I.

Problem Analysis

1. Mr. Sugiono, a 35 years old scavenger brought to the internist polyclinic

by his family with a chief complain of languid and frequent tiredness since
2 months ago and worsen on the current weeks. Mr. Sugiono also
complains of frequent headache. Mr. Sugiono also complains of frequents
headache. Mr. Sugiono is only able to by rice, with tempe an tofu.
Mr.Sugiono also dislikes eating vegetables.
a. What the meaning Mr Sugiono complain of languid and frequent tiredness
since 2 months ago and worsen on the current weeks ?
b. How about histology of blood ?
c. How about physiology in this case ? (Eritropoiesis)
d. What are the possible causes of the chief complain ?
e. How the mechanism of chief complain experience Mr Sugiono ?
f. What the correlation Mr Sugiono is only to buy rice, with tempe and tofu
and also dislike eating vegetables with main complain ?
g. What the possible disease of the chief complain ?
h. What is the meaning Mr Sugiono complain of frequent headache ?
i. What the pathofisiology of frequent headache in this case ?
j. What is the nutritional contains of rice, tempe and tofu ?
k. What is the impact only eat rice, tempe and tofu ?

2. Mr.Sugiono didn’t have any history of worm infestation, went to malaria

endemics area, and getting blood transfusion. Mr. Sugiono didn’t have any
other medical illnesses.
a. What the meaning of Mr.Sugiono didn’t have any history of worm
infestation, went to malaria endemics area, and getting blood transfusion
and didn’t have any other medical illnesses ?
b. What is the definition of Anemia ?
c. What are the classifications of anemia and what is anemia in this case ?
d. What are risk factor of Anemia ?
e. What are impact of Anemia ?
f. What is the pathofisiology of Anemia ?
g. What are clinical manifestation of Anemia in this case ?
3. Physical Examination :
General Appearance : Looks pale, BP 90/60 mmHg, Pulse 112x/m, RR
20x/m, Temp 36,8OC, BH 160 cm, BW 45 kg
Specific examination :
- Head : Pale conjungtive (+/+), Atrophy tongue papil (+), Icteric
Sclera (-)
- Neck : JVP (5-2) cm H2O, Lymph nodes enlargement (-)
- Thoraks : normal cor and pulmo
- Abdoment : flat, supple, normal bowel sound, hepar and lien were not
palpable
- Extremity : pale palmar pedis and manus, koilonychia (+)
a. What interpretation of physical and specific examination ?
b. How abnormal mechanism of physical and specific examination ?

4. Laboratory Examination :
Blood Chemistry : Hb 8,1 g/dl, RBC 3.800.000/mm3, Leukocyte 8000/mm3,
ESR 25 mm/hour, Diff count 0/1/20/58/20/1, Ht 26 vol %, reticulocyte 1%
a. What interpretation of laboratory examination ?
b. How abnormal mechanism of laboratory examination ?

5. How to diagnosis in this case ?

6. What are the differential diagnosis ?
7. What are the additional examination ?
8. What is the working diagnosis ?
9. What are the treatment ?
10. What are the complication ?
11. How about prognose ?
12. What is the Medicall doctor competence ?
13. Islamic point of view