Friday, February 6, 2009

O&G final

Wah lama sungguh tak update blog ni.Almaklumlah baru habis O&G posting Final Exam.The exam was tough I guess, especially the Long case clinical exam part.I got a GDM(Gestational Diabetes Patient).My patient was:

-at 37 weeks of gestation
-Gravida 7 Para 3+3 ( into her 7th pregnancy, with two history of miscarriages and 1 ectopic pregnancy)
- a Previous scar ( meaning a history of lower segment caesarean section due to GDM with macrosomic baby in previous pregnancy)
-3 previous MOGTT done ( ujian minum air gula, sampai kena minum 3 kali pulak tu due to various indications)
-Blood Sugar Profile (BSP) ranges 6.5-7.Poor diet control.Not on insulin therapy
-1 history of Dilatation and Curettage for miscarriage and one laparoscopic gynae surgery for the removal of ectopic pregnancy.
- 2 Pap smear done
-history of Menorrhagia

Diagnosis: GDM with previous scar.Poor diet control

In short, gile eventful k history patient aku ni AND I've got around 20 minutes to do the clerking.The most frustrating part was when my examiner Dr S said to me: 'Okay u have only 1 minute left"Adey tensyen tensyen.
Physical examination was alright I guess.The symphysio-fundalheight measured 39 cm.The abdomen is grossly overdistended.My impression was: Uterus larger than date with polyhydramnios.Bleh pulak tu aku lupe nk buat fluid thrill for confirmation.dang!
The discussion part was okay except when the examiner asked me,'So Nabil, what do you want to do with this patient".Daym, you know why I didnt say that we should deliver the baby as soon as possible is becoz she is at 37 weeks.Thats like borderline.My answer should sounded like this ' I would like to deliver the fetus by Caesarean section and not via Vaginal delivery considering that she had many previous gynae surgery.The fetus should be delivered as soon as possible (altho the fetal movement is more than 10 times per day) becoz poorly controlled GDM is associated with Sudden Intrauterine Death(SIUD)". Kan best aku cakap cam tu je....frust frust...

Written exam was fair.MCQ single best answer was rather tough, EMQ alright and SAQ was super fine.We had 3 SAQs-Preeclampsia, GDM and Ectopic pregnancy.

All of us went to Bentong utk mandi manda waterfall the next day.Many thanks to Ridzwan and family for their great hospitality!Will upload some pics in the next entry

Note 1: I'm just glad the examiner didnt asked me to give a counselling session to the patient.A few of my friend were asked to do some counselling to their respective patients during the long case clinical exam.Fiuhhh....

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