TUGAS TAMBAHAN

Valyandra P (2007031010100)

1. Bagaimana manajemen Community Acquired Pneumonia dan Hospital Acquired Pneumonia? a. Manajemen Community Acquired Pneumonia

a The optimal duration of therapy for CAP is unknown. With the exception of azithromycin (which has a long half-life), a 7to 10-day course is usually recommended. Pneumonia due to Legionella spp., P. aeruginosa, or Enterobacteriaceae usually requires therapy of longer duration (often up to 21 days). b Risk factors: (1)For penicillin-resistant S. pneumoniae: Previous use (within 3 months)of _-lactam antibiotics, alcoholism, age _5 years or _65 years, and (in some areas)residence in a nursing home. (2) For macrolide-resistant S. pneumoniae: Age _5 years or nosocomial acquisition of infection. (3)For quinolone-resistant S. pneumoniae: Older age, nursing home residence, chronic obstructive pulmonary disease, previous exposure to quinolones (especially ciprofloxacin in patients with chronic obstructive pulmonary disease)in the past 3 months, multiple hospitalizations, and _-lactam use. (4)For P. aeruginosa: Bronchiectasis, malnutrition, treatment with _10 mg of prednisone/d, previously undiagnosed HIV infection, and broad-spectrum antibiotic therapy for _7 days in the past month. c Some authorities suggest that a _-lactam be added if a quinolone is chosen as empirical therapy until it is clear that quinolone-resistant pneumococci are not involved. d For nursing home residents transferred to the hospital for treatment, see appropriate hospital/intensive care unit recommendations. e Clindamycin could be used, but, because of the increased rate of Clostridium difficileassociated diarrhea associated with this drug, metronidazole is preferred. Note: DRSP, drug-resistant S. pneumoniae.

b. Manajemen Hospital Acquired Pneumonia

MRSA: Methicillin-resistant S.aureus 2. Bagaimana cara diagnosis DM?

Spectrum of glucose homeostasis and diabetes mellitus (DM). The spectrum from normal glucose tolerance to diabetes in type 1 DM, type 2 DM, other specific types of diabetes, and gestational DM is shown from left to right. In most types of DM, the individual traverses from normal glucose tolerance to impaired glucose tolerance to overt diabetes. Arrows indicate that changes in glucose tolerance may be bi-directional in some types of diabetes. For example, individuals with type 2 DM may return to the impaired glucose tolerance category with weight loss; in gestational DM diabetes may revert to impaired glucose tolerance or even normal glucose tolerance after delivery. The fasting plasma glucose (FPG) and 2-h plasma glucose (PG), after a glucose challenge for the different categories of glucose tolerance, are shown at the lower part of the figure. These values do not apply to the diagnosis of gestational DM. Some types of DM may or may not require insulin for survival, hence the dotted line. (Conventional units are used in the figure.) (Adapted from American Diabetes Association, 2004.)

3. Bagaimana diagnosis hipoglikemia dan penatalaksanaannya?

Treatment: Oral treatment menggunakan tablet glukosa atau cairan yang mengandung gula, permen atau makanan yang mau&bisa dimakan oleh pasien. Dosis inisial adalah 20gr glukosa. Jika neuroglikopenia maka terapi parenteral sangat dibutuhkan. IV glucose (25gr) diberikan dalam 50% cairan NaCl disertai infus dextrose 5 atau 10%. Bila terapi IV tidak diberikan, subkutan atau IM glukagon bisa diberikan khususnya pada DM tipe1. Tidak cocok untuk pasien yg glycogen-depleted(alcohol-induced hypoglycemia) dan akan menstimulasi insulin pada DM tipe 2.

4. Bagaimana membedakan Ketoasidosis Diabetikum dan Hyperglicemic Hyperosmolar State dan manajemennya?

5. Apa beda hasil lab pada Cirrhosiss Hepatis dan Sindrom Nefrotik? Nephrotic syndrome: Proteinuria of >33.5 g/d, hypoalbuminemia, edema, hyperlipidemia,

 lipiduria, thrombotic diathesis, slow decline in GFR in 1030%. Cirrhosis Hepatis: SGOT-SGPT meningkat tapi tidak terlalu tinggi, namun apabila normal tidak bisa mengenyampingkan sirosis. Alkali fosfatase meningkat <2-3x normal, kadar tinggi pada kolangitissklerosis primer & sirosis billier primer. Gamma-glutamil transpeptidase(GGT) sama seperti alkali fosfatase, kadar tinggi pada penyakit hati alkoholik kronis karena alkohol dapat menginduksi GGT mikrosomal hepatik dan menyebabkan bocornya GGT dari hepatosit. Bilirubin normal pada sirosis hati kompensata dan meningkat pada sirosis lanjut. Albumin menurun sesuai dengan perburukan sirosis Waktu protrombin-memanjang Natrium serum-menurun terutama pada sirosis dan asites karena ketidakmampuan ekskresi air bebas. Kelainan hematologi-anemia(monokrom, normositer, hipokrom mikrositer, hipokrom makrositer). Anemia dengan trombositopenia leukopenia dan netropenia akibat splenomegali kongestif yang berkaitan dengan hipertensi porta sehingga terjadi hipersplenisme 6. Apakah perbedaan nyeri dada pada angina?