Voila. My first day of obs&gyn. Orientation was far more stressful than I would have expected. Did the hospital tag, further received a name tag to identify myself as “Phase 2″ med student, attended orientation for OT, Delivery Suite, Library room, and had some introductory talk on OBGYN history taking and the usual safety and vaccination status.

Random facts in my head right now:
1. We can get infected with 30 NSI. 3 common blood-borne infections- HBV, HCV, HIV
2. Visible blood always goes to clinical waste and bulk blood in confined container. cotton buds and gloves in normal bin.
3. EPP – exposure prone procedures. be wary of blood splashes. report anything.
4. 5 step to effective hand wash
scrub ur nails. thumb. every other parts of hands. wrist

The lecture on Sexual & Gynae History:
Before begin, clarify CONFIDENTIALITY and reassure as well as introduce yourself

Reproductive Health History:

• How far is pregnancy?
• 1st day of LMP
  • normal period? spotting? variation?
  • regular? (3-5, 5-7 days duration are normal)
• Previous Pregnancies? (ask: Have u been pregnant b4?)
  • ectopic? miscarriages? terminations? still birth?
    
• Begin systematically. Ask when is first pregnancy?
  
  • Go for structure and don just ask tell me about your pregnancies (you will get facts all over the place)
• Labour
  • Is it natural or is it induced? Complications?
  • How is the baby now?

1. Gravid (# pregnancies)
2. Parity (# births)

E.g. G1P0- This is the first pregnancy. G5P2- 5 pregnancies including the current one, 2 births.

1. Full Term
2. Premature
3. Miscarriage/Abortion
4. Living

E.g. G5P4= 4, 0, 1, 4. G1P2 (Twins)

Gynaecological History
Any significant gynaecological investigations or surgery?

Sexual history

• Have you ever had STIs?
  
  • Chlamydia? Vaginal discharge? Warts? ….
• Have you ever have the practice of using condom during sexual intercourse?
  
• Do you have male, female partner or BOTH?
• Is there a regular partner you have? Any protection you use?
• Do your partner have sex with other people? If partner is MALE, do they have sex with other male partner? (homosexual transmission opens up possibility of lots of infections?)
• Have you been sexually abused? Any emotional issue?
• Next proceed to look at skin. Any old and new stretch marks. Linea nigra, increse in pigmentation and melanin activity. Sign of previous surgery. Burns and scars?
  
• Check fundal height and look at the shape of the abdomen. then palpate
  

Glossary*
Amenorrhea- absence or abnormal cessation of the menses.
Thelarche- start of breast dvp.
Oligomenorrhea- infrequent/scanty periods
Polymenorrhea- unusually frequent
Polymenorrhagia- frequent or heavy
Postcoital bleeding – bleeding after sexual intercourse
Intermenstrual Bleeding – regular cycles interrupted by days of spotting or blood tinged discharge.
Dysmenorrhea- difficult and painful menstruation
Endometriosis- Ectopic occurence of endometrial tissue, frequently forming cysts, containing altered blood.
Mittelschmerz- Abdominal pain occurring at the time of ovulation, resulting from irritation of the peritoneum by bleeding from the ovulation site
Salpingtitis- inflammation of the uterine or Eustachian tube. normally have lower abdo pain with anorexia and fever, discharge, nausea

[*source: Stedman's Medical Dictionary]

A large part of my life revolves around my computer. As such, i will be sharing some thoughts on how to make good use of computers and internet in medicine. This is not something new as a simple search in google returned hundreds of results displaying latest gadgets/softwares/books/trends/tips which are popular amongst the medicals. A few notable ones include Medgadget, ScienceRoll, and AhYes Medical School.

Of course there are much more than this. In reality, there are millions of them and everyday i have been stumbling upon new ones. Talking about information overload… I was reading a few good ones, mainly concerning medical students writing about their experience in the hospitals and medical doctors explaining about their daily “dramas”. I will post a blogroll of my readings in the near future after i compiled all of them neatly. Sorry, I cant’t help it. Part of my obsession with keeping things organized.

The main reason behind the establishment of this blog is partly owing to the essay examination which i am required to reflect on my years of experience in medical school. My medical school stresses the importance of reflection and problem based learning and holistic learning.. I will go into this in another separate post on the traditional vs pbl (scenario-based) system.

They say pictures speak a thousands words.

I learn something new today. Breast move together with the movement of your arm. Scientifically, it is merely a layer of subcutaneous tissue that overlies your pectoralis major. It falls with gravity and in a person lying supine, the breast would appear to be smaller. The understanding of this concept can be used to detect the presence of tumours. It will manifest as a hard, solid mass which reside in the subcutaneous fat. Alternatively, if the cancer metastasize from other area via lymphatic drainage, one would be able to detect a large mass in the region of axilla nodes. When comparing the enlarged node from cancer and infection, several distinctions can be drawn up. With the enlarged node (lymphadenitis), the node will swell and appear to be more fluid in structure, growing at a more rapid rate than the enlargement due to tumour masses.

Wih the neoplasia lecture, the lecturer stresses that neoplasia is autonomous growth  and can respond without any stimuli as compared to hyperplasia. Increase in size (hypertrophy) and increase in number of cells (hyperplasia) both are consequence of either growth factors (hormones etc) and external stimuli. Two important concepts which allow cancer cells to survive in the human body for a long time is clonality and heterogenity of tumor cells. It can influence the body by three basic mechanism, altered cell growth, altered cell differentiation and exerting influence on surrounding tissue.

That’s about it. I am just too lazy..