tugas tambahan.docx

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TUGAS TAMBAHANValyandra P

(2007031010100)

1. Bagaimana manajemen Community Acquired Pneumonia dan Hospital AcquiredPneumonia?

a. Manajemen Community Acquired Pneumonia


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a The optimal duration of therapy for CAP is unknown. With the exception of azithromycin (which has a long half-life), a 7-to 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 withchronic 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 thatquinolone-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 withthis drug, metronidazole is preferred. Note: DRSP, drug-resistant S. pneumoniae.


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b. ManajemenHospital Acquired Pneumonia

MRSA: Methicillin-resistant S.aureus

2. Bagaimana cara diagnosis DM? Spectrum of glucose homeostasis and diabetesmellitus (DM). The spectrum from normalglucose 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 individualtraverses from normal glucose tolerance toimpaired glucose tolerance to overt diabetes.

Arrows indicate that changes in glucosetolerance may be bi-directional in some types

of diabetes. For example, individuals withtype 2 DM may return to the impaired glucose

tolerance category with weight loss; ingestational DM diabetes may revert toimpaired glucose tolerance or even normalglucose tolerance after delivery. The fasting

plasma glucose (FPG) and 2-h plasma glucose

(PG), after a glucose challenge for thedifferent categories of glucose tolerance, are

shown at the lower part of the figure. Thesevalues do not apply to the diagnosis ofgestational DM. Some types of DM may ormay not require insulin for survival, hence the

dotted line. (Conventional units are used inthe figure.) (Adapted from American Diabetes

Association,


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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 menstimulasiinsulin pada DM tipe 2.


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4. Bagaimana membedakan Ketoasidosis Diabetikum dan Hyperglicemic HyperosmolarState dan manajemennya?

5. Apa beda hasil lab pada Cirrhosiss Hepatis dan Sindrom Nefrotik?Nephrotic syndrome:

Proteinuria of >33.5 g/d, hypoalbuminemia, edema, hyperlipidemia,


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lipiduria, thrombotic diathesis, slow decline in GFR in 1030%.

Cirrhosis Hepatis:

SGOT-SGPT meningkat tapi tidak terlalu tinggi, namun apabila normal tidak bisamengenyampingkan sirosis.

Alkali fosfatase meningkat

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