PR

1. Dx Dengue based on WHO

2. Grafik NS, IgM, IgG
3. Sensivitas dan Spesifitas NS1, IgM, IgG
Primary Infection Secondary Infection
4. Grafik Fase Dengue
5. Gambaran Lab test untuk Leptospirosis
● leukocytosis with a left shift and elevated markers of inflammation (C-reactive
protein level and erythrocyte sedimentation rate
● Thrombocytopenia (platelet count ≤100 × 109/L)
● coagulation activation may be present, varying from borderline abnormalities
to a serious derangement compatible with DIC
● urinary sediment changes (leukocytes, erythrocytes, and hyaline or granular
casts
● mild proteinuria in mild disease to renal failure and azotemia in severe
leptospirosis
● Elevated amylase level
● High serum bilirubin
● Nonoliguric hypokalemic renal insufficiency (early leptospirosis)
Biphasic nature of leptospirosis and relevant
investigations at different stages of disease
 6. Indikasi
transfusi
thrombocyte

Kaur P, Kaur G. Transfusion support in patients with

dengue fever. Int J Appl Basic Med Res. 2014;4(Suppl
1):S8-S12.
7. Hipertensi Pulmonal Primer, sekunder, dan hasil
RO
1. 1975 WHO classification
a. Primary pulmonary hypertension
i. Diagnosis of exclusion
b. Secondary pulmonary hypertension
i. Presence of identifiable risk factors
2. Evolution of Pulmonary Hypertension Classification: Fifth World Symposium
on Pulmonary Hypertension (Nice, France; 2013)
a. Pulmonary arterial hypertension
b. Pulmonary hypertension due to left heart disease
c. Pulmonary hypertension due to lung disease and/or hypoxia
d. Chronic thromboembolic pulmonary hypertension
e. Pulmonary hypertension with unclear multifactorial mechanisms
8. Px untuk bedakan cardiac and non cardiac cause
● Heart failure Elevated natriuretic peptides
○ BNP>35 pg/ml and/or NT-proBNP>125 pg/ml
○ B-type natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide
9. Grading edema paru
Stage 1
Stage 2
Stage 3
alveolar edema with perihilar
consolidations and air
bronchograms (yellow arrows);
pleural fluid (blue arrow);
prominent azygos vein and
increased width of the vascular
pedicle (red arrow) and an
enlarged cardiac silhouette
(arrow heads).
10. Beda angina stable, unstable and variant
● Stable angina
○ Occurs when the heart must work harder, usually during physical exertion
○ Usually lasts a short time (5 minutes or less)
○ Is relieved by rest or medicine
○ Doesn't come as a surprise, and episodes of pain tend to be alike
○ May feel like gas or indigestion
○ May feel like gas or indigestion
● Unstable Angina
○ Often occurs while you may be resting, sleeping, or with little physical exertion
○ May get worse over time
○ May last longer than stable angina
○ Comes as a surprise
● Variant angina
○ spasm in the coronary arteries
○ usually occurs while resting and during the night or early morning hours
○ Can be relieved by taking medication
○ Are usually severe
11. Indikasi terapi streptokinase
● Early presentation (≤3 hr from symptom onset and delay to invasive strategy;
● Invasive strategy is not an option:
○ Catheterization laboratory occupied or not available
○ Vascular access difficulties
○ Lack of access to a skilled PCI laboratory*
● Delay to invasive strategy:
○ Prolonged transport
○ (Door-to-balloon)–(door-to-needle) more than 1 hr
○ Medical contact-to-balloon or door-to-balloon more than 90 min
12. Indikasi Pemberian Dobutamin pada CHF
Support inotropik/vasopressor diberikan apabila
systolic BP <90mmHg

Tanpa tanda shock: IV dobutamine 2.5 µg/kg/min,

uptitrasi s/d sBP >90mmHg [Sebagai inotropik
(beta1): ↑CO ↑MAP ↓PAOp ↓SVR ↑/=HR]

Dengan tanda shock: IV dopamine 5-10

µg/kg/min, uptitrasi s/d sBP >90mmHg [Sebagai
renal protector dopamine) dan inotropik (beta1)
pada low dose, +vasopressor (alpha1) pada high
dose: ↑CO ↑MAP ↑PAOp ↑SVR ↑HR]
13. Definisi AKI
AKI is defined as any of the following:

● Increase in SCr by ≥0.3 mg/dl (≥26.5 lmol/l) within 48 hours

or

● Increase in SCr to≥1.5 times baseline, which is known or presumed to have

occurred within the prior 7 days

or

● Urine volume <0.5 ml/kg/h for 6 hours

14. Wet and Dry CHF +
kontraindikasi
betablocker
Contraindications of beta blocker
● asthma and chronic obstructive lung disease may be considered as
relative contraindications to beta blockers, even to beta1-selective
Agents
● Second or third degree AV block
● Heart rate <50 bpm
15. Sensitivity&Specificity USG abd Dx Cholecystitis

Ultrasonography alone has a high rate of

false-negative studies for acute
cholecystitis. However, a higher rate of
accurate diagnosis can be achieved using
a triad of positive Murphy sign, elevated
neutrophil count and an ultrasound
showing cholelithiasis or cholecystitis.
16. Drug-induced Hepatitis vs. DILI
Drug-induced hepatitis adalah diagnosis KLINIS, yang ditegakkan berdasarkan
manifestasi klinis (jaundice, RUQ pain, fatigue, malaise, anorexia, nausea, and/or
vomiting), eksklusi kausa lain, dan adanya perbaikan klinis setelah penarikan obat
yang dicurigai sebagai penyebab.

Sedangkan DILI lebih mengarah kepada diagnosis LABORATORIS, yang

ditegakkan ketika pada konsumsi obat-obatan hepatotoksik terdapat kejadian
klinis berupa drug-induced hepatitis akut, yang terkonfirmasi melalui hasil lab
berupa: peningkatan AST/ALT >5x ULN (atau >3x dengan jaundice), atau serum
bilirubin >2-3mg/dL dan kenaikan serum aminotrasnferase >3x ULN.
17. DDx Cholestasis Intrahepatal
18. Prednisolone Test
DILI:

The hypersensitivity or immunoallergic phenotype may respond to steroids, but

there is not robust data for that practice. Drug-induced AIH generally responds to
prednisone and may be given for shorter durations when compared with de novo
or idiopathic AIH. Patients with suspected DI-AIH should be referred to a
hepatologist. The authors use 20 to 40 mg of prednisone for initial treatment
followed by a slow taper of prednisone over approximately 6 months if liver tests
normalize.

Leise, Michael D. et al.2014.Drug-Induced Liver Injury.Mayo Clinic Proceedings , Volume

89 , Issue 1 , 95 - 106
19. DOTS TB
1. Sustained political and financial commitment. TB can be cured and the epidemic reversed if adequate
resources and administrative support for TB control are provided

2.Diagnosis by quality ensured sputum-smear microscopy. Chest symptomatics examined this way helps
to reliably find infectious patients

3.Standardized short-course anti-TB treatment (SCC) given under direct and supportive observation
(DOT).Helps to ensure the right drugs are taken at the right time for the full duration of treatment.

4. A regular, uninterrupted supply of high quality anti-TB drugs. Ensures that a credible national TB
programme does not have to turn anyone away.

5. Standardized recording and reporting. Helps to keep track of each individual patient and to monitor
overall programme performance
20. Faktor Pemicu Eksaserbasi CHF

Causes of CHF: decreased myocardial

contractility (ischemia, infarction,
cardiomyopathy, myocarditis), pressure
overload states (HTN, valve abnormalities,
congenital heart disease), restricted cardiac
output (myocardial infiltrative disease,
cardiac tamponade)
21. Definisi Ce KaDe
1. Kidney damage for >= 3 months, as defined by structural or functional
abnormalities pf the kidney, with or without decreased GFR, manifest by
either:
● Pathological abnormalities; or
● Markers of kidney damage, including abnormalities inthe composition of the
blood or urine, oe abnormalities in imaging tests

2. GFR <60 mL/min/1.73 m2 for > months, with or without kidney damage
22. Gambaran EKG hyperkalemia dan terapi
● Peaked T waves
● Prolonged PR segment
● Loss of P waves
● Bizarre QRS complexes
● Sine wave
22. Gambaran EKG hyperkalemia dan terapi

Treatment of hyperkalaemia involves stabilizing the myocardium to prevent

arrhythmias, shifting potassium back into the intracellular space and removing
excess potassium from the body.
1. Correct Serious Conduction Abnormalities (Calcium)
Calcium stabilise the myocardium, as a temporising measure. Calcium is indicated
if there is widening of QRS, sine wave pattern (when S and T waves merge
together), or in hyperkalaemic cardiac arrest.The ‘cardiac membrane stabilising
effects’ take about 15-30mins.

● Calcium Chloride 10% 5-10mL

● Calcium Gluconate 10% 5-10mL
22. Gambaran EKG hyperkalemia dan terapi

2. Drive Potassium into the Cell:

● Insulin & Glucose Dose: IV fast acting insulin (actrapid) 10-20 units and glucose/dextrose 50g
25-50ml
● Sodium Bicarbonate Dose: 50- 200 mmol of 8.4% Sodium Bicarbonate
● Salbutamol Dose: 10-20mg via nebulizer

3. Eliminate Potassium From the Body:

● Calcium Resonium Dose: 15-45g orally or rectally, mixed with sorbitol or lactulose
● Furosemide Dose: 20-80mg depending on hydration status
● Normal Saline Used to help renally excrete potassium, by increasing renal perfusion and
urinary output.
● DialysisIs the gold standard for removing potassium from the body. Provides immediate and
reliable removal.Can lower potassium by 1mmol/L in first hour and another 1mmol/L over the
next 2 hours.
23. Klinis and treatment for Hypocalcemia
1. Clinical Manifestations
a. perioral numbness,
b. paresthesias of the hands and feet, muscle cramps
c. carpopedal spasm
d. Laryngospasm
e. focal or generalized seizures
f. Chvostek's and Trousseau's Signs
g. prolongation of the QT interval
h. emotional instability, anxiety, and depression
2. Treatment

● Severe acute and/or symptomatic hypocalcemia (serum corrected calcium to

≤7.5 mg/dL (1.9 mmol/L))
○ Initially, IV calcium (1 or 2 g of calcium gluconate, equivalent to 90 or 180 mg elemental
calcium, in 50 mL of 5 percent dextrose or normal saline) can be infused over 10 to 20
minutes
○ An IV solution containing 1 mg/mL of elemental calcium is prepared by adding 11 g of calcium
gluconate (equivalent to 1000 mg elemental calcium) to normal saline or 5 percent dextrose
water to provide a final volume of 1000 mL. This solution is administered at an initial infusion
rate of 50 mL/hour (equivalent to 50 mg elemental/hour).
● Mildly symptomatic or chronic hypocalcemia (serum corrected calcium
concentration of 7.5 to 8.0 mg/dL [1.9 to 2.0 mmol/L] or a serum ionized
calcium concentration above 3.0 to 3.2 mg/dL [0.8 mmol/L])
○ They can be treated initially with 1500 to 2000 mg of elemental calcium given as calcium
carbonate or calcium citrate daily, in divided doses.