Lampiran 1Daftar Masalah (Keluhan/Gejala)

Dalam melaksanakan praktik kedokteran, dokter berangkat dari keluhan atau masalah pasienatau masalah klien. Melalui penelusuran riwayat penyakit, pemeriksaan fisik, pemeriksaantambahan, serta karakteristik pasien, keluarga dan lingkungannya, dokter melakukan analisisterhadap masalah kesehatan tersebut untuk kemudian menentukan tindakan dalam rangkapenyelesaian masalah tersebut.

Daftar ini berisikan masalah, keluhan atau gejala yang banyak dijumpai pada tingkat pelayanankesehatan primer berdasarkan alasan yang membawa pasien atau klien mendatangi dokter ataupelayanan kesehatan. Selama pendidikan dokter, mahasiswa perlu dipaparkan pada berbagaimasalah, keluhan atau gejala tersebut, serta perlu dilatih bagaimana menyelesaikan masalahtersebut. Semakin banyak terpapar oleh berbagai jenis masalah, keluhan atau gejala yang akandijumpai di pelayanan kesehatan primer, lulusan dokter diharapkan memiliki kemampuanpenyelesaian masalah yang lebih baik.

Daftar masalah ini dibagi menjadi dua, yaitu daftar masalah individu dan daftar masalahkomunitas. Daftar masalah individu perlu dikuasai oleh lulusan dokter, karena merupakan masalahdan keluhan yang paling sering dijumpai pada tingkat pelayanan kesehatan primer. Daftar masalahindividu berisikan keluhan, gejala maupun hal-hal yang membuat individu sebagai pasien atauklien mendatangi dokter atau institusi pelayanan kesehatan.

Daftar masalah komunitas berisikan daftar masalah yang dirasakan oleh masyarakat di sekitartempat dokter praktik dan berpotensi dapat menimbulkan masalah kesehatan di tingkat individu,keluarga dan masyarakat.Daftar ini tidak menunjukkan urutan prioritas masalah kesehatan.

A. Daftar Masalah IndividuMasalah yang sering dijumpai

DemamKejangDiareBatuksesak napassakit tenggoroksakit kepalaSakit dadaGatal-gatalNyeri perutStandar Kompetensi DokterPerut kembungMuntahSulit Buang Air Besar atau sembelitNyeri sendiSakit punggungPusing

Kulit kuningKulit bersisikKulit merah dan nyeriKulit berminyakLuka bakarBenjolan leherWajah kakuMata merahMata gatalMata berairMata nyeriBelekanGangguan penglihatanTimbilanKelilipanSakit telingaKopoken (telinga bernanah)

TuliTelinga gatalPilek (ingusan)MimisanBersin-bersinGangguan penciumanSakit dan sulit menelanMulut keringBau mulutSakit gigiSariawanBibir pecah-pecahBibir sumbingBatuk (kering, berdahak, darah)Berdebar-debarASI tidak keluarBenjolan payudaraLuka putingPayudara mengencangRetraksi kulit dan putingBenjolan perutPerut kramSendawaCegukanNyeri ulu hatiNyeri sesudah makanKelainan tinja (lendir, nanah, darah)AmbeinNyeri saat BABGatal daerah anusPerdarahan saat BABNyeri daerah anusNyeri saat buang air kecilAnyang-anyanganSering buang air kecil pada malam hariKencing mengedanKencing tidak puasRetensi urinInkontinensia urinAkhir kencing menetesPancaran kencing menurunKencing bercabangWaktu kencing preputium melembung/ballooningFrekuensi urinDisuriaNokturiaUrgensi

StranguriaKencing merah (hematuria)Kencing campur udara (pnematuria)FaecaluriaDarah pada muara uretraHemospermiaAnuriaPoliuriaOliguriaPerubahan warna urinNyeri buah zakarBuah zakar tidak terabaDisfungsi ereksiKeputihanVagina (gatal, nyeri, rasa terbakar)Gangguan menstruasiGangguan menjelang menopauseGangguan menopauseNyeri sendiSendi (kaku, bengkak, kelainan bentuk)Nyeri pinggangNyeri ototGerakan terbatasBengkak pada kaki dan tanganKaku pada pagi hariPusing dan pusing sebelahHilang kesadaranEpilepsiKejangKesemutanGerakan tidak teraturGangguan gerak dan koordinasiGangguan ototGangguan jalanLumpuhGangguan bicaraPelupaPerubahan perilaku (termasuk perilaku agresif)StressDepresiCemasSusah tidurPemarahNgamukPenurunan fungsi berpikirPerubahan emosi dan moodGangguan fungsi seksualPelecehan seksual

PerkosaanTanda-tanda kehamilanHiperemesisNyeri perut waktu hamilPerdarahan vagina waktu hamilAnyang-anyangan waktu hamilKaki bengkak waktu hamil

KontrasepsiSulit punya anakKehamilan tidak diinginkanPersalinan prematurKetuban pecah diniBerat lahir rendah

B. Daftar Masalah Komunitas15Kurang gizi pada balitaTidak nafsu makan pada balitaLecet pada pantatCengengGangguan pertumbuhan dan perkembangan pada balitaKecelakaan pada balitaKejang demamPenyalahgunaan obatGangguan belajarTidak mau minum obat pada anak-anakKelelahanPingsan

Perdarahan per vaginamPerdarahan traumaPerdarahan spontanMuntah darahBatuk darahPenurunan berat badan drastisObesitasGangguan komunikasiNyeri dadaNyeri punggungDischarge urethraGangguan perilaku

Masalah yang sering dijumpaiKeluarga Berencana - Kesehatan reproduksi- Koordinasi di tingkat lapangan- Kontrasepsi mantap (suntik, pil, dst)

Kesehatan Ibu dan Anak- Angka kematian ibu- Angka kematian bayi

Gizi- Gizi buruk- Sosial ekonomi

Penyakit-penyakit diare dan penyakit infeksi lain- Flu burung- HIV Aids- New emerging disease

Imunisasi- Polio- Hepatitis B

Pelayanan Kesehatan- Revitalisasi posyandu

- Polindes- Revitalitasi puskesmas- Pembiayaan pelayanan kesehatan (bantuan langsung tunai, JPKM, asuransi kesehatan, dansebagainya).- Tidak ada koordinasi yang baik antara puskesmas dengan rumah sakit. Sistem belum berjalandengan baik

Kesehatan Lingkungan* Bencana alam (banjir, gempa,)* Bencana buatan manusia (limbah, tanah longsor, kebakaran hutan, banjir lumpur panas)* Sanitasi* Pariwisata (travel medicine)

Lain-lainMedical errorInfeksi nosokomialMedical negligenceKejadian tidak diharapkan (KTD)Keselamatan pasien

Masalah-masalah organisasi pelayanan kesehatan- Gaji rendah- Disiplin rendah- Medical supplies kurang- Dana terbatas- Kualitas SDM terbatas- Data terbatas (kurang lengkap)- Informasi ilmiah terbatas- Pengobatan tidak rasional- Regulasi Pelayanan Kesehatan- Tidak melaporkan penyakit KLB- Tidak berizin

15

Lampiran 2Daftar Penyakit

Daftar penyakit merupakan penyakit-penyakit yang dipilih menurut beban penyakit yang timbulberdasarkan perkiraan data kesakitan, data kematian serta case fatality rate di Indonesia padatingkat pelayanan primer, tingkat keseriusan problem yang ditimbulkan dan efeknya terhadapindividu, keluarga dan masyarakat. Lulusan Dokter yang akan bekerja di tingkat pelayanan primerharus mempunyai tingkat kemampuan yang memadai agar mampu merujuk, membuat diagnosisyang tepat, memberi penanganan awal atau memberi penanganan tuntas. Oleh karena itu, padasetiap penyakit yang dipilih, ditetapkan tingkat kemampuan yang diharapkan akan dicapai di akhirpendidikan dokter berdasarkan perkiraan kewenangan yang akan diberikan ketika bekerja ditingkat pelayanan kesehatan primer, sesuai dengan kondisi rata-rata di Indonesia.

Apabila setelah lulus, dokter akan bekerja di daerah yang terpencil dengan kondisi pelayanankesehatan yang minimal atau di daerah khusus sehingga membutuhkan kemampuan yang lebih,diharapkan pihak yang berwenang dapat memberikan pembekalan sebelum penempatan dokter.Daftar penyakit dikelompokkan menurut sistem, organ dan tahapan usia. Berikut ini tingkatkemampuan yang diharapkan akan dicapai di akhir pendidikan.

Tingkat kemampuan yang diharapkan dicapai pada akhir pendidikan dokter

Tingkat Kemampuan 1Dapat mengenali dan menempatkan gambaran-gambaran klinik sesuai penyakit ini ketikamembaca literatur. Dalam korespondensi, ia dapat mengenal gambaran klinik ini, dan tahubagaimana mendapatkan informasi lebih lanjut. Level ini mengindikasikan overview level.Bila menghadapi pasien dengan gambaran klinik ini dan menduga penyakitnya, Dokter segeramerujuk.

Tingkat Kemampuan 2Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaanpemeriksaantambahan yang diminta oleh dokter (misalnya : pemeriksaan laboratoriumsederhana atau X-ray). Dokter mampu merujuk pasien secepatnya ke spesialis yang relevandan mampu menindaklanjuti sesudahnya

Tingkat Kemampuan 3

3a. Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaanpemeriksaantambahan yang diminta oleh dokter (misalnya : pemeriksaanlaboratorium sederhana atau X-ray). Dokter dapat memutuskan dan memberi terapipendahuluan, serta merujuk ke spesialis yang relevan (bukan kasus gawat darurat).

3b. Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaanpemeriksaantambahan yang diminta oleh dokter (misalnya : pemeriksaanlaboratorium sederhana atau X-ray). Dokter dapat memutuskan dan memberi terapipendahuluan, serta merujuk ke spesialis yang relevan (kasus gawat darurat).

Tingkat Kemampuan 4Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan pemeriksaan-pemeriksaantambahan yang diminta oleh dokter (misalnya : pemeriksaan laboratoriumsederhana atau X-ray). Dokter dapat memutuskan dan mampu menangani problem itusecara mandiri hingga tuntas.

Cardiovascular

Cardiac disordersAngina pectoris Unstable angina Myocardial Infarction Imminent Myocardial Infarction Cardiac aneurysm Heart failure Cardiorespiratory arrest Mitral stenosis Mitral regurgitation Aortic stenosis Aortic regurgitation Other valvular heart diseases VSD ASD Sinus tachycardia Supraventricular tachycardia Atrial fibrillation Atrial flutter Supraventricular extrasystole Ventricular extrasystole BBB Other arrhythmias Endocarditis Pericarditis Myocarditis Cardiomyopathy

Aorta-arteries disordersEssential hypertension Secondary hypertension Pulmonary hypertension Raynaud's disease Arterial thrombosis Coarctation of the aorta Burger's disease Arterial embolism Atherosclerosis Subclavian steal syndrome

Aortic aneurysm Dissecting aneurysm Claudicatio Cardiogenic shock Septic shock Hypovolemic shock

VeinsVarices (primary, secondary) Obstructed venous return Deep vein thrombosis Thrombophlebitis

Lymph vesselsLymphangitis Lymphadenitis Lymphedema, primary and secondary 15

RespiratoryUncomplicated Pulmonary Tuberculosis TBC with HIV TBC with pneumothorax Acute Bronchitis Bronchiolitis Bronchial asthma Status asmaticus Lung emphysema Atelectasis Bronchiectasis COPD SARS Pneumonia Avian influenzae Lung abscess Pulmonary embolism Lung infarction Pleurisy TBC Pleurisy Cancer Pleurisy Lupus Pneumothorax Cystic fibrosis Aspiration pneumonia Gastrointestinal

MouthCleft lip and palate

Micrognatia and macrognatia Leukoplakia Candidiasis Mouth ulcers (aphthous, herpes) Glossitis

EsophagusEsophageal atresia Achalasia Corrosive lesions of esophageus Esophageal varices Esophageal rupture Reflux esophaghitis

DiaphragmaDiaphramatic hernia Hiatus hernia

Abdominal wall and herniaeInguinal hernia, direct and indirect Femoral hernia – Bedah Epigastric hernia Incisional hernia Umbilical hernia

Acute abdomenPeritonitis Abscess in pouch of Douglas Ileus Perforation Salphingitis Acute appendicitis Appendicular abscess Mesenteric lymphadenitis

Stomach and duodenumGastritis Gastric/duodenal ulcer Gastrointestinal bleeding Zollinger-ellison syndrome Mallory-weiss syndrome Gastroenteritis

LiverFatty liver Hepatitis A Uncomplicated Hepatitis B Active Hepatitis C

Cirrhosis hepatis Amoebic liver abscess Liver failure

Gall bladder, bile duct and pancreasChole(docho)lithiasis Acute cholecystitis Hydrops of gall bladder Empyema of gall bladder Pancreatitis

Jejunum, ileumIntestinal atresia Meckel's diverticulum Umbilical fistula, omphalocoele-gastroschisis Malrotation Enteritis

ColonIrritable bowel syndrome Necrotizing enterocolitis Diverticulosis/diverticulitis Colitis Rectal, anal prolapse Proctitis Hemorrhoids (peri)anal abscess Fistula Anal fissure

PediatricsEsophageal atresia Intestinal atresia Anal atresia Diapragmatic hernia (congenital) Pyloric stenosis Gastro-esophageal reflux Gastro-enteritis Gastro-enteritis dengan dehidrasi Worms Dehydration Malabsorbsion Food intolerance Acute abdomen Ileus Peritonitis tuberculosis Peritonitis pancreatitis Intussussception

Malrotation Umbilical hernia Meckell's diverticulum Crohn's disease Ulcerative colitis Hirschsprung's disease Biliary atresia Hepatitis Reye's syndrome Cirrhosis of the liver Food allergy

NefrologiAcute renal failure Chronic renal failure Nephrotic syndrome Acute glomerulonephritis Chronic glomerulonephritis Interstitial nephritis Renal colic Urinary stone diseases or urinary calculi without colic Polycystic kidneys symptomatic Urinary tract infection Acute tubular necrosis Horse shoe kidney Uncomplicated Pyelonephritis Urinary incontinence Nocturnal and diurnal enuresis Prostatitis

Male genitaliaHypospadia Epispadia Undescended testes/cryptorchidism Retractile testes Torsion of testis Epididymitis Spermatocele Varicocele Hydrocele Phimosis Paraphimosis Ruptur uretra Ruptur kandung kencing Ruptur ginjal Striktura uretra Priapismus Penyakit peironi

Ekstrophia vesicae Infertility Erection disorders Ejaculation disorders

VulvaVulvitis Dystrophy of vulva Cyst of bartholin, abscess of bartholin's gland Abscess of hair follicle or sebaceous gland Condylomata acuminata

VaginaCongenital malformations Vaginitis Bacterial vaginosis Cyst of gartner Cystocoele Rectocoele Enterocoele Fistula (vesico-vaginal, uretero-vaginal, rectovaginalfistula) Foreign body

CervixCervicitis Polyps Nabothian cyst

Body of the uterusCongenital malformations Uterine prolaps Hematocolpos Endometriosis

AdnexaeSalpingitis Adhesions Ovarian cyst Polycystic ovarian disease Carcinoma of ovary Ectopic pregnancy Torsion tumour / ovarian cyst Rupture of ovarian cyst / tubo - ovarian abscess Uterine bleeding at ovulation

BreastsInflammations

Mastopathy HematologyAplastic/hypoplastic anemia Iron deficiency anemia Macrocytic anemia Hemolytic anemia Hemoglobinopathy Anemia associated with chronic diseases Polycytemia Thrombocytopenia Thrombocytosis Hemophilia Von willebrand's disease DIC Agranulocytosis Haemorheologic disorders Antiphospholipid syndrome

ImmunologyAutoimmune rheumatological and autoimmuneorthopedic disordersUncomplicated SLE Complicated SLE Scleroderma Polyarteritis nodosa Vasculitis Lupus Polymyalgia rheumatica Rheumatoid arthritis

Immunological/allergic reactionsAnaphylactic reaction Rheumatic fever Juvenile chronic arthritis Henoch-schoenlein purpura Erythema multiforme Atopy Steven johnson's syndrome Transplantation immunology Immunodeficiency -HIV

Genetics/newborn/chromossal disoerder)Genetics/congenital disordersDown's syndrome Turner's syndrome Klinefelter's syndrome Gonadal xy-dysgenesis Testicular feminization Fragile x syndrome

PKU (Phenyl Ketonuria) Galactosemia Glycogen storage disease Other storage diseases Spina bifida Anencephaly Hydrocephalus Cleft palate and/or lip Marfan's syndrome

Disorders of newbornsHypothermia Bacteraemia and septicemia Respiratory stress syndrome Bronchopulmonary dysplasia Aspiration pneumonia Pneumo thorax Apnea attacks Jaundice of newborn Severe neonatal jaundice (kern icterus) Hypoglycemia Child of diabetic mother Neonatal convulsion Necrotizing enterocolitis Retinopathy of prematurity Anemia Rhesus incompatibility Blood group incompatibility Vitamine k defficiency Cerebral hemorrhage Conjuctivitis Infection of umbilicus Sudden infant death syndrome (sids)

Endocrine, metabolic disorder and nutritionEndocrinological disordersIDDM NIDDM Complication of DM (acute and chronic) Hypoglycemia Diabetes incipidus Acromegaly, gigantism Growth hormone deficiency Hyperparathyroidism Hypoparathyroidism Hyperthyroidism Hypothyroidism Thyroiditis

Cushing's disease Adrenal cortex failure Primary hyperaldosteroidism Phaeochromocytoma Precocious puberty Testicular feminization syndrome Hypogonadism Adrenogenital syndrome Addison's disease Multiple endocrinological neoplasia (mensyndrome) Tumor with ectopic production of hormone

Nutritional deficiencyMarasmus Kwashiorkor Vitamin deficiencies

Error of metabolismHyperlipoproteinemia Porphyria Gout Obesity

Central and peripheral neural system

Loss of consciousnessMetabolic Encephalopathy Comatous Brain death

HeadacheTension headache Migraine Cranial arteritis Trigeminal neuralgia Cluster headache

Cardio Vascular DiseasesTIA Cerebral infarction Intracerebral hematoma Subarachnoid hemmorhage Hypertensive encephalopathy

Cranial nerve and brain stem lesionsBels’ palsy

Brain stem lesions

Disorder of vestibular systemMenier's disease Benign paroxysmal positional vertigo Vertigo Central

Memory deficitVascular dementia Alzheimer's disease Pick's disease

Movement DisordersParkinson's disease Tremor Secondary parkinsonism Huntington disease Chorea sydenham Dystonia 2Hemifacial spasm 2

Epilepsy and other seizuresFocal epilepsy Generalized epilepsy Absence seizure Status epilepticus Narcolepsy Sleep apnea syndrome

Demyelination diseasesMultiple sclerosis Optic neuromyelitis (Devic's disease)

Diseases of spine and spinal cordAmyotrphic lateral sclerosis (ALS) Complete spinal transection Brown sequard syndrome Cauda equina syndrome Neurogenic bladder Syringomyelia Myelopathy Dorsal root syndrome Medulla compression acute Radicular syndrome/HNP Spondilitis TB

Neuromuscular diseases and neuropathyHorner syndrome

Carpal tunnel syndrome Tarsal tunnel syndrome Neuropathy Peroneal palsy Guillain Barre syndrome Myasthenia gravis Polymyositis Duchenne muscular dystrophy Neurofibromatosis (von reckling hausen disease)

Infectious diseasesMeningitis Encephalitis Malaria cerebral Tetanus Cerebral Toxoplasmosis Tuberculoma Brain abscess HIV AIDS

Congenital disordersHydrocephalus Spina bifida Phenyl ketonuria

Pediatrics neurologic disordersMeningitis Encephalitis Cerebral abscess Epilepsi Infantile spasms Petit mal epilepsy Febrile convulsion Duchene muscular dystrophy Poliomyelitis Cerebral palsy Kernicterus Mental Retardation Autism ADHD

Neurobehaviour DisordersAmnesia Pasca trauma Afasia 2 2 3A 3B 4MCI (Mild Cognitive Impairment) VCI (Vascular Cognitive Impairment) 2

Trauma CNS

Epidural hematom Subdural hematom SAH (Sub Arachnoid Hemorrhage) Trauma Medula Spinalis

Tumor CNSTumor primer Tumor sekunder

PainNyeri Nosiseptif Nyeri neuropatik

Gangguan visualButa mendadak Diplopia Visual field disorders

Ear, nose and throatEars, hearing and equilibriumInflammation of auricle Herpes zoster oticus Pre-auricular fistula Foreign body in ear Wax (serumen) Otitis externa Acute otitis media Otitis media serous (glue ear) Chronic otitis media Perforated tympanic membrane Bullous myringitis Otosclerosis Tymphanosclerosis Cholesteatoma Presbyacusis Mastoiditis Labyrinthitis Benign postural vertigo Motion sickness Meniere's diseases Vestibular neuritis Acoustic neuroma Acute acoustic trauma Ear, other trauma Perceptive hearing loss Conductive hearing loss Congenital deafness Facial palsy or paralysis

Noses and sinusesEpistaxis Furuncle of nose Acute rhinitis (common cold) Vasomotor rhinitis Allergic rhinitis Chronic rhinitis Rhinitis medicamentosa Acute frontal sinusitis Acute maxillary sinusitis Acute ethmoiditis Chronic sinusitis Deviation of nasal septum Choanal atresia Foreign body in nose

Larynx and pharynxPharyangitis Tonsilitis Hypertrophy of adenoids Pseudo-croop acute epiglotitis

NeckMedial and lateral branchial cyst and fistula Cystic hygroma Torticollis

Thyroid glad and parathyroid glandsCyst Goitre Hyperthyroidism Hyperparathyroidism Hypoparathyroidism

TracheaAspiration Foreign bodies Tracheitis

Eye

ConjunctivaConjunctiva, foreign body Conjunctivitis, allergy Conjunctivitis, viral Conjunctivitis, bacterial

Pterygium Subconjunctival haemorrhage

EyelidsBlepharitis Hordeolum Chalazion Eyelid laceration Entropion Trichiasis Lagophtalmos Epicanthus Ptosis Eyelid retraction Xanthelasma

Lacrimal apparatusDacryoadenitis Dacryocystitis Dacryostenosis Lacrimal duct, laceration

ScleraScleritis/episcleritis

CorneaErosion Cornea, foreign body Burn Keratitis Kerato-conjunctivitis sicca Corneal oedema Corneal dystrophy Keratoconus

EyeballEndophtalmitis Microphtalmos Buphtalmos

Anterior chamberHyphaema Hypopyon

Iris and ciliary bodyIridocyclitis, iritis Tumour of iris

GlaucomaGlaucoma, congenital Simple glaucoma Acute glaucoma Secondary glaucoma

LensCataract Aphakia Psudoaphakia (artificial lens) Lens dislocation

Refraction and accommodationHypermetropia Myopia Astigmatism Presbyopia Anisometropia

Vision and visual fieldsAmblyopia Diplopia Suppresion Night-blindness Scotoma Hemianopia, bitemporal and homonymous Loss of vision and blindness

RetinaRetinal detachment Retina, vessel occlusion or bleeding Degeneration of macula, age dependent Retinopathy of prematurity (rop) Diabetic retinopathy Hypertensive retinopathy

ChoroidChorioretinitis

Vitreous fluidVitreous haemmorrhage

Optic disc and optic nerveOptic disc cupping Papilloedema Optic atrophy Optic neuropathy

Optic neuritis

Skin

Eczematous dermatitisContact dermatitis irritant Contact dermatitis allergica Atopic dermatitis (kecuali recalcitrant) Nummular dermatitis Lichen simplex chronicus Napkin eczema

Erythro-squamous lesionsPsoriasis vulgaris Plamoplantar pustulosis Seborrheic dermatitis Pityriasis rosea

Disorders of skin eccrine and sebaceous glandsAcne vulgaris Rosacea Hidradenitis suppurativa Perioral dermatitis Miliaria Viral skin infectionsVerruca vulgaris Condyloma accuminata Molluscum contagiosum Herpes zoster

Bacterial infectionsImpetigo Ulcerative impetigo (ecthyma) Superficial folliculitis Furuncle, carbuncle Erythrasma Erysipelas

Superficial fungal infectionsTinea capitis Tinea barbae Tinea faciale Tinea corporis Tinea manus Tinea unguinum Tinea cruris

Tinea pedis Tinea versicolor Mucocutaneous candidiasis

Insect bites and infestationsPediculosis capitis Pediculosis pubis Scabies Insect bites reactions

Vesicobullous diseasesPemphigus vulgaris Pemphigoid Dermatitis herpetiformis Toxic epidermal necrolysis Stevens-johnson's disease

Allergic skin diseasesUrticaria Angioedema Allergic vasculitis

Autoimmune diseasesDermatomyositis Systemic sclerosis Scleroderma/morphea Lupus erythematosus

Disorders of hairsAlopecia areata Androgenic alopecia Trichotillomania Telogen eflluvium

Disorders of keratinizationsIchthyosis vulgaris

Other nonifectious inflammatory skindisordersLichen planus Granuloma annulare Morphea Lichen sclerosus er atrphicus

Drug reactionsExanthematous drug eruption Fixed drug eruption

Pigmentary disordersVitiligo Melasma Albinism Post-inflammatory hyperpigmentation Post-inflammatory hypopigmentation

Infectious and tropical diseasesLocalized infections and abscessesInfections of the handParonychia Suppurative tenosynovitis Human bite

Infections of the head and neckSuppurative parotitis Suppurative cervical adenitis Peritonsilar abscess Ludwig's angina Bezold abscess

Gram-positive cocciStaphylococcal and streptococcal infectionsSuperficial infections, including folliculitis,hidradenitis suppurativa, carbuncle. Osteomyelitis Staphylococcal pneumonia Staphylococcal bacteremia

Streptococcal infectionRheumatic fever Sinusitis, otitis media, mastoiditis, pertonsilar abscess Rheumatic heart disease

Gram-negative cocciMeningococcal infection (neuro)Meningitis (neuro) Nasopharyngitis

Gonococcal infectionsGonorrhea

Gram-negative bacilliUrinary tract infection (UTI) Typhoid fever Dysentry bacilli Cholera

Pertussis Plague (Pes) Chancroid

Toxin producing bacteriaDiphteria (THT) Tetanus (pediatri)

Mycobacterial diseasesTuberculosis kutis Leprosy Lepra reaction

Spirochetal diseasesSyphilis Yaws Leptospirosis

Deep fungal infectionsActinomycosis Chromoblastomycosis Maduromycosis

Viral infectionsInfluenza avian influenza (THT) Viral gastroenteritis Poliomyelitis Rabies Morbilli Varicella Herpes zoster Herpes simplex Mumps CMV infections Dengue hemorrhagic fever (DHF) HIV-AIDS

Protozoal infectionsAmebiasis Malaria Leishmaniasis dan tripanosomiasis Toxoplasmosis Giardiasis Trichomoniasis

Worms infestationsHookworm diseases

Strongyloidiasis Ascariasis Filariasis Schistosomiasis Cutaneus larva migran Taeniasis

Neoplasma

Blood and lymph nodesNon-hodgkin's lymphoma Hodgkin's lymphoma Acute leukemia Chronic leukemia Myelodysplastic syndromes Multiple myeloma Langerhans' cell histiocytosis

LungBronchogenic carcinoma Bronchoalveolar carcinoma Neuroendocrine tumor (carcinoid tumor) Mesothelioma

Head and neckLeukoplakia Polyps Nasopharynx carcinoma Pleomophic adenoma Warthins tumor

GatrointestinalBenign polyps Squamous cell carcinoma Adenocarcinoma Carcinoid tumor Lymphoma

Liver - HepatomaLiver cell adenoma Hepatocellular carcinoma Cholangiocarcinoma

PancreasCarcinoma of the pancreas

KidneyCortical adenoma Renal cell carcinoma Wilm's tumor

Male genitalsSquamous cell carcinoma Seminoma Teratoma testis Benign prostatic hyperplasia Carcinoma of the prostate

Female genitalsCondyloma accuminata Cervical carcinoma Extramammary Paget's disease Endometrial hyperplasia Endometrial carcinoma Ovarial teratoma (dermoid cyst) Ovarian carcinoma Hydatidiform mole Choriocarcinoma

BreastFibrocystic change Fibroadenoma mammae Phyllodes tumor Breast carcinoma Paget's disease of the breast Gynecomastia

Endocrine glandsSomatotropic adenoma Prolactinoma Thyroid adenoma Thyroid carcinoma

ThymusThymoma

SkinBenign epithelial tumors 1Seborrheic keratosis Epithelial cyst

Premalignant and malignant epithelial tumorsActinic keratosis

Bowen's disease Squamous cell carcinoma Basal cell carcinoma

Tumors of the dermisXanthoma Hemangioma Lymphangioma Angiosarcoma

Tumors of immigrant cells to the skinMycosis fungoides Mastocytosis Langerhans' cell histiocytosis

Tumors of melanocytic cellsLentigo Nevus pigmentosus Malignant melanoma

Bone and soft tissueOsteoma Osteoid osteoma Osteoblastoma Osteosarcoma Osteochondroma Chondroblastoma Chondrosarcoma Fibrous dysplasia Fibrosarcoma and mfh Ewing sarcoma Giant cell tumor Ganglion cyst Lipoma Liposarcoma Fibromatosis Desmoid tumor Fibroma Fribrosarcoma Benign fibrous histiocytoma Malignant fibrous histiocytoma (mfh) Rhabdomyosarcoma Leiomyoma Leiomyosarcoma Synovial sarcoma

Central and peripheral nervous systemAstrocytoma

Oligodendroglioma Ependymoma Medulloblastoma Retinoblastoma Meningioma Neurofibroma Schwannoma

Psychiatry and mental health

Developmental and behavioral disordersMental deficiency Autistic disorder Disorder of intellectual skills Disorder of motor development Disorder of coodination Behavior and attention disorders

Eating disordersAnorexia nervosa Bulimia Pica Rumination in infancy

Gender identity disorder

TicsGilles de la tourette syndrome Chronic motor of vocal tic disorders Transient tic disorders

Disorders of excressionFunctional encoperasis Functional enuresis

Speech disordersUncoordinated speech Stammer

Psych-organic syndromes and disorders due todrugsIntoxication Withdrawal syndrome Delirium Dementia Amnesic syndrome Other organic disorders

Misuse of psychoactive drugs

PsychosisSchizophrenia Other psychoses including reactive psychosis andpuerperal psychosis

Affective disorders

Bipolar disordersBipolar disorder, manic episode Bipolar disorder, depressive episode Cyclothymic disorder

Unipolar disordersEndogenous depression, single episode and recurrent Dysthymic disorder (or neurotic depression) Depressive disorder not otherwise classified

Anxiety disordersPanic disorder with agoraphobia Panic disorder without agoraphobia Agoraphobia without history of panic disorder Social phobia Simple phobia Obsessive compulsive disorder (neurosis) Post traumatic stress disorder Diffuse anxiety disorder Anxiety disorder not otherwise classified

Somatic disorderDisorder of body sensation Conversion disorder (hysterical neurosis) Hypochondriasis (hypochondriacal neurosis) Somatisation disorder Somatoform pain disorder Undifferentiated somatoform disorder Somatoform disorder not otherwise classified

Dissociative disorders (or hysterical neurosis,dissociative form)Multiple personality Fugu states Psychogenic amnesia Depersonalisation disorder or depersonalisation

neurosis

Dissociative disorder, noc

Sexual disordersParaphilia

Sexual dysfunctionsDisorder of sexual desire Disorder of sexual exitement Disorder of orgasm Sexual pain disorders Sexual dysfuctions, noc

Other sexual disordersSexual disorders, noc

Sleeping disorders

DyssomniaInsomnia Hypersomnia Sleep-wake cycle disturbances

ParasomniaNightmares Night terrors Sleep walking

Disorder of impulse control Adjustment disorder Psychological factors affecting physicalcondition Personality disordersParanoid personality Schizoid personalinty Schizotypal personality Antisocial personality Borderline personality Histerionic personality Narcisistic personality Avoidance personality Dependent personality Obsessive-compulsive personality Passive-aggressive personality Personality disorders, noc

Side effects of psychoactive drug therapyExtrapyramidal side effects (eg. Acute dystonia, tradivedyskenia, parkinsonism) Anticholinergic side effects Sedative side effects Malignant neuroleptic syndrome

Other items of knowledgeKnowledge of forensic psychiatry Knowledge of indication for involuntary admission tohospitalKnowledge of basic principles of methods used bydifferent psychotherapeutic schools (eg. Rogerrian,psychoanalytic, etc)

Neuropsychiatric and psychosomatic disorders(pediatrics)Pseudoconstipation Encopresis Anorexia nervosa Bulemia Tics, neuropathic behavior Hyperkinetic syndrome Primary infantile autism Disorders of mother-child relationship Disorders due to social deprivation Neurotic disorder of chilhood Breath holding due to exitement

Musculoskeletal system

Bone and joints (pediatrics)Congenital dislocation of the hips Arthritis Genu varum (bow legs) Genu valgum (knock knee) Pes planus Scoliosis Kyphosis Lordosis Terthes disease Slipped epiphysis Osgood-schlatter diseasev Chondromalacia patellae Club foot Marfan's disease

Osteogenesis imperfecta Bone cyst Achondroplasia

Generalized disorders of the musculoskeletalsystemRickets, osteomalacia Osteoporosis ? Fibrous dysplasia ? Paget's disease ?

Localized disorders of the musculoskeletalsystemPhysical overload Aseptic necrosis of bone Osteomyelitis, acute Arthritis Trauma of joint cartilage Trauma of joint capsule Ganglion Primary bone tumors Bone metastasis Pathological fracture

Degenerative disorders of jointsArthrosis deformans Crystal arthropathy Rheumatoid arthritis Bechterew disease

SpineSpina bifida Sacrococcygeal teratoma Scoliosis Kyphosis Lordosis Spondylarthrosis, spondylosis Spondylitis, spondylodiscitis Hernia of nucleus pulposus Spondylolisthesis Spondylolysis Metastases from elsewhere Pathological fractures Fractures and dislocations of spine Spinal transaction

Pelvic and lower extremitiesCongenital hip dislocation

Hip dysplasia Femoral head necrosis Intermittent arthritis of the hip Fractures of pelvis Fractures of hip Dislocation of hip Ligamentous lesions of hip Arthritis of hip Fractures of femur Fractures, capsule, tendon and ligament lesions ofkneeLesion of meniscus, medial and lateral Abnormal patellear cartilage Genu varum, genu valgum Osteochondritis dissecans Arthritis of the knee Achilles tendonitis Rupture of achilles tendon Tarsal tunnel syndrome Instability of ankle In growing toe nail Pes planus Club foot Claw foot Hallux valgus Hammer toe Metatarsalgia Onychogryposis Anisomelia

Traumatology

Birth traumaCaput succedaneum Brachial plexus injury Fracture (clavicle, humerus, rib)

Trauma (Tergantung ringan sampai berat)Drowning Head injury Burning Poisoning Suffocation Bleeding Hypovolemic shock Dislocation of jaw Fracture of jaw

Dislocation of knee Dislocation of patella Prepatellar bursitis Fractures of tibia Rib fractures/contusion Injury caused by rib fractures Sternal fractures Fractures of toes Crush injury to the heel (in children) Standar Kompetensi DokterFractures of fibula Whiplash Fractures, capsule, tendon and ligament lesions ofanklePneumothorax Hemothorax Injury to specific internal organs, such as liver,kidney, lung, etc

Peripheral nervesInjury of peripheral nerves

Neck, shoulder girdle and upper extremitiesFractures of shoulder Dislocation of shoulder Ligamentous lesions of shoulder Instability of shoulder Frozen shoulder Fracture of clavicle Fracture of humerus Fracture of radius/ulna Fractures, capsule, tendon, ligament lesions ofelbowFractures, capsule, tendon, ligament lesions of wrist Fractures, capsule, tendon, ligament lesions offingers and thumbLateral epicondylitis (tennis elbow) Dislocation of distal radius Dislocation of wrist Progressive inflammation of finger following injury Olecranon bursitis Carpal tunnel syndrome Injury to finger tendon, e.g. Boutonniere-deformity Mallet finger Dupuytren's contracture Nail loss Subungual hematome Traumatic vessel injury

Accidents and emergency neurologyHead injuries Diffuse brain damage Cerebral concussion and contusion Brain death Extradural hemorrhage Subdural hemorrhage Basilar fracture scalp Acute traumatic spinal transaction Injury of plexus and peripheral nerves

Reproduction systemInfection during pregnancy/deliverySyphillis Rubella CMV infection Toxoplasmosis AIDS Gonorrhoea Herpes virus infection type 2 Hepatitis B

Drugs and harmful substance duringpregnancyMother taking tobacco Mother taking drugs of addiction

Pregnancy disordersThreatened abortion Incompleted spontaneous abortion Completed spontaneous abortion Hyperemesis gravidarum Blood group incompatibility Hydatidiform mole Intra-uterine infection Pregnancy induced hypertension Pregnancy induced diabetes mellitus Dysmaturity Placental insufficiency Placenta previa Vasa previa Abruptio placenta - SOL Cervical incompetence Polyhydramnion Jaundice late in pregnancy Urinary tract infection Pyelitis in pregnancy

Iron dificiency anaemia Megaloblastic anaemia Dead fetus

DeliveryPremature contractions Premature delivery Rupture of uterus Postmature infant Premature rupture of membranes Unstable lie / malposition after 36 weeks Dystocia, fetal and passage Malpresentation of fetus Prolonged delivery Primary mild contractions – IMININ Secondary mild contractions Cord presentation / cord prolapse Hypoxia of fetus Failure to rotate / incorrect rotation Rupture of cervix Rupture of perineum Shoulder distortion, infant Retained placenta

PostpartumRetained placental tissue Uterine inversion Postpartum haemorrhage Thrombo – embolism Blood group incompatibility

PuerperiumMastitis Cracked nipple Inverted nipple Endometritis Inflammation of pelvis (salpingitis, pelviperitonitis,perimetritis etc)Incontinence of urine Incontinence of faeces Deep venous thrombosis Thrombophlebitis Embolism Post-natal psychoses Post-natal depression Subinvolution of uterus

Lampiran 3Daftar Keterampilan Klinis

Keterampilan adalah kegiatan mental dan atau fisik yang terorganisasi serta memiliki bagian-bagiankegiatan yang saling bergantung dari awal hingga akhir. Dalam melaksanakan praktik dokter,lulusan dokter perlu menguasai keterampilan klinis yang akan digunakan dalam mendiagnosismaupun menyelesaikan suatu masalah kesehatan. Keterampilan klinis ini perlu dilatihkan sejakawal pendidikan dokter secara berkesinambungan hingga akhir pendidikan dokter.

Daftar keterampilan klinis dikelompokkan menurut bagian atau departemen terkait. Pada setiapketerampilan klinik ditetapkan tingkat kemampuan menggunakan Piramid Miller (knows, knowshow, shows, does) yang diharapkan dicapai oleh mahasiswa di akhir pendidikan.Berikut ini pembagian tingkat kemampuan menurut Piramid Miller :

Tingkat kemampuan 1 Mengetahui dan MenjelaskanLulusan dokter memiliki pengetahuan teoritis mengenai keterampilan ini, sehingga dapatmenjelaskan kepada teman sejawat, pasien maupun klien tentang konsep, teori, prinsip maupunindikasi, serta cara melakukan, komplikasi yang timbul, dan sebagainya.

Tingkat kemampuan 2 Pernah Melihat atau pernah didemonstrasikanLulusan dokter memiliki pengetahuan teoritis mengenai keterampilan ini (baik konsep, teori,prinsip maupun indikasi, cara melakukan, komplikasi, dan sebagainya). Selain itu, selamapendidikan pernah melihat atau pernah didemonstrasikan keterampilan ini.

Tingkat kemampuan 3 Pernah melakukan atau pernah menerapkan di bawahsupervisiLulusan dokter memiliki pengetahuan teoritis mengenai keterampilan ini (baik konsep, teori,prinsip maupun indikasi, cara melakukan, komplikasi, dan sebagainya). Selama pendidikanpernah melihat atau pernah didemonstrasikan keterampilan ini, dan pernah menerapkanketerampilan ini beberapa kali di bawah supervisi.

Tingkat kemampuan 4 Mampu melakukan secara mandiriLulusan dokter memiliki pengetahuan teoritis mengenai keterampilan ini (baik konsep, teori,prinsip maupun indikasi, cara melakukan, komplikasi, dan sebagainya). Selama pendidikanpernah melihat atau pernah didemonstrasikan ketrampilan ini, dan pernah menerapkanketerampilan ini beberapa kali di bawah supervisi serta memiliki pengalaman untukmenggunakan dan menerapkan keterampilan ini dalam konteks praktik dokter secara mandiri.

Internal Medicine:

Physical examinationGeneral Surveyassessment of mental status assessment of apparent state of health assessment of nutritional condition assessment of habitus and posture assessment of respiration

palpation of pulse measurement of blood pressure measurement of jugular venous pressure measurement of height and weight inspection and palpation of skin inspection of mucous membranes palpation of lymph nodes

Head/neckinspection of eyes, nose, mouth and throat chvostek’s sign palpation of salivary glands throat swab palpation of thyroid gland palpation of trachea palpation of carotic arteria

The spineinspection at rest inspection in motion percussion for tenderness palpation for tenderness palpation for pain on vertical pressure (eg pressing down on shoulders)assessment of lumbar flexion

Thoraxinspection at rest inspection during respiration palpation of respiratory expansion palpation of tactile fremitus palpation of apex beat percussion of lungs, lung bases, cardiac size auscultation of lungs auscultation of heart inspection of breasts palpation of breasts

AbdomenInspection auscultation (bowel, sounds, bruits) percussion (especially liver, Traube’s area bladder dullness) palpation (abdominal wall, colon, liver,spleen, aorta, rigidity)eliciting abdominal tenderness and reboundtendernesseliciting shifting dullness eliciting a fluid thrill eliciting renal tenderness

Perineal examinationinspection of perianal area rectal examination palpation of prostate palpation of pouch of Douglas palpation of adnexae palpation of sacrum inspection of glove

Examination of female genitaliainspection of vulva, perineum vaginal examination: palpation of vagina,uterus, adnexae

Examination of male genitaliaInspection of penis Inspection and palpation of scrotum

Extremitiesinspection of skin, nails, muscle tone inspection of joints assessments of capillary pulse assessments of capillary refill palpation of arterial pulses detection of bruits palpation of skin, tendons, joints assessments of range of motion of joints examination of sensory system examination of monitor system eliciting reflexes: knee reflex, ankle reflex,triceps reflex,biceps reflex, plantar response

Diagnostic proceduresVenapuncture arterial puncture finger prick preparation and examination of blood film preparation and examination of urinary sedimentpreparation and examination of sputum preparation and examination of stool Gram stain Ziehl Nielsen X-ray examination: plain film X-ray contrast examination CT-scan NMR/MRI scintigraphic examination

Echography gastric endoscopy Proctoscopy kidney or liver biopsy tapping ascites pleural tap pathological examination of biopsy electrocardiography exercise ECG testing Phonocardiolography Doppler examination Holter examination cardiac catheterization automatic blood pressure measurement echocardiography lung function tests/spirometry histamine provocation test allergy tests hyperventilation provocation test perfusion/ventilation scan Bronchoscopy joint aspiration

Therapeutic skillsto advice a patient about life-style to prescribe a diet subcutaneous and intramuscular injection administration of insulin intravenous cannulation mouth to mouth resuscitation cardiac massage initiate resuscitation nasogastric tube Contraventil needle (needledecompression)

WSD Endoscopy bladder catheter renal dialysis sclerotherapy for varicose veins

Neurology: Skills listPhysical examinationCranial nerve functionassessment of sense of smell inspection of width of palpebral cleft

inspection of pupils (size and shape) pupillary reaction to light pupillary reaction of close objects assessment of extra-ocular movements assessment of diplopia assessment of nystagmus corneal reflex assessment of visual fields test visual acuity fundoscopy assessment of pupil assessment of facial symmetry assessment of strength of temporal andmasseter musclesassessment of facial sensation assessment of facial movements assessment of taste assessment of hearing (lateralization, airand bone conduction)assessment of swallowing inspection of palate test gag reflex assessment of sternomastoid and trapezius musclestongue, inspection at rest tongue, inspection and assessment of motorsystem (e.g. sticking out)

The motor systeminspection: posture, habitus involuntarymovementsassessment of passive stretch assessment of muscle strength assessment of strength of individual muscles

Coordinationinspection of gait (normal, on heels, ontoes, hopping in one place, heel-to-toe)shallow knee bend Romberg’s test reaction to a push (balance) point-to-point testing: between index fingerand nosepoint-to-point testing: heel on opposite knee, running down to big toetesting for dysdiadochokinesis

The sensory systemassessment of sense of pain assessment of sense of temperature assessment of light touch assessment of extinction phenomenon assessment of vibration assessment of position sense assessment of discriminative sensations (e.g. stereognosis)

Radicullar sensation disordersLasègue’s sign

Higher functionsassessment of level of consciousness bymeans of Glasgow coma scaleassessment of orientation assessment of aphasia assessment of apraxia assessment of agnosia assessment of new learning ability assessment of memory assessment of concentration

Reflexes

Physiological Reflexestendon reflexes (biceps, reflex, triceps reflexknee reflex, ankle reflex)

plantar response abdominal reflexes cremaster reflex anal reflex

Pathological ReflexesHoffmann-Trömner sign

Plantar response (Babinski Group)

Primitive Reflexessnout reflex rooting reflex grasp reflex glabela reflex -4-palmomental Reflex -4-

Othersdetections of neck stiffness assessment of fontanelles patrick’s and contra Patrick’s sign -1- -2- -4- -4-chvostek’s sign -1 -2- -4-

Additional diagnostic investigationsX-ray skull X-ray spine Seldinger angiography Myelography

Caudography CT-scan of cerebrum EEG EMG, EMNG ENG Brain mapping PET, SPECT visual evoked response examination,

BAEP, SSEP

digital substraction angiography duplex-scan of vessels biopsy of muscle lumbar puncture lumbar puncture, Queckenstedt test MRI, MRA

Therapeutic skillsLaminectomy therapeutic spinal tap opening the skull surgery for acoustic neuroma surgery of pituitary gland surgery for extradural haemorrhage surgery for subdural haemorrhage surgery for cerebral tumour surgery for carpal/tarsal tunnel syndrome surgery for intra cerebral aneurysm

The spineInspection at rest Inspection in motion Percussion for tenderness Palpation for tenderness Palpation for pain on vertical pressure Assessment of lumbar flections

Psychiatry: Skills listHistory takingpsychiatric history taking, from the patient, general psychiatric history taking, from the patient, biographical details

psychiatric history taking, social history psychiatric history taking, from a thirdperson

Psychiatric examination

assessment of consciousness assessment of perception assessment of orientation assessment of intelligence assessment of memory assessment of thought (form and contents) assessment of affect assessment of mood assessment of actions assessment of desire impression, general, systematic description being aware of personal reactions evoked by seeing a patientassessment of suicidal risk

Identifying problemsidentifying problem with the patient alone identifying problem with the couple (i.e.with partners)identifying problem with the family identifying problem in a crisis situation identifying problem after suicide attempt identifying problem with a group presenting psychiatric problem tocolleagues

Additional examinationadministering Mini Mental State Exam home visit psychological examination recognition and interpretation of the repeating patterns in interactionTo diagnose most likely according to DSM IIIR main criteriaindication for psychiatric hospitalization

Therapyconsulting team, participation in consultationoccupational therapy play therapy creative therapy psychomotor therapy electroconvulsion therapy (ECT) counselling therapy behaviour therapy psychotherapy hypnotherapy

Paediatrics: Skills listHistory takinghistory taking from third party taking a feeding history

history taking older child talking with anxious parents/ parents with a very ill child

Physical examinationgeneral physical examination with special attention to age of patient

Newborn and infantassessment of general condition, arousal, behaviour,crying

looking for congenital malformations palpation of fontanelles moro response palmar grasp reflex rooting reflex/suck reflex stepping reflexes vertical suspension positioning asymmetric tonic neck reflex anal reflex examination of hips

All agesphysical and developmental assessment assessment of speech and language development weight measurement of body length measurement of head circumference measurement of blood pressure measurement of temperature measurement of body mass index

Therapeutic skills, examinations and operation of thechildprescription of food for infant, In term a mother canunderstand

assessment of vision ewing test finger prick venepuncture insertion of cannula (peripheral vein) insertion of cannula (central venous) rumple Leed Test intubation resuscitation oropharyngeal tube insertion lung function test, peak flow meter cranial ultrasound EEG

lumbar puncture echocardiography cardiac catheterization

Surgery: Skill listPhysical examinationgeneral physical examination digital rectal examination bimanual ginjal

Orthopaedic examinationassessment of muscle atrophy determination range of motion of head inspection shoulder / upper extremity test function of shoulder joint test function of muscles and elbow joint test function of wrist joint, metacarpal and finger jointsinspection of posture of spine/pelvis inspection of scapula position inspection of flexion and extension of back assessment of lumbar flexion palpation of spine, sacro-iliac joints, back muscles inspection of gait measurement of length of lower extremities hip: assessment of flexion and extension, adduction, abduction and rotationknee : assessment of cruciate ligaments, collateral ligamentsassessment of menisci feet : inspection of posture and shape feet : assessment of dorsal / plantar flexion, inversion, eversion

Examination of patient with varicose veinsTrendelenburg test Perthes test

Examination of arterial vascular disordersposture tests of arterial insufficiency reactive hyperaemia test of arterial insufficiency capillary refill

Examination of abdominal herniainspection of groin during increased abdominal pressurepalpation of hernia

Examination of male genitaliapalpation of penis, testes, epididymis spermatic duct transillumination of scrotum urethral swab

Accident and emergencyfirst aid assessment of consciousness by means of Glasgow coma scaleexternal cardiac massage mouth-to-mouth/ nose resuscitation mask ventilation Intubation assessment and care external injuries (wounds, bleeding, burns, distortion, dislocation, fractures)stop bleeding (direct pressure, pressure point, pressure bandage)transport of casualty Heimlich manoeuvre apply a bandage fluid rescucitation

Additional examinationradiography (plane films) Arthrography Arteriography Scintiscan CT MRI ultrasound Endoscopy biopsy Uroflowmetry micturating cystography urodynamic examination Reflek bulbokavernos

Therapeutic skillspre-operative preparation of operative field forminor surgery, asepsis, antisepsis, local anaesthesiapreparation to watch/to assist in theatre scrub-up,gown up, put on sterile gloves etc)infiltration anaesthesia local nerve block incision and drainage of abscess wound cleaning wound debridement with scalpel and scissors wound stitching wound, removal of sutures wound care for burns apply a pressure dressing fracture repositioning, closed fracture stabilisation (without plaster) reduction of dislocation apply a sling nail bed cauterisation

nail removal nasogastric suction nasogastric insertion urethral catheterization in male urethral catheterization in female Clean intermitten chatheterization (Neuropathicblader)

Circumcision dorsumcircumcision Pungsi suprapubik

Operative surgeryEvery doctor should have attended the theatre several times to observe different operations. Thisexperience should give him/her an impression of what goes in surgery during operation, workingwith a team, the burden of surgery for a patient, and the relationship with pre-and postoperativecare.

Gynaecology / obstetrics : Skills list

colostomy, changing the bag enema injection of varices with sclerosant venous cannulation administration of analgesics to attend oncological patient regarding social andpsychological issues

GynaecologyPhysical examinationgeneral physical examination including breast inspection and palpation of external genitalia speculum examination: inspection of vagina andcervixbimanual examination : palpation of vagina, cervix, uterine corpus, ovariesrectal examination : palpation of pouch of Douglas,uterus combined recto-vaginal septum

Additional diagnostic examinationgenital discharge : smell genital discharge : pH genital discharge : gram stain genital discharge : vaginal swab genital discharge : examination with saline genital discharge : examination with potassium hydroxideendocervical swab and cervical scraping colposcopy abdominal ultrasound examination of uterus vaginal ultrasound examination of uterus curettage suction curettage

laparoscopy, diagnostic

Additional diagnostic tests for sub fertilityphysical examination of male genitalia assessment of results of semen examination basal temperature curve, instruction, assessment ofresults

examination of cervical mucus, fern test post-coital test, obtaining material, preparing and assessing slidehystero salpingography insufflation of Fallopian tubes artificial insemination

Therapy and preventioninstructions for self-examination of breasts insertion of pessary insertion of urinary catheter electro-or crycoagulation cervix laparoscopy, therapeutic

Contraception/ sterillizationadvise about contraception insertion I.U.D laparoscopic sterilization

ObstetricsSelection of high-risk pregnancy for Hospitalization/ clinical care

Pregnancyattending pregnant women inspection of abdomen of pregnant woman palpation : fundal height, Leopold’s manoeuvre, external assessment of positionassessment of fetal heart rate internal examination in early pregnancy pelvic examination pregnancy test, urine CTG : performance and interpretation ultrasound examination amniocentesis chorionic biopsy

Practical obstetricsNormal Deliveryattending woman in labour CTG : performance and interpretation obstetric examination (assessment of cervix, dilatation, membranes, presentation of fetus, descent)artificial rupture of membranes

insertion of catheter for intra-uterine pressure inspection and support of perineum local anaesthesia of perineum pudendal anaesthesia epidural anaesthesia episiotomy receive/ hold newborn aspiration of mouth/throat of newborn infant record Apgar score clamp cord/separation of placenta examination umbilical cord physical examination of newborn postpartum : examination fundal height, placenta: loose/ retaineddelivery of placenta examination of placenta and umbilical cord measure/estimate loss of blood, after delivery repair of episiotomy and lacerations chemical induction of labour support delivery in breech presentation fetal blood sampling assisted vaginal delivery caesarean section manual removal of placenta

Puerperiumassist and check mother and newborn assessment of lochia palpation of position of fundus breasts : inspection, lactation advice on hygiene discussing contraception inspection episiotomy scar inspection caesarean section scar

Dermatology: Skills listPhysical examinationLevel of expected abilityskin, inspection with magnifying glass skin, inspection with UVA-light (Wood’s lamp) nails, inspection dermographism skin palpation

Terminology of skin lesionsskin lesions description with primary and secondarychanges, as well as size, distribution, expansion andconfiguration

Additional examination of dermatological problemspreparation and assessment of potassium hydroxide slidepreparation and assessment of methylen blue slide preparation and assessment of gram stain urethral swab anal swab parasite identification punch biopsy patch test prick test colposcopy for condylomata acuminata proctoscopy

Therapy of skin diseasesskin, incision/ drainage of abscess skin, excision of tumour cryotherapy on tumours warts, cryotherapy acne, treatment of comedones wound care to apply a dressing varicose veins, compressive sclerotherapy varicose veins, ambulant compressive therapy on venous leg ulcerhaemorrhoids masking therapy phototherapy

Preventioncontact tracing

Otorhinolaryngology (ENT): Skills listDiagnostic skillsEars, hearing, equilibriuminspection of auricle, position of ear and mastoid examination of external auditory meatus with otoscope examination of thympanic membrane with otoscope use of head mirror use of head light hearing tests, tuning fork examination (Weber, Rinne, Schwabach)hearing tests, with whispering voice tone audiometry speech audiometry audiological examination of children pneumatic otoscopy (Siegle) performance and interpretation of tympanometry vestibular examination ewing test electronystagmography

Nose, sinusesinspection of shape of nose and nostrils assessment of nasal obstruction testing sense of smell anterior rhinoscopy transillumination of frontal sinuses nasopharyngoscopy ultrasound of sinuses radiology of sinuses, interpretation

Mouth, throat, speech, oesophagus, necktest taste sensation inspection lips and oral cavity inspection tonsils assessment of mobility of tongue assessment of mobility of hypoglossal muscles palpation of salivary glands (submandibular, parotid) inspection of base of tongue (with laryngoscope) inspection of nasopharynx cavity (withnasopharyngoscope, head mirror and laryngoscope)inspection of hypopharynx (with laryngoscope/ hypopharyngoscope)throat swab laryngoscopy, indirect

ENT SurgeryEvery doctor should have attended several operations on the ear, noses and throat duringhis training

Ophthalmology : Skills listlaryngoscopy, direct assessment of voice and speech speech assessment oesophagoscopy inspection of neck palpation of branchial lymph nodes palpation of thyroid gland

Therapeutic skillspolitzerization test valsalva manoeuvre insert cotton wool probe in ear cleaning external auditory meatus with swab removal of wax with hook or curette syringing the ear paracentesis ear, removal of foreign body insertion of grommet

to adjust hearing aid stopping a nose bleed packing the nose nose; removing of foreign body sinus lavage puncture of sinuses antroscopy tracheostomy intubation

General ophthalmologic examinationVisionassessment of vision assessment of vision, infant/ child

Refractionassessment of refraction, subjective assessment of refraction, objective (refractometry keratometer)

Visual fieldsvisual fields, Donders confrontation test visual fields, Amsler panes

External inspectioneyelids, inspection eyelids, inspection bye eversion of upper lid eyelash, inspection conjunctivae, inspection, including fornix sclerae, inspection lacrimal apparatus, inspection lymph nodes, pre-auricular, palpation

Position of eyesposition with corneal reflex images position with cover test eye movements, examination binocular vision, assessment

PupilsPupils, inspection Pupils, direct reaction to light and convergence

Mediamedia of eye, inspection by transillumination cornea, inspection cornea, inspection with fluorescein cornea, determination of sensation

anterior chamber, inspection iris, inspection lens, inspection slit-lamp examination

Fundifundoscopy, bringing the fundus into focus optic disc, inspection, discrimination between normal and abnormalretina vessels, inspection, discrimination between normal and abnormal

Intra-ocular pressureintra-ocular pressure, estimation by palpation intra-ocular pressure, measurement by indentationtonometer (Schiötz) or non-contact-tonometerintra-ocular pressure, measurement by aplanation tonometer

Additional general ophthalmological examinationdetermination of refraction after cycloplegia (skiascopy)fundus contact lens examination, e.g. gonioscopy measurement of lacrimal production measurement of exophthalmos (Hertel) lacrimal ducts, rinse through (Anel)

Special ophthalmological examinationorthoptic examination perimetry contact lenses (examination) colour vision test electroretinography electro-oculography eye, visual evoked potentials (VEP/VER) eye, fluorescein angiography (FAG) eye, echographic examination: ultrasonography (USG)

Therapeutic skillseye drops instillation eye ointment application flood ocular tissue eye, eversion upper eyelid with swab (removal of foreign body)to apply eyes dressing eye, removal of contact lens or eye prosthesis removal of eye lashes cornea, removal of foreign body and debris

Surgical therapyeye, laser therapy cataract, surgery squint, surgery

vitrectomy glaucoma surgery, trabeculotomy corneal transplantation eye, cryocoagulation : e.g. cyclocryocoagulation eyelid surgery (chalazion removal, entropion,ectropion, ptosis)detached retina, surgery

G eneral practice : Skills listThe eyeremoval of foreign body (conjunctiva) removal of foreign body (cornea)

The earremoval of wax syringe removal of foreign body (by syringing ear)

External and internal genitaliaendocervical swab examination of discharge (taking swab for culture,preparation of slide with saline and potassiumhydroxide)

The armdrainage of bursa, ganglion to apply a dressing (sling, shoulder bandage, finger bandage, hand bandage)

The legtreatment of leg ulcers to apply a dressing (leg bandage, foot bandage,ankle bandage, knee bandage)

Skin, mucosa and subcutaneous tissueadministration of drugs, intravenous administration of drugs, intramuscular administration of drugs, subcutaneous administration of drugs, intracutaneous application of topical anaesthetics (drops, spray) administration of local anaesthetics administration of nerve block incision of abscess excision of warts wound care suture a wound treatment of burns removal of splinter disinfection

COMMUNICATION AND RECORDING (4)Formulating orally and in writingEducating, advising and coaching of individuals and groupsMaking a management planTherapeutic consultationDrug prescriptionOral and written communication with colleagues and other health care professional (referral, consultation)Reporting and making recordInformation processing and applying (especially from scientific literature)

PUBLIC HEALTH MEDICINE (4)Prevention (vaccination policy included)Recognition of hazardous behaviour and life stylePerforming directed medical examinationAssessment of absent due to illnessPerformance of environmental researchPerformance of several interventions in the domain of primary, secondary and tertiary prevention like vaccination, periodical medical examination, social medical support and management, prevention of accident and set up a programme/ plan for individuals, their environment or an institution.Patient safety

Laboratory investigation, bloodfinger prick determination of sedimentation rate determination of Hb determination of blood glucose concentration monospot test

Laboratory investigation, urinetesting for protein testing for glucose testing for bile testing for blood preparation of slide and microscopy of urine dip slide method (urine culture) pregnancy test testing for Sputum

Laboratory investigation, faeces occult blood protozoa intestinal helminth

Death Certification