Archive for August, 2012


A 45-year-old woman who has been on chronic steroid treatment for her asthma has thin arms and legs but has a large amount of fat deposited on her abdomen, chest, and shoulders. Her skin is thin and atrophic, and she bruises easily. She has purple striae on her abdomen. Physical examination shows elevated blood pressure, and lab tests show decreased glucose tolerance. Which of the following psychiatric conditions is the most likely diagnosis?

a. Major depression

b. Bipolar-mania

c. Substance-induced mood disorder

d. Delirium

e. Schizoaffective disorder

the answer is below…

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A 43-year-old man is admitted to the neurology service after he went blind suddenly on the morning of admission. The patient does not seem overly concerned with his sudden lack of vision. The only time he gets upset during the interview is when he is discussing his mother’s recent death in Mexico—he was supposed to bring his mother to the United States, but did not because he had been using drugs and did not save the necessary money. Physical exam is completely negative. Which of the following is the most likely diagnosis?

a. Conversion disorder

b. Hypochondriasis

c. Factitious disorder

d. Malingering

e. Delusional disorder

the answer is below…

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Karl Menninger, a well known American psychiatrist, had many conceptualizations regarding the mentally ill and treating them. Amongst them, was the concept that when it comes to treating our patients, our goal should be to “care” for them, rather than to “cure” them. He believed this approach to be valid for both psychiatric and medical patients.

Kesan pertama saya terhadap statement di atas adalah: WOW. Karena saya menemukan jawaban atas ke-galau-an saya beberapa saat lalu. Tentang profesi saya. Tentang bagaimana saya terhadap profesi ini.

Dokter memang memiliki tujuan utama menyembuhkan. Cure. Kita belajar empat tahun plus dua tahun di fakultas kedokteran. Belajar apa? Menyembuhkan penyakit. Kita belajar anatomi fisiologi biokimia untuk memahami how human body works. Lantas kita belajar patologi, dan berbagai macam penyakit klinis berdasarkan sistem, anatomi, untuk menyembuhkannya. Kita harus tahu how to diagnose, apa obatnya, dan bagaimana serta ke siapa merujuknya. Residen atau PPDS? Sama. Kita diajarkan bahwa tugas utama kita, tujuan utama kita, adalah melenyapkan disease. Mengobati sakit fisik pasien. To cure patient.

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Sepotong Kenangan Spesial

Selasa, 21 Agustus 2012

“Dok, keluarganya bu Musi datang. Beliau bilang bu Musi sesak dan kakinya bengkak.” -08.30

“Waduh Mbak. Saya kalau tidak periksa tidak bisa melakukan apa-apa. Bukankah sekarang jadwal praktek dr. Nani? Apa beliau tidak hadir?” -08.31

“Tidak ada, Dok. Ini saya bingung bagaimana.” -08.31

“Mbak. Beri KIE ke beliau. Sesak pada pasien dengan riwayat payah jantung bisa karena paru-paru, bisa pula karena jantung. Apakah beliau masih rutin mengkonsumsi furosemid?” -08.33

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A 35-year-old man comes to the psychiatrist at the insistence of his wife. She reports that for as long as she has known her husband, he has been exceedingly suspicious of those around him. She states that he trusts no one and is always convinced that friends and neighbors are trying to take advantage of him in some way. Once slighted, he holds onto grudges for a very long time. The patient is guarded and mildly hostile toward the physician, convinced that he is not interested but, rather, is just “earning too much money” from the encounter. Which of the following is true of patients with this disorder?

a. They usually also suffer from paranoid psychosis

b. They have a predisposition to develop schizophrenia

c. They often have a preoccupation with helping the weak and the powerless

d. They usually present themselves in a quiet and humble fashion

e. They are often litigious

the answer is below…

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PK2Maba FKUB

Mars FKUB

Bangkit panji hijau muda… di depan telah menanti tanggung jawab kemanusiaan…
Derap langkah kakimu beriring ketulusan… serta penuh dengan pengorbanan…
Mengabdi pada bangsa negeri yang tercinta… Indonesia jaya sejahtera…

Putra FK Brawijaya… maju terus tanpa ragu untuk masyarakat semua…
Yang butuh pertolongan serta uluran tangan… ‘tuk lepas dari penderitaan…
Walau dimana saja ataupun kapan saja… engkau slalu siap sedia…

O FK Brawijaya… kau lahirkan putra abdi bangsa…
O FK Brawijaya… namamu agung selama-lamanya…

Hehe… Maaf untuk teman-teman semua. Karena lebaran jadi saya agak malas menulis. Aduh! Hehe… Dan kali ini saya kembali. Untuk menyambut PK2Maba adik-adik kelas saya FKUB (Fakultas Kedokteran Universitas Brawijaya) angkatan 2012. Bukan tips dan trik detil sih, tapi semoga bisa membantu.

Pengenalan Kehidupan Kampus Mahasiswa Baru a.k.a PK2Maba adalah sebuah program transisi paling dini untuk mengenalkan mental dan sikap mahasiswa. Waduh, kok muluk-muluk begitu, Dok? Benar. Memang sangat idealis dan sangat sulit diterapkan. Tetapi percayalah, sesuatu yang kita lakukan dengan serius akan memiliki impact yang baik bagi kita ke depannya. Saya menjalani PK2Maba dengan sangat serius. Dan bahkan membawa keluarga Surgery saya tercinta menjadi keluarga terbaik.

Tips nomor satu. Serius. PK2Maba di FKUB di desain untuk mengenalkan sedini mungkin etos belajar di FK. Coba bandingkan dengan tugas dari fakultas lain. Ketika saya menjadi mahasiswa baru saya mengenal. Ketika saya menjadi panitia PK2Maba tahun berikutnya, saya observasi. Ketika saya menjadi ketua panitia PK2Maba tahun berikutnya, saya berinovasi.

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A 29-year-old man is brought to the hospital because he was found running around on the streets with no shoes on in the middle of winter, screaming to everyone that he was going to be elected president. Upon admission to the hospital he was stabilized on olanzapine and lithium, then discharged home. Assuming the patient is maintained on the olanzapine and the lithium, which of the following tests should be performed at least once per year?

a. MRI of the brain

b. Liver function tests

c. Creatinine level

d. Rectal exam to look for the presence of blood in the stool

e. ECG

the answer is below…

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A 28-year-old woman sees her physician with the chief complaint of a depressed mood. She also notes that she is sleeping more than usual—up to 14 hours per night—but does not feel rested and that she feels tired and fatigued all the time. She has gained 14 lb in the last month, something that she is very unhappy about, but she says that she seems to have such a craving for sweets that the weight gain seemed inevitable. Which of the following is the most likely diagnosis?

a. Mood disorder secondary to a general medical condition

b. Substance-induced mood disorder

c. Cyclothymia

d. Seasonal affective disorder

e. Dysthymic disorder

the answer is below…

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An 8-year-old is accidentally hit in the abdomen by a baseball bat. After several minutes of discomfort, he seems to be fine. Over the ensuing 24 h, however, he develops a fever, abdominal pain radiating to the back, and persistent vomiting. On examination, the child appears quite uncomfortable. The abdomen is tender, with decreased bowel sounds throughout, but especially painful, with guarding in the midepigastric region. Which of the following tests is most likely to confirm the diagnosis?

a. Serum amylase

b. Complete blood count with differential and platelets

c. Serum total and direct bilirubin levels

d. Abdominal radiograph

e. Electrolyte panel

the answer is below…

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Kesempatan Kedua

“Dokter… ada adiknya bu Y di depan ingin konsultasi. Karena bu Y katanya masih muntah-muntah, Dok.” — Bidan saya memanggil saya.

Saat itu saya sedang bersantai di ruang tengah klinik. Bidan saya datang dan memanggil saya untuk menemui adik dari bu Y. Saya terkesiap. Ya Allah. Kenapa lagi dengan bu Y.

Sembari berjalan menuju ruang terima pasien di depan, saya mengingat kasus bu Y, 29 tahun, menderita hiperemesis gravidarum. Beliau hamil anak ketiga dengan usia kehamilan 8-10 minggu. Bu Y mual muntah selama hampir satu bulan. Bahkan riwayat anak pertama, beliau mual muntah selama tiga bulan. Saya berjalan sambil me-review kondisi pasien yang sempat saya rawat inap-kan selama dua hari dan sudah sangat membaik. Kenapa?

“Dokter, anak saya masih batuk. Bahkan lendirnya semakin kental dan sulit dibatukkan. Obat yang kemarin dari dokter sudah habis, Dok. Kira-kira kenapa anak saya, Dok?”

Pernahkah teman sejawat merasakan hal yang sama? Bahwa kita merasa gagal dalam menangani pasien. Bahwa kita terus mencari apa yang salah atau apa yang kurang. Lantas ada salah satu ingatan saya muncul pada sebuah wejangan supervisor ketika saya koass.

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