RESPIRATORY SYSTEMrepository2.uph.edu/550/1/A28.pdf · 2020. 6. 22. · Respiratory System / MEU...

RESPIRATORY SYSTEM

Module

Faculty of Medicine

Pelita Harapan University

Karawaci – Tangerang

2017/2018

Respiratory System / MEU FK-UPH Page 1

AUTHOR

Dr. dr. Allen Widysanto, SpP, CTTS


OVERVIEW

Problem based learning is a method of learning using problems as a starting point for the

acquisition and integration of new knowledge. In Respiratory Block, students have to learn not only

the basic science but also the disease of the lower respiratory tract. This block consists of 30 hours

of lectures, 20 hours of laboratory practices, 20 hours of clinical skills and the rest are self study

time.

The most important purpose of Respiratory Block is to build students’ knowledge and their

ability to analyze the respiratory cases so that the thinking framework would be developed. In order

to achieve these goals, all staffs of Pulmonology Department present a module, titled Respiratory

Module.

Respiratory Module could be used as a guiding book for lecturers to build the knowledge

and skills of the students. We hope that this book would be useful for all.

Karawaci, October 18th, 2017

Block Coordinator

Dr. dr. Allen Widysanto, SpP, CTTS


LIST OF CONTENT

Page Overview……………………………………………………………………………… 2

I. Course info…………………………………………………………………………… 4

II. Competencies……………………………………………………………………….. 5

III. Teaching and Learning method………………………………………………….. 7

IV. Department……………………………………………………………………………. 8 V. Objectives …………………………………………………………………………… 10

VI. List of disease ………………………………………………………………………. 26

VII. References…………………………………………………………………………… 28

VIII. Assessment………………………………………………………………………… 29

IX. Timetable……………………………………………………………………………. 32

X. Approval……………………………………………………………………………… 35


CHAPTER I

COURSE INFO

Block : Respiratory

Semester : III

Credits : 5

Duration : 5 weeks

Started : 30 Oktober 2017

Ended :1 December 2017

Coordinator : Dr. dr. Allen Widysanto, SpP, CTTS


CHAPTER II

COMPETENCIES

Medical Standard Competencies (KKI)

1. Scientific basis of medical knowledge Identify, explain, and plan a scientific approach to health problem-solving, based on current medical and health science, to get an optimal result.

1.1. Apply the concepts and principles of biomedical clinical appropriate to the delivery

of primary health care Students should be able to:

a. Explain the health problem in terms of the principles of the basic medical sciences, pathogenesis and pathophysiology of respiratory problem

b. Explain the molecular and cellular aspects of the health problem, based on an understanding of the normal mechanisms of the human body

c. Explain the non-biological factors which influence the health problems d. Develop an effective strategy to prevent the causes of a disease, based on

pathogenesis and pathophysiology and specific risk factors, and the effect of the respiratory disease

e. Explain the various options for patient management f. Justify the chosen intervention based on pharmacology, physiology, nutrition,

exercise and behavioural change g. Explain the possibility of drug interactions and side effects h. Explain the benefit of dietary therapy in the management of certain diseases

1.2. Conduct laboratory procedures

Students should be able to: a. Choose clinical and laboratory procedures which are appropriate for the

patient’s respiratory problem b. Conduct laboratory procedures which are appropriate for the patient’s problem

and the doctor’s accreditation c. Identify, choose and decide on appropriate laboratory procedures d. Conduct basic laboratory procedures e. Complete a request form for more advanced laboratory procedures f. Identify appropriate disease screening test(s)

1.3. Summarize an appropriate interpretation of the history, physical examination, and

laboratory tests Students should be able to:

a. Explain (using pathophysiologic or other approaches) the clinical and laboratory data to determine the diagnosis of respiratory disease

b. Explain the rationale for the diagnosis by reference to evidence based medicine


2. Management of health problems Manage health problems in a person, family, or community comprehensively, holistically, sustainable, co-ordinately and collaboratively in the context of a primary health care service

2.1. Manage the patient’s disease, illness, and problem as a whole individual, as part of a

family and a community Students should be able to:

a. Interpret clinical data to formulate provisional and differential diagnoses b. Explain the cause, pathogenesis, and pathophysiology of a disease c. Identify the various options for management of the patient’s disease d. Manage the health problem independently and responsibly according to

his/her accreditation e. Give reasons for the chosen management strategy based on pathophysiology,

pathogenesis, pharmacology, psychology, social and other appropriate factors f. Write clear, complete, accurate, and legible instructions g. Identify the indicators of successful treatment, monitor the progress of

management, revise and change therapy appropriately h. Predict, monitor, recognize the possibility of drug interactions and side effects,

and revise or change therapy appropriately i. Implement the principles of family medicine in a holistic, comprehensive,

coordinated, collaborative, and sustainable manner in managing the disease and the patient’s problem

j. Identify the role of the patient’s family, their occupation, and social environment as factors that may influence the occurrence of disease and the choice of therapy


CHAPTER III

TEACHING AND LEARNING METHOD

Lectures : 6 hours/week

Tutorials and Plenary : 7 hours/week

Laboratory practices : 4 hours/week

Clinical skills : 4 hours/week

University compulsory courses : 2 hours/week

Self directed learning : 14 hours/week


CHAPTER IV

DEPARTMENTS

1. Department of Anatomy

• Bernard. S. M. Hutabara, dr, PAK

• Stefanus Satria Sumali, dr, M.Biomed

• Deisy Budiono,dr.

2. Department of Histology

• Jan Tambayong, dr,.PHK

• Neneng Suryadinata,dr.,MSi

• Erna Kristianti, dr, SpPA

3. Department of Physiology

• Herman, dr

• Robert Stefanus, dr, M.Biomed

4. Department of Anatomy Pathology

• Darti Isbandiati Wibisono, dr MS, SpPA

• Patricia Diana, dr, SpPA

5. Department of Clinical Pathology

• T. Haryanto, dr., SpPK

6. Department of Microbiology

• Cucunawangsih, dr.,SpMK

• Veronica Wiwing, dr, SpMK

• Angela Abidin, MARS, SpMK

7. Department of Parasitology

• Sisirawaty dr., MS., Sp.ParK

• Danielle Tahitoe. dr., MS., Sp.ParK

• Jane Florida, dr

8. Department of Radiology

• Subagia Santosa, dr., SpRad

• Brian Lucas, dr, SpRad


9. Department of Pharmacology

• Dr. Nicolaski Lumbuun, dr., SpFK

10. Department of Paediatric

• Anita Halim, dr., SpA

• Andry Juliansen, dr, SpA

• Patricia Yulita Gunawan, dr, SpA

11. Department of Anesthesiology

• Hori Haryanto, dr, SpAn

12. Department of Pulmonology and Respiratory

• Allen Widysanto, Dr. dr., SpP, CTTS

• Taufan Situmeang dr., SpP

• Titis Dewi, Wahyuni, dr., SpP

• Frans Abednego Barus, dr, SpP


CHAPTER V

WEEK OBJECTIVES

WEEK ONE: RESPIRATORY EMERGENCY CASE (PNEUMOTHORAX)

Overall WEEK OBJECTIVES

1. Describe the embryological development of the lung and the diaphragm.

2. Describe the structure anatomy of the lung, the pleura, the relational between chest wall,

the thorax and the mediastinum, lungs and their lobes, the vascular system of the thorax,

the vagus and the phrenic nerves, structure of diaphragm, lymphatic system of the lung.

3. Describe the pressure differences in the chest wall, diaphragm, pleura and airways.

4. Classify two main disorders in the lung.

5. Classify the type and management of pneumothorax.

6. Describe the function of chest tube

7. Explain about lung oedema

Lecture Objectives

LECTURE 1 : HISTOLOGY OF THE LOWER RESPIRATORY TRACT

Duration : 50 minutes

Instructor : Jan Tambayong, dr, Histologist, Department of Histology

Objectives: 1. Describe the histological organization of trachea, bronchi, terminal bronchioles,

respiratory bronchioles, alveolar duct , alveolar saccus, interalveolar wall

2. Relate the ultrastructure of the alveolar-capillary barrier to its function in

gaseous exchange.

3. Identify the type 2 pneumocyte and the function to produce surfactant.

4. Describe how importance of elastin in the wall of airways

LECTURE 2,3 : PLEURAL DISEASES (Pleural effusion, pneumothorax)


Instructor : Frans Abednego Barus, dr, Pulmonologist

Objectives: 1. List the etiologies of pleural effusion and pneumothorax.

2. Describe the pathophysiology of those diseases.

3. Describe the difference between transudative and exudative pleural effusion.

4. Recognize the signs and symptoms

5. Develop a framework to diagnose those diseases using clinical features,

laboratory and radiographic findings.


6. Describe the treatment of each disease and how important is Water Sealed

Drainage being performed.

7. Recognize the emergency condition which needs treatment/action from the

specialist immediately.

LECTURE 4 : ANATOMY and DEVELOPMENT OF THE LUNG


Instructor : dr Stefanus Sumali, M.Biomed

Objectives: 1. Describe the structure of chest wall, pleura, and the lung

2. Describe the muscle of respiration

3. Describe the bronchial tree from trachea to alveoli.

4. Describe the vascular system, nerve system and lymphatic system of the lung

5. Describe the changes in the orientation of the embryonic coeloms during

development of the lung.

6. Describe the development of the diaphragm.

LECTURE 5 : THE FUNCTIONS OF THE RESPIRATORY SYSTEM


Instructor : Prof Irawan Yusuf

Objectives: 1. Describe the exchange of oxygen and carbon dioxide with the atmosphere and

relates gas exchange to the metabolism of the tissues of the body

2. Define the role of the respiratory system in acid-base balance.

3. Define and describes the site of gas exchange in the lungs.

4. Describe the transport of gas through the conducting airways to and from the

alveoli.

5. Describe the central nervous system initiation of breathing and the innervation

of the respiratory muscles

LECTURE 6 : LUNG OEDEMA


Instructor : Taufan Situmeang, dr, Pulmonologist

Objectives: 1. Define cardiogenic pulmonary oedema

2. Describe the patophysiology of cardiogenic pulmonary oedema

3. Investigate and treat cardiogenic pulmonary oedema within the emergency

department


Laboratories practice

LABORATORY 1: REVIEW OF GENERAL ANATOMY OF THE THORAX AND MEDIASTINUM


Instructor : Bernard,dr,PAK, Stefanus Sumali dr, Deisy Budiono, dr

Objectives 1. Identify the skeleton of the thorax.

2. Identify the respiratory muscles

3. Identify the contents of an intercostals space and the position of the

neurovascular bundle.

4. Identify the features of the right and left lungs

5. Identify the structure in the hilus of each lung.

LABORATORY 2: HISTOLOGY : LOWER RESPIRATORY TRACT


Instructor : Jan , dr, Histologist, Department of Histology, Neneng, dr, M.Psi T

Objectives : 1. Identify the histological appearance of the respiratory mucosa

2. Identify the histological appearance of bronchus, terminal bronchioles,

respiratory bronchioles, alveolar ducts, alveolar sacs and the surfactant.

LABORATORY 3: RADIOLOGY


Instructor : Brian Lucas dr, Radiologist, Department of Radiology

Objectives : 1. Identifiy the normal chest X ray.

2. Identifiy the normal CT scan thorax.

3. Describe the radiologic features of pleural effusion.

4. Describe the radiologic features of pneumothorax.

5. Recognize the various types of the position of imaging and describe the

characteristics for each position.

6. Identify the imagination line of major fissure and minor fissure on the right lung

and major fissure on the left lung in the posteroanterior imaging.


WEEK TWO : SPECIFIC INFECTION (PULMONARY TUBERCULOSIS) Overall WEEK OBJECTIVES

1. Describe the causes of hypoxemia.

2. Describe the diffusion process of oxygen and carbon dioxide across the alveolar capillary

membrane.

3. Describe pathological feature of specific infection due to Mycobacterium tuberculosis.

4. Describe the special supportive examinations (serological test) for diagnosing tuberculosis.

5. Describe and distinguish the active lesion and the inactive lesion of TB from imaging.

6. Distinguish and describe the pathogenesis of primer tuberculosis (TB) and post primer TB.

7. Describe the principle of Mantoux test.

LECTURE 1 : Paediatric TB


Instructor : Anita Halim, dr., Pediatrician

Objectives: 1. To know the importance of the natural history of tuberculosis in children

2. To know the pathophysiology of tuberculosis

3. To know the ability to diagnose a child with tuberculosis

4. To evaluate the management of TB in children

5. To know the complications of TB in children

LECTURE 1 : TB and HIV


Instructor : Frans Abednego Barus, dr, Pulmonologist,

Objectives: 1. To describe the epidemiology of TB-HIV

2. To describe the symptoms ,clinical feature of TB-HIV

3. To describe the supportive examination of TB-HIV

4. To describe the management of TB-HIV

LECTURE 2 : ACID-BASE BALANCE


Instructor : Hori Haryanto, dr, Anesthesiologist. Department of Anesthesiology

Objectives: 1. Define acids, bases and buffers.

2. List the buffer systems available in human body.

3. State the normal range of arterial pH, pO2, pCO2 , bicarbonate concentration,

base excess and O2 saturation.


4. Describe the interrelationship of the pH, the pCO2 of the blood and the plasma

bicarbonate concentration.

5. State the Henderson Hasselbach equation and Stewart model

6. List the potential causes of respiratory acidosis and alkalosis and metabolic

acidosis and alkalosis.

LECTURE 3 : MICROBIAL IN LOWER RESPIRATORY TRACT


Instructor : Veronica Wiwing, dr , Microbiologist, Department of Microbiology

Objectives:

1. To describe the characteristic of Mycobacteria species

2. To explain the clinical Mycobacteriology laboratory: speimen collection,

identification using ZN stain and culture method, immune-based methods and

molecular methods

3. To understand the molecular epidemiology of Mycobacterium tuberculosis

4. To understand the mechanisms of drug resistance in Mycobacterium tuberculosis

5. To describe the host immune responses and antigenic variation

LECTURE 4 : TB and HIV


Instructor : Allen Widysanto, dr, Pulmonologist,

Objectives: 1. To describe the epidemiology of TB-HIV

2. To describe the symptoms ,clinical feature of TB-HIV

3. To describe the supportive examination of TB-HIV

4. To describe the management of TB-HIV

LECTURE 5 : HEMOPTYSIS


Instructor : Allen Widysanto, dr, Pulmonologist

Objectives: 1. State the definition and pathophysiology of hemoptysis.

2. Differentiate hemoptysis and hematemesis.

3. State the etiologies of hemoptysis.

4. Categorize the severity of hemoptysis.

5. Describe the treatment and complication of hemoptysis.

6. State the criteria for surgery approach.


LECTURE 6 : Pertussis (chronic cough)


Instructor : Andry Juliansen, dr., Pediatrician

Objectives: 1. Describe the mechanism of action and causes of pertussis causing bacteria

2. Explain clinical manifestation of pertussis

3. Describe diagnostic measures of pertussis

4. Describe management of pertussis

5. Explain pertussis vaccination mechanism and schedule


LABORATORY 1: ANATOMY PATHOLOGY : SPECIFIC INFECTION


Instructor :Darti, dr, Pathologist, Department of Anatomy Pathology

Objectives: 1. To understand the changes of basic pathology seen in lung tuberculosis.

2. To differentiate the transudative and exudative fluid from cavum pleura.

LABORATORY 2 : MICROBIOLOGY : ACID FAST BACILLI


Instructor : Cucunawangsih , dr, Microbiologist, Department of Microbiology

Objectives

1. To understand that ZN staining is differential staining for acid fast bacilli

2. To apply the method of ZN staining for microbiology diagnostic

3. To identify the shape of acid fast bacilli in rods

4. To understand that LJ medium is selective medium for acid fast bacilli and mycobacterium

sp are slow growing bacteria

LABORATORY 3: RADIOLOGY


Instructor : Subagia Santoso, dr, Radiologist, Department of Radiology

Objectives:

1. Describe the feature of active tuberculosis and primary complex of TB.

2. Describe the signs of Ex tuberculosis and inactive TB.

3. Describe the signs of military tuberculosis (diffuse disseminated reticular and military

shadow).

4. Describe the radiologic features of pleural effusion, pleural schwarte, pneumothorax


WEEK THREE : OBSTRUCTIVE PULMONARY DISEASE (ASTHMA AND CHRONIC

OBSTRUCTIVE PULMONARY DISEASE/ COPD)


1. Describe the 4 main forms of obstructive lung disease (Asthma, COPD, bronchiectasis,

bronchiolitis obliterans), include epidemiology, risk factor, natural history.

2. Describe the concept of ventilation-perfusion relationship.

3. Describe the pathology, immunology and pulmonary function abnormalities of asthma and

COPD.

4. Describe the cellular mechanisms which are play role in asthma and COPD.

5. Differentiating asthma and COPD from patient’s history, physical examination findings and

pulmonary function test.

6. Distinguish the main principle of treatment between asthma and COPD.

7. Describe the use of oxygen therapy in obstructive lung disease, the role of assisted

ventilation and the complication of respiratory support devices.

8. Distinguish radiologic imaging between asthma and COPD.

9. Describe the group of drugs used to treat obstructive airways disorders, their mechanisms

of action and the rational in treatment approach for different obstructive.

10. Explain about cor pulmonale

LECTURE 1 : PATHOLOGICAL ANATOMY OF LUNG DISEASE


Instructor : Suga , dr., SpPA

Objectives

1. Know inflammatory lung disorders

a. Differences between bronchitis and pneumonia

b. Differences between specific and non-specific infections

2. Know chronic obstructive pulmonary disease

a. Pathogenesis and pathology of emphysema

b. Differences between emphysema and atelectasis

c. Pathogenesis and pathology of chronic bronchitis and bronchiolitis

3. Know pulmonary neoplasm

a. Pathogenesis and pathology of squamous cell carcinoma, adenocarcinoma

b. Primary and secondary lung cancer

4. Know pleural disorders


LECTURE 2 : Paediatric asthma and bronchiolitis


Instructor : Patricia Yulita Gunawan, dr., SpA

Objectives:

1. Define asthma and bronchiolitis.

2. Describe the natural history of asthma and bronchiolitis in children.

3. Discuss the pathophysiology and underlying mechanisms of asthma and bronchiolitis .

4. Demonstrate the ability to diagnose children with asthma and bronchiolitis.

5. Review the importance of appropriately classifying asthma.

6. Describe the disease control and management of asthma and bronchiolitis.

7. Discuss the importance of establishing a patient partnership for asthma management and

patient education.

LECTURE 3 : V/Q MISMATCH


Instructor : Robert Stefanus, dr, Physiologist, Department of Physiology

Objectives

1. What is the concept of matching ventilation and perfusion in the normal lung

2. What is the consequences of mismatched ventilation and perfusion

3. Describe the testing for non-uniform distribution of inspired gas and pulmonary blood flow

4. Describe the methods used to assess the matching of ventilation and perfusion

LECTURE 4 : CHRONIC OBSTRUCTIVE PULMONARY DISEASE



Objectives:

1. Describe the definition, etiologies and epidemiology .

2. Describe the pathology and pathophysiology

3. State the cellular pathophysiological which are involved and differentiating with the cellular

pathophysiological of asthma.

4. Establish the diagnosis of COPD from history, clinical signs, investigation and distinguish it

from asthma

5. State the differential diagnosis

6. State the prevention

7. Describe the treatment guidelines either on stable or exacerbation of COPD


8. Describe other treatment modalities such as vaccination, oxygen, pulmonary rehabilitation,

nutritional support and surgery. Why both pharmacological and non-pharmacological

treatments are important in the management of patients with obstructive lung disease?

9. State how is the prognosis of COPD

LECTURE 5 : CHRONIC COR PULMONALE



Objectives: 1. Interpret the term of chronic cor pulmonale

2. Describe the etiology of cor pulmonale

3. Explain the pathogenesis of cor pulmonale

4. Identify the clinical manifestation of cor pulmonale

5. Mention diagnostic measures of cor pulmonale

6. Describe medical management of cor pulmonale

LECTURE 6 : MEDICATIONS FOR ASTHMA AND COPD


Instructor : Nicolaski Lumbuun, dr, Pharmacologist, Department of Pharmacology

Objectives

1. To know the basic pathogenesis and therapeutic strategies for the management of asthma

and chronic obstructive pulmonary disease

2. To understand the mechanism of action of the three major classes of bronchodilators (B

agonists, PDE inhibitors, anticholinergics)

3. To understand the uses of corticosteroids in asthma and chronic obstructive pulmonary

disease

4. To know the prospects of new therapies for asthma and COPD



LABORATORY 1: ANATOMY PATHOLOGY :PATHOLOGY OF COPD, ASTHMA,

BRONCHIECTASIS


Instructor : Darti, MD, Pathologist, Department of Pathology

Objectives:

1. To understand the correlation of pathologic findings and physiologic findings in patients

with chronic airflow obstruction.

2. To understand how the pathologic findings and physiology differ in COPD, asthma and

bronchiectasis.

LABORATORY 2: CLINICAL PATHOLOGY: ACID BASE BALANCE


Instructor : Budhianto, MD, Dr, Prof, Department of Clinical Pathology

Haryanto, MD, Department of Clinical Pathology

Objectives:

1. Define acidosis and alkalosis.

2. Discuss the respiratory and renal mechanisms that help to compensate for acidosis

and alkalosis.

3. Evaluates blood gas data to determine a subject’s acid-base status.

LABORATORY 3: RADIOLOGY : CHRONIC OBSTRUCTIVE PULMONARY DISEASE


Instructor : Brian Lucas, Radiologist, Department of Radiology

Objectives: 1. Describe the radiographic features of COPD

2. Describe the characteristic feature of emphysema, atelectasis, bronchiectasis

and cor pulmonale

3. Describe the radiologic feature of pulmonary emboli


WEEK FOUR : NEOPLASM


1. List the major air pollutants and the factors which influences deposition of pollutants within

the respiratory system (particles, ozone, oxides of nitrogen, sulfur oxides, environmental

tobacco smoke, radon, organic dusts, metal fumes)

2. List the sources of exposure to pollutants in the work place.

3. Describe the macroscopic and microscopic pathology of the major types of lung and

pleural cancers- squamous, adenocarcinoma, large cell, small cell carcinoma and pleural

mesothelioma.

4. Recognize the clinical and therapeutic implications of Small Cell Carcinoma (SCC) and

NonSmall Cell Carcinoma (NSCC).

5. Describe the clinical procedures to get cells and tissues for the diagnosis of lung cancer

6. List some of pneumoconiosis which will develop lung cancer.

7. Distinguish lung tumor and mediastinum tumor

8. Describe the principles of chest radiography, computed tomography, magnetic resonance

imaging and positron emission tomography.

9. Describe how important the cigarette smoke causing lung cancer

10. Describe the indication of oxygen therapy

LECTURE 1 : GAS TRANSPORT


Instructor : Frans Abednego Barus dr, Pulmonologist

Objectives: 1. Define hemoglobin saturation, the oxygen-carrying capacity and the oxygen

content of blood.

2. Describe the chemical combination of oxygen with hemoglobin and the oxygen

dissociation curve.

3. List the physiologic factors that can influence the oxygen dissociation curve and

predicts their effects on oxygen transport by the blood.

4. List some other factors affecting oxygen transport

5. Explain transport of carbon dioxide by the blood and how most of the carbon

dioxide in the blood is transported as bicarbonate

6. Describe the Bohr and Haldane effects.

LECTURE 2: OXYGEN THERAPY


Instructor : Frans Abednego Barus dr, Pulmonologist

Objectives: 1. Define hypoxemia and hypoxia

2. Identify the conditions and indications for oxygen therapy


3. Outline the benefits and hazards of oxygen therapy

4. Select appropriate oxygen delivery devices

LECTURE 3: INTERSTITIAL LUNG DISEASES


Instructor : Titis Dewi dr, Pulmonologist

Objectives: 1. Define ILD

2. Describe sign and symptoms of ILD

3. Describe the supporting examination of ILD

4. Describe the management of ILD

LECTURE 4 : MEDIASTINUM TUMOR


Instructor : Titis Dewi dr, Pulmonologist

Objectives: 1. State and describe the diseases of the anterior mediastinum (thymoma,

mediastinal lymphoma, mediastinal germ-cell neoplasms)

2. State and describe the diseases of the middle mediastinum

3. State and describe the diseases of the posterior mediastinum (neurogenic

neoplasms)

LECTURE 5 : OCCUPATIONAL LUNG DISEASES



Objectives: 1. Define occupational lung diseases (OLD)

2. State the disease category relevant to OLD

3. State the agents and occupations which develop OLD

4. Describe the good history taking for diagnosing the case (assessing cumulative

exposure, timing of exposure, dose, additional source exposure)

LECTURE 6 : EFFECT OF SMOKING ON THE LOWER RESPIRATORY TRACT



Objectives: 1. Define Environmental Tobacco Smokes.

2. State all the contents and carcinogens in tobacco smoke

3. Describe the human defense mechanism on the lower respiratory tract and the

responses of the lung to cigarette smoke.


4. State the lung diseases due to cigarette smoke.

5. Describe why not all smokers develop lung cancer and why not all smokers

develop COPD.


LABORATORY 1: ANATOMY PATHOLOGY: PATHOLOGY OF LUNG CANCER

Duration : 60 minutes Instructor : Darti Wibisono, MD, Pathologist, Department of Pathology Objectives: 1. Describe the macroscopic and microscopic pathology of the major types of lung

and pleural cancers (squamous, adenocarcinoma, large cell, small cell and mesothelioma)

2. Describe the clinical procedures to acquire cells and tissue for the diagnosis of lung cancer.

LABORATORY 2 : DIAGNOSTIC IMAGING


Instructor : Subagia Santoso, dr, Radiologist, Department of Radiology

Objectives

1. Describe the radiologic feature of lung cancer, solitary nodule, lung metastasis. 2. Describe the radiologic feature of benign tumor 3. Describe the radiologic feature of mediastinal tumor 4. Introduction of PET Scan

5. State the basic principle of PET scan

6. Understand the strength and weakness of PET scan for lung compare to other examination

LABORATORY 3: REVIEW OF GENERAL ANATOMY OF THE THORAX AND MEDIASTINUM

Duration : 60 minutes Instructor : Bernard,dr,PAK, Stefanus dr, Deisy,dr Objectives: 1. Identify the skeleton of the thorax.

2. Identify the respiratory muscles 3. Identify the contents of an intercostal space and the position of the

neurovascular bundle. 4. Identify the bronchial tree 5. Identify the features of the right and left lungs 6. Identify the structure in the hilus of each lung.


WEEK FIVE : NONSPECIFIC INFECTION


1. Describe the responses of lung to microbials, fungi, parasites and viral.

2. Describe and recognize the all microbials, fungi and parasites which may cause infection

in the lung.

3. Describe and explain the pulmonary blood flow.

4. Describe the pathological features of pneumonia and Acute Respiratory Distress

Syndrome (ARDS) .

5. Review the imaging diagnostic algorithm for diffuse lung disease including pattern of

abnormality, distribution of abnormality correlated with physical findings.

LECTURE 1 : VIRAL PNEUMONIA (SARS, AVIAN FLU, SWINE FLU, MERS)


Instructor : Nata Pratama Lugito, dr., Internist

Objectives: 1. Define the cause of SARS, Avian Influenza, Swine Flu, MERS

2. Describe the global spread of each virus

3. Describe the clinical symptoms and diagnostic procedures

4. Describe the complication

5. Describe the management

6. State the prognosis

LECTURE 2 : ACUTE RESPIRATORY DISTRESS SYNDROME



Objectives: 1. Define ARDS and describe the pathophysiology.

2. State the cause of ARDS.

3. State and describe the stages of ARDS.

4. Describe the signs and symptoms of ARDS.

5. Describe the laboratory finding and chest radiograph.

6. Describe the treatment either

7. Describe the role of mechanical ventilation to overcome the problem of

breathing caused by respiratory distress.

LECTURE 3 : BRONCHIECTASIS AND BRONCHITIS




Objectives: 1. Define bronchiectasis and bronchitis

2. Describe the pathophysiology, causes and associated conditions

3. Describe the signs and symptoms

4. Describe another supportive examination to establish the diagnosis

5. Explain chest radiograph and management of bronchiectasis and bronchitis

6. State the prognosis

LECTURE 4 : HOSPITALIZED ACQUIRED PNEUMONIA



Objectives: 1. Define the Hospitalized Acquired Pneumonia.

2. Know the classification of HAP

3. Describe the pathophysiology

4. Describe the management

5. State the prevention

LECTURE 5,6 : FUNGAL AND PARASITIC PNEUMONIA


Instructor : Sisirawaty, MD, Clinical Parasitologist

Objectives: 1. Define fungal and parasitic pneumonia

2. State the agents of fungal and parasitic pneumonia

3. Describe the pathogenesis of fungal and parasitic pneumonia

4. Describe illness in which pulmonary infiltrates with eosinophilia

5. Differentiate the symptoms of fungal, parasitic and bacterial pneumonia

6. Establish the diagnosis of fungal and bacterial pneumonia

7. State the treatment and prognosis of both diseases


WEEK FIVE : NONSPECIFIC INFECTION

Lab objectives

LABORATORY 1 : ANATOMY PATHOLOGY: PATHOLOGY OF PNEUMONIA AND ARDS


Instructor : Darti, MD, Pathologist, Department of Pathology

Objectives

1. Understand the clinical and pathologic feature of pneumonia.

2. Understand the complication of pneumonia.

3. Understand the clinical and pathologic feature of ARDS


LABORATORY 2 : PARASITOLOGY: FUNGAL AND PARASITIC PNEUMONIA


Instructor : Sisirawaty, MD, Clinical Parasitologist, Danielle T., MD, Clinical

Parasitologist

Objectives

1. Perform sputum examination of pulmonary fungal infection .

2. Understand the pathologic feature of pulmonary fungal (candidiasis, cryptococcosis,

histoplasmosis, blastomycosis, coccidioidomycosis, paracoccidioidomycosis,

pneumocystis jiroveni) infection.

3. Understand the pathologic feature of pulmonary parasitic (ascariasis, ancylostomiasis,

strongyloidiasis, schistosomiasis, paragonimiasis)

4. Understand the pathologic feature of pulmonary infiltrates with eosinophilia (aspergillosis,

house dust mites / Dermatophagoides pteronyssinus)

LABORATORY 3 : RADIOLOGY: NONSPECIFIC INFECTION


Instructor : Brian Lucas, Radiologist, Department of Radiology

Objectives:

1. Describe the radiologic features of lobar pneumonia.

2. Describe the radiologic features of bronchiectasis

3. Describe the radiologic features of Describe the radiologic features of bronchitis,

pneumonia, lung abscess, fungal infection (aspergillosis, histoplasmosis)


CHAPTER VI

LIST OF DISEASES

Levels of competencies expected to be accomplished at the end of Medical Doctor degree program: (It is written in Indonesian to make sure the meaning of competence levels are correct) Tingkat Kemampuan 1: mengenali dan menjelaskan

Lulusan dokter mampu mengenali dan menjelaskan gambaran klinik penyakit, dan mengetahui cara yang paling tepat untuk mendapatkan informasi lebih lanjut mengenai penyakit tersebut, selanjutnya menentukan rujukan yang paling tepat bagi pasien. Lulusan dokter juga mampu menindaklanjuti sesudah kembali dari rujukan. Tingkat Kemampuan 2: mendiagnosis dan merujuk Lulusan dokter mampu membuat diagnosis klinik terhadap penyakit tersebut dan menentukan rujukan yang paling tepat bagi penanganan pasien selanjutnya. Lulusan dokter juga mampu menindaklanjuti sesudah kembali dari rujukan. Tingkat Kemampuan 3: mendiagnosis, melakukan penatalaksanaan awal, dan merujuk 3A. Bukan gawat darurat Lulusan dokter mampu membuat diagnosis klinik dan memberikan terapi pendahuluan pada keadaan yang bukan gawat darurat. Lulusan dokter mampu menentukan rujukan yang paling tepat bagi penanganan pasien selanjutnya. Lulusan dokter juga mampu menindaklanjuti sesudah kembali dari rujukan. 3B. Gawat darurat Lulusan dokter mampu membuat diagnosis klinik dan memberikan terapi pendahuluan pada keadaan gawat darurat demi menyelamatkan nyawa atau mencegah keparahan dan/atau kecacatan pada pasien. Lulusan dokter mampu menentukan rujukan yang paling tepat bagi penanganan pasien selanjutnya. Lulusan dokter juga mampu menindaklanjuti sesudah kembali dari rujukan. Tingkat Kemampuan 4: mendiagnosis, melakukan penatalaksanaan secara mandiri dan tuntas Lulusan dokter mampu membuat diagnosis klinik dan melakukan penatalaksanaan penyakit tersebut secara mandiri dan tuntas. 4A. Kompetensi yang dicapai pada saat lulus dokter 4B. Profisiensi (kemahiran) yang dicapai setelah selesai internsip dan/atau Pendidikan Kedokteran Berkelanjutan (PKB)


Standard of Medical Competency, Indonesia Level of competency

1 Influenza 4A

2 Pertusis 4A

3 Acute Respiratory distress syndrome (ARDS) 3B

4 SARS 3B

5 Flu burung 3B

6 Faringitis 4A

7 Tonsilitis 4A

8 Laringitis 4A

9 Hipertrofi adenoid 2

10 Abses peritonsilar 3A

11 Pseudo-croop acute epiglotitis 3A

12 Difteria (THT) 3B

13 Karsinoma laring 2

14 Karsinoma nasofaring 2

15 Trakeitis 2

16 Aspirasi 3B

17 Benda asing 2

18 Asma bronkial 4A

19 Status asmatikus (asma akut berat) 3B

20 Bronkitis akut 4A

21 Bronkiolitis akut 3B

22 Bronkiektasis 3A

23 Displasia bronkopulmonar 1

24 Karsinoma paru 2

25 Pneumonia, bronkopneumonia 4A

26 Pneumonia aspirasi 3B

27 Tuberkulosis paru tanpa komplikasi 4A

28 Tuberkulosis dengan HIV 3A

29 Multi Drug Resistance (MDR) TB 2

30 Pneumothorax ventil 3A

31 Pneumothorax 3A

32 Efusi pleura 2

33 Efusi pleura masif 3B

34 Emfisema paru 3A

35 Atelektasis 2

36 Penyakit Paru Obstruksi Kronik (PPOK) eksaserbasi akut 3B

37 Edema paru 3B

38 Infark paru 1

39 Abses paru 3A

40 Emboli paru 1

41 Kistik fibrosis 1

42 Haematothorax 3B

43 Tumor mediastinum 2

44 Pnemokoniasis 2

45 Penyakit paru intersisial 1

46 Obstructive Sleep Apnea (OSA) 1


CHAPTER VII

REFERENCES

1. Baker E, Dilys L. Respiratory Medicine: Clinical Cases Uncovered. New Jersey: Wiley-

Blackwell; 2008. 2. Broaddus VC et al. Murray and Nadel’s Textbook of Respiratory Medicine. 6th edition.

Philadelphia: Elsevier Saunders; 2015. 3. Duhamel DR, Harrell JH. Clinical Atlas of Airway Diseases: Bronchoscopy, Radiology and

Pathology. Philadelphia: Elsevier Saunders; 2005. 4. Hanley ME, Welsh CH. Current Diagnosis & Treatment in Pulmonary Medicine. International

Medicine. Singapore: McGraw-Hill Medical; 2003. 5. Kosasih A, Susanto AD, Pakki TR, Martini T. Diagnosis dan Tatalaksana Kegawatdaruratan

Paru Dalam Praktek Sehari-Hari. Jakarta: Sagung Seto; 2008. 6. Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI. Fishmans pulmonary

diseases and disorders, 5th Ed. New York: McGraw-Hill Professional; 2015. 7. Bordow RA, Ries AL, Morris TA. Manual of Clinical Problems in Pulmonary Medicine. 6th

edition. Philadelphia: Lippincott Williams & Wilkins; 2005. 8. West JB. Pulmonary Patophysiology: The Essentials. 7th edition. Philadelphia: Lippincott

Williams & Wilkins; 2008. 9. Shifren A, Lin TL, Goodenberger DM. The Washington Manual Pulmonary Medicine

Subspecialty Consult. Philadelphia: Lippincott Williams & Wilkins; 2006. 10. Adcock IM, Chung KF. Overcoming Steroid Insensitivity in Respiratory Disease. London:

Wiley; 2008. 11. Price D, Foster J, Scullion J, Freeman D. Asthma and COPD. London: Churchill Livingstone;

2004. 12. Fanta CH, Cristiano LM, Haver K. The Harvard Medical School Taking Control of Asthma: A

Comprehensive Prevention and Treatment Plan for You and Your Family. New York: Free Press; 2003.

13. Torres A, Menendez R. Community-Acquired Pneumonia: Strategies for Management. London: Wiley-Blackwelll; 2007.

14. Rello J. Nosocomial Pneumonia: Strategies for Management. London: Wiley-Blackwelll; 2008. 15. Light RW. Pleural Diseases. 5th edition. Philadelphia: Lippincott Williams & Wilkins; 2007. 16. Stein PD. Pulmonary Embolism. 2nd edition. Massachusetts: Blackwell; 2007. 17. WHO. Penanganan ISPA pada Anak di Rumah Sakit Kecil Negara Berkembang: Pedoman

untuk Dokter dan Petugas Kesehatan Senior. Jakarta: EGC; 2002. 18. Winarno FG, Widjajanto W. SARS Odyssey. Bogor: Brio Press; 2003. 19. Perhimpunan Dokter Paru Indonesia. ASMA: Pedoman Diagnosis & Penatalaksanaan di

Indonesia. Jakarta: PDPI; 2004. 20. Perhimpunan Dokter Paru Indonesia. PPOK: Pedoman Praktis Diagnosis dan

Penatalaksanaan di Indonesia. Jakarta: PDPI; 2004.

21. Sabarguna BS. Sistem Bantu Keputusan untuk Pengendalian Infeksi Nosokomial. Yogyakarta: Konsorsium Rumah Sakit Islam Jateng; 2007.

22. L.C.Juquira, J.Carneiro &R.O.kelley. Junqueira basic histology: text and atlas, 13th Ed. 2013. 23. Kliegman RM, Stanton B, Geme JS, Schor NF. Nelson Textbook of Pediatrics. 2015. 24. Katzung, Masters. Basic and Clinical Pharmacology. 13th ed. 2015. 25. Ash LR, Orihel TC. Atlas of Human Parasitology. 5th ed. 2007.

https://www.amazon.com/s/ref=dp_byline_sr_book_1?ie=UTF8&text=Robert+M.+Kliegman+MD&search-alias=books&field-author=Robert+M.+Kliegman+MD&sort=relevancerank

https://www.amazon.com/s/ref=dp_byline_sr_book_2?ie=UTF8&text=Bonita+M.D.+Stanton+MD&search-alias=books&field-author=Bonita+M.D.+Stanton+MD&sort=relevancerank

https://www.amazon.com/s/ref=dp_byline_sr_book_4?ie=UTF8&text=Nina+F+Schor+MD++PhD&search-alias=books&field-author=Nina+F+Schor+MD++PhD&sort=relevancerank


CHAPTER VIII

ASSESSMENT

I. Attendance requirements

Problem Based learning is an important and integral component of the UPH curriculum. This

instructional method emphasizes cooperative behavior and small group learning which for many

students, is a new way of learning. Thus for the groups to function successfully, regular full

attendance at tutorials is essential.

Attendance expectations as requirements and prerequisites to sit the examinations:

a. 100% for PBL tutorials and Clinical Skills sessions.

b. 80% for all other activities.

c. Exemptions permitted with Doctor’s certificate, event of Family crisis, disaster or

extraordinary reason with prior permission from tutor. Further criteria according to UPH

criteria for exemption.

II. Assessment of Student Performance

The system will include assessment of block learning, mandatory courses, assessment of clinical

skills and a comprehensive “end of year” knowledge based examination. Each component will

be given a relative value in calculating a Cumulative Score.

a. Assessment will be conducted for learning in each block and will include:

i. Knowledge based MCQ.

ii. Objective structured Practical Examination (OSPE).

iii. Tutorial performance.

b. Clinical skills learning will be assessed at the end of each semester using the

international standard Objective Structured Clinical Examination (OSCE).

c. A comprehensive knowledge based examination (MCQ) will be conducted at the year

end. This will cover content from all components of the 2 previous semesters.

d. The Cumulative Score calculated based on the components will be the final score and

required for a successful Pass for the YEAR .

e. The Cut-off score for Pass will be determined by recognized standard setting

processes.


1. PBL Tutorial performance

Students will be assessed at the end of the block on the following performance in tutorial

sessions as:

a. Preparation

b. Participation

c. Professional Behavior

All of performance above will be valued with the score as follows:

F (Fail) 50

P- (Need improvement) 60

P (Meet expectation) 75

2. Knowledge Assessment

Student’s applied knowledge will be assessed at the end of each block using:

a. Multiple Choice Questions (MCQ)

b. Objective Structured Practical Examination (OSPE)

3. Clinical Skills Assessment

Student’s applied clinical skills will be assessed at the end of semester using:

a. Objective Structured Clinical Examination (OSCE)

Standard setting

All assessment process such as MCQ, OSPE, OSCE, Extended matching are subjected to a

rigorous standard setting process. Methods such as Angoff, modified Angoff and Hofstee will

be used.

III. Relative values

1. At the end of the block, the relative value of the block consists of each component as

follows:

Component Percentage

1. PBL tutorials 25 %

2. MCQ 55 %

3. OSPE 20 %


2. At the end of the year, the relative value of Cumulative Score consists of the relative

value as follows:


1. MCQ comprehensive

(items will cover knowledge from all blocks within the year) 20 %

2. OSCE (compiled value within the year) 20 %

3. Blocks and courses (compiled value within the year) 45 %

4. Longitudinal course 15%

3. Standardization of Scores:

Passing grade at UPH is 56.00% (C) and will be determined through recognized Standards

Setting processes. Relationship to the Grading system and GPA is as indicated in the

table.

GRADE RANGE SCALE

A 90,00 - 100 4,00

A – 85,00 – 89,99 3,70

B + 80,00 – 84,99 3,30

B 75,00 – 79,99 3,00

B – 70,00 – 74,99 2,70

C + 65,00 – 69,99 2,30

C 60,00 – 64,99 2,00 (PASS)

C – 55,00 – 59,99 1,50

F 00,00 – 54,99 0,00


CHAPTER IX

TIMETABLE

Batch 2016

Block Coord. : Dr. dr. Allen Widysanto, SpP, TTS, FAPSR Room 701 GBFK

RESPIRATORY SYSTEMSemester III, ODD Academic Year 2017/2018

Week 1 Respiratory Emergency Case (Pneumothorax)

Time Mon, Oct 30 Tue, Oct 31 Wed, Nov 1 Thu, Nov 2 Fri, Nov 3

07.15 - 08.05

08.10 - 09.00

09.05 - 09.55 lunch break Lecture dr Stefanus

10.00 - 10.50 Lecture dr Jan

10.55 - 11.45 lunch break lunch break Lab Introduction

11.50 - 12.40 lunch break

12.45 - 13.35

13.40 - 14.30 Lecture dr Taufan

14.35 - 15.25 Plenary: dr Taufan

15.30 - 16.20

16.25 - 17.15

17.20 - 18.10

Lecture 1 JT : Histology of the Lower Respiratory Tract Lab 1, General Anatomy of Thorax and Mediastinum

Lecture 2,3 FB: Pleural Diseases Lab 2, Histology: Lower Respiratory Tract

Lecture 4 SS : Anatomy and Development of Lung Lab 3, Radiology BL

Lecture 5 Prof I: The Functions of The Respiratory System

Lecture 6 TS: Lung Oedema

Clinical Skill 2

dr Titis

Clinical Skill 2

dr Titis

Lab Practice

Anatomy/Histology

PBL/Tutorial PBL/TutorialClinical Exposure II,

Puskesmas /

Small Group Christian Worldview

2

Christian Worldview 2

/ Logika Terapan

Psikologi;

Pengenalan Diri

Faith activity /

lunch break

Lecture dr Frans

Lecture Prof Irawan

Lab Practice

Anatomy

Histology

Lab Radiology

PBL/Tutorial

Clinical Exposure II

(Lecture)

Lab Practice

Anatomy/Histology

Week 2 Specific Infection (Pulmonary Tuberculosis)

Time Mon, Nov 6 Tue, Nov 7 Wed, Nov 8 Thu, Nov 9 Fri, Nov 10

07.15 - 08.05

08.10 - 09.00

09.05 - 09.55 Lecture dr Anita Lecture dr Hori Lecture dr Andry J




12.45 - 13.35 Lecture dr Wiwing

13.40 - 14.30 Lecture dr Allen Plenary: dr Allen

14.35 - 15.25 Lecture dr Allen

15.30 - 16.20

16.25 - 17.15

17.20 - 18.10

Lecture 1 AH: Pediatric TB Lab 1, Pathology Anatomy: Specific Infection

Lecture 2 HH: Acid Base Balance Lab 2, Microbiology: Acid Fast Bacilli

Lecture 3 VW: Microbial in Lower Respiratory Tract Lab 3, Radiology SS

Lecture 4 AW : TB and HIV

Lecture 5 AW : Hemoptysis

Lecture 6 AJ: Pertussis

PBL/Tutorial

Lab Practice

Pathology Anatomy

Microbiology


(Lecture)

PBL/Tutorial

Christian Worldview

2

PBL/Tutorial

Faith activity /

lunch break

Lab Practice

PA/Micro

Lab Radiology

Lab Practice

PA/Micro

Clinical Exposure II,

Puskesmas /

Small Group

Psikologi;

Pengenalan Diri


/ Logika Terapan

Clinical Skill 2

dr Allen

Clinical Skill 2

dr Allen


Week 3 Obstructive Pulmonary Disease (Asthma And Chronic Obstructive Pulmonary Disease/COPD)


07.15 - 08.05

08.10 - 09.00

09.05 - 09.55

10.00 - 10.50 Lecture dr Suga



12.45 - 13.35 Lecture dr Robert

13.40 - 14.30 Lecture dr Allen Lecture dr Nico

14.35 - 15.25 Lecture dr Yulita Lecture dr Allen Plenary: dr. Allen

15.30 - 16.20

16.25 - 17.15

17.20 - 18.10

Lecture 1 STA: Pathological Anatomy of Lung Disease Lab 1, Pathology Anatomy: COPD, Asthma, Bronchiectasis

Lecture 2 PYG: Pediatric Asthma and Bronchiolitis Lab 2, Clinical Pathology: Acid Base Balance

Lecture 3 RS: V/Q Mismatch Lab 3, Radiology SS

Lecture 4 AW: Chronic Obstructive Pulmonary Disease

Lecture 5 AW: Chronic Cor Pulmonale

Lecture 6 NL: Medications for Asthma and COPD

Psikologi;

Pengenalan Diri

Clinical Skill 2

dr Allen

Guest Lecture

Prof Faisal Yunus

Lab Practice

PA / PK


/ Logika Terapan


Puskesmas /

Small Group

Faith activity /

lunch break

Lab RadiologyGuest Lecture

dr. Yusup, SpP

Lab Practice

Pathology Anatomy

Clinical Pathology Lab Practice

PA / PK

Christian Worldview

2

PBL/Tutorial PBL/Tutorial PBL/Tutorial


(Lecture)

Week 4 Neoplasm


07.15 - 08.05

08.10 - 09.00

09.05 - 09.55 Lecture dr Frans

10.00 - 10.50 Lecture dr Frans


11.50 - 12.40

12.45 - 13.35

13.40 - 14.30 Plenary

14.35 - 15.25

15.30 - 16.20 Lecture dr Titis Lecture dr Allen

16.25 - 17.15 Lecture dr Titis Lecture dr Allen

17.20 - 18.10

Lecture 1 FB: Gas Transport Lab 1, Pathology Anatomy: Lung Cancer

Lecture 2 FB: Oxygen Therapy Lab 2, General Anatomy of Thorax and Mediastinum

Lecture 3 TD: Mediastinum Tumor Lab 3, Radiology SS

Lecture 4 TD: Intersistial Lung Disease

Lecture 5 AW: Occupational Lung Disease

Lecture 6 AW: Effect of Smoking on The Lower Respiratory Tract

Clinical Skill 2

dr TitisClinical Skill 2

Lab Practice

Anatomy/PA


Puskesmas /

Small Group

Psikologi;

Pengenalan Diri

Faith activity /

lunch break

Lab Practice

Anatomy/PA

Lab Radiology


/ Logika Terapan

Lab Practice

Anatomy

Pathology Anatomy

PBL/Tutorial PBL/Tutorial PBL/Tutorial

Christian Worldview

2


Week 5 Nonspecific Infection

Time Mon, Nov 27 Tue, Nov 28 Wed, Nov 29 Thu, Nov 30 Fri, Des 1

07.15 - 08.05

08.10 - 09.00

09.05 - 09.55 Lecture dr Nata Plenary: dr. Titis

10.00 - 10.50 Lecture dr Nata

10.55 - 11.45 lunch break lunch break

11.50 - 12.40

12.45 - 13.35

13.40 - 14.30




17.20 - 18.10

Lecture 1 NPL: Viral Pneumonia (SARS, Avian Flu, Swine Flu, MERS) Lab 1, Pathology Anatomy: Pneumonia and ARDS

Lecture 2 NPL: Acute Respiratory Distress Syndrome Lab 2, Parasitology: Fungal and Parasitic Pneumonia

Lecture 3 NPL: Hospitalized Acquired Pneumonia Lab 3, Radiology SS

Lecture 4 NPL: Bronchiectasis and Bronchitis

Lecture 5,6 SS: Fungal and Parasitic Pneumonia

Lecture dr Sisy

Laboratory

Parasitology


Puskesmas /

Small Group

Clinical Skill 2

dr Frans

Clinical Skill 2

dr Titis

Lab Practice

Pathology Anatomy

Lab Practice

Pathology Anatomy

Psikologi;

Pengenalan Diri


/ Logika Terapan

Libur Maulid Nabi

Christian Worldview

2

Lab Radiology

Lab Practice

Pathology Anatomy

PBL/Tutorial PBL/Tutorial


CHAPTER X

APPROVAL

Block Book : RESPIRATORY SYSTEM

No. Document

FK/PRO-11.BB.08.08/REV.09 Date October 18th, 2017

Pages 35

Name Position Sign

Written by Dr. dr. Allen Widysanto, SpP, TTS, FAPSR Block Coordinator

Supervised by

Dr. dr. Vivien Puspitasari, SpS Medical Education Unit

Dr. dr. Allen Widysanto, SpP, TTS, FAPSR Vice Dean for Academic

Approved by Prof. George Mathew, MBBS, MS, MD,

FCAMS Executive Dean

Legalized by Prof. Dr. Dr. dr. Eka J. Wahjoepramono, SpBS,

PhD Dean

Introduction to

Clinical Medicine I

Module

Faculty of Medicine

Pelita Harapan University

Karawaci – Tangerang

2017/2018

Introduction to Clinical Medicine I, MEU FK UPH Page 1

AUTHOR

T.Haryanto Surijadi dr, SpPK

Margaret Merlyn, dr SpPD

Allen Widysanto, dr., SpP

Contributors

Prof .David Fairholm M.D., Neurosurgeon

Prof Eka J.Wahjoepramono, Dr Dr dr SpBS PhD

Prof. Wahyuni L. Atmodjo dr, PAK, Ph.D

Dina dr,SpA

Dr Cucuwaningsih dr,SpMK

Darti dr, SpPA

Vivien dr, SpS

Dr John dr, SpOT

Edwin dr, SpU

Rima dr SpRM

Karliana dr, SpM

Michael dr , SpTHT

Dr Hannah dr , SpKK

Mulyani dr, SpKK

Rusli dr,SpRad

Anita, drSpA

Priscilla , dr SpS

Werlinson, dr SpM

Melani dr SpA

Steven dr SpPD

Andree dr SpPD

Nata dr SpPD

Andri dr SpA

Theo dr SpPD

Freeda dr SpB

Jeremy dr SpB

Pulo dr Sp THT


OVERVIEW

The block is designed to fulfill specific needs of students in relation to find diagnosis and

treatment based on common symptoms. According to the topics, it scope is the most common

symptoms that the General Practitioner will find in out patient clinic.

The block is divided in weekly program comprises of lectures, case discussion, Clinical Practice

Introduction, practical laboratory and imaging study.

Lectures include the most common problem as General Practitioner and as Family Doctor.

An integrated laboratory practice for 2–3 hours once weekly is about to do a simple laboratory

examination by them self and ability to expertise laboratory result to support their diagnosis according

the symptoms.

The selected clinical cases are includes a multidisciplinary approach to discuss and find the

diagnosis based on common symptoms. Start by symptoms and how to make an algorithm of the

symptoms until the student finds the diagnosis and how to give the treatment of the disease. This

session is carried out in small group setting discussed two cases a week, three hours for every case

and wrapped up by an expert in the plenary session.


CHAPTER I

Curse Info

• Block : Introduction to Clinical Medicine I

• Semester : VII

• Credits : 6

• Duration : 7 weeks

• Started : 7 Augustus, 2017

• Ended : 29 September 2017

• Coordinator : T.Haryanto S dr., SpPK


CHAPTER II

Standard of Medical Competencies

1. Effective Communication

Core competency

Able to explore and exchange information verbally and non-verbally with patients.

The graduate is able to:

1. Establish rapport with the patient and his/her family.

▪ Greet the patient.

▪ Make the patient feel comfortable.

▪ Show empathy and trustworthiness.

▪ Listen actively

2. Collect information.

▪ Able to use open-ended and closed questions in acquiring information.

▪ Ask for clarification from the patient about any of his/her statements.

Use clinical reasoning in exploring the history of the present illness, family

history, and history of past illness.

▪ Conduct data exploration logically and efficiently.

▪ Not give education and explanation prematurely while collecting

information.

3. Describe the patient’s perspective.

▪ Respect the patient’s belief in everything related to his/her illness.

▪ Explore the patient’s needs, worries, and hopes.

▪ Respond professionally to the patient’s verbal and non-verbal language.

▪ Use polite and describe able language which is appropriate to the patient’s

age and level of education.

4. Give explanations and information.

▪ Anticipate and reduce the patient’s feeling of fright and stress before

physical examination.

▪ Warn the patient when physical examination and clinical procedures may

cause pain or discomfort.


2. Clinical skill

Core competency

Conduct clinical procedures based on the patient’s problems and needs.


• Perform history taking for Common Symptoms

• Collect and record accurate and important information according symptoms the

patient.

• Conduct complete physical examination.

• Conduct physical examination in ways which minimise pain and discomfort for the

patient.

• Conduct an appropriate physical examination based on the patient’s problem.

• Choice appropriate laboratory test, imaging and another examination for

determined diagnosis.

• Summarize an appropriate interpretation of the history, physical examination, and

laboratory tests according the symptoms

.3. Scientific basis of medical knowledge

Core competency

Identify, explain, and plan a scientific approach to health problem-solving, based on

current medical and health science, to get an optimal result.


• Apply the concepts and principles of family medicine, clinical and behavioural

science, and public health, appropriate to the delivery of primary health care.

• Able to lead and manage Small Clinic/Puskesmas in remote area


CHAPTER III

Teaching and Learning Method

• Clinical Practice Introduction in hospital : 12 hours/ week

• Lecture : 6 hours /week

• Tutorial and Plenary : 6 hours/week

• Laboratory practice : 2 hours/week

• Clinical skill/Management : 4 hours/week

• University compulsory course : 3 hours/week

• DPES : 2 hours/week

TOTAL : 35 hours/week


CHAPTER IV

Departement

• Management Hospital

• Out Patient Department

• Management in Ward

• Emergency Unit.

• Department of Internal Medicine

• Department of Pediatric

• Department of Surgery

• Department Obstetric and Gynecology

• Department of Neurology

• Department of Pulmonology

• Department of Radiology

• Department of Clinical Pathology

• Department of Anatomical Pathology

• Department of Microbiology

• Department of Anesthesiology

• Department of Pharmacology

• Department Skin and Venereal Disease

• Department of Psychiatry

• Department of ENT

• Department of Anesthesia

• Department of Medic Rehabilitation

• .Department of Nutrition


CHAPTER V

Week Objectives

WEEK 1

Theme : 1.Fatigue

2.Failure to thrive

Week chair : T.Haryanto S. dr,SpPK

Theme 1: Fatigue

Week objective : Student should be able to

• Recognize symptoms of fatigue.

• Describe the definition of fatigue

• Describe the etiology & path physiology of fatigue.

• Describe the algorithm how to do for patient with fatigue. .

• Determine laboratory examination or/and imaging to find causes of fatigue

• Understand lab result and imaging result to supporting diagnose causes of fatigue

• Determine diagnosis causes of fatigue

• Treat according diagnosis

Theme 2 : Failure to thrive


• Recognize symptoms of Failure to thrive.

• Describe the definition of Failure to thrive

• Describe the etiology & path physiology of Failure to thrive

• Describe the algorithm how to do for patient with Failure to thrive

• Determine laboratory examination to find causes of Failure to thrive

• Understand lab result and imaging result to supporting diagnose causes of Failure to thrive

• Determine diagnosis causes of Failure to thrive

• Treat according failure to thrive


LECTURE

LECTURE 1 : 50 minutes

Topic : Common causes of fatigue

Lecturer : Steven dr SpPD

Objective : Student should be able to

• Describe etiologies of fatigue

• Recognize symptoms of fatigue

• Determine diagnosis causes of fatigue


Topic : Anemia in adulthood

Lecturer : Andree, dr SpPD


• Identify Anemia in adulthood

• To know the etiologies of anemia in adulthood and algorithm for diagnosing

• Management anemia in adulthood


Topic : Chronic Fatigue Syndrome

Lecturer : Nata, dr SpPD


• Identify , diagnose and treatment the Chronic Fatigue Syndrome

• To know the etiologies of Chronic Fatigue Syndrome


Topic : Nutrition for baby and children

Lecturer : Fransiska, dr SpA


• To know golden standard of Infant Feeding

• To describe how to perform early initiation of breastfeeding / early skin to skin contact

• To explain the physiology of breastfeeding

• To describe the correct position and attachment of breastfeeding


• To explain how to do breastfeeding counselling

• To know Baby Friendly Hospital Initiative (BFHI) & 10 steps of successfull breastfeeding

• To describe recommended complementary feeding

• To explain how to do complementary feeding counselling

• To know The medical reasons of breastmilk subtitute

• To know the International Code of The marketing of BMS and explain its impact for health

workers and health facilities.


Topic : Evaluation of child growth..

Lecturer : Andri, dr SpA


• Able to assess the child growth

• Able to use WHO growth chart to evaluate the child growth

• Recognize signs and symptoms of malnutrition

• Able to manage a child with malnutrition


Topic : Anemia in children

Lecturer : Melani, dr SpA


• Describe the definition of anemia

• Discuss the common causes of anemia in children

• Discuss the manifestation of anemia in children

• Determine laboratory examination needed to distinguish etiology of anemia in children

• Understand laboratory result to define the etiology of anemia

• Manage a children with anemia

LABORATORY

Laboratory : Hb measurement and Leukocyte count.

Instructor : T.Haryanto.S dr, SpPK


• Do and interpretation leukocyte count

• Do and interpretation Hb measurement


WEEK 2

Theme : 1.Fever

2.Cough and sore throat

Week Chair : Merlyn dr SpPD

Theme 1 : Fever


• Recognize symptoms of fever.

• Describe the definition of fever.

• Describe the etiology path physiology of fever.

• Describe the algorithm how to do for patient with fever.

• Determine laboratory examination or/and imaging to find causes of fever

• Understand lab result and imaging result to supporting diagnose causes of fever

• Determine diagnosis causes of fever.


.

Theme 2 : Cough and sore throat


• Recognize symptoms of cough and sore throat.

• Describe the definition of cough sore throat.

• Describe the etiology & path physiology of cough and sore throat

• Describe the algorithm how to do for patient with cough and sore throat

• Determine laboratory examination to find causes of cough and sore throat

• Understand lab result and imaging result to supporting diagnose causes of cough and sore

throat.

• Determine diagnosis causes of cough and sore throat.



LECTURE


Topic : Diagnosis approach fever in adult

Lecturer : Margaret Merlyn dr SpPD

Objective : Students are able to

• Recognize symptoms of fever .

• Describe the etiology path physiology of fever.

• Describe the algorithm how to do for patient with fever .

• Determine laboratory examination or/and imaging to find causes of fever

• Understand lab result and imaging result to supporting diagnose causes of fever

• Determine diagnosis causes of fever.


Topic : Fever in child hood

Lecturer : Vinia, dr SpA


• Recognize symptoms of fever in child hood

• Describe the etiology & path physiology of fever in child hood

• Describe the algorithm how to do for patient with fever in child hood

• Determine laboratory examination or/and imaging to find causes of fever in child hood

• Understand lab result and imaging result to supporting diagnose causes of fever in child hood

• Determine diagnosis causes of fever in child hood

• Able to treat according diagnosis

.


Topic : Hemoptysis

Lecturer : Dr Allen dr SpP


• State the definition and path physiology of hemoptysis

• Differentiating hemoptysis and hematemesis

• State the etiologies of hemoptysis


• Categorized the severity of hemoptysis

• Describe the treatment and complication of hemoptysis

• State the criteria for surgery approach


Topic : Respiratory tract infection in children

Lecturer : Dr Fransiska dr SpA


• To explain about ARI in children

• To explain about differential diagnosis and the management of upper respiratory tract infection

in children (common cold, pharyngitis, otitis media)

• To explain about differential diagnosis and the management of lower respiratory tract infection

in children (croup, bronchitis, bronchiolitis, pneumonia)

• To know the evidence based medicine and global guidelines concerning ARI, its diagnosis

and management

• To know about the common irational practice in management of ARI in children


Topic : Adult Upper Respiratory Trac Infection/URTI

Lecturer : Pulo dr SpTHT


• Define the Upper Respiratory Trac Infection.

• State the causes of Upper Respiratory Trac Infection.

• Differentiate viral infection and bacterial infection.

• Describe the sign and symptoms of URTI.

• Determine laboratory examination and other supportive examination of URTI.

• Describe the treatment of URTI.

• State how to prevent and screen URTI.


Topic : ENT examination

Lecturer : Pulo, SpTHT dr



• Understand ENT examination

LABORATORY

Laboratory practice : Ziehl Nielsen Staining & Gram staining

Instructor : Cucuwaningsih dr SpMK

Objective : Student are able to

Do and interpretation Ziehl Nielsen Staining & Gram staining


WEEK 3

Theme : 1. Dyspepsia syndrome/Hepatitis

2. Diarrhea

Week chair : Nata, dr SpPD

Theme : 1.Dyspepsia syndrome

Week objective : Students are able to

• Recognize symptoms of Dyspepsia syndrome

• Describe the definition of Dyspepsia syndrome

• Describe the etiology & path physiology of Dyspepsia syndrome

• Describe the algorithm how to do for patient with Dyspepsia syndrome .

• Determine laboratory examination or/and imaging to find causes of Dyspepsia syndrome

• Understand lab result and imaging result to supporting diagnose causes of Dyspepsia syndrome

• Determine diagnosis causes of Dyspepsia syndrome.

• Able to give treatment to the patient according diagnosis

Theme : 2. Diarrhea


• Recognize symptoms of Diarrhea

• Describe the definition of Diarrhea

• Describe the etiology & path physiology of Diarrhea

• Describe the algorithm how to do for patient with Diarrhea

• Determine laboratory examination or/and imaging to find causes of Diarrhea

• Understand lab result and imaging result to supporting diagnose causes of Diarrhea

• Determine diagnosis causes of Diarrhea

• Able to give treatment for diarrhea patient

LECTURE


Topic : Dyspepsia

Lecturer : Nata dr SpPD



• Describe definition and etiologies, sign and symptoms, of dyspepsia

• Describe further examination of dyspepsia

• Describe algoritm for diagnose and management

• Describe treatment of dyspepsia ( focus on H. Pylory eradication)

• Differential Diagnose of dyspepsia


Topic : Hepatitis

Lecturer : Resa dr SpPD, Nata dr SpPD


• Recognize the sign and symptoms of hepatitis

• Choice laboratory examination to diagnose hepatitis.

• Interpret the laboratory result of hepatitis.

• Describe etiology of hepatitis in general.

• Determine therapy in general for hepatitis


Topic : Laboratory examination in hepatitis

Lecturer : Haryanto dr SpPK


• Describe and interpret laboratory examination in hepatitis


Topic : Diarrhea in child hood

Lecturer : Anita, dr SpA


• Describe the definition and classification of diarrhea

• Describe the pathophysiology of diarrhea

• Discuss the common causes of diarrhea in children

• Determine the hydration status in children with diarrhea


• Determine laboratory examination needed in children with dirrhea

• Able to manage a children with diarrhea


Topic : Loose of appetite and feeding difficulty in children

Lecturer : Fransiska, dr SpA


• To know the general process of feeding development

• Describe the etiology of loose of appetite in children

• Able to give management for children with lose appetite

• To know the differential diagnosis of feeding dificulties in children

• To know what to observe in children with feeding dificulties

• To know the steps of management of feeding dificulties in children

• To know thecommon irational practice in pediatric feeding dificulties


Topic : Vomiting in children

Lecturer : Vinia, dr SpA


• Know the definition and pathophysiology of vomiting

• Know the causes of vomiting in children of different age groups.

• Distinguish between nonorganic and organic causes of vomiting.

• Distinguish features of vomiting that suggest serious underlying conditions.

• Develop an initial management plan for a child with intestinal obstruction.

• Understand the role of various antiemetic medications in the treatment of vomiting in children.

LABORATORY / IMAGING

Laboratory : 1.Diagnose Hepatitis base in laboratory result

(Liver Function Test, Hepatitis A,B,C, Hepatoma etc)

2.Occult blood, Stool Examination

Instructor : T.Haryanto.S dr SpPK



• To choice lab examination for determine causes of dyspepsia

• To interpretation lab result to supporting diagnose hepatitis

• To choice lab examination for determine cause of hepatitis

• Do and interpretation Occult blood, stool Examination


WEEK 4

Theme : 1.Head ache

2.Muscular and Low Back Pain

Week chair : Septi dr

Week objective :

Theme : 1. Head ache


• Recognize symptoms of Head ache

• Describe the definition of Head ache

• Describe the etiology & path physiology of Head ache

• Describe the algorithm how to do for patient with Head ache

• .Determine laboratory examination or/and imaging to find causes of Head ache

• Understand lab result and imaging result to supporting diagnose causes of Head ache

• Determine diagnosis causes of Head ache


Theme : 2. Muscular and Low Back Pain


• Recognize symptoms of Muscular and Low Back Pain

• Describe the definition of Muscular and Low Back Pain

• Describe the etiology & path physiology of Muscular and Low Back Pain

• Describe the algorithm how to do for patient with Muscular and Low Back Pain

• Determine imaging to find causes of Muscular and Low Back Pain

• Understand imaging result to supporting diagnose causes of Muscular and Low Back Pain

• Determine diagnosis causes of Muscular and Low Back Pain


LECTURE


Topic : Brain Tumor


Lecturer :Dr Julius, dr SpBS

Objective Students are able to

• Recognize symptoms of Brain Tumor

• Describe the etiology & path physiology of Brain Tumor

• Describe the algorithm how to do for patient with Brain Tumor

• Determine laboratory examination or/and imaging to find causes of Brain Tumor

• Understand lab result and imaging result to supporting diagnose causes of Brain Tumor

• Determine diagnosis Brain Tumor


Topic : Dizzines/vertigo

Lecturer : Vivien dr SpS

Objective Students are able to

• Describe the definition of Dizziness/vertigo

• Recognize symptoms of Dizziness/vertigo

• Differentiate Dizziness/vertigo from headache

• Describe the algorithm how to do for patient with Dizziness/vertigo

• Determine diagnosis causes of Dizziness/vertigo



Topic : Headache and facial pain

Lecturer : Priscilla, dr SpS


• Define headache and its classification

• Differentiate between primary and secondary headache .

• Understand the mechanism of headache and the pathogenesis of migraine

• Recognize sign and symptom of serious headache

• Describe the clinical approach to the patient with headache

• Recognize sign and symptoms of serious headache


LECTURE 4

Topic : Medic Rehabilitation for patient Low Back Pain

Lecturer : Rima dr SpRM


• Understand and can do simple Medic rehabilitation for patient Low Back Pain.

• Able to know how to consultation for Medic rehabilitation patient Low back Pain


Topic : Radikulopati

Lecturer : Vivien dr SpS


• Describe the definition of Radiculopathy

• Recognize symptoms of Radiculopathy

• Determine diagnosis causes of Radiculopathy



Topic : Muscular pain

Lecturer : Dr John Butar Butar dr SpBO


• Explain symptoms of musculoskeletal pain

• Explain various sources of musculoskeletal pain

• Describe the algorithm of musculoskeletal pain management

LABORATORY /IMAGING

Imaging : Plain abdomen foto + Vertebrae foto

Instructor : Rusli dr SpR /Brian dr SpR


• Can interpretation plain abdomen foto

• Can interpretation vertebrae foto


WEEK 5

Theme : 1.Mass in neck and breast mass

2.Dysuria and hematuria

Week chair : Darti dr SpPA

Theme : 1. Mass in neck and breast mass


• Recognize symptoms of Mass in neck and breast mass

• Describe the definition of Mass in neck and breast mass

• Able to do physical examination of Mass in neck and breast mass

• Describe the etiology & path physiology of Mass in neck and breast mass

• Describe the algorithm how to do for patient with Mass in neck and breast mass

• .Determine laboratory examination or/and imaging to find causes of Mass in neck and breast mass

• Understand lab result and imaging result to supporting diagnose causes of Mass in neck and breast

mass

• Determine diagnosis causes of Mass in neck and breast mass

• Able to treat / consultation to specialist according diagnosis

Theme : 2. Dysuria and hematuria


• Recognize symptoms of Dysuria and hematuria

• Describe the definition of Dysuria and hematuria

• Describe the etiology & path physiology of Dysuria and hematuria

• Describe the algorithm how to do for patient with Dysuria and hematuria .

• Determine laboratory examination or/and imaging to find causes of Dysuria and hematuria

• Understand lab result and imaging result to supporting diagnose causes of Dysuria and

hematuria

• Determine diagnosis causes of Dysuria and hematuria

• Able to treat/ consultation to specialist according diagnosis Dysuria and hematuria


LECTURE


Topic : Breast mass

Lecturer : Freda dr SpB


• Recognize the basic physical examination of the breast , the diagnosis and treatment of breast

masses

• Do good history taking & physical examinations of the breast

• Recognize various supporting examination in diagnosing breast masses.

• Describe the clinical manifestations of breast masses.

• Recognize the indication & methods of biopsy of breast masses

• Describe the treatments of breast masses.


Topic : Neck mass

Lecturer : Jeremy dr SpB


• Describe the path physiology of mass in neck

• Recognize the basic physical examination and diagnosis neck mass

• Describe the clinical manifestation

• Recognize the indication and method of biopsy

• Describe the treatment


Topic : Pathology anatomy approach in breast/neck mass

Lecturer : Darti dr Sp PA


• Understand histopathology result to diagnose causes of mass in neck/breast

• Recognized the method of FNAB for neck mass


Topic : Diagnosis Approach and Management in Urology.


Lecturer : Edwin dr SpU


• Recognize symptoms of Tragtus urinary’s disorders

• Describe the etiology & path physiology of Tragtus urinary’s disorders

• Determine laboratory examination or/and imaging to find causes of Tragtus urinary’s disorders

• Understand lab result and imaging result to supporting diagnose causes of Tragtus urinary’s

disorders

• Determine diagnosis causes of Tragtus urinary’s disorders

• Able to treat/ consultation to specialist according diagnosis


Topic : Urethral Discharge

Lecturer : Edwin dr SpU


• Examine patient with urethral discharge

• Diagnosis patient with urethral discharge base on physical and laboratory examination.

• Algorithm management of urethral discharge.

• Give treatment/ consultation to specialist the patient with urethral discharge.


Topic : Hematuria in children

Lecturer : Melani , dr SpA


• Define hematuria.

• List the common conditions associated with hematuria.

• Identify the important elements of the history and physical examination that suggest serious

renal disease.

• Plan a practical and systematic approach to the evaluation of hematuria.

• Know when to refer to a pediatric nephrologist..


LABORATORY

Laboratory 1 : : Fine needle aspiration biopsy

Instructor : Darti dr SpPA

Lab assistant : Kis dr SpPA, Suga dr SpPA, Alex dr SpPA, Diana dr SpPA

Objective : Students should be able to

• Differentiate between abscess /infectious and neoplasm

• Differentiate between Non Hodkin Lymphoma and Hodkin Lymphoma

• Differentiate between Carcinoma and Sarcoma

Laboratory 2 : : Urinalisa

Instructor : Haryanto dr SpPK


Do examination and interpretation urine specimen


WEEK : 6

Theme : 1.Red eyes.

2.Loss of hearing

Week chair : Mona dr

Theme : 1. Red eyes.


• Recognize symptoms of Red eyes.

• Describe the definition of Red eyes.

• Able to describe the differentiate between Red eye with visual decrease and without visual

decrease

• Able to do physical examination of Red eyes.

• Describe the etiology & path physiology of Red eyes with visual decrease and without visual

decrease.

• Describe the algorithm how to do for patient with Red eyes.

• Determine laboratory examination or/and imaging to find causes of Red eyes.

• Understand lab result and imaging result to supporting diagnose causes of Red eyes.

• Determine diagnosis causes of Red eyes with visual decrease and without visual decrease

• Able to treat/ consultation to specialist according diagnosis.

Theme : 2. Loss of hearing


• Recognize symptoms of Loss of hearing

• Describe the definition of Loss of hearing

• Able to do physical examination of Loss of hearing

• Describe the etiology & path physiology of Loss of hearing

• Describe the algorithm how to do for patient with Loss of hearing

• Determine laboratory examination or/and imaging to find causes of Loss of hearing

• Understand lab result and imaging result to supporting diagnose causes of Loss of hearing

• Determine diagnosis causes of Loss of hearing



LECTURE


Topic : Clinical Approach “Red eye” with blurred vision

Lecturer : Karliana dr SpM


• Recognize symptoms of Red eye with blurred vision

• Describe the definition of Red eye with blurred vision

• Able to do physical examination of Red eye with blurred vision

• Describe the etiology & path physiology of Red eye with blurred vision

• Determine laboratory examination or/and imaging to find causes of Red eye with blurred vision

• Understand lab result and imaging result to supporting diagnose causes of Red eye with

blurred vision

• Determine diagnosis causes of Red eye with blurred vision



Topic : Clinical Approach of Ocular emergency and Trauma

Lecturer : Endang M Johani dr SpM


• Recognize symptoms of Ocular Emergency and Trauma

• Describe the definition of Ocular Emergency and Trauma

• Able to do physical examination of Ocular Emergency and Trauma

• Describe the etiology & pathophysiology of Ocular Emergency and Trauma

• Determine laboratory examination or/and imaging to find causes of Ocular Emergency and

Trauma

• Understand lab result and imaging result to supporting diagnose causes of Ocular Emergency

and Trauma

• Determine diagnosis causes of Ocular Emergency and Trauma




Topic : Clinical approach disturbance of hearing

Lecturer : Michael dr SpTHT


• Recognize symptoms of Loss of hearing

• Describe the definition of Loss of hearing

• Able to do physical examination of Loss of hearing

• Describe the etiology & path physiology of Loss of hearing

• Determine laboratory examination or/and imaging to find causes of Loss of hearing

• Understand lab result and imaging result to supporting diagnose causes of Loss of hearing

• Determine diagnosis causes of Loss of hearing

Able to treat/ consultation to specialist according diagnosis


Topic : Clinical Approach Ocular Medical Emergency associated with red eye

Lecturer : Werlinson dr SpM


• Recognize symptoms of Ocular Medical Emergency associated with red eye

• Describe the definition of Ocular Medical Emergency associated with red eye

• Able to do physical examination of Ocular Medical Emergency associated with red eye

• Describe the etiology & path physiology of Ocular Medical Emergency associated with red eye

• Determine laboratory examination or/and imaging to find causes Ocular Medical Emergency

associated with red eye

• Understand lab result and imaging result to supporting diagnose causes of Ocular Medical

Emergency associated with red eye

• Determine diagnosis causes of Ocular Medical Emergency associated with red eye



Topic : Vertigo and Tinnitus

Lecturer : Michael dr SpTHT



• Recognize symptoms of Vertigo and Tinnitus.

• Able to do physical examination of Vertigo and Tinnitus.

• Able to diagnosis Vertigo and Tinnitus



Topic : Clinical Approach “Red eye” without blurred vision

Lecturer : Werlinson , dr SpM


• Recognize symptoms of Red eye without blurred vision

• Describe the definition of Red eye without blurred vision

• Able to do physical examination of Red eye without blurred vision

• Describe the etiology & path physiology of Red eye without blurred vision

• Determine laboratory examination or/and imaging to find causes of Red eye without blurred

vision

• Understand lab result and imaging result to supporting diagnose causes of Red eye without

blurred vision

• Determine diagnosis causes of Red eye without blurred vision


LABORATORY/IMAGING

Imaging : Head CT scan Head MRI & head MRA

Instructor : Rusli dr SpRad / Brian dr SpRad

Objective : Students should be able to

• Can give explanation to the patient result of Head CT scan.

• Understand Head MRI & head MRA


WEEK 7

Theme : 1.Itching, redness, and pain of skin

2.Paresthesia

Week chair : Vivien dr SpS

Theme : 1. Itching, redness, and pain of skin


• Recognize symptoms of Itching, redness, and pain of skin

• Describe the definition of Itching, redness, and pain of skin

• Able to do physical examination of Itching, redness, and pain of skin.

• Describe the etiology & path physiology of Itching, redness, and pain of skin

• Describe the algorithm how to do for patient with Itching, redness, and pain of skin

• Determine laboratory examination or/and imaging to find causes of Itching, redness, and pain of

skin

• Understand lab result and imaging result to supporting diagnose causes of Itching, redness, and

pain of skin

• Determine diagnosis causes of Itching, redness, and pain of skin


CASE : NEUROPATI PERIFER

Theme : 2. Paresthesia


• Recognize symptoms of Paresthesia

• Describe the definition of Paresthesia

• Able to do physical examination of Paresthesia

• Describe the etiology & path physiology of Paresthesia

• Describe the algorithm how to do for patient with Paresthesia

• Determine laboratory examination or/and imaging to find causes of Paresthesia

• Understand lab result and imaging result to supporting diagnose causes of Paresthesia

• Determine diagnosis causes of Paresthesia



LECTURE


Topic : Sensory Impairment/ Pain

Lecturer : Pricilla dr SpS


• Define pain and its classification

• Differentiate neuropathic pain and nociceptive pain.

• Understand the mechanism of pain

• Determine diagnosis causes of pain



Topic : Itching

Lecturer : Dr Hannah dr SpKK


• Describe the etiology & path physiology of Itching

• Describe the algorithm how to do for patient with Itching

• Determine diagnosis causes of Itching



Topic : Myelopathy

Lecturer : Astra Dea, SpS, Dr Vivien dr SpS


• Describe the definition of myelopathy

• Recognize symptoms of myelopathy

• Describe the etiology & path physiology of myelopathy

• Determine diagnosis causes of myelopathy




Topic : Sensory Insensibility

Lecturer : Vonny dr SpS


• Review the functional anatomy of somatic sensory pathways

• Describe the terminology used insensibility disorders

• Describe the nature and distribution of sensory changes and their significance

• List the causes of peripheral neuropathy

• Describe several entrapment neuropathy syndrome


Topic : Skin discoloration

Lecturer : Dr Hannah dr SpKK


• Recognize symptoms of skin discoloration

• Able to do physical examination of skin discoloration

• Describe the etiology & path physiology of skin discoloration

• Determine and do laboratory examination to supporting diagnose of skin discoloration

• Determine diagnosis of skin discoloration



Topic : Skin growth

Lecturer : Dr Hanna dr SpKK


• Recognize symptoms or Determine laboratory examination to find causes of Skin growth

• Describe the classification of Skin growth

• Able to do physical examination of Skin growth

• Describe the algorithm how to do for patient with Skin growth

• Determine diagnosis causes of Skin growth



LABORATORY

Laboratory : KOH staining

Instructor : Dr Cucu dr SpMK


• Do and interpretation KOH skin staining

• Do and interpretation skin scrapping

WEEK 8 : Block Examination


CHAPTER VI

List of Diseases (KKI)

Level of competencies 1

Able to recognize and apply the sign and symptoms to establish a diagnosis when reviewing

literature . Able to recognize clinical manifestation and how to get further information. This level

indicates overview level. Doctor can refer the patient soon after recognizing the illness.


Able to establish a diagnosis depend on physical examination and the other examination ordered by

the doctor such as simple laboratory studies or X – ray imaging . Doctor can refer the patient as soon

as possible to specialist for further treatment

Level of competencies 3a

Able to make a clinical diagnosis depend on physical examination and the other examination

ordered by doctor such as simple laboratory studies or X- Ray imaging . Doctor can decide and give

initial therapy before referring the patient to specialist. Not an emergency case.

Level of competencies 3b


ordered by doctor such as simple laboratory studies or X- Ray imaging. Doctor can decide and give

initial therapy before referring the patient to specialist. In case of emergency case.



ordered by doctor such as simple laboratory studies or X- Ray imaging. Doctor can decide and give

initial therapy before referring the patient to specialist. Doctor can decide and manage the problem by

him self completely


LIST OF DISEASE

HEMATOLOGY Level of Competence

Iron deficiency anemia 4

LIVER

Active hepatitis C 2

Cirrhosis hepatis 2

CARDIOVASCULAR

Heart failure 3B

NUTRITIONAL DEFICIENCY

Marasmus 4

Kwarshiorkor 4

Vitamin deficiencies 4

LARYNX AND PHARYNX

Pharyngitis 4

Tonsilitis 4

RESPIRATORY

Pnemonia 3B

Uncomplicated Pulmonary Tuberculosis 4

STOMACH AND DUODENUM

Gastric and duodenal ulcer 3B

Gastroenteritis 4

HEAD ACHE


Migraine 3A

SPINE

Herniaof nucleus pulposus 2

BREAST

Breast carcinoma 2

NEFROLOGI

Urinary stone disease 3A

EYES

Conjunctivitis 4

ENT

Acute otitis media 3A

Perforated tympanic membrane 3A

SKIN

Contact dermatitis irritant 4

Contact dermatitis alergica 3A

Atopic dermatitis 4

Numular dermatitis 4

NEUROLOGY

Neuropathy 4


CHAPTER VII

Reference

1.McCann, Shaun. Case-based haematology. Blackwell. 2005

2..Daun RS, Canel JJ. Pedatric Examination & Board Review. Mc Graw Hill. 2007

3.Nazarian lF. Callenges in Pediatric Diagnosis. American Acedemy of Pediatrics. 2000

4.Lookingbill, Mark . Pinciple of Dermatology. Saunders. 2000

5.McPhee SJ, Papadakis MA, Tierney LM. Current Medical Diagnosis & Treatment. Mc Graw Hill.2011

6. Gandasoebrata R. . Penuntun Labaratorium Klinik. Dian Rakyat, 1999. .

7. Longo,Fauci,Kasper,Hauser,Jameson,Loscalzo. Harrison Manual of Medicine.Mc Graw Hill. 2013

8.Henry’S . Clinical Diagnosis and Management by Laboratory Methods Elsevier. 2017


CHAPTER VIII

Assessment

I. Attendance requirements

Problem Based learning is an important and integral component of the UPH curriculum. This

instructional method emphasizes cooperative behavior and small group learning which for many

students, is a new way of learning. Consequently for groups to function successfully, regular full

attendance at tutorials is essential.

Attendance expectations as requirements and prerequisites to sit the examinations:

a. 100% for PBL tutorials and Clinical Skills sessions.

b. 70 % for all other activities.

c. Exemptions permitted with Doctor’s certificate, event of Family crisis, disaster or

extraordinary reason with prior permission from tutor. Further criteria according to UPH

criteria for exemption.

II. Assessment of Student Performance

The system will include assessment of block learning, mandatory courses, assessment of clinical skills

and a comprehensive “end of year” knowledge based examination. Each component will be given a

relative value in calculating a Cumulative Score.

a. Assessment will be conducted for learning in each block and will include:

i. Knowledge based MCQ.

ii. Objective structured Practical Examination (OSPE).

iii. Tutorial performance.

b. Clinical skills learning will be assessed at the end of each semester using the international

standard Objective Structured Clinical Examination (OSCE).

c. A comprehensive knowledge based examination (MCQ) will be conducted at the year end.

This will cover content from all components of the 2 previous semesters.

d. The Cumulative Score calculated based on the components will be the final score and

required for a successful Pass for the YEAR .


e. The Cut-off score for Pass will be determined by recognized standard setting processes.

1. PBL Tutorial performance

Students will be assessed at the end of the block on the following performance in tutorial

sessions as:

a. Preparation.

b. Participation.

c. Professional Behavior.

All of performance above will be valued with the score as follows:

F (Fail) 50

P- (Need improvement) 60

P (Meet expectation) 75

2. Knowledge Assessment

Student’s applied knowledge will be assessed at the end of each block using:

a. Multiple Choice Questions (MCQ)

b. Objective Structure Practical Examination (OSPE)

3. Clinical Skills Assessment

Student’s applied clinical skills will be assessed at the end of semester using:

a. Objective Structure Clinical Examination (OSCE)

Standard setting

All assessment process such as MCQ, OSPE, OSCE, Extended matching are subjected to a

rigorous standard setting process. Methods such as Angoff, modified Angoff and Hofstee will

be used.

III. Relative values

1. At the end of the block, the relative value of the block consists of each component as

follows:



1. PBL tutorials 30 %

2. MCQ 50 %

3. OSPE 20 %

2. At the end of the year, the relative value of Cumulative Score consists of the relative value as

follows:


1. MCQ comprehensive

(items will cover knowledge from all blocks within the year) 35 %

2. OSCE (compile value within the year) 20 %

3. Blocks (compile value within the year) 45 %

3. Standardization of Scores:

Passing grade at UPH is 56.00% (C) and will be determined through recognized Standards

Setting processes. Relationship to the Grading system and GPA is as indicated in the table.

GRADE RANGE SCALE

A 90,00 - 100 4,00

A – 85,00 – 89,99 3,70

B + 80,00 – 84,99 3,30

B 75,00 – 79,99 3,00

B – 70,00 – 74,99 2,70

C + 65,00 – 69,99 2,30

C 60,00 – 64,99 2,00 (PASS)

C – 55,00 – 59,99 1,50

F 00,00 – 54,99 0,00






CHAPTER X

Approval

Block Book : Introduction to Clinical Medicine I

No.

Document FK/PRO-11.BB.17.05/REV-05

Date July 26 2017

Pages 46

Name Position Sign

Written by T.Haryanto Surijadi dr,SpPK Block Coordinator

Supervised

by Dr Allen Widysanto, dr., SpP

Vice Dean Medical

Education

Approved by Prof. George Mathew, MBBS, MS Executive Dean


Legalized by Prof. Dr. Dr. Eka J.

Wahjoepramono. dr., SpBS, PhD Dean

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