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
2.2.1.1. it talk about the invagon or metastatis
2.2.2. stage based therapy
2.2.2.1. stage 0 only in the TNM staging system
2.2.2.1.1. carcinoma in cit
2.2.2.2. stage 1
2.2.2.2.1. Ia surgery
2.2.2.2.2. stage IB surgery and lymph adinoctomy
2.2.2.3. stage 2
2.2.2.3.1. stage A surgery + adjuvant therapy
2.2.2.3.2. stage IIB usually radiotherapy
2.2.2.4. the rest usually is a palliative therapy
2.2.3. types of surgery
2.2.3.1. first
2.2.3.1.1. uterus and part of the vagina
2.2.3.2. second
2.2.3.2.1. half of the cardinal ligament
2.2.3.3. third
2.2.3.3.1. radical hysterectomy
2.2.3.4. fourth
2.2.3.4.1. is not used
2.2.3.5. surgery complication
2.2.3.5.1. short term
2.2.3.5.2. long term
2.2.4. follow up
2.2.4.1. in the first 2 years after the treatment
2.2.4.1.1. every 2-3 months
2.2.4.2. after 3-4 years
2.2.4.2.1. every 6 months or annually
2.2.4.3. for anemia
2.2.4.3.1. give erothropoitine
2.2.5. screening
2.2.5.1. 21 years we start the the screanign
2.2.5.1.1. from 21-29 every 3 years
2.2.5.1.2. from 30-65 every 5 years
2.2.5.1.3. above 65
2.2.6. vaccenation
2.2.6.1. bivelant or quadravelant
2.2.6.1.1. bivelant for the most common HPV 16 and 18
2.2.6.1.2. in quadravelant we add the 31 and 33
2.2.7. rule of the thumb
2.2.7.1. 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
2.3.1.1. medscape
2.3.1.2. 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
3.1.1.1. Infections
3.1.1.1.1. Schistosomiasis
3.1.1.1.2. Strept. infection
3.1.1.1.3. Cystitis
3.1.1.2. Malignancy
3.1.1.3. Stones
3.1.1.4. RCC
3.1.1.5. Benign neoplasia; BPH
3.1.1.6. Could be devided into urological and gynecological causes
3.1.2. to list the red flags for lower back pain (mainly on female)
3.1.2.1. Malignancy related; B symptoms
3.1.2.1.1. progressive and chronic
3.1.2.2. Lower back pain in immune-compromised patients
3.1.2.3. cauda equina syndrome
3.1.2.3.1. Saddel anasethesia
3.1.2.4. Old age
3.1.2.5. Infections; short duration
3.1.2.6. Recent history of trauma
3.1.2.7. Pain the presence of urinary symptoms
3.1.3. to know about the cervical cancer mainly manifestation
3.1.3.1. Early
3.1.3.1.1. Mostly asymptomatic
3.1.3.1.2. Vaginal discharge
3.1.3.1.3. post-coital bleeding
3.1.3.2. Advanced
3.1.3.2.1. Pain
3.1.3.2.2. Urinary symptoms
3.1.3.2.3. Bone pain
3.1.3.2.4. Hydronephrosis
3.1.3.2.5. Respiratory and neurological symptoms
3.2. Step (7): Gathering Information & Inquiry Plan
3.2.1. History
3.2.1.1. Presenting issue
3.2.1.1.1. Hematurea
3.2.1.1.2. Pain
3.2.1.2. Past
3.2.1.2.1. Cholesystectomy
3.2.1.3. Personal
3.2.1.3.1. lives in sydeny
3.2.1.3.2. works in a church
3.2.1.3.3. Given up smoking 3 years ago
3.2.1.4. Family
3.2.1.4.1. Father died of MI
3.2.1.5. Gynecological
3.2.1.5.1. 5 pregnancies with vaginal delivery
3.2.1.5.2. 2 pap smears
3.2.1.5.3. Periods are regular
3.2.1.5.4. Pst coital bleeding 2 times
3.2.2. Physical Examination
3.2.2.1. General appearnce and vitals
3.2.2.1.1. RR of 18
3.2.2.1.2. PR 76
3.2.2.2. Abdominal
3.2.2.2.1. Incesion of previous surgery
3.2.2.3. Gynecological
3.2.2.3.1. cervix is replaced by masses of tumor extending to the anterior and posterior fornices
3.2.3. Investigation
3.2.3.1. cysetoscpy
3.2.3.1.1. edmea but no tumor
3.2.3.2. Colposcopy
3.2.3.2.1. parametrial invasion
3.2.3.3. FBC
3.2.3.3.1. normal and no anemia
3.2.3.4. CT of abdomen and pelivis
3.2.3.4.1. 6 cm diameter tumor and no evedince of retroperitoneal lymphandenopathy
3.2.3.5. Pathology
3.2.3.5.1. non-keratizing squamous cell carcinoma
3.3. Step (8): Diagnostic Decision
3.3.1. Mechanism
3.3.2. Presentation
3.3.2.1. back pain and rt loin pain
3.3.3. Supporting Data
3.3.3.1. CT
3.3.3.2. Clinical exam
3.3.3.3. Pathology report
3.3.4. Diagnosis
3.3.4.1. stage 2B cervical cancer
3.4. OBJECTIVES
4. First Session
4.1. Step (1): Identifying Difficult Words & Cues
4.1.1. Difficult Words
4.1.2. Cues
4.1.2.1. female 46-y-o
4.1.2.2. low back pain
4.1.2.3. R loin pain
4.1.2.4. worsting in the last two months
4.1.2.5. microscopic hematoueara
4.1.2.6. 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