Rehabilitation for musculosceletal disorders SCENARIO

LEARNING OUTCOMES: Describe the Rehabilitation of musculoskeletal after injury degenerative disorders CURRICULUM CONTENTS: a. Execerise Therapy b. Deconditioning c. Physical modality d. Prosthesis ABSTRACTS Musculoskeletal disorders are the most frequent type of disabilities, and pain is the most common cause musculoskeletal disability. Musculoskeletal complaint include non specific symptoms such as pain in the neck, back, and extremities, chronic inflammatory or degenerative disorders, and a wide range of sports injuries, traffic and occupation accident. These disorder cause disability, suffering and reduce a person quality of life. Early mobilization in musculoskeletal disorder is needed for preventing immobilization syndrome. Management of rehabilitation for musculoskeletal disorders consist of giving some medicine, physical modality, exercise therapy and sometime need walking aid SELF DIRECTING LEARNING Basic knowledge that must be known:

1. Rehabilitation for musculosceletal disorders SCENARIO

Old men, 40 year, have a traffic accident. In emergency room, is got right thighbone fracture and left forearm, then planned to do operation. After operation, right thigh muscle minimizes and stiff in the knee and patient cannot walk. Learning Task 1. Mention kind of exercise therapy 2. Mention complication of long immobilization 3. Explain the way of prevention of that complication long immobilization 4. Mention what physical modalities able to be used 5. Mention kind of walking aid Self Assessment: What is the role of rehabilitation for the musculoskeletal disorders treatment? Udayana University Faculty of Medicine,DME 59 MODULE 24 BONE FORENSIC dr. Ida Bagus Putu Alit, Sp.F, DFM AIMS: Describe personal identity and pathological changes from skeleton LEARNING OUTCOMES: Describe personal identity and pathological changes from skeleton CURRICULUM CONTENTS: a. Animal bone b. Human bone c. Age of human bone ABSTRACTS Examination of Human Skeletal can provide important information to determine the identity of decease. The necessity for the identification of a decreased individual not only fulfill a legal obligation which may be down in law, but recognize the fundamental right of all individual to have an identity both in life and after death. The doctor must collect information that will established the identity, the time of death, the cause of death and the manner or mode of death homicide, suicide, accidental or natural. In identification process, the doctor have task to establish: 1. The Human or non human skeletal, 2. the number of deceased, 3. General identification of the skeletal gender, race, age, stature etc and specific traits of the bone. Human or non human skeletal can be established by gross anatomy, histology appearances and x-ray examination. The gender and race can be determined by examination of many bones especially skull, pelvic bone and long bones. The age can be estimated by the changes pattern of ectocranial sutures, pubic symphysis and pre auricular surfaces. The cause of death COD and the manner of death MOD can be established only if the trauma implicated the bone or related poison can be detected on bone. SELF DIRECTING LEARNING Basic knowledge that must be known: 1. The role of bone forensic 2. International protocol analysis 3. Medicolegal aspect of violence Udayana University Faculty of Medicine,DME Day 24 th 60 SCENARIO Case 1 Skeletal was found by a farmer in the field and reported to police immediately. After that, police came to secure the skeletal and did an investigation. From the investigation, police found that the skeletal was 35 year old Indonesian female, Type A Blood, height 149cm. The victim had already given birth twice with history of normal labor. Police asked for medical examination afterwards. The doctor, who examined, found that the skeletal was complete human skeletal. 1. What’s the purpose of this investigation? 2. a. To do bone sexing, the most accurate criteria can be seen from pelvic and cranium bone. Please mention the characteristic of the cranium and pelvic bone based on their gender. b. Beside cranium and pelvic bone, gender can also be determined from the other long bones. What are the differences of the long bones at each gender? 3. Race can be determined based on the characteristic of the skeleton and race indexes a. Please mention the race characteristics seen on their skeleton b. Please explain about cephalic indexes and pos-cranial indexes in determining race 4. Bone aging based on skeletal appearance can be evaluated from its ossification center, teeth eruption, suture closure, symphisis appearance and preauricular surface. Please mention and explain about bone aging. 5. Besides determining sex and age, pelvic bone can also be used to determine parturitas. What’s the characteristic of parturitas on the pelvic bone? How’s the process happened? 6. How to determine blood type from the skeleton? Case 2: A 40 year old male was hit with a block wood at the right thigh during a fight. Examination revealed wound and closed fracture femur at middle 13th 1. The fracture can be seen with 2 aspects, medical and judicial. What are those terms means ? 2. Please explain in medicolegal aspect of the fracture. 3. Please define the qualification of the fracture and the reason for the qualification 4. What are the purpose of fracture qualification in the conclusion of visum et repertum Learning Task: 1. Student know about international protocol analysis 2. Student know about bone and bone change according to age 3. Student know about medicolegal aspect of violence Self Assessment I: 1. Can we determine bone age? 2. Can we differentiate between human bone and animal bone? Self Assessment II: 1. What’s the meaning of visum et repertum? Udayana University Faculty of Medicine,DME 61 MODULE 25 NSAID AND MUSCLE RELAXANT dr. I.B. Ngurah, M.Kes AIMS: Describe the pharmacologic of NSAID and muscle relaxant LEARNING OUTCOMES: 1. Describe the classification of NSAID, toxicity and interaction 2. Describe the classification of muscle relaxants, toxicity and interaction CURRICULUM CONTENTS: 1. Classification the anti-inflammatory drugs, drugs used in Gout 2. Mechanism of actions of the NSAIDs, acetaminophen and drugs used in Gout 3. Pharmacokinetics of the NSAIDs and drugs used in Gout 4. Clinical used of the NSAIDs and drugs used in Gout 5. Toxicities of the NSAIDs and drugs used in Gout 6. Drug drug interactions of the NSAIDs 7. Pharmacologic aspects of Celecoxib, Rofecoxib, Meloxicam, Diclofenac, Diflunizal, Etodolac, Ibuprofen, Indomethacine, Mefenamic acid, Naproxen, Piroxicam 8. Classification the Disesase-Modifying, Slow-Acting Antirheumatic Drugs DMARDS, SAARDS ABSTRACT The treatment of patients with inflammation involves two primary goals : first, the relief of pain, which is often the presenting symptom and the major continuing complaint of the patient; and second, the slowing or- in theory- arrest of the tissue-damaging process. Reduction of inflammation with nonsteroidal antiinflamatory drugs NSAIDs often results in relief of pain for significant periods. Furthermore, most of the nonopioid analgesics aspirin, etc also have anti-inflammatory effects, so they are appropriate for the treatment of both acute and chronic inflammatory conditions. The glucocorticoids also have powerful anti-inflammatory effects and when first introduced were considered to be the ultimate answer to the treatment of inflammatory arthritis. Unfortunately, the toxicity associated with chronic corticosteroid therapy inhibits their use except in the control of acute flare ups of joint disease. Therefore, the nonsteroidal antiinflamatory drugs have assumed a major role in the treatment of arthritis. Another important group of agents are characterized as slow-acting antirheumatic drugs SAARDs or disesase-modifying antirheumatic drugs DMARDs. They may slow the bone damage associated with rheumatoid arthritis and are tought to affect more basic inflammatory mechanism than do the NSAIDs. Unfortunately, they may also be more toxic than the nonsteroidal anti-inflammatory agents. SELF DIRECTING LEARNING Udayana University Faculty of Medicine,DME Day 25 th 62 Basic knowledge that must be known: 1. Type of NSAID 2. Pharmacology of NSAID 3. Type of muscle relaxant 4. Pharmakologic of muscle relaxant SCENARIO : A 60-year-old woman complains with intense painful, warmth, redness and great swollen in the first toe her right foot. Examination of fluid from the inflammed joint revealed crystals of uric acid. The physician diagnosed the patient as acute attack of Gout. 1. Classify the treatment strategies in Gout arthritis 2. Explain the choice treatment for acute attack of Gout 3. List the toxicities drugs for acute attack of Gout Learning Task: 1. Classify the anti-inflammatory drugs and drug used in Gout Trevor, page 307 2. Describe the mechanism of actions NSAIDs, Acetaminophen and drugs used in Gout Trevor, page 307, 311 3. Explain the pharmacokinetics of theNSAIDs Trevor, page 308 4. List the toxicities of the NSAIDs Trevor, page 309 5. Describe the clinical used of the NSAIDs Trevor, page 308 6. Describe the advantages of the COX 2 inhibitor compare with non selective NSAIDs Trevor, page 309 7. List the toxicities of the COX 2 selective inhibitor coxibs, why? Lecture, Katzung, page 583 8. Explain the interaction of the NSAIDs and drugs used in Gout with other drugs ollowing drugs Trevor, page 313

9. Describe the pharmacologic aspects of the Celecoxib, Rofecoxib, Meloxicam,