Block B2 Recap Batch 2013

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Block B2 - Neuromusculoskeletal Problems


The text in boxes like these is the original recap compiled by the students of Batch 2013. Not every answer is correct.

The text below the box is the explanation by the FK Wiki author(s) and is often just excerpts from various sources.

1[edit]

Wolff’s rule

"Wolff's law, developed by the German anatomist and surgeon Julius Wolff (1836–1902) in the 19th century, states that bone in a healthy person or animal will adapt to the loads under which it is placed."

"The racquet-holding arm bones of tennis players become much stronger than those of the other arm. Their bodies have strengthened the bones in their racquet-holding arm since it is routinely placed under higher than normal stresses." - Wikipedia

2[edit]

Apa yang termasuk intra axial neuroplasm ? Glioblastoma Multiforme

"Glioblastoma multiforme (GBM) frequently crosses the midline by infiltrating the white matter tracts of the corpus callosum." - RadiologyAssistant.nl.

3[edit]

Pasien datang ke ER setelah lomba panco, krepitasi (+), di X-Ray ada bone lytic lesion, apa yang jadi baseline diagnosis pathologic fracture ? Low Energy trauma
Lytic lesions
are light areas found in otherwise dense bone on an x-ray, which suggest that something has destroyed or replaced that part of bone. There are both cancerous and noncancerous causes of lytic lesions, however given the potential for cancer this finding should be taken very seriously until cancer can be ruled out. The types of cancer that can cause lytic lesions include multiple myeloma, a type of blood cancer, as well as breast and lung cancer that get into the bones. Benign, noncancerous causes of lytic lesions include simple bone cysts, some types of bone infections, osteoblastoma, and chondroblastomas. - ZocDoc.

"A high-energy trauma may be the result of a motor vehicle accident, a high-height fall, or an industrial accident. A low-energy trauma may be the result of a disease which has affected the integrity of the bone. Osteoporosis is one such disease which can have devastating effects to the elderly and results in the degradation of quality of life." - Fractures.com.

4[edit]

Fungsi parathyroid hormone di ginjal ? Increase synthesis 1,25 dihydrolalalalalalalalalalla

"Calcitriol (INN), also called 1,25-dihydroxycholecalciferol or 1,25-dihydroxyvitamin D3, is the hormonally active metabolite of vitamin D. Calcitriol increases blood calcium levels ([Ca2+]) by promoting absorption of dietary calcium from the gastrointestinal tract and increasing renal tubular reabsorption of calcium, thus reducing the loss of calcium in the urine." - Wikipedia.

  • The parathyroid glands monitor the calcium in the blood 24 hours per day.
  • The four parathyroid glands make more or less parathyroid hormone (PTH) in response to the level of calcium in the blood.
  • When the calcium in our blood gets too low, the parathyroid glands make more PTH.
    • Increased PTH causes the body to put more calcium into the blood.
    • Increased PTH causes the bones to release their calcium into the blood.
  • When the calcium in our blood gets too high, normal parathyroid glands STOP making PTH--they shut down.
  • Calcium is the most important element for the nervous system, the muscular system, and the skeletal system.

- Parathyroid.com

5[edit]

Efek samping benzodiazepine ? Respiratory distress

High doses of benzodiazepines can produce more serious side effects. Signs and symptoms of acute toxicity or overdose may include the following:

  • Drowsiness
  • Confusion
  • Dizziness
  • Blurred vision
  • Weakness
  • Slurred speech
  • Lack of coordination
  • Difficulty breathing
  • Coma

- WebMD.

"Additive effects of benzodiazepines with other CNS depressants can aggravate or precipitate respiratory failure, particularly in the elderly and those with respiratory disease." - Benzo.org.uk.

6[edit]

Drugs of choice partial seizure ? Carbamazepine

"Carbamazepine (CBZ) is a major first-line AED for partial seizures and generalized tonic-clonic seizures. " - Medscape.

"CBZ is one of the most widely used AEDs in the world. It is highly effective for partial-onset seizures, including cryptogenic and symptomatic partial seizures. It also has demonstrated good efficacy in the treatment of generalized tonic-clonic seizures." - Medscape.

"Phenytoin (PHT) is one of the most commonly used first-line or adjunctive treatments for partial and generalized seizures, Lennox-Gastaut syndrome, status epilepticus, and childhood epileptic syndromes. It is not indicated for myoclonus and absence seizures. One disadvantage of PHT is that it causes central nervous system (CNS) and systemic adverse effects. Long-term use of PHT has been associated with osteoporosis." - Medscape.

7[edit]

Yang termasuk DMRAD ? Hyfroxychloroquine

"Disease-modifying antirheumatic drugs (DMARDs) are a group of medications commonly used in patients with rheumatoid arthritis. They work to decrease pain and inflammation, to reduce or prevent joint damage, and to preserve the structure and function of the joints. Some of these drugs are also used in treating other conditions such as ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus. DMARDs work to suppress the body's overactive immune and/or inflammatory systems. They take effect over weeks or months and are not designed to provide immediate relief of symptoms. The most common DMARDs are methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide." - UpToDate.

8[edit]

Levodopa mengobati ? Bradykinesia

"The main therapy for Parkinson's is the drug levodopa, also called L-dopa. Levodopa successfully reduces the tremors and other symptoms of Parkinson's during the early stages of the disease. However, not all symptoms respond equally to levodopa. It usually helps most with bradykinesia (slowness of movement) and rigidity. Problems with balance and other non-motor symptoms may not be helped at all." - NIH.

9[edit]

Postural tremor bisa diobati dengan ? GABApentin

"Postural tremor occurs when the person maintains a position against gravity, such as holding the arms outstretched. " - NIH.

"Treatment for postural tremors include: Beta blockers, primidone (Mysoline), acetazolamide (Diamox), clonazepam (Klonopin), botulinum toxin, brain gabapentin (Neurontin), deep stimulation, thalamotomy" - AAFP.

"Gabapentin is indicated for: Management of postherpetic neuralgia in adults; and Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy" - Drugs.com.

10[edit]

Obat yang tahan lama dan punya long half life di serum dan CSF ? 

11[edit]

Yang meningkatkan reseptor dopamine ? Bromocriptine ( dopamine agonist )

"Bromocriptine mesylate is a dopamine receptor agonist, which activates post-synaptic dopamine receptors. The dopaminergic neurons in the tuberoinfundibular process modulate the secretion of prolactin from the anterior pituitary by secreting a prolactin inhibitory factor (thought to be dopamine); in the corpus striatum the dopaminergic neurons are involved in the control of motor function. Clinically, Bromocriptine mesylate significantly reduces plasma levels of prolactin in patients with physiologically elevated prolactin as well as in patients with hyperprolactinemia." - Drugs.com.

12[edit]

Di X-ray film ada onion peeling effect ? Ewing Sarcoma

"Ewing sarcoma is the second most common highly malignant primary bone tumour of childhood after osteosarcoma, typically arising from medullary cavity with invasion of Haversian system. They usually present as moth-eaten destructive permeative lucent lesions in the shaft of long bones with large soft tissue component without osteoid matrix, and typical onion skin periostitis." - Radiopaedia.org.

13[edit]

23 tahun, ada soft lump 3 x 2 cm di extremity ? Lipoma

"Lipomas are benign tumours composed of mature adipocytes. They are the most common soft tissue tumour. Typically lipomas are superficial and present as a soft painless mass in the trunk or proximal extremities. They are likely to have been present for many years, and may change size with weight fluctuation." - Radiopaedia.

14[edit]

Yang benar mengenai craniopharyngioma ? benigna

"A craniopharyngioma is a noncancerous (benign) tumor that develops at the base of the brain near the pituitary gland. This tumor most commonly affects children 5 to 10 years of age. Adults can sometimes be affected. Boys and girls are equally likely to develop this condition." - NIH.

"Craniopharyngiomas are dysontogenic (any tumour of primitive cells, for which the suffix -blastoma is often attached) tumors with benign histology and malignant behavior. These lesions have a tendency to invade surrounding structures and to recur after a seemingly total resection." - Medscape

15[edit]

Penampakan CT MRI meningoencephalitis ? Hipodens, hiperintens

16[edit]

Pernyataan benar mengenai neurocystisercosis ? Baca HSC aja ya 

"Neurocysticercosis is the result of accidental ingestion of eggs of Taenia solium (ie, pork tapeworm), usually due to contamination of food by people with taeniasis. In developing countries, neurocysticercosis is the most common parasitic disease of the nervous system and is the main cause of acquired epilepsy. Neurocysticercosis is commonly diagnosed with the routine use of diagnostic methods such as computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. symptomatic presentations include the following: Epilepsy: Most common presentation (70%); Headache, dizziness; Stroke; Neuropsychiatric dysfunction." - Medscape

17[edit]

Obat neurocystisercosis ? Albandazole

"Two medications are available in the treatment of neurocysticercosis, praziquantel (PZQ) and albendazole. Both agents eliminate the cysticerci or markedly reduce their number. Albendazole appears to be superior to PZQ and seems to be more effective in giant cysts and subarachnoid, intraventricular, or spinal neurocysticercosis. Albendazole decreases ATP production in the worm, as well as inhibits polymerization of a component of the microtubules, thus preventing their formation. This causes energy depletion, immobilization, and finally death of the parasite. To avoid an inflammatory response in the central nervous system (CNS), patients also must be started on anticonvulsants and high-dose glucocorticoids." - Medscape

18[edit]

Administration LMWH ? Subcutan

"Traditionally, treatment for DVT required patients to be hospitalized for administration of intravenous heparin. With subcutaneous injections of low-molecular-weight heparin (LMWH), treatment of DVT can be initiated or completed in the outpatient setting with no increased risk of recurrent thromboembolism or bleeding complications." - AAFP.

19[edit]

Contoh obat GP IIa/IIIb ? Abcxicimab

"glycoprotein IIb/IIIa inhibitors, also GpIIb/IIIa inhibitors, is a class of antiplatelet agents. Some examples include: abciximab, eptifibatide, tirofiban, roxifiban, and orbofiban." - Wikipedia

20[edit]

Claw hand itu injury dari ? 

"An ulnar claw, also known as claw hand, or 'Spinster's Claw' is an abnormal hand position that develops due to a problem with the ulnar nerve." - Wikipedia.

It can be caused by muscular dystrophies, leprosy, Charcot-Marie-Tooth Disease, birth defects, and burns and lesions causing ulnar nerve injury.

21[edit]

Acetylcholine dihasilkan oleh ? Neuron

"Acetylcholine is the neurotransmitter used at the neuromuscular junction—in other words, it is the chemical that motor neurons of the nervous system release in order to activate muscles. This property means that drugs that affect cholinergic systems can have very dangerous effects ranging from paralysis to convulsions. Acetylcholine is also used as a neurotransmitter in the autonomic nervous system, both as an internal transmitter for the sympathetic nervous system and as the final product released by the parasympathetic nervous system." - Wikipedia.

22[edit]

Osteomyelitis disebabkan oleh ? Staph Aureus

"Osteomyelitis is inflammation of the bone caused by an infecting organism. Although bone is normally resistant to bacterial colonization, events such as trauma, surgery, the presence of foreign bodies, or the placement of prostheses may disrupt bony integrity and lead to the onset of bone infection. Osteomyelitis can also result from hematogenous spread after bacteremia. The major cause of bone infections is Staphylococcus aureus." - Medscape

23[edit]

Lab test untuk neurosyphillis ? Treponema test

"No laboratory study has proven sufficiently sensitive or specific to serve as a single test for the definitive diagnosis of neurosyphilis. Dark-field microscopy of the skin lesions is the most specific technique for diagnosis. This requires the presence of live treponemes from serous exudates collected gently on a glass slide. Microscopically, the spirochete has a characteristic corkscrew appearance. Biopsy with direct fluorescent antibody staining of material from the lesion has been successful. Further, the recently completed sequencing of the genome for Treponema pallidum may offer improved diagnostic testing; currently, however, serologic testing is the standard. Syphilitic infection produces 2 types of antibodies, the nonspecific reaginic (immunoglobulin E–mediated) antibody (ie, anticardiolipin) and specific antitreponemal antibody, which are measured by the nontreponemal and treponemal tests, respectively. " Medscape


24[edit]

Anti DNA antibody yang sesuai dengan phenomenon fact (?) 
a)	Untuk konfirmasi SLE
b)	Ditemukan di struktur kinetoplast hemoflagellum

"Anti-dsDNA antibodies are a group of anti-nuclear antibodies and their target antigen is double stranded DNA. They are highly diagnostic of systemic lupus erythematosus (SLE) and are implicated in the pathogenesis of lupus nephritis." - Wikipedia


25[edit]

Tampakan CMV radiologis ?
a)	MRI : Kista subependymal kalau diberi kontras
b)	CT : Kalsifikasi periventrikuler disertai atrofi

"CMV is the most common cause of intra-uterine infection and most common cause of congenital infective and brain damage, occurring in 0.2-2.4% of live births. "


Ultrasound[edit]

Fetal CMV is usually undetected by routine trans-abdominal ultrasound, but pre-natal transvaginal screening ultrasound in infected mothers may show:

Brain:

  • fetal intracranial calcification: particularly periventricular calcification (hyperechogenic foci), considered on the commonest of features:
  • fetal hydrocephalus
  • heterogeneous appearing parenchyma
  • microcephaly
  • intraventricular adhesions

Other:

  • fetal intra-hepatic calcification
  • fetal hepatomegaly
  • evidence of intra-uterine growth restriction (IUGR)
  • echogenic bowel

CT[edit]

When performed post natally, non-contrast CT demonstrates variable features, including:

  • intracranial calcifications: particularly thick and chunky in germinal matrix and periventricular regions with faint and punctate basal *ganglia calcifications
  • white matter low density regions
  • ventriculomegaly/cerebral atrophy/destructive encephalopathy
  • neuronal migration disorders

MRI[edit]

Features seen on MRI include:

  • microcephaly
  • migrational abnormalities: lissencephaly, pachygyria, and schizencephaly
  • white matter lesions: predominantly parietal or posterior white matter involvement with spared rim in immediately periventricular and subcortical white matter.
  • ventriculomegaly and subarachnoid space enlargement
  • delayed myelination
  • periventricular and temporal pole cysts

- Radiopaedia.

26[edit]

Pernyataan yang tidak benar tentang hematoma ? Diffuse axonal lalalala ( seharusnya irreversible )

27[edit]

Diagnosis RA menurut American Rheumatology Association ? Rheumatoid Factor (+)

"RF and anti-CCP antibodies – We perform both RF and anti-CCP antibody testing when initially evaluating a patient with suspected RA. The results of both tests are informative, since a positive result for either test increases overall diagnostic sensitivity, while the specificity is increased when both tests are positive. Despite this, both tests are negative on presentation in up to 50 percent of patients and remain negative during follow-up in 20 percent of patients with RA." - UpToDate

28[edit]

Pernyataan yang benar tentang toxoplasma cerebral ?
a)	Kata Sani : Kenaikan IgG both di immunocompromised & imminocompetent
b)	Kata Mitha : Serology test sensitive di HIV patients

"Toxoplasmosis is the leading cause of focal central nervous system (CNS) disease in AIDS. CNS toxoplasmosis in HIV-infected patients is usually a complication of the late phase of the disease. CNS toxoplasmosis results from infection by the intracellular parasite Toxoplasma gondii. It is almost always due to reactivation of old CNS lesions or to hematogenous spread of a previously acquired infection. CNS disease occurs during advanced HIV infection when CD4+ counts are less than 200 cells/µL. Serologic studies in patients with CNS toxoplasmosis may demonstrate rising titers of anti-toxoplasma immunoglobulin G (IgG) antibodies. An immunoglobulin M (IgM) antibody response is seen in cases of newly acquired toxoplasmosis or Toxoplasma encephalitis. However, anti-Toxoplasmagondii IgG detection may be unreliable in immunodeficient individuals who fail to produce significant titers of specific antibodies. Standard therapy consists of pyrimethamine, sulfadiazine, and folinic acid in combination. " - Medscape


29[edit]

Tampakan radiologis untuk temporal lobe epilepsy ? 

"Temporal lobe epilepsy (TLE) is the most common type of partial epilepsy. Ganglioglioma is the most common tumor associated with temporal lobe epilepsy. Calcification is common in ganglioglioma. " - RadiologyAssistant.nl.

30[edit]

Orang dibawa ke klinik memory dengan Sx : gangguan working memory, mood, ada gangguan lobus ? Frontal Lobe

"Damage to the frontal lobe can cause increased irritability, which may include a change in mood and an inability to regulate behavior. Patients with damaged frontal lobes show lower working memory and, therefore, a lessened ability to retrieve information from their secondary memory." - Wikipedia.

31[edit]

Kalau ada gangguan di lobus occipital ? Visual disruption

"The occipital lobe is the visual processing center of the mammalian brain containing most of the anatomical region of the visual cortex." - Wikipedia

32[edit]

Levodopa di perifer diubah menjadi ? Dopamine

"After being absorbed in the gastrointestinal tract, levodopa is transported to brain cells, where it is transformed into dopamine. It is subsequently released by brain cells and activates dopamine receptors, allowing for improved function of the movement control centers of the brain." - UCSF.edu.

33[edit]

Gangguan di temporal lobe jadi ? Memory and language

"The temporal lobe is involved in processing sensory input into derived meanings for the appropriate retention of visual memories, language comprehension, and emotion association." - Wikipedia.

34[edit]

Ada orang kecelakaan, beberapa bulan kemudian dia gak bisa merasa, kemungkinan karena ?

35[edit]

Ditemukan adanya giant bizarre cells, matrix osteoid, dx ? Osteosarcoma

Osteosarcoma:

  • High grade spindle cell tumor that produces osteoid matrix unconnected by cartilage (by definition)
  • Tumor cells produce neoplastic bone - basophilic thin trabeculae of neoplastic bone resembling fungal hyphae or neoplastic osteoid-eosinophilic, homogenous, glassy with irregular contours and osteoblastic rimming
  • Destroys or grows around trabeculae
  • Vascular invasion and necrosis common
  • May have osteoblastic, fibroblastic (pure spindle cell growth with minimal matrix) or chondroblastic predominance (malignant appearing cartilage with peripheral spindling and osteoid production)
  • Osteoid may be variable in amount
  • With bizarre giant cells in stroma or acellular stroma
  • Vessels may have hemangiopericytoma-like features
  • Tumor cells may be spindly, oval or round of variable size
  • 25% have osteoclast-like multinucleated giant cells
  • Cartilage may be mineralized, immature, myxoid

- PathologyOutlines.com.

36[edit]

Vertigo yang clinical manifestation-nya buruk ?

37[edit]

Prognosis neck pain ? Slow progressive

38[edit]

Conservative Tx untuk neck pain ? Collar neck

"Avoid wearing a neck collar – there is no evidence to suggest wearing a neck collar will help to heal your neck, and it's generally better to keep your neck mobile" - NHS.

39[edit]

DDx MG ? Oculopharyngeal Muscular Dystrophy -> kata Sani di medscape gak bener, udah jadi dosen aja san.

"A distinction between OPMD and myasthenia gravis or mitochondrial myopathy must be made. " - Wikipedia.

  • Chronic progressive external ophthalmoplegia
  • Myotonic dystrophy
  • Oculopharyngodistal myopathy
  • Myasthenia gravis
  • Paraneoplastic Lambert-Eaton Myasthenic Syndrome
  • Limb-girdle muscular dystrophy
  • Inclusion body myositis
  • Desmin myopathy
  • Myofibrillary myopathies
  • Adult-onset spinal muscular atrophy IV
  • X-linked spinobulbar muscular atrophy

- EyeRounds.

"OPMD is distinguished from facioscapulohumeral dystrophy (FSHD) by the different distributions of weakness. Extraocular weakness is far more severe in OPMD." - UpToDate.

40[edit]

Biomarker untuk bone formation ? Procollagen 1N-Terminal dan C-Terminal

A summary list of bone formation markers is as follows:

  • Serum total alkaline phosphatase
  • Serum bone–specific alkaline phosphatase
  • Serum osteocalcin
  • Serum type 1 procollagen (C-terminal/N-terminal): C1NP or P1NP

A summary list of bone resorption markers is as follows:

  • Urinary hydroxyproline
  • Urinary total pyridinoline (PYD)
  • Urinary free deoxypyridinoline (DPD)
  • Urinary collagen type 1 cross-linked N-telopeptide (NTX)
  • Urinary or serum collagen type 1 cross-linked C-telopeptide (CTX)
  • Bone sialoprotein (BSP)
  • Tartrate-resistant acid phosphatase 5b

41[edit]

Gejala yang sering dirasakan oleh young age dengan parkinson ?

"It is not unusual for younger people to notice some of the non-motor Parkinson's symptoms first, before some of the more well-known motor symptoms manifest. Depression, Anxiety, Apathy. People with young onset PD may notice changes in the way they retain and/or process information. Many young people report they are unable to manage as many tasks simultaneously as they once were. Executive functioning (i.e., difficulty multi-tasking), Slowed cognitive speed, Memory, Dementia" - APDA.

42[edit]

Movement disorder yang bisa di-trick dengan sensory trick ? Dystonia

"A geste antagoniste (aka sensory trick) is a physical gesture or position (such as touching your chin) which may serve to temporarily interrupt dystonic symptoms." - Dystonia.org.uk.

43[edit]

Open fracture, tidak mengenai blood vessel, 8 cm, exposed bone, klasifikasi ? IIIB
Gustilo open fracture Classification
Gustilo Grade Definition
I Open fracture, clean wound, wound <1 cm in length
II Open fracture, wound > 1 cm but < 10 cm in length without extensive soft-tissue damage, flaps, avulsions
III Open fracture with extensive soft-tissue laceration (>10 cm), damage, or loss or an open segmental fracture. This type also includes open fractures caused by farm injuries, fractures requiring vascular repair, or fractures that have been open for 8 hr prior to treatment
IIIA Type III fracture with adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration or damage
IIIB Type III fracture with extensive soft-tissue loss and periosteal stripping and bone damage. Usually associated with massive contamination. Will often need further soft-tissue coverage procedure (i.e. free or rotational flap)
IIIC Type III fracture associated with an arterial injury requiring repair, irrespective of degree of soft-tissue injury.

- Wikipedia

44[edit]

Apa yang harus di-consent untuk penderita Bell’s Palsy ? Harus menutup mata

Examinations needed to diagnose:

  • Cranial Nerve Assessment
  • Ear canal examination (Otoscopy)
  • Neurological assessment of Upper & Lower Limbs

- GeekyMedics

45[edit]

Obat untuk Guillain-Barre syndrome ? IV Immunoglobulin

"Immunomodulatory treatment has been used to hasten recovery. Intravenous immunoglobulin (IVIG) and plasma exchange have proved equally effective." - Medscape

46[edit]

Musculus yang menarik medial clavicula kalau fracture ? M. Sternocleidomastoideus

"The part of the clavicle near the center of the body is tilted upwards by the sternocleidomastoid muscle." - Wikipedia

47[edit]

Musculus yang terletak di intermediet layer of intrinsic muscle of back ? M. Erector Spina

48[edit]

Fungsi intervertebral joint? Limit rotation Nah kalau menahan berat badan itu Intervertebral disc.

"The meeting points of the two spinal bones involved in forming an intervertebral joint are the vertebral body (the front portion) and the vertebral arch (the back portion). Between the vertebral bodies, cushioning is provided by the presence of intervertebral discs. Between the vertebral arches, movement is facilitated and constrained by small facet joints." - About.com

"The intervertebral disc functions to separate the vertebrae from each other and provides the surface for the shock-absorbing gel of the nucleus pulposus. The nucleus pulposus of the disc functions to distribute hydraulic pressure in all directions within each intervertebral disc under compressive loads. " - Wikipedia

49[edit]

Pelajarin pengukuran GCS!
Glasgow Coma Scale
1 2 3 4 5 6
Eye Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A N/A
Verbal Makes no sounds Incomprehensible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A
Motor Makes no movements Extension to painful stimuli (decerebrate response) Abnormal flexion to painful stimuli (decorticate response) Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys commands

- Wikipedia.

50 & 51[edit]

50. Fungi yg sering menginfeksi CNS ? Cryptococcus Neoformans
51. Infeksi yang sering karena Cryptococcus ? Cerebral Cryptococcus

"Cryptococcus neoformans is an encapsulated yeast. Kingdom: Fungi. Infection with C. neoformans is termed cryptococcosis. Most infections with C. neoformans occur in the lungs. However, fungal meningitis and encephalitis, especially as a secondary infection for AIDS patients, are often caused by C. neoformans, making it a particularly dangerous fungus. In human infection, C. neoformans is spread by inhalation of aerosolized basidiospores, and can disseminate to the central nervous system, where it can cause meningoencephalitis." - Wikipedia

52[edit]

Tension type headache termasuk ? Primary headache

53[edit]

Chronic pain karena continuous inflammation mekanismenya gimana ?

54[edit]

Pernyataan yg benar tentang MMP9 ?

"Proteins of the matrix metalloproteinase (MMP) family are involved in the breakdown of extracellular matrix in normal physiological processes, such as embryonic development, reproduction, angiogenesis, bone development, wound healing, cell migration, learning and memory, as well as in pathological processes, such as arthritis, intracerebral hemorrhage, and metastasis. Most MMPs are secreted as inactive proproteins which are activated when cleaved by extracellular proteinases. Elevated MMP9 levels can be found in the cases of rheumatoid arthritis and focal brain ischemia. One of MMP9's most widely-associated pathologies is the relationship to cancer, due to its role in extracellular matrix remodeling and angiogenesis. MMP9 levels increase with the progression of idiopathic atrial fibrillation. MMP9 has been found to be associated with the development of aortic aneurysms." - Wikipedia

55[edit]

Masalah di osteoarthritis ?
Chondrocytes
are the only cells found in healthy cartilage. They produce and maintain the cartilaginous matrix, which consists mainly of collagen and proteoglycans. - Wikipedia.

"The trigger of OA is most often unknown, but OA sometimes begins with tissue damage from mechanical injury (eg, torn meniscus), transmission of inflammatory mediators from the synovium into cartilage, or defects in cartilage metabolism. The tissue damage stimulates chondrocytes to attempt repair, which increases production of proteoglycans and collagen. However, efforts at repair also stimulate the enzymes that degrade cartilage, as well as inflammatory cytokines, which are normally present in small amounts. Inflammatory mediators trigger an inflammatory cycle that further stimulates the chondrocytes and synovial lining cells, eventually breaking down the cartilage. Chondrocytes undergo programmed cell death (apoptosis). Once cartilage is destroyed, exposed bone becomes eburnated and sclerotic.

All articular and some periarticular tissues become involved in OA. Subchondral bone stiffens, then undergoes infarction, and develops subchondral cysts. Attempts at bony repair cause subchondral sclerosis and osteophytes at the joint margins. The osteophytes seem to develop in an attempt to stabilize the joint. The synovium becomes inflamed and thickened and produces synovial fluid with less viscosity and greater volume. Periarticular tendons and ligaments become stressed, resulting in tendinitis and contractures. As the joint becomes less mobile, surrounding muscles thin and become less supportive.

Primary OA may be localized to certain joints (eg, chondromalacia patellae is a mild OA that occurs in young people). Primary OA is usually subdivided by the site of involvement (eg, hands and feet, knee, hip). If primary OA involves multiple joints, it is classified as primary generalized OA.

Secondary OA results from conditions that change the microenvironment of the cartilage. These conditions include significant trauma, congenital joint abnormalities, metabolic defects (eg, hemochromatosis, Wilson disease), infections (causing postinfectious arthritis), endocrine and neuropathic diseases, and disorders that alter the normal structure and function of hyaline cartilage (eg, RA, gout, chondrocalcinosis)."

- Merck Manuals.

"Under normal conditions, this matrix is subjected to a dynamic remodeling process in which low levels of degradative and synthetic enzyme activities are balanced, such that the volume of cartilage is maintained. In OA cartilage, however, matrix degrading enzymes are overexpressed, shifting this balance in favor of net degradation, with resultant loss of collagen and proteoglycans from the matrix. The primary enzymes responsible for the degradation of cartilage are the matrix metalloproteinases (MMPs). These enzymes are secreted by both synovial cells and chondrocytes. d. Once activated, MMPs become susceptible to the plasma-derived MMP inhibitor, alpha-2-macroglobulin, and to tissue inhibitors of MMPs (TIMPs) that are also secreted by synovial cells and chondrocytes. In OA, synthesis of MMPs is greatly enhanced and the available inhibitors are overwhelmed, resulting in net degradation. In summary, MMPs and pro-inflammatory cytokines (e.g., IL-1) appear to be important mediators of cartilage destruction in OA. Synthesis and secretion of growth factors and of inhibitors of MMPs and cytokines are apparently inadequate to counteract these degradative forces. Progressive cartilage degradation and OA result." - Johns Hopkins.

56[edit]

Sel apa yang berfungsi untuk bone resorption ? Osteoclast

"Bone resorption is the process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood." - Wikipedia

"Bone is constantly being remodelled in a dynamic process where osteoblasts are responsible for bone formation and osteoclasts for its resorption." - PubMed

57[edit]

Serabut A alpha membawa apa ?

58[edit]

Non - narcotics Analgesic which lacks of anti inflammation?

"Acetaminophen (paracetamol) is antipyretic and analgesic, as are NSAIDs, but it lacks the anti-inflammatory and anticoagulatory properties of these drugs." - PubMed.

NSAIDs are used as anti-inflammation, such as diclofenac: "Diclofenac is used to treat pain, inflammatory disorders, and dysmenorrhea." - Wikipedia.

59[edit]

Pain measurement yang mengukur intensitas ? VAS

"The well-known visual analogue scale (VAS) and numeric rating scale (NRS) for assessment of pain intensity agree well and are equally sensitive in assessing acute pain after surgery, and they are both superior to a four-point verbal categorical rating scale (VRS)." - Medscape.

60[edit]

Sharp edged bone lytic lesion with thin cortex ?

61[edit]

Nama lain osteochondroma ?

"Osteochondromas or osteocartilaginous exostoses are the most common benign tumors of the bones." - Wikipedia

62[edit]

Laki laki suka makan jeroan, di jempol kaki ada redness, swelling, apa langkah selanjutnya untuk menegakkan diagnosis ? Cek uric  acid urine

"Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling." - Mayo Clinic.

63[edit]

Bukan indikasi parenteral administration ?

Oral: The oral route is generally the most convenient and carries the lowest cost. Topical: By delivering drugs almost directly to the site of action, the risk of systemic side effects is reduced. Inhaled: medications can be absorbed quickly, and act both locally and systemically.

Parenteral
in short, any route into the body that is not enteral (par- + enteral). Parenteral includes intramuscular, subcutaneous, intradermal, intravenous, intrathecal, and epidural routes. Nonparenteral encompasses oral, sublingual, topical, transdermal, ophthalmic, otic, nasal, rectal, and vaginal routes.

Injections act rapidly, with onset of action in 15–30 seconds for IV, 10–20 minutes for IM, and 15–30 minutes for SC. They also have essentially 100% bioavailability, and can be used for drugs that are poorly absorbed or ineffective when given orally. Ongoing IV infusions can be used to deliver continuous medication or fluids.

- Wikipedia, Pharmaceutical Dosage Form on Fk Wiki.

64[edit]

Penyebab septic arthritis pada usia 16 - 40 tahun ?

"Septic arthritis is most commonly caused by staphylococcal or streptococcal bacteria." - NHS

65[edit]

Faktor V leiden bisa mengarah ke thrombophilia sebab ?

"Factor V Leiden thrombophilia is an inherited disorder of blood clotting. Factor V Leiden is the name of a specific gene mutation that results in thrombophilia, which is an increased tendency to form abnormal blood clots that can block blood vessels. A particular mutation in the F5 gene causes factor V Leiden thrombophilia. The F5 gene provides instructions for making a protein called coagulation factor V. This protein plays a critical role in the coagulation system, which is a series of chemical reactions that forms blood clots in response to injury.

The coagulation system is controlled by several proteins, including a protein called activated protein C (APC). APC normally inactivates coagulation factor V, which slows down the clotting process and prevents clots from growing too large. However, in people with factor V Leiden thrombophilia, coagulation factor V cannot be inactivated normally by APC. As a result, the clotting process remains active longer than usual, increasing the chance of developing abnormal blood clots.

The chance of developing an abnormal blood clot depends on whether a person has one or two copies of the factor V Leiden mutation in each cell. People who inherit two copies of the mutation, one from each parent, have a higher risk of developing a clot than people who inherit one copy of the mutation. " - NIH.

66[edit]

Stroke yang onset cepat dan progresinya buruk ?

67[edit]

Marker untuk activated intravascular coagulation ?

"Disseminated intravascular coagulation (DIC), also known as disseminated intravascular coagulopathy or less commonly as consumptive coagulopathy, is a pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body. This leads to compromise of tissue blood flow and can ultimately lead to multiple organ damage. In addition, as the coagulation process consumes clotting factors and platelets, normal clotting is disrupted and severe bleeding can occur from various sites." - Wikipedia

In clinical practice, a diagnosis of DIC can often be made by a combination of the following tests:

  • Platelet count
  • Global clotting times (aPTT and PT)
  • One or two clotting factors and inhibitors (eg, antithrombin)
  • Assay for D-dimer or FDPs

- Medscape

68[edit]

Cluster headache itu jenis sakit kepalanya gimana ?

Cluster falls under the primary headache type.

69[edit]

Injury pada medial premotor area kiri menyebabkan ? Right leg paralysis

"The premotor cortex is an area of motor cortex lying within the frontal lobe of the brain just anterior to the primary motor cortex. It occupies part of Brodmann's area 6. Brodmann area 6, situated just anterior to the primary motor cortex, it is composed of the premotor cortex and, medially, the supplementary motor area, or SMA." - Wikipedia

A lesion in Brodmann's area 6 may cause apraxia.

"Lesions affecting the medial part of the premotor cortex, the SMA and sparing the precentral gyrus caused a contralateral hemiparesis predominating on the leg but predominating proximally on both leg and arm." - Oxford Journals.

70[edit]

Dx ataxia sensoris itu bisa dilakukan Px apa ?

"Sensory ataxia is distinguished from cerebellar ataxia by the presence of near-normal coordination when the movement in question is visually observed by the patient, but marked worsening of coordination when the eyes are shut. Sensory ataxia also lacks the associated features of cerebellar ataxia such as pendular tendon reflexes, scanning dysarthria, nystagmus and broken pursuit eye movements. Patients with sensory ataxia often demonstrate pseudoathetosis and Romberg's sign. They usually complain of loss of balance in the dark, typically when closing their eyes in the shower or removing clothing over the head. Sensory ataxia can be a manifestation of sensory large fiber peripheral neuropathies and conditions causing dysfunction of the dorsal columns of the spinal cord due to a variety of disorders: infectious, auto-immune, metabolic, toxic, vascular and hereditary diseases." - Wikipedia

Romberg's sign
A sign which is swaying of the body that occurs when the eyes are closed.

71[edit]

Kalau dokter bandingin kaki kanan dan kiri yang ada tumor ganas, fungsinya untuk apa ?

72[edit]

Temuan klinis untuk bell’s palsy ? Matanya gak bisa nutup

73[edit]

Fibrous Histiocytoma

74[edit]

Prinsip pada laboratory test autoimmune pada kegagalan imun (?)

75[edit]

Protein naik, glukosa turun, lymphocytes 95%, kena bakteri apa ?

76[edit]

Substance untuk mengobati non valvular A-Fib ? Dabigatran

77[edit]

SnS : Somnolent, convulsion, high fever, Dx ? Encephalitis

78[edit]

Ciri khas yang dimiliki oleh cervical vertebrae ? 

79[edit]

Kenapa ada gastric bleeding kalo pake NSAID ? Inhibibisi gastric prostaglandin

80[edit]

Obat XXX 500mg/100ml, diinfuskan selama 30 menit, 1 ml = 20 drops, berapa rate-nya ? 67 cyiiiiiiiiiiiiiiin coba kaya ginian banyak  di CBT

gtt means drops

(100 ml/30 min) x 20 gtt/ml = 67 gtt

81[edit]

Obatnya tension headache ?

"Ibuprofen as the first-line, followed by naproxen, ketoprofen, and ketorolac." - Medscape

82[edit]

Bakteri yang menginfeksi joints itu biasanya via apa ?

83[edit]

Urutan osteomyelitis ?