tHe_FifTh

Saturday, January 22, 2011

How He Became Muslim

He became a Muslim because he approach the right person..really amaze how they tarbiyyah him. Every problems/dalil, refer to al-Quran... I wonder if we have similar approach?

"TARBIYYAH BIL HAL"

Tuesday, January 11, 2011

Businessboys...

When to Melaka to see my niece last holiday & stopped by at a mussels store...managed by group of children. Pretty cool huh?

Tuesday, December 28, 2010

Clinical Exam: Short Case with Prof H

Dr : This patient LMP was 27 April 2010. What is her POA & EDD?

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)

Clinical Exam: Long Case with Dr B

26 years old Malay housewife from Muadzam, primidgravida at 28 weeks POA, gestitional diabetes mellitus on diet control with acceptable glucose control and asymptomatic anemia on double hematinics (which I don't emphasize earlier during summary) came with complaint of pervaginal bleeding 2 days prior to admission.

Discussion of History

Dr: Why didn't you emphasize on complications of GDM from ultrasound? What are the complications that I want?

Me: Fetal macrosomia & polyhydramnios. I did mention in the history, the fetal growth was corresponding to the date with adequate liquor

Dr: No, you should mention it specifically in this type of cases. (One more thing is that fetal anomalies only occur in preexisting DM not GDM)

(After the history presentation, because patient remember all the details...)

Dr : Did the patient tell you all this?

Me: Yes

Dr : So what is the patient education background?

Me: Err, sorry I didn't ask....(OMG lupa la plak)

(After summary, it is as above but minus the asymptomatic anemia)

Dr : What is other problem that patient had?

Me: Oh, asymptomatic anemia...

Dr : So why didn't you said so? You should not focus on presenting complaint only...treat patient as a whole. Since patient in the low social economic group, did she had basic amenities in house? What kind of toilet that she had? How about her diet? Did you ask?

Me: Sorry Dr, no...(isk3 my social history very poor)

Dr : What is the simple investigation that you would like to do in this patient since patient had anemia?

Me: TIBC, Serum ferritin, stool ova & cyst.

Examination revealed that she was not pale. No signs of infection at the web space of hands, axilla, mouth, neck and breasts. But I didn't look for it at groin & vagina. SFH was 26 cm and clinical fundal height was corresponding to 28 weeks gestation. Fetal part felt but could not appreciate the fetal lie/poles because it is so small with relatively thick skin. (Dr said that must try to assess and find it since we're gonna be HO)

Further Discussion

Must know site of infections in GDM (as listed above)

Dr : If you are in the district what do you want to do to this patient?

Me: I would like to do ultrasound to exclude PP, if PP excluded I would like to do speculum examination.

Dr : What do you want to find?

Me: Vulva and vagina erosion, liquor, cervical erosion, growth, irregular margin. Os opening..

Dr : Do you expect any infection in this patient?

Me: No because patient had good control of glucose.

Dr : Any other specific thing in cervical that you would like to check?

Me: Oh cervical polyps (while knocking my head)

Dr : If you unable to determine what is the cause of bleeding, what is your diagnosis?

Me: Indeterminate APH

Dr : How you manage APH? When to deliver patient?

Me: Take FBC, GXM...Resus...deliver at term

Dr : When?

Me: 38 (Goreng!). I not sure.

Dr : We not allowed post date. why?

Me: Don't know. (until now haha! I'll inform later)

Dr: If patient is in premature labour, what is your management? Patient at 28 weeks. Who to inform other than specialist, consultant, nurses...

Me: (After being pushed) IM Dexamethasone, tocolysis.....(Being pushed further) inform paeds for ventilator (at first I wrongly said "incubator"...pening2)