1. Step 5
1.1. 10 minutes
1.1.1. anatomy of external genitalia, vagina and glands
1.1.2. vaginal discharge
1.1.2.1. types
1.1.2.2. causes
1.1.2.2.1. physiological
1.1.2.2.2. STD
1.1.2.2.3. pregnancy, UTI or cyst??
1.1.2.2.4. others
1.1.2.3. history, examination and investigation
1.1.3. medicolegal consideration for a 16 y o female undergoing a pelvic examination
2. Step 2
2.1. 10 minutes
2.1.1. a 16 y o anxious female, presented to the clinic with a history of increasing vaginal discharge for the last 3 weeks.
3. Step 3
3.1. 40 minutes
3.1.1. vaginal discharge
3.1.1.1. exudate involoving inflammatory cells (infection)
3.1.1.1.1. can be viral or bacterial
3.1.1.2. maybe the discharge is from deeper structures to the vagina (uterus)
3.1.1.3. normal flora decreased and candiasis arises
3.1.1.4. we have to differentiate it from the normal vaginal secretion (during ovulation) for lubrication
3.1.1.5. if there is some mensrual cycle abnormalities
3.1.1.6. might be STD since she came alone and her age can be a hint
3.1.1.7. delayed menarche (puberty)
3.1.1.8. maybe has some coexisting disease like diabetes
3.1.1.9. maybe she takes some oral contraceptives
3.1.1.10. vaginal tumor or cyst
3.1.1.10.1. maybe it injures other tissue
3.1.1.11. psychological or mental causes like increased libido
3.1.1.12. UTI involving the lower part and accompanied by a vaginal discharge
3.1.1.13. a possibility that she feels that she is pregnant
3.1.1.14. hormonal imbalance
3.1.2. anxiety
3.1.2.1. sexual abuse
3.1.2.2. maybe she came alone to not let anyone knows
3.1.2.3. her friend had a bad experience in internal exam and she told her about that
4. Step 4
4.1. Hypothesis organization (tentative solution)
4.1.1. inection
4.1.1.1. STD
4.1.1.1.1. young and anxious
4.1.1.2. UTI
4.1.2. pregnancy
4.1.3. tumors or cysts
4.1.4. anxiets that causes menstrual irregularity and vaginal discharge
4.2. 20 minutes
5. Step 1
5.1. Identify terms and cues
5.2. New terms
5.2.1. internal examination
5.2.1.1. including pelvic examination
5.3. Cues
5.3.1. 16 y o female
5.3.2. 3 weeks o increasing vaginal discharge
5.3.3. uncomfortable and anxious
5.3.4. nervous about the internal examination
5.3.5. a friend told her that the examination was awful