PROBLEM BASED LEARNING (PBL)

6th Semester

CASE SECTION

MKK PULMONOLOGI
& KEDOKTERAN

RESPIRASI Session 1

Faculty of Medicine
Universitas Brawijaya
TA 2023/2024
Scenario:
Diesel and Dust

Bagus is a GP in a Town in Sulawesi, and see Mr. Andi Agam, one Saturday morning.
He is a 46-year-old plant operator at the open-cut mine, and says 'Sorry to bother you
about this, Doc. My wife’s been on at me for ages to come and see you, but you know
what a worrier she is. I’m just here to keep the peace. I get a bit short of breath
sometimes, not much really. I just put it down to not being 20 anymore. I suppose the
middle age spread doesn’t help, does it?'
Bagus asks Mr. Andi Agam when he gets short of breath, and he says that it is only
when he works hard, 'like changing the tire the other day – I haven’t had to do that for
ages. I had to rest a couple of times. I was pretty well buggered for the rest of the day.
Same thing happened last week when I dug some new garden beds'.

History
Bagus asks Mr. Andi Agam some specific questions about his recent health and the
history is clarified. He has been having some breathlessness on exertion for about
eighteen months. He thinks it is fairly constant but never happens at rest and never
disturbs his sleep. He said that he often heard wheeze sound when he breathe. He has
had a cough for as long as he can remember, worst in the mornings, but also
periodically during the day. He brings up 'about a teaspoon' of brownish sputum
during his morning coughing but He has never coughed up any bright blood.
He has gradually gained weight (about 10 kg) over the last three or four years. He
puts this down to a less active job.
Bagus reviews his history: Smokes: 30–40 cigarettes a day since his late teens;
Alcohol: 4 pots of beer on Friday nights
Past medical history: usually has 'bronchitis' each rainy season, requiring one or two
courses of antibiotics. No other past history of note. Family history: nil of note.
Occupational history: He has worked in the mining industry since the age of 16 years,
in Papua, and currently in South Sulawesi for 12 months. He has never worked
underground. When not working in the mining industry, he has done contracting
work for councils or builders. He has had occupational exposure to gold, silver and
copper – although mostly to 'diesel and dust!' he says. To his knowledge he has
never been exposed to uranium, asbestos or nickel.

Learning Resources

1. Grippi M A, Elias J A, Fishman J A, Kotloff R M, Pack A I, Senior R M, Fishman’s Pulmonary

Diseases and Disorders, 6th Edition, Department of Medicine Pulmonary, Allergy, and
Critical Care Division Perelman School of Medicine at the University of Pennsylvania Chief
Medical Officer, GSPP Specialty Hospital Philadelphia, Pennsylvania, 2022.
2. Pedoman Diagnosis & Penatalaksanaan Penyakit Paru Obstruktif Kronik (PPOK) di
Indonesia. Pokja PPOK Perhimpunan Dokter Paru Indonesia, 2020
3. Global Strategy For Prevention, Diagnosis And Management Of Copd: 2023
4. Increasing Serum Levels of Nephronectin Based on Exposure Duration of Marble Dust in
Industry Workers, J Akbar, T Astuti, NPP Putra, FI Sari, Jurnal Respirologi Indonesia 43
(1), 50-57
5. Silica Dust Exposure Duration and Increasing of TGF-β1 Serum Level in Marble Industry
Workers, NM Rini, TW Astuti, NPP Putra, International Journal of Scientific and Research
Publications.
6. Edukasi Faktor Resiko Penyakit Paru, Perilaku Hidup Bersih dan Sehat pada Pekerja
Sampah, TW Astuti, FI Sari, Z Dini, RD Anggraeni, Jurnal Pengabdian Dharma Wacana 4
(3), 220-232
7. Edukasi Risiko Asap Rokok Lingkungan pada Pekerja Industri Marmer, TW Astuti, NP
Putra, FI Sari, NM Rini, J Akbar, Jurnal Pengabdian Dharma Wacana 3 (2), 170-178
8. Edukasi Risiko Asap Rokok Lingkungan pada Pekerja Pasar Burung, T Astuti, GA Duta,
FI Sari, ZZ Firmansyah, Journal of Scientific and Social Community Service 1 (1), 12-20