o&G off tag question
off tag question in o&G hospital sibu.
1. Admission clerking
a.) pt came in usod .what did u do?
Rmb to mention although she usod u can still confirm again by asking lmp month then slowly guide by whether is early,end or mid of day. Dont expect sp or mo to help ho with that.
Then only u can say about confirm it with palpation , and tas.pls do not straight away jump into usg she will be very piss off.😂
2.) Vaginal exam(make sure to know ddx stage 1 latent vs active phase)
A.) How to differentiate 3,4,5cm
B.) What did u do when 4cm
C.) How to differentiate 5,6,7cm
3.) ARM
1.Now u have a pt t/o from anw to lr with os 4cm .what do u do first?
Remember to say flip the case note first to check whether is there any documentation for arm is my ho or mo.next rmb check ve finding bla bla.rmb set line ivd pt first.
2.) Why do we set ivd and hydrate pt? In case amniotic fluid embolism, or in case of sudden need emlscs..and pls read abit about amniotic fluid embolism.
3. What other obs emergency did u know? Eclampsia,pe,cord prolapse ,pph anything u know la.
4. When is contraindication for houseman to do arm?
-polyhydramnions !! Why?
Because fetal position instability. And risk of cord prolapse...
-Why oligohydramnions need to becareful? Risk of injuring fetal scalp.
-other cause arm done by mo: fetal high station,os <=2cm , when fail x2 attempt. Pls refer to the board in our wad.
What type of arm tools did u know. Koher forceps and amniohook.
4.) Conduct labour
A.) Your mo are performing vacuum assisted delivery+episiotomy and the baby seems to in distress ,peads mo havent come. U are now alone with the mother what did u do?
--> the part where she want u to know third stage of labour.
Rmb say after baby delivery rmb to give im syntho.
B.) What is the content of synto and pitocin. Rmb to say synto got oxytocin 5 iu+ergometrine 0.5mg
Pitocin only pure oxytocin 10 iu.
C.)When is ci to give synto? Hypertension, multigravida,heart disease.
D.)Why canot give them synto?
Because ergomerrine will cause vasoconrriction --> induce spasm of vessel --> cause angina
E.) When do u give syntho?
Anteriror shoulder delivery
F.) Next what did u do with this pt?
Pit 40
G.) What other uretotonic drug did u know? Carbetocin,carboprost, oxytocin ,ergometrine
H.) Next deliver the placenta.how do u deliver? What is Control cord traction?rmb the three sign of cct.
+Basically this question is asking active third stage of mngmt.
Must include three components :
I. Uretotonic help contract uterus
II. Clamping cord -make sure to know we practice delay cord clamping that benefits to the baby. Wait for 3 minutes.
III. CCT.
I.)Once placenta out what did u do?
Rmb check placenta.
J.) PPH .cause? Rmb the 4T la. Uterine atony rmb massage uterus.
Read pph mngmt abit la.
5.)Perineal repair
- rmb change the gloves and the set and all kain .make sterile field. Ensure lighthing.
What did u do prior to perineal repair?placenta blod clots already all out.make sure uterus well contract.
Ensure u get conset from mother for perineal repair .
Then steps of perineal repair from analgesia diclofenac sodium or lidocaine 2% then suture type rmb nylon 2/0 or ecosorb 2/0 .
-Why never use 1/0.?Risk of injuring anus muscle,vessels.
-suture start from 1cm above apex,tie know continuous suture vaginal submucosa layer until fouschette then tie a knot.
Why did we tie know inside not outside? To prevent infection.
Then rmb say subcuticular suture type tie knot and cut.
Go youtube learn makesure u agak agak know how to draw.she will ask u to draw.
After perineal repair done what u do?
Check suture any gapping ,next rmb say take out tampon dont leave tampon inside!! Dont forget to PR.
6.) Ceserean section
-Make sure from preop checklist say operation consent ,how to explain indication, then risk of lscs.
-What is inside ot chit?one by one.
-Preop meds?when to give cefazolin 4g? Obesity bmi>35, prolong operation>2-3hour.
- what u need to becareful with consent . <18yo who should sign?two sp ,husband or parents or guardian.
- informed surgeon assistance,paeds ho , post case to aneast
In ot what u do
Insert cbd
Bancuh abx,label give to anest
Whiteboard
Scrub in while waitinv anest spinal
Time out
Ceserean technique make sure u know in and out each layer.
First:test not directly cut.
Pfannestial incision .then know layer by layer la.basically is what u did and what u saw in ot jz say out.
And know close uterus by double layer non locking contunious suture. Pls refer to this website.
https://www.ogmagazine.org.au/18/4-18/caesarean-section-step-step/
What did u do beforw close uterus
How did u do fundal pressure
Why use 1/0
Suture uterus first layer apa second layer apa?
7.) Mgso4
First side effect? Flushing!!!!
Rmb laoding and maintenance dose !
Side effect ? What to monitor?
Rmb the buppr. And how often do u monitor.
8.) Normal value 7pbsp,mogtt dx criteria.
9.) Ie ssx,dx criteria of pe.urine pcr, 24hour urine protein. Prophylaxis.
1. Admission clerking
a.) pt came in usod .what did u do?
Rmb to mention although she usod u can still confirm again by asking lmp month then slowly guide by whether is early,end or mid of day. Dont expect sp or mo to help ho with that.
Then only u can say about confirm it with palpation , and tas.pls do not straight away jump into usg she will be very piss off.😂
2.) Vaginal exam(make sure to know ddx stage 1 latent vs active phase)
A.) How to differentiate 3,4,5cm
B.) What did u do when 4cm
C.) How to differentiate 5,6,7cm
3.) ARM
1.Now u have a pt t/o from anw to lr with os 4cm .what do u do first?
Remember to say flip the case note first to check whether is there any documentation for arm is my ho or mo.next rmb check ve finding bla bla.rmb set line ivd pt first.
2.) Why do we set ivd and hydrate pt? In case amniotic fluid embolism, or in case of sudden need emlscs..and pls read abit about amniotic fluid embolism.
3. What other obs emergency did u know? Eclampsia,pe,cord prolapse ,pph anything u know la.
4. When is contraindication for houseman to do arm?
-polyhydramnions !! Why?
Because fetal position instability. And risk of cord prolapse...
-Why oligohydramnions need to becareful? Risk of injuring fetal scalp.
-other cause arm done by mo: fetal high station,os <=2cm , when fail x2 attempt. Pls refer to the board in our wad.
What type of arm tools did u know. Koher forceps and amniohook.
4.) Conduct labour
A.) Your mo are performing vacuum assisted delivery+episiotomy and the baby seems to in distress ,peads mo havent come. U are now alone with the mother what did u do?
--> the part where she want u to know third stage of labour.
Rmb say after baby delivery rmb to give im syntho.
B.) What is the content of synto and pitocin. Rmb to say synto got oxytocin 5 iu+ergometrine 0.5mg
Pitocin only pure oxytocin 10 iu.
C.)When is ci to give synto? Hypertension, multigravida,heart disease.
D.)Why canot give them synto?
Because ergomerrine will cause vasoconrriction --> induce spasm of vessel --> cause angina
E.) When do u give syntho?
Anteriror shoulder delivery
F.) Next what did u do with this pt?
Pit 40
G.) What other uretotonic drug did u know? Carbetocin,carboprost, oxytocin ,ergometrine
H.) Next deliver the placenta.how do u deliver? What is Control cord traction?rmb the three sign of cct.
+Basically this question is asking active third stage of mngmt.
Must include three components :
I. Uretotonic help contract uterus
II. Clamping cord -make sure to know we practice delay cord clamping that benefits to the baby. Wait for 3 minutes.
III. CCT.
I.)Once placenta out what did u do?
Rmb check placenta.
J.) PPH .cause? Rmb the 4T la. Uterine atony rmb massage uterus.
Read pph mngmt abit la.
5.)Perineal repair
- rmb change the gloves and the set and all kain .make sterile field. Ensure lighthing.
What did u do prior to perineal repair?placenta blod clots already all out.make sure uterus well contract.
Ensure u get conset from mother for perineal repair .
Then steps of perineal repair from analgesia diclofenac sodium or lidocaine 2% then suture type rmb nylon 2/0 or ecosorb 2/0 .
-Why never use 1/0.?Risk of injuring anus muscle,vessels.
-suture start from 1cm above apex,tie know continuous suture vaginal submucosa layer until fouschette then tie a knot.
Why did we tie know inside not outside? To prevent infection.
Then rmb say subcuticular suture type tie knot and cut.
Go youtube learn makesure u agak agak know how to draw.she will ask u to draw.
After perineal repair done what u do?
Check suture any gapping ,next rmb say take out tampon dont leave tampon inside!! Dont forget to PR.
6.) Ceserean section
-Make sure from preop checklist say operation consent ,how to explain indication, then risk of lscs.
-What is inside ot chit?one by one.
-Preop meds?when to give cefazolin 4g? Obesity bmi>35, prolong operation>2-3hour.
- what u need to becareful with consent . <18yo who should sign?two sp ,husband or parents or guardian.
- informed surgeon assistance,paeds ho , post case to aneast
In ot what u do
Insert cbd
Bancuh abx,label give to anest
Whiteboard
Scrub in while waitinv anest spinal
Time out
Ceserean technique make sure u know in and out each layer.
First:test not directly cut.
Pfannestial incision .then know layer by layer la.basically is what u did and what u saw in ot jz say out.
And know close uterus by double layer non locking contunious suture. Pls refer to this website.
https://www.ogmagazine.org.au/18/4-18/caesarean-section-step-step/
What did u do beforw close uterus
How did u do fundal pressure
Why use 1/0
Suture uterus first layer apa second layer apa?
7.) Mgso4
First side effect? Flushing!!!!
Rmb laoding and maintenance dose !
Side effect ? What to monitor?
Rmb the buppr. And how often do u monitor.
8.) Normal value 7pbsp,mogtt dx criteria.
9.) Ie ssx,dx criteria of pe.urine pcr, 24hour urine protein. Prophylaxis.
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