A Concerned GP

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A Concerned GP by Mind Map: A Concerned GP

1. to list the differential diagnosis of hematouria

2. Third Session

2.1. Step (9): Review of Learning Objectives

2.2. Step (10): Management

2.2.1. GYN cancer staged by VEGO staging system it talk about the invagon or metastatis

2.2.2. stage based therapy stage 0 only in the TNM staging system carcinoma in cit stage 1 Ia surgery stage IB surgery and lymph adinoctomy stage 2 stage A surgery + adjuvant therapy stage IIB usually radiotherapy the rest usually is a palliative therapy

2.2.3. types of surgery first uterus and part of the vagina second half of the cardinal ligament third radical hysterectomy fourth is not used surgery complication short term long term

2.2.4. follow up in the first 2 years after the treatment every 2-3 months after 3-4 years every 6 months or annually for anemia give erothropoitine

2.2.5. screening 21 years we start the the screanign from 21-29 every 3 years from 30-65 every 5 years above 65

2.2.6. vaccenation bivelant or quadravelant bivelant for the most common HPV 16 and 18 in quadravelant we add the 31 and 33

2.2.7. rule of the thumb if the primary treatment is surgery we do radiotherapy as the first choice in the recurrent and verse versa

2.3. Step (11): Feedback & Resources

2.3.1. resources medscape up to date

3. Second Session

3.1. Step (6): Review of Learning Objectives

3.1.1. Definition: Presence of more than 3 RBCs in the urine Infections Schistosomiasis Strept. infection Cystitis Malignancy Stones RCC Benign neoplasia; BPH Could be devided into urological and gynecological causes

3.1.2. to list the red flags for lower back pain (mainly on female) Malignancy related; B symptoms progressive and chronic Lower back pain in immune-compromised patients cauda equina syndrome Saddel anasethesia Old age Infections; short duration Recent history of trauma Pain the presence of urinary symptoms

3.1.3. to know about the cervical cancer mainly manifestation Early Mostly asymptomatic Vaginal discharge post-coital bleeding Advanced Pain Urinary symptoms Bone pain Hydronephrosis Respiratory and neurological symptoms

3.2. Step (7): Gathering Information & Inquiry Plan

3.2.1. History Presenting issue Hematurea Pain Past Cholesystectomy Personal lives in sydeny works in a church Given up smoking 3 years ago Family Father died of MI Gynecological 5 pregnancies with vaginal delivery 2 pap smears Periods are regular Pst coital bleeding 2 times

3.2.2. Physical Examination General appearnce and vitals RR of 18 PR 76 Abdominal Incesion of previous surgery Gynecological cervix is replaced by masses of tumor extending to the anterior and posterior fornices

3.2.3. Investigation cysetoscpy edmea but no tumor Colposcopy parametrial invasion FBC normal and no anemia CT of abdomen and pelivis 6 cm diameter tumor and no evedince of retroperitoneal lymphandenopathy Pathology non-keratizing squamous cell carcinoma

3.3. Step (8): Diagnostic Decision

3.3.1. Mechanism

3.3.2. Presentation back pain and rt loin pain

3.3.3. Supporting Data CT Clinical exam Pathology report

3.3.4. Diagnosis stage 2B cervical cancer


4. First Session

4.1. Step (1): Identifying Difficult Words & Cues

4.1.1. Difficult Words

4.1.2. Cues female 46-y-o low back pain R loin pain worsting in the last two months microscopic hematoueara concerned about the appearance on the cervix

4.2. Step (2): Problem Formulation

4.2.1. a 46 year-old female presented with lower back and right loin pain. she has microscopic hematueria with the concern about the cervical appearance.

4.3. Step (3): Hypotheses Generation

4.3.1. lower back pain cause by a compression in the sacral plexus.

4.3.2. stone in the kidney

4.3.3. tumor

4.3.4. infection

4.3.5. neoplastic changes in the cervix and that metastasize to the surrounding area

4.3.6. human papilloma virus which lead to cervical cancer

4.3.7. blood result from an irritation in the urinary track

4.3.8. the lower back pain might be not related to the cancer in the cervix

4.3.9. urinary track infection symptoms are not present, thus it should have least priority

4.3.10. both the lower back and the loin pains are a refered pain due to the mass location

4.3.11. basic MSK problem

4.3.12. burgur disease

4.4. Step (4): Hypotheses Organization

4.4.1. gynaecological

4.4.2. urological

4.5. Step (5): Learning Objectives

4.5.1. Definition: Presence of more than 3 RBCs in the urine

4.5.2. to list the red flags for lower back pain (mainly on female)

4.5.3. to know about the cervical cancer mainly manifestation