Professional Documents
Culture Documents
TABLE OF CONTENTS
Page
Table of Contens
Introduction
Curriculum
Facilitators
Important Informations
Self Assessment
Assessment Method
14
Learning Programs
19
Curriculum Map
50
INTRODUCTION
The medical curriculum has become increasingly vertically integrated, with
stronger basic concept and support by clinical examples and cases to help in the
understanding of the relevance of the underlying basic science. Basic science
concepts may help in the understanding of the pathophysiology and treatment of
diseases. Respiratory system and disorders block has been written to take account
of this trend, and to integrate core aspects of basic science, pathophysiology and
treatment into a single, easy to use revision aid.
The respiratory system consists of a pair of lungs within the thoracic cage. Its
main function is gas exchange, but other roles include speech, filtration of
microthrombin arriving from systemic veins and metabolic activities such as
conversion of angiotensin I to angiotensin II and removal or deactivation of
serotonin, bradykinin, norepinephrine, acetylcholine and drugs such as propranolol
and chlorpromazine. So this block will discuss about anatomy, histology, symptom
and signs of lung disease and its pathophysiology, major upper respiratory diseases,
major lung diseases, major pediatric lung disease, and basic principle concept to
education, prevention, treatment and rehabilitation in respiratory system disorder in
patient, family and community.
The learning process will be carried out for 6 weeks (27 working days) starts from
17th of March 2014 as shown in the time table. The final examination will be
conducted on 28th of April 2014 in the form of MCQ. The learning situation include
lecture, individual learning, small group discussion, plenary session, practice, and
clinical skill.
Most of the learning material should be learned independently and discuss in
SGD by the students with the help of facilitator. Lecture is given to emphasize the
most important thing of the material. In small group discussion, the students gave
learning task to lead their discussion.
This simple study guide need more revision in the future, so that the planners
kindly invite readers to give any comments and critics for its completion. Thank you.
Planners
Faculty of Medicine Udayana University,DME
CURRICULUM
RESPIRATORY SYSTEM AND DISORDER
Aims :
Learning outcomes:
Concern about the size of problem and diversity of respiratory disease in the
community
Able to describe the structure and function of the respiratory system
Able to interpret the result of examination (physical, laboratory, function test,
blood gas analysis and chest imaging)
Able to explore patients with respiratory problem (runny nose, cough, dyspnea,
non cardiac chest pain, hemoptysis)
Able to manage major upper respiratory diseases (tonsillitis, rhinitis, sinusitis)
Able to manage major lung diseases (TBC, asthma, COPD, lung cancer,
pneumonia, occupational lung disease, pleural disease) on patient, family and
community
Able to manage major pediatric lung disease (bronchiolitis, TB, asthma)
Able to implement DOTS program against TB
Able to implement the strategy of smoking cessation, especially in patient with
respiratory disease
Curriculum contents:
PLANNER TEAM
LECTURERS
No
Department
Phone
Name
Pulmonology
08123804579
Histology
08123925104
Anatomy
0361-7864957
Biochemistry
081338776244
Paediatric Dept.
0812399533
Pulmonology
08123875075
Pulmonology
08123990362
Pulmonology
Prof.dr I Gst.Md.Aman,Sp.FK
Pharmacology
08123607874
8543948
081338770650
10
Physiology
081338505350
11
Pulmonology
08123994203
12
Thorax surgery
08123843260
13
dr.Elysanti Martadiani,SpRad
Radiology
08123807313
14
Pathology Anatomy
08123997328
15
Prof.Dr.dr. M.Wiryana,Sp.AnKIC
Anaesthesiology
0811392171
16
Paediatric
08123812106
17
Otorhinolaryngology
0813387826317
Otorhinolaryngology
08123806108
Pulmonology
08123989192
Pulmonology
085237068670
20
Pathology Anatomi
087862457438
21
Otorhinolaryngology
0811385299
18
19
~ FACILITATORS ~
Regular Class (Class A)
No
Name
Group
A3
A4
A5
6
7
8
9
10
A1
A2
A6
A7
A8
A9
A10
Venue
(2rd floor)
2nd floor:
R.2.09
2nd floor:
R.2.11
Departement
Phone
Radiology
081337165566
Interna
081916253777
Biochemistry
082144071268
2nd floor:
R.2.12
Interna
08123805344
2nd floor:
R.2.13
Andrology
081338605087
2nd floor:
R.2.14
Public Health
081337005360
2nd floor:
R.2.15
Neurology
081246751536
2nd floor:
R.2.16
Clinical
Pathology
081999450045
2nd floor:
R.2.20
Psychiatry
081916157658
2nd floor:
R.2.21
Anatomy
085792652363
2nd floor:
R.2.22
Name
dr. I Wayan Surudarma, MSi
dr. Dudut Rustyadi , Sp.F
Group
B1
B2
B3
B4
B5
B6
B7
B8
B9
Venue
(3rd floor)
2nd floor:
R.2.09
2nd floor:
R.2.11
Departement
Phone
Biochemistry
081338486589
Forensic
0818651015
Psychiatry
0816295779
2nd floor:
R.2.12
Obgyn
081558101719
2nd floor:
R.2.13
Microbiology
081339158241
2nd floor:
R.2.14
Microbiology
08553711398
2nd floor:
R.2.15
Public Health
08123816424
2nd floor:
R.2.16
Interna
08123914095
2nd floor:
R.2.20
Fisiology
08123989891
2nd floor:
R.2.21
Surgery
B10
0818484654
2nd floor:
R.2.22
TIME
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture
Independent learning
SGD
Break
Student project
Plenary session
TIME
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
CLASS B
ACTIVITIES
Lecture
Student project
Break
Independent learning
SGD
Plenary session
Lecture
Practice
Student project
Plenary session
Lecture will be held at room 402, while discussion rooms available at 3 rd floor
(room 3.09-3.17&3.19)
IMPORTANT INFORMATIONS
Meeting of the students representative
In the middle of block schedule, a meeting is designed among the student
representatives of every small group discussions, facilitators, and resource persons. The
meeting will discuss the ongoing teaching learning process, quality of lecturers and
facilitators as a feedback to improve the next process. The meeting will be taken based on
schedule from Medical Education Unit.
SELF ASSESSMENT
Self assessment of each lecture will be given after each lecture session, and will be
marked. This mark can determine whether the student pass this block or not. Any final mark
between 65 to 69 will be reconsidered with self assessments mark to see the students
status. Any student with self assessments mark more than 70 will pass this block. And for
the lower one will have to attend the remedial examination. It is important to do this self
assessment cautiously, because this activity may be your ticket to pass this block.
ASSESSMENT METHOD
Assessment in this theme consists of:
SGD
: 5%
Final Exam
: 80%
Student Project
: 15%
Final mark more than 70 considered to pass this block. Certain conditions applied for those
with final mark between 65 69. These students will be analyzed using their self
assessments mark. Students with final mark 65 69 and self assessments mark more than
70 will also considered pass this block.
TIME TABLE
REGULAR CLASS
DAY/DATE
TIME
08.00-08.15
08.15-09.00
1
Monday
Feb 16,
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
REGULAR
CLASS
Wednesday
Feb 18,
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Friday
Feb 20, 2015
09.00-15.00
08.00-09.00
Monday
Feb 23, 2015
PIC
Prof.I.B. Rai
dr.Wardana
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Histology of
Respiratory System
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Lecture 3
Class room
dr. Muliarta
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Anatomy:
1st floor
Histology:
4th floor
Class room
dr. Wardana
Disc room
Facilitator
Class room
dr. Desak
Wihandani
Lecture 1
Independent learning
SGD
Break
Student project
Plenary session
Lecture2
Physiology of
Respiratory System:
Ventilation
Independent learning
SGD
Break
Student project
Plenary session
Lecture 4
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
VENUE
Class room
Class room
Anatomy of
Respiratory System
2
Tuesday
Feb 17,
2015
ACTIVITY
Introduction
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
Independent learning
SGD
Break
Student project
Plenary session
dr. Sri
Wiryawan
dr. Desak
Wihandani
6
Tuesday
Feb 24, 2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
REGULAR
CLASS
Wednesday
Feb 25, 2015
Tuesday
Feb 26,
2015
Lecture 7
Control of
Respiratory Function
and Blood Gas
Analyzes
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Plenary session
9
09.00-15.00
08.00-09.00
10
Monday
March 2,
2015
Pathology of
Respiratory Tract
Independent learning
SGD
Break
Student project
08.00-09.00
Friday
Feb 27,
2015
Lecture 6
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture 9
Class room
dr. Desak
Wihandani
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital
Visit
Class room
Class room
dr. Winarti
dr. Winarti
Lung Defense
Mechanism
Independent learning
Practice : Physiology,
Pathology Anatomy
(PA)
Lecture 10
Pharmacological and
non pharmacological
interventions
Independent learning
SGD
Break
Student project
Plenary session
Physiology:
2nd floor
PA: Joint
Lab (4th
floor)
Class room
dr. Muliarta
Disc room
Facilitator
Class room
Prof. Aman
dr. Winarti
Prof. Aman
10
11
12
REGULAR
CLASS
Tuesday
March 3,
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Wednesday
March 4,
2015
13
Thursday
March 5,
2015
14
Friday
March 6,
2015
15
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Lecture 11
Pharmacological and
non pharmacological
interventions
Independent learning
SGD
Break
Student project
Plenary session
Lecture 12
Respiratory Imaging
Independent learning
SGD
Break
Student project
Plenary session
Lecture 13
Class room
Prof. Aman
Disc room
Facilitator
Hospital
Visit
Class room
Class room
Prof. Aman
dr. Elysanti
Disc room
Facilitator
Class room
Class room
dr. Elysanti
dr. IB
Subanada
Disc room
Facilitator
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Bronchiolitis, asthma
in children,
Pneumonia
Independent learning
SGD
Break
Student project
14.00-15.00
Plenary session
Hospital
Visit
Class room
08.00-09.00
Lecture 14
Class room
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Monday
March 9,
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
TB in children, Difteri,
Pertusis
Independent learning
SGD
Disc room
Break
Student project
Plenary session
Class room
Lecture 15
Class room
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
Independent learning
SGD
Disc room
Break
Student project
Hospital
dr. IB
Subanada
dr. Siadi
Purniti
Facilitator
dr. Siadi
Purniti
dr. Sutha,
dr. Bagiada
Facilitator
11
16
17
Plenary session
Visit
Class room
08.00-09.00
Lecture 16
Class room
Wednesday
March 11,
2015
19
Friday
March 13,
2015
20
Prof. IB Rai,
dr. Artana
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
08.00-09.00
Lecture 17
Class room
dr. Andrika,
dr, Yasa
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Pleural effusion,
Pneumothorax,
Hematothorax
Independent learning
SGD
Break
Student project
14.00-15.00
Plenary session
Hospital
Visit
Class room
08.00-09.00
Lecture 18
Class room
18
Thursday
March 12,
2015
dr. Sutha,
dr. Bagiada
Asthma,
COPD
Independent learning
REGULAR
CLASS
Tuesday
March 10,
2015
14.00-15.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-08.30
08.30-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
Independent learning
SGD
Break
Student project
Plenary session
Lecture 19
Disorder of nose, sinus
Independent learning
SGD
Break
Student project
Disc room
Disc room
Facilitator
Class room
dr.Dewa
Artika, dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
14.00-15.00
Plenary session
08.00-09.00
Lecture 20
Class room
Monday
Faculty of Medicine Udayana University,DME
dr. Andrika,
dr, Yasa
dr.Dewa
Artika,
dr. Saji
Hospital
Visit
Class room
Disorder of larynx,
Disorder of Pharynx
Facilitator
dr. Ratna,
Sp.THT
Prof.
Suardana, dr.
Dewa Artha Eka
Putra, Sp.THT
12
21
REGULAR
CLASS
March 16,
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Tuesday
March 17,
2015
Prof.
Suardana, dr.
Dewa Artha Eka
Putra, Sp.THT
dr. Muliarta
dr. Yasa
dr. Elysanti
08.00-15.00
BCS: Physical
Diagnostic of Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture,
practice, demo)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Saji
dr. Sutha
dr. Lely
08.00-15.00
BCS: Spirometry
BCS: Physical
Diagnostic of Thorax
(Pre-test, lecture,
practice, demo)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Saji
08.00-15.00
BCS: Physical
Diagnostic of Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture,
demo)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
08.00-15.00
BCS: Physical
Diagnostic of Thorax,
Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
25
Monday
March 23,
2015
Class room
08.00-15.00
24
Friday
March 20,
2015
Facilitator
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
23
Thursday
March 19,
2015
Disc room
BCS: Spirometry
BCS: WSD, Radio
Imaging
(Pre-test, lecture, demo
Practice, discussion)
22
Wednesday
March 18,
2015
Independent learning
SGD
Break
Student project
Plenary session
26
Tuesday
March 24,
2015
27
Wednesday
March 25, 2015
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Silent Day
Examination
13
TIME TABLE
ENGLISH CLASS
DAY/DATE
09.00-09.15
09.15-10.00
1
Monday
Feb 16,
2015
Wednesday
Feb 18,
2015
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
Class room
Class room
Prof.I.B. Rai
dr.Wardana
Disc room
Class room
Class room
Facilitator
dr.Wardana
dr. Sri Wiryawan
Student project
Break
Independent learning
SGD
Plenary session
Disc room
Class room
Facilitator
dr. Sri Wiryawan
Lecture 3
Class room
dr. Muliarta
Disc room
Class room
Class room
Facilitator
dr. Muliarta
dr. Muliarta
Anatomy:
1st floor
Histology:
4th floor
Class room
dr. Wardana
Disc room
Class room
Facilitator
dr. Desak
Introduction
Lecture 1
Student project
Break
Independent learning
SGD
Plenary session
Lecture2
Physiology of
Respiratory System:
Ventilation
Student project
Break
Independent learning
SGD
Plenary session
Lecture 4
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
Friday
Feb 20, 2015
10.00-16.00
Monday
Feb 23, 2015
PIC
Histology of
Respiratory System
VENUE
Anatomy of
Respiratory System
ENGLISH
CLASS
Tuesday
Feb 17,
2015
TIME
09.00-10.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student project
Break
Independent learning
SGD
Plenary session
dr. Sri
Wiryawan
dr. Desak
Wihandani
14
09.00-10.00
Class room
6
Tuesday
Feb 24, 2015
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student project
Break
Independent learning
SGD
Plenary session
Disc room
Class room
09.00-10.00
Lecture 7
Class room
Facilitator
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Class room
Class room
Facilitator
Prof. Wiryana
dr. Winarti
Control of
Respiratory Function
and Blood Gas
Analyzes
7
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
ENGLISH
CLASS
Wednesday
Feb 25, 2015
Lecture 6
Thursday
Feb 26,
2015
Lecture 8
Pathology of
Respiratory Tract
Student project
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Break
Independent learning
SGD
Plenary session
10.0016.00
Friday
Feb 27,
2015
09.00-10.00
Hospital
Visit
Disc room
Class room
Facilitator
dr. Winarti
Lung Defense
Mechanism
Independent learning
Class room
dr. Winarti
Practice : Physiology,
Pathology Anatomy
(PA)
Physiology:
2nd floor
dr. Muliarta
PA: Joint
Lab (4th
floor)
Class room
dr. Winarti
Lecture 9
Lecture 10
Prof. Aman
Pharmacological and
non pharmacological
interventions
10
Monday
March 2,
Student project
Break
Independent learning
SGD
Plenary session
10.00-11.30
09.0010.00
Wihandani
dr. Desak
Wihandani
10.00-11.30
11.30-12.00
Student project
Break
15
2015
Independent learning
SGD
Plenary session
Lecture 11
Disc room
Class room
Class room
Facilitator
Prof. Aman
Prof. Aman
Pharmacological and
non pharmacological
interventions
11
Tuesday
March 3,
2015
Student project
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Break
Independent learning
SGD
Plenary session
Disc room
Class room
Facilitator
Prof. Aman
09.00-10.00
Lecture 12
Class room
dr. Elysanti
Disc room
Class room
Class room
Facilitator
dr. Elysanti
dr. IB
Subanada
Hospital
Visit
Respiratory Imaging
12
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
ENGLISH
CLASS
Wednesday
March 4,
2015
13
10.00-11.30
Thursday
March 5,
2015
14
Friday
March 6,
2015
Lecture 13
Bronchiolitis, asthma
in children
10.00-11.30
Student project
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Break
Independent learning
SGD
Plenary session
Disc room
Class room
09.00-10.00
Lecture 14
Class room
Hospital
Visit
TB in children
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student project
Break
Independent learning
SGD
Plenary session
Disc room
Class room
09.00-10.00
Lecture 15
Class room
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host
15
Monday
March 9,
2015
Student project
Break
Independent learning
SGD
Plenary session
10.00-11.30
Student project
Facilitator
dr. IB
Subanada
dr. Siadi
Purniti
Facilitator
dr. Siadi
Purniti
dr. Sutha,
dr. Bagiada
Hospital
Visit
16
Break
Independent learning
SGD
Plenary session
Disc room
Class room
09.00-10.00
Lecture 16
Class room
Prof. IB Rai,
dr. Artana
Asthma,
COPD
16
17
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student project
Break
Independent learning
SGD
Plenary session
Disc room
Class room
09.00-09.00
Lecture 17
Class room
ENGLISH
CLASS
Tuesday
March 10,
2015
Wednesday
March 11,
2015
Thursday
March 12,
2015
Student project
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Break
Independent learning
SGD
Plenary session
Disc room
Class room
08.00-09.00
Lecture 18
Class room
19
Friday
March 13,
2015
Hospital
Visit
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-09.30
09.30-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Student project
Break
Independent learning
SGD
Plenary session
Facilitator
Prof. IB Rai,
dr. Artana
dr. Andrika,
dr, Yasa
Pleural effusion,
Pneumothorax
10.00-11.30
18
Facilitator
dr. Sutha,
dr. Bagiada
Facilitator
dr. Andrika,
dr, Yasa
dr.Dewa
Artika,
dr. Saji
Disc room
Class room
Facilitator
dr.Dewa
Artika, dr. Saji
Class room
dr. Ratna,
Sp.THT
Student project
Hospital
Visit
Lecture 19
Break
Independent learning
SGD
Plenary session
Disc room
Class room
Facilitator
dr. Ratna,
Sp.THT
17
Disorder of larynx,
Disorder of Pharynx
20
10.00-11.30
Student project
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Break
Independent learning
SGD
Plenary session
ENGLISH
CLASS
Monday
March 16,
2015
21
Class room
Lecture 20
Tuesday
March 17,
2015
dr. Muliarta
dr. Yasa
dr. Elysanti
08.00-15.00
BCS: Physical
Diagnostic of Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture,
practice, demo)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Saji
dr. Sutha
dr. Lely
08.00-15.00
BCS: Spirometry
BCS: Physical
Diagnostic of Thorax
(Pre-test, lecture,
practice, demo)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Saji
BCS: Physical
Diagnostic of Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture,
demo)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
08.00-15.00
25
Monday
March 23,
2015
Facilitator
Prof.
Suardana, dr.
08.00-15.00
24
Friday
March 20,
2015
Disc room
Class room
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
23
Thursday
March 19,
2015
BCS: Spirometry
BCS: WSD, Radio
Imaging
(Pre-test, lecture, demo
Practice, discussion)
22
Wednesday
March 18,
2015
Prof.
Suardana, dr.
08.00-15.00
26
Tuesday
March 24,
2015
Faculty of Medicine Udayana University,DME
BCS: Physical
Diagnostic of Thorax,
Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology Dept.
(2nd floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Silent Day
18
27
Wednesday
March 25, 2015
Examination
LEARNING PROGRAMS
LECTURE 1
ANATOMY OF RESPIRATORY TRACT
Abstract
dr. I Nyoman Gede Wardana, M.Biomed
The respiratory system consists of conducting zone and respiratory zone.
Conducting zone, whose walls are too thick to permit exchange of gases between the air in
the tube and the blood stream. The nostrils (nares), nasal cavity, pharynx, larynx, trachea,
bronchi, and terminal bronchioles are included in this zone. Respiratory zone, whose walls
are thin enough to permit exchange of gases between tube and blood capillaries
surrounding them. Air travels to the lungs through that zone. The right lung divided into
three lobes: superior, middle, and inferior. The left lung divided into two lobes: superior and
inferior. Each lung cover by a membrane that called pleura. Both lungs are inside the
thoracic cage. The thoracic cage is formed by the vertebral column behind, the ribs, and
intercostal spaces on other side and the sternum and costal cartilages in front. Below it
separated from the abdominal cavity by diaphragm
Learning Task
Vignette 1:
Kesawa, 32 years old, was seen in the clinic ten days ago, was diagnosed with rhinitis and
sent home with instructions for increased fluids, decongestants, and rest. Kesawa presents
today with worsened symptoms of malaise, low-grade temperature, nasal discharge, night
time coughing, mouth breathing, early morning pain over sinuses, and congestion. The
doctor diagnose he is suffering sinusitis.
1. Describe the boundaries of the nasal cavity and its blood supply
2. Describe the paranasal sinuses and its opening at nasal cavity
Vignette 2:
Gotawa, a singer-18 years old came to clinic with complain a hoarse voice for 3 days. She
also suffers sore throat, nose block, and fever. She was diagnosed laryngitis
1. Describe the structure of larynx and location of vocal cord
2. Describe the intrinsic and extrinsic muscle of larynx
Vignette 3:
Faculty of Medicine Udayana University,DME
19
LECTURE 2
HISTOLOGY OF RESPIRATORY TRACT
dr. Sri Wiryawan, MRepro
Abstract
The lower respiratory tract consists of : the lower part of the trachea, the two main
bronchi, lobar, segmental, and smaller bronchi, bronchioles and terminal bronchioles, and
last but not least is the end respiratory unit. These structure make up the tracheobronchial
tree. As for the structure distal to the main bronchi along with a tissue known as the lung
parenchyma.
There are several structure we should also understand, when talking about lower
respiratory tract. Several structures such as thorax, mediastinum, pleurae and pleural cavity,
and lung. Thorax especially thoracic cavity and thoracic wall protect our lung and
mediastinum and also play an important role in respiratory process. The mediastinum,
which has a role in protecting our heart , located between the two lungs, and contains the
heart and great vessels, trachea and esophagus, phrenic and vagus nerves, and lymph
nodes.
The pleurae covers the external surface of the lung, and is then reflected to cover
the inner surface of thoracic cavity. Pleurae divided into the visceral (lines the surface of the
lung) and parietal (lines the thoracic wall and diaphragm) one. The space between these
two pleurae called as pleural cavity which contains a thin film fluid to allow the pleurae to
slip over each other during breathing.
20
vocal fold !
II. Structure of The Lower Respiratory tract
Radha, a 17 years old beautiful girl, came to doctor Laksmi clinic with shortness of
breath, wheezing and cough with phlegm. The doctor diagnoses Radha with Asthma.
1.Describe the histological structure of the lower respiratory tracts are involved ?
2.Compare the histological structure and function between terminal bronchioles
and respiratory bronchioles !
Faculty of Medicine Udayana University,DME
21
LECTURE 3
PHYSIOLOGY OF RESPIRATORY SYSTEM: VENTILATION
dr. I Made Muliarta, MKes
Abstract
In living cells aerobic metabolism consumes oxygen and produces carbon dioxide. Gas
exchange requires a large , thin, moist exchange surface, a pump to move air circulatory
system to transport gases to cells. The primary function system are:
Vocalization.
In addition to serving these function, the respiratory system also source of significant
losses of water and heat from the lung.
Respiratory control resides in a central pattern generator, a net work of neurons in the
pons and medulla oblongata.
22
LEARNING TASK
23
2.
3.
Andi, male, 30 years old, has a puncture wound due to car accident in his right chest
and penetrate his pleural cavity. The patient has complained shortness of breathing and
doctor determine that his lung is collapsed.
a. What is this condition called?
b. Describe the mechanism of the lung collapse!
c. What kind respiratory system compensation to anticipate this condition (lung
collapse)
d. How can he still be alive in this condition?
4.
LECTURE 4
PHYSIOLOGY OF RESPIRATORY SYSTEM: GAS EXCHANGE, DIVING,
ALTITUDE
dr. I Made Muliarta, MKes
Abstract
Gas exchange during external respiration occurs in respiratory membrane. Several
factors may influence gas exchange. Daltons law and Henrys law may apply during gas
exchange.
Some physiologic responses on respiratory system at high altitude and during diving.
Some illnesses/injuries related pressure change may occurs
diving.
LEARNING TASK
dr. Muliarta, MKes
1.
2.
Describe the factors that influence oxygen diffusion from alveoli into the blood!
3.
Predict the response of the pulmonary arterioles and bronchioles when PO2 increase
and PCO2 decrease!
4.
5.
LECTURE 5
Faculty of Medicine Udayana University,DME
24
LECTURE 6
25
LECTURE 7
CONTROL OF RESPIRATORY FUNCTION
Prof. Dr. dr. Wiryana, SpAn
Abstract
When considering contol of breathing, the main control variable is P aCO2 (we try to
control this value near to 40 mmHg). This can be carried out by adjusting the respiratory
rate, the tidal volume, or both. By controlling PaCO2 we are effectively controlling alveolar
ventilation (see Ch.3) and thus PACO2. Although PaCO2 is the main control variable, PaO2 is
also controlled, but normally to a much lesser extent than PaCO2. However, the PaO2
control system can take over and become the main controlling system when the P aO2 drops
below 50 mmHg.
26
LECTURE 8
PATHOLOGY OF UPPER AND LOWER URINARY TRACT
dr. Ni Wayan Winarti, SpPA
ABSTRACT
The term upper airways is used here to include the nose, pharynx, and larynx and their
related parts. Disorders of these structures are among the most common afflictions of
humans, but fortunately the overwhelming majority are more nuisances than threats.
Inflammatory diseases are the most common disorders of the upper respiratory tract, i.e.
rhinitis, sinusitis, pharyngitis, tonsillitis and laryngitis. It may occur as the sole manifestation
of allergic, viral, bacterial or chemical insult. Although most infections are self-limited, they
may at times be serious, especially laryngitis in infancy or childhood, when mucosal
congestion, exudation, or edema may cause laryngeal obstruction. Tumors in these
locations are infrequent but include the entire category of mesenchymal and epithelial
27
Some
distinctive
types
are
nasopharyngeal
angiofibroma,
Sinonasal
28
LECTURE 9
LUNG DEFENCE MECHANISM
dr. Ni Wayan Winarti, SpPA
Abstract
Respiratory tract is an organ that constantly exposed by contaminated air. It is there
fore a small miracle that the normal lung parenchyma remains sterile. Fortunately, a
plethora of immune and non immune defense mechanisms exist in the respiratory system,
extending from the nasopharynx all the way into alveolar airspaces.
The major categories of defense mechanisms to be discussed include : (1)physical
or anatomic factors related to deposition and clearance of inhaled materials, (2)antimicrobial
peptides, (3) phagocytic and inflammatory cells that interact with inhaled materials,
(4)adaptive immune response, which depends on prior exposure to recognize the foreign
materials. Each components appears to have a distinct role, but a tremendous degree of
redundancy and interaction exists among different components.
Any condition breaks down the lung defense mechanism may result in lung injury
and respiratory tract infections
Learning Tasks
1.
Defense mechanism of the lung and respiratory tract ca be divided into four
major categories. Mention them, their components and explain how each of them
acts against foreign materials.
2.
Explain about diseases or conditions that break the lung defense mechanism
down which result in increase susceptibility to respiratory tract infections
LECTURE 10
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION I
29
LECTURE 11
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION II
Faculty of Medicine Udayana University,DME
30
LECTURE 12
RESPIRATORY IMAGING
dr. Elysanti, Sp.Rad
Abstract
The imaging investigations of the chest may be considered under the following heading:
1. Simple X- Ray.(conventional X-ray)
2. Chest screening.
3. Tomography.
4. Bronchography.
5. Pulmonary angiography.
6. Isotope scanning.
7. Computed tomography(CT-scan)
8. MRI.
9. Needle biopsy.
The conventional Chest X Ray has to diagnose the anatomical disorders of the chest for
example:
1. Lungs disease-----pneumonia, mass, atelectasis etc.
Faculty of Medicine Udayana University,DME
31
What kind of diagnosis you will consider if the imaging revealed some consolidation at
the apex of the right lung accompanied by rib destruction?
What kind of abnormality you hope to see on the chect X ray film?
LECTURE 13
BRONCHIOLITIS AND
ASTHMA IN CHILD
Dr. IB Subanada, SpA
Abstract
Bronchiolitis is an acute inflammatory disease of the lower respiratory tract
(bronchioles) caused predominantly by respiratory syncytial virus (RSV). The inflammation
response characterized by bronchiolar epithelial necrosis, bronchiolar occlusion, and
peribronchiolar collection of lymphocytes. Bronchiolus become edematous and obstructed
with mucus and celluler debris, which may lead to partial or complete collapse of the
bronchioles. By the age 2 years nearly all children have been infected, with severe disease
more common among infants aged 1-3 months.
The clinical manifestation, initially upper respiratory signs and symptoms and
followed by obstructed bronchioles signs and symptoms.
The white blood cell and differential counts are usually normal. Chest x-ray reveals
hyperinflation, peribronchial cuffing, and atelectasis.
The mainstay of therapy is supplemented oxygen with close monitoring and supportive care.
32
LECTURE 14
TB IN CHILD
dr. Ni Putu Siadi Purniti, SpA
Abstract
Tuberculosis (TB) is systemic infection cause by Mycobacterium tuberculosis
complex : M tuberculosis, M. Bovis, M. africanum, M. microti, and M. canetti. Tuberculosis
infection occurs after inhalation of infective droplet nuclei containing M. tuberculosis. A
reactive tuberculin skin test and the absence of clinical and radiographic manifestations are
the hallmark of this stage. Tuberculosis disease occurs when sign and symptoms or
radiographic changes becaome apparent. In the year 2001 prevalens rate of
TB is
5,6/100.000 population, of these, 931 (6 % ) cases occurred in children < 15 year of age
(rate 1,5/100.000 population). Transmission of M tuberculosis is person to person, usually
by airborne mucus droplet nuclei, particles 1-5 m in diameter that contain M tuberculosis.
In the United States, most children are infected with M. tuberculosis in their home by adult
33
malaise and flu like symptoms. The grandfather whom was diagnosed
pulmonary tuberculosis and she has been in recent closed contact. In physical examination
found that there were enlargement of neck lymph nodes.
Learning Resources
Nelson Textbook of Pediatrics Ed. 17 th 2004: pp 958-972
LECTURE 15
PULMONARY TB AND EXTRAPULMONARY TB
34
Objectives
1. Knowing the microbiology, epidemiology and pathogenesis of tuberculosis
35
What
should
you
do
to
ensure
the
diagnosis
of
this
patient?
2. What should you do for this patient with enlargement of gland in the neck?
3. If the sputum smear examination results - / +2 / -, what is diagnosis?
4.
Explain
the
treatment
program
appropriate
to
this
patient!
36
mellitus,
dan
penderita
yang
mendapatkan
terapi
TNF-.
Individu
immunocompromised kadang-kadang lebih rentan terhadap infeksi serius dan /atau komplikasi
dibanding orang sehat. Mereka juga lebih rentan untuk mendapatkan infeksi oportunistik, yaitu
infeksi yang biasanya tidak mengenai orang yang sehat.
Dalam keadaan penderita dengan imunokompromais, seorang dokter harus dapat mengenali penyakit
TB aktif. Diagnosis TB pada imunokompromais adalah dengan menemukan kuman BTA pada
sputum baik dengan pemeriksaan langsung BTA maupun kultur. Pengobatan TB penderita
imunokompromais sama dengan pada non-imunokompromais dan pengobatan TB-nya
diutamakan. Dokter harus mampu mengidentifikasi penderita TB pada imunokompromais
yang tidak respon (resisten) dengan obat TB, sehingga dapat melakukan tindakan lebih dini
untuk menurunkan perburukan prognosis (kematian).
Objektif
1. Mampu menjelaskan penegakan diagnosis TB pada imunokompromais
2. Mampu menyusun program pengobatan jangka panjang penderita TB pada
imunokompromais
3. Mampu mengidentifikasi
kemungkinan
gagal
respon
pengobatan
(resisten)
37
minum obat penurun panas dan obat batuk yang dibeli di warung tapi tidak ada
kesembuhan. Berat badan penderita dirasakan menurun drastis belakangan ini. Napsu
makan berkurang sehingga badan penderita dirasakan semakin kurus. Penderita adalah
seorang sopir pengangkut barang jawa bali, sudah menikah dan mempunyai anak wanita
usia 4 tahun. Sesekali penderita minum bir. Penderita mempunyai tattoo di badannya yang
dibuat sewaktu penderita klas 1 SMA.
Tugas
Diskusikan!
1. Jelaskan bagaimana Sdr memastikan bahwa pasien tersebut memang menderita TB
dan imunokompromais!
2. Mengapa TB laten menjadi reaktivasi (TB aktif)?
3. Bagaimana Sdr mengenali pasien TB imunokompromais mengalami Immune
Reconstitution Inflammatory Syndrome (IRIS)?
4. Jika ternyata pasien tersebut menderita TB dengan imunokompromais bagaimana
cara menyusun pengobatan penderita?
5. Bagaimana cara menilai respon pengobatan
TB
pada
pasien
dengan
imunokompromais?
6. Jelaskan kriteria TB pada imunokompromais!
LECTURE 16
ASTHMA
Prof. IB Rai
Abstract
38
Triger:
Anda sebagai seorang dokter yang bekerja di sebuah Puskesmas kota, datang
seorang pasien wanita, usia 36 tahun. Dia menyampaikan bahwa telah menderita
asma sejak usia remaja. Dalam 3 bulan terakhir ini, dia mengalami serangan asma
hampir setiap 3 hari , termasuk serangan di malam hari. Untungnya, kata pasien,
serangan asmanya dapat diatasi dengan obat semprot yang dia miliki. Pasien
menginginkan agar terbebas dari penyakitnya ini.
Tugas:
Diskusikan!
1. Jelaskan bagaimana Sdr. memastikan bahwa pasien tersebut memang
menderita asma!
2. Apakah asma pasien tersebut dalam keadaan terkontrol? Jelaskan!
3. Apakah inhaler yang dipergunakan oleh pasien tersebut termasuk ke dalam
kelompok pelega (reliever)? Jelaskan perbedaan fungsi antara reliever dan
controller, dan sebutkan obat-obat dari kedua kelompok tersebut!
4. Susun rencana penatalaksanaan jangka panjang pasien tersebut!
5. Apabila suatu saat pasien tersebut mengalami suatu serangan asma akut,
terapi apa yang akan Sdr. berikan?
39
LECTURE 16
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
dr. IGN Bagus Artana, SpPD
Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by airflow
limitation that is not fully reversible. COPD is the fourth leading cause of death in the world
and the number of patients is projected to increase worldwide in the future. Tobacco
accounts for an estimate of 90% to the risk of developing COPD. Patient with COPD first
complaining chronic cough with sputum and followed by dyspnea. This condition worsening
progressively until the patient unable to do his daily activities.
Treatment aim for COPD is to decrease symptom, without stopping the progression
of this disease. Prevention is more important in this condition, such as by smoking cessation
program.
Objektif:
1. Mampu menjelaskan penegakan diagnosis PPOK serta penilaian kombinasi pasien
2. Mampu menyusun rencana pengobatan pada kasus PPOK stabil
3. Mampu menangani factor risiko pasien PPOK
4. Mampu menentukan eksaserbasi akut dari PPOK
5. Mampu
menjelaskan
manajemen
gawat
darurat
pasien
dengan
PPOK
eksaserbasiakut
Kasus:
Seorang pasien laki-laki usia 70 tahun datang bersama anaknya kepoliklinik paru Rumah
Sakit Daerah tempat anda bertugas dengan mengeluh sesak nafas. Sesak nafas dirasakan
sangat berat, berpakaian pun pasien mengaku sesak. Sebelumnya pasien memang
merokok sejak usia 20 tahun sebanyak 2 pak sehari. Pasien juga mengatakan sering
opname di rumah sakit karena serangan sesak nafas yang sangat berat. Pasien dan
keluarganya ingin mengetahui dengan pasti mengenai penyakitnya serta tindak lanjut
penanganannya.
Tugas:
Diskusikanlah mengenai:
1. Jelaskan bagaimana penegakan diagnosis pasien tersebut
2. Bagaimanakan kombinasi penilaian pasien ini? Data apa saja yang saudara
perlukan untuk melengkapi kombinasi penilaian tersebut
40
anda
menyusun
rencana
penatalaksanaan
pasien
ini
secara
komprehensif?
5. Bagaimana penatalaksanaan pasien ini apabila mengalaami PPOK eksaserbasi
akut?
LECTURE 17
PLEURAL EFFUSION
dr. Putu Andrika, SpPD-KIC
PNEUMOTHORAX
dr. Yasa, SpBTKV
PLEURAL EFFUSION
dr. Putu Andrika, SpPD-KIC
Membran tipis pleura terdiri dari dua lapisan yaitu pleura visceralis dan pleura
parietalis. Penumpukan cairan melebihi jumlah fisiologis 10-20 ml disebut efusi pleura,
akibat dari peningkatan produksi yaang melebihi kemampuan absorpsi.
Penting untuk menegakkan diagnosis berdasarkan anamnesis yang baik dan pemeriksaan
fisik yang teliti, pemeriksaan radiologi torak serta melakukan pungsi pleura. Analisis cairan
pleura akan sangat berguna untuk menuntun kearah penyebab efusi pleura. Dibedakan
cairan efusi yang transudat dan eksudat.
Volume efusi pleura yang banyak akan menimbulkan
memerlukan pengeluaran cairan efusi melalui aspirasi cairan pleura (torako sentesis) atau
melalui pemasangan chest cube (Water Seal Drainage).
Dalam mengelola pasien dengan efusi selain menangani keluhan akibat menumpuknya
cairan efusi juga harus menangani penyebab terjadinya efusi tersebut.
Objektif:
1. Mampu menjelaskan penegakan diagnosis efusi pleura
2. Mampu menilai analisis cairan pleura
3. Mampu merencanakan pemeriksaan penunjang untuk mendapatkan penyebab
terjadinya efusi pleura.
4. Mampu mengidentifikasi kasus yang memerlukan penanganan segara dan
kasus yang harus dirujuk ke rumah sakit.
Faculty of Medicine Udayana University,DME
41
C, pemeriksaan torak asimetris, kanan tertinggal, perkusi redup dan suara nafas melemah
di bagian kanan bawah. Penderita juga mengeluh batuk batuk sejak 3 bulan yang lalu dan
pernah batuk berisi darah segar sedikit, juga nampak semakin kurus.
Tugas:
Diskusikan
1. Apakah kemungkinan penyebab keluhan pasien tersebut?
2. Pemeriksaan penunjang apa yang diperlukan?
3. Perlukah melakukan parasentesis? (jelaskan)
4. Perlukah pemasangan WSD, apa alasannya?
PNEUMOTORAKS
dr. Yasa, SpBTKV
Pneumotoraks merupakan salah satu kegawatdaruratan di bidang paru yang berarti
terisinya rongga pleura oleh udara. Pneumotoraks ini perlu mendapatkan perhatian serius,
karena dengan penanganan yang cepat dan tepat akan sangat mengurangi angka
kematiannya. Sebagai seorang dokter yang ada di fasilitas kesehatan primer, sangat
diperlukan pengetahuan mengenai keadaan ini.
Diagnosis pneumotoraks dapat ditegakkan dari anamnesis, pemeriksaan fisik dan foto
polos dada. Pneumotoraks dapat dibagi berdasarkan berbagai kriteria, tetapi yang paling
sering adalah dibagi menurut terjadinya (pneumotoraks artifisial, traumatic, serta spontan)
serta berdasarkan jenis fistelnya (pneumotoraks terbuka, tertutup, dan ventil).
Beberapa kondisi pneumotoraks akan sangat mengancam nyawa, sehingga memerlukan
penanganan yang tepat dan segera. Penatalaksanaan pneumotoraks pada prinsipnya
adalah mengeluarkan udara yang ada di rongga pleura tersebut, terapi penyebabnya, serta
edukasi untuk mencegah berulangnya pneumotoraks pada pasien yang memiliki risiko.
Objektif:
1. Mampu menjelaskan penegakan diagnosis pneumotoraks
2. Mampu menyebutkan beberapa penyebab pneumotoraks yang sering dijumpai
3. Mampu menjelaskan beberapa pembagian jenis pneumotoraks
4. Mampu menyusun rencana penatalaksanaan pasien dengan pneumotoraks
Kasus:
42
LECTURE 18
BRONCHITIS AND BRONCHIECTASIS
dr.Dewa Artika, SpP
LUNG CA AND SMOKING CESSATION
dr. Gede Ketut Sajinadiyasa, SpPD
BRONKITIS dan BRONKIEKTASIS
dr. Dewa Made Artika, SpP
Untuk menentukan suatu Bronkitis dan Bronkiektasis tidaklah terlalu sulit, tapi diperlukan
suatu pemahaman untuk mendiagnosis dan penatalaksanaan Bronkitis dan Bronkiektasis
dengan baik dan benar. Disamping prevalensinya cukup tinggi, penyakit ini bila tidak
ditangani dengan baik, akan berlanjut menjadi lebih parah.
Bronkitis adalah inflamasi saluran napas sentral yang mengenai mukosa ditandai oleh batuk
dengan dahak, sering disertai dengan panas dan sesak.Bronkiektasis adalah kelainan pada
dinding bronkus besar dan sedang berupa kelemahan otot sehingga terjadi pelebaran
lumen, karena proses infeksi transmural dan pelepasan mediator.
Diagnosis Bronkitis berdasarkan pada anamnesa, pemeriksaan fisik dan foto toraks,
sedang bronkiektasis ditegakkan dengan anamnesa, pemeriksaan fisik, foto toraks, CT
Scan, dan kultur sputum.
Prinsip penatalaksanaan Bronkitis dan Bronkiektasis adalah dengan menghilangkan batuk
dan produksi dahak. Bila disertai tanda infeksi dapat ditambahkan antibiotika. Pada
43
Kasus
Seorang penderita laki umur 35 th datang dengan keluhan : batuk berdahak sejak 3 bulan
dan memberat sejak 5 hari yang lalu dan disertai dengan panas badan. Bila diperhatikan
dahaknya ada 3 lapis yaitu dari atas sampai bawah mulai dari yang bening sampai keruh
dan batuknya terutama pagi hari. Dikatakan pula setahun lalu pernah menderita sakit
seperti ini dan kadang disertai sesak napas, bila dahaknya sulit dikeluarkan.
Tugas
Diskusikan
1.
2.
3.
4.
5.
6.
44
Triger
Seorang pasien laki-laki umur 65 tahun datang ketempat pratek saudara sendirian dengan
keluhan batuk berdarah. Satu minggu yang lalu pasien sempat menjalani cek up didapatkan
pada foto rontgen dada, tumor dengan ukuran diameter 2,5 cm pada hilus kiri menempel di
pinggang jantung kiri. Pada pemeriksaan USG abdomen didapatkan tumor multiple ukuran
diameter sekitar 1-1,5 cm pada hati, sedang pemeriksaan yang lain dalam batas normal.
Pasien memiliki kebiasaan merokok sejak umur 20 tahun dengan jumlah 1-2 bungkus per
harinya.
Tugas
1. Apa yang saudara lakukan untuk memastikan diagnosis pasien ini?
2. Kalau diperlukan tindakan invasive, prioritas tindakan yang saudara usulkan?
Jelaskan alasannya!
3. Bila ini kanker paru, apa kemungkinan klasifikasi histologinya?
4. Tentukan stadium pasien ini dan status performannya serta alasannya!
5. Tentukan modalitas terapinya!
LECTURE 19
DISORDERS OF NOSE AND SINUS
dr. Ratna, SpTHT
Abstract
The anatomy of the larynx consist of cart.Haginous framework bound together by
ligaments and covered with muscle and mucous membrane. The most important cartilage is
the arytenoid cartilages which is can rotate and slide on the cricoid cartilage and thus play
an important role in the movement of the vocal cords. The epiglottis is a leaf-shape cartilage
45
Throat
46
training. Misuse of the voice also happen in the schoolchildren, sometime call by
screamers node.
Vocal cord paralysis causes of dysphonia symptom, define as weakness or
even though temporary loss of the voice (aphonia). A vocal cord may paralysed by
mechanical fixation of the arytenoids or vocalis muscle or by nerve paralysis.
Paralysis may be unilateral or bilateral and the cords paralysed in abduction or
adduction. Abduction paralysis causes loss of the voice because the cord can not
move to the midline position and adduction paralysis, the cords can not move to the
lateral position and cause severe stridor.
Larengeal papilloma is a benign lesion single or multiple, non keratinizing
papilloma in characteristic is due by infection of human papilloma virus type 6 and
11. Papillomatosis present more frequently in children than in adult, the peak
incidence occurring between 2 and 5 years of age, and very common of high
recurrent. Relaps or recurrent may be precipitated by trauma or immunosuppressive
condition.
Gastrolaryngeal reflux is very common condition to causes hoarseness. The
pathology of gastro-esophageal-laryngeal reflux disease may be a result of direct
effect of gastric acid, bile salts or enzymes on mucosa of the larynx.
Learning Tasks
1. Describe and discuss of specific symptoms of the larynx disease & disorders.
2. Describe and discuss etiology and patophysiology of hoarseness, dysphonia and
stridor with its clinical implication
3. Manage and provide initial management or refer patient with certain larynx
disease and disordes
References
1. Textbook Diseases of the Ear, Nose and Throat edited by Martin Burton
CHURCHILL LIVINGSTQNE 15TH ED 2000: Section 5 The Larynx, Pharynx
and Oesophagus. Pp 165-206
2. Textbook Current Medical Diagnosis & Treatment Edited by Lawrence
M.Tierney,Jr. Stephen J.Mc Phee, Maxine A.Papadakis 45 Ed 2006: Diseases
of the Larynx p209-213
LECTURE 20
DISORDERS OF PHARYNX AND LARYNX
Prof. Suardana, SpTHT, dr. Dewa Artha Eka Putra, SpTHT
Abstract
The Adenoids (pharyngeal tonsils) are a triangular mass of lymphoid tissue located
on the posterior aspect of the boxlike nasopharynx. The nasopharynx serves as a conduit
47
is
best
diagnosed
by
clinical
history,
physical
examination.
48
~ CURRICULUM MAP ~
Smstr
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Senior Clerkship
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49
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