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INTERNAL MEDICINE Flashcards

1
Q

Batas Diabetes
1. HbA1c
2. GDP
3. GD2PP
4. GDS
5. TTGO

A
  1. ≥6.5
  2. ≥126
  3. ≥200
  4. ≥200
  5. ≥200
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2
Q

Batas Prediabetes
1. HbA1c
2. GDP
3. GD2PP
4. GDS
5. TTGO

A
  1. 5.7-6.4
  2. 100-125
  3. 140-199
  4. 140-199
  5. 140-199
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3
Q

GDP prediabetes, TTGO normal

A

GLUKOSA DARAH PUASA TERGANGGU

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4
Q

GDP normal, TTGO prediabetes

A

TOLERANSI GLUKOSA TERGANGGU

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5
Q

4P, Autoantibodi (+), C-peptide (-), sensitivitas insulin (+), anak

A

DMT1

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6
Q

4P, Autoantibodi (-), C-peptide (±), sensitivitas insulin (-), dewasa

A

DMT2

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7
Q

Autoantibodi (-), C-peptide (±), DMT2 anak

A

MODY

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8
Q

4P, Autoantibodi (+), C-peptide (-), DMT1 dewasa

A

LADA

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9
Q

Tatalaksana dan Sasaran Diabetes

A

Lifestyle [diet 60-20-20, akfis aerobik ≥sedang 150m/wk 3-5x/wk] + monoterapi (<7.5%); dual terapi (≥7.5%/>9% asimtomatis/refrakter 3mo); triple terapi (>9% asimtomatis/refrakter 3mo); insulin (>9% simtomatis). Target A1c <7%, IMT 18.5-<23, TD <140/90, GDP 80-130, LDL<100, TG<150

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10
Q

Kussmaul, kesadaran turun, keton (+), pH<7.3, HCO3<18, GDS>250

A

KAD

NaCl 0.9% 1L/h, NaCl 0.45% 500mL/h (Na>145), D5%+NaCl 0.45% 250 mL/h (GDS 200 KAD/300 HHS); K+ 20-30mEq/L (K+<5.2, maintain 4-5), tunda insulin (K+<3.3); insulin 0.1U/kg bolus lalu 0.1U/kg/h infusion IV / 0.14U/kg infusion IV, turunkan 0.05U/kg/h (GDS 200 KAD/300 HHS); HCO3 100mmol dalam 400mL akuades dengan KCl 20mEq 2h (pH<6.9, hingga ≥7)

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11
Q

Dehidrasi berat, kesadaran turun, Osm>320, pH>7.3, GDS>600

A

HHS

NaCl 0.9% 1L/h, NaCl 0.45% 500mL/h (Na>145), D5%+NaCl 0.45% 250 mL/h (GDS 200 KAD/300 HHS); K+ 20-30mEq/L (K+<5.2, maintain 4-5), tunda insulin (K+<3.3); insulin 0.1U/kg bolus lalu 0.1U/kg/h infusion IV / 0.14U/kg infusion IV, turunkan 0.05U/kg/h (GDS 200 KAD/300 HHS); HCO3 100mmol dalam 400mL akuades dengan KCl 20mEq 2h (pH<6.9, hingga ≥7)

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12
Q

Klasifikasi KAD

A

MILD: pH 7.25-7.30, bikarbonat ≤18, anion gap >10, alert
MODERATE: pH 7.00-7.24, bikarbonat <15, anion gap >12, drowsy
SEVERE: pH <7.00, bikarbonat <10, anion gap >12, stupor/coma

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13
Q

Whipple triad: Gejala klasik (autonom: diaforesis, gelisah, palpitasi; neuroglikopenik: lemah, lesu, pusing), GDS <70, gejala berkurang dengan pengobatan
1. CM
2. Tidak sadar

A

HIPOGLIKEMIA
1. RINGAN
2. BERAT

Glukosa murni 15-20g (ringan: CM), D10% 150mL / D20% 75mL / D40% 25mL IV dalam 15m (berat: tidak sadar), D10% (<2) / D25% (2-12) / D50% (>12) 2mL/kg (anak)

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14
Q

Poliuria, polidipsia, osm plasma turun, water deprivation test urine osm >600

A

POLIDIPSIA PSIKOGENIK

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15
Q

Poliuria, polidipsia, osm plasma naik, water deprivation test urine osm <300, Tes desmopressin peningkatan urine osm ≥50%

A

CENTRAL DI

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16
Q

Poliuria, polidipsia, osm plasma naik, water deprivation test urine osm <300, Tes desmopressin tidak meningkat

A

NEPHROGENIC DI

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17
Q

Pembesaran tiroid, takikardi/palpitasi, tremor, heat intolerance, hiperhidrosis, penurunan BB, nafsu makan meningkat, index wayne>19

A

HIPERTIROIDISME

Propanolol 3x 40mg (simtomatis), metimazole 1x 10-20mg (dewasa/anak/trimester 2-3), PTU 3x 100-200mg (trimester 1); RAI ablation; tiroidektomi

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18
Q

Klasifikasi Hipertiroidisme
1. Primer
2. Sekunder
3. Subklinis

A
  1. FT4 naik, T3 naik, TSH turun
  2. FT4 naik, T3 naik, TSH naik
  3. FT4 normal, T3 normal, TSH turun

Lihat FT4, naik = hipertiroid. TSH untuk bedakan primer dan sekunder, naik = dari sentral = sekunder

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19
Q

Etiologi Hipertiroidisme
1. Nyeri (+), bakterial
2. Nyeri (+), viral, diikuti hipotiroid
3. Nyeri (-), RAIU (+) fokal, USG goiter nodular, TRAb/TSI (-)
4. Nyeri (-), RAIU (+) difus, USG goiter non nodular, TRAb/TSI (+)

A
  1. ACUTE/SUPPURATIVE THYROIDITIS
  2. DE QUERVAIN/SUBACUTE GRANULOMATOUS THYROIDITIS
  3. TOXIC MULTINODULAR GOITER, TOXIC SOLITARY ADENOMA
  4. GRAVES DISEASE
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20
Q

Demam sangat tinggi, takiaritmia, altered mental status, gejala GI berat, burch-wartofsky point scale >45

A

THYROID STORM

Stabilisasi, PTU 500-1000MG LOADING LALU 4X 250MG PO, propanolol 4x 60-80mg PO, hidrokortison 3x 100mg IV, lugol 3x 10tts

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21
Q

Bradikardi, gangguan konsentrasi, cold intolerance, kulit kering, peningkatan BB, nafsu makan menurun

A

HIPOTIROIDISME

Levotiroksin 1.6-1.8mcg/kg/d

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22
Q

Klasifikasi Hipotiroidisme
1. Primer
2. Sekunder
3. Subklinis

A
  1. FT4 turun, T3 turun, TSH naik
  2. FT4 turun, T3 turun, TSH turun
  3. FT4 normal, T3 normal, TSH naik

Lihat FT4, turun = hipotiroid. TSH untuk bedakan primer dan sekunder, naik = dari sentral = sekunder

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23
Q

Etiologi Hipotiroidisme
1. Anti TPO (+), PA limfosit
2. Riwayat tinggal di pegunungan
3. Gejala obstruksi faring/laring, PA fibrosis

A
  1. HASHIMOTO THYROIDITIS
  2. GOITER ENDEMIK
  3. REIDEL THYROIDITIS
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24
Q

Hipotermia, bradiaritmia, altered mental status, kulit edema non pitting

A

KOMA MIKSEDEMA

Levotiroksin 5-8 mcg/kg loading lalu 50-100mcg/d IV

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25
Q

Hypercalcemia (bone pain, kidney stone, muscle weakness, fatigue, GI issues, polydipsia/uria), PTH naik, serum fosfat turun-normal, serum kalsium tinggi, QT pendek Adenoma/carcinoma

A

PRIMARY HYPERPARATHYROIDISM

Paratiroidektomi

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26
Q

Kifosis, fr. patologis, arteriosklerosis, PTH naik, serum fosfat naik, serum kalsium rendah-normal, kompensasi hipokalsemia kronis (CKD/vit D def)

A

SECONDARY HYPERPARATHYROIDISM

Kalsitriol 2mcg/d; paratiroidektomi

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27
Q

PTH naik, serum fosfat naik, serum kalsium naik, tHPT berkepanjangan

A

TERTIARY HYPERPARATHYROIDISM

Paratiroidektomi

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28
Q

Hypocalcemia (muscle crap, tetany, paresthesia, chvostek (+) kontraksi ketukan, trosseau (+) spasme dengan manset), post thyroidectomy

A

HYPOPARATHYROIDISM

Kalsium 1-3g/d, kalsitriol 0.25mcg/d

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29
Q

Hypercortisolism (obesitas sentral, buffalo hump, striae ungu, hiperpigmentasi, moon facies, muscle weakness, metabolic ds, psychiatric ds), late night salivary cortisol (+) tinggi, 24h urine free cortisol (+) tinggi, low dose dexa test (+) tinggi
1. ACTH rendah
2. ACTH tinggi, high dose dexa supresi, CRH test (+)
3. ACTH tinggi, high dose dexa tidak supresi, CRH test (-)

A

CUSHING SYNDROME
1. ACTH INDEPENDENT (ADRENAL/EKSOGEN)
2. ACTH DEPENDENT: CUSHING DISEASE
3. ACTH DEPENDENT: ECTOPIC ACTH SYNDROME

Urutan penunjang: low dose dexa –> ACTH –> high dose dexa

Mitotan 500mg/d uptitrasi / metirapon 3x 500mg, bedah transfenoid (ACTHd), adrenalektomi (ACTHi)

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30
Q

Hypocortisolism (fatigue, anorexia, BB turun, hipoglikemi), hypoaldosteronism (hipotensi, salt craving), cosyntropin test kortisol tidak naik
1. ACTH tinggi
2. ACTH rendah

A

INSUFISIENSI ADRENAL
1. PRIMER (ADDISON DISEASE)
2. SEKUNDER

Hidrokortison 15-25mg/d bagi 2-3 dosis, fludrokortison 0.2mg/d PO

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31
Q

Penghentian CS mendadak, hipoglikemia, hiponatremia, hiperkalemia, penurunan kesadaran

A

KRISIS ADRENAL

HIDROKORTISON 100MG IV LALU 3X 100MG IV, NaCl 0.9%, D5NS (hipoglikemia)

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32
Q

Batas Dislipidemia

A

KT≥240 (200)
TG≥200 (150)
LDL≥160 (130)
HDL<40

Dislipidemia (Borderline)

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33
Q

Tatalaksana Dislipidemia

A

Lifestyle (0 RF), +statin sedang (ada RF/DM+CKD) / +statin kuat (CAD/HF/DM+CKD+RF)

RF: merokok, HT, HDL rendah, CAD, ≥45y/≥55y
Ezetimibe 10mg, statin sedang [rosuvastatin 5-10mg, atorvastatin 10-20mg, simvastatin 20-40mg], statin kuat [atorvastatin 40-80mg, rosuvastatin 20-40mg]

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34
Q

≥3/5 [obesitas sentral (LP ≥102/≥88), HT ≥130/≥85, TG ≥150, HDL <40/<50, GDP ≥100]

A

METABOLIC SYNDROME

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35
Q

Klasifikasi Obesitas (BMI-ASIAN)

A

Underweight: <18.5
Normal: 18.5-22.9
Overweight: 23-24.9
Obesitas I: 25-29.9
Obesitas II: >30

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36
Q

Tatalaksana Obesitas

A

Diet rendah kalori + makanan sehat, akfis ≥30m/d / 150m/wk, orlistat 3x 120mg (BMI>30+sindrom metabolik), bedah bariatrik (BMI≥40)

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37
Q

Edema anasarka, proteinuria >3.5g/d, hipoalbuminemia <3.5, hiperkolesterolemia, oval fat body (+) urin

A

SINDROM NEFROTIK

Rendah garam, restriksi cairan, furosemid 1-3mg/kg ± spironolakton 2-4mg/kg (edema), statin (dyslipidemia), PREDNISON 1-2MG/KG lanjut tapering off

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38
Q

Edema, proteinuria <3.5/d, hematuria, HT, oliguria, azotemia, RBC cast urin (+)
1. Rw ISPA/kulit, ASTO (+), C3 turun
2. Biopsi crescentic formation

A

SINDROM NEFRITIK
1. GNAPS
2. RPGN

anti-HT, diuretik, Ab (GNAPS), CS (RPGN)

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39
Q

Disuria, frekuensi, urgensi, nyeri tekan suprapubik

A

ISK SISTITIS

Nitrofurantoin 2x 100mg 5d / TMP-SMX 2x 960mg 3d / ciprofloksasin 2x 250mg 3d / fosfomisin trometamol 3g SD (non komplikata), seperti pielonefritis komplikata (komplikata: laki, wanita hamil, anatomical/functional dysf, kateter, komorbid)

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40
Q

Demam, menggigil, mual muntah, nyeri pinggang + ketok CVA

A

ISK PIELONEFRITIS

Siprofloksasin 2x 500mg 7d / levofloksasin 1x 750mg 5d / TMP-SMX 2x 960mg 14d / ceftriaxone 1x 1g 3d IV (non komplikata), siprofloksasin 2x 400 mg IV / levofloksasin 1x 500mg IV / cefepime 2x 1g IV / ampisilin 4x 2g + gentamisin 1x 5mg/kg IV @5d (komplikata: laki, wanita hamil, anatomical/functional dysf, kateter, komorbid), ampisilin 4x 250mg / amoksisilin 3x 500mg (hamil)

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41
Q

Morning stiffness (+) weight bearing joint, unilateral, usia tua, nyeri dengan aktivitas, krepitasi (+), heberden/bouchard node (+), x-ray osteofit (+)

A

OSTEOARTRITIS

NSAID [indometasin 3x 50mg / diklofenak 3x 50mg / ibuprofen 3x 800mg / naproxen 2x 500mg / celecoxib 2x 200mg]

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42
Q

Derajat Osteoarthritis

A

KELLGREN LAWRENCE
0: normal
I: doubtful (osteofit minim)
II: mild (osteofit definitif)
III: moderate (osteofit multipel, penyempitan celah sedang)
IV: severe (osteofit kissing, penyempitan celah berat, sclerosis berat)

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43
Q

Morning stiffness (+) small distal joint, bilateral, bengkak, swan neck/boutonniere/deviasi ulna (+), asp cairan sendi [RF (+), anti-CCP (+)]

A

RHEUMATOID ARTRITIS

NSAID [indometasin 3x 50mg / diklofenak 3x 50mg / ibuprofen 3x 800mg / naproxen 2x 500mg / celecoxib 2x 200mg] (akut), MTX 7.5-15MG/WK PO / sulfasalazin 2x 500mg PO (definitif)

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44
Q

Morning stiffness (-), nyeri sendi mendadak (predileksi jempol), asp cairan sendi [monourate crystal (+) jarum negative birefringent], podagra (+), tophus (+), rat-bite erosion (+)

A

GOUT ARTRITIS

Kolkisin 1.8mg/d lalu 0.6mg/d, NSAID [indometasin 3x 50mg / diklofenak 3x 50mg / ibuprofen 3x 800mg / naproxen 2x 500mg / celecoxib 2x 200mg] (akut<24h), allopurinol 100mg/d / febuxostat 120mg/d, probenesid 500mg/d (kronis). Target asam urat <6

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45
Q

Ca pyrophosphate crystal (+) romboid negative birefringent, lutut

A

PSEUDOGOUT

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46
Q

Morning stiffness (-), gejala sistemik (+), asp cairan sendi bakteri (+)

A

SEPTIK ARTRITIS

Ab IV empiris: vankomisin 2x 15-20mg/kg IV (kokus gram (+)), ceftriaxone 1x 1-2g IV (gram (-))

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47
Q

Sendi bengkak lokasi beragam, <16y, demam/uveitis/limfadenopati/ruam, ANA test (+)

A

JIA

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48
Q

SOAPBRAINMD [serositis, oral ulcer, arthritis, photosensitivity, blood all low, renal, ANA(+), immunologic (dsDNA), neurologic, malar rash, discoid rash]

A

SLE

Hidroksiklorokuin 400mg/d ± CS dan NSAID (ringan: kulit + artritis), metilprednisolon 0.5-1mg/kg/d IV 3d lalu azatioprin 1-2mg/kg/d + CS 0.5mg/kg/d taper off (sedang: nefritis ringan, PLT<50), metilprednisolon 0.5-1mg/kg/d IV 3d + siklofosfamid 500mg/m2 (berat: nefritis berat, PLT<20, ancaman nyawa)

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49
Q

BMD ≤-2.5, dowager hump/kifosis dorsal (+)
1. Postmenopause
2. Usia >75 th
3. Penyakit sistemik, obat

A

OSTEOPOROSIS
1. OSTEOPOROSIS PRIMER/INVOLUSIONAL TIPE 1
2. OSTEOPOROSIS PRIMER/INVOLUSIONAL TIPE 2
3. OSTEOPOROSIS SEKUNDER

Vit D 400-800IU/d, intake ca2+ 1000-1500mg/d, bifosfonat

50
Q

CREST (calsinosis, raynaud phenomenon, esophageal dysfunction, sclerodactyly/morphea, telangiectasia)

A

SYSTEMIC SCLEROSIS/SCLERODERMA

51
Q

Kelemahan otot simetris panggul dan bahu progresif, CK naik, EMG (+) miopati, biopsi otot atrofi/nekrosis
1. Gottron sign (+), heliotrope rash (+), shawl sign (+)

A

POLIMIOSITIS
1. DERMATOMIOSITIS

PREDNISON 2MG/KG; azatioprin 1-2mg/kg/d / MTX 7.5-15mg/wk

52
Q

Derajat Anemia

A

ANEMIA (LAKI / PEREMPUAN / HAMIL)
Anemia ringan: <13 / <12 / <11
Anemia sedang: <11 / <11 / <11
Anemia berat: <8 / <8 / <7

53
Q

Anemia, MCV <80, serum Fe rendah, TIBC tinggi, ferritin rendah, pencil/cigar cell (+)

A

ADB

Ferro sulfat 3x 325mg / ferro fumarat 2x 325mg / furro glukonat 4x 325mg, vit C; transfusi PRC (Hb<7). Target Hb+1 2-3wk, lanjut 6-12mo jika sudah Hb = 11

54
Q

Anemia, MCV ≤100, serum Fe rendah, TIBC -/rendah, ferritin -/tinggi

A

ANEMIA PENYAKIT KRONIS

Etiologis

55
Q

Anemia, MCV <80, ikterik, facies cooley, hepatosplenomegali, x-ray (+) hair on end app, target cell/kodosit(+), Hb elekroforesis HbH/Hb barts naik (alfa), HbA1 turun HbA2 naik HbF naik (beta)

A

THALASSEMIA

Transfusi darah (Hb<7 / Hb>7+klinis), as folat 2x 1mg, deferoksamin (overload Fe); splenektomi

56
Q

Anemia, MCV <80, BST ring sideroblast (+), basophilic stippling (+), pappenheimer body (+)

A

SIDEROBLASTIC ANEMIA

57
Q

Anemia, MCV 80-100, retikulosit >2, bilirubin tinggi, LDH tinggi, haptoglobin rendah, coombs test (+), bite cell (+), skistosit (+), sferosit (+), trias (anemia, ikterus, organomegali)
1. Anti-IgG, DAT IgG
2. Anti-IgM, DAT C3

A

(AUTOIMMUNE) HEMOLYTIC ANEMIA
1. WARM TYPE
2. COLD TYPE

PREDNISON 1MG/KG PO; splenektomi

58
Q

Anemia, MCV 80-100, pansitopenia, FNAB fat infiltrated hypocellularity

A

ANEMIA APLASTIK

Suportif (transfusi darah Hb<7, cegah infeksi), siklofosfamid, TRANSPLANTASI SUMSUM TULANG

59
Q

Anemia, MCV 80-100, AIHA, rw obat (primakuin, TMP-SMX, dapson, nitrofurantoin)/konsumsi fava, heinz body (+)

A

ANEMIA DEFISIENSI G6PD

60
Q

Anemia, MCV >100, hypersegmented neutrophil (+), aniso/poikilo/makrositosis, homosistein tinggi, tes schilling B12 rendah, methylmalonic acid (MMA) tinggi, gejala neurologis (+), rw gastrektomi/vegan

A

ANEMIA DEFISIENSI B12

Vit B12 (kobalamin) 1mg/d IM/SC 1wk lalu 1mg/wk

61
Q

MCV >100, hypersegmented neutrophil (+), aniso/poikilo/makrositosis, homosistein tinggi, B9 rendah, rw malabsorbsi/hamil

A

ANEMIA DEFISIENSI B9

Vit B9 (as folat) 1-5mg/d PO

62
Q

Rw infeksi, palpable purpura, nyeri perut, artritis, hematuria, IgA (+), PLT normal

A

HENOCH-SCHONLEIN PURPURA (HSP)

Suportif. Prednisone 1 mg/kg/d 1-2 wk (inflamasi); IVIG

63
Q

BT memanjang, Rw infeksi, pendarahan (purpura/ptekie/ekimosis, mukosa, GI jika berat), PLT <100, megakariosit/megatrombosit

A

IMMUNE THROMBOCYTOPENIC PURPURA (ITP)

Prednisone 1 mg/kg/d 1-2 wk (PLT<20)

64
Q

CT memanjang, aPTT memanjang, X-linked resesif, pendarahan sendi/mukosa spontan susah berhenti:
1. Faktor VIII
2. Faktor IX
3. Faktor XI

A

HEMOFILIA
1. HEMOFILIA A
2. HEMOFILIA B
3. HEMOFILIA C

RICE, analgesik, FVIII/kriopresipitat (A), FIX/FFP (B), FXI/FFP (C)

65
Q

BT memanjang, aPTT memanjang, Autosomal dominan, pendarahan, vWF rendah, tes ristocetin aggregrasi turun, VIII rendah

A

VON WILLEBRAND DISEASE (VWD)

vWF, desmopressin, as traneksamat

66
Q

CT, aPTT, PT memanjang, Inj vit K lahir (-), usia <8mo, pendarahan intrakranial/GI

A

VITAMIN K DEFICIENCY BLEEDING

Profilaksis (vit K1 0.5-1 mg IM), vit K1 1-2 mg IV/SC

67
Q

CT memanjang, BT memanjang, aPTT memanjang, PT memanjang, Rw infeksi/kanker, perdarahan luas, purpura fulminan, disfungsi organ, PLT rendah, D-dimer tinggi

A

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

TX penyebab, suportif-simptomatik

68
Q

Painless lymphadenopathy, simptom B, reed-sternberg cell (+), rw EBV, demam pel-ebstein (1-2wk lalu remisi 1-2wk)

A

HODGKIN LYMPHOMA

69
Q

Painless lymphadenopathy, simptom B, starry sky appearance (+)

A

NON HODGKIN LYMPHOMA

70
Q

Gejala leukemia, Limfoblas imatur, FNAB hiperselular dengan limfoblas >20%, >anak

A

ALL

Kemoterapi, TRANSPLANTASI SUMSUM TULANG

71
Q

Gejala leukemia, Mieloblas imatur, FNAB hiperselular dengan mieloblas >20%, auer rod (+)

A

AML

Kemoterapi, TRANSPLANTASI SUMSUM TULANG

72
Q

Gejala leukemia, Limfosit matur abnormal, FNAB infiltrasi limfosit matur, smudge/basket/gumprecht cell (+)

A

CLL

Kemoterapi, TRANSPLANTASI SUMSUM TULANG

73
Q

Gejala leukemia, Granulosit abnormal, FNAB hiperselular dengan mielosit, philadelphia chromosome (+)

A

CML

Kemoterapi, TRANSPLANTASI SUMSUM TULANG

74
Q

Hb >16.5/>16, Hct >49%/>48%, mutasi JAK2 (+), EPO rendah

A

POLISITEMIA VERA

Flebotomi hingga Hct 45%, aspirin 80mg/d

75
Q

CRAB (hyperCalcemia, renal failure, anemia, bone lytic punched out lesion), biopsy fried egg app (+), protein elektroforesis M spike, urinalisis protein bence jones

A

MULTIPLE MYELOMA

76
Q

Gejala akut dari sistem: kulit-mukosa + ≥1 respirasi/CV ATAU ≥2 kulit-mukosa/respirasi/CV/GI + alergen dugaan ATAU SBP <90/>30% drop + alergen pasti

A

ANAFILAKSIS

ABCDE, trendelenburg, ADRENALIN/EPINEFRIN IM 1:1000 1MG/ML 0.3-0.5ML @5-15M

77
Q

Infeksi + qSOFA ≥2 (RR ≥22, GCS<15, SBP ≤100)
1. Butuh vasopressor MAP ≥65 + laktat >18mg/dl / >2mmol/L

A

SEPSIS
1. SYOK SEPTIK

1h bundle: ukur laktat, kultur darah, Ab broad spektrum [ceftriaxone 1x 2g / piperacillin tazobactam 4x 4.5g / vankomisin 3x 15-20mg/kg], kristaloid 30mL/kg jika hipotensi/laktat≥4, vasopressor [NE 0.05-0.15mcg/kg/m] hingga MAP≥65

78
Q

Stadium Klinis HIV

A

I (CD4 >500): asimptomatik, limfadenopati generalisata

II (CD4 <500): penurunan BB <10%, ISPA berulang, herpes zoster, angular cheilitis, ulkus mulut, papular eruption, derm. seboroik, onikomikosis

III (CD4 <200): penurunan BB >10%, diare kronis >1 bulan, demam menetap, oral kandidiasis, oral hairy leukoplakia, TB paru, infeksi bakteri berat, stomatitis nekrotikans, anemia/neutropenia/trombositopenia

IV (CD4 <200 + AIDS): wasting syndrome, PCP, herpes simplex >1mo, esophageal candidiasis, TB ekstraparu, kaposi sarcoma, CMV, cerebral toxoplasmosis, ensefalopati, cryptococcosis, cryptosporidiosis/isosporiasis kronis, histoplasmosis/coccidiomycosis/leishmaniasis diseminata, septikemia berulang, limfoma, nefropati/kardiomiopati

79
Q

Alur Pemeriksaan HIV dan Interpretasi

A

A1: donor/transplan
A2: studi epidemiologi
A3: diagnosis individu

POSITIF: A1+A2+A3 (+)
INDETERMINATE: 2 (+) / 1 (+) berisiko
NEGATIF: 1 (+) tidak berisiko / pengulangan (-) / (-)

ARV (positif)
Periksa ulang 2wk; PCR (indeterminate)
Periksa ulang 3,6,12mo (negatif berisiko)
Perilaku sehat (negatif tidak berisiko)

80
Q

Tatalaksana HIV

A

2 NRTI + 1 NNRTI
1. TLE (LINI 1)
2. ZLE/N
3. TLN

TMP-SMX 1x 960mg/d (St III/IV / CD<200 / TB(+))
Isoniazid 600mg/d (TB(-))

NRTI: Z / L / T / Em
NNRTI: E / N

81
Q

Tatalaksana Khusus
1. HIV + TB
2. HIV + TB (CD4<50)
3. HIV + TB + Meningitis Kriptokokus

A
  1. Obati TB, ARV setelah 2-8wk
  2. Obati TB, ARV setelah 2wk
  3. Obati TB + Kriptokokus, ARV setelah 5wk
82
Q

Demam, pusing, nyeri otot betis, suffusi konjungtiva, mual muntah, DFM (+) spirochaeta, MAT (+):
1. Ikterus, pendarahan spontan, gagal ginjal

A

LEPTOSPIROSIS
1. LEPTOSPIROSIS IKTERIK/WEIL’S SYNDROME

DOKSISIKLIN 2X 100MG / amoksisilin 4x 500mg / ampisilin 4x 500 mg PO 7d, doksisiklin 1x 200mg / azitromisin 1x 500mg (profilaksis)

PENISILIN G 4X 1.5JT IU / ampisilin 4x 1g / amoksisilin 4x 1g / ceftriaxone 1x 1g / cefotaxime 4x 1g / eritromisin 4x 500mg IV 7d (berat)

83
Q

Minggu 1 (demam stepladder, rose spot, GI), minggu 2 (demam konstan, bradikardia relatif, hepatomegali, tifoid tongue), kultur darah/feses/urin (+) minggu 1/2/3, widal titer O 1/320 (+) minggu 1

A

DEMAM TIFOID

Simtomatis, diet rendah serat, SIPROFLOKSASIN 2x 500MG 14D (dewasa), KLORAMFENIKOL 50-100MG/KG 14D (anak)

84
Q

Demam, menggigil, berkeringat, daerah endemis

A

MALARIA

85
Q

Tipe Malaria dan Tatalaksana

A
  1. Demam tak tentu, maurer spot (+), tropozoit accole ring, bulan sabit/pisang: FALSIPARUM
  2. Demam tertiana (setiap 2 hari), schuffner dot (+): VIVAX
  3. Demam tertiana (setiap 2 hari), james dot (+), skizont komet: OVALE
  4. Demam kuartana (setiap 3 hari), ziemann dot (+), band form, rosette form: MALARIAE

ANTIMALARIA [ACT 1x4/1x3 tab (BB>60/BB<60), primakuin 0.25mg/kg/d / 0.75 mg/kg/d (vivax-ovale/falsiparum), kina 3x 10mg/kg, klindamisin 2x 10mg/kg]

FALSIPARUM —> ACT 3d + primakuin SD
VIVAX —> ACT 3d + primakuin 14d
OVALE —> ACT 3d + primakuin 14d
MALARIAE —> ACT 3d

86
Q

Profilaksis Malaria

A

Klorokuin 2x 500/wk (sensitif klorokuin)

Doksisiklin 100mg/d / Atovaquone 250mg/d / Meflokuin 250mg/wk (resisten klorokuin)

87
Q

A. lumbricoides, inf telur, telur tebal berlapis-bergerigi-unsegmented, obstruksi GI-sindrom loeffler

A

ASKARIASIS

ALBENDAZOLE 400MG SD / mebendazole 2x 100mg 3d

88
Q

A. duodenale / n. americanus, inf filariform, telur tipis-unsegmented, anemia, harada mori (+)

A

HOOKWORM

89
Q

E. vermicularis, inf telur, telur bikonkav asimetris huruf D, gatal dubur, graham scotch tape (+)

A

ENTEROBIASIS

ALBENDAZOLE 400MG SD / mebendazole 2x 100mg 3d

90
Q

T. trichiura, inf telur, telur tempayan, diare-prolaps rekti

A

TRIKURIASIS

MEBENDAZOLE 2X 100MG 3D / albendazole 1x 400mg 3d

91
Q

S. spp, inf serkaria, telur spina samping (mansoni)/ujung (hematobium)/tidak ada (japonicum), diare-hematuria

A

SCHISTOSOMIASIS

Prazikuantel 10mg/kg SD

92
Q

F. spp, inf metaserkaria, telur satu operkulum, diare-nyeri RUQ

A

FASCIOLIASIS

Prazikuantel 10mg/kg SD

93
Q

T. spp, inf sistiserkus/telur (taeniasis/sistiserkosis), telur radial berkait seperti pedati, proglottid saginata&raquo_space; solium, diare-neurosistiserkosis

A

TAENIASIS/SISTISERKOSIS

Prazikuantel 10mg/kg SD (taeniasis), albendazole 2x 400mg 8-30d (neurosistiserkosis)

94
Q

Limfedema, elefantiasis
1. Lebar:panjang 1:1, sarung tidak berwarna, inti halus rapi, inti terminal 0, ekor pita
2. Lebar:panjang 1:2, sarung merah muda, inti kasar, inti terminal 2, ekor tumpul
3. Lebar:panjang 1:3: sarung tidak berwarna, inti kasar, inti terminal 2, ekor tumpul

A

FILARIASIS
1. W. BANCROFTI
2. B. MALAYI
3. B. TIMORI

Dietilcarbamazine 6mg/kg 12d / ivermektin 150mcg/kg SD (kuratif), DEC 6mg/kg + albendazole 400mg @1y (profilaksis)

95
Q

Anemia, atrofi papil lidah, licin, nyeri (+)

A

GLOSSITIS ATROFI

96
Q

Atopi, lidah geografis, asimtomatis

A

BENIGN MIGRATORY GLOSSITIS

97
Q

Merokok, lidah eritem bagian tengah

A

MEDIAN RHOMBOID GLOSSITIS

98
Q

Merokok/alkohol, plak putih tidak bisa dikerok asimtomatis

A

LEUKOPLAKIA

99
Q

Merokok/alkohol, plak merah asimtomatis

A

ERITROPLAKIA

100
Q

Plak putih kuning lidah, kerok dasar eritem

A

CANDIDIASIS ORAL

Nistatin drop 100rb IU

101
Q

Luka mukosa berupa ulkus, nyeri

A

STOMATITIS AFTOSA

Klorheksidin glukonat kumur 0.2% / triamsinolon asetonid krim 0.1%

102
Q

Heartburn, regurgitasi, nyeri ulu hati
1. Endoskopi (GS) mucosal break (+):
2. Endoskopi (GS) mucosal break (-):

A

GERD
1. EROSIVE REFLUX DISEASE (ERD)
2. NON EROSIVE REFLUX DISEASE (NERD)

PPI pantoprazole 40mg / esomeprazole 40mg / lansoprazole 30mg / omeprazole 20mg / rabeprazole 20mg @1x/d 2 wk, dosis ganda (refrakter)

103
Q

Alur Pemeriksaan GERD

A

Gejal GERD: GER-Q ≥8, alarm symptom (+) [age>50, loss of weight>5%, anemia, melena/hematemesis, restriction disfagia/odinofagia] RUJUK ENDOSKOPI. Jika alarm symptom (-), PPI TEST dosis ganda 1-2wk, jika membaik = DX GERD —> terapi 8 wk. Refrakter = endoskopi

104
Q

≥3mo, onset ≥6mo, nyeri epigastrium, rasa terbakar, alarm symptom (-)

A

DISPEPSIA TIPE ULCER

PPI pantoprazole 40mg / esomeprazole 40mg / lansoprazole 30mg / omeprazole 20mg / rabeprazole 20mg @1x/d

105
Q

≥3mo, onset ≥6mo, begah setelah makan, cepat kenyang, alarm symptom (-)

A

DISPEPSIA TIPE DISMOTILITAS

Prokinetik metoklopramid 10 mg / dompreidone 10mg

106
Q

Rw NSAID, nyeri epigastrium, PSCBA, UBT (+), ENDOSKOPI BIOPSI (+) ulkus >0.5cm + h. pylori
1. Nyeri dengan makan
2. Membaik dengan makan, nyeri beberapa jam kemudian

A

ULKUS PEPTIKUM
1. ULKUS GASTER
2. ULKUS DUODENUM

Triple therapy [omeprazole 2x 20mg + klaritromisin 2x 500mg + amoksisilin 2x 1000mg] 14d (suseptibel klaritromisin), quadruple therapy [omeprazole 2x 20mg + metronidazole 3x 500mg + tetrasiklin 4x 250mg + bismuth 300mg] 14d (resisten klaritromisin)

107
Q
A
108
Q

Disfagia progresif padat ke cair, relaksasi LES gagal karena degenerasi pleksus auerbach, barium swallow (+) bird beak, MANOMETRI ESOFAGUS (+) tek LES tinggi

A

AKALASIA

ISDN 5mg sebelum makan, injeksi botox; dilatasi pneumatik/heller myotomy (definitif)

109
Q
  1. Hematemesis, melena:
  2. Hematokezia:
A
  1. PSCBA
  2. PSCBB

Stabilisasi, PPI IV (ulkus), somatostatin 250mcg bolus lalu 250mcg/h drip / oktreotid drip 50 mcg/h (varises), endoskopis (definitif)

110
Q

Hipertensi porta, PSCBA, anemia, sirosis, HVPG ≥10, endoskopi red wale mark (+)

A

VARISES ESOFAGUS

Stabilisasi, somatostatin 250mcg bolus lalu 250mcg/h drip / oktreotid drip 50 mcg/h, transfusi PRC jika anemia berat (awal), ENDOSKOPI ligasi vena, TIPS (definitif), propanolol 2x 20mg/d (profilaksis)

111
Q

≥3mo, onset ≥6mo, ≥1x/wk nyeri abdomen + ≥2 (perbaikan dengan defekasi, perubahan frekuensi BAB, perubahan bentuk BAB)

A

IBS

Diet tinggi serat (IBS-C), hindari pencetus (IBS-D), diet FODMAP

112
Q

Skip lesion, diare ± darah, endoskopi cobblestone, PA inflamasi transmural + granuloma non kaseosa, enema string sign (+) skip lesion

A

PENYAKIT CROHN

CS, 5-ASA

113
Q

Continuous lesion usus besar distal, diare + darah, endoskopi ulkus/eritema, PA inflamasi submukosal + abses kripta, enema lead pipe sign (+)

A

KOLITIS ULSERATIF

CS, 5-ASA

114
Q

Fekal oral, demam, ikterus, urine teh, IGM ANTI-HAV (+)

A

HEPATITIS A

Simtomatis

115
Q

Rw seks bebas/jarum, ikterus, urin gelap, hepatomegali, HBV DNA (+)

A

HEPATITIS B

Simtomatis, tenofovir AF 1x 300mg / tenofovir DF 1x 25mg, entecavir 1x 0.5mg PO. Stop jika serokonversi HbeAg —> anti-Hbe, HbsAg (-), HBV DNA (-) ≥12mo

116
Q

Serologi Hepatitis B
1. HbsAg (+), HbsAb (-), HbcAb (+) IgM, HbeAg (+):
2. HbsAg (-), HbsAb (-), HbcAb (+) IgM, HbeAg (-):
3. HbsAg (-), HbsAb (+), HbcAb (+) IgG, HbeAg (-):
4. HbsAg (-), HbsAb (+), HbcAb (-), HbeAg (-):
5. HbsAg (+), HbsAb (-), HbcAb (+) IgG, HbeAg (+):
6. HbsAg (+), HbsAb (+), HbcAb (+) IgG, HbeAg (-):

A
  1. AKUT
  2. WINDOW
  3. SEMBUH
  4. IMUNISASI
  5. KRONIK AKTIF
  6. KRONIK INAKTIF
117
Q

Rw seks bebas/jarum, ikterus, urin gelap, hepatomegali, HCV RNA (+)

A

HEPATITIS C

Sofosbuvir/velpatasvir 1x 400/100mg 12 wk / glecaprevir/pibrentasvir 1x 300/120mg 12wk

118
Q

Nyeri RUQ, demam, ±ikterus, ludwig sign (+) nyeri tekan ICS VI AAL, air fluid level (+)
1. USG hipoekoik tunggal/multipel, rw infeksi bilier
2. USG hipoekoik tunggal, rw disentri

A

ABSES HEPAR
1. PIOGENIK
2. AMOEBIK

Metronidazole 3x 750mg PO/IV 7-10d (amebik), seftriakson 2x 1-2g IV + metronidazole 3x 500mg 10-14d (piogenik); aspirasi (refrakter, dekat perikardium, >5cm)

119
Q

SEGASIH [Splenomegali, eritema palmar, ginekomastia, asites, spider nevi, invers albumin, hematemesis melena], asteriksis/ensefalopati, LFT naik, USG hati kecil ireguler nodular

A

SIROSIS HEPATIS

Terapi varises (HT portal), laktulosa 3x 30mL (ensefalopati), spironolakton 100mg/d (asites), parasentesis + sefotaksim 3x 2g IV (asites)

120
Q

Hepar membesar, USG berdungkul dungkul, alfa fetoprotein (+)

A

HCC

121
Q

Rf dislipidemia/kolesistektomi, alkohol (-), nyeri RUQ, hepatomegali, LFT naik, AST/ALT<1, ALP naik, USG bright liver (+), BIOPSI >5% steatosis
1. Inflamasi (+)

A

NAFLD
1. NASH

122
Q
A

GAS (5 decks)

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