1. Step 8
1.1. Diagnostic decision
1.1.1. cervical sqeuamous cell carcinoma stage 2b
1.2. Mechanism
1.2.1. prolonged infection with HPV
1.2.2. risk factors
1.3. Presentation
1.3.1. lower back pain
1.3.2. R loin pain
1.3.3. microscopic hematouria
1.4. Supporting data
1.4.1. history and physical exam
1.4.2. colposcopy
1.4.3. CT scan
1.4.4. biopsy
1.5. 10 minutes
2. Step 7
2.1. Inquiry plan and info gathering
2.1.1. History of presenting complaint
2.1.1.1. worsening discahrge and pain
2.1.1.2. lower back pain and pelvis
2.1.1.2.1. worsned over 2 m
2.1.1.2.2. no radiation
2.1.1.2.3. like perioed pain but continuos
2.1.1.2.4. dull dragging
2.1.1.2.5. with R loin pain
2.1.1.2.6. not relieved by pain killers
2.1.1.3. no pain with urination
2.1.1.4. diacharge
2.1.2. Previous medical / surgical history
2.1.2.1. cholecysteectomy for gallstones
2.1.3. GYn history
2.1.3.1. regular period 28 days
2.1.3.2. one sexuall partner
2.1.3.3. five normal pregnancy with normal vaginal delivery
2.1.3.4. intermenstural postcoital bleeding two times in the last few months
2.1.3.5. two pap smears
2.1.3.5.1. the last one two and half ago
2.1.3.6. tubal ligation
2.1.4. Drug history / allergy
2.1.5. Family history
2.1.5.1. no malignancy in family
2.1.5.2. father died of heart attck at 72
2.1.5.3. mother a life and well 78y
2.1.6. Social / occupational history
2.1.6.1. stopped smoking three y ago
2.1.6.2. 20 ciggirate per day perviously
2.1.6.3. not a drinker
2.1.6.4. recreational activiter
2.1.7. Systemic review
2.1.8. Physical examination
2.1.8.1. vitals
2.1.8.1.1. rr 18 per min
2.1.8.1.2. P 76
2.1.8.1.3. BP 130/70
2.1.8.1.4. T 36.8
2.1.8.1.5. weight 67
2.1.8.1.6. hight 163
2.1.8.2. general appearance
2.1.8.2.1. looks well
2.1.8.3. abdominal
2.1.8.3.1. scar
2.1.8.3.2. liver and spleen are not palpable
2.1.8.4. genital
2.1.8.4.1. normal vulva
2.1.8.4.2. cervix irregular mass tumor 6 CM
2.1.8.4.3. extened to anterior and posterior vaginal vornizes
2.1.8.4.4. DRE early parametrial involvment
2.1.8.4.5. syaged 2b
2.1.8.5. cystoscopy
2.1.8.5.1. no tumor in bladder
2.1.8.5.2. are of bollus edema
2.1.8.6. scolscoospy
2.1.8.6.1. invasive carcinoma in cervixs
2.1.9. tests results
2.2. 50 minutes
3. Step 6
3.1. Review session 1
3.2. Report new knowledge
3.2.1. cervical cancer
3.2.1.1. definition
3.2.1.2. epidemiology
3.2.1.3. etiology
3.2.1.3.1. HPV
3.2.1.4. risk factors
3.2.1.5. pathophysiology
3.2.1.6. presentation
3.2.1.7. diagnosis
3.3. 30 minutes
3.3.1. The scribe does not have to write in this step!