Study Guide The Respiratory System and Disorders
TABLE OF CONTENTS
Page
Table of Contens
1
Introduction
2
Curriculum
3
Planner team & Lecturers
4
Facilitators
6
General Time Table
7
Important Informations
8
Meeting of the students’ representative
8
Self Assessment
8
Assessment Method
8
Time Table (Regular Class)
9
Time Table (English Class)
14
Learning Programs
19
Faculty of Medicine Udayana University,DME
1
Study Guide The Respiratory System and Disorders
INTRODUCTION
The medical curriculum has become increasingly vertically integrated, with stronger
basic concept and support by clinical examples and cases to help in the understanding of
the relevance of the underlying basic science. Basic science concepts may help in the
understanding of the pathophysiology and treatment of diseases. Respiratory system and
disorders block has been written to take account of this trend, and to integrate core aspects
of basic science, pathophysiology and treatment into a single, easy to use revision aid.
The respiratory system consists of a pair of lungs within the thoracic cage. Its main
function is gas exchange, but other roles include speech, filtration of microthrombin arriving
from systemic veins and metabolic activities such as conversion of angiotensin I to
angiotensin II and removal or deactivation of serotonin, bradykinin, norepinephrine,
acetylcholine and drugs such as propranolol and chlorpromazine. So this block will discuss
about anatomy, histology, symptom and signs of lung disease and its pathophysiology,
major upper respiratory diseases, major lung diseases, major pediatric lung disease, and
basic principle concept to education, prevention, treatment and rehabilitation in respiratory
system disorder in patient, family and community.
The learning process will be carried out for 6 weeks (27 working days) starts from 22nd of
February 2016 as shown in the time table. The final examination will be conducted on 4th of
April 2016 in the form of MCQ. The learning situation include lecture, individual learning,
small group discussion, plenary session, practice, and clinical skill.
Most of the learning material should be learned independently and discuss in SGD by the
students with the help of facilitator. Lecture is given to emphasize the most important thing
of the material. In small group discussion, the students gave learning task to lead their
discussion.
This simple study guide need more revision in the future, so that the planners kindly invite
readers to give any comments and critics for its completion. Thank you.
Planners
Faculty of Medicine Udayana University,DME
2
Study Guide The Respiratory System and Disorders
CURRICULUM
RESPIRATORY SYSTEM AND DISORDER
Aims :




Comprehend the structure, physiologic, and pathologic of the respiratory system.
Interpret the laboratory and imaging examination of the respiratory system
disorders
Diagnose and treat the patient with common respiratory system disorders
Plan education, prevention, management and rehabilitation of respiratory system
disorders to patient, family and community.
Learning outcomes:









Concern about the size of problem and diversity of respiratory disease in the
community
Able to describe the structure and function of the respiratory system
Able to interpret the result of examination (physical, laboratory, function test,
blood gas analysis and chest imaging)
Able to explore patients with respiratory problem (runny nose, cough, dyspnea,
non cardiac chest pain, hemoptysis)
Able to manage major upper respiratory diseases (tonsillitis, rhinitis, sinusitis)
Able to manage major lung diseases (TBC, asthma, COPD, lung cancer,
pneumonia, occupational lung disease, pleural disease) on patient, family and
community
Able to manage major pediatric lung disease (bronchiolitis, TB, asthma)
Able to implement DOTS program against TB
Able to implement the strategy of smoking cessation, especially in patient with
respiratory disease
Curriculum contents:








Structural and function of the respiratory system
Physiology of lung in related with oxygen consumption and acid base balance
Symptoms and signs of lung disease
Pathophysiology of respiratory system disorders
Basic physical, laboratory and imaging examination
Interpretation of examination results.
Drugs that commonly used in respiratory system disorders (decongestant, antiasthma & bronchodilators, antitussive, expectorant
Basic principle concept to education, prevention, treatment and rehabilitation in
respiratory system disorders in patient, family and community.
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
PLANNER TEAM
Name
Department
Phone (HP)
Prof. Dr.dr.Ida Bagus Ngurah Rai,
SpP (Coordinator)
dr.I Made Muliarta, MKes
(Secretary)
dr.Wiryana, SpA
(member)
Prof.dr I Gst.Md.Aman,SpFK
(member)
dr.Winarti
(member)
dr.Desak Wihandani (member)
Pulmonology
08123804579
Physiology
081338505350
Anaesthesiology
Pharmacology
0811392171
081338770650
Phatology Anatomy
Biochemistry
08123997328
081338776244
LECTURERS
No
Department
Phone
1
Prof. Dr.dr.IB Ngr Rai Sp.P (K)
Name
Pulmonology
08123804579
2
dr.I GN Sri Wiryawan,M.Repro
Histology
08123925104
3
dr.Gede Wardana, M.Biomed
Anatomy
0361-7864957
4
Biochemistry
081338776244
5
Dr.dr.Dsk Made Wihandani,
M.Kes
dr.Ida Bagus Subanada, Sp.A
Paediatric Dept.
0812399533
6
dr.Dewa Artika, Sp.P
Pulmonology
08123875075
7
dr.Ida Bagus Suta, Sp.P
Pulmonology
08123990362
8
dr. Made Bagiada, Sp.PD-KP
Pulmonology
9
Prof.dr I Gst.Md.Aman,Sp.FK
Pharmacology
08123607874
8543948
081338770650
10
Dr. dr.Muliarta, M.Kes
Physiology
081338505350
11
dr. IGN Bagus Artana, Sp.PD
Pulmonology
08123994203
12
dr.Ketut Putu Yasa, Sp.BTKV
Thorax surgery
08123843260
13
dr.Elysanti Martadiani,Sp.Rad
Radiology
08123807313
14
dr. Wayan Winarti, Sp.PA
Pathology Anatomy
087860990701
15
Prof.Dr.dr. M.Wiryana,Sp.AnKIC
Anaesthesiology
0811392171
16
dr.Putu Siadi Purniti,Sp.A
Paediatric
08123812106
17
dr.DGA Eka Putra,Sp.THT
Otorhinolaryngology
0813387826317
18
dr. Luh Made Ratnawati,
Otorhinolaryngology
08123806108
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
Sp.THT(KL)
18
dr. Putu Andrika, Sp.PD-KIC
Pulmonology
08123989192
19
dr. Gede Ketut Sajinadiyasa,
Sp.PD
Prof. Suardana, Sp.THT
Pulmonology
085237068670
Otorhinolaryngology
0811385299
20
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
~ FACILITATORS ~
Regular Class (Class A)
No
1
2
Name
dr. Gde Somayana, Sp.PD
dr. Ida Bagus Wirakusuma,
MOH
Group
Departement
Phone
Venue
(2&3 rd floor)
A1
Interna
081345136913
2nd floor:
R.2.09
A2
Public Health
08124696647
2nd floor:
R.2.10
A3
Andrology
081338605087
2nd floor:
R.2.11
A4
Anasthesi
081337711220
2nd floor:
R.2.12
4
dr. I Gusti Ngurah
Pramesemara , M.Biomed,
Repro
Dr.dr. Tjok G A Senapathi,
Sp.An. KAR
5
Dr. dr. I Dewa Made Sukrama,
MSi, Sp.MK(K)
A5
Microbiology
081338291965
2nd floor:
R.2.13
6
Dr.dr. Ketut Sudartana, Sp.BKBD
A6
Surgery
0811398996
2nd floor:
R.2.14
A7
Parasitologi
08124649002
2nd floor:
R.2.15
A8
Radiologi
081916442626
2nd floor:
R.2.16
A9
Surgery
08123811106
2nd floor:
R.2.23
A10
Andrology
085935054964
3nd floor:
R.3.21
3
7
8
9
10
dr. I Kadek Swastika , M Kes
dr. Made Widhi Asih, Sp.Rad (K)
dr. Ketut Sudiasa, Sp.B (K)
Trauma
dr. I Made Oka Negara, FIAS
11
dr. Ida Ayu Sri Wijayanti,
M.Biomed, Sp.S
A11
Neurology
081337667939
3nd floor:
R.3.22
12
dr. I Gusti Ayu Agung Elis Indira
, Sp.KK
A12
Dermatology
081338718384
3nd floor:
R.3.23
Departement
Phone
Venue
(2&3rd floor)
Biochemistry
081338776244
2nd floor:
R.2.09
DME
081338644411
2nd floor:
R.2.10
Interna
08123814688
2nd floor:
R.2.11
Pharmacology
08123650481
2nd floor:
R.2.12
Psychiatry
081338748051
2nd floor:
R.2.13
Surgery
0811398971
2nd floor:
R.2.14
English Class (Class B)
No
Name
Group
1
Dr. dr. Desak Made Wihandani,
M.Kes
B1
2
dr. I Gusti Ayu Sri Darmayani,
Sp.OG
B2
3
Dr. dr. Made Ratna Saraswati,
Sp.PD-KEMD-FINASIM
B3
dr. I Gusti Ayu Artini, M.Sc
B4
dr. Ni Ketut Sri Diniari, Sp.KJ
B5
Dr.dr. I Wayan Sudarsa, Sp.B
(K) Onk
B6
4
5
6
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
7
8
9
10
11
12
Dr. dr. Anak Agung Wiradewi
Lestari , Sp.PK
B7
Dr.dr. Susy Purnawati, MKK
B8
Dr.dr. Ni Made Linawati, M.Si
B9
Dr.dr. Elysanti Dwi Martadiani,
Sp.Rad
B10
dr.Kumara Tini, Sp.S
B11
dr. Nyoman Suryawati , M.Kes,
Sp.KK
B12
Clinical
Pathology
08155237937
2nd floor:
R.2.15
Fisiology
08123989891
2nd floor:
R.2.16
Histology
081337222567
2nd floor:
R.2.23
Radiology
081805673099
3nd floor:
R.3.21
Neurology
081238701081
3nd floor:
R.3.22
Dermatology
0817447279
3nd floor:
R.3.23
GENERAL TIME TABLE
FOR A AND B CLESSES
CLASS A
TIME
CLASS B
ACTIVITIES
TIME
ACTIVITIES
08.00-09.00
Lecture
09.00-10.00
Lecture
09.00-10.30
Independent learning
10.00-11.30
Student project
10.30-12.00
SGD
11.30-12.00
Break
12.00-12.30
Break
12.00-13.30
Independent learning
12.30-14.00
Student project
13.30-15.00
SGD
14.00-15.00
Plenary session
15.00-16.00
Plenary session
There are several types of learning activity:

Lecture

independent learning based on the lecture’s topic

Small group discussion to solve the learning task

Practice

Student project

Clinical skill and demonstration

Self assessment at the end of every topic

Plenary session
Lecture will be held at room 401, while discussion rooms available at 2nd and
3rd floor (room A209-A216, A223, A321, A322, A323)
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
IMPORTANT INFORMATIONS
Meeting of the students’ representative
In the middle of block schedule, a meeting is designed among the student
representatives of every small group discussions, facilitators, and resource persons. The
meeting will discuss the ongoing teaching learning process, quality of lecturers and
facilitators as a feedback to improve the next process. The meeting will be taken based on
schedule from Medical Education Unit.
SELF ASSESSMENT
Self assessment of each lecture will be given after each lecture session, and will be
marked. This mark can determine whether the student pass this block or not. Any final mark
between 65 to 69 will be reconsidered with self assessment’s mark to see the student’s
status. Any student with self assessment’s mark more than 70 will pass this block. And for
the lower one will have to attend the remedial examination. It is important to do this self
assessment cautiously, because this activity may be your ticket to pass this block.
ASSESSMENT METHOD
Assessment in this theme consists of:
SGD
: 5%
Final Exam
: 80%
Student Project
: 15%
Final mark more than 70 considered to pass this block. Certain conditions applied for those
with final mark between 65 – 69. These students will be analyzed using their self
assessment’s mark. Students with final mark 65 – 69 and self assessment’s mark equal or
more than 70 will also considered pass this block.
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
TIME TABLE
REGULAR CLASS
1
Monday
Feb 22,
2016
TIME
08.00-08.15
08.15-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Prof.I.B. Rai
dr.Wardana
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Lecture2
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Sri Wiryawan
Lecture 3
Class room
dr. Muliarta
Independent learning
SGD
Break
Student project
Plenary session
Lecture 4
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Anatomy: 1st
floor
Histology: 4th
floor
Class room
dr. Wardana
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
09.00-15.00
08.00-09.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
5
Friday
Feb 26,
2016
Class room
Class room
Physiology of
Respiratory System:
Ventilation
4
Thursday
Feb 25,
2016
Lecture 1
PIC
Histology of
Respiratory System
3
Wednesday
Feb 24,
2016
Introduction
VENUE
Anatomy of
Respiratory System
2
Tuesday
Feb 23,
2016
ACTIVITY
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Class room
dr. Sri Wiryawan
dr. Desak
Wihandani
Facilitator
dr. Desak
Wihandani
9
REGULAR CLASS
DAY/DATE
08.00-09.00
6
Monday
Feb 29, 2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 7
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 9
9
10
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital Visit
Class room
Class room
dr. Winarti
dr. Winarti
Pathology of
Respiratory Tract
08.00-09.00
Thursday
March 3,
2016
dr. Desak
Wihandani
Control of
Respiratory Function
and Blood Gas
Analyzes
8
Wednesday
March 2,
2016
Class room
Control of acid base
balance, Arterial Gas
Analysis (AGA)
7
Tuesday
March 1,
2016
Lecture 6
Lung Defense
Mechanism
Independent learning
09.00-15.00
Practice : Physiology,
Pathology Anatomy (PA)
Physiology:
2nd floor
PA: Joint Lab
(4th floor)
dr. Muliarta
Class room
Prof. Aman
Disc room
Facilitator
dr. Winarti
BKFK
Friday
March 4,
2016
11
08.00-09.00
Lecture 10
Pharmacological and
non pharmacological
interventions
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
Independent learning
SGD
Break
Student project
Faculty of Medicine Udayana University,DME
10
REGULAR CLASS
Study Guide The Respiratory System and Disorders
Monday
March 7,
2016
14.00-15.00
Plenary session
Class room
Prof. Aman
08.00-09.00
Lecture 11
Pharmacological and
non pharmacological
interventions
Class room
Prof. Aman
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Hospital Visit
Class room
Class room
Prof. Aman
dr. Elysanti
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Elysanti
08.00-09.00
Lecture 13
Bronchiolitis, asthma
in children,
Pneumonia
Class room
dr. IB Subanada
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Hospital Visit
Class room
Class room
dr. IB Subanada
dr. Siadi Purniti
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr. Siadi Purniti
dr. Sutha,
12
Friday
March 11,
2016
13
Monday
March 14,
2016
14
Tuesday
March 15,
2016
15
Wednesday
March 16,
2016
16
Thursday
March 17,
2016
Lecture 12
Respiratory Imaging
Lecture 14
TB in children, Difteri,
Pertusis
Lecture 15
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 16
Asthma,
COPD
17
Faculty of Medicine Udayana University,DME
dr. Bagiada
Disc room
Hospital Visit
Class room
Facilitator
dr. Sutha,
dr. Bagiada
Class room
Prof. IB Rai,
dr. Artana
11
REGULAR CLASS
Study Guide The Respiratory System and Disorders
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 17
Pleural effusion,
Pneumothorax,
Hematothorax
18
Monday
March 21,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 18
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
19
Tuesday
March 22,
2016
20
Wednesday
March 23,
2016
21
Thursday
March 24,
2016
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-08.30
08.30-09.00
Lecture 19
Disorder of nose,
sinus
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 20
Disorder of larynx,
Disorder of Pharynx
09.00-10.30
Independent learning
10.30-12.00
SGD
12.00-12.30
Break
12.30-14.00
Student project
14.00-15.00
Plenary session
Faculty of Medicine Udayana University,DME
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
Class room
dr. Andrika,
dr, Yasa
Disc room
Hospital Visit
Class room
Facilitator
dr. Andrika,
dr, Yasa
Class room
dr.Dewa Artika,
dr. Saji
Disc room
Facilitator
Class room
dr.Dewa Artika,
dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
Hospital Visit
Class room
dr. Ratna,
Sp.THT
Class room
Prof. Suardana,
dr. Dewa Artha
Eka Putra,
Sp.THT
Disc room
Facilitator
Class room
Prof. Suardana,
dr. Dewa Artha
Eka Putra,
Sp.THT
12
REGULAR CLASS
Friday
March 18,
2016
REGULAR CLASS
Study Guide The Respiratory System and Disorders
Study Guide The Respiratory System and Disorders
22
Monday
March 28,
2016
08.00-15.00
BCS: Spirometry
BCS: WSD, Radio Imaging
(Pre-test, lecture, demo
Practice, discussion)
08.00-15.00
BCS: Physical Diagnostic of
Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture, practice,
demo)
08.00-15.00
BCS: Spirometry
BCS: Physical Diagnostic of
Thorax
(Pre-test, lecture, practice,
demo)
23
Tuesday
March 29,
2016
24
Wednesday
March 30,
2016
25
Monday
March 31,
2016
08.00-15.00
26
Friday
April 1,
08.00-15.00
2016
27
Monday
April 5,
2016
Faculty of Medicine Udayana University,DME
BCS: Physical Diagnostic of
Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture, demo)
BCS: Physical Diagnostic of
Thorax, Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Yasa
Elysanti
dr. Saji
dr. Sutha
dr. Lely
dr. Muliarta
dr. Saji
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Examination
13
dr.
Study Guide The Respiratory System and Disorders
TIME TABLE
ENGLISH CLASS
1
Monday
Feb 22,
2016
TIME
09.00-09.15
09.15-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr.Wardana
dr. Sri Wiryawan
Lecture2
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
dr. Sri Wiryawan
Class room
Lecture 3
dr. Muliarta
Independent learning
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Class room
dr. Muliarta
dr. Muliarta
Lecture 4
Anatomy: 1st
floor
Histology: 4th
floor
Class room
dr. Wardana
Disc room
Facilitator
Class room
dr. Desak
Wihandani
Physiology of
Respiratory System:
Gas Exchange,
diving, altitude
Independent learning
10.00-16.00
09.00-10.00
Practice : Anatomy,
Histology
Lecture 5
Carriage of oxygen
and Carbon dioxide
5
Friday
Feb 26,
2016
Prof.I.B. Rai
dr.Wardana
Physiology of
Respiratory System:
Ventilation
4
Thursday
Feb 25,
2016
Lecture 1
Class room
Class room
Histology of
Respiratory System
3
Wednesday
Feb 24,
2016
Introduction
PIC
Anatomy of
Respiratory System
2
Tuesday
Feb 23,
2016
VENUE
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
dr. Sri Wiryawan
dr. Desak
Wihandani
14
ENGLISH CLASS
DAY/DATE
09.00-10.00
6
Monday
Feb 29, 2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 7
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 8
Thursday
March 3,
2016
10
Disc room
Facilitator
Class room
Class room
dr. Desak
Wihandani
Prof. Wiryana
Disc room
Facilitator
Class room
Class room
Prof. Wiryana
dr. Winarti
Disc room
Facilitator
Hospital Visit
Class room
dr. Winarti
Class room
dr. Winarti
Physiology:
2nd floor
PA: Joint Lab
(4th floor)
dr. Muliarta
Class room
Prof. Aman
Disc room
Facilitator
Class room
Prof. Aman
Pathology of
Respiratory Tract
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 9
9
dr. Desak
Wihandani
Control of
Respiratory Function
and Blood Gas
Analyzes
8
Wednesday
March 2,
2016
Class room
Control of acid base
balance, Arterial Gas
Analysis (AGA)
7
Tuesday
March 1,
2016
Lecture 6
09.00-10.00
Lung Defense
Mechanism
10.00-16.00
Independent learning
Practice : Physiology,
Pathology Anatomy (PA)
dr. Winarti
BKFK
Friday
March 4,
2016
09.00-10.00
Pharmacological and
non pharmacological
interventions
11
Monday
March 7,
2016
Lecture 10
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Faculty of Medicine Udayana University,DME
Independent learning
SGD
Break
Student project
Plenary session
15
ENGLISH CLASS
Study Guide The Respiratory System and Disorders
09.00-10.00
Monday
March 14,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
16
Thursday
March 17,
2016
Disc room
Facilitator
Plenary session
Lecture 12
Hospital Visit
Class room
Class room
Prof. Aman
dr. Elysanti
Respiratory Imaging
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 13
Disc room
Facilitator
Class room
dr. Elysanti
Class room
dr. IB Subanada
Disc room
Facilitator
Bronchiolitis, asthma
in children,
Pneumonia
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 14
Hospital Visit
Class room
dr. IB Subanada
Class room
dr. Siadi Purniti
Disc room
Facilitator
Class room
Class room
dr. Siadi Purniti
dr. Sutha,
TB in children, Difteri,
Pertusis
15
Wednesday
March 16,
2016
Independent learning
SGD
Break
Student project
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
14
Tuesday
March 15,
2016
Prof. Aman
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-10.00
Independent learning
SGD
Break
Student project
Plenary session
Lecture 15
Pulmonary TB and
Extrapulmonary TB,
TB in the
Immunocompromised
Host, Abses TB
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
09.00-10.00
Lecture 16
Asthma,
COPD
17
12.00-13.30
Faculty of Medicine Udayana University,DME
dr. Bagiada
Disc room
Hospital Visit
Class room
Facilitator
dr. Sutha,
dr. Bagiada
Class room
Prof. IB Rai,
dr. Artana
Independent learning
16
CLASS
13
Class room
Pharmacological and
non pharmacological
interventions
12
Friday
March 11,
2016
Lecture 11
ENGLISH CLASS
Study Guide The Respiratory System and Disorders
Study Guide The Respiratory System and Disorders
Friday
March 18,
2016
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
SGD
Break
Student project
Plenary session
Disc room
Facilitator
Class room
Prof. IB Rai,
dr. Artana
09.00-09.00
Lecture 17
Class room
18
Monday
March 21,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
Independent learning
SGD
Break
Student project
Plenary session
08.00-09.00
Lecture 18
20
Wednesday
March 23,
2016
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
09.00-09.30
09.30-10.00
12.00-13.30
13.30-15.00
11.30-12.00
10.00-11.30
15.00-16.00
22
Monday
March 28,
2016
Independent learning
SGD
Break
Student project
Plenary session
Lecture 19
Disorder of nose, sinus
Independent learning
SGD
Break
Student project
Plenary session
08.00-15.00
BCS: Spirometry
BCS: WSD, Radio Imaging
(Pre-test, lecture, demo
Practice, discussion)
08.00-15.00
BCS: Physical Diagnostic of
Thorax
BCS: Bronchoscopy
BCS: THT
(Pre-test, Lecture, practice,
demo)
23
Tuesday
March 29,
2016
Disc room
Hospital Visit
Class room
Faculty of Medicine Udayana University,DME
Facilitator
dr. Andrika,
dr, Yasa
Class room
Bronchitis and
Bronchiectasis,
Lung Ca and
Smoking Cessation
19
Tuesday
March 22,
2016
dr. Andrika,
dr, Yasa
Pleural effusion,
Pneumothorax,
Hematothorax
dr.Dewa Artika,
dr. Saji
Disc room
Facilitator
Class room
dr.Dewa Artika,
dr. Saji
Class room
dr. Ratna,
Sp.THT
Disc room
Facilitator
Hospital Visit
Class room
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Ratna,
Sp.THT
dr. Muliarta
dr. Yasa
Elysanti
dr. Saji
dr. Sutha
dr. Lely
17
dr.
Study Guide The Respiratory System and Disorders
24
Wednesday
March 30,
2016
08.00-15.00
25
Monday
March 31,
2016
08.00-15.00
26
Friday
April 1,
08.00-15.00
2016
27
Monday
April 5,
2016
Faculty of Medicine Udayana University,DME
BCS: Spirometry
BCS: Physical Diagnostic of
Thorax
(Pre-test, lecture, practice,
demo)
BCS: Physical Diagnostic of
Thorax
BCS: Provocation test
BCS: THT
(Pre-test, lecture, demo)
BCS: Physical Diagnostic of
Thorax, Provocation test,
Spirometry, WSD,
Bronchoscopy, Radio
Imaging, THT
(Practice, post-test)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
Class Room
Physiology
Dept. (2nd
floor
Joint Lab (4th
Floor)
Anatomy (1st
floor)
dr. Muliarta
dr. Saji
dr. Saji
dr Artana
dr. Lely
dr. Saji
dr Artana
dr. Sutha
dr. Muliarta
dr. Yasa
dr. Elysanti
dr. Lely
Examination
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Study Guide The Respiratory System and Disorders
LEARNING PROGRAMS
LECTURE 1
ANATOMY OF RESPIRATORY TRACT
Abstract
dr. I Nyoman Gede Wardana, M.Biomed
The respiratory system consists of conducting zone and respiratory zone.
Conducting zone, whose walls are too thick to permit exchange of gases between the air in
the tube and the blood stream. The nostrils (nares), nasal cavity, pharynx, larynx, trachea,
bronchi, and terminal bronchioles are included in this zone. Respiratory zone, whose walls
are thin enough to permit exchange of gases between tube and blood capillaries
surrounding them. Air travels to the lungs through that zone. The right lung divided into
three lobes: superior, middle, and inferior. The left lung divided into two lobes: superior and
inferior. Each lung cover by a membrane that called pleura. Both lungs are inside the
thoracic cage. The thoracic cage is formed by the vertebral column behind, the ribs, and
intercostal spaces on other side and the sternum and costal cartilages in front. Below it
separated from the abdominal cavity by diaphragm
Learning Task
Vignette 1:
Kesawa, 32 years old, was seen in the clinic ten days ago, was diagnosed with rhinitis and
sent home with instructions for increased fluids, decongestants, and rest. Kesawa presents
today with worsened symptoms of malaise, low-grade temperature, nasal discharge, night
time coughing, mouth breathing, early morning pain over sinuses, and congestion. The
doctor diagnose he is suffering sinusitis.
1. Describe the boundaries of the nasal cavity and its blood supply
2. Describe the paranasal sinuses and its opening at nasal cavity
Vignette 2:
Gotawa, a singer-18 years old came to clinic with complain a hoarse voice for 3 days. She
also suffers sore throat, nose block, and fever. She was diagnosed laryngitis
1. Describe the structure of larynx and location of vocal cord
2. Describe the intrinsic and extrinsic muscle of larynx
Vignette 3:
Mande, 30 years old male came to clinic with chief complaint difficulty to breath start from
this morning. He also suffers cough, runny nose and fever. He has history bronchial asthma
when he was 2 years old. The doctor diagnose he is suffering bronchial asthma.
1. Describe the structure of trachea
2. Describe the different between right and left main bronchus
3. Describe the principal different between trachea, bronchi, and bronchioles
Vignette 4:
A 57-year-old male is admitted to the hospital with a chief complaint of shortness of breath
for 2 weeks. The radiology examination shows a large left-side pleural effusion.
1. Describe the different between right lung and left lung
2. Describe the structure of pleura
3. Describe the structure of thoracic wall
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Study Guide The Respiratory System and Disorders
LECTURE 2
HISTOLOGY OF RESPIRATORY TRACT
dr. Sri Wiryawan, MRepro
Abstract
The lower respiratory tract consists of : the lower part of the trachea, the two main
bronchi, lobar, segmental, and smaller bronchi, bronchioles and terminal bronchioles, and
last but not least is the end respiratory unit. These structure make up the tracheobronchial
tree. As for the structure distal to the main bronchi along with a tissue known as the lung
parenchyma.
There are several structure we should also understand, when talking about lower
respiratory tract. Several structures such as thorax, mediastinum, pleurae and pleural cavity,
and lung. Thorax especially thoracic cavity and thoracic wall protect our lung and
mediastinum and also play an important role in respiratory process. The mediastinum,
which has a role in protecting our heart , located between the two lungs, and contains the
heart and great vessels, trachea and esophagus, phrenic and vagus nerves, and lymph
nodes.
The pleurae covers the external surface of the lung, and is then reflected to cover
the inner surface of thoracic cavity. Pleurae divided into the visceral (lines the surface of the
lung) and parietal (lines the thoracic wall and diaphragm) one. The space between these
two pleurae called as pleural cavity which contains a thin film fluid to allow the pleurae to
slip over each other during breathing.
The lungs are placed within the thoracic cavity. The lungs contain airways structure,
vessels, lymphatic and lymph nodes, nerves, and supportive connective tissue. The trachea
divides and form the left and right primary bronchi, which in turn divide to form lobar bronchi.
Each lobar bronchi divide again to give segmental bronchi to supply air to
bronchopulmonary segments. The tracheobronchial tree can also be classified into two
functional zones: the conducting zone (proximal to the respiratory bronchioles) which
involved in air movement, and the respiratory zone (distal to the terminal bronchioles) which
involved in gaseous exchange.
The other term to show functional structure of the lower respiratory tract is the
acinus. The acinus defined as the part of the airway that is involved in gaseous exchange.
The acinus consist of respiratory bronchioles, alveolar ducts, and alveoli as the smallest
functional structure of the lung. The areas of lung containing groups of between three to five
acini surrounded by parenchimal tissue are called lung lobules.
The alveolus is an blind-ending terminal sac of respiratory tract. Most gaseous
exchange occurs in the alveoli. The alveoli are lined with type I (structural) and type II
(produce surfactant) of pneumocytes cell. The understanding about histological pattern of
these functional structures of the lung is important in pathophysiology of lung problems.
Learning Tasks
I. Structure of The Upper Respiratory tract
Krishna, a man, 25 years old came to doctor Arjuna clinic with fever, sore throat,
sneezing, runny nose and sometimes blocked nose. He also cannot smell well. The
doctor diagnoses Krishna with acut Rhinopharingitis.
1. Describe the histological structure of the upper respiratory tracts
are involved ?
2. Describe the histological structure and function of epiglottis !
3. Compare the histological structure and function between vestibular fold and
vocal fold !
II. Structure of The Lower Respiratory tract
Radha, a 17 years old beautiful girl, came to doctor Laksmi clinic with shortness of
breath, wheezing and cough with phlegm. The doctor diagnoses Radha with
Asthma.
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
1.Describe the histological structure of the lower respiratory tracts are involved ?
2.Compare the histological structure and function between terminal bronchioles and
respiratory bronchioles !
3.Describe the histological structure of the interalveolar septum !
4.Describe the histological structure of blood-air barrier ?
5.Describe about the pulmonary surfactant ?
LECTURE 3
PHYSIOLOGY OF RESPIRATORY SYSTEM: VENTILATION
dr. I Made Muliarta, MKes
Abstract
 In living cells aerobic metabolism consumes oxygen and produces carbon dioxide. Gas
exchange requires a large , thin, moist exchange surface, a pump to move air circulatory
system to transport gases to cells. The primary function system are:
 Exchange the gases between atmosphere and the blood.
 Homeostatic regulation of body pH .
 Protection from inhaled pathogens and irritation substance
 Vocalization.
 In addition to serving these function, the respiratory system also source of significant
losses of water and heat from the lung.
 A single respiratory cycle consists of an inspiration and expiration. Relation with
ventilation had to know about compliance, surfactant, lung volume and capacities
 Respiratory control resides in a central pattern generator, a net work of neurons in the
pons and medulla oblongata.
LEARNING TASK
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Study Guide The Respiratory System and Disorders
dr. Muliarta, MKes
1. What is the sequence of event during quiet inspiration (muscle involvement, pressure
changes (intrapulmonary and intrapleura), volume changes)
2. What is pulmonary ventilation and alveolar ventilation means?
3. Andi, male, 30 years old, has a puncture wound due to car accident in his right chest
and penetrate his pleural cavity. The patient has complained shortness of breathing and
doctor determine that his lung is collapsed.
a. What is this condition called?
b. Describe the mechanism of the lung collapse!
c. What kind respiratory system compensation to anticipate this condition (lung
collapse)
d. How can he still be alive in this condition?
4. Describe the Boyle’s Law!
LECTURE 4
PHYSIOLOGY OF RESPIRATORY SYSTEM: GAS EXCHANGE, DIVING,
ALTITUDE
dr. I Made Muliarta, MKes
Abstract
Gas exchange during external respiration occurs in respiratory membrane. Several
factors may influence gas exchange. Dalton’s law and Henry’s law may apply during gas
exchange.
Some physiologic responses on respiratory system at high altitude and during diving.
Some illnesses/injuries related pressure change may occurs at high altitude and during
diving.
LEARNING TASK
dr. Muliarta, MKes
1. Describe the Dalton’s Law!
2. Describe the factors that influence oxygen diffusion from alveoli into the blood!
3. Predict the response of the pulmonary arterioles and bronchioles when PO2 increase
and PCO2 decrease!
4. Describe some illnesses/injuries due to high altitude
5. Describe some illnesses/injuries due to diving
LECTURE 5
CARRIAGE OF OXYGEN AND CARBON DIOXIDE
dr. Desak Wihandani
Abstract
Gas Transport
The supply of oxygen to the tissues is our most immediate physical need. We take in about
250 ml of oxygen gas per minute and this is our most pressing physical need. If our oxygen
supply is interrupted for more than a few minutes, irreversible damage is done to some
tissues, notably the brain. Oxygen is abundantly available in the air around us but cannot
diffuse into our tissues at sufficient rate to meet our needs. It must be transported from the
lung, the specialized organ for gas exchange, by the blood to all the other tissue.
While oxygen has to be transported from lungs to tissues, carbon dioxide must be
transported from the tissues for excretion by the lungs. Carbon dioxide has physicochemical
properties that make its transport less difficult then transport of oxygen. Carbon dioxide can
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
be transported in the blood in three ways: in simple solution, by reversible conversion to
bicarbonate and by reversible combination with haemoglobin to form carbamino
haemoglobin.
LEARNING TASK:
1. Describe the structure and function of hemoglobin
2. Describe the mechanism of oxygen binding to hemoglobin
3. Describe the differences between hemoglobin and myoglobin
4. Describe the mechanism of oxygen binding to myoglobin
5. Describe conformational differences between deoxygenated and oxygenated Hb!
6. Summarize the processes by which carbondioxide is transported from peripheral
tissues to the lungs
LECTURE 6
CONTROL OF ACID BASE BALANCE, ARTERIAL GAS ANALYSIS (AGA)
dr. Desak Wihandani
Abstract
Acid-Base Balance
There is large daily flux of oxygen, carbon dioxide and hydrogen ion through the human
body. Carbon dioxide generated in tissues dissolves in H2O to form carbonic acid, which in
turn dissociates releasing hydrogen ion. The blood concentration of hydrogen ion is
constant, it remains between 36 and 46 nmol/L (pH 7,36-7,46). Changes in pH will affect
the activity of many enzyme and tissue oxygenation. Problems with gas exchange and acidbase balance underlie many diseases of respiratory system.
Blood Gases
Blood gas measurement is an important first-line investigation performed whenever there is
a suspicion of respiratory failure or acid-base disorders. In respiratory failure, the results of
such measurements are also an essential guide to oxygen therapy and assisted ventilation.
The key clinically used parameters are pH, pCO2 and pO2, the bicarbonate concentration is
calculated from pH and pCO2 values.
Learning Task:
1. Describe organs in our body involved in acid-base balance, and how they work
2. Describe acid-base balance disorders! What is mean by : a. Respiratory
alkalosis, b. metabolic alkalosis, c.respiratory acidosis, and d. metabolic
acidosis
3. In which condition respiratory acidosis and respiratory alkalosis occurs ?
4. What is the importance of blood gas measurement. To perform measurement
where are the blood sample taken from? What kind of measurement are done?
LECTURE 7
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Study Guide The Respiratory System and Disorders
CONTROL OF RESPIRATORY FUNCTION
Prof. Dr. dr. Wiryana, SpAn
Abstract
When considering contol of breathing, the main control variable is PaCO2 (we try to
control this value near to 40 mmHg). This can be carried out by adjusting the respiratory
rate, the tidal volume, or both. By controlling PaCO2 we are effectively controlling alveolar
ventilation (see Ch.3) and thus PACO2. Although PaCO2 is the main control variable, PaO2
is also controlled, but normally to a much lesser extent than PaCO2. However, the PaO2
control system can take over and become the main controlling system when the PaO2 drops
below 50 mmHg.
Control can seem to be brought about by :
1. Metabolic demands of the body (metabolic control)-tissue oxygen demand and acidbase balance.
2. Behavioural demands of the body (behavioral control) – singing, coughing, laughing
(i.e.control is voluntary).
These are essentially feedback and feed-forward control systems, respectively. The
behavioural control of breathing overalys the metabolic control.
Its control is derived from higher centres of the brain. The axons of neurons whose cell
bodies are situated in the cerebral cortex bypass the respiratory centres in the brainstem
and synapse directly with lower motor neurons that control respiratory muscles. This system
will not be dealt with in this next;we shall deal only with the the metabolic control of
respiration.
Learning Tasks
1. Discuss the central control of breathing with reference to the pontine respiratory
group and the dorsal-ventral respiratory groups of medulla spinalis
2. List the different types of receptors involved in controlling the respiratory system
3. Describe factors that stimulate central and peripheral chemoreceptor
4. outline the response of the respiratory system to change in carbon dioxide
concentration, oxygen concentration and pH.
5. discuss the mechanism thought to influence the control of ventilation in exercise
6. discuss the changes that occur in response to high altitude
LECTURE 8
PATHOLOGY OF UPPER AND LOWER URINARY TRACT
dr. Ni Wayan Winarti, SpPA
ABSTRACT
The term upper airways is used here to include the nose, pharynx, and larynx and their
related parts. Disorders of these structures are among the most common afflictions of
humans, but fortunately the overwhelming majority are more nuisances than threats.
Inflammatory diseases are the most common disorders of the upper respiratory tract, i.e.
rhinitis, sinusitis, pharyngitis, tonsillitis and laryngitis. It may occur as the sole manifestation
of allergic, viral, bacterial or chemical insult. Although most infections are self-limited, they
may at times be serious, especially laryngitis in infancy or childhood, when mucosal
congestion, exudation, or edema may cause laryngeal obstruction. Tumors in these
locations are infrequent but include the entire category of mesenchymal and epithelial
neoplasms. Some distinctive types are nasopharyngeal angiofibroma, Sinonasal
(Schneiderian) Papilloma, Olfactory Neuroblastoma and Nasopharyngeal Carcinoma.
Faculty of Medicine Udayana University,DME
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Study Guide The Respiratory System and Disorders
Classification of lower respiratory tract (lung) diseases can be made based on the result of
lung function test, although some authors prefer etiology and pathogenesis background.
Some important diseases are obstructive lung disease (asthma, COPD, bronchiectasis) and
restrictive lung disease (ARDS), and also infections, diseases of vascular origin and tumors.
Pleura as protective structure of the lungs, are sometimes involved as secondary
complication of some underlying disease, but in rare case, can be primary.
Because of the complexity of respiratory disease, it is important to understand their
pathogenesis, supported by recognizing their morphologic changes.
LEARNING TASK
Case 1
A male patient, 16 year old, came to a doctor with chief complaint difficulties in breathing. It
has occurred since 1 month ago. This patient suffers from rhinitis alergica since he was 3
year old. On physical examination, a pedunculated nodule in right nasal cavity was found. It
was whitish in color, 1.5 cm in diameter occluding the nasal cavity.
1. Based on clinical finding, what is the most possible diagnosis?
2. What are the DDs?
3. Describe the morphological appearance (macroscopy and microscopy) that
supposed to be found to confirm your diagnosis!
4. Explain the pathogenesis of this diasease!
Case 2
A male patient, 65 year old, has suffered from dyspnea and productive cough since 1 year
ago. Lung function test showed increased of FEV1 with normal FVC (confirm an obstructive
lung disease). He is a heavy smoker since he was 25 year old. No history of atopy. No
evidence of cardiac disorders.
A. Mention 4 diseases including in the spectrum of obstructive lung disease!
B. Explain their pathogenesis!
C. Distinguish their morphology!
Case 3
A female patient, 50 year old, has suffered from tumor of right lung with pleural effusion. As
the first step to confirm the diagnosis, doctor asked the patient to do cytology test.
A. Mention some cytology test can be choose for this patient!
B. Among the test mention above (A), which one is the most simple and non-invasive?
And, discuss how to collect the specimen
LECTURE 9
LUNG DEFENCE MECHANISM
dr. Ni Wayan Winarti, SpPA
Abstract
Respiratory tract is an organ that constantly exposed by contaminated air. It is there
fore a small miracle that the normal lung parenchyma remains sterile. Fortunately, a
plethora of immune and non immune defense mechanisms exist in the respiratory system,
extending from the nasopharynx all the way into alveolar airspaces.
The major categories of defense mechanisms to be discussed include : (1)physical
or anatomic factors related to deposition and clearance of inhaled materials, (2)antimicrobial
peptides, (3) phagocytic and inflammatory cells that interact with inhaled materials,
(4)adaptive immune response, which depends on prior exposure to recognize the foreign
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materials. Each components appears to have a distinct role, but a tremendous degree of
redundancy and interaction exists among different components.
Any condition breaks down the lung defense mechanism may result in lung injury
and respiratory tract infections
Learning Tasks
1.
Defense mechanism of the lung and respiratory tract ca be divided into four
major categories. Mention them, their components and explain how each of them
acts against foreign materials.
2.
Explain about diseases or conditions that break the lung defense mechanism
down which result in increase susceptibility to respiratory tract infections
LECTURE 10
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION I
Prof. dr. GM Aman
Abstract
Drugs for cough, rhinitis, asthma bronchiale
Cough is a protective reflex mechanism that removes foreign material and secretions
from the bronchi and bronchioles. It can be inappropriately stimulated by inflammation in the
respiratory system or by neoplasia. In these cases, antitussive (cough suppressant) drugs
are sometimes used. It should be understood that these drugs merely suppress the
symptom without influencing the underlying condition. In cough associated with
bronchiectasis or chronic bronchitis, antitussive drugs can cause harmful sputum thickening
and retention. They should not be for the cough associated with asthma.
Most drugs used in rhinitis are effectively relief the symptom of rhinitis, not affect the
underlying disease. No drug can relief symptom completely. Drugs are more effective for
allergic rhinitis than non allergic rhinitis, and acute form of allergy respond more favorable
than chronic form of allergy. The most common drugs used for rhinitis are antihistamine,
nasal disodium cromoglycate, nasal decongestant, anticholinergic, intranasal corticosteroid.
Bronchial Asthma is a disease characterized by airway inflammation, edema and
reversible bronchospasm. Bronchodilator and anti-inflammatory are the most useful drugs
used in asthma. B2 selective agonists, muscarinic antagonists, aminophylline and
leucotriene receptor blockers are the most effective bronchodilator. Anti-inflamatory drugs
such as corticosteroid, mast cell stabilizers, leucotriene antagonists, and an anti IgE
antibody are widely used. Short acting B2 agonist are the most widely used for acute
asthma attack, by relaxing airway smooth muscle. Theophylline, aminophylline and
antimuscarinic agent are also used for acute asthma attack. Long term control can be
achieved with an anti-inflammatory agent such as corticosteroid (systemic or inhaled), with
leucotriene antagonist, mast cell stabilizers (cromolyn or nedocromil). Long acting B2
agonists such as Salmeterol and Formeterol, are effectively in improving asthma control,
when taken regularly.
Learning Tasks Day 10
The patient complained about a sore throat and a nasty cough. It started two weeks ago
with a cold. The cold was over within a week, but he continued coughing, especially at night.
He is a heavy smoker. After physical examination you diagnosed a dry, tickling cough.
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Task 1
1. Differentiate between Antitussive, Expectorant, Mucolytic
2. Differentiate the effects of Codeine, Dextromethorphan and Diphenhydramine
3. List the side effects of Codeine
4. In this patient, what kind of anti cough you give best.
Task 2
If the patient also has sneezing, rhinorrhea and congested nose and then you diagnosed as
rhinitis.
1. List the group of drugs used for Rhinitis
2. List the drugs used as oral nasal decongestant, and describe the important side effects.
3. List the side effects of intranasal decongestant
4. what is the drug of choice for patient suffer from Rhinitis Medicamentosa
LECTURE 11
PHARMACOLOGICAL AND NON PHARMACOLOGICAL INTERVENSION II
Prof. dr. GM Aman
Task Day 11
If the patient come with cough, breathless, and in your examination, you found wheezing.
After physical examination you diagnosed Acute attack of bronchial asthma.
1. Chose the drug of first choice for this patient
2. List the side effects of this drug
3. Compare the effect of this drug with Salmeterol
4. Theophyllin is a bronchodilator, but has a narrow safety margin. List the side effects &
toxic effect of Theophyllin.
5. Ipratropium not as effective as Salbutamol in treating bronchial asthma. What is the
main use of Ipratropium
6. Cromolyn and Nedocromil are often used for Asthma bronchial. Describe the
mechanism of action of Cromolyn (Disodium Cromoglycate)
7. To decrease the side effet of Corticosteroid in asthma patient, Corticosteroid often use
as inhaled Corticosteroid. What are the side effect of inhaled Corticosteroid
1. List the anticough that are contraindicated in acute asthma attack.
2. If you need anticough, what drug you give best
LECTURE 12
RESPIRATORY IMAGING
dr. Elysanti, Sp.Rad
Abstract
The imaging investigations of the chest may be considered under the following heading:
1. Simple X- Ray.(conventional X-ray)
2. Chest screening.
3. Tomography.
4. Bronchography.
5. Pulmonary angiography.
6. Isotope scanning.
7. Computed tomography(CT-scan)
8. MRI.
9. Needle biopsy.
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The conventional Chest X Ray has to diagnose the anatomical disorders of the chest for
example:
1. Lungs disease-----pneumonia, mass, atelectasis etc.
2. Pleural disease----pleural effuse, pneumothorax etc
3. Cardiac disease----cardiomegali
4. Bone disorders ----fracture
5. Soft tissue disease—emphysema cutis.
Sometimes conventional X-ray diagnostic can not enough for diagnostic of the chest
disorders, for this the CT scan, MRI, bronchography and arteriography can be help.
Learning Tasks
A male patient, 68 years old, with chronic cough and hemoptoe.
 What is the imaging choice for establish the diagnosis ?
 What kind of diagnosis you will consider if the imaging revealed some consolidation at
the apex of the right lung accompanied by rib destruction?
A 1- month old female patient is suffered from fever and dyspneu
 What kind of abnormality you hope to see on the chect X ray film?
 What do you thing about the diagnosis of the disease?
LECTURE 13
BRONCHIOLITIS AND
ASTHMA IN CHILD
Dr. IB Subanada, SpA
Abstract
Bronchiolitis is an acute inflammatory disease of the lower respiratory tract
(bronchioles) caused predominantly by respiratory syncytial virus (RSV). The inflammation
response characterized by bronchiolar epithelial necrosis, bronchiolar occlusion, and
peribronchiolar collection of lymphocytes. Bronchiolus become edematous and obstructed
with mucus and celluler debris, which may lead to partial or complete collapse of the
bronchioles. By the age 2 years nearly all children have been infected, with severe disease
more common among infants aged 1-3 months.
The clinical manifestation, initially upper respiratory signs and symptoms and
followed by obstructed bronchioles signs and symptoms.
The white blood cell and differential counts are usually normal. Chest x-ray reveals
hyperinflation, peribronchial cuffing, and atelectasis.
The mainstay of therapy is supplemented oxygen with close monitoring and supportive care.
There are higher incidence of wheezing and asthma in children with history of
bronchiolitis. Pooled hyperimmune RSV intravenous immunoglobulin (RSV-IVIG) and
palivizumab intramuscular are effective to preventing severe RSV disease in high risk
infants. The case fatality rate is less than 1%.
Learning Tasks
A 6-months old male infant came to Outpatient Clinic, Department of Child Health,
Medical School, Udayana University, Sanglah Hospital, Denpasar with the chief complaint of
difficult to breath since yesterday. According to his mother, three days before, he suffered
from coryza, cough, and low grade fever. On physical examination, fast breathing, wheezing
and a prolonged expiratory phase were found.
Please discuss his mother the disease of the infant!
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Learning Tasks
1. explain the pathological concept of asthma in child
2. explain the clinical manifestations of asthma in child
3. explain the diagnosis principles of asthma in child
4. determine the severity of asthma and the degree of asthma attack in child
5. construct management plans for asthma attack in child (reliever) and determine the
need for controller management
6. abl to identify the need for referral
LECTURE 14
TB IN CHILD
dr. Ni Putu Siadi Purniti, SpA
Abstract
Tuberculosis (TB) is systemic infection cause by Mycobacterium tuberculosis
complex : M tuberculosis, M. Bovis, M. africanum, M. microti, and M. canetti. Tuberculosis
infection occurs after inhalation of infective droplet nuclei containing M. tuberculosis. A
reactive tuberculin skin test and the absence of clinical and radiographic manifestations are
the hallmark of this stage. Tuberculosis disease occurs when sign and symptoms or
radiographic changes becaome apparent. In the year 2001 prevalens rate of TB is
5,6/100.000 population, of these, 931 (6 % ) cases occurred in children < 15 year of age
(rate 1,5/100.000 population). Transmission of M tuberculosis is person to person, usually
by airborne mucus droplet nuclei, particles 1-5 µm in diameter that contain M tuberculosis.
In the United States, most children are infected with M. tuberculosis in their home by adult
patient tuberculosis close to them. The tubercle bacilli multiply initially within alveoli and
alveolar duct. Most of bacilli are killed, but some survive within nonactivated macrophages,
which carry them through lymphatic vessels to the regional lymph nodes. When the primary
infection is the lung, the hilar lymph nodes ussualy are involved. The primary complex of
tuberculosis includes local infection at the portal of entry ( primary focus) and the regional
lymph nodes that drain the area. During the development of the primary complex, tubercle
bacilli are carried to most tissues of the the body through the blood and lymphatic
vessels.Pulmonary tuberculosis that occurs more than a year4 after the primary infection is
usually caused by endogenous regrowth of bacilli persisting in partially encapsulated
lesions. The majority of children with tuberculosis infection develop no signs or symptoms at
any time. Occasionally, infection is marked by low grade fever and mild cough, and rarely by
high fever, cough, malaise, and flu like symptoms. Several drugs are used to effect a
relatively rapid cure and prevent the emergence of secondary drug resistance during
therapy. The standard therapy of intrathoracic tuberculosis (pulmonary disease and/or hilar
lymphadenopathy) in children, recommended by the CDC and AAP, is 6 month regiment of
isoniazid (INH), rifampin (RIF) supplemented in the first 2 month of treatment by
pyrazinamide (PZA).
Learning Tasks
In Outpatient Clinic Department of Pediatric, the baby 10 month of age carried by the
mother with the chief complaint is loss of weight since 3 month, suffered low grade fever,
chronic cough, malaise and flu like symptoms. The grandfather whom was diagnosed
pulmonary tuberculosis and she has been in recent closed contact. In physical examination
found that there were enlargement of neck lymph nodes.
Learning Resources
Nelson Textbook of Pediatrics Ed. 17 th 2004: pp 958-972
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LECTURE 15
PULMONARY TB AND EXTRAPULMONARY TB
TB IN THE IMMUNOCOMPROMISED HOST
dr. IB Sutha, SpP and dr. Bagiada, SpPD
PULMONARY TB AND EXTRAPULMONARY TB
dr. IB Sutha, SpP
Abstract
WHO estimates that about 9.27 million new cases in 2007 compared with 2.24
million cases in 2006, with 44% or 4.1 million cases of the infectious cases (sputum
smear new cases with positive). TB problem in Indonesia is a national problem, the case
is increasing and increasingly concerned with the increasing HIV infection and AIDS are
rapidly growing emergence of multi-drug resistance TB problem.
Tuberculosis is an infectious disease directly caused by the bacteria Mycobacterium
tuberculosis that primarily attacks the lungs. TB bacteria are rod-shaped, aerobic with a
complex cell wall structure, it was mainly composed of fatty acids that are acid resistant
and can survive in a dormant form.
TB germs enter through inhalation of the bacteria will reach the alveoli and catched
by alveolar macrophages, the bacteria will die. If the germs stay alive it will proliferate to
form primary apex (Primer Apex) and will limphogen or hematogenous spread. Primary
apex surround by limphogen spreading form the "primary complex of Ghon" and formed
specific cellular immunity is characterized by a positive tuberculin test. If the immunity is
low, complex primary complications, the patient became ill and the symptoms and
clinical signs of disease. M. tuberculosis may attack any organ of the body and most
importantly the lungs.
Clinical symptoms involve respiratory symptoms and prodromal symptoms, whereas
clinical signs obtained at once with the examination depends on the type and extent of
lesions in the lungs and surrounding organs. Radiological examination of the thorax will
get the infiltrates, fibrosis and kaverna. Bacteriological examination by smear and
culture of sputum smear examination.
TB treatment follow national treatment program. Tuberculosis control which refers to
the eradication of TB WHO guideline.
Objectives
1. Knowing the microbiology, epidemiology and pathogenesis of tuberculosis
2. Knowing the clinical symptoms, clinical and radiological signs of pulmonary TB and extrapulmonary TB
3. Able to clasify Tuberculosis
4. able to explain treatment program of tuberculosis and side effect
5. Able to describe the prevention of tuberculosis and MDR TB
Triger
A male patient aged 25 years came to a health center with complaints of bloody cough
every time since one month ago. That was not originally phlegm but since two weeks ago a
yellowish productive cough. The coughing did not disappear with anti-cough medicine.
Shortness of breath and chest pain is absent. Patients feel the slightly fever and night
sweating and also weakness, no appetite. Patients had never been sick before, enough
food, smoking and family sometimes there is no similar illness. Physical examination has
been found: look thin, alert state, blood pressure 110/70 mmHg; pulse rate 108 x/mnt;
Respiration rate 24 breaths/mnt, T.aksila 370C. Lymph nodes enlargement on the right
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neck. On chest examination: symmetrical right-left chest, normal heart, vesicular breath
sounds in the chest and rhales on the third upright.
Learning Tasks:
1. What should you do to ensure the diagnosis of
this patient?
2. What should you do for this patient with enlargement of gland in the neck?
3. If the sputum smear examination results - / +2 / -, what is diagnosis?
4.
Explain
the
treatment
program
appropriate
to
this
patient!
5. Explain about patient monitoring and Communication-Information-and Education
for this patient and his family?
TB IN THE IMMUNOCOMPROMISED HOST
dr. Made Bagiada, SpPD-KP
Sebagai seorang dokter yang bekerja di tingkat pelayanan primer, pemahaman tentang
diagnosis dan penatalaksanaan TB pada imunokompromais sangatlah penting. Kejadian TB
lebih tinggi pada imunokompromais dibanding dengan non-imunokompromais. Penyakit
infeksi kronik ini bila tidak ditangani dengan baik menyebabkan morbiditas dan mortalitas
yang tinggi. Di Indonesia dengan beban TB tinggi (nomor 5 di dunia) akan lebih tinggi lagi
dengan meningkatnya prevalensi penderita HIV/AIDS.
TB adalah penyakit infeksi kronis yang disebabkan oleh M.tuberculosis. Tempat masuk dan
target organ terbanyak adalah paru. Orang yang terinfeksi M.tuberculosis hanya sebagian
kecil yang menjadi sakit TB dan sebagian besar tidak menjadi sakit (latensi). Orang yang
tidak sakit (latensi) akan menjadi sakit (reaktivasi) atau TB aktif bila terjadi penurunan daya
tahan tubuh atau imunitas (imunokompromais). Secara umum klinis TB ditandai dengan
batuk-batuk produktif lebih dari 2 – 3 minggu disertai dengan gejala-gejala respiratorik
lainnya dan gejala non-respiratorik. Namun, manifestasi klinis dari TB pada individu
imunokompromais terletak pada derajat beratnya penurunan imunitas. Sering tanda dan
gejala TB atipikal, sering terjadi kesalahan diagnosis, sehingga prognosis menjadi lebih
buruk.
Imunokompromais adalah suatu kondisi dimana sistem kekebalan tubuh seseorang
melemah atau tidak ada. Individu yang imunokompromais kurang mampu melawan atau
memerangi infeksi karena respon imun yang berfungsi tidak benar. Contoh orang
imunokompromais adalah mereka yang terinfeksi HIV atau AIDS, wanita hamil, atau sedang
menjalani kemoterapi atau terapi radiasi untuk kanker. Kondisi lain dengan
imunokompromais, seperti kanker tertentu dan kelainan genetik, diabetes mellitus, dan
penderita yang mendapatkan terapi TNF-α. Individu immunocompromised kadang-kadang
lebih rentan terhadap infeksi serius dan /atau komplikasi dibanding orang sehat. Mereka
juga lebih rentan untuk mendapatkan infeksi oportunistik, yaitu infeksi yang biasanya tidak
mengenai orang yang sehat.
Dalam keadaan penderita dengan imunokompromais, seorang dokter harus dapat
mengenali penyakit TB aktif. Diagnosis TB pada imunokompromais adalah dengan
menemukan kuman BTA pada sputum baik dengan pemeriksaan langsung BTA maupun
kultur. Pengobatan TB penderita imunokompromais sama dengan pada nonimunokompromais dan pengobatan TB-nya diutamakan. Dokter harus mampu
mengidentifikasi penderita TB pada imunokompromais yang tidak respon (resisten) dengan
obat TB, sehingga dapat melakukan tindakan lebih dini untuk menurunkan perburukan
prognosis (kematian).
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Objektif
1. Mampu menjelaskan penegakan diagnosis TB pada imunokompromais
2. Mampu menyusun program pengobatan jangka panjang penderita TB pada
imunokompromais
3. Mampu mengidentifikasi kemungkinan gagal respon pengobatan (resisten) penderita
TB pada imunokompromais
4. Mampu menyusun pengobatan utama pada penderita TB dengan imunokompromais
5. Mampu mengidentifikasi penderita TB dengan imunokompromais yang perlu rujukan
lebih lanjut.
Trigger
Anda sebagai seorang dokter yang bekerja di sebuah Puskemas, datang seorang pasien
laki-laki, usia 28 tahun. Dia mengeluhkan panas badan sejak lebih kurang 2 minggu.
Demam tidak begitu tinggi dan tidak sampai menggigil. Disamping demam juga ada batukbatuk ringan tanpa disertai dahak yang dialami lebih dari 1 minggu. Penderita sudah
minum obat penurun panas dan obat batuk yang dibeli di warung tapi tidak ada
kesembuhan. Berat badan penderita dirasakan menurun drastis belakangan ini. Napsu
makan berkurang sehingga badan penderita dirasakan semakin kurus. Penderita adalah
seorang sopir pengangkut barang jawa – bali, sudah menikah dan mempunyai anak wanita
usia 4 tahun. Sesekali penderita minum bir. Penderita mempunyai tattoo di badannya yang
dibuat sewaktu penderita klas 1 SMA.
Tugas
Diskusikan!
1. Jelaskan bagaimana Sdr memastikan bahwa pasien tersebut memang menderita TB
dan imunokompromais!
2. Mengapa TB laten menjadi reaktivasi (TB aktif)?
3. Bagaimana Sdr mengenali pasien TB imunokompromais mengalami Immune
Reconstitution Inflammatory Syndrome (IRIS)?
4. Jika ternyata pasien tersebut menderita TB dengan imunokompromais bagaimana
cara menyusun pengobatan penderita?
5. Bagaimana cara menilai respon pengobatan TB pada pasien dengan
imunokompromais?
6. Jelaskan kriteria TB pada imunokompromais!
LECTURE 16
ASTHMA
Prof. IB Rai
Abstract
Airway hyper responsiveness is known as the denominator underlying all form of
asthma. The basis of this abnormal bronchial response is not fully understood. Most current
evidence suggests that bronchial inflammation is the substrate for this hyper
responsiveness, manifested by the presence of inflammatory cells and by damage of
bronchial epithelium. In extrinsic (allergic) asthma, bronchial inflammation is caused by type
I hypersensitivity reactions, but in intrinsic asthma, the cause is less clear. Incriminated in
such cases are viral infections of the respiratory tract and inhaled air pollutant such as sulfur
dioxide, ozone and nitrogen dioxide.
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Objektif:
1.
2.
3.
4.
5.
Mampu menjelaskan penegakan diagnosis asma
Mampu menyusun program pengobatan jangka panjang asma
Mampu mengidentifikasi pasien dengan serangan asma akut.
Mampu memberikan pengobatan awal pasien dengan serangan asma akut.
Mampu mengidentifikasi pasien asma akut yang perlu perawatan inap di rumah
sakit, dan merujuknya
Triger:
Anda sebagai seorang dokter yang bekerja di sebuah Puskesmas kota, datang seorang
pasien wanita, usia 36 tahun. Dia menyampaikan bahwa telah menderita asma sejak usia
remaja. Dalam 3 bulan terakhir ini, dia mengalami serangan asma hampir setiap 3 hari ,
termasuk serangan di malam hari. Untungnya, kata pasien, serangan asmanya dapat
diatasi dengan obat semprot yang dia miliki. Pasien menginginkan agar terbebas dari
penyakitnya ini.
Tugas:
Diskusikan!
1. Jelaskan bagaimana Sdr. memastikan bahwa pasien tersebut memang menderita
asma!
2. Apakah asma pasien tersebut dalam keadaan terkontrol? Jelaskan!
3. Apakah inhaler yang dipergunakan oleh pasien tersebut termasuk ke dalam
kelompok pelega (reliever)? Jelaskan perbedaan fungsi antara reliever dan
controller, dan sebutkan obat-obat dari kedua kelompok tersebut!
4. Susun rencana penatalaksanaan jangka panjang pasien tersebut!
5. Apabila suatu saat pasien tersebut mengalami suatu serangan asma akut, terapi
apa yang akan Sdr. berikan?
6. Jelaskan kreteria serangan asma akut berat!
LECTURE 16
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
dr. IGN Bagus Artana, SpPD
Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by airflow
limitation that is not fully reversible. COPD is the fourth leading cause of death in the world
and the number of patients is projected to increase worldwide in the future. Tobacco
accounts for an estimate of 90% to the risk of developing COPD. Patient with COPD first
complaining chronic cough with sputum and followed by dyspnea. This condition worsening
progressively until the patient unable to do his daily activities.
Treatment aim for COPD is to decrease symptom, without stopping the progression
of this disease. Prevention is more important in this condition, such as by smoking cessation
program.
Objektif:
1. Mampu menjelaskan penegakan diagnosis PPOK serta penilaian kombinasi pasien
2. Mampu menyusun rencana pengobatan pada kasus PPOK stabil
3. Mampu menangani factor risiko pasien PPOK
4. Mampu menentukan eksaserbasi akut dari PPOK
5. Mampu menjelaskan manajemen gawat darurat pasien dengan PPOK
eksaserbasiakut
Kasus:
Seorang pasien laki-laki usia 70 tahun datang bersama anaknya kepoliklinik paru Rumah
Sakit Daerah tempat anda bertugas dengan mengeluh sesak nafas. Sesak nafas dirasakan
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sangat berat, berpakaian pun pasien mengaku sesak. Sebelumnya pasien memang
merokok sejak usia 20 tahun sebanyak 2 pak sehari. Pasien juga mengatakan sering
opname di rumah sakit karena serangan sesak nafas yang sangat berat. Pasien dan
keluarganya ingin mengetahui dengan pasti mengenai penyakitnya serta tindak lanjut
penanganannya.
Tugas:
Diskusikanlah mengenai:
1. Jelaskan bagaimana penegakan diagnosis pasien tersebut
2. Bagaimanakan kombinasi penilaian pasien ini? Data apa saja yang saudara
perlukan untuk melengkapi kombinasi penilaian tersebut
3. Sebutkan dan jelaskan obat-obat yang dapat digunakan untuk menangani kasus
PPOK stabil
4. Bagaimana anda menyusun rencana penatalaksanaan pasien ini secara
komprehensif?
5. Bagaimana penatalaksanaan pasien ini apabila mengalaami PPOK eksaserbasi akut
?
LECTURE 17
PLEURAL EFFUSION
dr. Putu Andrika, SpPD-KIC
PNEUMOTHORAX
dr. Yasa, SpBTKV
PLEURAL EFFUSION
dr. Putu Andrika, SpPD-KIC
Membran tipis pleura terdiri dari dua lapisan yaitu pleura visceralis dan pleura
parietalis. Penumpukan cairan melebihi jumlah fisiologis 10-20 ml disebut efusi pleura,
akibat dari peningkatan produksi yaang melebihi kemampuan absorpsi.
Penting untuk menegakkan diagnosis berdasarkan anamnesis yang baik dan pemeriksaan
fisik yang teliti, pemeriksaan radiologi torak serta melakukan pungsi pleura. Analisis cairan
pleura akan sangat berguna untuk menuntun kearah penyebab efusi pleura. Dibedakan
cairan efusi yang transudat dan eksudat.
Volume efusi pleura yang banyak akan menimbulkan gangguan fungsi respirasi yang
memerlukan pengeluaran cairan efusi melalui aspirasi cairan pleura (torako sentesis) atau
melalui pemasangan chest cube (Water Seal Drainage).
Dalam mengelola pasien dengan efusi selain menangani keluhan akibat menumpuknya
cairan efusi juga harus menangani penyebab terjadinya efusi tersebut.
Objektif:
1. Mampu menjelaskan penegakan diagnosis efusi pleura
2. Mampu menilai analisis cairan pleura
3. Mampu merencanakan pemeriksaan penunjang untuk mendapatkan penyebab
terjadinya efusi pleura.
4. Mampu mengidentifikasi kasus yang memerlukan penanganan segara dan
kasus yang harus dirujuk ke rumah sakit.
Triger:
Seorang wanita muda datang dengan keluhan sesak nafas yang semakin memberat sejak
seminggu. Pada pemeriksaan fisik didapatkan frekwensi nafas 24x/mnt, suhu tubuh 37,5 o
C, pemeriksaan torak asimetris, kanan tertinggal, perkusi redup dan suara nafas melemah
di bagian kanan bawah. Penderita juga mengeluh batuk batuk sejak 3 bulan yang lalu dan
pernah batuk berisi darah segar sedikit, juga nampak semakin kurus.
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Tugas:
Diskusikan
1. Apakah kemungkinan penyebab keluhan pasien tersebut?
2. Pemeriksaan penunjang apa yang diperlukan?
3. Perlukah melakukan parasentesis? (jelaskan)
4. Perlukah pemasangan WSD, apa alasannya?
PNEUMOTORAKS
dr. Yasa, SpBTKV
Pneumotoraks merupakan salah satu kegawatdaruratan di bidang paru yang berarti
terisinya rongga pleura oleh udara. Pneumotoraks ini perlu mendapatkan perhatian serius,
karena dengan penanganan yang cepat dan tepat akan sangat mengurangi angka
kematiannya. Sebagai seorang dokter yang ada di fasilitas kesehatan primer, sangat
diperlukan pengetahuan mengenai keadaan ini.
Diagnosis pneumotoraks dapat ditegakkan dari anamnesis, pemeriksaan fisik dan foto
polos dada. Pneumotoraks dapat dibagi berdasarkan berbagai kriteria, tetapi yang paling
sering adalah dibagi menurut terjadinya (pneumotoraks artifisial, traumatic, serta spontan)
serta berdasarkan jenis fistelnya (pneumotoraks terbuka, tertutup, dan ventil).
Beberapa kondisi pneumotoraks akan sangat mengancam nyawa, sehingga memerlukan
penanganan yang tepat dan segera. Penatalaksanaan pneumotoraks pada prinsipnya
adalah mengeluarkan udara yang ada di rongga pleura tersebut, terapi penyebabnya, serta
edukasi untuk mencegah berulangnya pneumotoraks pada pasien yang memiliki risiko.
Objektif:
1. Mampu menjelaskan penegakan diagnosis pneumotoraks
2. Mampu menyebutkan beberapa penyebab pneumotoraks yang sering dijumpai
3. Mampu menjelaskan beberapa pembagian jenis pneumotoraks
4. Mampu menyusun rencana penatalaksanaan pasien dengan pneumotoraks
Kasus:
Seorang pasien laki-laki usia 30 tahun datang kePuskesmas tempat anda bertugas dengan
mengeluh sesak nafas tiba-tiba dan sangat berat. Pasien sebelumnya dengan riwayat
menderita penyakit TB paru dan sudah berobat dengan lengkap. Sebelumnya pasien
sempat terbatuk-batuk, kemudian tiba-tiba sesak nafas. Pasien ini tampak sesak dan
sianosis.
Tugas:
Diskusikan mengenai
1. Jelaskan temuan fisik dan foto polos dada yang kemungkinan ditemukan pada
pasien pneumotoraks tersebut
2. Sebutkan beberapa penyebab pneumotoraks yang anda ketahui
3. Bagaimana penatalaksanaan kasus dengan pneumotoraks tersebut ?
LECTURE 18
BRONCHITIS AND BRONCHIECTASIS
dr.Dewa Artika, SpP
LUNG CA AND SMOKING CESSATION
dr. Gede Ketut Sajinadiyasa, SpPD
BRONKITIS dan BRONKIEKTASIS
dr. Dewa Made Artika, SpP
Untuk menentukan suatu Bronkitis dan Bronkiektasis tidaklah terlalu sulit, tapi diperlukan
suatu pemahaman untuk mendiagnosis dan penatalaksanaan Bronkitis dan Bronkiektasis
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dengan baik dan benar. Disamping prevalensinya cukup tinggi, penyakit ini bila tidak
ditangani dengan baik, akan berlanjut menjadi lebih parah.
Bronkitis adalah inflamasi saluran napas sentral yang mengenai mukosa ditandai oleh batuk
dengan dahak, sering disertai dengan panas dan sesak.Bronkiektasis adalah kelainan pada
dinding bronkus besar dan sedang berupa kelemahan otot sehingga terjadi pelebaran
lumen, karena proses infeksi transmural dan pelepasan mediator.
Diagnosis Bronkitis berdasarkan pada anamnesa, pemeriksaan fisik dan foto toraks,
sedang bronkiektasis ditegakkan dengan anamnesa, pemeriksaan fisik, foto toraks, CT
Scan, dan kultur sputum.
Prinsip penatalaksanaan Bronkitis dan Bronkiektasis adalah dengan menghilangkan batuk
dan produksi dahak. Bila disertai tanda infeksi dapat ditambahkan antibiotika. Pada
Bronkiektasis perlu dilakukan Chest Fisioterapi atau bronkoskopi untuk mempermudah
pengeluaran sputum. Pada keadaan eksaserbasi sering disebabkan oleh infeksi apakah
viral atau bakteri.
Obyektif
1. Mampu menjelaskan penegakan diagnosis bronkitis dan bronkiektasis
2. Mampu menyususn program pengobatan jangka panjang
3. Mampu mengidentifikasi pasien dengan keadaan eksaserbasi
4. Mampu memberikan pengobatan awal pasien dengan serangan akut
5. Mampu mengidentifikasi pasien eksaserbasi yang perlu rawat inap dan merujuknya.
Kasus
Seorang penderita laki umur 35 th datang dengan keluhan : batuk berdahak sejak 3 bulan
dan memberat sejak 5 hari yang lalu dan disertai dengan panas badan. Bila diperhatikan
dahaknya ada 3 lapis yaitu dari atas sampai bawah mulai dari yang bening sampai keruh
dan batuknya terutama pagi hari. Dikatakan pula setahun lalu pernah menderita sakit
seperti ini dan kadang disertai sesak napas, bila dahaknya sulit dikeluarkan.
Tugas
Diskusikan
1. Jelaskan bagaimana sdr. Memastikan bahwa pasien tsb. menderita bronkitis
2. Bagaimana sdr membedakan dengan bronkiektasis.
3. Apakah penderita tsb dalam keadaan eksaserbasi, jelaskan
4. Jelaskan prinsip pengobatan pasien dg bronkitis dan bronkiektasis
5. Obat-obat apa saja yang diperlukan pada pasien tsb diatas
6. Apa yang dikerjakan bila sputum pasien tsb diatas sulit dikeluarkan
KANKER PARU (LUNG CANCER)
dr. Gede Ketut Sajinadiyasa, SpPD
Kanker Paru merupakan penyebab kematian tersering diantara kematian oleh karena
kanker di seluruh dunia baik pada laki-laki ataupun perempuan. Insiden kanker paru di
dunia diperkirakan 1,3 juta kasus per tahunnya. Kanker paru terjadi sebagai akibat proses
yang komplek antara paparan karsinogen dan kerentanan genetik. Faktor kebiasaan dan
lingkungan berhubungan dengan terjadinya kanker paru dan merokok merupakan faktor
risiko utama. Jenis histologi kanker paru sebagian besar adalah Small Cell Lung Cancer
(SCLC) dan Non Small Cell Lung Cancer(NSCLC) . NSCLC terdiri atas squamus cell
carcinoma, adeno carcinoma dan large cell carcinoma. Manifestasi klinis dari kanker paru
dapat asimtomatik pada stadium awal dan baru bergejal pada stadium lanjut. Pasien
biasanya datang dengan keluhan batuk, batuk darah, sesak, nyeri dada dan suar serak.
Sering juga dijumpai tanda-tanda syndrome paraneoplastik dan gejala umum seperti
anoreksia, asthenia dan berat badan yang menurun.
Diagnosis kanker paru dapat ditegaknya dengan anamnesis, pemeriksaan fisik dan
pemeriksaan penunjang. Pemeriksaan penunjang yang umum dikerjakan seperti sitologi
sputum, rontgen dada, ct scan toraks, Biopsi(FNAB/TTB), bronkoskopi, PET scan dan
lainnya. Setelah diagnosis ditegakkan dan sebelum memulai pengobatan ditentukan
stadium penyakit dan status performan. Dengan diketahuinya jenis histology dan stadium
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penyakit kemudian ditentukan modalitas terapi. Modalitas terapi pada pasien kanker paru
diantaranya adalah pembedahan, kemoterapi, radiasi dan target terapi
Objektif
1. Mengetahui pathogenesis , faktor risiko dan usaha preventif kanker paru
2. Dapat mengetahui klasifikasi kanker paru
3. Mengetahui proses penegakan diagnosis dan stadium kanker paru
4. Mengetahui modalitas penunjang dalam penegakan diagnosis
5. Mengetahui modalitas terapi kanker paru dan merujuk
Triger
Seorang pasien laki-laki umur 65 tahun datang ketempat pratek saudara sendirian dengan
keluhan batuk berdarah. Satu minggu yang lalu pasien sempat menjalani cek up didapatkan
pada foto rontgen dada, tumor dengan ukuran diameter 2,5 cm pada hilus kiri menempel di
pinggang jantung kiri. Pada pemeriksaan USG abdomen didapatkan tumor multiple ukuran
diameter sekitar 1-1,5 cm pada hati, sedang pemeriksaan yang lain dalam batas normal.
Pasien memiliki kebiasaan merokok sejak umur 20 tahun dengan jumlah 1-2 bungkus per
harinya.
Tugas
1. Apa yang saudara lakukan untuk memastikan diagnosis pasien ini?
2. Kalau diperlukan tindakan invasive, prioritas tindakan yang saudara usulkan?
Jelaskan alasannya!
3. Bila ini kanker paru, apa kemungkinan klasifikasi histologinya?
4. Tentukan stadium pasien ini dan status performannya serta alasannya!
5. Tentukan modalitas terapinya!
LECTURE 19
DISORDERS OF NOSE AND SINUS
dr. Ratna, SpTHT
Abstract
The anatomy of the larynx consist of cart.Haginous framework bound
together by ligaments and covered with muscle and mucous membrane. The most
important cartilage is the arytenoid cartilages which is can rotate and slide on the
cricoid cartilage and thus play an important role in the movement of the vocal cords.
The epiglottis is a leaf-shape cartilage of the larynx which is attached to the base of
the tongue by the glossoepiglottic ligament and inner part of thyroid cartilage. The
thyroid cartilage is that which makes the prominence upon the front of the neck
known as ‘Adam’s apple, particularly visible in man. Interior of the larynx can looking
down by laryngoscopy indirect or direct. The function of the larynx includes
protection of lower respiratory tract and phonation. The protection of respiratory tract
acting by the epiglottis, sensory nerve supply which is produce cough and vocal
cords. Voices or phonation is produce by vocal cords function consist adduction and
abduction movement and vibration of the vocal cords.
Throat
Normal Vocal cord and disorders
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The symptoms of laryngeal disorders are hoarseness, dysphonia and stridor.
Hoarseness is caused by an abnormal flow of air past the vocal cords. The voice is harsh
when turbulence is created by the irregularity of the vocal cords. The irregularity of the vocal
cord caused by vocal nodule, edema of the vocal cord and laryngitis. Dysphonia is
weakness of the voice caused by paresis or paralysis of the vocal cords. And aphonia is
loss of voice. Stridor is a high pitch sound, is produce by lesion that narrowing the airway. If
narrowing of the airway upper the vocal cord produce inspiratory stidor, and if narrowing the
airway below the vocal cord will produce inspiratory and expiratory stridor.
Some lesion will be discussed are vocal cord nodule, vocal cord paralysis, laryngeal
palillomas and gastrolaryngopharyngeal reflux disease. Vocal nodule or Singer’s nodes is
benign lesion in the vocal cord particularly at the site of the junction of the anterior third and
posterior two-thirds of the cord (halfway along the membranous cord). This condition is
caused by misuse of the voice or overuse as well as singers, teachers, priest, actors who
have not undergone formal voice training. Misuse of the voice also happen in the
schoolchildren, sometime call by screamer’s node.
Vocal cord paralysis causes of dysphonia symptom, define as weakness or even
though temporary loss of the voice (aphonia). A vocal cord may paralysed by mechanical
fixation of the arytenoids or vocalis muscle or by nerve paralysis. Paralysis may be unilateral
or bilateral and the cords paralysed in abduction or adduction. Abduction paralysis causes
loss of the voice because the cord can not move to the midline position and adduction
paralysis, the cords can not move to the lateral position and cause severe stridor.
Larengeal papilloma is a benign lesion single or multiple, non keratinizing papilloma
in characteristic is due by infection of human papilloma virus type 6 and 11. Papillomatosis
present more frequently in children than in adult, the peak incidence occurring between 2
and 5 years of age, and very common of high recurrent. Relaps or recurrent may be
precipitated by trauma or immunosuppressive condition.
Gastrolaryngeal reflux is very common condition to causes hoarseness. The
pathology of gastro-esophageal-laryngeal reflux disease may be a result of direct effect of
gastric acid, bile salts or enzymes on mucosa of the larynx.
Learning Tasks
1. Describe and discuss of specific symptoms of the larynx disease & disorders.
2. Describe and discuss etiology and patophysiology of hoarseness, dysphonia and stridor
with its clinical implication
3. Manage and provide initial management or refer patient with certain larynx disease and
disordes
References
1. Textbook Diseases of the Ear, Nose and Throat edited by Martin Burton
CHURCHILL LIVINGSTQNE 15TH ED 2000: Section 5 The Larynx, Pharynx and
Oesophagus. Pp 165-206
2. Textbook Current Medical Diagnosis & Treatment Edited by Lawrence M.Tierney,Jr.
Stephen J.Mc Phee, Maxine A.Papadakis 45 Ed 2006: Diseases of the Larynx p209213
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LECTURE 20
DISORDERS OF PHARYNX AND LARYNX
Prof. Suardana, SpTHT, dr. Dewa Artha Eka Putra, SpTHT
Abstract
The Adenoids (pharyngeal tonsils) are a triangular mass of lymphoid tissue located
on the posterior aspect of the boxlike nasopharynx. The nasopharynx serves as a conduit
for Inspired air and Sinonasal Sections that drain from the nasal cavity into the oropharynx.
a resonance box for for speech and a drainage area for the Eustachian tube — middle ear
mastoid complex.
Adenoid have three types of Surface epithelium ciliated pseudostratified squamous, and
transitional.
The Adenoids and tonsils, like all lymphoid tissue, enlarge when infected. Although
lymphoid tissue does act to fight infection. Some time bacteria and viruses can lodge within
it and survive. Group A B—hemolytic streptococcus (GABHS) is classically described as the
only bacterium implicated frequently in acute Adenoiditis or tonsilitis.
Chronic infection, either viral or bacterial, can keep the pad of adenoids enlarged for
years, even into adulthood. Some viruses, Such as the Epstein Barr virus, can cause
dramatic enlargement of lymphoid tissue.
Clinical classification of the adenoid : Acute adenoiditis, recurrent Acute Adenoiditis,
chronic adenoiditis and obstructive Adenoid Hyperplasia. Clinical classification of the tonsils:
acute tonsillitis, recurrent acute tonsillitis, chronic tonsillitis, and obstructive tonsilar
hyperplasia.
The main symptoms of adenoid diseases is Rhinorhea, chronic nasal obstruction
(associated with Snoring and obligate mouth breathing), malodorous, cough, post nasal
drip, sinusitis, otitis media and a hyponasal voice. The main symptomsof tonsils diseases
are: sore throat, dysphagia, fever, halithosis, muffled voices, snoring, and other symptomsof
sleep disturbance and tender cervical adenopathy.
Adenoiditis is best diagnosed by clinical history, physical examination.
nasopharyngoscopy and Radiography. The physical examination should include both
anterior and posterior rhinoscopy. A lateral neck Radiograph and Sinus Radiography taken
to show soft tissue density, can show the adenoids and sinus. Tonsilitis is diagnosed by
clinical history, physical examination, throat culture, and flexible laryngoscope.
Management of diseases of the adenoids and tonsils: antimicrobial, intranasal
steroids and adenoidectomy. Indications for tonsillectomy and adenoidectomy are
obstruction, infection and Neoplasia.
Learning Tasks
1. Describe and discuss of etiology of adenoid diseases.
2. Explain pathogenesis of adenoid diseases.
3. Describe and discuss of clinical classification of diseases in the adenoids
4. Describe clinical evaluation to support diagnosis of the adenoid diseases.
5. Manage and provide initial management or refer patient with certain adenoid
diseases.
6. Explain indications for adenoidectomy.
7. Describe complications of adenoid diseases and adenoidectomv.
Learning Resources
1. Linda Brodsky. Christhopher Poje. Tonsilitis, Tonsillectomy and Adenoidectomy. In BaiIe
BJ Editor. Head and Neck Surgery-Otolaryngologv 3 ed. Philadelphia Lippincort
Williams and Willkins; 2001 p 979— 991.
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