PROBLEM BASED LEARNING

FK Universitas Airlanggga
Semester 2

6B GROUP
LEADER
Tasya Firdausi

011111143

SECRETARY
Siti Annisa Dewi R

011111135

MEMBERS
Aditya Brahmantio Sujaka
011111245
Karina Ayu Pramesti 011111137
Cholid Noor Dindromono

011111133
Nur Fitriana Corprianti Marchilia
011111206
Shaviq
011111186
Reinhard Bungin
011111157
Dinar Alifia Yudiasti 011111213
Abyan Irzaldy011111127
Herdina Ramadhani 011111176

OBJECTIVE
General Instruction Objective
To be able identification anatomy-histology structure of
human, growth and development, with regard to health
clinics a problem.

Specific Instruction Objective

To be able Identification anatomy-histology structure

of human, with growth and development

can identify abnormalities of human anatomy-

histology structure, growth and development, due to

interference from the disorder/certain factors, such
as: genetic, congenital, metabolic, immunology,
infection, trauma, vascular diseases, neoplasm,
degenerative

To be able explain the basic pathofisiologi disorders

PREFACE 1

ISSUE
A 75 years old woman came to the health centre with

pain and swelling in her joint

Additional information :
Information

Details

1. Mrs. Q works as legal secretary

2. BMI : 35.5 kg/m2

weight : 80 kg
height : 150 cm

3. Her complain is on lower extremity

4. Has limited movement

for 6 month

5. Stiffness

for 1 year

6. Pain and stiff

on her back, knee, hip joints (in the morning).

Eventough she is not in motion or
motionless, she was still felt pain and stiff.

7. If she walked for a while, would feel pain.

8. Consume seafood and fatty meet.

9. She got fell from the stairs and

leant on the left.

six years ago

Additional information :
Information
10.She has been told to drink low doss
aspirins by cardiologist.

Details
to eliminate pain

11.Heartbeat rate :130/minutes, Breath

rate : 20/minutes and no wheezing sounds
12.There isnt any sickness history on her
family.

13.Her thorax was normal

14.Body temperature 37oC

15.She had deformity distal

interphalangeal joint

16.Hand perfusion was normal

17.Limitation movement on her left hip

joint

18. Right hip joint

for abduction, adduction, external

rotation and internal rotation
Pain, stiffness, limited ROM

Additional information :
Information

Details

19.Crepitations and stiffness on

her right knee joint.

She felt crepitation in her firt movement.

20.Laboratory check

Erythrocytes Sedimentation Rate was

increased

21.Rontgen data

fracture of left femoral neck

in right knee joint, there were narrow
in synovial cavity and osteophyst
in her lumbal vertebrae joint was also
osteophyst.
in her hip joint, narrow in synovial
cavity.

MAIN PROBLEM
Mrs. Q felt stiff and painful on her joint

KEYWORDS
Women, 75 years old
Stiffness on her joint
Pain on her joint

EARLY HYPOTHESIS
Miss Q has an osteoarthritis on her joint
The reducing of synovial liquid in Miss Qs joint
Miss Q has traumatic joint

EARLY MIND MAP

Distal interphalang joints:
limited ROM, pain, swelling.
Lumbar vertebrae:
osteophytes, pain, stiffness
Hip Joints:
Right: limited ROM, pain,
stiffness, crepitation
Knee Joints:
Right: Osteophytes,
narrowing synovial cavity,
pain, stiffness, limited ROM.

Osteoarthritis
rheumatoid
arthritis

Aging
obesity
Trauma:
incomplete
left femoral
neck

LEARNING ISSUE
1. What anatomy and histology structure(s) is/are

likely affected according to the scenario?

2. How do/does this (these) structure(s) normally
grow; and how is/are the physiological form of
these structure(s)?
3. According to the sign and symptoms of the patient
in the scenario, how likely this (these) structure(s)
are changed?

LEARNING ISSUE
4. What is/are the basic pathophysiology of this

(these) abnormality(ies)?
5. What is osteophyst and its symptoms?
6. What is osteoarthritis and its symptoms ?
7. What is rhematoid arthritis and its symptoms ?

PREFACE 2

1. What anatomy and histology structure(s) is/are likely

affected according to the scenario?
Interphalanges
The distal interphalangeal joint is
complex and is formed by the
articular surfaces of the head of
the
middle
phalanx,
distal
phalanx, and navicular bone.
They
form
three
separate
articulations: between the middle
and distal phalanx, between the
middle phalanx and navicular
bone, and between the distal
phalanx and navicular bone.

Lumbal

Anatomy of the Hip

The hip joint is a ball-and-socket
type joint and is formed where the
thigh bone (femur) meets the three
bones that make up the pelvis: the
ilium at the rear, the ischium at the
lower front and the pubis above it
The articular cartilage is kept
slippery by fluid made in the
synovial membrane (joint lining.
Large ligaments, tendons, and
muscles around the hip joint (called
the joint capsule) keep it from
dislocating.

Knee
Structures of the Knee
The main parts of the knee joint are
bones, ligaments, tendons, cartilages
and a joint capsule, all of which are
made of collagen. Collagen is a fibrous
tissue present throughout our body. As
we age, collagen breaks down.
Ligament in the Knee
The function of ligaments is to attach
bones to bones and give strength and
stability to the knee as the knee has
very little stability.
Medial Collateral Ligament (tibial
collateral ligament).
Lateral Collateral Ligament (fibular
collateral ligament.
Anterior cruciate ligament
Posterior cruciate ligament
Patellar ligament.

2. How do/does this (these) structure(s) normally

grow; and how is/are the physiological form of
these structure(s)?

3. According to the sign and symptoms of the patient in

the scenario, how likely this (these) structure(s) are
changed? And What is/are the basic pathophysiology
of this (these) abnormality(ies)?

5. What is osteophyte and its symptoms?

In spite of their name, bone spurs are smooth, bony growths
that form over a long period of time. They are a growth of
normal bone that tends to occur as we age.
The spurs themselves are not painful. Their effect on nearby
structures such as nerves and the spinal cord can be.
Our spines are made up of 33 bones (vertebrae) designed to
protect the spinal cord. Gel-filled discs between the bones
serve as shock absorbers. The discs also allow us to bend
forwards and backwards and twist our backs in a variety of
directions.

Symptoms
Back or neck pain is the most common sign of bone spurs. The joint
becomes inflamed (swollen and tender) and the back muscles become
tender.
Common symptoms are:
Burning or tingling (pins and needles in the hands or feet)
Loss of coordination in a part of the body
Radiating pain in the buttocks and thighs (if the affected bone is in the back
or lower back)
Radiating pain into the shoulders or headaches (if the affected bone is in
the neck)
If there is severe pressure on the nerves, a person may have problems
controlling his or her bladder or bowels.

6. What is osteoarthritis and its symptoms ?

Osteoarthritis (OA) is the most common form of arthritis [1-4] and
the World Health Organization estimates that globally 25% of adults
aged over 65 year suffer from pain and disability associated with
that disease. OA is a debilitating condition characterized by pain,
joint inflammation, and joint stiffness, and results in a substansial
degree of physical disability. OA is caused primarily by the
degradation of collagen and proteoglycans in cartilage, leading to
fibrillation, erosion, and cracking in the superficial cartilages layer.

Symptoms:
Pain and stiffness in the joints are the most common symptoms. [18]
The pain is often worse after exercise and when you put weight or
pressure on the joint.
The joints probably stiffer and harder to move over time, it is may
notices a rubbing, grating, or crackling sound when you move the
joint.
Morning stiffness, we may feel when we first wake up in the morning,
stiffness usually lasts for 30 minutes or less, it is improved by mild
activity that warms up the joint.
The pain may get worse when we are active and feel better when
you are resting after a while, the pain may be present when you are
resting, it may even wake you up at night.

7. What is rhematoid arthritis and its

symptoms?
The word arthritis means inflammation of the joint.[20]
Rheumatoid arthritis (RA) is a long-term disease that leads to
inflammation of the joints and surrounding tissues. It can also
affect other organs.
Rheumatoid arthritis (RA) is a type of inflammatory arthritis
and an autoimmune disease.

Symptoms
RA usually begins slowly, starting in a few joints and then spreading to
other joints over a few weeks to a few months. As time goes on, RA
involves more and more joints on both sides of the body in a symmetrical
pattern. Wrists, fingers, knees, feet, and ankles are the most commonly
affected.
feel pain and stiffness in the morning, typically lasting more than 30-60
minutes before you loosen up and start feeling better.
Over time, joints may lose their range of motion and may become
deformed
Chest pain when taking a breath (pleurisy)
Dry eyes and mouth (Sjogren syndrome)
Sleep difficulties.

Final
concept
mapping

PREFACE 3

ANALYSIS
Based on the scenario and the data we get, our final
hypothesis is Mrs. Q suffer from osteoarthritis.

Therapeutic Options for Osteoarthritis

Aerobic exercise can maintain or improve joint function, and,
as part of weight management programme, can reduce body
mass index and therefore the mechanical stress on joint.
A physiotherapist may employ modalities (such as heat),
suggest specific exercise to improve joint motion and
muscular strength, and provide devices to aid walking.

Reference

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http://spinwarp.ucsd.edu/neuroweb/Text/sp-700.htm. Date 21/04/2012
http://

www.cedars-sinai.edu/Patients/Health-Conditions/Bone-Spurs-Osteophytes.aspx
http://
healthpages.org/anatomy-function/hip-structure-function-common-problems/
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www.sepeap.org/archivos/libros/endocrino/Atlas_of_Hand_Bone_Age%5B1%5D.p
df
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