AMC Clinical exam preparation

amc clinical exam

A 12 week pregnant lady came for regular AN visit. Her Urine MCS showed GBS positive on culture.
Task- Discuss the result with the patient.

Me- Hello, Mrs X, how are you doing today? We have to discuss about your urine result today.
Before that, can I ask you couple of questions?
How is your pregnancy so far? Any bleeding? Any fever and vaginal discharge? Any pain in your tommy?
RP- Everything fine.

Me- What about your wee? Any burning or stingy sensation? Any fever? Any pain in your loin? Any change in colour of urine?
RP- Nothing

Me- Good. Ok, let’s talk about your urine result then. Your urine grows a bug called GBS. Have you heard of that before ?
RP- No

Me- It is a bug which normally comes from back passage in about 50% of pregnant women. It usually doesn’t cause problems either to mother or baby until delivery.
You don’t have any signs and symptoms of urinary tract infections or genital tract infections now. So, we don’t need to do anything at this stage. We will just repeat the urine test, will do all the other routine pregnancy blood tests, USG at appropriate times.
The reason we don’t treat without any signs and symptoms of infection before delivery is that, even if we treat, it can come back again. It can never be completely cured cos it just stays normally in back passage.

However, we have to take action in certain situations such as at the onset of labour, at the time of rupture of membrane to prevent spread of infection to the baby.
The chance of baby being getting infection is around 1% if we don’t treat and it is usually very serious and can be life threatening infections.
With treatment, the risk of baby getting infection reduces a lot.
So, we will give you an antibiotic once you start your labour or if you rupture your waterbag before labour commences.
Having said that, if you develop signs and symptoms of infection at any stage of pregnancy as mentioned recently, then we will treat you immediately.

RP- What infections will my baby get if we don’t treat?
Me- Pneumonia, meningitis which is inflammation of covering of brain and sepsis which is infection spreading in the blood.

Despite treating you, if the bay has signs and symptoms of infections after delivery, paediatricians will treat your baby with antibiotics though it is unlikely to happen.

If your baby doesn’t have any signs and symptoms of infection then whether to treat the baby or not depends on specialist. Some specialists give the baby antibiotics without any signs and symptoms of infection while some don’t. So, it is specialist’s decision.

Me- Is there any other concern ?
RP- No

Me- If you have any problems such as fever, smelling discharge from your vagina, pain in your tommy, stingy or buring wee, change in colour of wee, don’t hesitate to come back immediately.

( 3 mins time remaining and I was not confident to go out as I still have dilemma in my mind whether it should be regarded as asymptomactic bacteriuira and treated or not. Cos GBS is positive in Urine MCS which  I am not very familiar with . So I continued my conversation which complicated things a little bit. )

Me- However, I will get advice from specialist to make sure that we don’t need to treat you. Because if it is not GBS but any other bug, then we have to treat it with or without signs and symptoms. Such condition is called asymptomatic bacteriuira.

RP was happy and smiling before this. She frowns now and asks

RP- So, are you not sure whether you have to treat me or not ?
You told me you can’t completely clear even you treat it. It normally stays in many pregnant women, doesn’t it ?

( Only by now, I become confident. Actually RP gave me a big hint !)

Me- Yes, I am sure we don’t need to treat it. I am just double checking with my specialist.

Examiner- Will you treat or not ?
Me- No

Bell rang.

Feedback- We can be guided by role players a lot cos they have answers with them 