Tutor: R.B Suherman, dr., MH.

Kes, Kelompok
Problem Hipotesis Mekanisme More I don’t know Learning Issue
Info
Mr. Nana, 58 y.o - Epitaksis 1. Apa itu Epitaksis? 1. Anatomi no 2, 9
cc: Anterior 2. Tipografi, Anatomi, (Ami & Onco)
Nasal Bleeding - Ca Vaskularisasi 2. Histologi no 3
ac: Nasephary Nasopharynx? (Sharah)
- Obstruksi hidung nx 3. Histologi 3. Fisiologi no 5
kanan sejak 6 - Undifferent Nasopharynx (Nono)
bulan lalu hingga iated 4. Macam-macam 4. Case: 4, 6, 7, 12,
sekarang epidermoid dan penyebab 13, 17, 18 (Shofa,
- Tidak bisa Ca of epitaksis, patgen, Sasa, Wiwi)
bernafas lewat nasopharyn patfis, manajemen 5. Pemeriksaan&
hidung kanan x 5. Fisiologi duktus Interpretasi:
- Ada benjolan di eustasius 8,10,11,14,15,16
leher atas 6. Perbedaan (Aya, Tiwi, Kes)
- Merokok 1 epitaksis lokal & 6. Management: 19,
pack/hari selama sistemik 20 (Bahar)
20 tahun 7. DD Head & Neck 7. Patmek: BIP
Tumor (Nursol)
PE: 8. Hearing test
- Height 165 cm (pemeriksaan +
- Weight 50 kg interpretasi), torus
- Blood pressure: tubarius,
120/80 mmHg Rossenmuller
- Pulse: 72x/m fosia, neck : on
- Temp: 37oC level II, maksudnya
- Head: Head is apa, palpasi lymph
round, no mass, node N1
symetris (klasifikasinya
 Eye: emang ada
Right: vision 1, berapa)?
movement 9. Anatomi kelenjar
within normal lymph di sekitar
limit. leher!
Left: vision 1, 10. Interpretasi
movement Hearing Test apa?
within normal 11. Pemeriksaan
limit. Rhinoscopy
Pupil: round, posterior
symmetrical, 12. Pengaruh rokok
reflex +/+, No terhadap pemb.
papil edema Tumor/kanker
- EAR: bagaimana?
 Tympanic (secara molekul)
Membrane: 13. Gambaran PA yang
Left : intact, khas pada kasus ini
cone of light 14. X-Ray projection
(+) dinus tujuan &
Right : intact, jenis!
cone of light(- 15. Apa keuntungan
), retraction CT-Scan dari pada
(+) X-Ray?
 Hearing test: 16. Submentovertex x-
ray tujuannya apa?
 o Rhinne test: 17. Nasopharynx!
R(-), L(+) Gambaran PA
o Weber test : 18. Staging MN
lateralizatio meningkat, Ca
n to the Nasopharynx di
right hidung & leher
o Tympanome 19. Chemotherapy
try: Right: drug!
type C / Left: 20. Radiotheraphy
type A head & neck
21. BIP
- Nose:
 Right: Mucosa
are normal,
septum
deviation (-),
Air passage (-)
 Left: Mucosa
are normal,
mass (-),
septum
deviation (-),
air passage (+)
- Throat:
 Posterior
rhinoscopy
with
nasopharyngo
scope:
o Left: Torus
tubarius,
Rossenmulle
r fossa &
choana are
within
normal limit
o Right: mass
involving on
the right
nasopharynx
, roof and
torus
tubarius,
reddish &
uneven
surface
- Neck:
 On level II of
the right
side of the
neck we
could
palpate N1
lymph node
which 3 cm
in diameter,
 fixed, no
tenderness

Laboratory
Examination:
- Lab Results:
 CBC:
o Hb:
10gr%
- Radiology
Examination:
 Paaranasal
sinus x-ray:
mass filling
right
nasopharynx
, extended
into
posteriority
right nasal
cavity
 Submentove
rtex x-ray:
mass filling
right
nasopharynx
 Axial&coron
nal CT: mass
in right
nasopharynx
: involving
tip of as
petrosum &
foramen
lacerum.
Biopsy was taken
from the right
nasopharynx
mass under local
anasthesia with
the aid of a
nasopharyngosco
pe & the report
was:
undifferentiated
epidermoid ca.

Diagnosis:
Undifferentiated
epidermoid Ca of
nasopharynx.

Internal medicine
consultation was
made to evaluate
the readiness of
the patients for
going to have
chemo
irradiation. Their
answer was that
the the patient
condition need to
be improved.

The patient have

chemotheraphy &
irradiation 6000
Rad.