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OSCE Traning Station PF Paru
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  1. OSCE Traning Station PF Paru Aldo Ferly, M.Res

  2. General TIPS untukosce

  3. Tips 1: Persiapkandiri mental/fisik • 8 station @ 10-12 menit high intensity • posistirahathanya 2

  4. Tips 2: Baca soalbaik-baik • They might not ask you to perform all of the checklist. • Example: PF paru • Anamnesis • auscultation

  5. 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

  6. Tips 4: Learn how they grade your OSCE

  7. Important : introduce yourself and wash hand IN ALL STATION

  8. PemeriksaanParu : Anamnesis+PF Aldo Ferly Veteran rumahsakitpersahabtan

  9. Anamnesis paru

  10. Why learn anamnesis? • Setiapstasionada 50% komponen anamnesis dan PF.

  11. Sistematik anamnesis paru • Identitas • Keluhanutama • Riwayatpenyakitsekarang • Faktorrisiko • Riwayatpenyakitdahulu • Family history • Penggunaanobat sudahdiobati?

  12. Identitas • Umur!! • Dewasa Caparu/COPD (40 thn++) • Anak/remaja  asma • Pekerjaan • pentingkrnberkaitandngnpenyakitparu • pekerjaindustrigenteng risikocaparu

  13. Chief complain yang berhubungandngnparu • Sesaknafas • Batuk (berdahak) • Batuk darah

  14. Riwayatpenyakitsekarang • Sesaknafas: • Kapanmunculnya? • Setelahberaktivitas • Kapansaja? • Ada terbangunpadamalamhari • Assess NYHA functional class • Mendadak/ gradual? • Trigger? Debu/cemas

  15. RiwayatPenyakitSekarang • Batuk (berdahak) • Explore batukdandahaknya • Batuk: • sejakkapan kronikcuriga TB • adadahaknyaatautidak? • adadarahnya? • apakahminumobat anti hipertensi ace inhibitor • disekitarnyaapakahadayg batuk2 jg

  16. RiwayatPenyakitSekarang • Dahak • Warnaapa? • Berapabanyakkahdahaknya (biasanyapasieningetnyabrpgelas aqua) • adaperubahanwarnadahak?

  17. Riwayatpenyakitsekarang ! SAMAKAN PERSEPSI: Batuk darah/muntahdarah • Mengapapenting? Etiologiberbeda

  18. Riwayatpenyakitdahulu • Pernah batuk2 lama?  infeksi • hipertensi • panastinggi • asma

  19. yang lain2 • sudahpernahdiobati?

  20. Faktorrisiko • merokok • penyakit yang sama di keluarga • atopi(dermatitis/allergic rhinitis/asma)

  21. Disease yang harus kalian waspadai • TB • Asma • Caparu

  22. PF paru

  23. First thing first • Cucitangan • Perkenalkandiri: • “Selamatpagipak, namasaya dr. muda ….. padapagihariinisayainginmemeriksabapakterkaitdengankeluhan …. bapak. Untukitu, sayaharusmembukabajubapak, mohonizinnyayapak”

  24. Komponendari PF • Inspeksi • Palpasi • Perkusi • Auskultasi

  25. Inspeksi • Gambaranumum: • Apakahadakesulitanbernafas? Dengarkansuara, apakahada wheezing/stridor? Perhatikannafasnyatorakal/abdominal RR apakahmeningkat?

  26. Accessory Respiratory Muscle?

  27. Mention whether there are • Hoarseness : Suaraserak • Gangguan di Larynx • Wheezing : Mengi • Stridor

  28. Skin color: Cyanosis

  29. Pale skin

  30. Inspection of neck-respiratory related • Sternocleidomastoideus • Suprasternal • Neck vein blockage • lymph node enlargement

  31. Sternocleidomastoideus

  32. Suprasternal notch

  33. Neck vein blockage

  34. Enlargement of Lymph Nodes

  35. Extremity inspection: Clubbing

  36. Examination: Schamroth Sign

  37. Anterior Chest Inspection • Mention the presence or absence of venous blockage, lump, gynecomastia, subcutaneous emphysema

  38. Subcutaneous emphysema? • Cannot be assessed by inspection • need palpation 

  39. Anterior Chest Inspection • m.intercostal retraction

  40. Anterior Chest Inspection • Assessing anteroposterior diameter compared to sagittal diameter

  41. Anterior Chest Inspection • Narrowing and Widening between the ribs. Angulus costae

  42. Anterior Chest Inspection • Simmetry between left and right hemithorax in static and dynamic condition

  43. Anterior Chest Inspection • Frequency of breathing by looking at the chest motion • ! Bawa jam tangan !

  44. 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

  45. Anterior Chest Inspection • Mention respiratory rythm

  46. Palpation • Neck &Anterior chest palpation

  47. Neck & Palpation • Lymph node examination

  48. Neck & Palpation • Trachea position