Kata Pengantar
Assalamualaikum Assalamualaikum Wr. Wb. Wb.
Alhamdulillahhirabbil Alhamdulillahhirabbilalamin, alamin, segala puji dan syukur kehardirat Allah SWT karna atas segala nikmat dan karuniaNya kegiatan program pengenalan klinik ini dapat berlangsung hingga selesai. Dan tak lupa shalawat serta salam kita limpahkan kepada kepada junjung junjungan an kita Nabi Nabi
Agung Agung Nabi Muhamm Muhammad ad S.A.W yang sangat sangat kita
nantikan syafaatnya diyaumul kiyamah nanti. Syuk Syukur ur Alham lhamdu duli lill llah ah,, apo apora ran n penu penuga gasa san n
dala dalam m
!egi !egiat atan an
"rog "rogra ram m
"engenalan !linik #lok Masalah pada Dewasa $ semester % &akultas !edokteran 'ni(ersitas )slam )ndonesia *+$ yang dilaksanakan di "uskesmas Depok $ pada tanggal - April *+$ telah terselesaikan. Sehubungan dengan telah terlaksanakannya kegiatan "rogram "engenalan !linik !linik penulis penulis banyak banyak mempelaj mempelajari ari mengenai mengenai penyakit penyakit khususny khususnya a yang berkaita berkaitan n dengan dengan penyakit penyakitgang gangguan guan pada mata, penyakit penyakitgang gangguan guan pada telinga, telinga, hidung, hidung, teng tenggo goro roka kan/ n/T0 T0T1 T1,, peny penyak akit itg gan angg ggua uan n pada pada kuli kulit, t, ramb rambut ut dan dan muko mukosa sa,, dan dan penyakitgangguan terkait kesehatan kerja, 2ara berkomunikasi yang baik dengan pasien, etiologi, faktor resiko, diagnosis, manifestasi, dan tatalaksana dari penyakit pada pada kasus kasus.. Semog Semoga a denga dengan n tersel terselesa esaika ikanny nnya a lapora laporan n ini ini dapat dapat member memberika ikan n manfaat baik bagi penulis maupun bagi pemba2a. Amin. Terima kasih. Wassalammualaikum Wr. Wb
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DAFTAR ISI
KATA KATA PENGANTAR....... PENGANTAR.............................. .............................................. .............................................. .............................................. ....................................1 .............1 DAFTAR DAFTAR ISI............................................. ISI.................................................................... .............................................. .............................................. ...................................2 ............2 BAB I. DESKRIPSI KASUS • • • • • • • •
I. IDENTITAS...... IDENTITAS............................. .............................................. .............................................. .............................................. .....................................3 ..............3 II. ANAMNESIS........................ ANAMNESIS............................................... .............................................. .............................................. ......................................3 ...............3 III. PEMERIKSAAN.......... PEMERIKSAAN................................. .............................................. .............................................. .............................................5 ......................5 IV. PEMERIKSAAN PENUNJANG/USULAN PEMERIKSAAN PENUNJANG.....6 V. RINGKASAN DAN DAFTAR MASALAH............................................................6 VI. DIAGNOSIS.................................. DIAGNOSIS......................................................... .............................................. .............................................. ............................7 .....7 VII. PENAT PENATALAKSANAAN................... ALAKSANAAN.......................................... .............................................. .............................................. .......................7 7 VIII. PROGNOSIS................................. PROGNOSIS........................................................ .............................................. .............................................. ..........................7 ...7
BAB II. PENDAHULUAN............................ PENDAHULUAN................................................... .............................................. .............................................. ..............................8 .......8 BAB III. PEMBAHASAN ANAMNESIS • •
Pa!"#$#%&%..................................................................... Pa!"#$#%&%.............................................. .............................................. .............................................. .........................' ..' "a()a*a$ +,&$&%............................................. +,&$&%.................................................................... .............................................. ........................................1.................1-
PEMERIKSAAN • • •
%a% "#$#*a,&%aa............................ "#$#*a,&%aa................................................... .............................................. .............................................. ...............................13 ........13 P#(#*&+%aa$ %#$%a)&,&a%............................. %#$%a)&,&a%.................................................... .............................................. ..........................................15 ...................15 P#(#*&+%aa$ $"%& (!!*&+......................................... (!!*&+................................................................ .............................................. .........................16 ..16
PEMERIKSAAN PENUNGJANG • • • •
P#(#*&+%aa$ )a+#*&!%+!0&+............... )a+#*&!%+!0&+...................................... .............................................. .............................................. ............................18 .....18 P#(#*&+%aa$ &%!0a!,!"&+.................................... &%!0a!,!"&+............................................................ ............................................... ..............................1' .......1' P#(#*&+%aa$ %#*!,!"&%............................................. %#*!,!"&%.................................................................... .............................................. ..............................2.......2P#(#*&+%aa$ ,#0*!(&$......................................... ,#0*!(&$................................................................ .............................................. ..................................2...........2-
DIAGNOSIS • •
D&a"$!%&% +#*a................................................. +#*a........................................................................ .............................................. .....................................21 ..............21 D&a"$!%&% )a$&$"..................................... )a$&$"............................................................ .............................................. ............................................2 .....................22 2
PENAT PENATALAKSANAAN................ ALAKSANAAN....................................... .............................................. .............................................. ...........................................24 ....................24 PROGNOSIS................................. PROGNOSIS........................................................ .............................................. .............................................. .............................................2 ......................25 5 BAB IV. IV. PENUTUP. PENUTUP............................................... ..................................................................... .............................................. ..........................................26 ...................26 DAFTAR DAFTAR PUSTAKA................. PUSTAKA........................................ .............................................. .............................................. .............................................. ........................27 .27
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LAMPIRAN............................................................................................................................28 BAB I DESKRIPSI KASUS
I.
II.
IDENTITAS Na(a U(* J#$&% K#,a(&$ Sa% P#*+a&$a$ A"a(a
T$. H 25 ,a+&,a+& M#$&+a I%,a(
S+ Ba$"%a a*"a N#"a*a P#$&&+a$ P#+#*aa$ A,a(a
Ma*a I$!$#%&a SMA SASTA G*!"!,9 Ma"!a*!
ANAMNESIS K#,a$ a(a • Ka++a+ 0aa a*& a$"a$ &%#*a& )#$"+a+ %#a+ 1 (&$"" :a$" ,a, R&a:a 0#*a,a$a$ 0#$:a+& • Baa, 0aa $"+a& a$"a$ )aa a$ $"+a& +a+& )aa %#a+ 2 a$ :a$" ,a,9 +#(&a$ (#$"a,a(& ,+a a*& %$a$ *!+!+ & ,#$"a$ )aa +a$a$ :a$" &a+ & %aa*& +a*#$a &a+ )#*a%a a$ 0#$:#()a$ ,a(a %#*a (#$&$""a,+a$ )#+a%. K#,a$ "a &%#*a& #$"a$ ($;,$:a ,#%& a$a%#%&
)#*0a
(a+,a
a$
0a;
:a$"
&0!0&"(#$a%&
a$
&0#*0&"(#$a%& #$"a$ +*a$ :a$" )#*
#a0& ,#%& &a+ %#() aa (#()a&+ )a+a$ (#$a& ,#)& ,a%.+#aaa$ ,#%& &0#*)#*a +#&+a +!$&%& ;a;a 0a$a% a$ %aa )aa$ )#*+#*&$"a9 ,#%& a(0a+ #*,&a (#(#*a a$ %#(a+&$ #,a%. Ja*&a*& a$"a$ 0a%&#$ )a"&a$ +&*& %aa &$& (#$"a,a(& 0#*)aa$ :a& (#$a& )#$"+!+ a$ &a+ )&%a &,*%+a$ ,a"&9 $+ a*&a*& )a"&a$ +a$a$ a$:a a*& +#,&$"+&$"9 a*& (a$&%9 a$ a*& #$"a :a$" %a (#$"a,a(& +#+a+a$ a$ %#&+& )#$"+!+ %#a+ 2 (&$"" :a$" ,a,. K#($;,a$ ,#%& %#,a$$:a & )#,a+a$" $"+a& #$"a$ +*a$ %#+&a* 2 ;( %#a+ )#)#*a0a a*& :a$" ,a,9 0a%&#$ &a+ (#$#a %#;a*a 0a%& +a0a$ ,#%& & ($;, a$ 0a%&#$ "a &a+ (#$:aa*& +#($;,a$ ,#%& #*%#). Pa%&#$ (#$*+a$ aa )#)#*a0a ,#%& :a$" ($;, a$ +#&+a
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,#%& & &,a$" (a+a +#($"+&$a$ ,#%& a+a$ ($;, & ,a&$ #(0a a$0a •
0a%&#$ (#*a%a %a+& aa a0a0$ &. R&a:a "a$""a$/0#$:a+& %#)#,($:a B#)#*a0a +a,& (#$"a,a(& ,+a a+&)a %$a$ *!+!+ a$ "$&$" *a(). L+a :a$" #*a& &a+ &%aa*& +a*#$a 0a%&#$ &a+ (#*a%a+a$
•
•
%a+&9 a$ +*a$$:a +*a$" a*& 1 ;(. R&a:a "a$""a$/0#$:a+& 0aa +#,a*"a T&a+ aa "a$""a$ %#*0a 0aa +#,a*"a R&a:a +!$&%& ,&$"+$"a$ %!%&a, U$+ +!$&%& ,&$"+$a$ %!%&a,9 #*+a& )$"a$ 0a%&#$ #$a$ !*a$" %#+&a* #*a,&$ ;+0 )a&+9 a, &$& &&$a a*& +#aaa$ & ,&$"+$"a$ %#+&a* :a$" )#*a%a, a*& 1 a#*a9 :a& Ma*a (a+a (#()a
)$"a$$:a #*a,&$ #$"a$ )a&+. K!$&%& *(a +*a$" (#(aa&9 +a*#$a *(a a$:a )#*+*a$ %#+&a* 5( ? 4( a$ &)a"& 3 *a$"a$ :a& 1 +a(a* &*9 1 +a(a* (a$& a$ 1 a0*9 a,a% *(a #*)a a*& %#(#$ (plester) 9 #()!+$:a (a%& a(0a+ )aa. U$+ a0* a$ +!$&%& +a(a* (a$& +*a$" )#*%& a$ (a%& #*+#%a$ +!!*9 a&* &a0a+a$ a*& %(*
•
:a$" &a,&*+a$ (#$""$a+a$ 0!(0a a&* (sanyo). R&a:a ,&$"+$"a$ +#*a Ka(& %#,a+ 0#(#*&+%a (#(a$" &a+ ,a$%$" )#*+$$" +# ,!+a%& +#*a 0a%&#$9 #a0& )#*a%a*+a$ 0#$*a$ 0a%&#$9 0a%&#$ )#+#*a %#)a"a& tukang cukur :a$" )#*,!+a%& & a#*a Ma"!a*!9 a$ ,!+a%&$:a ;+0 (#(aa& &+a &"$a+a$ $+ )#+#*a9 &%a$a ,aa$
•
%#a a$ )#,&a "a %a ;+0 ,a(a )#+#*a %#)a"a& tukang cukur. K#)&a%aa$ %#a*&a*& K*a$" )#*%&9 &,&a a*& +!$&%& *(a a$ +!$&%& ,&$"+$"a$ %#+&a* :a$" +*a$" a,a( (#$a"a +#)#*%&a$ ,&$"+$"a$. I%*& 0a%&#$ (#$*+a$ $+ 0#()a$"a$ %a(0a &,a++a$ %#&a0 %!*# & a,a(a$ %#)#,a *(a9 $+ (a$& %a +#,a*"a &$& (a$& 2 +a,& %#a*& (#%+&0$ +aa$" 0a%&#$ (a$&$:a & (a,a( a*& +a*#$a 0,a$" +#*a$:a (a,a( %#+&a* a( '.
III.
PEMERIKSAAN Sa% G#$#*a,&%aa • K#aaa$ (( K#%aa*a$ G&@& BB
+!(0!%(#$&%9 a$0a+ %#a 0a%&#$ a,a( +!$&%& %aa* 55 +"
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TB IMT
Ta$a <&a, Na& R#%0&*a%& TD K#aaa$ %0#%&&+ K#0a,a
165 ;( BB / =TB =(>>2 55 / =1965> 2 55 / 297225 2-92 = N!*(a, > 7- +a,& / (#$& 21 +a,& / (#$& 11- / 7- ((H" +#aa$ +#0a,a 0a%&#$ )a&+9 +!$&%& (aa a,a(
)aa% $!*(a, &a+ aa a$aa$a a$#(&% aa0$ &0#*#(&% 0aa +!$$"&
#$"a$ &0!0&"(#$a%&. L##* +#aaa$ ,##* a(0a+ aa$:a ,&(a#$!0a& a$ 0#()#%a*a$ 0#(), a*a 0aa %#"&&"a %#*<&;a,&%.
Ta(0a+ aa$:a )#+a% )&!0%& & ,##* )#,a+a$" 0a%&#$. T!*a? +#aaa$ !*a+ a,a( )aa% $!*(a,9 &a+ a$0a+ aa$:a +#,a&$a$ 0aa !*a+9 +!$&%& 0a* %&(#*&% a$ 0a%&#$ "a (#$*+a$ &a+ 0#*$a (#$"a,a(& %#%a+ $aa%. Na($ 0aa 0$""$" a(0a+ aa$:a )#)#*a0a ,#%& )#*0a (a+,a a$ 0a; &%#*a& &0!0&"(#$a%& a$ &0#*0&"(#$a%&
#$a$ +*a$ :a$" )#*
#$"a$ &0#*0&"(#$a%& a$0a #*&#(a. G#$&a,&a +a(& &a+ (#,a++a$
0#(#*&+%aa$
"#$#*a,&%aa +a*#$a +##*)aa%a$ 0aa 0#(#*&+%a a$ "a 0aa
0a%&#$. E+%*#(&a%
0aa #+%*#(&a% aa% :a& ,#$"a$ )aa
)a"&a$ +a$a$ #*a0a ,#%& )#*0a +*%a )#*a*$a ;!+,a +#&a(a$ #$"a$ +*a$ %#+&a* 3 ;( a$0a &%#*a& #*&#(a a$ &a+ )#*$a$a. Paa #+*#(&a% )aa :a& $"+a& )#,a+a$" )a"&a$ +a$a$ #*a0a ,#%& )#*0a +*%a #$"a$ +*a$ 23 ;( )#*a*$a ;!+,a +#&a(a$ a$0a &%#*a& #*&#(a a$ $a$a. IV.
PEMERIKSAAN PENUNJANG/USULAN PEMERIKSAAN PENUNJANG
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Ka(& &a+ (#,a++a$ 0#(#*&+%aa$ 0#$$a$" a0a0$ $+ 0a%&#$ a$ )#*a%a*+a$ +##*a$"a$ 0aa !+#* 0%+#%(a%9 0a%&#$ #,a &*+ $+ (#,a++a$ 0#(#*&+%aa$ ,#$"+a0 a$ )&!0%& & ,a)!*a!*&( &%!0a!,!"& & RS V.
Sa*&!. RINGKASAN DAN DAFTAR MASALAH B#*a%a*+a$ )#)#*a0a a%&, 0#(#*&+%aa$ #*(a%+ a%&, 0#(#*&+%aa$ ,a)!*a!*&( a$ )#*a%a*+a$ 0#$#,a%a$ !+#* +a(& (#$a0a+a$ &a"$!%&% 0a%&#$ :a& L#0*a aa K%a aa M!*)% Ha$%#$ :a$" (#*0a+a$ 0#$:a+& +,&. Daa* (a%a,a :a$" +a(& #(+a$ a*& +a%% &$& 1. Ba"a&(a$ +!$&%& a%a, 0a%&#$ a0a+a 0#$:a+& &$& )#*a%a, a*& ,!+a%& :a$ (#(a$" #$#(&+ L#0*a aa (#(a$" a*& &*& a0%&#$ :a$" +*a$" (#$a"a &*& 2. Ba"a&(a$ #$"a$ &%*& a$ a$a+$:a &+a 0a%&#$ #a0 a,a( +!$&%& %a *(a a$ &a+ (#$0 +#(&$+&$a$ a+a$ #a0 (#,a++a$ )$"a$ %a(& &%*&9 a0a+a &%*& a+a$ #*,a* aa )a"a&(a$a 3. Ba"a&(a$a +#aaa$ !*a$" a 0a%&#$ :a$" %#)#$a*$:a A0a+a aa %a,a %a +#,a*"a :a$" 0#*$a #*+#$a 0#$:a+& L#0*a &$&
VI.
DIAGNOSIS Pa%&#$ #*&a"$!%&% #$"a$ &a"$!%&% +#*a :a& M!*)% Ha$%#$ )#*a%a*+a$ a%&, 0#(#*&+%aa$ 0#$$a$" :a$" (#*0a+a$ 0#(#*&+%aa$ Gold Standart.
VII.
PENATALAKSANAAN Pa%&#$ #,a &)#*&+a$ !)a :a& MDT C!()& N!
VIII.
PROGNOSIS B#*a%a*+a$ a%&, &%+%& #$"a$ !+#* 0%+#%(a%9 0*!"$!%&% 0a%&#$ aa,a )&a a (a,a(9 :a& ;#$#*$" (#()*+ +a*#$a 0#$:a+& +%a &$& (#*0a+a$ 0#$:a+& +,& :a$" ;+0 %,& a,a( 0#$:#()a$$:a (#%+&0$ #,a &,a++a$ 0#$"!)aa$9 a0a,a"& &0# +%a :a$" (,&)a%&,#*.
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BAB II PENDAHULUAN
Laa* B#,a+a$" I$!$#%&a aa,a $#"a*a $!(#* 3 a*& )a$:a+$:a +a%% 0#$#*&a L#0*a aa 0#$:a+& M!*)% Ha$%#$ &$&9 %a aa )a$:a+ ;a*a :a$ &,a++a$ $+ (#(&$&(a,+a$ +a%% &$& #a0& (a%& )a$:a+ "a !*a$" :a$" )#,( (a(0 (#$a"a &*& %#$&*& %0a:a #*&$a* a*& %a,a %a 0#$:a+& +,& :a$" (#(a&+a$ &$&. M!*)% a$%#$ =L#0*a aa K%a> (#*0a+a$ 0#$:a+& &$#+%& :a$" +*!$&+9 a$ 0#$:#)a)$:a &a,a mycobacterium leprae :a$" )#*%&a &$*a%#,,#* !),&"a. M. L#0*a# )#*)#$+ +(a$ #$"a$ +*a$ 38 ( ? -95 (9 aa$ a%a( a$ a,+!!, %#*a 0!%&& "*a(. Sa*a 0#*&#* %#)a"a& a&$&a% 0#*a(a9 ,a, +,& a$ (+!%a *a+% *#%0&*a!*&% )a"&a$ aa%9 +#(&a$ a0a +# !*"a$ ,a&$ +#;a,& %%$a$ %a*a 0%a. Ca*a 0#$,a*a$ )#,( &+#a& 0a%& a$:a )#*a%a*+a$ a$""a0a$ +,a%&+ :a& (#,a,& +!$a+ ,a$"%$" a$a* +,& :a$" ,a(a a$ #*a. A$""a0a$ +#a &a,a %#;a*a &$a,a%&9 %#)a) M. Leprae (a%& a0a &0 )#)#*a0a a*& a,a( *!0,#. Ma%a $a%$:a )#*
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BAB III PEMBAHASAN I.
ANAMNESIS Patogenesis Ma%+$:a M.L#0*a#
+#
a,a(
)
a+a$
&a$"+a0
!,#
APC
=A$&"#$P*#%#$&$" C#,,> a$ (#,a,& a %&"$a, :a& %&"$a, 0#*a(a a$ %&"$a, +#a. S&"$a, 0#*a(a aa,a #*"a$$" 0aa TCR #*+a& a$&"#$ =TCR T ;#,, *#;#0!* > :a$" &0*#%#$a%&+a$ !,# (!,#+, MHC 0aa 0#*(+aa$ APC %#a$"+a$ %&"$a, +#a aa,a 0*!+%& %&!+&$ a$ #+%0*#%&$:a 0aa 0#*(+aa$ a*& (!,#+, +!%&(,a!* APC :a$" )#*&$#*a+%& #$"a$ ,&"a$ %#, T (#,a,& CD28. Aa$:a +#a %&"$a, &$& a+a$(#$"a+&a$ 0*!,&#*a%& %#, B. S#,a&$ &9 IL 2 "a a+a$ (#$"a+&+a$ CTL ,a, CD8.D& a,a(a"!%&9 #$!,a ",&+!,&0& I a+a$ (#,&$$"& )a+#*& a*& 0#$"a$;*a$ !+%&a& !,#a$&!$ %0#*!+%&a a$ *a&+a, &*!+%&, :a$" a0a (#$"a$;*+a$ %#;a*a +&(&a&.Ka*#$a "a"a, (#()$ a$&"#$ (a+a %&!+&$ a$ "*! a;!*% a+a$ #*% &a%&,+a$a$ a+a$ (#*%a+ a*&$"a$ a+&)a$:a (a+*!a" a+a$ #*% &a+&+a$ a$ ,a(a +#,a(aa$%&!0,a%(a a$ !*"a$#,,a a*& (a+*!a" a+a$ (#()#%a*9 %#+a*a$" (a+*!a" %a&%#) #$"a$ %#, #0&#,!& a$ 0#$:aa$ %#, #0&#,&!& &$& a+a$ (#()#$+ "*a$,!(a.
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T2 a+a$ (#$"a%&,+a$ IL 49 IL 1-9 IL 59 IL 139 a$ IL 5 :a$" a+a$ (#$"a+&a%& #!%&$!&,. IL 4 a$ IL 1- a+a$ (#$"a+&a%& (a+*!a". IL 4a+a$ (#$"a+&a%& %#, B $+ (#$"a%&,+a$ I"G a$ I"E. IL 4 9 IL1-9 a$ IL 13 a+a$ (#$"a+&a%& %#, (a%. S&"$a, I a$0a aa$:a %&"$a, II a+a$ (#$"&$+%& aa$:a %#, T a$#*"& a$ &a+ #*a+&. M. L#0*a# (#$"a+&
)#*&+aa$ #$"a$ %#, %;aa$ (#,a,& *#%#0!* :%*!",&+a$ ,a, a+a$ (#$"a+&+a$ MHC +#,a% II %##,a & (#$a+&+a$ CD4. CD4 a+a$ (#$"a+&+a$T1 a$ T2 &(a$a T1 a$ T2 a+a$ (#$"a+&+a$ (a+*!a". Ma+*!a" "a"a,(#(a+a$ M. L#0*a# a+&)a aa$:a #$!,a ",&+!,&0& I :a$" (#,&$$"&$:a & a,a((a+*!a". K#&a+(a(0a$ (a+*!a" a+a$ (#*a$"%a$" &a )#+#*a #*% (#$#*% $+ (#$"a%&,+a$ %&!+&$ a$ GF :a$" ,#)& )a$:a+ ,a"&. S&!+&$ a$ GF &a+ (#$"#$#,a& )a"&a$ %#, aa $!$%#, %#&$""a a+a$ (#*%a+ %a*a a$ %a*a :a$" *%a+ a+a$ &"a$& #$"a$ a*&$"a$ &)*!% %#&$""a #*a&,a 0#$#)a,a$ %a*a #0&. Ga!aran k"inis
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P#(#*&+%aa$ &$& &,a++a$ #$"a$ (#$""$a+a$ a*( #*aa0 *a%a $:#*&9 +a0a% #*aa0 *a%a *a)a a$ &+a (a%& )#,( #,a% #$"a$ +#a ;a*a #*%#) )a*,a 0#$"&a$ #*aa0 *a%a %9 :a& 0a$a% a$ &$"&$ #$"a$ (#$""$a+a$ 2 a)$" *#a+%& :a$" &&%& (a%&$"(a%&$" a&* 0a$a% #$"a$ % 4-45!C a$ a&* &$"&$ #$"a$ % 51- !C. Ka*#$a #*)aa%$:a a,a 0aa %aa 0#(#*&+%aa$9 &a+ &,a++a$ 0#(#*&+%aa$ $"%& %#$%!*&+ #*aa0 0a%&#$. Ca*a 0#(#*&+%aa$ $"%& %#$%!*&+ %#)a"a& )#*&+ =0a$a$ +##*a(0&,a$ (#&+9FKUII> a. P#(#*&+%aa$ %#$%a%& a+&, D#$"a$ (#$""$a+a$ +a0a% )#*& *a$"%a$"a$ %#*&$"a$ ($"+&$ a$"a$ %a(0a& (#()#*& #+a$a$ #*aa0 a*&$"a$ %)+a$. Pa%&#$ (#$0 (aa$:a a$ &(&$a $+ (#$:aa+a$ :a aa &a+ a0a)&,a &a (#*a%a+a$ aa &a+ (#*a%a+a$ aa$:a *a$"%a$"a$ a$ &(&$a $+ (#$"aa+a$ #(0a aa )a"&a$ ) (a$a :a$" &*a$"%a$". ). P#(#*&+%aa$ %#$%a%& $:#*& A,a :a$" &"$a+a$ )#*0a a*( 0#$, =+a*#$a $" a$ +#0a,a/0#$, a*( a0a &"$a+a$ %#;a*a )#*"a$&a$>. Maa 0#$#*&a #*09 0#(#*&+%a #*,#)& a, (#$;!)a a*( #*aa0 &*&$:a %#$&*&. Ra$"%a$"a$ #*aa0 +,& &+#*a+a$ #$"a$ $" a*( a$ +#0a,a a*( %#;a*a )#*"a$&a$9 %#(#$a*a & 0#$#*&a &(&$a $+ (#$:aa+a$ %#$%a%& %#%a& 0#$a0a$:a. ;. P#(#*&+%aa$ %#$%a%& % A,a :a$" &"$a+a$ a)$" :a$" &&%& a&* &$"&$ a$ 0a$a%9 0#$#*&a 0aa 0!%&%& )#*)a*&$" a$ (aa #*0. Ta)$" &$"&$ aa 0a$a% #*,#)& a, &;!)a 0aa &*& %#$&*&9 +#(&a$ a)$" &#(0#,+a$ 0aa +,& 0#$#*&a9 a$ 0#$#*&a &(&$a $+ (#$:aa+a$ a0a+a #*a%a &$"&$ aa 0a$a%. Paa !*a$" $!*(a, aa$:a 0#*)#aa$ % 25 !C %a (a(0 $+ (#$"#$a,&$:a. S#,a&$ $+ (#$"#a& aa$:a +#*%a+a$ $"%& %a*a !!$!( 0#*a&+a$ aa &a+$:a #&*a%& & a#*a ,#%& :a$" a0a #,a% a$ a0a 0,a &a+9 :a$"
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P#(#*&%aa$ $"%& (!!*&% =Voluntary muscle test) M#$"#$a& %a*a 0#*&#* :a$" 0#*, &0#*a&+a$ &a,a 0#()#%a*a$9 +!$%&%#$%&9 aa aa &a+$:a $:#*& %0!$a$ a$ aa $:#*& #+a$. Ha$:a )#)#*a0a %a*a %0#*&%&a, :a$" a0a a$ 0#*, &0#*&+%a9 :a& N. Fa%&a,&%9 N. A*&+,a*&% (a"$%9 N. Ra&a,&%9 N. U,$a*&%9 N. M#&a$%9 N. P!,&#a ,a#*a,&%9 a$ N. T&)&a,&% 0!%#*&!*. Ba"& &0# +# a*a ,#0*a(a!%a +#,a&$a$ %a*a )&a%a$:a )&,a#*a, a$ (#$:#,*9 %#a$"+a$ )a"& &0# )#*+,!& +#,a&$a$ %a*a$:a ,#)& #*,!+a,&%a%& (#$"&+& #(0a ,#%&$:a. D#!*(&a% aa ;a;a +%a %#%a& #$"a$ 0a!&%&!,!"&$:a9 a0a &)a"& a,a( #!*(&a% 0*&(#* a$ %#+$#*. Ca;a 0*&(#* %#)a"a& a+&)a ,a$"%$" !,# "*a$,!(a :a$" #*)#$+ %#)a"a& *#a+%& #*aa0 M. Leprae :a$" (#$#%a+ a$ (#*%a+ a*&$"a$ &%#+&a*$:a9 :a& +,&9 (+!%a *a+% *#%0&*a!*&% aa%9 ,a$",a$" a*&9 a$ aa. Ca;a %#+$#* #*a& %#)a"a& a+&)a aa$:a #!*(&a% 0*&(#*9 #*a(a +#*%a+a$ %a*a =%#$%!*&+9 (!!*&+9 !!$!(> a$a*a ,a&$ +!$*a+* %#$&9 (&,a%& a$"a$ a$ +a+&. G#a,a"#a,a +#*%a+a$ %a*a •
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Tutorial 5 Kel 5D Blok Masalah Pada Dewasa I
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La#iran
Tutorial 5 Kel 5D Blok Masalah Pada Dewasa I
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)!at -ang 'ikonsusi Pasien
Kon'isi "esi #asien 'i #unggung
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Kon'isi "esi #asien 'i #inggang
Kon'isi #e!esaran n. auriku"aris 'i "e$er Tutorial 5 Kel 5D Blok Masalah Pada Dewasa I
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Kea'aan 9ari49ari tangan #asien
Ke"o#ok Tutoria" :
Tutorial 5 Kel 5D Blok Masalah Pada Dewasa I
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