PROBLEM HYPOTHESIS MECHANISM MORE INFO IDK LI

38 Yo Boy Cardiac Cardiac Anamnesis 1. Bagaimana mekanisme inf 1. Anatomi vascular (5,7) 3
1. Infeksi katup jantun 1. MO  invasi  infeksi  1. Demam? No eksi katup jantung menye 2. Histologi vascular(6) 3
CC: pain in both of his tiptoes g (no history of fev inflamasi  menyerang ka 2. Riwayat trauma? No babkan pain di ujung jari k 3. Fisiologi vascular (1,2,3,4,
er) tup jantung  ?  Pain (S 3. Riwayat penyakit (Diabete aki 9) 4
1. His complaint started since 1 mo 2. Gangguan pembulu S) s, hipertensi , dislipidemia, 2. Bagaimana dari jantung bi IDK N0 8
nth ago h darah Coroner 2. Kolesterol  atherogenesi autoimmune) No sa menimbulkan nyeri di k
(Lipid profie s  penyumbatan  supp 4. Riwayat keluarga (autoim aki
2. complaining started with tingling normal) ly darah berkurang ke ara mune, diabetes) 3. Gejala apa yang menyeba
sensation h bawah  Pain (SS) 5. Life style: active smoker bkan Ketika berjalan sakit 1. Resti, denden, augy
Non Cardiac 6. Riwayat pengobatan tetapi istirahat dia tidak sa 2. Yesi, denisa
Non cardiac 1. Autoimmune  menyerang 7. Pekerjaan kit 3. Alya, dimas, yodi, dafa
3. started feel pain in his legs while
1. Gangguan syaraf (n PNS  infeksi  inflamasi 4. Kaki nya merasakan dingin
walking several hundred meters
o history autoimmu  pain (SS) PE dan sakit saat terkena air
ne) 2. Resistensi insulin  hypergl 1. GA pada pagi hari cuaca dingi LI pertemuan 2
4. pain got worse 2. Gangguan metaboli icemi  diabetes  kompli 2. TTV Normal + saturation O n? 1. PAD (2) (denden, denisa)
c kasi neuropati  pain (SS) 2 5. Struktur apa saja dikaki (va 2. TO (4) )(yesi, alya, augy, dafa)
5. There was changes in skin colour a. Diabetes (no h 3. Accident trauma lower li 3. HTT skularisasi) 3. Keunggulan (
to black starting from the tips of t istory diabetes) mb  inflamasi  pain (SS) 6. Perbedaan arteri dan arter
he toes 3. Gangguan lower li 4. ?  Penyumbatan perifer Penunjang iol hubungkan dengan tuni
mb  supply darah berkurang 1. Lab Exam ca (H)
6. Since 1 week ago, he could not w a. Trauma lower l kea rah bawah  pain (SS) a. CBC 7. Distribusi aorta , posisi, m
alk anymore imb (no history b. Blood glucose enyilang (A)
trauma) c. Lipid profile 8. Pemeriksaan arteri tibialis
7. his feet felt cold and pain when e 4. Gangguan pembulu d. anterior & posterior
xposed to water in the morning. h darah perifer 9. Bagaimana pertukaran di k
apiler dengan jaringan terj
8. He admitted he is an active sm adi (lewat apa ?)
oker.
Pertemuan 2
9. He smoked 1-3 packs cigarette 10. Ankle brachial index?
s per day. 11. corkscrew configurations
adalah?
12. peripheral artery disease
10. He started smoking since 15 y
13. etiologi PAD sampai
ears old.
mekanisme sampai
menimbulkan tanda dan
11. Extremities: gejala
14. epidemiology
a. Anterior tibialis artery puls 15. symptom
e: reduce 16. mekanisme PAD
17. pada saat dingin vasokontr
b. Posterior tibialis artery pul iksi? Nyeri pada saat dingi
se: reduce n kenapa?

c. a/r pedis dextra: a red to
blackish colored necrotic ti
ssue appears in digiti I, IV,
and V as high as the distal
phalanx to the proximal ph
alanx, pain (+), palpation
of dorsalis pedis artery is n
ot strong enough to lift.
d. a/r pedis sinistra: a blackis
h colored necrotic tissue a
ppears in digiti I, II, and I
V as high as the distal phal
anx to the proximal phalan
x, pain (+), palpation of d
orsalis pedis artery is not s
trong enough to lift
Pertemuan 2
The doctor suspected the patient as pe
ripheral artery disease and referred to
the cardiologist. The cardiologist asked
the patient to do some test in the next
day.
12. Ankle Brachial Index left/right =
0.75/0.80
18. thromboangiitis obliterans
- hubungan dengan
PAD
- Faktor resiko
- SS
- Raynaud P
- Etiologi
- Mekanisme sampai
terjadi sumbatan
- Kriteria diagnosis
- Gejala dan tanda
chronic dan akut
- Management luka
dan ss
- Prinsip terapi
- Prognosis
19. PAD ada apa saja, masing
masing bedanya apa,
etiologi nya, dan sampai
selesai, saling
berhubungan?
20. Keunggulan institusi
BHP(usia, rokok), PHEP,
Keislaman, Kesundaan
21. Etiologi dari semua gejala

13. Ultrasound doppler was perform

ed and showed distal anterior an
d posterior tibial arteries has occl
uded.

14. collateral vessels originating from

occluded vessels.

15. Angiography was performed and

showed distal anterior and poster
ior tibial arteries narrowing with
almost complete obliteration in t
he distal third of left leg.
16. typical corkscrew configurations
of collateral vessels originating fr
om occluded vessels

17. diagnosed this patient as thromb

oangiitis obliterans

18. Ibuprofen 2 x 400 mg

19.
 RF
1. active smoker.
Cardiac Non cardiac 2. He smoked 1-3 packs cig
BSCM arettes per day.
38 yo Man 3. He started smoking since
15 years old.

Resistensi
Mikroorganisme Kolesterol Autoimmun insulin Trauma ?
e
Infeksi katup Gangguan Gangguan Gangguan Gangguan Gangguan
jantung pembuluh syaraf metabolic lower limb pembuluh
darah coroner darah perifer
No history of No history No history
No history of
autoimmune of diabetes of trauma
fever
1,2,3

pain in both of tingling sensati feel pain in his legs his feet felt cold and p Since 1 week ago, he c changes in skin colour t
his tiptoes on while walking sever ain when exposed to ould not walk anymore o black starting from th
al hundred meters water in the morning. e tips of the toes

Pain got worse

Physical Examination 4

1. Anatomi vasc Anterior tibialis artery Posterior tibialis artery a/r pedis dextra: a red to blackis a/r pedis sinistra: a blackish colo
pulse: reduce pulse: reduce h colored necrotic tissue appears red necrotic tissue appears in di
ular
in digiti I, IV, and V as high as t giti I, II, and IV as high as the di
2. Histologi vasc
he distal phalanx to the proximal stal phalanx to the proximal phal
ular
phalanx, pain (+), palpation of d anx, pain (+), palpation of dorsa
3. Fisiologi vasc
orsalis pedis artery is not strong lis pedis artery is not strong eno
ular
enough to lift. ugh to lift
4. Pemeriksaan
 OCM RF
38 Yo Man - active smoker.
- He smoked 1-3 packs c
igarettes per day.
LI - He started smoking sin
1. Anatomi vascular ce 15 years old.
2. Histologi vascular
3. Fisiologi vascular

1,2,3

Cardiac Non cardiac

Kolesterol
Mikroorganism Resistensi
e insulin
No history of
Atherogenesis Accident Rokok
No history of No history of No history of
Invasi fever Hiperglicemia
Autoimmune autoimmune diabetes trauma
Penyumbatan Trauma lower Injury intima
Inflamasi Diabetes limb
Menyerang PNS
Supply darah
Menyerang berkurang Komplikasi
katup jantung kearah Inflamasi Thrombosis
pain in both of h bawahtingling sensatio Inflamasi neuropati
feel pain in his legs w his feet felt cold and pai Since 1 week ago, he cou changes in skin colour to
is tiptoes n hile walking several h n when exposed to wate ld not walk anymore black starting from the ti
undred meters r in the morning. ps of the toes
Infeksi katup Gangguan Gangguan Gangguan Gangguan Gangguan
jantung Pain got worse
pembuluh syaraf metabolic lower limb pembuluh
darah darah
coroner

Physical Examination 4

Anterior tibialis artery pul
se: reduce
Posterior tibialis artery p
ulse: reduce
a/r pedis dextra: a red to blackish c
olored necrotic tissue appears in di
giti I, IV, and V as high as the dista
l phalanx to the proximal phalanx,
pain (+), palpation of dorsalis pedis
artery is not strong enough to lift.
a/r pedis sinistra: a blackish colore
d necrotic tissue appears in digiti I,
II, and IV as high as the distal phal
anx to the proximal phalanx, pain
(+), palpation of dorsalis pedis arte
ry is not strong enough to lift