my long case.
clinical summary :
43 years old, Malay gentleman was currently admitted to SH for further management post operatively (uroplasty).
8 months ago, he was involved in MVA and was admitted to SBH.
injured his urethra. was on CBD since then.
hospitalized for 1 month.
cannot passed urine normally.
so, was refered to urology dep at SH for futher investigations.
since then, he he was on follow up with SH to fixed his urethra.
went to SH two times for IVU and it shows obstruction at spongy urethral
planned for uroplasty on 29th february 2012 which was 22days ago.
and currently he was admitted to SH for management post operatively.
present your history
- i say something about cannot control urine. dr ask, what is that called?
- ans : incontinence.
PE. general
i start with vital sign
me : PR -- RR --
dr : what else in vital signs?
me : BP and temp
dr : whats the value?
me : not done.
dr : is it not important?
me : it is important. sorri dr.
but juujur sgt cakap not done.
padahal leh je bantaaii. haiiih.
inspection of genitalia
there is sutured wound posterior to scrotum. extending 3 cm from anal canal. it is clean wound, no pus. on palpation, it was tender and not warmth.
qs : is there any sign of infections?
ans : no
qs : what is sign of infection??
ans : pus, erythema, warmth
inspection of abdomen
on inspection, there are surgical scar at groin region..
qs : are those surgical scar?
ans : yes. (tapi salah sebenarnya kot?)
qs : what is surgical scar?
ans : scar from incision and when we suture it back. (?)
dr told me, surgical scar is scar from surgery that had been done by a surgeon.
qs : is it done by surgery?
ans : ortho dep yang letak besi kat both pelvic dia, nak compress pe sume..
dr says, most probably from the trauma. tapi xfaham sangat konsep besi untuk compress tuh, either surgery or what. baca eh.
proceed :
there is tube attached at suprapubic region most probably from bladder, it was connected to bladder drainage. the content is urine 250 ml, urine are normal with no blood clot, hematuria.
qs : why letak suprapubically?
ans : bcause urethral is damaged/obstructed due to MVA
thats all for abdomen.
qs : what is this? (pointing his finger to hypertrophic scar)
ans : hypertropic scar
qs : how do u differentiate hypertropic scar and keloid?
ans : HS : confined to the wound, kalau keloid dia merebak kan. xtau ayat die cane.
qs : how to check for peripheral pulses at leg?
-dorsalis pedis : between toes and index
qs : do u compare pulses of both legs?
ans : yes.
qs : what other arteries in leg?
ans : post tibial
qs : can u show me?
ans : lateral side of medial maleolus
ok thanx you.
discussion will be update later. :D insyaAllah
