Step I Terminology

• Stridor: abnormal high-pitched sound produced by air turbulence through the airway.

• Retraction: attraction of the movement of the chest cavity of respiratory failure intercostal muscles are interested into.

• PR interval: the distance from the beginning of the P wave to the beginning of the QRS complex waves. normally 0.12 to 0.20 seconds

Step II PROBLEM FORMULATION

1. What are the causes shortness of breath and breath sounds?

2. Relationship of age and gender with the complaint on Teri?

3. How the interpretation of anamnesis? 4. Relationship with the state immunization Teri

now? 5. How the interpretation of the physical

examination?

6. Why the examination of the heart sound disorganized and weakened heart?

7. Why Teri should be referred? 8. How the interpretation of ECG that looks

elongated PR interval? 9. How to work on Teri diagnosis? 10.What is the meaning of symptoms in children

next to Teri (joint pain moving)?

Step III ANALYSIS PROBLEM1. a. blown

shortness of breath of oxygenation: - Disruption disusi => interruption of pulmonary blood flow - Reperfusion => interruption of blood exchange dijaringan

• Stertococcus in upper airway obstruction that lead to inflammation and narrowing => shortness of breath.

• Diphtheria cause a sore throat in the pharynx secrete exotoxin => neksrosis. body response by releasing macrophages causing inflammation => edema => clog airways => shortness of breath b. wheezing due to turbulence due to obstruction

2. - Teri age 5 years => occurrence of streptococcal pharyngitis due to a lot of children age 5-10 years who peak at the age of 8 years - gender => no effect but complications and manifestations of different possibilities

3. a.demam:> 37 C due to exogenous pyrogens of germs causing the resistance mechanisms of the body that will transform a set of points in the hypothalamus so that the occurrence of fever

b. very tired Diphtheria kumam infectious cause of myocarditis is so inadequate heart action => reduced oxygen supply => anaerobic process produces lactic acid which causes fatigue.

c.no want to eat inflammation due to bacteria that attacks the nerve so that the nerve and narrowing the channel.

4. Active immunization is immune, if it is not done then the memory cells will be a particular disease, the illness can be severe immediately.

- DPT immunization diphtheria germs are - Streptococcus plumpness caused by low socioeconomic,

hygiene and will be less likely to become infected

5. The peripheral cyanosis decreased oxygenation - There streptococcal polysaccharide structure (protein m) which is similar to the body of the heart, the skin that can be recognized by the immune system as foreign substances that can cause damage. - When the heart valve damage will occur resulting in a narrowing of turbulence

6. weakened heart: - Damage to the mitral and tricuspid valves, more audible at the mitral valve if damaged then weakened heart sounds - Perfusion pericardial => heart like a picture of a bottle of water (covered by the effusion of fluid from the vasculature) so that negative auscultation or reduced.

7. referred because of heart disease and valve 2 is competence so as a general practitioner only management of early so should be referred also to confirm the diagnosis

8. PR interval lengthening due to: - Disruption of the AV node due to the stiffness of the valve caused by a streptococcal infection that impaired impulse to the AV node bundle Hiss. - Diphtheria infection inhibits Hiss bundle

9. symptoms: heart infection => endocarditis (valve), myocarditis (muscle) and pericarditis (membrane) endocarditis: SBHGA myocarditis: streptococcus and diphtheria Rheumatic fever: Jones criteria

10. Poliatritis migrens namely the large joints => moved around => autoimmune factors three mechanisms: direct infection, autoimmune (moved around) and can be lost with the administration of salicylates, acute rheumatic fever.

LOStudents are able to explain the epidemiology,

etiology, risk factors, classification, pathogenesis and pathophysiology, clinical manifestations, investigations, management of a comprehensive, complications and prognosis of:

1. Infection of the heart (pericarditis, myocarditis and endocarditis)

2. Demam rheumatism 3. Valvular heart disease