1. Elzan Zulqad Maulana 2. Al-Amirah Zainab 3. Helen 4. Intan Fajrin Karimah 5. Muthiah Ramadhina 6. Achmad Randi Raharjo 7.

Muhammad Tata Suharta 8. Yesi Eka Molita 9. Michael Sintong Halomoan P 10. Abdur Rozak 11. Stefen Agustinus 12. Inthan Atika 13. Elmo Saviro H

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Skenario

Mr. x, a 30 year old truck driver, was

admitted to hospital with massive hemoptoe. He

complained that 6 hours ago he had severe bout of coughing with fresh blood of about 3 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 : 70kg), 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 : 170cm, body weight : 50kg BP: 100/70mmHg, HR : 110x/minute, RR : 36xminute, temp 37,8oC. There was a tattoo on the left arm 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.

Laboratory : Hb : 8 g%, WBC : 7.000/L, ESR 70 mm/hr, Diff Count : 0/3/2/75/15/5, acid Fast Bacili : (-), HIV test (+), CD4 140/ L

Radiology : Chest radiograph show infiltrate at right upper lung

Klarifikasi istilah 1. Massive Hemoptoe : batuk darah 100-600ml dalam 24 jam 2. Coughing : refleks fisiologi karena adanya benda asing di saluran pernafasan 3. Phlegm : mucus kental yang dieksresikan saluran pernafasan dalam jumlah yang abnormal 4. Fever : kenaikan suhu tubuh diatas normal, lebih tinggi dari 37,5o C 5. Lymphadenopathy : penyakit kelenjar limfe 6. Stomatitis : peradangan umum pada mukosa mulut 7. Vesicular sound : memiliki frekuensi bunyi yang rendah, seperti bunyi nafas normal pada paru selama ventilasi 8. CD4 : sel T tipe yang membantu fungsi imun T helper

Identifikasi Masalah 1. Mr. x, a 30 year old truck driver, was admitted to hospital with massive hemoptoe. He complained that 6 hours ago he had severe bout of coughing with fresh blood of about 3 glasses

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 : 70kg), and shortness of breath. Since a week ago, he felt his symptoms were worsening. 3. Physical examination : General appearance : he looked severely sick and pale. Body height : 170cm, body weight : 50kg BP: 100/70mmHg, HR : 110x/minute, RR : 36xminute, temp 37,8oC. There was a tattoo on the left arm 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. 4. Laboratory : Hb : 8 g%, WBC : 7.000/L, ESR 70 mm/hr, Diff Count : 0/3/2/75/15/5, acid Fast Bacili : (-), HIV test (+), CD4 140/ L 5. Radiology : Chest radiograph show infiltrate at right upper lung Analisis Masalah 1. Mr. x, a 30 year old truck driver, was admitted to hospital with massive hemoptoe. He complained that 6 hours ago he had severe bout of coughing with fresh blood of about 3 glasses a. Apa etiologi massive hemoptosis ? 1,2,3 b. Bagaimana mekanisme dari massive hemoptosis? 4,5,6 c. Apa makna dari batuk berdarah sebanyak 3 gelas pada 6 jam yang lalu? 7,8,9 d. Apa hubungan pekerjaan, jenis kelamin, umur dengan keluhan Mr.X ? 10,11,12 e. Apa penyakit yang gejalanya hemoptysis ? 13,1,3

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 : 70kg), and shortness of breath. Since a week ago, he felt his symptoms were worsening. a. Etiologi : a. Productive cough with phlegm 2,4,6 b. Mild fever 5,7,9

c. Loss of appetite 8,10,12 d. Rapid loss of body weight 11,13,1 e. Shortness of breath 2,3,4 b. Mekanisme : a. Productive cough with phlegm 5,6,7 b. Mild fever 8,9,10 c. Loss of appetite 11,12,13 d. Rapid loss of body weight 1,3,5 e. Shortness of breath 2,4,6 c. Apa hubungan gejala dengan keluhan utama? 7,9,11 d. Mengapa gejalanya tambah parah sejak seminggu yang lalu? 8,10,12

3. Physical examination : General appearance : he looked severely sick and pale. Body height : 170cm, body weight : 50kg BP: 100/70mmHg, HR : 110x/minute, RR : 36xminute, temp 37,8oC. There was a tattoo on the left arm 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. Interpretasi dan mekanisme abnormal : General appearance : he looked severely sick and pale 13,1,2 Body height : 170cm, body weight : 50kg 3,4,5 BP: 100/70mmHg 6,7,8 HR : 110x/minute 9,10,11 RR : 36xminute 12,13,1 temp 37,8oC 2,4,6 There was a tattoo on the left arm and lymphadenopathy of the right neck 3,5,7 Stomatitis 8,10,12 In chest auscultation there was an increase of vesicular sound at the right upper lung with moderate rales 9,11,13 b. Apa hubungan tattoo dengan keluhan yang dialami? 1,2,3

4. Laboratory : Hb : 8 g%, WBC : 7.000/L, ESR 70 mm/hr, Diff Count : 0/3/2/75/15/5, acid Fast Bacili : (-), HIV test (+), CD4 140/ L a. Interpretasi dan mekanisme abnormal ? Hb : 8 g% 4,5,6 WBC : 7.000/L 7,8,9 ESR 70 mm/hr 10,11,12 Diff Count : 0/3/2/75/15/5 13,1,5 acid Fast Bacili : (-) 2,6,12 HIV test (+) 3,7,9 CD4 140/ L 4,8,10

5. Radiology : Chest radiograph show infiltrate at right upper lung a. Interpretasi dan mekanisme abnormal? - Chest radiograph show infiltrate at right upper lung 11,13,1 b. pada kondisi apa saja ditemukan infiltrate pada pemeriksaan radiologis? 2,3,4

Hipotesis Mr. x, seorang supir truk yang berumur 30 tahun didugamengidap TB paru yang merupakan komplikasi dari HIV. Template : a. DD 5,6 b. WD 7,8 c. Epidemiologi 9,10 d. Patofisiologi11,12 e. Etiologi 13,1 f. Sign and symptoms 2,3 g. Tatalaksana 4,5 h. Pencegahan 6,7

i. Komplikasi 8,9 j. prognosis 10,11 k. KDU12,13

LEARNING ISSUES 1. Anatomi dan Fisiologi Sistem Pernafasan 1,3,5,7 2. TB Paru 2,4,6,8 3. HIV 9,10,11,12,13