Tutor : dr. Aida Farida, Sp.PA

Skenario A Blok 16 Tahun 2015

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Nama Kelompok

JudulNama KelompokOutlineSkenarioKlarifikasi IstilahIdentifikasi MasalahAnilisis MasalahLearning IssueKeranngka KonsepKesimpulan

Outline

Mr. Y, a 40-year old, sailor, was admitted to hospital with hemoptoe. He complained that 6 hours ago he had a severe bout of coughing with fresh blood of about 2 glasses. He also said that in the previous month he had had productive cough with a lot of phlegm, mild fever, loss of appetite, rapid loss of body weight (previous weight: 70 kg), and shortness of breath. Since a week ago, he felt his symptoms were worsening.

Physical examination :General appearance : he looked severely sick and pale. Body height : 175 cm. Body weight: 55 kg BP: 100/70 mmHg, HR: 112x/minute, RR: 36x/minute, temp 37,6○ C.There was a tattoo on the chest and lymphadenopaty of the right neck, and stomatitis.In chest auscultation the was increase of vesicular sound at the right upper lung with moderate rales.

Additional information:Laboratory :

Hb : 8,5 g%, WBC : 6.000/µL, ESR 65 mm/hr, Diff Count : 0/3/2/75/15/5, Acid Fast Bacili : (-), HIV test (+), CD4 120/µL,

Radiology :Chest radiograph showed infiltrate at right lower lung.

Skenario

HemoptoeBatuk ProduktifPhlegmDemam RinganSesak NafasSakit BeratLymphadenopatyStomatitisSuara vesikuler Ronki Sedang

Klarifikasi Istilah

Mr. Y, a 40-year old, sailor, was admitted to hospital with hemoptoe. He complained that 6 hours ago he had a severe bout of coughing with fresh blood of about 2 glasses.

He also said that in the previous month he had had productive cough with a lot of phlegm, mild fever, loss of appetite, rapid loss of body weight (previous weight: 70 kg), and shortness of breath. Since a week ago, he felt his symptoms were worsening.

Identifikasi Masalah

Physical examination :General appearance : he looked severely

sick and pale. Body height : 175 cm. Body weight: 55 kg BP: 100/70 mmHg, HR: 112x/minute, RR: 36x/minute, temp 37,6○ C.

There was a tattoo on the chest and lymphadenopaty of the right neck, and stomatitis.

In chest auscultation the was increase of vesicular sound at the right upper lung with moderate rales.

Additional information:Laboratory :

Hb : 8,5 g%, WBC : 6.000/µL, ESR 65 mm/hr, Diff Count : 0/3/2/75/15/5, Acid Fast Bacili : (-), HIV test (+), CD4 120/µL,

Radiology :Chest radiograph showed infiltrate at

right lower lung.

Mr. Y, a 40-year old, sailor, was admitted to hospital with hemoptoe. He complained that 6 hours ago he had a severe bout of coughing with fresh blood of about 2 glasses.

a. Bagaimana anatomi dan fisiologi saluran pernafasan?

b. Apa hubungan umur,jenis kelamin, dan pekerjaan dengan keluhan?

c. penyakit/gangguan apa yang disertai batuk darah? d. bagaimana patofisiologi batuk darah? e. apa dampak batuk darah sekitar 2 gelas selama 6

jam?

Analisis Masalah

f. apa saja kemungkinan penyebab batuk darah?

g. apa saja factor resiko terjadinya batuk darah?

h. Bagaimana klasifikasi dan kriteria batuk darah?

He also said that in the previous month he had had productive cough with a lot of phlegm, mild fever, loss of appetite, rapid loss of body weight (previous weight: 70 kg), and shortness of breath. Since a week ago, he felt his symptoms were worsening.

a. Bagaimana patofisiologi dari :- batuk produktif dengan banyak dahak - demam ringan- hilang nafsu makan-kehilangan berat badan-sesak nafas

b. mengapa batuk berdarah pada tn. Y dapat menjadi batuk berdarah dalam 1 bulan?

c. bagaimana perbedaan batuk produktif dan non produktif?

d. bagaimana mekanisme terbentuknya dahak dihubungkan dengan pertahanan tubuh?

e. bagaimana klasifikasi dan tipe demam? f. bagaimana klasifikasi dahak?g. apa saja jenis-jenis sesak nafas?h. Bagaimana korelasi antar hubungan?

Physical examination :General appearance : he looked severely

sick and pale. Body height : 175 cm. Body weight: 55 kg BP: 100/70 mmHg, HR: 112x/minute, RR: 36x/minute, temp 37,6○ C.

There was a tattoo on the chest and lymphadenopaty of the right neck, and stomatitis.

In chest auscultation the was increase of vesicular sound at the right upper lung with moderate rales.

a. bagaimana interpretasi dan mekanisme abnormal?

b. bagaimana hubungan tattoo dengan kasus? c. bagaimana membedakan lympadenopati dengan

benjolan lain di region leher? ranid. mengapa bunyi vesikuler pada kasus meningkat? e. bagaimana jenis-jenis suara paru?f. bagaimana gambaran histopatologi

lympadenopaty? g. kemungkinan penyakit dari rales sedang

terdengar di paru kanan bagian apex?

Additional information:Laboratory :

Hb : 8,5 g%, WBC : 6.000/µL, ESR 65 mm/hr, Diff Count : 0/3/2/75/15/5, Acid Fast Bacili : (-), HIV test (+), CD4 120/µL,

Radiology :Chest radiograph showed infiltrate at right lower lung.

a. bagaimana interpretasi dan mekanisme abnormal?

b. bagaimana cara pemeriksaan BTA?

c. Apa saja DD dari infiltrate di paru kanan bagian bawah?

d. apa saja pemeriksaan penunjang yang akan dilakukan untuk menentukan diagnosis?

e. apa diagnosis kerja? f. apa definisi dari diagnosis?belbong. apa epidemiologi dari diagnosis?h. apa etiologi dari diagnosis?i. apa factor resiko dari diagnosis?j. bagaimana patofisiologi dari diagnosis?k. bagaimana pathogenesis dari diagnosis?

l. apa saja gejala klinis dari diagnosis? m. apa saja terapi yang harus diberikan?n. bagaimana cara pencegahannya? o. apa komplikasi dari diagnosis? p. bagaimana prognosis dari diagnosis? q. jelaskan skdi dari diagnosis?

a. anatomi dan fisiologi system pernafasan b. TB paru c. imunologi sist respirasi

Learning Issue

Keranngka Konsep

Tn. Y, 40 tahun seorang pelaut menderita TB paru dengan BTA negativ dan HIV positif dengan keluhan batuk darah, hilang nafsu makan, penurunan berat badan, demam ringan dan sesak nafas yang semakin lama semakin memburuk

Kesimpulan

Terima kasih