TUTORIAL 1

PAGE 1

Mr. Andi, 42 years old, came to dr. William, a general practitioner, with the chief complaint
of chest pain of 3 days duration. It is a sharp knife like pain in the right chest which occurs
on breathing. There was no radiation of the pain and no history of prior trauma. He also
complains that the is “too tired and breathless if I am doing some moderate activities” and
has been coughing up thick phlegm for more than 4 weeks. Sometimes he coughs out blood.
“I have poor appetite and lost about 2 kg weight over the past month”. He is a smoker with
2 packs of cigarette/ day since 3 years ago

1. What are the problems?

2. What hypothesis could you make?

3. What further information do you need

PAGE 2

On physical examination, blood pressure was 120/80, respiratory rate 30 times/ minute,
pulse rate 110x/min, regular temperature was 37,2OC. The conjungtiva looked pale. On
chest examination dr William found right hemithorax is larger than the left one. There was
decreased tactile fremitus and dullness to percussion on the right side below the 7th
intercostal space. Right vesicular breath sound were decreased and he found crackles on the
apex of the right lung.

1. What are the positive signs that you can find?

2. What further information do you need?

PAGE 3

Lab shows everything is normal but ESR (high), WBC (high), RBC (low) and Hb (low)
1. What are ESR, Hb, WBC, and RBC and what do they indicate?

2. What kind of examination do you need to perform?

TUTORIAL 2
PAGE 1

Tuberculin test showed redness and induration 16mm in diameter. Sputum examination for
acid test bacilli were positive three times. Radiologic imaging of the chest shows sign of
tuberculosis and pleural effusion in left lung.

1. What is the interpretation of tuberculin test result? What is the interpretation of

sputum result?

2. What is the signs and symptoms Tuberculosis?

3. What causes Tuberculosis?

4. What is Pleural Effusion?

PAGE 2
dr. Deni assumed that the pleural fluid is related to the lesion which was seen on chest X
ray. She decided to treat the patients for six month and advised him to take the following
medications: Pyrazinamide (500 mg 1x2), Rifampicin (450 mg 1x1), Ethambutol (500 mg
1x2), Isoniazid (300 mg 1x1) for 2 weeks and has to come back for follow up.

1. Why give this treatment?

2. What are the functions of the drugs?

3. What are the preventive measures of Tuberculosis?

EPILOGUE

Mr. Andi continued taking his medicine regularly for 6 months. There was clinical
improvement. There was no more coughing, chest pain as well as breathlessness improved
and he began to notice weight gain. The results of sputum for AFB is still negative and the
chest X ray showed some fibrosis in both upper lung fields. Doctor Deni confirmed that Mr
Andi was doing well and encourage him to eat a good diet and look after his health.