Skenario A Blok 16 Tahun 2015

Mr. Y, a 40-year old, sailor, was admitted to hospital with hemoptoe, He complained that 6
ours 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 apperarance: he looked severely sick and plate. Body height: 175 cm, Body weight:
55 kg. BP: 100/70 mmhg, HR: 112x/minute, RR: 36xminute, temp 37,6oC. There was a
tattoo on the chest and lymphadenopathy of the right neck and stomatitis. In chest
auscultation there was an increase of vesicular sound at the right upper lung with moderate
rales
Laboratory:
Hb: 8,5g%, WBC: 6000/ul, ESR: 65 mm/hr, Diff count: 0/3/2/75/15/5, Acid fast bacilli: (-),
HIV test (+), CD4: 120/ uL .
Radiology: chest radiograph showed infiltrate at right lower lung

I.

Klarifikasi Istilah
1. Hemoptoe: Batuk akibat pecahnya kapiler paru.
2. Phlegm: Mukus kental yang diekskresikan dari saluran nafas dalam jumlah yang
abnormal.
3. Stomatitis: Peradangan umum pada mukosa mulut.
4. Lympadenopathy: Penyakit pada kelenjar limfe biasanya ditandai dengan pembengkakan
5. Rales: Bising terputus-terputus yang terdiri atas serangkaian bising pendek, terdengar
pada saat inhalasi
6. Infltrat: Gambaran akibat adanya mucus di paru-paru.
7. Acid fast Bacilli: Basil yang dinding selnya dapat mempertahankan fuchsin walaupun
dicuci dengan alkohol
8. Vesicular: Memiliki frekuensi atau nada bunyi yang rendah. Seperti bunyi nafas normal
pada paru selama ventilasi
II.

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

3. Since a week ago, he felt his symptoms were worsening.

4. Physical examination:
General apperarance: he looked severely sick and plate. Body height: 175
cm, Body weight: 55 kg. BP: 100/70 mmhg, HR: 112x/minute, RR:
36xminute, temp 37,6oC. There was a tattoo on the chest and
lymphadenopathy of the right neck and stomatitis. In chest auscultation
there was an increase of vesicular sound at the right upper lung with
moderate rales
5. Laboratory:
Hb: 8,5g%, WBC: 6000/ul, ESR: 65 mm/hr, Diff count: 0/3/2/75/15/5, Acid
fast bacilli: (-), HIV test (+), CD4: 120/ uL
Radiology: chest radiograph showed infiltrate at right lower lung
III.

Analisis Masalah
1. 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. Apa hubungan umur, jenis kelamin dan pekerjaan pada kasus? 1a
B. Apa etiologi dari hemoptoe/ batuk berdarah? 1b
C. Apa makna klinis hemoptoe pada kasus? 1a
D. Bagamana patofisiologi hemoptoe? 1b
E. Bagaimana klasifikasi hemoptoe dan pada kasus ini termasuk golongan
apa? 1a
F. Apa arti klinis dari batuk dengan darah segar dan apa saja differensial
diagnosis dari batuk darah segar? 1b
2. 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.
A. Bagaimana mekanisme imun dalam saluran pernafasan? 4
B. Bagamana etiologi dan mekanisme dari productive cough with a lot of
phlegm? 2
C. Bagaimana etiologi dan mekanisme dari mild fever? 3
D. Bagaimana etiologi dan mekanisme dari lost of appetite dan rapid loss of
body weight? 2
E. Bagaimana etiologi dan mekanisme dari shortness of breath? 3
F. Bagaimana hubugan antar keluhan pada kasus? 3
G. Bagaimana klasifikasi batuk? 1A
H. Apa arti klinis batuk selama 1 bulan? (DD) 2
3. Since a week ago, he felt his symptoms were worsening.
A. Mengapa symptoms makin memburuk? 4
B. Apa saja faktor yang memperberat symptom? 4
4. Physical examination:

General apperarance: he looked severely sick and plate. Body height: 175
cm, Body weight: 55 kg. BP: 100/70 mmhg, HR: 112x/minute, RR:
36xminute, temp 37,6oC. There was a tattoo on the chest and
lymphadenopathy of the right neck and stomatitis. In chest auscultation
there was an increase of vesicular sound at the right upper lung with
moderate rales
A. Bagaimana Interpretasi dari pemeriksaan fisik? 2
B. Bagaimana mekanisme abnormal dari pemeriksaan fisik? 2
C. Apa tujuan dari pemeriksaan fisik yang dilakukan? 3
D. Apa makna klinis ditemukannya tattoo pada dada? 4
E. Bagaimana cara auskultasi paru pada kasus? 1a
5. Laboratory:
Hb: 8,5g%, WBC: 6000/ul, ESR: 65 mm/hr, Diff count: 0/3/2/75/15/5, Acid
fast bacilli: (-), HIV test (+), CD4: 120/ uL
Radiology: chest radiograph showed infiltrate at right lower lung
A. Bagaimana interpretasi dari pemeriksaan laboratorium? 4
B. Bagaimana mekanisme abnormal dari pemeriksaan laboratorium? 4
C. Bagaimana cara pemeriksaan BTA? 3
D. Mengapa hasil BTA negative pada kasus ini? 4
E. Apa saja pemeriksaan tambahan yang diperlukan pada kasus? 3
F. Bagaimana foto radiologi TB? 1a
6. Template
A. Apa saja DD pada kasus? 1b
B. Bagaimana cara penegakkan diagnosis pada kasus? 1b
C. Apa working diagnosis pada kasus? semua LI
D. Apa etiologi pada kasus? 1a
E. Apa epidemiology pada kasus? 1b
F. Bagaimana patofisiologi? 1a
G. Apa faktor resiko pada kasus? 1b
H. Bagaimana tatalaksana pada kasus? (Sistem rujukan) 3
I. Bagaimana prognosis? 2
J. Apa saja komplikasi pada kasus? 2
K. Bagaimana SKDI pada kasus? semua LI
IV.

Learning Issue
1. TBC dengan HIV a.( davin, indah) & b.(nuari, sisca)
2. Anatomi dan histopatologi paru ( sasini, vita)
3. OAT (venny , ica, galih)
4. Immunologi TB dengan HIV (matius, afifa, kokoh)

V.

Hipotesis
Mr Y, 40 tahun, menderita TB paru BTA negatif dengan HIV

DEADLINE : AM DAN LI DIKUMPUL HARI KAMIS TGL 5 MARET 2015 JAM 9

icakhairinnisa@gmail.com

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