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
Thursday, September 30, 2010
Thursday, September 23, 2010
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
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
Subscribe to:
Posts (Atom)