Wednesday, April 14, 2010

Presenting Gynae Case

Plz refer to presenting obs case note also

Scenario: presenting new case

Opening statement:

This is madam__a __ years old, --occupation --,para __ post menopausal for ___(registrar selalu mention not breastfeeding,not on OCP,not on HRT,tp dulu ada studnt present cam2 kena marah lak,so x sure la kena ckp ke x) known case of ___ for __ years ago,admitted when due to what and planned for what

Pas2 masuk when did d problem started n go on mcm biasa.rasanya xde masalah sgt la gynae case yg biasa camni...dont forget 2 mention LMP.tgk tiket cam biasa utk tau flow

Scenario 2: Gynae onco case

Haaaa….yg ne yg slalunya bila kena kat bed kta rasa macam,aduuuhhhhh…….tiket de plak,wouuuuu…….tebal…..yg itu baru volume 2,pe jadi pd volume 1?ntah lar…meh,sy kongsi camne nk present together with contoh,which happens to be my long case assessment…
Opening statement as above,tapi ada certain patient 2 known case dia panjaaaaaaannnnnggg pnah tgk presentation yg mcm ne;

Madam so n so,a 70 yrs old housewife..bla..bla..with a known case ovrian cancer stage 2a since 10 years ago. she was 1st presented 10 years ago complain of what,n then she go to see gp,n then refer ke hosp,n then scan found cancer
>>refer ke PPUKM,must state why,nape x wat kat sana je,usually logistic problem
>>ca125 asalnya berapa
>>buat debulking how long after that,what was d intraoperative findings during dat time (yg penting jela,jgn la citer mcm baru smlm de wat debulking),n what was d HPE result
>>ca125 after debulking bape
>>followed by chemo,what kind of chemo,how many cycle ,any comp from d chemo,time cycle keberape,what was done back then
>>what was d trend of d ca125,increasing or decreasing, is she responding well to the treatment,selak onco report ye,xpun study tiket betul2
>>barulah masuk,she is admitted yesterday for the 2nd cycle of what chemo,currently day 1 of chemo…

Tu dia…pas2 sambung

Second problem…
She had hypertension since how many years ago,on what medication,any comp such as stroke

Third problem…
She is asthmatic since when on what medication,last exacerbation was when

Fourth proble….begitulah seadanya…

Pastu baru sambung history lain if dr nk dgr gak…As long as Nampak teratur je,boleh la 2…
Kat sini xde specific guide,yg penting,follow d flow,on how they first presented,what was d investigation done,what was found,what treatment modalities was done,how was d response on treatment,any issues in between,sampailah ke today…tgk tiket,usually flow de ade.

This is d contoh of d case I presented during my rounds,time ne Prof Hatta xde,so xtau la menepati citarasa de ke x,tapi prof Shu n Dr Natasha x komen much on d flow(ok la 2 agaknya)…Cuma ada la technical problem yg kena marah gak

My patient Madam W.S a 72 years old para 4 post menopausal for 21 years with a known case of cervical cancer stage 2b diagnose 7 month ago, and currently today post day 6 of simple vulvectomy, due to verrucous cancer @ d vulvular region which was diagnose 2 months ago.

This is d opening statement,if u guys realize,there are 2 main problems,n problems ne very closely related,n may have relationship,so start with the 1st big problem cervical cancer. But during d presentation,dr xnk dgr pasal cerita ne,because pt da bnyk kali di present.but if I were 2 present,I present it this way

She was first presented 8 month ago with 1 day history of painless per vaginal bleed,3 pads fully soaked. She went to Hospital Petani to get it checked. Patient claimed that the doctors told her that there was a mass at the cervix clinically 8cm in size, but there was no report. A biopsy(or was it a pap smear??) was done confirming cervical cancer and she was diagnosed with cervical ca stage 3b.she was subsequently started on chemotherapy (where and when) and completed when.she had also undergo radiotherapy 48.6 GY/27F and 3 HDR brachytherapy (when) under oncology here(where)

Dis is d summary of d previous case followed by d problem she is having now

2 months after that,she notices that there was small multiple, nodular lesion @ d vulva region while she was urinating. There was no dysuria, bleeding, discharge, itchiness, or any other urinary problem (if ada differential diagnosis lain,ckp all d relevant negatives here). It was rapidly growing and started to fused together, subsequently,it gets bigger,and because of the friction during walkin,there was minimal bleeds n it becomes painful.She came to PPUKM and a biopsy was examination under anesthesia followed by cystoscopy was also done at 3/11/09 (if da banyak sgt event xpe kot nk guna dates). EUA findings:

There was multiple wart like mass over both vulva region,ranging around 1x1 to 3x2 cm.firm in consistency, irregular margin, well define border and bleed to touch. biopsy was taken and HPE findings was consistent with verrucous cancer (tp kena tau gak detail HPE ne,ada dlm tiket)
cystoscopy found small 0.5x0.5 cm soft nodule over opening,no curuncle,urethera was normal.

D nxt day,ultrasound was done to assess d upper tract and it was normal. She was scheduled for simple vulvectomy and it was done 1 week ago.intrapoeratively ….tgk dlm notes ya(plz summarize dis if possible,but don’t miss any detail)

So currently pt is well,had started ambulating since day 4, wound was clean and healthy, there was no discharge from d wound (sy x tgk pun time 2,but if u want 2 present make an effort to go see also,don’t juz copy from d notes,kang kena tnya karang…)

She is planned to keep d perineal dry, continue subcutaneous heparin, tablet Arcoxia, continue physio and allow ambulation. Currently we are waiting for HPE result from biopsy (time intraoperative amek lagi biopsy)

Basically 2 je la…for Onco,make sure tau d term neo adjuvant,post adjuvant treatment,conservative management,debulking surgery,all the relevant tumour markers if ada…yg radiotherapy atas 2 tadi, 48.6 GY/27F and 3 HDR brachytherapy,in case jumpa dlm tiket n nk present kena sebut betul la kan. nak pronounced mcm ne:

48.6 Gray with 27 fraction (ini lebih kurang mcm dose la) and 3 high dose rate brachytherapy

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