FINAL CVS BATCH 2009

1.
2.
3.
4.
5. In a balance coronary artery pattern WOTF is the blood supply of the majority of IV
septa?
A. RCA posterior IV 1/3 posterior
B. AV Artery
C. Posterior IV artery
D. Anterior IV
E. Circumflex
6.
7.
8.
9. Level of rib to find Sternal Angle? Ans : 2nd ribs di bag posterior adalah
level antara T4 danT5
10.Which valve will be open during ventricular systole?
A. Aortic & Tricuspid
B. Aortic & Pulmonic
C. Aortic & Mitral
D. Mitral & Tricuspid
E. Mitral & Pulmonary
11.Veins that have direct connection to IVC & SVC? Ans : azygous vein
12.How many vein enter left atrium? Ans : 4
13.
14.
15.
16.15. What is the underlying etiology?
A. polmonary valve stenosis
B. mitral valve regurgitation due to RHD
C. aortic valve insufficiency due to RHD
D. aortic valve regurgitation
E. pulmonary valve collapse
17.
18.
19.
20.If you want drainage fluid from pericardial cavity which of the following best
location to do:
A. right 2nd parasternal line
B. left 2nd parasternal line
C. left 4 intercoastal & midclavicula
D. right 5th or 6th intercoastal space
E. left 5th or 6th intercoastal space
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.WOTF is the most appropriate about fetal circulation?
A. Oxygenated rich blood is from the lung
B. Oxygen rich blood reach the right atrium through the IVC
C. Most of it passes through the foramen ovale into the RA
D. Blood of the aorta carried by the umbilical arteries to the lung
E. The oxygenated blood is from the placenta
32.Arteris wall has three layers that difference with veins wall in some points. WOTF
statements about the smooth muscle of the arteries?
A. The nucleus cell is in the peripheral cell
B. Myofibrils smooth muscle is bigger than the vein
C. Myofibril and artery is thicker than the vein
D. Innervation is involuntary
E. The lumen is collapse
33.There are some layers to compose hearts wall. WOTF statements about
Myocardium?
A. Innervation is involuntary
B. There is smooth muscle
C. There is no artery for nutrition
D. Have not anastomose itsa other of myofibril
E. Have intercalated disk
34.The dorsal aortae and the aortic arches perform transformation into definitive blood
vessel. WOTF aortic arches is most likely to transform into external carotid
arteries?
A. 2nd aortic arch
B. 1st aortic arch
C. 4th aortic arch
D. 3rd aortic arch
E. 5th aortic arch
35.A 2 yo girl which abnormality of the conotruncal region is due to an unequal
division of the conus resulting from anterior displacement of the
conotruncal septum. Displacement of the septum produce cardiovascular
alteration, a pulmonary infundibular stenosis, a large defect of the IV septum, an
overriding aorta that arises directly above the septal defect and hypertrophy of the
RV wall. WOTF cardiac-defects is the most likely to be present?
A. Persistent truncus arteriosus
B. Transportation of great vessels
C. Paten ductus arteriosus
D. Tetralogy of Fallot
 E. Cor triculare biventriculare
36.A 6 week old infant has a pulmonary infundibular stenosis, a large defect of
the IV septum and the overriding aorta that arises directly above the septal
defect from both ventricular cavities and hypertrophy of the RV wall. The infant
is cyanosis. WOTF congenital heart disease is the most likely to be present?
A. PDA
B. VSD
C. ToF
D. Dextrocardia
E. Coarctation of the aorta
For questions 37 & 38
A 27 yo G2 P1 woman has screening ultrasound performed a 18 week gestation. The
fetus is appropriate in size 18 weeks. The fetal kidney, liver, head, and extremities
appear normal. However, the fetus has a heart with a membranous ventricular
defect, overriding aorta, and marked pulmonary atresia.
37.If the baby were to be live born. WOTF characteristics on PE would likely result from
these cardiac defect:
A. Systemic hypertension
B. Weak lower extremities pulse
C. Clubbing digits
D. Telengiectasis
E. Cyanosis
38.If the baby were to be live born. WOTF characteristics on PE would likely result from
these cardiac defect:
A. Right to left shunt
B. Left to right shunt
C. Decrease oxygen demand
D. Decrease oxygen supply
E. Normal cardiac cycle
For questions 39 41
A 50 yo man comes to emergency department with the chief complaint sudden onset
of substernal chest pain. The pain persists for 3 hours. He became shortness of
breath and diaphoresis. On PE found that his BP 130/90 mmHg, temp 37oC, RR
25/min. A chest radiograph shows a slightly enlarged heart and mild pulmonary
edema. An ECG shows ST segment elevation in anterior leads V1 V6.
39.WOTF serum laboratory test findings are most likely to be present in this man?
A. Urea nitrogen of 110 mg/dL
B. Sodium of 115 mmol/L
C. ALT of 876 U/L
D. Troponin l of 32 ng/mL
E. HDL cholesterol of 55 mg/dL
40.What is mainly cause of myocardial ischemia in shock?
A. Decreased coronary artery pressure
B. Increased myocardial O2 demand
C. Decreased myocardial O2 supply
 D. Increased myocardial O2 supply
E. Increased coronary artery pressure
41.Base on ECG interpretation, what is the possible diagnosis of this man?
A. Ischemic in inferior wall
B. AMI in inferior wall
C. Old myocardial infarct in anterior wall
D. AMI in anterior wall
E. AMI in lateral wall
42.WOTF will require the smallest increase in oxygen consumption by the
heart?
A. Generating an increase in left ventricular pressure
B. Severe hypertension
C. Generating an increase in stroke volume
D. Aortic stenosis
43.Base on ECG interpretation, what is the possible diagnosis of this man?
A. Ischemic in inferior wall
B. AMI in inferior wall
C. Old myocardial infarct in anterior wall
D. AMI in anterior wall
E. AMI in lateral wall
44.46 y.o, male comes to see the doctor complaining of chest pain. He also malaise,
sweating, headache. Fam history: his father has diabetes, and died at age 62
years of AMI. ECG : T wave inverted in left precordial leads. Cardiac marker
should be run on this patient?
A. CK-MM
B. Troponin T
C. ALT
D. LDH
E. CK-BB
For questions 45 & 46
A 50 yo man came to your clinic with the chief complain ulcer at his thumb of toe.
He also feels numbness and pain. He has been smoking since 13 years. He
smokes one pack of cigarette a day.
45.What is possible mechanism of his disease?
A. Obstruction on distal microcirculation
B. Imbalance on O2 supply and demand
C. Antigen antibody reaction
D. Atherosclerosis
E. Vasodilation
46.What is possible mechanism of his disease?
A. Superoxide dismutase
B. Allergic reaction
C. Reactive oxygen species
D. Infection
E. Plaque formation
47.WOTF vessels have the largest effect on total peripheral resistance?
A. Arteries
B. Arterioles
C. Veins
D. Venules
E. Capillaries
For questions 48 50
A 40 yo man admitted to the emergency department with chief complaint severe
dyspnea, that condition makes you unable to ask him question. His wife explains that
her husband has dyspnea on exertion accompanied by weakness during a month ago.
She also said that her husband feels sharp pain when he takes a deep breath, coughing
and swallowing, but he was ignored to see a doctor. He has history lung TB a year ago
but he refused to take the medication. From vital sign found that his general condition
is severly ill, blood pressure 90/60 mmHg with pulsus paradoxus, RR 36 bpm, pulse rate
110 bpm, and temp : 37.9oC. From physical exam found that he has elevated JVP,
kussmaul sign was observed, the precordium is quiet without palpable apex beat. On
auscultation found muffled heart sound. From chest x ray shows enlarged
cardiopericardial silhouette without lung congestion.
48.What is further examination that is most likely to be present in this man?
A. Echocardiography
B. ECG
C. USG
D. Troponin
E. Angiography
49.What is possible mechanism of his disease?
A. Pericardial effusion
B. Infection of myocardium
C. Imbalance on O2 supply and demand
D. Antigen-antibody reaction
E. Atherosclerosis
50.What is principal management for this disease?
A. Antibiotic for his lung tuberculosis
B. Decompression
C. Diuretic
D. Oxygen therapy
E. Digoxin
For questions 51 53
A 29 yo female was admitted to the emergency room with palpitation. The palpitation
started one day before admission, which was felt as rapid and irregular heartbeats.
She had also complaint of shortness of breath in the last few weeks which
worsened to dyspnea even at rest, after the palpitation occurred. She was
hospitalized 2 months ago, due to dyspnea on mild exertion accompanied with easy
fatigability and shortness of breath. 3 months ago, she was hospitalized because of
heart disease and discharged after ten days. At home, she continued to take her
medication a small white tablet which increases her urination, but she refused
to follow up. From PE found her pulse was irregularly irregular, unequal, with a rate of
128 BPM. Her heart was enlarged; S1 was variable with normal S2, and no discernible
cardiac murmur. The heart beat was irregularly irregular with a rate of 148 BPM. The
electrolytes exam showed sodium concentration of 133 mEq/L (135-145) and
potassium concentration of 2.3 mEq/L. (3.5-4.5) hypoxemia, with a normal pH was
found in the BGA.
51.Base on her conditions, what is most possible factor that can trigger her chief
complains?
A. Septal defect
B. Infection on the cardiac wall
C. Compression on cardiac muscle
D. Electrolytes imbalance
E. Ischemic cardiac muscle
52.Base on her conditions, what is the most possible interpretation that you can find
on ECG exam?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Ventricular flutter
E. AV complete block
53.Sodium enters the cell during the upstroke of action potential. What is the major
mechanism for removing Na from the cell?
A. It passively diffuse out of the cell
B. It is extruded via an ATP-dependent Na-K pump
C. It is extruded via an ATP-dependent Na-Ca pump
D. It is extruded via an ATP-independent Na-K pump
E. It is extruded via an ATP-independent Na-Ca pump
54.A 42 yo woman with mitral prolapsed is admitted to the hospital for evaluation of
her cardiac function. WOTF values are the best index of the preload on her
heart?
A. Blood volume
B. Central venous pressure
C. Pulmonary capillary wedge pressure
D. Left ventricular EDV
E. Left ventricular EDP
55.A patient presents to the emergency department with intermittent chest pain. The
ECG and blood test are negative for MI, but the echocardiogram shows thickening of
the left ventricular muscle and narrowing of the aortic valve. Medications to lower
afterload are prescribed. WOTF values would provide the best measure of
effectiveness of the medication in lowering left ventricular afterload in this
patient?
A. Left ventricular EDV
B. Left ventricular mean systolic pressure
C. Pulmonary capillary wedge pressure
D. Total peripheral resistance
 E. Mean arterial blood pressure
56.A 75 yo woman presents with fatigue, edema, and shortness of breath. Her
physician prescribes a diuretic and a positive inotropic agent. WOTF changes is
primarily responsible for the improvement in her condition?
A. A reduction in Heart rate
B. A reduction in heart size
C. An increase in ventricular EDP
D. An increase in wall thickness
E. An increase in cardiac exitability
57.A 22 yo woman is hospitalized with a history of respiration distress, fever, and
fatigue. ST segment and T wave abnormalities suggest myocarditis which is
attributed to an acute viral origin. Over the next several days, significant peripheral
edema develops. The edema is most likely caused by WOTF?
A. Decreased capillary permeability
B. Decreased arterial pressure
C. Increased plasma protein concentration
D. Increased lymphatic flow
E. Increased central venous pressure
58.A 24 yo woman undergoes an annual physical exam for participation on the athletic
team at her college. While auscultating her heart sounds, the sports medicine
physician instructs the woman to take in a deep inspiration. During this maneuver,
he detects splitting of the second heart sound. WOTF is the Mechanism of
splitting s2 during inspiration?
A. A decrease in heart rate
B. An increased left ventricular stroke volume
C. Delayed closing of aortic valve
D. Delayed opening of mitral valve
E. Delayed closing of the pulmonic valve
59.Auscultation reveals a holosystolic murmur leading to diagnosis of mitral
regurgitation. WOTF lab findings are most likely to be present?
A. A decreased arterial pressure
B. An increased pulse pressure
C. An increased a wave
D. A decreased cardiac output
E. A decreased left ventricular preload
60.An emergency team arrives at the scene of an automobile accident, and finds a
hemorrhaging, unconscious young woman. WOTF is a sign of hemorrhagic shock?
A. Metabolic alkalosis
B. Dry skin
C. Polyuria
D. Bradycardia
E. Low hematocrit
61.A 56 yo man presents with complaints of fatigue and headaches. During the
physical examination, he is found to have a wide pulse pressure. WOTF conditions
cause pulse pressure to increase?
 A. Tachycardia
B. Hypertension
C. Hemorrhage
D. Aortic stenosis
E. Heart failure
62.A 32 yo male is diagnosed with primary hypertension. His physician recommends a
new drug for hypertension that acts by decreaseing vascular smooth muscle
contractile activity without affecting ventricular contractility. WOTF is the most likely
site of action for the new drug?
A. Beta-adrenergic receptors
B. Calmodulin
C. Troponin
D. Tropomyosin
E. Protein kinase A
63.A 22 yo male ruptures his spleen in a motorcycle accident. A reduction in blood
pressure would cause a decrease in WOTF?
A. Heart rate
B. Myocardial contractility
C. Total peripheral resistance
D. Venous compliance
E. Cardiac output
64.A 60 yo , ou of shape hunter attempted to push his friends truck out of a mud hole.
This activity caused a clot to break free (embolize) from a fatty plaque and lodge in
a coronary arteriole of the RV. Consequently, right ventricular pumping ability is
diminished. After the embolism, blood pressure will increase in the
A. Left ventricle
B. Pulmonary artery
C. Pulmonary vein
D. Vena cava
65.During physiological laboratory work, the strength of cardiac muscle contraction is
observably increased by addition of calcium solution. What is the explanation
of this phenomenon?
A. Calcium enters sarcoplasmic reticulum
B. Fast sodium channels are stimulated
C. Slow calcium channel are activated
D. Potassium efflux is inhibited
E. Sarcoplasmic calcium is increased
66.During physiological laboratory work, a recording series were done to see the
relation between ECG, chamber and vessel pressure and volume as well as heart
sound recording. Once P wave is seen in ECG, what should be found in other
recording sets?
A. Initial reduction of aortic pressure
B. Initial increase of atrial pressure
C. First sound will be directly heard
D. Marked increase of ventricular pressure
67.
68.A 16 yo male student fainted as he was standing to watch the marching band
attraction. On physical examination, the heart rate was not heard and palpable for a
while, but then it automatically started to beat with frequency of 40 bpm. What is
the most responsible mechanism in this case?
A. Increase rate of sinus nodal discharge
B. Increase force contraction of atrium
C. Increase conductivity of AV node
D. Decrease resting potential of SA node
E. Decrease potassium permeability in SA node
69.Emergency team found a patient with bizarre ECG. Electroshock defibrillation of the
ventricles was then performed. After several attempts, the condition can be
normalized. What is the most suitable mechanism of that therapeutic action?
A. Sinus node is hyperpolarized
B. Reentrant focus Is depolarize
C. Low voltage of ECG
D. Large masses of muscles contract
E. Ventricular muscles are in refractoriness
For questions 70 72
A 43 yo man is brought to emergency department with sudden severe, crushing chest
pain that radiates down to his left arm and to his jaw. PE reveals a well-developed
patient in moderate distress. Obtaining a medical history, you discover that his father
died of a myocardial infarction (MI) before age of 40 and almost every day he eats
nasi padang komplit with double portion of rice. PE reveals the patients cholesterol
level to be 675 mg/dl. Elevated level of CK-MB, troponin T, and LDL are also found.
70.Which one of the following is appropriate for patients cholesterol level related to
his eating habit?
A. Energy already fulfilled the activity of cholesterol synthesis will be depressed
B. Double portion of rice will be oxidized to become cholesterol precursor
C. Rice will not be oxidized to become cholesterol precursor
D. Cholesterol will not be burned to become energy
E. People who eat a lot of rice tend to eat less fat
71.For this individual, simvastatin could be given to reduce his serum cholesterol level.
WOTF processes is inhibited directly by the drug?
A. Acyl coenzyme A (CoA) cholesterol acyl transferase
B. Lipoprotein lipase of adipose tissue
C. LDL receptor synthase
D. HMG-CoA reductase
E. Squalene synthase
72.WOTF is appropriate for immediate major source of patient plasma LDL?
A. Chylomicrons
B. Chylomicrons remnants
C. HDLs
D. VLDLs
E. IDLs
For questions 73 & 74
AMI is a deathly case that threatening in this decade. We need to know sign and
symptoms of AMI well. In most case, AMI was caused by atherosclerosis which leads to
abnormality function of the heart
73.AMI caused by atherosclerosis. 1st step of atherosclerosis?
A. increase blood cholesterol
B. injury of endothel cell
C. shifting macrophage to foam cell
D. changing monocyte to macrophage
E. proliferasi & infiltrasi muscle cell to subintima
74.Preventive?
75.Cholesterol with fastest electrophoretic mobility and lowest TG: Chylomicrons
76.Lipoprotein contribute in fasting moslems
A. LDL
B. HDL
C. VLDL
D. IDL
77.AMI-atherosclerosis, what in artery wall? Ans : LDL
78.Structure of LDL: Cholesterol, sedikit phosphate & NO triglycerida
79.
80.No.79
Antara VLDL, IDL,Chylomicron, sama LDL. Dari lowest ke high density nya
urutannya gimana? Sowie laah x igt (anggie I) : Chylo-VLDL-IDL-LDL
81.
82.
83.
84.
85.
86.
87.The clinical manifestation of CAD in an older person is differ than in younger. The
following clinical manifestation of CAD in the elder is not true :
A. Dyspnea on exertion is a more common clinical manifestation of CAD
B. The typical exertional chest pain of angina pectoris is more common than
dyspnea on exertion
C. Substernal chest pain due to angina pectoris is less frequent
D. Gastrointestinal symptoms are less frequent
E. Neurologic symptoms are less frequent
A 62 yo man is being managed in the ICU following a large anterior wall MI. he has
been appropriately managed with oxygen aspirin, nitrat, and beta-adrenergic receptor
blockers but has developed recurrent episodes of ventricular tachycardia. During these
episodes he remains conscious but feels dizzy, and he becomes diaphoretic and
hypotensive. He is given an IV bolus of lidocaine and started on an IV lidocaine infusion.
88.Why lidocaine is a drug of choice in his Ventricular Tachycardia?
A. Lidocaine selective blocks activated sodium channels in ventricle
B. Lidocaine have greater effects on cells with long action potentials
 C. Lidocaine inactivate selective depression of conduction in depolarized cells
D. Lidocaine is a potent blocker of sodium and potassium channels with slow
unblocking kinetics
E. Lidocaine is significantly blocks inactivated sodium and calcium channels
89.Beside lidocaine, amiodarone is commonly used for prevent further reccurence of
the VT. Which hormone function should be assessed before use of amiodarone?
A. Suprarenal hormone
B. Insulin hormone
C. Thyroid hormone
D. Parathyroid hormone
E. Gonad hormone
90.Her doctor diagnosis angina and prescribes isosorbide dinitrate (ISDN) tablets,
which are to be dissolved under the tongue, not swallowed.
What is the most appropriate reason that this drug should be administrated through
under the tongue?
A. To reach therapeutic blood levels within a few minutes
B. To avoid side effects
C. To avoid the first pass metabolism
D. To achieve longer duration
E. To prevent interaction with gastric acid
91.The total dose administered by this route must be limited to avoid excessive effect.
What is acute side effect of ISDN?
A. Throbbing headache
B. Orthostatic hypertension
C. Bradycardia
D. Gastric ulcer
E. Glaucoma

For question 92-94

A 44-yeasrs old woman, a lawyer, controlled for tightness or ache in her chest
whenever she was climbing to the next floor although she had taken ISDN that had
been prescribed since 2 months ago. She felt better if she took a rest and deep breath.
Two months ago, her doctor diagnosed angina and prescribed ISDN tablets. She also
couldnt stand of ISDNs side effects.
She had had mild asthma for years, but it troubled her very little and as well controlled.
Her present cholesterol level is 290 mg/dl.
The doctor noted the worsening of her symptoms. He decided to prescribe her an
alternative ani-angina agent and simvastatin once daily.

92.What is the most appropriate alternative anti-anginal agent can be used for her
chest pain?
A. Prednisone (steroid anti-inflammation drug)
B. Metoprolol (1-adrenoreceptor antagonist)
C. Propanolol (-adrenoreceptor antagonist)
D. Amlodipine (calcium channel blocker)
 E. Ibuprofen (NSAID)
93.Write prescription for lowering her blood cholesterol level
A. R/Simvastatin 10 mg tab. No. XXX
S 0-1-0 tab p.c
B. R/Simvastatin 10 mg tab. No. XXX
S s.dd tab.1 q.h.s
C. R/Simvastatin 10 mg tab. No. XXX
S s.dd tab. 1 q.h.s (Quaque hora somni)
D. R/Simvastatin 10 mg tab. No. XXX
S. q.dd tab.1 q.h.s
E. R/Simvastatin 10 mg tab. No. XXX
S. 1dd 1 tab. a.c
94.What is laboratory examination should be monitor regularly when use simvastatin?
A. Aminotransferase level
B. Ureum level
C. Triglyseride level
D. Glucose level
E. Kreatinine level

For question 95-97

A 68 years old man has recently experience some chest pain and has come
increasingly short of breath in the last two years. He insisted on going out early one
day to clean up fallen leaves from his garden. Soon after going out, his wife found him
collapsed and unconscious on the grass with a very feeble pulse. She immediately
called an ambulance.
His heart fibrillated on the way to hospital and he was resuscitated using a defibrillator.
His ECG changes were found to be consistent with a diagnosis of myocardial infarction
and assessment of plasma creatine kinase-MB and troponin I and T later confirmed
diagnosis.
Once the heart has stopped fibrillating, he is given oxygen via a mask, morphine, low
dose aspirin, and streptokinase.

95.What is the most appropriate mechanism of streptokinase in this patient?

A. Reduce platelet aggregation by inhibiting the ADP pathway of platelet
B. Inhibits clotting factor protease by forming equimolor stable complexes
C. -carboxylation of several glutamate residues in prothrombin and factors VII,
IX, and X
D. Inactivate plasminogen that is bound to fibrin
E. Catalyzes the conversion of inactive plasminogen to active plasmin
96.What is the most appropriate role of aspirin in this patient?
A. Enhance the pain relief in morphine
B. Minimize the risk of blood clotting
C. Breaks up blood clots
D. Prevent cardiac fibrillation
E. Coronary artery vasodilatation
97.What is the most appropriate aspirin prescription for this patient?
A. R/Aspirin 81 mg tab. no. XXX
S 1-1-1 tab. I d.c
B. R/Aspirin 81 mg tab. no. XXX
S 3 dd tab. I p.c
C. R/Aspirin 81 mg tab. no. XXX
S 3 dd I tab. a.c
D. R/Aspirin 81 mg tab. no. XXX
S 2 dd I tab. p.c
E. R/Aspirin 81 mg tab. no. XXX
S.q.dd tab. I p.c
98.What is the most appropriate note that must be written in prescription for indicating
should to be priority?
A. ITER -> diulang-ulang berapa kali
B. PRO INJ.
C. CITO
D. EMERGENCYPRO RE NATA
99.Which class antiarrythmic agents suppress abnormal automaticity and permit the
sinoatrial node to gain assume the role of the dominant pacemaker?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class III and IV
100. 50 years old man came to ER with chest pain that occured with exertion and
disappeard by rest. Doctor gave him sublingual Nitroglycerine. what MOA of this
drug?
A. inhibits platelet aggregation
B. blocks calcium channel
C. activate guanylate cyclase
D. inhibit angiotensin converting enzyme
E. antagonist AT-1 receptor
101.
102.
103.
104.
105.
106.
107. Minerals that influences water balance is :
A. Potassium
B. Magnesium
C. Calcium
D. Selenium
E. Sodium
108. Mrs. AM, a 75 year old woman presents to the Emergency Department with left
chest pain and vague left arm pain of 6 hours duration. Her chief complain also
accompanited with vomit. Physical examination shows BP 110/80 mmHg, pulse 72
bpm, respiration 22x/min and chest examination are unremarkable. ECG
examination shows mild non specific ST changes.
Which of these following cardiac markers will be suitable for Mrs. AM disease?
A. Creatinine Kinase MM
B. Creatinine Kinase MB
C. Creatinine Kinase BB
D. Myoglobin
E. Total Creatinine Kinase
109. Eight hours after Mrs/ AM chest pain, the blood was drawn and taken to the
laboratory for several examination. The laboratory results as followed: Hb 12,5 g/dl
(12-16 g/dl), Hct 36% (36-48%), Leukocyte 7000/mm3 (5000-10000/mm3)
Thrombocyte count 220.000/mm3 (150.000-300.000/mm3) CKMB 6 ng/mL (normal:
<5 ng/mL); LDH 150 U/L (normal: 140-280 U/L)
What is your interpretation of Mrs. AM laboratory result?
A. Unstable angina pectoris
B. Acute myocardial infarction
C. Stable angina pectoris
D. Atypical chest pain
E. Typical chest infarction
110. Mr. TS, a 50 year old man had suffered for hypertension for last 5 years. To
maintain the hypertension and pther ralted cardiac event, you as his doctor were
given anti hypertension drug and aspirin. Aspirin was knows an anti platelet drug to
inhibit the thrombus formation.
What kind of laboratory examination that you suggest to Mr. TS as monitoring of
aspirin therapy?
A. Prothrombin time
B. Activated partial thromboplastin time
C. Thrombocyte
D. Fibrinogen
E. D-Dimer
111. A 45 year old man presents to the Emergency department with crushing chest
pain of 6 hours duration, EKG shows ST elevation and new Q wave. Laboratory
result show Troponin I: 10.00 ng/ml (normal: <0,15 ng/ml) and CKMB: 15.00 ng/ml
(normal <5 ng/ml). the patient was diagnosed as ST elevation myocardial infarction
and undergo with some medication ICCU. 24 hours after chest pain the troponin I
and CKMB was re examined and the result was Troponin I: 20.00 ng/ml and CKMB:
7.00 ng/ml.
Based on laboratory result about Troponin I and CKMB, which of the following
statement are TRUE?
A. CKMB is specific for cardiac muscle injury and can differentiate for other
smooth muscle injury
B. Both CKMB and Troponin have peak concentration at 12-24 hours
 C. Troponin is specific for cardiac muscle and not elevated with skeletal muscle
damage or in renal failure
D. CKMB may not be elevated in chronic renal failutr
E. Troponin may be mildly elevated in chronic renal failure
112.
113.
114.
115. Lab result from a 53 y.o woman with typical pain of MI. (n=normal, t=tinggi). On
admission : CK total (N), CK-MB (N), Troponin T (T). 6, 12, 24 hours : All (T) What
does it mean?
A. CK-MB is as specific as CK Total to diagnose MI.
B. CK-MB specific for cardiac and skeletal muscle
C. Troponin T is more specific to diagnose MI.
D. CK total elevate longer than Troponin T, more than 24 hours
E. CK total have a contribution do determine mortality in myocardial infarct.
116.
117.
118. Narrow of lumen from artery surrounding myocardium, doc advice diet because
high level of lipid.
What is the possible pathological event occur?
A. Atherosclerosis due to formation of plaque, inflammation, foam cell
B. Atherosclerosis due to edema of lumen artery and inflammation
C. Atherosclerosis due to chronic inflammation and lumen hypertrophy
D. Atherosclerosis due to formation of plague, lumen hypertrophy and foam cell
E. Atherosclerosis due to edema of lumen, foam cell and lumen hyperthropy
119. mr.Y,emergency room,suddenly left chestpain & vague pain on left arm.ICCU
give streptokinase.laboratory test that must monitor for streptokinase:
A. APTT& PT
B. PT & thrombocyte count
C. APTT & thrombocyte count
D. PT & D-dimer
E. APTT,PT,dimer
120. Streptokinase given. Test for streptokinase?
121.
122. Arrange the following numbered statements in the correct order of the expected
sequence of events that normally occur during healing of myocardial infarction.
1 = Collagen is deposited, forming fibrous scar
2 = flocculent densities form within mitochondria
3 = granulomatous tissue begins to form
4 = Macrophages begin to arrive at the area of coagulative necrosis
5 = neutrophil begin to arrive at the area of coagulative necrosis
A. 2,3,4,5,1
B. 2,4,5,3,1
C. 2,5,4,3,1
D. 4,5,3,2,1
E. 5,4,3,2,1
For question 124-125
Mr. A, 65 yo man was admitted to ER because of shortness of breath. He was known to
have prior myocardium infarction 6 years ago, and hospitalized 3 times within 3 years
because of chest pain. Since then he had been seeing a cardiologist but not on regular
basis. Consequently his hypertension and dyslipidemia had not been under control.
Over the past year, he had been noticing some shortness of breath when climbing 2
flights of stairs.
123. WOTF is the most probably for this patient?
A. Complete thrombosis
B. Plaque rupture
C. <75% stenosis
D. Thromboemboli
E. Incomplete thrombosis
124. WOTF is most probably condition of his heart?
A. Augmentation of myocytes number
B. Concentric hyperthrophy
C. Increase of myocytes size
D. No deposition of fibrous tissue
E. A lot of collateral
125. Atherosclerosis is characterized by intimal lesions called atheromas (also called
atheromatous or atherosclerotic plaques) that protrude into vessel lumen. Arrange
the following numbered statements in the correct order of the expected sequence
of events that normally occur during atherogenesis:
1 = Monocyte adhesion to the endothelium
2 = platelet adhesion
3 = accumulation of lipoproteins (mainly LDL and its oxidized forms) in vessel wall
4 = endothelial injury
5 = factor release from activated platelets, macrophages, and vascular cell walls
6 = lipid accumulation both extracellularly and within cells
7 = smooth muscle cell proliferation and ECM production
A. 1,2,3,4,5,6,7
B. 4,3,1,2,5,7,6
C. 4,3,2,1,7,6,5
D. 1,2,3,5,6,7,4
E. 3,4,5,7,6,2,1
126. Vasculitis is a general term for vessel wall inflammation. The clinical features of
the various vasculitides are diverse and largely depend on the vascular bed
affected. WOTH showed giant cell granulomatous in microscopic features?
A. Kawasaki disease
B. Takayasu disease
C. Buergers disease
D. Polyarteritis nodosa
E. Kimura disease
127. Ischemia is most pronounced in the sub endocardium; thus, irreversible injury of
ischemic myocytes occurs first in the subendocardial zone. When the complete
necrosis will occur in severe myocardial ischemia?
A. 4 hours
B. 7 hours
C. 6 hours
D. 8 hours
E. 12 hours
128. Valvular disease can come to clinical attention due to stenosis, insufficiency
(regurgitation or incompetence), or both. WOTH showed Aschoff body in
microscopic feature?
A. Mitral stenosis
B. Mitral insufficiency
C. Rheumatic heart disease
D. Mitral valve prolapse
E. Infective endocarditis
129. Infective endocarditis has been classified on clinical grounds into acute and sub-
acute forms. This subdivision reflects the range of the disease severity and tempo,
which are determined in large part by the virulence of the infective microorganism
and whether underlying cardiac disease is present. WOTF is the best describe for
pathogenesis of IE?
A. Sterile vegetation
B. Vegetation of microbes
C. Implantation of immune complex
D. Valve injury
E. First bacteremia from port dentry from far part of body
For questions 131 & 132
An 18 yo boy was brought to the ER due to dyspnea. 3 weeks ago he had pharyngitis
and was diagnosed with acute tonsillitis. On PE found diastolic murmur and polyarthritis
migrans.
130. The most likely diagnosis is:
A. Acute bacterial endocarditis
B. Rheumatic heart disease
C. SBE
D. Pericarditis
E. Diptheritic myocarditis
131. Further examination that can be used as diagnosis base is:
A. From blood culture found Staphylococcus epidermidis
B. From pharynx swab found rheumatogenic strain of Streptococcus pyogens
C. From endocardium biopsy found vegetation consist of Streptococcus pyogens
D. From serological test found antistreptolysine O is > 200 U/mL
E. The Gram test from synovial fluid found Gr (+) coccus with chain formation
132. What is the most likely pathogenesis for this condition?
A. The M protein of the microbes induct an activation to complement system
causing an endocardium and synovial problem
 B. Bacteria producing an exotoxin that circulating in blood circulation
C. Bacteria is colonizing inside the synovial and heart valve causing inflammation
D. Bacterial antigen fragment induct antibody production that finally has cross
reaction with the synovial and heart valve
E. Released endotoxin by lysing bacteria induct IL-1 and TNF that causing
inflammation on synovial and heart valve
133. A 23 yo man comes to clinic with fever from yesterday. The patient said about 5
days ago theres a rash at his both hand that blackening. From the anamnesis
found recently he went to hunted wild animal at the jungle. On the examination
vital sign is BP 80/60 mmHg, pulse 128 x/min, respiration 25x/min, temperature
39.5oC. The condition that this patient had possibly caused by:
A. Bacillus subtilis -> Saprofit
B. Rickettsia rickettsia
C. Streptococcus pyogens
D. Treponema pallidum
E. Staphylococcus epidermidis
For questions 135 & 136
A 12 yo boy brought by his mother to emergency center because of delirium from
this afternoon. The boy has been in fever condition for a while. From the exam,
blood pressure is 80 per palpation. He is predicted having a septic shock condition.
134. What is the most possible as causing microbe for this condition?
A. Eschericia coli
B. Staphylococcus epidermidis
C. Streptococcus viridans
D. Yersinia pestis
E. Staphylococcus aureus
135.
136.
137.
138.
139.
140.
141. Which one is triad Virchow of DVT? Stasis, injury, hypercoagulability
142. Fat woman, call pain but no trauma. Why?
143.
144. Cause symptom of leg vein?
A. Drug intoxication
B. Allergic vein disease
C. Phlebo disese
D. Vein blood cell aggregration
E. Phlebitis
(Lebih lengkap di nmr 88 buku gajah cvs part 1
145.
146.
147. A 7 year-old female baby with tetralogy of fallot was brought to the hospital
because increasing cyanosis with rapid and deep respiration, irritability, and
prolonged crying. These happen in the morning after she was crying. The patient
without fever, cough, or cold. On auscultation there was a normal first heart sound,
decreasing intensity of second heart sound, and without murmur.
What is happening in this patient?
A. Hypoxic spell
B. Heart failure
C. Respiratory failure
D. Pulmonary hypertension
E. Infective Endocarditis
148. Atasnya kepotong bla bla bla with rapid and deep respiration, irritability, and
prolonged crying. These happen in the morning after she was crying. The patient
was without fever, cough, or cold. On auscultation there was a normal first heart
sound, decreasing intensity of second heart sound and without murmur.
What is happening in this patient?
A. Hypoxic spell
B. Heart failure
C. Respiratory failure
D. Pulmonary hypertension
E. Infective endocarditis
149. A 7 moth old female baby was brought to the hospital with cyanosis around the
mouth and fingertips with rapid and deep respiration and unconsciousness. On
auscultation there was a normal first heart sound, decreasing intensity of second
heart sound, and without systolic murmur. The babsy was diagnosed as Tertralogy
of Fallot since she was 2 month old.
150. What is the initial treatment for these condition?
A. The infant should be picked up and held in a knee chest position and morphine
sulfate, 0,2 mg/kg administered subcutaneously
B. Propanolol, 0.01 to 0.25 mg/kg administered by slow intravenous push
C. Ketamine, 1 to 3 mg/kg (average of 2 mg.kg) administered intravenously over
60 seconds
D. Intubation and positive pressure ventilation
E. Oxygen (40 % to 50 %) with humidity
151. An 8 year old boy came to the outpatient department with a 2 days history of
fever, nausea, vomiting, anorexia, chills, and night sweats. During the last 24 hours,
his symptoms not only worsened, but he stated complaining of shortness of breath.
At this time, he is brought to the Emergency Department, his past medical history is
only remarkable for a small ventricular septal defect which hase never bothered
him before. The patient has a number deep caries of the lower left first molar of his
teeth.
What is the common complication in this patient?
A. Infective endocarditis
B. Acute rheumatic fever
C. Heart failure
 D. Kawasaki disease
E. SLE
For question number 153 to 154, refer to scenario below:
A 10 year old boy, the star goalie for the Bandung little league, soccer team, had a sore
throat since two weeks ago but did not tell anyone because he was afraid he would
miss the play offs. Since several children had been diagnosed with rheumatic fever in
the area, his mother worried that he might be risked as well
152. You tell her that several criteria must be net to make the diagnosis.
Which of the following criteria is the most commonly found?
A. Carditis
B. Athralgia
C. Erythema marginatum
D. Chorea
E. Subcutaneous nodules
153. What would be preventive to rheumatic eart disease?
A. Benzanthine Penicillne G 1.200.000 U every 4 weeks
B. Corticosteroid 2 mg/kg body weight everyday
C. Cephradoxil oral 2 x 500 mg everyday
D. Ampicilline oral 4 x 250 mg everyday
E. Amoxicillin oral 4 x 250 mg everyday
154. A 4 month old male baby was brought to the outpatient clinic with failure to
thrive and recurrent respiratory infections as chief complaint. There was no cyanotic
on the fingertips or around the mouth. Physical examination revealed normal first
and second heart sounds. Continuous murmur was found in left infraclavicular
grade 3/6
155. Which of the following is the most likely diagnosis in this patient?
A. Patent ductus arteriosus
B. Ventricle septal defect
C. Atrial septal defect
D. Pulmonary stenosis
E. Tricuspid regurgitation
156. A 5 day ole premature male baby was hospitalized in the perinatology ward of a
hospital. Physical examination revealed the pulse rate 120 x/minute, repiration rate
56 x/minute. Normal first and second heart sounds. Holosystolic murmur grade 2
with bounding pulse and hyperdynamic precordial. No intercostal retraction nor
hepatomegaly . echocardiography showed patent ductus arteriosis.
What is the first choice of therapy?
A. Digoxin oral
B. Indomethacin oral
C. No drugs, observation till spontaneous closure of ductus
D. Furosemide oral
E. Captopril oral
157. A 14 year old girl came to the clinic with repiratory distress as chief complaint.
She used to sleep using three pillows. Physical examination revealed pulse rate 120
x/minute, respiratory rate 60 x/minute. There waws an increase in jugular venous
 pressure. On auscultation there was a systolic murmur stating with first heart
sound, grade 4/6, at the apex, with good transmission to the left axilla. She had
acute rhematic fever when she was 7 years old.
What kind of heart anatomic anomaly that occurred in this girl?
A. Mitral regurgitation
B. Coronaria dilatation
C. Aortic stenosis
D. Tricuspid insufficiency
E. Pulmonary hypoplasia
158. A 9 month old baby was brought to the pediatric emergency with repiratory
failure. The baby was difficult to breastfed since 12 hours before. Physical
examination revealed pulse rate 160 x/minute, respiration rate 60 x/minute, no
fever. Normal first heart sound increased second heart sound with holosystolic
murmur on the left side sternum. There was hepatomegaly and retraction. He was
diagnosed as ventricle septal defect when he was 2 months old. What is the initial
treatment you should give?
A. Digoxin oral
B. Antibotic oral
C. Aminophyllie
D. Propanolol
E. Mucolytic
159. A 12 month old female baby was diagnosed as Tetralogy of Fallot since 6
months old was brought to the clinic after three times attack during a week, i.e.
increasing cyanosis with rapid and deep respiration irritability and prolonged crying.
These happen in the morning after she was crying or defecation.
What is the precise therapy before correcting surgery of the heart?
A. Digoxin oral
B. Propanolol oral
C. Captopril oral
D. Furosemide oral
E. Spironolactone oral
160. Preload of the heart is best defined as:
A. End systolic wall tension
B. Shortening of muscle fiber
C. Function of length of muscle fiber
D. Aortic impedance
E. Pulmonary artery impedance
161. A gentleman, who was hypertensive, experienced acute heart failure with
pulmonary rales. His blood pressure was 230/130 mmHg. The echocardiogram
showed concentric left ventricular hypertrophy, normal size of the left ventricle
chamber, and normal ejection fraction
Which is the following condition that may relate to the development of acute heart
failure in this patient?
A. Reduced contractility of the myocardium
B. Low compliance of the left ventricle
 C. Systolic dysfunction of the left ventricle
D. Reduced shortening of muscle fiber
E. Reduced end left ventricular systolic wall tension
162. One of the disease stated below can cause high-output heart failure. Whoch of
the following is the best condition that cause high output failure?
A. Coronary heart disease
B. Hypertensive heart disease
C. Valvular heart disease
D. Arterio venous fistule
E. Pericardial disease
163. A patient bla bla bla (kepotong) of breath, wet rales in the lower half of the lung
fields, and S3 gallop.
Which of the following is the Killip classification, for this patient?
A. Killip class I
B. Killip class II
C. Killip class III
D. Killip class IV
E. Killip class V
164. There are many kinds purpose of therapy for heart failure.
What is the main purpose of the aim of treating a patient with heart failure?
A. Reduce preload and afterload
B. Reduce preload but not afterload
C. Reduce afterload but not preload
D. Increase preload and contractility
E. Increase afterload and contractility
For question number 165 to 168, refer to scenario below
A 60 year old man came to Hasan Sadikin Hospital with complaints of swelling in both
legs. Swelling has been felt since a month ago. In the past 2 years the patient tired
easily when waling 10 m but still be able to sleep supine. Patients had been treated in
R. ICCU of a heart attack three years ago with irregularly follow up. Since four months
ago the patient taked medication only when there are complaints.
On physical examination found: CM, BP 100/60 mmHg, HR = N = 100/minute, RR =
22x/minute, shallow, afebrile. Full JVP, HJR (+), heart enlarged to the left, S1 S2 (-), S3
(+). Rhonchi (-). The liver is palpable 5 finger BPX. Spleen not palpable. Lateral side
dullness +. Extremities: pretibial edeman +/+
Investigations showed; ECH: sinus tachycardia with old infarction in the anterior wall.
CXR: enlarged heart accompanied by signs of visible lung dam.
165. What is the functional diagnosis mos appropriate for the above case?
A. Right cardiac compensation
B. Left cardiac decompensation NYHA class I function
C. Left cardiac decompensation NYHA class II function
D. Left cardiac decompensation NYHA function class III
E. Left cardiac decompensation NYHA class IV function
166. For the above case , leg edema occurs due to:
A. pneumonia lobaris
 B. Left and right hear failure
C. Left heart failure
D. Left heart failure and pneumonia
E. Right heart failure
167. What is examination that you recommend to find the etiology of the above
cases?
A. Coronary angiography
B. Echocardiography
C. Holter monitoring
D. Treadmill exercise test
E. Sidik nuclear perfusion
168. For the above case, in addition to a sitting postion and oxygen administration.
Which needs to be given the following drugs?
A. Ace inhibitor, aspirin, diuretic
B. Calcium antagonists, nitrates, digitalis
C. Beta blocker, aspirin, nitrate
D. Diuretic , nitrates, aspirin
E. Digitalis, nitrates and Ca antagonist
For question number 169 to 170, refer to scenario below:
A 50 year old man arrived in the emergency room with complaints of left chest feels
heavy when the patient is resting. Complaints continue to be felt until arrival at
hospital. Complaints like these have often feltm but before not too great. EKG at
presentation in the emergency room showed ST segment depression but no ST
segment elevation. No T wave inversion. Laboratory examination of blood showed no
abnormalities in cardiac markers.
169. Under these circumstances most likely to cause complaints in patients with the
above:
A. Atypical angina
B. Stable angina
C. Unstable angina
D. Prinzmetal angina
E. Angina type kresendo
170.
For questions number 171 to 172, refer to scenario below:
A 55 year old male came to clinic. He is known had hypertension, dyslipidemia, and
smoking, since the last 10 months the patient complained of retrosternal area chest
pain, such as tingling, arising when the activity, duration of pain a few minutes. Chest
pain was initially lost when the patient gets a rest, but since last 3 months of chest pain
just disappear with a nitrate tablet which put under the tongue, and now he must use a
minimum of 3 tablets. Doctors have suggested for further examination, but he always
refuse.
On physical examination found; blood pressure: 140/90 mmHg, HR = N = 88x/1, RR
18x/1 , JVP normal, S1 S2 (N), S3 (-), S4 (-), no abnormalities in pulmonary
examination. ECG showed no significant changes in ST segment and T wave, except for
axis -300 and biphasic P wave in V1 with SV2 + RV5 = 42 mm.
171. The cause of complaints of chest pain the most appropriate in these patient is:
A.Unstable angina pectoris
B.Stable angina pectoris
C.Acute myocardial infarction
D.Angina kresendo
E.Aneurysma aorta
172. What is the EKG on above case?
A. Left ventricular hyperthropy
B. Left ventricular hyperthropy, left atrial enlargement
C. Left ventricular hyperthropy and right ventricular hyperthrophy
D. Right ventricular hyperthropy, right atrial enlargement
E. Left and right atrial enlargement
173. A 25 year old man had complaints of shortness of breath since 3 weeks ago. On
physical examination: ictus cordis palpable in fith intercostals, left midclavicular
line. The first and second heart sound is normal, no additional heart sounds. There
was a diastolic murmur in second intercostals, right parasternal line. What is the
valve abnormality that causes that clinical state?
A. Mitral valve regurgitation
B. Pulmonary valve regurgitation
C. Tricuspid valve regurgitation
D. Aortic valve regurgitation
E. Mitral valve prolapse
174. A 61 year old man arrived at the emergency room with complaints of chest pain
at rest. EKG showed T wave inversion in sandapan V2 to V4. Laboratory test showed
elevated levels of troponin T (0,4 ng/ml). mention therapy is indicated for the
clinical state of the above:
A. Streptokinase
B. Minor tranquilizers
C. Inhibitor of HMG CoA
D. Sublingual nitrate
E. Diuretics
175. The normal sequence of conduction within the heart is:
A. SA node atrioventricular (AV) node bundle of His bundle branches Purkinje
fibers
B. SA node bundle of His AV node bundle branches Purkinje fibers
C. AV node SA node bundle of His bundle branches Purkinje fibers
D. SA node AV node bundle of His Purkinje fibers bundle branches
E. AV node bundle of His SA node bundle branches Purkinje fibers
176. In a normal ECG:
A. The P-R interval is greater than 0.2 seconds
B. The ST segment represents the duration of the ventricular action potential
C. The T wave represents ventricular repolarization
D. The duration of the QRS is greater than 0.2 seeconds
E. The QRS represents atrial repolarization
177.
178.
179.
180.
181.
182. Besides the person identity & declaring time of death, a death certificate
contains:
A. Types of death
B. Autopsy report
C. Cause of death
D. Manner of death
E. The changes after death
183. A 3 year old child has difficulty of breathing. The chest X ray reveals: the heart
in enlarged to the left with rounded apex above the left diaphragm. The aortic arch
is small. The hila are wide with increased vascular markings. Diagnosis is:
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Pulmonary stenosis
E. Tetralogy of Fallot
184. A 4 year old girls is cyanotic, dyspnea, has oligaemia pf pulmonary
vasculatures, lucency of both lungs, rounded apex, and the size of the heart is
normal.
Which of the following is the most likely diagnosis?
A. Tetralogy of Fallot
B. Tetralogy of Fallot
C. Pulmonary stenosis
D. TAPVR
E. Pulmonary atresia
185.
186.
187.
188.
189.
190.
191. Heart enlarged, outline well defined, lung normal. Kondisi yang berhubungan
dengan hal-hal tersebut adalah..
A. cardiomyopathy
B. right heart failure
C. left heart failure
D. right & left heart failure
E. pericardial effusion
192. In Multigated Radionuclide Ventriculography (MUGA) for the assessment of
ventricular function test, which one of the following statements is TRUE?
A. It is less accurate compared to other modalities
B. It cannot be used to calculate total blood volume
 C. It is the only technique that allows EF determination
D. Tc-99m labeled red blood cells is the only radiopharmaceutical for it
E. It can be performed during stress exercise
193. Which one of the following tests is the assessment of Myocardial perfusion,
ventricular function, and myocardial viability can be done simultaneously?
A. Coronary angiography
B. Stress echocardiography
C. Gated-SPECT
D. Treadmill exercise ECG
E. Tc-99m RBC multigated blood pool scan
194. Which one of the following statements is correct in the clinical application of
Myocardial Perfusion Imaging (MPI)?
A. MPI evaluates coronary arteries directly
B. MPI cannot separate high risk from low risk factor
C. MPI act as a gate-keeper for referral to angiography test
D. MPI has lower sensitivity compared to treadmill test for CAD
E. Coronary arteries can be well visualized with MPI
195. For the diagnosis of CAD, which one of the following is the least accurate non-
invasive technique?
A. Electrocardiography
B. Coronary angiography
C. Echocardiography
D. Exercise MPI
E. Rest MPI
196. A 45 yo man has bilateral carotid bruits that are audible with auscultation.
WOTF is the physiologic mechanisms that cause this phenomenon?
A. The velocity of a blood within the vessel increase
B. The viscosity of a blood within the vessel increase
C. The diameter of the vessel decrease
D. The density of the blood decrease
E. The length of the vessel increase
For question 197-200
A 40 yo man suffered from high blood cholesterol level. The um of his uncontrolled
dietary cholesterol intake and cellular synthesis, and that made him vulnerable of the
developing of atherosclerotic plaque resulting in obstruction of his blood vessels.
197. What cells mostly elaborate ECM in the growing that plaque?
A. Monocytes
B. Foam cells
C. Macrophage
D. Smooth muscle cells
E. Vascular endothelial cells
198. What is the first step of evolution of that plaque?
A. Lipoprotein entry to sub intimal region
B. Lipoprotein modification
C. Endothelial dysfunction
 D. Leucocytes recruitment
E. Foam cells formation
199. He is suggested to do physical exercises because exercise will:
A. Dilate blood vessel
B. Promote cholesterol excretion
C. Reduce the precursor of cholesterol synthesis
D. Oxidize cholesterol into H2O, CO2 and energy
E. Promote steroid hormone synthesis from cholesterol
200. Which lipoprotein mostly transport cholesterol from his liver to his heart ?
A. plasma albumin
B. chilomicron
C. VLDL
D. LDL
E. HDL