Skenario 1

Mentari, 60-year-old woman came to the emergency room hospital with fever, shortness of
breath, chest pain and coughing yellow phlegm perceived worsening since 5 days ago. As
the age of 25 years had suffered from pulmonary tuberculosis and when it has been
declared cured. When these symptoms are felt almost the same as at the onset of pulmonary
tuberculosis that had that cough and shortness of breath, but this time felt appear suddenly,
while the first is not. The doctor said the pain may be caused by bacteria, viruses, fungi, or
parasites.
Patients often take corticosteroids due to arthritis suffered. Patients also often use alcohol
since the age of 20 years.
On physical examination found blood pressure is 150/90 mm Hg, pulse 110x / minute,
respiratory rate of 34x / min accompanied by retraction of the chest wall, a temperature of
39 C, bronchial sounds in the left lung field, the other in the normal range. Laboratory
tests found leukocytosis, other results are within normal limits. On radiographs obtained
pleural effusion, empyema and lung abscess
1. Explain about the rule of diagnose!
2. Mention about clinical reasoning the diagnose!
3. Mention about risk factor the diagnose!
4. Explain about patophysiology shortness of breath!
5. Explain the management of the diagnose!

Skenario 2
Christie, a girl aged 5 years old, came to the clinic with complaints of cough with green
phlegm that has been felt for 6 days. At first the child only experienced sore throat, runny
nose and dry cough. But this time coughs green phlegm accompanied by fever. The
temperature reached 38,5C, pulse 130x / minute, and breathing 35x / min. There were no
complications and danger signs. His father and brother at home smoke 1 pack per day at
home. There is no family history of shortness of breath.
1. Explain about the rule of diagnose!
2. Mention about clinical reasoning the diagnose!
3. Mention about risk factor the diagnose!
4. Explain about patophysiology of cough!
5. Explain the management of the diagnose!

Skenario 3
Havid, a man aged 62 years came to the hospital emergency department with a chief
complaint: shortness of breath increasingly become heavy since 7 days accompanied by
chest pain right. In the last 3 days to cough more often with a thick yellow sputum. History
of cough and breathlessness since 10 years ago, two years is considered more severe and
often followed by wheezing. Never given a reliever inhaler medication and advised to stop
smoking. Worked on asbestos factory for 10 years. Havid a smoker since high school 17
years old. The day approximately 1 pack of cigarettes. The second leg swollen 1 month.
On examination of the general condition: the patient restless and looked tight. Lung
examination: Inspection static symmetrical and chest when breathing right behind
compared to the left chest. Auscultation of breath sounds weakened in the lower lung, right
lung lower percussion dim. Upper right lung and the left lung obtained crackles and
wheezing. Examination of the number of leukocytes there are no results. No assessment of
blood gas analysis. Spirometry examination can not be done. Radiographic examinations:
lung looks emfisematous, bilateral infiltrates, pulmonary bottom right looks perselubungan
homogeneous. Examination of microorganism culture and sputum cytology there are no
results. Punksi examination found pleural fluid seroxanthochrom trial, the results of the
analysis suggest exudate.
1. Explain about the rule of diagnose!
2. Mention about clinical reasoning the diagnose!
3. Mention about risk factor the diagnose!
4. Explain about patophysiology of the diagnose!
5. Explain the management of the diagnose!

Skenario 4
Faiz, A man aged 30 years, came to the hospital emergency department with a chief
complaint of cough blood, three times, every cough approximately 1/3 cup of leatherback
since 1 day ago. Since three months ago Patients complained of cough with phlegm hard to
get out followed by intermittent fever, and sweating at night. Decreased appetite, weight
decreased 7 kg. The patient is a smoker. four years ago claimed to have suffered from lung
spots with hoarseness and received treatment from health centers planned package for 6
months. But when he gets it in the second month of treatment, patients hospitalized with
vomiting and yellow eyes. Patients have three children who are toddlers. His father died of
a contagious lung disease and heart six years ago.
On physical examination found blood pressure: 100/60 mmHg, konjunctiva pale, amforik
sound auscultation of the right lung and obtained an enlarged neck glands. When the first
negative sputum examination, blood tests there are no results. Photos looked a picture
fibroinfiltrat piston and the cavity in the right lung. Picture of a wasp nest in the apex of the
left lung. Fine-needle biopsy (BJH) and if necessary a bronchoscopy on the operating table.
Patients soothed, blood coming out of the coughing fit and monitored volume.
Patients works as a pedicab driver and a place to stay in a seedy neighborhood with poor
sanitation.
1. Explain about algoritma to diagnose!
2. Mention about clinical reasoning the diagnose!
3. Mention klasification about Tuberkulosis!
4. Explain about patophysiology of diagnose!
5. Explain the management of the diagnose

Skenario 5
Ridwan, a boy aged 12 years came to the clinic with complaints of cough for 2 weeks.
Cough felt always occur at night. Patients also experience mild fever, but never measured
how temperature. According to his mother, Ridwan no shortness of breath (wheezing) when
coughing night. Frequent sneezing and nasal congestion morning when cold and wanted to
go to school. Previously, he had the same complaint but this time the worst. Ridwan does
not have any food allergies and medications.
Past medical history of eczema and dry skin since birth. But in general he is healthy and has
been given a complete immunization. Family history of disease brother had asthma. In the
home environment no smokers and pets. Two days later the patient came back with
complaints of shortness of breath accompanied by wheezing. The patient is awake and
cooperative, sitting position, when spoken answer only 1-2 words (a few words) looked
tight and nervous. On physical examination found:
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Temperature : 37,8 C
Pulse : 110x /m
Respiration Rates : 26x/min
Blood Pressure : 100/60
Oxygen saturation : 95% in room air.
Swollen nasal mucosa no discharge,
There is a small multiple palpable lymph nodes in the upper neck.
Increases AP diameter,
Hipersonor on percussion
Ronkhi and loud wheezing on auscultation
There suprasternal retraction.
Heart regular, no murmurs.
Dry skin, no inflammation

1. Explain about the rule of diagnose!

2. Mention about clinical reasoning the diagnose!

3. Mention about risk factor the diagnose!

4. Explain about patophysiology shortness of breath!
5. Explain the algoritma management of the diagnose!