Soal McQ Kedokteran

A 35-year-old man presents with hemoptysis, chest pain, and weight loss. Tuberculin test shows 20 mm. Histopathology shows caseating granuloma with epithelioid cells and Langhans giant cells. The dominant immune mechanism is...

• CD8+ T cell activation causing alveolar cell lysis

• IL-4 and IL-13 production increases mucus and bronchoconstriction

• CD4+ Th1 activation, increased IFN-γ and TNF-α

• Eosinophil activation and histamine release (type I)

• Alternative complement pathway activation

A 40-year-old woman experiences shortness of breath for 2 months. CXR shows ILD. Pulmonary function?

• Normal

• Pulmonary vascular disorder

• Chest wall abnormality

• ILD

• Asthma

A 50-year-old man presents with cough and dyspnea. HRCT shows fibrosis. FEV1/FVC is normal, TLC is decreased, VC is decreased, DLCO is decreased.

• Obstructive

• Emphysema

• Mixed

• Restrictive

• Normal

A 45-year-old man with diabetes and advanced pulmonary TB, BTA (+), TCM: MTB detected, Rif R (-). Treatment options?

• 2RHZE/4HR repeat

• 6 Bdq-Lfx-Lnz-Cfz-Cs / 14 Lfx-Lnz-Cfz-Cs

• 20 Mfx-Lnz-Cfz-Cs-Dlm

• 4KTD + levofloxacin

• 4-6 Bdq-Lfx-Cfz-Hdt-Z-E-Eto / 5 Lfx-Cfz-Z-E

A 32-year-old man presents with chronic cough, chest pain, HRCT shows perilymphatic nodules, GGO. Biopsy shows non-caseating granuloma. Diagnosis?

• Pneumoconiosis

• Sarcoidosis

• IPF

• DIP

• Hypersensitivity pneumonitis

A 66-year-old man presents with dyspnea for 3 weeks, chest pain, weight loss. CXR shows homogeneous opacity. Thoracic ultrasound shows effusion. Diagnostic examination?

• Bronchoscopy

• Transthoracic biopsy

• VATS

• Pleural biopsy

• Mediastinoscopy

A 45-year-old man presents with a cough for 3 months, high IgE, eosinophils increased, provocation test positive. Immune mechanism?

• Th1 → IFN-γ

• Alveolar autoantibodies

• Th2 → IL-4, IL-5, IL-13

• Classical complement pathway

• Dysfunctional macrophages

A 65-year-old man with lung cancer presents with stridor and 70% tracheal obstruction. Management?

• Corticosteroids

• Tracheostomy

• Debulking via bronchoscopy

• Palliative radiotherapy

• Chemotherapy

A 45-year-old woman experiences shortness of breath during exercise, FEV1 improves by 8%, methacholine provocation decreases by 25%. Diagnosis?

• Normal

• Asthma

• ILD

• COPD

• Overlap

A 52-year-old man with lung cancer, EGFR wildtype, ALK (+), PD-L1 60%. Therapy?

• Osimertinib

• Alectinib

• Dacomitinib

• Atezolizumab

• Chemotherapy: Carboplatin + Pemetrexed