Archive for July, 2012


“I challenge you to make your life a masterpiece. I challenge you to join the ranks of those people who live what they teach, who walk their talk.” – Anthony Robbins

Pagi ini, seusai sahur.
Saya menyaksikan tayangan pembukaan Olimpiade London 2012. Saya melihat satu demi satu kontingen peserta Olimpiade. Sosok-sosok sumringah nan bangga. Malam itu mungkin bagi para kontingen adalah satu malam sakral dalam hidup mereka. Muda, bertalenta, dan berprestasi. Senyum seolah terpahat permanen dalam tiap langkah mereka.

Mewakili negara merupakan sebuah prestasi tersendiri. Terutama Olimpiade yang seleksinya sangatlah ketat. Maka wajar bagi para kontingen, malam ini menjadi satu momen membanggakan, mengharukan, dan tak terlupakan. Terpilih dari sekian ratus juta penduduk. Berjuang menjadi seorang Olympian.

Nah, para kontingen ini kini sedang menciptakan masterpiece dalam hidup mereka. Masterpiece berupa waktu tercepat bagi para pelari, gaya terindah bagi para pelompat indah, smash terdahsyat bagi para pebulutangkis atau posisi tertinggi bagi para pesepakbola. Masterpiece ini setara dengan gubahan Mozart, sapuan kuas Van Gogh, ataupun cinematografi karya James Cameron.

Kawan pembaca. Lihatlah. Di sekitar kita juga banyak pencetak masterpiece. Adik-adik kelas saya beberapa waktu yang lalu menggondol medali emas dan kontingen Universitas Brawijaya menjadi juara umum dalam Pekan Ilmiah Mahasiswa Nasional (PIMNAS). Beberapa penelitian adik kelas saya adalah temuan bahan aktif sebagai vaksin untuk diabetes, dan temuan bahan aktif sebagai terapi regenerasi stem cell. Kontingen PIMNAS juga merupakan pencetak masterpiece. Pertanyaannya: Bagaimanakah dengan kita?

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A 13-year-old boy has a 3-day history of low-grade fever, upper respiratory symptoms, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. Which of the following is the most appropriate initial therapy for this patient?

a. Narcotic analgesics

b. Trial of oral penicillin V

c. Surgical consultation for incision and drainage under general anesthesia

d. Rapid streptococcal screen

e. Monospot test

the answer is below…

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A 7-year-old child is brought by his mother for a school physical. His growth parameters show his height to be fiftieth percentile and his weight to be significantly higher than ninety-fifth percentile. His mother complains that he always seems sleepy during the day and that he has started complaining of headaches. His second-grade teacher has commented that he has difficulty staying awake in class. His mother complains that he wakes up the whole house with his snoring at night. Which of the following is the most appropriate next step in evaluating and managing this condition?

a. Try steroids to decrease tonsillar and adenoid hypertrophy

b. Refer to an otolaryngologist for tonsillectomy and adenoidectomy

c. Arrange for continuous positive airway pressure (CPAP) at home

d. Arrange for home oxygen therapy for use at night

e. Arrange for polysomnography

the answer is below…

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A 2-year-old girl is playing in the garage, only partially supervised by her father, who is weed-whacking around the garden gnomes in the front yard. He finds her in the garage, gagging and vomiting. She smells of gasoline. In a few minutes she stops vomiting, but later that day she develops cough, tachypnea, and subcostal retractions. She is brought to your emergency center. Which of the following is the most appropriate first step in management?

a. Administer charcoal

b. Begin nasogastric lavage

c. Administer ipecac

d. Perform pulse oximetry and arterial blood gas

e. Administer gasoline binding agent intravenously

the answer is below…

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A 64-year-old man is admitted to the psychiatric unit after an unsuccessful suicide attempt. Following admission, he attempts to cut his wrists three times in the next 24 hours and refuses to eat or drink anything. He is scheduled to have electroconvulsive therapy (ECT) because he is so severely depressed that an antidepressant is deemed too slow-acting. Which of the following side effects should the patient be informed is common after ECT?

a. Headache

b. Palpitations

c. Deep venous thromboses

d. Interictal confusion

e. Worsening of the suicidal ideation

the answer is below…

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Yup.
Datanglah posting ketiga alias terakhir dari serial posting selamat datang untuk mahasiswa FK. Kita telah bahas tentang apa yang harus kita lakukan sebelum benar-benar kuliah di FK. Selanjutnya langkah awal ketika kuliah di FK. Sekarang kita akan membahas tentang bagaimana hidup di FK.

Kuliah di FK itu keras. Benar. Bagi mereka yang belum menjalani mungkin kesannya berlebihan. Tapi cobalah bayangkan apa saja yang harus ada di kepala kita sebagai dokter yang baik. Jaringan, organ, sampai sel harus kita kenali. Baik bentuk, fungsi, maupun kelainannya. Jumlah kelainannya pun ribuan. Masing-masing kelainan memiliki tanda dan gejala. Tanda dan gejala ini tidak lantas langsung muncul sa’grenjengan pada satu pasien. Kadang hanya dua gejala yang arahnya ke satu kelainan. Tiga yang lain “punya”nya kelainan yang lain. So semrawut, tho?

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A 54-year-old man sees a physician complaining of a depressed mood and inability to sleep for the past three weeks. He tells the physician that in the past when he has had similar episodes, he was placed on a monoamine oxidase inhibitor, which proved effective. The physician diagnoses the patient with a major depression and agrees to use an MAOI. Which of the following foods must be completely avoided by this patient while on this medication?

a. Licorice

b. Coffee

c. Chocolate

d. Cheddar cheese

e. Soy sauce

the answer is below…

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A 38-year-old woman with bipolar disorder has been stable on lithium for the past two years. She comes to her psychiatrist’s office in tears after a two-week history of a depressed mood, poor concentration, loss of appetite, and passive suicidal ideation. Which of the following is the most appropriate next step in the management of this patient?

a. Start the patient on a second mood stabilizer

b. Start the patient on a long-acting benzodiazepine

c. Stop the lithium and start an antidepressant

d. Start an antidepressant and continue the lithium

e. Stop the lithium and start an antipsychotic

the answer is below…

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A 35-year-old female has progressive numbness of the right arm and difficulty seeing objects in the left visual field. She is known to be HIV-positive, but has not consistently taken medications in the past. On examination, she appears healthy, but has a right homonymous hemianopsia and decreased sensory perception in her left upper extremity and face. Her CD4 count is 75 cells per µL, and her MRI is consistent with a demylinating lesion of the left parietooccipital area. CSF PCR for JC virus is positive.

a. Amphotericin B

b. Cranial radiation

c. Highly active antiretroviral therapy (HAART)

d. Intravenous acyclovir

e. Intravenous ceftriaxone

the answer is below…

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Nah. Beberapa saat yang lalu kita sudah memulai tips untuk teman-teman yang diterima kuliah di Fakultas Kedokteran (FK). Yaitu: menikmati hari-hari terakhir kita sebelum memulai kuliah kedokteran.

Maka ketika kita sudah melalui fase menikmati waktu bebas, kita memasuki dunia baru. Kuliah kedokteran. Wow! Bayangkan teman-teman yang dulu harus pakai seragam ke sekolah. Pelajarannya itu-itu saja. Kini kuliah! Kedokteran lagi. Gairah itu akan muncul. Membayangkan belajar tubuh manusia, anatomi dan fungsi-fungsinya. Lantas apa tips berikutnya?

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