Me: 34 weeks + 1 day POA, EDD was 3 February 2011
Dr : (Showing the red book) This is the patient past obstetric history. Summarize it
Doctor's Summary (obviously!)
In summary, the patient, G6P5 at 34 weeks with 4 living children with history of low birth weight baby and history of premature labour at 28 weeks for last child. the child died at 2 months of age. Currently came with premature labour. Examine this patient abdomen.
During examination I could not heard fetal heart upon auscultation (even after given 3 chances)
Dr : You never practice ye...(dusH! head shot..)
So basically singleton fetus with longitudinal lie, cephalic presentation, head 2/5 palpable.
Dr : If you are the houseman at screening what do you want to do.
Me: After history and physical examination, I would like to time contraction. Exclude Braxton-Hick and true premature contraction. I would like to do speculum examination to look for vulva vagina excoriation, liquor, sign of infection such as candidiasis (tembak!) and opening of os
Dr : Really candidiasis? What causes premature labour? Infective causes. (Dr must have expected me to go around the bush with all sort of answer..haha)
Me: Bacterial vaginoses, group B streptococci.....candidiasis, I'm not sure.
Dr : Candida did not cause premature contraction. How would you manage?
Me: I would like to investigate...
Dr : You haven't finish your PE. What else in vaginal examination?
Me: (Knock in the head) I would like to check for the station, cervical opening and effacement...(basically all the bishop score but couldn't remember the other 2)
Dr : OK investigation?
Me: I would like to do high vaginal swab, CTG
Dr : What other investigation? Let's say if it is available here..
Me: Fetal fibronectin
Dr : What is its significant?
Me: If positive, patient is having premature labour. (tet! wrong again...)
Dr : Basically if it is positive, patient will deliver within 1 week. Patient is been admitted, what do you do?
Me: Since patient is at 34 weeks, I would like to give 2 injections of IM dexamethasone 12mg 12 hours apart. Tocolytic agent to let the effect of dexa took place.
Dr : After tocolyse?
Me: I would monitor patient for fetal heart rate, respiratory rate & blood glucose...
Dr : Why glucose? Patient is not diabetic.... ok that all. Did you think you perform well during Long Case?
Me: I'm not sure. (Dalam hati..pasrah)
2 comments:
Hehehe.. so hillarious la.. (imagined ur expressions)
Btw, always pray for ur success. And I believe in u :) amin
memang camni la tiap kali exam...thanks, pray for you too
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