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KICKSTART FOR O&G

POSTING

1. Hafal template for obs, gynae and postnatal clerking sehafalhafalnya


2. First of all, know the doctors well hehe :
Doctors
1. Dr DK (benign dr)

2. Dr Sakina (malignant stage 4


dr)

By Azmyza Azmy

Characteristics
- Paling baik dalam dunia and
mmg takkan pernah marah.
- Tp dia suka tanya soalan
preclinicals and definition so
before bedside make sure dah
prepare your anatomy well
and all the definitions
- Dia sgt pentingkan nutrition
status jd make sure tnye
patient about their nutrition
very thoroughly (breakfast
mkn apa, lunch apa, dinner
apa) then kira calories sekali.
(WAJIB buat ni dgn dk)
- Usually klu dk tnye whats the
underlying cause of this
patients illness, jwb je poor
nutrition status haha. (klu
betul poor lah)
- She will be your worst
nightmare!
- Sebelum bedside make sure
korang dah master psl case
yg nak present tu
- And make sure everyone in
your group tau and baca jgk

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3. Dr Salini (benign dr)

4. Dr Sarah (benign dr)

5. Dr Thani (benign dr)

By Azmyza Azmy

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about that case (sebaiknya


buat discussion)
Just know EVERYTHING about
the chief complaint. Cth if
patient complaint of per
vaginal bleeding in early
pregnancy, baca semua
differential diagnosis for that
and sebab kenapa semua.
Jgn jwb mengarut pulak cth
patient dtg sbb antepartum
hemorrhage then korang bg
ddx endometriosis... bertukar
naga lah dia (pengalaman
sendiri)
Baca baca baca and baca
before class sbb dia akan
tanya tanya tanya dan tanya
lg smpi rasa nak nangis.
Dia sgt pentingkan PE and
nak korang bg running
commentary time bt PE so klu
kena marah depan patient tu
kira biasalah :(
One word : AWESOME
Shes an angel trust me klu
korang nak tnye apa2 ke
shes the one you should
meet.
Tp dia akan marah jgk klu
HOPI korang x memenuhi
criteria dia so HOPI and chief
complaint and summary mmg
kne buat betul2.
History yg lain dia mcm x
ambil kisah sgt.
Jenis tak kisah sgt
Tapi dia suka tnye soalan
clinical and pentingkan HOPI
jgk. So be prepared to answer
her questions.
Dia jenis tak suka korang bg
diagnosis terus.
Dia nak korang describe in

details about the chief


complaint je.
Management received by the
patient pun dia xnak tau.
Dia mmg akan selalu interrupt
time kita cerita HOPI tp nti dia
gelak sorang2. Layan jelah

Aku pernah bedside dgn dr kat atas ni je. Kalau dr lain tanya kawan2
yg lain. Rasanya dr malignant dr sakina and prof suzana je so klu
dpt yg lain rileks je. Cuma dorang suka tanya soalan so baca baca
dan baca

Wards :

Ward 6A : Gynae
Ward 6B : Obs
Ward 6C : Induction of labour
Ward 6D : Postnatal

(Tapi semua ward ada je postnatal. Bercampur-campur dah sbb tak cukup katil)

Ward 9C : Gynae only and case kat sini best-best


Labour room level 2 :
EPAU ( Early Pregnancy Assessment Unit)
High-risk

COMMON DISORDERS IN OBS PATIENT IN HSB :


1.
2.
3.
4.
5.
6.

PPROM / PROM (leaking liquor)


Hyperemesis gravidarum
Gestational Diabetes Mellitus
Hypertension in Pregnancy
Placenta Previa
Obstetric hemorrhage :
Bleeding in early pregnancy :
a) Miscarriage
b) Ectopic pregnancy
c) Gestational Trophoblastic Disease

By Azmyza Azmy

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d) Lower genital tract pathology


Antepartum hemorrhage :
a) Placenta Previa
b) Abruptio placenta
c) Vasa previa
d) Lower genital tract pathology
e) Cervical trauma/ vagina trauma
f) Show
g) Preterm labour
h) Systemic coagulopathy
Postpartum hemorrhage
7. Anemia in pregnancy
8. Asthma in pregnancy
9. Intrauterine Fetal Death
10. Oligohydramnios/polyhydramnios
11. Post datism

COMMON ILLNESSES IN GYNAE PATIENTS IN HSB


1. Uterine fibroid
2. Abnormal uterine bleeding (common is dysfunctional uterine bleeding tapi baca
differential diagnosis yang lain jugak)
3. Miscarriage
4. Ectopic pregnancy
5. Ovarian cysts
6. Cervical ca
7. Postmenopausal bleeding
8. Molar pregnancy
9. Baca all genital pathology yang lain cth cervical polyps, bartholin abscess (pernah
jumpa kat wad sekali), dan lain lain.
(Basically, ni disorders yang memang korang akan selalu encounter dekat hospital so
bacalah awal-awal nti tak mcm aku yang terpinga-pinga masa first time masuk O&G -.- Byk
je lagi disorders actually tp aku tak rajin pergi hospital haha :p Dr sgt pentingkan chief
complaints, HOPI and investigations so... get ready!)

By Azmyza Azmy

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PE script
A.

Obstetric patient

General inspection (MUST BE DONE AT THE END OF BED, NOT BESIDE


PATIENT)

1. On general inspection, the patient is lying supine comfortably at 30


degrees angle and she is supported by 1 pillow. She is conscious
and alert to time, place and person. She is not in pain or in
By Azmyza Azmy

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2.

3.
4.
5.
6.

7.

respiratory distress. There is a branula attached on the dorsum of


her left hand and the branula is attached to an IV solution which is
normal saline. (Tengok kiri kanan patient if ada lagi benda penting
yang kena mention. Kalau ada supplement ke kat meja sebelah
patient kena mention jugak.) There is an observational chart on the
table at the end of bed.
On general examination, the palms are warm/cold and dry/moist.
There is no sign of peripheral cyanosis, no pallor and no palmar
erythema. There is no koilonychias and no evidence of clubbing
(time ni tgk kuku dari eye level acah-acah je lah, tak payah buat
yang diamond shape tu unless betul-betul nampak clubbing) Tapi
ada dr tak suka sebut negative findings. Contoh korang dah ckp
patient is not in respiratory distress so takyah sebut there is no
peripheral cyanosis (time ni aku kena dgn dr nadzra, habis kena
bebel)
The pulse rate is 81 beats per minute with regular rhythm and good
volume.
(Eyes) There is no conjunctival pallor and no yellowish discolouration
of the sclera (kalau dgn dr sakina sebut je terus no scleral jaundice)
(Check thyroid gland, cakap kt patient : puan tolong dongak sikit
saya nak check leher.) The thyroid gland is not enlarged.
(Legs examination. If dgn prof suzana, WAJIB cakap ideally i will
expose the patient from the mid thigh area to down below but for
patients modesty, i will only expose from knee area to down
below. Sambil ckp sambil expose) The skin looks dry (kalau korang
mmg nampak dry lah) There is no pallor or cyanosis and no scars.
Both legs are not swollen and there is no bilateral pitting edema
(kalau ada, sebut there is bilateral pitting edema from shin to knee
area, contoh) There is no evidence of varicose veins which is
common in pregnant women (WAJIB SEBUT)
(Abdomen examination) Ideally, I will expose the patient from the
nipple line to the mid thigh. But for patients modesty I will expose
her from xiphisternum to pubic symphysis. (Script ni memang wajib
hafal sebelum PE dgn dr sakina and prof suzana kalau tak, rest in
peace dear friends) Mintak consent patient , puan saya nak check
perut boleh?

a. Go to end of bed
b. On inspection, the abdomen is distended most probably due to
gravid uterus with evidence of linea niagra and striae
gravidarum. I can also see fetal movement. The abdomen is
moving with respiration. (If patient with previous caesarean scar
there is a surgical scar noted at the suprapubic region most
By Azmyza Azmy

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probably due to previous caesarean section. The scar is


transverse/midline/diagonal in position and it is keloid/flat
measuring about ___ cm. There is no skin change around the
scar.) Besides that, there is no other scar / there is also scar at
_____ region most probably due to previous _________. There is no
visible pulsation and no dilated veins. The umbilicus is centrally
located and inverted/flat/everted.
c. (Proceed with superficial palpation. Make sure tanya patient dulu
puan ada sakit mana-mana? Sambil palpate mesti tengok muka
patient) The abdomen is soft and non-tender.

(WAJIB crouch cmni kat sebelah patient or duduk atas kerusi)


d. NOTE THAT IN PREGNANT WOMEN, NO DEEP PALPATION AND NO
NEED TO PALPATE FOR LIVER, SPLEEN OR KIDNEYS. JUST DO
SUPERFICIAL PALPATION.
e. In patient with previous caesarean scar, check for scar
tenderness by palpating the scar sambil tengok muka patient.
There is no scar tenderness. (Time long case aku tak buat sebab
tak pernah tau pun lalu kena marah. So korang dah tau buat ye)
f. (Proceed with measuring symphysio-fundal height/SFH) Siapkan
awal-awal tarik measuring tape pastu letak sebelah patient.

By Azmyza Azmy

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The symphysiofundal height is __ cm while the clinical fundal height


(yang ni korang akan belajar dgn dr) is about ___ weeks of gestation.
Therefore the uterus is corresponding/smaller/larger than dates.
g. Next is Leopold Maneuvers.

i.
ii.
iii.
iv.

First fundal grip (untuk rasa head or butt.)


Lateral grip (rasa fetus spine and limbs kalau yg keras tu
spine. Kalau mcm lembut tu limbs dia)
Pelvic grip (to feel for fetal pole)
Pawlicks grip (mcm gambar C yg pakai satu tangan je tu) Tapi
yang ni dr jarang buat sbb sakit utk patient so takpayah buat
pun unless dr suruh)

There is a singleton fetus lying longitudinally/transversely with


cephalic/breech presentation. The fetal back is on the maternal

By Azmyza Azmy

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right/left side. The presenting part is 0-5/5th palpable and it is


already/not yet engaged. (if 2/5th palpable dah engaged)
(Ini kalau dr tanya saja. Sebab aku kena tanya benda ni time long
case) I know that it is the fetal head because it is ballotable, hard
and round in shape. I know that it is fetal butt because it is soft
(cushioned by fats) and it feels globular.
h. Auscultate fetal heart by using a pinard put at the anterior
shoulder of the fetus.

(This is the only photo I found on the internet that shows the right method
and position to use a pinard. Semua sama dgn yang dr ajar)

i. (dah habis semua ni cakap) Now I will end my examination by


doing ______ examination to ______. (Time ni dr sakina suka tanya
examination apa yang korang nak buat so be prepared!)
Basically semua ni korang kena tgk live baru faham. Aku mampu
bagi script je

B.
patients.

Postnatal and gynae

1. General examination semua sama mcm patient obs.


2. On inspection, the abdomen is symmetry, moving with
respiration, no previous scars noted, there is no visible pulsation
and the umbilicus is centrally located and inverted.
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3. Bezanya utk patient gynae and postnatal, kena buat deep


palpation, palpate for liver, spleen and ballot the kidneys.
4. If patient postnatal, time deep palpation kalau dpt rasa mcm
uterus tu mengeras ckp On deep palpation, the abdomen is soft,
non-tender, no palpable mass and the uterus is well contracted.)
Pastu buat SFH mcm dlm patient obs then ckp The uterus is
now corresponding to ____ weeks of gestation)
5. If patient gynae, sama jugak cuma buang yang uterus is well
contracted tu. Kalau rasa ada mass, describe about the mass.)
On deep palpation, there is a mass in suprapubic / RIF / LIF region. It is
single / multiple, round / oval in shape measuring about _____ cm by
_____ cm in diameter and it is corresponding to _____ weeks of gravid
uterus. It is firm / cystic and non-tender / tender. It has well-demarcated /
not demarcated margin with a smooth / irregular surface. It is side to side /
up and down mobile and I cannot / can get below the mass.
6. There is no hepatomegaly and no splenomegaly. The kidneys are
not ballotable.
7. Shifting dullness There is no fluid in the intraperitoneal cavity
8. Percussion. No ascites is detected. All the regions are resonance.
9. Auscultate the bowel sound (normal : 3-5 sounds per minute)
10. (For patient postnatal, last sekali kena buat breast
examination. Palpate all the 4 quadrants and then picit the
nipple.) On breast examination, the skin is homogenous, there is
no palpable mass. The breast is firm, the nipple is not retracted
and it is everted. There is no nipple discharge.

Maaf kalau tak membantu sangat. Hanya share


apa yang patut. Hehe GOODLUCK GUYS! Lets
ace clinical years together insyaAllah

By Azmyza Azmy

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