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Soal McQ Medis

Total questions: 54

Worksheet time: 35mins

Name
Class
Date
1.

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...

a)

CD8+ T cell activation causes alveolar cell lysis

b)

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

c)

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

d)

Eosinophil activation and histamine release (type I)

e)

Alternative complement pathway activation

2.

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

a)

Normal

b)

Pulmonary vascular disorder

c)

Chest wall abnormality

d)

ILD

e)

Asthma

3.

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

a)

Obstructive

b)

Emphysema

c)

Mixed

d)

Restrictive

e)

Normal

4.

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

a)

2RHZE/4HR repeat

b)

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

c)

20 Mfx-Lnz-Cfz-Cs-Dlm

d)

4KTD + levofloxacin

e)

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

5.

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

a)

Pneumoconiosis

b)

Sarcoidosis

c)

IPF

d)

DIP

e)

Hypersensitivity pneumonitis

6.

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

a)

Bronchoscopy

b)

Transthoracic biopsy

c)

VATS

d)

Pleural biopsy

e)

Mediastinoscopy

7.

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

a)

Th1 → IFN-γ

b)

Alveolar autoantibodies

c)

Th2 → IL-4, IL-5, IL-13

d)

Classical complement pathway

e)

Dysfunctional macrophages

8.

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

a)

Corticosteroids

b)

Tracheostomy

c)

Debulking via bronchoscopy

d)

Palliative radiotherapy

e)

Chemotherapy

9.

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

a)

Normal

b)

Asthma

c)

ILD

d)

COPD

e)

Overlap

10.

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

a)

Osimertinib

b)

Alectinib

c)

Dacomitinib

d)

Atezolizumab

e)

Chemotherapy: Carboplatin + Pemetrexed

11.

A 25-year-old man presents with progressive shortness of breath. History of TB therapy for 6 months, FB negative. Bronchoscopy shows partial obstruction. Interventional procedure?

a)

Brachytherapy

b)

Cryotherapy

c)

ND-YAG laser

d)

Fogarty balloon

e)

Endobronchial electrocautery

12.

A 45-year-old woman presents with shortness of breath. CT shows an 8 cm tumor, mediastinal lymph nodes (+), pleural effusion. IHC shows TTF1+, PD-L1 60%, EGFR mutation exon 20. Therapy?

a)

Afatinib

b)

Osimertinib

c)

Pembrolizumab

d)

Chemotherapy

e)

Alectinib

13.

A 50-year-old man presents with chronic shortness of breath, CT scan shows sarcoidosis. Pulmonary function test shows restrictive pattern. Histopathology shows non-caseating granuloma. Diagnosis?

4 lines
14.

A 50-year-old man with chronic dyspnea, CT scan shows sarcoidosis. Pulmonary function test shows restrictive pattern. Histopathology shows non-caseating granuloma. Diagnosis?

4 lines
15.

A 63-year-old man with COPD, chronic hypoxemia, SaO2 87%, very low FEV1. Long-term management?

a)

Single bronchodilator

b)

Pulmonary rehabilitation

c)

Lung volume surgery

d)

Long-term oxygen

e)

NIV

16.

A 67-year-old man with COPD, chronic dyspnea. Referred to medical rehabilitation. Main goal?

a)

Exercise tolerance

b)

Quality of life

c)

Avoid hospitalization

d)

Treat comorbidities

e)

Increase saturation

17.

Criteria for OSA according to AASM?

a)

AHI < 5

b)

AHI > 5 without symptoms

c)

Difficulty waking up

d)

AHI > 15 without symptoms

e)

Loud snoring + apnea episodes noticed by patient

18.

Gold standard examination for OSA?

a)

Polysomnography

b)

STOP-BANG

c)

CT thorax

d)

Routine blood tests

e)

Pulse oximetry

19.

Main function of T helper cells in immunity?

a)

Antibody production

b)

Secretion of cytokines activating other cells

c)

Direct killing

d)

Recruitment of leukocytes

e)

Immunosuppression

20.

Type of T cell that inhibits the immune system?

a)

CTL

b)

Th

c)

T regulator

d)

Naive T

e)

NK cell

21.

How do tumor antigens stimulate immunity?

a)

Cause inflammation

b)

Stimulate specific adaptive immunity

c)

Attack immune cells

d)

Avoid immune detection

e)

Suppress immune system

22.

A 60-year-old man with COPD, worsening FEV1, bronchodilator not helping. CT scan shows interstitial fibrosis. Most likely diagnosis?

a)

Acute interstitial pneumonia

b)

Non-specific interstitial pneumonia

c)

Respiratory bronchiolitis

d)

Sarcoidosis

e)

Usual interstitial pneumonia

23.

A 56-year-old man, dry cough, shortness of breath, exposure to bird nests. CT: ground glass, bronchiectasis, honeycombing. Diagnosis?

a)

Hypersensitivity pneumonitis

b)

Idiopathic pulmonary fibrosis

c)

Sarcoidosis

d)

Cryptogenic organizing pneumonia

e)

TB with fibrosis

24.

A 14-year-old child, history of cystic fibrosis, brownish sputum, Aspergillus test (+), CT: central bronchiectasis. Diagnosis?

a)

ABPA

b)

Invasive aspergillosis

c)

SAFS

d)

Aspergilloma

e)

Chronic cavitary pulmonary aspergillosis

25.

A 40-year-old woman, cough and shortness of breath for 3 months, joint pain, rash on cheeks, dry skin. SpO2 89%, RR 30. Diagnosis?

a)

CTD-ILD

b)

Asthma

c)

COPD

d)

Hypersensitivity pneumonitis

e)

Bronchiectasis

26.

A man experiences exacerbation of COPD, SpO2 87%, pH 7.41, PaCO2 67. Therapy?

a)

ICS-SABA

b)

CPAP

c)

Long-term oxygen

d)

NIV with high flow

e)

Nebulization LABA + LAMA

27.

A 27-year-old man HIV+, productive cough for 1 month, TCM Rif sensitive, after ARV severe dyspnea. Diagnosis?

a)

Drug-induced

b)

IRIS

c)

TB-MDR

d)

TB sarcoidosis

e)

Reactivation TB

28.

A farmer experiences fever, muscle pain, heavy breathing after 8 hours in a warehouse. Symptoms resolve the next day. Diagnosis?

4 lines
29.

Diagnosis for a patient with TB-MDR?

a)

IRIS

b)

TB-MDR

c)

TB sarkoidosis

d)

Reaktivasi TB

30.

Diagnosis for a farmer with fever, muscle pain, and heavy breathing after 8 hours in a warehouse?

a)

ILD

b)

Asthma alergi

c)

Hypersensitivity pneumonitis akut

d)

Bronkitis

e)

Pneumonia komunitas

31.

Diagnosis for a 44-year-old woman with progressive dyspnea and bilateral micronodular nodules on CT?

a)

Sarkoidosis

b)

Histoplasmosis

c)

Langerhans cell histiocytosis

d)

TB

e)

Hypersensitivity pneumonitis

32.

What is the side effect of long-term TB RO treatment with Hb 6 gr/dL, thrombocytopenia, and leukopenia?

a)

Clofazimine

b)

Cycloserine

c)

Bedaquiline

d)

Linezolid

e)

Levofloxacin

33.

What is the next therapy for a TB RO patient who stopped treatment for 1 month and wants to continue?

a)

Repeat initial regimen

b)

Culture examination

c)

Repeat with a new regimen

d)

Continue initial regimen

e)

Evaluate first

34.

Regimen for a 33-year-old woman with TB RO who stopped treatment during pregnancy due to jaundice?

a)

6 Bdq-Lfx-Cfz-Cs-E / 12 Lfx-Cfz-Cs-E

b)

6 Bdq-Lfx-Lzd-Cfz-Cs / 12 Lfx-Lzd-Cfz-Cs

c)

6 Bdq-Mfx-Lzd-Cfz-Cs / 12 Mfx-Lzd-Cfz-Cs

d)

4-6 Bdq6-Lfx-Eto-Ht-E-Z-Cfz / 5 Lfx-E-Z-Cfz

e)

6 Bdq-Lfx-Cfz-Cs-E-Z / 12 Lfx-Cfz-Cs

35.

Considerations for pre-flight screening for a 68-year-old man with COPD GOLD C?

a)

Number and duration of flights

b)

Air quality in the plane

c)

Length of stay in the destination city

d)

Portable oxygen

e)

Flight altitude

36.

Initial therapy for a 19-year-old man with dyspnea and decreased consciousness after climbing?

a)

Oxygen + methylprednisolone

b)

Oxygen + broad-spectrum antibiotics

c)

Oxygen + ICS-SABA

d)

Oxygen + nifedipine

e)

Oxygen + diuretics

37.

Which lung disorder caused by electronic cigarettes is not included?

a)

Sarcoidosis

b)

EVALI

c)

Eosinophilic pneumonia

d)

Respiratory bronchiolitis

e)

Alveolar hemorrhage

38.

What is the most efficient minimal dose regimen for latent TB treatment currently?

a)

6H 180 doses

b)

3HR 84 doses

c)

3HP 12 doses

d)

3HP 84 doses

e)

6H 168 doses

39.

What therapy for a woman with HIV+ and TB lung, OAT category 1 month 5, BTA (+), TCM: MTB detected, Rif sensitive, DST: monoresistant INH?

a)

Repeat 2RHZE/4HR

b)

Add levofloxacin

c)

6 Bdq-Lfx-Lzd-Cfz-Cs / 14 Lfx-Lzd-Cfz-Cs

d)

20 Mfx-Lzd-Cfz-Cs-Dlm

e)

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

40.

What is the cause of gynecomastia and impotence in a TB RO patient on a 9-month regimen?

a)

Levofloxacin

b)

Ethionamide

c)

Clofazimine

d)

Ethambutol

e)

Bedaquiline

41.

Diagnosis for a 50-year-old patient with pulmonary fibrosis and milky white pleural fluid?

a)

Empyema

b)

Chylothorax

c)

TB pleuritis

d)

Pseudochylothorax

e)

Parapneumonic effusion

42.

Pleura putih susu. pH 8, TG 40, kolesterol 220. Diagnosis?

a)

Empyema

b)

Kilotoraks

c)

Pleuritis TB

d)

Pseudokilotoraks

e)

Efusi parapneumonik

43.

Pria HIV+, demam, sesak, batuk, X-ray infiltrat bilateral, uji Galaktomanan dipilih karena...?

a)

Lebih spesifik dari BDG

b)

Akurat pada pasien PPOK

c)

Satu-satunya biomarker pada pasien transplantasi

d)

Akurat untuk infeksi kulit

e)

Untuk skrining asimtomatik

44.

Pria 68 tahun, bronkiektasis kronik, CT: tree-in-bud, kultur: MAC. Terapi awal?

a)

Azithromycin, ethambutol, rifampin

b)

Clarithromycin, levofloxacin, ethambutol

c)

Rifampin, isoniazid, pyrazinamid

d)

Doxycycline, amoxicillin, clavulanate

e)

Ciprofloxacin, ethambutol, rifampin

45.

Pasien kanker paru minum afatinib, diare hebat, dehidrasi. AGD: pH 7.30, paCO2 36 mmHg, HCO3 18 mEq/L. Gangguan?

a)

Alkalosis metabolik

b)

Asidosis respiratorik

c)

Asidosis metabolik

d)

Alkalosis respiratorik

e)

Normal

46.

Mahasiswa kedokteran melakukan hiperventilasi. Apa yang terjadi pada PO₂ alveolar?

a)

Naik 35 mmHg

b)

Naik 30 mmHg

c)

Naik 40 mmHg

d)

Naik 25 mmHg

e)

Naik 20 mmHg

47.

Pernyataan benar terkait tahanan saluran napas?

a)

Tertinggi di bronkiolus distal

b)

Tidak berubah saat napas paksa

c)

Berbanding terbalik dengan radius

d)

Naik saat bernapas lewat mulut

e)

Tidak dipengaruhi radius

48.

Kapiler paru mengandung enzim yang...?

a)

Memecah bradikinin

b)

Mengubah angiotensin I menjadi II

c)

Menurunkan NO

d)

Meningkatkan adrenalin

e)

Menyimpan histamin

49.

Pasien overdosis heroin. AGD paling mungkin?

a)

Respiratory alkalosis

b)

Metabolic alkalosis

c)

Respiratory acidosis

d)

Metabolic acidosis

e)

Normal

50.

Seorang pria 26 tahun sesak setelah lari, FEV1 turun 15% setelah uji provokasi. Terapi paling sesuai?

a)

ICS sebelum olahraga

b)

SABA sebelum olahraga

c)

LTRA harian

d)

LABA harian

e)

Antikolinergik inhalasi

51.

Pasien sesak, batuk, dan berat badan turun. CT: honeycombing. Pekerjaan: tukang cat. Diagnosis?

a)

IPF

b)

Hypersensitivity pneumonitis

c)

Sarcoidosis

d)

COPD

e)

ABPA

52.

Seorang pria HIV, BTA (+), tidak vaksin BCG, TST 12 mm, IGRA dilakukan. Perbedaan utama TST vs IGRA?

a)

IGRA deteksi antibodi

b)

IGRA deteksi DNA

c)

TST reaksi tipe IV, IGRA deteksi IFN-γ

d)

TST tipe I, IGRA deteksi sitokin

e)

TST ukur antibodi

53.

Pasien PPOK, sudah vaksin PCV13. Vaksin lanjutan?

a)

PCV20

b)

Tdap

c)

PPV23

d)

Hib

e)

Tidak perlu

54.

Skor ACT pasien asma = 23. Mana yang bukan bagian dari proses sensitisasi?

a)

Ekspansi CD4 Th2

b)

Mast cell degranulasi

c)

IgE menempel FcεR

d)

Antigen langsung ikat IgE

e)

Dendritik presentasikan antigen

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