MDE HIS 2010

1. the special type of lymphatic

capillaries in the small intestine are
called?
a. lacteals
b. rugae
c. pylorus
d. fundus
e. corpus
2. tempat maturasi T-cell?
thymus

4. thymus produces hormones that

stimulate lymphocyte maturation.. what
is the hormone?
a. oxytocine
b. thymocyine
c. calcitonine
d. progesterone
e. esterogen
5. jalur lymphatic vessels
a. afferent-sinus-efferent
9. Which of the following is the most
presence in SLE ?
A. hyperreactivity B cell
B. hyperreactivity T cell
C. hyperreactivity B and T cell
D. hyperreactivity stem cell
E. hyperreactivity thrombocyte
10. WOTF most likely cause of SLE?
a. complement fixation factor
b. anti DNA ab factor
c. immune complex factor
d. autoantibody factor
e. coagulation factor
12.part of immunoglobulin molecule that
bind to its antigen is called region (VH &
VL) because it has a variability in its:
a. molecular weight
b. amino acid sequence
c. (ga jelas tulisannya)
d. number of polymeration
e. antigen recognition ability
for number 13-17

a. G6PD
b. Methemoglobin reductase
c. ALA synthase
d. Phosphoglycerate mutase
e. NADH oxidase
13. deficiency of this enzyme reduce
NADPH level inside RBC causing
hemolytic anemia A
14. deficiency this enzyme will maintain
heme FE in that reducing from fe2+ B
15. product of their enzyme is important
in regularly that binding of O2 to Hb
16. this enzyme is the key to regulating
enzyme in controlling heme biosynthesis
C
17. this enzyme plays a key role in
producing potent microbial agent inside
active leukocyte
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?
a. sodium citrate
b. sodium oxalate
c. sodium heparin
d. .heparin
e. EDTA
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?
a. bleeding time
b. clotting time
c. rumple leede test
d. substitution test
e. platelet aggregation test
22. A 5 y.o. boy,epistaxis,prolonged
aPTT,yang lain normal. Ada history pada
male family member. What is the
diagnosis? HEMOFILI
23. tujuan torniquete test?
a. ability of capillary to resist
pressure
b. ability of platelet to resist pressure

c. ability of capillary to resist heat

d. ability of platelet to resist heat
e. ability of platelet and capillary to
resist pressure
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?
a. plasma potassium naik
b. plasma sodium naik
c. plasma Hb turun
d. 2,3 DPG naik
e. pH naik
25. WBC = 15.000, apa itu?
a. leukocytosis
b. leucopenia
26. bagaimana rumus mencari MCV?
27. jika kadar Hb = 10, Ht = 31%, maka
berapa nilai MCHC?
hypochromic microcytic Hb: low, MCV:
67 fL, possible morphology RBC 28.
Marys CBC
29. a 5 year, fever, red dots on his
extremities. Platelet count 50.000. term?
a. thrombocytopenia
b. thrombocytosis
c. thromboasthenia
d. thrombopathia
e. thrombosis
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
a. normocytic-normochromic anemia
b. microcytic-normochromic anemia
c.microcytic-hypochromic anemia
d. normocytic-hypochromic anemia
e. macrocytic-normochromic anemia
32. , , RBC fever, mild sore throat,
easy bruising, gingival bleeding. Hb , diff

count: blast: 73%, promyelocyte: 10%,

myelocyte: 10%,, WBC PLT lymphocyte:
7%. Diagnosis?
a. AML
b. acute myelomonoblastic leukemia
c. ALL
d. CML
e. CLL
33. anak 7 thn, lymphadenopathy,
spleenomegaly. Blast 78%, neutrofil 3%,
limfosit 24%. Diagnosis?
a. AML
b. ALL
c. CLL
d. CML
e. burkitts lymphoma
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?
a. superantigen activation of CD4+ T
cells
b. CD8+ cell mediated cytolysis of
keratinocyte in the skin
c. CD4+ cell mediated delayed type
hypersensitivity to poison ivy
d. complement activation by antibodyantigen immune complex in the skin
e. activation of IgE coated mast cell
induce release of histamine
37. increased HbA2 found in..
a. IDA
b. sideroblastic
c. megaloblastic
d. aplastic
e. thalasemia
39. in hemolytic anemia, there will be?
40. in aplastic anemia you will find:
a. pancytopenia
b. polychromasia
c. poikylocytosis
d. anisocytosis
e. normoblastosis

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:
Hb :13.2 g/dl (N:12-16)
RBC : 4.52 million/mm3 (N :3.8-5.2
million/mm3)
PCV : 38.2% (N:36-46)
Platelet : 10.000 (N: 150000-440000)
WBC : 5300 (N:4000-11000)
MCV 82.30 (N: 80-100)
MCH : 29.7 pg/dl (N: 26-34)
MCHC : 35.9% (N 31-37%)
Diff count : PMN: 47%, lymphocyte :
39%, monocyte :14%
Result of blood smear exam:
RBC morphology : normocytic,
normochromic
WBC morphology : within normal limit
PLT morphology : appear increased in
size
Result of coagulation test
APTT : 24.8 sec (N: 23-34)
TT : 15.8 sec (N: 13-18)
What is the most likely diagnosis?
a. Secondary thrombocytopenia
b. Thrombotic thrombocytopenic purpura
c. Dengue hemorrhagic fever
d. Immune thrombocytopenic purpura
e. Drug induce thrombocytopenia
42. which PE result is causing a blood
donor rejection?
a. weight of 55 kg
b. pulse of 75 bpm
c. temperature of 36.50 C
d. diastolic pressure of 110 mmHg
e. Hb of 13.5 g/dl
43. what would be result of group A
blood given to a group O patient?
a. non immune transfusion reaction
b. immediate hemolytic transfusion
reaction
c. delayed hemolytic transfusion reaction
d. immediate non immune transfusion
reaction
e. delayed non immune transfusion
reaction

44. a patient with present a platelet

count of 350 x 10?./L and bleeding time
of 12 minutes. These result most
probably suggest:
a. decreased platelet production
b. defective platelet function
c. increased platelet production
d. increased platelet destructive
e. decreased platelet destructive
45. neutrophilic granulocyte
development occurs in bone marrow.
Which is the following stages
development of that cell?
a. promyelocyte, myeloblast, myelocyte,
metamyelocyte, band, and segmented
neutrophils
b. myeloblast, promyelocyte, myelocyte,
metamyelocyte, band, and segmented
neutrophils
c. myeloblast, myelocyte,
promyelocyte,metamyelocyte, band, and
segmented neutrophils
d. myeloblast, promyelocyte,
metamyelocyte,myelocyte, band, and
segmented neutrophils
e. segmented neutrophils, band,
metamyelocyte, promyelocyte,
myelocyte, and myeloblast,
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?
a. Hb, Leukocyte, platelet
b. Hb, Leukocyte, Differential counting
c. leukocyte, platelet, and differential
counting
d. leukocyte, erythrocyte, platelet
e. Hb, leukocyte, erythrocyte
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.

What is the most possible diagnosis in
this case?
a. Acute lymphoblastic leukemia
b. Chronic lymphoblastic leukemia
c. Acute lymphocytic leukemia
d. Acute myeloblastic leukemia
e. Acute myelocytic leukemia
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?
a. IgA
b. IgD
c. IgE
d. IgM
e. IgG
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?
a. face, especially cheeks
b. scalp
c. diaper area
d. extensor area of the extremities
e. flexural fold of the extremities
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?
a. intra epidermal blister
b. sub epidermal blister
c. infrabasal blister
d. infradermal blister
e. intradermal blister

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?
a. type I hypersensitivity
b. type II hypersensitivity
c. type III hypersensitivity
d. type IV hypersensitivity
e. autoimmunity
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?
a. urinalisis: bilirubin (+)
b. Hb : 16 gr/dl
c. SGOT/SGPT 50/60
d. leukosit 2000/mm3
e. urinalysis: urobilinogen (+)
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?
a. exenthematous eruption
b. pustular eruption
c. fixed drug eruption
d. bulous eruption
e. drug induced lichenoid
57. most important cell in
hypersensitivity type IV?
TEN58. 24 y.o. man complain : crust,
hyperemic nasal mucus.. total body
surface affected 35%. What is the
diagnose?

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?
a. contact urticaria
b. irritant contact dermatitis
c. atopic dermatitis
d. allergic contact dermatitis
e. seborrheic dermatitis
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?
a. sebrrhoic dermatitis
b. nummular dermatitis
c. acrodermatitis
d. atopic dermatitis
e. stasis dermatitis
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?
a. liver
b. spleen
c. palatine tonsil
d. thymus gland
e. payer patche
64. a developing erythrocyte +
neutrophil in RBM may be differentiated
from one another by presence of:
a. golgi apparatus
b. granule
c. mitochondria
d. peroxisome
e. RER

66. antigen specific binding that occurs

in graft rejection as result from..
a. T-Cell
b. plasma cell
c. monocyte
d..
e.
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?
a.iron deficiency anemia
b. hemolytic anemia
c. aplastic anemia
d. pernicious anemia
e. sideroblastic anemia
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?
a. myelofibrosis with myeloid metaplasia
b. chronic granulocytic leukemia
c. lymphocytic chronic leukemia
d. polycytemia vera rubra
e. multiple myeloma
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?
a. elimination the cause
b. avoid certain diet
c. while blood transfusion
d. vitamin supplementation
e. hematinic agent therapy
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?
a. chest X-ray
b. lymph node biopsy
c. abdominal CT scan
d. neck ultrasonography
e. peripheral blood smear
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 patients
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?
a. moist hand
b. brittle hair
c. clubbing finger
d. hepatomegaly
e. splenomegaly
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?
a. VDRL

b. anti nuclear antibody

c. Rheumatoid factor
d. Anti ds-DNA
e. Anti ss-DNA
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?
a. quantitative platelet disorder
b. qualitative platelet disorder
c. coagulation disorder
d. thrombosis disorder
e. vascular disorder
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?
a. liver enzyme level
b. creatinine level
c. LDH level
d. uric acid level
e. Hb level
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?
a. pathology findings like with IgA
dermatitis
b. microscopically: there is basal cell
vacuolization but without lymphocyte
infiltration
c. immunofluoresence studies no
granular band of immunoglobulin and
complements
d. microscopically there are epidermis
atrophy with hydrophic generation
e. hyperkeratosis and parakeratosis
usually can fined in the microscopic
findings
for question 76 to 77, refer to scenario
below:
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
76. if his bone marrow smear shows
cellular hypoplasia, which of the
following is the most likely to predict the
prognosis of his disease?
a. Hb
b. Ht
c. RBC count
d. WBC count
e. PLT count
77. if his bone marrow smear shows
cellular hypoplasia and he needs blood
transfusion, what kind of transfusion
would you give to this patient?
a. fresh whole blood
b. packed red cell

c. washed red cell

d. platelet concentrate
e. fresh frozen plasma
for question number 78-79, refer to
scenario below:
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
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?
a. acute myeloblastic leukemia- M0
b. acute myeloblastic leukemia- M1
c. acute myeloblastic leukemia- M2
d. acute myeloblastic leukemia- M3
e. acute myeloblastic leukemia- M4
79. what is the next appropriate step in
making diagnosis?
a. cytochemistry
b. cytogenetic
c. immunophenotyping
d. absolute values
e. peripheral smear
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?
a. Hepatitis C virus
b. Hepatitis B virus
c. Ebstein Barr virus
d. Human papiloma virus
e. HTLV-1
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?
a. intracranial bleeding
b. DIC
c. Gastrointestinal bleeding
d. menomethorrhargi
e. joint bleeding
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?
a. blood transfusion
b. splenectomy
c. corticosteroid
d. immunoglobulin
e. radiotherapy
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?
a. antibiotic
b. cytostatic
c. tuberculostatic
d. operation
e. radiation
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?
a. vascular disorder
b. thrombosis disorder
c. coagulation disorder
d. qualitative platelet disorder
e. quantitative platelet disorder
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:
a. Erythropoietic hypoplasia
b. granulopoietic hypoplasia
c. thrombopoietic hypoplasia
d. giant stab cell
e. giant platelet
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:
a. chronic myelocytic leukemia
b. chronic lymphocytic leukemia
c. multiple myeloma
d. myelofibrosis
e. leukemoid reaction
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?
a. curable with radiotherapy
b. curable with chemotherapy
c. curable with chemoradiation
d. curable with immunotherapy
e. curable with antibiotics
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?
a. conjunctivitis
b. gingivitis
c. arthrititis
d. stomatitis
e. glossitis
89. which statement is true for arterial
thrombosis?
a. long term use if oral contraceptive pill
b. stasis in blood vessel
c. begin with endothelial injury
d. deficiency of natural inhibitor is the
basic process
e. deficiency of plasminogen activator
inhibitor I (PAI-1)
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 50kg) over
6 months interval. PE : bilateral
supraclavicularloss (60kg 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?
a. inflammation
b. infection
c. metastases malignancy
d. lymphnode malignancy
e. autoimmune

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?
a. non hodgkins malignant lymphoma
stadium II
b. non hodgkins malignant lymphoma
stadium III
c. hodgkins lymphoma stadium, stadium
III
d. hodgkins lymphoma stadium II
e. non hodgkins malignant lymphoma
stadium IV
96.gen untuk replikasi HIV?
a. gp120
b. tat
c. gp41
d. p11
104. the highest concentration of
immunoglobulin that secreted by gut
a. IgG
b. IgA
c. IgM
d. IgD
e. IgE
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?
a. intradermal test
b. patch test
c. prick test
d. radioallergosorbent test
e. skin end point titration test
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?
a. fungal rhinitis
b. allergic rhinitis
c. vasomotor rhinitis

d. occupational rhinitis
e. medicamentosa rhinitis
111.which Ig that has a role in allergic
rhinitis?
a. IgG
b. IgA
c. IgD
d. IgE
e. IgM
112. seorang wanita 24 tahun, hamil 32
minggu datang ke klinik alergi chief
runny nose dan nasal stiffing. PE:
enlarge inferiorcomplaint turbinate,
watery mucous, ada latar belakang
keluarga alergi dan asma. Which of the
following substance beside histamine
that make nasal problem?
a. bradikinin
b. esterogen
c. leukotrien
d. prostaglandin
e. progesterone
113. 90% of ATP needed by RBC is
generated by :
A. Hexose monophospate shunt
B. Krebs cycle
C. Leukering-rappaport pathway
D. Embden-meyerhof glycolytic pathway
E. MetHb reductase pathway
115. the clinical manifestation that
distinguish pernicious anemia from folic
acid anemia with the presence of..
a. neurologic abnormalities
b. fatigue
c. weakness
d. shortness of bresth
e. slight jaundice
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?
a. 0,18 ml 1:1000
b. 0,36 ml 1:1000
c. 3,6 ml 1:1000
d. 0,18 ml 1:1000

e. 0,36 ml 1:1000
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?
a. glucocorticoid
b. NSAID
c. Cyclosporin
d. immunoglobulin
e. cyclosulphate
angioedema dan gatal2. Obat yang
cocok?119. anak kecil, habis makan
shrimp
antihistamine
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?
a. type I
b. type II
c. type III
d. type IV
e. type I-IV
122. kinds of urticaria that immediately
appear after vigorous swimming at
seawater in the beach, at high noon on
hot summer day, except:
a. heat urticaria
b. solar urticaria
c. cholinergic urticaria
d. psychogenic urticaria
e. aquagenic urticaria
123. lymphoid organ yang
perkembangannya tidak dipengaruhi
antigen
a. spleen
b. thymus
c. bone marrow
d. bursa equivalent
e. yolk sac
124. in which hypersensitivity

determination plasma/serum tryptase is

helpful?
a. DD IgE mediated and non IgE
mediated type I
b. diagnose type I hypersensitivity
c. diagnose type II hypersensitivity
d. diagnose type III hypersensitivity
e. diagnose type IV hypersensitivity
125. which of the following antibody,
involve in atopic disease?
ans: IgE
126. 12 y.o. boy follow skin prick test.
The purpose of the test is to identified.
a. IgE mediated type I hypersensitivity
b. non IgE mediated type I
hypersensitivity
c. IgE & non IgE type I hypersensitivity
d. type II hypersensitivity
e. type III hypersensitivity
128. diagnosis thalasemia trait is
frequently misdiagnosed with
a. IDA
b. aplsatic anemia
c. megaloblastic anemia
d. autoimmune hemolytic anemia
e. sideroblastic anemia

e. IgM
133. characteristic of cutaneous lesion of
NLE:
a. facial
b. acral
c. extensor
d. diffuse
e. photo distribution
138. which of the following clinical
manifestation is permanent in NLE?
a. congenital heart block
b. cutaneous lesion
c. pulmonary involvement
d. neurology involvement
e. thrombocytopenia
142. appropriate treatment for IDA
a. blood transfusion
b. multivitamin intake
c. oral ferrous sulfate
d. intramuscular iron dextrant
e. an iron fortified cereal

129. what is the right indicating to do

ceasarian section operation in HIV
pregnant mother?
e. transversal transmission preventing

146. WOTF agent would be the most

likely to dampen the immune response
in organ transplantation and
autoimmune disease
a. levimasole
b. thalidomide
c. serolimus
d. IFN
e. IL-2

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..
a. anti HIV-1
b. HIV p-24
c. HIV RNA
d. HIV DNA
e. culture

154. WOTF is the site of action of

corticosteroid in allergic reaction?
a.
b. inhibiting IgE class switching on
plasma cells
c. inhibiting interaction on mast cell
d. inhibiting phospolipase-A2 liberated
arachidonic acid
e. inhibiting leukotriene binding its
receptor on eosinophils

132. antibody yang dapat ditransfer dari

ibu ke janin melalui transplacental?
a. IgE
b. IgA
c. IgG
d. IgD

156. drugs that need intrinsic factor for

its absorption?
a. pyridoxine
b. folic acid
c. cyanocobalamine
d. riboflavin

e. Iron
158. moleku yang membantu absorbs
non heme Fe..
a. vit C
b. vit B12
c. Vit B6
d. Vit D
e. Vit A
159. which of the following drug yang
punya efek ke numbness and weakness?
a. vit b12
b.
c. pyridoxine
d.
e..
163. which of the following statement is
correct about phenothiazine?
a. produce marked sedation
b. produce marked adverse GI bleeding
c. may cause increase appetite weight
gain
d. also act as antitussive
e. only marketed as sleeping aid
164. which of the following statement is
regarding the effect of H1 receptor
antagonist is true?
a. poor absorbed after oral
administration
b. have limited use in allergic
bronchospasm
c. all have muscarinic-cholinergic
antagonis activity
d. not induce microsomal enzymes
e. cause increase in appetite
165. Mengenai alegy dan
hypersensitivity
a. delayed reaction occurs in asthma
b. histamine play role in bronchospasm
c. hay fever, other than histamine lead
to nose irritation
d. red flare and hives in urticaria karena
mixture toxic leukotrient
e. anaphylaxis : localized reaction in
vascular system
166. girl 5 y.o., chief complaint rash di
trunk dan extremities, easy brushing, no

fever, no history bleeding, PE no

splenomegaly. Lab : normal, platelet
15.000. treatment for this patient?
Hb,Hct, WBC
a.
b.
c. suspension for thrombocyte
d.
e.
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..
a. factor I deficiency
b. factor V deficiency
c. factor VII deficiency
d. factor VIII deficiency
e. factor XIII deficiency
170. . Neurological examination
show tetraparesis, stocking glove
paresethesia and decreased physiologic
reflex. Lumbar puncture is done. What is
the result?
a. increased glucose with normal cell
b. increased glucose with increased
protein
c. decreased protein with normal cell
d. decreased protein with decreased
glucose
e. decreased protein with increased
glucose
171. which is the most possible cause of
this case
a. H.influenza
b. campylobacter jejuni
c. CMV
d. salmonella thypii
e. Herpes zoster
174. which of the following has been the
mainstay treatment for this patient (SJS)
a. glucocorticoid
b. NSAID
c. cyclosporine

d. immunoglobulin
e. cyclophospamide
177. red eye, pain, easy tearing.
Peripheral corneal ulcer. Treatment..
a. oral antibiotic
b. anti fungal
c. topical corticosteroid
d.antihistamin
e. topical antibiotic
179. male, 50 y.o. chief complain red
eye,pain, excessive tearing, objective
exam : peripheral corneal ulcer. Main
treatment?
A. oral antibiotic
B. antifungal
C. topical corticosteroid
D. antihistamine
E. topical antibiotic
184. immunoglobulin paling terpengaruh
untuk melindungi tubuh seperti
contohnya toxic infection : dipteri?
A .IgG
b. IgM
c. IgA
d. IgD
e. IgE
189. 54 y.o. woman terkena rhinitis. Dia
menggunakan nasal spray. Obat tersebut
dapat menyebabkan apa?
a.
b. rebound phenomenon
c. mulberry rhinitis
d.
e.

MDE HIS 2009

1. Lymph vessel in small intestines
a. Lacteal
b. Rugae
c. Pylorus
d. Corpus
e. Fundus

199. bleeding time which of the following

option is markedly prolonged?
a. VIII deficiency
b. Taking high dose of aspirin
c. malabsorption of vit.k
d. abnormal liver function
e. .

Jawab : A
Alasan : Specialized lymphatic vessels in
the intestinal villi (tiny projections of the
mucous membrane) that absorb fat are
called lacteals (Moore hlm 265)
3. Largest lymphatic organ in body?
a. Gallbladder
b. Pancreas

c. Spleen

Alasan : Megaloblastic anemia is a

subgroup
of
macrocytic
anaemia
characterized by defective nuclear
maturation caused by impaired DNA
synthesis (Harmening hlm 112)

d. Tonsils
e. Liver

13. Hb, WBC, Ht, Platelet, RBC increase.

Diagnosis?

Jawab : C
Alasan : As the largest of the lymphatic
organs, it (spleen) participates in the
body's defense system as a site of
lymphocyte
(white
blood
cell)
proliferation and of immune surveillance
and response (Moore hlm 281)
9. 45 y.o., pallor, fatigue, pancytopenia,
blood smear?
a. Erythrocyte normocytic normochromic
b. Erythrocyte microcytic normochromic
c. Leucocyte shift to the left
d. Myeloblast
e. Megakaryoblast
Jawab : A
Alasan : Kemungkinan diagnosis dengan
SS di atas adalah aplastic anemia,
dengan
ciri
RBC
normocytic
normochromic (Harmening hlm 133)
10. Pathogenesis megaloblastic anemia?
a. Abnormal
maturation

nuclear

&

cytoplasm

b. Defective DNA synthesis & nuclear

maturation
c. Defective RNA synthesis & nuclear
maturation
d. Defective RNA synthesis & cytoplasm
maturation
e. Defective DNA synthesis & cytoplasm
maturation
Jawab : B

Jawab : polycythemia vera

Alasan : Polycythemia vera (PV), also
commonly called polycythemia rubra
vera,
is
a
chronic,
clonal,
myeloproliferative disorder characterized
by a striking, absolute increase in the
number of red blood corpuscles and in
the total blood volume, and usually by
leukocytosis,
thrombocytosis,
and
splenomegaly. The bone marrow is
typically hypercellular and exhibits
hyperplasia of myeloid, erythroid, and
megakaryocyte lineages. (Wintrobe hlm
1822)
15.A.untuk melihat dari et causa secara
tepat dari penyebab lymphadenopathy,
jika optionnya demikian maka pilihan
kita adalah lymphnode biopsy. (Note:
sebenarnya apabila dicurigai dari CA
paru, maka dengan X-Ray juga bisa
mendukung diagnose, lymphadenopathy
sebagai akibat metastase s el CA)
18. E. dengan hasil pemeriksaan lab
yang menunjukan low count of
thrombocyte, maka sudah jelas bahwa
ini gangguan dikarenakan jumlah
platelet
a. fibrinolytic disorder related terhadap
pembentukan thrombus
b, biasanya tidak berasosiasi dengan
gannguan pada platelet secara kualitatif
dan kuantitatif
c.jawaban tidak spesifik
d. ditandai dengan normal-slight low
pada jumlah platelet, tapi terdapat
gannguan dari fungsi platelet (biasanya
dapat dibuktikan dengan pemeriksaan
protein assay atau periksa lab untuk
mengetahui underlying disease atau
related-disease circulating agents )

21. D. cryoprecipitates. Ada di

harmening hal 497

27. What is normal

cytoplasma in RBC?

24. C. maksud dari soal sepertinya

urutan organ yang terlibat dalam
hematopoiesis

A. Decrease in basophilic colour

Yolk sac (1st week 8th week of fetal life)

liver/spleen (2nd months-9th months)
bone marrow (shifting ketika 7th month
dan seterusnya jadi major site of
hematopoiesis)

C. Decrease in nucleoli

25. A. Yolk Sac. Lihat penjelasan di atas

(Harmening hal 9)
26.
WOTF
characteristic
of
erythropoietin?
A. Cannot cross placental barrier
B. Of chromosome 11
C. Adult, secretion in liver most
D. Unborn, secretion in liver most
Jawaban : A.(?)

maturation

of

B. Decrease in granules

D. Increase in azurophilic granules

E. Increase in chromatin
Jawaban : A.
Pembahasan :
RBC yang normal warnanya semakin
pink (decrease in basophilic colour),
tidak
mempunyai
nucleus
(juga
nucleolus & chromatin di dalamnya),
tidak mempunyai ganules. (Harmening,
tabel 1-6, hlm13)

Pembahasan :

28. For reticulocyte count measurement,

staining should be done?

EPO adalah hormon yang dihasilkan di

ginjal
yang
membantu
proses
erythropoiesis.

A. Giemsa staining

Hybridization analysis of DNA from

human chromosomes isolated by high
resolution dual laser sorting provides
evidence that the gene for human
erythropoietin is located on human
chromosome 7. (internet)
These results demonstrate that EPO
does not cross the placenta into the
fetus
even
under
conditions
of
chronically elevated maternal EPO levels,
and suggest that red cell production in
the fetus is regulated by EPO produced
from sites within the fetus. (internet)
There is no transport of erythropoietin
across fetal membranes. This finding is
particularly remarkable in view of results
published
recently
indicating
the
placenta as a site of erythropoietin
production. The lack of its transport
across the human placenta is most likely
due to its high molecular weight.
(internet)

B. Brilliant cresyl blue staining

C. Wright stain
D. Myeloperoxidase stain
E. Sudan black B stain
Jawaban : B. (?)
Pembahasan :
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)
Cytoplasm
of
reticulocytes
stains
slightly basophilic with Wright's stain.
However, when stained with a supravitalstain such as new methylene blue or
brilliant
cresyl
blue,
precipitated
ribrosomal RNA (reticulum) can be
demonstrated within the cell. (internet)

30. Largest cell in bone marrow : 30-300

m.
Nucleus
shape
:
lobular,
cytoplasma : pale blue (white pink cast).
Numerous azurophilic granules. What
cell?

CT waktu yang dibutuhkan oleh darah

untuk membentuk benang-benang fibrin.
APTT

screening
test
mengevaluasi
coagulation
(intrinsic & common pathway)

untuk
factor

A. Normoblast
B. Myeloblast
C. Lymphoblast
D. Pronormoblast
E. Megakaryocyte
Jawaban : E.
Pembahasan :
Megakaryocyte berukuran besar (30-100
m), nucleus berlobus, chromatin bergranular, cytoplasm pale blue with pink
cast, numerous fine azurophilic granules.
(Harmening, tabel 1-13, hlm27)
35. Boy 12 y.o. dibawa ibunya ke ER,
chief complaint hemarthrosis di lutut.
Riwayat pendarahan di anggota keluarga
laki-laki. What is the appearance in lab
result?
A. CT normal, BT normal
B. PT normal, APTT normal
C. BT prolong, CT normal
D. PT prolong, APTT normal
E. PT normal, APTT prolong
Jawaban : A. (?)
Pembahasan :
Spontaneous
hemarthrosis
and
hematomas of deep structures are
typical features of coagulation protein
deficiency states and not platelet /
vascular defects. (Harmening, hlm 471).
BT waktu yang dibutuhkan agar luka
pada
kulit
berhenti
berdarah,
mengeveluasi jumlah / fungsi platelet.

PT screening test untuk mengevaluasi

coagulation factor (extrinsic & common
pathway)
38. B. Pasien ini punya (+) family history
of pulmonary emboli->thrombosis. PT
normal (tidak ada masalah pada
extrinsic pathway). ACA increased.
Pasien ini terkena APS (1clinical
criteria+1lab criteria)
39.C. hemarthrosis->gangguan pada
coagulation factor.BT decreased (2.5-9.5
min). aPTT decreased.
40.A. karakteristik B&C adalah utk lymph
node. Untuk tonsil karena ada crypt
sehingga dia tidak totally encapsulated
(seharusnya partially encapsulated) dan
secara histology adalah simple stratified
epithelium
41.E.Pasien kita ada sensasi gatal, runny
nose, allergen : debu, IgE increased.
42.B.jelas.
43. cytokine? Histamine
*soalnya ga jelas
44. WOTF major substance is the most
suitable H-1 antihistamine to treat this
patient?
a. Cetrizine
b. Chlorpheniramine
c. Promethazone
d. Tripelonnamine
e. Diphenylamine
jawaban: A. Cetrize
Cetirizine adalah metabolit aktif dari
hidroksizin dengan kerja kuat dan

panjang.
Merupakan antihistamin selektif,
antagonis reseptor H1 periferal dengan
efek sedative yang rendah pada dosis
aktif farmakologi dan mempunyai sifat
tambahan sebagai anti alergi.
Cetirizine menghambat pelepasan
histamin pada fase awal dan mengurangi
migrasi sel inflamasi.
45. 70 y old with runny nose,since
10 y old,nasal
blockage,sneezing,dll,what
appropriate diagnostic tool?
a. Nasal endoscopy
b. Rhinoscopy
c. Nasal cyt
d. Total IgE
e. Skin prick test
jawaban: D
49. What aeroallergens highly involved
in case above?

pencegahan adalah treatment jangka

panjang terbaik untuk therapy allergy
51)answer : A
Explanation : sign & symptoms
semuanya mengarah pada allergic
contact dermatitisIgEtype 1
hypersensitivity (more about allergic
rhinitis??find it in Lange,10th ed,pg 356)
52)answer : A
Explanation : histaminerelease by mast
cell,one of it action-smooth muscle
contraction
(further reading in chapter 13,lange,ed
10th ed,pg 194)
53)answer : characteristics of allergic
rhinitis??

a. Latex
Explanation : lange,10th ed,pg 356
b. Pollen

e. Human dander

*immunology,immunopathology &
immunity,5th ed,steward sell,pg 403 exam : may reveal a transverse wrinkle
across the middle of the nose caused by
allergic salute.there is edema of
submucosal tissue with an infiltration of
eosinophils that is reversible.

jawaban: B.Pollen

54)answer :

50. 35 y old woman runny nose since 20

y ago,accompany with stiffy nose,nasal
itchness,sneezing,after dust exposure.
Symptomps felt for 5 days a week
especially in the morning and before
bedtime,difficult to
concentrate,fatigue,sleeping
disturbance. PE: bluish hue under the
eyes,turbinate enlarge,pale bluish
mucosal,IgE 1000. Long life therapy?

56)answer : A

c. Dust mite
d. animal dander

a. immunotherapy
b. frequent exercise
c. allergen avoidance
d. 6 month steroid nasal spray
e. 6 month antihistamine
jawaban: C. Allergen avoidance

Explanation : milk contain more than 16

protein that might be allergenic,and skin
reaction to a no.of these proteins occur
in some sensitive children
(immunology,immunopathology &
immunity,5th,pg 405)
In Spain,fish in the 3rd most frequent
allergen in children under 2 year of age
after egg & cow`s milk (pediatric allergy
& immunology,volume 19,Blackwell
publishing)
*breastfeeding has been recognized for
many years result in a dramatic
reduction in incidence of food allergy in
children,particularly allergic eczema
(immunology,immunopathology &
immunity,5th ed,steward sell,406)

58. C anaphylaxis

70. A/B

71. C

72. Zidovudine can improve cognitive

function in short term

74. Corticosteroid or immunosupressant

drugs
75. e. Burkitt lymphoma
- Follicular lymphoma: the most common
form of NHL
Morphology: two principal cell
types: (1) small cells with
irregular or cleaved nuclear
contours and scant cytoplasm
(centrocytes-small cleaved cell),
and (2) larger cell with open
nuclear chromatin several
nucleoli, and modest amount of
cytoplasm (centroblast)
CF: tend to present with painless,
generalized lympadenophaty, 3050% occur histologic
transformation, most commonly
to diffuse large B-cell lymphoma
- Hodgkins lymphoma: characterized
morphologically by the presence of
distinctive neoplastic giant cell called
Reed-Sternberg cell that induce the
accumulation of reactive lymphocyte,
histiocyte (macrophage), and
granulocyte
Morphology: diagnostic ReedSternberg cell are large (15-45m
in diameter) and have either
multiple nucleoli with multiple
nuclear lobes, each with a large
inclusion-like nucleolus about the
size of small lymphocyte
Mononuclear variant contain only
a single round or oblong nucleus
with a large inclusion-like
nucleolus

Lacunar cell seen predominantly

in nodular sclerosis subtype
Reed-Sternberg present in an
appropriate background of nonneoplastic inflammatory cells
(lymphocytes, plasma cell,
eosinophils)
- Diffuse Large B-cell Lymphoma (DLBCL)
Morphology: relatively large cell
(usually 4-5 times diameter of
small lymphocyte) and a diffuse
pattern growth
CF: rapidly enlarging, often
symptomatic, mass at single
nodal or extranodal site
- Burkitt lymphoma
Morphology: high mitotic index is
typical, as apoptotic tumor cell
death, accounting for the
presence of numerous tissue
macrophages with ingested
nuclear debris
Benign macrophage are diffusely
distributed among the tumor cell
and have abundant clear
cytoplasm, creating characteristic
starry sky pattern
77. b. Hodgkin
- Clinical difference between Hodgkin and
NHL
Hodgkin
More often localized to a single axial
group of nodes (cervical, mediastinal,
para-aortic)

More fre
peripher

Orderly spread by contiguity

Noncont

Mesenteric nodes and Waldeyer ring

rarely involved

Mesente
common

Extranodal involvement uncommon

Extranod

- Chronic Lymphocytic Leukimia (CLL)/Small

Lymphocytic Lymphoma (SLL)
Morphology: prolymphocyte
gather together focally to form
loose aggregates referred to
proliferation center, because they
contain large number of
mitotically active cells

Lymphocyte are round, fragile

and frequently disrupted in the
process of making smear, called
smuged cell
CF: asymptomatic, disrupt normal
immune function through
uncertain mechanism
78. a. EBV
- Hodgkin
Etiology: one important clue is
the frequent present of EBV
episomes in the Reed-Sternberg
cell of many cases of mixed
cellularity HL

The nuclear chromatin is delicate

and finely stippled, and nucleoli
are either absent or
inconspicuous
CF: abrupt stormy onset,
symptoms related to depression
of normal marrow function, bone
pain and tenderness, generalized
lymphadenopathy, splenomegaly,
and hepatomegaly caused by
neoplastic infiltration, CNS
manifestation, headache,
vomiting
Source from Robin 7thed, page 673-691

79. a. I A
- Clinical staging of Hodgkin and NHL (Ann
Arbor Classification)
Stage
I

II

80. 39-year-old male has been infected

by HIV since 8 years ago. From the PE,
doctor found lymph node enlargement in
right cervical region. Diagnosis ?
Distribution of Disease
A. Diffuse large B cell lymphoma

Involvement of single lymph node region (I) or involvement of a

B. Small
lymphoma
single extralymphatic organ
or sitelymphocytic
(IE)
C. Non-Hodgkin lymphoma
Involvement of two or more lymph node region on the same
side of diaphragm alone (II) or with involvement of limited
D.organ
Lymphoblastic
lymphoma
contiguous extralymphatic
or tissue (IIE)

III

E. Follicular
Involvement of lymph node
region onlymphoma
both side of diaphragm
(III), which may include spleen (IIIS) and/or limited contiguous
Jawab
A
extralymphatic organ or site
(IIIE,: IIIES)

IV

Pembahasan
:
Multiple or disseminated foci
of involvement
of one or more
extralymphatic organ or tissue with or without lymphatic
Robbins edisi 7 hal. 667 pada
involvement

80. ???
- Acute Lymphoblastic Leukemia/Lymphoma:
group of neoplasm composed of
immature, precursor B or T lymphocyte
referred to lymphoblast
Majority (85%) of ALL are
precursor B-cell tumor that
typically manifest as childhood
acute leukemia
Less common precursor T-cell ALL
tend to present in adolescent
male as lymphomas often with
thymic involvement
Morphology: ALL with
lymphomatous presentation are
mostly of pre-T cell type

ETIOLOGICAL AND PATHOGENETIC

FACTORS IN WHITE CELL NEOPLASIA :
OVERVIEW
Environmental Agents
menyebutkan :
Sustained B-cell stimulation due to
immune dysregulation may increase the
risk of oncogenic events. An important
example is HIV infection, which leads to
polyclonal B-cell activation and marked
hyperplasia of germinal center B cells.
HIV-infected individuals are at high risk
for B-cell lymphomas derived from
germinal center B cells and most such

tumors have oncogenic chromosomal

translocations involving immunoglobulin
loci.

distributed symmetrically on upper arm

and chest. Obat apa yang diberikan
tadi ?

Dari situ, dapat dilihat bahwa HIV adalah

faktor risiko untuk lymphoma yang
melibatkan B cell.

A. Prednisolone

Dari option, yang merupakan tumor

yang melibatkan B cell adalah option A,
B, C, D, E.

C. Chlorpheniramine maleate

Namun, option C dan D tidak ditujukan

spesifik untuk lymphoma B-cell (bisa Tcell juga). Karena itu bisa dicoret.

Jawab : D

Lalu kita selidiki option A, B, dan E.

Untuk option A : diffuse large B cell
lymphoma, pada Robbins edisi 7 hal.
677,
disebutkan bahwa penyakit ini memiliki
2 subtype khusus yang sering ditemui
pada pasien terinfeksi HIV
manifestasi klinisnya yang sering
ditemukan adalah rapidly enlarging,
often symptomatic mass at a single
nodal or extranodal site.
Kedua keadaan di atas cocok dengan
pasien.
Untuk option B : small lymphocytic
lymphoma, pada Robbins edisi 7 hal.
674, manifestasi klinisnya adalah often
asymptomatic. When symptoms appear,
they are nonspecific and include easy
fatigability, weigt loss, and anorexia.
Generalized lymphadenopathy and
hepatosplenomegaly are present in 5060% of all cases
Untuk option E : follicular lymphoma,
pada Robbins edisi 7 hal. 675,
disebutkan manifestasi klinisnya adalah
painless, generalized
lymphadenopathy.
Pada pasien kita, lymphadenopathy
hanya ditemukan di satu tempat, yaitu
right cervical region. Sehingga, bisa
disimpulkan option A benar.
81. Acute enteritis, lalu diberi obat.
Timbul target lesion 2-5 cm,

B. Hydrocortisone

D. Trimethoprim-sulfomethoxazole

Pembahasan :
Target lesion adalah ciri khas dari
keadaan erythema multiforme, dan bisa
disebabkan oleh administrasi beberapa
obat : sulfonamide, penicillin,
barbiturate, salicylate, hydantoin,
antimalarial (Robbins edisi 7 p. 1255).
Erythema multiforme, pada
patogenesisnya, disebabkan oleh reaksi
imunologi yang melibatkan cytotoxic Tcell dengan akibat apoptosis maupun
perusakan sel epithelial (Robbins edisi 7
p. 1256).
Jawaban D, karena :
trimethoprim-sulfomethoxazole
termasuk pada golongan sulfonamide,
yang memang dapat menyebabkan
erythema multiforme. Sulfonamide
banyak digunakan bersama dengan
trimethoprim.
Prednisolone & hydrocortisone adalah
golongan glucocorticoids, yang justru
digunakan untuk supresi reaksi
imunologi, sehingga tidak mungkin
menyebabkan kondisi di atas
(berdasarkan patogenesisnya).
Chlorpheniramine adalah golongan antihistamine yang toxicity-nya tidak
termasuk pembentukan target lesion
(toxicity anti-histamine : sedation,
convulsion, excitation, anti-muscarinic
action, Katzung p. )
82. 26-year-old man, with target cell.
A. erythema multiforme
B. bullous pemphigoid

C. pemphigus

D. Neutrophil cell

Jawab : A

E. Fibrin

Pembahasan :

Jawab : A

Mungkin yang dimaksud disini adalah

target lesion, yang merupakan ciri dari
erythema multiforme

Pembahasan :

83. Which of the following is the most

likely diagnosis of subepidermal bullae ?
A. Bullous pemphigus
B. Pemphigus vulgaris
C. Erythema multiforme
D. Pemphigus folliaceus
E. Subcorneal pustular dermatosis

Subepidermal bullae berarti mengarah

ke penyakit bullous pemphigoid (lihat
penjelasan no. 83). Morfologi dari bullous
pemphigoid :
Early lesions show a dsuperficial and
sometimes deep perivascular infiltrate of
lymphocytes and variable numbers of
eosinophils, occasional neutrophils,
superficial dermal edema, and
associated basal cell layer vacuolization.
Eosinophils showing degranulation are
typically detected directly beneath the
epidermal basal cell layer. The
vacuolated basal cell layer eventually
gives rise to a fluid-filled blister.

Jawab : A
(Robbins edisi 7 p. 1261)
Pembahasan :
Bullous pemphigoid : morfologinya
adalah terdapat subepidermal, nonacantholytic blister (Robbins edisi 7 p.
1261)
Pemphigus vulgaris : morfologi khasnya
adalah terdapat suprabasal acantholytic
blister (Robbins edisi 7 p. 1260)
Erythema multiforme : morfologi
khasnya adalah terdapat target lesion
pada ekstremitas yang terdistribusi
secara simetris. Pada lesi itu ditemukan
nekrosis sentral dikelilingi inflamasi
perivenular (Robbins edisi 7. p. 1256)

Limfosit, eosinophil, neutrophil,

semuanya adalah sel inflammatory. Di
penjelasan no. 83, juga disebutkan
bahwa blister-nya non-acantholytic (tidak
ada lysis epidermis), karena itu option B
salah. Option C salah karena tidak
disebutkan ada edema intercellular pada
epidermis (yang ada adalah edema pada
dermis). Option E salah karena tidak ada
hal yg melibatkan fibrin.
85. If platelet count is low, which of the
following will be prolonged ?
A. clotting time
B. bleeding time

Pemphigus folliaceus : C. thrombin time

Subcorneal pustular dermatosis : D. prothrombin time
84. What substances are contained
predominantly in subepidermal bullae ?

E. activated partial thromboplastin time

A. Inflammatory cell

Jawab : B

B. Acantholysis cell

Pembahasan :

C. Spongiosis cell

Untuk mengetahui fungsi platelet,

dilakukan bleeding time. Jika ada
kelainan kuantitatif maupun kualitatif
dari platelet, maka bleeding time akan
meningkat (abnormal). (Tabel 23-26
Harmening edisi 4 p. 467 )
Prothrombin time dan activated partial
thromboplastin time adalah untuk
mengetahui fungsi sistem koagulasi jalur
ekstrinsik dan intrinsik. Thrombin time
digunakan untuk menilai proses
pembentukan fibrin. Clotting time ? tidak
ditemukan istilah tsb. di Harmening, tapi
berdasarkan kata-kata clotting,
mungkin ini lebih mengarah ke penilaian
hemostasis sekunder, yang lebih banyak
melibatkan faktor koagulasi daripada
platelet.
94. Which is the most important in
delivering O2 from maternal blood to
fetal blood?
a. ATP

Alasan : loss of ATP decrease in the

phosphorylation of spectrin (Harmening
hlm 61)
96. RBC maintains Fe state?
a. ATP
b. NADH
c. NADPH
d. Glucose
e. 2,3 DPG
Jawaban : B
Alasan : pada gbr metabolisme RBC
terdapat NADH-metHb reductase yang
berfungsi mengubah metHb menjadi Hb
menjaga agar tetap dalam bentuk Fe2+

b. NADP

97. Iron deficiency anemia Fe

supplement tidak efektif. Mengapa?

c. NADPH

Jawaban : antacid

d. Glukosa

Alasan : Goodman & Gillman hlm 1448

e. 2,3 DPG
Jawaban : E

98. Patient 33 y.o. woman complains

fatigue and increase dyspnea with
exercise. History reveals heavy
menstrual bleeding. Lab result : increase
TIBC, decrease serum transferase and
ferritin. Diagnosis?

Alasan : faktor penting untuk mengontrol

afinitas Hb terhadap O2 adalah 2,3 DPG
(Harmening)
95. Compound yang bertanggung jawab
agar membrane RBC tidak mengalami
denaturasi akibat oxidant injury adalah

a. Thallasemia

a. ATP

c. Pernicious anemia

b. NADP

d. Aplastic anemia

c. NADPH

e. Iron deficiency anemia

d. Glucose

Jawaban : E

e. 2,3 DPG

Alasan : Harmening hlm 105 table 6-7

Jawaban : A

99. E. Pronormoblast. Ciri khasnya

round/oval moderate to large cell with
large nuclei. Its nuclei is very little
different to myeloid. Harmening.

b. Acquired hemolytic anemia

Pronormoblast agak sulit dibedakan

dengan promyeloblast dengan giemsa
staining karena butuh pewarnaan yang
lebih spesifik. catatan lab act.
Note: biasanya sel darah yang belum
terdifferensiasi dengan sempurna, maka
ciri-ciri spesifiknya juga belum jelas
terlihat.
Normoblast acidophil = sel erythrocyte
immature dengan cytoplasm yang lebih
pinkish karena sudah terproduksi HB

112. D.Ferrosulfate. toksisitass akut

dapat menyebabkan gastroenteritis
nokrotikans dengan vomit,nausea,
abdominal pain, dan bloody diare.
EPO,Cyanocobalamin, dan folic acid tidak
ditemukan adanya side effect..
113. Most likely structure of thymus :
A. Medulla
cortex

appear

B. Large number
cortex

darker

of

than

T-cell

in

Normoblast polikromatrofil = ketika

distaining, sel tersebut memiliki
campuran warna biru dengan adanya
warna pink

C. Has mesenchymal reticular cells

Normoblast= ?

E. The cortex has Hassals corpusle

D. Has lymph vessels

Retikulosit = nucleinya sudah terextrude

dengan gambaran staining new metilen
blue masih ada sedikit granule-network
ribosom

Jawaban : B.

104. ?

A seharusnya lighter

106. B. Thalasemia, karena adanya

tanda2 dari hemolytic anemia
( increased bilirubin, icteric, hepatosplenomegaly, dengan decreased RBC,
MCH,MCHC dan increased reticulocyte
count) yang terjadi pada first year of
life. Tanda2 lain for the next years
berupa hypertrophied of maxilla causing
forward protrusion of the upper teeth
and overbite, dan gambaran mongoloid
face

C seharusnya epithelial reticular cells

107.Aplastic anemia. Dicirikan

gambaran bone marrow berupa
hypocellular = karena failure blood cell
production oleh bone marrow yang
melibatkan RBC, WBC, dan platelet
(penurunan jumlah RBC,WBC, dan
platelet melalui blood smear)
Manifestasi klinis : anemia = progressive
fatigue, dyspnea, palpitasi
Thrombocytopenia: petechiae,purpura,
ecchymoses, mucosal bleeding
Leukopenia : sign of infection (late
manifest)

Pembahasan :

D thymus tidak memiliki afferent

lymph vessel & hanya punya sedikit
efferent lymph vessel
E seharusnya medulla
B benar, karena pada cortex terdapat
banyak sel limfosit-T kecil yang nantinya
akan berproliferasi & bermaturasi ke
arah medulla
(Junquiera, 266-267)
115. WOTF susbstane is the 1st line
deense against this disease?
A. Antibody
B. Complement
C. Interleukin-1
D. Class 1 interferon
E. Class 2 interferon

Jawaban : ?
Pembahasan : ? (soalnya ga ada)
117. HIV, yang benar?
A. RNA, SS, envelope (-)
B. RNA, SS, envelope (+)
C. DNA, SS, envelope (-)

3. Protease
Inhibitor
(PI)

mencegah
cleavage
Gag-Pol
polyprotein,
sehingga
yang
diproduksi adalah partikel virus
yang imatur & non-infeksi.
4. Fusion Inhibitor menegah
perubahan bentuk (konformasi)
dari virus, yang dibutuhkan untuk
fusi virus dengan membran sel,
sehingga mencegah masuknya
virus ke dalam sel.
(Katzung, 798-811)

D. DNA, DS, envelope (+)

E. DNA, DS, envelope (-)
Jawaban : B.

119. 20 tahun, diagnosis fever, 3 hari

yang lalu tertusuk paku di plantar pedis,
T=39C, lymph node enlargement di
right groin, apa yang berperan?

Pembahasan :

A. NK cell

HIV adalah retrovirus, yang memiliki

envelope yang mengandung 2 copy
(diploid)
single-stranded
RNA.
(Immunology Mosby,316)

B. Mastocyte
C. Marophage
D. T-lymphocyte

118. MOA treatment HIV?

E. Complement
Jawaban :
Jawaban : C. (?)
Pembahasan :
Pengobatan
HIV
adalah
dengan
antiretroviral therapy (ART), dengan
metode Highly Active ART (HAART)
yang berupa kombinasi 3-4 antiretroviral
agent untuk memaksimalkan efektivitas
& mengurangi risiko resistensi. Ada 4
kelas obat :
1. Nucleoside & Nucleotide Reverse
Transcriptase Inhibitor (NRTI)
inhibitor kompetitif HIV-1 reverse
transcriptase, dengan bantuan
aktivasi intrasitoplasmik lewat
fosforilasi oleh enzim seluler
menjadi
bentuk triphosphate.
MoA lain memasuki rantai DNA
virus, lalu melakukan terminasi.
2. Non-Nucleoside
Reverse
Transcriptase Inhibitor (NNRTI)
menempel langsung ke HIV-1
reverse transcriptase (tanpa perlu
aktivasi lebih dahulu), sehingga
memblok RNA- & DNA-dependent
DNA polymerase.

Pembahasan
:
Karena
terdapat
pembesaran
lymph
node
yang
merupakan hyperplasia dari lymphoid
follicles & hyperplasia sel fagositik di
sepanjang sinus lymph node, yaitu
macrophage yang memfagosit partikel
asing yang masuk untuk mencegah
penyebaran
ke
seluruh
tubuh.
(Robbins,84 & Guyton, 432-433)
120.B.
121. sori ga jelas (T cell yang mana?
Cytotoxic? T h2/ Th1?)
122. sori ga ngerti maksudnya.
123. A. Pada pasien kita mengalami
allergy (increased of histamine>bronchoconstriction, increased of
mucus production). Oleh karena itu ditherapy dengan antihistamine.
126. C (lange 103)

129. angioedema terjadi karena apa?

Mastocyte
130. pada type I hypersensitivity
yang bertanggungjawab untuk
perkembangan mast cell,B
cell,eosinophil?
a. CD4 T Lymphocyte
b. CD8
c. macrophage
d. monocyte
jawaban: CD4 T lymphocyte
133. 21 y.o woman malar rash,photo
distribution,derm exam: atrophic
lesion on periauricular region,ANA
(+),Anti DsDNA(-),No urine protein.
Treatment?
a. vit C
b. steroid
c. retinoid
d. sunblock
e. antibiotic
137. Most life threatening
complication (ITP)?
a. intracranial bleeding
b. DIC
c. GI bleeding
d. Menomethrorhagi
e. joint bleeding
137. WOTF can cause death?
a. Intracranial hemorrhage
b. DIC
c. GI bleeding
d. Menomethrorhagi

LYMPHOPROLIFERATIVE
DISORDERS(TABLE 17-5,STAGING
SYSTEM FOR CHRONIC LYMPHOCYTIC
LEUKEMIA),PG 310
144) ANS : B
EXP : afibrinogenemia it can cause
profuse bleeding after slight trauma
& delay in wound healing.initial
symptoms include bleeding from the
umbilical cord stump.other
symptoms:intracranial bleeding,
epistaxis,gastrointestinal bleeding &
menorrhagia.
Lab result : prolongation of
PT,APTT,RT,TT,and absence of
measurable fibrinogen
REFERENCE : HARMENING,4TH
ED,DISORDERS OF PLASMA
CLOTTING FACTORS,PG 497.
145) QUESTION NOT COMPLETE..
146) ANS : A
EXP : characterized by decrease in Hb
concentration,hematocrit,MCV.
REFERENCE : HARMENING,4TH ED,PG 104
(sorry friends,but please,do explore
more)
149. Anak 5 thn bleeding setelah
immunization hepatitis B. Platelet N,
WBC N. RBC/Hb , PT dan APTT .
Diagnosis ?
a. Factor deficiency
b. Factor

e. joint bleeding

c. Vit. K deficiency

138) ANS: A
EXP: primary hemostasis is defined by
platelet membrane glycoprotein
Ib(GPIb) and von Willebrand`s
factor(vWF)
REFERENCE : HARMENING,4TH
ED,INTRODUCTION TO
HEMOSTASIS,PG 442.
141) ANS : A
EXP : table 17-5,staging system for
chronic lymphocytic leukemia,from
Rai system,stage 1 is characterized
by lymphocytosis and enlarged
lymph node,whereas for Binet
system,stage a is characterized by
2/<>10 + no anemia /
thrombocytopenia
(Hgb10g/dL,platelet > 100 x
10^9/L)
REFERENCE : HARMENING,4TH
ED,CHRONIC LEUKEMIA & RELATED

Ans.
a. Factor deficiency
PT & APTT prolonged = defisiensi factor
intrinsik dan ekstrinsik
151. 3 y.o pale, underweight, lab :
Hb 7,2 Ht 23 % Platelet % Leukocyte N.
eosinophilia, leucocyte diff. count : MCV
, MCH, Reticulocyte, diagnosis ?
a. thalassemia
b. thalassemia major
c. Iron deficiency

d. Sideroblastic anemia

Lihat pembahasan di atas

e. Lead fusion
Ans.

156. Youngest cell erythrocyte, cell size

14-18 m. N:C = 8:1. Scanty bluish
cytoplasm.

Wah bingung sayah

a. Pronormoblast

153. a 5 y.o boy admitted to hospital for

pallor dan easy bruising. PE : pallor,
widespread ptechiae, ecchymosis,
bleeding gums, fever. No
lymphadenopathy, no
hepatosplenomegaly. CBC, reticulocyte
. MCV, MCH, MCHC N. BM smear
hypocellular (25 % cellularity). Most
likely diagnosis ?

b. Normoblast acidophilic

a. IDA
b. ALL
c. Myelodysplastic syndrome
d. Aplastic anemia
e. Megaloblastic anemia
Ans.
d. Aplastic anemia
Merupakan kegagalan bone marrow
dalam menghasilkan komponen darah
yang ditandai dengan hypocellular
(penurunan aktivitas cellular, N = >30%)
sehingga semua komponen darah
berkurang.

c. Normoblast polichromatophilic
d. Normoblast basophilic
e. Reticulocyte
Ans.
a. Pronormoblast
Ukuran 14-19 m, tapi N:C harusnya 4:1,
ga ada fase erythroid yang N:Cnya
sampai 8:1.
?? (3) 60 tahun male left abdominal
discomfort & dizziness. PE : BP 160/95
RR 24 Pulse 96. Liver just palpable.
Spleen schuffner 3. Lab Hb 18,2 Hct 56
% WBC 20.000 Platelet 550.000.
Complication of this disease ?
a. Bleeding
b. Thrombosis
c. Infection
d. Anemia

154. Etiology ?

e. Hemolysis

a. Infiltrative malignant

Ans.

b. Bone marrow failure

d. Anemia

c. Coagulation disorder

Ini adalah ciri2 policythemia vera, Hct,

WBC, Platelet, Hb .

d. Overwhelmed infection
e. Platelet disorder
Ans.
b. Bone marrow failure

Komplikasi policythemia vera adalah

anemia.
?? (4) 7 years old boy, yellowish since 3
days ago, no fever, he dranks
sulfomethoxazole 3 weeks ago, further

has the same history but neither of his

sister
Ans.
Sayah bingung. Tapi yellowish seperti ini
mungkin hemolytic anemia.
157. Neutrophil granulocytic
development
Myeloblast: round nucleus, reddishblue, nucleoli, N:C=4:1, 10-20m
Promyelocyte: primary granule,
reddish-blue, N:C=3:1, 20m
N. myelocyte: secondary granule,
eccentrally round nucleus, pinkish,
N:C=2:1
N. metamyelocyte: nucleus slightly
indented, pinkish granule, N:C=1:1,
10-18m
Band netrophil: nuclear indentation
greater than half, pink granule,
smaller
Segmented netrophil: nucleus
divide into 2-5 lobes connected by
thin filament
159. FAB Classification of Acute
Myelogenous Leukemias (AML)
M0, Minimally differentiated AML
Blasts lack cytologic and
myeloperoxidase negative but
express myeloid antigens and
resemble myeloblasts
M1, AML without differentiation
Very immature, >3% of blasts are
peroxidase positive; few granules
and little maturation at myeloblast
stage.
M2, AML with maturation
Full myeloid maturation through
granulocytes; Auer rods present in
most cases
M3, Acute promyelocytic leukemia
Most cells are hypergranular
promyelocytes, often with many
Auer rods per cell; patients are 35
to 40 years age
M4, Acute myelomonocytic
leukemia
Myelocytic and monocytic
differentiation; myeloid elements
show maturation; monoblasts are
positive for nonspecific esterases
M5, Acute monocytic leukemia

- M5a subtype, monoblasts

(peroxidase-negative, nonspecific
esterase-positive) and
promonocytes predominate in
marrow and blood;
- M5b subtype, mature monocytes
predominate in the peripheral blood;
- M5a and M5b occur in older
patients; characterized by
incidence of organomegaly,
lymphadenopathy, and tissue
infiltration.
M6, Acute erythroleukemia
Dysplastic erythroid precursors
(megaloblastoid, with giant or
multiple nuclei), and within the
non-erythroid cells, >30% are
myeloblasts; seen in advanced age.
M7, Acute megakaryocytic
leukemia
Blasts of megakaryocytic
predominate; blasts react with
platelet-specific antibodies directed
against GPIIb/IIIa or vWF;
myelofibrosis or increased marrow
reticulin seen in most cases.
165. ?
- If diagnosis is Chronic
Lymphocytic Leukimia, yg
increase pada BM smear:
B-cell with prolymphocytic
transformation to diffuse large B-cell
lymphoma
Worse prognosis, mungkin well
differentiated lymphocyte
167. ?
- Chronic Lymphocytic Leukimia
(CLL) / Small Lymphocytic
Lymphoma (SLL)
Merupakan peripheral B-cell
Neoplasm
Morphology: prolymphocyte gather
together focally to form loose
aggregates referred to proliferation
center, because they contain large
number of mitotically active cells
Lymphocyte are round, fragile and
frequently disrupted in the process of
making smear, called smuged cell

CF: asymptomatic, disrupt normal

immune function through uncertain
mechanism
- Chronic Myelogenous Leukimia
(CML)
Between 25-60 years of age
Patfis: merupakan chronic MPDs
with presence of distinctive
molecular abnormality, yaitu ABL
gene on chromosome 9 and BCR
gene on chromosome 22
Morphology: CML marrow usually
100% cellular with mostly
maturing granulocytic precursor;
megakaryocyte increase;
erythroid progenitor normal or
decrease; pheripheral blood
reveal leukocytosis; ada
splenomegaly; hepatomegaly and
mild lymphadenophaty
CF: insidious, mild to moderate
anemia, abdomen sensation
caused by extreme splenomegaly
169. Hasil lab: normal RBC, find in
smear?
c. normochrom normocytic
- hypochromic: pale RBC,
kekurangan Fe
- anisocytosis: banyak RBC yg
bervariasi ukurannya
- normocytic: RBC of normal size
176.Atrophy Lingual?
Gak tahu pertanyaanya apa tapi atropi
lingual terjadi pada keadaan iron
deficiency anemia (IDA).
Dimana pemeriksaan Lab IDA:
- Serum Iron : Tinggi
- TIBC : Tinggi
- Ferritin : Rendah
178.6 Year old girl oupatient RSHS redt
itchy circumscribed patched with central
blanching on body.Ate shrimp an hour
ago she also allergic to cold weather skin
layer..?
Dari
cerita
diatas
bahwa
mengalami
hypersensitivitas
ditandai oleh adanya urticaria.

pasien
yang

Ciri-ciri urticaria:
Lesion:
papule/wheal,circumscibed
lightly
erythematous
with
central
blanching/blanched
with pressure.
- Location: Upper cornum of the
dermis
- Sensation: Pruritis
Patfis:
Vascular permeability is the most
important
factor
in
the
pathofisiology
of
urticarial
lession.Histopatologi exam pada
urticarial
lesion
menunjukan
dilation engorgement of minute
cutaneus blood vessel,dilated
lympatic,
and
a
minimal
perivascular infiltrat that may
predominantly
contain
eosinophile.
For 180-182
A 24 Year old man,IDU, Came to
dept.internal medicine for general
check up.Lab
result HIV (+)
180.WOTF cell killed by above virus?
C.CD4 T-cell
HIV infects primarily vital cells in the
human immune system such as Thelper cell(to
be specific, CD4 T cells), macrophage
and dendritic cell.
HIV infection leads to low levels of CD4 +
T cell through three main mechanisms:
First, direct viral killing of infected cells;
second, increased rates of apoptosis in
infected cells; and third, killing of
infected CD4+ T cells by CD8 cytotoxic
lymphocytes that recognize infected
cells. When CD4+ T cell numbers decline
below a critical level, cell-mediated
immunity is lost, and the body becomes
progressively
more
susceptible
to
opportunistic infections.
181.WOTF gene is most likely need for
replication of above cell?
B.Tat
a. Gp 120: p120 is essential for virus
entry into cells as it plays a vital
role in seeking out specific cell
surface receptors for entry.

b. Tat: Tat vastly increases the level

of transcription of the HIV DNA.

site dari Ig terhadap antigen, yaitu di

variable heavy chain

c. Pol: it means polymerase

185.B. sudah jelas ya bahwa APC seperti

dendritic cell dan macrophage, setelah
mereka memprocessed antigen melalui
proses endosomal, processing antigen
tersebut akan diekspresikan bersama
MHC class II di membrane sel untuk
derecognize oleh THelper dalam proses
adaptive immunity

d. Gp41: is a glycoprotein noncovalently-bound to gp120, and

provides the second step by
which HIV enters the cell. It is
originally buried within the viral
envelope, but, when gp120 binds
to a CD4 receptor, gp120
changes its conformation, causing
gp41 to become exposed, where
it can assist in fusion with the
host cell.
e. P11: Sorry.I havent find it.
182.WOTF is the component above virus
that enhances penetration of virus
into host cell?
A.Gp120
Penjelasan lihat no 181
183. Which of the following cell that
presenting the antigen to CD4 T-cell?
A. NK cell
B. Dendritic cell
Jawaban : B
Alasan : dendritic cell mengekspresikan
protein MHC II (Lange)
184. After binding to its specific antigen,
B lymphocyte may switch to what of the
following component?

187. C.macrophage memiliki

kemampuan sebagai phagocyte dan
sebagai APC. Hubungannya dengan
antibody ialah macrophage memiliki Fc
receptor dan receptor untuk opsonin dan
complement component receptor untuk
memfagosit opsonized imunnogen.
Kemudian melalui FcR (dan yang lainnya
via Toll-like Receptor) activate oxidative
killing. Atau selain dibunuh, processed
fragmented immunogen tersebut
kemudian dipresentasikan di sel
membrane
b. lysing virus merupakan respon tugas
dari cytotoxic T-Cell
c.activating cytotoxic cell dilakukan oleh
TH cell melalui IL-2
e. activating plasma cell dilakukan oleh
TH cell melalui Il-4 dan IL-13 atau
contact dengan CD40-CD40L (Blymphocyte) atau langsung contact
immunogen dengan membrane bound
antibody

B. Ig heavy chain

11y.o. boy with itchy skin rashes on both

elbows, also complaints dry skin on
limbs. His mother has history of allergy
to seafood and cat dander. Dermato
status : erythematous papules, scales,
lichenefication on both elbows.

C. Variable region of IgG heavy chain

188. Diagnosis?

A. Ig light chain

D. Variable region of IgG light chain

A. Nummular dermatitis

E. Hinge region of the heavy chain

B. Xerosis cutis

Jawaban : C

C. Atopic dermatitis

Alasan : agak ga ngerti maksudnya apa,

mungkin yang dimaksud adalah binding

D. Food allergy
Jawaban : C.

Pembahasan :
Nummular
dermatitis
berbentuk koin / diskoid

lesi

kulit

Xerosis cutis keadaan kekeringan pada

kulit, ditandai dengan : eritema,
deskuamasi kering, retak halus, gatal;
terutama selama musim dingin saat
kelembaban udara rendah sehingga
terjadi kehilangan air berlebih dari
stratum korneum (Dorland)
Food allegy tidak disebutkan setelah
makan apa
Atopic dermatitis kecenderungan
seseorang (secara herediter) untuk
memproduksi IgE dalam jumlah banyak
terhadap paparan allergen dosis endah
& memunculkan manifestasi pada kulit
(eczema)
189. WOTF is predilection of this case?
A. Face, especially cheeks
B. Scalp
C. Diaper area
D. Extensor
E. Flexural
fold
extremities

of

the

Jawaban : E.
Pembahasan :
Pada bayi terutama pipi & menyebar
ke sekitarnya
Pada anak2 & dewasa terutama
permukaan
fleksor
(antecubital
&
popliteal fossa)
(Fitzpatrick pocket, 36)

For number 1-3, refer to clinical scenario

below
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
1. What is the most possible findings on
the physical exam?
A. icteric sclerae
B. gum hypertrophy
C. atrophy of lingual papilae
D. lymphadenopathy on the neck
E. mass on the abdomen
Jawaban : C
Alasan tanda salah satu tanda iron
deficiency anemia. A : koilonychia
hemolytic anemia. B& tanda
hepatosplenomegaly, tanda AML. E D

tidak ada di kasus (Wintrobe ch 28)

2. Which of the following cells in
erythropoiesis is dominant on her BM
smear?
A. pronormoblast
B. basophilic normoblast
C. polychromatophilic normoblast
D. acidophilic normoblast
E. reticulocyte
Jawaban : E?
Alasan : sebenernya jawabannya lack of
stainable iron in reticuloendothelial
cells, tapi ga ada di pilihan.
3. What is the first to treat the patient?
A. blood transfusion
B. iron therapy
C. folate therapy
D. cobalamine therapy
E. eliminate the cause
Jawaban : B
Alasan : 1st choice treatment untuk IDA
adalah mengembalikan kadar Fe. A
indikasi Hb <7mg/dl. C& manifestasi
klinis berbeda. (WintrobeD ch 28)
For number 4-5 refer to clinical scenario
below
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.
4. Which of the folowing process is the
most likely for the patient?
A. excess Hb synthesis
B. vit B12 deficiency
C. A quantitative defect in Hb synthesis
D. A qualitative defect in globin protein
chains
E. folate deficiency
Jawaban : C
Alasan :peripheral blood smear
menunjukkan IDA (Harmening hlm 103)
5. Which of the following test may useful
in confirming the diagnosis?
A. measurement of serum Fe dan TIBC
B. Hb electrophoresis
C. vit B12 deficiency
D. chromosome analysis
E. flow cytometry
Jawaban : A

Alasan : kasus di atas adalah IDA, jadi

pemeriksaan selanjutnya adalah
pengukuran serum Fe dan TIBC
(Harmening hlm 103-106)
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.
What is the most likely etiology of this
anemia?
A. vit B12 deficiency
B. folic acid deficiency
C. iron deficiency
D. beta globin deficiency
E. G6PD deficiency
Jawaban : C
ciri IDAAlasan: microcytosis,
hypochromia
7. What kind of peripheral blood smear
appearances will be found?
A. Hypochromic, microcytic,
anisopoikilocytosis with abundant of
pencil cells
B. Hypochromic, microcytic,
anisopoikilocytosis with abundant of
target cells
C. Normochromic, normocytic,
anisopoikilocytosis with abundant of
target cells
D. Normochromic, normocytic,
anisopoikilocytosis with abundant of
pencil cells
E. Normochromic, macrocytic,
anisopoikilocytosis with abundant of
target cells
Jawaban : B
Alasan : ciri IDA (Harmening hlm 108
tabel 6-13)
8. What kind of lab exam will be found ?
A. Low serum Fe level, low TIBC, low
transferrin saturation
B. Low serum Fe level, increased TIBC,
low transferrin saturation
C. Low serum Fe level, low TIBC,
increased transferrin saturation
D. Increased serum Fe level, increased
TIBC, increased transferrin saturation
E. Increased serum Fe level, increased
TIBC, increased ferritin saturation
Jawaban : C
Alasan : Harmening hlm 108 tabel 6-13

9. What is the most appropriate

recommended treatment for this
patient?
A. Multivitamin
B. Blood transfusion
C. Oral ferrous sulphate
D. An iron fortified cereal
E. Intramuscular iron dextran
Jawaban : C
Alasan : untuk memperbaiki status iron
dalam serum
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?
A. Simple stratified keratinized
B. simple stratified nonkeratinized
C. simple squamous
D. simple cuboidal
E. simple ciliated columnar
Jawaban : B
Alasan : lidah termasuk simple stratified
nonkeratinized
For number 11&12, refer to clinical
scenario below
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.
11. What is the 1st lab study would you
order to investigate this?
A. Complete blood count (CBC)
B. bleeding time (BT)
C. Clotting time (CT)
D. Prothrombin time (PT)
E. activated partial thromboplastin time
(aPTT)
Jawaban : A
Alasan kelainan hemostasis. Oleh
karena itu perlu dicek terlebih: bruising
dahulu jumlah keseluruhan dari sel
darah melalui CBC (Harmening hlm 517)
12. IF the PLT count is low which will be
prolonged?
A. CT
B. BT
C. thrombin time (TT)
D. PT

E. aPTT
Jawaban : B
evaluasi PLT dan fungsi vaskular untuk
membentuk PLT plug (Labman
HIS)Alasan : BT
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:13min), aPTT 70sec (N:24-45), PT 12sec
(N:10-14), TT 14 sec (N:11-15).
What is the other test will be suggested?
A. bone marrow smear
B. Cytokimia
C. Factor assay
D. Lupus anticoagulant
E. Hb electrophoresis
Jawaban : C
Alasan kelainan hemostasis, history of
bleeding in male family: bleeding
penyakit genetik, BTmember & bukan
kelainan PLT ataCBC normal extrinsic
dan common pathway normal, TT normal
vaskular, PT normal kelainan pada
intrinsic pathway common pathway
normal, aPTT prolonged perlu factor
assay (Wintrobe figure 51.8)
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.
Which of the following ability is
measured by this test?
A. the capillaries to resist pressure
B. the PLT to resist pressure
C. the capillaries to resist heat
D. the PLT to resist heat
E. the fibrinogen to resist heat
Jawaban : A
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
For number 15-16 refer to this scenario
below
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), ACAIgG 80gpl. A Doppler ultrasound reveals

a deep vein thrombosis.

15. What is the diagnosis of this case?
A. Factor V Leiden
B. antithrombin III deficiency
C. antiphospholipid syndrome
D. protein C deficiency
E. protein S deficiency
Jawaban : C
tanda APS (Harmening ch 27)Alasan :
DVT, pulmonary emboli (di kasus ada
family member)
16. What is the additional test will be
suggested?
A. Factor assay
B. Lupus anticoagulant assay
C. TPHA
D. ASTO
E. blood smear
Jawaban : B
Alasan : APS biasanya disebabkan oleh
lupus anticoagulant atau anticardiolipin
antibodies (Harmening ch 27)
For number 17-18 refer to the scenario
below
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.
17. What is the cause of the bleeding?
A. fibrinolysis disorder
B. vascular disorder
C. coagulation disorder
D. Quantitative PLT disorder
E. Qualitative PLT disorder
Jawaban : D
menandakan kompensasi jumlah PLT
yang kurangAlasan : giant PLT
18. What is most likely appearance of
the bone marrow smear of this patient?
A. large promegakaryocyte
B. large megakaryoblast
C. small promegakaryocyte
D. megakaryocyte with PLT formation
E. megakaryocyte without PLT formation
Jawaban : D
Alasan : megakaryocyte with increased
or normal number (Harmening hlm 474475)
19. What is PLT receptor for von
Willebrand factor?

A. glycoprotein Ia
B. glycoprotein Ib
C. glycoprotein IIa
D. glycoprotein Iib
E. glycoprotein III
Jawaban : B
Alasan : primary receptor for vWF is GpIb
(Harmening ch 23)
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?
A. PT prolonged, aPTT normal
B. CT normal, BT normal
C. BT prolonged, CT normal
D. PT normal, aPTT prolonged
E. PT normal, aPTT normal
Jawaban :
Alasan :
21.D. kasus kita kan ITP, untuk
treatment dari penyakit autoimun, maka
kita harus berikan obat imunosupressan..
di sini kortikosteroid. (wintrobe: ITPTreatment)
22.B. keadaan ini kita curiga ke
hemophilia, jadi untuk memastikan
apakah ini hemophilia atau bukan, maka
kita melakukan melakukan assay dari
factor VIII
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 .
jelas ya dari hasil pemeriksaan dan
eksklusi dari option yang24.D
Hemophillia ada.
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.
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.
27. D. Vit K
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.

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.
30. A. kalo option E itu biasanya dengan
gejala yang purpura, petechiae dll yang
mencirikan masalah pada kapiler.
31.c. vWF bisa dilakukan assay untuk
mendeteksi kadarnya secara terpisah
dari FVIII-vWF complex.
32. B. DDAVP therapy of choice for vWD
(type 1) dan hemophilia A minor. DDAVP
mengakibatkan transient increase of
VIIIc and VIIIag
33. C
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 (1056%), ga ada keterangan dari bone
marrow. Tapi kecurigaan saya itu adanya
statement B-cell dengan
prolymphocytoid transformation), jadi
kemungkinan jawabannya adalah E.
35.A. jelas primarynya jumlah trombosit
yang dibawah 150rb
36.B
37.D, karena ga ada tanda2
lymphadenopathy
38. C
39.D. karena ada keterlibatan
hematopoietic cellskecurigaannya
adalah CLL di bone marrow dan
lymphadenopathy. Jadi untuk kofirmasi
setelah peripheral blood smear, kita
smear ke tempat yg dicurigai, yaitu bone
marrow.
40.b.
41. Jawaban : E. Stage IV
Penjelasan :
Penyakit yang dimaksud adalah CLL

(Chronic Lymphocytic Leukemia).

Staging menurut Rai System :
0 : lymphocytosis in peripheral blood &
bone marrow
I : + lymphadenopathy
II : + splenomegaly
III : + anemia
IV : + thrombocytopenia
(Harmening, 310)
42. Jawaban : B/C/E(?) tapi akademik
2006 jawab A. hyperkalemia
Penjelasan :
Salah satu hasil lab CLL adalah
hypogammaglobulinemia (Harmening,
302).
Dari beberapa sumber internet ada yang
mengikutsertakan hyperkalemia (B),
hyperuricemia (E), & hypernatremia (C).
43. Jawaban : A. Increased sensitivity of
hematopoietic stem cell to erythropoietin
Penjelasan :
Penyakit yang dimaksud adalah PV
(Polycythemia Vera) ->soalnya ga
lengkap.
Erythroid progenitors are extremely
sensitive to low levels of EPO supplied by
serum that is inherently present in the
basic culture medium. (Harmening,
342)
44. Jawaban : A. Phlebotomy
Penjelasan :
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)
45. Jawaban : C.(?) tapi akademik 2006
jawab E. polycythemia, burned out,
leukemic phase
Penjelasan :
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)
Saya cenderung jawab C. erythrocte,
burned out, myelofibrosis.

46. Jawaban : D. Lymphocytic lymphoma

well-differentiated
Penjelasan :
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)
47. Jawaban : A. Diffuse large B-cell
lymphoma
Penjelasan :
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)
48. ga ada soalnya
49. ga ada soalnya
50. Jawaban : C. Follicular lymphoma
Penjelasan :
These lymphomas (-> follicular center
lymphomas) are composed
predominantly (more than 50%) of large
cleaved cell (large cebtrocytes) & large
non-cleaved (centroblast) cell.
(Harmening, 405).
51. ga ada soalnya
52. Jawaban : B. Epstein-Barr virus
Penjelasan :
Penyakit yang dimaksud adalah Burkitts
lymphoma.
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)
The endemic & immunodeficiencyrelated cases are also assiciated with a
high frequency of tumor cell
incorporated EBV genomes.
(Harmening, 414)
53. ga ada soalnya
54. ga ada soalnya
55. Jawaban : A. Afferent lymphatics,
medullary sinuses, hilus, efferent

lymphatics
Penjelasan :
Struktur lymph node :
Lymphatic vessel : afferent vessel ->
sub-capsular sinuses -> trabecular
sinuses -> medullary sinuses -> hilum ->
efferent vessel. (Labman Histology &
Junquiera)
56. Jawaban : B/C(?) tapi akademik 2006
jawab D.HTLV-1
Penjelasan :
Penyakit yang dimaksud adalah
Hodgkins lymphoma.
Karena ada non-painful lymph node
swelling (Harmening, 402) dan gejalanya
sesuai dengan klasifikasi Ann-Arbor
(Harmening, 403).
Salah satu kemungkinan etiologinya
adalah RNA-tumor-virus & EBV (EpsteinBarr virus). Kemungkinan lain adalah
cytomegalovirus (B) & herpes virus 6 (C).
(Harmening, 398-399).
HTLV-1 ditemukan pada non-Hodgkins
lymphoma (Harmening, 416).
57. Jawaban : C. A nucleated ReedSternberg cell with large, inclusion
nucleoli, & abundant cytoplasm is
surrounded by mature lymphocytes
Penjelasan :
The cytologic hallmark of Hodgkins
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)
58. Jawaban : D. Stage III B
Penjelasan :
Berdasarkan Ann-Arbor Staging :
I : involvement of single lymph node
region / localized single extralymphatic
site (IE)
II : involvement of 2/more lymph node
regions at the same side of diaphragm /
associated extralymphatic site (IIE)
III : involvement of lymph node regions
on both side of diaphragm / associated
extralymphatic site (IIIE)
IV : disseminated (multifocal)
involvement of extralymphatic site &
associated lymph nodes
Tambahan : A = asymptomatic, B =
symptomatic (weight loss >10% in 6
months, fever >38C, night sweat)
(Harmening, 403)
Pada kasus ini bilateral cervical &

inguinal lymphadenopathy (=stage III) &

ada symptom weight loss, fever, night
sweat (=B).
59. Jawaban : B. Radiation
Penjelasan :
Current modalities for the therapy of
Hodgkins lymphoma are radiation,
chemotherapy, or combination.
(Harmening, 403)
60. Jawaban : A G6PD-deficiency
Penjelasan :
Tabel 10-2 (Harmening, 159)
chloramphenicol bisa menyebabkan
G6PD deficiency.
Gejalanya anemia normochromic
normocytic, back pain, hemoglobinuria &
jaundice. (Harmening, 159)
61. E. Severe anemia (Hb < 7g/dl)
62. D. Karena : 8 mo, mild icterus,
hepatosplenomegaly, decreased Hb,
RDW increased, microcytosis,
hypochromic
63. D jelas
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.
Packed red cell = RBC + small amounts
of plasma with anticoagulant.
65. B. Semua sign n symptoms
mengarah pada hemolytic anemia
66. A. Sign symptoms mengarah pada
megaloblastic anemia ( terutama :
malnourished). Di peripheral blood
smear ditemukan : pancytopenia, macroovalocytes, hypersegmented neutrophils
67. B. Semua ciri2 pasien kita mengarah
pada thalassemia. Peripheral blood
smear : microcytic, hypochromic, >>>
target cells (Harmening 196)
68. C (liat no 64)
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.
70. C. Alasan diperkuat krn multiple Auer
rod were seen.

71. D. Pasien kita anemia,

leukocytosis,thrombocytopenia.
Sepertinya dia kena leukemia.
72. B. Aplastic anemia : CBC shows
pancytopenia, often with anemia being
the most notable. The anemia is usually
normochromic normocytic (Harmening
133)
73. B. Pasiennya mengalami
pancytopenia (bukan leukemia), tapi
aplastic.
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
75. C. Each unit of PRBCs is expected to
raise circulating Hb by 1g/dl.
76. C. Disturbed cell = platelet (dont
have nuclear in mature cell, function :
hemostasis, have OCS)
77. gtww..sorii
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)
79. D. Jelas,merupakan treatmenu utk
IDA
80. B. Ferric iron is typically converted
into ferrous state by the ACID of the
stomach. (Harmening 101)
81. A.Folic Acid
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)
82. E. Cyanocobalamine
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.
83. A. Blood Transfusion
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.
84. B. Urokinase
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.
85. the question is not complete
87. A. Decrese of basophilic color
The changes of RBC
maturation,particularly in cytoplasma is
from basophilic to red cytoplasma
because of increase of HB.
88. C. Yolc sac - liver and spleen red
bone marrow
See harmening page 9
89. B. Briliant cresyl blue staining
See harmening page 80
90. C. Tissue hypoxia
See harmening page 15
91. B. Pelger-huetanomaly
Netrophil that has a bilobus nuclei or
monolobed/round
93. B. ITP
More closed diagnose from the option is
ITP
96.
98.
99. mechanism of action of allopurinol
Inhibitor to enzyme xanthin oxidase in
uric acid production to treat of gout.
101)
102) ANS : D
incompletely encapsulated,each tonsil
has 10-20EXP : tonsil 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)
103)
107)
108)
110) ANS : D

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)
111) ANS : C
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.
NURSING MOTHERS: It is not known
whether thalidomide is excreted in
breast milk.
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)
112)
113) ANS : E
advantages :EXP : corticosteroid
Promote normal intermediary
metabolism
increase resistance to
stress(exp;trauma,fright,infection)give
high energy Increase resistance to
stress high glucose
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
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.

 Affect other components of endocrine

system
Effects on other systems
(Lippincott,pharmacology,3rd ed,308309)
114) ANS : C
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)

115) ANS : C
hyperglycemia may developEXP : side
effects of glucocorticoid & lead to
DM,other side-osteoporosis,increase risk
of infection & classic Cushing-like
syndrome (pharmacology,Lippincott,3rd
ed,pg 312)
116)
117) ANS : A
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)
118) ANS : D
EXP : refer to explanation of the answer
above
119) ANS : E
EXP : refer to explanation of the ans no.
117
120) ANS : B
EXP :
121. Which of the following is the best
place in-patient care ?
a. burn unit room
b. recovery room
c. high care unit room

d. standard in-patient room

e. intensive care unit room
Ans.
a/e
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 eyes topical glucocorticoid
treatment, need monitoring of an
ophthalmologist, due to defective cell
mediated immunity.
122. Which of the following is the most
unlikely sign of PE ?
a. allergic salute
b. Dennie-Morgan folds
c. facial twitching or grimacing
d. hyperemic nasal mucous
e. transverse nasal crease
Ans.
d
PE pada allergic rhinitis :
- facial twitching or grimacing
- allergic salute
- dennie-morgan folds
- transverse nasal crease
123. The eyes 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 ?
a. cataract
b. corneal ulcer
c. glaucoma
d. herpes simplex virus infection
e. sight threatening side effect
Ans.
c
Topical intraocular pressure in normal
eyesglucocorticoid therapy frequently
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.
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
cows milk formula and was exclusively
breastfed there after. Since 8 days ago

cows milk formula containing porridge

was added to her daily feeding. Her
brother (5 yo) will wheeze and her
mother sneeze after exposure to dust.
124. Which one of the following is the
most likely diagnosis ?
a. contact dermatitis
b. irritant dermatitis
c. atopic dermatitis
d. Steven Johnsons Syndrome
e. Streptococcal skin scalded syndrome
Ans.
c
Terjadi akibat konsumsi susu sapi.
125. Which one of the following is the
most likely cause of this babys disease ?
a. house dust
b. house dust mite
c. wheat
d. cows milk
e. breast milk
Ans.
d
Telah diberikan selama 8 hari.
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
129. Runny nose. Major substance
release ?
Ans.
IgE
130. for the above case, what is the
most suitable H. I. Antihistamine for this
patient ?
a. ceftrizine hydrochloride
b. chlorpheniramine maleat
c. promethazine hydrochloride
d. tripehennamite hydrochloride
e. diphenhydramine hydrochloride
Ans.
a
Sesuai dengan case. Efek samping pada
CNS rendah.
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 ?
a. estrogen
b. bradykinin
c. prostaglandin
d. progesterone
e. leukotrienes
Ans.
e
Menampakkan late phase mediator yang
memiliki efek sama dengan histamine
namun lebih potent.
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 ?
a. pale mucosa
b. post nasal drip
c. pseudomembrane
d. hyperemic mucosa
e. cobblestone appearance
Ans.
b
.terjadi akibat produksi mucus
139. During christmast dinner, female is
hospitalized because of tight throat and
shortness of breath after eating shrimp.
What is the diagnosis ?
a. choking
b. anaphylactic shock
c. shrimp in throat
d. laryngeal edema
e. asthma
Ans.
b
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 ?
a. aquagenic urticaria
b. cholinergic urticaria
c. heat urticaria
d. psychogenic urticaria
e. solar urticaria
Ans.
b
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.
161. From case 160. Permanent
symptom in NLE
A. Cutaneous lesion
B. Congenital heart block

C. Pulmonary involvement
D. Neurologic involvement
E. Thrombocytosis
Jawab : B
162. Major cause of death to chronic
corticosteroid administration ?
A. Infection
B. Nephritis
C. CNS disease
D. Pulmonary hemorrhage
E. Myocardial infarction
Jawab : A
Kenapa bukan E ? Karena kelainan
jantung yang bisa disebabkan oleh
corticosteroid adalah heart failure
(terutama congestive heart failure),
bukan myocardial infarction (= heart
attack).
163. IV drug user, Anti-HIV (+), CD4 =
66, shortness of breath, bilateral
infiltrate of lung. Which is true ?
A. Risk of multiple opportunistic infection
B. Risk of myocardial infarction
C. Risk of autoimmune disease
D. Risk of hematological disease
E. Risk of drug allergy
Jawab : A
164. 30 y.o. male had symptom of
anemia, diagnosed as megaloblastic
anemia. Drug avoided through
A. Oral
B. Intravenous
C. Intravascular
D. Subcutaneous
E. Intracutaneous
Jawab : B
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.
165. Patient with malar rash,
photosensitivity, atrophic lesion at
periauricular, ANA (+), dsDNA (-), no
protein in urine. Diagnosis ?
A. DLE
B. SLE
C. CLE
D. Acute SLE
E. Acute CLE
Jawab : E
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.
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 ?
Jawab :
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.
167.
168. Patient present with polyarthritis
around small joint of hand and feet.
According to Americal College of
Rheumatology for rheumatoid arthritis ?
A. Systemic symptom
B. Swan neck appearance
C. Rheumatoid nodules
D. Oligoarthritis
E. Osteosclerosis
Jawab : maaf, saya kurang tahu maksud
pertanyaannya >.<
diagnosis RA) :Kriteria diagnosis untuk
RA dari American College of
Rheumatology (minimal 4 terpenuhi
1. Morning stiffness > 1 hour for at least
6 weeks
2. Arthritis and soft tissue swelling of >3
of 14 joints/joint groups, present for at
least 6 weeks
3. Arthritis of hand joints, present for at
least 6 weeks
4. Symmetric arthritis, present for at
least 6 weeks

5. Subcutaneous nodules in specific

places
6. Rheumatoid factor at level above 95th
percentile
7. Radiological changes suggestive of
joint erosions
169.
170. Histopathology for above case :
171. Chief complaint : difficulty of
breathing
3 weeks ago, had diarrhea and febrile.
General practitioner gave antibiotic and
antidiarrhea, these drugs decrease the
symptoms.
2 weeks ago, felt numbness and
weakness in both extremities, which
become worse.
PE : alert, RR 14/min, temperature 36.7
Neurological exam : symmetrical and
bilateral tetraplegic, flaccid, gloves &
stocking anesthetic.
Physiologic reflex absent
Oxygen saturation is decreased
CSF analysis : cytoalbuminic dissociation
Which of the following type of
hypersensitivity is the most likely occur
in this case ?
A. 1
B. 2
C. 3
D. 4
E. 1 4
Jawab : D
Dari chief complain difficulty of
breathing, riwayat adanya infeksi
gastrointestinal sebelumnya, hasil
pemeriksaan neurologis yang
menunjukkan adanya ascending
paralysis, sepertinya ini adalah GuillainBarre Syndrome, yang disebabkan reaksi
hypersensitivity tipe 4.
172.
173. HIV antibodies positive since 5
years
CD4 = 65
Difficulty in breathing.
Which one is true ?
A. High risk for infection
B. High risk for myocardial infection
(infarction mgkn maksudnya)
C. High risk for hematologic disease
D. High risk for drug allergy
Jawab : A

174. Which of the following causes that

can proceed to respiratory failure in this
case ?
A. Ascending paralysis
B. Descending paralysis
C. Uncal herniation
D. Rostrocaudal herniation
E. Transtentorial herniation
Jawab : kalau ini kasus GBS, jawabnya A.
175.
176.
177. Appropriate tools to confirm
diagnostic for babys HIV infection
state ?
A. HIV DNA PCR
B. HIV RNA PCR
C. HIV culture
D. HIV p24 Ag ex
E. Anti-HIV-1
Jawab : B
178. Based on Indonesian Medical, what
is appropriate drug for treatment for
neonatal HIV infection ?
A. AZT + 3TC + NVP, 6 weeks
B. AZT + 3TC + ZDV, 6 weeks
C. AZT + ZDV
D. AZT + ZDV
E. Antimycotic
Jawab : A
untuk terapi AIDS, diperlukan gabungan
2 NRTI + 1 NNRTI atau 1 protease
inhibitor. AZT dan 3TC termasuk NRTI,
NVP termasuk NNRT, ZDV termasuk
NRTI.
179. Which one of the following is
mediator of early phase of mast cell
degranulation ?
A. Prostaglandin
B. Leukotriene
C. PAF
D. Tryptase
E. IL-4
Jawab : D
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.
180. Which of the following molecule is
opsonin that facilitates efficient
phagocytosis of microbes by neutrophil

and macrophage ?
A. IgA
B. IgG
C. IgE
D. CRP
E. IF
Jawab : B
Tabel 2-10 Lange Medical Immunology
hal. 36 menyebutkan, opsonin dari
macrophage salah satunya adalah
immunoglobulin, especially IgG
181.8 months old boy, mild icterus,
mycrocytosis, hypocromia,
anisopoikilicytosis, polychromasia,
basophilic stippling.Most appropiate
condition
a. moderate anemia+splenomegali
b. moderate anemia+
hepatosplenomegali
c. severe anemia+ hepatomegali
d. severe anemia+ splenomegali
e. severe anemia+ hepatosplenomegali
182.which of following is present to
facilitate efficient phagocytosis of
microbe by neutrophil and macrophage
a.IgA d.CRP
b.IgG e.IF
c.IgE
Alasan: IgG protect against bacteria and
virus by enhancing phagocytosis,
neutralizing toxins, and triggering
complement system.
183. a man diagnosed with AIDS 5 years
ago.CD4+ count decreased.What is big
risk
a.he is at risk getting oppurtunistic
infection
b.he is at risk of getting trauma
c.he is at big risk of getting malformation
d.he is at risk of getting inflamation
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.
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?
a.positive IgM specific to streptococcal
antigen
b.positive IgG specific to streptococcal
c.positive anti-double stranded DNA
d.positive rheumatoid factor
e.positive ASLO
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
Dimana ciri RA ialah: presence
rheumatoid factorbin serum and synovial
fluid, infiltartion lymphocyte and
activated macrophage into involved
synovium, dan local production TNFalpha dan other proinflamatory cytokines
in inflamed synovium.
185.SLE is the diseasse of autoimmune
origin.Which of following act as antigen
from the production of antibodies in the
case
a.snRNP (small nuclear
ribonucleoprotein)
b.Mrna
c.rRNA (ribosomal ribonucleic acid)
d.cDNA (circular deoxyribonucleic acid)
e.dsDNA (double stranded DNA)
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)\
186.lihat soalny di buku kumpulan soal
a.hair fall d.difficult concentration
b.skin rash e.symetrical polyarticular
inflamation
c.systemic symptom
alasan: main problem / chief complain
ialah keluhan yang mebuat seseorang
datang beribat ke dokter.
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
a.SLE d.artritis reactive
b.Rheumatoid artritis e.osteomyelitis
c.spondyloartritis alasan : lihat
pembahasan no 184
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
a.systemic symptom d.oligoartritis
b.swan neck deformities e.osteoslerosis
c.rheumatoid nodule
Alasan: most characteristic feature of
hand in RA are
- 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.
- swan neck deformities (hyperextention
of proximal interphalange joint and
- flexion of distal interphalange joints
resulting from contarcture of intinsic
muscle of the hand)
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
A.gouty artritis and osteoartritis
b.rheumatoid artritis and spondyloartritis
c.septic artritis and rheumatoid artritis
d.osteoartritis and rheumatoid artritis
e.SLE and spondyloartritis
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
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
a.low dose aspirin d.paracetamol
b.allupurinol e.prednisone
c.hydrochlorothiazide
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.
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.
a.neutrophile d.NK cells
b.monocyte e.dendritic cell
c.CD4 cells
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.
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
a.neutrophle d.NK cells
b.monocyte e.basophile
c.B cell
Alasan: MHC II diekspresi oleh APC
(dendritic cell, macrophage, dan B cell)
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
a.spongiosis within epidermis
b.superficial perivascular lymphocytic
infiltrate
c.intraepidermal blister with acantholitic
d.dermal and epidermal edema and
mast cell degranulation
e.subcorneal blister with acantholitic
cells.
Alasan: microscopic pada pemphigius
folaceus ialh subcorneal clister is
apparent with acantholysis.
196.Gouty artritis that is caused by
overproduction of uric acid.which of the
following is a precursor of uric acid
a.pyrimidine d.thymine
b.purine e.uracil
c.cytosine
alasan: uric acid produced by xanthine
oxidase from xanthine and
hypoxanthine, which in true produced
from purine.
197.allupurinol is compound used to
trear gout.which of the follwing is the
mechanism of action of the dug above
a.inhibit degradation of guanosine to
guanine
b.inhibits degradation of guanine to
xanthine
c.increase excretion of hypoxanthine
d.activates degradation of uric acid to
allantoin
e.inhibit degradation of hypoxanthine to
xanthine
alasan: allopurinol inhibit synthesis
xanthine oxidase and prevent synthesis
of urate from hypoxanthine and xanthine
(xanthine oxidase: ubah degradasi
xypoxanthine menjadi xanthine)
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:
a.trasferrin d.albumin

b.acid phosphatase e.globulin

c.scaferrin
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
a.interfering with spermmatozoa
production
b.interfering with spermatozoa
capacitation
c.reducing the amount of spermatozoa
d.reducing the mobility of spermatozoa
e.agglutinating and immobilizing the
spermatozoa
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
a. objective of transplantation
b. antigens in the HLA system are
controlled by cromosome 8
c. alleles of the genotype maybe
homoxygous and heteroxygous
d. alleles of the genotype are always
homozygous
e. alleles of the genotype are always
heterozygous
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.
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komentar
MDE HIS 2007-2
1. Jawaban : C
Alasan : soal kurang lengkap, klo hanya
segini harusnya bisa semua. Tapi klo ada
hemarthrosis (bleeding in joint) biasanya
karena masalah koagulasi.
2. Jawaban : A
Alasan : ada thrombocytopenia

sedangkan blood count lain normal, ada

sejarah bleeding (Harmening hlm 474)
3. Jawaban : C
150000-350000 (tabel Harmening)
4800-10800, PLT 12-16 (women), WBC
Alasan : Hb nomal
4. Jawaban : A
Alasan : gejala paling sering pada ITP
adalah bleeding, dan yang paling
berbahaya bila terjadi di intrakranial
5. Jawaban : C/D
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)
6. Jawaban : C
peningkatan jumlah megakaryocyte
(harmening hlm 444)Alasan : BM smear

newborn
multiple coagulation factor disorder
kelainan pada intrinsic dan extrinsic
pathway Alasan : prolonged PT dan
aPTT
16. Jawaban : A/B
kemungkinana kelainan di faktor
koagulasi (Harmening hlm 465466)Alasan : PLT count normal
17. Jawaban : E
Alasan : nampak soalnya salah,
harusnya PLT count berkurang, jadi
diagnosisnya ITP
18. Jawaban : B
kelainan proses koagulasi (secondary
hemostasis)Alasan : ada faktor genetis
(pada male family member) dan
peningkatan aPTT

7. Jawaban : A
Alasan : Harmening hlm 444

19. Jawaban : C
Alasan : prolnged aPTT, hemarthrosis,
history of bleeding in male family
member (Harmening hlm 501)

8. Jawaban : C
Alasan : dari SS mungkin yang bterjadi
adalah Hodgkins lymphoma

20. Jawaban : D
kelainan faktor VIIIAlasan : hemophilia
A

9. Jawaban : A
Alasan : diagnosis untuk keganasan pada
lymph (node) dilakukan melalui biopsy

21. E. jelas ya, liat penjelasan no 24

tahun 2007-1
22. E. pasien kita ini kemungkinan
dikarenakan DIC (salah satu etiologynya
terjadi peningkatan konsumsi dari
faktor2 koagulasi adalah sepsis)
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 DDimer. Coba lihat harmening hal 528
tabel 26.4
Note: DIC itu mempunyai manifestasi
yang unik, tergantung dari manifestasi
mana yang dominan, bisa manifestasi
pendarahan atau manifestasi
thrombotic.
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

10. Jawaban : D
Alasan : Robbins hlm 688
11. Jawaban : B
Alasan : kebanyakan pasien ditreatment
dengan chemotherapy (cytostatic)
12. Jawaban : E
Alasan : adverse prognostic factors
identified in the international study are:
Age >= 45 years, Stage IV disease,
Hemoglobin < 10.5 g/dl, Lymphocyte
count < 600/l or < 8%, Male, Albumin <
4.0 g/dl, White blood count >= 15,000/l
13. Jawaban : IDA
Alasan : sign & symptom cocok dgn IDA
14. Jawaban : Acidophilic normoblast
Alasan : sebenernya jawabannya lack of
stainable iron in reticuloendothelial
cells, tapi ga ada di pilihan.
15. Jawaban : Hemorrhagic disease of

mempengaruhi factor II,VII,IX,X..

24.B. karena abnormal response dari
mast cell dari compensatory cholinergic
in thermoregulation.
25.?
26.?
27?
28?
pale yang disertai icterus, splenomegaly
(SII) 29. E. jelas ada tanda2 hemolytic
anemia
30. splenectomy; untuk Thalasemia
danagak ga jelas. Untuk H.spherocyte
transfusion PRC, hydroxyurea atau bone
marrowSickle Cell disease
dikasihtransplantation. Untuk hemolytic
anemia karena autoimmune
glucocorticoid, tapi di sini soalnya ga
gitu jelas.
31. jika optionnya seperti ini, diagnosis
pastinya melalui Hb electrophoresis.
33.??
38. D.kalo granulocyte
hyperpigmentation itu ga ada.adanya
adalah hypersegmentation yang muncul
pada megaloblastic anemia.
39. D. robbins hal 676
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
41. Jawaban : E. cryoprecipitate
Pembahasan :
Penyakitnya adalah hemophilia, karena
ada riwayat bleeding pada keluarga lakilaki & APTT turun.
Cryoprecipitate = a concentrated
source of coagulation fator VIII.
(Harmening, glossary 699)
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)
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)
Yawda kasih cryo- aja, daripada yang
laen lebih ga nyambung, ya ngga??
42. Jawaban : C. scafferin
Pembahasan :
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)
43. Jawaban : B. BCB staining
Pembahasan :
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)
Cytoplasm of reticulocytes stains
slightly basophilic with Wright's stain.
However, when stained with a supravitalstain such as new methylene blue or
brilliant cresyl blue (BCB), precipitated
ribrosomal RNA (reticulum) can be
demonstrated within the cell. (internet)
44. Jawaban : (?) akademik 2006 jawab
A. increase potassium
Pembahasan :
45. Jawaban : (?) akademik 2006 jawab
A. whole blood
Pembahasan :
46. Jawaban : pronormoblast / rubriblast
Pembahasan :
Youngest RBC -> pronormoblast /
rubriblast (Harmening, 10, tabel 1-6, 13)
47. Jawaban : myeloblast promyelocyte
N.myelocyte N.metamyelocyte
N.band N.segmented
Pembahasan :
Stage of neutrophil development
(Harmening, tabel 1-7, 17)
48. Jawaban : B. leukocyte, Hb, diff.count
Pembahasan :
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.
49. Jawaban : A. microcytic, hypochromic
anemia
Pembahasan :
(Harmening, tabel4-3, 77)
MCV (80-100 fL) -> turun, microcytic
MCH (22-31 pg)
MCHC (32-36%) -> turun, hypochromic

Pada kasus, ketiganya turun, maka

microcytic hypochromic anemia.
50. Jawaban : B. iron deficiency anemia
Pembahasan :
MCV, MCH, MCHC turun -> microcytic
hypochromic anemia.
A. megaloblastic anemia -> macrocytic
normochromic
B. IDA -> microcytic hypochromic (V)
C. hemolytic anemia -> normocytic
normochromic
D. aplastic anemia -> normocytic
normochromic
E. pernicious anemia = megaloblastic
(Harmening, tabel 4-3, 77)
51. Jawaban : B. normoblast with marked
nucleus
Pembahasan :
IDA > the bone marrow revealed a
mild to moderate increase in erythroid
progenitors (normoblasts). (Robbins,
646)
52 53. ga ada soalnya...
54. Jawaban : E. bullous pemphigoid
Pembahasan :
Bullous pemphigoid > a bullous
autoimmune disease usually in eldery.
Lesion = pruritic papular / urticarial
lesion with large tense bullae,
subepidermal blister with eosinophils.
Mechanism = interaction of antibody
with bullous pemphigoid antigen
(BPAG12) at hemidesmosome of basal
keratinocyte. (Fitzpatrick pocket, 112)
55. ga ada soalnya...
56. Jawaban : A. abnormal synthesis of
globin chain
Pembahasan :
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)
57. Jawaban : C packed red cell
Pembahasan :
Karena terdapat defek pada
pembentukan rantai globin dari Hb, dari
RBC. Maka transfusi yang sesuai adalah
packed red cell.
58. Jawaban : E. aplastic anemia

Pembahasan :
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)
59. Jawaban : (?)
Pembahasan :
Penyakitnya adalah IDA, karena serum
iron & ferritin turun.Terapi dengan iron
replacement.
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)
60. ga ada soalnya...
61. D
62. C. Tanda2 dari pasien ini mengarah
ke IDA. Lab result dari pasien yg
mengidap IDA adalah decreased serum
ferritin, increased TIBC
63. E. seperti case IDA kita (no
hepatosplenomegaly)
64. D
65. C
66. A.
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.
68. C. Pasien kita terkena leukemic tipe
AML (dewasa), khususnya AML M3
69. B.
70. ga nyambung soalnya
71. A
73. E
74.C
75. C
78. A
79. D
80. ga jelas soalnya
100) A
101) C
102) A
103) D
104) D
105)
106) A
107) E

108) C
109) A
110) D
111) C
112) D
124. which of the following is the
characteristic of rhinorrhea ?
Ans.
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 ?
Ans.
B. Exocrine
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. Shes allergic to cold but has
no history of food allergy. Which of the
following skin layer is abnormal ?
Ans.
A. Pars papillaris
128. a 24 years old male, IV drug user,
lab result shows HIV (+). Which of the
following cell killed by the virus ?
Ans.
C. CD4+ T lymphocyte
132. which of the following cells is
mediated in transmitting this virus to
CD4+ and T lymphocytes ?
Ans.
?
133. which of the following target cell
will be killed by cytotoxic T cell induced
by viral infection ?
Ans.
B. Infected by virus and identical at class
I MHC loci at cytotoxic T cell
134. after binding to its specific antigen,
a B lymphocyte may switch which of the
following component ?
Ans.
B. Immunoglobulin heavy chain class
135. which of the following must be
exposed on the surface of APC that
activate T helper ?
Ans.
D. Class II antigen
136. which of the following class
immunoglobulin is present in highest
concentration in the blood of human
newborn ?
Ans.

A. IgG
137. which of the following statement is
the most likely is the macrophage during
an antibody response ?
Ans.
D. Processing antigen and presenting it
139. MoA of allopurinol ?
Ans.
Allopurinol inhibits xanthineoxidase and
prevents the synthesis of urate from
hypoxanthine and xanthine.
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.
140. which of the following is the most
likely diagnosis ?
Ans.
D. SLE
190.A.Prevent rather than reversing
histamin action on target tissue
193.E.Agglutinating and immobilizing the
spermatozoa
196.B.Competitive inhibitor of histamine,
by reversible binding of H1 receptor.
197.D.Topical Antihistamin
198.B.NSAID
199.C.IgA
200.D.Polyclonal antibody generate by
injection of human thymocyte in animal
Pembahasan bisa dilihat di MDE 2007-1
Diposkan oleh superstar2007 di 05:35 0
komentar
MDE HIS 2007-1
1. Male, 14 y.o : joint bleeding. Ada
history bleeding. Hemarthrosis. Hb
14gr/dL. WBC 8000. PLT 225.000. How
can you explain this problem?
A. quantitative PLT disorder

B. qualitative PLT disorder

C. coagulation disorder
D. thrombotic disorder
E. vascular disorder
Jawaban : C
Alasan : karakteristik coagulation
disorder : hemarthrosis dan hematoma.
A, B, PLT qualitative primary
hemostasis disorder E & quantitative,
vasculat defect. (Harmening hlm 471472)
2. Lab test apa untuk konfirmasi
diagnosis?
3. Diagnosis?
A. ITP
B. henoch S purpura
C. von Willebrand disease
D. DIC
E. Acute leukemia
Jawaban : C
Alasan : kelainan koagulasi dengan SS di
atas paling mungkin vWF disease
4. Character of cell in IDA?
Jawaban : hypochromic, microcytic RBC
5. Abnormalities PLT di atas disebabkan
oleh?
Jawaban : ITP
6. Most appropriate statement of the
case?
A. mostly will have spontaneous
remission
B. mostly will need splenectomy
C. mostly will need IV Ig
D. about half respond to corticosteroid
E. about half will change to leukemia
Jawaban : D
Alasan : Patients with ITP are initially
treated with corticosteroid to rapidly
increase PLT and improve hemostasis
(Harmening hlm 475)
7. Cells that will increase in bone marrw
smear as a compensation in this case?
A. thrombocyte
B. reticulocyte
C. magakaryocyte
D. myeloblast
E. normoblast
Jawaban : C
dikompensasi dengan bentuk dan
ukuran yang besar dikarenakan
pembentukan yang belum
sempurnaAlasan : jumlah PLT

8. In primary hemostasis, what mediates

the PLT adhesion to expose collagen
within the endothelium of the vessel
wall?
A. GpIb
B. fibrinogen
C. plasmin
D. PDGF
E. kinin
Jawaban : A
Alasan : Harmening bab introduction to
hemostasis
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 (-)
9. Which is the cause of
lymphadenopathy?
A. Inflammation
B. Infection
C. Metastasis malignancy
D. Lymph node
E. Autoimmune
Jawaban : C
kemungkinan besar ada
keganasanAlasan : ada mass, fever,
night sweat, weight loss
10. The most appropriate exam :
A. lymph node biopsy
B. Abdomen USG
C. LDH
D. Bone marrow aspiration
E. PBS
Jawaban : A
Alasan : untuk memeriksa jenis jaringan
lymph yang terkena diperlukan biopsy
11. Clinical stage :
A. IA
B. IB
C. IIA
D. IIB
E. IIIA
Jawaban : D
Alasan : dengan ciri2 di atas
kemungkinan kasus yang terjadi adalah
hodgkin lymphoma. Klasifikasi :
Stage I is involvement of a single
lymph node region (I) or single
extralymphatic site (Ie);
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);

 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);
Stage IV is disseminated involvement
of one or more extralymphatic organs
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.
12. Which is the most appropriate source
of the most cause of lymph adenopathy?
A. Head
B. Oral cavity
C. Thorax
D. Inguinal
E. Inferior extremity
Jawaban : A
Alasan : Cervical adenopathy is a
common feature of many viral/bacterial
infections

15. What cell that will be difficult to

found in bone marrow smear?
A. Basophilic normoblast
B. Polychromatophilic normoblast
C. Acidophilic normoblast
D. Reticulocyte
E. Pronormoblast
Jawaban : E?
Alasan : sebenernya jawabannya lack of
stainable iron in reticuloendothelial
cells, tapi ga ada di pilihan.
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?
A. Hemophilia
B. von Willebrand disease
C. ITP
D. Hemorrhagic disease for newborn
E. DIC
Jawaban : C
Alasan : PLT <30.000, ada petechiae
(Harmening hlm 474)

13. What is the positive factor to

determine prognosis?
A. Liver enzyme level
B. Creatine level
C. LDH level
D. Uric acid level
E. Hb level
Jawaban :
Alasan : The adverse prognostic factors
identified in the international study are:
Age >= 45 years
Stage IV disease
Hemoglobin < 10.5 g/dl
Lymphocyte count < 600/l or < 8%
Male
Albumin < 4.0 g/dl
White blood count >= 15,000/l

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 :
A. PLT
B. plasma fibrinogen
C. factor VIII
D. tPA
E. D-dimer
Jawaban : E
akan menghasilkan D-dimer (Harmening
hlm 463) menandakan banyak
pemecahan fibrinogen Alasan :
penurunan fibrinogen

Female, 33 y.o. fatigue, shortness of

breath with exercise, heavy menstrual
bleeding for several years, increase
TIBC, decrease ferritin and transferrin
14. Diagnosis?
A. Thalassemia
B. Acquired hemolytic anemia
C. Pernicious anemia
D. Aplastic anemia
E. Iron deficinecy anemia
Jawaban : E
Alasan : karena ada increase TIBC,
decrease ferritin and transferrin

18. unconscious for the 3rd day of life.

CT scan :a previous healthy baby
intrasranial bleeding. Lab : HB 11, WBC
6000, PLT 117.500, PT dan aPTT , BP
normal.
A. PLT
B. fibrinogen
C. AHF
D. factor II, VII, IX, X
E. nature inhibitor of coagulation
Jawaban : D
Alasan gangguan extrinsic/common
pathway. Peningkatan aPTT :
peningkatan PT gangguan
intrinsic/common pathway. Kemungkinan

mengalami gangguan multifactor.

19. Diagnosis :
A. Hemophilia
B. DIC
C. Hemorrhagic disease in newborn
D. congenital hypofibrinogenemia
E. von Willebrand disease
Jawaban : C
Alasan : gangguan koagulasi akibat
kurangnya vit K untuk pembentukan
faktor koagulasi (Wintrobe ch )60
20. Vitamin yang dibutuhkan?
A. Vit A
B. Vit B
C. Vit K
Jawaban : C
Alasan : vit K merupakan vit yang
dibutuhkan untuk pembentukan faktor
koagulasi.
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..
22. Penampakan yang muncul apabila
seseorang terkena IDA yaitu
Peripheral blood smear :
microcytic,hypochrome, anisopoikilocytosis, terdapat pencil shape,
juga terdapat target cell
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
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).
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.
25.?? Ga ngerti.. sorii
26. A. hypovolemic condition..
berdasarkan wintrobe pada
bab pendarahan transfusion medicine,

keadaan hypovolemic ditangani dengan

transfuse whole blood.
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.
28.?
29. selama acute inflammation : CBC,
CRP / ESR.
30.A. gambarannya ialah MCV rendah =
microcytic, MCHC rendah = hypochrome.
31.B. gambarannya mengarah Fe
deficiency.
-Megalloblastic = MCV biasanya naik
-Hemolytic anemia = MCV,MCH turun,
MCHC turun(hereditary spherocytocyte
naik) tapi ada peningkatan dari RBC dan
reticulocyte count serta ada tanda2
seperti jaundice,splenomegaly
-Aplastic = jumlah WBC dan platelet juga
turun
-Pernicious anemia = gambaran
megalloblastic.
32. B. liat penjelasan no 22
33. C. adanya peningkatan yang besar
dari blast cell golongan myeloid. Jadi
jelas merupakan AML.
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.
35.A. adanya tanda2 anemia : pale dan
hb turun, increasing destruction dari RBC
berupa splenomegaly, dan adanya
kecurigaan hemolytickompensasi
anemia, yaitu peningkatan retikulosit
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.
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.
37. A. jelas ya..
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)
39.C.
40. ??
41. Jawaban : D. decrease serum ferritin
Pembahasan :
Merupakan ciri-ciri Iron Deficiency
Anemia (IDA).
Hasil lab : decrease serum ferritin level,
derease serum iron level, increase TIBC
(Harmening, 104)
42. Jawaban : C. vitamin C
Pembahasan :
Menurut internet, vitamin C memang
membantu absorbsi non-heme iron.
43. Jawaban : A. vitamin B12
Pembahasan :
Clinical manifestation of vit.B deficiency:
-peripheral nerve : paresthesia, areflexia,
symmetric tingling.
-posterior spinal columns : clumsiness,
incoordinate gait.
-lateral spinal columns : weakness &
stiffness of limbs, memory impairment,
depression.
(Harmening, 119)
44. Jawaban : (?) akademik 2006 jawab
D. gum hypertrophy
Pembahasan :
Classic symptoms of vit B12 deficiency
include weakness, glossitis,
paresthesia. (Harmening, 118)
45. Jawaban : B hemolytic
Pembahasan :
Subiteric sclera -> banyak bilirubin di
darah -> banyak pemecahan RBC
(hemolytic) -> splenomegaly (kerja
berat, tempat pemecahan RBC)
46. Jawaban : E. glossitis
Pembahasan :
Merupakan penyakit anemia
megaloblastik, karena ada ciri-ciri
weakness, numbness, hypersegmented
neutrophil (Harmening115,119). Maka
PE-nya kemungkinan terdapat glossitis

(Harmening, 118)
47. Jawaban : E. hyperativity of
macrophage cell
Pembahasan :
Penyakitnya anemia hemolitik, karena
yellow skin.
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)
48. Jawaban : C. gaster
Pembahasan :
Penyakitnya anemia megaloblastik,
karena ada giant stab/band cell
(Harmening, tabel 7-1,115).
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)
49. Jawaban : (?) akademik 2006 jawab
A. Hodgkin lymphoma
Pembahasan :
Penyakit yang histopatologinya ada
rossete-like formation = ?
50. Jawaban : B. chronic lymphocytic
leukemia
Pembahasan :
WBC sangat meningkat -> keganasan.
Periphreal blood, mature lymphocyte
meningkat -> chronic lymphocytic
leukemia /CLL (Harmening, tabel 16-2,
275)
51. Jawaban : C. observe
Pembahasan :
Klasifikasi Rai-Binet untuk CLL
(Harmening, tabel17-5, 310).
Pada kasus ada splenomegali, jadi
masuk stage II. Treatmentnya
observation, karena pada kasus ini
asymptomatic (Harmening, tabel17-6,
311)
52. Jawaban : (?) akademik 2006 jawab
A. B-prolymphoid transf well diff.
Pembahasan :
CLL is most frequent neoplasm of B
lymphocyte. (Harmening, 302)

Photomicrogaph of bone marrow

aspirate smear from CLL patient. Note
monotonous appearance of matureappearing lymphocytes with condensed
nuclear chromatin. (Harmening, fig 172, 303)
A. pro- vs mature = ?
53-60. ga ada soalnya...
83.
84.
85. B. G6PD
Sulfamethoxazole has side effect that
cause deficiency of glucose 6 phosphate.
Deficiency of this enzyme can cause
breakdown of RBC (hemolisys)
86. C. Normochromic normocytic
Hemolityc blood smear
87.
88. B. Type B child
89. D. Father Rr
90. C. Palatine tonsil
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 1020 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)
95. E. 0,3 in 1:1000
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.
96. B. irreversible shock
The most frequent cause of death in the
case of anaphylaxis
97. D. IgG
IgG is the autoantibody of SLE so it can
cross placenta
98. D. between 12-16 week of gestation
99. A. congenital heart block
100. A. infection
One of effext of steroid administration is
immunosuppressant. It is increase the r
isk of infection.
100)
103)
104)
105)

D
A
B
A

106)
107) A
108) hypersensitivity type 1
109) A
110) B
111)
112)
113)Ig E (+) = atopy
114) B
115) A
116)
117)
118) D (I think)
119) C
120) A
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 ?
Ans.
D. Pars papillaris
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 ?
Ans.
C. Capillary
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 ?
Ans.
C. CD4+ T lymphocyte
129. most likely characteristic above
virus ?
Ans.
C. Have single stranded RNA
130. what gene is likely needed for
replication for above virus ?
Ans.
B. Tat
133. following target cell will be killed by
cytotoxic T cell induced by viral infection
?
Ans.
B. Infected by virus and identical at class
I MHC loci of the cytotoxic T cell
134. after binding to its specific antigen,
B lymphocytes may switch t which of the
following component ?
Ans.
C. Variable region of the Ig heavy chain
135. which one of the following must be
expressed on the surface of APC that
activate T helper cells ?
Ans.
D. Class II MHC antigen
136. which of the following class of

immunoglobulin is present in highest

concentration in the blood of a
newborn ?
Ans.
A. IgG
137. which of the following statement is
the response of macrophage for antibody
reaction ?
Ans.
A. Lysing virus infected cell
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 ?
Ans.
A. Gouty arthritis
141. which of the following criteria
include the ACR diagnostic criteria for
her disease ?
Ans.
B. Increase ANA titer and positive anti
dsDNA
For questions number 161 163, see the
case below :
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 37.5C. PR 130/min
161. Which of the following mediator
most likely inhibiting the process causing
the above condition ?
A. PGI2
B. PGE2
C. PGD2
D. PGF2
E. TXA2
Jawab : E
Hipersensitivitas tipe I. Gejala-gejalanya
disebabkan oleh mediator-mediator yang
menyebabkan vasodilatasi dan
peningkatan permeabilitas vascular.
Thromboxane (vasokonstriktor) dapat
menyebabkan penghambatan.
162. What is the enzyme responsible ?
A. Adenylate cyclase
B. Guanylate cyclase
C. Thymidine cyclase
D. Uridine cyclase
E. Cystosine cyclase
?

163. Which mediator is inhibited on this

phase ?
A. Histamine
B. Leukotriene
C. Prostaglandin
D. Prostacyclin
E. Thromboxane
Jawab : E
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 ?
A. IgG
B. IgA
C. IgE
D. IgM
E. IgD
Jawab : C
IgE-mediated Allergic rhinitis
165. Malar rash especially on
photosensitivity area, caused by immune
complex. What type of hypersensitivity
responsible ?
A. I
B. II
C. III
D. IV
E. All above
Jawab : C
Kata kuncinya adalah immune
complex, apalagi sign and symptom
merujuk ke lupus. Jadi, hypersensitivity
type III.
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 ?
A. Decrease IgE
B. Decrease basophilic histamine release
C. Decrease IL-13 by TH1
D. Increase IFN gamma by TH-2
E. Increase soluble IL-2 receptor
Jawab : C
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-, dan TNF-. (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.
Maka karena pada psoriasis yang
dominan adalah TH1, terjadi supresi TH2
cytokine (yakni IL-13).
See the case below :
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.
167. The most likely diagnosis is :
A. Vernal conjunctivitis
B. Atopic conjunctivitis
C. Acute conjunctivitis
D. Flictenuralis conjunctivitis
E. Follicle conjunctivitis
Jawab : A
Kata cobblestone in superior tarsal
conjunctivae menunjukkan vernal
conjunctivitis (Lange Immunology hal.
527).
168. Which type of hypersensitivity can
cause this reaction :
A. Type I and II
B. Type I and III
C. Type I and IV
D. Type II and III
E. Type II and IV
Jawab : A
Di Lange (hal. 527) disebutkan vernal
conjunctivitis adalah atopic disease, jadi
termasuk tipe I. Selain itu, dia
dikategorikan juga di bawah antibodymediated disease, jadi masuk tipe II
juga. Memang immunologic
pathogenesisnya belum terlalu jelas.
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 ?
A. Acute uveitis
B. Vitritis
C. Choroiditis

D. Endophthalmitis
E. Pars planitis
Jawab : A
Uveitis dikarakteristikkan dengan adanya
keratotic precipitate (berupa WBC) pada
endothelium. Selain itu, ada ciliary
injection (tapi tidak spesifik untuk
uveitis).
170. The drug for acute uveitis ?
Cycloplegics (block nerve impulse to
ciliary muscles, therefore easing pain)
dan topical steroid.
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 ?
A. Bacterial ulcer
B. Herpetic ulcer
C. Geographian ulcer
D. Fungal ulcer
E. Maroon ulcer
?
See the case below :
A worst and numbness. 10 days ago, he
had20-year-old man. Weakness fever,
diarrhea, and was healed by treatment.
PE : dyspnea. Neurologic exam :
tetraparesis, glove-stocking hypesthesia
and decreased physiological reflex.
172. What is the finding in blood ?
A. Increase glucose with normal protein
B. Increase glucose with normal cell
C. Increase glucose with normal glucose
?
173. What microbe can cause this case ?
A. H. influenza
B. Campylobacter jejuni
C. Cytomegalovirus
D. S. typhii
E. Herpes zoster
Jawab : B
Guillain-Barre Syndrome bisa disebabkan
Campylobacter jejuni, HIV, EBV,
cytomegalovirus. Tapi karena didahului
gastrointestinal infection (diare yang
disembuhkan dengan treatment), maka
B lebih tepat.
174. What is the possible cause of
dyspnea ?
A. Ascending paralysis
B. Metabolic acidosis
C. Pulmonary distress

D. Laryngeal spasm
E. Metabolic alkalosis
Jawab : A
Guillain-Barre Syndrome
dikarakteristikkan dengan adanya
ascending paralysis dari ekstremitas
bagian distal. Salah satu komplikasinya
adalah respiratory failure.
175. Neurophysiological examination as
an additional for this case :
A. EEG
B. EMG
C. NCS
D. Evoked potential
E. TCD
Jawab : NCS atau EMG
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.
176. Drugs of choice for this case :
A. Corticosteroid
B. Immunoglobulin
C. Plasmapharesis
D. Neurotrophic
E. Neuroprotected
Jawab : B
Treatmentnya berupa plasmapharesis
dan immunoglobulin IV. Karena
pertanyaannya drugs of choice, jadi
jawabnya B.
177.
178.
179.
180.

182.D.Intraepidermal blister with

acantholitic cell
Alasan: Microscopic pada pemphigus
vulgaris ialah: an intraepidermal blister
is present containing acantholytic
cells.There is marked intracellular edema
and eosinophilic spongiosis.
189.C.Decrease cAMP dependent protein
kinase
Alasan: dengan penurunan cAMP
dependent protein kinase akan
mengakibatkan peningkatan cAMP yang
akan menghambat degranulasi.
190.A.preventing rather than reversing

histamins action on target tissue

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.
192.C.Scofferin
193.E.Agglutination and immobilizing
spermatozoa
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.
194.A.Object of transplatation
Alasan: The succes of an organ or tissue
transplant depends on histocompabilitythat is, the tissue compability between
the donor and the recipient.
195.E.Loratadine
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.
197.B.NSAID
Alasan: pada treatment RA, NSAID
merupakan first line treatment
sedangkan cytotoxic agent seperti MTX
dan cyclophosphamide dan
corticosteroid merupakan second line.
198.C.Topical Antihistamin
Alasan: Pada pasein ini mengalami
hypersensitivity type I sehingga
treatment paling cocok ialah permberian
anti-histamin
199.B.IgA
Alasan: IgA merupakan antibody yang
banyak dijumpai di cairan tubuh (secret)
seperti air liur, keringat, air mata,
vaginal secret dsb

200.D.Polyclonal antibody generated by

repeated rejection of human tymocyte
into animals
Diposkan oleh superstar2007 di 05:34 0
komentar
MDE HIS 2006

Alasan : poison ivy contact dermatitis

hypersensitivity tipe 4 T cell berperan
10. Jawaban : E
Alasan : 15 minutes acute phase
reaction A, B, C, D benar. E late
phase reaction
11. Jawaban : C

1. Jawaban : C
Alasan : Hb, Hct anemia, MCV
microcytic, MCHC hypochromic
2. Jawaban : B
Alasan : diagnosis IDA (harmening hlm
104)

Alasan : kemungkinan diagnosis adalah

Hodgkins lymphoma
12. Jawaban : A
Alasan : diagnosis untuk keganasan pada
lymph (node) dilakukan melalui biopsy
13. Jawaban : C

3. Jawaban : A
Alasan : promyelocyte&myelocyte
myeloblastic, immature cells acute
leukimia (AML)

Alasan : Robbins hlm 688

14. Jawaban : B

4. Jawaban : D

Alasan : kebanyakan pasien ditreatment

dengan chemotherapy (cytostatic)

Alasan : blast , PMN , lymphocyte N.

ALL lebih sering pada anak-anak.

15. Jawaban : E

5. Jawaban : E
Alasan : hasil lab merujuk pada CML
6. Jawaban : C
Alasan : kemungkinan yang btrjadi
adalah contact dermatitis
(hypersensistivity tipe 4)

Alasan : adverse prognostic factors

identified in the international study are:
Age >= 45 years, Stage IV disease,
Hemoglobin <>, Lymphocyte count
<>, Male, Albumin <>, White blood
count >= 15,000/l
16. Jawaban : A
Alasan : petechiae, ecchymosis, PLT
(Harmening hlm 474)

7. Jawaban : B
17. Jawaban : B
Alasan : ELISA menggunakan enzim dan
substrat dari enxim tsb yang akan
memberi warna pada antigen
8. Jawaban : D

Alasan : Harmening hlm 475

18. Jawaban : B
Alasan : Harmening hlm 475

Alasan : salah satu tes untuk SLE adalah

tes anti dsDNA

19. Jawaban : B

9. Jawaban : A

Alasan : Harmening hlm 475

20. Jawaban : D

Alasan : Harmening hlm 475

- dietary : kurang banyak vit b12-nya

21.C. jelas ya, setelah kita tahu kadar

Hb, kita tahu keadaan RBCnya secara
blood chemistry dan komponen2 yang
terlibat yang diindikasikan (serum iron,
TIBC, dll), lalu kita liat morfologinya RBC
dengan smear

- needednya meningkat pada wanita

hamil

22. B. IDA juga bisa bermanifest ke

lapisan kulit (spoon nail, atrophy tongue,
brittle hair)
23. C. Wintrobe bilangnya 3-6 months,
tapi Harisson bilangnya 6-12 bulan
karena di harisson itu prinsip treatment
adalah hilangkan anemia dan increase
and relieve iron storage 0,5-1 mg.
24.D. kalo liat dari wintrobe dan
harisson, respon therapy itu diliat dari
- symptom yang relieve
- increase back of reticulocyte ke jumlah
normal
- Hb naik ke arah normal
- kadar EPO yang turun
- Fe absorption turun
Tapi kalo diliat dari prinsip treatmentnya
harisson yang melihat sampai adanya
iron storage, maka melihat
keberhasilannya ya kita lihat storagenya
berupa feritin.
25. A. EPO masih punya efek untuk
menghiperplasiakan sel erythroid
precussor pronormoblast yang CFU-E,
yang masih sensitive terhadap EPO.
(compare: Sedangkan yang BFU-E itu
sensitive terhadap Interleukin)
26. B.
27. D. jelas ya, AML-M3 itu dicirikan
dengan promyelocyte dominant, adanya
faggot cell dengan adanya manifestasi
DIC , bisa berupa thrombosisnya atau
hemorhagicnya. Di sini kebetulan
manifestasinya berupa hemorrhagic.
28. D. di sini kecurigaan kea rah
deficiency dari vit b12. Etionya berupa:

- absorption : infeksi, kelainan congenital

pada GI tract, adanya autoimun (cthnya
yang ganggu parietal cell bwt release IF),
hereditary deficiency release dari
IF,neoplasia, gangguan release IF
gasterektomy, dll. Ngeliat dari kasus,
achlohydria ini merupakan salah satu
etiologi dari absentnya release
substance dari sel2 parietal yang juga
release IF.
29.D. anemia apalstik treatmentnya
berupa supportive dan transplantion of
bone marrow.
30.C. pada spherocyte, ditandai dengan
adanya kenaikan MCHC dan osmotic
fragility test yang meningkat karena
ketidakmampuan cytoskeleton RBC
untuk mempertahankan bentuk dan
resistensi tekanan osmosis
31. A. karena makin banyak
tersintesisnya Hb, warna cytoplasmanya
jadi makin jadi merah.
32. normal maturasi RBC:
- perubahan warna kea rah acidophil
karena increasing dari kadar Hb
- chromatin condensed, loss nucleoili,
loss nucleus
- decrease of mitochondria
33. B. azurophillic granule itu ada di
tahap progranulocyte, kalo uda mature,
granulocyte itu akan mengandung
specific granule. Di lecture note,
maturasi abnormal pada WBC
bisahypersegmen nuclei dan persisten
azurophillic granule di cytoplasm.
34. D.
35. C. ngeliat optionnya, ini mengarah ke
WBC maturation. Jadi yang jelas adalah
C.
36. E. karena adanya defect di rantai
beta, maka akan adanya mekanisme

kompensasi berupa switching rantai beta

ke rantai gamma dan delta, sehingga
membentuk rantai Hb 2 alfa + 2 gamma
atau 2 delta. Sehingga yang meningkat
masing2 adalah HbF (dengan gamma)
dan HbA2 (dengan delta)
37. B. jelas ya..

The incidence of acute GVHD (graftversus-host disease) can be reduced by

depleting the donor marrow of the cell
responsible for the GVHD reaction,
namely T-lymphocyte. (Harmening, 324)
45. Jawaban : B. mast cell
Pembahasan :

38. C. karena adanya penurunan jumlah

RBC maka mekanisme yang terjadi
adalah reaksi kompensasi berupa
peningkatan retikulosit.
39. A. aplastic anemia berupa
pancytopenia (penurunan sel2
hematopoietic) di perifer dan
hypoccellular pada bone marrow.

Anaphylactic shock terjadi karena

pelepasan histamin secara masif &
sistemik dari mast cell yang mengalami
degranulasi akibat menempelnya
antigen spesifik dengan antibodi yang
menempel pada permukaan mast cell.
46. Jawaban : C. causing the
histamine ...

40. D. ada di harmening

41. Jawaban : B. eosinophils

Pembahasan :
Penjelasan sama dengan nomor 45...

Pembahasan :
Jelas ya... eosinophil naik saat keadaan
alergi & infeksi parasit.
42. Jawaban : D. basophils

47. Jawaban : D. hemophilia

Pembahasan :
Terdapat hematoma. Hasil lab, BT
normal, PT normal, APTT prolong.

Pembahasan :
Mast cell granules, in addition to all
other substances that are present in the
granules of basophils, contain serotonin
& proteolytic enzymes. (Harmening, 42)

Penyakitnya hemophilia A. (Harmening,

tabel 25-1, 496)
48. Jawaban : D. deficiency of factor
VIII

43. Jawaban : A. sternum

Pembahasan :

Pembahasan :

Hemophilia A terjadi akibat defisiensi

faktor VIII. (Harmening, tabel 25-1, 496)

The sites for bone marrow studies in

adults are most commonly the posterior
superior iliac crest, occasionally the
sternum, and very rarely anterior
superior iliac crest & spinal process of
vertebral bodies. (Harmening, 43)
44. Jawaban : A. T-lymphocyte
Pembahasan :

49. Jawaban : D. defect of secondary

hemostasis
Pembahasan :
Secondary hemostasis involves the
enzymatic activation of coagulation
proteins to produce fibrin from
fibrinogen, thereby stabilizing the fragile
clot. (Harmening, 442).
Hemophilia A terjadi akibat defisiensi
faktor koagulasi VIII -> defek pada
secondary hemostasis.

50. Jawaban : D. deficiency of factor

VIII
Pembahasan :
Penjelasan sama dengan nomor 48,
51. Jawaban : D. defect of secondary
hemostasis
Pembahasan :
Penjelasan sama dengan nomor 49,
52. Jawaban : A. cryoprecipitate
Pembahasan :
Penyakitnya adalah hemophilia.
Cryoprecipitate = a concentrated
source of coagulation fator VIII.
(Harmening, glossary 699)
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)
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)
Yawda kasih cryoprecipitate aja,
daripada yang laen lebih ga nyambung,
ya ngga??
53. Jawaban : E. hemarthroses
Pembahasan :
Hemarthrosis is a primary symptom of
hemophilia involving knees, elbows,
ankles, shoulders, hips, wrists.
(Harmening, 501)
54. Jawaban : B. defect of platelet
production
Pembahasan :

D & E salah karena PT & APTT

normal,berarti tidak ada kelainan pada
fungsi faktor koagulasi (intrinsik &
ekstrinsik). Petechiae adalah
karakteristik abnormality of vessel or the
platelets, and are exceedingly rare in
coagulation disorders. Dan dari kasus,
jelas jumlah plateletnya sangat turun.
Maka defek produksi platelet yang
mungkin.
55. Jawaban : B. immune
thrombocytic purpura
Pembahasan :
Platelets undergo premature
destruction as a result of autoantibody.
Antiplatelet antibody can also bind to
precursor bone marrow megakaryocyte.
Tha bone marrow is characterized by
increased or normal number of
megakaryocyte. (Harmening, 474)
56. Jawaban : D. defect in factor
coagulation
Pembahasan :
Prolong PT -> defect in factor
coagulation (common pathway &
extrinsic)
Prolong APTT -> defect in factor
coagulation (common pathway &
intrinsic)
57. Jawaban : C. vitamin K deficiency
Pembahasan :
Acquired deficiencies of the vitamin Kdependent coagulation factors are
relatively common because the body
does not contain appreciable stores of
vitamin K. (Harmening, 655)
58. Jawaban : C. fresh frozen plasma
Pembahasan :
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)

59. Jawaban : B. polycythemia vera

rubra
Pembahasan :

67. sori gtw

68. E
69. B

Coffee ground vomit = muntahan yang

mengandung darah yang berubah gelap
bercampur dengan isi lambung akibat
pengumpulan darah dalam lambung.
(Dorland)
Elevation of the RBC count, Hb, and Ht
are the most important findings in PV.
(Harmening, 343)

70. C
71. E
72. B
73. C

GI disorders associated with PV include

peptic ulcer, and possibly, massive
hemorrhages from varices in the
esophagus, stomach, or bowel.
(Harmening, 342)

74. A

60. Jawaban : C.normal O2 saturation,

erythrocyte mass over 36 ml/kg,
high serum vit.B12

77. B

Pembahasan :

79. B

The arterial O2 saturation is normal in

most patients with PV. (Harmening,
344)

80. C

75. B
76. C

78. D

100)
101)
102)
103)
104)
105)
106)
107)
108)
111)
112)
113)
114)
115)
116)
117)
118)
119)
120)

Absolute erythocytosis is present in

men with values at least 36 mL/kg, and
in women with at least 32 mL/kg.
(Harmening, 343)
Increased serum vitamin B12 or vitamin
B12-binding proteins. (Harmening, tabel
18-8, 345)
A. salah low B12 / B. salah low O2 / D.
salah pada kasus male / E. salah high
O2.
61. sori gtw
62. A
63. D
64. D
65. A (mungkin yg dimaksud diagnosis
of CML depends on)
66. sorii gtw

B
A
A
C
D
C
C
A
A
E
C
E
C
A
E
A
D
D

121. how is the mechanism of action of

antihistamine ?
Ans.
-

122. which of the following is the

characteristic for the first generation of
antihistamine ?
Ans.

129. antigen that come from human

body substance and has ability to induce
immune response to human body self is
called ?
Ans.

B. Cross blood brain barrier

C. Autologous antigen
123. how does the antihistamine works
best in allergic disease ?
Ans.
B. Reversing rather than preventing
histamines actions on target tissue

130. the role of class I MHC in immune

response is presenting antigen from ?
Ans.
A. Infected cell to Tc cell

124. which of the following can be given

simulaneously with antihistamine,
metabolized through hepatic cytochrome
P450 pathway ?

131. viral receptor of HIV on human cell

is ?

Ans.

D. CD4

132. the most important defense body

mechanism in infection of HIV is ?

125. when might corticosteroids be NOT

beneficial at all in the management of
anaphylaxis ?
Ans.

Ans.

Ans.
D. Cell mediated immunity

133. one of the following statement of

HIV characteristics is not true ?

126. where exactly is the site of action of

glucocorticoids in allergic inflammation ?

Ans.

Ans.
?

E. Grouped in unenveloped virus

134. antigen binding site of
immunoglobulin are build by ?

127. cytokines that release by

macrophage and have role in maturation
of T helper cell is ?

Ans.

Ans.

135. if the amount of IgM can be

detected from sera of neonatus, it
indicates ?

B. IL-12

E. N-terminal of H&L chains

128. the highest concentration of

immunoglobulin that can be found in gut
secretion is ?

Ans.

Ans.

136. which of the following human body

cells does NOT have class I MHC on its
surface ?

B. igA

C. Intrauterine infectious disease

Ans.

illness, failure of patient to take

prescribed
medication,
inadequate
prescription
(dose
form),
and
malabsorbtion of iron.

?
137. one of the following is TRUE
regarding Discoid Lupus Erythematous
(DLE) ?

182.The drug that has effect of

myelinization process in peripheral nerve

Ans.

A.Iron

A. Patients with systemic lupus

erythematous (SLE) can develop DLE-like
skin patches

B.Cobalt

138. the lupus band test has correlation

with ?

D.Cyanocobalamin

C.Folic Acid

E.Riboflavin
Ans.
B. Discoid Lupus Erythematous
139. microscopic studies on biopsy of
DLE show ?
Ans.

Alasan: Pada keadaan Megaloblastic

anemia
(deficiency
B12)
biasanya
disertai
gangguan
neuropsyciatric
dimana B12 berperan dalam mencegah
degenerasi peripheral nerve, posterior
colum dan lateral colum.
183.The majority of iron in the body is
found in

C. Epidermal atrophy
140. one of the following pathologic
finding is most likely associated with
systemic lupus erythematous (SLE) ?

A.Myeloglobin

Ans.

C.Hemoglobin

A. Glomerular deposition of immune

complex

D.Storage iron

B.Enzyme

E.Hemosiderine
181.The presence of iron deficiency
anemia to iron therapy is influenced by?
A.The type of iron compound
B.Sex

184.The most common cause

nutritional anemia in human being is

C.Dose interval
D.Ability of patient
medicinal iron

Alasan: 2/3 iron berupa hemoglobin iron

sedangkan 1/3 berupa tissue iron dan
proporsi kecil berupa plasma dan
transport iron.

to

absorb

E.Age
Alasan:
Failure of iron therapy dapat diakibatkan
oleh: incorrect diagnosis, complicating

A.Iron deficiency
B.Riboflavin deficiency
C.Pyridoxine deficiency
D.Vit- B12 deficiency
E.Folic acid deficiency

of

Alasan: pada wanita sering terjadi IDA

khususnya saat menstruasi begitu juga
pada pria , kasus IDA juga sering
dijumpai.

188.Which pysical examination result

can cause a blood donor rejected

185.Substance
know
to
absorption of non-heme iron

B.Pulse 75 bpm

facilitate

A.Weight 55 kg

C.Temperature 36.5 c

A.Vit A

D.Diastolic 110 mg

B.Vit E

E.Hb 13.5 g/dl

C.Vit C

189.what transmitted disease test shold

be performed on blood that will
transfused to donor.

D.Vit D
E.Vit K
Alasan: Absorbis acid (Vit C) dan
succinate acid increase absorbtion of
ferrous iron.
186.The drug which has effect such as
paresthesia of hand and feet, dimunation
of vibration, and resultant unsteadiness.

A.Malaria,HBSag, VDRL, and ebstein barr

virus
B.Ebstein barr virus, VDRL,HBSag, and
cytomegalovirus
C.HIV, HBSag, HCV, and malaria
D.HLV,HCV,HBSag and VDRL

A.Vit B12

Alasan: seluruh type penyakit tersebut

sering diperiksa saat akan transfusi
darah sedangkan VDRL tidak dilakukan
karena VDRL tidak ditransmisi melalui
darah melainkan STI

B.Iron
C.Cupprum
D.Pyridoxin
E.Cobalt

190.What blood type is possible for an

offspring of AO dan BO person

Alasan: lihat pembahasan no 183.

a.AB,A or B

187.Soalny lihat di buku soal ya (panjang

banget)

b.A or B
c.AB,A.B or O

What is the most likely diagnosis:

d.AB or o

A. Secondary trombocytopenia
e.O
B. Thrombotic
purpura

trombocytopenia

C. Dengue hemorhagic fever

D. Immune
purpura

trombocytopenic

E. Drug induced trombocytopenia.

Alasan: IAIO + IBIO > IAIB (AB), IAIO (A), IOIB

(B), IOIO (O)
191.What would be the result of group A
blood given to group O pasien
A.non immune transfusion reaction

b.immediate hemolytic transfusion

reaction

Alasan: 1 PRC dapat meningkatkan 1 g/dl

Hb dan 3-4 Ht

c.delayed hemolytic transfusion reaction

194.What is characteristic finding seen in

the peripheral smear patien with
multiple myeloma

d.immediate
reaction

non

immune

transfusio

a.microcytic hypocromic cells

e.delayed
reaction

non

immune

trasfusion

Alasan: apabila darah A diberi ke darah

O akan terjadi agglutinasi dimana proses
ini melibatkan proses immune cytotoxic
(hemolytic)
transfusion
reaction.
Kejadian
ini
termasuk
type
hypersensitivity type 2
192.A
patien
with
hypofibrinogenemia.What component is
the best choice for transfusion
a.granulocyte
b.cryoprecipitate
c.FFP
d.platelet concentrate
e.PRC (Packed Red Cell)
Alasan: Cryoprecipitate kaya akan FC VIII
dan fibrinogen
193.a
male
cancer
patient
with
hemoglobin of 6 g/dl was admitted to the
hospital with acute abdominal pain.Small
bowel
resection
was
indicated,the
attending physician wanted to raise the
patiens
Hb
to
12
g/dl
before
surgery.How many units of RBCs would
most likely to be required to accomplish
this?

b.intracellular inclusion bodies

c.rouleux
d.hypersegmented neutropil
e.teardrop cell
Alasan: Pada multiple myeloma terdapat
high level serum M protein yang
mengakibatkan red cell in smear of
peripheral blood to stick to one another
in linear array yang disebut roulex
formation
195.What are the
polycytemic vera

lab

finding

in

b. peningkatan Ht,RBC, granulocyte

and platelet
Alasan:
polycytemic
vera
ialah
hematopoietic
stem
cell
disorder
characterized
by
accelerated
erytropoiesis ,proliferasi myeloid dan
megakaryocytic
element
of
bone
marrow.
196.a patient present with platelet count
of 1500/L and bleeding time of 12
minutes.these result probably suggest
a.penurunan platelet production
b.penurunan platelet function

a.eight

c.peningkatan platelet production

b.seven

d.peningkatan platelet destruction

c.six

e.penurunan platelet destruction

d.five

Alasan: pada kasus tersebut pasien

mengalami prolonge bleeding time
(N=30 Second- 2 minute) dimana akibat
produksi
platelet
yang
rendah
(N=150.000-450.000)

e.four

197.Which
coagulation
decreased
activity
of
VIIIC,vf:Ag,VWF and cause
bleeding time test?

disorder
factor
prolong

a.hypoprothrombinemia

199.whIch of the following process in

involved in alternative pathway of the
complement
a.induced by binding IgGI and CI

b.von willebrand disease

b.induced
complex

c.hemophilia A

c.induced by activation of C4

d.hemophilia B

d.induced by microbial cell suface

e.parahemophila

e.induced by activation by C2

198.The factor that efect that has normal

APTT and a prolonged PT is

200.whuch of the following cytokines

play important role in synovitis?

a.hypoprothrombinemia

a.INF Gamma

b.Von willebrands disease

b.IL-12

c.hemophilia A

c.TNF-alpha

d.hemophilia B

d.IL-2

e.decreased platelet destruction

E.IL-4

Alasan : b,c,d slah karena yang terjadi

adalah normal PT dan prolonged APTT
sedangkan e salah karena PT dan APTT
nya normal

Alasan: pada synovitis melibatkan 3

cytokines major yakni TNF-alpha,IL-12
dan IFN-gamma namun proporsinya TNFalpha > IL-12 > IFN-gamma

Karena PT untuk melihat kadar factor

I,II,V,VII, dan X sedangkan APTT untuk
melihat kadar factor I,II,V,VIII,IX,X,XI,XII

by

antigen-antigen

IgG2