Draft Osce Dms His

Fakultas Kedokteran UNP

Draft OSCE DMSHIS

Draft OSCE EMS-NBSS

DMS TOPIC 1: Dermatological examination CIEN! ASSESMEN! 1. 2. '. +.

.

Sapa paien paien !enga !engan n rama"# rama"# per$e per$enal$ nal$an an !iri !iri Per"ati$ Per"ati$an an $ean $ean $lini $lini a%al: a%al: terli" terli"at at a$it a$it ga& ga& Beri$an Beri$an pen(ela pen(elaan an )ang )ang c*$*p c*$*p $epa! $epa!a a paien paien tentang pemeri$aan )ang a$an $ita la$*$an Tempat$a empat$an n paien paien pa!a tempat tempat !enga !engan n penca"a)aan )ang c*$*p# ter*tama ca"a)a mata"ari,ca"a)a lamp* Minta Minta paie paien n *nt*$ *nt*$ melepa melepa$ $an an pa$ai pa$aian an

E"AMINA!ION !HE SKIN# HAI$# NAI# % MUCOUS MEM&$ANE Pe'er(ksaan kul(t  Duu Can!(k

)* D(str(+ D(str(+ut( ut(on on of less(o less(on n Peri$a perm*$aan $*lit  menilai $el*aan: /o$ai: locali0e! "an)a 1 # regional le3i" l*a nam*n men*mp*$ pa!a !aera" tertent*# general "ampir el*r*" 3a!an 456 ,

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*m3ilicate!: eperti *m3ili$* menon(ol tapi tenga"n)a ce$*ng# !ll. arrangement of m*ltiple leion: a. "erp "erpeti etifor form m : gro gro*p *p 7eic 7eicle le "erpe "erpe  3. 0ote 0oterif rifor orm m : 7e 7eicl icle,3 e,3*ll *llae ae !i !ermatom eperti pita c. ann*lar !. arciform e. linear f. er erpigi pigino no* * : epe epert rtii *lar *lar g. cor)m3i )m3ifo forrm : cen central tral cl*te *terr,le ,lei 3ear# a!a lei atelit !i ampingn)a ". pol) pol)c) c)cl clic ic : ga3 ga3*n *ng g le leii 3*l 3*lat at-3 -3*l *lat at >$*ran lei : >$*r lei !engan per$iraan ..cm ? @ cm ?@ cm ata* *$*ran peiA$: milier $ecil-$ecil# g*tata e3ear tetean air# n*mm*lar e3ear $oin Bor!er lei: %ell-!eAne! 3ata tega, (ela  3ia !i3e!a$an !engan $*lit normal, ill-!eAne! ti!a$ (ela & Denan alas( Ele7ate!, plane, !epree! !ari $*lit e$itarn)a 8ering, 3aa" Conitenc) an! feel leion: oft# "ar! # eperti a!onan# $*at# mo3ile, ten!er •

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3* !4es !4es of of sk(n sk(n les less( s(on on Tent*$an Tent*$an : /ei /ei $*lit *lit

im

Draft OSCE EMS-NBSS

DMS TOPIC 1: Dermatological examination CIEN! ASSESMEN! 1. 2. '. +.

.

Sapa paien paien !enga !engan n rama"# rama"# per$e per$enal$ nal$an an !iri !iri Per"ati$ Per"ati$an an $ean $ean $lini $lini a%al: a%al: terli" terli"at at a$it a$it ga& ga& Beri$an Beri$an pen(ela pen(elaan an )ang )ang c*$*p c*$*p $epa! $epa!a a paien paien tentang pemeri$aan )ang a$an $ita la$*$an Tempat$a empat$an n paien paien pa!a tempat tempat !enga !engan n penca"a)aan )ang c*$*p# ter*tama ca"a)a mata"ari,ca"a)a lamp* Minta Minta paie paien n *nt*$ *nt*$ melepa melepa$ $an an pa$ai pa$aian an

E"AMINA!ION !HE SKIN# HAI$# NAI# % MUCOUS MEM&$ANE Pe'er(ksaan kul(t  Duu Can!(k

)* D(str(+ D(str(+ut( ut(on on of less(o less(on n Peri$a perm*$aan $*lit  menilai $el*aan: /o$ai: locali0e! "an)a 1 # regional le3i" l*a nam*n men*mp*$ pa!a !aera" tertent*# general "ampir el*r*" 3a!an  456 , *ni7eral el*r*" t*3*"  1556 8ara$ter pola : imetri 2 ii# $iri $anan ama# mi. atopic !ermatiti, aimetri  1 ii# mi. Cell*liti# 3ilateral  2 ii t*3*"# conto" !i tangan# mi. Poriai# a*toim*n, *nilateral 1 ii t*3*"# mi. Congenital# epi!ermal ne7*# !ermatomal mengi$*ti !ermatom# mi. 9erpe 0oter

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,* o oa at(o t(on n of of less less(o (on n −

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Tent*$a Tent*$an n lo$ai lei !ari $*lit $epala $epala ampai ampai telapa$ $a$i ecara 3ert*r*t-t*r*te*ai anatomical region 8ara$teriti$ lo$ai: ex*ral !aera" exor# mi. ;topic !ermatiti# extenor  !aera" extenor# mi. ec0ema#intertrigino* !aera" lipatan# mi. Infe$i (am*r# gla3ro* !aera" )ang 3an)a$ $elen(ar *3oroi!  !a"i# !a!a# p*ngg*ng# palm mi. Ptiriai r*3ra pilari# ole mi. ICD !an expoe! area mi. Pol)morp" lig"t er*ption.

.* C/ara C/arater( ter(st( st(  of of less( less(on on !entukan karakter(st(k les( denan (nseks( <*mla" lei: lei: Soliter,m*ltiple Soliter,m*ltiple
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*m3ilicate!: eperti *m3ili$* menon(ol tapi tenga"n)a ce$*ng# !ll. arrangement of m*ltiple leion: a. "erp "erpeti etifor form m : gro gro*p *p 7eic 7eicle le "erpe "erpe  3. 0ote 0oterif rifor orm m : 7e 7eicl icle,3 e,3*ll *llae ae !i !ermatom eperti pita c. ann*lar !. arciform e. linear f. er erpigi pigino no* * : epe epert rtii *lar *lar g. cor)m3i )m3ifo forrm : cen central tral cl*te *terr,le ,lei 3ear# a!a lei atelit !i ampingn)a ". pol) pol)c) c)cl clic ic : ga3 ga3*n *ng g le leii 3*l 3*lat at-3 -3*l *lat at >$*ran lei : >$*r lei !engan per$iraan ..cm ? @ cm ?@ cm ata* *$*ran peiA$: milier $ecil-$ecil# g*tata e3ear tetean air# n*mm*lar e3ear $oin Bor!er lei: %ell-!eAne! 3ata tega, (ela  3ia !i3e!a$an !engan $*lit normal, ill-!eAne! ti!a$ (ela & Denan alas( Ele7ate!, plane, !epree! !ari $*lit e$itarn)a 8ering, 3aa" Conitenc) an! feel leion: oft# "ar! # eperti a!onan# $*at# mo3ile, ten!er •

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3* !4es !4es of of sk(n sk(n les less( s(on on Tent*$an Tent*$an : a. /ei /ei $*lit *lit prim primer er 1. Mac* Mac*le le : at at## ti! ti!a$ a$ non( non(ol ol## a!a a!a per*3a"an %arna  ")perpigmente! # ")popigmente!# !epigmente! 2. Pap*l ap*le e : ton ton(o (ola lan n pa! pa!at at## ol oli! i!## ele ele7a 7ate te!# !#   5#cm '. Pla Pla*e *e : $*m $*mp* p*la lan n pap pap*l *le e !# !#   1 cm +. P*t* *t*le le : 3er 3eriii nana nana" " p*r p*r*l *len entt ex*!ate . No!*le F. C)t C)t : a!a a!a $anto $antong ng 3erii 3erii emio emioli! li! G. H"ea H"eall : a!a a!a 3eng 3eng$ $a$ )an )ang g terl terlo$ o$al ali ia ai# i# mi. >rticaria: alergi  ma$an *!ang  3i3ir men(a!i te3al 4. eicle eicle : 3erii 3erii cairan cairan (erni" (erni" !an 3ening# 3ening#  5# cm J. B*ll B*llae ae : *$*r *$*ra an le3i le3i" " 3ea 3earr !ar !arii 7e 7eic icle le##  5# cm 3. /ei /ei $*l $*lit it e$ e$*n *n!e !err 1. Eroi Eroion on : "ilan "ilang g e3agi e3agian an , em*a em*a epi!ermi 2. Excoria Excoriation tion:: "ilan "ilangn)a gn)a le3i" le3i" !ala !alam m ampa ampaii $e 3agian papilar) !ermi '. Ki*re : pe peca"-peca" +. Scar Scar at"r at"rop op") ") , ")pe ")pert" rt"ro rop) p) . >lcer >lcer : 3oro 3oro$# $# le3i" le3i" !alam !alam !ari !ari eroi eroi !an excoriation F. Scale : $*lit lepa# 3erii$ G. Cr*t : ca caira iran t* t*3*" )ang meng menge ering ring  cr*ta ero*a %arna $*ning# cr*ta me!ica mentoa mi. Cacar air ter* !i3e!a$in# cr*ta ang*inolenta !ara" )ang mengering c. /ei /ei $*lit *lit pe peAA AA$ $ 1. Come Come!on !one e : $eratin eratin Le3*m Le3*m## !ilate !ilate! ! piloe3aceo* %"ite# 3lac$

Ka$*lta 8e!o$teran >NP;D 2515 Draft Draft OSCE DMS-9IS DMS-9IS Perfecten

Draft OSCE EMS-NBSS 2.

Telengiectai : !ilatai pem3*l*" $apiler '. Canalic*li : $ema*$an cacing +. Milia : a!a $ita, $ant*ng $ecil Pe'er(ksaan ra'+ut 10* Peri$a: !itri3*i# te$t*r !an ronto$,ga& Pe'er(ksaan kuku 11* Peri$a: %arna# perm*$aan# te$t*r  tan!a-tan!a peiA$ $*$*: Pitting nail : mele$*$ Splinter "emorr"age : pen!ara"an 3a%a" $*$* /e*$onic"ia On)c"o!)trop"): 3ent*$ $*$* ala" Onc)c"ol)i : $*$* ma* lepa S*3*ng*al ")per$eratoi: $*$* nai$ $e ata# a!a (am*r !i3a%a" Pe'er(ksaan 'e'+ran 'ukosa 4an +er/u+unan denan kelu/an uta'a 12. Inpe$i mem3ran m*$oa: $on(*ngti7a# oral# genital#  !aera" anal apa$a" a!a erit"ema# eroi# excoriation# *l$*# !ll.&

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C* H(stor4 of resent (llness# 7(t/ art(ular reard to onset# e8olut(on and re((tat(n fators .

8el*"an *tam: a!a )ang 3ia a)a 3ant*&,$el*"ann)a apa&

!el(na F.

External otiti n)eri telinga Telinga )ang mana,telinga 3agian mana& >nilateral ata* 3ilateral& 8apan ter(a!i& *!a" 3erapa lama& ;!a n)eri, a$it telinga& ;!a cairan )ang $el*ar !ari telingan)a ga& atal !i l*3ang telinga& e(ala ter$ait - !emam&# a$it $epala&# pen*r*nan pen!engaran&# lema otot %a(a"&  $alo a!a 3erarti *!a" itemi$ =i%a)at: 3erenang# mengore$ telinga =i%a)at pengo3atan: $on*mi o3at& Otiti me!ia 3erair# 3ia (*ga !iertai n)ari telinga ;!a a$it,n)eri !i3ela$ang telinga ga& ;!a a$it,n)eri te$an pa!a trog*, 3eng$a$ 3ela$ang telinga ga& Da*n telinga 3eng$a$, 3er*3a", 3erganti poii& =i%a)at $onmi o3at& Telinga 3agian mana& >nilateral ata* 3ilateral& Cairan telinga& 8apan ter(a!i& D*rai 3erapa lama& Ter*-mener* ata* $a!ang-$a!ang& N)eri telinga ga& Pre!ipoing factor& 3erenang# mengore$ telinga 8ara$teriti$ cairan: m*$* len!ir# m*cop*r*lent len!ir L nana"# p*r*lent nana"# ero* cairan 3ening& Ber$aitan !engan otalgia n)eri telinga ga& Cairann)a 3a*, ga& e(ala ter$ait  !emam&# a$it $epala&# pen*r*nan pen!engaran&# p*ing&# lema %a(a"&# n)eri !i 3agian 3ela$ang telinga&# !iplopia pan!angan gan!a& =i%a)at tra*ma telinga ata* operai& Ser*men Telinga 3agian mana& >nilateral ata* 3ilateral& =i%a)at: 3erenang# mengore$ telinga& =i%a)at $on*mi o3at& Telinga pen*", telingan)a $eraa pen*" ga& N)eri telinga pen*r*nan pen!engaran# a$it $epala&

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5ENE$A E"AMINA!ION IN DE$MA!OO56

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1'. Pemeri$aan Ai$ ecara *m*m !iin!i$ai$an !engan clinical preentation  DD# ter*tama *nt*$ 7ital ign# l)mp"a!enopat")# ,ata* (oint

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DESC$IP!ION OF !HE PH6SICA E"AMINA!ION

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B*at $eimp*lan !ari "ail pemeri$aan mengg*na$an pola:  Dermatolo!ical tat* : a. Ditri3*tion : @@@@.. 3. /ocation : @@@@.. c. C"aracteritic of leion : @@@@.. !. T)pe of leion : @@@@@ Simp*l$an "ail pemeri$aan "air# nail# m*co* mem3rane !an general p")ical examination eneral tat* : @@@@@

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TOPIC 2: "itor) ta$ing ENT A* Cl(ent assess'ent 1. 2. '.

Sapa paien !an per$enal$an !iri Paien e"ar*n)a mem3eri$an c*$*p pen(elaan tentang "itor) ta$ing
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&* Ident(f4(n data +.

Tan)a !engan opan: i!entita paien Nama >ia
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H(dun J.

Epita$i, mimian 3er!ara" 9i!*ng 3agian mana& >nilateral ata* 3ilateral& ;nterior# poterior# ata* !iQ*e camp*ran& Spontan ata* pot-tra*matic& S*!a" 3erapa lama& 8apan ter(a!,e(a$ $apan& Pertama $ali# e3el*mn)a perna" mengalami ga,*!a" ering, 3er*lang& Dara" )ang $el*ar 3an)a$ ga&  ering ganti ga, ganti ti*e 3erapa $ali&

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Ka$*lta 8e!o$teran >NP;D 2515 Draft OSCE DMS-9IS Perfecten

Draft OSCE EMS-NBSS 9i!*ng ter*m3at# cairan "i!*ng, ing*# 3erin# "i!*ng gatal& Maala" ter$ait: *# 3*ang ing* terlal* $era, $encang# me!ical pro3lem eperti ")perteni# min*m o3at pengencer !ara"# min*m o3at anti$oag*lan# tan!a !ari 3loo! !)craia m*!a" 3er!ara", $elainan !ara"# renal !ieae# 3en(olan& =i%a)at !ari tra*ma "i!*ng ata* operai# mengore$ "i!*ng& =i%a)at pengo3atan 15. ="inoin*iti 9i!*ng ter*m3at& Cairan "i!*ng& 9i!*ng gatal& Berin& 9i!*ng 3agian mana& >nilateral ata* 3ilateral& Pot naal !rip : !a"al ngalir !i 3ela$ang tenggoro$an# *a" $el*ar  eperti meraa menelan len!ir "i!*ng,ing*& *!a" 3erapa lama&# e(a$ $apan& 8ontan tetap ata* a$i3at c*aca, m*im tertent*& Sa$it aat *(*!& a$it pa!a poii tertent* Sa$it !i %a(a"& e(ala ter$ait: a$it tenggoro$an# ama# a$it $epala 8on*mi o3at =i%a)at pengo3atan 11* ar(n(t(s Sa$it tenggoro$an& 8apan ter(a!i, e(a$ $apan& S*!a" 3erapa lama& Ter*-mener*, $a!ang-$a!ang& Progre, per$em3angan pen)a$itn)a gimana& S*lit menelan& Per*3a"an *ara& *ara enga*& Ti!*r ngoro$,men!eng$*r& =i%a)at menelan 3en!a aing& =i%a)at menelan 3en!a-3en!a $oroif 3a)gon# al$o"ol !ll& S*ara era$& S*lit 3ernafa& Infe$i al*ran pernapaan ata& Pattern of time of !a) %oriene!& Terpapar 0at $imia& =i%a)at tra*ma# operai !engan general anatei# operai le"er !an !a!a# tat* t")roi!# en!o trac"eal int*3ation& =i%a)at $on*mi o3at& 12* Naso/ar 4neal tu'or 9a7aln4a +erdara/ sed(k(t-sedk(t: Se(a$ $apan& S*!a" 3erapa lama& Sema$in lama# ma$in para" ga& Per*3a"an *ara& S*ara enga*& S*ara era$ mimian !ari "i!*ng& 9i!*ng ter*m3at& Cranial ner7e paral)i : CN '# +# F  gera$an 3ola mata CN J# 15  *lit nelan −

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− − − − −

+

Ben(olan !i le"er& 8el*"an !i telinga: $el*ar cairan# 3eraa pen*"# pen*r*nan pen!engaran Sa$it $epala& S*lit menelan& e(ala ter$ait: pen*r*nan 3erat 3a!an& S*lit 3ernafa& =i%a)at $on*mi o3at

−

D* 5eneral /(stor4 of resent (llness related to /(ef o'la(nt# 7(t/ art(ular attent(on to onst(tut(onal % rodro'al s4'to'

−

− −

1'. ;c*te illne )n!rome !emam# 3er$eringat# menggigil# a$it $epala# m*al# m*nta"# !ll& 1+. C"ronic illne )n!rome leti"# anorexia# pen*r*nan 3erat 3a!an# lela"& 1. =i%a)at ter!a"*l* )ang 3er"*3*ngan !engan $el*"an *tama &  *!a" perna" a$it ini e3e*mn)a& 1F. =i%a)at me!i $el*arga  ;!a anggota $el*arga mengalami ge(ala )ang ama, pen)a$it er*pa ga& 1G. =e7ie% i!entita# $el*"an *tama#  "ail anamnei

− − − −

− −

− − −

TOPIC ': ort"opae!ic P9RSIC;/ examination

− −

A* Ket(ka kl(en datan ke ruan e'er(ksaan

−

1* 2*

−

− −

a)a 3er(alan a3normal# eperti: pincang Bent*$ !an pot*r $*r*, o3ee# for%ar!, i!e 3en!ing

&* Cl(ent assess'ent

−

1* Sapa paien 2* Per$enal$an !iri !engan rama" ;* Tan)a i!entita paien: nama# ri%a)at me!i !an (eni $elamin <* 9itor) ta$ing: e(ala a$it# $a$*# 3eng$a$# !eformita# lema"# inta3ilit)# c"ange in eni3ilit)# lo in f*nction& =i%a)at ter!a"*l* pen)a$it e3el*mn)a, $ecela$aan& =i%a)at $el*arga& /atar 3ela$ang oial& =*
− − − −

− − − − − −

−

I*

EK$IMI!AS Catatan: elal* 3an!ing$an anatar $e!*a ii $iri#$anan

A* ook 1* 2* ;*

Bent*$ Ben(olan *$*ran# tepi 8*lit


Draft OSCE EMS-NBSS

<*



Harna p*cat# $e3ir*an# mera" /*$a >l$* Be$a l*$a Deformita ang*lar# "ortening# rotation

&* Feel 1*

2*

;*

<* =*

8*lit 9angat, !ingin& /em3a3, $ering& Normal enation&
C* Mo8e 1* 2* ;* <* =*

II*

;cti7e mo7ement !an =OM !ari en!i )ang trli3at  !igera$in en!iri ole" paien Pai7e mo7ement !an =OM !ari en!i )ang terli3at  !i gera$in ole" pemeri$a ;pa$a" a!a fale mo7ement gera$an )ang ga e"ar*n)a & ;pa$a" a!a n)eri aat 3ergera$& ;pa$a" a!a m*cle pam&

SPINE A* ook 1*

Pot*r  aat 3er!iri /*r*, c*r7e!&  !ili"at !ari amping  l*r* ga&&  !ari 3ela$ang  eim3ang ga&& Catatan: Yang jadi patokan pas ngelihjat dari samping: lubang telinga  bahu  siku  pelvic  head of tibia  malleus lateral . Yang jadi patokan pas ngelihat dari belakang: bahu  jarak tangan  pelvic  posture (soinalnya lurus ga???)

;*

8*lit Harna p*cat# $e3ir*an# mera" /*$a >l$* Be$a l*$a

&* Feel 1*

8*lit 9angat, !ingin& /em3a3, $ering& Normal enation& 2*
C* Mo8e Sen!i-en!i pinal  minta paien e$i,e$teni $e amping $anan  $iri

Kle$i  minta paien *nt*$ mem3*ng$*$ $e !epan

2*

Ben(olan *$*ran !an tepi


Draft OSCE EMS-NBSS

F

Catat dan laorkan /as(l e'er(ksaan >s(k

TOPIC +: %o*n! care  !reing 1* Saa as(en dan erkenalkan d(r( • •

•

Men)apa !engan rama" !an opan Tan)a i!entita paien: nama# ri%a)at me!i# !an (eni $elamin
2* Pers(aan alat-alat •

Scior teril  non-teril

•

Korcep teril non-teril

E$teni  $e 3ela$ang

=otai  minta paien *nt*$ merotai$an 3atang t*3*"n)a $e $anan  $iri

a!a a$it ga aat 3ergera$&

D* Motor funt(on ---- ada ekstr('(tas M*cle tone 8e$*atan =eex P")iological reexe Bicep (er$ C-F ;n$le (er$ S1 Patellar reex Pat"ological reex Ba3in$) ign

;natomical S*rgical • •

• • •

Normal aline !alam container ;ntieptic !alam container po7i!one io!ine '6# c"lor"ex)!ine 8aa teril Sar*ng tangan teril  teril  non 8i!ne) 3ain


Draft OSCE EMS-NBSS •

•

G

/epa ar*ng tangan# impan !i !econtamination container C*ci tangan !engan lar*tan antiepctic

,* Doku'entas( reka' 'ed(s as(en • • • •

• •

Pleter Dipoal container

Dress(n re'o8al cnt". Ngelepain $aa 3e$a

'.

Tanggal !an %a$t* Penem*an aat proe!*r =epon paien ter"a!ap proe!*r Nama !o$ter )ang mela$*$an

Topic : %o*n! toilet  !e3ri!ement of open fract*re P$EPA$A!ION M(nor sur(al test •

(a"itan /ang$a" non-teril  C*ci tangan !engan lar*tan antieptic !i %ar! 3o%l Pa$ai ar*ng tangan non-teril entl) remo7e t"e pot operati7e !reing B*ang !reing $e container

Nee!le "ol!er  g*nting *nt*$ megang (ar*m *(*ngn)a pen!e$

• •

• • •

?ound assess'ent

+. • •

 IMPO=T;NT /ang$a" non-teril Inpe$i l*$a: O3e7ai tan!a-tan!a infe$i $emera"an# !iQ*e %elling O3er7ai cairan )ang $el*ar !ari l*$a ero* *i! 3ening# ero-ang*ino* $*ning# !ara"# p*"i(a* Palpai l*$a area e$itar l*$a# tan!a-tan!a infe$i ten!erne# *ct*ation# acti7e !ic"arging

−

−

−

=* &ers(/kan dan tutu luka • • •

/ang$a" teril anti !engan ar*ng tangan teril
•

S*rgical 3la!e p ia*

•

Bla!e "ol!er  pengait pia*

−

− •

− − −

− − −

)* anka/ terak/(r • •

8*mp*l$an em*a !ipoal $e container C*ci tangan mai" pa$ai glo7e !engan lar*tan antieptic

• •

Ti*e !iector metzenbau  g*nting (aringan Scior


Draft OSCE EMS-NBSS

•

4

Ti*e forcep anatomical )ang ompong  *rgical 3ergigi

A % ant(set( e@u('ents  Po7i!one io!ine '6 P")iologic aline for !il*tion S*rgical ma$ S*rgical cap Sterile *rgical glo7e Sterile !rap $ain *n!el 3olong

• • • • • •

Suort(8e e@u('ent  /amp

•

P$OSEDU$ 1. 2. '.

Men)apa paien Per$enal$an !iri Tan)a i!entita paien: nama# *m*r#ri%a)at me!i#  (eni $elamin +.
•

•

;natomical S*rgical ;rterial clamp

• •

−

)* Metode suture • •

oal anest/et( set • •

Dipoa3le )ringe ?)locaine in(ection

• •

Simple *t*re, interr*pte! Simple r*nning *t*re Mattre *t*re S*3c*tic*lar *t*re

Suture 'ater(al ;3or3a3le *nt*$ $*lit Nona3or3a3le *nt*$ (aringan *3$*tan

,* !e/n(al stes Pa$ai clean "an! go7e  e3el*mn)a lepa$an em*a a$eori )ang !i pa$e !i tangan# c*ci tangan G lang$a" /a$*$an traction pa!a fra$t*r immo3ili0ation  cara: !il*r*$an# !ie*ai$an !engan poii axi Ka$*lta 8e!o$teran >NP;D 2515 Draft OSCE DMS-9IS Perfecten

Draft OSCE EMS-NBSS

•

•

4.

t*lang ecara anatomi# tari$ !engan lem3*t tapi $*at# minta 3ant*an Beri"$an area e$itar l*$a !engan $aa L io!ine  pegang $aa pa$e 7ena clamp# 3eri"$an !ari area perifer $e central ecara meling$ar 15 cm Beri lo$al anatei !engan x)locaine in(ection  la$*$an !i pinggir l*$a# !engan in(e$i intrac*tan *!*t 145 o !i tiap ii l*$a  ce$ apa$a" *!a" 3aal ata* 3el*m pa$ai pinet anatomi Irigai l*$a !engan lar*tan aline  3otol !ite$an  !ialir$an pa!a *!*t + o ter"a!ap l*$a Scr*33ing 3agian l*$a tenga" !engan $aa L po7i!one io!ine "ar* 1 ara"# aga$ !ite$an# 3*ang $aa $e $i!ne) 3ain Irigai $em3ali !engan normal aline lar*tan NaCl  3otol !ite$an  !ialir$an pa!a *!*t + o ter"a!ap l*$a Pa$ai "an! glo7e terile *na$an po7i!one io!ine pa!a !aera" l*$a ecara entrif*gal *na$an $aa teril *nt*$ mengg*na$an po7i!one io!ine !i 3agian l*$a at* ara"# 3*ang $aa $e $i!ne) 3ain Paang terile !rap  *nt*$ memperl*a area terile /a$*$an %o*n! e!ge exciion $*lit  (aringan *3$*tan  potong, 3eri"$an Tangan $anan: pegang g*nting, 3la!e Tangan $iri: pegang pinet c)r*gi /a$*$an proe!*r "emotatic  (ka ada (nd(kas(   *nt*$ meng"enti$an pen!ara"an,3lee!ing # !engan ' cara : 1. Te$an, $ompre area 3lee!ing !engan $aa 2. Pa$ai clamp arteri,7ena: *nt*$ (epit pem3*l*" !ara" '. /igai nee!le "ol!er $eal(n'ent % (''o+(l(Bat(on of t/e frature lihat skill station of fracture immobilization  *na$an $aa lem3a3 aline  pera i!one cara: pa$e pinet L g*nting $em*!ian terap$an $aa $ering !iatan)a# t*t*p pa$ai pleter Do$*mentai re$am me!i paien: a. Tanggal !an %a$t* !ila$*$an tin!a$an 3. Nama,(eni tin!a$an c. =epon paien L "ail tem*an ex: (eni fra$t*r !. Nama !o$ter

Topic F: %oo! plinting proce!*re 3i!ai,pal$ ASSESSMEN! 1* Menilai paien apa$a" a!a in!i$ai !iperl*$an plinting, ga&

PANNIN5 2* Pili" tipe !an *$*ran %oo! plinting IMPEMEN!A!ION ;* Sapa paien <* Per$enal$an !iri !engan rama" !an opan

J

=* Tan)a i!entita paien: nama# ri%a)at me!i !an (eni $elamin

)*
APP6IN5 ,* Pe'er(ksaan >s(k ook % ask %arna $*lit  perf*i aliran !ara" /*$a Deformita ang*lation "ortening Beng$a$

Feel: Palpai e$trimita *nt*$ menilai enori$ f*ngi araf !an n)eri te$an in(*ri (aringan l*na$,fra$t*r %ote: Sakit nueri tekan bengkak & deformitas dengan abnormal movement adalah tanda positif untuk fraktur

C(rulat(on Menilai p*lai !ital !engancara mengece$ capillar) reAll pa!a (ari

.* Fraktur a/a 9t/(/t: Menilai tat* ne*ro7a$*lar /a$*$an tra$i longit*!inal !engan tra$i !i an$le !an tra$i !i pingg*l, "ip /eta$$an $a)* 3i!ai !i poterior !ari pa"a# !ari 3o$ong men*(* $e $a$i Bal*t rolling !engan elatic 3an!age !ari !ital $e pro$imal =e-ae tat* ne*ro7a$*lar

3* Fraktur +et(s 9le: Menilai tat* ne*ro7a$*lar /a$*$an tra$i longit*!inal !engan tra$i !i an$le !an tra$i !i pingg*l,"ip /eta$$an $a)* 3i!ai !i poterior !ari 3eti leg# !ari l*t*t men*(* $e $a$i Bal*t rolling !engan elatic 3an!age !ari !ital $e pro$imal =e-ae tat* ne*ro7a$*lar

10*Fraktur tanan % erelanan tanan 9forear' and 7r(st: Menilai tat* ne*ro7a$*lar /a$*$an tra$i longit*!inal !engan tra$i !i Anger !an tra$i !i arm /eta$$an $a)* 3i!ai !i anterior !ari forearm # !ari i$* men*(* $e Anger Bal*t rolling !engan elatic 3an!age !ari !ital $e pro$imal =e-ae tat* ne*ro7a$*lar

11*Fraktur ar' Menilai tat* ne*ro7a$*lar /a$*$an tra$i longit*!inal !engan tra$i !i "o*l!er !an tra$i !i forearm /eta$$an $a)* 3i!ai !i poterior !ari arm # !ari "o*l!er men*(* $e i$* Bal*t rolling !engan elatic 3an!age !ari !ital $e pro$imal


Draft OSCE EMS-NBSS

15

=e-ae tat* ne*ro7a$*lar 12* Do$*mentai re$am me!i paien: a* Tanggal !an %a$t* plinting inertion +* Tipe  *$*ran plinting * =epon paien ter"a!ap proe!*r d* Nama !o$ter )ang mela$*$an

Topic G: traction immo3ili0ation &&&&&&&&&&&&& 

Topic 4: 3aic *rgical $ill intr*ment  $notting INS!$UMEN! 9kalo a sala/ art (n( 7aktu sk(lls a d( laku(n  lansun knott(n# ta( +uat aa-aa/e/e/e: Pers(aan 1* Ce$ em*a intr*ment 2* Pati$an em*a intr*ment !i terile container !alam $ea!aan teril

KNO!!IN5 9SIMPU: 1* $eef Knot

;* B*$a 3*ng$* terile *rgical 3la!e !an leta$$an !i area teril

<* C*ci tangan !engan antieptic =* 8ering$an !engan "an!*$ )* Pa$ai ar*ng tangan teril Handl(n Instru'ent 9sesua( aa 4an terad( d( sk(lls  OO! dar( 'odul: G. 4.

J. 15. 11. 12. 1'. 1+. 1.

1F. 1G.

(lihat gambar bagian alat$alat topik ' & ) 8enali nama etiap alat !an f*ngin)a Saat a$an 'enunt(n# g*na$an (ari tel*n(*$ tangan $iri e3agai 3ae# e"ingga ti!a$ ter(a!i tremor. 8eti$a mengg*nting (aringan ata* (a"itan# le3i" 3ai$ !ita"an !engan mengg*na$an (ari tel*n(*$ $iri. Pean kle' ater(  ama eperi pegang g*nting
Cara:

1

2

;


Draft OSCE EMS-NBSS

1;

11

1<

2* Sur(al Knot

<

=

)

KNO!!IN5 PAKAI INS!$UMEN! 1* $eef Knot Cara:

,

.

3

1

10

2

11

12


Draft OSCE EMS-NBSS

12

OCA ANAES!HESIA

2

<

SU!U$IN5 Cl(ent asses'ent 1. 2. '. +.

.

F. = )

G.

Sapa paien !an per$enal$an !iri Ce$ re$am me!i: i!entiA$ai paien !an in!i$ai menilai lei,!aera" )ang a$an !ioperai Beri$an pen(elaan proe!*r ecara ing$at !an (a%a3 etiap pertan)aan )ang !ia(*$an paien !engan 3a"aa )ang m*!a" !imengerti Minta paien *nt*$ melepa pa$aiann)a *nt*$ mem3eri$an area operai )ang 3ai$ ata* minta paien *nt*$ mema$ai "opital go%n Minta paien *nt*$ menggoo$ !aera" operai !engan a3*n  air, ter*tama *rgical oap Biar$an paien 3er3aring !i ata me(a# ampaimen!apat poii )ang n)aman.

Plann(n 4.

Ce$ em*a intr*men )ang !i3*t*"$an: 1 )ang teril !an 1 )ang ti!a$ teril J.
I'le'entat(on

, .

2* Sur(al knot

/OC;/ ;N;EST9ESI; ;ND S>T>=IN

1'. C*ci !aera" operai !engan $aa antiepti$ ecara men)el*r*" 1+. T*t*p area !engan terile !rape 1. Beri$an anatei lo$al !an t*ngg* elama 3e3erapa menit *pa)a efe$tif 1F. Mem3*at a)atan !engan mengg*na$an calpel 1G. Mem3*at !ie$i 14. /a$*an "aemotai ligation 3ila !iperl*$an 1J. ;m3il nee!le "ol!er !an pegang !engan 3enar 25. Ma*$an (ar*m $e nee!le "ol!er 21. M*lai pen(a"itan: Interuted suture Tempat$an ecara perla"an !i *!*t $anan tepi l*$a


Draft OSCE EMS-NBSS 22. I$at imp*l !engan "ati-"ati !an impan !i at* ii !ari l*$a 2'. Potong *(*ng (a"itan e$itar 5# cm *nt*$ mem*!a"$an aat mengang$atn)a 2+. Saat melepa$an *t*re# potong !engan tepat pa!a perm*$aan (aringan 2. Practie ma$ing Cont(nuous sutures: place a ingle *t*re an! ligation 3*t onl) c*t t"e "ort en! of t"e *t*re 2F. /an(*t$an (a"itan epan(ang l*$a 3iar$an menegang !engan cara aiten memegang *t*re !engan $etegangan )ang ama 2G. Ta$e care not to Up*re-tringV t"e %o*n! 3) too m*c" tenion 24. 9ati-"ati *pa)a ti!a$ menga"ail$an terlal* 3an)a$ $etegangan !engan mengg*na$an pan(ang *t*re )ang pen!e$ 2J. 8*nci (a"itan pa!a a$"ir anatomoi !engan imp*l mati '5. Practie ma$ing Mattress sutures: 3ai$ 7erti$al ata* "ori0ontal '1. Practie ma$ing Su+ut(ular sutures

1'

;: HO$IGON!A MA!!$ESS SU!U$E

<: CON!INUOUS SU!U$E 9$UNNIN5 SU!U$E:

E8aluat(on '2. E7al*ai apa$a" em*a l*$a *!a" !i(a"it ''. E7al*ai apa$a" mai" a!a per!ara"an '+. T*t*p l*$a !enagn $aa teril,pleter

Doku'entas( a. 3. c. !. e.

Tanggal !an %a$t* operai Diagni !an (eni operai Tipe !an *$*ran *t*re 8e*litan )ang !i"a!ap Nama operator !an tan!a tangan

=: SU&CU!ICUA$ SU!U$E

en(s-en(s 1: SIMPE IN!E$UP!ED SU!U$E

2: E$!ICA MA!!$ESS SU!U$E

HIS TOPIC 1: "itor) ta$ing OK 9EM;TO/OR P=OB/EM IN!$ODUC!ION Ka$*lta 8e!o$teran >NP;D 2515 Draft OSCE DMS-9IS Perfecten

Draft OSCE EMS-NBSS Men)apa paien  per$enal$an !iri  (angan l*pa tan)a i!entita 

1.

• •

HIS!O$6 !AKIN5 1.

2. •

•

•

•

•

'.

Tan)a $el*"an *tama paien  a!a )ang 3ia a)a 3ant*,$el*"ann)a apa& 8ategori$an $el*"an apa$a" terma*$ anemia# 3lee!ing#  malignanc) Tan)a le3i" !etail *nt*$ tiap ge(ala: Se(a$ $apan&# m*nc*l ecara ti3a-ti3a, 3erta"ap& 8el*"an m*nc*l ecara pontan, etela" $e(a!ian tertent*& Ini pertama $ali ter(a!i ata* e3el*mn)a perna" mengalami& Tan)a per*3a"an, progre  gimana per$em3angan a$itn)a !ari a%al ter(a!i ampai e$arang& ;pa )ang mem3*at $el*"an (a!i mem3ai$, mem3*r*$&  $alo $eraa a$it 3iaan)a ngapain 3iar raa a$itn)a 3er$*rang&# a$itn)a (a!i ma$in para" pa!a aat ngapain a(a& Simp*l$an ri%a)at )ang coco$ !engan 3e3erapa pola pen)a$it )ang !i$enali

•

•

•

•

2. • • • •

•

•

• • •

Tan)a $el*"an lain /ema"# p*ing# p*cat aat 3ercermin, pen!apat orang# m*!a" mara"# mala ma$an anorexia# leti"# *lit $onentrai Sea$ nafa aat 3era$ti7ita# (ant*ng 3er!e3ar# ort"opnoe# pergelangan $a$i mem3eng$a$# a$it $epala# ering B;8 Mentr*ai ti!a$ terat*r Tan)a fa$tor pen)e3a3 =i%a)at premat*r $"** ana$-ana$ =i%a)at (a*n!ice 3ere =i%a)at per!ara"an p*rp*ra, 3erca$ mera"# "ematemei, m*nta" !ara"# per!ara"an pa!a pencernaan B;B 3er!ara"&&&# per!ara"an pa!a g*i# per!ara"an pa!a "i!*ng @. ;!an)a infetai "e%an parait# alergi# $on*mi o3at, pro!*$ r*ma" tangga )ang !apat mene$an "ematopoiei ata* men)e3a3$an "emol)i# pica mema$an "al ane"# ma$an tana"# !ll# perna" terpapar ra!iai Sering ter$ena infe$i al*ran pernafaan  infe$i lainn)a# a!a pen)a$it (ant*ng# gatrointetinal# en!o$rin# atai pen)a$it gin(al# n)eri t*lang  3eng$a$ pa!a en!i# pem3earan l)mp" no!e ;*pan ma$anan **# !aging# a)*ran# !ll. Mati raa# *l$*# tomatiti, aria%an =i%a)at oial mengenai etni$# geograA 3ia !iper$ira$an !ari alamat# oioe$onomi 3ia !iper$ira$an !ari pe$er(aan

Perna" 3epergian $e !aera" en!emi$ malaria& =i%a)at $el*arga mengenai anemia# per!ara"an =i%a)at me!i mengenai o3at# tranf*i

Perdarahan (bleeding) 1. •

•

•

2. • •

S6MP!OM Anemia 1.

1+

• •

Tan)a le3i" lan(*t mengenai manifetai per!ara"an: Per!ara"an *perAcial !i $*lit  mem3ran m*$oa ata* per!ara"an )ang mai7e: petec"iae 3erca$ mera" 5# cm# p*rp*ra 3erca$ mera" 5# cm# ecc")moe p*rp*ra# "ematemei m*nta" !ara"# melena B;B "itam# "ematoc"e0ia B;B 3er!ara"# "emart"roi# per!ara"an pa!a g*i# per!ara"an pa!a *3$on(*ngti7al# per!ara"an pa!a tali p*ar *m3ilical cor!#  menometrorr"agia. Serangan per!ara"an onet of 3lee!ing: 3er*lang ga&# cepat&# per!ara"an $roni ata* lama !ari tali p*ar&# etela" ca3*t gigi&# tonillectom)&# $"itan,*nat&# operai. Single,m*ltiple ite& =i%a)at: In(*ri,tra*ma Per!ara"an lama etela" $"itan,*nat# ca3*t gigi ata* tra*ma lainnn)a =i%a)at $el*arga =i%a)at $ee"atan tranf*i  o3at

Malignancy 1. •

• • •

• • •

2. • •

e(ala: Pallor p*cat# m*!a" lela"# !emam# per!ara"an# m*!a" memear# infe$i# nig"t %eat 3er$eringat pa!a malam "ari# pen*r*nan 3erat 3a!an Pem3earan l)mp" no!e ;3!ominal !itenion per*t tegang, $ram N)eri t*lang# art"ralgia# (alann)a ga ta3il, pincang M*nta"# a$it $epala# gangg*an pernafaan ;!a maa, 3en(olan !i 3agian tertent* Pen*r*nan $ea!aran =i%a)at: =i%a)at $el*arga Paparan ter"a!ap o3at# ra!iai#  0at $imia

KESIMPUAN Conto": (a!i !ari "ail o3rolan ta!i i3*, 3p$ $em*ng$inan mengalami anemia, per!ara"an, malignanc)# *nt*$ memati$ann)a perl* !ila$*$an pemeri$aan le3i" lan(*t

Topic 2: C/INIC;/ E?;MIN;TION OK 9EM;TO/OR P=OB/EM PH6SICA E"AMINA!ION Anemia 1* •

Pe'er(ksaan a7al ;pa$a" paien terli"at a$it,e"at&

Draft OSCE EMS-NBSS /e7el $ea!aran Pernafaan ==  *a"a *nt*$ 3ernafa# c)anoi Sir$*lai,Pere!aran !ara" BP# 9=, P= S*"* t*3*" Meng*$*r 3erat 3a!an  tinggi 3a!an  C*ma e3*tin a(a !a'(lan k/usus fa(es oole4 !anda-tanda ane'(a 1. =am3*t: =am3*t $ering# m*!a" ronto$ pa!a $a* ID; 2. Mata 8on(*ngti7a: P*cat,ga& Se!i$it pen!ara"an pa!a $on(*ngti7a men(a!i tan!a igniA$an !ari per!ara"an. Sclera 3er%arna p*ti". Sclera 3er%arna $*ning men(a!i tan!a pertama !ari clinical (a*n!ice '. M*l*t: Harna 3i3ir# p*cat,ga& M*$opa m*l*t: p*cat,ga& /i!a": "al*  mera" tan!a megalo3latic anemia Stomatiti ang*lari# oral patc" tan!a oral can!iloi,can!i!iai +.
• •

2. •

•

2* ;*

• •

•

•

melena# "ematoc"e0ia# "emart"roi a$*m*lai !ara" pa!a en!i# per!ara"an pa!a g*i# per!ara" pa!a *3$on(*ngti7al# per!ara"an !ari tali p*ar# metrorr"agia  mai7e 3lee!ing I!entiA$ai tempat per!ara"an: Single,m*ltiple# g*i# per!ara"an pa!a "i!*ng# en!i# l*$a operai# $"itan.*nat# ata* lo$ai lainn)a Simetri$,aimetri$ Mem3ran m*$oa# "emart"roe# !eformita pa!a en!i

Malignancy 1* • •

•

• •

• • •

•

1

2. •

•

Pe'er(ksaan a7al I!entiA$ai tan!a: Demam# tac")car!ia# m*!a" mara" ;nemia Per!ara"an S$in inAltrate# 3eng$a$ pa!a perior3ital# papile!ema# a!enopat")# tan!a pem3earan me!iatinal !)pnea# 7enectation# le"er 3eng$a$# "epatomegal)# plenomegal)# pem3earan tatic*lar# n)eri t*lang# tan!a infe$i# maa !i a3!ominal  maa lainn)a Heato'eal4 9os(s( t(dur: Normaln)a li7er ti!a$ tera3a ata* !apat tera3a e3agai maa *perAcial 1-2 cm !i3a%a" rig"t cotal margin# !engan 3ata ta(am

•

•

<*

.

•

Proe!*r: a. Tempat$an tangan $iri !i3ela$ang per*t 3agian $anan paien !i3a%a" ri3 11  12 3. Ingat$an paien *nt*$ relax c. Tent*$an arc* cotrat*m: tari$ gari l*r* !ari mi!cla7icila pertenga"an# papillae mammae "ingga $e cota mela)ang !. Tempat$an tangan $anan !i ata per*t $anan paien. /a$*$an pera3aan !an te$an mema$ai ' (ari , Anger tip pa!a lateral rect* a3!omini 3a%a" $e ara" arc* cotrat*m

Perdarahan 1.

I!entiA$ai tipe per!ara"an: p*rp*ra# petec"iae# ecc")moe# "ematoma# epitaxi# "ematemei#


Draft OSCE EMS-NBSS

1F

8e) of tep: Tari$ gari !ari mi! cla7ic*la $e arc* cotali "epar !i*$*r perpotongan t3 $e *m3ili$*  tangan $iri taro !i 3a%a" co 11  12 paien  tangan $anan mempalpai !ari lateral re a3!omini inferior $e ata  $alo *!a" $era3a# *$*r perpoton $e ara" *m3ili$* pa$e meteran  tan)a a$it ga&  g palpai $e ara" x)p(oi! proce*# *$*r $e ara" *m3ili$* 9;SI/: reg*ler# *(*ng ta(am# $en)al# *$*ran @ cm. Mi! cla7ic*la lina

e.

Minta paien *nt*$ tari$ nafa# $em*!ian minta *nt*$ mengel*ar$an nafa# aat it* p*la $ita te$an perla"an  lan(*t$an proe tere3*t ecara 7ertical ampai menem*$an ton(olan

/ateral rect* a3!omini >m3ili$*

'.

f.

g.

$*rann)a Perm*$aann)a $aar ata* ti!a$ N)eri& Batan)a ta(am,t*mp*l& !an reg*lar ti!a$ ;m3il pita *$*r# tempat$an !ari titi$ arc* cotar*m men*(* *m3ili$*# *$*r pan(angn)a. Dari titi$ )ang *!a" !i*$*r# ara"$an $e x)p"oi! proce* >$*r !ari titi$ x)p"oi! $e 3ata "epar !i3a%a"n)a

Sleno'eal4 Normal pleen:

− − − −

".

Splenomegal):

−

−


Draft OSCE EMS-NBSS

1G

3agian $iri 3a%a" cotal margin mele%ati *m3ili$* ampai SI;S Caran)a: 3agi !aera" men(a!i 4 3agian !engan (ari tangan# c"*Qner 1-+ 3rra!a !i ata p*ar# e!ang$an -4 3era!a !i3a%a" tali p*ar S**ri ini*ra pleen le$*$an !i limfa !ari 3a%a" $e ata "ingga 3ata cota 15

f.

g.

8e) of tep: Tari$ gari !ari anterior axillar) $e arc* corali  palpai !ari 3agian inferior axillar) anterior  etela" pleen tera3a# cari inci*ra lienari 3*at matiin $alo 3ener pleen# <;N;N DI/EP;S tan)a a!a n)eri ga&  tent*$an c"*Qnern)a  9;SI/: ga !a ten!erne# c"*Qner @

Prosedur e'er(ksaan sleen a. Tangan $iri !itempat$an !i 3a%a" ri3 $iri paien# !i 3a%a" cota 11-12 3. Tent*$an 3ata cota 15  tari$ gari !ari maxillar) line "ingga 3ata cota 15 c. M*lai ra3a !an te$an mema$ai ' (ari, Anger tip memati$an a!an)a pem3earan pleen

anterior

+.

;xillar)

SI;S *pina iliaca anterior *perior

4'/ node Prosedur

Topic ': 3loo! mear !. e.

Minta paien *nt*$ menari$ nafa# 3*ang lal* $ita te$an perla"an =aa$an a!an)a pem3earan pleen lal* nilai: Perm*$aan: $aar# ti!a$& N)eri& Conto*r Spleen enlargment c"*Qner I-III  gari ima(iner c"*Qner I-III: gari !ari

− − − −


Draft OSCE EMS-NBSS &aso/(l Eos(no/(l Neutro/(l +and Neutro/(l se'ented 4'/o4tes Mono4tes

0-1 1-) ;-= <0,0 ;0<= 2-10

14

5ranule urle +lue Orane 2 lo+us P(nk# lenkun adat &erse'en# >la'en Purle +lue &leu re4# 8auole 

Topic +: !iQerential co*nt A* Set of la+orator4 e@u('ent and reaents for t/e roedures 1. 2. '. +. . F. G. 4.

Microcope Prepare! 3loo! mear, taine! normal 3loo! mear Immerion oil ?)lol Ti*e paper DiQerential 3loo! cell "eet Examiner g*i!e Bloo! cell atla

N. 3an!

N.

egmente!

&* Proedure ;ement 1.

Menilai periapan 3loo! emar

Plann(n 2. '.

Ce$ intr*ment !an alat-alat )ang a$an !ig*na$an C*ci tangan !engan mengg*na$an a3*n antiepti$# g*na$an glo7e

I'le'entat(on <*

I!entiA$ai paien : nama# me!ical recor!# *m*r !an (eni $elamin

Proedure =*

/eta$an li!e !i mi$rocope tage !an (epit !engan clip )* *na$an per3earan )ang ren!a"  15? lena o3(ectif *nt*$ menent*$an 3ata mear ,* Tent*$an area )ang ti!a$ terent*", n*mp*$ .* Tete$an min)a$ imeri 1 tete !i tenga" li!e 3* Tempat$an per3earan 155x !i poii li!e 10* *na$an ma$rometer !an mi$rometer ampai el !apat terli"at !engan (ela 11* Nai$an $on!enor 3*$a !iafragma *nt*$ ca"a)a ma$im*m 12* ;mati HBC Ser(es  Ka$*lta 8e!o$teran >NP;D 2515

Eoinop"il Baop"il

C/arater(st( Draft OSCE DMS-9IS

Perfecten

Draft OSCE EMS-NBSS

1J

>ia nemplo)e! peron

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.

Monoc)te /)mp"oc*)e 1;* 9it*ng el $e 1  155# !i etiap $ota$# (*mla" 15 el

C* H(stor4 of resent (llness )*

C/(ef o'la(nt a. 8el*"an *tama& 3. Se(a$ $apan& c. Ter(a!in)a "ilang tim3*l, ter* menr*& !.
1<*
− − − − −

Clean(n and safet4

−

1,* a. /eta$an 3loo! mear li!e $e tempat em*la +* /epa$an ar*ng tangan * C*ci tangan !engan a3*n antieptic

− −

!est result &aso/(l  @@@@..  Eos(no/(l  @@@@@@..  Neutro/(l +ands @@@@@  Neutro/(l se'ented @@ 4'/o4te  @@@@@@..  Mono4tes  ..

D* 5eneral /(stor4 of resent (llnes related to /(ef o'la(nt a.

;c*te illne )n!rome: >m*m : Demam# menggigil# leti"# p*ing# pingan 8*lit : >rti$aria 3entol# $emera"an# gatal Ha(a" : men)eringai# menggoo$ "i!*ng a$i3at gatal allergic al*te Mata : gatal# 3erair# mata mera"# pan!angan $a3*r# ila* ter"a!ap ca"a)a# $otoran mata 9i!*ng : "i!*ng ter*m3at# 3erin# "i!*ng meler 3erair# gatal M*l*t : 3ernafa le%at m*l*t# a!a l*$a, lecet !i m*l*t Tenggoro$an: 3at*$# gatal# *ara era$# eperti terce$i$

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−

Topic : "itor) ta$ing in allergic an! imm*nologic !ieae A* Cl(ent asses'ent 1. 2. '.

Sapa paien !engan rama" # per$enal$an !iri Beri$an pen(elaan tentang "itor) ta$ing  minta i0in
&* Ident(f4(n data +.

Tan)a$an !engan opan: i!entita paien Nama

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−

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−


Draft OSCE EMS-NBSS Da!a : nafa pen!e$# ea$ nafa# nafa cepat# ngoro$, !eng$*r# nafa 3*n)i# a$it, n)eri !a!a Per*t : $ram per*t# m*al# m*nta" #!iare enital: eroi, l*$a C"ronic illne )n!rome /ema# naf* ma$an 3er$*rang# 3erat 3a!ana t*r*n# le* Pert*m3*"an !an per$em3angan : 3an!ing$an !engan ana$ e*ia

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− −

3.

−

− −

25

lainn)a Ti!a$ ta"*

F* $(7a4at Keluara 1+. ;!a$a" anggota $el*arga a)a"# i3*# a*!ara $an!*ng p*n)a alergi, ge(ala )ang ama& Mialn)a: at"ma# "i!*ng 3erair, meler# gatalgatal# alergi ma$anan

−

E* Past /(stor4 related to C/(ef o'la(nt# ese(all4 aller( ato( /(stor4 G. 4.

Se(a*" )ang paien ta"*# paien p*n)a alergi ga e3el*mn)a&
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Topic F: p")ical examination in allergic an! imm*nologic !ieae A* CIEN! ASSESSMEN! 1* Per"ati$an ta'(lan kl(n(s a7al as(en ;pa$a" paien terli"at a$it& Ber!aar$an tampilan:

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er3al contact ::paien mai" 3ia 3er3icara !engan 3ai$ ata* ti!a$&
−

Ha(a"

−

men)eringai# menggoo$-goo$ "i!*ng allerg) al*te, r"initi

−

J.

Mata

− −

−

−

15.

− − −

11.

−

− − −

− −

−

−

−

−

12.

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− −

−

: e!ema pa!a $elopa$ mata# mata

mera" 3erair con(*ncti7a allerg) 9i!*ng : "i!*ng meler# 3erin# niWng mengen!* Bi3ir : e!ema pa!a 3i3ir S*ara : enga*#era$ Tenggoro$an

: 3at*$# tri!or*ara ngoro$#

ea$ nafa Informed consent:  jadi bu karena pada anak ibu ditemukan kelainan kulit dan pernafasan maka saya akan melakukan pemeriksaan *sik silahkan pakaian anak ibu dibuka kemudian berbaring di meja pemeriksaan.

&* PH6SICA E"AMINA!ION 1* 5eneral aearane a* Poii : normal +* 8ea!aran: compomenti * D)pnea : L a!a $er(a otot tam3a"an eperti c*ping "i!*ng

d* C)anoi : e* E!ema : L f* Mai" 3ia 3icara !engan (ela %ala*p*n !engan *ara era$ ata* enga*

* Bagaimana $ea!aan paien& Tent*$an !era(at $epara"an pen)a$it paien 3er!aar$an : =e7ie% i%a)at !an preentai tampilan $lini a%al

−

1'.

: 3eng$a$ allerg) ma$anan#

−

Ti!a$ a$it Mil! : ti!a$ menggangg* a$ti7ita.

−


Draft OSCE EMS-NBSS

21

Mo!erate : menggangg* a$ti7ita# tapi ti!a$ mengancam (i%a.

−

Se7ere

: menggangg* a$ti7ita !an

mengancam (i%a# !itan!ai !engan a!an)a: Sea$ nafa E!ema )ang men)el*r*" De"i!rai Pen*r*nan $ea!aran 8e(ang

Open-mo*t"e! face

2* In(t(al 'easure'ent a* =epirai: T)pe : a3!ominot"oracal ana$-ana$# t"oracoa3!ominal

!e%aa

Kre*enc) rate,min*te: reg*lar, irreg*lar

+* * d*

ce$ !engan cara menempat$an tangan !i antara t"orac !an a3!omen Te$anan !ara" Den)*t na!i: fre$*eni rate,min*te# 7ol*me !an e*alit) reg*lar, irreg*lar S*"* menempat$an t"ermometer pa!a $etia$n)a

;* Kul(t Berca$-3arca$, $emera"an E!ema ten!er non pitting

<* Keala

Dennie-Morgan infra-or3ital fol!  a!a lipatan !i infraor3ital ;llergic "iner

)* Mata Secret

: ero*#m*coi!#m*cop*r*lent

Per"ati$an !itri3*i  te$t*r ram3*t# ata* $eronto$an

=* ?aa/ E!ema ten!er non pitting

Palpe3rae: e!ema# 3lep"aropam

Men)eringai

Con(*ncti7ae 3*l3i: %ater)# ")peremia# e!ema# 3loo! 7eel in(ection

Menggoo$-goo$ "i!*ng allergic al*te Ka$*lta 8e!o$teran >NP;D 2515 Draft OSCE DMS-9IS Perfecten

Draft OSCE EMS-NBSS

22

;*$*ltai cara: tempat$an 3agian !iafragma teto$op: *ara par*# 7eic*lar 3reat"ing o*n! normal# rale %"ee0ing# tri!or

12*antun S*ara (ant*ng cara: tempat$an 3agian 3el teto$op !i IC # e(a(ar mi!cla7ic*la# tepat !i3a%a" p*tting: reg*lar, irreg*lar 1;*

A+do'en Epigatric retraction

1<*

Con(*ngti7a taral on e7ertion: e!ema#")peremia#7ii3le 3loo! 7eel#pinpoint papil

,* H(dun − −

SniWng Pigmente! tran7ere naal creae

Anoen(tal

E!ema# ")peremia# eroion# excoriation 1=* EJtre'(tas: Dingin# lem3a3 Sen!i: normal pai7e mo7ement Ce$ capillar) reAll: Cara: tangan !iang$at e(a(ar (ant*ng # $ea!aan pronai  te$an *(*ng (ari ampai p*cat  lepa$an Normal: $em3ali pin$ *p $*rang !ari 2 !eti$  2 !eti$  oor erfus(on − − −

Topic G: pe in7etigation ent N O

P$OSEDU$ Prearat(on C*ci tangan !engan a3*n antiepti$ !an $ering$an !engan ti* *na$an ma$er

− −

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−

Naal enlargement Klaring or nlae nai 3ra!ening of naal 3ri!ge  pernafaan c*ping "i!*ng# Secret : %ater)# ero*# m*coi!# m*cop*r*lent M*co* : pale-3l*i"

.* Mulut Bi3ir: e!ema# ten!er

*na$an "ea! lamp *na$an "an! glo7e

Cl(ent assess'ent Penilaian a%al: $ea!aran !an !era(at $epara"an paien Ppenilaian Ai$
Pe'er(ksaan 7aa/ Inpe$i# palpai# !an per$*i pa!a in* frontal !an maxilla

Pe'er(ksaan tel(na Dental maloccl*tion 9ig" arc"e! palate /i!a" : geograp"ic tong*e# e!ema

e/er

3*

− −

10*

S*praternal retaraction S*pracla7ic*lar retraction

!/oraJ Inpe$i : 3ent*$ !an pergera$ann)a imetri$, aimetri$&# 3arrel c"et intercotal retraction

M*lai !engan inpe$i e$ternal telinga mengg*na$an !irect lig"t Tari$ pinna $e3ela$ang !an $e!epan *nt*$ meli"at ear!r*m !an tel*n(*$ )ang lain *nt*$ mena"an trag*. *na$an "ea! l*mp *n menginpe$i eternal a*!itor) canal !an ear!r*m /a$*$an proe!*r )ang ama pa!a ii lainn)a

Pe'er(ksaan denan Otosoe pegang otocope eperti memegang p*lpen !an 3iar$an $eling$i !i pipi paien *nt*$ A$ai. Tangan at*n)a menari$ pinna $e 3ela$ang !an $e!epan li"at $onii external a*!itor) canal li"at $on!ii ear!r*m !an peri$a poin of lig"t n)a

11*Paru-aru Ka$*lta 8e!o$teran >NP;D 2515 Draft OSCE DMS-9IS Perfecten

Draft OSCE EMS-NBSS

2'

Sem*a orang )ang terli3at !alam penanganan (ena0a" "ar* mem$ai ;PD ;lat Prote$i Diri# !im*lai $(nne test !ari go%n# ma$er# goggle# $em*!ian epat* 3oot. 2. *na$an !o*3le "an! glo7e (ela$an proe!*r )ang a$an !ila$*$an '. C*ci tangan !engan a3*n antiepti$ e3el*m pegang garp*tala !engan at* tangan. etar$an !an !engar ole" mengg*na$an glo7e. pemeri$a !an leta$$an !i t*lang matoi! paien ampai paien la$*$an proe!*r )ang ama pa!a ii lainn)a

ti!a$ men!engar lagi *aran)a pin!"$an $e external ear

1.

Prosedur

1. tan)a paien apa$an mai" men!engar *ara ata* ti!a$ 2.

/a$*$an proe!*r !engan cepat# (angan 3*ang %a$t* Management (ena0a" !i 3angal =S: Informai$an $e r*ang penanganan (ena0a" la$*$an proe!*r )ang ama pa!a ii lainn)a B*$a em*a peralatan me!i inf*ion et# cat"eter# naogatric t*3e# !ll# ma*$$an $e ?e+er test $ant*ng plati$ )ang mengan!*ng !iinfe$tan !an (ela$an proe!*r )ang a$an !ila$*$an perla$*$an e3agai ampa" me!i. pegang garp*tala !engan at* tangan. etar$an !an !engar ole" T*t*p em*a l*$a !engan %aterproof plater pemeri$a !an tempat$an i tenga" !a"i paien plater ta"an air. tan)a telinga mana )ang !ominan ata* ama a(a& Ma*$an (ena0a" $e $ant*ng plati$ tranparan !an $irim $e r*ang penanganan (ena0a" !engan Pe'er(ksaan /(dun mengg*na$an 3rang$ar Anter(or r/(noso4 Sprei# ar*ng 3antal !an elim*t !iren!am !alam pegang naal pe$*l*m !negan at* tangan# i3* (ari !i (oint (ari cairan o!i*m ")poc"lorite elama '5 menit tel*n(*$ !i "i!*ng paien !an (ari )ang lainn)a memegang e3el*m !ic*ci. pe$*l*m. Ma*$$an e(a(ar !engan "i!*ng la$* p*tar !an 3*$a $e Diinfe$i 3lang$ar !an peralatan lain )ang $onta$ ata.
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•

•

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Topic 4: infectio* corpe management

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−

Prearat(on Ka$*lta 8e!o$teran >NP;D 2515 Draft OSCE DMS-9IS Perfecten

Draft OSCE EMS-NBSS Non-M*lim : g*na$an pa$aian $em*!ian ma*$$an $e $ant*ng plati$ tranparan. Bia (*ga !ima*$$an $e !alam peti. B*$a alat pelin!*ng !iri !im*lai !ari go%n 3eramaan !engan glo7e lal* c*ci tangan. B*$a

goggle !an ma$er !ari 3ela$ang $em*!ian c*ci tangan lagi.

−

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2+

•

Diinfe$i r*angan !engan o!i*m ")poc"lorite.


Draft Osce Dms His

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