SOAL RHEUMATIC HEART DISEASE, ANEMIC HEART DISEASE, THYROID HEART DISEASE ( dr. Agus Harsoyo )

1. Penyebab tersering dari Demam Rematik Akut :a. Group A ( Streptococcal.

b. Group B ( Streptococcalc. Group C ( Streptococcald. Group A ( Streptococcale. Group A ( Gonococcal2. Manifestasi klinis demam reumatik akut :

a. Migratory polyarthritis

b. Fever

c. Carditis d. Sydenhams chorea

e. Migratory polyarthritis, fever, carditis, Sydenhams chorea, subcutaneous nodule, erythema marginatum.3. Demam rematik akut merupakan masalah kesehatan utama anak anak di Asia, Africa, Middle East dan Latin Americaa. Usia 15 35 tahunb. Usia 5 15 tahun.c. Usia dibawah 15 tahun d. Usia diatas 5 tahun e. Usia dibawah 5 tahun 4. Efek toksin dari kuman AH streptococcus yaitu :

a. Streptolysin S

b. Streptolysin O

c. Streptolysin S atau O.d. Streptolysin P atau O

e. Streptolysin Q

5. Pada demam rematik akut, pernyataan di bawah ini ini benar, kecuali :a. CD4 of helper lymphocyte (b. Ratio CD4 : CD8 (c. Interleukin 1 and Interleukin 2 (d. Ratio CD4 : CD8 (.e. Scaring valve, destruction myocyte 6. Kelainan akut yang di dapati di jantung berupa :

a. Pericarditis

b. Tamponadec. Pelebaran seluruh ruang jantungd. Pericarditis, tamponade, enlargement all chamber, fragmentation collagen,lymphocytic infiltration, fibrinoid degeneration ( Aschoff nodule ( pathognomonic RF ) central necrotic - lymphocyte, plasma cell, large mononuclear, and giant multinuclear cell, if elongated nucleus called Atinschkow myocite.

e. Small fibrineous, vegetation valve and chorda tendineae or edema and inflammation valve leaflets

7. Sedangkan kelainan kronis yang di dapati di jantung berupa :

a. Small fibrineous b. Vegetation valve c. Bigest fibrineous

d. Vegetation chorda tendineae e. Small fibrineous, vegetation valve and chorda tendineae or edema and inflammation valve leaflets.

8. Pola demam pada demam rematik akut, kecuali :

a. Less than 5% Acute Rheumatic Fever due to group A ( Streptococcal infection. b. Febrile a few day to 6 weeks earlier with temperature of > 38 C occurs

c. Joints pain : migratory or polyarthritis, swelling, redness, effusion of knees, ankles, elbows, hips

d. Skin lesion and nodules back hand

e. Carditis causes erythema marginatum, nonpruritic, macular, rash with blanched centers, nodule subcutaneous firm, moveable, nontender, diameter 0,5 to 2 cm, near tendon or prominences of joints elbows, knuckles, wrist, knees, scalp 9. Tanda tanda Chorea terlihat setelah 6 bulan terinfeksi kuman group A (emolithicus Streptococcal, kecuali :a. Hyperirritabilityb. Deterioration handwriting

c. Inability concentrate, purposeless

d. Non repetitive, involuntary muscle spasms poor muscle coordinatione. Chorea resolves with residual neurologic damage.

10. Gambaran klinis demam rematik akut, kecuali :

a. General - High fever, lassitude, prostration, tachycardia

b. Cardiac - Cardiomegaly, congestive heart failure, Acute pericarditis, pericardial effusion

c. Apical ejection diastolic murmur ( mitral regurgitation ), Apical mid systolic murmur ( Carey Coombs ), Basal diastolic (aortic regurgitation).

d. Dermatologic - Subcutaneous nodules, Erythema marginatum

e. Rheumathologic - Arthralgia , Migratory polyarthritis, Neurologic - Sydenham's chorea11. Yang tidak termasuk dalam Kriteria Jones demam rematik akut yaitu :

a. Major Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules

b. Minor Arthralgia, Fever, ( erythrocyte sedimentation rate, ( C Reactive protein, prolonged P-R interval

c. Positive throat culture streptococcal, ( streptococcal antibody titer

d. Latent periode 10 until 15 week ( median 29 days ).e. Arthritis 75%, Carditis 40 50%, Chorea 15%, Subcutaneous nodules and erythema marginatum < 10% 12. Pemeriksaan penunjang yang diperlukan pada demam rematik akut yaitu, kecuali :a. ( White blood cell count, ( Erythrocyte sedimentation rate, slight anemia due to suppresed erythropoesis during inflammation

b. C reactive protein positive, ( cardiac enzym c. (Antistreptolysin O titer in 95% pts within 2 month, ( antiDnase B test, ECG PR interval is prolonged in 20% pts

d. Chest X Ray - ( pulmonary vascularisation as in HF, pericardial effusione. Echocardiography valvular, chamber size, and LV function always normal.

13. Dalam menegakkan diagnosis demam rematik akut diperlukan :

a. Demonstration of current/ recent group A H Streptococcal infection b. 2 Majorc. 1 Major d. 1 major plus 2 minor jones criteriae. Requires both : demonstration of current/ recent group A H Streptococcal infection , 2 Major, or 1 major plus 2 minor jones criteria.

14. Pada fase akut, pilihan pengobatan demam rematik akut yaitu :a. Penicillin G 1,2 milion U single dose IM, or Penicillin V 250 mg po ( Adult 500 mg ) tds for 10 days, or Erythromycin if penicillin alergic 20 40 mg/ KgBW/ day (Adult 250 mg qds), Aspirin or other NSAIDS for arthritis (high dose 80 100 mg/ KgBW/ day; Adult 4 8 g/ day, in divided doses), Prednisolone 40 60 mg/ d, tapering after 2 3 weeks.b. Penicillin V 250 mg po ( Adult 500 mg ) tds for 10 days c. Erythromycin if penicillin alergic 20 40 mg/ KgBW/ day (Adult 250 mg qds), d. Aspirin or other NSAIDS for arthritis (high dose 80 100 mg/ KgBW/ day; Adult 4 8 g/ day, in divided doses )

e. Prednisolone 40 60 mg/ d, tapering after 2 3 weeks15. Pengobatan suportif demam rematik akut, kecuali :a. Total bed rest sampai 5 minggu sampai arthritis dan gagal jantung membaik, Haloperidol untuk pencegahan chorea, Penicillin V 250 mg bd ( or Penicillin G 1,2 milion U IM every 28 days ), minimum duration 5 years or until age 21 ( whichever is later ) if severe valve destruction - continues to age 30 or more Surgery : severe M Insuf or A Insufb. Total bed rest sampai 5 minggu sampai arthritis membaik c. Total bed rest sampai 5 minggu sampai arthritis dan gagal jantung membaik, Haloperidol untuk pencegahan chorea, surgery : severe Mitral Insufisiensi or Aorta Insufisiensid. Total bed rest sampai 5 minggu sampai gagal jantung membaike. Penicillin V 250 mg bd ( or Penicillin G 1,2 milion U IM every 28 days ), minimum duration 5 years or until age 21 ( which ever is later ) if severe valve destruction - continues to age 30 or more. 16. Pernyataan benar tetang thyroid, kecuali :

a. Hormon tiroid mempengaruhi system jantung dan pembuluh darah

b. Kadar hormone tiroid tinggi maupun rendah akan mempengaruhi sistim hemodinamik jantung dan pembuluh darah

c. Efek hypothyroidism sama dengan hyperthyroidism.

d. Efek hypothyroidism berlwanan dengan hyperthyroidism

e. Pengaruh akut pada hyperthyroid dapat berupa berdebar debar17. Pengaruh Triiodothyronine ( active celluler of thyroid hormone ) pada sistim jantung dan pembuluh darah adalah, kecuali :

a. Heart rate lambat cenderung bradiaritmia.

b. Systemic vascular resistance and effective arterial filling volume

c. renin release and activation angiotensin aldosteron

d. erythropoietin secretion blood volume and preload Cardiac output ; peripheral oxygen consumption

e. contractility18. Di tingkat sel, kerja hormone thyroid benar, kecuali :

a. Triiodothyronine merespon cicin actif dan menekan cicin

b. Mempengaruhi kontraktilitas sel miosit otot jantung cardiac contractilec. Melaksanakan pompa aktif Calsium di lumen sarcoplasmic reticulum

d. Menyebabkan fungsi Diastolic normal in heart failure and thyroid disease.e. Menyebabkan peningkatan contractility and peningkatan diastolic function in hyperthyroidism19.Pengaturan Positive hormone thyroid di tingkat genetic, kecuali :

a. Cincin

b. Ca2+ - ATPase

c. 1-adrenergic receptors

d. Na+ /K+- ATPasee. Cincin .

20.Akibat Hyperthytoid, kecuali :

a. SVRI 2100 2700 dyne.sec.cm-5.

b. Heart Rate 88 130 BPMc. Ejection fraction > 60 %

d. COP > 7 L/mnt

e. IVRT 25 40 msec