Monday, October 7, 2013

End Posting 9th term OBG

Erm, lambatnya update. 

Sorry, malas sungguh. Tapi, mengenangkan ini akan membantuku di kala nak dekat finals nanti, ku laratkan jugak. 

Kali ni dapat viva dengan cekgu old-school. The HOD. A very quiet male doctor. The only  old Beetle surrounded by Flowers in the OBG garden. Heheh. I wonder why they made him the Head of Department. Maybe he is guy? An d female can't take the post because they are too emotional and not as rational as the male colleagues when put under pressure? People keep saying that it is really distressing being in this specialty.

I got this  combination of worst case scenario during postings. A combination of many differential diagnosis and topics in both Gynaecology and Obstetrics. 

I think it is better to present the Obstetric case first as the questions are quite predictable.

Viva End Posting (Obstetrics)

Summary : 33 year old, G2P1L1  at 38 weeks 5 days of gestational age, with previous lower section caeserean section and overt diabetis melitus with single fetus, cephalic presentation and mobile head.

  • Urine pregnancy test. Other method of confirming pregnancy.
  • Folic Acid. Why it is given?
  • History of fever with rash. How Rubella is manifested?
  • Tetanus toxoid. Why it is given?
  • History of pedal oedema(pitting type). Differential diagnosis of oedema in pregnancy.
  • History of previous LSCS indicateed by Cephalo pelvic disproportion. Was started insulin after delivery. Stopped after 2 month. 
  • What is Lower section caesearean section? Describe the incision made. 
  • Past history of Diabetes melitus since 1 year.On Medication.
  • On Examination: thyroid enlarged
  • Inspection: overdistended abdomen, globular shape. Falnks full.Horizontal scar present 3cm above symphysis pubis measuring 13cm wide. No keloid, non tender scar.
  • Palpation:
            Fundal grip: Soft irregular, broad mass suggestive of breach.
            Lateral grip: Right- Continuos uniform resistance with smooth hard surface                                             suggestive of spine.
                                 Left: Small irregular Knob like structures, suggestive of limb                                          buds.
          1st Pelvic grip: Ballotable mass, non enggaged.
          2nd pelvic grip : Fingers converged, not enggaged.
  • Auscultation: Fetal  heart sound not heard. Why?

Viva End Posting(Gynaecology)

Summary: 53 year old(menopause) P3L3 with chronic cervicitis/vaginitis/endometrial polyp/adenomyosis/malignancy of cervix/endometrium

Chief complaints : History of passage of white discharge x 3 month
                              History of backache and abdominal pain x 1 month
                              H/o bleeding per vagina x 1 month 

  • DDx of discharge per vagina. Colour? 
  • What is clue cells?
  • DDx of painful lower abdomen.
  • DDx of mass in the lower abdomen.
  • DDx of bleeding per vagina in menopausal woman.
  • What is PID? Definition.

Lesson learnt: 

-Bring ALL books related. Even the note books. 
-Fight and dont give till the end. Open your mouth and speak clearly and loudly These people are getting old. Make their job easier. Dont say a word if you dont know anything. Just shake your head and ZIP your mouth.


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