Multiple Choice Questions

HEMATO-ONCOLOGY
FK UPH 2014
Friday, 17 Jan. 17
08.10 – selesai

1. Cewek usia 31 tahun. Susah mikir sejak 3 bulan. menstruasi berkepanjangan sejak 3 bulan. No
bleed. No family history. No other symptoms. Hb: 7.5 MCV 74 MCH 24. Eritrosit rbc 5.16
TIBC 450. Sakit apakah dia?
A. Hemoglobinopathy
B. Follat deficiency
C. Iron deficiency
D. B 12 deficiency
E. Anemia of Chronic Disease

2. A 24 years old male came with fatigue since 1 month. He was in TB treatment for 3 months.
Hb 8,2 g/dl. MCV 78. MCH 27. Serum iron was normal. The blood smear showed many
lymphocytes. What is the problem?
A. Hemoglobinopathy
B. Follat deficiency
C. Iron deficiency
D. B 12 deficiency
E. Anemia of Chronic Disease

3. A 26 year old female came with underweight since childhood. She looked pale. She had no
history of transfusion. Her aunty had history of get frequent transfusion. The hemoglobin 8
gram/dl. The blood smear showed target cells. What is the mechanism of his problem?
a. Hemoglobinopathy
b. Alpha major thalassemia
c. Anemia on chronic disease
d. Iron deficiency anemia
e. Nutrient anemia

4. 45 years old male come with a fever since 2 motnh ago. He abis jalan jalan dari Papua. Looked
pale and underweight. HB 7.2 Blood smear ditemukan shisctocyte dan Urinalysis trlihat
HBnuria. What is the mechanism of the pathogenesis :
a. Nutrient deficiency

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 b. Gangguan iron absorption
c. gangguan Dna synthesis
d. Lysis of RBC
e. G6PD

5. A 36 years old healthy man came to the clinic and was concerned with his family history of
colon cancer. His brother was diagnosed with colon cancer at the age of 50. Other siblings were
healthy. Both parents died not due to cancer. He would like to do colonoscopy now. What
would you recommend?
A. Do colonoscopy now.
B. Do colonoscopy at 45.
C. Do colonoscopy at 50.
D. Do colonoscopy at 55.
E. Decline colonoscopy. Just do fecal occult blood test.

6. 50 y.o. woman with history of breast cancer. Come with SOB. On PE, JVP increased. On chest
x-ray pulmo edema and kerley b line was seen. She was previously treated with radical
masectomy, chemo with cyclophosphamide, taxane, doxorubicin, radiotherapy and endocrintw
therapy. What causes her SOB ?
A. Radiotherapy
B. Endocrine therapy
C. Taxane
D.cyclophosphamide
E. Doxorubicin

7. 15 y.o boy came with jaundice since 1 week ago, ans jaundice since 3 weeks ago. Lab results
Hb 9,2 g/dL, increase indirect bilirubin and platelet count 350.000. Abdominal USG showed
cholelithiasis.
A. Non immune hemolytic anemia
B. Malnutrision
C. Evan syndrome
D. Anemia of chronic disease
E. Iron deficiency anemia

(8.) Laki-laki, 34 tahun, datang dengan penurunan kesadaran sejak 1 minggu. Creatinine 8, Hb 6.7,
platelet 67.000, ureum 78. Blood smear schistocyte. What is the cause of anemia?
A. Microangiopathic hemolytic anemia

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 B. Severe malaria
C. HUS
D. Anemia on chronic disease
E. B 12 deficiency

9. A 45-year-old Alcoholic american male came to international hospital with a complain of

frequent slept since 5 months. Hb 7,6. MCV 110. MCH 36. Blood smear shows
Hypersegmented neutrophil. What is the problem?
A. Liver disease
B. Folic deficiency
C. Myelodysplastic Syndrome
D. Myelofibrosis
E. Toxic Poisoning

(10.) A 35-year-old man came with tingling sensation in finger. No diabetes. Hb 13,3 g/dl.
Reticulocyte decreased. Blood smear shows Hypersegmented neutrophil. What is the problem?
A. B12 deficiency
B. Folic deficiency
C. EPO deficiency
D. Iron deficiency
E. Vitamin C deficiency

11. Male, 34 y.o., painter, datang dengan keluhan could not do anything since 2 weeks ago. MCV
90, MCH 28, reticulocyte low. Night sweats since 3 months ago. Both leg are rash. Whats the
probable diagnosis?
A. Anemia on chronic disease
B. Aplastic anemia
C. Autoimune hemolytic anemia
D. Evans Syndrome
E. Nutritional deficiency anemia

12. A 28 y.o mother come with fatigue since 2 month after delivery. There is history of transfusiom
during pregnancy. Hb = 8.2 g/dl. MCV = 81. MCH = 28, with increased reticulocyte. Direct
coombs test was negative with negative IgG, IgM and C3.
What would we explain about her condition?
A. Autoimmune hemolytic anemia with warm type
B. Alloimmune hemolytic anemia

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 C. Autoimmune hemolytic anemia with cold type
D. Paroxysmal cold hemoglobinuria
E. Mixed type of warm and cold type

13. What is the function of EPO?

A. Maturation of reticulocyte
B. Proliferation Erythrocyte Progenitor Cells
C. Proliferation Basophilic Erythroblast
D. Proliferation Polychromatophilic erythroblast
E. Maturarion of Erythrocyte Progenitor cells

14. What is the meaning of MCV?

a. measurement of the variation in RBC cell size
b. The number of reticulocytes/1000RBC
c. the average concentration of hemoglobin in g/dl (or %)
d. the average volume/RBC in femtoliters (10-15 L)
e. the average weight of hemoglobin/cell in picograms (pg= 10-12 g)

15. what is the principal source of hemoglobin in myelo stage of hematopoiesis 3 months before
birth?
A. Liver become principal source
B. Bone marrow become the principle source
C. Spleen become the principal source
D. Yolk sac become the principle source
E. Mesothelial layer of placenta become the principle source

16. The 3 days newborn boy baby observated that he had icteric. His blood type is O and Rh+. The
icteric was reducing after he given ultra violet loght therapy. What is the enzyme was reducing
serum bilirubin ?
A. UDP Glucoronyl Hidroxilase
B. UDP Glucoronyl Oxigenase
C. UDP Glucoronyl Transferase
D. UDP Glucoronyl Reductase
E. UDP Glucoronyl Dehidrogenase

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17. A 67 y.o. man came with sign of ascites and positive spider nevi. USG shown liver cirrhosis
and ascites. He felt tired for 2 weeks. Occult blood positive. Hb 8.3, MCV 88, MCH 30. Blood
smear shown pencil cells and hypersegmented neutrophil. What is the cause of tired?
A. Anemia on chronic disease
B. Iron deficiency
C. Variceal bleeding
D. Liver cirrhosis
E. Folic acid deficiency

18. 25 years old repeated nose bleeding especially on a hectic day. What suggestions do you give
him to evaluate his bleeding?
A. APTT
B. BT
C. PT
D. Mixing APTT
E. Ecarin thrombin time

19. A 21 years old female came with petechiae in both legs for 10 days. Platelet count was
decreased and in peripheral blood smear was found giant cell. What is your diagnosis?
A. Dengue Fever
B. Zika virus infection
C. Scurvy disease
D. Hereditary platelet defect
E. Immune Thrombocythemia

20. 24 y.o male fatigue & blood smear shows ovalocytes. Hb 6,4. MCV 73. MCH 19. What do you
do to relieve Hb?
A. Give Leuko depleted red cells
B. Give Packed red cells
C. Transfuse washed red cells
D. Whole blood
E. Give Eritrosit apheresis

21. 35 year old male painter, came to you with could not do anything since 2 weeks ago. Hb 9
gram/dl. MCV 90 MCH 28. He felt night sweat in the last 3 months. In the both leg wash rash.
Reticulocyte count was low. What is the most likely problem of this case?
A. Anemia of chronic disease

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 B. Aplastic anemia
C. Autoimmune hemolytic anemia
D. Evan's syndrome
E. Nutrient deficiency anemia

22. A 34-year-old woman with sign of heart failure. Hb 6 g/dl. MCV 82 MCH 28. Platelet 340.000.
Blood smear shows spherocytes and erythrophagocytosis. No bleed. What is the cause of her
anemia?
A. Anemia of Chronic Disease
B. Autoimmune Hemolytic
C. Evan’s syndrome
D. Aplastic anemia
E. MDS

23. A 58 years old man has leakage of fluid from surgical site since 1 day. He had a surgery for
humeri fracture 4 days ago. BT, PT, aPTT normal. What is his problem?
A. VWF Disease
B. Hemophilia B
C. Surgical bleeding
D. Liver disease
E. Factor 13 deficiency

24. A 34 years old male came with gingival bleeding. Bleeding time was normal. INR 5.6. Others
within normal limit. What do you give him?
A. Fresh Frozen Plasma
B. Cryoprecipitate
C. Thrombo-apheresis
D. Thrombocyte concentrate
E. Vitamin K

25. A 25 years old female with menorrhagia. Bleeding time was increased. aPTT was increased. PT
was normal. What is the cause?
A. Factor XI deficiency
B. Vitamin K deficiency
C. Uremic platelet
D. VWD
E. Liver Cirrhosis

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26. A 37 years old man came with itching and rash all over his legs. He had history of transfusion
of packed red cell because his Hb was 7 g/dl. What is the mechanism of his problem?
A. Allergic reaction
B. Alloimmune
C. Lysis red blood cell
D. ABO mismatch
E. TACO

27. A 31 years old female with CA Mamae. Proliferating sustaining signal receptor +, ER and PR
receptor -. What is the Target Therapy for this breast Cancer?
A. Bevacizumab
B. Transtuzumab
C. Tamoxifen
D. Rituximab
E. Imatinib

28. A 61 years old man came to general check up due to fear of his father having cancer. His
weight is decreases. He was a heavy smoker. He has been smoke 2 packs a day for more than
25 years. What is the best test for this patient?
A. Chest X-Ray
B. PET Scan
C. Cytologic sputum
D. Low dose CT Scan
E. Bronchoscopy

29. A 29 years old lady came with dyspnea on effort since 3 days ago. Hb level was 5 g/dl. She got
750 mL packed red cell, the symptoms persists and worsens. The rales increased. What drugs
should be given before to prevent her condition after transfusion?
A. Anti-histamine
B. Steroid
C. Should be given washed red cell
D. Furosemide
E. Red cell apheresis

30. A 25 years old lady come to a clinic for anemia. She was diagnosed with Autoimmune
hemolytic anemia. She have gotten steroid for 2 months. She was cured, but for the last 2 days

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 her fatigue returns. In laboratory test result, shows Hb 8 gr/dL, MCV 110, MCH 32. What is
happening to her?
A. Autoimmune hemolytic anemia relaps
B. B12 deficiency
C. Folic Acid deficiency
D. Iron deficiency Anemia
E. Adrenal insufficiency

31. Woman 22 y.o. with a history of frequent transfusion for several past year. Hb: 7, MCV: 82,
MCH: 28. Blood smear: ovalocyte. What is the pathogenesis of her problem?
A. Hemoglobin Disorder
B. Erythrocyte Membrane Disorder
C. Erythrocyte Enzyme Disorder
D. DNA disorder
E. External Destruction

32. Cowo, 36 tahun, melena 4 hari. Hb 7 g/Dl. Lagi masa pengobatan obat aspirin dan clopidogrel.
Clotting time normal. Diberi obat apa?
A. Fresh Frozen Plasma
B. Cryoprecipitate
C. Desmopressin
D. Trombopheresis
E. Vitamin K

33. Female 56 years old came with bleeding. aPTT increased and there is factor IX deficiency.
What is the treatment?
a. Fresh frozen plasma
B. Steroid
C. Factor XI concentrate
D. Erythrocyte aphresis
E. Vitamin K

34. 37 y.o man, fatigue, nausea, vomiting. On PE : spleen S4. Lab : HB 13, leukocyte 23000,
platelets 231000. Bone marrow examination found all stages development of leukocyte and
myeloblast. Diagnosis?
A. Acute Myeloid Leukemia
B. Accelerated phase CML

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 C. Crisis blasts CML
D. Chronic CML
E. Hairy cell leukemia

35. A 45 years old man came with swelling leg, pain and homan sign were positive. What will you
do next?
A. D-dimer
B. Compression doppler ultrasound
C. Venography
D. CT

36. A 21 years old female with sweliing in right arm, no pain, no edema, no venectasis. What will
you do next?
A. Venography
B. Compression doppler ultrasound
C. Venography
D. Lymphography
E. D-dimer

37. A 45yo man comes with SOB since 5 days ago. His chest Xray shows lung effusion in the left.
He has history of thrombosis in the right leg since 3 days ago. What is your next step
management?
A. BTA sputum
B. CTPA
C. Lateral x-ray
D. Venography of lung
E. Analysis blood gas

(38.) Pasien datang dengan keluhan jaundicendan pale sejak 2 minggu yg lalu. Hb 6.4 g/dl. Indirect
billirubin naik. Direct coombs test positive. Urinalysis normal. What is the mechanism of her
anemia?
A. Destruction of erythrocyte in lien
B. Cytokine action
C. Membrane attack complex
D. Autolysis of RBC
E. Immune to erythrocyte progenitor cell

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39. A 43 year old man come with fatigue since 3 months ago. Hb 8 g/dl. Abdominal ultrasound
show contracted kidney. Blood smear show macroytic anemia and hypersegmented neutrophil.
What is the pathogenesis of decreased hemoglobin?
A. Reduced EPO
B. Loss of blood
C. Frequent dialysis
D. Uremic syndrome
E. Reduce RBC production

40. A 46 years old male, came with fatigue since 8 weeks, often felt night sweats and gum
bleeding. Hb leves was 8,1 g/dl. Reticulocyte was decreased, blood smear show normocytic
anemia with leucopenia and thrombocytopenia. Pathogeneis?
A. Destruction erythrocyte in lien.
B. Loss of blood
C. B 12 deficiency
D. Immune to eruthrocyte progenitor cell
E. Folic acid deficiency

41. 35 y.o man came with easily tired since 2 months. Hb 8,2 g/dl, MCV 78, MCH 26. Chest xray
showed infiltration in upper left lobe. Ferittin 1200. What is the pathogenesis?
A. Decreased absorption of iron
B. Hemoglobinopathy
C. Enzyme defect
D. Hepcidin increased

42. 18 years old male came with repeated transfusion before. Hb level 9.8, MCV 62, MCH 21.
Blood smear showed target cell. What is the pathogenesis of his problem ?
A. Trapping RBC in capillary
B. Membrane attack complex
C. Hereditary decreased RBC
D. Frequent transfusion
E. Denatured of Hb

43. 74 year old man goes to general practitioner. Blood smear many small lymphocytes, 60%.
Possible diagnosis?
A. ALL
B. CML

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 C. CLL
D. AML
E. Hodgkin lymphoma

44. 38 year old female came with malaise, fatigue and nights sweat for 4 weeks. Hb 8.2, leukosit
24k, platelet 123000. Blood smear shows positive blast with promyelocyte, metamyelocyte.
Diff count 0/0/1/42/34/0. Diagnosis:
A. Acute Myeloid Leukemia
B. Chronic phase CML
C. Accelerated phase CML
D. Crisis Blast CML
E. Chronic Promyelocytic Leukemia

45. 35 y.o. woman come because abnormal vaginal bleeding and vaginal discharge. History of
multiple sex partners. She is heavy smoker.
What is your recommendation?
A. Vaginal culture
B. CT scan abdomen
C. USG gynecology
D. HPV vaccination
E. Pap smear

46. A 8 years old boy came with confirm of neuroblastoma. He was given a surgery, chemotherapy,
and radiotherapy. The chemotherapy is cisplastin, CCNS, vincristine. What is the mechanism of
vincristine?
A. Inhibit DNA synthesis
B. Inhibit Microtubule formation
C. Inhibit Microtubule diassembly
D. Increase DNA degradation
E. Antimetabolite

47. A 44 years old male came with fever of unknown origin since 6 months. Leukocyte 34000. Diff
count was 0/0/1/45/40/0. There was myeloblast. Diagnosis?
A. AML
B. Accelerated phase CML
C. Chrisis phase CML

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 D. Chronic phase CML
E. Post PV-Acute myeloid leukemia

48. Cowo 36 thn. fever 2 weeks , night sweats, recurrent infection. Hb 10.2 , leukocyte 5400,
platelet 178.000, diff count 0/0/0/24/50/0 , blood smear atypical lymphocyte. what is the
diagnosis?
A. hodgkin lymphoma
B. non hodgkin lymphoma
C. multiple myeloma
D. ALL
E. CLL

49. A 35 year old woman came with right axillary node lump. On examination, there is a hard
nontender lump at the left breast. Result of node biopsy shows Reed-Steinberg cells. What is
the diagnosis?
A. Hodgkin lymphoma
B. non-Hodgkin lymphoma
c. metastatic breast cancer
d. ALL
e. Breast lymphoma

50. A 41 years old man came with mass in inguinal with diameter 5 cm. The biopsy of the nodes
shows small lymhocytic with CD20 cell. What is the appropiate diagnosis?
A. Hodgkin Lymphoma with nodular sclerosis
B. Diffuse large B cell Lymphoma
C. Multiple Myeloma
D. Acute Lymphocytic Leukemia
E. Chronic Lymphocytic Leukemia

51. A 70-year-old male came with fatigue since 6 weeks ago. Hb 8,2 Platelet 87.000 Blood smear
blast positive Reticulocyte count was increased. What is the possible diagnosis?
A. AIHA
B. Occult bleeding
D. Accelerated CML
D. MDS
E. AML

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52. A 47 y.o. female came with complain of fatigue since 3 months ago. There is No fever, hb level
was 6.3 g/dl, leuko 2400, and thrombo 97.000. The reticulocyte count was increased. There is
history of hepatitis B infection, positive stigmata chirrosis, what is the reason of the fatigue?
A. Aplastic anemia
B. Evan syndrome
C. Thrombosis of lien vein
D. Dengue fever with bleeding
E. Nutrient Deficiency

53. A 55-year-old mand was diagnosed with colorectal cancer. He underwent surgery resection,
chemotherapy, and radiotherapy. Chemotherapy regiments were 5-Fluorouracil, Oxaloplatin,
and Leucovorin. 5-Fluorouracil works at what stage of cell cycle?
A. Non-cycle dependent
B. S
C. S and G2
D. M
E. G1

54. A 55 years old man was diagnosed metastasis colorectal cancer. He have been treated by full
dose chemotherapy and targeted therapy. What receptor does play role in metastasis and
angiogenesis ?
A. EGFR
B. CD-20
C. VEGF receptor
D. Her-2 receptor
E. PD-L1 receptor

55. 67 y.o. male came with bone pain in the lumbar area. Xray shows lytic in bone (lytic bone
lesions?). Peripheral blood normal. Albumin: 2.1g/dl, globulin 5.2g/dl. What is the next step?
A. Bone scan
B. Bone survey
C. Urinalysis
D. Protein electrophoresis
E. Blood smear

56. Permpuan sudah fatigue selama 3 bulan. Hb rendah, ada proteinuria, Platelet 234.000.
Reticulcyte count increase. Positive DAT test for IGg and C3. Possible Diagnosis?

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 A. Hepatitis A
B. Hepatitis C
C. SLE
D. Hypersensitivity vasculitis
E. Evan syndrome

57. A 34 years old man came with orthopnea since 2 weeks ago. Hb 5. MCV 67. MCH 21. Folic
and B12 low. Treatment?
A. Folic acid 5 mg three times a day.
B. B12 10 mg three times a day.
C. PRC 500 ml.
D. Ferrous Soulfate 200 mg.
E. Washed PRC 400 ml.

58. A 46 years old man came with a complaint of easily tired since 4 months ago. He also felt pain
on his shoulders. Hb level was 8,7 g/dl. MCV 84. MCH 28. Normal reticulocyte count. Bone
marrow smear shows rouleaux formation. What is the most likely diagnosis?
A. Multiple Myeloma
B. Acute Leukemia
C. CLL
D. Occult Malignancy
E. Malaria infection

59. A 67 years old male came with history of bleeding and anemia with Hb 9 g/dl. The WBC count
86 thousands. Blood smears shows myeloblasts. What is your advice to his family?
A. Supportive care
B. Reccomend of leucophoresis
C. Refer to radiation oncologist
D. Ask for bone marrow aspiration
E. Give antibiotics.

60. A 69 years old man came with enlargement of lien since 4 months ago. Blood smear : varities
leucocyte development. Cytogenetic : mutation on break cluster region of abelson. What is your
advice for him?
A. Chlorambucil
B. Imatinib
C. Capecitabine

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 D. Polatinib
E. Nilotinib

61. A 43 year old came with the complaint of fatigue, night sweats, tiredness for 3 months. Lien is
schuffner 5, hb is 8.2g/dl, leucocyre 38.000, platelets 540rb. Blood smear shows tear drop cells.
What is possible diagnosis?
A. Myelodysplastic syndrome
B. Essential thrombocytosis
C. Chronic myeloid leukimia
D. Myelofibrosis.
E. Accelerated phase CML

62. A 65-year-old man comes with main complaint of shortness of breath. Hb 18 g/dl. He is living
near Bromo mountain. JAK 2 negative. Diagnosis?
A. Polycythemia Vera
B. Essential Thrombocytosis
C. High Altitude Syndrome
D. Dehydration
E. Chronic Pulmonary Disease

63. A 2 years old girl came to you after receiving regular blood transfusion. Her parents
complained that her skin got darker despite good outcome for her disease. What iron storage
causes this?
A. Ferritin Erythrocyte
B. Ferritin Subcutan
C. Transferrin
D. Hemosiderin
E. Denaturated Hemoglobin

64. A 12-year-old boy was brought because of fever and cough for three days. Laboratory
Examination shows leukocyte count to be 15.000/mm3 with differential count 0/1/2/73/22/2.
Which cytokine that could cause such condition?
A. Interleukin-1
B. Interleukin-4
C. Interleukin-6
D. Interleukin-8

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65. 20 years old lady came with gum bleeding two hours ago. It’s alson accompanied by petechie over
her both legs/ Her blood exam shows platelet counts to be 98.000/mm3. Which binding protein
mediated disorder of her? GPIIb
A. GP1A
B. GP1B
C. GP2A
D. GP3A
E. GP3B

66. 14 years old male was brought whit burises over his left knee. NO bleeding episodes before.
However, his great gradnfather also has the same problem. WHat is the initial blood
examination require?
A. Bleeding time
B. Clotting time
C. Prothrombin time
D. Activated partial thromboplsatin time
E. Thrombin time
67. A man diagnosed with pancreatic adenocarcinoma and had been treated by some courses of
chemotheraphy. What test should be done to follow up the therapy?
A. Ca 19-9
B. Ca 15-3
C. Ca 125
D. CEA
E. Cyfra-21

68. A 52 years old woman with repeated headache. Hb 15 g/dl. Ht 45%. Leucocyte 12000. Platelet
1,2 million. JAK2 positive. Spleen was enlarged. Diagnosis?
A. ET
B. PV
C. Reactive Thrombocytosis
D. Hypercoagulable state
E. Myelofibrosis

69. a 48 years old male with syncope. Ht 60%, He is smoker. JAK 2 mutation (+), BM aspiration
showed trilineage proliferation. What next?
A. plebotomy everyday
B. aspirin

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 C. warfarin
D. Autologous BM trasplant
E. Hydartion adequate

70. A 35-year-old male came with suddenly feel tired the hemoglobin level was 6.5 g/dL. Billirubin
indirect was increased and haptoglobin was decreased. From the Coombs test there is anti-
body IGM near the Erythrocyte. what do you do next?
A. Give dexamethasone
B. Transfer with leucodepleted PRC
C. Rituximab
D. Go to top of mountain
E. Take artesurate

71. A 34-year-old woman came with hematoma without serious trauma. No history of bleeding,
others were normal. Possible Diagnosis?
A. Immune Thrombocytopenia
B. Vit K antagonist overdose
C. Scurvy disease
D. Post-operative
E. Hemophilia B

72. Seorang pria 56 tahun dengan riwayat liver cirrhosis child plg A datang dengan keluhan melena
sejak 1 minggu lalu. Kemudian setelah di eso-gastro-duodenumscopy ditemukan stable
esophageal varices(/varicouse). Kemudian ada riwayat thrombosis (atau hematoma, lupa) di
kedua kaki. Apakah penyebab keluhan pendarahan pada pasien?
A. Decreased fibrinolysis
B. Increased plasminogen activator inhibitor
C. Decreased Factor VIII
D. Decreased Factor VII
E. Decreased von Willebrand Disease

73. A 60 y.o. male with advanced gastric cancer since 3 months. Felt tired and dyspnea if walked
around 100 m. Hb level 8.4 g/dl. Blood smear shows pencil cells. What do you give?
A. Folic acid 5 mg daily
B. Ferrosulfate 200 mg 3 times per day
C. Treat gastric cancer
D. B12 50 mg daily

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 E. PRC 300 ml

74. 54 y.o. women is noted to have cervical cancer and present with vaginal bleeding with Hb level
7. Her left leg swollen, Doppler investigation reveals DVT. Best treatment for thrombus?
A. IV unfractionated Heparin
B. Fractionated Subcutaneous Heparin
C. Subcutaneous unfractioned Heparin
D. Oral warfarin
E. Vena cava filter

75. A 39 years old man noted DVT, without any risk factor. His brother kena PE umur 45 tahun,
His mother ada clot di leg di umur 30an. Inherited disorders apa yang orang ini punya?
A. Occult cancer
B. Anti-thrombin III deficiency
C. Factor V leiden mutation
D. Antiphospolipid antibody syndrome
E. Familial malignancy disorder

76. A healthy woman 26 years old has had red spots on her legs during the last 24 hours.
Laboratory studies shows Hb 13.1, Ht 39.7, leukosit 8500, platelet 20.000, neutrofil 65%,
limfosit 30%, monosit 5%. A peripheral blood smear shows normal red cell morphology, bone
marrow smear shows megakaryocytic cell hyperplasia. What is the most likely diagnosis?
A. Hereditary platelet syndrome
B. Trombocytopenia gestational
C. Trombotic Trombocytopenia Purpura
D. Immune Trombocytopenia Purpura
E. Hepatitis A infection

77. 40 years female , go to medical check up because she has a mass in her right breast. The biopsy
was made and found to be a breast cancer. she was given methrotexate. termasuk ke dalam
mana obat mtx ini :
A. anklylating agent
B. anti metabolite
C. inhibitors microtubues
D. monoclonal antibody
E. platinum

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78. 14 tahun perempuan, heavy mens bleeding udah 2 bulan. Easy bruising dan mudah berdarah
saat sikat gigi udh 6 tahun. Ibu dan brothernya ada gejalan yg sama. Ecchymosis over all
extremities (hands and feet). PT normal, aPTT memanjang, Bleeding time memanjang, platelet
normal. Diagnosis?
A. Proconvertin deff
B. Stuart factor deff
C. Hageman factor deff
D. vWF deff
E. Vit. K deff

79. Laki laki dg Hodgkin lymphoma. Shortly after treatment dia mengalami chronic cough dan
susah untuk bernafas, kulit juga makin gelap, ada minimal myelosupression. Obat yang
menyebabkan efek samping ini ?
A. Bleomycin
B. Dactinomycin
C. Doxorubicin
D. Vinblastine
E. Vincristine

80. 45 tahun pria datang dengan keluhan gum bleed, epistaxis, ecchymosis sejak tiga hari lalu. Dua
minggu yang lalu dia mengeluhkan sesak nafas (SOB) dan fever.
PF : blood pressure 100/70, HR 114x/menit, RR 26x/menit, tempratur 35,8oC, ecchymosis +,
nose bleed +, gum bleed +
Lab : Hb 11g/dl, Leukosit 16500, platelet 30.000, PT dan clotting time memanjang, Fibrinogen
50 (N: 150-200), D-dimer 400.
Diagnosis?
A. Immune thrombocytopenia
B. DIC
C. TTP
D. Hemophilia
E. VWD

81. While shaving in the morning 23 yr old man nicks his lips w a razor, seconds after the injury
the bleeding stops. Which of the mechanisms is to reduce blood immediately?
A. Platelet adhession
B. Vasoconstriction
C. Protein C activation

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 D. Neutrofil chemotaxis
E. Fibrin polymerization

82. 29 years old female ada nose bleed and increased menstrual flow. PF: petechiae, purpura on
skin and extremity. Lab examinations shows normal PT, aPTT, and platelet count, with
decrease in cWF activity. Which of the hemostasis prosess is disrupted?
A. Vasoconstriction
B. Platelet adhesion
C. Platelet aggregation
D. Fibrin polymerization
E. Prothrombin activation

83. Cewe 23 taun ductal ca breast. 3 taun lalu sister nya ovarian cancer. Tante nya mastectomy
karna ductal ca breast. Gene apa yang berperan?
A. Cerb 2 aka Her 2
B. Cmy c
C. Brca 1
D. Rb 1
E. Estrogen receptor

84. Which of the follwoing diagnostic screening techniques commonly used in health care which
has had greatest reduction in cervical cancer deaths?
A. Maturation index test
B. Pap smear
C. VCE scrapping
D. Serum tumor marker
(85.) A 45 years old man has expereineced recureent fever. BB turun 6 kg dalam 5 bulan, Pada PF
temperature 37,6 C, Punya cervical lymphadenopath. Lymph node biopsy shows effacement of
the nodul architecture by a population of small lymphocytes, plasma cells, eosinophils,
macrophage and scattered Reed-stern berg cell. Diagnosis ?
A. TB lymphadenitis
B. Hodgkin lymphoma
C. Non-Hodgkin lymphoma
D. Burkitts lymphoma
E. LAngerhans cell hystiocytosis

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86. A 60 years old male, on auscultation there was wheezing in right lung posterior. On X-ray
there was 6 cm mass. FNAB shows non-small cell bronchogenic. There is P53 mutation. What
is the impact of p53 mutation?
A. Inability to hydolize GTP
B. Microsatellite insatbility
C. Lack of necrosis
D. ack of cell cycle arrest
E. Trasncriptional activation

87. A 21 years old fatigue with ovalocyte. He has history of transfusion before. Hb 7,4 g/dl. MCV
73. MCH 19. What do you do to relieve the Hb?
A. PRC
B. Washed red cell
C. Leucodepleted red cell
D. Whole blood
E. Erythrocyte apheresis

88. A 24 years old woman has breast lump at both breast since 1 year ago. The lump increase in
size in 1 year. She find that the lump get bigger at menstrual period. Physical examination :
Lump 3 cm, Supermedial quadrant, painless, no nipple retraction, no dimpling, no peau de
orange. She is afraid that her condition is serious because her aunt is diagnosed with breast
cancer 3 years ago. What is the Most probable diagnosis?
A. Fibroadenoma Mammae
B Mammary aberans
C. Fibrocystic disease
D. Paget disease
E. Breat lymphoma

89. There is Starry Sky appearance. Diagnosis?

A. AML
B. Hodgkin Lymphoma
C. Burkitt;s lymphoma
D. (lupa)
E. Wilm’s tumor
90. Mr raysid 32 yeaes old come to ER with complains of fever, headache, adn nausea vomitting since
1 week ago. He recently came back from travelling outside java island. In PF: HR 104x/mnt,
BP 130/90 ,RR 18 x permenit, temperaturet 38,8, pale conjungtiva, sclera slighlty icteric and

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 splenomegaly. His laboratory shows: HB 9.8, Ht 30%, MCV 88, SGOT 23, SGPT 32. What is
most likely daignosis:
A. Aplastic anemia
B. Hemolytic anemia
C. Anemia ec Liver disease
D. Drug induced anemia
` E. Leukemia

91. 45 years old woman came with a biospy of breast carcinoma is analyzed for ER (+), PR (+).
Estabhlsiing the ER and PR status is compulsatory fro predicing :
A. Immunogenecitiy of the tumor
B. Risk for the familial breast cancer
C. HER 2 status
D. Response to theraphy
E. Presence of metastases
92. A boy has anemia. He looks pallor but have good nutrition. MCV was increased. You as the
doctor order schilling test negative. What is the cause of anemia?
A. Folic deficiency
B. Percinious anemia
C. Fe deficiency
D. Infection association anemia
E. Chronic diarhhea

93. A 5 years old girl suffers from thalassemia, and she gets transfusion for treatment. What is the
management if there is a complication at the treatment?
A. Ferrous Sulfate
B. Defepirone (temennya deferoxamine)
C. Calcium
D. Phlebotomy
E. Hydroxyurea

94. 60 tahun wanita fatigue, feeling full when eating a little, spleenomegaly, tear drop cell
Myelofibrosis

(95.) Colorectal cancer mutation pathway? K-Ras

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96. A 49 y.o. man come with lower urinary tract symptoms. DRE nya multinoduler, hard, immobile
mass. PSA 31. Next step management apa?
A. MRI
B. USG prostat
C. Staging
D. Transrectal USG biopsy
E. Prostatectomy

97. A 10 year old boy with diarrhea, febrile and seizure. On physical examination found petechiae
and purpura. Lab results show mild anemia and thrombocytopenia. Blood smear shows
schistocytes. Ureum and creatinine increased. What do you suspect in this child?
A. HUS
B. Dengue shocked syndrome
C. Toxic typhoid
D. TTP
E. Severe sepsis

98. cewe 26 tahun ada lump di breast, ga ada di tempat lain. Pf: lump mobile smooth no
lymphadenopathy. Patologi : proliferation of epithelial and glands
Fibroadenoma mammae

99. A 25 years old Female did medical check up. Doctor tell her to do self exam and follow up the
next month. She want to check if she has malignant or benign lump. She has family history of
breast Ca. What is the best way to check?
A. MRI
B. BRCA 1,2
C. USG Mammae
D. Mammography
E. CEA

100. A disruption in platelet aggregation. Diagnosis?

A. vonWillebrand disease
B. Bernard-Soulier syndrome
C. Glanzmann Trombasthenia

(101.) di papua ada bapaknya ada history polyp di colon. Screening pake apa?
Fecal occult blood test

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102. 32 tahun cewe dm tipe 1 ada renal failure selama 2 tahun belum dialisis. Hb 9, ht 28, mcv 94.
Semar normochromic normocytic
Erytrhopoietin deficiency

103. Cowo 34 th dgn keluhan unknown fever since 4 bln. Pf ada lymphnode membesar di cervical
region around 3cm. Lab normal. Plan selanjutnya?
A. Biopsi lymphnode
B. Bone marrow aspirasion
C. Bone marrow biopsi
D. Consult to ENT
E. Observasi

104. A 7 year old boy came to the Emergency Department with chief complain pain in his right
knew after he fell from his bicycle 2 hours ago. On physical examination you suspect there was
bleeding in his right knee joint. What first examination do want to do?
A. Bleeding time
B. Clotting time
C. Hemoglobin
D. Platelet count
E. vW Factor

105. headache 50 tahun cowo pusing vertigo pruritu. Dulu ada angina pectoris. Ht 65 wbc 12000 rbc
mass meningkat, epo concentration menurun, splenomegaly s4
Polycithemia verae

106. A 64 year old man with Non-Hogdkin Lymphoma comes to physician because of a 3 week
history of numbness in his hands and feet and weakness in his legs when he stands. He received
his 3rd chemotherapy 4 weeks ago. Physical examination showed areflexia. Which of the
following drugs is the most likely cause of these adverse side effects?
A. 5-FU
B. Doxorubicin
C. Prednisone
D. Cyclophosphamide
E. Vincristine

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107. A 12 years old came to Primary Health Care in rural area, with fever for 4 days and epistaxis 2
times on the 3rd and 4th day. What is simple and first simple examination for this patient?
A. Blood smear
B. Rumpel-Leed test
C. Complete Blood Count
D. Platelet function analysis
E. Bleeding time

108. The cytology examination from 55 years-old malewho has some blood noticeable in his urine
reveals malignancy of uro-epithelial cell. The examination of the excised specimen shows
transitional cracinoma grade III. Which of the following statements regarding those findings is
the most proper?
A. His neoplasm is primary
B. His neoplasm is a secondary tumor
C. His neoplasm is Carcinoma in situ
D. He has a paraneoplastic syndrome

109. A 53-year old female came with fever, fatigue and purpura in both legs. The laboratory results
are as follows:Hb 9.1 g/dL, leukocyte 32 thousand and platelet 34 thousand. No splenomegaly.
Bone marrow aspiration showed hyper-cellular of myeloid clone with blast 24 percent. What is
your possible diagnosis?
A. Acute myeloid leukemia
B. Accelerated phase chronic myeloid leukemia
C. Crisis blast phase chronic myeloid leukemia
D. Acute lymphoblastic leukemia
E. Hairy cell leukemia

110. Pada blood smear, ditemukan banyak sel (-cytes). Mutasinya?

A. t(9;22)
B. t(9;12)
C. t(7;14)
D. t(13;27)
E. t(18;21)

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