An Early Arrival

Rohani, 30, 2 past pregnancies in the past, currently 3rd pregnancy

Occupation=work in paddy field, strenous, under hot sun.

Cone biopsy in the past because of cervical carcinoma in situ. Increased frequency, T=38C

Urinalysis=positive for blood and UTI.

Membrane intact, 2cm dilated. 30th week of pregnancy.

Ddx=Pre-term labour, UTI?

Diagnosis=Pre-term labour.

Causes of preterm labour?
=multiple pregnancies, infection, drugs, stress, low SES(malnutrition etc), cone biopsy.




Definition, Causes, Epid :Kaarthik

Signs and Symptoms : Pik Yin

Normal physiology of labour : Huey Ting, Jun Beng


Causes of pre-term labour :Fuad



Management of pre-term labour, pre-term neonatal care(APGAR Score, normal scores for heart rate, Oxygen saturation, RR, Pa02) : Kee Hao, Mona

Prognosis of baby delivered 30/40
complications of baby(10 weeks early:respiratory, cranial haemorrhage, T regulation and mother
Breastfeeding complications, Respiratory Distress Syndrome : Prish, Shakir, Ewe Jin


Psychosocial and cultural issues
involving mother and preterm baby, family support : Rui Wan

PCL 10 - Waterworks

Symptoms:
Nocturia
Urgency
Dribbling

Diff Dx:
Benign Prostatic Hyperplasia (most likely la ha.)
Prostate Cancer
Bladder Cancer

Learning Issues:
Definition for BPH, Prevalence, Incidence, Types (How common are these symptoms in the population) -Mona

Signs and Symptoms (IPSS - Internation prostate symptom score) - Prish

Anatomy of the Prostate, Pathophysio (What is BPH compared to prostate cancer?) - Fuad, Huey Ting

Causes - Ewe jin

Diagnosis and investigation (What are you likely to find through DRE?; Diagnostic accruacy of DRE ; Characteristics that indicate BPH or malignancy; What happens if the test is positive, negative, or inconclusive? ; investigation for BPH and prostate cancer; reliability of available tests; PSA; Biopsy complications) - Alex, Karthik, Jun Beng

Management (consider risk and benefits.) - Pik Yin

Prognosis and complications - Shakir

Psychosocial and cultural issues (Why was Marzuki embarrassed to admit his problem?) - Kee Hao

Waterworks

Been trying to have baby for 2 years but fail.

Night manager at tesco and primary school teacher, not stress
examination done before, breast examination, uterus, sperm, no ED or premature ejaculation ( 15ml of testicles-normal size and texture )

37 years old (W)
40 years old (H)
sex 2-3 times a week
Takes folic acid (W)
BMI 23
uterus ovaries not enlarges
pap smear not done for 3 years

smoke 15-20 ciggs/day, half a bottle of wine/day (W) (H)

Diet - good, healthy (W) (H)
Renal system - ok (H)
Menstrual hx - not heavy, regular, not painful, menarche 14 yrs old, frequency? features? STD?

Married in past for 10 years and failed to get children and ex-wife have 2 children (H)

on OCP sometime ago but stop 2 years ago, also had pregnancy 10 years ago with former husband but termination at 10 weeks (suction)(W)

catholic (W) think being punished for her past.

Differentials: Infertility

Tasks:

Definition for infertility(primarysecondary,)fecundability, Prevalance, Incidence - Shaq

Normal ovarian cycle and what happens when pregnancy occurs - Kaarthik

Key factors on history and examination - Alex

Causes for male and female - Jun Beng & Huey Ting

Diagnosis and investigation for male and female - Fuad & Mona

Management and cost where applicable - Kee Hao

Prognosis and complications - Piggy

Psychosocial and cultural issues - Prish & Ewe Jin

PCL 8: IT'S A BOY....NOT!!!

DDx:
1. Congenital Adrenal Hyperplasia (CAH)

Learning issues
1. definitions, incidence, prevalence (Why might there have been some doubt at the assignation of Kamal sex at the time of birth?) - Prish
2.signs and symptoms (Why might Kamal be losing salt?, What other things might go wrong other than losing sodium?) -Huey Ting
3. pathophysiology (If Kamal has been exposed to excess androgen in fetal life and has a deficiency in the production of mineralocorticoids, how could have these come about?, Why is a genitalia ambiguous? What causes this?, What do you think Kamal's internal reproductive organs may have been like?, Why both of glucocorticoid and mineralocorticoid are necessary?) -Alex, Kee Hao

5. commonest causes and provoking factors - Karthik

7. investigations, genetics (Can prenatal diagnosis be achieved?) - Shakir
8. treatment, management and prevention -Mona
9. Psychosocial randoms (What are the parental issues? What sources of information they could identify with?Comment on the quality of those sources of information, What are the arguments for and against raising Kamal as a girl?, What do you think of the decision to raise the baby as a girl or boy?)- JB
What were the specific instructions that Lisa and Omar receive regarding the medications for Nabila(Kamal as a girl) when she became sick and what was the rational behind that advice?, Doctor-patient interaction regarding this condition,
If the parents present to Dr. Yasmin with a large quantity of information, how should the doctor respond and how should the parents act upon it?,- FUAD
How would you as a doctor to help the parents make this difficult decision? What sort of question would you put to them and how would you help work through it? Would or should you give advice or recommendation?, - TJ KOH
What sort of impact might be raised on Nabila on her mental health and social functioning? What ethical issues can you identify regarding Nabila's decision to have a surgery? - py
-Ewe Jin, Fuad, Pik Yin, JB


www.rch.org/cah_book

The Wedding

Differentials:

1. Hyperthyroidism
2. HIV
3. Infections: Parasitic ( no fever, acute onset)

Learning Issues:

1. definitions, incidence, prevalence (fuad)
2.signs and symptoms(shakir)
3. pathophysiology(pik yin)
4. what is thyroid and its function(jun beng)
5. commonest causes and provoking factors(huey ting)
6. what distinguishes grave's and other forms of hyperthyroidism(ewe jin)
7. investigations and why (alex, prish)
8. management , esp grave's disease (mona, kaarthik)
9. psychological stress affects immune function such as grave's (keehao)

Websites:
www.mja.com.au/public/issues/180_04_160204/top10414_fm.html

www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Thyroid_disorders_hyperthyroidism/$File/Thyroid_disorders_hyperthyroidism.pdf#search='hyperthyroidism'

www.acadmed.org.my/cpg/thyroid_consensus2000



3.

Cushing Syndrome Week 6

Siti 43
Have hypertension
Depressed
Growing moustache (Hirsutism)
Took steroids, immunosuppresants?

Round plethoric face
oily skin with acne
abdominal obesity with striae
new bruises
infected tear in the skin
Hirsutism

Differential
Cushing syndrome
PCOS
Hypothyroidism
Metabolic syndrome

Learning issues for CUSHING SYNDROME

Definition, Prevalance Incidence, Differential diagnosis - Alex

Pathophysiology - 4 different thyroid hormones testosterone oestrogen glucocorticoids. names, site of production and site of release, main target organs and means of transport and feedback loop. Rship between blood pressure and cushing syndrome - Pik Yin and Kee Hao and Fuad

Causes and Risk Factors - Mona

Sign and Symptoms : explain S&S why facial hair oily skin how bruising happens, striae, potential for easy tear, reasons of weight gain - Jun Beng


Examination and Investigation - 24 hour urinary free cortisol - Kaarthik

Treatment and Management - (lifestyle, medical, firstline, CAM, surgical), ACTH and adrenal, dexamethasone, microsurgical and why headache after surgery, why HRT necessary after surgery and complications of surgery - Shakir and Huey Ting

Complications, Prognosis - Ewe Jin

Psychosocial, How does it affect? - Prish

Anatomy Pract Abdomen V

Q 1, 2, 3 - Prish, Ewe jin, Jun Beng
Q 4, 5 - Alex, Mona, Fuad
Q 6, 7, 8 - Kaarthik, Pikky, HT