Scenario A blok 16 :

Mrs.Y, a 40-year old, house wife, was admitted to hospital with coughing of blood. She
complained that 6 hours ago she had a severe of coughing with fresh blood of about 2 glasses.
She also said that in the previous months, she had productive cough with a lot of phlegm, mild
fever, loss pf appetite, rapid loss of body eight (previous weight : 55 kg), and shortness of breath.
Since a week ago, she felt his symptoms were worsening. From further interview, Mrs. Y have
similar symptoms 6 months she was given medication after consulting with doctor at that time.
But she stop the treatment after 3 weeks because she feeling better. Her husband has died
because of AIDS 1 years ago.

Physical examination:
General appearance: she looked severely sick and pale. Body height: 165 cm, Body weight: 40
kg BP: 100/70 mmHg, HR: 112 x/minute, RR: 36 x/minute, temp 37.6o C. In chest auscultation
there was an increase of vesicular sound at the right apex lung with moderate rales.

Klarifikasi istilah :
1. Coughing of blood : meludah darah atau seputum bercampur darah, volume ringan < 15-
2 ml/ jam , moderate > 15 30 dan < 600 ml, massive : > 600 ml .
2. Phlegm : mucus kental disekresikan oleh mukosa traktus respiratorius dan dikelurkan
pada proses infeksi tertentu. ( Dorland )
3. mild fever : peningkatan temperature tubuh di atas normal ( 37 C ). ( Dorland )
4. productive cough : batuk yang efektif dalam mengeluarkan benda asing dalam traktus
respiratorius. ( Dorland )
5. AIDS : manifestasi yang paling parah dari penyakit di karenkan virus HIV.
6. Vesicular sound : bunyi nafas normal pada paru selama ventilasi.
7. Moderate rales : suara tambahan yang di hasilkan oleh aliran udara melalui saluran nafas
yang berisi secret atau eksudat.
8.

Identifikasi masalah :
1. Mrs.Y, a 40-year old, house wife, was admitted to hospital with coughing of blood. She
complained that 6 hours ago she had a severe of coughing with fresh blood of about 2
glasses.

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 2. She also said that in the previous months, she had productive cough with a lot of phlegm,
mild fever, loss pf appetite, rapid loss of body eight (previous weight : 55 kg), and
shortness of breath. Since a week ago, she felt his symptoms were worsening.
3. From further interview, Mrs. Y have similar symptoms 6 months she was given
medication after consulting with doctor at that time. But she stop the treatment after 3
weeks because she feeling better.
4. Her husband has died because of AIDS 1 years ago
5. Physical examination
General appearance: she looked severely sick and pale. Body height: 165 cm, Body
weight: 40 kg BP: 100/70 mmHg, HR: 112 x/minute, RR: 36 x/minute, temp 37.6o C. In
chest auscultation there was an increase of vesicular sound at the right apex lung with
moderate rales.
6. Lab :
HIV : ( -)
HB : 9,5
Wbc : 6000
Diffcoun : 0/3/2/70/20/5
x-ray : infiltrate pada paru kanan.

Analisis masalah :

1. Mrs.Y, a 40-year old, house wife, was admitted to hospital with coughing of blood. She
complained that 6 hours ago she had a severe of coughing with fresh blood of about 2
glasses.
A. Bagaimana mekanisme batuk berdarah?
B. Apa saja yang menyebabkan batuk berdarah ?
C. Bagaimana hubungan umur, jenis kelamin an pekerjaan dari pasien terhadap
keluhan yang di alami ?
D. Bagaimana klasifikasi batuk berdarah dan termasuk yang mana ?
E. Bagaimana tatalaksana awal batuk berdarah ?

2. She also said that in the previous months, she had productive cough with a lot of phlegm,
mild fever, loss pf appetite, rapid loss of body eight (previous weight : 55 kg), and
shortness of breath. Since a week ago, she felt his symptoms were worsening.
a. Klasifikasi sputum ?
b. Bagaimana hubungan antar gejala?
c. Bagaimana mekanisme dan penyebab batuk productive dengan banyak dahak
pada kasus ?

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 d. Bagaimana mekanisme dan penyebab mild fever ?
e. Bagaimana mekanisme dan penyebab loss of appetite?
f. Bagaimana mekanisme dan penyebab penurunan berat badan ?
g. Bagaimana mekanisme dan penyebab sesak nafas ?
h. Mengapa seminggu lalu gejala nya makin parah ?

3. From further interview, Mrs. Y have similar symptoms 6 months she was given
medication after consulting with doctor at that time. But she stop the treatment after 3
weeks because she feeling better.
a. Mengapa gejala timbul kembali setelah berhenti pengobatan ?
b. Obat apa yang kira-kira di konsumsi oleh mrs.Y?
c. Apa dampak menghentiakn pengobatan seperti pada kasus ?
d. Bagaimana cara melanjutkan pengobatan jika pernah terputus ?
e. Bagaimana mengidentifikasi MDR?

4. Her husband has died because of AIDS 1 years ago

a. Apa hubungan aids pada kasus ?
b. Mengapa mrs.Y tidak terkena AIDS padahal suaminya terkena AIDS ?

5. Physical examination:
General appearance: she looked severely sick and pale. Body height: 165 cm, Body
weight: 40 kg BP: 100/70 mmHg, HR: 112 x/minute, RR: 36 x/minute, temp 37.6o C. In
chest auscultation there was an increase of vesicular sound at the right apex lung with
moderate rales.
a. Interpretasi dari pemriksaan fisik ?
b. Mekanisme abnormal dari pemfis?
c. Apa saja jenis suara yang di dapatkan pada saat auskultasi paru?
d. Apa saja macam-macam suara tambahan di paru ?

6. Lab :
HIV : ( -)
HB : 9,5
Wbc : 6000
Diffcoun : 0/3/2/70/20/5
x-ray : infiltrate pada paru kanan.
a. Interpretasi dari pemriksaan lab?
b. Mekanisme abnormal dari pemlab?

Hipotesis : Mrs.Y mengalami batuk berdarah etcausa TB paru BTA (-)

a. DD?
b. Diagnosis etiologi?

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 c. Definisi?
d. Epidemiologi?
e. Etiologi?
f. Klasifikasi ?
g. Pathogenesis ?
h. Patofisio?
i. Gejala klinis ?
j. Factor resiko?
k. Algoritma diagnosis ?
l. tatalaksana (rencana edukasi dan pemeriksaan, farmako dan non farmako) ?
m. komplikasi?
n. Pencegahan?
o. Prognosis ?
p. Skdi?

LI:
1. Tb paru
a. DD?
b. Diagnosis etiologi?
c. Definisi?
d. Epidemiologi?
e. Etiologi?
f. Klasifikasi ?
g. Pathogenesis ?
h. Patofisio?
i. Gejala klinis ?
j. Factor resiko?
k. Algoritma diagnosis ?
l. tatalaksana (rencana edukasi dan pemeriksaan, farmako dan non farmako) ?
m. komplikasi?
n. Pencegahan?
o. Prognosis ?
p. Skdi?
2. Terapi farmakologi dan non farmakologi
3. Anatomi dan fisiologi
4. Pemfis
5. Pemlab dan penunjang