Archive for May, 2012


A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures and drawings and nods and shakes her head to communicate. The parents report that the little girl talks only in the home and only in the presence of her closest relatives. Which of the following is the most likely diagnosis?

a. Autism

b. Expressive language disorder

c. Oppositional defiant disorder

d. School phobia

e. Selective mutism

the answer is below…

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A 19-year-old woman presents to the emergency room with the chief complaint of a depressed mood for two weeks. She notes that since her therapist went on vacation she has experienced suicidal ideation, crying spells, and an increased appetite. She states that she has left 40 messages on the therapist’s answering machine telling him that she is going to kill herself and that it would serve him right for leaving her. Physical exam reveals multiple well-healed scars and cigarette burns on the anterior aspect of both forearms. Which of the following diagnoses best fits this patient’s clinical presentation?

a. Dysthymic disorder

b. Bipolar disorder

c. Panic disorder

d. Borderline personality disorder

e. Schizoaffective disorder

the answer is below…

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A 36-year-old woman with schizophrenia comes to the emergency room with the chief complaint that “they are trying to kill me.” In the examining room, she is hypervigilant and insists on sitting in the corner with her back to the wall. Suddenly she begins to stare intently into the corner and say, “No, you can’t make me do that!” Which of the following symptoms is this patient most likely experiencing?

a. Concrete thinking

b. Depersonalization

c. Flight of ideas

d. Hallucination

e. Idea of reference

the answer is below…

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A 24-year-old man is admitted to the inpatient psychiatry unit after his mother observed him standing in place for hours at a time in abnormal postures. During his exam, the patient stands with one arm raised directly above his head and the other straight out in front of him. He is mute, does not appear aware of his surroundings, and actively resists any attempts to change his position. Which of the following best describes the patient’s behavior?

a. Apraxia

b. Dystonia

c. Synesthesia

d. Catatonia

e. Trance state

the answer is below…

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Vitamin D3 ternyata dapat berfungsi sebagai angiotensin-converting-enzyme (ACE) inhibitor pada pasien obese dengan hipertensi. Pemberian vitamin D3 dalam jangka waktu lama bahkan diduga dapat menurunkan resiko penyakit ginjal kronis pada pasien obese dengan menurunkan aktifitas renin-angiotensin system (RAS).

Adalah Anand Vaidya, MD, MMSc, dari Harvard Medical School di Boston, Massachusetts, yang mempresentasikan poster penelitian pada the Arteriosclerosis, Thrombosis and Vascular Biology 2012 Scientific Sessions.

Melalui poster tersebut, dr. Vaidya menjelaskan hasil dari penelitian dengan intervensi manusia untuk pertama kali untuk mengetahui apakah terapi vitamin D3 memiliki efek terhadap aktivitas RAS pada pasien obese. Pasien-pasien ini dipilih dengan parameter: memiliki resiko tinggi penyakit ginjal kronis. Penelitian lanjutan yang melibatkan pasien dengan berat badan normal sedang berjalan saat ini.

Penelitian ini melibatkan 14 subjek studi dengan obese (body mass index, 36 kg/m²) dengan hipertensi, prediabetik, kadar 25-hydroxyvitamin D (25[OH]D) dibawah 25 ng/mL, dan fungsi ginjal yang normal. Peneliti menggunakan protokol yang sangat cermat agar bias dalam pengukuran RAS bisa diminamilisir. Di antara protokol ini adalah menghentikan semua pengobatan selama 3 bulan. Karena banyak medikasi dapat mempengaruhi RAS.

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A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?

a. Intubation and intravenous antibiotics

b. Inhaled epinephrine and oral steroids

c. Inhaled steroids

d. Observation in a cool mist tent

e. Oral antibiotics and outpatient follow-up

the answer is below…

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Wah. Cape bahas vaksin terus. Ayo kita bahas sesuatu yang lebih ringan. Judulnya bisa dibaca. Saya mengamati ada perubahan tren di kalangan mahasiswa kedokteran. Bahkan di kalangan dokter. Yaitu munculnya fenomena tablet.

Kok bisa? Karena teknologi kini semakin murah dan lengkap. Evolusi pun muncul. Dari awal zaman dimana kita bergantung pada mesin ketik, komputer, laptop, hingga kini tablet. Mengingat kini kita ada di zaman tablet, jelas evolusi ini menawarkan yang semua orang cari, simpel, mudah dibawa, lengkap, dan bergaya. Tapi perlu nggak sih tablet itu bagi mahasiswa kedokteran atau dokter?

Di US, 30% dokter telah menenteng iPad®. Wow! Ini spesifik pada produk dari raksasa elektronik berlogo apel tergigit. Dan Apple sendiri berani mengklaim bahwa lebih dari 80% dokter di RS Top US menggunakan iPad. Meski tidak dijelaskan RS mana yang disebut Top.

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You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about nausea and a funny feeling in his chest. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis?

a. Endotracheal intubation

b. Intramuscular injection of diphenhydramine

c. Administration of oxygen

d. Subcutaneous injection of 1:1000 epinephrine

e. Administration of corticosteroids

the answer is below…

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A 24-year-old woman arrives in the emergency center in active labor. She is at term, but received no prenatal care after 16 weeks of gestation when she lost her insurance coverage. The mother has an uncomplicated vaginal delivery. You are paged shortly after birth when the baby is noted to have respiratory distress. The infant has diminished breath sounds on the left, and the PMI is shifted toward the right. A chest radiograph reveals a large multiloculated mass in the left hemithorax. The NG tube you placed earlier reveals the stomach to be below the diaphragm. Which of the following is the most likely diagnosis at this point?

a. Cystic adenomatoid malformation

b. Congenital diaphragmatic hernia

c. Bronchogenic cysts

d. Congenital lobar emphysema

e. Congenital pneumonia

the answer is below…

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Ah, masih tentang vaksin. Saya memang masih akan terus mengulik vaksin. Insya Allah akan berakhir di edisi kelima.

Edisi pertama dan kedua adalah pemaparan vaksin dari seorang dokter yang belajar khusus ilmu vaksin sampai ke Italia. Dirgarambe. Edisi ketiga adalah ikhtisar tentang kelemahan sumber ilmiah kelompok anti-vaksin. Kami, para dokter, wajib hati-hati dalam menerima suatu informasi. Terutama terkait dengan narasumbernya. Karena itu, semoga edisi ketiga dapat menjadi inspirasi para pembaca untuk selalu cross-check atas informasi ilmiah sampai ke narasumbernya.

Lantas, ada apa di edisi keempat? Edisi kali ini saya kutip langsung dari situs Dinas Kesehatan Kabupaten Bantul. Untuk membaca sila klik disini. Kenapa saya kutip? Karena satu lagi sumber data untuk melengkapi pertimbangan para pembaca sekalian tentang vaksin adalah IDAI (Ikatan Dokter Anak Indonesia). Artikel ini berupa FAQ’s. Jadi membahas beberapa pertanyaan yang sering muncul disertai dengan jawabannya.

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