SCENARIO A TUTORIAL REPORT BLOCK XII

Group 5
Lecturer of Tutor : dr. RA. Tanzila, M.Kes
1. Ahmad Winarto (702018032)
2. Shabrina Ananda Heparrians (702015024)
3. Tasya Aulia Dita (702018019)
4. Rindi Amelia (702018023)
5. Radicha Maurisha (702018027)
6. Nabila Tahiyyah (702018035)
7. Msy. Nabila Muthiaddinda (702018042)
8. Rahmi Nurbadriya Ningsih (702018062)
9. Dinda Nafatilana (702018068)
10. M. Zulisandi Ghifari (702018094)

FACULTY OF MEDICINE
MUHAMMADIYAH UNIVERSITY PALEMBANG
2019/2020

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 CHAPTER I
INTRODUCTION
1.1. Background
Blok endocrine is the twelfth block in the second semester IV of
the competency based curriculum of Doctors of the Faculty of Medicine,
Universitas Muhammadiyah Palembang.
On this occasion carried out a case study tutorial as a learning
ingredient to face the actual tutorial on an upcoming occasion. The author
of this time explained the case given about Mrs. A, a 48 years old woman,
brought to the emergency department of RSMP by her family with a chief
complain of shortness of breath that keeps on worsening since 4 hours ago.

1.2. Purpose and Objectives

As for the purpose and objectives of the tutorial reports this time, namely:
1. As a report of task group tutorials that are part of the KBK learning system
at the Faculty of Medicine of Muhammadiyah University of Palembang.
2. Can resolve cases given in scenarios with analysis methods and learning
group discussions.
3. Achieving the objectives of the tutorial learning method.
4. Students can understand and understand new material that has been taught
in the learning process.

1.3. Benefits
1. In order to practice analyzing an issue
2. In order to know the process in the tutorial
3. In order to apply the program based learning method in a case

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 CHAPTER II
DISCUSSION

2.1 Tutorial Data

Lecturer of Tutor : dr. RA. Tanzila, M. Kes
Moderator : M. Zulisandi Ghifari
Table Secretary : Msy. Nabila Muthiaddinda
Board Secretary : Radicha Maurisha
Times : Thursday, 16 April 2020
08.00-11.00 WIB
Saturday, 18 April 2020
08.00-11.00 WIB

2.2 Rules
1. Deactivate the phone or condition the phone to silence
2. Bend the hand when you will make an opinion
3. Request permission when going out of room

2.3. Case of Scenario A

“Periculum In Mora“
Mrs. A, a 48 years old woman, brought to the emergency
department of RSMP by her family with a chief complain of shortness of
breath that keeps on worsening since 4 hours ago. The shortness of breath
were not triggered by activity or weathers change, and were not followed
with wheezing. Mrs. A also complains of productive cough accompanied
with pain while swallowing and fever since one weeks ago, she went to the
Puskesmas and was given an antibiotic but she didnt take it. Her blood
sugar level also being checked at the Puskesmas, and the result was 280
mg/dl, and she also claimed that she often feels thirsty, famished, and
urinate a lot, then she was given an oral anti diabetic but she didnt take it
regularly.

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 According to her family, Mrs. A had a medical history of Diabetes
Mellitus since the age of forty, but she didnt take her medicine regularly,
and seldomly control her condition to the Puskesmas.
Physical Examination:
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW 40 kg

Vital Sign: BP 100/60 mmHg, HR 120x/mnt, Temp 38,8°C, RR:

38x/menit (deep and fast breathing)

Head: Pale conjungtive (-/-), icteric sclera (-/-)

Neck: JVP 5-2 cmH2O

Thorax : Heart and lung within normal limits

Abdoment: flat, supple, bowel movement (+), hepar and lien were not
palpable

Extremitie: cold extremities (-), edema (-/-). Turgor return slowly.

Laboratory Examination:

Blood Chemistry: Hb 13g/dl, Leukocyte 18.000/mm3, thrombocyte

250.000/ mm3

BSN 300 mg/dl

Urinalysis: Keton urin +3, glukose urin +3

2.2. Clarification of Trem

Shortness of breth Often described as an intense tightening in the cest, air
hunger, difficulity breathing, breathlessness or a feeling
of suffocation. (Dorland, 2015)
Whezzing A type of continuous sound like whistling that is heard
at the end of expiration. (Dorland, 2015).

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Fever A fever is any body temperature elevation over 100ºF
(37, 8ºC). (Dorland, 2015)
Antibiotic Chemical substances are usually produced by a
microorganism or semi-synthesis that has the ability to
kill or inhibit the growth of microorganism. (Dorland,
2015)
Urine Urine is the residual fluid of metabolic results excreted
from the body. The urine is composed of water with
dissolved residual metabolism (such as urea), dissolved
salts, and organic matter. (Dorland, 2015)
Productive cough A cough accompanied by expectoration of ingredients
from the bronchi. (Dorland, 2015)
Apathic Is a condition where someone does not care or feel shy
about the surrounding environment. (Dorland, 2015)
Turgor Circumstances to be turgit or normal or other full
sensations. (Dorland, 2015)
Diabetes mellitus A disorder of carbohydrate metabolism, usually
occurring in genetically predisposed individuals,
characterized by inadequate production or utilization of
insulin and resulting in excessive amounts of glucose in
the blood and urine, excessive thirst, weight loss, and in
some cases progressive destruction of small blood
vessels leading to such complications as infections and
gangrene of the limbs or blindness. (Dorland, 2015).
Keton Is a metabolism product of fatty acids and proteins
consisting of 3 compounds namely asetoacetic acid,
acetone and beta hydroxybutyric acid, when the body
experiences metabolic disorders, especially
carbohydrate metabolism disorders, the body will use
the deposits of fatty acids and proteins as fuel to
produce energy. (Dorland, 2015)
Bowel movement Tenderness in the bladder at the time of palpation.
(Dorland, 2015)

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2.3. Identification of Problem
1. Mrs. A, a 48 years old woman, brought to the emergency department
of RSMP by her family with a chief complain of shortness of breath
that keeps on worsening since 4 hours ago. The shortness of breath
were not triggered by activity or weathers change, and were not
followed with wheezing.
2. Mrs. A also complains of productive cough accompanied with pain
while swallowing and fever since one weeks ago, she went to the
Puskesmas and was given an antibiotic but she didnt take it.
3. Her blood sugar level also being checked at the Puskesmas, and the
result was 280 mg/dl, and she also claimed that she often feels thirsty,
famished, and urinate a lot, then she was given an oral anti diabetic but
she didnt take it regularly.
4. According to her family, Mrs. A had a medical history of Diabetes
Mellitus since the age of forty, but she didnt take her medicine
regularly, and seldomly control her condition to the Puskesmas.
5. Physical Examination:
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW
40 kg
Vital Sign: BP 100/60 mmHg, HR 120x/mnt, Temp 38,8°C, RR:
38x/menit (deep and fast breathing)
Head: Pale conjungtive (-/-), icteric sclera (-/-)
Neck: JVP 5-2 cmH2O
Thorax : Heart and lung within normal limits
Abdoment: flat, supple, bowel movement (+), hepar and lien were not
palpable
Extremitie: cold extremities (-), edema (-/-). Turgor return slowly.
6. Laboratory Examination:
Blood Chemistry: Hb 13g/dl, Leukocyte 18.000/mm3, thrombocyte
250.000/ mm3

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 BSN 300 mg/dl
Urinalysis: Keton urin +3, glukose urin +3

2.4. Priority of Problem

Number 1 because shortness of breath is the main complain of patients
that make her came to te emergency department and if the complain isn’t
managed properly will increase mortality and morbidity.

2.5. Analysis of Problem

1. Mrs. A, a 48 years old woman, brought to the emergency department of
RSMP by her family with a chief complain of shortness of breath that
keeps on worsening since 4 hours ago. The shortness of breath were not
triggered by activity or weathers change, and were not followed with
wheezing.
a. What is the anatomy and physiology in this case?
b. What is the meaning of “Mrs. A, a 48 years old woman, brought to
the emergency department of RSMP by her family with a chief
complain of shortness of breath that keeps on worsening since 4 hours
ago.
c. What is the correlation with her age and gender with the complain?
d. What is the meaning of ”The shortness of breath were not triggered by
activity or weathers change, and were not followed with wheezing”?
e. What is the etiology of shortness of breath?
f. What is the classification of shortness of breath?
g. How is the pathophysiology of shortness of breath in this case?
h. What is possibility disease with shortness of breath?

2. Mrs. A also complains of productive cough accompanied with pain while

swallowing and fever since one weeks ago, she went to the Puskesmas and
was given an antibiotic but she didnt take it.

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 a. What is the meaning of “Mrs. A also complains of productive cough
accompanied with pain while swallowing and fever since one weeks
ago, she went to the Puskesmas and was given an antibiotic but she
didnt take it”?
b. What is the possibility of antibiotics being given?
c. What is the etiology of productive cough with pain while swallowing
and fever in this case?
d. How is the pathophysiology of productive cough accompanied with
pain while swallowing and fever since one weeks ago?
e. What is the correlation of main complaints and additional complaint?

3. Her blood sugar level also being checked at the Puskesmas, and the result
was 280 mg/dl, and she also claimed that she often feels thirsty, famished,
and urinate a lot, then she was given an oral anti diabetic but she didnt take
it regularly.
a. What is the meaning of “BSS 280 mg/dl”?
b. What is the blood sugar test?
c. What is the meaning of “She often feels thirsty, famished and urinate a
lot?
d. What is the relatiton of BSS 280 mg/dl and shortness of breath?
e. What is the impact of Mrs. A didn’t take the oral anti diabetic
regulary?
f. How is the pathophysiology of often feels thirsty, fashimed and urinate
a lot?

4. According to her family, Mrs. A had a medical history of Diabetes

Mellitus since the age of forty, but she didnt take her medicine regularly,
and seldomly control her condition to the Puskesmas.
a. What is the meaning of ” Mrs. A had a medical history of Diabetes
Mellitus since the age of forty, but she didnt take her medicine
regularly, and seldomly control her condition to the Puskesmas”?

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 b. What is the etiology of diabetes mellitus?
c. What is the risk factors of diabetes mellitus?
d. What are the classification of diabetes mellitus?
e. How is the pathophysiology of diabetes mellitus?

5. Physical Examination:
General Appearance: Looks severely sick, apathic, BH: 154 cm, BW 40 kg
Vital Sign: BP 100/60 mmHg, HR 120x/mnt, Temp 38,8°C, RR:
38x/menit (deep and fast breathing)
Head: Pale conjungtive (-/-), icteric sclera (-/-)
Neck: JVP 5-2 cmH2O
Thorax : Heart and lung within normal limits
Abdoment: flat, supple, bowel movement (+), hepar and lien were not
palpable
Extremitie: cold extremities (-), edema (-/-). Turgor return slowly.
a. What is the interpretation of physical examination results?
b. How is the abnormal mechanism of physical examination?

6. Laboratory Examination:
Blood Chemistry: Hb 13g/dl, Leukocyte 18.000/mm3, thrombocyte
250.000/ mm3
BSN 300 mg/dl
Urinalysis: Keton urin +3, glukose urin +3
a. What is the interpretation of laboratoy examination results?
b. How is the abnormal mechanisme of laboratory examination?

7. How to diagnose?
8. What is the differential diagnose?
9. What is the additional examination of this case?
10. What is the working diagnose of this case?
a. Definition?

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 b. Epidemiology?
c. Etiology?
d. Pathogenesis?
e. Risk factors?
f. Clinical manifestations?
11. How is the treatment of this case?
12. What is the complication of this case?
13. What is the prognose of this case?
14. What is the medical doctor competences of this case?
15. What is the islamic point of view of this case?

2.6 Hypothesis
Mrs. A, a 48 years old woman, experience shortness of breath,
productive cough accompanied with pain while swallowing and fever,
dehydration, URI, ketoniuria, glukouria because of ketoasidosis diabetic from
uncontrol DM type 2.

2.7 Conceptual Framework

Risk factors (age, gender,

history family)

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 Insulin resistence

DM type 2 uncontrolled

Metabolic disorder

↑Level of acid in the System inflamation

blood (ketoasidosis)

URI (Upper
Shortness of Respiratory
breath, Fever, Tract
Cough and Pain Infections)
Swallowing

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