Study Guide skin and disorders
GENERAL CORE COMPETENCY
1. Patient Care
Demonstrate capability to provide comprehensive patient care that is
compassionate, appropriate, and effective for the management of health problems,
promotion of health and prevention of disease in the primary health care settings
2. Medical knowledge base
Mastery of a core medical knowledge which includes the biomedical sciences,
behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of
medicine and the principles of medical ethics, and apply them.
3. Clinical skill
Demonstrate capability to effectively apply clinical skills and interprete the findings
in the investigation of patient.
4. Communication
Demonstrate capability to communicate effectively and interpersonally to establish
rapport with patient, family, community at large, and professional associates, that results
in effective information xchange, the creation of therapeutically and ethicallysound
relationship.
5. Information management
Demonstrate capability to manager information which includes information access,
retrieval, interpretation, appraisal, and application to patient’s specific problem, and
maintaining records of his or her practice for analysis and improvement.
6. Professionalism
Demonstrate a commitment to carrying out professional responsibilities and to
personal probity, adherence to ethical principles, sensitivity to diverse patient population,
and commitment to carrying out continual self-evaluation of his or her professional
standard and competence.
7. Community-based and health system-based practice
Demonstrate awareness and responsiveness to larger context and system of
health care, and ability ti effectively use system resources for optimal patient care.
Faculty of Medicine UNUD,MEU
1
Study Guide block skin and hearing systems and disorders
BLOCKS OUTCOMES
LEARNING OUTCOMES
CURRICULUM CONTENT
1. Describe the functional
1.1 Describe the functional structure of
structure of the skin and its
the skin and its appendices and
appendices and hearing
hearing systems.
systems
2. Identify typical skin
manifestation related to
skin and hearing disorders
2.1 Common pathological bases of skin
disorders.
2.2 Skin manifestation (effluorescenses)
in common skin disorders.
3. Identify the risks and
compatibility of topical
treatment in dermatology
3.1 Identify the risks and compatibility of
topical treatment in dermatology.
4. Diagnose and manage
common skin and hearing
systems disorders
4.1 Symtoms and sign of common
skin and hearing systems disorders.
4.2 Clinical diagnostic of common skin
and hearing systems disorders
4.3 Management of common skin and
hearing system infection
5. Refer patient with
life/disability threatening,
refractory and unidentified
skin and hearing systems
disorders
5.1 Refer patient with life/disability
threatening, refractory and
unidentified skin and hearing
syatems disorders
6. Educate the patient and
their family about skin
health.
6.1 General principles of skin health
6.2 Education and prevention of common
and contagious skin disease.
Faculty of Medicine Udayana University,MEU
2
Study Guide block skin and hearing systems and disorders
~ CURRICULUM ~
Aims:
 Manage common skin disorders knowledges in the context of primary health care settings
 Identify skin disorders which may require referral
Learning outcomes:
 Describe the functional structure of the skin and its appendices and hearing systems
 Identify typical skin manifestation related to skin disorders
 Identify the risks and compatibility of topical treatment in dermatology
 Diagnose and manage common skin and hearing systems disorders
 Refer patient with life/disability threatening, refractory and unidentified skin and hearing
systems disorders
 Educate the patient and their family about skin health.
Curriculum contents:
 Functional structure of the skin and its appendices and hearing systems.
 Common pathological bases of skin disorders.
 Primary skin manifestation in common skin disorders
 Risks and compatibility of topical treatment in dermatology.
 Secondary skin manifestations.

Symtoms and sign of common skin disorders, clinical diagnose of common skin
disorders, management of common skin disorders : Papulo-erythrosquamosa, Tumor
of the skin, Drug eruption of the skin, Pigmentary and sebaseous gland disorders,
Insect bite and infestation, Dermatitis, bacterial infection, vaginitis and cervicitis.

Symtoms and sign, clinical diagnose and management of common hearing systems
disorders : pericondritis, wax, foreign bodies, bulous myringitis; membrane tymphani
perforation, OMS, labirinitis, paresis nervus Facialis, ear trauma/othematoma,
barotrauma, motion sickness, PGPKT, hearing loss, noise induced hearing loss.
 Referal of patient with life/disability threatening, refractory, or unidentified skin and
hearing systems disorders
 General principles of skin and hearing systems health
 Education and prevention of common and contagious skin and hearing systems diseases.
Faculty of Medicine Udayana University,MEU
3
Study Guide block skin and hearing systems and disorders
~ PLANNERS TEAM ~
NO
NAME
DEPARTMENT
1
2
3
4
5
dr. Ni Komang Suryawati, SpKK (K) (Head)
dr. Ni Made Linawati,M.Si (Secretary)
dr. IGA Sumedha Pindha, SpKK (K)
dr. Made Wardana, SpKK (K)
dr.Made Lely rahayu, Sp.THT-KL
Dermatovenereology
Histology
Dermatovenereology
Dermatovenereology
ENT
~ LECTURERS ~
NO
1
2
3
4
5
6
7
8
9
10
11
12
12
13
14
15
16
17
18
19
20
21
22
23
24
NAME
dr. Ni Komang Suryawati, Sp.KK
dr. Ni Made Linawati,M.Si
dr. IGA Sumedha Pindha, SpKK (K)
Dr. dr. Made Wardana, SpKK (K)
Prof dr Made Swastika Adiguna SpKK
(K)
dr. AA Gde Putra Wiraguna,SpKK (K)
dr. IGA Praharsini, SpKK
dr. Luh Mas Rusyati, SpKK
dr. Herman Saputra, SpPA
Dra. I A Alit Widhiartini, Apt, M.Si
dr.A A Wiwiek Indrayani, M.Kes / dr.
IGN. Surya Trapika, M.Sc
dr. IGK Darmada, SpKK (K)
dr. IGA Elies Indira, Sp.KK
dr. IG Nym Darma Putra, Sp.KK
dr.IGA Dwi Karmila, Sp.KK
dr. Luh Putu Ratih Vibriyanti K, Sp.KK
dr. Ni Made Dwi Puspawati, Sp.KK
DEPARTMENT
Dermatovenereology
Histology
Dermatovenereology
Dermatovenereology
Dermatovenereology
PHONE
0817447279
081337222567
08155735977
08563704591
08123828548
Dermatovenereology
Dermatovenereology
Dermatovenereology
Patology anatomy
Farmacy
Farmacology
081338645288
081238888794
081337338738
081558028879
0816572852
08886855027
Dermatovenereology
Dermatovenereology
Dermatovenereology
Dermatovenereology
Dermatovenereology
Dermatovenereology
dr. I Putu Kurniawan Dhanasaputra,
Sp.KK
dr. Lely Rahayu, SpTHT-KL
dr. Andi Dwi Saputra, Sp.THT
dr.Eka Putra Setiawan, Sp.THT
dr. I Made Wiranadha, Sp.THT –KL
dr. IG Kamasan Arijana, Msi Med
dr.I Made Krisna Dinata, M.Erg
dr. Yuliana, M.Biomed
Dermatovenereology
081338044921
081338718384
08124644451
08123978446
081337808844
08123766268;
(0361)8563718
081236234153
ENT
ENT
ENT
ENT
Histology
Physiology
Anatomy
08113809882
081338701878
087861361255
08123968294
085339644145
08174742566
0816555671
Faculty of Medicine Udayana University,MEU
4
Study Guide block skin and hearing systems and disorders
~ FACILITATORS ~
Regular Class
No
Group
Department
Phone
Room
A1
DME
081338644411
A2
Interna
08123657130
3.
dr. I Gusti Ayu Sri Darmayani,
Sp.OG
dr. I Made Pande Dwipayana,
Sp.PD
dr. I Made Oka Negara, S.Ked
A3
Andrology
08123979397
4.
dr. I Made Muliarta, M.Kes.
A4
Fisiology
081338505350
5.
dr. I Made Krisna Dinata, S.Ked
A5
Fisiology
08174742566
6.
dr. I Made Dwijaputra Ayustha,
Sp.Rad
dr. I Made Bagiada, Sp.PD
A6
Radiology
08123670195
A7
Interna
08123607874
A8
Anasthesi
08123621422
9.
dr. I Made Agus Kresna Sucandra,
Sp.An
dr. I Ketut Wibawa Nada, Sp.An
A9
Anasthesi
08786060995
10.
dr. I Ketut Suanda, Sp.THT-KL
A10
ENT
081337788377
11.
dr. Komang Ayu Kartika Sari, MPH
A11
Public Health
082147092348
12.
Drs. I Gede Made Adioka, Apt,
M.Kes
A12
Pharmacy
081999418471
3nd floor:
R.3.01
3nd floor:
R.3.02
3nd floor:
R.3.03
3nd floor:
R.3.04
3nd floor:
R.3.05
3nd floor:
R.3.06
3nd floor:
R.3.07
3nd floor:
R.3.08
3nd floor:
R.3.20
3nd floor:
R.3.21
3nd floor:
R.3.22
3nd floor:
R.3.23
1.
2.
7.
8.
Name
English Class
No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Name
Group
Department
dr. I Gusti Ngurah Mahaalit
Aribawa , Sp.An.
dr. I Gusti Ngurah Bagus Artana,
Sp.PD
dr. Ni Wayan Winarti , Sp.PA
B1
Anasthesi
0811396811
B2
Interna
08123994203
B3
087860990701
dr. Ni Komang Suryawati,
Sp.KK(K)
dr. I Gusti Ayu Sri Mahendra Dewi,
Sp.PA(K)
dr.Hengky, Sp.F
B4
Anatomy
Pathology
Dermatology
081338736481
B6
Anatomy
Pathology
Forensic
dr. I Gusti Ayu Putu Eka Pratiwi,
M.Kes.,Sp.A
dr. Luh Seri Ani, S.KM,M.Kes
B7
Pediatric
08123920750
B8
Public Health
08123924326
dr. I G Nyoman Darma Putra ,
Sp.KK
dr. I Gst.Ngr.Ketut Budiarsa , Sp.S
B9
Dermatology
08124644451
B10
Neurology
0811399673
B11
Interna
085237068670
B12
DME
081805391039
dr. I Gede Ketut Sajinadiyasa,
Sp.PD
dr. I Gde Haryo Ganesha, S.Ked
Faculty of Medicine Udayana University,MEU
B5
Phone
0817447279
08123988486
Room
3nd floor:
R.3.01
3nd floor:
R.3.02
3nd floor:
R.3.03
3nd floor:
R.3.04
3nd floor:
R.3.05
3nd floor:
R.3.06
3nd floor:
R.3.07
3nd floor:
R.3.08
3nd floor:
R.3.20
3nd floor:
R.3.21
3nd floor:
R.3.22
3nd floor:
R.3.23
5
Study Guide skin and disorders
TIME TABLE ENGLISH CLASS (B)
BLOCK SKIN AND HEARING SYSTEMS AND DISORDERS
3rd Semester Medical Faculty Udayana University 2014
Days /
Date
Jan 2,
2015
Friday
Time
Activity
Venue
08.00-08.30(30’)
Lecture 1 : Introductionary
to Block Skin and Hearing
and Disorders
Class Room
08.30-09.00(30’)
09.00-10.30(90’)
10.30-12.00(90’)
Jan 5,
2015
Monday
Linawati
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
Linawati
BCS: Efforesensi
Prak : mikroscopic
structure of the skin and
appendages and hearing
system
Lecture 3 : Common
Pathophysiological bases
of the skin and hearing
system disorders
Independent Learning
Class room
Joint lab
Dwi Puspawati
Linawati / Arijana
08.00- 15.00
(see BCS
schedule)
09.00-10.30(90’)
10.30-12.00(90’)
Herman
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Lecture 4 : Benign skin
tumor (veruka, moluskum,
kista, kondiloma
akuuminata), and vaginitis,
servicitis
Independent Learning
09.00-10.30(90’)
10.30-12.00(90’)
Fasilitator
Herman
Class Room
Class Room
Wiraguna/ Dhana
Saputra
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
Faculty of Medicine UNUD,MEU
Fasilitator
Class Room
SGD
08.00-09.00(60’)
Jan 7,
2015
Wednes
day
Suryawati
SGD
08.00-09.00(60’)
Jan 6,
2015
Tuesday
Lecture 2 : functional
structure of the skin and
it’s appendices
Independent Learning
Lecturers
Fasilitator
Wiraguna/ Dhana
6
Study Guide block skin and hearing systems and disorders
Jan 8,
2015
Thursdy
08.00-09.00(60’)
Lecture 5 : Drug eruption (
eritema multiforme )
09.00-10.30(90’)
Independent Learning
10.30-12.00(90’)
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-09.00(60’)
Lecture 6:
Papuloerythrosquamosa
Class Room
Jan 12,
2015
Monday
Jan 13,
2015
Tuesday
10.30-12.00(90’)
Independent Learning
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
Class Room
08.00-09.00(60’)
Lecture 7 : Dermatitis
(numularis,
neurodermatitis, napkin
eksema, perioral, urtikaria,
dermatitis fotokontak,
angioederma/angioedema)
10.30-12.00(90’)
Rusyati/ karmila
Fasilitator
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-09.00(60’)
Lecture 8: Pigmentary and
Sebaceous gland
disorders
(hipo/hiperpigmentasi,
miliaria, hidradenitis
supuratif)
09.00-10.30(90’)
Independent Learning
Class Room
Wardana/ Suryawati
Sumedha/ Elies/
Praharsini
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
Faculty of Medicine Udayana University,MEU
Fasilitator
Wardana/ Suryawati
SGD
10.30-12.00(90’)
Prof Suastika A/
Ratih
Discussion
Room
Independent Learning
Fasilitator
Rusyati/Karmila
SGD
09.00-10.30(90’)
Prof Suastika A/
Ratih
-
SGD
09.00-10.30(90’)
Jan 9,
2015
Friday
Class Room
Facilitator
Sumedha/ Elies/
Praharsini
7
Study Guide block skin and hearing systems and disorders
08.00-09.00(60’)
Jan 14,
2015
Wednes
day
Jan 15,
2015
Thursda
y
Jan 16,
2015
Friday
09.00-10.30(90’)
10.30-12.00(90’)
Independent Learning
Class Room
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-09.00(60’)
Lecture 10: Insect bite and
infestation (pedikulosis,
kapitis and pubis, scabies)
09.00-10.30(90’)
10.30-12.00(90’)
Independent Learning
Class Room
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
Presentation (skin)
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-08.30(30’)
08.30-09.00(30’)
Lecture 11: Rational
topical treatment in
dermatology
Lecture 12:
Dermatofarmacology
Class Room
09.00-10.30(90’)
Independent Learning
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
Presentation (skin)
-
14.00-15.00(60’)
Plenary Session
08.00-08.30(30’)
Lecture 13: Anatomical of
Hearing Systems
Lecture 14: Histology of
Hearing Systems
09.00-10.30(90’)
10.30-12.00(90’)
Independent Learning
Facillitator
Praharsini / Dhana
Saputra
Alit Widhiartini
Wiwiek
Facillitator
Alit, Wiwiek
Class Room
Class Room
Yuliana
Arijana/ Ratnayanti
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
Faculty of Medicine Udayana University,MEU
Darma
Praharsini/ Dhana
Saputra
SGD
10.30-12.00(90’)
Darma
Fasilitator
SGD
08.30-09.00(30’)
Jan 20,
2015
Tuesday
Lecture 9: Bacterial
Infection (impetigo,
skrofuloderma, erisipelas,
selulitis, eritrasma)
8
Study Guide block skin and hearing systems and disorders
Jan 21,
2015
Wednes
day
Jan 22,
2015
Thursda
y
Jan 23,
2015
Friday
14.00-15.00(60’)
Plenary Session
Class Room
08.00-08.30(30’)
Class Room
08.30-09.00(30’)
Lecture 15: Physiology of
Hearing systems
Lecture 16: Otic Drug
09.00-10.30(90’)
Independent Learning
10.30-12.00(90’)
Alit Widhiarthini
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-09.00(60’)
Lecture 17: Pericondritis,
Wax, Foreign bodies,
Bulous Myringitis
Class Room
09.00-10.30(90’)
10.30-12.00(90’)
Independent Learning
Lely Rahayu
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-09.00(60’)
Lecture 18: Membrane
tymphani perforation,OMS,
labirinitis, paresis nervus
fasialis
09.00-10.30(90’)
10.30-12.00(90’)
Independent Learning
Andi dwi Saputra
Class Room
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
-
14.00-15.00(60’)
Plenary Session
Class Room
08.00-08.30(30’)
Lecture 19: Ear Trauma/
othematoma, barotrauma,
Motion Sickness, PGPKT
Lecture 20: Hearing loss,
noise induced hearing loss
08.30-09.00(30’)
Jan 26,
2015
Monday
Krisna Dinata
09.00-10.30(90’)
10.30-12.00(90’)
Independent Learning
Eka Putra
Class Room
Wiranadha
-
SGD
Discussion
Room
12.00-12.30(30’)
Break
-
12.30-14.00(90’)
Student Project
Presentation (hearing)
-
14.00-15.00(60’)
Plenary Session
Faculty of Medicine Udayana University,MEU
Class Room
9
Study Guide block skin and hearing systems and disorders
Jan 27,
28, 29,
30, 2015
Jan 31,
2015
Saturda
y
Feb 2,
2015
Monday
08.00 - 13.00
BCS 2, 3, 4 dan 5
L. Bersama,
pharmacy L,
RK.302
EXAM. PREPARATION
EXAMINATION
Faculty of Medicine Udayana University,MEU
FAS
LEC
10
Study Guide block skin and hearing systems and disorders
TIME TABLE REGULAR CLASS (A)
BLOCK SKIN AND DISORDERS
Days /
Date
Jan 2,
2015
Friday
Time
Activity
09.00-09.30 (30’)
Lecture 1 :
Introductionary to Block
Skin and Disorders
09.30-10.00 (30’)
Jan 5,
2015
Monday
11.30-12.00 (30’)
12.00-13.30 (90’)
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
11.30-12.00 (30’)
12.00-13.30 (90’)
Plenary Session
BCS 1: Effloresensi
Prak : mikroscopic
structure of the skin
and appendages and
hearing system
Lecture 3 : Common
Pathophysiological
bases of the skin and
hearing system
disorders
Student Project
(searching for
references)
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
11.30-12.00 (30’)
12.00-13.30 (90’)
Plenary Session
Lecture 4 : Benign Skin
tumor (veruka,
moluskum, kista,
kondiloma akuminata),
and vaginitis, servicitis
Student Project
(searching for
references)
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
09.00 – 16.00
(see BCS
schedule)
09.00-10.00 (60’)
Jan 6,
2015
Tuesday
10.00-11.30 (90’)
09.00-10.00 (60’)
Jan 7,
2015
Wednes
day
10.00-11.30 (90’)
Lecturers
Suryawati
Class Room
Lecture 2 : Functional
structure of the skin
and it’s appendices
Student Project
(searching for
references)
Break
Independent Learning
10.00-11.30 (90’)
Venue
Faculty of Medicine Udayana University,MEU
Linawati
Discussion
Room
Class Room
Facilitator
Class room
Joint lab
Dwi Puspawati
Linawati / Arijana
Class Room
Herman
Linawati
Discussion
Room
Class Room
Class Room
Fasilitator
Herman
Wiraguna/ Dhana
Saputra
Discussion
Room
Class Room
Facilitator
Wiraguna/ Dhana S
11
Study Guide block skin and hearing systems and disorders
11.30-12.00 (30’)
12.00-13.30 (90’)
Lecture 5 : Drug
eruption ( eritema
multiforme )
Student Project
(searching for
references)
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
09.00-10.00 (60)
Lecture 6:
Papuloerythrosquamos
a
10.00-11.30 (90’)
Student Project
11.30-12.00 (30’)
12.00-13.30 (90’)
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
Class Room
Rusyati/ karmila
09.00-10.00 (60’)
Lecture 7 : Dermatitis
(numularis,
neurodermatitis, napkin
eksema, perioral,
urtikaria, dermatitis
fotokontak,
angioderma/angioede
ma)
Class Room
Wardana / Suryawati
10.00-11.30 (90’)
11.30-12.00 (30’)
12.00-13.30 (90’)
Student Project
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
09.00-10.00 (60’)
Lecture 8: Pigmentary
and Sebaceous gland
disorders
(hipo/hiperpigmentasi,
miliaria, hidradenitis
supuratif)
10.00-11.30 (90’)
11.30-12.00 (30’)
12.00-13.30 (90’)
Student Project
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
09.00-10.00 (60’)
Jan 8,
2015
Thursdy
10.00-11.30 (90’)
Suastika A /Ratih
Class Room
Discussion
Room
Class Room
Facilitator
Suastika A / Ratih
Rusyati/Karmila
Jan 9,
2015
Friday
Jan 12,
2015
Monday
Jan 13,
2015
Tuesday
Faculty of Medicine Udayana University,MEU
Class Room
Discussion
Room
Discussion
Room
Class Room
Class Room
Discussion
Room
Class Room
Facilitator
Facilitator
Wardana/ Suryawati
Sumedha/ Elies/
Praharsini
Facilitator
Sumedha/ Elies/
Praharsini
12
Study Guide block skin and hearing systems and disorders
Jan 14,
2015
Wednes
day
09.00-10.00 (60’)
Lecture 9: Bacterial
Infection (impetigo,
skrofuloderma,
erisipelas, selulitis,
eritrasma)
10.00-11.30 (90’)
11.30-12.00 (30’)
12.00-13.30 (90’)
Student Project
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
11.30-12.00 (30’)
12.00-13.30 (90’)
Lecture 10: insect bite
and infestation
(pedikulosis, kapitis
and pubis, scabies)
Student Project
Presentation (skin)
Break
Independent Learning
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
09.00-10.00 (60’)
Jan 15,
2015
Thursda
y
10.00-11.30 (90’)
Jan 21,
2015
Wednes
Discussion
Room
Class Room
Class Room
Discussion
Room
Class Room
13.30-15.00 (90’)
SGD
15.00-16.00 (60’)
Plenary Session
09.00-09.30 (30’)
Class Room
09.30-10.00 (30’)
Lecture 13: Anatomical
of Hearing Systems
Lecture 14: Histology
of Hearing Systems
10.00-11.30 (90’)
Independent Learning
-
11.30-12.00 (30’)
SGD
-
12.00-13.30 (90’)
Break
13.30-15.00 (90’)
Student Project hearing
15.00-16.00 (60’)
Plenary Session
Discussion
Room
Class Room
09.00-09.30 (30’)
Lecture 15: Physiology
of Hearing systems
Lecture 16: Otic drug
10.00-11.30 (90’)
09.30-10.00 (30)
Faculty of Medicine Udayana University,MEU
Facilitator
Darma
Praharsini/ Dhana
Saputra
-
11.30-12.00 (30’)
12.00-13.30 (90’)
09.30-10.00 (30’)
Jan 20,
2015
Tuesday
Class Room
Lecture 11: Rational
topical treatment in
dermatology
Lecture 12:
Dermatopharmacology
Student Project
presentation (skin)
Break
Independent Learning
09.00-09.30 (30’)
Jan 16,
2015
Friday
Darma
Class Room
Facillitator
Praharsini / Dana
Saputra
Alit widhiartini
wiwiek
Discussion
Room
Class Room
Facillitator
Alit w, wiwiek
Yuliana
Arijana/ Ratnayanti
Krisna Dinata
Class Room
Alit W
13
Study Guide block skin and hearing systems and disorders
day
10.00-11.30 (90’)
Independent Learning
-
11.30-12.00 (30’)
SGD
-
12.00-13.30 (90’)
Break
13.30-15.00 (90’)
Student Project hearing
Discussion
Room
15.00-16.00 (60’)
Plenary Session
Class Room
Krisna, Alit W
Jan 22,
2015
Thursda
y
Jan 23,
2015
Friday
09.00-10.00 (60’)
Lecture 17:
Pericondritis, Wax,
Foreign bodies, Bulous
myringitis Bulosa
Class Room
10.00-11.30 (90’)
Independent Learning
-
11.30-12.00 (30’)
SGD
-
12.00-13.30 (90’)
Break
13.30-15.00 (90’)
Student Project
15.00-16.00 (60’)
Plenary Session
Discussion
Room
Class Room
09.00-10.00 (60’)
Lecture 18:
Membrane tymphani
perforation, OMS,
labirinitis, paresis
nervus fasialis
10.00-11.30 (90’)
Independent Learning
-
11.30-12.00 (30’)
SGD
-
12.00-13.30 (90’)
Break
13.30-15.00 (90’)
Student Project hearing
15.00-16.00 (60’)
Plenary Session
Discussion
Room
Class Room
Class Room
Class Room
10.00-11.30 (90’)
Independent Learning
-
11.30-12.00 (30’)
SGD
-
12.00-13.30 (90’)
Break
-
13.30-15.00 (90’)
Student Project
Presentation (hearing)
15.00-16.00 (60’)
Plenary Session
09.30-10.00 (30’)
Faculty of Medicine Udayana University,MEU
Lely Rahayu
Andi Dwi Saputra
Lecture 19: Ear
Trauma/ othematoma,
barotrauma, Motion
Sickness, PGPKT
Lecture 20: Hearing
loss, noise induced
hearing loss
09.00-09.30 (30’)
Jan 26,
2015
Monday
Lely Rahayu
Andi Dwi Saputra
Eka Putra
Discussion
Room
Class Room
Wiranadha
Eka Putra,
Wiranadha
14
Study Guide block skin and hearing systems and disorders
Jan 27,
28, 29,
30, 2015
Jan 31,
2015
Saturda
y
Feb 2,
2015
Monday
08.00 - 13.00
BCS 2, 3, 4 dan 5
L. Bersama,
Physiology L,
Pharmacy L,
RK.302
EXAM.
PREPARATION
EXAMINATION
FAS
LEC
3rd Semester Medical Faculty Udayana University 2014
Faculty of Medicine Udayana University,MEU
15
Study Guide block skin and hearing systems and disorders
PRACTICUM AND BCS SCHEDULE ( 3th Semester)
08.00 – 09.00
09.00 – 10.00
10.00 – 11.00
11.00 – 12.00
12.00 - 13.00
08.00-09.00
09.00-10.00
10.00-11.00
11.00-12.00
12.00-13.00
05-01-2015 27-01-2015 28-01-2015 29-01-2015
30-01-2015
R.kuliah
Efflore
sensi
kulit, kuku,
mukosa,
rambut,
dermogra
fisme
(dr. Dwi
Puspawati)
R.kuliah
Labora
tory
investiga
tion (KOH,
Giemsa)
( dr.
Suryawati,
dr.
Karmila)
R.kuliah
Perawatan
luka,
kompres,
bebat
kompresi
pd vena
varikosum
R.kuliah
Insisi
abses,
Eksisi
tumor,
rozerplasti
kuku,
ekstraksi
komedo
(dr.Darma)
R.kuliah
Manuver
valvalva,
pembersiha
n MAE dg
usapan,
pengambila
n serumen
dan benda
asing di
telinga
(dr.
Wiranadha)
A, B
A, B
C, D
C, D
A,B
A,B
C,D
C,D
A,B
A,B
C,D
C,D
A,B
A,B
C,D
C,D
A,B
A,B
C,D
C,D
Lab
Bersama
Lab
Bersama
Histology
Practicum
skin and
hearing
organ
(dr.Lina
Wati/
Arijana)
Patologi
Anatomi
Practicum
skin and
hearing
systems
(dr.
Herman)
Physiolog
y&
Pharmacy
Lab
Topical
Prepa
Ration in
skin and
Otic drug
(Dra. IA Alit
W)
Physiolog
y&
Pharmacy
Lab
Farma
cology
practicum
in Skin
and
hearing
(dr.
Wiwiek/dr.
Surya)
C
D
A
B
C
D
A
B
C
D
A
B
(dr. Dhana
S, dr Luh
Mas
Rusyati )
C
D
A
B
Physiology
Lab
Physiology
practicum
(dr. Krisna)
C
D
A
B
Group A: SGD A1, A2, A3, A4, A5.
Group B: SGD A6, A7, A8, A9, A10.
Group C: SGD B1, B2, B3, B4, B5.
Group D: SGD B6, B7, B8, B9, B10.
Faculty of Medicine Udayana University,MEU
16
Study Guide block skin and hearing systems and disorders
~ STUDENT PROJECT ~
No
Topics
Supervisors
1
Prurigo
2
Disorders of Keratinization
(Ichtyosis Vulgaris)
3
Miliaria
4
Lupus Erythematosus
(Cutaneous Discoid Lupus)
5
Deafness
Dr. Luh Mas
Rusyati, Sp.KK/ dr.
Karmila, Sp.KK
Dr. Suryawati,
Sp.KK/ dr. Ratih,
Sp.KK
dr. IGA Praharsini,
Sp.KK/ dr. IGA
Elies Indira, Sp.KK
dr. IGN Darma
Putra, Sp.KK / dr.
IGN Darmada,
Sp.KK
dr. Eka Putra,
Sp.THT/ dr.
Wiranadha, Sp.THT
dr. Lely Rahayu,
Sp.THT-KL
6
Fistula Preauricular
Faculty of Medicine Udayana University,MEU
Time of
presentation
January 15, 2015
A : 10.00 - 10.45
B: 12.30 – 13.15
January 15, 2015
A : 10.45 - 11.30
B: 13.15 – 14.00
January 16, 2015
A : 10.00 - 10.45
B: 12.30 – 13.15
January 16, 2015
A : 10.45 - 11.30
B: 13.15 – 14.00
January 21, 2015
A : 10.00 - 10.45
B: 12.30 – 13.15
January 21, 2015
A : 10.45 - 11.30
B: 13.15 – 14.00
17
Study Guide block skin and hearing systems and disorders
Regulation for Strudent Project
1. Each small group discussion must make 2 scientific writing (see topic for each
group)
2. Each small group discussion must ready to present their scientific writing (due to the
above schedules)
3. Each small group must collect their scientific writing after paper presentation.
4. Evaluation of student project will be performed in concordance with final examination
in form of multiple choice question. There will be 2 questions to each topics.
Report Format
I. Introduction
II. Content
a. Etiology
b. Pathogenesis
c. Clinical feature
d. Diagnosis
e. Therapy
III. Conclution
IV. References ( vancouver style) (min. 8)
15- 20 halaman; 1,5 spasi; Times New Romance; jilid warna hijau
Cover 
Tittle
Name
Student Registration Number
Faculty of Medicine, Udayana University 2014
Student Project Topic
No
1
Group
A1
2
A2
3
A3
4
A4
5
A5
6
A6
7
A7
8
A8
9
A9
10
A10
Faculty of Medicine Udayana University,MEU
Topic
- Prurigo
- Deafness
- Disorders
of
keratinization
(Ichtyosis vulgaris)
- Fistula preauricular
- Miliaria
- Deafness
- Cutaneous discoid lupus
- Fistula preauricular
- Prurigo
- Disorders
of
keratinization
(Ichtyosis vulgaris)
- Miliaria
- Cutaneous discoid lupus
- Prurigo
- Deafness
- Disorders
of
keratinization
(Ichtyosis vulgaris)
- Fistula preauricular
- Miliaria
- Deafness
- Cutaneous discoid lupus
18
Study Guide block skin and hearing systems and disorders
11
B1
12
B2
13
B3
14
B4
15
B5
16
B6
17
B7
18
B8
19
B9
20
B10
-
Hearing systems 2
Prurigo
Disorders
of
keratinization
(Ichtyosis vulgaris)
Miliaria
Cutaneous discoid lupus
Prurigo
Fistula preauricular
Disorders
of
keratinization
(Ichtyosis vulgaris)
Fistula preauricular
Miliaria
Deafness
Cutaneous discoid lupus
Fistula preauricular
Prurigo
Disorders
of
keratinization
(Ichtyosis vulgaris)
Miliaria
Cutaneous discoid lupus
Disorders
of
keratinization
(Ichtyosis vulgaris)
Fistula preauricular
Miliaria
Deafness
ASSESSMENT METHODES
NO
TOPIC
1
2
Introductionary to Block Skin and Disorders
Functional structure of the skin and it’s
appendices and hearing system disorder
3
4
Common Pathological bases of the skin
disorders
Rational topical treatment in dermatology
and hearing systems
Dermatofarmacology and hearing systems
MCQ
MCQ
5
Skin manifestation (effloresences) in
common skin disorders
OSCE
6
Dermatitis (numularis, fotocontact,
neurodermatitis, napkin eksema, perioral,
urtikaria)
7
Papulo-erythrosquamosa
MCQ
8
Drug eruption of the skin
MCQ
9
Pigmentary and sebaceous gland disorders
MCQ
5
Faculty of Medicine Udayana University,MEU
ASSESSMENT/
METHOD
MCQ
MCQ
MCQ
MCQ
19
Study Guide block skin and hearing systems and disorders
10
11
12
13
15
16
17
18
19
20
21
22
23
24
25
26
27
Bacterial infection (impetigo,
scrofuloderma, erisipelas, selulitis,
eritrasma, hidradenitis)
Eksisi tumor and curetase
Insect bite and infestation (Scabies,
creeping eruption, pediculosis)
Tumor of the skin, vaginitis, servicitis
Abcess incision
Miliaria
Laboratory investigation
Disorders of keratinization
Prurigo
Cutaneous discoid lupus
Pericondritis, wax, foreign bodies, and
bulous myringitis
Perforasi membran
timpani,OMS,LABIRINITIS,paresis nervus
fasialis
Ear trauma/ othematoma,
barotrauma,motion sickness,PGPKT
Hearing loss, noise induced hearing loss
Deafness
Fistula preauricular
Manuver valsalva, pembersihan MAE
dengan usapan, pengambilan serumen
dengan kait/kuret, pengambilan benda
asing di telinga
Faculty of Medicine Udayana University,MEU
MCQ
OSCE
MCQ
MCQ
OSCE
MCQ
OSCE
MCQ
MCQ
MCQ
MCQ
MCQ
MCQ
MCQ
MCQ
MCQ
OSCE
20
Study Guide skin and disorders
~ MEETING ~
Meeting of the student representatives
The meeting between block planners and student group representatives will be held on
Wednesday, Jan 14 , at 10.00 until 11.00 at Class Room. In this meeting, all of the student
group representatives are expected to give suggestions and inputs or complaints to the
team planners for improvement. For this purpose, every student group should choose one
student as their representative to attend the meeting.
Meeting of the facilitators
The meeting between block planners and facilitators will take place on Wednesday, Jan 14
at 11.00 until 12.00 at Class Room. In this meeting all the facilitators are expected to give
suggestions and inputs as evaluation to improve the study guide and the educational
process. Because of the importance of this meeting, all facilitators are expected to attend
the meeting.
~ PLENARY SESSION ~
For each learning task, the student is requested to prepare a group report. The
report will be presented in plenary session. Lecturer in charge will choose the group
randomly. The aim of this presentation is to make similar perception about the topic that
has been given.
~ ASSESSMENT METHOD ~
Assessment will be performed on Monday, February 2th 2015 for both Regular class
and English class. There are 100 questions for the examination that consist of Multiple
Choice Question (MCQ).
The borderline to pass exam is 70. The proportion of final results are:
Small group discussion
: 5%
Final exam (MCQ)
: 95%
BLOCK RULES:
1. Each student must follow all of the block activity, if they don’t do that, they have to
make paper related to the block topic when was they absent (lecture,
practicum/BCS) and they have to collect to the lecture/ supervisor/ conveyer on that
day.
2. Student have to prepare for pre and post test every day during the block.
3. Each student must on time, more than 5 minutes late, they wouln’t permitted to
enter the room.
4. Cheating is prohibited, violent of the rules would be considered to decrease 10 % of
final exam result.
Faculty of Medicine UNUD,MEU
21
Study Guide block skin and hearing systems and disorders
~ LEARNING PROGRAMS ~
ABSTRACTS OF LECTURES
Day 1
Lecture 1. Introduction to The Block Skin and Disorders
Suryawati
Lecture 2. Functional Structure of the Skin and Its Appendices
Linawati
The skin consist of three layers firmly attach to one another. (1) The outer is
epidermis, derived from ectoderm; (2) the deeper dermis, derived from mesoderm; and (3)
the hypodermis or subcutaneous layer, corresponding to the superfisial fascia in gross
anatomy. The epidermis is stratified squamous epithelial layer which consists of four
distinct cell types; keratinocyte, melanocytes, langerhans cells and merkel cells. The
epidermis consist of in five layer or strata : (1) stratum basale, (2) stratum spinosum, (3)
stratum granulosum, (4) stratum lusidum and (5) stratum corneum. Skin appendages
consist of hair, nail, sebaseous gland, sweat gland and nails.
Skin is generaly classified into two types : (1) thick skin and thin skin. Thick skin
(more than 5 mm thick) covers the palms of the hands and the soles of the feet and has a
thick epidermis and dermis. Thin skin (1 to 2 mm in thickness) lines the rest of the body; the
epidermis is thin.
The skin has several functions : (1) Protection (mechanical function); (2) as a
water barrier; (3) Regulation of body temperature (conservation and dissipation of heat);
(4) Non spesifik defense (barrier to microorganism); (5) Excretion of salts; (6) synthesis of
vitamin D; (7) as sensory organ
The epidermis and dermis display a tight fit interface at the dermal-epidermal
junction, where a basal lamina and hemidesmosomes are located. A primary epidermal
ridge interlocks with a subjacent primary dermal ridge. An epidermal interpapilary peg,
projecting downward from the primary epidermal ridge, interlocks with the primary dermal
ridge, which is subdivided into two secondary dermal ridges. A number of dermal papillae
project upward from the surface of each secondary dermal ridge into the epidermal region,
interlocking with downward projections of the epidermis. This arrangement is predominant in
hairless thick skin. Dermal papillae are numerous and branched. In thin skin, papillae are
low and their number is reduced.
Day 2
Lecture BCS 1 : Effloresensi
Puspa
Distribution of the rash, arrangement and morphology of individual rash, distribution of the
lesion: symmetrical, asymmetrical, exposed area, sun exposed area, scalp region, hand,
extensor aspect, flexor aspect.
Arrangement and configuration of the lesion: grouped (as in insect bites, dermatitis
herpetiformis, herpes simplex, common warts), annular or arciform (as in granuloma
annulare, mycosis fungoides, tinea circinata, erythema annulare centrifugum), linear pattern
(as in Koebner phenomenon, Psoriasis, lichen planus, plane wart, molluscum contagiosum;
epidermal naevus, sporotrichosis, lichen striatus, lichen simplex, morphoea, lichen sclerosis,
phytophotodermatitis).
Faculty of Medicine Udayana University,MEU
22
Study Guide block skin and hearing systems and disorders
Morphology of lesion: Individual lesion described with the help of magnifying glass. To find
out the early primary lesion and to inspect it closely. Note the shape(geometric shape, oval),
colour(salmon-pink, erythematous, skin colour, yellow), size, margin (sharpness of edge,
well-defined, ill-defined), the surface characteristics (dome-shaped, umbilicated, spike like),
temperature and smell.
It is a good practice if affordable to have thorough examination of the whole body especially
for new consultation and for the elderly. Sometimes, examination of the back and buttock of
the elderly may pick up unexpected lesions, even the patient himself or herself may not
notice them e.g. persistent chronic annular erythematous rash in the buttock found in a case
of tuberculoid leprosy.
The major types of primary lesions are:
 Macule. A small, circular, flat spot less than [frac25] in (1 cm) in diameter. The color of a
macule is not the same as that of nearby skin. Macules come in a variety of shapes and
are usually brown, white, or red. Examples of macules include freckles and flat moles. A
macule more than [frac25] in (1 cm) in diameter is called a patch.
 Vesicle. A raised lesion less than [frac15] in (5 mm) across and filled with a clear fluid.
Vesicles that are more than [frac15] in (5 mm) across are called bullae or blisters. These
lesions may may be the result of sunburns, insect bites, chemical irritation, or certain
viral infections, such as herpes.
 Pustule. A raised lesion filled with pus. A pustule is usually the result of an infection,
such as acne, imptigeo, or boils.
 Papule. A solid, raised lesion less than [frac25] in (1 cm) across. A patch of closely
grouped papules more than [frac25] in (1 cm) across is called a plaque. Papules and
plaques can be rough in texture and red, pink, or brown in color. Papules are associated
with such conditions as warts, syphilis, psoriasis, seborrheic and actinic keratoses,
lichen planus, and skin cancer.
 Nodule. A solid lesion that has distinct edges and that is usually more deeply rooted
than a papule. Doctors often describe a nodule as "palpable," meaning that, when
examined by touch, it can be felt as a hard mass distinct from the tissue surrounding it.
A nodule more than 2 cm in diameter is called a tumor. Nodules are associated with,
among other conditions, keratinous cysts, lipomas, fibromas, and some types of
lymphomas.
 Wheal -Urtica. A skin elevation caused by swelling that can be itchy and usually
disappears soon after erupting. Wheals are generally associated with an allergic
reaction, such as to a drug or an insect bite.
 Telangiectasia. Small, dilated blood vessels that appear close to the surface of the
skin. Telangiectasia is often a symptom of such diseases as rosacea or scleroderma.






The major types of secondary skin lesions are:
Ulcer. Lesion that involves loss of the upper portion of the skin (epidermis) and part of
the lower portion (dermis). Ulcers can result from acute conditions such as bacterial
infection or trauma, or from more chronic conditions, such as scleroderma or disorders
involving peripheral veins and arteries. An ulcer that appears as a deep crack that
extends to the dermis is called a fissure.
Scale. A dry, horny build-up of dead skin cells that often flakes off the surface of the
skin. Diseases that promote scale include fungal infections, psoriasis, and seborrheic
dermatitis.
Crust. A dried collection of blood, serum, or pus. Also called a scab, a crust is often part
of the normal healing process of many infectious lesions.
Erosion. Lesion that involves loss of the epidermis.
Excoriation. A hollow, crusted area caused by scratching or picking at a primary lesion.
Scar. Discolored, fibrous tissue that permanently replaces normal skin after destruction
of the dermis. A very thick and raised scar is called a keloid.
Faculty of Medicine Udayana University,MEU
23
Study Guide block skin and hearing systems and disorders


Lichenification. Rough, thick epidermis with exaggerated skin lines. This is often a
characteristic of scratch dermatitis and atopic dermatitis.
Atrophy. An area of skin that has become very thin and wrinkled. Normally seen in
older individuals and people who are using very strong topical corticosteroid medication.
Day 3
Lecture 3: Common Pathological bases of Skin disorders
Herman S
Little more than 100 years ago, the noted pathologist Rudolph Virchow considered
the skin as protective covering for more delicate and functionally sophisticated internal
viscera. Then, and for the century that followed, the skin was considered primarily a passive
barrier to fluid loss and mechanical injury. During the past three decades, however, of
scientific inquiries have demonstrated the skin to be a complex organ in which precisely
regulated cellular and molecular interactions govern many crucial responses of the skin to
our environment.
Accurate description of the clinical appearance of the skin at a macroscopic level is often
critical for diagnosis. Correlation between the gross and histologic appearances is often
essential in formulating diagnoses and in understanding p
athogenesis. Accordingly, efforts are made in the following pages to depict and describe
clinical lesions whenever possible and to relate these findings to the microscopic
appearance of lesions.
Day 4
Lecture 4: Benign skin tumors, Vaginitis and Cervicitis
Wiraguna/ Dhana Saputra
Benign tumors of the skin is a dermatosis which consists of multiple entities.
Examination of skin tumors, not only determine the malignant or benign , but also determine
the origin of the tumor cell component of the skin. Tumors can be derived from epidermal
keratinocytes or accessory gland cells. Epidermal nevus is a benign skin tumor that is a
proliferation of epithelial hamartoma include; verukosa epidermal nevus derived from
keratinocytes, sebaceous nevus derived from sebaceous gland, nevus komedonikus
derived from pilosebaceous units, eccrine nevus derived from eccrine glands and apocrine
nevus that derived from apocrine glands. Expression of epidermal nevus mosaicsm
considered to have a genetic mutation occurs not only on the skin but also other networks.
Lesions follow Blaschko lines which indicate the presence of mutations postzigotik. In
general, large lesions and the wide distribution of lesions in the head and neck have internal
organ involvement and is known as the epidermal nevus syndrome. Epidemiology,
pathology and clinical course of the disease can vary depending on the clinical variations of
tumor cell origin .
Infection of Human Papilloma Virus ( HPV ) can cause mucosal and skin epithelial
proliferation and cause warts. Warts can be classified by anatomic location or its
morphology , such as verruca vulgaris , verruca plana and palmo plantar warts . Humans
are the only hosts and intermediaries. Warts Treatment based on clinical appearance ,
location and the patient's immune status, common warts are more difficult to treat in patients
with immunosuppression. Because warts are linked as a cofactor cancer, it is necessary to
be evaluated histologically .Molluscum is caused by poxviruses , MCV 1-4 and its variants.
In children, the infection is caused by MCV 1. In patients who have HIV infection, MCV type
2 cause infection in most cases. Molluscum is easily transmitted through skin contact chiefly on wet skin . Treatment is determined based on the clinical situation, in
immunocompetent pediatric patients, sometimes no treatment is required.
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Sexually transmitted infections (STIs) can be caused by various etiologies that have
various clinical symptoms. Etiologic agent of STIs in women such as Neisseria
gonorrhoeae, Trichomonasvaginalis and Candida albicans infections can produce vaginal
discharge and cause vaginitis or cervicitis. The diagnosis can be confirmed by laboratory
tests such as microscopic examination, culture or the latest diagnostic methods such as
nucleic acid amplification test. Besides syndromic approach can be useful in tertiary care
centers that do not have a complete diagnostic tool. Early diagnosis and appropriate
therapy gives good prognosis accompanied by prevention of sexual transmission through
treatment of sexual partners, sex abstinencia and safe sexual behavior.
Day 5
Lecture 5 : Drug eruption (exantematous drug reaction, fixed drug reaction,
erythema nodosum, erythema multiforme )
Suastika A/ Ratih
Exanthematous drug reaction are the most common form of adverse cutaneous drug
eruption. They are characterized by erythema, often with small papules throughout. They
tend to occur within the first two weeks of treatment but may appear later, or even within 10
days after the medication has been stopped. Lesions tend to appear first proximally,
especially in the groin and axilla, generalizing within 1 or 2 days. Pruritus is usually
prominent. The most common cause is an antibiotisc semisynthetic penicillins and
trimethoprim-sulfamethoxazole.
Fixed drug reaction are common. Fixed drug eruptions are so named because they
recur at the same site with each exposure to the medication. In most patients, six or fewer
lesions appear, frequently only one. Uncommonly, fixed eruptions may be multifocal with
numerous lesions. They may present on the body, but half occur on the oral and genital
mucosa. Clinically, a fixed eruption begins as a red patch that soon evolves to an iris or
target lesion identical to erythema multiforme, and may eventually blister and erode.
Characteristically, prolonged or permanent post inflammatory hyperpigmentation results,
althought a nonpigmenting variant of a fixed drug eruption is recognized.
Erythema nodosum is the most commonly diagnosed form of inflamatory
panniculitis, with most cases occuring in young adult women. The eruption consists of
bilateral, symetrical, deep, tender, bruise-like nodules, 1-10 cm in diameter, located
pretibially. Initially the skin over the nodules is red, smooth, slightly elevated, and shiny. The
onset is generally acute, frequently associated with malaise, leg edema and arthritis or
athralgias.
Erythema multiforme minor is a self-limited recurrent disease, usually in young
adults, occuring seasonally in the spring and fall, with each episode lasting 1-4 weeks. The
individual clinical lesions begin as sharply marginated, erythematous macules, which
become raised, edematous papules over 24 to 48 h. The lesions may reach several
centimeters in diameter. Typically EM minor is usually associated with a preceding orolabial
herpes simplex virus infection.
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Day 6
Lecture 6 : Papuloerytroskuamosa
(psoriasis, pityriasis rosea and erythrodermi)
Luh Mas Rusyati/ Karmila
Erythrosquamous skin disease are disease with efflorescence in the form of
erythema and squama. These diseases include psoriasis, pityriasis rosea, seborrheic
dermatitis and erythrodermi.
Psoriasis is a common scaly erythematous disease of unknown cause showing wide
variation in severity and distribution of skin lesions. It usually follows an irregular chronic
course marked by remissions and exacerbations of unpredictable onset and duration.
Factors that may lead to more lesions include drug reactions, respiratory infections, cold
weather, emotional stress, surgery, and also viral infections. The goal of therapy in psoriasis
is to achieve remission in which all or almost all lesions have disappeared. Topical therapy
should be used if possible. Systemic therapy is used if topical therapy has failed. If psoriasis
is limited to a few plaques, topical corticosteroids or tar should be used initially. Application
of topical corticosteroids under an occlusive or intralesional injection of corticosteroid may
result in rapid clearing of limited lesions.
Seborrheic dermatitis or also known as pityriasis sicca is a very common chronic
dermatosis characterized by redness and scaling, occurring in regions where the sebaceous
glands are most active such as the face, scalp, presternal area and in the body folds. Mild
seborrheic dermatitis causes flaking which is familiar in the term of dandruff. Generalized
seborrheic dermatitis, failure to thrive, and diarrhea in infants should bring to mind Leiner’s
disease which also accompanied by a variety of immunodeficiency disorders.
Pityriasis rosea is a mild inflammatory exanthema characterized by salmon coloured
papular and macular lesions that are first discrete but may be confluent. The individual
patches are oval or circinate, and are covered with finely crinkled, dry epidermis which often
desquamates, leaving a collarate of scalling. When stretched across a long axis, the scales
tend to fold across the lines of stretch forming the so called “hanging curtain” sign. The
disease most frequently begin with a single herald or mother patch, the efflorescence of
new lesions spreads rapidly, and after 3-8 weeks they usually disappear spontaneously.
Erythrodermi is characterized by erythema over the whole of the body. It can be
triggered by widely sebhorreic dermatitis, widely psoriasis vulgaris, or drug eruptions.
Day 7
Lecture 7: Dermatitis (numularis, neurodermatitis, napkin eksema, perioral,
urtikaria, fotokontak)
Wardana/ Suryawati
Numular dermatitis
Nummular dermatitis is defined as an eruption of round (discoid) eczematous
patches almost exclusively of the extremities often the lower legs in men and the forearms
and dorsal aspects of the hands in women. The lesions are well demarcated and measure
1–3 cm, only occasionally being larger. They may be acutely inflamed with vesicles and
weeping, but are more often lichenified and hyperkeratotic. The pathogenesis has not been
fully elucidated. Pruritus may be intense and excoriations are often prominent. Nummular
dermatitis usually takes a very chronic course. Options comprise medium-to high-potency
topical corticosteroid ointments, topical tacrolimus or pimecrolimus, and emollients. Tar
preparations have also been used successfully. However, a number of patients will require
phototherapy to clear the lesions.
Lichen simplex chronicus (circumscribed neurodermatitis)
Paroxysmal pruritus is the main symptom. Lichen simplex chronicus is a result of
long-continued rubbing and scratching, more vigorously than a normal pain threshold would
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permit, the skin becomes thickened and leathery. Chronic scratching of a localized area is a
response to unknown factors; however, stress and anxiety have long been thought
important. It is important to stress the need for the patient to avoid scratching the areas
involved if the sensation of itch is ameliorated. High-potency agents should be used initially
and the treatment can be shifted to the use of medium-to lower-strength topical steroid
creams as the lesions resolve. Topical doxepin, capsaicin, or pimecrolimus cream or
tacrolimus ointment provides significant antipruritic effects and is a good adjunctive therapy.
Intralesional injections of triamcinolone suspension, using a concentration of 5 or (with
caution) 10 mg/mL, may be required.
Diaper (napkin) dermatitis
Diaper dermatitis is the cumulative result of several factors, in particular dampness
and exposure to urine and feces. Prolonged use of diapers, dampness, and the factors
detailed above lead to the breakdown of the horny layer barrier function. An alkaline pH also
facilitates the development of secondary C. albicans infection. Diaper dermatitis is strictly
confined to the diaper area, presenting with mild to pronounced erythema, erosions and
scaling. Refractory diaper dermatitis may require a biopsy to exclude some of the above
conditions. In the acute phase, mild corticosteroid preparations are helpful. Topical
imidazole creams are added for secondary infection with Candida spp. The major goal of
long-term management is avoidance of the causative factors. Frequent changing of highly
absorbent disposable diapers is associated with a lower incidence and severity of diaper
dermatitis, and it leads to a more physiologic pH. Emollients containing white paraffin or soft
zinc pastes provide both protective and soothing effects.
Perioral Dermatitis
Perioral dermatitis is characterized by small discrete papules and pustules in
periorificial distribution. Patients often reveal a history of an acute steroid-responsive
eruption around the mouth, nose and/or eyes that worsen when the topical corticosteroid is
discontinued. If the topical corticosteroid are being used, they should be discontinued.
Patients should be educated about the link between application of topical corticosteroid and
exacerbation of the dermatitis. In the most cases, treatment includes oral tetracycline,
doxycycline or minocycline for a course 8-12 weeks, including a taper over the last 2-4
weeks. Topical antibiotic therapy most commonly with topical metronidazole, should be
initiaed concurrently wiyh the systemic antibiotic. Other options include topical clindamycin
or erythromycin, topical sulfur-based preparations, and topical azelaic acid.
Photoallergic Contact Dermatitis
Certain substances are transformed into irritants or sensitizers (photosensitizers)
after irradiation with UV or short-wave visible radiation (280–600 nm). The photoactivated
molecules may be transformed into new substances capable of acting as irritants or
haptens. Photoallergic reactions are based on immunological mechanisms, and can be
provoked by UV radiation only in a small number of individuals who have been sensitized by
previous exposure to the photosensitizer. The reaction to a photoallergen is based on the
same immunological mechanism as contact allergic reactions. The action spectrum for
photoallergy is generally in the UVA range. Many photocontact allergens have been
identified with varying degrees of confirmatory evidence, and these are perfumes, topical
non-steroidal anti-inflammatory agents, phenothiazines, sulphonamides used for topical
treatment, bithionol and hexachlorophene (in toilet soaps, shampoos and deodorants),
quinines.
Photoallergic reactions can resemble sunburn, but usually show the same spectrum
of features seen with allergic contact dermatitis. The dermatitis is localized to exposed areas
of the skin, usually with well-demarcated margins where the skin is covered by clothing, for
example at the collar and ‘V’ of the neck, below the end of the sleeves and trouser leggings.
The area below the chin is usually spared.
Urticaria (Wheals)
Urticaria is a vascular reaction of the skin characterized by the appearance of
wheals, generally surrounded by a red halo or flare and associated with severe itching,
stinging, or pricking sensations. These wheals are caused by localized edema. Lesions may
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be a few millimeters in diameter or as large as a hand, and the number can vary from a few
to numerous. The hallmark of wheals is that individual lesions come and go rapidly, by
definition, in general within 24 hours. Angioedema swellings occur deeper in the dermis and
in the subcutaneous or submucosal tissue. They may also affect the mouth and, rarely, the
bowel. The areas of involvement tend to be normal or faint pink in color, painful rather than
red and itchy, larger and less well defined than wheals, and often last for 2 to 3 days.
Etiologic factors including drug, food, food additives, infections, emotional stress, menthol,
neoplasm, inhalant, alcohol, hormonal imbalance, and genetics.
A comprehensive history is essential in every patient with urticaria. Patients should
be given advice and information on common precipitants, treatments and prognosis.
Antipruritic lotions and the avoidance of aggravating factors, including NSAIDs, may be
sufficient for some, but many will need additional interventions, including systemic
medications. Antihistamines are the mainstay of management for most patients with
urticaria, although not all patients will respond and only about 40% of those attending
tertiary care clinics will clear or almost clear at licensed doses. For severe reactions,
including anaphylaxis, respiratory and cardiovascular support is essential. A 0.3 mL dose of
a 1 : 1000 dilution of epinephrine is administered every 10–20 min as needed. In young
children, a half-strength dilution is used.
Day 8
Lecture 8: Pigmentary and sebaseous gland disorders
Sumedha P/ Elies/ Praharsini
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles,
characterized by comedones, papules, pustules, nodules, and often scars. The comedo is
the primary lesion of acne. Acne affects primarily the face, neck, upper trunk and upper
arms. Acne is primarily a disease of the adolescent, with 85% of all teenagers being
affected to some degree.Treatment consist of systemic and topical antimicrobials, systemic
and topical retinoids, and systemic hormonal therapy.
Melasma is characterized by brown patches, typically on the malar prominences and
forehead. There are three clinical patterns : 1) centrofacial, 2) malar, and 3) mandibular.
Melasma occurs during pregnancy, using oral contraceptives or with hormone replacement
therapy (HRT). Treatment: exposure to sunlight should be avoided and a complete sunblock
with broad-spectrum UVA coverage should be used daily. Bleaching creams with
hydroquinone are the gold standard. The combination of hydroquinone, tretinoin, topical
steroid has been called Kligman’s formula and is excellent.
Day 9
Lecture 9: Bacterial infection
Darma
Bacterial infection of the skin and it’s appendages are manifested as folliculitis,
furunculosis, carbuncles, pyogenic paronichia, impetigo, staphylococcal scalded skin
syndrome (SSSS), ecthyma, erysipelas and cellulitis. These bacterial infections above
commonly caused by staphylococcal infection (S.aureus, S.epidermidis ) and streptococcal
infection (S.aureus, S.pyogenes, S.β-hemolyticus group A, S.β-agalactiae, S.pneumoniae).
The treatment of these bacterial infections needs local and systemic antibiotics.
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Day 10
Lecture 10. Insect bite, Infestation (scabies, creeping eruption), Pediculosis,
Cycticercosis cellulosa, Bedbugs and Mosquito bites
Praharsini/ Dhana
Scabies is transmisibble ectoparasite skin infection characterized by superficial
burrow, intense pruritus and secondary infection. Scabies is worldwide problem and all
ages, races and socioeconomic groups are susceptible. There is variation in prevalence
rates in some developing countries ranging from 4% to 100 %. The caused is Sarcoptes
scabiei varian homonis.
The intense pruritus is accentuated at night. Typical sites of involvement include the
interdigital webbing of hands, flexural aspect of the wrist, axillae, buttock and genital area.
Primary lesions is small erythematuos papules, variable numbers of excoriation, visicles.,
indurated noduls, excematous dermatitis and secondary bacterial infection. The
pathognomonic sign is burrow.
Treatment options include either topical or oral medication. Topical option include
permetrim cream, lindane, sulfur, crotamiton, benzyl benzoate. Oral option includes
ivermectin, but is not avalaible in Indonesia.
Creeping eruption is term applied to twisting, winding linier skin lesions produced by
the burrowing of larvae of various nematoda parasites . People who go bare footed on the
beach, children playing on sandhoxes, carpenter and gardener are often victims.
The most common areas involved are the feet, buttock, genital and hands,
accompanied by light local itching and the appareance of papules at the site of infection.
After few days, the larvae migrate in the skin, creating bizzare erythematous curved lines.
Topical treatment include cryotherapy, topical theabendazole compounded as a 10
% suspension or 15 % cream.
The 3 mayor lice that infest humans are Pediculus humanus var. capitis (head lice),
Pthirus pubis ( Crab louse), and Pediculus humanus var. Corporis ( Body Louce). Patient
with louse infestation present with scalp pruritus, excoriations, cervical lymphadenopathy,
and conjungtivitis. Head louse infestation crossses all social and geographic boundaries,
occuring in affluent suburban schools and inner city school alike. Clinical manifestation is
immediate urticarial lesion, a small 2-to 3 mm red macula or papul developing hours to days
later, or the classic macula cerulae. Pubis infestation often ia acquired as a sexually
transmitted disease. Treathment of louse infestation are topical pediculides ( permethrin,
lindane, malathion) and envirommental control.
Cysticercosis refers to tissue infection after exposure to eggs of Taenia solium, the pork
tapeworm. The disease is spread via the fecal-oral route through contaminated food and
water, and is primarily a food borne disease. Humans are T. solium reservoirs. They are
infected by eating undercooked pork that contains viable cysticerci. The condition known as
cysticercosis in humans occurs due to the ingestion of tape worm eggs, either from external
sources or from the person's own feces. In some cases the cysts will eventually cause an
inflammatory reaction presenting as painful nodules in the muscles and seizures when the
cysts are located in the brain.
The disease is most prevalent in countries in which pigs feed on human feces. A
positive diagnosis is established where the parasite will be found. Albendazole and
praziquantel is effective, however the status of CNS, spinal and ocular involvement needs to
be thoroughly assessed prior treatment. None of these regimens clears the calcified
parasites, however need to be surgically removed.
Bedbugs have flat oval bodies and retroverted mouthparts used for taking blood
meals. They breed through a process referred to as traumatic insemination, where the male
punctures the female and deposits sperm into her body cavity. Bedbugs hide in cracks and
crevices then descend to feed while the victim sleeps. It is common for bedbugs to inflict a
series of bites in a row (breakfast, lunch and dinner), bites may mimic urticaria and patients
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with popular urticaria commonly have antibodies to bedbug antigens.Bullous and urticarial
reactions occur. Bedbugs are suspected vectors for chagas disease and hepatitis B,
although data are sparse. Bedbugs often infest in bats and birds and these hosts may be
responsible for infestations in houses. Management of the infestations may require
elimination in houses. The area treated with an insecticides such as dichlorvos or
permethrin.
Mosquitoes are vectors of malaria, encephalitis and yellow and dengue fevers. Their bite
can also cause allergic reactions in sensitive individuals.
Image of a Mosquito Biting a Human
Mosquito bites are a common cause of popular urticaria. More severe local reactions are
seen in young children, individuals with immunodeficiency and those with new exposure to
indigenous mosquitos. Both necrotizing fasciitis and the hemophagocytic syndrome have
been reported following mosquito bites and exaggerated hypersensitivity reactions to
mosquito bites. Those with mild reactions to a mosquito bite can take antihistamines to
reduce itching and swelling. Over time, some individuals develop immunity to the saliva of a
mosquito and do not experience any symptoms at all upon being bitten.
Day 11
Lecture 11: Rational Topical Treatment in Dermatology
Alit Widhiartini
Dermatological therapy usually involves the use of topical therapy that was known
since ancient times. Many agents are applied to the skin either for cosmetic or therapeutic
purposes. However it is important that the basic principles underlying effective therapy
should be well-understood. There are many factors to be considered, these include patient’s
age, hormonal status, and history. The anatomy and physiology of the skin and its
appendages change with age and especially in woman, hormonal status may considerably
influence the skin texture. The nature of the lesion, e.g. wet or dry, will determine the choice
of the vehicle, the kind of topical preparation exactly, in which the active ingredient (drug)
will be administered. The concepts of “If it’s wet , dry it;if it’s dry, wet it” will be clarified in
detail during the small group learning.
The basic principles of topical therapy from the view point of pharmacotherapy, will
guide the general practitioner to develop confidence in using topical therapy for common
skin disorders such as wound dressing, acne, intralesional therapy, etc.
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Lecture 12 : Dermatofarmacology
Wiwiek Indrayani
Therapy for cutaneous diseases often introduced by citing the skin’s role as a
supportive interface between human’s external and internal milieu and as a barrier to
potentially harmful agents in the environment. The fact that most dermatologic disorders are
not life threatening should not lessen a physician’s responsibility for having to make as
correct a therapeutic decision as is currently possible.
The general pharmacokinetic principles governing the use of drugs applied to the
skin are the same involved in other routes of drug administration. Quantification of the flux of
drugs and drug vehicles through these barriers is the basis of pharmacokinetic analysis of
dermatologic therapy, techniques for making such measurements are rapidly increasing in
number and sensitivity.
Topical medications usually consist of active ingredients incorporated in a vehicle
that facilitates cutaneous application. Important consideration in selection of a vehicle
include the solubility of the active agent in the vehicle, the rate of release of the agent from
the vehicle. The ability of the vehicle to hydrate the stratum corneum, the stability of the
therapeutic agent in the vehicle and interactions, chemical and physical of the vehicle,
stratum corneum and active agent
The risks of less than through evaluation of simple dermatologic problems apply
when problems become more complex. The drugs usually used in dermatologic disorders
such as antibacterial agents, antifungal agents, topical antiviral agents, ectoparasiticides
agents, agents affecting pigmentation, acne preparations, agents for psoriasis,
antiinflamatory agents, keratolytic & destructive agents, antipruritic agents and trichogenic
agents.
Day 12
Lecture 13. Anatomy of the Ear
Yuliana
The Ear
The ears are vestibulocochlear organs. Each ear comprises three portions: external, middle
and internal. External and middle ear function is for hearing process only. Internal ear
function is for hearing and equilibrium.
The external ear (the external acoustic/auditory meatus) conducts sound toward the
middle and internal components of the ear. It protects middle and internal ear from outside
damage and acts as pressure amplifier. It is about 25mm in length, extends from the concha
to the tympanic membrane. External ear is composed of auricle (pinna), which collect sound
and external acoustic meatus (canal), which conducts sound to the tympanic membrane.
The lateral part is largely cartilaginous and slightly concave anteriorly. Skin of auricle
continuously lines the meatus tightly. In cartilaginous part of auricle, there are hair follicles,
sebaceous and ceruminous glands. The sensory innervations of external ear is derived from
the auricular nerve (5th cranial nerve), the cervical plexus, and 7th cranial nerve.
Glossopharyngeal nerve (9th cranial nerve) and vagus nerve (10th cranial nerve) innervate
concha region. The blood supply mainly from the posterior auricular and superficial temporal
arteries (of the external carotid).
The Tympanic Membrane/Ear Drum is about 1 cm in diameter, faces laterally, forward and
downward. It is divided into tense part and flaccid part. Tense part is the larger portion and
attached to the tympanic plate of the temporal bone. Flaccid part is thinner in the
anteriorsuperior portion and is limited by anterior and posterior mallear fold. Its lateral
surface is concave and the center is called the umbo. The tympanic membrane is
innervated by 5th and 10th cranial nerves for its lateral surface and 9th cranial nerve for
medial surface.
The Middle Ear consists of tympanic cavity and auditory ossicles.
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The tympanic cavity communicates with (1) the mastoid air cells and the mastoid
antrum by means of the auditus, and (2) the nasopharynx by means of the auditory tube
(phrayngotympanic tube). Auditory tube acts as equalizer for both ears. The cavity is divided
into 3 portions (1) the affic or epitympanic recess situated above the level of the tympanic
membrane. Its contains the head of the malleus and the body and short crus of the incus.
This recess communicate with the aditus. (2) mesotympanum, the main portion, and (3) the
lowest portion, the hypotympanic recess. The tympanic cavity is bounded laterally by
tympanic membrane. The roof of the cavity is formed by tegmen tympani, a portion of the
petrous temporal.
Auditory ossicles are three small bones: malleus (hammer), incus (anvil), and
stapes (stirrup). They joint as incudomallear and incudo stapedial joints in type of synovial
joint. The chain of the auditory ossicles act as a system of levers. The handle and the lateral
process of the malleus are embedded in the fibrous layer of the tympanic membrane. So the
motion of the membrane by the sound waves are converted into intensified movements of
the stapes.
Two important muscles are tensor tympani and stapedius muscles. Tensor tympani muscle
arises from cartilaginous part of the auditory tube and inserted on the handle of the malleus.
It draws the handle medially, thereby tightening the tympanic membrane. The muscle
supplied by the mandibular nerve and tympanic plexus. The stapedius muscle draws the
stapes laterally and perhaps rotate the incus. The muscle is supplied by the 7th cranial
nerve.
The chief blood supply to the middle ear is from the external carotid (stylomastoid artery
from posterior auricular artery) and the maxillary (anterior tympanic artery).
The internal ear is located within the petrous part of the temporal bone. It consists of the
membranous and bony labyrinth. Membranous labyrinth is located within bony/osseous
labyrinth. The bony labyrinth is a series of cavities composed of three parts: cochlea,
vestibule and semicircular canals. The membranous labyrinth consists of three parts: (1)
utricle and saccule, two small communicating sac in the vestibule; (2) three semicircular
ducts in the semicircular canals and (3) cochlear duct in the cochlea that contains the organ
of hearing. Its chief divisions are the cochlear labyrinth and the vestibular labyrinth. The
utricle and saccule have specialized area of sensory epithelium, the maculae. The macula
of the utricle is in the floor of the utricle; the macula of the saccule is vertically placed on the
medial wall of the saccule. The hair cells in the macula are innervated by the
vestibulocochlear nerve and the cell bodies are in the vestibular ganglion, which is in the
internal acoustic meatus. The roof of the cochlear duct is formed by the vestibular
membrane and the floor by the basilar membrane plus the outer adge of the osseous spiral
lamina. The spiral organ (of Corti) contain hair cells situated on the basilar membrane. The
tips of cells are embedded in the gelatinous tectorial membrane. The vibration of the base of
stapes ascend to the apex by one cannel, the scala vestibule; then the pressure waves
pass through the helicotrema and descend back to the basal turn by the other channel, the
scala tympani.
Lecture 14. Histology of Hearing Systems
Arijana / Ratnayanti
The functions of the ear are for hearing and equilibrium. Ears consisted of three
major parts, namely external ear which received sound wave, middle ear which transmitted
from air to fluid via a set of small bone and internal ear which transform fluid movement to
nerve impulses. External ear has auricle, external acoustic meatus, ceruminous glands and
tympanic membrane. Middle ear has tympanic cavity, Eustachian tube, oval window, round
window, and auditory ossicles (malleus, incus and stapes). Internal ear has bony labyrinth
and membranous labyrinth. Membranous labyrinth has vestibular labyrinth (equilibrium
system) and cochlear labyrinth (hearing system). Vestibular labyrinth has utricle, saccule
and semicircular ducts. For equilibrium the receptors are located in 2 maculae (utricular
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macula and saccular macula) and 3 cristae ampullaris (in each semicircular duct). For
hearing the receptors are located in spiral organ of Corti in cochlear duct. The receptors are
mechanoreceptors called hair cells which convert sound wave into electrical impulses in
nerve. All regions of bony labyrinth are filled with perilymph and membranous labyrinth is
filled with endolymph.
Day 13
Lecture 15 : Physiology of Hearing systems
Krisna Dinata
Audition, the sense of hearing, involves the transduction of sound waves into
electrical energy, which then can be transmitted in the nervous system. Most sounds are
mixtures of pure tones. The human ear is sensitive to tones with frequencies between 20
and 20,000 Hz and is most sensitive between 2000 and 5000 Hz. The usual range of
frequencies in human speech is between 300 and 3500 Hz, and the sound intensity is about
65 dB. Sound intensities greater than 100 dB can damage the auditory apparatus, and
those greater than 120 dB can cause pain.
Sound waves are directed toward the tympanic membrane, and, as the tympanic
membrane vibrates, it causes the ossicles to vibrate and the stapes to be pushed into the
oval window. This movement displaces fluid in the cochlea and cause vibration of the organ
of Corti. Thus, vibration of the organ of Corti causes bending of cilia on the hair cells by a
shearing force as the cilia push against the tectorial membrane. Bending of the cilia
produces a change in K+ conductance of the hair cell membrane. Thus, oscillating
depolarizing and hyperpolarizing receptor potentials in the hair cells cause intermittent
release of glutamate, which produces intermittent firing of afferent cochlear nerves.
Information is transmitted from the hair cells of the organ of Corti to the afferent
cochlear nerves. The cochlear nerves synapse on neurons of the dorsal and ventral
cochlear nuclei of the medulla, which send out axons that ascend in the CNS.
Lecture 16. Otic Drug
Alit Widhiartini
Middle and inner ear disorder often requires oral systemic or topical medications. Treatment
of external ear however depend on topical otic drugs instilled directly into the external
meatus of the ear for local action to prevent or treat disorders. These drugs include
antibiotics, antiinfectives, anti-inflammatory, anesthetics, drying and cerumen softener
solvents. Many otic drugs are consist of single or combination of 2 or more drugs these are
used to treat external ear infections, inflammation, and pain, and removing excessive or
impacted cerumen.
Day 14
Lecture 17. Pericondritis, Wax, Foreign Bodies, Bulous Myringitis
Lely Rahayu
Ear is one off indera wich have important function. The ear caught sound and then
processed at the hearing cortex area at cerebri. This connect us with others. That’s why we
must take good care of our ear. Ear divided into three part wich are outer, middle and inner
ear. Outer ear diseases include perichondritis, foreign bodies, bulous myringitis. Wax or
cerumen in normal production have protective function
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Day 15
Lecture 18. Membrane tymphani perforation, OMS, Labirinitis, Paresis
N.Facialis
Andi Dwi Saputra
Infections of the middle ear space and their sequelae have plagued mankind from
the beginning of time. First described by Hippocrates in 450 BC, this universally observed
process continues to present one of the most perplexing medical problems of infancy and
childhood, while being the leading cause of hearing loss in this age group.
Complications of acute and chronic otitis media can cause grave morbidity and even
mortality. Eventhough the incidence and prevalence of these complications have
dramatically declined, their potential gravity requires physicians to have a thorough
understanding of the diagnosis and management of each one.
Labyrinthitis could be part of otitis media when the infections spread into inner ear.
Acute facial palsy is a common diagnostic problem encountered by the otolaryngologist, but
its presentation often provokes consternation on the physician's part. This reaction stems
from our limited knowledge of facial nerve pathology, from the shortcomings of currently
popular electrophysiologic tests in defining nerve injury, and from the controversy
surrounding the management of facial palsy.
Day 16
Lecture 19. Ear trauma/othematoma, Barotrauma, Motion Sickness, PGPKT
Eka Putra
Trauma of the ear can cause damage to the ear structures such as Othematum,
external ear canal, middle ear canal and tympanic membrane rupture as a change
inpressure in the middle ear, and dinner ear damage. The journey traveled either by air, sea
and land can lead to complaints of motion sickness, with symptoms: nausea, vomiting,
pallor, sweating, so it should be anticipated. Broadly speaking the causes of hearing loss
and deafness are: wax obsturan, OMSK, Noisy, Presbicus is and Congenital deaf, because
the Ministry of Health and its staff enough trouble to his ministry then formed an
independent forum that is the National Committee for Prevention Hearing Loss and
Deafness (PGPKT).
Lecture 20. Hearing loss, noise induced hearing loss
Wiranadha
There are two major categories of hearing loss that are key concepts for the clinician
to understand. The first, conductive hearing loss, is due to an outer or middle ear problem—
a problem “conducting” sound waves through the ear canal to the eardrum and then through
the middle ear apparatus toward the inner ear. Causes of conductive loss might include
obstruction of the ear canal by cerumen (wax), impairment of middle ear function by fluid, or
fixation of the middle ear ossicles by disease. With conductive loss, sounds coming from
within, such as one’s own voice, are perceived as louder because of reduced competing
ambient noise. Plug your right ear with your finger, creating a conductive loss, and note how
your own voice sounds louder on this side. This phenomenon is known as autophony. A
patient with a conductive loss often feels like he or she is talking “in a barrel,” or “under
water.”
Sensorineural hearing loss is due to a malfunction somewhere in the inner ear, from
the cochlea inward through the auditory nerve. This is often termed “nerve deafness” and
with this type of loss even one’s own voice does not sound loud. The distinction between
these two types of loss is obviously important for determining the cause of a patient’s
hearing complaint. Both conductive and sensorineural loss in the same ear. This would be
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referred to as a mixed loss. Tuning-fork evaluation can differentiate between the two
hearing loss. The 512-Hz tuning fork is themost accepted frequency for assessing hearing
using the Weber and Rinne tests. Audiometry is the precise method of hearing assessment.
Noise refers to unwanted, undesirable, or excessively loud sound experienced by an
individual. The effects of noise depend on various characteristics of the sound: intensity,
spectrum, cumulative lifetime exposure, and pattern. NIHL results from trauma to the
sensory epithelium of the cochlea.
Patients with NIHL frequently complain of a gradual, insidious deterioration in
hearing. The most common complaint is difficulty in comprehending speech, especially in
the presence of competing background noise. NIHL is frequently accompanied by tinnitus.
The diagnosis of NIHL characterized by “4000 Hz notch”. Evoked otoacoustic emissions
(OAE) may be useful in detecting early NIHL in persons with normal audiograms. No
medical or surgical treatments are available to reverse the effects of NIHL. In patients with
NIHL, hearing generally stabilizes if the patient is removed from the noxious stimulus. NIHL
does not progress after the worker is removed from the source of the hazardous noise.
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LEARNING TASKS
Day 1
Functional Structure of the skin and its appendices
Vignette 1
A baby boy present with erythroderma and severe blisters blister at his feet. The doctor
diagnosed him with epidermolytic hyperkeratosis.
1. In which stratum of epidermis the disorder occurs?
2. What type of keratins involved in this disorders?
Vignette 2
A male 18 years old present with chief complaint with odor secretion in his armpit.
1. Why these situation could be happen ?
2. Please describe the microscopic structure involved !
Self assesment
1. Describe the differences between ecrine and apocrine sweat gland
2. Describe the hair growth cycles
3. Describe the anatomical structure of the thin and thick skin
4. List and describe the sensory receptor of the skin
5. Describe the hair growth cycles
6. Describe the morphology of 4 type cells that located in epidermis
Day 2 : BCS and Practicum 1 (see BCS schedule)
Day 3
Common pathological bases of skin disorders
Learning task
List and describe the Descriptive term of microscopic features in dermatopathology bellow:
1. Hyperkeratosis
2. Parakeratosis
3. Hypergranulosis
4. Acanthosis
5. Papillomatosis
6. Dyskeratosis
7. Acantholysis
8. Spongiosis
9. Hydropic swelling
10. Exocytosis
11. Erosion
12. Ulceration
13. Vacuolization
14. Lentigenous
Self assesment
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Day 4
Benign skin tumor (veruca, moluscum, kista), vaginitis and servicitis
Vignette 1
A woman, aged 23 years came out with complaints of vaginal discharge that smells
since 5 days ago, the first time a complaint is sustained. History obtained from patients with
frequent vaginal douching and taking oral glucocorticoids within the last 3 months because
of disease SLE (systemic lupus erythematosus) who suffered. For discharge complaints the
patient was taking amoxicillin itself purchased for 1 month but said the complaint is not
reduced. Patients having undergone sexual partners and monogamous relationship for 2
years, found no complaints on sexual partner. In a speculum examination found a white
vaginal discharge that is attached to a homogeneous vaginal wall. In the cervical region
found no abnormality.
a. Give other differential diagnosis that have similar symptom with the case.
b. Explain clearly the comparison of candidiasis, trikomoniasis dan bakterial
vaginosis based on: sign and symptom, color of the discharge, consistency,
smell, pH, microscopy and etiology finding
c. Mention the other risk factor of the case
d. Mention the laboratory examination to established diagnosis
e. What is the diagnosis of the case based on your evaluation
f. Mention the risk factor that may cause recurrence cases
g. What is the treatment modality may be given in case
Vignette 2
A mother dropping her 7-year-old to the clinic with complaints arise "warts" on her
feet since 2 weeks ago. Patient's sister also had the same complaint. Known history of
these lesions multiplied because the lesions often carded. According to her, her children
love to play water with his friends.
a. Mention the diagnosis of the case
b. Mention other clinical variant of the disease
c. Mention the laboratory examination to established diagnosis
d. Mention the etiology that might be found based on polymerase chain reaction (PCR)
e. Mention the reason to give invasive treatment in these case, mention what are they
?
f. Mention the reason to give non invasive treatment in these case, mention what are
they ?
Vignette 3
A 70-year-old man presents with raised black spots on his face, is not painful or
itchy. Patients observe the complaint and began to arise since 5 years ago and is currently
perceived to multiply and grow. Patients worked as a gardener and rarely use sun
protection both physically and sunscreen. The spotting never bleed or smell formed
wounds.
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a.
b.
c.
d.
mention the diagnosis of the case
mention the risk factor of the case
mention the other clinical variant of the case
how
we
differentiate
between
benign
and
malignant
lesion?
e. mention the clinical sign that may related with internal organ malignancy
e. what is the treatment modality we can give to the patient?
Day 5
Drug Eruption
Vignette 1
A 14 yo karate athlets, complain abaout rash of his body since 2 days ago. He also
had fever since 3 days ago.He denied ever taking drugs because he never sick in this 2
month. He regularly take herb capsul which is given by his coach, for his stamina and
decrease muscle pain after exercise.
1. Is there any possibility he had drug eruption
2. If the answer yes, what anamnesis need to be ask to the patient to support diagnosis
drug eruption
On Physical examination, blood pressure 110/80, pulse 90 x/menit, axila
temperature 38,5oC
Didnt found konjungtivitis and enlargement of lymphnode. On laboratory
examination blood, liver function test and kidney functiont test within normal limit
3. What is differential diagnosis
4. What is management of this patient
5. Counseling, information and education for this patient?
6. In another case, the patient was given medication from general practicioner or
midwife. What the explaination should give to the patient or family.
Self Assesment
1. List the symptoms of drug eruption
2. What is expected from the laboratory?
3. How is pathogenesis of the disease?
4. How is the prognosis?
Vignette 2
A man 45 yo, complained about of the black spot on his lips , penis and also his thigh. Last
year he has the same symptom after took antibiotic from dentist.
1. What are the other complaints ?
2. What kind of examination do we need ?
3. What is the diagnosis ?
4. Are there any other possible diseases?
5. How are the management and KIE?
6. How is the prognosis of this patient?
Self Assessment
1. List the symptoms of fixed drug eruption
2. What is expected from the laboratory?
3. How is pathogenesis of the disease?
4. How is the prognosis?
Vignette 3
A woman 30 yo, consulted from ER. She complaine about blister on her skin, rednes of her
eyes and her lips easily bleeding since 2 days ago. Last week she got diarrhea and taken
antibiotic from GP. She also applied bokasi oil all over her body
1. What are the other complaints ?
2. What kind of examination do we need ?
3. What is the diagnosis ?
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4. Are there any other possible diseases?
5. How are the management and KIE?
6. How is the prognosis of this patient?
Self Assessment
1. List the symptoms of Stevens Johnson syndrom
2. What is expected from the laboratory?
3. How is pathogenesis of the disease?
4. How is the prognosis?
Day 6
Papulo-erytroskuamosa (psoriasis, pityriasis rosea and erythrodermi)
Vignette 1
A 43 years old man came to the hospitals complaining red patches that felt itchy and
scaly on upper back, scrotum, and at the back of the ears. He also complain his hair easily
felt oily if he was late washing his hair. He has suffered from this complain for a long time
and often recurrent.
Learning Task
1. Ask about other questions regarding this complain!
2. What is the possible diagnosis for this complain?
3. What is the other differential diagnosis for this complain?
4. How is the management and education for this patient?
Self Assessment
1. Mention other clinical manifestation of this disease!
2. What should be expected from the laboratory result?
3. How is the pathogenesis?
4. How is the histopathological pictures of this disease?
5. How is the prognosis?
Vignette 2
A woman complaining unwell and malaise, with red patches, not so itchy, at her part of body
that enclosed by clothes, with varying size diameter 0,5-1 cm, round-oval shape. This is the
third time she was suffering from the same complain.
Learning Task
1. Ask about other questions regarding this complain!
2. What is the other examination that needed to confirm the diagnosis?
3. What is the possible diagnosis for this complain?
4. What is the other differential diagnosis for this complain?
5. How is the management and education for this patient?
Self Assessment
1. Mention other clinical manifestation of this disease!
2. What should be expected from the laboratory result?
3. How is the pathogenesis?
4. How is the histopathological pictures of this disease?
5. How is the prognosis
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Day 7
Dermatitis (Numularis, neurodermatitis, napkin eksema, perioral, urtikaria,
dermatitis fotocontact)
Vignette
Man 35 years old, complained itchy skin rash on almost over the body since 1 weeks ago.
He felt the rash come and go in one day. On physical examination there were wheals,
generally surrounded by a red halo. Patient come to you, asking for explaination and
treatment.
Learning Task :
Draw and explain the etiology, patophysiology, diagnosis, diff. diagnosis, planning to
confirm the diagnosis, and treatment for the case
Self Assessment
1. Explain what should we ask in the anamnesis?
2. Explain symptoms, signs and what kind of examinations do we need for the patient?
Day 8
Pigmentary and sebaceous gland disorders
Vignette 1
A woman, aged 25 years, came to the dermatovenereology clinic with complain having acne
since 2 years ago. Physical examination reveal comedo, papul, pustule, nodul and scars.
Learning task
1. What we should ask to the patient in the anamnesis?
2. What is the diagnosis of the patient?
3. What should we look for if we considered the patient on hyperandrogenic state?
4. What is the management of non medicamentosa in this patients?
5. What is the management of medicamentosa in this patients?
6. How is the prognosis of the disease
7. How is management of acne scars ?
8. What advice we could give to the patients
Vignette 2
A 33 years old woman came to the clinic with complaint brown spots at her face appeared
since 2 years ago. First it appeared in both ceek than spread to the forehead. This is not
accompanied with pain and itchy.
Learning task
1. What kind of anamnesis asked to the patients?
2. What are clinical picture obtained in patients?
3. What is the diagnosis ?
4. What kind of additional examination need to be done?
5. What result that expected from additional examination?
6. What are the principal management of these patients?
7. How is the prognosis?
8. What advice we can give to the patients?
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Self assessment
1. Describe the definition of melasma
2. Explain the pathogenesis of melasma
3. Describe the clinical forms of melasma
4. Describe predisposing factors of melasma
5. Explain the classification of melasma according from light wood examination
6. Explain prevention of melasma
7. Explain some topical agents for treatment of melasma, the mechanism and side
effect
8. Describe the definition of acne vulgaris
9. Explain the pathogenesis of acne
10. Explain predisposing factors of acne
11. What is the general principle to manage acne vulgaris
12. Explain the condition in Neonatal acne
13. Explain about topical acne medication
14. Explain about oral acne medication
15. Explain about hormonal therapy in acne vulgaris
Day 9
Bacterial infection
Vignette
1. Old woman complained with a pain mass at her back which drained a pus from multiple
hole. It’s begin with small pain spot since one week ago. She came to you to ask
explanation and treatment.
2. a 60 years old man complained with redness, swelling and pain at his right lower leg
since 2 days ago. Before he suffer with this symptoms his right foot was pricked by a
needle. He had history of fever after swelling. Then came to you to ask explanation and
treatment.
3. a 5 months old baby came to you with his mother with chief complain, thin wall vesicles
that rapidly become pustular and then rupture which leaving a thick yellow crust around
his nose since 3 days ago. There are no pain, itchy, and fever. They came to you to ask
explanation and treatment.
4. a mother complained about the exfoliativa skin at the whole of her’s child skin (3 years
old). Before that her’s child got disfagia. She didn’t gave any kind of medicine to her
child. We can’t find another disorder at her’s child lip or mouth. Then came to you to ask
explanation and treatment.
Learning task :
Draw and explain the Etiology, pathophysiology, diagnosis, diff diag, treatment of all cases
above.
Self Assesment “For all case above”
1. Explain what should we ask in the anamnesis?
2. Explain symptoms , signs and what kind of examination do we need for the patient.
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Day 10
Insect bite, Infestation (scabies, creeping eruption) and pediculosis
Vignette 1
A 19-year-old female patient presented with multiple swellings of 1 year duration all
over the body. The lesions started as two small swellings over the right side of the forehead.
Since then, it gradually spread to involve the whole body over a period of 4 months. The
lesions were asymptomatic. She gave a history of seizures 10 months ago. They were
generalised tonic clonic seizures with loss of consciousness in the post ictal period. On
examination, multiple nodules (approximately 80) were present all over the body. They were
skin-colored, well-circumscribed, nontender, firm in consistency, mobile and varying in size
from 0.5 - 1.5 cm in diameter. There was no regional or generalised lymphadenopathy.
1. Discuss and explain about the treatment of choice you can give
2. Discuss and explain the prevention you can advice
Vignette 2
A 22 year old balinese male who had traveled for several weeks, returned to his
apartment in the kuta area. A few days later he observed reddish spots on his body, which
were accompanied by intense pruritus. The bites were concentrated on the hands, legs and
neck area. He was treated repeatedly with scabicides and systemic corticosteroids but there
was little improvement in his clinical symptoms. The patient, who was living alone, noticed
new bites on his skin for several weeks, and then discovered on his body some crawling
insects. They were sent to our laboratory and identified as adult and nymphal stages of C.
lectularius
1. Discuss and explain about the disease
2. Discuss and explain about the treatment
3. Discuss and explain about your advis
Vignette 3
An 8-year-old boy8 with symptoms very itchy nodules on the penis. Two weeks ago
the patient went to the doctor with complaints of itching at night. On examination was found
papules, excoriation in the lower abdomen, axilla and umbilicus. Patients have received the
drug but there is no improvement.
1.What is the most likely diagnosis ?
2.What evaluations or lab study must be perform before giving the treatment?
3.What is the treatment options?
Vignette 4
A 26-year –old male came with complaints of an itchy eruption on his back and arms
of 2 months duration. He was a fisherman by occupation and gave a history of sleeping on
the beach for long hours. He was treated with antihistamines, but without any response.
Cutaneus examination revelaed multiple erythematous papules, plaques and wavy
serpentine tracts on the back and posterior aspect of arms.
1. What is the most likely diagnosis ?
2. What is the treatment options ?
Vignette 5
A-20 year old man complaints severe pruritus burning or pain. On examination
presented with small blue-black dots (macula cerulea ) and scratch mark on perianal and
gluteal. Wood’s lamp examination will reveal bluish, pearl-colored nits.
1 What is the most likely diagnosis ?
2 What is the treatment options
Self Assesment for all case above : Explain the etiology, clinical sign and symptoms and
the management
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Day 11
Rational Topical Treatment in Dermatology
Vignette
A 9 -month-old infant presents with an intensely pruritic generalized atopic dermatitis with
multiple areas of excoriation and lichenification on the flexor side of the upper arm. The
eruption spares only the diaper area, the palms, and the soles. Most skin regions are dry
and fissured.
Learning task
1. Should you treat this patient with topical steroid, and if so, what type of topical
steroids and what kinds of preparation are available in Indonesia?
2. Should you treat this patient with systemic steroids, and if so. What kind of systemic
steroid?
3. Should you apply occlusive dressings in this patient over the affected areas, and if
so. what type of occlusive dressings ?
4. Should you treat this patient with an emollient, and if so, why?
5. Is this patient an appropriate candidate for antihistamines, and if so, Why?
Self assesment
Dermatofarmacology
Vignette 1
A women, 18 years old come to public hospitals with chief complain feel itchy in her
whole body especially in the night since a week ago. The doctor had found : erythema ,
papule, vesicle, tunnel and excoriation on the skin of the finger.
Learning task
1. What is the best treatment for this patient ?
2. Please explain the pharmacokinetic and pharmacodynamic profile of that medicine?
3. What is the adverse effect of that medicine ?
Vignette 2
A women , 25 years old come to policlinic with red spot and feel icthy on the face
since 3 days ago. Past history she has been used new cosmetics since two weeks ago.
Physical examination: there is some eflorescencia and erythematous papules . In some
part of the face there is some erotion and slight edema.
Learning task
1. What is the best treatment for this patient ?
2. Please explain the pharmacokinetic and pharmacodynamic profil of that medicine?
3. What is the adverse effect of that medicine ?
Self assesment
1. A woman with non inflammatory acne needs topical treatment for her acne. Which is
the best treatment for her acne ?
2. A man with eczema on his skin. Which is the best treatment can be used for the
inflammatory process for this condition?
3. What kinds of antifungal drugs can be used in onycomycosis ? Please explain
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Day 12
Anatomy of Hearing systems
Vignette 1
A male (35 years old) complained of sudden right ear pain after scuba diving this
morning. Patient never had the same problem before. There is no fever. He had terrible
nose blocked for two days.
a. Based on knowledge of anatomy, which part of the ear might be affected?
b. Describe the anatomy features of the answer on question a!
c. What would you suggest to the patient to prevent the same problem?
Vignette 2
A female (27 years old) complained of motion sickness and got vomited when
travelling from Denpasar to Gilimanuk.
a. Which part of the ear might be affected in this case?
b. Describe the part of the ear (on the answer of question a) in details!
SELF ASSESSMENT
1. Describe the anatomy characteristic of external ear, including the innervations and
blood supply
2. Describe the role of the tensor tympani and stapedius mucles
3. Describe the anatomy of middle ear in detail
Histology of Hearing systems
Vignette 1
A man, 40 years old come to Hospital complains vomiting since one hour ago. He felt his
body is rotating. Anamnesis and physical examination is performed. The diagnosis is
vertigo.
Learning Task
1. Vertigo is related to vestibular system, which one?
2. Describe the histological structure!
Vignette 2
A woman, 35 years old come to ship’s clinic due to motion sickness 10 minutes ago.
Learning Task
1. Seasickness is related to vestibular system, which one?
2. Describe the histological structure!
Vignette 3
A woman, 35 years old come to ship’s clinic due to motion sickness 10 minutes ago.
Learning Task
3. Seasickness is related to vestibular system, which one?
Describe the histological structure!
Self Assessment
1. Describe histological structure in vestibular system!
2. Describe histological structure in hearing system!
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Day 13
Physiology of Hearing systems
Learning task
1. What is the function of pinna, external auditory, tympanic membrane, ossicles,
middle ear bones, and oval window?
2. Explain the mechanism of transduction in hearing!
3. Could listen the music with an earphone makes deafness? Explain about that!
Self Assesment
1. What is the function of eustachius tube?
2. The sound energy is amplified by two effects. Explain about this statement!
Otic Drug
Scenario 1
A two years old boy brings by his mother to a primary health care clinics with fever and he
cried and told his mother that his ear was pain since two days ago. His mother told that he
got sore throat since 3 days ago. His father is an active smoker. Clinical examination found
his axial temperature was 38 °C and found mucus in middle ear. His body weight is 16 kg.
Questions
1. Do you think that he need painkiller? What kind of analgesic will you prescribe for
him? Discussion must include groups of analgesic antipyretic, the pharmacokinetic
and pharmacodynamic, the rute of administration, analgesic choice, the dose, the
duration of treatment.
2. Will you prescribe another drugs for treatment. What kinds of drugs? Discussion
must include mapping of the drug, drug of choice, rute of administration, the dose,
the duration of treatment.
Scenario 2
Mrs Anna middle age woman comes to you and ask your advise. Over the two weeks ago
she feels that his hearing particularly in his right ear has become progressively deaf and she
feel “full up”. She did not take any medication but she instilled ear drops for one weeks and
she stopped as she confused to her self therapy.
Questions
1.How do the products generally use to treat the condition work? Discussion must include
group of otic drugs and their characteristics.
2. How can product formulation affect the outcome of treatment for the condition?
Discussion must include drug dosage form for oral and topical, the positive and negative of
them.
3. What advice can you give to help the patient to manage this condition? Discussion must
be include the effectivity, safety, suitability and cost of rational therapy.
Day 14
Pericondritis, wax, foreign bodies, bulous myringitis
A girl 25 years old come to ENT clinic with chief complain pain and sweeling at right
ear since 2 days ago after scratching because of its itchy. The girl already take paracetamol
but the sweeling and pain didn’t subside. At physical examination, there’s hyperemic and
swelling at the right auricle without affecting lobule area
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Learning task
1 Describe other question needed to complete the anamnesis
2 Describe diagnosis, etiology, pathogenesis, sign and symptom, plan of treatment
and complication
Self assessment
1. What is pericondritis?
2. Explain pathogenesis of pericondritis
3. What bacteria caused pericondritis
4. How to managed pericondritis
5. What is bulous myringitis?
6. Explain pathogenesis bulous myringitis
7. Explain how to treat bulous myringitis
8. Describe tipe of cerumen
9. Explain how to treat cerumen obturans
10. Explain how to manage foreign bodies in the ear
Day 15
Membrane typmphani perforation, OMS, labirinitis, paresis N. Facialis
Vignette 1
A man, 30 y.o, feel dizzy since 3 days ago. He did not dare open his eyes and just lie in
bed. He feels like the world spins and increasingly serious when he moves his head. His
right ear often produce odorless liquid since last 1 year.
Learning task
1. What happened to this man? Explain the pathophysiology.
2. Indicate the types of labyrinthitis and describe the symptoms of each.
3. Can you explain, why labyrinthitis can cause deafness?
4. Can you explain, why labyrinthitis can cause vertigo?
Vignette 2
A boy, 10 y.o complained of buzzing in the ears since last 3 months. He also frequently
complain of runny nose and sneezing. Parents also told that while sleeping, he is snoring.
Learning task
1. Explain, what are the causes of serous otitis media in children.
2. Explain the pathophysiology of serous otitis media.
3. Can you explain, why deafness can occur in serous otitis media.
4. Specify and explain the necessary examinations on this case.
Day 16
Ear trauma/othematome, barotrauma, motion sickness, PGPKT
Vignette 1
A New student is currently facing a college event Orientation Introduction universities
facing seniors. Due to an in advertent, senior supset then slapped, hit exactly. The student
felt his ear sringing and reduced hearing one side.
1. The question of whether that is necessary to complete towards the diagnosis?
2.What kind of examination is needed to diagnose?
3. What is the therapy?
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Vignette 2
A family consisting of father, mother and daughters aged 12 years old and 9 year
old boy driving a sedan traveled to Bedugul. Moments before arriving, the girls experienced
nausea, vomiting, pallor, sweating. Other family members feel a buzzing ears.
1. The question of whether the diagnose is needed to drive the girl to the family?
2. What kind of examination is needed to diagnose?
3. What is the therapy?
4. What happened to the other family members?
Self Assesment
1. Mention division ear barotrauma?
2. Is flying with a diving barotraumas difference?
3. Why do people get drunk trip to the place of high?
4. Mention 5 diseases causes of hearing loss and deafness?
5. Mention the target group of PGPKT Team?
6. What is the target to be achieved?
Hearing loss, noise induced hearing loss
Vignette 1
A 19 years woman complained of impaired hearing in the right ear suddenly after
swimming, the ear feels full, and pain. Patients do not complain of cough and colds.
Learning task
1. What question is needed to complete anamnesis?
2. Describe etiology and pathophysiology of this hearing loss?
3. Describe about diagnose of the disease and learn symptoms and sign, plan of the
treatment and complication could be of the disease?
Vignette 2
A 3 years old boy was brought to the ENT-HNS clinic with complaints has not been
able to speak to the present, the patient does not respond when called upon. The patient
does not respond well to hear the sound of thunder or a loud closed door.
Learning task
1. What question is needed to complete anamnesis?
2. What investigations are needed?
3. Describe about plan of the treatment of the disease?
Vignette 3
A 37-year male workers were complaints difficult to catch the conversation of his
friends, especially in a crowded place. There were no previous complaints of hearing loss,
do not use ear protective devices. Patient work as gamelan maker, with exposure to noise
at work> 95 db, has been working for 17 years.
Learning task
1. What question is needed to complete anamnesis?
2. Describe what is obtained from the examination of the tuning fork?
3. What investigations are needed?
4. What education we can give to the patient?
5. Treatment plan for patients
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Study Guide block skin and hearing systems and disorders
BSC 1 : Effloresensi (16-1-2014)
dr. Puspawati, Sp.KK
at class room
Please describe the efflorescence below
Laboratory Guideline for Histology
Topic “ Skin and Hearing Structure “
Thick Skin, Thin Skin and skin appendages
Aim
: To increase understanding about thick, thin skin, and skin appendages
structure
Date and place
:
- January 16, 2014
Lab. Bersama
Conveyer
: dr. Ni made Linawati, M.Si; dr. IGK. Arijana, M.Si Med
Material
: Microscope, Histological preparat about thick,
thin skin and skin
appendages
a. Thick Skin :
- Epidermis, dermis
b. Thin Skin (eyelid, lip,scalp etc)
- Epidermis, dermis
c. Skin appendages (in thick and thin skin):
- Hair,sweat gland, sebaseous gland
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Study Guide block skin and hearing systems and disorders
Farmacology Practicum
dr. AA Wiwiek Indrayani, M.Kes
Aim : To understand the principles of rationale drug therapies for topical preparations in
dermatology diseases
The process of the rationale drug therapies :
Step 1 : What is the problem
Step 2 : What is the aim of the therapy
Step 3 : Is the Personalized therapy (P therapy ) suitable for your patient (efficacy,
safety, suitability, cost)
Step 4 : Start treatment
Step 5 : Giving the information about the therapy, how to apply and adverse effect
Step 6 : Monitoring and stop the treatment
Physiology Practicum
dr. I Made Krisna Dinata, M.Erg
TUJUAN :
Untuk mempelajari pemeriksaan pendengaran dengan garpu tala dan tajam dengar.
ALAT DAN BAHAN :
1. Garpu tala ukuran 256, 512 dan 100 Hz
2. Arloji
TATA KERJA :
TES PENDENGARAN :
1. Cara Rhine :
1.1. Getarkan garpu tala 256 Hz dengan cara memukulkan salah satu ujungnya pada teli
telapak tangan (jangan sekali-kali pada benda keras)
1.2. Tekanlah gagang garu tala yang bergetar itu pada prosesus mastoideus salah satu
telinga orang coba, dimana orang coba akan mendengar garu tala mendengung di
telinga yang diperiksa.
1.3. Tepat pada saat dengung menghilang (orang coba saat itu mengangkat
telunjuknya), garpu tala dipindahkan oleh pemeriksa ke depan liang telinga yang
diperiksa sedekat-dekatnya.
1.4. Bila orang coba sekarang mendengar kembali dengung garpu tala tersebut untuk
beberapa waktu, maka hasil pemeriksaan disebut Rhine negatif, bila tidak
mendengar lagi maka disebut Rhine positif.
1.5. Ulangi percobaan dengan telinga yang lain.
2. Cara Weber :
2.1. Getarkan garu tala 512 Hz dengan cara di atas, dan tekanlah gagang garpu tala tadi
pada dahi orang coba di garis median.
2.2. Tanyakan apakah orang coba mendengar dengung sama kuatnya di antara kedua
telinganya. Bila demikian disebut tidak ada lateralisasi. Bila dengungan didengar
lebib kuat di salah satu telinga, maka disebut terdapat lateralisasi ke arah telinga
yang mendengar dengungan lebih kuat.
2.3. Bila tidak dapat lateralisasi, dalam percobaan untuk mendapatkan lateralisasi
secara buatan, maka tutuplah salah satu telinga dengan kapas, dan ulangilah
percobaan di atas.
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Study Guide block skin and hearing systems and disorders
3. Cara Schwabach :
3.1. Getarkan garpu tala 100 Hz dengan cara di atas, dan tekankan gagangnya pada
prosesus mastoideus salah satu telinga orang coba.
3.2. Suruh orang coba mengacungkan tangannya pada saat dengungan menghilang,
dan pada saat itu pemeriksa memindahkan garpu tala pada prosesus
mastoideusnya sendiri.
3.3. Bila masih terdengar dengungan oleh pemeriksa, maka disebut schwabach
memendek.
3.4. Bila pemeriksa tidak mendengar lagi, maka ulangi percobaan di atas, hanya
urutannya dibalik. Pemeriksa terlebih dahulu mendengarkan, bila sudah tidak
mendengar lagi dipindahkan pada orang coba. Bila orang coba masih mendengar
dengung tadi disebut Schwabach memanjang.
3.5. Bila orang coba tidak mendengar lagi, maka dikatakan tidak ada Schwabach
memanjang atau memendek.
4. Cara Bing :
4.1. Getarkan garpu tala 256 Hz atau 512 Hz dengan cara di atas, dan tekankan
gagangnya pada salah satu prosesus mastoideus orang coba.
4.2. Tanyakan telinga mana yang mendengar dengungan paling keras.
4.3. Tututplah liang telinga yang lain dengan jari dan tanyakanlah lagi telinga mana yang
mendengar paling keras.
TAJAM DENGAR
Untuk pemeriksaan tajam dengar (yang berbanding terbalik dengan ambang rangsang)
tiap-tiap telinga dipergunakan sumber-sumber suara seperti arloji yang berdetak-detak,
peluru yang dijatuhkan, suara berisik, suara membisik, audiometer dan sebagainya.
Satu kriteria tajam dengar mutlak harus dilakukan dalam kamar yang benar-benar bebas
berisik, tetapi dalam praktikum ini hanya diperiksa perbedaan tajam dengar telinga kanan
dan kiri.
TATA KERJA :
1. Tutuplah rapat pada salah satu liang telinga orang coba dengan ujung jari telunjuk.
2. Dengarkan dengan telinga lainnya bunyi sebuah arloji yang dipegang pemeriksa,
sedang pemeriksa dalam saat yang sama selalu mengukur jaraknya dengan orang
coba.
3. Mula-mula arloji itu didekatkan pada telinga orang coba untuk kemudian perlahan-lahan
dijauhkan, sehingga orang coba tidak mendengar lagi bunyi arloji tersebut. Catat
jaraknya.
4. Dekatkan kembali arloji perlahan-lahan sehingga orang coba mendengar kembali, dan
catatlah jaraknya saat itu.
5. Lakukan hal yang sama pada telinga yang lain dan catat jarak-jaraknya.
6. Bandingkan hasil-hasilnya antara telinga kanan dan kiri orang coba dan dengan hasil
kawan lainnya.
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Study Guide block skin and hearing systems and disorders
~ REFERENCES ~
Used in the Block skin and disorders
1. Gartner LP and Hiatt JL. Concise Histology. Integument. 2011.p. 204-217. Saunders
Elsevier.
2. James WB, Berger TG and Elston DM. Andrew’s Disease of The Skin Clinical
dermatology. 10ed. 2006
3. Trozak, DJ; Tennehouse, dan J; Russel JJ. 2006. Theraphy. In Dermatology Skill
For Primary care an illustrated guide human press Inc. USA. p. 37-49
4. Fitz-Patrick. Basic Pathology Reaction of The Skin. p.43-56
5. Katzung BG, Dirk B Robertson, Howard I Maibach. Basic & Clinical Pharmacology.
In Dermatologic Pharmacology. 9ed.
6. Moore,
K.L.,
Agur
M.R.
Essential
Clinical
Anatomy.
3rd
edition.
2007.
Philadelphia:Lippincott Williams and Wilkins.
7. Medical Physiology eleventh edition, Guyton & Hall.
8. Physiology fifth edition, Linda S. Costanzo.
9. Mescher, AL. 2010. Jonqueira’s Basic Histology. 12th edition McGraw Hill Lange,
Singapore
10. Boeis, Fundamentals Of Otolaringology.1989
11. Menner, A Pocket Guide to the Ear © 2003 Thieme
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KETRAMPILAN KLINIS
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Study Guide block skin and hearing systems and disorders
~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
10
Senior Clerkship
9
Senior Clerkship
8
Senior Clerkship
7
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Elective Study III
(6 weeks)
Clinic Orientation
(Clerkship)
(6 weeks)
6
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The
Cardiovascular
System and
Disorders
(4 weeks)
The Urinary
System and
Disorders
(3 weeks)
The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health Systembased Practice
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
BCS (1 weeks)
Elective Study II
(1 weeks)
5
4
3
2
BCS (1 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
1
Pendidikan Pancasila & Kewarganegaraan (3 weeks)
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