Professional Documents
Culture Documents
1. PREFACE
Endocrinology is an expanding science with new concepts and ideas appearing in the
literature almost daily. The term endocrine denotes internal secretion of biologically active
substances. Basically, the endocrine system uses hormones to convey information between
different tissues. Hormones are released by endocrine glands and transported through the
bloodstream to tissues where bind to specific receptor molecules and regulate the target
tissues function. In addition to this traditional views, hormones can also act locally by
binding to receptors that are expressed by cells that are close to the site of release, remain
in the membranes of the one cell, acts on receptors located in the same cell, or can act
inside the cell without being released. The action is called paracrine, juxtacrine, autocrine,
or intracrine.
In this block, we will learn about the basic of hormone synthesis, release and action,
continue with discussing of each endocrine organs and their hormones and diseases
including pituitary organ and disorders, diabetes mellitus, lipid metabolism, energy balance:
obesity and metabolic syndrome, thyroid and parathyroid gland and disorders, adrenal
gland and disorders, and also congenital hypothyroid and ambiguous genital.
This block will take 16 meeting to be completed, each meeting consist of introductory
lecture continued by individual learning, single group discussion and self assessment,
ending with plenary session. In each topic there will be a list of tasks to discuss which some
of them are based on a case that commonly find in clinical practice. There will also a simple
clinical problem that you need to discuss and respond, each part will be given a cut of
clinical information for you to be responded.
Evaluation in this block will be formative and summative. The formative evaluation is
directive and will take as checklist and peer assessment, while summative will be conducted
at the end of this block.
We believe that the basic of endocrinology that you will learn in this block will impulse you to
learn more about it to help you dealing with endocrine problems in patients.
Good luck,
Planner team
2. LIST OF CONTENT
List
Page
no.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Cover
Preface
List of Contents
Planners Team
Facilitators
Seven General Core Competency
Curriculum Block: The endocrine system, metabolism, and disorders
General Learning Outcome
Time Table
2
3
4
5
6
7
10
11
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21
14
14
15
19
31
32
38
39
40
43
45
46
3. PLANNERS TEAM
No.
NAME
DEPARTEMENT
PHONE
1.
Internal Medicine
08123814688
Biochemistry
081338776244
Histology
Internal Medicine
08155715359
0811380916
Internal Medicine
0811398205
Internal Medicine
Internal Medicine
Pediatric
Pediatris
Biochemistry
Biochemistry
08155736480
08123657130
081338596115
081338465525
081338486589
081239990399
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
4. FACILITATORS
Regular Class
NO
1
2
3
4
5
6
7
8
9
10
11
12
NAME
dr. Ni Nyoman Mahartini, Sp.PK
dr Ni Nyoman Metriani Nesa,
M.Sc.,Sp.A
dr. I Dewa Ayu Inten Dwi
Primayanti, M.Biomed.
dr. I Wayan Surudarma, M.Si
dr. I Wayan Niryana, Sp.BS, M.
Kes.
Dr.dr. Susy Purnawati, MKK
dr. Anak Agung Ayu Yuli
Gayatri, Sp.PD
dr. I Gede Ngurah Harry Wijaya
Surya, Sp.OG
Dr. dr. Made Sudarmaja, M.Kes
dr. I Wayan Juli Sumadi, Sp.PA
dr. Anak Agung Mas Putrawati
Triningrat, Sp.M (K)
dr. I Gusti Ngurah
Pramesemara , M.Biomed
GROUP
DEPT
PHONE
A1
Clinical
Pathology
081337165577
A2
Pediatric
081337072141
A3
Fisiology
081337761299
A4
Biochemistry
081338486589
A5
Surgery
08179201958
A6
Fisiology
08123989891
A7
Interna
08123803985
A8
Obgyn
0814386935
A9
Parasitology
08123953945
A10
Anatomy
Pathology
082237407778
A11
Opthalmology
08123846995
A12
Andrology
081338605087
GROUP
DEPT
PHONE
B1
Neurology
0811388818
B2
Interna
081803651656
B3
Histology
085104550344
B4
Interna
08123853700
B5
Forensic
081916613459
B6
Interna
08123814688
B7
Clinical
Pathology
08155237937
B8
Opthalmology
085238238999
B9
Psychiatry
08123813831
A10
Radiology
08164745561
A11
Interna
081916253777
B12
Surgery
081236288975
ROOM
3rd floor
R.3.01
3rd floor
R.3.02
3rd floor
R.3.03
3rd floor
R.3.04
3rd floor
R.3.05
3rd floor
R.3.06
3rd floor
R.3.07
3rd floor
R.3.08
3rd floor
R.3.20
3rd floor
R.3.21
3rd floor
R.3.22
3rd floor
R.3.23
English Class
NO
1
2
3
4
5
6
7
8
9
10
11
12
NAME
Dr. dr. A.A. Ayu Putri
laksmidewi, Sp.S(K)
dr. Ni Made Renny Anggreni
Rena , Sp.PD
dr. I G A Dewi Ratnayanti ,
M.Biomed
dr. I Ketut Mariadi, Sp.PD
dr. Ida Bagus Alit, Sp.F, DFM
Dr. dr. Made Ratna
Saraswati, Sp.PD-KEMDFINASIM
dr. Anak Agung Wiradewi
Lestari , Sp PK
dr. Putu Budhiastra, Sp.M(K)
dr. Ida Ayu Kusuma Wardani,
Sp.KJ, MARS
dr. Sri Laksminingsih Sp. Rad
dr. Tjok. Istri Anom Saturti,
Sp.PD
dr. I Made Suka Adnyana,
Sp.BP-RE
ROOM
3rd floor
R.3.01
3rd floor
R.3.02
3rd floor
R.3.03
3rd floor
R.3.04
3rd floor
R.3.05
3rd floor
R.3.06
3rd floor
R.3.07
3rd floor
R.3.08
3rd floor
R.3.20
3rd floor
R.3.21
3rd floor
R.3.22
3rd floor
R.3.23
1. Patient care
Demonstrate capability to provide comprehensive patient care that is compassionate,
appropriate, and effective for the management of health problems, promotion of health
and prevention of disease in the primary health care settings.
2. Medical knowledge base
Mastery of a core medical knowledge which includes the biomedical sciences,
behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of
medicine and the principles of medical ethics, and apply them
3. Clinical skill
Demonstrate capability to effectively apply clinical skills and interpret the findings in the
investigation of patient.
4. Communication
Demonstrate capability to communicate effectively and interpersonally to establish
rapport with the patient, family, community at large, and professional associates, that
results in effective information exchange, the creation of a therapeutically and ethically
sound relationship.
5. Information management
Demonstrate capability to manager information which includes information access,
retrieval, interpretation, appraisal, and application to patients specific problem, and
maintaining records of his or her practice for analysis and improvement
6. Professionalism
Demonstrate a commitment to carrying out professional responsibilities and to personal
probity, adherence to ethical principles, sensitivity to a diverse patient population, and
commitment to carrying out continual self-evaluation of his or her professional standard
and competence
7. Community based and health system- based practice
Demonstrate awareness and responsiveness to larger context and system of health
care, and ability to effectively use system resources for optimal patient care
6. CURRICULUM BLOCK:
THE ENDOCRINE SYSTEM, METABOLISM AND
DISORDERS
Learning
Outcome
1. Comprehend
the hormone
action
2. Summarize
the pituitary
gland function
and provide
initial
management
and/or refer
patient with
pituitary
disorders
3. Summarize
the insulin
action, provide
initial
management
and/or refer
patient with
diabetes
mellitus (DM)
Learning Objectives
Educational
strategy
Learning
Resourc
es
Student
assess
ment
0 Intro.le
c
1 IL
2 SGD
3 Pleno
Refferen
ces
MCQ
4 Intro.le
c
5 IL
6 SGD
7 SE
8 Pleno
MCQ
9 Intro.le
c
10
IL
11SGD
12
Pl
eno
PBL
13
MCQ
4. Summarize
and select the
appropriate
drug in patient
with lipid
metabolism
disorders
5. Summarize the
energy
balanced and
heat
metabolism,
and provide
management
in patient with
obesity and
metabolic
syndrome
14
In
tro.lec
15
IL
16
S
GD
17
Pl
eno
18
C
BL
MCQ
19
In
tro.lec
20
IL
21
S
GD
22
P
leno
23
C
BL
MCQ
7. Summarize the
mineral
metabolism
(calcium and
phosphate)
and
parathyroid
hormone
functions
8. Provide initial
management
and/or refer
patient with
adrenal
disorders
9. Provide initial
management
and/or refer
patient with
congenital
hypothyroid
and
ambiguous
genital
24
In
tro.lec
25
IL
26
S
GD
27
P
leno
28
C
BL
33
tro.lec
34
35
GD
36
leno
MCQ
29
In
tro.lec
30
IL
31
S
GD
32
P
leno
In
IL
S
P
37
In
tro.lec
38
IL
39
S
GD
40
P
leno
MCQ
10
8. TIME TABLE
Day
Date
Topic
Monday,
Oct, 26,
2015
Introduction
(The hormone
action)
Tue, Oct,
27, 2015
Histology and
Anatomy of the
endocrine system
Wed,
Oct, 28,
2015
Thursday
, Oct, 29,
2015
Carbohydrate
metabolism
Friday,
Oct, 30,
2015
Insulin secretion,
insulin action.
Monday,
Nop, 02,
2015
Pathogenesis and
diagnosis of
diabetes
Tue,
Nop,03,
2015
Management of
Diabetes
Wed,
Nop, 04,
2015
PBL 1
5 Nop
Clinical skills 1:
Insulin injection
Management of
Diabetes in
Children
10
Thursday
, Nop,
05, 2015
Learning
situation
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
SGD
Pleno
SP
Clinical
Skills
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
English Class
Regular Class
PIC
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-09.45
09.45-10.30
10.30-12.30
12.30-14.00
14.00-15.00
15.00-16.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Suastika/Ratna
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Bikin/Arimbawa
Yuliana
Mayun
Ratna
Dewi Wiryanthini
Suastika/Ratna
Suastika/Ratna
Suastika/Pande
Budhiarta
Pande
Budhiarta
11
Monday,
Nov, 09,
2015
PBL2
Clinical skill 2:
self monitoring
blood glucose
Lipid metabolism
12
Tue,
Nov, 10,
2015
13
Wed,
Nov, 11,
2015
Lipid metabolism
and disorder
14
Thursday
, Nov,
12, 2015
The energy
balance
15
Friday,
Nov, 13,
2015
PBL3
16
Monday,
Nov, 16,
2015
Clinical skills 3:
Diabetic Foot
Examination
Obesity and
metabolic
syndrome
17
Tue,
Nov, 17,
2015
Iodine metabolism,
and thyroid hormon
function
18
Wed,
Nov, 18,
2015
Calcium,
phosphate, and
vitamin D
metabolism, PTH
function
19
Thursday
, Nov,
19, 2015
20
Friday,
Nov, 20,
2015
SGD
Pleno
SP
Clinical
Skills
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
SGD
Pleno
SP
Clinical
Skills
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Surudarma
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Budhiarta
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Wihandani
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Ratna
Wiragotera
Pande
Suastika/Pande
Adiputra
Suastika/Ratna
Pande
Sutadarma
Wira Gotera
12
Monday,
Nov, 23,
2015
Cushing syndrome
Adrenal Crisis
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Ratna
22
Tue,
Nov, 24,
2015
Congenital
hypothyroid and
disorder of sex
development (DSD)
Wed,
Nov, 25,
2015
PBL3
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Bikin/
Arimbawa
23
Intro. Lect
IL & L task
SGD
SP
Pleno
SGD
Pleno
SP
Clinical
Skills
SGD
Pleno
SP
Clinical
Skills
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Suastika/Ratna
Pleno
08.00-13.00
08.00-13.00
Lecturers and
Fasilitators
24
Thursday
, Nov,
26, 2015
25
Friday.
Nov, 27,
2015
26
Monday,
Nov, 30,
2015
Clinical skills 4:
Thyroid Nodule
Examination
PBL 4
Clinical Skills 5:
Lab result
interpretation
(case studies)
Student project
presentation
Evaluation
Suastika/Ratna
Pande
Pande
Team
13
14
15
16
17
18
Day 2.
Learning Task:
1. Discuss the structure of thyroid and parathyroid gland, include the vascularisation
and identify their position in the neck
2. Discuss anatomical structures of pituitary gland and hypothalamus
3. Discuss anatomical structures of pancreas
4. Discuss anatomical structures of adrenal gland
Self assessment:
1. Decribe the structure of thyroid and parathyroid gland, include the vascularisation
and identify their position in the neck
2. Describe anatomical structures of pituitary gland and hypothalamus
3. Describe anatomical structures of pancreas
4. Describe anatomical structures of adrenal gland
19
Day 3.
Day 4.
Carbohydrate metabolism
Learning Task:
1. Red blood cell is the simplest cell in the body in term of its structure and metabolism.
Please elaborate that statement!
2. What are the differences of carbohydrate metabolism in red blood cell compare to
brain cell or hepatocyte?.
3. Explain what happened during investment stage, splitting stage and yield stage on
glycolisis.
4. What enzymes are regulating glycolisis and what are their functions?
5. Explain about glycogenesis, glycogenolysis and hormonal control of glycogenolysis!
6. Where is Pentosa phosphate pathway started and what are the main products?
Explain why its called shunt?
7. How many ATP produced from one molecule glucose metabolized at Krebs cycle?
20
21
Day 7.
Management of Diabetes
Day 8.
22
Day 10.
Day 11.
PBL 2 and Clinical skills 2: Self monitoring blood
glucose
n
Day 12.
Lipid metabolism
Learning Task:
1. Explain about beta and alpha oxidation of lipid metabolism!
2. Explain the relation between carbohydrate and lipid metabolism!
3. What are the function of carnitin and what happened if carnitin deficiency occured?
4. Explain the interrelation between obesity and lipid metabolism!
Day 13.
Case
Data 1
A 45 years, male patient with history of diabetes type 2 since 5 years carried out routine
laboratory examination. Serum total cholesterol result is 259 mg/dL
Learning Task:
What other laboratory assay you will suggest to patient to complete lipid profile of this
patient? How to interpret each of it?
Data 2
Lipid profile results as follow :
Total cholesterol 250 mg/dL
Cholesterol LDL 110 mg/dL
Cholesterol HDL 17 mg/dL
Trigliserida 210 mg/dL
23
Day 14.
Learning Task:
1. Explain adenosine triphosphast (ATP) functions as an energy in metabolism
2. Explain phosphocreatine functions as an accessory storage depot for energy and as
ATP buffer
3. Explain aerobic and unaerobic energy
4. Explain about metabolic rate
5. Explain energy metabolism factors that influence energy output
6. Describe the mechanism of heat production
7. Explain the body temperature is controlled by balancing heat production against heat
loss
8. Explain the mechanism of bodily heat loss
9. Describe the pathogenesis of obesity
Day 15.
Day 16.
Data 1
A 45 years male patient, complain body weakness and sometime difficulty in breathing when
sleeping. On physical examination, body weight 92 kg, height 162 cm and waist
circumference 105 cm. Patients has 1 brother and 1 sister. His brother died due to heart
attack at age of 52 year. All of them are fat since they were child. Patient weight increases
since he married and starts to neglect exercise.
Learning Task:
1. What are the problems of this patient?
2. What are factors contribute to those problems?
3. What are the possible risks that this patient will face in the future?
24
Learning Task:
1. What syndrome is this patient suffered?
2. How the mechanism that this syndrome could occur?
3. What factors contribute to the increase of blood glucose in this patient?
4. Explain briefly about the management of this patient!
Data 1 .
A 36 years male patient, complain snoring and difficulty in breathing when sleeping. Almost
all patient family are fat. Patient himself alredy fat since he was child and his body weight
even more increasing after he married. His present body weight is 98 kg with height 165 cm,
and waist circumference 108 cm. Patient feel less self confidence due to dark appearance
on the neck skin just like untreated well..
Learning Task:
1. What are the problems of this patient?
2. What are additional data that you need to diagnose this patient?
Data 2.
Patient blood pressure 150/90 mmHg.
Random blood glucose concentration 130 mg/dL, 2 hour post prandial 180 mg/dL, but he
never complain frequent urinating or thirsty. Trigliserida 170 mg/dL, HDL 25 mg/dL,
cholesterol LDL 250 mg/dL
Learning Task:
1. What is the sndrome that this patient suffered?
2. What are the causes of this syndrome?
3. Explain the management of this patient?
Self assessment:
1. Define the criteria of obesity for Asia Pacific region!
2. Explain the pathogenesis of obesity (nutrient balance or homeostatic model)!
3. What is the complication of obesity?
4. Mention the criteria of metabolic syndrome by adult treatment panel III National
Cholesterol Education Program (ATP III-NCEP)!
5. Explain the treatment of metabolic syndrome!
25
Day 17.
Iodine metabolism, thyroid hormone synthesis and
secretion, thyroid
hormone function
Learning Task:
1. Explain step by step the synthesis of thyroid hormone !
2. What is thyroglobulin? What is the function in synthesis of thyroid hormone?
3. What is meant by iodinize and deiodinize in thyroid gland?
4. Explain the secretion process of tiroksin!
5. Explain the transport of thyroid hormone!
6. Explain how thyroid secretion is controlled
7. Explain the main action of thyroid hormone
8. Describe the main consequence s of abnormal thyroid function
Self assessment:
1. Explain about the axis of hypothalamic-pituitary-thyroid system and its regulatory
function of thyroid hormone secretion!
2. Describe the schema of biosynthesis of thyroid hormone!
3. Explain about transport of thyroid hormone in the blood!
Day 19.
Case : a lady with increasing body weight and first degree AV block
Data 1.
A 45 year female patient come clinic with complaining weakness, difficult to concentrate and
increase of body weight. On physical examination, blood pressure 100/70mmHg, pulse 52
x/minutes,regular with edema at both legs. Laboratory result reveal that total cholesterol 460
mg/dL.
Learning Task:
1. What is the diagnose of this patient?
2. What are other examinations that you need to confirm the diagnose? (3 items)
26
27
28
Day
22.
Clinical skill 4: Thyroid gland
examination
and student project presentation 1
physical
29
30
31
32
= BMI (kg/m2)
= WHR
BMI (kg/m2)
< 18.5
Normal range
Overweight
At risk
Obese I
Obese II
Waist circumference
18.5 22.9
> 23
23 24.9
25 29.9
> 30
Normal
< 90 cm (men)
< 80 cm (women)
WHR
Risk of co-morbidities
Low (but increased risk of
other clinical problem)
Average
Increased
Moderate
Severe
Abdominal obesity
> 90 cm
> 80 cm
> 1.0 (men)
> 0.85 (women)
33
Learning task:
Check your body mass index, waist circumference and waist to hip ratio, and
interpretate the result.
Place the fingers of both hands on the patients neck so that your index fingers are just
below the cricoid cartilage
Ask the patient to sip and swallow water as before. Feel the thyroid isthmus rising up
under your finger pads. It is often but not always palpable.
Displace the trachea to the right with the fingers of the left hand; with the right hand
fingers, palpate laterally for the right lobe of the thyroid in the space between the
displaced trachea and the relaxed sterbomastoid. Find the lateral margin. In similar
fashion, examine the left lobe.
The lobe are somewhat harder to feel than the isthmus, so practice is needed.
The anterior surface of a lateral lobe is approximately the size of the distal
phalanx of the thumb and feels somewhat rubbery.
Note the size, shape, and consistency of the gland and identify any nodules or
tenderness.
Soft in Graves disease
Firm in Hashimotos thyroiditis, malignancy
Benign and malignant nodules
Tenderness in thyroiditis.
Note: The thyroid gland is usually easier to feel in a long slender neck than in a short stocky
one. In shorter necks, added extension of the neck may help.
In some persons, however, the thyroid gland is partially wholly substernal and not amenable
to physical examination.
34
Auscultation
If the thyroid gland is enlarged, listen over the lateral lobes with a stethoscope to detect
a bruit, a sound similar to a cardiac murmur but of noncardiac origin.
A localized systolic or continuous bruit may be heard in hyperthyroidism.
Learning task:
Try the physical examination of your friends thyroid gland and note the
size, shape, and consistency of the gland and identify any nodules or
tenderness.
Case 2.
Male 44 years old came to outpatient clinic with an acute swelling and pain of his thyroid
nodule.
The first laboratory result was:
TSHs 0.023 uIU/ml (normal range: 0.25 5 uIU/ml)
FT4 20.51 ug/dl
(normal range: 5.13 14.06 ug/dl)
The second laboratory result after 3 months was:
TSHs 7.23 uIU/ml (normal range: 0.25 5 uIU/ml)
FT4 2.33. ug/dl
(normal range: 5.13 14.06 ug/dl)
Learning task:
1. What is the meaning of the first result and the second result?
2. Why this patient come up with the different result after 3 months?
3. What do you think the diagnosis of this case?
Udayana University Departement of Medicine Education, DME
35
Learning task:
1. What is the interpretation of laboratory finding?
2. What other laboratory examination do you suggest?
36
15. REFFERENCES
Student Standard References:
Basic & Clinical Endocrinology, 9th ed, Lange Medical Publication
Additional Recommended Reading
1. Essential Clinical Anatomy, 2 nd ed. Lippincott Williams & Wilkins, Philadelphia. 2002.
2. Fawcett DW, Jenish RP : Bloom and Fawcett`s Concise Histology, 2 nd ed, London,
Arnold, 2002. p. 220-221, 251-266.
3. Guyton A. C and Jhon E. Hall Textbook of Medical Physiology:Page: 836-914
4. Harper, 25 ed.p.451-626
5. Baynes J; Dominiczak Marek H. Medical Biochemistry.1999. chapter 12, chapter 17,
and chapter 23 page 297-304
6. Robbins Basic Phatology, 7 ed, 2003.p.221-225
7. Henry JB; Alexander ; Eng C D. Evaluation of Endocrine function In : Henry JB Ed.
Clinical Diagnosis and Management by Laboratory Method. 19th Ed.1996. p.322-373
8. Gartner LP, Hiatt JL : Color Text Book of Histology, 2 nd ed, Philadelphia, W.B.
Saunders, 2001,p. 301-324.
9. Wales J.K H, 1996. Pediatric endocrinology and growth: Abnormal Genitalia; 99-116
10.
Styne DM, 2004. Handbooks in Pediatric endocrinology: Disorders of sexual
differentiation; 134-158
Reference Clinical Skills
1. Bickley LS, Szilagyi PG. Bates Guide to Physical Examination and History Taking. 8th
eds. Lippincott William & Wilkins. Philadelpia, 2003.
2. American Diabetes Association. Clinical Practice Recommendations 2015. Diabetes
Care 2015
3. The Asia-Pacific perspective: Redefining Obesity and its treatment, 2000.
37
16.
4A
4A
3A
3B
3B
3B
4A
1
1
1
1
3A
3A
3B
3A
2
3B
3B
1
2
2
1
2
2
38
17.
A
1.
2.
3.
4.
5.
Topic
Introduction ( The hormone action)
The pituitary gland and disorder
Anatomy & Histology of islet cells
Carbohydrate metabolism
Insulin secretion, insulin action and Pathogenesis and
Diagnosis of diabetes mellitus (DM)
Management of Diabetes
Acute and chronic complication of diabetes
Drug treatment in endocrine disorder
Lipid metabolism
Lipid metabolism and disorder
6.
7.
8.
9.
10
.
11.
12
.
13
.
14
.
15
.
16
.
17
.
18
.
19
.
B
1.
2.
3.
4.
5.
6.
Score
2
3
4
39
Lecturer
Prof.DR.dr. K Suastika,SpPD-KEMD
Prof.Dr.dr. AAG Budiartha,SpPD-KEMD
dr. Made Ratna Saraswati, SpPD-KEMD
dr. Desak Made Wihandani, M.Kes
dr I Gst Ngr Mayun Sp.HK
Dr. I Wayan Surudarma, M.Si
dr. Yuliana
Dr. IA Dewi Wiryanthini, M.Biomed
Prof.dr. N Adiputra, MOH
Dr. I Wayan Bikin Suryawan, SpA
dr. Arimbawa, SpA
Dr. Pande Dwipayana, SpPD
Facilitator
Name of your group facilitator
:
Assessment
Time provided
Suitability of questions with topic given
Score :
1. Bad or not suitable with expectation
2. Insufficient or inadequate with expectation
3. Sufficient or adequate with expectation
4. Good or suitable with expectation
5. Excellent or exceed expectation
40
Lecturer
Facilitator
Assessment
Your suggestion/input:
Topic
Learning strategy
Lecturer
Facilitator
Assessment
TITLE
41
1.
2.
3.
4.
Introduction (Pendahuluan)
Content (Isi, sesuai topik yang dibahas)
Summary (Ringkasan)
Refferences: (Daftar Pustaka) Van Couver style
Example:
Journal
Sheetz MJ, King GL. Molecular understanding of hyperglycemias adverse effect for
diabetic complications. JAMA. 2002;288:2579-86.
Textbook
Libby P. The Pathogenesis of atherosclerosis. In: Braunwald E, Fauci A, Kasper D,
Hoster S, Longo D, Jamason S (eds). Harrisons principles of internal medicine. 15 th
ed. New York: McGraw Hill; 2001. p. 1977-82.
Internet
WHO. Obesity: preventing and managing the global epidemic. Geneva: WHO 1998.
[cited
2005
July].
Available
from:
http://www.who.int/dietphysicalactivity/publications/facts/ obesity/en.
42
19.
Topic
A1
1. Diabetes insipidus
A2
2. Acromegaly ,gigantism
A3
3. Prolactinoma
A4
A5
5. Hypopituitarism
A6
6. Hyperparathyroid
A7
7. Hypoparathyroidism
A8
8. Hypothyroidism
A9
9. Thyroiditis
A10
A11
A12
B1
B2
B3
15. Phaeochromocytoma
B4
B5
B6
18. Hypogonadism
B7
B8
B9
B10
B11
23. Hyperaldosteronism
B12
43
: ________________________________________
Facilitator
: ________________________________________
Title
:-
__________________________________________________
__________________________________________________
__________________________________________________
Time table of consultation
Point of discussion
1. Title
2. Refferences
3. Outline of paper
4. Content
5. Final discussion
Week
1
2
3
4
5
Assessment
A. Paper structure
B. Content
C. Discussion
:
:
:
Total point
Date
7
7
7
8
8
8
Tutor sign
9
9
9
10
10
10
( A + B + C ) : 3 = _____________
Denpasar, ______________________
Facilitator,
20.
44
Topic
No of question
PIC
5
4
4
5
5
7
Suastika
Yuliana
Mayun
Ratna
Dewi Wiryanthini
Ratna
7
5
6
5
6
5
6
5
5
6
5
5
6
Suastika/Pande
Bikin/Arimbawa
Budhiarta
Surudarma
Suastika/Pande
Adiputra
Budhiarta
Desak
Suta
Wiragotera
Ratna
Ratna
Bikin/Arimbawa
100 soal
~ CURRICULUM MAP ~
Smstr
45
10
Senior Clerkship
Senior Clerkship
Senior clerkship
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Clinic Orientation
(Clerkship)
(6 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The
Cardiovascular
System and
Disorders
(4 weeks)
The Urinary
System and
Disorders
(3 weeks)
The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health Systembased Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
BCS (1 weeks)
Elective Study
II
(1 weeks)
5
BCS (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
46