CLINICAL EXAMINATIONS IN

CHILDREN
Prof.Dr. Dedi Subardja, dr,SpA(K)

Curriculum vitae
Nama : Prof. Dr. Dedi Soebardja,
dr., Sp.AK
NIP
: 130367227
Tempat/tanggal lahir : Tasikmalaya, 22
Februari , 1948
Alamat
: Jl. Lembah Hijau Kav. 90
Gegerkalong Permai, Bandung
Telp. (022) 2020464

 Latar belakang pendidikan :

Dokter,Fakultas Kedokteran Universitas Padjadjaran, Bandung,
1974
Dokter Spesialis Anak,Fakultas Kedokteran Universitas
Padjadjaran , Bandung, 1984
Doktor, Universitas Padjadjaran, Bandung, 2000.
Training on inborn error of metabolism. Sophia Children
Hospital, Rotterdam, Netherlands, 1992
Course of Immunology and Inborn Error Metabolism. Erasmus
University Rotterdam, Netherlands, 1994.
Training on Molecular Genetics. Sylvius Laboratory, department
of Human and Clinical Genetics, Leiden University, Netherlands,
1999.
Training on Pediatric Endocrinology. Leiden University Medical
Center, Leiden, Netherlands, 1999.

 Jabatan Sekarang

Guru Besar Ilmu Kesehatan Anak (konsultan

endokrinologi)
Kepala Pusat Penelitian Kesehatan, Universitas
Padjadjaran
Pemimpin Redaksi : Majalah Kedokteran Bandung
Kepala Sub-bagian Endokrinologi Anak Bagian Ilmu
Kesehatan Anak FK Unpad/RS Hasan Sadikin ,Bandung

Jabatan Terdahulu

Dosen Biokimia ,Fakultas Kedokteran ,Universitas

Padjadjaran, 1974-1980
Dosen Gizi anak, Fakultas Kedokteran, Universitas
Padjadjaran, 1986-1992
Staff Ahli LPM,Universitas Padjadjaran, 1990-2000

DOCTOR (MEDICAL)
= PHYSICIAN

TO PRACTICE MEDICINE

TREATING PATIENTS

MAKING DIAGNOSIS

CLINICAL EXAMINATION

KONWLEDGE

SKILLS

ATTITUDE

CLINICAL EXAMINATION

HISTORY TAKING
(ANAMNESIS)

PHYSICAL
EXAMINATION

ADDITIONAL
EXAMINATION

WORKING DIAGNOSIS
-TREATMENT
-FOLLOW UP
-OTHER INFORMATIONS

FINAL DIAGNOSIS

PROGNOSIS

PEMERIKSAAN KLINIS ANAK

ANAMNESIS

FISIS

INTUISI
DIAGNOSIS BANDING
(DIFFERENTIAL DIAGNOSIS)
DIAGNOSIS KERJA
(WORKING DIAGNOSIS)
TERAPI

FOLLOW UP

PEMERIKSAAN
KLINIS

DIAGNOSIS AKHIR (FINAL DIAGNOSIS)

PROGNOSIS

SISTEMATIKA ANAMNESIS
RIWAYAT PENYAKIT
MASA LAMPAU

ANAMNESIS KHUSUS

PROGNOSIS
MASA DEPAN

-KETERANGAN UMUM
-KELUHAN UTAMA

ANAMNESIS UMUM

ANAMNESIS
TAMBAHAN

SEKARANG (SAAT PERTAMA KALI BERTEMU

PENDERITA)

KELUHAN UTAMA

ANAMNESIS
KHUSUS

KETERANGAN
UMUM
ANAMNESIS

ANAMNESIS
TAMBAHAN

ANAMNESIS
TAMBAHAN

KELUHAN UTAMA
(CHIEF COMPLAINT)
Keluhan yang menyebabkan anak dibawa ke dokter
(berobat, diperiksa)
Orang tua
Profesi kesehatan lain
Pihak non medis

Fokus masalah
Identifikasi masalah logika deduktif
Pendekatan anatomi, patofisiologi, etiologi

Upayakan hanya satu keluhan yang paling bermakna

Panas
Mencret
kejang

History
PRESENTING COMPLAINT (PC)
Patients or parents own brief account of the complaint and its
duration
~ CHIEF COMPLAINT

PRESENT ILLNESS (PI) or Interval History

How and when didi the disturbances start ?

Progress of disease, order and date of onset of new symptoms
Spesific symptoms and physical signs that may have develop
Significant medical attention and medications given and over
what period
Health immediately before the illness
~ SPESIFIC ANAMNESIS

ANAMNESIS KHUSUS
KARAKTERISTIK KELUHAN UTAMA
-Onset
-Lama
-Progresivitas
-Intesitas
-Frekuensi

Pengetahuan patofisiologi

Arah diagnosis secara kasar

(diagnosis kemungkinan)

ANAMNESIS UMUM
GEJALA DAN TANDA PENYERTA YANG MENYOKONG ATAU TIDAK
MENYOKONG DIAGNOSIS
KARAKTERISTIK RINCI
HUBUNGAN SATU SAMA LAIN
DAN DENGAN KELUHAN UTAMA
Relevan
Keluhan
Utama
Diagnosis Banding

Tidak Relevan

Penyakit lain
Keluhan Utama ?

Diagnosis Kemungkinan
(Anamnesis)

ANAMNESIS TAMBAHAN

Riwayat antenatal, persalinan, post natal

Riwayat penyakit yang telah dialami
Riwayat penyakit di keluarga
Riwayat imunisasi
Anamnesis makanan
Anamnesis tumbuh kembang
Anamnesis Gigi geligi
dll

-Pelengkap diagnosis
Sumber etiologi patogenesis
Sumber prognosis

ADDITIONAL OR GENERAL HISTORY

PREVIOUS HEALTH

Antenatal
Natal
Neonatal
Development

DEVELOPMENT
NUTRITION
Breast or formula
Solid foods
Appetite

ILLNESSES
Infection
Contagious disease

Immunization
Operation
Accident/ injuries

PERSONALITY HISTORY

A. Relation with other children

Independent or clinging to mother,
negativistic, shy, submissive separation from
parents, hobbies, easy or difficult to get
along with. How does child phsical
deformities affecting personality.

B. School Progress
Class, grades, nursery school, special
attitude, reaction to school.

SOCIAL HISTORY

A. FAMILY :
Income, home (size, number of rooms, living
conditions, sleeping fascilities), type of
neighbourhood, access to playground.
Localities in which patient has lived
Who cares for patient if mother works ?

B. School :
Public or private, overcrowded, type of
students.

C. Insurance

PENTING DIPERHATIKAN DALAM PROSES

ANAMNESIS

BIARKAN SANG ANAK BICARA :

- DENGARKAN
- IKUTI POLA PIKIR MEREKA

BERBICARA DENGAN ORANG TUA :

- JADILAH PENDENGAR YANG BAIK
- BERIKAN INFORMASI YANG DIINGINKAN
- UNSUR PENDIDIKAN KESEHATAN JANGAN
DILUPAKAN

HAL-HAL PENUNJANG YANG PERLU DIPERHATIKAN WAKTU

ANAMNESIS

Sosekbud orang tua/keluarga

Pengetahuan/sikap orang tua mengenai penyakit yang
bersangkutan dengan keluhan utama empati
Pengetahuan kesehatan secara umum
Intelegensia, kepribadian anak (bila sudah dapat dinilai)
Hubungan anak dengan orang tua/pendamping

Teknik Komunikasi Yang Baik dan Sesuai

KARAKTERISTIK ANAMNESIS PADA ANAK

Tumbuh kembang Auto-Heteroanamnesis

Riwayat persalinan kehamilan
Riwayat penyusuan, penyapihan, makanan
Imunisasi
Riwayat penyakit sebelumnya
Riwayat penyakit dalam keluarga
Riwayat penyakit dalam lingkungannya

TEORI ILMU KEDOKTERAN

(SARJANA KEDOKTERAN)

BACA (IQRA)

PHYSICAL EXAMINATION
OVERVIEW :
APPROACHING THE CHILD
OBSERVATION OF PATIENT
RECORDING FOR EXAMINATION
Before 6 months
Age 6 months to 3 4 years

REMOVAL OF CLOTHING
SEQUENCE OF EXAMINATION
PAINFUL PROCEDURES

GENERAL PHYSICAL EXAMINATION

GENERAL CONDITION :
TEMPERATURE
PULSE RATE
RESPIRATORY RATE
BLOOD PRESSURE
WEIGHT
PERIODICALLY
HEIGHT

WHOLE BODY EXAMINATION

NOSE
MOUTH
THROAT
EARS
NECK
THORAX
LUNGS

* HEART
* ABDOMEN
* GENITALIA
* RECTUM & ANUS
* EXTREMITIES
* SPINE & BACK

INSPECTION, PALPATION, PERCUSSION,

AUSCULTATION (IPPA)

NEUROLOGIC EXAMINATION
CEREBRAL FUNCTION
CRANIAL NERVES :
- OLFACTORY (I)
- OPTIC (II)
- OCCULOMOTOR (III)
- TROCHLEAR (IV)
- ABDUCENS (VI)
- TRIGEMINIC (V)
CEREBELLAR FUNCTION

MOTOR SYSTEM
REFLEXES

- FACIAL (VII)
- ACOUSTIC (VIII)
- GLOSSOPHARYNGEAL (IX)
- VAGUS (X)
- ACCESSORY (XI)
- HYPOGLOSSAL (XII)

ADDITIONAL EXAMINATION
ROUTINE
- BLOOD
- URINE
- STOOL
ON INDICATION
- SPECIMEN CULTURE
- SPECIFIC BIOCHEMICAL
PARAMETERS;
- IMAGING (X-ray, etc)
- PATHOLOGY
- RADIO-NUCLIDE

ADDITIONAL
OR
FOLLOW UP EXAMINATIONS
In

accordance to confirm the diagnosis

Choose only the relevant procedures or measurement

Avoid too sophisticated or expensive procedures health
economic
Conclude the results in a comprehensive manner

DIFFERENTIAL DIAGNOSIS
Conclude maximal three possible diagnosis
according to or based on finding anamnesis,
physical examination and routine laboratory
examinations
In certain condition (disease) it is allowed to make
a working diagnosis only without any differential
diagnosis
The most possible diagnosis will be your working
diagnosis

WORKING DIAGNOSIS
The first of your differential diagnosis
Consequently implemented in the management
of the patient
More than one diagnosis is not unusual or
frequently found

MANAGEMENT ( THERAPY )
Emergency procedures or resuscitation at first
if necessary
Causative treatment
Symptomatic treatment if necessary
Supportive treatment i.e nutritional, physiotherapy
Prevention

PROGNOSIS
Patients clinical course prediction
Include at least two aspects vitam, functionam
Influenced by
- General condition
- Type and severity of disease
- Epidemiologic Data
- Literatures
- Facilities
- Human Resources