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TIM AKADEMIK 2009FINAL HIS

1. a. b. c. d. e.
Which of the following is the sign of abnormal blood cells maturation? Large nucleus Small nucleus Secondary granule Reduction of cell volume Reduction of N : C ratio

b. c. d. e.

Cyt Calia Surface CD22 Cytosolic CD22

6. a.

Yang jadi growth factor pada .(maaf lupa tapi inisialnya PGC) IL-1 IL-3 TNF G-CSF Fit Ligand During the 1st few weeks of embryonic life, hematopoiesis begins in the mesoderm of yolk sac. Which of the following cells produced in that time? Large primitive monocyte Large primitive granulocyte Large primitive lymphoid cells Large primitive megakaryocyte Large primitive nucleated erythroid cells

2. a. b. c. d. e.

Which of the following is the sign of abnormal blood cells maturation? Myeloblast with 5 nucleoli Lymphoblast with 2 nucleoli PMN with 7 lobes of nucleus Reticulocyte with acidophilic cytoplasm Pronormoblast with basophilic cytoplasm

b. c. d. e. 7.

a. b. c. d. e.

3. a. b. c. d. e.

Sel mana yang paling immature? Myelocyte Promyelocyte Myeloblast Acidophilic myelocyte Metamyelocyte

8. a.

Which of the following organ will hematopoiesis in 7 months gestation? Lung Liver Spleen Yolk sac Bone marrow

act

in

4. a. b. c. d. e.

Which of the following cell still has a clearly seen a nucleoli? Myeloblast Promyelocyte Myelocyte Metamyelocyte PMN

b. c. d. e.

9. a. b. c. d.

Extramedullary hematopoiesis pada orang dewasa? Yolk sac Spleen -

5. a.

Which of the following cell marker can be found In mature B lymphocyte? Tdt

TIM AKADEMIK 2009FINAL HIS


e.
diagnose as hemophilia A. Which of the following tests is expected can support the diagnosis?

a. 10. Which of the following changes occur in development


stage of erythropoiesis?

Bleeding time Platelet count Prohtrombin time APTT Thrombin time

b. c. d. e.

a. b. c. d. e.

Decreased cell volume Decreased N : C ratio Increased RNA in cytoplasm Increased number of nucleoli Gradual decrease of Hb synthesis

15. A

45 years old who regularly takes aspirin since 2 years ago underwent screening hemostasis for tooth extraction. Abnormal? Bleeding time Platelet count Prothrombin time Thrombin time APTT

11. Which a. b. c. d. e.

of the following cells is the most immature in the granulocyte lineage? Myelocyte Myeloblast Promyelocyte Metamyelocyte Band neutrofil anak mengalami nose bleeding, dilakukan Bleeding Test. Apa yang mau didapatkan dilihat dari situ? Fungsi platelet Platelet count .... Intrinsic factor Extrinsic factor

a. b. c. d. e.

16. .

12. Ada

50 years old women is diagnosed as having acute myocardial infarction and treated with oral anticoagulant. To monitor... Bleeding time Platelet count PT APTT Thrombin Time

a. b. c. d. e.

a. b. c. d. e.

13. Laboratory

result a 23 years old female patient showed platelet count 100.000/mm3. Abnormal result? Bleeding time Clotting time PT APTT Thrombin

17. Along with PT result, lab can also reports INR.


of the following substance is standardized with this parameter? subject

Which to be

a. b. c. d. e.

a. b. c. d. e.

Thrombin Thromboplastin Thrombospondin Thrombomodulin Thrombostenin

14. A

3 year old boy easy bruishing, his older brother is

18. A

11 month age with chief complain pale and lethargic. Nutrisi buruk. No fever, no bleeding. Hb

TIM AKADEMIK 2009FINAL HIS


7.6, WBC 6800, PLT 260.000. Diagnosis? berenang dia langsung ada papule yang gatal diameter 1-3 mm dan extensive erythema. Penyakit apa? Urticaria Dermatitis atopy Contact dermatitis Numular dermatitis Sunburn papule 1-3 mm, extensive erythema after swimming at hig noon. Patfis mast cell degranulasi? Atopy Contact/ irritant Simpatetik efek Parasimpatetik efek Physical stymulation mengalami hipotensi, hilang kesadaran setelah injeksi metimazole. 6 bulan lalu mengalami erythem setelah konsumsi analgetik. Shock jenis apa yang dialami? Cardiogenik Sepsis Hypovolemik Anaphylaxis Neurogenik is the following dose of epinephrine is the most suitable: (BW 15 kg) 0,15 ml 1:1000 0,3 ml 1:1000 3 ml 1:1000 0,15 ml 1:100 0,3 ml 1:100 y.o boy loss conciousness, hipotensi, takikardi, after metimazole injection, past history 6 months ago, urticaria after analgesic tab. Body wight 30 kg. WOTF is the leading cause of death? Cardiac arrythmia Irreversible shock Laryngospasm Seizures Abdominal cramp

19. Iron deficiency anemia

20. 9

month old, pallor since 3 month ago pale conjunctiva, mild icterus, hepatomegaly, splenomegaly, Hb 4.6 g/dL, microcytosis, hypochromia, mild anisopoikilocytosis, polychromasia. Diagnosis? Thalassemia Aplastic anemia Megaloblastic anemia IDA Anemia of chronic disease

a. b. c. d. e.

32. Multiple pruritic a. b. c. d. e.

a. b. c. d. e.

33. Pasien

21. ANNISA
Eja)

NURFITRIANI (katanya mau dikirim ke Bang

22. Deficiency a. b. c. d.

clotting factor have abnormality bleeding because of : platelet are unable to form primary hemolitic plug without adequate clotting factor bone marrow can't make make adequate quantities of platelet when clotting factor are deficient blood vessel can't constric when clotting factor deficient fibrin is formed more slowly

a. b. c. d. e.

34. Which a. b. c. d. e.

35. 15

23. 24. 25. 26. 27. 28. 29. 30. soal a. b. c. d. e.


ibu yang nyusuin anaknya trus ganti susu sapi,,apa yang menyebabkan kondisinya? glucose intolerance wheats allergy cows milk allergy kontak dermatitis lupa hot holiday, 5 y,o boy berenang, segera setelah

a. b. c. d. e.

36. Ada tabel. (Hb, C3, C4 ), (Urea, CRP ) ESR 87, ANA a. b. c. d. e.
1:320, Anti-sm (+). Most likely diagnosis? SLE Wegener granulomatosis Henoch-Schoenlein Purpura Thypoid fever Cryoglobulinemia is the most complication of this disease in children? Cutaneous lesion Pulmonary involvement Neurology involvement Trombocytopenia Nephritis

37. What a. b. c. d. e.

31. On

TIM AKADEMIK 2009FINAL HIS


38. Gambaran tubercle pada sel disebabkan karena.. a. bacterial infection b. viral infection c. parasitic infection d. microbial infection e. non specific infection 39. A 35 y.o woman complained an enarging in the right
axilla lymph node. The biopsy was performed. Macrocopically , the lypmh node measured 1x0,8x0,5 cm, the cut surface white/ gray, the capsule still intact. What cellular response that correlates whit this condition? Hyperthropy Atrophy Metaplasia Necrosis Hyperplasia area since 1 year ago. Cannot reduce on antibiotic treatment. Microscopic appearance in LN replaced by an infiltrate of small lymphocyte in diffuse pattern. No lymphoid follicle. Diagnosis? Lymphocytic lymphoma Lymphoblastic lymphoma Follicular lymphoma Hodgkin lymphoma Burkitt lymphoma

a. b. c. d. e.

45. Aldi, 12 y.o, felt shortness of breath, weakness, dizzy


20 minutes after taking penicillin. 6 month ago Aldi suffered red, itchy, swollen lips, and itchy throat after taking amphicillin. Weak and dizziness because : Cellular hypoxia Myocarditis Vasculitis Elevated C13 Activated simpatis

a. b. c. d. e.

a. b. c. d. e.

40. Laki-laki usia 15 tahun, chief complaint: pembesaran


cervical lymph node sejak 2 bulan yang lalu, terkadang disertai sakit. Dilakukan biopsy untuk menentukan diagnosis, dari hasil mikroskop terlihat follicular lymph node wih germinal center reacion and larger lymphocyte that ongoing activation. Possibly cause? Bacterial infection Viral infection Parasitic infection Mikrobial infection Non specific infection y.o man, enlargement left axillary lymph node. Biopsy : reactive pattern of distention and prominance lymphoid sinus, endothelial cell hyperthropy and infiltration macrophages. Diagnosis? Follicular hyperplasia Paracortical hyperplasia Sinus hystiocytosis Lymphadenopathy tubercullosa Acute lymphadenopathy woman with renalnephrophathy,long standing joint disease n bilateral rash on cheek n nose. There is hair follicle plugging n athropic dermatitis hydropic degeneration. Diagnosis? 50 y.o women complained difficulty in swallowing and had signs of vena cava compression. She had a medical history of long standing joint problems, present with a rash in bilateral cheeks and nose. From the lesion, sent to PA. Microscopic appearance of lesion composed of epithelial reticular cell with a rich or scant lymphocytic infiltration. Diagnosis? SLE Spondylitis TB Reactive lymph node Thymoma Malignant lymphoma

46. At autopsy some pateint may be found to have? a. b. c. d. e.


Myocardial infarction Myocarditis Cardiomegaly Right side cardiac dilatation Dilatation pulmonary vasculature th laki2, shortness of breath, weakness, dizzy 20 menit setelah konsumsi penicillin. Dia punya history alergi ampicillin. At this patient, mediator release because of? Absent of Ca in cell PGE1 PGE2 converts ATP to cAMP Guanylate cyclase inhibit GTP Absent receptor IgE Absent receptor cholinergic

a. b. c. d. e.

47. 12

41. 30

a. b. c. d. e.

a. b. c. d. e.

48. At this patient, release mediator inhibition because of


:

42. 27y.o

a. b. c. d. e.

Microtubule aggregation Microtubule dissociation Complement dependent reaction Fc receptor Antireceptor antibody

43. A

49. Clinical manifestation of the patient can be : a. b. c. d. e.


Arthritis Glomerulonephritis Serum sickness Hives Farmer's lung yearsold man complain of fatigue & enlarged glands in the neck, both axilla, & the left groin. Blood count shows a lymphocytosis & the diagnosis was chronic lymphocytic leukemia. Which of the following is most likely the histology

a. b. c. d. e.

50. 42

44. 55 y.o male had several lymphadenopathy in cervical

TIM AKADEMIK 2009FINAL HIS


structure of affected cell? Cytoplasma has many mitochondria Large golgi complex Sparse chromatin Multiply in the bone marrow Inconspicuous nucleoli patient with microcytic anemia. WOTF affected cell? Fully formed stain basophilic Have a life span 3 weeks Contain myoglobin Peripheral protein spectrin and actin serve to form the shape Cyclosphorin is determinanr ABO BG the

a. b. c. d. e.

d. e.

HHV Influenza virus

58. Diagnosis for lymphadenitis tuberculosis? a. Infiltration neutrophil, casseous,


datialanghans

epiteloid,

59. which a. b. c. d. e.

51. A a. b. c. d. e.

of the following microscopically diagnostic for Hodgkin lymphoma? Hodgkin cell Lymphoblast cell Lymphocyte cell Owl eyes-like cell Plasma cell clinical stage for disease (Histopatological Lymphoma)? IA IB IIA IIB IIIA

60. WOTF a. b. c. d. e.

52. Histology thrombocyte? a. central hyalomere b. GAGs and glycoprotein di membrane untukadhesi c. Nuclear fragment d. (Terussisanyaguelupa,
pokoknyatentangstrukturnyasitrombosit)

53. 54. Laki-laki a. b. c. d. e.


30 tahunmengalami allergy contact dermatitis. Sel yang berperansebagai APC paling efektif? Monosit - macrophage Mast cell B lymphocyte T lymphocyte Dendritic - Langerhans years old woman "catches" the flu from her students. Which of the following statment is most likely ? phagocytosis of virus by CD4 T cell presentation of antigen by CD4 T cell killing of virus infective by CD4 T cell formation of memory T&B cells killing of virus infected cells by neutrophils

61. 40 y.o: lump in lymph node axilla for 1 week ago. PE:
enlarged, nontender, and mobile. Biopsy: proliferated of follicle with germinal center of lymphoid with surrounding normal lymphocytes cells. Diagnosis? Lymphadenitis chronic non specific Lymphadenitis chronic specific Reactive hyperplasia of lymph node Nodular sclerosis Hodgkin lymphoma Follicular lymphoma allergen stimulates the immune response of Tcell. Which is the main cytokine that is specially relevant to TH-1 response? IL4 IL5 IL10 IL12 IL13 vascular rejection is characterized by necrosis of individual cell of graft blood vessel. Which one of the following antibody mediates process? IgA IgD IgE IgG IgM is the first step in class II MHC associated antigen presentation? Recognition of the complexes by T cells that are specific for the foreign peptide and the self MHC molecule Internalization of native protein antigen from the extracellular environment into APCs Binding of peptides to class II MHC molecules within the exocytic vesicles Processing of the antigen in acidic endosomes/

a. b. c. d. e.

62. inhalation a. b. c. d. e.

55. 27 a. b. c. d. e.

63. Acute a. b. c. d. e.

56. MikroskopisBurkitt Lymphoma? a. sheets of intermediate-size lymphoid b. c. d. e. f.

cells, coarse chromatin, several nucleoli, banyak mitosis Replacement monomorphous large lymphoid, enlarged nuclei, prominent nuclei, less mitosis sheets of small-sized lymphoid cells, coarse chromatin, several nucleoli, several mitosis Replacement .. Sheets of large-size lymphoid cells, coarse chromatin, several nucleoli, (maafgaklengkap, panjangdandudukdidepan T_T)

64. What a. b. c. d.

57. Virus apa yang menyebabkanBurkitt Lymphoma? a. EBV b. HIV c. HPV

TIM AKADEMIK 2009FINAL HIS


lysososmes leading to the generation of peptide fragments. Expression of peptide MHC complex on the cell surface

e.

65. Enzyme inhibited by allopurinol a. Uricase b. guanase c. Xantine oxidase d. purine phosphotilase e. adenosine deaminase 66. Methampiron. a. b. c. d. e.
Enzyme which inhibit of mediator release? Adenylate cyclase Guanylate cyclase Thymidin cyclase Uridine cyclase Cytosin cyclase yang menjaga membrane dan haemoglobin dari denaturasi oleh oksidan adalah ATP NADH NADPH glukosa 2,3 DPG

a. b. c. d. e.

T lymphocyte B lymphocyte endothelial cell macrophage cell mesenchymal reticular cell

72. In the adult, the best place to sample for cells of this a. b. c. d. e.
lineage would be the bone marrow: Sternum Fibula Humerus Tibia Scapula 8 year old girl was brought to the Pediatric Outpatient Department Hasan Sadikin Hospital General Hospital with chief complain of fever. From P.E. you found T2b-2b hyperemic tonsil. Which of following is the normal histologic appearance of the organ that is found abnormal on physical examination above? Has crypt Has cortex Has medulla Encapsulated totally Simple cuboidal epithel 35 year old woman comes to your clinic with a chief complaint of physical weakness since two months ago. She looks pale and on PE you find papilla atrophy of her tongue and spoon nails. The differential diagnosus of what you see on the patient's blood smear is: Aplastic anemia Pernicious anemia Hereditary sideroblastic anemia Chronic lymphocytic anemia Chronic myelocytic leukemia 25 year old man, comes to our clinic with chief complain of mass in left axilla and both inguinal region. He also feel weakness and fever occasionally. On PE you find: relatively good conditions except temperature 37.8oC. You are sure to palpate lymph node and enlargement in left axilla and both inguinal region. What is not inclusive in your DD? TBC of lymph nodes Acute leukemia Malignant lymphoma Mononucleosis infectiosa

73. A

67. Substansi a. b. c. d. e.

a. b. c. d. e.

74. A

68. New T lymphocyte occur in lymphatic region? a. Deep medulla b. Superficial cortex c. Thymus nodule d. Thymus corpuse e. Cortimedula junction 69. Which a. b. c. d. e.
one of the following hematopoietic cell of the red bone marrow is postmitotic? Myelocyte Basophilic erythroblasts Band cell Promyelocyte Polychromatophilic erythroblast y.o pallor, malaise, as chief complaint. No history of bleeding, also irregular eating habits. PE : conjunctivae pale, blood smear : normochrom normositer, neutropenia with giant neutrophil (giant stab cell). WOTF organ is most likely disturb that cause above condition? thymus lien kidney liver

a. b. c. d. e.

75. A

70. 30

a. b. c. d.

a. b. c. d.

76. you a. b. c. d. e.

order routine lab exam, chets x-ray,abdominal ultrasound, what other exam is not needed? fine needle aspiration biopsy of lymph node bone marrow biopsy surgical biopsy of lymph node HIV test if he is an IDU surgical biopsy of lymph node 35 year old woman come with chief complaint of physical weakness since 2 month ago. She looks pale and on physical examination you find fine papilla

71. 6 m.o boy was brought to pediatric emergency room


with palor as cc. from the HT, his parents stated that he looked quiet pale, weak and his skin had turn slightly ayellow. No history of bleeding. From the PE you found the tip of the spleen was felt 5 cm below the left costal margin (schuffner 3), wotf cell hyperactivity is the most likely cause of abnormality organ above?

77. a

TIM AKADEMIK 2009FINAL HIS


atrophy of her tongue & spoon nail. What is the most appropriate parameter which should be assessed to evaluate the response of this patient after 3 month treatment? transferin saturation ferritin serum ion Hb IBP

a. b. c. d. e.

a. b. c. d. e.

blood smear? basophilic stippling cabot's ring auer rod howel jolly bodies acanthocytes

83. a 20 year old 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 reveal 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 test result specific for this condition is a high titer of autoantibodies against. Which of the following the most appropriate serologic test for this patient? VDRL ANA RF anti dsDNA anti ssDNA

78. Pale,

a. b. c. d. e.

gusi berdarah, fatigue, dizzy, tidak ada pembesaran lymph, tdk ada hepatosplenomegaly. Lab: Hb, ht, wbc, platelet turun. Bone marrow smear: cellular hypoplasia. Prognosis penyakit ini ditentukan dari: Hb Ht wbc RBC platelet red dots, gum bleeding, petechiae & achymosis on extremities . Hb 12,5, WBC 4000, PLT 25.000. treatment? PLT transfusion B. corticosteroid azathioprine IV Ig splenectomy 40 years old 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 hemoglobin level is 8 gr/dL. The internist finds that the patient's conjunctivae are pale, and there is papilla atrophy of his tongue and spoon nail. What is the most appropriate next step in making the diagnosis? digital rectal exam faecal occult bleeding exam peripheral blood smear exam bone marrow smear exam chemical blood exam 20 year old female complains of easy bruising of the arms and legs for several months. She also has recurrent bleeding from the nose and heavy menstrual bleeding since 2 weeks. PE reveals ecchymoses and petechiae on the thighs and forearm, no other obvious bleeding. Lab findings show Hb: 13 g/dL, WBC : 4,000/mL, PLT : 25,000/mL. what is the most appropriate statement about this case? most of the cases will have spontaneously remission most of the cases need splenectomy most of the cases need IV gamma globulin about half of the cases will response to corticosteroid about half of the cases will change to leukemia 38 year old man is admitted to the hospital with nose bleeding. PE reveals liver enlargement. Lab exam : Hb 5 g/dL, WBC 120,000/mL, PLT 17,000/mL. what is the most possible finding on his peripheral

79. Women, a. b. c. d. e.

a. b. c. d. e.

84. FOR 85-86 the major blood group locus of allele in human produces type A (AA or Aa), B (ABAB or ABa), AB (AAB) or O (aa)

80. a

85. for each pair of parents, match the possible offspring. a. b. c. d. e.


Type O father, type AB mother AB child B child O child A or AB child B or AB child

a. b. c. d. e.

86. for each pair of parents, match the possible offspring. a. b. c. d. e.


Type AB father, type O mother AB child B child O child A or AB child B or AB child were shown to impair sperm migration through the female reproductive tract, and to interfere with gamete interactions when antibody coated spermatozoa reach the site of fertilization. Which of the following is most likely the genome region controlling foreign proteins of tissue or organ? interfering sperm production auto-agglutination of spermatozoa in the ejaculate reducing the fertilizing ability of the spermatozoa impairment of sperm-oocyte interaction have been found to carry numerous different

81. a

87. ASA

a. b. c. d. e.

82. a

a. b. c. d.

88. WBC

TIM AKADEMIK 2009FINAL HIS


antigen in the HLA system. The presence of a particular antigen on leucocyte means that a corresponding allele is present in the genotype making up that person. Which of the following is most likely explanation of HLA system? the objective of transplantation antigen on HLA system are controlled by chromosome 8 alleles of the genotype may be homozygous or heterozygous alleles of the genotype are always homozygous alleles of the genotype are heterozygous do the antihistamine work best in allergic diseases? preventing rather than reversing histamine's actions on target tissues than preventing histamine's action on target tissue equally reversing and preventing reversing rather histamine's action on target tissue preventing rather than reversing histamine's actions on mast cell reversing rather than preventing histamine's action on mast cell 12 year old girl presents to your clinic with sore throat and fever. You diagnose her with pharyngitis. She is given an IM injection of penicillin. Approximately 5 minutes later, she is found to be in respiratory distress and audibly wheezing. Her skin is mottled and cool, she is tachycardic and her BP fallen to 70/20 mmHg. You give her a subcutaneous injections of epinephrine. Which of the following effects is the objective of giving above mentioned drug? 1-adrenergic effects b 2-adrenergic effects 1-adrenergic effects 2-adrenergic effects and - adrenergic effects 30 y.o. Women farmer comes to outpatient clinic with fatigue & also accompanied by dizziness & weakness since 4 months ago during last 10 days she complaints of shortness of breath on activity &palpitation. She has not taken some medication. pernicious anemia. Which vitamin can mask the symptoms of pernicious anemia by alleviating the anemia but not preventing the neurological damage? vit b12 Niacin Folic acid Vit.c Vit.d anemia;yg penting treatment pemberian vitamin morfologi rbc folic acid di darah vitamin b12 di darah vitamin b12 di hati folic acid di bone marrow utk diagnosis n

a. b. c. d. e.

94. Most cmmon etiology of iron dfciency in child: a. Defsiensi fktr intrinsik b. upper respi tract infction c. Acute diare d. Ankylostomiasis e. Hereditary 95. A a. b. c. d. e.
most important defense body mechanism in infection of HIV is.. IgA NK-cell class A interferon cell-mediated immunity antibody-mediated immunity

89. how a. b. c. d. e.

96. characteristic HIV a. Oncogene virus genus b. Genome is negative sense c. Have ssRNA d. Genome consist of dsDNA e. Does not have envelope 97. Lymphatic
capillaries differ from blood capillaries in that : A. One is lined by endothelium, the other by mesothelium. B. The limphatic is lined by type I endothelium, the blood capillaries type II. C. The limphatic capillaries has numerous pericytes. D. The limphatic capillaries has no basal lamina. E. The blood capillaries contains smooth muscles.

90. a

a. b. c. d. e.

91. A

98. Bedanya spleen sm lymphnode? a. Spleen lbh byk filter darah b. Terdapat populasi T cell c. Ada bill cord d. Lupa maaf :( e. Pilihannya cm sampe D kok. 99. Which
there is an increased demand of blood cell, extramedullary hematopoiesis will occur. Which of the following organ will acts in this condition in adults? Spleen Yolk sac Pankreas Adrenal Thyroid In which organ are immature (undifferentiated) T lymphocyte most likely to be found? Bone marrow liver lymphnode spleen thymus A first year medical student observing sample of normal spleen at microscope. What of the following cell that can be found in splenic sinuses? B lymphocyte

a. b. c. d. e.

a. b. c. d. e.

100. a. b. c. d. e.

92. Pernicious a. b. c. d. e.

101.

93. a.

TIM AKADEMIK 2009FINAL HIS


b. c. d. e.
Hassal's corpuscle Macrophage Red corpuscle Reticulocyte

e.

Temperature

106.

Jika ada penurunan jumlah platelet, maka apa yang bemasalah? JAWAB : peningkatan bleeding time

102. a. b. c. d. e.

Which lymph node does the majority of lymph from the breast drains into? Pectoral nodes Subcapsular nodes Lateral axillary nodes Upper internal thoracic nodes Lower internal thoracic nodes

107.

The mode of action of vitamin K in production of vitamin K dependent clotting factors is thought to be Induction of protein synthesis Regulation of protein synthesis Attachment of carbohydrate moiety Attachment of lipid moiety Attachment of calcium binding site

a. b. c. d. e.

103. a. b. c. d. e.

What is the characteristic of the white pulp of the spleen? Produce lymphocyte Contains neutrophils Produce erythrocyte Is lined by endothelial cells Forms the cord of billroth

108.

A 49 y.o. female in hemodyalisis treatment for kidney failure comes with tiredness and fatigue. Temperature is 37.4oC, Hb is 10.2 g/dL, WBC 9000. The doctor asked whether she has been having her regular injection of erythropoietin. Which of the following the biological activity and importance of management of erythropoietin? It stimulate the production of active vitamin D It stimulate the activation of vitamin D by kidney It stimulate the formation of WBC It stimulate the maturation of RBC It stimulate the maturation of immature platelets

a. b. c. d.

104.

Under which of the following circumstances would you expect a decrease in concentration of circulating prothrombin? In vit K deficiency In vit B12 deficiency After ingestion of heparin In platelet deficiency An increase in which of the following would produce the greatest increase inarterial O2 content when PaO2 is 90 mmHg? 2.3 DPG PaCO2 Hb concentration Hydrogen ion concentration

e.

a. b. c. d.

109.

A 56 y.o female sustained major injuries from a motor vehicle accident and was being transfused blood in the Emergency Department. The medical student on duty was informed by his supervisor that the shelf life of packed red cells was a maximum of 43. The student was able to tell him that the normal life span of an erythrocyte in vivo is: 60 days 90 days 120 days 200 days 300 days

105.

a. b. c. d. e.

a. b. c. d.

TIM AKADEMIK 2009FINAL HIS


110.
A 18 y.o vegetarian woman with history of prolonged menstruation is suspected to suffer from iron deficiency. Which of the following condition is the most likely? The rate of iron absorption will be increased The transferrin becomes difficult to release iron to the tissues No new iron absorbed in the intestine will be accepted by the transferrin Liver decreases its rate of formation of apotransferrin There is a massive deposition of hemosiderin

c. d. e.

Fibrinogen Tissue factor Factor XII

a. b. c. d. e.

115. a. b. c. d.

which IV fluid can be used to reduce the viscoucity of packed RBC? saline D5W(5% dextrone in water) lactat ringer d10w dextran

111. a. b. c. d. e.

Correct statement regarding p50 is the tension of O2 that produce: 100 % saturation of Hb 75 % saturation of Hb 50% saturation of Hb 27 % saturation of Hb 25 % saturation of Hb

e.

116.

35 years old male lost enough blood to reduce his Hb concentration dari 15 menjadi 10 g/dL. Would lead to decrease in... Artery PO2 Vein PO2 Afinity Hb >> Oxyde Arterial blood Hb saturation

a. b. c.

112. a. b. c. d.

WBC apa yang mengandung histamin

d. e.

Basofil Neutrofil Eosinofil Monosit

117.

Which of the following protein is involved in convertion of temporary into definitive hemostasis plug? Protein C Factor XIII Endothelin Plasminogen Factor VII

a. b. c. d. e.

113. a. b. c. d.

oxygen-Hb dissocation curve, at what partial pressure of O2 50% saturation of Hb is achieved? 21 mmHg PO2 27 mmHg PO2 38 mmHg PO2 50 mmHg PO2

118.

114. a. b.

Which of the following initiate the extrinsic pathway? Prothrombin Plasmin

119.

A diagnosis of megaloblastic anemia was made in an elderly patient with gastrectomy. Which substance will most likely be increase in the blood of this patient? anti intrinsic factor antibody

a.

TIM AKADEMIK 2009FINAL HIS


b. c. d. e.
methionine cobalamine transcobalamine methylmalonic acid

c. d. e.

a prolonged clotting time a prolonged bleeding time PT -

129.

120. a. b. c. d. e.

What the initiate factor of extrinsic pathway of blood clotting? Protrombin Platin Factor xii Sekresi apa yang disupress pada penderita microcytic anemia yang diberikan NSAID? Adrenaline Erythropoitin Cortisol Hepcidine thyroxin

130. yang dihasilkan oleh vascular endothelial? a. prothrombin b. fibrinogen c. vWF d. protein C e. factor VII 131.
57 years old on pre-admission clinic due to a partial thyroidectomy in 10 days time for a solitary nodule. He is generraly fit, but take aspirin 150mg daily without prescription because the paper say it picient heart attack and .... . there are no abnormalities to find on examination. The doctor advise him to stop the aspirin 7 days before his planned surgery. How will the effect of aspirin be corrected during this period? drug dissociation from Cox binding sites drug drug dissociation from thrombin binding sites regeneration of COX within platelets restoration of Ca2+ level in platelets synthesis of new platelets

121. a. b. c. d. e.

a. b. c. d. e.

132. Agranulocytosis in blood a. Mefenamic acid b. Metampyrone c. Salisilat d. Paracetamol e. Pyroxycam 133. a. b. c. d. e.
Obat antimalaria yang bikin hemolytic anemia. Obat apa itu? Chloroquinine Quinine Pyrimethamine Mefloquine Primaquine

122.

123. 124.

lupa redaksinya, tapi intinya ditanya fungsi eosinofil. An increase oxidation of lipid within the body is charactezristic of old age and is a factor associated with heigh tened tisk of vascular disease. The extent of lipid oxidationin vivo can be best assessed by measuring what in a subject blood? superoxide radicals saturated fatty acid lipofucsin MDA PT -

a. b. c. d. e.

134. Which is a platelet GpIIB/IIIa receptor inhibitor? a. Clopidogrel b. Abciximab c. Ticlopidine d. Dipyridamole e. Aspirin 135. a. b. c. d. e.
68 y.o man, BP tinggi, diabetes, OA, massive tongue swelling. No urticaria, wheezing or dizzy. WOTF mediactions responsible for tongue swelling? Clopidogrel Metformin Atenolol Perindopril Codein phosphate what characterizes the action of warfarin?

125. 126. 127.

128. what is the main defect in hemophilia? a. an increase vascular fragility b. a decrease in the number of platelets

136.

TIM AKADEMIK 2009FINAL HIS


a. b. c. d. e.
the anticoagulant effect of warfarin is slow in onset about 95% of a dose of warfarin is free in plasma overdoses can be treated with vit K antagonists warfarin is actives in vitro&vivo warfarin is administered intravenously agen topikal apa yang bisa mengatasi photosensitivity pd sle? Jwbnya sunblock topical (lele) a 60 y.o. man come to polyclinic with chief complain red eyes and reduce visual acuity, he has history of Rheumatoid arthritis. Biomicroscopy slit lamp exam on both eyes showed cilliary injection flare ++ and cell ++ in anterior chamber, what is the most appropriate drug for this patient?? ankylosing agent antimetabolites cyclosporine glucocorticoid NSAID Which antifungal drug binds to ergoserol &damages the fungal cell membrane irreversibly with leakage of ions? Imidazole Allylamines Echinocandins Triazoles Polyenes Synthesis of what is inhibited aminoglycosides, macrolides, & tetracyclins protein cell wall folate cell membrane nucleic acid bioavailability of anticoagulant drug A following oral administration is 100%. this drug also excessive bound to plasma. by what mechanism does a concurrent administration of NSAID compound increase anticoagulant effect of drug A? reducing amount calcium for anticoagulant displace drug A from protein binding site reduce metabolism drug A increase plasma concentration process increase absorption from GI tract for coagulation by converting plasminogen to plasmin can be achieved by: Warfarin, inhibisi epoxide reductase yang penting untuk regenerasi vit K Tissue plasminogen activator Heparin Aspirin Enoxaparin Mechanism of aspirin in antipyretic reaction is :

a. b. c. d. e.

137.

144. a. b. c. d. e.

138.

Blocking cytokine receptor in hypothalamus Decrease activity of immune response Decreasing production of IL-1 Decreasing production of PGE2 Decreasing release of bacterial endotoxin 47 years old woman came to the outpatient clinic with pale, fatique, and dizziness. she also complain paresthesia, confusion, and loss memory. PE : there was decrease tendon reflexes. which of the following is the most appropriate drug?

a. b. c. d. e.

145.

139. a. b. c. d. e.

a. Cyanocobalamine b. folic acid c. ferro sulfat d. riboflavin e. piridoksin 146. Individual had

140. a. b. c. d. e.

a. b. c. d. e.

a homosexual contact on July 25, on september 17 of the same year he went to see his family doctor and had HIV blood test. Interpretation? Individual has not had HIV Individual does not need to practice safe sex Safe to donate blood Time from contact until blood test may be too short for seroconversion of blood test Individual may have IgG but no IgM antibodies Poxvirus used to against smallpox (vaccine)

141.

147. a. b. c. d. e.

a. b. c. d. e.

Variola major Variola minor Monkeypox virus Molluscum contangiousum Vaccinia virus Herpes lymphoma? CMV EBV varicella zooster HHV tipe 6 HSV-2 Nurse in neddle injury, immunoglobulin and vaccines is given to prevent: hepatitis A hepatitis B virus yg brhubungan dgn burkit

148. a. b. c. d. e.

142. Heparin, an injection anticoagulant: a. inhibit platelet aggregation b. competitive inhibitor for vit k c. inhibit thrombin function d. potent fibrinolysis e. treatment for hemolytic disease in newborn 143.
A 49 yo man,severe chest pain. ECG: diagnosed myocardial infarction. Opening the occluded artery of this patient through

149. a. b.

TIM AKADEMIK 2009FINAL HIS


c. d. e.
hepatitis C hepatitis D hepatitis E supraclavicular fossae and both axillae. There is enlargement of the mediastinum on chest x-ray. No night sweat, loss 15 kg weight in 3 months. What stage? IIa IIb c. d. e. A patient with a peptic ulcer has his first acute and massive hemorrhage from his ulcer at 04.00 pm. Blood studies are done at 05.00 pm. Which of the following lab finding is most likely? hipochromic, microcyte peripheral blood smear increase reiculocyte count decrease serum iron, high iron binding capacity normal Hb prolong thrombin time Transfusi 2 packed RBC, 3 hari kemudian Hb, haptoglobin menurun. Serum unconjugated bilirubin naik. Direct coomb test (-), indirect coomb test (+). Diagnosis? hemolisis karena defisiensi G6PD blood loss dari surgical procedure delay hemolytic transfusion reaction blood loss dari colorectal cancer combine Fe dan Fc deficiency A 43 years old woman presents to you with anemia. PE shows pallor only investigation shows: (Hb, WBC, PLT turun) dan (MCV naik). Oval macrocytosis, rare hypersegmented neutrophils, serum folate is low. Appropriate management? Folate 5mg p.o dialy Vit. B12, 1000 mikrogram IV q.monthly Bone marrow aspirate and biopsy Measured red cell folate and serum vit. B12 levels

150. Adenovirus can avoid the immune system by a. Inhibiting cellular mRNA transport b. The toxic effect of its fiber c. Inhibiting protein synthesis d. Forming a dsDNA that blocks interferon e. Integrating into the chromosomal DNA & becoming
latent

a. b. c. d. e.

162.

151. 152. 153. 154. 155. a. b. c. d. e.

PenyebabBurkitt lymphoma EBV -

a. b. c. d. e.

Filarial infection due to bancroftian infection cause elephantiasis. What specific methode is recommended as the diagnosis investigators ? daytime blood specimen microscopy microscopy of lymphatic fluid serological testing by enzyme assay midnight blood specimen microscopy biopsy lymph node Parasit yang bisaditransmisikanlewat transfuse darah Leishmaniatropica Brugiamalayi Dipalelonemaperstans Loa loa Trypanosomacruzi B-lymphocytes are the target cells of EBV infection. What is the effect? Produce mature virus particles B-cells are lysed B-cells are immortalized Transform to T-cell Loose their cell membrane -

163.

156. a. b. c. d. e.

a. b. c. d. e.

164.

157. a. b. c. d. e.

a. b. c. d. e.

158. 159. 160.

165. APTT prolonged a. faktorII b. faktorVII c. faktorIX d. faktorXII e. faktor X 166. a. b. c. d. e.


Bruising&gum bleeding. Retinol heamorrhage. Cbc: hb+wbc+platelet turun, reticulocyte normal. Diagnosis: Hypersplenisme ITP Immune haemolytic anemia Aplatic anemia Thrombotic thrombocytopenic purpura. Ada tabel: hb 90, wbc 2x10^9, pltlt 2x10^9, reticulocyte 1%. Treatmentnya ? high dose steroid. iv gama globulin. platelet transfusion.

a. b. c. d. e.

A 40 year old man presented with periodic fever, sweating chills, malaise, headache. He has just came from Cambodia one week ago. WOTF is the most relevant diagnostic test to be preformed? HIV ELISA VDRL Thick and thin blood films Blood culture Urine culture 20 y.o woman: nodular sclerosing hodgkin's disease on biopsy of a right anterior cervical lymph node. PE: palpable nodes in the right and left

167. a. b. c.

161.

TIM AKADEMIK 2009FINAL HIS


d. e.
fresh frozen transfusion. plasma exchange.

168. Hemophilia (xiii), lab yg abnormal? a. PT b. TT c. Aktif thromboplastin test d. Blood clot adhesive e. Platelet coagulation 169. 170. 171. a. b. c. d. e.
Hb trn, mcv naik, wbc turun, diagnosis? Bentuk simpanan iron dalam tubuh??

b. c. d. e.

transferrin fibrinogen X albumin myoglobin & Hb use heme asa prosthetic group in the binding of oxygen. Which statement are true> Myoglobin has sigmoid oxygen adsorption isotherm fetal Hb bind O2 more tightly than adult Hb has hyperbolic O2 adsorption isotherm 2,3 BPG bind to the oxygenated form of Hb concentration CO2 has no effect on O2 release by Hb. biliverdin production during heme metabolism occur in the spleen bone marrow liver gut kidney -

179. a. b. c. d. e.

Why does oxyhemoglobin in RBCs release oxygen more easily than purified oxyhemoglobin? release of O2 requires ATP, absent in the purified Hb oxygen release requires NADH as a cofactor 2,3 BPG binds the conformation of HB high (K+) in the RBCs facilitates the release of O2 the biconcave shape of RBCs facilitates O2 release. -

180. a. b. c. d. e.

172. 173.

181. 182. 183. 184. 185. 186.

a. b. c. d. e.

6 y.o girl complain loss of consciousness, hypotensi after antibiotic injection. Doctor give aqueous epinephrine. What mast cell mediator in early phase? prostaglandin leukotrin PAF tryptase IL4 -

limfosit : berperan penting dalam sistem imun dan dalam pembentukan antibodi -

174. 175. 176. a. b. c. d. e.

187. 188.
growing of low

what hemoglobin can precipitate extended filament..under condition oxygen HbA2 Hb bast HbC Hb H Hb S

a. b. karena ada NADH c. karena ada BPG (1,2 biphosphoglycerate) d. karena ada K+ e. karena RBC berbentuk bikonkaf 189. 190. a. b. c. d. e.

mengapa oxyhemoglobin di RBC lebih mudah merilis O2 daripada purified oxyhemoglobin? karena ada ATP

177. a. b. c. d. e.

How does the binding of 2,3 bisphosphoglycerate to Hb after the carriage of oxygen in human erythrocyte? it competes with oxygen in binding heme groups. It prevents oxygen binding by dissociation Hb dimer from oxygen dimer it decreases Hb oxygen binding xapacity by 50% it lowers oxygen affinity by stabilizing the deoxy conformation. it increases total oxygen by releasing heme prosthetic groups from globin polypeptides.

coagulation factor VIII is extremely labile. what substance can "protect" factor VIII from degradation protein C thromboxane tissue factor VWF HMWK Which of the following substances released by cytotoxic T lymphocytes kill infected cells? Antibodies specific for the infectious agent Complement C-reactive protein Perforin

191. a. b. c. d.

178. CLD edema. Low plasma level a. immunoglobulin

TIM AKADEMIK 2009FINAL HIS


e.
Heat shock protein anaphylactic shock;mediator yg pertama keluar apa? prostaglandin

192.

a. b. leukotrine c. paf d. il-4 193. 194.

Effect of ibuprofen that exarcebates bleeding (heavy mens, epstaxis since chldhood, parents got epstxis too)...

a. b. c. d. e.

The antiinflmtion property of it its efek on sintesis fktr koagulan Asosiated w/ hipoprotrombinemia Its antiplatelet efek Anti angiogenic efek epigastric pain, fatigue, sesak nafas. PE : pucat, pulse cepat, stool sample:black. Peripheral blood smear-nya? ukuran RBC uniform Hct 45% jmlh RBC 5 juta Hb 6g/dL normal hb/red cell ratio -

195. a. b. c. d. e.

196.

197. The most likely cell type to be increased in an acute bacterial infection is ? A. Limfosit. B. Neutrofil. C. Eosinofil. D. Monosit. E. Red blood cells.

197. Platelet jmlhnya ttp byk,jd harus dikasih apa? a. Interferon b. Inferferon+aspirin c. Hydroxyurea d. Hydroxyurea+aspirin e. Hydroxyurea+interferon 198. a. b. c. d. e.
all lymphoid tissues have efferent lymphatics, Which of the following has afferent lymphatics? Lymph nodes Thymus Lymph nodules Spleen Lymph node and spleen 35 y.o female is presented to ER with epistaxis & gum bleeding,headache & dizziness. Ecchymoses on her legs. Spleen enlargement (schuffner 1), no liver enlargement. WBC 125.000/mm3. Hb 6,2 g/dL. Platelet 7000/mm3. Most possible finding on PE: brittle hair gum hyperthrophy clubbing fingers papilla atrophy of tongue koilonychia

199.

a. b. c. d. e.