TYPE X

1. Pneumothorax
a. Intrapulmonary shunt increase
b. Physiological dead space increase
c. Transpulmonary pressure is unchanged
d. VQ ratio decrease
e. Vital capacity increase

2. 45 yo woman presents with lethargy and dypnea. Hx of diplopia, dysphagia under ix recently. She claims that
her sx worsen as the day progress. Blood test showed elevated serum ACh receptor antibodies. Regarding her
condition
a. ACh release into the synaptic cleft is reduced
b. It causes postsynaptic membrane destruction
c. Associated with thymoma
d. Respi muscle failure is a known complication
e. Ach antibodies act on smooth muscle cell

3. 56 year old man, u/l IHD presented with gum bleeding and easy bruising for 3 weeks. Based on
presenting complain, which of these statement is/are correct?
a. Bleeding time measures plt fx
b. Large hematomas indicate abnormal plt fx
c. Recombinant factor VIIa is a mode of tx
d. Ticagrelor is a potential cause
e. vWF factors are involved

4. Glucocorticoids
a. Are produced in the zona reticularis
b. Decrease insulin sensitivity in adipose tissue
c. Increase liver glycogen stores
d. Inhibit the production of IL-2
e. Promote mobilization of amino acid from skeletal muscle

5. Physiological changes from supine to standing

a. Decrease CVP
b. Increase cardiac output
c. Increase mean arterial pressure
d. Increase RV filling pressure
e. Increase in stroke volume

6. VQ ratio increases in following

a. Atelectasis
b. Cor pulmonale
c. Neuromuscular disorder
d. Positive pressure ventilation
e. Shock

7. Regarding autoregulation of blood flow

a. Preserved in transplanted kidney
b. To maintain urinary filtrate sodium concentration
c. Macula densa plays a role
d. RAAS involved
e. Vascular resistance is increased when perfusion pressure increases

8. Compared to plasma, CSF has

a. Higher chloride
b. Higher glucose
 c. Higher CO2
d. Lower cholesterol
e. Lower protein

9. Regarding asthma med

a. Side effect of salbutamol is hypokalemia
b. Inhaled salbutamol inhibit antigen antibody reactions in lung
c. Ipratropium bromide dilates larger bronchi
d. Leukotrienes antagonist are indicated in refractory cases
e. Salmeterol is a long acting selective B2 agonist bronchodilator

10. Propofol
a. Acts on NMDA receptor
b. Causes apnea
c. Cause bronchoconstriction
d. Decrease cerebral metabolic rate
e. Contraindicated in hypovolemic shock

11. PCM is metabolized by

a. Deamination
b. Glucuronidation
c. Hoffman degradation
d. Hydroxylation
e. Sulfation

12. A drug that acts as competitive antagonist

a. Activate a receptor to produce effect opposite to agonist
b. Cause conformational changes to receptor
c. Competes for the same binding site as the receptor agonist
d. Overcome by higher concentration of agonist
e. Reduces maximal efficacy of the agonist

13. Regarding abdominal wall

a. Aponeurosis of the abd wall muscle is located below arcuate line
b. Groin is innervated by T12
c. Linea alba is highly vascular
d. Transversalis fascia runs posteriorly throughout its length
e. Umbilicus is innervated by t10

14. The right coronary artery

a. Arises form anterior aortic sinus
b. Cause infarction at the apex of the heart if occluded
c. Gives off circumflex branch
d. Accompanied by great cardiac vein
e. Supplies SA node

15. Le Fort III , fracture line passes through the

a. Alveolar ridge
b. Maxillofrontal suture
c. Nasofrontal suture
d. Oribital wall
e. Zygomatic arch

OBA

1. 55 y.o man presented with new AF 2 weeks following myocardial infarction. Which pathophysiology
of the arrhythmia best corresponds to the patient’s condition?
 a. Unidirectional block in one of the AV pathway
b. Automaticity of a small region of atrial cells
c. Delayed after-depolarization due to drug
d. Other myocardial cells depolarize faster than SA node
e. Slow conduction in AV pathway

2. Immediate effect of systemic nervous system in response to anemia secondary to acute hemorrhage
is to
a. Enhance O2 delivery by increasing blood flow
b. Increase antidiuretic hormone secretion
c. Increase intravascular volume by promoting renal sodium reabsorption
d. Maintain perfusion by increasing SVR
e. Stimulate adrenal cortex to produce aldosterone

3. 55 year old man with hx of IHD was witnessed to suddenly collapse, unresponsive and pulseless. The
most likely initial rhythm is
a. AF
b. Bradyasystole
c. Idioventricular rhythm
d. PEA
e. VF

4. 39 y.o man presents wiuth sudden onset severe crushing chest pain at rest. He was chronic renal
failure. He admits to smoking and taking amphetamines. He is a hypertensive but defaulted his
diltiazem. Angiogram one year ago was normal. From the following, which the most likely etiology of
his condition?
a. Anemia
b. Coronary vasospasm
c. Papillary valve rupture
d. Polycythemia
e. Sudden atherosclerotic plaque rupture

5. 40 year old obese lady is dx with DVT. She is in her 3rd trimester of pregnancy. She has chronic
hypertension. Previously on OCP. Examinations revealed varicose vein on both legs. Which of the risk
factors below is the most likely precipitating factor of the patient to develop DVT
a. Hypertension
b. Obesitiy
c. OCP
d. Pregnancy
e. Varicose vein

6. Previously healthy 40 y/o man had a hx of cough and fever for 5 days. He then presented with a
sudden onset shortness of breath and sweating. IV abx was given. Subseqently his BP dropped to
70/50 and HR of 120 bpm. Fine crepitations and loud systolic murmur were heard. ECG showed ST
depression on II, III, AVF. PR examination revealed melenic stool. Which of the following describes the
pathophysiology of his acute condition?
a. Coronary thrombosis
b. DIVC
c. Mast cell response
d. Pump failure
e. SIRS

One Correct Answer

7. Tall young male complains of sudden spontaneous onset chest discomfort and shortness of breath.
There were hyperresonance on percussion and reduced air entry on right lung. Left lung is normal.
Which of the pathophysiologic mechanism below is consistent with him?
 a. Hyperinflation occurs in the right lung
b. Intrapleural pressure in the right lung is higher than normal
c. Mediastinum shifted towards the right
d. Right chest wall recoils inward
e. VQ ratio on the right lung is higher than normal

8. Regarding control of breathing

a. Incrase in arterial pH increases ventilation
b. Central chemoreceptor are located in the midbrain
c. Peripheral chemoreceptor are more sensitive to PaO2 than PaCO2
d. Stimulation of apneustic center result in cessation of breathing
e. Stretching of lung mechanoreceptor increases respi rate

9. Regarding release of Ach at motor nerve ending

i. Depends of calcium level
ii. Inhibited with tetanus
iii. Reduced by Mg So4
iv. Terminated by potassium influx

a. I and III
b. II and IV
c. I, II, III
d. I, II, IV
e. All of the above

10. Causes of ST elevation myocardial infarction

i. Amphetamine poisoning
ii. Atherosclerotic plaque rupture
iii. Post PCI
iv. Salicylate poisoning

a. I
b. II, IV
c. I, II, III
d. I, II, IV
e. All of the above

11. Which of the following is effective in relieving vomiting by acting on CTZ

a. Apomorphine
b. Bromocriptine
c. Imipramine
d. Morphine
e. Prochlorperazine

12. Regarding aortic dissection

a. Arterial wall tension decreases as the radius increases
b. Involves ballooning of all three layers of the arterial wall
c. Degeneration of media of aortic wall
d. Start with tears in adventitia
e. Descending aorta is more commonly involved.