Supervisor:dr. H. Oscar Djauhari, Sp. THT-KL

• Name : Mr. Y• Age : 55 years old• Sex : Male• Occupation : Retirement• Race : Javanese• Address : Cisaat, Sukabumi• Weight : 50 kg• Height : 170 cm

• Chief complaint:sudden hoarseness and difficulty swallowing •Additional complaint:

Persistent cough, weight loss, blood when coughing

• History of present illness: Patient came with sudden hoarseness and difficulty swallowing. He had a persisten cough for a year and had received medication for about 6 months but never had any improvement. Bad cough came with productive phlegm that was green in color. Sometimes there was a stain of redness in the phlegm. The phlegm got often swallowed by the patient. The cough was progressively worsening. Patient also had a weight loss for around 10 kilos in the last 1 year. He smoked 3 pack a week for 30 years.

1. General status General appearance: Calm Consciousness : Compos mentis Blood pressure : 120/70 mmHg Pulse rate : 88 x/min Respiratory rate : 24 x/min Temperature : 37,4 C

2. Pulmonal Inspection : Chest simetris in static and dynamic

condition Palpation : Stem fremitus dextra increased Percussion : Dull in apex region pulmonal dextra Auscultation : Ronchi +/+, wheezing -/-

3. ENT Status ◦ Right ear :

Mucuos membrane : hyperemic (-), edema (-), mass (-), Secretion (-), laceration (-), cerumen (-)

Tymphanic membrane : intact, bulging (-), light reflex (+)

◦ Left ear : Mucuos membrane : hyperemic (-), edema (-), mass (-),

secretion (-), laceration (-), cerumen (-) Tymphanic membrane : intact, bulging (-), light reflex

(+)

Right nose : ◦ Mucous membrane: hyperemic (-), edema (-),

secretion (-), mass (-), laceration (-), crust (-)◦ Concha: eutrophy◦ Septum: no deviation◦ Air passage: normal

Left nose : ◦ Mucous membrane: hyperemic (-), edema (-),

secretion (-), mass (-), laceration (-), crust (-)◦ Concha: eutrophy◦ Septum: no deviation◦ Air passage: normal

Throat: ◦ Uvula in the middle◦ Pharynx: normal pharyngeal arch, hyperemic (-)◦ Tonsils : T1 / T1, detritus (-), enlarged crypt (-)

Neck: Enlargment Lymph nodes

Laboratory finding ( Complete blood count ) Chest radiograph PA position Mantoux test Sputum test Direct laryngoscopy

1. LaboratoryHaemoglobin : 13.4 g/dLWBC : 7300/uLESR : 25/51 mm/hourHaematocryte : 39.3%Platelet : 289000/uL

CXR result : Active Tuberculosis in the right lung

2. Chest Radiograph

Chronic Laryngitis e.c. suspect lung tuberculosis

To prevent dehydration : ◦ RL IV line

Emergency proceedings to hypovolemic shock e.c dehydration:◦ Airway : head tilt-chin lift maneuver◦ Breathing : look, listen, feel◦ Circulation : chest compression if necessary

To treat tuberculosis :◦ Rifampisin 450 mg 1x1◦ INH 300 mg 1x1◦ Pirazinamid 500 mg 2x1◦ Ethambutol 500 mg 1x1