OSCE Traning Station PF Paru

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OSCE Traning Station PF Paru. Aldo Ferly, M.Res. General TIPS untuk osce. Tips 1: Persiapkan diri mental/ fisik. 8 station @ 10-12 menit high intensity pos istirahat hanya 2. Tips 2: Baca soal baik-baik. They might not ask you to perform all of the checklist. Example: PF paru
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OSCE Traning Station PF ParuAldo Ferly, M.ResGeneral TIPS untukosceTips 1: Persiapkandiri mental/fisik
  • 8 station @ 10-12 menit high intensity
  • posistirahathanya 2
  • Tips 2: Baca soalbaik-baik
  • They might not ask you to perform all of the checklist.
  • Example: PF paru
  • Anamnesis
  • auscultation
  • Tips 3: Learn anamnesis for each station
  • Learn some of the most “important” disease of each organ system
  • Respi Asma/COPD
  • Kardio  MI, Heart failure
  • Infeksi  DHF/thypoid
  • etc
  • Tips 4: Learn how they grade your OSCEImportant : introduce yourself and wash handIN ALL STATIONPemeriksaanParu : Anamnesis+PFAldo FerlyVeteran rumahsakitpersahabtanAnamnesis paruWhy learn anamnesis?
  • Setiapstasionada 50% komponen anamnesis dan PF.
  • Sistematik anamnesis paru
  • Identitas
  • Keluhanutama
  • Riwayatpenyakitsekarang
  • Faktorrisiko
  • Riwayatpenyakitdahulu
  • Family history
  • Penggunaanobat sudahdiobati?
  • Identitas
  • Umur!!
  • Dewasa Caparu/COPD (40 thn++)
  • Anak/remaja  asma
  • Pekerjaan
  • pentingkrnberkaitandngnpenyakitparu
  • pekerjaindustrigenteng risikocaparu
  • Chief complain yang berhubungandngnparu
  • Sesaknafas
  • Batuk (berdahak)
  • Batuk darah
  • Riwayatpenyakitsekarang
  • Sesaknafas:
  • Kapanmunculnya?
  • Setelahberaktivitas
  • Kapansaja?
  • Ada terbangunpadamalamhari
  • Assess NYHA functional class
  • Mendadak/ gradual?
  • Trigger? Debu/cemas
  • RiwayatPenyakitSekarang
  • Batuk (berdahak)
  • Explore batukdandahaknya
  • Batuk:
  • sejakkapan kronikcuriga TB
  • adadahaknyaatautidak?
  • adadarahnya?
  • apakahminumobat anti hipertensi ace inhibitor
  • disekitarnyaapakahadayg batuk2 jg
  • RiwayatPenyakitSekarang
  • Dahak
  • Warnaapa?
  • Berapabanyakkahdahaknya (biasanyapasieningetnyabrpgelas aqua)
  • adaperubahanwarnadahak?
  • Riwayatpenyakitsekarang! SAMAKAN PERSEPSI: Batuk darah/muntahdarah
  • Mengapapenting? Etiologiberbeda
  • Riwayatpenyakitdahulu
  • Pernah batuk2 lama?  infeksi
  • hipertensi
  • panastinggi
  • asma
  • yang lain2
  • sudahpernahdiobati?
  • Faktorrisiko
  • merokok
  • penyakit yang sama di keluarga
  • atopi(dermatitis/allergic rhinitis/asma)
  • Disease yang harus kalian waspadai
  • TB
  • Asma
  • Caparu
  • PF paruFirst thing first
  • Cucitangan
  • Perkenalkandiri:
  • “Selamatpagipak, namasaya dr. muda ….. padapagihariinisayainginmemeriksabapakterkaitdengankeluhan …. bapak. Untukitu, sayaharusmembukabajubapak, mohonizinnyayapak”
  • Komponendari PF
  • Inspeksi
  • Palpasi
  • Perkusi
  • Auskultasi
  • Inspeksi
  • Gambaranumum:
  • Apakahadakesulitanbernafas?
  • Dengarkansuara, apakahada wheezing/stridor?Perhatikannafasnyatorakal/abdominalRR apakahmeningkat?Accessory Respiratory Muscle?Mention whether there are
  • Hoarseness : Suaraserak
  • Gangguan di Larynx
  • Wheezing : Mengi
  • Stridor
  • Skin color: CyanosisPale skinInspection of neck-respiratory related
  • Sternocleidomastoideus
  • Suprasternal
  • Neck vein blockage
  • lymph node enlargement
  • SternocleidomastoideusSuprasternal notchNeck vein blockageEnlargement of Lymph NodesExtremity inspection: ClubbingExamination: Schamroth SignAnterior Chest Inspection
  • Mention the presence or absence of venous blockage, lump, gynecomastia, subcutaneous emphysema
  • Subcutaneous emphysema?
  • Cannot be assessed by inspection
  • need palpation 
  • Anterior Chest Inspection
  • m.intercostal retraction
  • Anterior Chest Inspection
  • Assessing anteroposterior diameter compared to sagittal diameter
  • Anterior Chest Inspection
  • Narrowing and Widening between the ribs. Angulus costae
  • Anterior Chest Inspection
  • Simmetry between left and right hemithorax in static and dynamic condition
  • Anterior Chest Inspection
  • Frequency of breathing by looking at the chest motion
  • ! Bawa jam tangan !
  • Anterior Chest Inspection
  • Metion the breathing type by assessing the respiratory movement of the chest and abdomen
  • Abdominal-thoracal : more common in men
  • Thoracal-abdominal : more common in women
  • Anterior Chest Inspection
  • Mention respiratory rythm
  • Palpation
  • Neck &Anterior chest palpation
  • Neck & Palpation
  • Lymph node examination
  • Neck & Palpation
  • Trachea position
  • Trachea positionAnterior chest palpation
  • General chest palpation  find whether there’s pain. Subcutaneous emphysema. Palpate spaces between ribs
  • Anterior chest palpation
  • Chest expansion examination
  • Fremitus test
  • 77 from top to botom
  • Anterior chest percussion
  • General percussion
  • Percuss from top to bottom. Compare right and left
  • Anterior chest percussion
  • Lung-liver border
  • Right midclavicular
  • Change sound: sonor dull
  • Right heart border
  • 2 fingers above lung-liver border
  • percuss medially
  • Anterior chest percussion
  • Lung-gaster border:
  • Left anterior axillary line: sonor tymphaci
  • Left heart border:
  • 2 fingers above left heart border  change of sound
  • Anterior Chest AuscultationPosterior Chest Exam
  • Inspection
  • Palpation
  • Percussion
  • Aucultation
  • Inspection
  • Lump/Spinal deformity/Lump
  • Palpation
  • General palpartion
  • Chest exmpansion exam
  • Touch fremitus
  • Percussion
  • General percussion
  • Posterior lungborder.. scapular line
  • AuscultationImportant sound that u should remember
  • Vesicular
  • Wheezing
  • Ronchi
  • Questions?
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