PLENO KELOMPOK 1

Mala Needs Injection

Mrs.Mala, 30 years old, come to the doctor

complaining about her joint discomfort. She feels it
every morning in her knees. She also feels that her
knee is swelling. Beside that, Maya also feel ache in
her arm. After following the historical diseases, Mala
said that she often had cough, flu, and sorethroat.
Because shes already bored for consuming drugs,
Mala wants to be injected by analgetic. After the
doctor asks about the history of drug allergic and
she hasnt have it, Mala is injected with an
analgetic. Few times later, Mala feels dizzy, blurring
eyes and hard to breath. What is actually happened
to Mala.

STEP 1
There is no unfamiliar terminology

STEP 2

1. What is the diagnose and differential

diagnose from mrs Mala disease?
2. What is supportif examination for Mrs Mala?
3. What is the etiology and risk factor from Mrs
Mala disease?
4. Why Mrs Mala got dizzy, blurring eyes and
hard to breath after she got injected an
analgetic?
5. What is the treatment for Mrs Mala?
6. What is the complication from Mrs Mala
disease?

STEP 3
1. Based on scenario we suspect that
Mrs Mala Got Reumathoid Arthritis and
Hipersensitivity Reaction (Anafilaktik)
And the differential diagnose for Mrs
mala disease is : SLE, Osteoarthritis,
Arthritis Gout
And other hypersensitivity reaction

2. Laboratory examination and other

examination we can do are :
CRP
Led
Leukocyte count
3. The etiology of Mrs Mala disease is :
Autoimun
Genetic

And for the risk factor of Mrs Mala

disease is :
Gender
Age
Radiation
4. Mrs Mala felt the Manifestation clinic
of Anafilactic reaction

5. Treatment for Mrs Mala are:

Farmacology and
Non-Framacology treatment
6. The complication of Mrs Mala disease
are:
anemia
Carpal tunnel syndrome
Infections
Deformity
Complication to another organ

Step 4
1. A chronic disease characterized by
the inflammation of the lining of the
joints, which is called the synovium.
More common in women than men.
The exact cause of RA is unknown.
Suspected causes are:
Bacterial Infection *Viral Infection
Genetic Marker
*Stress

Clinical manifestation of RA patients are:

Fatigue.
Stiffness, especially in early morning
and after sitting a long period of time.
Low Grade Fever, Weakness.
Muscle pain and pain with prolonged
sitting.
Symetrical, affects joints on both
sides of the body.
Rheumatoid nodules.
Deformity of your joints over time.

Diagnose Criteria of Reumathoid

Arthritis
Morning stiffness
Arthritis of 3 or more joints
Arthritis of hand joints
Symmetric arthritis
Rheumatoid nodules
Serum rheumatoid factor
Radiographic changes

A person shall be said to have

rheumatoid arthritis if he or she has
satisfied 4 of 7 criteria, with criteria

The differential diagnose for RA are:

SLE,
Osteoarthritis,
Arthritis Gout

2. Laboratory examination
CRP : increase until > 0,7 pg/ml
LED : increase until > 30 mm/hour
Hb : decrease, until 10g/dl
Leukocyte count : usually increase
Trombocyte count : increase
RF : positive in 90 % RAs patient

Radiology
Radiology : normal/ there is
osteopeni or erosion
Symmetrical
Early: no sig changes
Late:
Juxta-articular osteoporosis w/
decr bone density
Uniform jt narrowing
Marginal erosions

3. The etiology of Mrs Mala disease is

(RA) is unknown. Suspected causes
are:

Bacterial Infection
Genetic Marker
Stress
Viral Infection
Hormonal
Autoimun

And for the risk factor of Mrs Mala

disease is :
Gender
Age
Familial history
Smoking
Radiation

4. Anaphylaxis may be an allergic response

that is immunologically mediated, or a
non-immunologically mediated response,
or idiopathic. Certain foods, insect
venoms, some drugs and latex are
common precipitants of immunoglobulin
E (IgE)-mediated allergic anaphylaxis.
Many drugs can also act through nonallergic mechanisms. A significant
proportion of anaphylaxis is classified as
idiopathic, in which there are significant
clinical effects but no readily

5. Treament for Mrs Mala are:

pharmacology (symptomatic):
Anlagetic
OAINS
DMARD
Glukokortikoid

Non-pharmaclogy:

Take a rest
Fasting
Exercise
Cod liver oil suplement (NSAIDsparing agent)

6. The complication of Mrs Mala

disease are:
Anemia
Cancer
Cardiac complication
Infections
Deformity (Carpal tunnel syndrome,
swan neck, piano key)
Complication to another organ
Vasculitis

Step 5
1. Nutrition for management for RA
patients
2. Another autoimmune disease that can
damage the juntional
3. Another medicine than can cause
allergy
4. Reumathoid Non-inflamation
5. Treatment for anafilaksis

Step 6
Independent learning

Step 7
1. Nutritonal or RA patein is more
consumption:
. Vit D
. Vit E (antioksidan)
. Omega 3 (antural analgetic)
. Cod liver oil (NSAIDs-sparing
agent)
. Fresh fruits an green vegetables

2. SLE (Systemic Lupus Eritematous)

Systemic lupus erythematosus (also called
SLE, or lupus) is an autoimmune disease of
the body's connective tissues. Autoimmune
means that the immune system attacks the
tissues of the body. In SLE, the immune
system primarily attacks parts of the cell
nucleus.
SLE affects tissues throughout the body.
Five times as many women as men get SLE.
Most people develop the disease between
the ages of 15 and 40, although it can show
up at any age.

Clinical manifestation :
Fatigue
Weight loss
Musculosceletal manifest
Skin manifest (malar rash)
Lung maifest (pneumonitis)
Heart manifest (pericarditis)
Rena manifest

Criteria diagnose for SLE:

There is positive if we can found 4 or

more sign

Treatment for SLE patient:

Pharmacology:
NSAIDs
Antimalarial drugs
Steroid-sparing drugs
Corticosteroids
Immunosuppressive drugs

Non- pharmacology:
education

3. The medicine that can cause alergy:

Antibiotics
*Analgesics
Penicilline
(NSAIDs)

Antiseizure
Phenytoin
Carbamazepine

- Codein
- Tetracycline

4. Arthritis non-inflamatory:
Osteorthritis:
Age of Onset > 40 years
Commonly Affected Joints
Cervical and lumbar spine
First carpometacarpal joint
Proximal interphalangeal joint
Distal interphalangeal joint
Hip
Knee
Subtalar joint
First metarsophalangeal joint

Diagnose :
Symptoms
Pain
Stiffness
Gelling
Physical examination
Crepitus
Bony enlargement
Decreased range of motion
Malalignment
Tenderness to palpation
The more features, the more likely the diagnosis

Treatment:
Non-pharmacology: pharmacology:
Weight loss
* Analgetic
Physicology
* NSAID
Rest
* Corticosteroid
Exercise
* operation

Treatment for Anaphylactic

THANK YOU