HISTORY TAKING AND PHYSICAL EXAMINATION OF DIARRHEA

A. General Information
1. Year Academic : 2021-2022
2. Semester 5
3. System : GIS
B. Learning Guide
1. General Objective:
After finishing skill practice of clinical examination of diarrhea, the student will be able
to perform history taking and physical examination of diarrhea, to determine the
severity and the management of diarrhea correctly.
2. Specific Objective:
At the end of skill practices, the student will be able to perform clinical
examination and management of diarrhea correctly.
3. Syllabus Description:
a. Sub Module Objective
After finishing skill practice of examination of acute abdomen, the student will
be able to perform history taking and physical examination correctly.
b. Expected Competencies
Students perform history taking of diarrhea.
Students perform physical examination of diarrhea.
Students perform management of diarrhea based on the severity.
c. Topics
History taking of diarrhea
Greet the patient and parents and confirm identity: train the student to
perform the informed concerns, and collecting the patient data.
Chief complaint: Determine the chief complaint and onset of illness, to
train the student to collect data of chief complaint and timeline of the
symptom.
Other related symptoms: train the student to get other information
related of the symptoms of diarrhea.
Collect the previous history, family history, other significant illness, and
house environment: train the student to find the risk factor of the
present illness.
Collect the history of current medication: to collect data about present
medication.
Physical examination of diarrhea.
Preparation: train the students to perform informed consent and
prepare the patient and them self for the physical examination.
Implementation
o General examination: train the students to examine general
appearance and the signs of dehydration.
o Decision: train the students to make decision the severity of dehydration.
o Management: train the students to manage the diarrhea based on
the severity of dehydration.

d. Methods
Presentation
Demonstration
 Coaching
Self-practices: role - play
C. Attachment
1. Instrument, substances, and material
needed Presentation:
Audiovisual: Slides presentations on LCD projector.
Demonstration and coaching:
a. Table
b. Chairs
c. Examination couch
d. Baby mannequin
e. Oral rehydration solution

2. Assessment:
Performance scale 0 = Neither mention nor do the
procedure Performance scale 1 = Only mention the
procedure Performance scale 2 = Mention and do the
procedure

3. Specimen Handling
4. Standardized patient& Preparation for the
Patient These skills do not need
standardized patient.
5. Reference
Guidelines WHO 2013
MTBS diarrhea 2019
 Learning Guide HTPE Diarrhea
Performan
No. Step ce
s Scales
0 1 2
HISTORY TAKING
1 Salam ibu.
2 Perkenalkan dirimu.
3 Menanyakan nama dan usia pasien.
4 Tanyakan tentang alasan mengapa dia datang kepada Anda. (Keluhan
utama)
5 Tanyakan tentang onset/durasi diare.
6 Tanyakan tentang frekuensi dan jumlah diare.
7 Tanyakan tentang sifat diare: tinja berdarah, berlendir, atau berair.
8 Tanyakan tentang perkembangan keluhan.
Ask related symptoms (9-14)
9 Mual dan muntah (tanyakan volume dan frekuensinya)
10 Mikturisi (tanyakan volume dan frekuensinya)
Tanyakan tentang tanda-tanda dehidrasi: lekas marah, gelisah, lesu, ingin
11 minum

12 Demam, batuk, dan kejang

13 Riwayat menyusui sebelumnya (ASI atau susu formula)
14 Tanyakan riwayat vaksinasi
15 Tanyakan riwayat kesehatan
16 Beritahu pasien ibu tentang kesimpulan dari anamnesis pasien.
PHYSICAL EXAMINATION
1 Salam ibu.
2 Perkenalkan dirimu.
3 Penjelasan dan persetujuan
4 Cuci & keringkan tangan
5 Minta izin pada ibu
Periksa penampilan umum anak (normal, rewel, lesu atau tidak sadar
6 atau floopy)
7 Periksa berat badan anak dan tanda-tanda vital
8 Periksa mata (mata normal, cekung)
9 Amati air mata (Tidak ada atau tidak ada)
10 Periksa mukosa mulut dan lidah (lembab, kering, atau sangat kering)
11 Periksa bising usus
Lakukan cubitan kulit (Kembali cepat, lambat, atau sangat lambat)

12

13 Periksa perianal (ruam atau tidak ada)

14 Amati pasien saat minum (tampak haus, kurang minum)
LAB EXAMINATION
1 Rutin hematologi
2 Pemeriksaan feses
DIAGNOSIS
Tipe klinis diare:

- diare berair akut - berlangsung beberapa jam atau hari, dan termasuk
kolera
- diare berdarah akut - juga disebut disentri; dan
- diare persisten - berlangsung 14 hari atau lebih.

Derajat dehidrasi:

- Tidak dehidrasi
- Dehidrasi ringan-sedang
- - Dehidrasi berat
MANAGEMENT
Management therapy for dehydration:
- Plan A : penangan diare di rumah (pemberian oralit 3 jam
1 pertama, jumlah nya sesuai BB x 75mL, diberikan sedikit2 tp
sering, kalo muntah diberika 10 selanjutnya secara perlahan,
kalo mau
- Plan B : Pananganan Dehidraei Rlngan/Sadang dengan oralit
- Plan c
PREVENTION
1 Jelaskan kepada ibu tentang cara mencegah diare (kalo ngasih obat
cucitangan dulu, pake air matang bersih)
2 Jelaskan kepada ibu tentang pengobatan diare di rumah (bayi : ASI
sesuai yg anak mau trs dikasih oralit 50-100 mL/buang poop)
Jelaskan kepada ibu tentang kapan anak diare harus dirujuk ke tenaga
3 kesehatan (kalo frekuesinya lebih dari 3x/hari atau tidak kunjung
membaik setelah pertolongan pertama)
TOTAL SCORE
ZINC SUPLEMENT
Mengurangi durasi dan keparahan dari diare pd anak dan secara potensial
mencegah proporsi secara besar pd kasus yg terulang kembali.
Mengurangi mortalitas 46% dan rawat inap 23%.
Meningkatkan angka penyembuhan diare.
Semua anak yg lebih tua 6 bln dengan akut diare pd area yg yg berisio=ko
disarankan diberi oral zinc (20mg/hari) yg diberi sekitar 10-14 hari selama dan
sesudahnya dari diare.

MENGAPA PD ANAK TIDAK BOLEH DIBERKAN OBAT ANTIDIARE?

Karena adanya malbsorpsi atau infeksi, jadi tugas utamanya menggantikan caian
dan menanggulangi adanya infeksi.
Fakultas Kedokteran Universitas
Pasundan

History Taking and Physical Examination Acute Abdoment

A. General Information
1. Year Academic : 2021/2022
2. Semester 6
3. System : GIS

B. Learning Guide
1. General Objective :After finishing skill practice of Clinical examination of surgical
diseases and disorders of the abdomen, the student will be able to perform history
taking and physical examination of surgical diseases and disorders of the
abdomen correctly.

2. Specific Objective :
At the end of skill practices, the student will be able to perform clinical examination
of acute abdomen correctly.

3. Syllabus Description:
a. Sub Module Objective
After finishing skill practice of examination of acute abdomen, the student
will be able to perform history taking and physical examination of acute
abdomen correctly.
b. Expected Competencies
Students perform history taking of acute abdomen.
Students perform physical examination of acute abdomen.
c. Topics
History taking of acute abdomen
Greet the patient and confirm identity: train the student to perform
the informed concent, and collecting the patient data.
Chieft complain: Determine the chief complaint and onset of illness,
train the student to collect data of chief complaint and timeline of
the symptom.
Other related symptoms: train the student to get other information
related of the symptoms of acute abdomen, train the student to find
differential diagnosis and exclude it.
Collect the previous history, family history, other significant illness,
and house environment: train the student to find the risk factor of the
present illness.
Collect the history of current medication: to collect data about
present medication.
Physical examination of acute abdomen.
Preparation: train the students to perform informed consent and
prepare the patient for the physical examination.
Implementation
Fakultas Kedokteran Universitas
Pasundan

o General examination: train the students to examine general

appearance, vital sign, other system, and ask the patient to
expose his abdomen.
o Abdominal examination: train the students to performe

abdomen, and digital rectal examination to get any sign of acute

abdomen.

d. Methods
Presentation
Demonstration
Coaching
Self practices: role-play

C. Attachment
1. Instrument, substances and material
needed Presentation :
Audiovisual : Slides presentations on LCD projector or online presentation.
Demonstration and coaching :
a. Table
b. Chairs
c. Examination couch
d. Stethoscope
e. Pelvic model

2. Assessment:
Performance scale 0 = Neither mention nor do the
procedure Performance scale 1 = Only mention the
procedure Performance scale 2 = Mention and do the
procedure

3. Speciment Handling
4. Standardized patient& Preparation for the Patient
Adult male (for aloanamnesis), 25-30 y.o, skinny/muscular
5. References:
 Learning Guide HTPE Acute Abdomen
Performanc
No. Procedur e
e Scale
0 1 2
Introduction
1. Sapa pasien, dan kembangkan lingkungan yang hangat dan membantu
2. Perkenalkan diri Anda kepada pasien
Patient Identity
3. Tanyakan pasien dengan sopan mengenai nama dan usianya
4. Menanyakan status pernikahan pasien
Chief complaint
5. Tanyakan pasien tentang mengapa pasien datang kepada Anda.
6. Nyeri:
Kapan pertama kali timbul
Biasanya timbul saat kapan dan dimana lokasinya
Faktor yang memberatkan dan Faktor yang meringankan Durasi
Tingkat keparahan Jenis nyeri
Radiasi
Other related symptoms
7. Ask the patient concerning related symptoms of gastro-intestinal function:
Mual - Muntah
Kehilangan nafsu makan & Pingsan
Gangguan pencernaan sebelumnya (kebiasaan)
8. Bowel habit:
Sembelit? Diare?
Warna ee? Ada atau tidak adanya darah dan lendir (lendir)
9. Jaundice (nampak kuning)
10. Fungsi kemih: jumlah & warna urin, ketidaknyamanan perut bagian bawah.
11. Gynaecological functions:
Fungsi menstruasi Tertunda atau hilang periode
Pendarahan atau sekret yang tidak normal (warna, jumlah)

10. Previous history of :

Nyeri serupa sebelumnya
Operasi perut sebelumnya
Penyakit utama sebelumnya: termasuk. demam, cedera perut.
Narkoba
Alergi
Performanc
No. Steps e
Scales
0 1 2
11. Diagnosis:
Acute appendicitis
Ovarial cyst torsion or rupture
PHYSICAL EXAMINATION
1 Minta pasien dengan sopan untuk mengekspos perutnya
Abdominal examination
Inspection
2 Inspeksi gerakan: respiratory movement, visible bowel movement
3 Apakah ada bekas luka di kulit perut?
4 Apakah ada distensi abdomen? flatus, cairan, janin.
Apakah ada ruam/perubahan warna? Tanda turner abu-abu, tanda cullen,
5
echimosis of dinding perut
6 Apakah ada massa? tumor, situs hernia, tumor dengan pulsasi
 Auscultation
Dengan menggunakan stetoskop, letakkan dengan lembut di perut. dengarkan
bunyi usus dan bruit setidaknya selama satu menit:
Absen?
7 Bernada tinggi dan hiperaktif?
Suara metalik?
Bruit vaskular?

Palpation
8 Minta pasien untuk menemukan nyeri maksimum dengan ujung jari.
Dengan menggunakan permukaan palmar jari-jari Anda, palpasi perut
9 dengan lembut mulai dari tempat terjauh dari nyeri maksium, gerakkan
secara bertahap ke arahnya. Dan cari tanda-tanda:
10 muscle guarding/ rigidity
11 tenderness / rebound tenderness
12 sign
13 sign
14 masses or swelling
15 expansile pulsation
Percussion
Tempatkan aspek palmar tangan kiri Anda di perut, dan dengan lembut
16 perkusi aspek punggungnya dengan ujung jari tengah tangan kanan,
bergerak di sekitar daerah perut: Dengarkan apakah ada
17 Tympanic, dull, shifting dullness
18 Lokasi dari liver dullnessdan apa itu menghilang?
19 DRE (hanya bicara)
History Taking & Physical Examination of
Groin Lump
1. General Objective
After finishing skill practice of clinical examination of groin lump, the studentwill be able to perform
history taking and physical examinations of groin lumpcorrectly.

2. Specific Objective :
At the end of skill practices, the student will be able to:
a. perform history taking of groin lump correctly.
b. perform physical examination of groin lump correctly

3. Syllabus Description :
a. Sub Module Objective
After finishing skill practice, student will be able to perform historytaking and physical examination
of groin lump correctly

b. Expected Competencies
Students perform history taking of groin lump correctly.
Students perform history taking of inguinal and femoral herniacorrectly.
Students perform physical examination of groin lump correctly.
Students perform specific physical examination for indirect, direct,and femoral hernia
correctly.

c. Topics
History taking of groin lump
Greet the patient and confirm identity: train the student to perform the informed concent, and
collecting the patient data.
Chieft complain: Determine the chief complaint and onset of illness,train the student to collect
data of chief complaint and timeline of the symptom.
Other related symptoms: train the student to get other information related of the symptoms of
groin lump, train the student to find differential diagnosis and exclude it.
Collect the previous history, family history, other significant illness, and house environment: train
the student to find the risk factor of thepresent illness.

Physical examination of groin lump.

Preparation: train the students to perform informed consent and prepare the patient and also them
selve for the physical examination.
Implementation
o General examination: train the students to examine generalappearance, vital sign, other system,
and ask the patient toexpose his inguinal region.
o Inguinal and lump examination: train the students to performe inspection and palpation the
inguinal region include the lump, anddetermine the position of the lump: indirect inguinal hernia,
directinguinal hernia, or femoral hernia.
d. Methods
Presentation
Demonstration
Coaching
Self practices: role - play

A. Attachment
1. Instrument, substances and material needed
Presentation :
Audiovisual : Slides presentations on LCD projector.
Demonstration and coaching :
a. Examination couch
 b. Table
c. Chairs
d. Stethoscope
e. Pelvic model
2. Assessment:
Performance scale 0 = Neither mention nor do the procedure
Performance scale 1 = Only mention the procedure
Performance scale 2 = Mention and do the procedure
3. Speciment Handling
4. Standardized patient & Preparation for the Patient: This skills not need standardized patient.
5. Venue: Zoom Meeting
6. Reference
7. Resource Department: Department of Surgery, Faculty of Medicine UniversitasPadjadjaran
 Learning Guide of HTPE Groin Lump

Performance
Scale
No. Procedure
0 1 2
HISTORY TAKING
Introduction
1. Sambutlah pasien, dan kembangkan lingkungan yang hangat dan membantu
2. Perkenalkan diri Anda kepada pasien
Patient Identity
3. Tanyakan pasien dengan sopan tentang nama dan usianya
4. Rekam gender, tanyakan status perkawinan pasien
Chief complaint
5. Tanyakan kepada pasien tentang mengapa pasien datang kepada Anda.
Lump on the groin:
6 Lokasi: unilateral / bilteral
7 Onset: akut atau kronis
8 Ukuran benjolan saat ini (MEMBESAR / TDK)
9 Sifat benjolan: persisten / intermiten (menetap / hilang timbul)
10 Jika intermiten: Reduksibel? merasakan kekonfanaan? faktor-faktor apa yang
memperburuk faktor dan menghilangkan faktor?
11 jika persisten : benjolan berkembang (semakin bengkak?), menyertai nyeri
(nyeri perut terus menerus / intermiten / kolik) ?
12 Tanyakan kepada pasien tentang gejala terkait:
Fungsi GI: mual, muntah, sindrom usus
Fungsi urin: LUTS
Demam: onset, jenis demam
13. Sejarah sebelumnya:
Benjolan serupa
Hernia bedah (berulang?)
Penyakit mayor: cedera batuk kronis, penyakit kuning (FR: tk. Intra-abdomen?).
PHISICAL EXAMINATION
Preparation of Phisical Examination
1. Periksa semua peralatan yang diperlukan dan memiliki cahaya yang baik:
Sofa ujian
Stetoskop
2. Jelaskan prosedur dan tujuannya kepada pasien.
3. Cuci tangan dengan sabun antiseptik.
4. Keringkan dan hangatkan tangan Anda dengan tisu dan kenakan sarung tangan.
Implementation
General Examination
5. Kesadaran

Suasana hati: tertekan? Gelisah?

Tidak bergerak (letargi dsb)
Warna: Pucat? Pembilasan?

Periksa tanda-tanda vital: (cukup disebutkan saja akan melakukan

pemerikasaan)
Suhu
Denyut nadi
Tekanan darah
Tingkat pernapasan
6. Pasien diminta untuk berdiri di depan Anda. Minta pasien dengan sopan untuk
mengekspos daerah inguinalnya.
7. Terdapat benjolan pada daerah scrota,
A. Periksa benjolan dan tentukan:
Warna benjolan: Kemerahan?
Lokasi benjolan
Edema kulit
B. Palpasi benjolan, tentukan :
Tanda kelembutan lokal
Isi (kistik? Krepitasi? Padat bulat? (omentum/ ovarium-pd wanita)
C. Tes transiluminasi (khusus untuk skrotum): hidrokel.
Konfirmasi konten (positif/negatif)
Menggunakan penlight yang diletakkan di skrotum bagian bawah
8. Cobalah untuk mengecilkan benjolan secara manual dengan menggunakan jari
Anda, mulai dari cincin luar atau bagian paling bawah dari benjolan, naik ke
cincin internal (Tanda anatomi: Anterior Superior Iliac Spine, tuberkulum pubis).
Jika gagal, jangan dilanjutkan. Prosedur yang berhasil ditunjukkan ketika
benjolan menghilang dengan atau tanpa suara gemericik.
9. Letakkan jari telunjuk kanan Anda di atas kanalis inguinalis atau letakkan jari
kanan/kiri Anda pada cincin eksternal dan jari yang berlawanan pada cincin
internal. Minta pasien untuk mengulangi manuver valsava, perhatikan apakah
ada benjolan yang keluar dari cincin. Tentukan posisi benjolan dalam kaitannya
dengan ligamen inguinalis:
Hernia inguinalis indirek (tidak ada benjolan, jika kompresi jari dilepas,
 benjolan akan muncul kembali).
Hernia inguinalis direk (Benjolan Bulat di atas ligamentum inguinalis)
Hernia femoralis (benjolan di bawah ligamentum inguinalis).
10. Minta pasien untuk berbaring di sofa dalam posisi terlentang.
11.
12. Lakukan pemeriksaan sistem lain, termasuk sistem kardio-paru.
13. Minta pasien dengan sopan untuk mengekspos perut dan daerah inguinalnya.
Groin examination:
14. Lakukan pemeriksaan pangkal paha saat Anda melakukan posisi berdiri.
15. Simpulkan diagnosis Anda.
A. Hernia inguinalis lateralis dext/sinistr (indirek)/ Hernia ingunalis indirek + Reponible/ irreponible
B. Hernia inguinalis medialis dext/ sinistra + Reponible/ irreponible

Dicekik a/b
Dikurung a/b

Hernia ingunalis lateral kanan yang dapat direduksi

Siapkan skenario:
Langsung
Tidak Langsung
Strangulata
Tidak Tertanggung

Alat PJJ.

TTV dan status umum ujian Abd

PE, posisi terlentang: tes jari (menentukan hernia inguinalis medial atau lateral dengan memasukkan jari ke cincin

(children, dengan cara meraba daerah inguinal spermatic tali pusat.Jika ada hernia teraba keras)
 History Taking
Jaundice

A. General Information
1. Year Academic 2021
2. Semester 5
3. System : GIS

B. Learning Guide
1. General Objective :After finishing skill practice of Clinical examination of
jaundice and disorders of the liver, the student will be able to perform history
taking of jaundice and liver diseases correctly.

2. Specific Objective :
At the end of skill practices, the student will be able to perform history taking of
patients with:
a. jaundice correctly.
b. liver failure correctly.

3. Syllabus Description:
a. Sub Module Objective
Students will be able to perform history taking of jaundice and liver failure
correctly.
b. Expected Competencies
Students perform history taking of patients with jaundice and liver failure.
c. Topics
History taking of jaundiced and liver failure patients.
Greet the patient and confirm identity: train the student to perform
the informed consent, and collect the patient data.
Chief complaint: Determine the chief complaint and onset of
illness, train the student to collect data of chief complaint and
timeline of the symptom.
Other related symptoms: train the student to get other information
related to the symptoms of jaundice and liver failure, train the
student to find differential diagnosis and exclude it.
Collect the previous history, family history, other significant illness,
and house environment: train the student to find the risk factor of
the present illness.
Collect the history of current medication: to collect data about
present medication.

d. Methods
Presentation
Demonstration
Coaching
 Self practices: role - play

C. Attachment
1. Instrument, substances and material
needed Presentation :
Audiovisual : Video able in
LMS Demonstration and coaching :
a. Table
b. Chairs
c. Examination couch
2. Assessment:
Performance scale 0 = Neither mention nor do the
procedure Performance scale 1 = Only mention the
procedure Performance scale 2 = Mention and do the
procedure
3. Specimen Handling: -
4. Standardized patient Preparation for the Patient
Adult male (for alloanamnesis), 25-30 y.o, skinny/muscular
5. Reference

Learning Guide HT Jaundice

Perfor
No. Steps mance
Scales
0 1 2
HISTORY TAKING
Introduction
1. Sapa pasien, dan kembangkan lingkungan yang hangat dan membantu
2. Memperkenalkan diri kepada pasien
Patient Identity
Tanyakan pasien dengan sopan tentang dirinya:

3.

Chief complaint
4. Tanyakan kepada pasien tentang keluhan utama.
Penyakit kuning
5. Onset/duration
Progression

Other related symptoms

6 Kelelahan dan malaise
7 Demam
8. Mual dan/atau muntah
9 Kehilangan selera makan
10 Gatal
11 Warna urin? terlihat seperti cola/teh
12 Penurunan berat badan
13 Hematemesis / melena
14 Pembesaran perut
15 Benjolan di perut
16 Nyeri di kuadran kanan atas
17 Warna poop ? kuning/acholis
Previous history of :
Penyakit kuning serupa sebelumnya
Kebersihan makanan yang buruk
Riwayat konsumsi obat hepatotoksik
Riwayat konsumsi alkohol
Transfusi atau pembedahan
Pergaulan/homoseksual
Penyalahgunaan narkoba (suntikan)
Jumlah anak
Family history of :
Thalassemia atau anemia hemolitik lainnya
Riwayat penyakit kuning dalam keluarga (jika ada penyakit kuning, tanyakan apakah
karena Hepatitis, kanker hati, atau kanker pankreas)
 FACULTY OF MEDICINE UNIVERSITAS
PASUNDAN OBJECTIVE STRUCTURED
CLINICAL EXAMINATION
HIS-HISTORY TAKING & PROCEDURAL
CIRCUMSISION
THIRD YEAR PROGRAM 2021/2022

PERIH KONTEN
AL
Tata letak alat -
1. Ipad atau PC untuk komunikasi dengan host,
Yang harus dipersiapkan oleh pembagian scenario soal, dan alat pengganti
mahasiswa
1. Skenario dari PJ
2. Gadget untuk monitoring pelaksanaan ujian
Kebutuhan laboran
3. ATK
1. Skenario & dari PJ
Kebutuhan set alat yang 2. Gadget untuk monitoring pelaksanaan ujian
dipersiapkan oleh penguji/ host 3. ATK
Kebutuhan standar pasien -
1. dr. Shellita Melanie A.S, M. Kes
Penulis
2. dr. Muhammad Fadhil, M.Kes
Jumlah Skenario 3 buah

RUBRIK HISTORY TAKING DAN PERSIAPAN ALAT

SIRKUMSISI
NO PROCEDURE PERMORFANCE COMME
SCALE
NT
0 1 2 3

ANAMNESIS
1 Memperkenalkan diri kepada pasien/orang tua dengan sopan

2 Identifikasi pasien, meliputi: nama, umur dan rekam medis

Nama:
Umur:
Jenis Kelamin:
Ras:
Pendidikan:
Alamat:
3 Screening
Status pasien generalis Riwayat gangguan perdarahan Mudah memar?
Berdarah lebih banyak dengan operasi dan perawatan gigi?
Pendarahan yang sulit dihentikan?
Penyakit komorbid
Epilepsi? Diabetes Mellitus tipe 1?
Penyakit autoimun?
Penyakit kronis? Masalah gizi?
4 St. generalis patient

St.Localized patient

:
ASSESMENT
5 Kaji kondisi penis:

Jika tidak ada kontra indikasi, lanjutkan ke informed consent.

INFORMED CONSENT
6 Jelaskan prosedur, dan berikan jawaban rinci ketika orang tua dia mengajukan
pertanyaan tentang prosedur dengan kata-kata sederhana
keuntungan/kerugian

sempatan untuk bertanya, memastikan apa yang telah

disampaikan jelas atau tidak)
IMPLEMENTATION
Periksa instrumen dan bahan yang dibutuhkan
a.Menyiapkan peralatan (gunting, klem, spuit 3 cc, Nalpuder Hecting,
pinset chirurgis dan anatomi, neddle + cutgut 3.0)
b. Atur lampu agar mendapatkan cahaya yang cukup
c.Atur bidang steril dan peralatan steril
d.Buka semprit steril dengan cara menyobek bungkus ke luar dengan
kedua tangan keluar bungkus, lalu jatuhkan ke wadah steril
7 e. Buka larutan antiseptik dan tuangkan ke dalam baskom
f.Siapkan larutan anestesi lokal (lidokain)
Total

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FAIL BORDER LINE PASS

 RUBRIK PROSEDURAL SIRKUMSISI
NO PROCEDURE PERMORFANC COMME
E SCALE NT
STEPS OF THE PROCEDURE

A. Cuci tangan sampai bersih dengan sabun antiseptik

B. Kenakan sarung tangan steril
C. Area genital disiapkan dengan hati-hati dengan povidone Iodine
D. Tempatkan tirai bedah lubang di tengah sehingga penis berada di
tengah lubang. Letakkan tirai polos di atas paha.
E. Berikan blok penis lokal dan anestesi infiltrasi
F. Uji efek anestesi dengan mencubit kulup dengan tang bedah
G. Tarik kembali kulup, jika ada fimosis, dilatasi dilakukan dengan
memasukkan tif dari klem hemostat yang melengkung kemudian
melebarkannya. lepaskan smegma dengan kasa dan lepaskan semua
adhesi glanular dengan ujung klem hemostat atau kasa sampai glans
benar-benar terbuka.
H. Bersihkan kelenjar sekali lagi dengan povidone Iodine
I. Tarik kulup kembali ke posisi normal
J. Tandai area kulup yang akan dipotong kira-kira 0,5 ke area korona
dengan mencubitnya dengan tang bedah
K. Terapkan 4 klem, tang lurus diterapkan ke punggung (pukul 12)
memanjang ke area yang ditandai (0,5 cm dari area koronal) 3 klem
lainnya diterapkan ke ujung kulup (2 klem lateral dan satu klem di 6 o
posisi jam Penjepit punggung kemudian dilepas meninggalkan bekas
membujur pada jaringan yang dijepit.
1 L. Jaringan yang dijepit dipotong dengan gunting sampai ujung jaringan
yang dijepit. Kulit khatan dipotong dan diangkat secara sirkular dengan
menyisakan 0,5 cm kulit di sulkus koronal, dengan hati-hati agar frenulum
tetap utuh.
M. Setiap pembuluh darah yang berdarah kemudian dijepit dan diikat
dengan catgut halus. Ini harus dilakukan dengan sangat hati-hati karena
gunting akan menutup sementara pembuluh darah kecil, yang mulai
berdarah setelah anak meninggalkan klinik.
N. Setelah hemostasis memuaskan, tepi kulit didekati dengan jahitan
catgut halus yang terputus.
O. Bersihkan penis dengan kasa garam yang telah dibasahi, keringkan,
amati adanya perdarahan. Jika tidak berdarah, oleskan antibiotik zalf dan
biarkan tanpa perban
P. Kumpulkan dan buang peralatan sekali pakai. Bersihkan peralatan
non-disposable
Q. Cuci tangan sampai bersih dengan sabun tangan antiseptik
EVALUATION AND DOCUMENTATION
2 Evaluasi kriteria berikut:
General : stabil/tidak
A. Amati kemungkinan perdarahan
B. Tanggal dan waktu prosedur sunat
C. Nama dokter bedah
Total
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PEDIATRIC BLOOD PRESSURE
MEASUREMENT
I. GENERAL OBJECTIVE
After finishing skill practice of blood pressure measurement procedure, the student will be able
to measure the blood pressure by using appropriate technique.

II. SPECIFIC OBJECTIVES

At the end of skill practices, the student will be able to demonstrate blood pressure
measurement procedure by using appropriate techniques

III. SYLLABUS DESCRIPTION

3.9 Sub Model Objective

After finishing skill practice of catheterization procedure, student will be able to

demonstrate blood pressure measurement procedure by using appropriate techniques.
3.10 Topics
c. Blood Pressure Measurement Procedure

3.11 Methods
e. Presentation
f. Demonstration
g. Coaching
h. Self practices on Standardized Patient

3.12 Laboratory Facilities

n. Skills Laboratory
o. Trainers
p. Standardized Patient
q. Student Learning guide
r. guide
s. References
t. Blood Pressure Measurement sets

3.13 Venue
Skills Laboratory

3.14 Organizer
Block of genitourinary system of Clinical Skills Program Faculty of Medicine Universitas Padjadjaran, Hasan
Sadikin Hospital.

3.15 Evaluation
g. Skill demonstration in model unit
h. Point nodal evaluation
 21
i. OSCE

LEARNING GUIDE FOR BLOOD PRESSURE MEASUREMENT

BY AUSCULTATION TECHNIQUE

POINT NODAL
LEARNING GUIDE FOR BLOOD PRESSURE MEASUREMENT BY AUSCULTATION
TECHNIQUE

0 1 2 Comment

I PREPARATION
Instrument :
1. Menyesuaikan ukuran cuff bladder dengan anak-anak

2. memilih cuff bladder yang sesuai berdasarkan panjang dan lebarnya. Lebar cuff
bladder harus menutupi setidaknya 40% dari lingkar lengan atas (upper arm
circumference) pada titik tengah antara olecranon dan akromion. Panjang cuff
A. bladder harus menutupi 80-100% dari lingkar lengan atas (upper arm
circumference)
3. Memeriksa manometer apakah ada kerusakan mekanik yang mempengaruhi
pengukuran.
PLACE :
B.
Dalam situasi terkendali

C. PATIENT :
1. Tidak mengkonsumsi stimulant drugs atau makanan apapun yang merangsang

2. Duduk di kursi selama 5 menit dengan bantuan, kaki menggantung, lengan

kanan diposisikan dengan disangga setinggi/sejajar jantung. Pada anak yang lebih
muda, pengukuran dapat dilakukan pada posisi berbaring dan sisi lengan lurus
dengan tubuh

II. BLOOD PRESSURE MEASUREMENT

1. Lapisi upper arm with cuff bladder dengan kuat ± 3 cm dari elbow/ seperti
di bawah batas. Fossa cubiti.
2. Penentuan posisi arteri brakialis dengan cara meraba fossa cubiti
kemudian dipasang stetoskop.
3. Pompa manset sekitar 20-30 mmHg di atas tekanan yang dibutuhkan untuk
membuat oklusi di arteri brakialis. Tekanan darah turun perlahan 2-3
mmHg/detik sampai terdengar suara korotkoff (fase 1 korotkoff =tekanan
darah sistolik), kemudian terdengar fase-2, fase 3, fase-4 dan fase-5.
Hilangnya suara (fase-5) diindikasikan tekanan darah diastolik (suara
terdengar pelan), digunakan sebagai penanda tekanan darah diastolik.
4. Interpretasikan tinggi badan pasien dan konversikan ke CDC Chart (Grafik
panjang/tinggi badan untuk persentil usia)
5. Interpretasikan persentil panjang/tinggi pasien dan ubah ke grafik tekanan darah.

Final Score : ( Total Score/ 22 ) x 100%

Pass / Fail
 Birth to 36 months: Girls NAME
Length-for-age and Weight-for-age percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS)
cm in
41 41 L
40 40 E
100 95 100
39 90 39 N
38 G
75 38
95 95 T
37 50 37 H
36 25 36
90 90
35 10 35
5
34
85
33
32 38
80 95 17
31
L 30 36
75 90 16
E
N
29
34
G 28
70 75
15
T 27 32
H 26 65 14
25 50 30 W
24 E
60 13
23 25 28 I
G
22 55 12 H
10 26
21 5 T
20 50 11 24
19
18 45 10 22
17
16 40 9 20
15
8 18

16 16
7 AGE (MONTHS)
kg lb
12 15 18 21 24 27 30 33 36
14
6 Mother’s Stature Gestational
W Father’s Stature Age: Weeks Comment
E 12
Date Age Weight Length Head Circ.
I 5 Birth
G 10
H
T
4
8
3
6
2
lb kg
Birth 3 6 9
Published May 30, 2000 (modified 4/20/01).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 Birth to 36 months: Boys NAME
Length-for-age and Weight-for-age percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS)
cm in
41 41 L
40 95 40 E
100 90 100 N
39 39
75 G
38 38
95 50 95 T
37 37 H
25
36 36
90 10 90
35 5 35
34
85
33
32 95 38
80 17
31
L 90 36
30
E 75 16
N
29
75
34
G 28
70 15
T 27 32
H 26 50
65 14
25 30 W
24 25 E
60 13
23 28 I
10 G
22 55 12 H
5 26
21 T
20 50 11 24
19
18 45 10 22
17
16 40 9 20
15
8 18

16 16
7 AGE (MONTHS)
kg lb
12 15 18 21 24 27 30 33 36
14
6 Mother’s Stature Gestational
W Father’s Stature Age: Weeks Comment
E 12
Date Age Weight Length Head Circ.
I 5 Birth
G 10
H
T
4
8
3
6
2
lb kg
Birth 3 6 9
Published May 30, 2000 (modified 4/20/01).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 2 to 20 years: Girls NAME
Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
190
74
185 S
72
180 T
70 A
95
175 T
90
68 U
170 R
75 66
165 E
in cm 3 4 5 6 7 8 9 10 11 50
64
160 25 160
62 62
155 10 155
60 5 60
150 150
58
145
56
140 105 230
54
S 135 100 220
T 52
A 130 95 210
50
T 125 90 200
U
48 190
R 120 85
E 95 180
46
115 80
44 170
110 90 75
42 160
105 70
150 W
40 75
100 65 140 E
38 I
95 60 130 G
50
36 90 H
55 120
25 T
34 85 50 110
10
32 80
5
45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 2 to 20 years: Boys NAME
Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
95
190
74
90
185 S
75
72
180 T
50 70 A
175 T
25 68 U
170 R
10 66
165 E
in cm 3 4 5 6 7 8 9 10 11 5
64
160 160
62 62
155 155
S 60 60
T 150 150
A 58
T 145
U 56
140 105 230
R
54
E 135 100 220
52
130 95 95 210
50
125 90 200
90
48 190
120 85
46 180
115 80
75
44 170
110 75
42 160
105 50 70
150 W
40
100 65 140 E
25
38 I
95 60 130 G
10
36 90 5 H
55 120
T
34 85 50 110
32 80 45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
TABLE 5
BP Levels for Girls by Age and Height Percentile
Age (y) BP Percentile SBP (mm Hg) DBP (mm Hg)
Height Percentile or Measured Height Height Percentile or Measured Height
5% 10% 25% 50% 75% 90% 95% 5% 10% 25% 50% 75% 90% 95%
1 Height (in) 29.7 30.2 30.9 31.8 32.7 33.4 33.9 29.7 30.2 30.9 31.8 32.7 33.4 33.9
Height (cm) 75.4 76.6 78.6 80.8 83 84.9 86.1 75.4 76.6 78.6 80.8 83 84.9 86.1
50th 84 85 86 86 87 88 88 41 42 42 43 44 45 46
90th 98 99 99 100 101 102 102 54 55 56 56 57 58 58
95th 101 102 102 103 104 105 105 59 59 60 60 61 62 62
95th + 12 mm Hg 113 114 114 115 116 117 117 71 71 72 72 73 74 74
2 Height (in) 33.4 34 34.9 35.9 36.9 37.8 38.4 33.4 34 34.9 35.9 36.9 37.8 38.4
Height (cm) 84.9 86.3 88.6 91.1 93.7 96 97.4 84.9 86.3 88.6 91.1 93.7 96 97.4
50th 87 87 88 89 90 91 91 45 46 47 48 49 50 51
90th 101 101 102 103 104 105 106 58 58 59 60 61 62 62
95th 104 105 106 106 107 108 109 62 63 63 64 65 66 66
95th + 12 mm Hg 116 117 118 118 119 120 121 74 75 75 76 77 78 78
3 Height (in) 35.8 36.4 37.3 38.4 39.6 40.6 41.2 35.8 36.4 37.3 38.4 39.6 40.6 41.2
Height (cm) 91 92.4 94.9 97.6 100.5 103.1 104.6 91 92.4 94.9 97.6 100.5 103.1 104.6
50th 88 89 89 90 91 92 93 48 48 49 50 51 53 53
90th 102 103 104 104 105 106 107 60 61 61 62 63 64 65
95th 106 106 107 108 109 110 110 64 65 65 66 67 68 69
95th + 12 mm Hg 118 118 119 120 121 122 122 76 77 77 78 79 80 81
4 Height (in) 38.3 38.9 39.9 41.1 42.4 43.5 44.2 38.3 38.9 39.9 41.1 42.4 43.5 44.2
Height (cm) 97.2 98.8 101.4 104.5 107.6 110.5 112.2 97.2 98.8 101.4 104.5 107.6 110.5 112.2
50th 89 90 91 92 93 94 94 50 51 51 53 54 55 55
90th 103 104 105 106 107 108 108 62 63 64 65 66 67 67
95th 107 108 109 109 110 111 112 66 67 68 69 70 70 71
95th + 12 mm Hg 119 120 121 121 122 123 124 78 79 80 81 82 82 83
5 Height (in) 40.8 41.5 42.6 43.9 45.2 46.5 47.3 40.8 41.5 42.6 43.9 45.2 46.5 47.3
Height (cm) 103.6 105.3 108.2 111.5 114.9 118.1 120 103.6 105.3 108.2 111.5 114.9 118.1 120
50th 90 91 92 93 94 95 96 52 52 53 55 56 57 57
90th 104 105 106 107 108 109 110 64 65 66 67 68 69 70
95th 108 109 109 110 111 112 113 68 69 70 71 72 73 73
95th + 12 mm Hg 120 121 121 122 123 124 125 80 81 82 83 84 85 85
6 Height (in) 43.3 44 45.2 46.6 48.1 49.4 50.3 43.3 44 45.2 46.6 48.1 49.4 50.3
Height (cm) 110 111.8 114.9 118.4 122.1 125.6 127.7 110 111.8 114.9 118.4 122.1 125.6 127.7
50th 92 92 93 94 96 97 97 54 54 55 56 57 58 59
90th 105 106 107 108 109 110 111 67 67 68 69 70 71 71
95th 109 109 110 111 112 113 114 70 71 72 72 73 74 74
95th + 12 mm Hg 121 121 122 123 124 125 126 82 83 84 84 85 86 86
7 Height (in) 45.6 46.4 47.7 49.2 50.7 52.1 53 45.6 46.4 47.7 49.2 50.7 52.1 53
Height (cm) 115.9 117.8 121.1 124.9 128.8 132.5 134.7 115.9 117.8 121.1 124.9 128.8 132.5 134.7
50th 92 93 94 95 97 98 99 55 55 56 57 58 59 60
90th 106 106 107 109 110 111 112 68 68 69 70 71 72 72
95th 109 110 111 112 113 114 115 72 72 73 73 74 74 75
95th + 12 mm Hg 121 122 123 124 125 126 127 84 84 85 85 86 86 87
8 Height (in) 47.6 48.4 49.8 51.4 53 54.5 55.5 47.6 48.4 49.8 51.4 53 54.5 55.5
Height (cm) 121 123 126.5 130.6 134.7 138.5 140.9 121 123 126.5 130.6 134.7 138.5 140.9
50th 93 94 95 97 98 99 100 56 56 57 59 60 61 61
90th 107 107 108 110 111 112 113 69 70 71 72 72 73 73
95th 110 111 112 113 115 116 117 72 73 74 74 75 75 75
 95th + 12 mm Hg 122 123 124 125 127 128 129 84 85 86 86 87 87 87
9 Height (in) 49.3 50.2 51.7 53.4 55.1 56.7 57.7 49.3 50.2 51.7 53.4 55.1 56.7 57.7
Height (cm) 125.3 127.6 131.3 135.6 140.1 144.1 146.6 125.3 127.6 131.3 135.6 140.1 144.1 146.6
50th 95 95 97 98 99 100 101 57 58 59 60 60 61 61
90th 108 108 109 111 112 113 114 71 71 72 73 73 73 73
95th 112 112 113 114 116 117 118 74 74 75 75 75 75 75
95th + 12 mm Hg 124 124 125 126 128 129 130 86 86 87 87 87 87 87
10 Height (in) 51.1 52 53.7 55.5 57.4 59.1 60.2 51.1 52 53.7 55.5 57.4 59.1 60.2
Height (cm) 129.7 132.2 136.3 141 145.8 150.2 152.8 129.7 132.2 136.3 141 145.8 150.2 152.8
50th 96 97 98 99 101 102 103 58 59 59 60 61 61 62
90th 109 110 111 112 113 115 116 72 73 73 73 73 73 73
95th 113 114 114 116 117 119 120 75 75 76 76 76 76 76
95th + 12 mm Hg 125 126 126 128 129 131 132 87 87 88 88 88 88 88
11 Height (in) 53.4 54.5 56.2 58.2 60.2 61.9 63 53.4 54.5 56.2 58.2 60.2 61.9 63
Height (cm) 135.6 138.3 142.8 147.8 152.8 157.3 160 135.6 138.3 142.8 147.8 152.8 157.3 160
50th 98 99 101 102 104 105 106 60 60 60 61 62 63 64
90th 111 112 113 114 116 118 120 74 74 74 74 74 75 75
95th 115 116 117 118 120 123 124 76 77 77 77 77 77 77
95th + 12 mm Hg 127 128 129 130 132 135 136 88 89 89 89 89 89 89
12 Height (in) 56.2 57.3 59 60.9 62.8 64.5 65.5 56.2 57.3 59 60.9 62.8 64.5 65.5
Height (cm) 142.8 145.5 149.9 154.8 159.6 163.8 166.4 142.8 145.5 149.9 154.8 159.6 163.8 166.4
50th 102 102 104 105 107 108 108 61 61 61 62 64 65 65
90th 114 115 116 118 120 122 122 75 75 75 75 76 76 76
95th 118 119 120 122 124 125 126 78 78 78 78 79 79 79
95th and 12 mm Hg 130 131 132 134 136 137 138 90 90 90 90 91 91 91
13 Height (in) 58.3 59.3 60.9 62.7 64.5 66.1 67 58.3 59.3 60.9 62.7 64.5 66.1 67
Height (cm) 148.1 150.6 154.7 159.2 163.7 167.8 170.2 148.1 150.6 154.7 159.2 163.7 167.8 170.2
50th 104 105 106 107 108 108 109 62 62 63 64 65 65 66
90th 116 117 119 121 122 123 123 75 75 75 76 76 76 76
95th 121 122 123 124 126 126 127 79 79 79 79 80 80 81
95th + 12 mm Hg 133 134 135 136 138 138 139 91 91 91 91 92 92 93
14 Height (in) 59.3 60.2 61.8 63.5 65.2 66.8 67.7 59.3 60.2 61.8 63.5 65.2 66.8 67.7
Height (cm) 150.6 153 156.9 161.3 165.7 169.7 172.1 150.6 153 156.9 161.3 165.7 169.7 172.1
50th 105 106 107 108 109 109 109 63 63 64 65 66 66 66
90th 118 118 120 122 123 123 123 76 76 76 76 77 77 77
95th 123 123 124 125 126 127 127 80 80 80 80 81 81 82
95th + 12 mm Hg 135 135 136 137 138 139 139 92 92 92 92 93 93 94
15 Height (in) 59.7 60.6 62.2 63.9 65.6 67.2 68.1 59.7 60.6 62.2 63.9 65.6 67.2 68.1
Height (cm) 151.7 154 157.9 162.3 166.7 170.6 173 151.7 154 157.9 162.3 166.7 170.6 173
50th 105 106 107 108 109 109 109 64 64 64 65 66 67 67
90th 118 119 121 122 123 123 124 76 76 76 77 77 78 78
95th 124 124 125 126 127 127 128 80 80 80 81 82 82 82
95th + 12 mm Hg 136 136 137 138 139 139 140 92 92 92 93 94 94 94
16 Height (in) 59.9 60.8 62.4 64.1 65.8 67.3 68.3 59.9 60.8 62.4 64.1 65.8 67.3 68.3
Height (cm) 152.1 154.5 158.4 162.8 167.1 171.1 173.4 152.1 154.5 158.4 162.8 167.1 171.1 173.4
50th 106 107 108 109 109 110 110 64 64 65 66 66 67 67
90th 119 120 122 123 124 124 124 76 76 76 77 78 78 78
95th 124 125 125 127 127 128 128 80 80 80 81 82 82 82
95th + 12 mm Hg 136 137 137 139 139 140 140 92 92 92 93 94 94 94
17 Height (in) 60.0 60.9 62.5 64.2 65.9 67.4 68.4 60.0 60.9 62.5 64.2 65.9 67.4 68.4
Height (cm) 152.4 154.7 158.7 163.0 167.4 171.3 173.7 152.4 154.7 158.7 163.0 167.4 171.3 173.7
50th 107 108 109 110 110 110 111 64 64 65 66 66 66 67
90th 120 121 123 124 124 125 125 76 76 77 77 78 78 78
95th 125 125 126 127 128 128 128 80 80 80 81 82 82 82
95th + 12 mm Hg 137 137 138 139 140 140 140 92 92 92 93 94 94 94
Use percentile values to stage BP readings according to the scheme in Table 3 (elevated BP: ≥90th percent
and stage 2 HTN: ≥95th percentile + 12 mm Hg). The 50th, 90th, and 95th percentiles were derived by usi
normal-weight children (BMI <85th percentile). 77
TABLE 4
BP Levels for Boys by Age and Height Percentile
Age (y) BP Percentile SBP (mm Hg) DBP (mm Hg)
Height Percentile or Measured Height Height Percentile or Measured Height
5% 10% 25% 50% 75% 90% 95% 5% 10% 25% 50% 75% 90% 95%
1 Height (in) 30.4 30.8 31.6 32.4 33.3 34.1 34.6 30.4 30.8 31.6 32.4 33.3 34.1 34.6
Height (cm) 77.2 78.3 80.2 82.4 84.6 86.7 87.9 77.2 78.3 80.2 82.4 84.6 86.7 87.9
50th 85 85 86 86 87 88 88 40 40 40 41 41 42 42
90th 98 99 99 100 100 101 101 52 52 53 53 54 54 54
95th 102 102 103 103 104 105 105 54 54 55 55 56 57 57
95th + 12 mm Hg 114 114 115 115 116 117 117 66 66 67 67 68 69 69
2 Height (in) 33.9 34.4 35.3 36.3 37.3 38.2 38.8 33.9 34.4 35.3 36.3 37.3 38.2 38.8
Height (cm) 86.1 87.4 89.6 92.1 94.7 97.1 98.5 86.1 87.4 89.6 92.1 94.7 97.1 98.5
50th 87 87 88 89 89 90 91 43 43 44 44 45 46 46
90th 100 100 101 102 103 103 104 55 55 56 56 57 58 58
95th 104 105 105 106 107 107 108 57 58 58 59 60 61 61
95th + 12 mm Hg 116 117 117 118 119 119 120 69 70 70 71 72 73 73
3 Height (in) 36.4 37 37.9 39 40.1 41.1 41.7 36.4 37 37.9 39 40.1 41.1 41.7
Height (cm) 92.5 93.9 96.3 99 101.8 104.3 105.8 92.5 93.9 96.3 99 101.8 104.3 105.8
50th 88 89 89 90 91 92 92 45 46 46 47 48 49 49
90th 101 102 102 103 104 105 105 58 58 59 59 60 61 61
95th 106 106 107 107 108 109 109 60 61 61 62 63 64 64
95th + 12 mm Hg 118 118 119 119 120 121 121 72 73 73 74 75 76 76
4 Height (in) 38.8 39.4 40.5 41.7 42.9 43.9 44.5 38.8 39.4 40.5 41.7 42.9 43.9 44.5
Height (cm) 98.5 100.2 102.9 105.9 108.9 111.5 113.2 98.5 100.2 102.9 105.9 108.9 111.5 113.2
50th 90 90 91 92 93 94 94 48 49 49 50 51 52 52
90th 102 103 104 105 105 106 107 60 61 62 62 63 64 64
95th 107 107 108 108 109 110 110 63 64 65 66 67 67 68
95th + 12 mm Hg 119 119 120 120 121 122 122 75 76 77 78 79 79 80
5 Height (in) 41.1 41.8 43.0 44.3 45.5 46.7 47.4 41.1 41.8 43.0 44.3 45.5 46.7 47.4
Height (cm) 104.4 106.2 109.1 112.4 115.7 118.6 120.3 104.4 106.2 109.1 112.4 115.7 118.6 120.3
50th 91 92 93 94 95 96 96 51 51 52 53 54 55 55
90th 103 104 105 106 107 108 108 63 64 65 65 66 67 67
95th 107 108 109 109 110 111 112 66 67 68 69 70 70 71
95th + 12 mm Hg 119 120 121 121 122 123 124 78 79 80 81 82 82 83
6 Height (in) 43.4 44.2 45.4 46.8 48.2 49.4 50.2 43.4 44.2 45.4 46.8 48.2 49.4 50.2
Height (cm) 110.3 112.2 115.3 118.9 122.4 125.6 127.5 110.3 112.2 115.3 118.9 122.4 125.6 127.5
50th 93 93 94 95 96 97 98 54 54 55 56 57 57 58
90th 105 105 106 107 109 110 110 66 66 67 68 68 69 69
95th 108 109 110 111 112 113 114 69 70 70 71 72 72 73
95th + 12 mm Hg 120 121 122 123 124 125 126 81 82 82 83 84 84 85
7 Height (in) 45.7 46.5 47.8 49.3 50.8 52.1 52.9 45.7 46.5 47.8 49.3 50.8 52.1 52.9
Height (cm) 116.1 118 121.4 125.1 128.9 132.4 134.5 116.1 118 121.4 125.1 128.9 132.4 134.5
50th 94 94 95 97 98 98 99 56 56 57 58 58 59 59
90th 106 107 108 109 110 111 111 68 68 69 70 70 71 71
95th 110 110 111 112 114 115 116 71 71 72 73 73 74 74
95th + 12 mm Hg 122 122 123 124 126 127 128 83 83 84 85 85 86 86
8 Height (in) 47.8 48.6 50 51.6 53.2 54.6 55.5 47.8 48.6 50 51.6 53.2 54.6 55.5
Height (cm) 121.4 123.5 127 131 135.1 138.8 141 121.4 123.5 127 131 135.1 138.8 141
50th 95 96 97 98 99 99 100 57 57 58 59 59 60 60
90th 107 108 109 110 111 112 112 69 70 70 71 72 72 73
95th 111 112 112 114 115 116 117 72 73 73 74 75 75 75
 95th + 12 mm Hg 123 124 124 126 127 128 129 84 85 85 86 87 87 87
9 Height (in) 49.6 50.5 52 53.7 55.4 56.9 57.9 49.6 50.5 52 53.7 55.4 56.9 57.9
Height (cm) 126 128.3 132.1 136.3 140.7 144.7 147.1 126 128.3 132.1 136.3 140.7 144.7 147.1
50th 96 97 98 99 100 101 101 57 58 59 60 61 62 62
90th 107 108 109 110 112 113 114 70 71 72 73 74 74 74
95th 112 112 113 115 116 118 119 74 74 75 76 76 77 77
95th + 12 mm Hg 124 124 125 127 128 130 131 86 86 87 88 88 89 89
10 Height (in) 51.3 52.2 53.8 55.6 57.4 59.1 60.1 51.3 52.2 53.8 55.6 57.4 59.1 60.1
Height (cm) 130.2 132.7 136.7 141.3 145.9 150.1 152.7 130.2 132.7 136.7 141.3 145.9 150.1 152.7
50th 97 98 99 100 101 102 103 59 60 61 62 63 63 64
90th 108 109 111 112 113 115 116 72 73 74 74 75 75 76
95th 112 113 114 116 118 120 121 76 76 77 77 78 78 78
95th + 12 mm Hg 124 125 126 128 130 132 133 88 88 89 89 90 90 90
11 Height (in) 53 54 55.7 57.6 59.6 61.3 62.4 53 54 55.7 57.6 59.6 61.3 62.4
Height (cm) 134.7 137.3 141.5 146.4 151.3 155.8 158.6 134.7 137.3 141.5 146.4 151.3 155.8 158.6
50th 99 99 101 102 103 104 106 61 61 62 63 63 63 63
90th 110 111 112 114 116 117 118 74 74 75 75 75 76 76
95th 114 114 116 118 120 123 124 77 78 78 78 78 78 78
95th + 12 mm Hg 126 126 128 130 132 135 136 89 90 90 90 90 90 90
12 Height (in) 55.2 56.3 58.1 60.1 62.2 64 65.2 55.2 56.3 58.1 60.1 62.2 64 65.2
Height (cm) 140.3 143 147.5 152.7 157.9 162.6 165.5 140.3 143 147.5 152.7 157.9 162.6 165.5
50th 101 101 102 104 106 108 109 61 62 62 62 62 63 63
90th 113 114 115 117 119 121 122 75 75 75 75 75 76 76
95th 116 117 118 121 124 126 128 78 78 78 78 78 79 79
95th + 12 mm Hg 128 129 130 133 136 138 140 90 90 90 90 90 91 91
13 Height (in) 57.9 59.1 61 63.1 65.2 67.1 68.3 57.9 59.1 61 63.1 65.2 67.1 68.3
Height (cm) 147 150 154.9 160.3 165.7 170.5 173.4 147 150 154.9 160.3 165.7 170.5 173.4
50th 103 104 105 108 110 111 112 61 60 61 62 63 64 65
90th 115 116 118 121 124 126 126 74 74 74 75 76 77 77
95th 119 120 122 125 128 130 131 78 78 78 78 80 81 81
95th and 12 mm Hg 131 132 134 137 140 142 143 90 90 90 90 92 93 93
14 Height (in) 60.6 61.8 63.8 65.9 68.0 69.8 70.9 60.6 61.8 63.8 65.9 68.0 69.8 70.9
Height (cm) 153.8 156.9 162 167.5 172.7 177.4 180.1 153.8 156.9 162 167.5 172.7 177.4 180.1
50th 105 106 109 111 112 113 113 60 60 62 64 65 66 67
90th 119 120 123 126 127 128 129 74 74 75 77 78 79 80
95th 123 125 127 130 132 133 134 77 78 79 81 82 83 84
95th and 12 mm Hg 135 137 139 142 144 145 146 89 90 91 93 94 95 96
15 Height (in) 62.6 63.8 65.7 67.8 69.8 71.5 72.5 62.6 63.8 65.7 67.8 69.8 71.5 72.5
Height (cm) 159 162 166.9 172.2 177.2 181.6 184.2 159 162 166.9 172.2 177.2 181.6 184.2
50th 108 110 112 113 114 114 114 61 62 64 65 66 67 68
90th 123 124 126 128 129 130 130 75 76 78 79 80 81 81
95th 127 129 131 132 134 135 135 78 79 81 83 84 85 85
95th and 12 mm Hg 139 141 143 144 146 147 147 90 91 93 95 96 97 97
16 Height (in) 63.8 64.9 66.8 68.8 70.7 72.4 73.4 63.8 64.9 66.8 68.8 70.7 72.4 73.4
Height (cm) 162.1 165 169.6 174.6 179.5 183.8 186.4 162.1 165 169.6 174.6 179.5 183.8 186.4
50th 111 112 114 115 115 116 116 63 64 66 67 68 69 69
90th 126 127 128 129 131 131 132 77 78 79 80 81 82 82
95th 130 131 133 134 135 136 137 80 81 83 84 85 86 86
95th and 12 mm Hg 142 143 145 146 147 148 149 92 93 95 96 97 98 98
17 Height (in) 64.5 65.5 67.3 69.2 71.1 72.8 73.8 64.5 65.5 67.3 69.2 71.1 72.8 73.8
Height (cm) 163.8 166.5 170.9 175.8 180.7 184.9 187.5 163.8 166.5 170.9 175.8 180.7 184.9 187.5
50th 114 115 116 117 117 118 118 65 66 67 68 69 70 70
90th 128 129 130 131 132 133 134 78 79 80 81 82 82 83
95th 132 133 134 135 137 138 138 81 82 84 85 86 86 87
95th and 12 mm Hg 144 145 146 147 149 150 150 93 94 96 97 98 98 99
Use percentile values to stage BP readings according to the scheme in Table 3 (elevated BP: ≥90th percent
and stage 2 HTN: ≥95th percentile + 12 mm Hg). The 50th, 90th, and 95th percentiles were derived by usi
normal-weight children (BMI <85th percentile). 77
 Fakultas Kedokteran Unpas | 1

SKILL LABORATORY PRACTICE MODULE

GENITOURINARY SYSTEM
MEDICAL FACULTY OF PASUNDAN UNIVERSITY
TOPIC: HISTORY TAKING AND PHYSICAL EXAMINATION IN
GENITOURINARY SYSTEM

After finishing skill practice of history taking and physical examination, the student will
be able to do the appropriate history taking ang proper physical exam.

SPECIFIC OBJECTIVES
At the end of skill practices, the student will be able to:
a. Demonstrate the appropriate history taking
b. Demonstrate proper physical examination

LEARNING METHODS
Demonstration
Coaching
Self-practice
 Fakultas Kedokteran Unpas | 2

DAFTAR ALAT DAN BAHAN ABLE & KBM SKILL LAB

HISTORY TAKING AND PHYSICAL EXAMINATION
GENITOURINARY SYSTEM
FK UNPAS TA 2021/2022

NO ALAT DAN BAHAN JUMLAH KETERANGAN

1. Foto/Gambar Male &Female Genitalia 1
2. Meja Pemeriksaan 1
3. Examining hand gloves 1 pasang
4. Sabun Secukupnya
5. Tissue/handuk 1
6. Penlight 1
 Fakultas Kedokteran Unpas | 3

SCORE
NO HISTORY TAKING IN UROLOGIC ASSESSMENT 1 2 3
CHIEF COMPLAINT
1. Greet the patient and introduce yourself, develop a warm and
helpful environment
2. Politely ask : Patient identity ( Nama, usia, alamat )
3. Ask the reason why the patient needs to come to the clinic
( alasan datang )
Ask the followings:
Pain - sharp or dull ( tajam, ditusuk2 atau tumpul )
- identify location of the maximal point/area
( lokasiya dimana, yg paling sakit dimana)
- localized or spreading ( disatu tempat atau menyebar )
Micturition: ( perubahan saat buang air kecil )
Lower Urinary Tract Symptoms (LUTS):
- Storage: frequency, urgency, nocturia, urge
incontinence
( frekuensi ada perubahan tidak, atau
disatu waktu pengen buang air kecil, ada
perasaan pengen buang air kecil tp ga bisa
keluar, malam2 ngompol )
- Voiding: hesitancy, intermittency, slow stream, straining,
terminal dribbling and feeling incomplete emptying

Apakah susah untuk memulai buang air kecil, alirannya

ada yg berubah ga, ada perasaan pengen ngeden pas
BAK, pa pipiss netes2, ada perasaan kurang puas
seperti ada sisa
- Change of urine color: hematuria, cloudy urine.
Ada perubahan warna,atau ada sesuatu beda diurinnya
pak, kemerahan
History of passing stone
Oliguria, Anuria, Polyuria, Pneumaturia, Chyluria..
Waktu buang air ada beda ga pak volnya sedikit lebih dikit
atau lebih banyak, atau bahkan tidak ada sm sekali
Ada bunyi saat buang air kecil ga pak ?
Ada terlihat warna putih ga pak diurinnya ?
Incontinence : True, Stress, Urge,Overflow.
Ngompol saat stress, Ada rasa ingin buang air kecil tp ga
keluar sama sekali
Kandung kemih penuh
4. Ask the past medical history
Ada Riwayat penyakit sebelumnya ??
INFORMED CONSENT
5. - Explain the procedure to the patient
- Explain the goals or the expected result of the examination
- Ask for verbal consent if the patient agree soon as he or she
understands the procedure
Jadi pak, selanjutnya ini kita lakukan pemeriksaan fisik yaa,
prosedurnya bagian bawahny dibuka secara menyeluruh,
diperiksa secara menyeluruh..tujuannya untuk menegakkan
diagnosis dari keluhan2 yg bapak rasakan
Apakah bapak setuju ?
Jika bapak setuju silakan pak,tidur dimeja pemeriksaan
PHYSICAL EXAMINATION
 6. General State
Pemeriksaan status generalis
Height ( tinggi )
Weight ( berat )
Color of conjunctiva (icterus, anemic)
Periksa konjungtiva apakah ada ikterik atau tidak
Vital sign measurement
Periksa tanda tanda vital
Inspection for enlargement, masses or abnormality.
Dan inspeksi apakah ada pembesaran, masa atau
keabnormalan
7. Specific: Inspection and palpation of;
Lakukan inspeksi dari area flank supra pubic external genital
Flank area
Supra pubic
External genitalia
PREPARATION ( Persiapan )
8. Patient
- Examining table
Meja pemeriksaan
- Lamp
lampu
Examining physician
- Examining hand gloves
gloves
- Soap and water
Air dan sabun
- Clean and dry towel
Handuk bersih dan kering
- Penlight
GETTING READY
 Fakultas Kedokteran Unpas | 4

9. After finishing the history taking, ask patient to expose the

abdominal region
Setelah selesai anamnesis, suruh pasien membuka baju
mengekspose bagian perut
10. Ask the patient to lay down on the examination table
Suruh pasien tidur di meja pemeriksaan
11. Turn on the lamp and direct it to the examining area
Nyalakan lampu pemeriksaan, dan mengarahkan ke area
pemeriksaan
12. Putting on examination hand gloves prior to external genitalia
examination
Mengenakan gloves sebelum melakukan pemeriksaan
external genitalial
EXAMINATION
13. The physician always stands on the right of thepatient
Pemeriksa berdiri disebelah kanan pasien
14. Inspection on the abdominal and suprapubic region, and
external genitalia
Inspeksi pada abdominal dan regio suprabupic, dan bagian
ekxternal genitalia
Perhatikan bila ada tanda2 abnormalitas
15. Palpation of the right kidney :
Palpate the costovertebral angle area by using two hands
examination, place your left hand behind the patient just
below and parallel to the 12th rib, with your fingertips just
reaching the costovertebral angle. Place your right hand
gently in the right upperquadrant, lateral and parallel to the
rectus muscle.

Palpasi di daerah costovertebral angel dengan 2 jari,

tempatkan tangan kiri di belakang pasien tepat dibawah dan
sejajar dengan ribs ke 12 dengan ujung jari menyentuk
costovertebral angel
Tempatkan tangan kanan dengan lembut di RUQ, secara
lateral dan sejajar dengan rectusabdominus

Asked the patient to bended his/her right knee. Asked the

patient to take a deep breath. At the peakof inspiration, press
your right hand firmly and deeply into the right upper

the kidney between your two hands. If the kidney is palpable,

describe its size, contour and tenderness.
If there is no tenderness, proceed to fist percussion test to
assess kidney tenderness by placing the ball of one hand in
the costovertebral angle and strike it with the ulnar surface
of your fist. Use force sufficient to cause a perceptible but
painless jar or thud in a normal person.

Minta pasien menekuk lutut kanan, minta pasien Tarik nafas

dalam, pada puncak inspirasi, tangan kanan menekan
dengan kuat dan dalam di Kuadran kanan atas, tepat
dibawah costal marginal dan coba untuk menangkap ginjal
dengan kedua tangan anda, jika ginjal teraba gambarkan
kontur, ada atau ada tidak nyeri
 Jika tidak ada nyeri lakukan perkusi dengan test dengan
kepalan tangan, kekutan cukup keras

Palpation of the left kidney :

To capture the left kidney
Without changing position, do the same thing on the left site.

16. Inspect, Palpate and perform percussion on the suprapubic

area. Bladder disorder may cause suprapubic pain.
Pain associated with bladder infection, if present at all in the
abdomen, is typicallydull and steady. Pain associated with
sudden overdistention of the bladder is often agonizing, while
chronic bladder distention is usually painless.
17. Examination of Male external genitalia (Wear gloves
throughout the examination):
- Penis :
Inspect and palpate
The skin, the prepuce (foreskin). If it is present.
retract it or ask the patient to retract it.
Kulit dan kulum jika ada minta pasien untuk
menariknya
Glans. Look for any ulcers, scars, nodules orsign
of inflammation.
Glands Apakah ada ulkus, skar , nodul atau
inflamasi
Urethral meatus, note the location. Compress the
glans gently between your index finger above and
your thumb below ( meatus urethra , perhatikan
lokasi dan menekan glands penis dengan lembut
dengan telunjuk atas dan ibu jari dibawah ). This
maneuver should open the
urethral meatus and allow you to inspect it for
 Fakultas Kedokteran Unpas | 5

discharge. If the patient has reported a discharge but

penis from its base tothe glans. Alternatively, do it

yourself.
Jika pasien bilang ada discharge maka,minta dia
mengurut penis dari pangkal sampe ke gland , atau
pemeriksa bisa lakukan sendiri
Palpate the shaft. Palpate any abnormalityof the
penis, noting for any tenderness or induration.
Palpate the shaft of the penis between your thumb
and first two finger, noting for any induration.
Palpasi setiap kelainan di batang penis
menggunakan ibu jari dan jari telunjuk dan jari
tengah
If you retract the prepuce, replace it before
proceeding on to examine the scrotum.
- Scrotal area :
Inspect, palpate the Scrotum. Note for any
swelling, lumps or veins.
Inspeksi dan papasi skrotum Perhatikan apakah
ada pembengkana atau benjolan.
Testis, epididymis. Palpate each testis and
epididymis between your thumb and first two
fingers. Note for size, shape, consistency and
tenderness. Feel for anynodules

Testis dan epididymis , Menggunakan jari telunjuk

atau jari tengah, perhatikan bentk, ukuran ,
konsistensi dan ada atau tidaknya tenderness,
apakh ada nodul dan tidak

Spermatic cord, including vas deferens, between

your thumb and fingers from epididymis to
superficial inguinal ring. Note any nodules or
swelling
Untuk memerika sprematic cord dan vas deferens
menggunakan ibu jari dan jari telunjuk dan jari
tengah periksa dari testis epididymis hingga
superficial inguinal rig, apakah nodul dan
pembengkakaan
Any swelling in the scrotum other than the testicles
should be evaluated by transillumination. After
darkening the room, shine the beam of a strong
flashlight from behind the scrotum through the
mass. Look for transmission of the light as a red
Jika ada pembengkakan scrotum selain testis di
evaluasi dengan transiluminasi an sorot dengan
senter dari belakang skrotum melewati masa ,
carilah transmisi cahaya berwarna merah
keemasan

- DRE
 Examination of Female External Genitalia :
- Inspect the whole vulva and perineum
Inspeksi vulva dan perineum
- Separate the major labium to open the vulva with the left
thumb and index finger, then inspect the urethral meatus
and vaginal introitus
Pisahkan labium mayor dan buka vulva menggunakan
ibu jari dan jari telunjuk kiri periksa meats uretra dan
inroitus vaginal
- With your right thumb and index finger palpate both
area.
Dengan ibu jari dan jari telunjuk kanan rabalah kedua
sisi labium mayor disisi kelenjar barholin
- DRE

FINAL CONCLUSION
18. Draw a conclusion of the examination result
19. State the patient condition in the conclusion