1. Seorang wanita 25 tahun datang ke klinik untuk “medical check up” karena adanya keluhan cepat lelah dan berdebar-debar akhir-akhir ini, pemfis keadaan umum baik, TD 120/80 mmHg, nadi 90/menit. BJ I normal, BJ II “wide fixed split”, EKG menunjukkan irama sinus dengan tanda-tanda RVH…Pertanyaan : Apa diagnosis sementara kasus di atas?A. MRB. TOFC. ASDD. VSDE. MVP (mitral valve prolaps) 2. Pemeriksaan penunjang non-invasif yang sianjurkan untuk menegakkan dianosis?A. CXR-PAB. CT-scanningC. EchocardighraphyD. Thalium scintigraphyE. MRI 3. Gambaran radiologist yang terlihat pada kasus di atas adalah?A. Kardiomegali dengan densitas gandaB. Kardiomegali dengan penonjolan aurikel kiriC. Kardiomegali dengan penyempitan ruang retrosternalD. Kardiomegali dengan penyempitan ruang retrokardialE. Kardiomegali dengan penekanan cabang bronkus kiri 4. Pembesaran jantung pada kasus di atas terutama disebabkan oleh?A. RA volume overloadB. RV volume overloadC. LV volume overloadD. LV pressure overloadE. RV pressure overload 5. Kelainan bunyi jantung di atas diakibatkan oleh peningkatan penutupan?A. Katup aorta dan mitra;B. Katur aorta dan pulmonalC. Katup mitral dan pulmonalD. Katup mitral dan trikuspidalE. Katup pulmonal dan trikuspidal 6. A 62-y.o man is transferred to your hospital because of recurrent pain and dyspnea 5 days after suffering a large myocardial infarction. On the day of arrival he is free of chest pain but still breathing with moderate difficulty. CXR confirms increase distended pulmonary vasculature, and enlarged heart. Echocardiogram shows enlarged heart and EF of 30% with minimal systolic motion of the anterior and apical portions of the heart. EKG: normal sinus rhythm with HR of 110. Arterial BP is 95/65, R=25. On auscultation you hear S3 gallop, S4 gallop, and systolic murmur grade II/VI at the apex and radiates to the left axilla. There are crepitations heard both of basal lung fields. Question: what is the most likely diagnosis on the day of arrival?

A. Cardiogenic shockB. Myocardial reinfarctionC. Acute pulmonary edemaD. Acute mitral regurgitationE. Heart failure caused by old anterior infarction 7. Seorang gadis 20 tahun datang ke poliklinik dengan keluhan jantung berdebar-debar kencang secara tiba-tiba disertai rasa agak sulit bernapas. Kadang-kadang timbul nyeri dada dan merasa sangat gelisah. Tidak ada riwayat penyakit jantung dan peru sebelumnya. Saat awal diperksa keadaan umum baik namun keluhan masih terasa. Tekanan darah 110/70 mmHg, denyut jantung 170/menit, pernapasan 24/menit, tidak demam. Penderita dianjurkan untuk pemeriksaan ekokardiografi. Question: berdasarkan keluhan dan denyut jantung yang meningkat maka diagnosis aritmia yang paling mungkin adalah:A. Takikardia sinusB. Torsade d’pointesC. Flutter-fibrilasi atriumD. Takikardia supraventrikularE. Takikardia ventrikel monomorfik 8. Dari hasil pemeriksaan ekokardiografi kemungkinan besar kelainan yg dijumpai adalah?a. Ruptur korda tendinaeb. Kalsifikasi di katup aortac. Regurgitasi mitral sedangd. Septum Inteventrikuler 2 mme. Prolaps daun katup mitral anterior 9. Seorang ibu hamil berusia 30 tahun G1P0A0 dengan usia kehamilan 22 minggu, saat pemeriksaan kehamilan dipoliklinik obstetri dengan keluhan kurang enak badan dan agak gelisah. Fisis: ditemukan adanya edema pretibial. Tekanan darah 170/100 mmHG, denyut nadi 95/menit. Rekam jantung tidak jelas adanya kelainan dan dari pemeriksaan fisik batas jantung masih normal. Diagnosis sementara adalah preeklamsia. Pertanyaan: edema pretibial pada kasus di atas disebabkan oleh mekanisme?a. gagal ginjal akutb. hipertensi primerc. hiperalbuminuriad. gangguan fungsi hatie. gagal jantung kongestif 10. Secara anatomis maka pembuluh darah yang mengalami gangguan terjadinya edema pretibial pada kasus di atas adalah?A. Vena iliacaB. Vena popliteaC. Vena femoralisD. Vena cava inferiorE. Vena saphena parva 

11. You are asked to supervise an exercise stress test on a 65.y.o man with a history of exertional chest pain and mild dyspnea last week. He has chest pain when he walks more than 500 meter, and if he continues he becomes breathless. He never has chest pain or dyspnea at rest. He has no ankle swelling, orthopnea, or PND. Before the stress test his BP is 110/85, HR 82 and regular, JVP 5 cmH2O and lungs are clear. The carotid pulses are delayed and diminished. You can hear sistolic murmur at the upper right sternal border grade III/VI, radiating to the carotids and the apexQuestion: Based on the physical exam, what is the likely diagnosis?a. Severe aortic stenosisb.Pulmonary hipertensionc. Moderate pulmonary stenosisd. Assymetric septal hipertrofie. Combined MS and MR 12. A 53.y.o woman presents with a prolonged episodic of chest discomfort. She has had this on and off for 3 months. It usually occurs whe she goes up two flights of stairs, but never when resting. Tonight, the discomfort began while walking to buy cigarettes, and lasted fro 40 min. Her father died of heart attack when he was 74 years old. Her BP is 135/85 and HR 74. JVP is 7 cm H2O at supine position, and her lungs are clear to percussion and auscultation. Cardiac exam is normal. An EKG shows normal sinus rhtyhm without abnormalitiesQuestion: what kind of examination do you need to make diagnosis:a. Echocardiographyb. Coronary angiographyc. Treadmill exercise testd.Serial electrocardiography recordingse. Holter electrocardiography monitoring 13. Seorang perempuan, 30 tahun datang ke UGD dgn keluhan sesak napas yg dialami sejak 1 bulan trakhir. Keluhan sesak napas bertambah berat dari hari ke hari. Pada pemeriksaan ekokardiografi didapatkan pembesaran atrium kiri tanpa pembesaran ruang jantung lainnya.Pertanyaan: Bila dilakukan pemeriksaan foto thoraks pada penderita ini maka gambaran yang terlihat adalah:a. Batas kanan jantung kurang dari 1/3 diameter hemithoraks kananab. Batas kiri jantung lebih besar dari 1/3 diameter hemithoraks kiric. Kontur ganda dan bronkus utama kiri terankatd. Aurikel kanan dan aurikel kiri menonjole. Trunkus arteri pulmonalis konkaf 14. Analisis kembali data yg tertera pada kasus diatas.Pertanyaan: diagnosis yg paling memungkinkan dari kasus adalah?a. Stenosis mitralb. MRc. Regurgitas Trikuspidald. Kombinasi MS dan MRe. Kombinasi regurgitasi dan stenosis trikuspidal 

15. Seorang laki-laki, 50 tahun masuk UGD dengan keluhan utama nyeri dada sejak 4 jam yang lalu. Nyeri menjalar ke rahang dan lengan kiri disertai keringat dingin. Ada riwayat merokok 2 bungkus perhari. Pada pemeriksaan fisik nampak sakit berat, tekanan darah 100/70 mmHg, denyut nadi 100/mmHg. Gambaran EKG menunjukkan elevasi segmen ST di sadapan V1-V4. Pertanyaan: Apa diagnosis kasus di atas?A. Infark miokard akutB. Angina PrinzmetalC. Angina tak stabilD. Perikarditis akutE. Diseksi aorta 16. Perhatikan kembali kasus di atas. Perlu diketahui kelainan anatomis yang akurat. Pertanyaan: pemeriksaan yang paling penting dilakukan untuk menunjang kelainan di atas adalah?A. AngiografiB. Cor analisaC. EkokardiografiD. Elektrokardiografi seriE. MRI 17. Seorang penderita masuk RS dengan keluhan cepat capek Ada riwayat serangan jantung sebulan yang lalu. Tekanan darah 130/80 mmHg, denyut nadi 110/ment, laju napas 30/menit. Desakan vena jugularis 10 cmH2O pada posisi baring 30 derajat. EKG menunjukkan gambaran elevasi segmen ST dengan gelombang Q patologis di sadapan V1-V5. Pertanyaan: diagnosis yag paling memungkinkan pada penderita di atas adalah gagal jantng yang disebabkan atau disetai dengan?a. aneurisma aortab. aneurisma ventrikel kiric. infark lama yang ekstensifd. akibat IMAe. akibat infark ventrikel kanan 18. Seorang penderita laki-laki, 55 tahun datang ke poliklinik jantung untuk mengontrol penyakitnya dengan riwayat pernah mengalami infark miokard sebulan yang lalu. Pada pemeriksaan fisik TD 130/80 mmHg, nadi 86/menit, inspeksi dada terlihat adanya gerakan sistolik yang paradoks. Rontgen: Kardiomegali. Pertanyaan: bila dilakukan rekaman EKG, maka kelainan apa yang dilihat?A. Gelombang Q patologis dengan primordial ”r” di V1-V5B. Gelombang Q patologis dengan gelombang T yang terbalikC. Gelombang Q patologis dengan elevasi segmen ST di V1-V5D.Elevasi segmen ST di V1-V5 dengan gelombang T yang terbalikE.Depresi segmen ST di V1-V5 dengan gelombang T yang terbalik. 19. Perhatikan kembali soal di atas. Pada proses penyembuhan maka jaringan bekas infark akan mengalami proses?A. Penimbunan jaringan ikat fibrosisB. Penimbunan sel radang PMN

C. Serbukan sel radang eosinofilD.Peningkatan Gp IIb/IIIaE.Penurunan GpIb 20. Seorang wanita, 50 tahun datang ke UGD dengan keluhan sakit punggung tembus ke dada yang dirasakan seperti tertarik atau tersayat, lamanya 5 menit yang kemudian berkurang. Keluhan ini dirasakan sejak 3 jam yang lalu. Badan terasa lemah disertai perasaan mual. Ada riwayat hipertensi lama yang tak terkontrol. Pada pemeriksaan fisik: TD 170/100 mmHg. HR 100/menit, pernapasan 28/menit. Suhu 37C, EKG menunjukkan irama sinus tak ada kelainan berarti. Foto toraks: kardiomegali dan dilatasi aorta. Pertanyaan: keluhan penderita di atas disebabkan oleh adanya kelainan pada?A. AortaB. Katup aortaC. perikardiumD. miokardiumE. Arteri pulmonal 21. Lihat kembali kasus di atas. Sakit punggung yang tembus ke depan melibatkan perangsangan pada?A. Nervus axillarisB. Nervus phrenicusC. Nervus subscapularisD. Nervus splanchnicus thoracicusE. Ramus cardiacus inferior dextra N.X 22. Terapi awal yang diberikan pada kasus di atas adalah obat beta-blocker karena (pilih yang paling tepat)?A. menurunkan ”afterload”B. bersifat analgetik potentC. mengurangi dilatasi aortaD. menurunkan venous returnE. menurunkan double-product 23. Masih berhubungan dengan kasus di atas. Selain terapi medikamentosa, maka dilakukan terapi invasif yang definitif yakni?A. implantasi graft stentingB. aortic balooningC. operasi bypassD. atheroktomiE. embolisasi 24. Seorang penderita laki-laki, 40 tahun masuk rumah sakit dengan keluhan sesak napas berat disertai nyeri dada dan batuk darah. Keluhan ini baru pertama kali dialami. Pada pemeriksaan fisik ditemukan tekanan darah 100/60 mmHg, denyut jantung 120/menit, pernapasan 35/menit, tidak ada ronki, DVJ R+5 pada posisi 30 derajat. Pertanyaan: apa diagnosis yang paling memungkikan?

a. perikarditsb. emboli paruc. diseksi aortad. edema paru akute. infark miokard akut 25. Bila dilakukan penyadapan jantung pada penderita di atas maka akan ditemukan adanya peningkatan tekanan pada?a. aortab. atrium kiric. ventrikel kirid. atrium kanane. vena pulmonalis 26. Selama fase membran potensial istirahat potensial otot jantung tergantung pada:a. Kaliumb. Kalsiumc. Natriumd. Asetilkoline. Norepinefrin 27. Selama tahap awal fase plateau potensial aksi pada sel otot ventrikel?a. Sel mengalami masa refrakter relatifb. Membran potensial sedikit lebih positifc. Konduktans saluran K melebihi konduktans saluran Cad. Pengeluaran Ca dari sel melebihi pemasukan Ca ke dalam sele. Masuknya Ca ke dalam Retikulum sarkoplasma melebihi keluarnya Ca dari retikulum sarkoplasna 28. A 75.y.o woman in evaluated for refractory hypertension. She is taking 3 differents antihypertensive, including a thiazid diuretic, ACE-I, and beta-blocker, but her blood pressure is still 186/105 mmHg. Someone finally auscultates her abdomen and detects a bruit. Question: what is the most appropriate diagnostic examination?A. abdominal ultrasonographyB. intravenous pyelographyC. abdominal angiographyD. creatinin clearanceE. renal arteriography 29. A 60 year old man comes in for his third visit in two months. He has had a BP of approximately 155/95 mm Hg on each occasion. HR 110/min. No abdominal bruits are auscultated on exam. Diet and exercise modification fail to reduce his BP; therefore he is started on the beta blocker, atenololQuestion: You agree that atenolol was the first choice in this case, why?a. Atenolol is non-cardioselective beta blockerb. Atenolol is well tolerated for elderly patients

c. Atenolol can decrease HR and contractilityd. Atenolol is the drug of choice of primary hipertensie. Atenolol is contraindicated for patiens with abdominal bruits 30. A 47 year old man is newly diagnosed with tipe 2 diabetes and hipertensi. In addition to an oral hipoglicemic agent, his physician prescribed captopril for hipertensi. After about one month the patient developed an annoying dry cough. The physician switched his prescription from captopril to Iosartan, and the cough disappearedQuestion: why are ACE inhibitors prefferd antihipertensiv therapy in this patient?a. ACEI prevent the converision of renin to angiotensin Ib. ACEI can cause hipokalmia that inhibits insulin secretionc. ACEI can prevent the diaphoresis commonly seen in hipoglicemiad. ACEI has been proved to reduce the progession of proteinuria in DMe. All of the undesirable side effect of ACEI can be avoided by using ARBs 31. On a routine office visit, 45 year old ma is found to have abnormal level of lipid profile. The level of LDL-C was 230 mg/dl, TG was 280 mg/dl, and serum level of HDL-C was 30 mg/dl. His meager attempts a diet and exercise do not alter his lipid profile significantly, and he is started on simvastatin. Before he takes the first dose, his liver enzymes are checked, and he is told that his test will be repeated in 3 months.Question: beside simvastatin you can choose the more potent agent to optimize the improvement of lipid profile of this patient. Which drug?a. Ezitimibeb. Fenofibratec. Gemfibrozild. Nicotinic acide. Bile-sequesting resin 32. A 65 year old man complains of left sided chest pain with exertion. The pain always resolves with rest and if needed sublingual nitroglicerine. He described the pain as substernal pressure with a bit of burning sensation. The pain remains localized and not radiate to the arms, shoulder or jaws. He denies any associated nausea, vomitting, or diaphoresis during these episodes of chest pain. An EKG stress test is performed to confirm diagnosis.Question: what do we expect to see in the electrocardiogram by EKG stress test?a. ST-segment elevation in one or two contagious leadsb. ST-segment depression in two contagious leadc. Q wave patologic> 0.04 sec in only one leadd. T wave inversion in precordial leadse. Prolonged QT interval 33. A 48 year old man who is obese and diaphoretic presents to the emergency department complaining of a crushing substernal pressure sensation since four hours ago. An immediate EKG is performed and reveals ST elevation in lead V1-V4. A chest X ray doesn’t show mediastinal widening or other abnormalitiesQuestion: what is the most important drug should we administer to this patient?a. Morphine sulfate

b. Acetyl salicyclic acidc.ADP receptor antagonistd. Tissue plasminogen activatore. Low molecule weight heparin 34. A 70 year old man with long history of poorly controlled hipertension present with fatigue, lethargy, and increasing difficulty with breathing over the past year. Initially, he experienced difficulty with breathing only with exertion. Recently he needed two pillows to sleep on at night. Physical examination reveals jugular venous pressure R+4 at the supine position, pulmonary rales, hepatonegaly, and bilateral pitting edema of the ankles. The diagnosis is CHF.What is the best therapy:a. Furosemide + B blockerb. Furosemid + ACEIc. ACEI + spironolactoned. B blocker + isosorbid dinitratee. ACEI + isosorbid dinitrate 35. A 50 y.o man complain of angina that occurs at gradually diminishing levels of physical exertion as well as two recent episodes of syncope while golfing. Pemfis: narrow pulse pressure, and his carotid pulse is delayed and weak. Auscultation reveals a sistolic ejection murmur heard best in the second right interspaceQuestion: what is the next most approriate diagnosit step:a. Chest X-rayb. Echocardiographyc. EKGd. Cardiac catheterizatione. Exercise Electrocardiagraphic test 36. A 52 yo male presents to emergency department with a history several days of dyspnea, occasional fevers, and new onset sincope. Pemfis: his temperatur 38,2° C, pulse 30, R 26 and BP 70/40. He is ill appearing and diaphoretic. Lungs are clear, normal S1 and S2 and II/VI sistolic murmur at the apex, radiating to the axilla. EKG shows third degree heart blockQuestion: what is the most likely diagnosis?

1. Pericarditis2. Bacterial endocarditis3. Acute MR4. Myocardial infarction with cardiogenic shock5. Inferior Myocardial infarction with RV infarction

 37. A 35 yo female is admitted to hospital for hemoptysis and as 1 month history of progressive shortness of breath. The cardiac exam shows a loud opening snap at S1 and low pitched diastolic murumur that is loudest at the apex. CXR show Kerley B. A diagnois fo MS is made. Echo shows a dilated LA and a mitral orifice size of 1,1 cm2 . the mitral leaflet has minial calcification. There is no mitral regurgitation.Question: what is the appropriate management?a.. Surgical valvulotomy

b. Cardiac transplantionc. Mitral valve replacementd. Balloon mitral valvuloplastye. Antibiotic prophylaxis, diuretics, a repeat echo in 6 months 38. An 80 y.o male presents to your clinic with 5 months history of progressive shortness of breath, dyspnea on exertion, orthopnea, ane lower extremity edema. He notes chest pressure while walking up that is relieved by rest. On exam, JVP: R+4 at supine position. There is an audible grade IV sistolic ejection murmur heard at the base with radiation to the carotid arteries. An EKG shows evidence of LVH. Echo shows a stenotic, calcified aortic valve with an estimaded valve are of 0,7 cm2. EF ±40 %Question: what management step should you recommend to improve long term survival?

1. Surgical valvulotomy2. ACEI + HCTZ3. Digoxin +furosimede4. Ballon valvuloplasty

e. Aortic valve replacement 39. A 55 yo male presents with severe substernal chest pain for the last hour. It began at rest and is associated with dyspnea and nausea. The EKG shows bradycardia with Mobitz type II second-degree AV block. Chest pain film is normal. Question: which of the following is likely to be found in addition on EKG?A. ST elevation in lead V1-V3B. Deep T inversion in lead V1-V3C. ST depression in leads I and aVLD. ST elevation in lead II, III, and aVFE. No other abnormalities in EKG recording 40. A 55 yo man presents with a 24-h istory of shortness of breath and palpitation. He has mild dizziness and diaphoresis. There is no prior record old myocardial infarction, but he has long standing hypertension and cigarette smoking. His BP is 80/50, HR is 186 beats/min and regular, and his respiratory rate is 26. there are crackles bilaterally, JVP is R+5 in 30 degree position, and a III/VI holosystolic murmur at the apex radiates to the axilla. Q: what is the most likely diagnosis?A. Mitral regurgitation with ventricular tachycardiaB. Aortic stenosis with supraventricular tachycardiaC. Congestive cardiomyophaty with atrial fibrillationD. Ventricular septal defect with ventricular tachycardiaE. Mitral regurgitation with supraventricular tachycardia 41. A 65 year old man, developed an AMI several days ago. His course has been complicated in the last 24 h by a pericardial friction rub and pleuritic chest pain, which has been difficult to control with narcotis or steroids. BP is 70/50 mm Hg. JVP is R+3 at supine position. There is an electro mechanical association. No murmurs are audible.Question: what is the most likely etiology of this patient’s acute difficulty:a. External cardiac rupture

b. Ventricular septal rupturec. Right ventricular infarctiond. Extension of an acute myocardial infarctione. Acute myocardial infarction due to rupture of papillary muscle 42. A 74 yo man with a long history of left ventricular failure secondary to several myocardial infarctionscomes to emergency room acutely show…. 2 hours after a large holiday meal. EKG shows a narrow complex tachycardia at a rate of 130/min with 1 mm ST segment depression in v4-v6. BP; 170/100 mmHg; R: 32/min. His current medical treatment: nitrates, CCB, digoxin, HCTZQuestion: which myocardium has experienced ischemic process in this:

1. high lateral wall2. apicolateral wall3. anteroseptal wall4. posterolateral wall5. whole anterior wall

 43. What is the pathognomonic radiologic findings of this patient?a. LVH with Kerley B linesb. Honey combs appearancec. Cardiac waist disappearedd. Aortic dilatation with LVHe. LVH with pulmonary hyperinflation 44. A 38 year old woman without a past history of medicall illness presented with mild exertional dyspnea and fatigue of one months duration. The BP was 90/60 mm Hg, HR was 95/min and the rhythm by the EKG was irreularly irregular. Physical exam: s1 was accentuated, S2 was loud and heard over a wide area, OS was heardQuestion: the other physical abnormality can be found in this patient is:

1. Friction rub2. Deficit pulse3. Alternating pulse4. Holosystolic souffle5. Systolic ejection click

 45. A 48 yo black man who smokes 1 pack of cigarettes per day, drinks 3-4 beers each night and has type-2 DM treated with metformin is referred for hypertension. His BP remains 190/100 mmHg despite atenolol 100 mg/day. You want to arrange his daily menu.Question: what kind of substances can modestly lower his blood pressure:

1. Calcium and sodium2. Fosfat and potassium3. Calcium and potassium4. Sodium and magnesium5. Potassium and magnesium

 

46. A 42 yo layer comes in for his annual physical exam and his BP is 148/96. He has no family history, doesn’t smoke, total cholesterol was 180 mg/dL last year. His BMI is 27. He doesn’t get regular exercise.Question: which one will be the first management for this patient:

1. Following a strict diet.2. Give CCB with diuretic3. There is no specific treatment4. Give HCTZ together with beta-blockade5. Lifestyle modification for at least 6 months

 47. A 75 y o woman returns to the clinics for follow-up. BP was 160-170/70-80 at presentation and are now 140-150/60-70 on amlodipine 5 mg/day. She asks if she can stop her medication because she thinks it’s making her tired and her feet are swelling, making it difficult to wear her beast shoes. BP 149/62. P 84Question: what should u tell her?

1. Stop her medication2. Reduce the dose of amlodipine3. Combine amlodipine with HCTZ4. Recommend salt restriction and weight loss5. Change her medication with other calcium antagonist

 48. A 62 y.o woman presents to your office concerned about shortness of breath, while walking and when trying to sleep, one month after a non Q-wave MI. She is taking atenolol and isosorbide dinitrate. She has not had chest paint or palpitations since her MIQuestion: what phsyical exam findings would confirm it?

1. Tachypnea with pulsus alternans2. JVP>8 cm at 45°position + irregular rhythm3. The JVP > 8 cm at 30° position + gallop rhythm4. Crackles bibasilar lung+ JVP>8cm at supine position5. Paradoxical systolic movement seen by inspection or palpitation

 49. A 60 yo man with a history of chronic stable angina develops ankle swelling and increasing shortness of breath and coughing during his daily walks. PMH: type 2 DM, hiperlipidemia, quit smoking 5 years ago. He takes metformin, pravastatin, ASA, and nitrogylcerin. JVP is 10 cm ato 30° positon, +S3 without murmur, 2+ edema. His EKG shows old Q waves in II, III, and AVF.Question: what is the best medication for this patient?A.B.C.D.E. 50. ……… 51. Seorang laki-laki, 45 tahun mengeluh rasa nyeri pada kaki kanan yang dirasakan sejak kemarin. Mulai terasa pada ujung jari kaki kemudian menyebar sampai mata kaki. Nyeri terasa

panas dan kadang berdenyut, baik pada waktu istirahat dan terutama waktu berjalan. Sehari sebelum timbul keluhan penderita jatuh dari tangga dan dipijat pada bagian kaki. Pemeriksaan fisik: nampak pada ujung jari-jari kaki 1-3 kanan berwarna merah kebiruan, nyeri bila disentuh, pulsasi dorsalis pedis melemah dan sulit digerakkan. Riwayat merokok 12 tahun, 2 bungkus per hari. Hasil X ray kaki hanya memperlihatkan pembengkakan jaringan lunak. Pertanyaan: keluhan penderita disebabkan oleh adanya?A. fraktur pada tulang jari kakiB. Thrombosis vena dalamC. Iskemik tungkai akutD. Penyakit buergerE. Varices 52. Sehubungan dengan kasus di atas; penyebab melemanya pulsasi dorsalis pedis disebabkan oleh?A. Menurunnya curah jantung semenitB. Menurunnya aliran darah arteriC. Pembengkakan jaringan lunakD. Adanya proses aterosklerosisE. Meningkatnya aliran balik 53. …E. Arakidonat 54. Seorang penderita laki-laki, 65 tahun masuk UGD, rujukan dari RS daerah dengan diagnosis infark miokad akut. Telah diberikan aspilet dan oksigen. Pada saat di UGD tekanan darah 80/40 mmHg, denyut jantung 115/menit dan lemah. Lima menit kemudian tiba-tiba penderita tidak sadar, pernapasan melemah, badan teraba dingin dan akhirnya nadi tidak teraba. Pertanyaan : Hasil rekaman EKG penderita pada keadaan terakhir, menunjukkan?A. takikardi supraventrikelB. sinus bradikardiaC. fibrilasi ventrikelD. fibrilasi atriumE. block AV total 55. Pada penderita di atas, gangguan fisiologis yang mendasari kehilangan kesadaran adalah?A. kontraksi ventrikel dan atrium yang tidak sinkronB. tidak adanya aliran listrik jantungC. tidak adanya aliran darah balikD. tidak adanya isi sekuncupE. tahanan perifer menurun 56. Pada situasi terakhir penderita di atas maka akan terjadi perubahan metabolisme jantung dan proses biokimiawi jantung yang mengalami gangguan adalah?A. dekarboksilasi – oksidatifB. fosforilasi – defosforilasiC. fosforilasi – karboksilasi

D. okidasi – hidroksilasiE. fosforilasi – oksidatif 57. Perhatikan kembali kasus di atas yang masuk ke UGD dengan IMA. Bila ada fasilitas dan diprediksi keadaan penderita akan memburuk, maka tindakan terbaik yang dapat dilakukan segera adalah?A. pemberian morfin sulfat intravenaB. pemberian dobutamin intravenaC. pemasangan balon intra-aortaD. intervensi koroner primerE. bedah pintas koroner 58. Bila pada penderita di atas hanya dilakukan prosedur siagnosis invasif waktu masuk rumah sakit maka kita dapat melakukan pengambilan sampel jaringan di daerah yang megalami IMA untuk pemeriksaan PA. Yang diharapkan dapat ditemukan adalah?A. penurunan ICAM-1B. peningkatan MMPOC.D.E. 59. …… E. Konduksi cabang berkas kiri 60. Di ruang ICCU, laki2 60 tahun, dirawat dengan IMA disertai blok AV derajat-2 tipe Wenckebach. Setelah dirawat 2 hari, keadaan umum melemah. Pada pemfis, BP 80/40 mm Hg, HR 35/min. Hasil rekaman jantung menunjukkan adanya blok AV total.Pertanyaan: Tindakan yang paling penting untuk menyelamatkan penderita adalah:a. kardioversi listrikb. Pasang pacu jantung sementarac. Pemberian obat trombolitik intravenad. Pemberian nitrogliserin IV dititrasie. Pemberian dopamine bersaa-sama dengan dobutamin 61. Melihat data klinis dan EKG yg ada maka penderita di atas kemungkinn besar mengalami infark di dinding?a. Ventrikel kananb. Posteriorc. Anteriord. Inferiore. Lateral B. AngiographyC. Chest radiography 76. The caused TOF…..

77. Policitemia occurs in TOF if?A. Congestive heart failure occuresB. The blood oxygens saturation increasesC. The blood oxygens saturation decreasesD. The blood flow from right to the left shuntE. Hemoglobin consentration of the patient decreases 78. A 7 month old boy comes to he hospital because of cough and hard to breath. These symptoms occur frequently since he was 2 monht baby. On physical exam murmur is heard grade 4/6 p.m. at LSB4 spread to RSB, axillary and suprasternalQuestion: the diagnosis will be?a. ASDb. PDAc. TOFd. TGAe. VSD 79. The shunt will be right to left if?a. Roger’s disease is foundb. Diameters of VSD is small.c. LVH occursd. Right and left ventricel activities increasee. Vascular pulmonary resistance highter than systemic resistence  80. Chest radiography shows?a. Coer en sabotb. Like an egg on its sidec. Right atrium Hipertrofid. Decrease of pulmonary circulatione. Lung vascularisation increases with prominent pulmonary artery  81. Seorang pria berumur 85 tahun datang ke prakter dokter spesialis dengan keluhan nyeri dada kiri menjalar ke lengan kiri. Keluhan tersebut baru pertama kali. Lama nyeri 1-2 menit dan tidak ada riwayat trauma dada. Pada rekaman EKG ditemukan adanya elevasi segmen sadapan V1-V3. Segera dokter memberi …..nitrat sublingual dan 3 menit kemudian nyeri dada hilang. EKG masih dalam batas normal. CKMB 10 U/l dan troponin T negatif.Pertanyaan: Diagnosis yg paling mungkin:

1. Prinzmetal angina2. Angina pektoris stabil3. Physio-physiologic reaction4. Infark miokard sub endokard5. Infark miokard inferior lama

 

82. Sehubunganngan kasus di atas, maka elevasi segment ST yang kembali normal setelah pemberian nitrat disebabkan oleh?a. Trombus sbg penyebab oklusi mengalami lisis spontanb. Penyebab elevasi segemen ST hanya oleh spasme koronerc. Adanya stenosis bermakna tapi kolateral tdk berkembangd. Terjadi IMA tanpa elevasi segment STe. Lepasnya trombus dari cabang arteri koronaria 83. Seorang kakek, 75 tahun, dirawat di ICCU dengan IMA. Pada hari kedua, penderita tiba2 merasa sakit dada yg semakin keras intensitasnya dan pada pemfis terdengar adanya friction rub. Diagnosis suspek perikarditis.Pertanyaan: Seandainya selain pericardial friction rub juga terdengar pleural fricition rub pada penderita ini maka kemungkinan dia menderita?a. Pleurutus akibat infeksi sekunderb. Dressler sindromec. Metastasis tumord. Emboli parue. Uremia 84. An 11 y.o girl comes with pain and swelling left knee. One week before the symptoms she had fever and cough sniffer. Pemfis: sistolic murmur grad 3/6 p.m at apex and temperatur is 38° C. Inflammatory sign at her knee is positive. Increase of ASTO titer is voted.Question: diagnosis of this patient is due to?

1. Rheumatoid juvenile arthritis2. Rheumatic heart disease3. Tonulo-pharyngitis4. Rheumatic fever5. Common Cold

 85. Diagnosis is confirmed by using Jone’s criteria namely?  90. Apabila hasil ….. pada penderita di atas positif, maka pemeriksaan ………. adalah?A. MRIB. MRCTC. EkokardiografiD. HolterE. …. ECG 91. Apabila ditemukan adanya stenosis yang …. arteri koronaria dan adanya lesi di “left main artery” maka dianjurkan untuk terapi?A. PTCA & implantasi stentB. Aortic ballooning pumpingC. coronary arteri bypass graftingD. beta-bloker + asam salisilat + nitratE. asam salisilat + nitrat + ACE-I + beta-blocker 

92. Mekanisme biokimiawi yg terjadi pada jantung penderita di atas adalah pergeseran metabolisme aerob menjai metabolisme anaerob yg akan menyebabkan peningkatan?a. Sintesis ATPb. pH kardiomiositc. Deposti nukleotidad. Osmolaritas intrasele. NAD yg teroksidasi 93. Andaikata penderita di atas tidak segera dilakukan terapi yg tepat, kemungkinan akant erjadi kerusakan otot jantung yg irreversibel seiring dengan deplesi nukleotida?a. Tiaminb. Uridinc. Sitokind. Guanine. Adenin 94. Wanita 55 tahun, mengeluh sering pusing. Tekanan darah 150/95 mm Hg. Hepar teraba 2 jari bawah arkus kosta kanan. EKG ritme sinus dgn denyut nadi 90/min, LVH. Gambaran foto thorax: elongasi aorta dan kardiomegali, corakan paru kasar. Pemeriksaan lab: ureum 80 mg/dl, kreatinin 3,5 mg/dl, CT scan: ditemukan edema serebri.Pertanyaan: Organ-organ yg termasuk target organ damage pada kelainan di atas adalah?a. Otak dan jantungb. Otak, jantung dan aortac. Otak, jantung, aorta dan ginjald. Otak, jantung, aorta, ginjal dan hatie. Otak, jantung, aorta, ginjal, hati, paru 95. Selama fase isovolumetrik yang terjadi adalah:a. Semua katup jantung tertutupb. Katup Aorta tertutup dan katup mitral terbukac. Katup aorta terbuka dan katup mitral tertutupd. Katup pulmonal terbuka dan katup trikuspidal tertutupe. Katup pulmonal tertutup dan katup trikuspidal terbuka 96. Seorang wanita dengan riwayat kanker payudarakiri sekitar 10 tahun lalu, telah dilakukan mastektomi dan terapi radiasi. Selama itu tidak ada keluhan. Sejak seminggu terakhir timbul keluhan sesak napas yg makin hari makin berat. Tdk ada sakit dada. Badan terasa demam. Fisisi: BJ I dan II normal agak melemah, BP 90/50 mm Hg, HR 120/min. R 24/min, afebris, EKG low voltage dan kompleks QRS menunjukkan pulsus alternas. Foto thorax kardiomegali. Dianjurkan ekoPertanyaan: Maksud pemeriksaan ekokardiografi adalah untuk mendeteksi adanya?a. Vegetasib. Efusi perikardc. Kardiomegalid. Radang perikarde. Myoxoma atrium kiri

 97. Denyut jantung 120/min merupakan mekanisme kompensasi akibat?a. Penurunan prabebanb. Peningkatan pasca bebanc. Penurunan curah jantungd. Peningkatan lusitropik ventrikele. Penurunan inotropik miokardium 98. Meningkatnya preload pada otot jantung akan?a. Mengurangi tegangan pada otot jantungb. Meningkatkan tegangan dinding ventrikelc. Mengurangi tekanan akhir diastolik ventrikeld. Meningkatkan kecepatan awal kontraksi jantunge. Mengurangi waktu yang dibutuhkan otot jantung untuk mencapai tegangan maksimal 99. Selama fase diastole, aliran darah yang cepat ke ventrikel dapat menimbulkan?a. BJ Ib. BJ IIc. BJ IIId. BJ IVe. BJ V 100. Fraksi ejeksi:a. Fraksi curah jantung yang dipompa setiap kontraksi jantungb. Stroke volume dikurangi volume residu yg terdpt pada ventrikelc. Rasiod. Rasioe. Rasio