Tutorial scenario A blok 16

Scenario
Mr.Y, a 40-year old, sailor, was admitted to hospital withhemoptoe. 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 112 x/minute, RR : 36 x/minute temp 37,6 0C.
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.
Additional information ;
Laboratory :
Hb ; 8,5g%, WBC : 6000/uL, ESR 65 MM/hr, diff count 0/3/2/75/15/5, Ac id Fast Bacilli (-),
HIV test (+), CD4 120/uL.
Radiology ;
Chest radiograph showed infiltrate at the right lower lung.

Klarifikasi istilah
1. Batuk darah : meludah darah atau sputum bercampur darah ditandai dengan batuk dan di
tandai dengan perburukan kesehatan perlahan-lahan.
2. Moderate rales : ronki basah sedang atau suara berisik dan terputus akibat aliran udara
3.
4.
5.
6.
7.
8.

yang melewati cairan

Batuk produktif : batuk yang ditandai dengan pengeluaran bahan-bahan dari bronkus.
Dahak : mucus yang keluar saat batuk dari saluran pernapasan atas.
Sub febris :peningkatan suhu tubuh diatas 37,5C sampai 38C
Lymphadenopathy : penyakit kelenjar limfe biasanya ditandai dengan pembengkakan.
Stomatitis : radang dan bisul di mulut yang mungin ringan dan lokal atau berat dan luas.
Suara vesicular : suara nafas utama normal dan terdengar besar di paru-paru

9. Infiltrat pada lobus bawah paru kanan : penimbunan patologis pada lobus bawah paru
kanan

Identifikasi masalah
1. Mr.Y, a 40-year old, sailor, was admitted to hospital withhemoptoe. He complained that 6
hours ago he had a severe bout of coughing with fresh blood of about 2 glasses. (VVV)
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. Since a week ago, he felt his symptoms were worsening. (VV)
3. Physical examination :
General appearance; he looked severely sick and pale. Body height: 175 cm, body
weight: 55 kg
BP: 100/70 mmHg, HR 112 x/minute, RR : 36 x/minute temp 37,6 0C.
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.(V)
4. Additional information ;
Laboratory :
Hb ; 8,5g%, WBC : 6000/uL, ESR 65 MM/hr, diff count 0/3/2/75/15/5, Ac id Fast Bacilli
(-), HIV test (+), CD4 120/uL.
Radiology ;
Chest radiograph showed infiltrate at the right lower lung. (V)

Analisis masalah
1.

Mr.Y, a 40-year old, sailor, was admitted to hospital withhemoptoe. He complained that
6 hours ago he had a severe bout of coughing with fresh blood of about 2 glasses. (VVV)
a. Bagaimana penyebab dan mekanisme batuk darah pada kasus?nia bangsat echa ayub
b. Bagaimana hubungan jk usia dan pekerjaan dengan keluhan diatas?nia bangsat echa
c. Apa makna klinis dari batuk darah dua gelas? (tingkat keparahan)feli Miranda tari
ayub
d. Apa dampak dari batuk berdarah?feli Miranda tari

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. Since a week ago, he felt his symptoms were worsening.
a. Bagaimana penyebab dan mekanisme dari ?
1.
Batuk produktif indro alex sindih ayub
2.
Subfebris indro alex sindih
3.
Nafsu makan berkurang mita butet dea ayub
4.
Penurunan BB cepat mita butet dea
5.
Sesak nafas mita butet dea
b. Mengapa semua keluhan bertambah parah sejak seminggu yang lalu? Mita butet dea
ayub
c. Bagaimana hubungan antar gejala pada kasus?indro alex sindih ayub
d. Apa saja organ yang terganggu pada kasus ini ? jelaskan! Indro alex sindih
3. Physical examination :
General appearance; he looked severely sick and pale. Body height: 175 cm, body
weight: 55 kg
BP: 100/70 mmHg, HR 112 x/minute, RR : 36 x/minute temp 37,6 0C.
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? Nia bangsat echa ayub
b. Bagaimana mekanisme abnormal dari pemeriksaan fisik? Nia bangsat echa ayub
c. Bagaimana perhitungan nutrisi yang seharusnya diberikan pada Tn.Y? feli Miranda
tari
d. Apa hubungan riwayat tato pada dada dengan kasus?feli Miranda tari
e. Mengapa lymphadenopathy nya terjadi di leher kanan? Feli Miranda tari
f. Bagaimana hubungan adanya lymphadenopathy dan stomatitis pada kasus?feli
Miranda tari
g. Bagaimana gambaran histopatologi dari TB? Mita butet dea

4. Additional information ;
Laboratory :
Hb ; 8,5g%, WBC : 6000/uL, ESR 65 MM/hr, diff count 0/3/2/75/15/5, Ac id Fast Bacilli (-),
HIV test (+), CD4 120/uL.
Radiology ;
Chest radiograph showed infiltrate at the right lower lung.
a. Bagaimana interpretasi pemeriksaan laboratorium? Mita butet dea
b. Bagaimana mekanisme abnormal? Mita butet dea

c. Mengapa di gambaran radiologi terlihat infiltrasi di lobus kanan bawah? Feli Miranda
tari
d. Mengapa pada pemeriksaan fisik di dapat moderet rales pada right upper lung
sedangkan pada pemeiksaan radiologi didapatkan infiltrate pada lobus kanan bawah?
e.
f.
g.
h.

(SEMUANYA NYARI)
Mengapa WBCnya normal padahal dia infeksi? Nia bangsat echa
Apa indikasi pemeriksaan CD4? Nia bangsat echa
Bagaimana mekanisme pertahanan tubuh pada kasus? Indro alex sindih
Kenapa BTAnya negative? Indro alex sindih

Hipotesis
Mr.Y 40th menderita HIV (+) dengan komplikasi TB paru dan TB ekstra paru
1. Bagaimana cara menegakan diagnosis pada kasus? Indro alex sindih
2. Apa daiagnosis banding pada kasus? Indro alex sindih
3. Pemeriksaan penunjang apa saja yang bisa menyingkirkan diagnosis banding pada kasus?
Mita butet dea
4. Apa diagnosis kerja pada kasus? Mita butet dea
5. Apa definisi diagnosis kerja pada kasus? Nia bangsat echa
6. Bagaimana epidimiologi diagnosis kerja? Nia bangsat echa
7. Bagaimana etiologi diagnosis kerja? Feli Miranda tari
8. Bgaimana faktor resiko diagnosis kerja? Feli Miranda tari
9. Bagaimana patofisiologi diagnosis kerja? Feli Miranda tari ayub
10. Bagaimana pathogenesis diagnosis kerja? Feli Miranda tari
11. Bagaimana gejala klinis diagnosis kerja? Nia bangsat echa
12. Bagaimana terapi (farmako & non farmako) diagnosis kerja? Nia bangsat echa
13. Bagaimana cara pencegahan diagnosis kerja?indro alex sindih
14. Bagaimana komplikasi diagnosis kerja? Indro alex sindih ayub
15. Bagaimana prognosis diagnosis kerja? Mita butet dea
16. Bagaimana SKDI diagnosis kerja? Mita butet dea

learning issue
1. anatomi & fisiologi saluran pernafasan FELI MITA DEA SINDIH ALEX TARI
INDRO
2. system imun(pada kasus) BANGSAT AYUB BUTET MITA NIA DEA MIRANDA
3. HIV INDRO SINDIH ALEX FELI DEA ECHA BUTET

4. TB NIA ECHA TARI MIRANDA BANGSAT AYUB