely diagnosis:
a. Pneumonia
b. Bronchiolitis
c. Mild ashtma first attack
d. Nasal obstruction due to respiration infection
e. Primarily tubercuosis primer, during incubation period

19. Which infection etiologic agent is found relativey rare in this age group (2 months).
a. Mycoplasma pneumonia
b. E. Coli
c. Strep. Pneumonia
d. H. Influenza B
e. Respiratori syncitian virus

20. If there is an indication of empirical antibiotic administrition , which is are the following initial antibiotic administrasion :
a. Single administration of a narrow spectrum antibiotic from penicyilin group
b. Single broad spectrum antibiotic from penicylin group
c. Two combination of both broad spctrum antibiotic
d. Two or more broad spectrum from various group of antibiotic
e. Broad spectrum antibiotic from third generation cephalosporins.

21. One among risk factor of disease to the baby of this case is :
a. Obesity
d. Low burden of nasopharyngeal carriage
b. Extended family e. History of atopic in his father
c. Nuclear family

22. Hfhjdf
23. Fedf
24. Fdf

25. In a patient suffered from asma episodic frequent with moderate attack. The treatment use
a. Beta 2 agonist inhalation
b. Steroid inhalation
c. Aminophylin injection
d. Steroid injection
e. Antibiotic injection

26. An accepted and important function of the paranasal sinus is :

a. Regulating intranasal pressure
b. Lightening of the skull
c. Humadifying inspirated air
d. Increasing surface inspirated air
e. Secretion of mucus

27. An increase insidence of paranasal sinus infection is usually observed when :

a. Mucus viscocity increase
b. Mucus viscocity decrease
c. Mucus volume increase
d. Mucus volume decrease
e. Mucus tranport decrease

28. An important anatomic different between children and adult with regard to the maxillary sinus is :
a. Sinus volume
d. Level of floor
b. Overalshape
e. Venous drainage
c. Mucosal lining

29. The most common complication associated with acute with eithmoid sinusitis in children is :
a. Orbital cellulitis
b. Osteomyelitis of the frontal bone
c. Epidural or subdural trombosis
d. Cavernous sinus trombosis
e. Orbital apex syndrome and complete optalmophlegia

30. The most common compilation of caldweld luc is :

a. Deviatalized teeth
b. Dacriocystitis
c. Facial parasthesia
d. Oroantral fistula
e. Osteomyelitis
choking and continous coughing where observe in a newborn infant . the pediatricion was unable to pass a catether through
the oesophagus in to the stomach.
31. A newborn infant with oesophagial atresia experienced respiratorry distress with sianosis shortly after birth . radiograh
demonstrated air in the infant stomach :
a. Piloric stenosis
d. Oesophageal inflammation
b. Bronchial atresia
e. Upper respiratory inflammation
c. Traceoesophaeal fistula

32. What congenital anomaly should be suspect ?

a. Piloric stenosis
d. Oesophageal inflammation
b. Bronchial atresia
e. Upper respiratory inflammation
c. Traceoesophaeal fistula

33. What kind of an examination do u think would be use to confimed the tentative diagnosis ?
a. Gastric acid examination
b. Radiographic examination without insertion nasogastric tube
c. Radiographic examination with insertion nasogastric tube
d. Laryngoscopy
e. Bronchoscopy

34. A 62 yo male patient expressess concern that his voice has changed offer the preceding months. Imaging reveals a
growth located within the aortic arc, adjucent to the left pilmonary artery. Which neural structure is most likely being
compressed to cause the change in the patient voince ?
a. Left phrenic nerve
b. Oesopagheal plexus
c. Left recurrent laryngeal nerve
d. Left vagus nerve
e. Left sympatic tract.

35. 17 yo. Girls is admitted to the hospital with severen dyspneu. Physical exam reveal that thw patient is suffering from
asma attack with associated bronchospasm, which of the following nerve is responsible for the innervation of the bronchial
smooth muscle ?
a. Greater thoracic splenic d. intercostal
b. Phrenic
e. Laser thoracic splenic
c. Vagus

36. In earliest stadium of infection TB , pleura parietalis near the costal will be inflammation and pain. This pain was
delivered by:
a. N. phrenicus
d. N. intercostalis
b. N. Vagus
e. N. splachnicus
c. N. Recurrent laryngeus

37. In physical diagnose 37 years man with alcohol abuse , doctor found beaf in percussion and the doctor think he gets a
aspiration pneumonia. Segment of the bronchopulmonalis that usually affected by this condition is :
a. Left or right apical
b. Left or right superior
c. Left or right basal anterior
d. Upper lingual
e. Lower lingual

38. Epistaxis that happen in superior anterior of septum nasi. Artery that supply this area from :
a. Sphenopalatine
d. Palatina major
b. Facialis
e. labialis
c. Eithmoidalis

39. A baby born premature sent by village region hospital to city hospital with complain difficult of breathing. The baby born
history : normal process with BW 1750 kg. From CXR : show of granuler spotted mark in both of lung with airbronchogram
(+). This is that the baby suffer cause by :
a. Uncomplete air-blood barrier form
b. Unform alveolaris porus
c. Forming disorder of alveolus squmosa cell (Type I cell)
d. Forming disorder of dust cell
e. Forming disorder of surfactant (alveoli macrophag)

40. A patient come to emergency unit suffering from severe difficult of breathing. From inspection show asymetric chest and
CXR show: colaps of dextra hemithorax.
a. Capiler endothel cell
b. Septal cell
c. Clara cell
d. Thin flat alveolar cell
e. Debu cell

41. A woman 40 yo. Come to the clinic with chief complaint difficult of breathing with chest pain on right hemithoraks. After
perform physcal assessment, the doctor advise to do CXR. And the result is dextra pleural effussion as high as posterior
costa VI. The characteristic histologic in this patient is ?
a. Pseudostratified ciliated columnar epithel
b. Stratified squamous non-keratinized epithel
c. Simple-squamous epithel
d. Transitional epithel
e. Stratified squamous keratinized epithel

42. The wrong statement about bronchiolus respiratorius is :

a. Proximal part of mucosa
b. Thin cilia cell cubical flat layer
c. Tight
d. The end of conduction system
e. Mucous with respiratorius epithel

43. A medical student come to the clinic with chief complaint unable of smelling since 1 weeks. A few last days, he said that
always runny nose. Light fever and headache. The location of olfactorius organ where the disorder impossible occur is :
a. Nasalis septum d. Medius nasalis chonca
b. Nasalis fossa e. Inferior nasalis chonca
c. Superior nasalis chonca
45 yo woman who has been suffering from Diabetes for 5 years. Is taken to hospital due to. A couple of days prior to
hospitalisation, she complaint for frequent defecation several times a days. She has been on insulin injection for her
diabetes treatment. The following are her lab test result : BP 92/20 mmHg , blood glucose 670mg/dL, hematocrite 49%,
Breathing frequent 32x/min, Blood PH 6,9 , PCO2 20 mmHg.
44. what is the patient acid-base status ?
a. Asidosis metabolic
b. Uncompensated asidosis metabolic
c. compensated asidosis metabolic
d. Uncompensated asidosis respiratoric

e. compensated asidosis resiratoric

45. besides her diarrhea condition the above acid base inbalance condition is most probably deteriorating due to :
a. bicarbonate inbalance due to high blood glucose
b. increase of blood acidity due to keton bodies over priduction
c. decrease of PCO2
d. significant increase of blood glucose
e. decrease of BP

46. which one of above vital sign and lab test that signifies her body compensation toward the imbalance :
a. BP 92/20 mmHg
b. blood glucose 670mg/dL
c. hematocrite 49%,
d. pulse 122 beat/min
e. PCO2 20 mmHg

47. By looking that above lab test, how much do u expect the plasm bicarbonate to be :
a. Moderately low
b. Approaching normal
c. Normal
d. Slightly over normal
e. Signifficantly over normal

48. The above condition is compensation by :

a. Asidosis metabolic
b. Asidosis respiratoric
c. Alcalosis metabolis
d. Alkalosis respiration
e. No longer able to be compensated
17 yo teenage, Bram was brought to the emergency care unit with stabbing wound in his right lateral chest followed by
difficulty in breathing. Respiratory rate was 40x/min.

49. The following caused difficulty of breathing for brams case:

a. Swelling of the lungs intentisial d. Alveoli collapsed
b. Respiratory tract gets narrower e. the lungs cannot inflate
c. Blood in trachea

50. The increasing of respiratori rate is change by percapnia that will stimulated peripheral cemo receptor in carotid arteri
which is connected to the respiratory center by :
a. N.phrenicus
d. N. Glossofaringeus
b. N.Intercostalis
e . N.Subclavius
c. N. Vagus

51. Oxygen transported through the vessel mostly as :

a.Dissolved in Plasma
d. Bicarbonic compound
b. Binding with HB
e. Binding with carbonic anhidrase

c. Binding with plasma protein

Wendy was a swimming atlet attending a general check up for olimpic contingent. The result of the examination were :
Respiratory rate 19 x /min, symmetrical chest movement, on pathological findings in spirometry test.

52. The part of respiratory tract which always has negative pressure in both inspiration and expiration is :
a. Pleural cavity
d. Lungs interstitial
b. Respiratory bronchiole
e. Secondary bronchi
c. Alveolar sac

53. At wendys respiratory tract does oxygen diffuse to the blood in :

a. Cavum nasi
d. Alveolus
b. Trachea
e. Terminal Bronchiole
c. Primary bronchus

54. A 32 YO on oral contraceptives developes tachepnea and reports dyspnea. A ventilation / perfusion sean is ordered to
check for pulmonary thromboemboli. Which of the following best explains why, as the takes in a normal inspiration, more
air goes to the alveoli at the base of the lung than to the alveoli at the apex of the lung?
a. The alveoli at the base of the lung have more surfactant
b. The alveoli at the base of the lung are less compliant
c. The alveoli at the base of the lung have higher V/Q ratio
d. There is a more negative intrapleural pressure at the base of the lung
e. There is more blood flow to the base of the lung

55. A patient complains of paroxysmal episodes of not being able to catch her breath. when do abnormalities are derected
with conventional Pulmonary function screaning the pulmonologist orders a methacholine challenge test. which of the
following will increase as a result of stimulating cholinergic receptor on the bronchial smooth muscle?
a. Lung compliance d. Restative work of breating
b. Air way diameter e. Anatomic dead space
c. Elastic work to breating

56. A 62 yo factory worker, who has worked in the insulation industry for over 30 years, developes progressive shortness of
breath. His wife has tried to get him to go the doctor, and he finally relents with appearance of hemoptysis. A chest x-ray is
consistent with an alveolitis from asbestos inhalation. Which of the following is the mayor route for removal of small
particlas from the alveoli?
a. Bulk flow
d. Phagocytosis
b. Diffution
e. Ciliary Transport
c. Expectoration

57. Voluminous sputum can be found in patient with the undermention disease except :
a. Advance TB with cavities
d. TB of early stages
b. Bronkiektasis with edema
e. Pulmonary edema, abscess
c. Acute bronchitis, pneumonia

58. Sputum consisting pus in yellowish-green colour is characteristic for :

a. Bronkiektasis
d. Advance TB
b. Lobar pneumonia
e. Early stages TB

c. Pulmonary infarction

59. The red spot on was observed on sputum, disease to be suspected?

a. Pulmonary Empyema
d. Wide spread of early TB
b. Severe pneumonia
e. Bronkiektasis
c. Pulmonary Emphysema

60. Sputum crudum is to mention for :

a. A. Redish serous sputum
b. Sputum covered by mucus
c. Sputum mixed with blood material

d. Hard Sputum and appeared rusty

e. Voluminous sputum in green colour

61. Dittirich plug is caseous and yellowis mass which can be found in patient with :
a. A long standing TB
d. Bronkiektasis
b. TB early phase
e. Severe pneumonia
c. Pulmonary edema
62. Mucociliary clearance except:
a. is inhbited in smoking
b. allows foreign material to be trapped in a sticky mucus film within the bronchi and bronchioles
c. covered by a layer of mucus secreted by goblet cells and submucosal glands
d. forms part of cough reflex
e. the cilia beat synchronously

63. Type I pneumocytes, except:

A. To aid gaseous diffusion
B. Contain of flattened nuclei and fer mitochondri
C. Together with Type B, produces surfactant
D. To aid bronchial circulation to supply oxygen, water and nutrient
E. Make up 90% of surface forming of the alveolar wall

64. Removal of foreign substances, except:

A. Cough reflex
B. Mucociliary clearance
C. Alveolar macrophage
D. Surface tension and surfactant
E. A1-antitrypsin

65. Below are the characteristics of pneumocystic carinii, except:

A. Is a fungal infection
B. The commonest opportunistic infection in the immunocompromised patient
C. Interstitial infiltrate of mononucleus cells
D. Prognosis is really good
E. Alveolar airspaces are filled with foamy eosinophilic material
66. cigarette smoking has many major effects:
1. impairs ciliary movement
2. causes mucous gland hypertrophy

3. alters the structure and function og alveolar macrophage

4. productive cough

67. the top lordotic projection of a chest x-ray is used to confirm the abnormality:
a. the aortic arch
b. the heart
c. the lower lung field
d. the upper lung field
e. the diaphragm

68.lobar pneumonia:
a. the border of the lung is indistinct
b. the lesion appear homogenously
c. it does not cause shift to the nearby structure
d. the sinus is blunt
e. the diaphragm at the affected side is elevated66. Oppo 2006
69. In chest X-Ray of patient with tension pneumothorax of the right lungs field, there will be :
A. Heart enlargement
B. Hyperlucency with avascular region in the right hemithorax
C. No mediastinal shift is noted
D. The diaphragm of the affected side is elevated
E. The contralateral lung will show dense opacity
70. Lobar pneumonia
A. The border of the lungs is indistinct
B. The lesion appear inhomogenously
C. It does not cause shift to the nearby structure
D. The sinuses is blunted
E. The diaphragm at the affected side is elevated
71. The distance of the focal spot in X-ray tube to the object in making a chest-xray?
A. 0.75 meter
B. 0.90 meter
C. 1.25 meter
D. 1.5 meter
E. 1.8 meter
72. The radiologic findings of the patient with tuberculosis in CXR?
I. patchy infiltration in the peripheral lungs
II. fibrotic spreads in the lungs field
III. regional hilar lymphnodes enlargement
IV. ateletesis of the lung segment
73. The term known as "primary complex of Ranke" shows in CXR means that:
I.there is atelectasis of along segment combined with pleural effusion
II. there is bronchitis pattern combine with pleural effusion
III. there is bronchiectasis combined with bronchopnuemonia
IV. the is the primary gohn focus combine with hilar lympnode enlargement
74. Nh

75. pneumonia;
a) the border of hte lungs is indistinc
b) the lesion appear inhomegenously
c) it does not cause shift to the nearby structure
d) the sinuses is blunted
e) the diaphgram at the affected side is elevated
case
27 yrs old women, cought for past 2 months, blood tinged sputum for the past 3 days, fatique, anorexia, subfebrile, short of
breath occassionally. PEMFIS, ronchi in his right lungs, increased density in upper right lobe. Periphereal WBC count 6000
mm3 and Hb 11.0 mg/dl.
76. diagnose?
a) pneumonia
b) chronic asthma
c) asthma bronchial
d) tuberculosis
e) congestive heart failure
77. Drug of choice in this patient?
a) antibiotics
b) antiarrrythmia
c) tuberculostic
d) antihistamine
e) chemotherahpy
78. G
79. G v
80. Jjb

81. As part of a multidrug attack on the patient infection with M. TB which the following the most active agains the bacillus :
a. Amikacyn
b. Kamamycin
c. Momyein
d. Streptomycin
e. .......

82. A patient with active TB is being treat with isoniazid and ethambuthol. As part of the overall regiment. Which are the
following is the main reason for including the ethambuthol ?
a. To fasilitated and three the NINH into the Mycobacterria
b. To facilitated penetration of the blood brain barrier
c. To retard the developmet of organism resistance
d. To retard absorption after IM injection
e. To slow renal ekskretion of INH to help maintain effecive blood level

A 65 yo. Male diabetic patient was admitted to hospital care. The patient presented with history of low grade fever that
persisted for about a month and cough for 2 weeks. There was no clinical history of pneumonia. He was on
immunosuppressive therapy with tacrolimus, azathioprine and steroid after renal transplantation. On CT-Scan, there was
evidance of multiple confluent nodular oppacities and patchy parenchymal oppacities seen in bilateral lung parenchym ,
more evident on the right side in upper and lower lobes. Fluffy sentrilobular opacities were seen difusely involving bilateral

lung parenchyma with three-inbud apperreance. A small thin-walled cavitary lession was seen on posterior segment of right
upper lobe. These radiograph sign suggest of inactive actiollogy-possibility of TB.
Routine blood exam include high sensitivity c-reactive protein (HsCRP) and BACTEC blood culture were ordered. The culture
result was negative. There was a slight increase in HsCRP. Gram stain of broncho-alveplar fluid (BAL) fluid revealed
numerous polymorphonuclear cells (PMNS) but no organism were detected. The patient was HIV (-). BAL fluid was sent for
acid fast bacilli (AFB) smear and culture and both were negative. Fugal smear and culture were performed using the
patients BAL fluid. On direct smear preparation, buidding yeast cells were detected and on India ing, a clear halo around the
yeast cell was noted. Colonis appeared on saburaud agar after 3 days.

83. The above information supports the diagnosis of :

a. Tuberculosis
d. Kidney rejection
b. Viral infection
e. Candidosis
c. Fungal infection

84. The clear halo around the yeast cells seen under the microscope are indicative of the presence of :
a. Capsule
d. Velvetlike colony
b. Reddish mold
e. Germinative tube
c. hyphae

85. microscopy reveals many fungal spores inside and outside of microphages. The capsulated yeasts are suggestive of :
a. Criptococcus
d. candida
b. Histoplasmosis
e. Histoplasmosis
c. Blastomyces
Boy 11 yo, visited hospital because of fever since 3 days ago, there was cough and runny, slightly narrower, felt nausea and
vomiting, pain throughout the body, last few days ago some of bird died without any reasons.

86. In this case we can suspect this patient with :

a. TB
d. Bird flu
b. Typhoid fever e. Japanese encephalityis
c. Dengue fever

87. In this case the possibility the cause of the desease will be :
a. Bacterial TB d. Fungus
b. Virus RNA e. Protozoa
c. Virus DNA

88. Gold standar for identivication of the organism of those disease will be :
a. Simple PCR
d. Culture invitro with cell line
b. RT-PCR
e. culture invivo in t5he aminal
c. Smear microscope
Woman 39 yo , come to policlinic with shortness of breath shallow brearths fever. In the examination of thorax photo found
cloudy in the lower part of left lung. In the microscope examination of aspirate function in the chest patient found bacil
gram positive and acid fast negative. TThis bacterial aerobe and can grow in the all of growth media of bacterialand also in
TB media.

89. The possibility of bacteria cause of the disease in the lung of patient will be :
a. M. TB
b. M. Bovis
c. Candida Albicans
d. Streptococcus
e. Nocardiosis

90. The goals of nutrition intervention of acute respiratory disease syndrome (ARDS) is :
a. Gain the weight
b. Decrease PCO2
c. Decrease catabolism of respiratory muscle nerve
d. Optimize gas exchange
e. Decrfease inflammatory respon

91. Nutrition care in acute respi failure is :

a. Parenteral nutrition is preterred
b. Fluid restriction
c. Adequate in carbohydrate
d. Adequate in fat
e. Adequate in omega 6

92. Protein need in patient with failure of increasing minute ventilation is :

a. Higher than normal need
b. Lower than normal need
c. Adequate need
d. Depend on carbohydrate need
e. Depend on fat need

93. Condition that can not be given parenteral nutrition in patient with :
a. Failure in gastrointestinal function
b. Unconsciousness
c. Short bowel syndrome
d. Hemodynamic unstable
e. Only in adequate
94. Which are the following change can follow structural change in respiratory tract due to smoking
1. Peribronchiolar inflammation and fibrosis
2. Increase of mucosal permeability and change in patogen adherence
3. Impaired mucocilliary clearrance
4. Disrrupted respiratory epithelium

95. Which are the following statement is not true about the relationship between smoking and TB :
a. Smoking lower immune respon and increase the likelyhood of infection TBC
b. Smoking associated with high mortality rate of TB patient
c. Smoking increase the activity of phagocyte
d. Reduce the release of proinflammatory cytokiness smoking
e. Smoking reduce neutrophi or CD8+ and reduce the number of eusonophi.

96. Which of the following effect is not associated with smoking and TB patient?
a. Smoking increase the risk of pulmo TB
b. Smoking enhancess clinical manifestation of TB infection
c. Smoking decrease the chnce of cavity TB
d. Smokig increase the risk of gating positive smear
e. Smoking decrease phagocyte activity
A man 45 years smokers diagnose with TB since 1 month ;ago. Patient living with the family, the wife of 35 years who are
prenant, first child 17 yo male , second child 15 yo male, female 12 years, III and IV girls 8 years

97. What is the most appropriate preventive action perform on this patient ?
a. Health promotion
b. Specific protection
c. Early diagnosis and prompt treatment
d. Disability limatation
e. Rehability

98. What is the most appropriate action done to the baby that will be born ?
a.Health promotion
b. Specific protection
c. Early diagnosis and prompt treatment
d. Disability limatation
e. Rehability

99. 33 years woman came to the clinic with coughing up with bloody sputum. The doctor diagnose she get pulmonary TB
diseaase. Base on ICD X this disease is included in the what classification :
a. Communicable disease
b. Infection disease and paracyte
c. Respiratorysystem disese
d. The disease in act contagious
e. Disese virus infection

100. Goverment imposed rules limiting the level of incoting in cigarrete is in production and not to impose on smoking in
public place impose to on smoking in public place like office and etc. What the type prevention by the government :
a. Primordial prevention
b. Primary prevention
c. Secondary prevention
d. Tertiary prevention
e. Specific protection