RESPONSI DOKTER MUDA

Cases:
Psoriasis Vulgaris
MH
Pitiriasis Rosea
DISUSUNOLEH :
AMANDA TRILANA 011211131004
ADELIAANGGASTAADZHANI 011211131041
PUTUDWIPAKRISNA DEVI 011211132075
ARDYA PRATAMA KOESHERDOYO 011211132004
DICKYTEGUHPRAKOSO 011211132005
FIESTYOANNISA S. 011211133079
AMALIA MARTINI M. 011211133083

PEMBIMBING
PROF. DR. INDROPOAGUSNI, DR., SPKK (K)
 Case 1:
Psoriasis Vulgaris
 CASE1 – Psoriasis Vulgaris

I. PATIENT IDENTITY
Registration NO. :12. 15. 22. 29
Name:Mrs. SS
Sex :Female
Age : 50Years
Address :Waru
Religion : Islam
Ethnicity : Javanese
Date of Examination :21st of September, 2016
II .Basic Data
Anamnesis
Chief Complaint
Red blotches

History of Current Illness

The patient came, complaining of red elevated blotches of skin since
5 months. The blotches are round/oval shaped with a diameter of over 1cm.
The patient reported that it started to appear on the elbows, knees chest,
and face, then spread to the rest of the body. When the blotches first
appeared on the patient’s face, the blotches on the left and ride side of her
face werenot the same. The blotches are itchy, warm, and thick without
pain. The skin peels off and bloody blotches appear if the patients
scratches.
They are also affected by sunlight, causing them to get redder The skin feels
dry, and the patient’s fingernails look dark and cloudy. The patient also
complains of joint pain on her fingers and toes, hair loss, a dry head that
flakes when scratched and has recently had a fever of about 38 degrees
Celsius. Patient denies having and oral ulcers. Previously, she was a patient
from RS Sidoarjo. The patient complains of difficulty in breathing when
stressed, sometimes has headaches, palpitations, and has had white vaginal
discharges since her menopause that are not itchy. The patient sleeps
without using pillows. Patient also reports that one day before the
examination, she had red bloody stools. Urination within normal ranges.
History of Past Illness
- History of hospital stay twice on July of 2012 for 1 month and
on October of 2012 for also one month with the diagnosis,
Psoriasis Vulgaris
- Endoscopy and colonoscopy 2x at RS Haji, indication:
hematemesis and melena
- History of vertigo (+)
- History of kidney stones (+) > cured through drug therapy and
drinking healthy
- History of fatty liver (+) since before 2012
- History of teeth caries (+)
- History of high uric acid levels
- DM (-), HT (+), food/drug allergies (-)
History of Familial Illness
No family member with similar illness

Sosial History
- The patient spends her days as a housewife, rarely
exercises, smoking (-), consumption of alcohol (-),
use of herbal medicine (+)
Physical Examination
Status Generalis
General State: Good, compos mentis, GCS 4-5-6
Vital Sign :
Blood Pressure : 130/80 mmHg
Pulse Rate :104x/menit
Respiratory rate :20 x/menit
Temperature : 36,8o C
K/L : a- / i- / c- / d-
Thorax :Symetrical, Retraction -/-, Usage of secondary respiratory muscle -/-Cor :
S1, S2 single, regular, gallop-, ekstrasistole-,murmur-
Pulmo :Vesikuler/vesikuler, rhonki -/-, wheezing -/-
Abdomen :Simetris, BU(+) N, Soepel, flat, hepar / lien not palpable
Extremity :Acral HKM, CRT < 2”, edema -/-

Status Lokalis
1.) Regio :generalisata
Efloresensi :makulaeritematuswith clear boundaries, erosion and thick squama
2.) Regio : scalp
Efloresensi :skuama (+)
3.) regio : manus et pedis D et S
Efloresensi :skuama (+)
4.) Regio :lingula
Efloresensi : geographic tongue (-)
PemeriksaanPenunjang :

Clinical Lab Test: Hematologic Testing:

SGOT: 35 WBC: 9,7
SGPT: 49 Neu%: 72,7
Creatinin: 0,73 Lym%: 20,3
BUN: 10 Mono%: 5,01
Natrium: 139 Eos%: 1,39
Kalium: 4,1 Baso%: 0,61
Chlorid: 104 RBC: 4,98
HGB: 14,3
HCT: 45,8
MCV: 92
MCH 28,8
MCHC: 31,3
PLT: 261
Problem List

 Round, red, elevated blotches on skin  History of hospital stay twice on July of
(Diameter>1cm) 2012 for 1 month and on October of
 Peeling skin, followed by bloody 2012 for also one month with the
blotches diagnosis, Psoriasis Vulgaris
 Blotches increasing in amount (started  History of maintenance in RS Sidoarjo
from elbows and knees to the whole  History of uncontrolled HT
body)  History of cardiomyopathy 21 years ago
 Blotches are itchy, warm, and thick  History of hospital stay twice on July of
without pain 2012 for 1 month and on October of
 Blotches become redder when exposed 2012 for also one month with the
to sunlight diagnosis, Psoriasis Vulgaris
 Dry skin  Endoscopy and colonoscopy 2x at RS
 Patient’s fingernails look dark and Haji, indication: hematemesis and
cloudy melena
 Joint pain on fingers and toes  History of vertigo (+)
 Difficulty breathing  History of kidney stones (+) > cured
 Fever through drug therapy and drinking
healthy
 Palpitation  History of fatty liver (+) since before
 Headache 2012
 Bloody stool  History of teeth caries (+)
 Vaginal discharge  History of high uric acid levels
V. DIAGNOSIS:
Psoriasis vulgaris + HT stage 1 JNC VII

VI. Differential Diagnosis:

- Pityriasisrosea
- Morbus Hansen
- TineaCorporis
- Dermatitis seboroic

VII. Initial Plan

Diagnosis :Histopathology
Therapy : - Cetirizine tab. 1 x 10mg
- MTX 3 intervals of 12 hours for 2 cycles
- Folic acid 2x1 during the resting phase
- Dexamethasone 0,25% cream
- Amlodipin 1x10 mg p.o
 21 September, 2016
R/ Cetirizine tab 10mg No. XXI
 3 dd I
R/ Methotrexate 2mg No. XV
 2-2-2 tab 1 (12 hour interval)
R/ Folic acid tab 1mg No. X
 2dd tab I
R/ Dexamethasonecream 0,25% No. I
u e
R/ Amlodipine tab 10mg No. VII
 1ddtab I
Monitoring: Patient’s complaint
and healing progress.
Education:
 Explaining about the patient’s
condition, plan of treatment,
prognosis, and possible
complication
 Imploring the patient to take
the prescribed medicine
regularly
 Educating the patient to not
manipulate the lesion by
scratching or peeling it.
DOCUMENTATION
 Case 2:
Morbus Hansen Multibasiler type
+ Type II Reaction
Case 2: Morbus Hansen Multibasiler type + Type
II Reaction

I. IDENTITY
Name : Mr. TI
Gender : Male
Age : 32 years-old
Marital status : Married
Religion : Islam
Address : Rungkut Tengah III, Surabaya
Job : Employee
DMK Number : 12 53 40 75
Date of Examination : 22nd of September 2016
ANAMNESIS
Main Complent: Wound on the left foot

History of present illness:

Patient comes complaining about a wound on his left foot since
eight days before going to the hospital. The wound is
accompanied by red blotches that started appearing on the feet
and hands, belly, then spreading to the entire body. The patient
also complains about numbness on the bottoms of both his feet.
The patient’s right foot has swollen and is painful if used to walk
since 8 months and has gotten worse since 7 days. The patient
also reports of stiffness of both hands and feet and having a
fever that goes up and down since 8 days and is unaffected by
paracetamol and amoxicillin, and also thinning of eyebrows
since 8 months after receiving MH treatment. The patient also
complain of headaches and weakness The patient does not
complain about itchiness, numbness of the ears, cough,
congestion, or pain. Palpitation (-), difficulty breathing (-), teeth
cavities (-)
 Past medical history: - it started as a small wound
because of a metal nail that became a scab, then
enlarged and became numb, itchiness (-), pain (-).
The patient went to a clinic 2 years ago and was
checked positive for MH, then was given therapy
for 1 year. After a year the patient got checked
negative for MH
 - DM (-), HT (-), Drug allergy (+) (forgot the name
of drug)
 Family history of disease: There is no families who
have complaints such as patient.
PHYSICAL EXAMINATION
 Generalis status
 General conditions : good enough, compos mentis, GCS 4-5-
6
 Weight 50kg ; Height 150 cm
 Vital Sign :
 Blood Pressure : 120/ 80 mmHg
 Heart rate : 100 x/menit
 Respiratory rate : 20 x/menit
 Temperature : 36,5o C
 K/L : a- / i- / c- / d-
 Thorax : symmetric, retraction -/-
 Cor : murmur -, gallop -
 Pulmo : Vesikuler/vesikuler, rhonki -/-, wheezing -/-
 Abdomen : Soepel, flat, BU(+) N, hepar / lien impalpable
 Extremity : Akral HKM, CRT < 2”
 Localis status
Regio : Facialis, extremitas superior
inferior D/S, abdomen, thoracalis
anterior posterior
Efloresensi : Eritematous macula,
unclear borders with a variant
diameter 2-5cm, anesthesia (+),
Amount > 5
SUPPORT EXAMINATION
 Hematologi (18/9/2016)  KK (18/9/2016)
o WBC : 14.5 (↑) o BUN : 6 (↓)
o RBC : 4.43 o K Serum : 0.63
o Hb : 11.3 (↓) o Albumin : 3.3 (↓)
o HCT : 35.2 (↓) o SGOT : 34
o MCV : 79.5 (↓) o SGPT : 24
o MCH: 25.5 (↓) o Na : 128 (↓)
o MCHC : 32.1 o K : 3.5
o Plt : 402 o Cl : 93 (↓)
o Neut % : 69.5
o Lymp % : 22.2 (↓)
o Mono % : 6.4
o Eos % : 1.4
o Baso % : 0.5
PROBLEM LIST
 Wound on left foot
 Red blotches (entire body)
 Numbness in both feet
 Right foot swollen and painful
 Fever
 Madarosis
 History of MH treatment for one year
 Lethargy and headaches
 Teeth cavities (+)
 Drug allergy (+)
 History of anti pain medication (+)
DIAGNOSIS:
 Morbus Hansen Multibasiler + Type II Reaction +
RFT

DIFFERENTIAL DIAGNOSIS:
 Dermatofitosis,
 Psoriasis vulgaris,
 Contact dematitis,
 Pityriasis rosea
 Surabaya, 21st March 2016
Monitoring :
R/ Methylprednisolon tab 4 mg No. VI  Complaint
 1 dd tab II  Vital sign
 Effectiveness and side
effect of the therapy
Pro: Mr. TI/ 32 years-old/ Education:
Surabaya
 Enough rest
 Routinely take
medication
 Explain that this disease
may relapse
 CASE 3:
Ptyriasis Rosea
 CASE 3: Ptyriasis Rosea

I. Patient Identity
Registration Number : 12 52 85 32
Name : Mr. CA
Sex :Male
Age :17Years
Address :Bangkalan
Occupation :Student
Religion : Islam
Ethnicity : Madura
Examination date : 23rd of September, 2016
II. Basic Data
 Anamnesis

Chief Complaint:
Itchiness

History of Current Illness

The patient complains about itchiness since 4 months ago. It
started below the chin in the form of a red blotch, and spread
to the neck, upper chest and back with a variation of sizes.
Itchiness is sometimes accompanied by a burning sensation.
Itchiness increases when sweating. Patient treats her
condition with “minyaktawon” but does not get better. Patient
denies history of using new clothes or old clothes that have
not been washed.
 History of Past Illness
 No history of past illness relevant to the suspected
diagnosis
 Drug/food allergies (-), asma (-), History of self therapy
(+) minyaktawon, kalpanax, kanesten, “bumbulaos”
 History of Familial Illness
 No Family or coworker with history of similar illness
around her.
 Social History
 Highschool student, hobby of swimming 3x a week,
smoking (-), alcohol (-)
Physical Examination

 Status Generalis :
General State: Good, compos mentis, GCS 456
Vital sign : Within normal limits
K/L : a- / i- / c- / d-
Thorax : simetris, retraksi -/-
Cor : S1, S2 tunggal, murmur -, gallop
Pulmo :Vesikuler/vesikuler, rhonki -/- , wheezing -/-
Abdomen :Soepel, flat, BU(+) N, hepar/ lien not palpable
Ekstremitas : Akral HKM
Gizi : Good

 Status Lokalis
Regio :Submandibula, colli, thoracalis anterior posterior
Efloresensi :Makulaeritematous, clear borders, active borders, thin
squama (+)
III. Supporting Examination
 KOH (-)

IV. Problem List:

 Itchiness
 Red blotches
 Burning sensation, especially when sweating
 Hobby of swimming 3x a week
VI. Diagnosis
 PityriasisRosea
VII. Differential Diagnosis:
 Dermatitis seboroic
 Tineacorporis
 Psoriasis vulgaris
VII. Initial Plan
 Diagnosis :-
 Terapi : - Cetirizine 1 x 10mg P.O.
- salicyl talk 2%
- momethasonefuroat 0,1%
R/ Cetirizine tab 10 mg No. V
Monitoring:
 1 dd tab I
 Complaint
 Vital sign
R/ Salicyltalk 2% No. I  Effectiveness and side
u e ( after shower ) effect of the therapy
Education :-
R/ Momethasonefuroat 0,1% No. I  Enough rest
u e  Routinely take medication
 do not scratch
Pro: Mr. CA/ 17 years-old/
 Explain that this disease
Madura
may relapse
Thankyou 