Study Guide Respiratory Semester VI 16 Pebruari 2015

8/9/2019 Study Guide Respiratory Semester VI 16 Pebruari 2015

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Study Guide The Respiratory System and Disorders

INTRODUCTION

T#e medical curriculum #as become increasingl/ %erticall/ integrated it#

stronger basic concet and suort b/ clinical eamles and cases to #el in t#eunderstanding of t#e rele%ance of t#e underl/ing basic science5 asic science

concets ma/ #el in t#e understanding of t#e at#o#/siolog/ and treatment of

diseases5 )esirator/ s/stem and disorders bloc #as been ritten to tae account

of t#is trend and to integrate core asects of basic science at#o#/siolog/ and

treatment into a single eas/ to use re%ision aid5

T#e resirator/ s/stem consists of a air of lungs it#in t#e t#oracic cage5 Its

main function is gas ec#ange but ot#er roles include seec# filtration of

microt#rombin arri%ing from s/stemic %eins and metabolic acti%ities suc# as

con%ersion of angiotensin I to angiotensin II and remo%al or deacti%ation of

serotonin brad/inin noreine#rine acet/lc#oline and drugs suc# as roranolol

and c#lorroma8ine5 o t#is bloc ill discuss about anatom/ #istolog/ s/mtom

and signs of lung disease and its at#o#/siolog/ ma9or uer resirator/ diseases

ma9or lung diseases ma9or ediatric lung disease and basic rincile concet to

education re%ention treatment and re#abilitation in resirator/ s/stem disorder in

atient famil/ and communit/5

T#e learning rocess ill be carried out for 6 ees (27 oring da/s* starts from

17t# of "arc# 2.14 as s#on in t#e time table5 T#e final eamination ill be

conducted on 2!t# of 'ril 2.14 in t#e form of "C:5 T#e learning situation include

lecture indi%idual learning small grou discussion lenar/ session ractice and

clinical sill5

"ost of t#e learning material s#ould be learned indeendentl/ and discuss in

G b/ t#e students it# t#e #el of facilitator5 Lecture is gi%en to em#asi8e t#e

most imortant t#ing of t#e material5 In small grou discussion t#e students ga%e

learning tas to lead t#eir discussion5

T#is simle stud/ guide need more re%ision in t#e future so t#at t#e lanners

indl/ in%ite readers to gi%e an/ comments and critics for its comletion5 T#an /ou5

Planners

Facult/ of "edicine 0da/ana 0ni%ersit/", 2


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CURRICULUM

RESPIRATORY SYSTEM AND DISORDER

Aims :

• Comre#end t#e structure #/siologic and at#ologic of t#e resirator/ s/stem5

• Interret t#e laborator/ and imaging eamination of t#e resirator/ s/stem

disorders

• iagnose and treat t#e atient it# common resirator/ s/stem disorders

• Plan education re%ention management and re#abilitation of resirator/ s/stem

disorders to atient famil/ and communit/5

Learning outcomes:• Concern about te si!e o" #ro$%em and &i'ersit( o" res#irator( &isease in t#e

communit/

• 'ble to describe t#e structure and function of t#e resirator/ s/stem

• 'ble to interret t#e result of eamination (#/sical laborator/ function test

blood gas anal/sis and c#est imaging*

• 'ble to elore atients it# resirator/ roblem (runn/ nose coug# d/snea

non cardiac c#est ain #emot/sis*

• 'ble to manage ma9or uer resirator/ diseases (tonsillitis r#initis sinusitis*

• 'ble to manage ma9or lung diseases (TC ast#ma C;P lung cancer

neumonia occuational lung disease leural disease* on atient famil/ andcommunit/

• 'ble to manage ma9or ediatric lung disease (bronc#iolitis T ast#ma*

• 'ble to imlement ;T rogram against T

• 'ble to imlement t#e strateg/ of smoing cessation eseciall/ in atient it#

resirator/ disease

Curricu%um contents:• tructural and function of t#e resirator/ s/stem

• P#/siolog/ of lung in related it# o/gen consumtion and acid base balance

•

/mtoms and signs of lung disease• Pat#o#/siolog/ of resirator/ s/stem disorders

• asic #/sical laborator/ and imaging eamination

• Interretation of eamination results5

• rugs t#at commonl/ used in resirator/ s/stem disorders (decongestant anti<

ast#ma & bronc#odilators antitussi%e eectorant

• asic rincile concet to education re%ention treatment and re#abilitation in

resirator/ s/stem disorders in atient famil/ and communit/5



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1! dr5 Lu# "ade )atnaati5T@T(>L*

;tor#inolar/ngolog/ .!123!.61.!

1! dr5 Putu 'ndria 5PIC Pulmonolog/ .!123+!+1+2

1+ dr5 Gede >etut a9inadi/asa5P

Pulmonolog/ .!-237.6!67.

2. dr5 ?inarti 5P' Pat#olog/ 'natomi .!7!624-743!

21 Prof5 uardana 5T@T ;tor#inolar/ngolog/ .!113!-2++



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) FACILITATORS )

Regu%ar C%ass *C%ass A+

No Name ,rou# De#artement Pone-enue

*.r& "%oor+

1dr5 Firman Parulian itanggang5)ad(>*)I

'1)adiolog/ .!133716--66 2nd floor

)525.+

2dr5 T9o5 Istri 'nom aturti5P '2

Interna .!1+162-3777 2nd floor)52511

3dr5 I ?a/an Gede utadarma" Gi8i '3

ioc#emistr/ .!2144.7126! 2nd floor)52512

4dr5 Aenn/ >andarini 5P<>G@ed '- 'ndrolog/ .!133!6.-.!7 2nd floor)52514

6dr5 I ?a/an ?eta "

'6Public @ealt# .!1337..-36. 2nd floor

)5251-

7dr5 I '5 ri Indra/ani 5

'7=eurolog/ .!12467-1-36 2nd floor

)52516

!dr5 T9oorda Gde ;a "5P> '!

ClinicalPat#olog/

.!1+++4-..4- 2nd floor)5252.

+dr5 ?a/an ?esta 5>D (>*

'+Ps/c#iatr/ .!1+161-76-! 2nd floor

)52521

1.

dr5 Auliana " iomed

'1.

'natom/ .!-7+26-2363 2nd floor

)52522

Eng%is C%ass *C%ass B+

No Name ,rou# De#artement Pone-enue

*/r& "%oor+

1dr5 I ?a/an urudarma "i

1ioc#emistr/ .!133!4!6-!+ 2nd floor

)525.+

2dr5 udut )ust/adi 5F

2Forensic .!1!6-1.1- 2nd floor

)52511

3r5dr5 Coorda agus Da/aLesmana 5>D 3

Ps/c#iatr/ .!162+-77+ 2nd floor)52512

4r5dr5 Ida agus Gede Fa9ar"anuaba 5;G"') 4

;bg/n .!1--!1.171+ 2nd floor)52513

-dr5 "ade 'gus @endra/ana "5>ed -

"icrobiolog/ .!133+1-!241 2nd floor)52514

6r5dr5 =i =/oman ri uda/anti5">(>* 6

"icrobiolog/ .!--37113+! 2nd floor)5251-

7r5dr5 Gde =gura# IndragunaPinati# "5c '55G> 7

Public @ealt# .!123!16424 2nd floor)52516

!r5dr5 I ?a/an ud#ana 5P<>G@


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1.r5dr5 T9oorda Gde agus"a#adea "5>es5 1.

urger/ .!1!4!46-4 2nd floor)52522

,ENERAL TIME TABLE

FOR A AND B CLESSES

CLASS A CLASS B

TIME ACTI-ITIES TIME ACTI-ITIES.!5..


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IMPORTANT INFORMATIONS

Meeting o" te stu&ents re#resentati'e

In t#e middle of bloc sc#edule a meeting is designed among t#e student

reresentati%es of e%er/ small grou discussions facilitators and resource ersons5 T#e

meeting ill discuss t#e ongoing teac#ing learning rocess Eualit/ of lecturers and

facilitators as a feedbac to imro%e t#e net rocess5 T#e meeting ill be taen based on

sc#edule from "edical ,ducation 0nit5

SELF ASSESSMENT

elf assessment of eac# lecture ill be gi%en after eac# lecture session and ill be

mared5 T#is mar can determine #et#er t#e student ass t#is bloc or not5 'n/ final mar

beteen 6- to 6+ ill be reconsidered it# self assessment$s mar to see t#e student$s

status5 'n/ student it# self assessment$s mar more t#an 7. ill ass t#is bloc5 'nd for

t#e loer one ill #a%e to attend t#e remedial eamination5 It is imortant to do t#is self

assessment cautiousl/ because t#is acti%it/ ma/ be /our ticet to ass t#is bloc5

ASSESSMENT MET;ODAssessment in tis teme consists o":

G -

Final ,am !.

tudent Pro9ect 1-

Final mar more t#an 7. considered to ass t#is bloc5 Certain conditions alied for t#ose

it# final mar beteen 6- 6+5 T#ese students ill be anal/8ed using t#eir self

assessment$s mar5 tudents it# final mar 6- 6+ and self assessment$s mar more t#an

7. ill also considered ass t#is bloc5



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TIME TABLERE,ULAR CLASS

DAY

.!5..


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=Tues&a(Fe$ .13 .27>

.!5..


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77Tues&a(Marc /3

.27>

.!5..


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Bisit145..

.!5..

.!5..

.!5..

.!5..


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Marc 7=3.27>

.+5..

.!5..Mon&a(

Marc ./3.27>

.!5..


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TIME TABLEEN,LIS; CLASS

DAY

.+5..


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?i#andani

=Tues&a(

Fe$ .13 .27>

.+5..


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.27>

125..

.+5..


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1153.

.+5..

.!5..

.+5..


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.2Mon&a(

Marc 7=3 .27>

.+5..

.!5..

.!5..


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.8?e&nes&a(

Marc .>3 .27>Eamination

LEARNIN, PRO,RAMSLECTURE 7

ANATOMY OF RESPIRATORY TRACT

A$stract

dr5 I =/oman Gede ?ardana "5iomed

T#e resirator/ s/stem consists of conducting 8one and resirator/ 8one5

Conducting 8one #ose alls are too t#ic to ermit ec#ange of gases beteen t#e air in

t#e tube and t#e blood stream5 T#e nostrils (nares* nasal ca%it/ #ar/n lar/n trac#ea

bronc#i and terminal bronc#ioles are included in t#is 8one5 )esirator/ 8one #ose alls

are t#in enoug# to ermit ec#ange of gases beteen tube and blood caillaries

surrounding t#em5 'ir tra%els to t#e lungs t#roug# t#at 8one5 T#e rig#t lung di%ided into

t#ree lobes suerior middle and inferior5 T#e left lung di%ided into to lobes suerior and

inferior5 ,ac# lung co%er b/ a membrane t#at called leura5 ot# lungs are inside t#e

t#oracic cage5 T#e t#oracic cage is formed b/ t#e %ertebral column be#ind t#e ribs and

intercostal saces on ot#er side and t#e sternum and costal cartilages in front5 elo it

searated from t#e abdominal ca%it/ b/ dia#ragm

Learning Tas

Bignette 1

>esaa 32 /ears old as seen in t#e clinic ten da/s ago as diagnosed it# r#initis and

sent #ome it# instructions for increased fluids decongestants and rest5 >esaa resents

toda/ it# orsened s/mtoms of malaise lo


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"ande 3. /ears old male came to clinic it# c#ief comlaint difficult/ to breat# start from

t#is morning5 @e also suffers coug# runn/ nose and fe%er5 @e #as #istor/ bronc#ial ast#ma

#en #e as 2 /ears old5 T#e doctor diagnose #e is suffering bronc#ial ast#ma515 escribe t#e structure of trac#ea

25 escribe t#e different beteen rig#t and left main bronc#us35 escribe t#e rincial different beteen trac#ea bronc#i and bronc#ioles

Bignette 4

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T#e lungs are laced it#in t#e t#oracic ca%it/5 T#e lungs contain aira/s structure

%essels l/m#atic and l/m# nodes ner%es and suorti%e connecti%e tissue5 T#e trac#ea

di%ides and form t#e left and rig#t rimar/ bronc#i #ic# in turn di%ide to form lobar bronc#i5

,ac# lobar bronc#i di%ide again to gi%e segmental bronc#i to sul/ air to

bronc#oulmonar/ segments5 T#e trac#eobronc#ial tree can also be classified into to

functional 8ones t#e conducting 8one (roimal to t#e resirator/ bronc#ioles* #ic#

in%ol%ed in air mo%ement and t#e resirator/ 8one (distal to t#e terminal bronc#ioles* #ic#

in%ol%ed in gaseous ec#ange5

T#e ot#er term to s#o functional structure of t#e loer resirator/ tract is t#e

acinus5 T#e acinus defined as t#e art of t#e aira/ t#at is in%ol%ed in gaseous ec#ange5

T#e acinus consist of resirator/ bronc#ioles al%eolar ducts and al%eoli as t#e smallest

functional structure of t#e lung5 T#e areas of lung containing grous of beteen t#ree to fi%e

acini surrounded b/ arenc#imal tissue are called lung lobules5

T#e al%eolus is an blind


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35escribe t#e #istological structure of t#e interal%eolar setum

45escribe t#e #istological structure of blood


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LEARNIN, TAS



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&r4 Mu%iarta3 Mes

15 ?#at is t#e seEuence of e%ent during Euiet insiration (muscle in%ol%ement

ressure c#anges (intraulmonar/ and intraleura* %olume c#anges*

25 ?#at is ulmonar/ %entilation and al%eolar %entilation meansH

35 'ndi male 3. /ears old #as a uncture ound due to car accident in #is rig#t c#est

and enetrate #is leural ca%it/5 T#e atient #as comlained s#ortness of breat#ing and

doctor determine t#at #is lung is collased5

a5 ?#at is t#is condition calledH

b5 escribe t#e mec#anism of t#e lung collase

c5 ?#at ind resirator/ s/stem comensation to anticiate t#is condition (lung

collase*

d5 @o can #e still be ali%e in t#is conditionH45 escribe t#e o/le$s La

LECTURE 1

P;YSIOLO,Y OF RESPIRATORY SYSTEM: ,AS EC;AN,E3 DI-IN,3

ALTITUDE

&r4 I Ma&e Mu%iarta3 Mes

A$stract

Gas ec#ange during eternal resiration occurs in resirator/ membrane5 e%eral

factors ma/ influence gas ec#ange5 alton$s la and @enr/$s la ma/ al/ during gas

ec#ange5

ome #/siologic resonses on resirator/ s/stem at #ig# altitude and during di%ing5

ome illnessesJin9uries related ressure c#ange ma/ occurs at #ig# altitude and during

di%ing5

LEARNIN, TAS

&r4 Mu%iarta3 Mes

15 escribe t#e alton$s La

25 escribe t#e factors t#at influence o/gen diffusion from al%eoli into t#e blood

35 Predict t#e resonse of t#e ulmonar/ arterioles and bronc#ioles #en P;2 increase

and PC;2 decrease

45 escribe some illnessesJin9uries due to #ig# altitude

-5 escribe some illnessesJin9uries due to di%ing

LECTURE >



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CARRIA,E OF OY,EN AND CARBON DIOIDE

&r4 Desa ?ian&ani

A$stractGas Transort

T#e sul/ of o/gen to t#e tissues is our most immediate #/sical need5 ?e tae in about

2-. ml of o/gen gas er minute and t#is is our most ressing #/sical need5 If our o/gen

sul/ is interruted for more t#an a fe minutes irre%ersible damage is done to some

tissues notabl/ t#e brain5 ;/gen is abundantl/ a%ailable in t#e air around us but cannot

diffuse into our tissues at sufficient rate to meet our needs5 It must be transorted from t#e

lung t#e seciali8ed organ for gas ec#ange b/ t#e blood to all t#e ot#er tissue5

?#ile o/gen #as to be transorted from lungs to tissues carbon dioide must betransorted from t#e tissues for ecretion b/ t#e lungs5 Carbon dioide #as #/sicoc#emical

roerties t#at mae its transort less difficult t#en transort of o/gen5 Carbon dioide can

be transorted in t#e blood in t#ree a/s in simle solution b/ re%ersible con%ersion to

bicarbonate and b/ re%ersible combination it# #aemoglobin to form carbamino

#aemoglobin5

LEARNIN, TAS:

15 escribe t#e structure and function of #emoglobin

25 escribe t#e mec#anism of o/gen binding to #emoglobin

35 escribe t#e differences beteen #emoglobin and m/oglobin

45 escribe t#e mec#anism of o/gen binding to m/oglobin

-5 escribe conformational differences beteen deo/genated and o/genated @b

65 ummari8e t#e rocesses b/ #ic# carbondioide is transorted from eri#eral

tissues to t#e lungs

LECTURE =



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15 "etabolic demands of t#e bod/ (metabolic control*


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neolasms5 ome distincti%e t/es are naso#ar/ngeal angiofibroma inonasal

(c#eiderian* Pailloma ;lfactor/ =euroblastoma and =aso#ar/ngeal Carcinoma5

Classification of loer resirator/ tract (lung* diseases can be made based on t#e result of

lung function test alt#oug# some aut#ors refer etiolog/ and at#ogenesis bacground5

ome imortant diseases are obstructi%e lung disease (ast#ma C;P bronc#iectasis* and

restricti%e lung disease (')* and also infections diseases of %ascular origin and tumors5

Pleura as rotecti%e structure of t#e lungs are sometimes in%ol%ed as secondar/

comlication of some underl/ing disease but in rare case can be rimar/5

ecause of t#e comleit/ of resirator/ disease it is imortant to understand t#eir

at#ogenesis suorted b/ recogni8ing t#eir mor#ologic c#anges5

LEARNIN, TAS

Case 7

' male atient 16 /ear old came to a doctor it# c#ief comlaint difficulties in breat#ing5 It

#as occurred since 1 mont# ago5 T#is atient suffers from r#initis alergica since #e as 3

/ear old5 ;n #/sical eamination a edunculated nodule in rig#t nasal ca%it/ as found5 It

as #itis# in color 15- cm in diameter occluding t#e nasal ca%it/5

15 ased on clinical finding #at is t#e most ossible diagnosisH25 ?#at are t#e sH

35 escribe t#e mor#ological aearance (macrosco/ and microsco/* t#atsuosed to be found to confirm /our diagnosis

45 ,lain t#e at#ogenesis of t#is diasease

Case .

' male atient 6- /ear old #as suffered from d/snea and roducti%e coug# since 1 /ear

ago5 Lung function test s#oed increased of F,B1 it# normal FBC (confirm an obstructi%e

lung disease*5 @e is a #ea%/ smoer since #e as 2- /ear old5 =o #istor/ of ato/5 =o

e%idence of cardiac disorders5

'5 "ention 4 diseases including in t#e sectrum of obstructi%e lung disease5 ,lain t#eir at#ogenesisC5 istinguis# t#eir mor#olog/

Case /

' female atient -. /ear old #as suffered from tumor of rig#t lung it# leural effusion5 's

t#e first ste to confirm t#e diagnosis doctor ased t#e atient to do c/tolog/ test5

'5 "ention some c/tolog/ test can be c#oose for t#is atient5 'mong t#e test mention abo%e ('* #ic# one is t#e most simle and non


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LECTURE 5

LUN, DEFENCE MEC;ANISM

&r4 Ni ?a(an ?inarti3 S#PA

A$stract

)esirator/ tract is an organ t#at constantl/ eosed b/ contaminated air5 It is t#ere

fore a small miracle t#at t#e normal lung arenc#/ma remains sterile5 Fortunatel/ a

let#ora of immune and non immune defense mec#anisms eist in t#e resirator/ s/stem

etending from t#e naso#ar/n all t#e a/ into al%eolar airsaces5

T#e ma9or categories of defense mec#anisms to be discussed include (1*#/sical

or anatomic factors related to deosition and clearance of in#aled materials (2*antimicrobial

etides (3* #agoc/tic and inflammator/ cells t#at interact it# in#aled materials

(4*adati%e immune resonse #ic# deends on rior eosure to recogni8e t#e foreign

materials5 ,ac# comonents aears to #a%e a distinct role but a tremendous degree of

redundanc/ and interaction eists among different comonents5

'n/ condition breas don t#e lung defense mec#anism ma/ result in lung in9ur/

and resirator/ tract infections

Learning Tass

15 efense mec#anism of t#e lung and resirator/ tract ca be di%ided into four

ma9or categories5 "ention t#em t#eir comonents and elain #o eac# of t#em

acts against foreign materials5

25 ,lain about diseases or conditions t#at brea t#e lung defense mec#anism

don #ic# result in increase suscetibilit/ to resirator/ tract infections

LECTURE 72

P;ARMACOLO,ICAL AND NON P;ARMACOLO,ICAL INTER-ENSION I



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Pro"4 &r4 ,M Aman

A$stractDrugs "or coug3 rinitis3 astma $roncia%e

Coug# is a rotecti%e refle mec#anism t#at remo%es foreign material and secretionsfrom t#e bronc#i and bronc#ioles5 It can be inaroriatel/ stimulated b/ inflammation in t#eresirator/ s/stem or b/ neolasia5 In t#ese cases antitussi%e (coug# suressant* drugsare sometimes used5 It s#ould be understood t#at t#ese drugs merel/ suress t#es/mtom it#out influencing t#e underl/ing condition5 In coug# associated it#bronc#iectasis or c#ronic bronc#itis antitussi%e drugs can cause #armful sutum t#iceningand retention5 T#e/ s#ould not be for t#e coug# associated it# ast#ma5

"ost drugs used in r#initis are effecti%el/ relief t#e s/mtom of r#initis not affect t#eunderl/ing disease5 =o drug can relief s/mtom comletel/5 rugs are more effecti%e for allergic r#initis t#an non allergic r#initis and acute form of allerg/ resond more fa%orablet#an c#ronic form of allerg/5 T#e most common drugs used for r#initis are anti#istaminenasal disodium cromogl/cate nasal decongestant antic#olinergic intranasal corticosteroid5

ronc#ial 'st#ma is a disease c#aracteri8ed b/ aira/ inflammation edema andre%ersible bronc#osasm5 ronc#odilator and anti


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Pro"4 &r4 ,M Aman

Tas Da( 77If t#e atient come it# coug# breat#less and in /our eamination /ou found

#ee8ing5 'fter #/sical eamination /ou diagnosed 'cute attac of bronc#ialast#ma515 C#ose t#e drug of first c#oice for t#is atient25 List t#e side effects of t#is drug35 Comare t#e effect of t#is drug it# almeterol45 T#eo#/llin is a bronc#odilator but #as a narro safet/ margin5 List t#e side

effects & toic effect of T#eo#/llin5-5 Iratroium not as effecti%e as albutamol in treating bronc#ial ast#ma5 ?#at is

t#e main use of Iratroium65 Cromol/n and =edocromil are often used for 'st#ma bronc#ial5 escribe t#e

mec#anism of action of Cromol/n (isodium Cromogl/cate*75 To decrease t#e side effet of Corticosteroid in ast#ma atient Corticosteroid

often use as in#aled Corticosteroid5 ?#at are t#e side effect of in#aledCorticosteroid

15 List t#e anticoug# t#at are contraindicated in acute ast#ma attac525 If /ou need anticoug# #at drug /ou gi%e best

LECTURE 7.

RESPIRATORY IMA,IN,

&r4 E%(santi3 S#4Ra&

A$stract

T#e imaging in%estigations of t#e c#est ma/ be considered under t#e folloing #eading

15 imle < )a/5(con%entional


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25 Pleural disease


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T#ere are #ig#er incidence of #ee8ing and ast#ma in c#ildren it# #istor/ of

bronc#iolitis5 Pooled #/erimmune )B intra%enous immunoglobulin ()B


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atient tuberculosis close to t#em5 T#e tubercle bacilli multil/ initiall/ it#in al%eoli and

al%eolar duct5 "ost of bacilli are illed but some sur%i%e it#in nonacti%ated macro#ages

#ic# carr/ t#em t#roug# l/m#atic %essels to t#e regional l/m# nodes5 ?#en t#e rimar/

infection is t#e lung t#e #ilar l/m# nodes ussual/ are in%ol%ed5 T#e rimar/ comle of

tuberculosis includes local infection at t#e ortal of entr/ ( rimar/ focus* and t#e regional

l/m# nodes t#at drain t#e area5 uring t#e de%eloment of t#e rimar/ comle tubercle

bacilli are carried to most tissues of t#e t#e bod/ t#roug# t#e blood and l/m#atic

%essels5Pulmonar/ tuberculosis t#at occurs more t#an a /ear4 after t#e rimar/ infection is

usuall/ caused b/ endogenous regrot# of bacilli ersisting in artiall/ encasulated

lesions5 T#e ma9orit/ of c#ildren it# tuberculosis infection de%elo no signs or s/mtoms at

an/ time5 ;ccasionall/ infection is mared b/ lo grade fe%er and mild coug# and rarel/ b/

#ig# fe%er coug# malaise and flu lie s/mtoms5 e%eral drugs are used to effect a

relati%el/ raid cure and re%ent t#e emergence of secondar/ drug resistance during

t#era/5 T#e standard t#era/ of intrat#oracic tuberculosis (ulmonar/ disease andJor #ilar

l/m#adenoat#/* in c#ildren recommended b/ t#e CC and ''P is 6 mont# regiment of

isonia8id (I=@* rifamin ()IF* sulemented in t#e first 2 mont# of treatment b/

/ra8inamide (P'*5

Learning Tass

In ;utatient Clinic eartment of Pediatric t#e bab/ 1. mont# of age carried b/ t#emot#er it# t#e c#ief comlaint is loss of eig#t since 3 mont# suffered lo grade fe%er

c#ronic coug# malaise and flu lie s/mtoms5 T#e grandfat#er #om as diagnosed

ulmonar/ tuberculosis and s#e #as been in recent closed contact5 In #/sical eamination

found t#at t#ere ere enlargement of nec l/m# nodes5

Learning Resources

=elson Tetboo of Pediatrics ,d5 17 t# 2..4 +-!

PULMONARY TB AND ETRAPULMONARY TB



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TB IN T;E IMMUNOCOMPROMISED ;OST

&r4 IB Suta3 S#P an& &r4 Bagia&a3 S#PD

PULMONARY TB AND ETRAPULMONARY TB&r4 IB Suta3 S#P

A$stract

?@; estimates t#at about +527 million ne cases in 2..7 comared it# 2524

million cases in 2..6 it# 44 or 451 million cases of t#e infectious cases (sutum

smear ne cases it# ositi%e*5 T roblem in Indonesia is a national roblem t#e case

is increasing and increasingl/ concerned it# t#e increasing @IB infection and 'I are

raidl/ groing emergence of multinoing t#e microbiolog/ eidemiolog/ and at#ogenesis of tuberculosis



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25 >noing t#e clinical s/mtoms clinical and radiological signs of ulmonar/ T and

etra


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T adala# en/ait infesi ronis /ang disebaban ole# M.tuberculosis5 Temat masu dan

target organ terban/a adala# aru5 ;rang /ang terinfesi M.tuberculosis #an/a sebagian

ecil /ang men9adi sait T dan sebagian besar tida men9adi sait (latensi*5 ;rang /ang

tida sait (latensi* aan men9adi sait (reati%asi* atau T atif bila ter9adi enurunan da/a

ta#an tubu# atau imunitas (imunoomromais*5 ecara umum linis T ditandai dengan

batu


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Trigger

'nda sebagai seorang doter /ang beer9a di sebua# Pusemas datang seorang asien

lai


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'ira/ #/er resonsi%eness is non as t#e denominator underl/ing all

form of ast#ma5 T#e basis of t#is abnormal bronc#ial resonse is not full/

understood5 "ost current e%idence suggests t#at bronc#ial inflammation is t#e

substrate for t#is #/er resonsi%eness manifested b/ t#e resence of inflammator/cells and b/ damage of bronc#ial eit#elium5 In etrinsic (allergic* ast#ma bronc#ial

inflammation is caused b/ t/e I #/ersensiti%it/ reactions but in intrinsic ast#ma

t#e cause is less clear5 Incriminated in suc# cases are %iral infections of t#e

resirator/ tract and in#aled air ollutant suc# as sulfur dioide o8one and nitrogen

dioide5

O$eti":

15 "amu men9elasan enegaan diagnosis asma25 "amu men/usun rogram engobatan 9anga an9ang asma35 "amu mengidentifiasi asien dengan serangan asma aut545 "amu memberian engobatan aal asien dengan serangan asma aut5-5 "amu mengidentifiasi asien asma aut /ang erlu eraatan ina di

ruma# sait dan meru9un/a

Triger:

'nda sebagai seorang doter /ang beer9a di sebua# Pusesmas ota datang

seorang asien anita usia 36 ta#un5 ia men/amaian ba#a tela# menderita

asma se9a usia rema9a5 alam 3 bulan tera#ir ini dia mengalami serangan asma

#amir setia 3 #ari termasu serangan di malam #ari5 0ntungn/a ata asien

serangan asman/a daat diatasi dengan obat semrot /ang dia milii5 Pasien

menginginan agar terbebas dari en/aitn/a ini5

Tugas:

isusian

15 Delasan bagaimana dr5 memastian ba#a asien tersebut memang

menderita asma25 'aa# asma asien tersebut dalam eadaan terontrolH Delasan35 'aa# in#aler /ang diergunaan ole# asien tersebut termasu e dalam

elomo elega (relie%er*H Delasan erbedaan fungsi antara relie%er dan

controller dan sebutan obat


40/50


65 Delasan reteria serangan asma aut berat

LECTURE 7=C;RONIC OBSTRUCTI-E PULMONARY DISEASE

&r4 I,N Bagus Artana3 S#PD

C#ronic ;bstructi%e Pulmonar/ isease (C;P* is a disease state c#aracteri8ed b/ airflo

limitation t#at is not full/ re%ersible5 C;P is t#e fourt# leading cause of deat# in t#e orld

and t#e number of atients is ro9ected to increase orldide in t#e future5 Tobacco

accounts for an estimate of +. to t#e ris of de%eloing C;P5 Patient it# C;P first

comlaining c#ronic coug# it# sutum and folloed b/ d/snea5 T#is condition orsening

rogressi%el/ until t#e atient unable to do #is dail/ acti%ities5

Treatment aim for C;P is to decrease s/mtom it#out stoing t#e rogression

of t#is disease5 Pre%ention is more imortant in t#is condition suc# as b/ smoing cessation

rogram5

O$eti":

15 "amu men9elasan enegaan diagnosis PP;> serta enilaian ombinasi asien

25 "amu men/usun rencana engobatan ada asus PP;> stabil

35 "amu menangani factor risio asien PP;>

45 "amu menentuan esaserbasi aut dari PP;>

-5 "amu men9elasan mana9emen gaat darurat asien dengan PP;>

esaserbasiaut

asus:

eorang asien lai


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35 ebutan dan 9elasan obat stabil

45 agaimana anda men/usun rencana enatalasanaan asien ini secara

omre#ensifH

5. agaimana enatalasanaan asien ini aabila mengalaami PP;> esaserbasi

autH

LECTURE 78

PLEURAL EFFUSION

&r4 Putu An&ria3 S#PD6IC

PNEUMOT;ORA

&r4 Yasa3 S#BT-

PLEURAL EFFUSION

&r4 Putu An&ria3 S#PD6IC

"embran tiis leura terdiri dari dua laisan /aitu leura %isceralis dan leura

arietalis5 Penumuan cairan melebi#i 9umla# fisiologis 1.


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Triger:

eorang anita muda datang dengan elu#an sesa nafas /ang semain memberat se9a

seminggu5 Pada emerisaan fisi didaatan freensi nafas 24Jmnt su#u tubu# 37- o

C emerisaan tora asimetris anan tertinggal erusi redu dan suara nafas melema#

di bagian anan baa#5 Penderita 9uga mengelu# batu batu se9a 3 bulan /ang lalu dan

erna# batu berisi dara# segar sediit 9uga nama semain urus5

Tugas:

isusian

15 'aa# emunginan en/ebab elu#an asien tersebutH

25 Pemerisaan enun9ang aa /ang dierluanH

35 Perlua# melauan arasentesisH (9elasan*

45 Perlua# emasangan ? aa alasann/aH

PNEUMOTORAS

&r4 Yasa3 S#BT-

Pneumotoras meruaan sala# satu egaatdaruratan di bidang aru /ang berarti

terisin/a rongga leura ole# udara5 Pneumotoras ini erlu mendaatan er#atian serius

arena dengan enanganan /ang ceat dan teat aan sangat mengurangi anga

ematiann/a5 ebagai seorang doter /ang ada di fasilitas ese#atan rimer sangat

dierluan engeta#uan mengenai eadaan ini5

iagnosis neumotoras daat ditegaan dari anamnesis emerisaan fisi dan foto

olos dada5 Pneumotoras daat dibagi berdasaran berbagai riteria tetai /ang aling

sering adala# dibagi menurut ter9adin/a (neumotoras artifisial traumatic serta sontan*

serta berdasaran 9enis fisteln/a (neumotoras terbua tertutu dan %entil*5

eberaa ondisi neumotoras aan sangat mengancam n/aa se#ingga memerluan

enanganan /ang teat dan segera5 Penatalasanaan neumotoras ada rinsin/a

adala# mengeluaran udara /ang ada di rongga leura tersebut terai en/ebabn/a serta

eduasi untu mencega# berulangn/a neumotoras ada asien /ang memilii risio5

O$eti":

15 "amu men9elasan enegaan diagnosis neumotoras

25 "amu men/ebutan beberaa en/ebab neumotoras /ang sering di9umai

35 "amu men9elasan beberaa embagian 9enis neumotoras

45 "amu men/usun rencana enatalasanaan asien dengan neumotoras

asus:



43/50


eorang asien lai


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ronietasis erlu dilauan C#est Fisioterai atau bronosoi untu memermuda#

engeluaran sutum5 Pada eadaan esaserbasi sering disebaban ole# infesi aaa#

%iral atau bateri5

O$(eti"

15 "amu men9elasan enegaan diagnosis bronitis dan bronietasis25 "amu men/ususn rogram engobatan 9anga an9ang35 "amu mengidentifiasi asien dengan eadaan esaserbasi45 "amu memberian engobatan aal asien dengan serangan aut-5 "amu mengidentifiasi asien esaserbasi /ang erlu raat ina dan meru9un/a5

asus

eorang enderita lai umur 3- t# datang dengan elu#an batu berda#a se9a 3 bulan

dan memberat se9a - #ari /ang lalu dan disertai dengan anas badan5 ila dier#atian

da#an/a ada 3 lais /aitu dari atas samai baa# mulai dari /ang bening samai eru#

dan batun/a terutama agi #ari5 iataan ula seta#un lalu erna# menderita sait

seerti ini dan adang disertai sesa naas bila da#an/a sulit dieluaran5

Tugas

isusian

15 Delasan bagaimana sdr5 "emastian ba#a asien tsb5 menderita bronitis25 agaimana sdr membedaan dengan bronietasis535 'aa# enderita tsb dalam eadaan esaserbasi 9elasan45 Delasan rinsi engobatan asien dg bronitis dan bronietasis-5 ;bat


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iagnosis aner aru daat ditegan/a dengan anamnesis emerisaan fisi dan

emerisaan enun9ang5 Pemerisaan enun9ang /ang umum dier9aan seerti sitologi

sutum rontgen dada ct scan toras iosi(F='JTT* bronosoi P,T scan dan

lainn/a5 etela# diagnosis ditegaan dan sebelum memulai engobatan ditentuan

stadium en/ait dan status erforman5 engan dieta#uin/a 9enis #istolog/ dan stadium

en/ait emudian ditentuan modalitas terai5 "odalitas terai ada asien aner aru

diantaran/a adala# embeda#an emoterai radiasi dan target terai

O$eti"

15 "engeta#ui at#ogenesis fator risio dan usa#a re%entif aner aru25 aat mengeta#ui lasifiasi aner aru35 "engeta#ui roses enegaan diagnosis dan stadium aner aru45 "engeta#ui modalitas enun9ang dalam enegaan diagnosis-5 "engeta#ui modalitas terai aner aru dan meru9u

Triger

eorang asien lai


46/50


of t#e lar/n #ic# is attac#ed to t#e base of t#e tongue b/ t#e glossoeiglottic ligament

and inner art of t#/roid cartilage5 T#e t#/roid cartilage is t#at #ic# maes t#e rominence

uon t#e front of t#e nec non as 'dam$s ale articularl/ %isible in man5 Interior of t#e

lar/n can looing don b/ lar/ngosco/ indirect or direct5 T#e function of t#e lar/n

includes rotection of loer resirator/ tract and #onation5 T#e rotection of resirator/

tract acting b/ t#e eiglottis sensor/ ner%e sul/ #ic# is roduce coug# and %ocal cords5

Boices or #onation is roduce b/ %ocal cords function consist adduction and abduction

mo%ement and %ibration of t#e %ocal cords5

Troat

Norma% -oca% cor& an& &isor&ers

T#e s/mtoms of lar/ngeal disorders are #oarseness d/s#onia and stridor5@oarseness is caused b/ an abnormal flo of air ast t#e %ocal cords5 T#e %oice is#ars# #en turbulence is created b/ t#e irregularit/ of t#e %ocal cords5 T#eirregularit/ of t#e %ocal cord caused b/ %ocal nodule edema of t#e %ocal cord andlar/ngitis5 /s#onia is eaness of t#e %oice caused b/ aresis or aral/sis of t#e%ocal cords5 'nd a#onia is loss of %oice5 tridor is a #ig# itc# sound is roduce b/lesion t#at narroing t#e aira/5 If narroing of t#e aira/ uer t#e %ocal cordroduce insirator/ stidor and if narroing t#e aira/ belo t#e %ocal cord illroduce insirator/ and eirator/ stridor5

ome lesion ill be discussed are %ocal cord nodule %ocal cord aral/sislar/ngeal alillomas and gastrolar/ngo#ar/ngeal reflu disease5 Bocal nodule or inger$s nodes is benign lesion in t#e %ocal cord articularl/ at t#e site of t#e 9unction of t#e anterior t#ird and osterior to


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training5 "isuse of t#e %oice also #aen in t#e sc#oolc#ildren sometime call b/screamer$s node5

Bocal cord aral/sis causes of d/s#onia s/mtom define as eaness or e%en t#oug# temorar/ loss of t#e %oice (a#onia*5 ' %ocal cord ma/ aral/sed b/mec#anical fiation of t#e ar/tenoids or %ocalis muscle or b/ ner%e aral/sis5

Paral/sis ma/ be unilateral or bilateral and t#e cords aral/sed in abduction or adduction5 'bduction aral/sis causes loss of t#e %oice because t#e cord can notmo%e to t#e midline osition and adduction aral/sis t#e cords can not mo%e to t#elateral osition and cause se%ere stridor5

Larengeal ailloma is a benign lesion single or multile non eratini8ingailloma in c#aracteristic is due b/ infection of #uman ailloma %irus t/e 6 and115 Paillomatosis resent more freEuentl/ in c#ildren t#an in adult t#e eaincidence occurring beteen 2 and - /ears of age and %er/ common of #ig#recurrent5 )elas or recurrent ma/ be reciitated b/ trauma or immunosuressi%econdition5

Gastrolar/ngeal reflu is %er/ common condition to causes #oarseness5 T#eat#olog/ of gastro


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for Insired air and inonasal ections t#at drain from t#e nasal ca%it/ into t#e oro#ar/n5

a resonance bo for for seec# and a drainage area for t#e ,ustac#ian tube M middle ear

mastoid comle5

'denoid #a%e t#ree t/es of urface eit#elium ciliated seudostratified sEuamous and

transitional5

T#e 'denoids and tonsils lie all l/m#oid tissue enlarge #en infected5 'lt#oug#

l/m#oid tissue does act to fig#t infection5 ome time bacteria and %iruses can lodge it#in

it and sur%i%e5 Grou ' M#emol/tic stretococcus (G'@* is classicall/ described as t#e

onl/ bacterium imlicated freEuentl/ in acute 'denoiditis or tonsilitis5

C#ronic infection eit#er %iral or bacterial can ee t#e ad of adenoids enlarged for

/ears e%en into adult#ood5 ome %iruses uc# as t#e ,stein arr %irus can cause

dramatic enlargement of l/m#oid tissue5

Clinical classification of t#e adenoid 'cute adenoiditis recurrent 'cute 'denoiditis

c#ronic adenoiditis and obstructi%e 'denoid @/erlasia5 Clinical classification of t#e tonsils

acute tonsillitis recurrent acute tonsillitis c#ronic tonsillitis and obstructi%e tonsilar

#/erlasia5

T#e main s/mtoms of adenoid diseases is )#inor#ea c#ronic nasal obstruction

(associated it# noring and obligate mout# breat#ing* malodorous coug# ost nasal

dri sinusitis otitis media and a #/onasal %oice5 T#e main s/mtomsof tonsils diseases

are sore t#roat d/s#agia fe%er #alit#osis muffled %oices snoring and ot#er s/mtomsof slee disturbance and tender cer%ical adenoat#/5

'denoiditis is best diagnosed b/ clinical #istor/ #/sical eamination5

naso#ar/ngosco/ and )adiogra#/5 T#e #/sical eamination s#ould include bot#

anterior and osterior r#inosco/5 ' lateral nec )adiogra# and inus )adiogra#/ taen

to s#o soft tissue densit/ can s#o t#e adenoids and sinus5 Tonsilitis is diagnosed b/

clinical #istor/ #/sical eamination t#roat culture and fleible lar/ngoscoe5

"anagement of diseases of t#e adenoids and tonsils antimicrobial intranasal

steroids and adenoidectom/5 Indications for tonsillectom/ and adenoidectom/ are

obstruction infection and =eolasia5

Learning Tass

15 escribe and discuss of etiolog/ of adenoid diseases5

25 ,lain at#ogenesis of adenoid diseases5

35 escribe and discuss of clinical classification of diseases in t#e adenoids

45 escribe clinical e%aluation to suort diagnosis of t#e adenoid diseases5

-5 "anage and ro%ide initial management or refer atient it# certain adenoid

diseases5

65 ,lain indications for adenoidectom/5



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75 escribe comlications of adenoid diseases and adenoidectom%5

Learning Resources

15 Linda rods/5 C#rist#o#er Po9e5 Tonsilitis Tonsillectom/ and 'denoidectom/5 In aiIe

D ,ditor5 @ead and =ec urger/


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Documents

Study Guide Respiratory Semester VI 16 Pebruari 2015