Block Book SSS 2015 - 2016 Utk Mahasiswa

Skin and Special Sense
Block Book
Faculty of Medicine
Pelita Harapan University
Karawaci – Tangerang
2015/2016
The author
Dr Hannah Kiati Damar, dr., SpKK
Dr Mulyani Enggalhardjo dr., SpKK
Endang M. Johani, dr., SpM
Werlinson Tobing, dr., SpM
Pulo S Banjarnahor, dr., SpTHT
Andi S Budihardja, drg., SpBM
The contributors
Dr Eka J. Wahjoepramono, dr., SpBS
Dr Allen Widysanto, dr., SpP
Michael Lekatompessy, dr., SpTHT
Eko Tegus Prianto, dr, SpTHT
Indah Saraswati, dr, Sp THT
dr. Bernard S.M. Hutabarat, PAK
Karliana T Djohan, dr., SpM
Budi Suryanto,dr., SpM
Rini Hersetyati, dr., SpM
Josiah Irma, dr., SpM
Hendrik Kunta Adjie, dr., SpKK
Darti Wibisono, dr., SpPA
Jan Tambayong, dr., PHK
dr. Herman Mulijadi AIF
dr. Sylvia Tan, SpKK
Michael warouw, dr, SpKK
Skin and Special Sense/FK UPH/2015 Page 1

OVERVIEW
Everything we know about the world comes to us through our senses. The traditional
five senses in human kind are the senses of vision, hearing, taste, and smell, and touch. In
medicine, the special senses are the first four of these; touch is specifically excluded as a
special sense. Instead, the various aspects of touch (pain, heat, pressure) are all categorized as
somatic senses.
This block book provides full coverage of all important topics that students will need
to accomplish. Accordingly, this block book covers of several areas including Opthalmology,
Odontology, Otology, Dermatology, Histology, Microbiology, ENT, Neurosurgery, etc.
The block is divided in weekly program comprises of lectures, practical and clinical
skill laboratory, and as well as group discussion using PBL method.
Lectures include visual system, dental problems, basic otology, structure of skin and
its pathologic disorder, and also basic science such as anatomy, pathology anatomy,
physiology, microbiology, pharmacology, for each major.
In order to have a three dimensional aspect of the morphology and arrangement of
macroscopic and microscopic structural components of special sense, we arrange an
integrated laboratory practice 2 hours twice weekly. The session of the PBL is carried out in
small group discussion three times a week and wrapped up by an expert in the plenary
session.
Block Coordinator,
Dr. dr. Hannah Kiati Damar, Sp.KK

LIST OF CONTENT
I. Course info
II. Standard of Medical Competencies
III. Teaching and Learning method
IV. Departments
V. Week objectives of lecture and lab practice
VI. References
VII. Assessment
VIII. Approval

CHAPTER I
Course info
Block : Skin and Special Sense
Semester : VI
Credits : 5 credits
Duration : 5 weeks
Started : March 28th, 2016
Ended : April 29th, 2016
Coordinator : Dr. Hannah Kiati Damar, dr., SpKK
Theme of the week
Week 1 : Hearing and Balance

Week 2 : Smell and taste
Week 3 : Visual System
Week 4 : Skin
Week 5 : Veneric

CHAPTER II
Standard of Medical Competencies
1. Effective communication
Communicate with the patient and members of his/her family.
Students should be able to:
a. Greet the patient
b. Make the patient feel comfortable
c. Show empathy and trustworthiness
d. Listen actively (be attentive, and give enough time to the patient to express
his/her complaint and to explore his / her problem)
e. Summarize the patient’s problem, worries and hopes
f. Always establish and maintain the patient’s dignity, confidentiality and privacy
g. Able to use open-ended and closed questions in acquiring information
h. Ask for clarification from the patient about any of his/her statements which
cannot be clearly understood
i. Explore the history of the present illness, family history, and history of past
illness
j. Not give education and explanation prematurely while collecting information
k. Respect the patient’s belief in everything related to his/her illness
l. Explore the patient’s needs, worries, and hopes
m. Be sensitive to local biological, psychological, social, cultural factors and norms
in order to implement and maintain holistic therapy, and to maintain a
professional doctor-patient relationship
n. Use polite and understandable language (including local language) which is
appropriate to the patient’s age and level of education, in asking questions and
summarizing information
o. Anticipate and reduce the patient’s feeling of fright and stress before physical
examination
p. Answer questions honestly, and provide consultation or referral for difficult
problems
q. Provide education or health promotion for the patient and his/her family

r. Reconfirm that the patient has understood all of the information and choices
about potential procedures
s. Give enough time for the patient to reconsider and consult before agreeing to a
procedure
t. Deliver bad news professionally in accordance with medical ethics
2. Clinical skills
a. Explore and record clearly the complaints, present illness, medical, family, and
other relevant history
b. Identify physical signs and record them clearly and correctly
3. Scientific basis of medical knowledge

a. Explain the health problem in terms of the principles of the basic medical
sciences, pathogenesis and pathophysiology
b. Explain the molecular and cellular aspects of the health problem, based on an
understanding of the normal mechanisms of the human body
c. Explain the non-biological factors which influence the health problems
d. Explain the possibility of drug interactions and side effects

CHAPTER III
Teaching and Learning Method
1. Lecture : 6 hours/week
2. PBL discussion and Plenary : 7 hours/week
3. Laboratory practice : 4 hours /week
4. Clinical skill V : 4 hours/week
5. Clinical Exposure V : 2 hours/week
6. DPES III : 2 hours/week

CHAPTER IV
Departments
1. Department of Histology
2. Department of Physiology
3. Department of Pharmacology
4. Department of Anatomical Pathology
5. Department of Dermato-venerology
6. Department of Ophthalmology
7. Department of ENT
8. Department of Oral Medicine

CHAPTER V
OBJECTIVES
WEEK ONE
THEME : HEARING
Week chair : Pulo Raja S Banjarnahor, dr., Sp THT
Week Objectives
1. Describe the anatomy of the middle ear and ossicles
2. Describe the ultrastruture of cochlea and central connections
3. Describe the physiology of the hearing
4. Describe the anatomy and ultra structure of the vestibular system and its central
connections
5. Describe physiology of equilibrium and its application
6. Classify the causes and explain the pathophysiology of the hearing loss
7. Describe pathophysiology of imbalance, disequillibrium, dizziness and vertigo
8. Understand causes and describe management options for hearing impairment in
children and the role of cochlear implants
9. Describe the pharmacology of anti nausea and anti vertigo drugs
LECTURES
Lecture 1 & 2
Topic : Anatomy and physiology of hearing apparatus
Duration : 100 minutes
Lecturer : Eko Teguh Prianto, dr., SpTHT
Objectives : Student should be able to
1. Understand the anatomy and embryological of the ear
2. Describe the anatomy of the middle ear cleft and the cochlea
3. Describe central hearing pathways
4. Understand the physiology of hearing
5. Describe the components and functions of the external, middle, and inner ear.

6. Describe the way that movements of molecules in the air are converted into
impulses generated in hair cells in the cochlea.
7. Trace the path of auditory impulses in the neural pathways from the cochlear hair
cells to the auditory cortex, and discuss the function of the auditory cortex.
8. Explain how pitch, loudness, and timbre are coded in the auditory pathways.
Lecture 3 & 4
Topic : Anatomy and physiology of balance apparatus
Lecturer : Eko Teguh Prianto, dr., SpTHT
1. Understand the anatomy and embryological of the labyrinthine structures
2. Describe the anatomy of the temporal bone and the vestibular apparatus
3. Describe central pathways for balance
4. Understand the physiology of equilibrium
5. Explain how the receptors in the semicircular canals detect rotational acceleration
and how the receptors in the saccule and utricle detect linear acceleration.
6. List the major sensory inputs that provide the information which is synthesized in
the brain into the sense of position in space.
Lecture 5
Topic : Pathophysiology of hearing impairment
Lecturer : Pulo Raja S Banjarnahor, dr., Sp THT
1. Describe pathological condition of hearing
2. Understand risk factors for hearing impairment
3. Know classification of hearing loss
4. Know how to measure hearing level in children and adult
5. Know how to prevent hearing loss
6. Know to rehabilitation patients with hearing impairment

Lecture 6
Topic : Pathophysiology of imbalance and equilibrium
Lecturer : Pulo Raja S Banjarnahor, dr., Sp THT

1. Describe Pathological condition of balance impairment
2. Understand risk factors for vertigo and how to measurement
3. How to prevent dizziness
4. Describe pharmacology of anti-vertigo and anti nausea agents
LABORATORY PRACTICES
Laboratory 1 : Anatomy of ear, nose and mouth
Instructor : dr. Bernard S.M. Hutabarat, PAK, dr. Herman Mulijadi AIF
1. Describe the structure of the ear and important practical relations of the temporal
bone.
2. Describe the structure of nose and paranasal sinus and important pratical relations
of the maxilofascial.
3. Describe the structure of tongue and mouth.
4. Describe the blood supply, lymphatic system, innervation of the ear.
5. Describe the blood supply, lymphatic system, innervation of nose and mouth.
6. Describe the role of cranial nerve in ear, nose and tongue.
Laboratory 2 : Histology of sense

Instructor : (Jan Tambayong, dr., PHK)
Objectives : Students should be able to describe
The microscopic structures of middle ear mucosa and inner ear (cochle and vestibuler).

WEEK TWO
THEME : TASTE AND SMELL; ORAL CAVITY

Week chair : Michael Lekatompessy, dr., SpTHT
Week Objective
At the end of this week learning period, the students are able to understand the basic
sciences of taste and smell and basic dental science which are the basic sciences required to
solve the clinical problems.
TEETH AND ORAL CAVITY

1. Explain the dentition period, nomenclature/methods dental records.
2. Explain the anatomy of primary and permanent teeth
3. Describe the growth and development of teeth (incision to eruption phases)
4. Describe the histology of dental organ (enamel, dentin and pulp) and gingival and
periodontal tissues
5. Describe the pathogenesis and pathology of caries in primary teeth and permanent
teeth.
6. Describe gingivitis and explain how the pathogenesis and pathology of dental
plaque and calculus can cause symptoms.
7. Explain what is the toothache, and describe pathophysiology and causes of
toothache?
8. Describe the anatomy and radiological appearances of maxillary and mandible bone
and temporomandibular joint (TMJ)
9. Explain the anatomy, histology and function of mucous membranes, soft tissues and
salivary glands
10. Describe the pathology and histopathology of tumors of the oral cavity and
surrounding structures
TASTE AND SMELL

1. Describe the anatomy structure and function of nose and olfactory structures

2. To describe the anatomy and physiology of the smell and pathways to olfaction
centres of the brain.
3. Understand the morphology of nasal and olfactory mucosa
4. Explain the pathophisiology of disorders of olfaction
5. Explain the risk factors for olfactory disorders
6. Understand how inflammation in the nose affects process of smell
7. Describe anatomy of the tongue and related mouth structures
8. Describe the histological of the tongue and taste buds
9. Describe anatomy and function of the pathways to taste centres of the brain.
10. Identify the causes and describe the pathophysiology of decreased taste activity
LECTURES
Lecture 1
Topic : Teeth and Gums
Lecturer : Andi S Budihardja drg., SpBM
Ojectives : The student can explain
1. The process of teeth growth and development ( odontogenesis), during mixed and
permanent dentition
2. The structure, nomenclature and primary function of teeth and gums
3. Anatomy of maxilla and mandible, sinuses, and TMJ.
4. Caring and Disorder of the teeth and gum
5. Function of the jaw and Temporo mandibular Joint disorder
6. Mouth ulcers. Oral lichen planus. Oral leukoplakia.
7. Cancers of the Tongue, Mouth and salivary glands.
Lecture 2
Topic : Anatomy and physiology of tongue and taste
Lecturer : Andi S Budihardja drg., SpBM
Objectives : Student should be able
1. Describe histological appearance of the tongue and taste buds.

2. Understand the nerve system in the tongue and pathways to taste centers of the
brain.
3. Understand physiology of the taste and its interaction with smell.
4. Understand causes and pathophysiology of. abnormality of taste
5. Glossitis.
Lecture 3 and 4
Topic : Anatomy and physiology of nasal and olfactory system
Lecturer : Michael Lekatompessy, dr., SpTHT
1. Describe the histology of nasal and olfaction mucosa
2. Understand the physiology of smell and function of the nose
3. Understand the nerves for olfactory receptors and pathways to olfaction centres of
the brain
4. Understand pathofisiology of anosmia and hyposmia
5. Identification the risk factors of dysfunction olfactory system
6. Cancers of the nose Olfactory system
Lecture 5 and 6
Topic : Anatomy and physiology of taste, pharnyx, larynx, and esophagus
Lecturer : Michael Lekatompessy, dr., SpTHT
1. Understand the inflammation process in the nose and paranasal sinus.
2. Understand physiology of pharynx, larynx, and esophagus
3. Understand the abnormailties of nasopharynx and oropharynx
4. Understand the speech and language disturbance as a result of larynx disfunction
5. Disorders of the pharynx, larynx

1. Dental histology (Jan Tambayong, dr., PHK)
o Histology of teeth, tounge, and papilla
o Histology of saliva gland
2. Dental anatomy pathology (Darti Wibisono, dr., SpPA)
o Histopathology of oral cancer
WEEK THREE
THEME : VISUAL SYSTEM

Week chair : Endang Djohani, dr., SpM
Week Objectives :
1. Describe general anatomy of the orbit, eye, innervation & vascularization, ocular
muscles intrinsic & extrinsic.
2. Describe the physiology of the conductive system of visual information from the
cornea to retina and visual pathways to Occipital lobe.
3. Describe histological structure of the eye: cornea, iris, lens, retina, photoreceptor cells
and optic nerves.
4. Explain the production and flowing of humor aquos and disorders.
5. Describe the basic principles of optical system, refraction and anomalies of refraction.
6. Describe the physiology and function of rods and cones cells of the retina.
7. Describe central and peripheral visual pathways and clinical correlations of
abnormality.
8. Describe the etiology and pathogenesis of glaucoma.
9. Describe pathology of orbital neoplasms (retinoblastoma) and neoplasma / laesi
compressing the visual pathway.
10. Describe the action of miotic and mydriatic drugs and medicine for glaucoma.

LECTURES
Lecture 1
Topic : Embryology & Anatomy of The Eye
Physiology of Visual Pathway
Session : 50 minutes
Lecturer : Werlinson Tobing, dr., SpM
Objective : Students should be able to :
1. Understand the embryology of visual organ
2. Understand the anatomy & topography of the Eye ball
3. Understand the visual and pupillary pathway
Lecture 2
Topic : Drugs and Eye Medications
Lecturer : Karliana T Johan, dr., SpM
Objecives : Students should be able to
1. Describe the action of miotic and mydriatic drugs.
2. Describe the used of miotic & mydriatic in Glaucoma and Uveitis.
3. Describe the used of acetazolamide in Glaucoma.
4. Describe the used of steroid in eye medication.
5. Describe the effects of systemic medications on the eye and vision.
Lecture 3
Topic : Red eye
Lecturer : Josiah Irma , dr., SpM
Objectives : Students should be able to
1. Describe the pathophysiology of Red eye.
2. Describe the diagnosis and management of cataracts.
3. Understand about the diseases with visual decrease in red eyes

Lecture 4
Topic : Diseases of the Orbita, Neoplasms of the Orbit (Retinoblastoma)
Lecturer : Werlinson Tobing, dr., SpM
1. Describe the incidence, histopathology of Retinoblastoma.
2. Describe clinical sign and symptom of Retinoblastoma.
3. Understand the genetics of RB and about counseling.
4. Describe the other diseases of the orbita.
Lecture 5
Topic : Sosio Opthalmology community
Erradication of blindness
Visual loss in Indonesia – causes and social effects
Lecturer : dr. Endang M Johani, SpM
1. Understand to the eye diseases causing blindness.
2. Understand to the program “THE RIGHT TO SIGHT 2020”.
3. Understand to the program CATARACT ERADICATION.
4. Understand to the program of the EYE BANK.
Lecture 6
Topic : Sudden loss vision and Vitreoretinal Disease
Lecturer : Rini Hersetyati, dr., SpM
1. Understand anatomy and topography of Retina
2. Understand about the functionof retinal layers
3. Understand about Fundus: retina,macula and optic nerve.
4. Understand about the function of the cells: rods, cones.
5. Understand about colour vision and colour blindness.
6. Describe anatomy of Retinal vessels and pathophysiology of abnormality CRAO,
CRVO, Amaurosis Fugax, AMD.
7. Classify and describe causes of visual loss and their pathogenesis.
8. Describe the causes and pathophysiology of the painful eye.
9. Describe the anatomy of the optic nerve and pathophysiology of its diseases: papilitis,
papiledema.
10. Describe causes pathology and clinical symptoms of retinal detachment.
11. Understand retinopathy caused by systemic diseases.
Session : 2 x 50 minutes
Instructor : Jan Tambayong, dr., PHK, Darti Wibisono, dr., SpPA, Endang M. Johani,
dr., SpM
Objectives :
1. Histology of cornea, retina (Jan Tambayong, dr., PHK – Histologist)
2. Pathology and histopathology of visual system including: retinal degenerations,
retinoblastoma. (Darti Wibisono, dr., SpPA – Pathologist)
3. Able to do swab the eye secret  direct examination for bacteria or fungus.
4. Able to examine tears by Ferning test and Schirmer test for Dry Eyes (Endang M.
Johani, dr., SpM – ophtalmologist)
CLINICAL SKILLS
Session : 2 X 100 minutes
Instructor : Budi Suryanto, dr., SpM, Werlinson Tobing, dr., SpM.
Objectives :
History
1. Take the history of progressive visual blurring
2. Take the hsitory of transient visual loss
3. Take the history of the painful red eye
Physical Examination
1. Examine visual acuity from normal -> blindness (0)
2. Able to do Digital Tonometry
3. Able to do lid eversion and corneal assessment using fluorescein test

4. Able to do perform confrontation test for visual fields
5. Interpret tangent screen abnormalities including scotoma and visual
fields defects
6. Able to do Shadow test
7. Able to examine fundus reflex
8. Able to do funduscopy
9. Able to examine pupil light reflexes
WEEK FOUR
THEME : SKIN
Week chair : Dr Hannah Kiati Damar, dr., SpKK
WEEK OBJECTIVES
1. Gain an overview of structure and function of the skin and appendages.
2. Understand the principles of diagnosis of the skin.
3. Identify the classification of skin diseases.
4. Gain inside into some of the protection mechanisms (skin sensations, melanin
production and epidermal barrier).
5. Identify normal histology of skin, hair and nail.
6. Identify the pathologic changes of skin diseases.
7. Recognize the correlation between the clinical appearance of the disorder and the
pathophysiologic processes due to trauma / stimulation.
8. Describe some of the laboratory test used in the diagnosis of skin disease.
Lecture 1
Topic : Development & Structure of the Skin
Lecturer : Dr Hannah Kiati Damar, dr., SpKK
1. Define the development, structure and function of the skin.

2. Explain hair, nail, sebaceous glands, sweat glands, its growth regulation and
functions.
3. Describe an overview of classification of skin diseases.
4. Describe some approach to make a skin diagnostic.
5. Gain an overview of classification and features of various forms of dermatoses.
Lecture 2
Topic : Skin as an organ of protection
Lecturer : Herman Mulijadi, dr., AIF
1. Identify the structure of the epidermis as a physical permeable barrier.
2. Know the functions of the epidermal and dermal layers in skin protection.
3. Know the neurologic pathway of skin sensation.
4. Understand the pathophysiology and clinical aspects of itch
5. Recognize the pathologic skin barriers in dermatoses
6. Treatment implications and approaches: restoring the skin’s protective function
Lecture 3
Topic : Microscopic feature of the skin
Lecturer : dr. Darti Wibisono, Sp PA
1. Describe morphology and terminology of skin lesions.
2. Normal histology skin and appendages, nerve endings.
3. Describe the clinical gross morphologic and microscopic histopathological changes
of the skin and the appendages.
Lecture 4
Topic : Parasitic infestation
Lecturer : Dr Hannah Kiati Damar, dr., SpKK
 To name the causative organism of Parasitic infestation.
 To discuss the immunopathogenesis and type of reaction in Parasitic infestation.
 To recognize the signs and symptoms of Parasitic infestation
 To recognize the anti parasitic agents and modalities to treat parasitic infestation.
Lecture 5
Topic : Inflammatory of the skin disorders
Lecturer : Hendrik Kunta Adjie, dr., SpKK
1. Describe the pathogenesis immune reaction and clinical disorder of the skin.
inflamation on the epidermis, dermis, subcutis layers.
2. Identify skin disorders caused by allergy (Dermatitis).
3. Recognize various skin manifestations in conjunction with internal diseases.
Lecture 6
Topic : Emergency skin disorders
Lecturer : Hendrik Kunta Adjie, dr., SpKK.
1. Identify some agent that usually cause severe allergic reactions.
2. Recognize emergency skin condition and its primary treatment.
3. Know the skin manifestation of systemic disease.
4. Understand the skin emergency problems and how to treat the patient in a team work,
it’s referral system and prognosis of the disease
Session : 2 x 50 minutes.
Laboratory 1 : Histology (Jan Tambayong, dr., PHK)
Histology of Skin, hair and nail:
a. Epidermis.
b. Dermal-epidermal junction.
c. Dermis.
d. Skin Appendages.
e. Cutaneous vasculature.
f. Cutaneous nerves and receptors.
g. Hypodermis (subcutis).
Laboratory 2 : Anatomy Pathology (Darti Wibisono, dr., SpPA)

Pathology and histopathology of Skin including:
a. Keratinization disorders :
1) Hiperkeratosis.
2) Psoriasis.
b. Fluid-filled lesions:
1) Miliaria / Impetigo.
2) Pemphigus.
3) Pemphigoid bullosa.
CLINICAL SKILLS
Instructor : Dr Hannah K Damar dr, SpKK and Dr. Michael Warouw, dr., Sp KK
Objective :
History
1. Take the history of acute itchy rash
2. Take the history of chronic itch
3. Take the history of objective skin lesion observation
Photo session and video session
1. Know how to perform proper skin examination with angled light
2. Know how to perform Wood’s light examination
3. Able to describe primary and secondary skin lesion
WEEK FIVE
THEME : SEXUALLY TRANSMITTED DISEASES, EMERGENCY SKIN

CONDITIONS
Week chair : Dr. Mulyani Enggalhardjo, dr., SpKK
Week Objective
1. To gain an overview of structure and function of the genital tract
2. To explain classification of Sexually transmitted disease.
3. To understand pathogenesis, causative agents, transmission and prevention of
sexually transmitted disease.
4. To explain the principles in the treatment of sexually transmitted disease.
5. To describe some of the laboratory test used in the diagnosis of venereal disease.
6. To understand how venereal diseases affects the patient’s quality of life and
psychosocial issues.
7. To recognize the approach of the healthcare team work together to treat the ‘whole’
patient
8. Classify and describe the pathology and pathogenesis on skin cancers.
9. Describe the management of skin malignancy, its referral system and prognosis of the
disesase.
10. Know the diagnosis and management of emergency skin disorders and its referral
system and prognosis of the disease.
LECTURES
Lecture 1 & 2
Topic : Pharmacology of medications for skin disease
Lecturer : Dr. Mulyani Enggalhardjo, dr., SpKK
1. The basic therapeutic regimen for various skin condition.
2. Understand the principles therapy in dermatology.
3. Know the 2 main drugs, antihistamine and corticosteroid, used for skin diseases.
4. Recognize the management of steroid treatment.
Lecture 3
Topic : Skin Appendages disorder
Lecturer : Sylvia Tan, dr., SpKK
1. Describe morphology and terminology of skin appendages lesions.
2. Understand the pathophysiology and clinical aspects of skin appendages disorder
3. Recognize various skin manifestations in conjunction with parasitic infestation
Lecture 4
Topic : Skin malignancy
Lecturer : dr. Sylvia Tan, SpKK.
1. Know the melanin roles in cutaneous photobiology and photoimmunology.
2. Identify some of the key mechanism of skin damage process by influence of light and
chemical substance
3. Know the predispotition factor of malignancy.
4. Identify malignant and pre malignant condition of the skin
5. Know some of hereditary and congenital disease of the skin and appendages
6. Know the management of skin malignancy its referral system and prognosis of the
diseases
Lecture 5 & 6
Topic : Sexually transmitted diseases
Lecturer : Dr. Mulyani Enggalhardjo, dr., SpKK
1. Understand the anatomy and physical examination of male and female genital tract.
2. Know sexually transmitted agents, classification, pathogenesis, and its clinical
manifestations.
3. Know the mode of transmission and immunization of Sexually transmitted diseases.
4. Recognize preventive health behavior in sexually transmitted diseases.
5. Understand the principles therapy of sexually transmitted diseases.
Session : 2 x 50 minutes
Laboratory 1 : Physiology (dr. Herman Mulijadi AIF)
1. Know how to do two point discrimination
2. Know how to do discrimination of hot and cold
Laboratory 2 : Anatomy Pathology (Darti Wibisana, dr., SpPA)

Know the histopathology of skin cancer
CLINICAL SKILLS
Instructor : Mulyani Enggalharjo, dr., Sp KK, Sylvia Tan, dr,.Sp KK
Objectives :
History
1. Take the history of uretheral discharge
2. Take the history of genital ulcer
Photo session and video session

1. Recognize how to perform uretheral discharge examination
2. Recognize how to perform skin biopsy
3. Able to describe genital skin lesion

CHAPTER VI
LIST OF DISEASE (KKI)
The list of diseases consist of chosen diseases which are derived from diseases
burdens that arise based on morbidity, mortality, and case fatality rate data estimated in
primary health services; severity of the problems and their effect to individual, family and
society. Medical Doctor Graduates who will be working in primary level should have
adequate levels of competencies thus able to refer, to make a diagnosis, to give an initial
management, or to provide a comprehensive management. Therefore on every chosen
diseases, certain level of competency is set, which expected to be accomplished at the end of
Medical Doctor degree program, based on estimated competency which will be given when a
medical doctor work in primary health care, in line with common condition in Indonesia.
Provided, after graduated, a medical doctor would like to work in remote area where
health care services is very minimal, or in certain area which an extra competency is needed;
the authority is expected to give briefing prior to settlement.
The list of diseases is categorized based on systems, organs, and age. The levels of
competencies which are expected to be accomplished at the end of Medical Doctor degree
program are as follow:
Levels of competencies expected to be accomplished at the end of Medical Doctor

Degree program:
Level of Competencies 1
A Medical Doctor is able to identify and to situate clinical features of the diseases
when reading references. In correspondences, he is able to identify these clinical features,
and know how to obtain further information. This level indicates overview level. When
facing a patient with these clinical features, and then assuming the diseases, the Medical
Doctor directly refers.
A medical Doctor should be able to make a clinical diagnosis based on physical
examination and further examination requested (for example: basic laboratory examination or

X-ray). Medical Doctor is able to refer immediately to relevant specialist and able to manage
afterward.
3a. A medical Doctor should be able to make a clinical diagnosis based on physical
examination and further examination requested (for example: basic laboratory
examination or X-ray). Medical Doctor is able to decide and provide initial
management and refer to relevant specialist (not an emergency case).
3b. A medical Doctor should be able to make a clinical diagnosis based on physical
examination and further examination requested (for example: basic laboratory
examination or X-ray). Medical Doctor is able to decide and provide initial
management and refer to relevant specialist (emergency case).
A medical Doctor should be able to make a clinical diagnosis based on physical
examination and further examination requested (for example: basic laboratory examination or
X-ray). Medical Doctor is able to decide and independently manage problem
comprehensively.

LIST OF DISEASE
Telinga Tingkat Kemampuan

Telinga, Pendengaran, dan Keseimbangan
Tuli (kongenital, perseptif, konduktif) 2

Inflamasi pada auricular 3A
Herper Zoster pada telinga 3A
Fistula pre-aurikular 3A
Labirintitis 2
Otitis Eksterna 4A
Otitis media akut 4A
Otitis media serosa 3A
Otitis media kronik 3A
Mastoiditis 3A
Miringitis bullosa 3A
Benda asing 3A
Perforasi membran timpani 3A
Otosklerosis 3A
Timpanosklerosis 2
Kolesteatoma 1
Presbiakusis 3A
Serumen prop 4A
Mabuk perjalanan 4A
Trauma akustik akut 3A
Trauma aurikular 3B
Hidung
Hidung dan Sinus Hidung
Deviasi septum hidung 2
Furunkel pada hidung 4A
Rhinitis akut 4A
Rhinitis vasomotor 4A

Rhinitis alergika 4A
Rhinitis kronik 3A
Rhinitis medikamentosa 3A
Sinusitis 3A
Sinusitis frontal akut 2
Sinusitis maksilaris akut 2
Sinusitis kronik 3A
Benda asing 4A
Epistaksis 4A
Etmoiditis akut 1
Polip 2
Mata
Konjunctiva
Benda asing di konjungtiva 4A
Konjungtivitis 4A
Pterigium 3A
Perdarahan sub konjungtiva 4A
Mata kering 4A
Kelopak mata
Blefaritis 4A
Hordeolum 4A
Chalazion 3A
Laserasi kelopak mata 3B
Entropion 2
Trikiasis 4A
Lagoftalmus 2
Epikantus 2
Ptosis 2
Retraksi kelopak mata 2
Xanthelasma 2

Aparatus Lakrimalis
Dakrioadenitis 3A
Dakriosistitis 3A
Dakriostenosis 2
Laserasi duktus lakrimal 2
Sklera
Skleritis 3A
Episkleritis 4A
Kornea
Erosi 2
Benda asing di kornea 2
Luka bakar kornea 2
Keratitis 3A
Kerato-konjungtivitis sicca 2
Edema kornea 2
Keratokonus 2
Xerophtalmia 3A
Bola Mata
Endoftalmitis 2
Mikroftalmos 2
Anterior Chamber
Hifema 3A
Hipopion 3A
Cairan Vitreous
Perdarahan vitreous 1
Iris dan Badan Silier

Iridosisklitis, iritis 3A
Tumor iris 2
Lensa
Katarak 2
Afakia kongenital 2
Diskolasi lensa 2
Akomodasi dan refraksi 4A
Hipermetropia ringan 4A
Miopia ringan 4A
Astigmatism ringan 4A
Presbiopia 3A
Anisometropia pada dewasa 2
Anisometropia pada anak 2
Ambliopia 2
Diplopia binokuler 4A
Buta senja 2
Skotoma 2
Hemianopia,bitemporal, and homonymous 2
Gangguan lapang pandang 2
Retina
Ablasio retina 2
Perdarahan retina, oklusi pembuluh darah retina 2
Degenerasi macula karena usia 2
Retinopati (diabetic, hipertensi, prematur) 2
Korioretinitis 1
Diskus Optik dan Saraf Mata
Optic disc cupping 2
Edema papil 2
Atrofi optic 2
Neuropati optic 2
Neuritis optic 2

Glaukoma
Glaukoma akut 3B
Glaukoma lainnya 3A
Kulit
Infeksi Virus
Veruka vulgaris 4A
Kondiloma akuminatum 3A
Moluskum kontagiosum 4A
Herpes zoster tanpa komplikasi 4A
Morbili tanpa komplikasi 4A
Varisela tanpa komplikasi 4A
Herpes simpleks tanpa komplikasi 4A
Infeksi Bakteri
Impetigo 4A
Impetigo ulseratif (ektima) 4A
Folikulitis superfisialis 4A
Furunkel, karbunkel 4A
Eritrasma 4A
Erisipelas 4A
Skrofuloderma 4A
Lepra 4A
Reaksi lepra 3A
Sifilis stadium 1 dan 2 4A
Infeksi Jamur
Tinea kapitis 4A
Tinea barbae 4A
Tinea fasialis 4A
Tinea korporis 4A
Tinea manus 4A

Tinea unguium 4A
Tinea kruris 4A
Tinea pedis 4A
Pitiriasis vesikolor 4A
Kandidosis mukokutan ringan 4A
Gigitan Serangga dan Infestasi Parasit

Cutaneus larva migran 4A
Filariasis 4A
Pedikulosis kapitis 4A
Pedikulosis pubis 4A
Skabies 4A
Reaksi gigitan serangga 4A
Dermatitis Eksim
Dermatitis kontak iritan 4A
Dermatitis kontak alergika 3A
Dermatitis atopik (kecuali recalcitrant) 4A
Dermatitis numularis 4A
Liken simpleks kronik/neurodermatitis 3A
Napkin eczema 4A
Lesi Eritro-Squamosa
Psoriasis vulgaris 3A
Dermatitis seboroik 4A
Pitiriasis rosea 4A
Kelainan Kelenjar Sebasea dan Ekrin

Akne vulgaris ringan 4A
Akne vulgaris sedang-berat 3A
Hidradenitis supuratif 4A
Dermatitis perioral 4A
Miliaria 4A

Penyakit Vesikobulosa
Toxic epidermal necrolysis 3B
Sindrom Stevens-Johnson 3B
Penyakit Kulit Alergi
Urtikaria akut 4A
Urtikaria kronis 3A
Angioedema 3B
Penyakit Autoimun
Lupus eritematosis kulit 2
Gangguan Keratinisasi
Ichthyosis vulgaris 3A
Reaksi Obat
Exanthematous drug eruption, fixed drug eruption 4A
Kelainan Pigmentasi
Vitiligo 3A
Melasma 3A
Albino 2
Hiperpigmentasi paska inflamasi 3A
Hipopigmentasi paska inflamasi 3A
Neoplasma
Keratosis seboroik 2
Kista epitel 3A
Tumor Epitel Premaligna dan Maligna

Squamous cell carcinoma (Karsinoma sel skuamosa) 2
Basal cell carcinoma (Karsinoma sel basal) 2

Tumor Dermis
Xanthoma 2
Hemangioma 2
Tumor Sel Melanosit
Lentigo 2
Nevus pigmentosus 2
Melanoma maligna 1
Rambut
Alopesia areata 2
Alopesia androgenik 2
Telogen eflluvium 2
Psoriasis vulgaris 2
Trauma
Vulnus laseratum, punctum 4A
Vulnus perforatum, penetratum 3B
Luka bakar derajat 1 dan 2 4A
Luka bakar derajat 3 dan 4 3B
Luka akibat bahan kimia 3B
Luka akibat sengatan listrik 3B

CHAPTER VII
1. Fitzpatrick's Dermatology In General Medicine 6th edition

2. Hall - Sauer's Manual of Skin Diseases 8th edition
3. Vaughan & Asbury's General Ophthalmology, 17e
4. CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 2e
5. Byron - Head and Neck Surgery - Otolaryngology 3rd edition
6. Cummings - Otolaryngology - Head and Neck Surgery 3rd edition

CHAPTER VIII
ASSESSMENT
I. ATTENDANCE REQUIREMENTS
Attendance requirements and eligibility to write examinations:
Problem Based learning is an important and integral component of the UPH curriculum.
This instructional method emphasizes cooperative behavior and small group learning
which for many students, is a new way of learning. Consequently for groups to function
successfully, regular full attendance at tutorials is essential.
Attendance expectations as requirements and prerequisites to sit the examinations:
100% for tutorials
80% attendance at lectures
80% attendance in lab practical sessions
Exemptions permitted with Doctor’s certificate, event of family crisis, disaster or
extraordinary reason with prior permission from tutor. Further criteria are implemented
according to UPH criteria for exemption.
II. ASSESSMENT of STUDENT PERFORMANCE

The system will include assessment of block learning, mandatory courses, assessment of
clinical skills and a comprehensive “end of year” knowledge based examination. Each
component will be given a relative value in calculating a Cumulative Score.
a. Assessment will be conducted for learning in each block and will include:
 Knowledge based MCQ
 Objective Structured Practical Examination (OSPE)
 Tutorial performance
b. Clinical skills learning will be assessed at the end of each semester using the
international standard Objective Structured Clinical Examination (OSCE)
c. A comprehensive knowledge based examination (MCQ) will be conducted at the year
end. This will cover content from all components of the 2 previous semesters.
d. The Cumulative Score calculated based on the components will be the final score and
required for a successful Pass for the YEAR
e. The Cut-off score for Pass will be determined by recognized standard setting
processes.

1. Tutorial performance
A. Formative:
 Weekly discussions with tutor in the group
 Mid-block (course) discussions with tutor in the group and written
assessment summary provided to the student. During this encounter, the
tutor will identify any issues of concern with the student and assist in efforts
to improve.
B. Summative:
 Students will be assessed at the end of the block on the following
performance in tutorial sessions: Preparation, Participation, Professional
Behavior
III. RELATIVE VALUE

At the end of the block, the relative value of the block consists of each component as follows:
Component Percentage
1. PBL tutorials 25 %
2. MCQ 55 %
3. OSPE 20 %
At the end of the year, the relative value of Cumulative Score consists of component as
follows:
Component Percentage
1. MCQ comprehensive 25 %
2. OSCE (compile value within the year) 20 %
3. Blocks (compile value within the year) 45 %
4. Longitudinal Course 10%

Passing grade at UPH is 60.00 (C) and will be determined through recognized Standards
Setting processes. Relationship to the Grading system and GPA is as indicated in the table.
GRADE RANGE SCALE

A 90,00 - 100 4,00
A– 80,00 - 89,99 3,70
B+ 75,00 - 79,99 3,30
B 68,00 - 74,99 3,00
B– 65,00 - 67,99 2,70
C+ 60,00 - 64,99 2,30
C 56,00 - 59,99 2,00 (PASS)
C– 50,00 - 55,99 1,50
D 40,00 - 49,99 1,00
E 00,00 - 39,99 0,00

CHAPTER IX
SKIN AND SPECIAL SENSES
EVEN SEMESTER 2015/2016
Block Coordinator : Dr. Hannah Kiati Damar, dr., SpKK BATCH 2013
ROOM 301
Week 1 - Hearing faring Week chair : dr Pulo RS Banjarnahor, dr., Sp THT
Monday Tuesday Wednesday Thursday Friday

Time
28-Mar-16 29-Mar-16 30-Mar-16 31-Mar-16 1-Apr-16
07.15 - 08.05 Lecture 1-2
Chapel for staffs DPES III
08.10 - 09.00 dr. Reno, Sp.THT Clinical Exposure V,
09.05 - 09.55 PBL PBL Small Group PBL
10.00 - 10.50 Discussion 1 English Discussion 2 Class/Field Discussion 3
(09.25-11.25) Plenary
10.55 - 11.45
Pulo, dr, Sp.THT
11.50 - 12.40 Lecture 3-4
Lab practice A & B Faith activity
12.45 - 13.35 dr. Reno, Sp.THT
13.40 - 14.30 Clinical Skill V Clinical Skill V
PF Telinga dan garpu tala Lab practice A & B PF Tenggorok
14.35 - 15.25 Pulo RSB Pulo RSB
15.30 -16.20 Lecture 5-6 Clinical Exposure V,
16.25 - 17.15 Pulo, dr, Sp.THT Class
L1, L2 : dr. Reno, Sp.THT L5, L6 : Tenggorokan

L3, L4 : dr. Reno, Sp.THT
Week 2 - Smell and Taste Week chair : Michael L, dr., Sp THT

Time
4-Apr-16 5-Apr-16 6-Apr-16 7-Apr-16 8-Apr-16
07.15 - 08.05 Lecture 5-6
08.10 - 09.00 Clinical Exposure V, dr. Michael L, Sp.THT
10.00 - 10.50 Discussion 1 English Discussion 2 Class/Field Discussion 3
(09.25-11.25) Plenary
10.55 - 11.45
Michael dr,Sp THT/Indah
11.50 - 12.40
Lab practice A & B Faith activity
12.45 - 13.35 Lecture 1-2
13.40 - 14.30 drg. Andy, Sp.BM Clinical Skill V Clinical Skill V
PF Hidung Lab practice A & B PF Hidung
14.35 - 15.25 dr. Michael L, Sp.THT dr. Michael L, Sp.THT
15.30 -16.20 Lecture 3-4 Clinical Exposure V,
16.25 - 17.15 dr. Michael L, Sp.THT Class
L1, L2 : Teeth, gums, tongue and taste L5, L6 : Smell and taste
L3, L4 : Smell and taste

Week 3 - Visual System Week Chair: Endang M.Johani,dr.,SpM

Time
11-Apr 12-Apr 13-Apr 14-Apr 15-Apr
Lecture 1
07.15 - 08.05
dr. Werlinson, SpM
Lecture 2
08.10 - 09.00 Clinical Exposure V,
dr. Karliana, SpM
Small Group
09.05 - 09.55 PBL PBL PBL
Class/Field
10.00 - 10.50 Discussion 1 English Discussion 2 Discussion 3
Lecture 3 (09.25-11.25) Lecture Clinical Skill Plenary
10.55 - 11.45
dr.Josiah Irma,SpM (dr. Budi S,SpM) dr. Endang M Johani,SpM
11.50 - 12.40 lunch b reak lunch b reak lunch b reak
Lecture 4 Lab practice A & B Lecture 6 Faith activity
12.45 - 13.35
dr. Werlinson, SpM dr. Rini H, SpM
13.40 - 14.30 Lecture Clinical Skill
Clinical Skill V Lab practice A & B Clinical Skill V
14.35 - 15.25 (dr.Budi S,SpM)
Lecture 5
15.30 -16.20 Clinical Exposure V,
dr.Endang M.Johani,SpM
Class
16.25 - 17.15
L1 : Anatomy&Physiology L4 : Dissease of Orbita,Neoplasm of the Orbit

L2 : Drugs & Eye Medications L5 : Ophthalmology Community,Vision 2020
L3 : Red Eye L6 : Vitreoretina Dissease
Week IV – Skin Week chair : Dr. Hannah Kiati Damar, dr., Sp KK

Time
07.15 - 08.05 L1: Dr. dr. Hannah, SpKK
English
10.00 - 10.50 Discussion 1 Discussion 2 Class/Field Discussion 3
(09.25-11.25)
10.55 - 11.45 L2: dr. Herman M, AIF lunch b reak Plenary: Dr. dr. Hannah, SpKK
11.50 - 12.40 lunch b reak lunch b reak lunch b reak
Introduction Clinical Skill Lab practice Faith activity
12.45 - 13.35 L3: dr. Darti, SpPA
(dr. Michael Warouw, Sp.KK) Histology
13.40 - 14.30 L4: Dr. dr. Hannah, SpKK Clinical Skill V Pathology Anatomy Clinical Skill V
14.35 - 15.25 History Taking Skin PF Skin
15.30 -16.20 L5 & L6 : dr. Hendrik Clinical Exposure V,
16.25 - 17.15 Kunta, SpKK Class
L1 : Development & Structure of the Skin L4 : Parasitic infestation

L2 : Skin as an organ of protection L5 : Inflammatory of the skin disorders
L3 : Microscopic feature of the skin L6 : Emergency skin disorders
Week V – Veneric Week chair : Dr. Mulyani Enggalhardjo dr., SpKK

Time
07.15 - 08.05
English
10.00 - 10.50 Discussion 1 Discussion 2 Class/Field Discussion 3
(09.25-11.25)
10.55 - 11.45 L1, 2: Dr. dr. Mulyani, lunch b reak Plenary: Dr. dr. Mulyani, SpKK
11.50 - 12.40 SpKK lunch b reak
L5, 6 : Dr. dr. Mulyani,
Introduction Clinical Skill Lab practice Faith activity
12.45 - 13.35 lunch b reak SpKK
(dr. Michael Warouw, Sp.KK) Histology
13.40 - 14.30 Pathology Anatomy
Clinical Skill V Clinical Skill V
14.35 - 15.25
15.30 -16.20 L3 & L4 : dr. Sylvia Tan, Clinical Exposure V,
16.25 - 17.15 SpKK Class
L1, 2 : Pharmacology of medications for skin disease

L3 : Skin Appendages disorder
L4 : Skin malignancy
L5, 6 : Sexually transmitted diseases

Examination week for Block SSS

Time
2 Mei 3 Mei 4 Mei 5 Mei 6 Mei
07.15 - 08.05
08.10 - 09.00
09.05 - 09.55
TEORI SSS
10.00 - 10.50
10.55 - 11.45
PUBLIC PUBLIC
11.50 - 12.40 HOLIDAY HOLIDAY
12.45 - 13.35 OSPE
13.40 - 14.30 SSS
14.35 - 15.25
15.30 -16.20
16.25 – 17.15

Block Book SSS 2015 - 2016 Utk Mahasiswa

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Skin and Special Sense

Skin and Special Sense/FK UPH/2015 Page 1

Dr. dr. Hannah Kiati Damar, Sp.KK

Skin and Special Sense/FK UPH/2015 Page 2

II. Standard of Medical Competencies

III. Teaching and Learning method

V. Week objectives of lecture and lab practice

Skin and Special Sense/FK UPH/2015 Page 3

Theme of the week

Week 1 : Hearing and Balance

Skin and Special Sense/FK UPH/2015 Page 4

Skin and Special Sense/FK UPH/2015 Page 5

3. Scientific basis of medical knowledge

Skin and Special Sense/FK UPH/2015 Page 6

Skin and Special Sense/FK UPH/2015 Page 7

Skin and Special Sense/FK UPH/2015 Page 8

Skin and Special Sense/FK UPH/2015 Page 9

Skin and Special Sense/FK UPH/2015 Page 10

Objectives : Student should be able to

Laboratory 2 : Histology of sense

Skin and Special Sense/FK UPH/2015 Page 11

THEME : TASTE AND SMELL; ORAL CAVITY

TEETH AND ORAL CAVITY

TASTE AND SMELL

Skin and Special Sense/FK UPH/2015 Page 12

Skin and Special Sense/FK UPH/2015 Page 13

Skin and Special Sense/FK UPH/2015 Page 14

THEME : VISUAL SYSTEM

Skin and Special Sense/FK UPH/2015 Page 15

Skin and Special Sense/FK UPH/2015 Page 16

Skin and Special Sense/FK UPH/2015 Page 18

Skin and Special Sense/FK UPH/2015 Page 19

Laboratory 2 : Anatomy Pathology (Darti Wibisono, dr., SpPA)

THEME : SEXUALLY TRANSMITTED DISEASES, EMERGENCY SKIN

Laboratory 2 : Anatomy Pathology (Darti Wibisana, dr., SpPA)

Photo session and video session

Skin and Special Sense/FK UPH/2015 Page 25

Levels of competencies expected to be accomplished at the end of Medical Doctor

Skin and Special Sense/FK UPH/2015 Page 26

Skin and Special Sense/FK UPH/2015 Page 27

Telinga Tingkat Kemampuan

Tuli (kongenital, perseptif, konduktif) 2

Skin and Special Sense/FK UPH/2015 Page 28

Skin and Special Sense/FK UPH/2015 Page 29

Iris dan Badan Silier

Skin and Special Sense/FK UPH/2015 Page 30

Skin and Special Sense/FK UPH/2015 Page 31

Skin and Special Sense/FK UPH/2015 Page 32

Gigitan Serangga dan Infestasi Parasit

Kelainan Kelenjar Sebasea dan Ekrin

Skin and Special Sense/FK UPH/2015 Page 33

Tumor Epitel Premaligna dan Maligna

Skin and Special Sense/FK UPH/2015 Page 34

Skin and Special Sense/FK UPH/2015 Page 35

1. Fitzpatrick's Dermatology In General Medicine 6th edition

Skin and Special Sense/FK UPH/2015 Page 36

II. ASSESSMENT of STUDENT PERFORMANCE

Skin and Special Sense/FK UPH/2015 Page 37

III. RELATIVE VALUE

Skin and Special Sense/FK UPH/2015 Page 38

GRADE RANGE SCALE

Skin and Special Sense/FK UPH/2015 Page 39

Week 1 - Hearing faring Week chair : dr Pulo RS Banjarnahor, dr., Sp THT