CHAPTER I

INTRODUCTION

1.1 Background
Sensory and Integumentum System is the 16th block on semester 5 of
Kurikulum Berbasis Kompetensi (KBK) system in Medical Faculty of
Muhammadiyah Palembang University. One of the strategy from these curriculum
is Problem Based Learning (PBL). Case tutorial is one of the implementation of
this PBL methode. In this section, Students are divided into small groups and every
groups will be guided by a mentor or a lecturer as a facilitator who will guide the
students to solve the case.
Tutorial process is a part of student’s evaluation exactly as a formative
evaluation. These evaluation helps the students to reach the aim of study. Tutorial
process is also requirment for students to join the block’s exam called OSOCA
(Objective Structure Oral Case Analysis) which is included in summative
evaluation. The aim of summative evaluation is assesing the student’s achievement
in order to determine the competencies that have been achieved. Summative
assessment is done by referring to the learning taxonomy proposed by Bloom that
consist of cognitive, psychomotor, and affective assessment.

1.2 Purpose and Objectives

The purpose and objectives of this case study tutorial, namely:
1. As a report task group tutorial that is part of KBK learning system at the
Faculty of Medicine, Muhammadiyah Palembang University.
2. Can solve the case given in the scenario with the method of analysis and
learning group discussion.
3. Achieving the objectives of the tutorial learning method.
 CHAPTER II
DISCUSSION

2.1 Tutorial’s Data

Tutor : dr. Vina Pramayastri
Moderator : Zadi Oktariansyah
Secretary : Sindy Olivia Sari
Notulis : Amalia Chairunnisa
Date and Time :
1. Tuesday, November 27th 2018
Time : 08.00 to 10.30 p.m
2. Thursday, December 29st 2018
Time : 08.00 to 10.30 p.m
Rules :
1. Everyone in the group should express their opinion
2. Gadget should be nonactive or in silent mode.
3. Ask for permission if want to go outside.
4. Eating and drinking are not allowed in the room.

2.2 Case Scenario

“eyes of kokus”
Mr Kokus, a 54 years old male office worker, came to the eyes
polyclinic with a chief complain of redness on the left eyes since 1 weeks ago.
Since 4 days ago, the patient feels pain in his eye, followed with swollen eye
lid and a sensation “like theres something in his eye”, but the patient also said
that his vision was like the usual. 3 days ago, the patient starts to feel a light
itchiness on his left eye, and theres a yelowish green secret on his eye, followed
 with a difficulty to open his eye in the morning. 2 days ago, his right eyes also
starting to ache, and become red.
Mr. Kokus bough some eyedrops and tries to treat this symptom all by
himself, but theres no improvement. History of making a contact to people with
eyes disease (+), approximately 1 weeks ago. Mr kokus also uses bifocus
glasses on his left, and right eyes since the age of 40 years old.

Physical Examination
General appearance: Compos mentis
Vital sign: Blood Pressure: 120/80 mmHg, Pulse Rate: 92x/minute,
Respiratory Rate: 18x/minute, Temperature: 36,7oC.
Head; enlargement of pre aurikuler lymph nodes (-)
EYES:
OD: VOD 6/20
OS: VOS 6/15, Conjungtiva injection (+), yellowish green secret (+),
blefarospasme (+)
Glasses history:
S+1.00, S+1.50
Add +2.50

2.3 Clarification of Terms

Table 1. Clarification of Terms

No Terms Clarifications
Excessive of blood in an eye that due to
1. Redness
local of general relaxation of arteriole.
Distressing feeling often cause by intens or
2. Pain
damaged stimuli
 Sudden contraction involunter muscle of
3. Blefarospasme
eyelid..
Also reffered to as periorbital puffiness,
reffered to the presents of access fluid
4. Swollen eyelids
(edema) in the connective tissue around the
eye
Excretion of caruncula lacrimali that
5. Yellowish green secret
contain bacterial and mucous
Vision oculi dekstra to measure sharp
6. VOD
vision dekstra
Vision oculi sinistra to measure sharp
7. VOS
vision sinistra

8. Bifocus glasses Glasses with bifoal lenses

9. Conjungtiva Is the clear and thin membrane that covers

part of the fronts surface of the eye and the
inner surface of the eyelid.

2.4 Identification of Problems

1. Mr Kokus, a 54 years old male office worker, came to the eyes polyclinic with
a chief complain of redness on the left eyes since 1 weeks ago.
2. Since 4 days ago, the patient feels pain in his eye, followed with swollen eye
lid and a sensation “like theres something in his eye”, but the patient also said
that his vision was like the usual.
3. 3 days ago, the patient starts to feel a light itchiness on his left eye, and theres
a yelowish green secret on his eye, followed with a difficulty to open his eye in
the morning.
4. 2 days ago, his right eyes also starting to ache, and become red.
 5. Mr. Kokus bough some eyedrops and tries to treat this symptom all by himself,
but theres no improvement
6. History of making a contact to people with eyes disease (+), approximately 1
weeks ago. Mr kokus also uses bifocus glasses on his left, and right eyes since
the age of 40 years old.
7. Physical Examination

General appearance: Compos mentis

Vital sign: Blood Pressure: 120/80 mmHg, Pulse Rate: 92x/minute,
Respiratory Rate: 18x/minute, Temperature: 36,7oC.
Head; enlargement of pre aurikuler lymph nodes (-)
EYES:
OD: VOD 6/20
OS: VOS 6/15, Conjungtiva injection (+), yellowish green secret (+),
blefarospasme (+)
Glasses history:
S+1.00, S+1.50
Add +2.50

2.5 Analysis dan Synthesis of Problem

1. Mr Kokus, a 54 years old male office worker, came to the eyes polyclinic
with a chief complain of redness on the left eyes since 1 weeks ago.

a. How is the anatomy, physiology and histology in this case?

b. What is the meaning of chief complain of redness on the left eyes since 1
weeks ago?

c. What is the possible cause of the redness on the eyes?

d. What is the possible disease of redness of the eyes?

 e. What is the relation between age, gender, and job in this case?

f. What is patophysiology of redness of the eyes?

2. Since 4 days ago, the patient feels pain in his eye, followed with swollen eye
lid and a sensation “like theres something in his eye”, but the patient also said
that his vision was like the usual.

a. What is the meaning since 4 days ago the patient feels pain in his eye,
followed with swollen eye lid and a sensation “like theres something in his
eye”, but the patient also said that his vision was like the usual?

b. What is the patophysiology of the complain above?

c. What are the possible disease with chief complain red eye with the decreased
of the vision?

3. 3 days ago, the patient starts to feel a light itchiness on his left eye, and
theres a yelowish green secret on his eye, followed with a difficulty to open his
eye in the morning.

a. What is the meaning of 3 days ago , the patient starts to feel a light itchiness
on his left eye, and theres a yelowish green secret on his eye, followed with
a difficulty to open his eye in the morning?

b. What is the patophysiology of the complain above?

4. 2 days ago, his right eyes also starting to ache, and become red.

a. What is the meaning 2 days ago , his right eyes also starting to ache, and
become red?

b. What is the patophysiology of the right eyes also starting to ache, and become
red?
 c. What is the relation between additional complain and the chief complain?

5. Mr. Kokus bough some eyedrops and tries to treat this symptom all by
himself, but theres no improvement

a. What is the meaning of Mr. Kokus bough some eyedrops and tries to treat
this symptom all by himself, but theres no improvement?

b. What is the possible drugs that Mr Kokus use?

6. History of making a contact to people with eyes disease (+), approximately

1 weeks ago. Mr kokus also uses bifocus glasses on his left, and right eyes since
the age of 40 years old.

a. What is the meaning of history of making a contact to people with eyes

disease (+), approximately 1 weeks ago?

b. What is the classification of Conjungtivitis?

c. What is the relation between Mr. Kokus also uses bifocus glasses since 40
years old with his complain?

d. What are the types of anomaly of refraction?

e. What are the types of lenses?

7. Physical Examination
General appearance: Compos mentis
Vital sign: Blood Pressure: 120/80 mmHg, Pulse Rate: 92x/minute,
Respiratory Rate: 18x/minute, Temperature: 36,7oC.
Head; enlargement of pre aurikuler lymph nodes (-)Spesific Examination
Eyes:
OD: VOD 6/20
 OS: VOS 6/15, Conjungtiva injection (+), yellowish green secret (+),
blefarospasme (+)
Glasses history:
S+1.00, S+1.50
Add +2.50

a. What is the interpretation of the physical examination?

b. What is the mechanism of the physical examination?

c. How to examine visus?

d. What are the types of eye injection?

8. How to diagnose in this case?

9. What disturbances might happen in this case?
10. What investigations are needed to diagnose this case?
11. What disturbances are most likely to occur in this case?
12. How does the comprehensive management for this case?
13. What will happen if these circumstances are not manage comprehensively?
14. Is this disorder can be overcome thoroughly, how the odds?
15. How does the competence of general practitioner for this case?
16. How does the Islamic point of view of this case?

2.6 Hypothesis
Mr Kokus a 54 years complain of redness on the left eyes followed by
swollen eyelids and yellowish green secret because suffering bacterial
conjungtivitis, hypermetrophy and presbyopia
 2.7 Conceptual Framework

Risk Factor

Contact to people with eye disease Age

Infection by bacteria in conjungtiva Presbiopi hypermetrophy

Conjungtivitis

Swolen eyelids Redness of the eye Yellowish green secret