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. MR B. TOF C. ASD D. VSD E. MVP (mitral valve prolaps) 2. Pemeriksaan penunjang non-invasif yang sianjurkan untuk menegakkan dianosis? A. CXR-PA B. CT-scanning C. Echocardighraphy D. Thalium scintigraphy E. MRI 3. Gambaran radiologist yang terlihat pada kasus di atas adalah? A. Kardiomegali dengan densitas ganda B. Kardiomegali dengan penonjolan aurikel kiri C. Kardiomegali dengan penyempitan ruang retrosternal D. Kardiomegali dengan penyempitan ruang retrokardial E. Kardiomegali dengan penekanan cabang bronkus kiri 4. Pembesaran jantung pada kasus di atas terutama disebabkan oleh? A. RA volume overload B. RV volume overload C. LV volume overload D. LV pressure overload E. RV pressure overload 5. Kelainan bunyi jantung di atas diakibatkan oleh peningkatan penutupan? A. Katup aorta dan mitra; B. Katur aorta dan pulmonal C. Katup mitral dan pulmonal

D. Katup mitral dan trikuspidal E. 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 shock B. Myocardial reinfarction C. Acute pulmonary edema D. Acute mitral regurgitation E. 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 sinus B. Torsade dpointes C. Flutter-fibrilasi atrium D. Takikardia supraventrikular E. Takikardia ventrikel monomorfik 8. Dari hasil pemeriksaan ekokardiografi kemungkinan besar kelainan yg dijumpai adalah? a. Ruptur korda tendinae b. Kalsifikasi di katup aorta

c. Regurgitasi mitral sedang d. Septum Inteventrikuler 2 mm e. 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 akut b. hipertensi primer c. hiperalbuminuria d. gangguan fungsi hati e. gagal jantung kongestif 10. Secara anatomis maka pembuluh darah yang mengalami gangguan terjadinya edema pretibial pada kasus di atas adalah? A. Vena iliaca B. Vena poplitea C. Vena femoralis D. Vena cava inferior E. 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 apex Question: Based on the physical exam, what is the likely diagnosis? a. Severe aortic stenosis b.Pulmonary hipertension c. Moderate pulmonary stenosis

d. Assymetric septal hipertrofi e. 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 H2 O at supine position, and her lungs are clear to percussion and auscultation. Cardiac exam is normal. An EKG shows normal sinus rhtyhm without abnormalities Question: what kind of examination do you need to make diagnosis: a. Echocardiography b. Coronary angiography c. Treadmill exercise test d.Serial electrocardiography recordings e. 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 kanana b. Batas kiri jantung lebih besar dari 1/3 diameter hemithoraks kiri c. Kontur ganda dan bronkus utama kiri terankat d. Aurikel kanan dan aurikel kiri menonjol e. Trunkus arteri pulmonalis konkaf 14. Analisis kembali data yg tertera pada kasus diatas. Pertanyaan: diagnosis yg paling memungkinkan dari kasus adalah? a. Stenosis mitral b. MR c. Regurgitas Trikuspidal d. Kombinasi MS dan MR e. 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 akut B. Angina Prinzmetal C. Angina tak stabil D. Perikarditis akut E. 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. Angiografi B. Cor analisa C. Ekokardiografi D. Elektrokardiografi seri E. 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 aorta b. aneurisma ventrikel kiri c. infark lama yang ekstensif d. akibat IMA e. 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-V5 B. Gelombang Q patologis dengan gelombang T yang terbalik C. Gelombang Q patologis dengan elevasi segmen ST di V1-V5 D.Elevasi segmen ST di V1-V5 dengan gelombang T yang terbalik E.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 fibrosis B. Penimbunan sel radang PMN C. Serbukan sel radang eosinofil D.Peningkatan Gp IIb/IIIa E.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. Aorta B. Katup aorta C. perikardium D. miokardium E. Arteri pulmonal 21. Lihat kembali kasus di atas. Sakit punggung yang tembus ke depan melibatkan perangsangan pada? A. Nervus axillaris B. Nervus phrenicus C. Nervus subscapularis D. Nervus splanchnicus thoracicus

E. 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 potent C. mengurangi dilatasi aorta D. menurunkan venous return E. menurunkan double-product 23. Masih berhubungan dengan kasus di atas. Selain terapi medikamentosa, maka dilakukan terapi invasif yang definitif yakni? A. implantasi graft stenting B. aortic balooning C. operasi bypass D. atheroktomi E. 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. perikardits b. emboli paru c. diseksi aorta d. edema paru akut e. infark miokard akut 25. Bila dilakukan penyadapan jantung pada penderita di atas maka akan ditemukan adanya peningkatan tekanan pada? a. aorta b. atrium kiri c. ventrikel kiri d. atrium kanan e. vena pulmonalis

26. Selama fase membran potensial istirahat potensial otot jantung tergantung pada: a. Kalium b. Kalsium c. Natrium d. Asetilkolin e. Norepinefrin 27. Selama tahap awal fase plateau potensial aksi pada sel otot ventrikel? a. Sel mengalami masa refrakter relatif b. Membran potensial sedikit lebih positif c. Konduktans saluran K melebihi konduktans saluran Ca d. Pengeluaran Ca dari sel melebihi pemasukan Ca ke dalam sel e. 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 ultrasonography B. intravenous pyelography C. abdominal angiography D. creatinin clearance E. 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, atenolol Question: You agree that atenolol was the first choice in this case, why? a. Atenolol is non-cardioselective beta blocker b. Atenolol is well tolerated for elderly patients c. Atenolol can decrease HR and contractility d. Atenolol is the drug of choice of primary hipertensi e. 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 disappeared Question: why are ACE inhibitors prefferd antihipertensiv therapy in this patient? a. ACEI prevent the converision of renin to angiotensin I b. ACEI can cause hipokalmia that inhibits insulin secretion c. ACEI can prevent the diaphoresis commonly seen in hipoglicemia d. ACEI has been proved to reduce the progession of proteinuria in DM e. 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 HDLC 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. Ezitimibe b. Fenofibrate c. Gemfibrozil d. Nicotinic acid e. 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 leads b. ST-segment depression in two contagious lead c. Q wave patologic> 0.04 sec in only one lead

d. T wave inversion in precordial leads e. 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 doesnt show mediastinal widening or other abnormalities Question: what is the most important drug should we administer to this patient? a. Morphine sulfate b. Acetyl salicyclic acid c.ADP receptor antagonist d. Tissue plasminogen activator e. 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 blocker b. Furosemid + ACEI c. ACEI + spironolactone d. B blocker + isosorbid dinitrate e. 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 interspace Question: what is the next most approriate diagnosit step: a. Chest X-ray b. Echocardiography c. EKG d. Cardiac catheterization

e. 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 block Question: what is the most likely diagnosis? 1. 2. 3. 4. 5. Pericarditis Bacterial endocarditis Acute MR Myocardial infarction with cardiogenic shock 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 transplantion c. Mitral valve replacement d. Balloon mitral valvuloplasty e. 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. 2. 3. 4.

Surgical valvulotomy ACEI + HCTZ Digoxin +furosimede 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-V3 B. Deep T inversion in lead V1-V3 C. ST depression in leads I and aVL D. ST elevation in lead II, III, and aVF E. 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 tachycardia B. Aortic stenosis with supraventricular tachycardia C. Congestive cardiomyophaty with atrial fibrillation D. Ventricular septal defect with ventricular tachycardia E. 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 patients acute difficulty: a. External cardiac rupture b. Ventricular septal rupture

c. Right ventricular infarction d. Extension of an acute myocardial infarction e. 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, HCTZ Question: which myocardium has experienced ischemic process in this: 1. 2. 3. 4. 5. high lateral wall apicolateral wall anteroseptal wall posterolateral wall whole anterior wall

43. What is the pathognomonic radiologic findings of this patient? a. LVH with Kerley B lines b. Honey combs appearance c. Cardiac waist disappeared d. Aortic dilatation with LVH e. 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 heard Question: the other physical abnormality can be found in this patient is: 1. 2. 3. 4. 5. Friction rub Deficit pulse Alternating pulse Holosystolic souffle 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. 2. 3. 4. 5. Calcium and sodium Fosfat and potassium Calcium and potassium Sodium and magnesium 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, doesnt smoke, total cholesterol was 180 mg/dL last year. His BMI is 27. He doesnt get regular exercise. Question: which one will be the first management for this patient: 1. 2. 3. 4. 5. Following a strict diet. Give CCB with diuretic There is no specific treatment Give HCTZ together with beta-blockade 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 its making her tired and her feet are swelling, making it difficult to wear her beast shoes. BP 149/62. P 84 Question: what should u tell her? 1. 2. 3. 4. 5. Stop her medication Reduce the dose of amlodipine Combine amlodipine with HCTZ Recommend salt restriction and weight loss 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 MI Question: what phsyical exam findings would confirm it? 1. 2. 3. 4. 5. Tachypnea with pulsus alternans JVP>8 cm at 45position + irregular rhythm The JVP > 8 cm at 30 position + gallop rhythm Crackles bibasilar lung+ JVP>8cm at supine position 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 kaki B. Thrombosis vena dalam C. Iskemik tungkai akut

D. Penyakit buerger E. Varices 52. Sehubungan dengan kasus di atas; penyebab melemanya pulsasi dorsalis pedis disebabkan oleh? A. Menurunnya curah jantung semenit B. Menurunnya aliran darah arteri C. Pembengkakan jaringan lunak D. Adanya proses aterosklerosis E. Meningkatnya aliran balik 53. A. B. C. D. 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 supraventrikel B. sinus bradikardia C. fibrilasi ventrikel D. fibrilasi atrium E. block AV total 55. Pada penderita di atas, gangguan fisiologis yang mendasari kehilangan kesadaran adalah? A. kontraksi ventrikel dan atrium yang tidak sinkron B. tidak adanya aliran listrik jantung C. tidak adanya aliran darah balik D. tidak adanya isi sekuncup

E. 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 oksidatif B. fosforilasi defosforilasi C. fosforilasi karboksilasi D. okidasi hidroksilasi E. 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 intravena B. pemberian dobutamin intravena C. pemasangan balon intra-aorta D. intervensi koroner primer E. 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-1 B. peningkatan MMPO C. D. E. 59. A. B. C. D. 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 listrik b. Pasang pacu jantung sementara c. Pemberian obat trombolitik intravena d. Pemberian nitrogliserin IV dititrasi e. 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 kanan b. Posterior c. Anterior d. Inferior e. Lateral 62. . 63. .. 64. 65. . 66. . 67. 68. 69. . 70. . 71. . 72. . 73. . 74. . 75. A. B. Angiography C. Chest radiography

D. E. 76. The caused TOF.. A. To B. To C. To D. To E. To 77. Policitemia occurs in TOF if? A. Congestive heart failure occures B. The blood oxygens saturation increases C. The blood oxygens saturation decreases D. The blood flow from right to the left shunt E. 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 suprasternal Question: the diagnosis will be? a. ASD b. PDA c. TOF d. TGA e. VSD 79. The shunt will be right to left if? a. Rogers disease is found b. Diameters of VSD is small. c. LVH occurs d. Right and left ventricel activities increase e. Vascular pulmonary resistance highter than systemic resistence

80. Chest radiography shows?

a. Coer en sabot b. Like an egg on its side c. Right atrium Hipertrofi d. Decrease of pulmonary circulation e. 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. 2. 3. 4. 5. Prinzmetal angina Angina pektoris stabil Physio-physiologic reaction Infark miokard sub endokard 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 spontan b. Penyebab elevasi segemen ST hanya oleh spasme koroner c. Adanya stenosis bermakna tapi kolateral tdk berkembang d. Terjadi IMA tanpa elevasi segment ST e. 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 sekunder b. Dressler sindrome

c. Metastasis tumor d. Emboli paru e. 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. 2. 3. 4. 5. Rheumatoid juvenile arthritis Rheumatic heart disease Tonulo-pharyngitis Rheumatic fever Common Cold

85. Diagnosis is confirmed by using Jones criteria namely? 86. . 87. . 88. . 89. . 90. Apabila hasil .. pada penderita di atas positif, maka pemeriksaan . adalah? A. MRI B. MRCT C. Ekokardiografi D. Holter E. . ECG 91. Apabila ditemukan adanya stenosis yang . arteri koronaria dan adanya lesi di left main artery maka dianjurkan untuk terapi? A. PTCA & implantasi stent B. Aortic ballooning pumping C. coronary arteri bypass grafting D. beta-bloker + asam salisilat + nitrat

E. 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 ATP b. pH kardiomiosit c. Deposti nukleotida d. Osmolaritas intrasel e. 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. Tiamin b. Uridin c. Sitokin d. Guanin e. 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 jantung b. Otak, jantung dan aorta c. Otak, jantung, aorta dan ginjal d. Otak, jantung, aorta, ginjal dan hati e. Otak, jantung, aorta, ginjal, hati, paru 95. Selama fase isovolumetrik yang terjadi adalah: a. Semua katup jantung tertutup b. Katup Aorta tertutup dan katup mitral terbuka c. Katup aorta terbuka dan katup mitral tertutup

d. Katup pulmonal terbuka dan katup trikuspidal tertutup e. 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 eko Pertanyaan: Maksud pemeriksaan ekokardiografi adalah untuk mendeteksi adanya? a. Vegetasi b. Efusi perikard c. Kardiomegali d. Radang perikard e. Myoxoma atrium kiri 97. Denyut jantung 120/min merupakan mekanisme kompensasi akibat? a. Penurunan prabeban b. Peningkatan pasca beban c. Penurunan curah jantung d. Peningkatan lusitropik ventrikel e. Penurunan inotropik miokardium 98. Meningkatnya preload pada otot jantung akan? a. Mengurangi tegangan pada otot jantung b. Meningkatkan tegangan dinding ventrikel c. Mengurangi tekanan akhir diastolik ventrikel d. Meningkatkan kecepatan awal kontraksi jantung e. Mengurangi waktu yang dibutuhkan otot jantung untuk mencapai tegangan maksimal 99. Selama fase diastole, aliran darah yang cepat ke ventrikel dapat menimbulkan? a. BJ I b. BJ II c. BJ III d. BJ IV

e. BJ V 100. Fraksi ejeksi: a. Fraksi curah jantung yang dipompa setiap kontraksi jantung b. Stroke volume dikurangi volume residu yg terdpt pada ventrikel c. Rasio d. Rasio e. Rasio