1. Step [9]: Review of Learning Session
2. Step [6] Review of Previous Session
2.1. Vaginal discharge
2.1.1. Increased during pregnancy
2.1.2. Not smelly
2.1.3. Yallow or green
2.1.4. Bloody or browny (sometime could be normal)
2.1.5. Clear n thick before ovulation (because of strogen)
2.1.6. whtie n clear (pregnancy)
2.1.7. Pefuse, foul (bacteria) small amount, oducrless (fungi) all plusee burning senstation
2.1.8. OCT increase amount
2.1.9. before mensis (bac
2.1.10. Normal flora >> lactobacilluse (main organims, maintain acidity >> H2O2 >> it has bacteriocidal or bacteriostatic (protection from other organism- candida - e-coli and streptococci
2.1.11. bacterial vaginosis >> white or grey - no pain (more sus to have another organisms)
2.1.11.1. more than 4.5 - positive wef test - chara of discharge
2.1.12. Some bugs they end up by causing cancer
2.1.13. bacterial >> thin white grey
2.1.14. thin, yallow to green (frothy)
2.1.14.1. viable and motile
2.1.15. STI's
2.1.15.1. Herpes vaginalis and oralis
2.1.15.1.1. Asymptomatic - vaginal discharge with pain if left untreated >> complicationts
2.1.15.2. Bacteria
2.1.15.2.1. Clamidia
2.1.15.2.2. Gonorea
2.1.15.2.3. Syphilis
2.1.15.3. Viruses
2.1.15.3.1. HPV
2.1.15.3.2. HIV
2.1.15.4. Fungi
2.1.15.4.1. Candida
2.1.15.5. Parasites
2.1.15.5.1. Trichomonas
3. Step [11]: Feedback & Resources
3.1. Feedback
3.2. Resources
3.2.1. CDC
3.2.2. Uptodate
3.2.3. Medscape
4. Step [7]: Inquiry Plan & Information Gathering
4.1. History
4.1.1. Present
4.1.1.1. last 3 weeks >> increased
4.1.1.2. heavy periods
4.1.1.3. men at 13
4.1.1.4. Uses tampons
4.1.2. Medical
4.1.2.1. Tonsiloctmy
4.1.3. Sexual
4.1.3.1. Condoms OCTS used
4.1.3.2. Lst intercourse 3 days
4.1.3.3. 5 partners in her
4.1.3.4. 1 month before (veginal sex)
4.1.3.5. first sexual intercourse at 14
4.1.4. Drugs
4.1.5. Social
4.1.5.1. Smoking
4.1.5.2. Drinking
4.1.5.3. Marjuana (2-3 times year)
4.1.5.4. lives with her mother
4.1.5.5. Grade 10 - she planes to leaves school
4.1.5.6. Sees her father regularley
4.2. PE
4.2.1. Take permission
4.2.2. Explain
4.2.3. Expose the area
4.2.4. Make sure emptied the bladder
4.2.5. Inspection
4.2.6. Tenderness n adnexal tenderness (bi manual exam)
4.3. invistigation
4.3.1. Positive foe clamidia
5. Step [10]: Management
5.1. Clamedia
5.1.1. Manifestations
5.1.1.1. Urethritis, proctitis, Reiter's, PID, congectevivts in babaies, epededmitis, fever and infertelity etc
5.1.1.1.1. There is a widow period
5.1.2. Pathology
5.1.2.1. 2 major antigens >> majore outer membrane and heat shok protein
5.1.2.2. It increases the pH
5.1.2.3. WBC's seen under microscope
5.1.3. Diagnosis
5.1.3.1. Screening
5.1.3.2. Test for AIDS
5.1.3.3. NAAT is the best choice
5.1.3.3.1. Does not tell if active or not
5.1.3.4. CT for complications
5.1.4. Serotypes
5.1.4.1. A b c
5.1.4.2. D - k
5.1.4.2.1. genetal infection
5.1.4.3. L1 - 3
5.1.4.3.1. LGV
5.2. Drugs
5.2.1. Doxacyclin 100 mg
5.2.2. Azithromycine 1 g
5.2.2.1. Pregnancy
5.2.3. Erthromycine and levofloxcacin
5.2.4. Consider treating the partner
5.2.4.1. with in 60 days - or more
5.2.5. No contraindications with OCTs
5.2.6. GI symptoms and candida and rash with doxa
5.2.7. Educations
5.3. Ethics
5.3.1. The partner has to know if ther is long term complications
5.3.2. Parents
5.3.2.1. mature minor
5.3.2.1.1. STD's, OCT's, pregnancy, drug abuse and mental health
5.4. The case
5.4.1. No unprot sex
5.4.2. Doxacycling 100 mg oraley for 21 days - metronidzole
5.4.3. Adice partner
5.4.4. Counsed about safe sex
5.4.5. HIV na dsyphilis
5.4.6. Improved and condoms
6. Step [8]: Diagnostic Decision
6.1. Presentation
6.1.1. discharge for 3 weeks
6.2. Mechanism
6.3. Supporting Data
6.3.1. mutiple partners
6.3.2. Clamidia is positive
6.4. Objectives
6.4.1. What is clamidia
6.4.2. Management of clamidia infection
7. Step [1]: Identifying Cues & Difficult Word
7.1. Difficult Words
7.2. Identifying Cues
7.2.1. 16 YEARS OLD
7.2.2. Female
7.2.3. 3 weeks of vaginal discharge
7.2.4. Nervouse and uncomfortable
8. Step [2]: Problem Formulation
8.1. 16 years old female complaining of vaginal discharge for three weeks. She is anxious about whether to have internal examination or not.
9. Step [3]: Hypotheses Generations
9.1. Normal (menstruation)
9.1.1. Clear fluid
9.1.2. No smell
9.2. Infection
9.2.1. risk factors
9.2.1.1. Age
9.2.1.2. Hygiene
9.2.1.2.1. The use of pads
9.2.1.2.2. Tampons
9.2.1.2.3. The use of pads
9.2.2. Characterstic
9.2.2.1. Colorful
9.2.2.2. Odor
9.3. Pregnancy
9.4. Cervical cancer
9.5. Hormonal imbalance
9.6. OCT
9.7. Endometriosis
10. Step [4]: Hypothesis Organization
10.1. Differential Diagnoses
10.1.1. 1 Pathological
10.1.1.1. Infections
10.1.1.2. Cervical cancer
10.1.1.3. Hormonal imbalance
10.1.1.4. Endometriosis
10.1.2. 2 Physiological
10.1.2.1. Normal menstruation
10.1.2.2. Pregnancy
10.1.2.3. OCT