Skenario B blok 23 Tahun 2014 Mrs.

Mima,30 years old pregnant woman G4P3A0 29 weeks pregnancy,was brought by her husband to the puskesms due to convulsion 2 hours ago. She has been complaining of headache and visual disturbance for the last days. According to her husband, she has been suffering from Graves disease since 3 years ago, but was not uncontrolled. Examination finding : Upon admission , Height = 152cm, Weight 65kg BP = 180/110 mmHg,HR : 120x/min, RR :24x/min

Head and neck examination revealed exoftalmus and enlargement of thyroid gland. Pretibitibial edema. Obstetric exam : Outer KlarifikasiIstilah 1. 2. 3. 4. 5. 6. 7. 8. 9. G4P3A0 : gravida ke-4, Partus ke-3,Abortus tidakpernah Convulsion : KOntraksiinvolunteratauserangkainkontraksiotot-ototvolunter Headache :Sensasinyeripadakepala Visual disturbance :Gangguanpeglihatan Graves Disease :Penyakitautoimundiamnatiroidterlaluaktifsehinggamenghasilkan hormone tiroid yang berlebihan Exoftalmus : Keadaanmata yang abnormal dimanmatalebihtertarikkedepanmelebihibatas normal Pretibial edema : Pengumpulancairansecara abnormal di ruanginterseluar di depan tibia Cylinder urine : Suatuzat yang terbentukdalamtubulusginjaldengan matrix glikoprotein yang berasaldariselepiteginjal Protein (++) :S

IdentifikasiMasalah 1. Mrs. Mima,38 years old pregnant woman G4P3A0 39 weeks pregnancy,was brought by her husband to the puskesms due to convulsion 2 hours ago. a. Bagaimanaanatomidanfisiologi system reproduksiwanita? 1 b. ApaMaknakliniskejangpadakehamilan? 2 c. Apaetiologidanpatofisiologikejangpadakasusini? 3 d. ApaketerkaitanUsiadengankeluhanpasien? 4

e. f. g. h.

Apakomplikasikejangterhadapjanin? 5 Apakomplikasikejangterhadapibu? 6 Bagaimanaperkembanganjaninusia 39 minggu? 7 Berapabatasanusia ideal untukhamil ? 8

2. She has been complaining of headache and visual disturbance for the last 2 days. a. Apaetiologidanpatofisiologi headache dan visual disturbance? 9 b. Apaketerkaitankeluhantersebutdengankasus (keluhanutama)? 10 3. According to her husband, she has been suffering from Graves disease since 3 years ago, but was not uncontrolled. a. Bagaimanaanatomidanfisiologikelenjartiroid?11 b. ApaEtiologi Graves disease?12 c. Bagaimanapatofisiologi graves disease ? 13 d. Apadampakpenyakit Graves disease padajanin ? 14 e. Bagaimana Antenatal care padaibudengan Graves disease? 15 f. 4. Examination finding : Upon admission , Height = 152cm, Weight 65kg BP = 180/110 mmHg,HR : 120x/min, RR :24x/min

Head and neck examination revealed exoftalmus and enlargement of thyroid gland. Pretibitibial edema. a. b. c. d. Apainterpretasipemeriksaanfisikpadakasus? 16 BagaimanaPatofisiologipemeriksaanfisik yang abnormal? 17 Bagaiamanacarapemeriksaankelenjartiroid? 18 Bagaimanacarapemeriksaan Pretibial edema? 19

5. Obstetric exam : a. Apainterpretasipemeriksaanobstetric ? 20 b. Bagaimanaptofisiologipemeriksaan obstetric yang abnormal? 21 c. Bagaimanacarapemeriksaaan fundus uteri? 22 6. Lab exam :Hb a. Apainterpretasipemeriksaan lab?23 b. Bagaimanapatoofisiologipemeriksaan lab yang abnormal? 24 7. Apa DD kasusini? 25

8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

Bagaimanacaramenegakkan diagnosis? 26 Apapemeriksaanpenunjangpadakasus? 27 Apa Working diagnosis padakasus? 28 Apa factor resikopadakasus? 29 Bagaimanaepidemiologipadakasus? 30 Bagaimana pathogenesis kasusini? 31 Bagaimanatatalaksanafarmakodanpadakasusini (eklampsiadan graves)? 32 Bagaimanapencegahanpadakasus 33 Apakomplikasipadakasus? 34 Apa prognosis padakasus? 35 Apa SKDI padakasus? 36

Hipotesis :Ny. Mima 38 tahun G4P3A0 denganusiakehamilan 39 minggumengalamikejang et causaeklampsiadanpenyakit Grave Triindah Rahnowi Shranjit Iqbal Satria Citra Beby Meida Maya teguh 1 , 11, 21, 31, 5, 15 ,25, 35 2, 12 ,22, 32, 6, 16, 26 ,36 3, 13, 23, 33, 7, 17, 27, 1 4, 14, 24, 34, 8 ,18, 28 ,2 5 ,15 ,25 ,35, 9 ,19, 29 ,3 6, 16, 26, 36, 10 ,20, 30, 4 7 ,17, 27 ,1 ,11, 21, 31, 5 8, 18, 28, 2, 12, 22 ,32, 6 9 ,19 ,29, 3 ,13 ,23, 33, 7 10, 20, 30 ,4 ,14 ,24 ,34 ,8

LI :

1. Kehamilan normal 2. Eklampsia 3. Graves disease ,