CARDIO

1. Embryology of the heart. The correct statement about atria partition?

A. Grow upward from endocardial cushion.
B. Grow downward from common roof of atria.
C. Septum primum make a valve of foramen ovale (?)
D. Ostium primum is a common atrial septal defect.
E. Ostium primum tempat lewatnya darah dari RA ke LA

2. What is the origin of myocardium?

a. Mesodermal cells
b. Ectodermal cells
c. Endodermal cells
d. Neural cells
e. Lung cells

3. Pasien 65 tahun cardiac arrest dgn keadaan unconscious dan tidak ada carotid pulse. Management?
Cardiac Arrest : MONACO : Morfin; Oksigen; Nitrogliserin; Aspirin; Clopidogrel ; Opium dan Morfin
jika severity sakit sangat parah ( >8).

4. Ibu Jody pain and discomfort on her left chest. High BP, but regularly controlled. Pada saat
pemeriksaan, BP 140/90, HR 76 bpm. Kemungkinan besar penyebab dia pain and discomfort di left
chestnya apa?
a. External force to myocardium
b. Plaque rupture
c. Unbalanced myocardial oxygen supply and demand

5. Ada x-ray jantung. Terlihat left ventricular hypertrophy. Posisi left ventricle ada dimana? (Ini susah
dijawab karena gk ada gambarnya disini)
a. Marker A
b. Marker B
c. Marker C
d. Marker D
e. Marker E

6. Ada orang chest pain, diberikan Nitroglycerin. Bagaimana mekanisme obatnya?

 a. Increase
b. Decrease anxiety of the patient
c. Increase
d. Vasodilate coronary artery
e. ACE inhibitor

7. Mr. Ahmad, umur 63 thn. Pernah MI 2 tahun yg lalu, shortness of breath, kalau jalan jauh atau naik
tangga 2 steps sakit, namun keluhannya tidak mengganggu aktifitas sehari-hari. Klasifikasi
berdasarkan NYHA, dia masuk yang mana?
a. NYHA 1
b. NYHA 2
c. NYHA 3
d. NYHA 4
e. Cannot be determined

8. In mitral regurgitation, the regurgitating blood circulating to?

a. Left atrium during systole
b. Right Atrium during systole
c. Left atrium during diastole
d. Right atrium during diastole
e. Aortic during systole

9. Protein Jantung yang berfungsi untuk kontraksi otot jantung adalah

a. Tropomyosin & troponin
b. Actin & myosin
c. Tropomyosin & actin
d. Troponin & myosin
e. Actin & titin

10. Myosin head activation terjadi karena

a. ATP hydrolysis >>> (Miosin ATPase, memecah ATP ADP + Pi, Sehingga Miosin head bisa
COCK dan menempel dengan Miosin Binding Site pada filamen Miosin )
b. ADP hydrolysis
c.
d. Troponin activation
11. Which conduction display the slowest conduction.
a. SA
Purkinje fiber
b. AV

12. An ECG of a patient shows PQRST waves. The R are positive in lead II, III, and aVF but negative in
aVR. What's the origin of the signal?
SA node

13. Dalam normal ECG, QRS itu menunjukkan apa?

Ventricular depolarisation

14. Small R wave di V1. Bagian yang pertama kali terdepolarisasi adalah
Left side of ventricle septum

15. Normal impulse conduction of the heart adalah...

SA node, AV node, bundle of His, bundle branches, Purkinje fibers

16. Second heart sound disebabkan oleh...

a. Closure of mitral and tricuspid
b. Opening of mitral and tricuspid
c. Closure of aortic and pulmonic.
d. Opening of aprtic and pulmonic.
e. Filling of left ventricle

17. A 20 year old lady was diagnosed with severe mitral stenosis. Ada right atrial enlargement. Yang
abnormal di EKG-nya apa? (tergantung pilihannya apa)
18. A 50 years old with a history of "mild" heart attack presents to the emergency department with 1
hour history of "crushing" chest pain associated with nausea, shortness of breath, diaphoresis, and
radiation to the left arm and neck. The ECG shows: (ST segment elevation of lead II, III, and aVF).
What is the diagnosis?
 a. STEMI inferior wall
b. STEMI anterior wall
c. STEMI lateral wall
d. NSTEMI inferior wall
e. NSTEMI anterior wall

19. Ada orang dengan chest discomfort, bradycardia, block di AV node. Vessel mana yang
memperdarahi?
a. RCA -> Tepatnya AV nodal artery ( percabangan Distal Part of RCA )
b. LCA
c. Anterior descending coronary artery
d. Posterior descending artery
e. Marginal coronary artery

20. Ada pria 55 thn datang buat checkup. BP 180/90, HR 80, suhu 37C. MAP-nya berapa?
a. 60
b. 90
c. 100
d. 110
e. 120 >>> MAP = Diastol + 1/3 x Pulse pressure | Pulse Pressure = Sistol - Diastol
21. A 47 year old man reported a six month history of intermittent chest discomfort while playing
squash. He described lower substernal tightness with numbness of the upper left arm only during
exertion. Relieved at rest. What is most likely the diagnosis?
a. Unstable angina
b. Chronic stable angina
c. STEMI
d. NSTEMI
e. Printzmetal angina

22. Mr Jono 55 thn mempunyai CAD. Dia smoker, BP 150/70, ada riwayat DM 5 thn yg lalu dan obese.
What is the non-modifiable risk factor?
a. DM
b. Smoker
c. Male
d. Hipertensi
e. Obesity

23. Arrythmia is an abnormal electrical activity. Bisa karena abnormal electrical generation. Which one
of the following is due to abnormal electrical generation?
a. 1st degree AV Block
b. 2nd degree AV Block
c. 3rd degree AV Block
d. Sick Sinus Syndrome
All of the above

24. Dikasi ekg prolong PR interval

a. av blok 1
b. av blok 2 type 1 (Wenkebach)
c. av blok 2 type 2
d. total av blok
e. atrial fibrilation
25. ECG berikut apa yg ke blok?

Sinus block

26. EKG yang PR intervalnya normal awalnya tapi lama2 makin pendek trs nempel sama QRS-nya.
Penyebabnya?
Masalah di AV conduction

27. Mr. T ada kena palpitations. Di ECG abnormal (ada gambarnya) what's the diagnosis?

Atrial fibrillation

28. Mr. R, 53 year old come to the ER with shortness of breath, edamatous limb and nausea. He had a
history of Chronic Kidney Disease since 3 years ago. He refused to undergo hemodialysis. Which of
the following electrolyte imbalance: (ekg p mitrale)
 a. Hypokalemia
b. Hyperkalemia
c. Hypocalcemia
d. Hypercalcemia
e. hyponatrimia

29. Hasil EKG berikut apa namanya?

a. Atrial Fibrillation
b. PSVT
c. VT

30. He had been suffered from chronic lung disease. He was diagnosed of having cor pulmonale. The
ECG is showed below. What is your findings?
 a. P pulmonale
b. Right atrial enlargement
c. Right ventricle hypertrophy
d. All of the above

31.

32. Mrs. Sherly a 70 year old woman came to the emergency department with shortness of breath, she
could not sleep without using 3 pillows. X-ray shows
Cranialization

33. Yang bedain action potential di cardiac muscle dan pacemaker adalah phase 2. Yang terjadi di phase
2 adalah...
a. Rapid influx Na
b. Influx K
c. Influx Ca
d. Influx Mg
e. Influx Cl

34. Fase 0 sel kontraktil jantung terjadi perpindahan ion?

 Influx Na

35. Kenapa saturation O2 di right ventricle meningkat?

Ada blood flow dari Left ke Right side lewat shunt (VSD)

36. Mr. B was diagnosed with heart failure. What is the underlying mechanism?
a. Sodium and water retention
b. Renin system blockage
c. Symphatetic blockage
d. Vagal

37. Women 50 years old complaint her heart is beating too slow. PQRST wave recorded with R-R
interval 1200ms. Calculate HR!
a. 100
b. 80
 c. 60
d. 50
e. 40

38. In mitral regurgitation, the regurgitating blood circulating to?

a. Left atrium during systole
b. Right Atrium during systole
c. Left atrium during diastole
d. Right atrium during diastole
e. Aortic during systole

39. Mrs. Aprillia came to her physician for medical check-up. The doctor heard a wide fixed splitting of
the second heart sound but the first heart sound was normal. Why was the second heart sound
splitted?
a. Prolonged ejection time in the atrium
b. Ventricular septal defect
c. Stenosis of the mitral valve
d. Delay in pulmonic valve closing
e. Rupture of chordae tendinae of tricuspid valve

40. Seorang pria dengan past history of myocardial infarct 5 years ago, kakinya edema dan mengalami
shortness of breath. (pulmo edema)
Increase hydrostatic pressure

41. Mrs. Enny aged 70 years old, have coronary artery stenosis. She came with chest pain & palpations.
HR 100, BP 160. Diagnosis angina pectoris caused by worsening myocardial infarct. Whats the
mechanism of worsening MCI?
a. Old age
b. Increased wall stress
c. Increased HR
d. Increased contractility
e. Increased stenosis

42. Male 70 y.o. chest pain. BP 200/100. Chest pain because?

a. Myocardial ischaemia due to increase HR
b. Myocardial ischaemia due to increase wall stress
 c. Myocardial ischaemia due to anxiety
d. Myocardial ischaemia due to decrease O2
e. Myocardial ischaemia due to decrease contractility

43. Ada pressure volume loop diagram. Poin D-A?

Isovolumetric contraction

44. Pink frothy sputum

Pulmonary capillaries

45. Mr. Mike, 38 year old, is suffering from a sudden onset of chest pain. It was felt like a heavy burden
sensation on his chest, radiating to his left arm. This was the first time he felt this kind of chest
discomfort. It was not accompanied by any sweating nor nausea. He was admitted to the hospital -
the ECG and cardiac enzymes results are normal. What is your clinical diagnosis?
a. Stable Angina Pectoris
b. Unstable Angina Pectoris
c. Myocardial Infarction
d. Gastrointestinal Reflux
e. Musculoskeletal Pain

46. Mr. Mike, 38 years old is suddenly having cardiac arrest. No response, breathing was gasping, no
pulse at carotid artery palpation. Possible rhythm in cardiac arrest?
a. Ventricular Tachycardia
 b. Ventricular Fibrillation
c. Asystole
d. Pulseless Electrical Activity
e. All of the above

47. Mr. Eko, 50 year old, has recent myocardial infarction. He developed shortness of breath and easily
fatigue. Recently, he awakened each night with difficulty of breathing. Using 3 pillow relieves his
symptoms. JVP not elevated. What is his clinical diagnosis?
a. Right heart failure
b. Left heart failure
c. Pulmonary embolism
d. Renal disease
e. Asthma attack

48. Male 50 tahun. You hear fourth heart sound on auscultation. What is the mechanism of that heart
sound?
a. Aortic valve closing
b. Mitral valve closing
c. Turbulence of mitral regurgitation
d. Turbulence of aortic valve turbulence
e. Impaired compliance of left ventricle

49. Pria 40 tahun breathlessness for the past 2.5 years. Dateng pansystolic dari apex radiate ke axilla.
a. Mitral stenosis
b. VSD
c. Mitral regurgitation
d. Decrease/increase left ventricle compliance (?)
e. ASD

50. On lab practice of pharmacology, there is a trial using rabbits. After giving a drug, you found several
phenomena: BP was increased due to vasoconstriction, widening pupils of the eye, and sphincter
contraction of the gastrointestinal tract & urinary bladder. Which drug has been given to the rabbit?
a. A drug which block alpha adregenic receptor
b. A drug which stimulate alpha adregenic receptor
c. A drug which block beta adregenic receptor
d. A drug which stimulate beta adregenic receptor
e. A drug which non selectively block adregenic receptor
51. A 20 years old man is stabbed immediately to the fifth intercostal space of left midclavicula. The
knife most likely penetrated what part of the body?
a. Left ventricle
b. Left atria
c. Right atrium
d. Right ventricle
e. Aorta descenden

52. Male, 63 tahun with past history of myocardial infarction. He has been experiencing shortness of
breath on exertion. His leg were edematous. At emergency departement he was diagnosed of
having acute lung edema. What is the mechanism of his situation?
a. Vasoconstriction at pulmonary arteriole
b. Increased permeability arteriole
c. Increased oncotic preassure
d. Impaired lymphatic drainage
e. Increased hydrostatic pressure

53. Di mikroskop keliatan many elastin membranes dan ada vas vasis di tunica adventitia. Apakah itu?
a. Venule
b. Lympathic vein
c. Large vein
d.
e. Aorta

54. 15 yo ada keringat. Ada mur mur di apex. Terus ada subcutaneous nodule & errythrma. Pathogen
nya apa?
a. Staphylococcus aureus
b. Streptococcus beta haemolyticus
c. Staphylococcus viridans
d. MRSA
e. S. Epidermidis

55. Gambar berikut diagnosisnya apa?

 Aortic stenosis

56. Ada ad wiggers diagram. Ada bagian yang digelapin gitu warnanya (LA-LV). Abnormal heart sound
apa yang terdengar? (Diagramnya mirip2 yg dibawah ini, bagian yg digelapin LA dan LV tulisannya)

Diastolic murmur

57. A patient with severe chest pain and bradycardia brought to you in emergency department. ECG
reveal conduction block in AV node. What is the coronary artery involved?
a. Left coronary artery
b. Right coronary artery
 c. Anterior descending coronary artery
d. Posterior descending coronary artery
e. Marginal coronary artery

58. A neonates came to your clinic with short of breath and tachycardia right after birth. The doctor
sent him to radiology department, the chest x-ray reveals enlarged silhouette and increase blood
flow to the lungs. This is the sign of Patent Ductus Arteriosus Botalii. What are the valves involved in
this case?
a. A. Pulmonary and V. Pulmonary
b. Aorta and V. Pulmonary
c. A. Cava superior and V. Cava superior
d. Aorta and V. Azygous
e. Aortic Arch and A. Pulmonary

59. Male 53 tahun. Ada anterior MI. Arteri apa yang responsible?
a. Circumflexa
b. Left anterior (harusnya left anterior descending)
c. Right coronary artery

60. A 20 year old man had a car accident. X-ray shows a fractured sternum. The fragments tore a vessel
that runs in the anterior mediastinum. Thorax surgeon was performed to stop the bleeding. Which
vessel is injured?
a. Aorta ascendens
b. Internal thoracic artery
c. Pulmonary Artery
d. Intercostal Artery
e. Subclavian Artery

61. Di mikroskop keliatan endotel dan few layer of smooth muscle cell. Apakah itu?
Arteriol

62. Most sensitive but less specific serum cardiac marker for supporting diagnosis of myocardial
infarction?
a. CK MB
b. Troponin T
c. Myoglobin
 d. SGOT
e. HBDH

63. Ms. Indah, 20-years-old, has shortness of breath. Her chest X-ray revealed pruning pattern of
pulmonary vascularization. What is the cause of the pattern?

a. Pulmonary vein congestion

b. Acute lung edema
c. Pulmonary artery hypertension
d. Pulmonary infection
e. Pneumothorax

64. EKG sinus rhythm, kenapa dibilang sinus rhythm?

a. P wave positif di lead II dan negatif di aVR
b. QRS regular
c. He is your friend

65. Ada aortic dissection. Yang robek bagian mananya?

a. Tunika intima
b. Tunika media
c. Tunika adventitia

66. Formation of the foam cell

Makrofag makan lipid
67. Ada orang yang sakit dada pas kegiatan berat tapi mereda ketika istirahat atau konsumsi
nitroglycerine sublingually.
a. Myocard ischemic due to increase HR
b. Myocard ischemic due to increase contractility
c. Myocard ischemic due to decrease O2

68. Mechanism of beta blocker?

69. Kena aortic stenosis terus dia ada syncope, knp bisa terjadi syncope?
Small orifice through the aortic valve and low cardiac output

70. frank starling

***Anak ada erythematum marginatum, ada cardiac murmur, (rheumatic fever kalo ga salah) ada upper
respiratory tract infection. Bakteri penyebabnya apa?
a. Staphylococcus A
b. streptococcus beta haemolyticus
c. staphy viridans
d. MRSA

***ada gambar ekg (T tall). Diagnosisnya?

a. Hypercalcemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia
e. Hypernatreumia

***Ada gambar RR interval sama, P wave konstan? Blockage of AV node

***Ada gambar EKG, P mitrale. Dimana masalahnya?