1. Step [6] Review of Previous Session
1.1. Vaginal discharge
1.1.1. Increased during pregnancy
1.1.2. Not smelly
1.1.3. Yallow or green
1.1.4. Bloody or browny (sometime could be normal)
1.1.5. Clear n thick before ovulation (because of strogen)
1.1.6. whtie n clear (pregnancy)
1.1.7. Pefuse, foul (bacteria) small amount, oducrless (fungi) all plusee burning senstation
1.1.8. OCT increase amount
1.1.9. before mensis (bac
1.1.10. Normal flora >> lactobacilluse (main organims, maintain acidity >> H2O2 >> it has bacteriocidal or bacteriostatic (protection from other organism- candida - e-coli and streptococci
1.1.11. bacterial vaginosis >> white or grey - no pain (more sus to have another organisms)
1.1.11.1. more than 4.5 - positive wef test - chara of discharge
1.1.12. Some bugs they end up by causing cancer
1.1.13. bacterial >> thin white grey
1.1.14. thin, yallow to green (frothy)
1.1.14.1. viable and motile
1.1.15. STI's
1.1.15.1. Herpes vaginalis and oralis
1.1.15.1.1. Asymptomatic - vaginal discharge with pain if left untreated >> complicationts
1.1.15.2. Bacteria
1.1.15.2.1. Clamidia
1.1.15.2.2. Gonorea
1.1.15.2.3. Syphilis
1.1.15.3. Viruses
1.1.15.3.1. HPV
1.1.15.3.2. HIV
1.1.15.4. Fungi
1.1.15.4.1. Candida
1.1.15.5. Parasites
1.1.15.5.1. Trichomonas
2. Step [7]: Inquiry Plan & Information Gathering
2.1. History
2.1.1. Present
2.1.1.1. last 3 weeks >> increased
2.1.1.2. heavy periods
2.1.1.3. men at 13
2.1.1.4. Uses tampons
2.1.2. Medical
2.1.2.1. Tonsiloctmy
2.1.3. Sexual
2.1.3.1. Condoms OCTS used
2.1.3.2. Lst intercourse 3 days
2.1.3.3. 5 partners in her
2.1.3.4. 1 month before (veginal sex)
2.1.3.5. first sexual intercourse at 14
2.1.4. Drugs
2.1.5. Social
2.1.5.1. Smoking
2.1.5.2. Drinking
2.1.5.3. Marjuana (2-3 times year)
2.1.5.4. lives with her mother
2.1.5.5. Grade 10 - she planes to leaves school
2.1.5.6. Sees her father regularley
2.2. PE
2.2.1. Take permission
2.2.2. Explain
2.2.3. Expose the area
2.2.4. Make sure emptied the bladder
2.2.5. Inspection
2.2.6. Tenderness n adnexal tenderness (bi manual exam)
2.3. invistigation
2.3.1. Positive foe clamidia
3. Step [8]: Diagnostic Decision
3.1. Presentation
3.1.1. discharge for 3 weeks
3.2. Mechanism
3.3. Supporting Data
3.3.1. mutiple partners
3.3.2. Clamidia is positive
3.4. Objectives
3.4.1. What is clamidia
3.4.2. Management of clamidia infection
4. Step [11]: Feedback & Resources
4.1. Feedback
4.2. Resources
4.2.1. CDC
4.2.2. Uptodate
4.2.3. Medscape
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 [9]: Review of Learning Session
7. Step [4]: Hypothesis Organization
7.1. Differential Diagnoses
7.1.1. 1 Pathological
7.1.1.1. Infections
7.1.1.2. Cervical cancer
7.1.1.3. Hormonal imbalance
7.1.1.4. Endometriosis
7.1.2. 2 Physiological
7.1.2.1. Normal menstruation
7.1.2.2. Pregnancy
7.1.2.3. OCT
8. Step [1]: Identifying Cues & Difficult Word
8.1. Difficult Words
8.2. Identifying Cues
8.2.1. 16 YEARS OLD
8.2.2. Female
8.2.3. 3 weeks of vaginal discharge
8.2.4. Nervouse and uncomfortable
9. Step [2]: Problem Formulation
9.1. 16 years old female complaining of vaginal discharge for three weeks. She is anxious about whether to have internal examination or not.
10. Step [5]: Learning Objectives
10.1. characteristic of vaginal discharge (normal and abnormal)
10.2. Nomrla flora of the vegina
10.3. To identify the most common sexually transmitted infections and their clinical manifestations
11. Step [3]: Hypotheses Generations
11.1. Normal (menstruation)
11.1.1. Clear fluid
11.1.2. No smell
11.2. Infection
11.2.1. risk factors
11.2.1.1. Age
11.2.1.2. Hygiene
11.2.1.2.1. The use of pads
11.2.1.2.2. Tampons
11.2.1.2.3. The use of pads
11.2.2. Characterstic
11.2.2.1. Colorful
11.2.2.2. Odor