2.5 Block Exam Recap 2014

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Block C4 - Adolescence and Adulthood

Please note: the questions and the answers written next to them were compiled by batch 2014. Many answers are wrong. If you find the correct answer, write it below and include a link to the source.

1 to 10[edit]

1.	Diabetes mellitus yang minum obat metformin : lipolysis

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2.	Grave’s disease dengan difuse : TSH turun

Graves disease is a thyroid-specific autoimmune disease that is caused by a genetic predisposition and in some cases thought to develop due to a reaction to a viral infection. In Graves’ disease, the body produces antibodies to the thyroid stimulating hormone receptor, causing abnormally high amounts of thyroid hormone to be synthesized and released, which ultimately leads to hyperthyroidism and goiter (enlarged thyroid). ([https://cellularphysiology.wikispaces.com/Graves%27+Disease Source)

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3.	Cushing syndrome : hiperglikemi

Cushing's syndrome, also known as hypercortisolism or hyperadrenocorticism, is an endocrine disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol (in the blood) from a variety of causes, including primary pituitary adenoma (known as Cushing's disease), primary adrenal hyperplasia or neoplasia, ectopic ACTH production (e.g., from a small cell lung cancer), and iatrogenic (steroid use).

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Cushings-adrenal-tumor.png Cushingsdisease-new.png

4.	kriteria SLE : discoid rash

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Chronic cutaneous lupus (also called DLE, discoid lupus erythematosus): These lesions are found in only about 20% of SLE patients. Chronic discoid lupus is also found in people who have no trace of systemic lupus. In discoid lupus patients, the lupus is confined to the skin only. The lesions are rarely found below the chin, occurring most often on the scalp (often causing hair loss), and outer ear, and almost never on the legs. (Source)

Malar rash
a rash shaped like a butterfly that is usually found of the bridge of the nose and the cheeks.
Discoid rash
a raised rash usually found on the head, arms, chest, or back.
5.	kriteria RA : poliartheritis

"Polyarthritis is any type of arthritis that involves 5 or more joints simultaneously. Polyarthritis is most often caused by an auto-immune disorder such as rheumatoid arthritis, amyloidosis, psoriatic arthritis, and lupus erythematosus"

Arthritic jointsra.jpg

Osteoarthritis (OA)
is a painful, degenerative joint disease that often involves the hips, knees, neck, lower back, or small joints of the hands. OA usually develops in joints that are injured by repeated overuse from performing a particular task or playing a favorite sport or from carrying around excess body weight. Eventually this injury or repeated impact thins or wears away the cartilage that cushions the ends of the bones in the joint. As a result, the bones rub together, causing a grating sensation. Joint flexibility is reduced, bony spurs develop, and the joint swells. Usually, the first symptom of OA is pain that worsens following exercise or immobility. Treatment usually includes analgesics, topical creams, or nonsteroidal anti-inflammatory drugs, appropriate exercises or physical therapy; joint splinting; or joint replacement surgery for seriously damaged larger joints, such as the knee or hip.
Rheumatoid arthritis (RA)
is an autoimmune inflammatory disease that usually involves various joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles. An autoimmune disease is one in which the body releases enzymes that attack its own healthy tissues. In RA, these enzymes destroy the linings of joints. This causes pain, swelling, stiffness, malformation, and reduced movement and function. People with RA also may have systemic symptoms, such as fatigue, fever, weight loss, eye inflammation, anemia, subcutaneous nodules (bumps under the skin), or pleurisy (a lung inflammation).

Rheumatoid arthritis vs osteoarthritis comparison zoom out pharmacotherapy.png

6.	organ specific : hashimoto's thyroiditis

Also called Hashimoto's disease, Hashimoto's thyroiditis is an autoimmune disease, a disorder in which the immune system turns against the body's own tissues. In people with Hashimoto's, the immune system attacks the thyroid. This can lead to hypothyroidism, a condition in which the thyroid does not make enough hormones for the body's needs. (Source).

7.	treatment reitners disease :

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Reactive arthritis, formerly referred to as Reiter's syndrome, is a form of arthritis that affects the joints, eyes, urethra (the tube that carries urine from the bladder to the outside of the body), and skin.

The disease is recognized by various symptoms in different organs of the body that may or may not appear at the same time. It may come on quickly and severely or more slowly, with sudden remissions or recurrences.

Reactive arthritis primarily affects sexually active males between the ages of 20 and 40. Those with HIV (human immunodeficiency virus) are at a particularly high risk.

The cause of reactive arthritis is still unknown, but research suggests the disease is caused, in part, by a genetic predisposition: Approximately 75% of those with the condition have a positive blood test for the genetic marker HLA-B27.

Bacterial infections, such as chlamydia, will need to be treated with antibiotics. Joint inflammation from reactive arthritis is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, aspirin, or ibuprofen. Skin eruptions and eye inflammation can be treated with steroids.

Those with chronic disease may be prescribed other medications, including methotrexate. Patients with chronic arthritis also may be referred to a physical therapist and may be advised to exercise regularly. (Source).

8.	sering keguguran : anti phospolipid antibodies

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Antiphospholipid antibodies can also cause blood vessels to constrict, causing decreased blood flow throughout the circulatory system. The combination of blood clots and constricted blood vessels may impair blood supply to the fetus and placenta resulting in complete fetal demise or growth retardation. Some phospholipid molecules have adhesion properties i.e. glue like, and allow cells to fuse. The formation of the normal placenta involves the fusion of small cells called cytotrophoblasts into giant cells known as syncytiotrophoblasts. The syncytiotrophoblasts play a key role in the regulation of nutrients going to the baby. Antibodies to phospholipid molecules can, therefore, interfere with the development of the placenta. (Source).

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9.	kortikosteroid menghambat : 

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10.	kontraindikasi kortikosteroid :

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11 to 20[edit]

11.	klonal proliferasi sel kanker

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12.	tangan membesar setelah mastektomi rusak di : lnn. axila

Lymphedema after breast cancer surgery

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13.	Repair gene : p53

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14.	Yang buat proliferasi endotel : vegf b

"VEGF-B stimulates endothelial cell proliferation" - (Source)

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15.	masa kecil : fibrokistik

"Fibrocystic breasts or fibrocystic breast disease or fibrocystic breast condition commonly referred to as "FBC" is a condition of breast tissue affecting an estimated 30-60% of women and at least 50% of women of childbearing age." " - [(https://en.wikipedia.org/wiki/Fibrocystic_breast_changes Source]).

16.	merah, immobile, discharge darah : kanker

"The character of breast lumps is particularly important. Characteristics that suggest cancer include a hard or gritty texture, immobility, an irregular border, and a size greater than 2 cm. " (Source).

17.	kanker jinak : myoma uteri

"A uterine myoma is a benign growth of smooth muscle in the wall of the uterus." (Source).

18.	bukan termasuk non-neoplasma : dermoid kista

"A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. " (Source).

19.	secondary cancer : krukenberg tumor

"Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast." "Microscopically, Krukenberg tumors are often characterized by mucin-secreting signet-ring cells in the tissue of the ovary; when the primary tumor is discovered, the same signet-ring cells are typically found." (Source).

20.	kanker payudara prognosis paling buruk : triple negative

"A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and the HER-2/neu gene– are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER), and progesterone receptors (PR). Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option." "Triple negative breast cancer can be more aggressive and difficult to treat. Also, the cancer is more likely to spread and recur. The stage of breast cancer and the grade of the tumor will influence your prognosis. (Source).

21 to 30[edit]

21.	hereditari kanker payudara : BRCA

"BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material. When either of these genes is mutated, or altered, such that its protein product either is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer. Specific inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers, and they have been associated with increased risks of several additional types of cancer. Together, BRCA1 and BRCA2 mutations account for about 20 to 25 percent of hereditary breast cancers" (Source).

22.	deteksi payudara 30 tahun : periksa payudara sendiri

"Research does not show a clear benefit of physical breast exams done by either a health professional or by yourself for breast cancer screening. Due to this lack of evidence, regular clinical breast exam and breast self-exam are not recommended. Still, all women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away." - American Cancer Society.

However, since UGM loves to teach their students about EBM but (unfortunately) rarely updates their exam questions to reflect currently accepted knowledge, it's recommend to answer this question incorrectly to get it correct on the exam.

23.	palliative dilakukan saat : stage 3 - 4

"Palliative care is a multidisciplinary approach to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis. The goal of such therapy is to improve quality of life for both the patient and the family. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. Therefore, although it is an important part of end-of-life care, it is not limited to that stage. " - (Source)

24.	bukan prinsip palliative care : ecomonis

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patients illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation *therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

- (WHO)

25.	target volume radioterapi cervix : tumor saja
26.	aspek psikologi akan mati : denial anger bargaining depresi acceptance

"The Kübler-Ross model postulates a series of emotions experienced by survivors of an intimate's death, wherein the five stages are denial, anger, bargaining, depression and acceptance." - (Source).

27.	CLL : philadelpia kromosom

The Philadelphia chromosome or Philadelphia translocation is a specific genetic abnormality in chromosome 22 of leukemia cancer cells (particularly chronic myelogenous leukemia (CML) cells). This chromosome is defective and unusually short because of reciprocal translocation of genetic material between chromosome 9 and chromosome 22, and contains a fusion gene called BCR-ABL1. This gene is the ABL1 gene of chromosome 9 juxtaposed onto the BCR gene of chromosome 22, coding for a hybrid protein: a tyrosine kinase signalling protein that is "always on", causing the cell to divide uncontrollably.

The presence of this translocation is a highly sensitive test for CML, since 95% of people with CML have this abnormality (the remainder have either a cryptic translocation that is invisible on G-banded chromosome preparations, or a variant translocation involving another chromosome or chromosomes as well as the long arm of chromosomes 9 and 22). However, the presence of the Philadelphia (Ph) chromosome is not sufficiently specific to diagnose CML, since it is also found in acute lymphoblastic leukemia (ALL, 25–30% in adult and 2–10% in pediatric cases) and occasionally in acute myelogenous leukemia (AML). - (Source).

28.	Trombositosis : CML

Wrong.

"Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a myeloproliferative disorder characterized by increased proliferation of the granulocytic cell line without the loss of their capacity to differentiate. It accounts for 20% of all leukemias affecting adults. The following are signs and symptoms of progressive disease: Increasing anemia, thrombocytopenia, basophilia, and a rapidly enlarging spleen in blast crisis." - (Source).

"Essential thrombocythaemia (ET) is a disorder in which too many platelets are produced in the bone marrow. Platelets are normally needed in the body to control bleeding. However, excess numbers of platelets can lead to abnormal blood clotting which can block the flow of blood in the blood vessels. There are a number of conditions that can cause a rise in the number of platelets in the circulating blood (thrombocytosis). These include bleeding, infection and some types of cancer. In essential thrombocythaemia however, the blood platelet count is persistently elevated as a result of increased bone marrow production of platelets, in the absence of any identifiable cause." - (Source)

29.	terapi abcess : aspirasi total
30.	hidradenitis supurative : jika parah dilakukan eksisi glandula apokrin

"Hidradenitis suppurativa is rare, long-term skin condition that features small, painful lumps under the skin. They typically develop where the skin rubs together, such as the armpits, the groin, between the buttocks and under the breasts. The lumps may break open and smell or cause tunnels under the skin." - (Source).

"Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in the apocrine gland–bearing skin. This condition is a chronic disabling disorder that relentlessly progresses, frequently causing keloids, contractures, and immobility. " - (Source).

"When the process becomes chronic, wide surgical excision is the procedure of choice. " - (Source).

31 to 40[edit]

31.	gastroenteritis karena : s. enteritidis

"Many different types of bacteria can cause bacterial gastroenteritis, including:

  • Campylobacter jejuni
  • E coli
  • Salmonella
  • Shigella
  • Staphylococcus
  • Yersinia" - (Source).

S. enteritidis = Salmonella enteritidis.

32.	leptospira yang ada diseluruh dunia :

"One of the most common species of Leptospira is Leptospira interrogans. This species is the most predominant pathogen of the Leptospira phylum and results in a disease called leptospirosis. Leptospirosis is a zoonotic disease, predominant in the subtropical and tropical regions of the world. Most cases of leptospirosis in humans originate from a reservoir host, most commonly rodents, and are transmitted through water or contaminated soil. Specifically, L. interrogans colonizes the renal tubules of the host organism." - (Source).

33.	penempelan virus : struktur protein

"Attachment is achieved when receptors on the capsid or viral envelope become connected to complementary receptor proteins on the cell membrane of the target cell." - (Source).

34.	deteksi virus menggunakan : Ag

In the diagnostic laboratory virus infections are confirmed by several methods that include:

  • Growth of the virus in a cell culture from a specimen taken from the patient.
  • Detection of virus-specific antibodies in the blood.
  • Detection of virus antigens
  • Detection of virus nucleic acids
  • Gene sequencing to characterise viral strains
  • Observation of virus particles by electron microscopy.
  • Hemagglutination assay

- (Source).

35.	deteksi virus Ig G : infeksi awal

"When the adaptive immune system of a vertebrate encounters a virus, it produces specific antibodies which bind to the virus and render it non-infectious. This is called humoral immunity. Two types of antibodies are important. The first called IgM is highly effective at neutralizing viruses but is only produced by the cells of the immune system for a few weeks. The second, called, IgG is produced indefinitely. The presence of IgM in the blood of the host is used to test for acute infection, whereas IgG indicates an infection sometime in the past." - (Source).

36.	lepra mendapat stigma : cacat permanen

"From ancient times the disease was feared because of the disfigurement it caused and lack of understanding about how it was transmitted; it was long believed to be inherited and was associated with ideas of "unclean blood". The stigma was renewed in the late 19th century as Europeans encountered cultures where leprosy was or became more widespread than in their own, or where it was associated with poverty and developing economies." - (Source).

37.	aksi farmakologis dapson : 

"As an antibacterial, dapsone inhibits bacterial synthesis of dihydrofolic acid, via competition with para-aminobenzoate for the active site of dihydropteroate synthase. Dapsone has anti-inflammatory and immunomodulatory effects, which are thought to come from the drug's blockade of myeloperoxidase. As part of the respiratory burst that neutrophils use to kill bacteria, myeloperoxidase converts hydrogen peroxide (H2O2) into hypochlorous acid (HOCl). HOCl is the most potent oxidant generated by neutrophils, and can cause significant tissue damage during inflammation. Dapsone arrests myeloperoxidase in an inactive intermediate form, reversibly inhibiting the enzyme. This prevents accumulation of hypochlorous acid, and reduces tissue damage during inflammation." - (Source).

38.	kulit kering di lepra karena : menghambat saraf

"Nerve damage produces anaesthesia, dryness and muscle weakness. These three factors lead to misuse of the affected limb, with resultant ulceration, infection and ultimately, severe deformity. Dryness of the skin leads to skin cracking and secondary infection. Patients should soak their feet and hands in water and apply petroleum jelly (vaseline) on their hands and feet." - (WHO).

39.	first line uncomplicated malaria : kina + primaquin

Treatment of uncomplicated P. falciparum malaria:

  • artemether + lumefantrine
  • artesunate + amodiaquine
  • artesunate + mefloquine
  • dihydroartemisinin + piperaquine
  • artesunate + sulfadoxine - pyrimethamine (SP)

- (WHO)

40.	obat malaria saat hamil : sulfonid + pirimetamin

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41 to 50[edit]

41.	fase saat di hepar : sporozoit

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42.	nyamuk exofilik : suka istirahat diluar ruangan

"Exophilic - tends to inhabit/rest in outdoor areas. After biting, an exophilic mosquito flies outside and rests woods, grass, or other outside areas." - ([www.malaria.org/malariaglossary.html Source]).

43.	obat filariasis : dietilkarbamasin

"Diethylcarbamazine — DEC, a piperazine derivative, is a potent microfilaricidal and macrofilaricidal agent with activity against W. bancrofti, B. malayi, and B. timori. The mechanism of action is uncertain; it is thought to alter microfilarial surface membranes or inhibit filarial release of immunomodulatory eicosanoids, thereby enhancing destruction via host immune responses. DEC also has macrofilaricidal activity, likely via hyperpolarization leading to immobilization of adult worms. Estimates suggest DEC kills approximately 50 percent of adult worms, and its effect on adult worms in turn decreases the microfilarial burden." - (Source).

"Ivermectin is at least as effective as DEC in reducing microfilaremia due to Bancroftian filariasis."

"Albendazole has no direct effect on microfilariae but leads to a slow decline in microfilaremia due to macrofilaricidal activity against the adult worms."

"Doxycycline — A promising alternative approach to attacking the worm directly is to focus treatment against Wolbachia, an intracellular bacterial symbiont of filarial parasites that is present in microfilariae and adult worms of W. bancrofti and both Brugia species. Doxycycline has both microfilaricidal and macrofilaricidal activity and has demonstrated efficacy in both W. bancrofti and B. malayi infections."

44.	wucheria bancrofti : ruang kepala panjang sama dengan lebar

Wucheriafilariasis.jpg

45.	gejala akut filariasis : limfadenitis

"Acute manifestations of lymphatic filariasis include acute adenolymphangitis, dermatolymphangioadenitis, filarial fever, and tropical pulmonary eosinophilia." - (Source).

46.	obat cutaneous
47.	dermatitis kontak alergi : menyebar dari tempat yang terpapar

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48.	jamur di kuku : trichophyton sp

"Onychomycosis refers to nail infections caused by fungi, including dermatophytes (tinea unguium), yeasts, and nondermatophyte molds. Trichophyton rubrum was the most common causative organism, accounting for approximately 45 percent of cases." - (Source).

49.	informed consent : persetujuan yang diberikan setelah dijelaskan dokter
50.	informed consent berhak : diatas 21 tahun

51 to 60[edit]

51.	(gambar ngebor langit-langit) :
52.	gerakan stasis dapat menyebabkan : 
53.	sering menggunakan sarung tangan latex : urtikaria kontak

"People who are at higher risk for developing latex allergy include: Health care workers and others who frequently wear latex gloves. Latex allergy symptoms may include hives, itching, stuffy or runny nose. It can cause asthma symptoms of wheezing, chest tightness and difficulty breathing. Symptoms begin within minutes after exposure to latex containing products. The most severe latex allergy can result in anaphylaxis. A second type of skin allergy called “allergic contact dermatitis” may be caused by chemicals used to manufacture rubber gloves. This dermatitis is recognized by the eczema and blisters on the back of the hands. It resembles a poison ivy rash, and begins 1 to 3 days after wearing rubber gloves." - (Source).

54.	toksis besi : siderosis

"Iron toxicity is not always due to an increase in dietary iron. There are many diseases that can lead to a problem in iron absorption and in turn iron toxicity. With acute iron poisoning, much of the damage to the gastrointestinal tract and liver may be a result of a high localized iron concentration and free radical production, leading to heptatoxicity via lipid peroxidation and the destruction of the hepatic mitochondria. Therefore, the patient needs rapid removal of iron from the gut to prevent tissue damage. The iron accumulating disease is Hemochromatosis. This is an iron storage disease the results from the inability of the intestine to keep out unneeded iron. Instead, iron accumulates in the liver causing siderosis (the accumulation of storage iron in tissues) and damage to the storage organs. " - (Source).

55.	jenis pengobatan administrative : APD
56.	105 db tanpa earplug

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57.	manfaat kecerdasan intelektual, emosi, spiritual : menghindari tekanan dari orang lain
58.	adaptasi lingkungan : kecerdasan intelektual
59.	obat negative symptom : risperidon

"The most effective treatment for secondary symptoms is to target the underlying cause. Neuroleptic-induced akinesia may respond to anticholinergic agents, reduction in antipsychotic dose, or a change in antipsychotic. Using one of the newer-generation antipsychotics (clozapine, risperidone, olanzapine, quetiapine, or ziprasidone) may prevent EPS." - (Source).

60.	mediator kokain : dopamin

61 to 64[edit]

61.	agresi predator : lateral

"Adequate electrical stimulation of extreme lateral hypothalamic regions of healthy, non-aggressive male cats was employed to produce aggression on live but anaesthetized rats. " - (Source).

62.	agresi predator : yang bukan mata dilatasi, pamer

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63.	jomblo adek adeknya sudah menikah : gangguan cemas menyeluruh
64.	skuama