4 Pemeriksaan fungsi tiroid, FT4 normal, TSH turun.

Apa yang anda rencanakan

1 a. Observasi dan cek lab berkala
b. Pemberian PTU
c. Pemberian propanolol
d.

Tergantung umur dan gejala, kalau >65 ato <65 + ada gejala diterapi, kalau <65 dan
asimptomatik tidak diterapi (cek lab berkala aja).
tergantung nilai TSH juga, kalo TSH <0,1 diterapi walau ga ada gejala (bico dr. pugud)
terapi: ATD (anti tiroid drug: PTU, Methimazol, Solusio lugol)
B blocker (Propanolol cuma untuk fase akut, jadi bukan pilihan terapi pada SH)
Subclinical hyperthyroidism (SH) is most often caused by release of excess thyroid hormone by
the gland. This condition is defined as a low or undetectable serum thyroid-stimulating hormone
(TSH) with values within the normal reference range for both triiodothyronine (T3) and free
thyroxine (T4) estimates.
A TSH level of <0.1 mU/L on repeated measurement over a 36-month period is considered to
be persistent, effectively ruling out transient thyroiditis as a cause. The thyroid disorder
underlying SH should be diagnosed, and is most commonly TMNG, GD,or TA. (TMNG= toxic
multinodular goiter, TA= toxic adenoma, GD= grave disease)

The treatment of SH is similar to the treatment of overt hyperthyroidism. Radioactive iodine is

appropriate for most patients, especially in older patients when TMNG is a frequent cause of
SH. There are no data to inform whether elderly patients with SH would benefit from
pretreatment with ATDs to normalize thyroid function before radioactive iodine therapy. Given
the low risk of exacerbation, the risks of ATD therapy may outweigh any potential small benefit.
Long-term ATD therapy is a reasonable alternative to radioactive iodine in patients with GD and
SH, especially in younger patients, since remission rates are highest in persons with mild
disease.

4 Terapi gold standard untuk tetanus adalah..

2 a. Penicillin
b. Ceftriaxon
c. Metronidazole
d. Ciprofloxacin
4 Antiretroviral pada pasien HIV yang punya gangguan hati adalah..
3 a. Duviral dan Reviral
b. Duviral
c. Neviral
d. Stavudin
e. Efavirenz

Dalam pengobatan Anti Retroviral (ARV) pada koinfeksi hepatitis C,

saat ini tersedia ARV gratis di Indonesia. ARV yang tersedia gratis
adalah Duviral (Zidovudine + Lamivudine) dan Neviral (Nevirapine).
Sedangkan Efavirenz (Stocrin) tersedia gratis dalam jumlah yang
amat terbatas. Didanosine atau Stavudine tidak boleh diminum
 untuk penderita sedang mend efek samping terhadap gangguan faal
hati (Depkes, 2007).
N/B :
AZT : contohnya revival
Duviral merupakan FDC dari AZT+3TC
Stavudin : contohnya staviral

4 Pasien wanita diare setelah makan roti, keluhannya kembung dan nyeri perut. Kulit pasien
4 terlihat gambaran dermatitis herpetiformis. Diagnosis?
a. Celiac disease
b. Kolitis uslseratif
c. Chron disease

4 Obat antiviral yang digunakan pada Hepatitis B Kronik adalah

5 a. Ribovafir
b. Entecavir dan lamivudin

4 Hepatitis B kronis, udah ada asites, splenomegali, hasil endoskopi ditemukan ada varises
6 esofagus, sudah diligasi...terapi selanjutnya..
a. Furosemid
b. Spironolacton
c. Propanolol
d. Semua salah
e. Semua benar
4 Sirosis hepatis. Hematemesis melena TD drop, Hb 7, Trombosit 99.000n West Haven grade II.
7 Billirubin.. Albumin PT... (lupa angka pastinya)
Sirosis hepatis child pugh kelas... dengan syok hemoragik

hepatic encephalopathy
Two broad categories of hepatic encephalopathy are covert (CHE) and overt (OHE) hepatic
encephalopathy[3] ; CHE is particularly associated with poor outcomes.[3, 4]

Grading of the symptoms of hepatic encephalopathy is performed according to the so-called West
Haven classification system, as follows [26] :

Grade 0 - Minimal hepatic encephalopathy (also known as CHE [27] and previously known
subclinical hepatic encephalopathy); lack of detectable changes in personality or behavior; minimal
 changes in memory, concentration, intellectual function, and coordination; asterixis is absent.
Grade 1 - Trivial lack of awareness; shortened attention span; impaired addition or
subtraction; hypersomnia, insomnia, or inversion of sleep pattern; euphoria, depression, or
irritability; mild confusion; slowing of ability to perform mental tasks
Grade 2 - Lethargy or apathy; disorientation; inappropriate behavior; slurred speech; obvious
asterixis; drowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality
changes, inappropriate behavior, and intermittent disorientation, usually regarding time
Grade 3 - Somnolent but can be aroused; unable to perform mental tasks; disorientation
about time and place; marked confusion; amnesia; occasional fits of rage; present but
incomprehensible speech
Grade 4 - Coma with or without response to painful stimuli

syok hemoragik

4 Pasien 68 tahun datang dengan keluhan nyeri dada. Memiliki riwayat hipertensi sejak 3 bulan
8 yang lalu. EKG terdapat T inverted, LVH, saat ini penurunan kesadaran TD 80/60. Nadi 110
x/menit. Diagnosis yg mungkin adalah
A. Syok septik
B. Syok kardiogenik
C. Syok hipovolemik
D. Syok anafilaktik

4 Umur 19 tahun ke poliklinik karena keluhan BB menurun terus. Setelah dicek GDS 235, terapi
9 awal?
a. Sulfonilurea
b. Biguanid
c. Acarbose
d. Metformin
 Baca perkeni DM 2015 lagi ya, soalnya kurang lengkap juga.

5 Pasien usia 58 tahun GD2PP 210, GDP normal

0
GD2PP >200 DM