Tài liệu tham khảo dành cho giáo viên, sinh viên ngành y khoa chuyên ngành phụ khoa - Các chứng bệnh, biểu hiện và cách điều trị bệnh trong phụ khoa. | now TO APPROACH CLINICAL PROBLEMS 15 c. 1 lysterosalpingogram HSG i. A small amount of radiopaque dye is introduced through a transcervical cannula and radiographs are taken. ii. It is useful for the detection of intrauterine abnormalities submucous fibroids or intrauterine adhesions and patency of the fallopian tubes tubal obstruction or hydrosalpinx . PART 2. APPROACH TO CLINICAL PROBLEM SOLVING There arc typically four distinct steps that a clinician undertakes to solve most clinical problems systematically 1. Making the diagnosis. 2. Assessing the severity and or stage of the disease. 3. Rendering a treatment based on the stage of the disease. 4. following the patient s response to the treatment. Making the Diagnosis The diagnosis is made by careful evaluation of the database analysis of the information assessment of the risk factors and development of the list of possibilities the differential diagnosis . The process includes knowing which pieces of information are meaningful and which may be thrown out. Experience and knowledge help to guide the physician to key in on the most important possibilities. A good clinician also knows how to ask the same question in several different ways and use different terminology. For example patients at times may deny having been treated for pelvic inflammatory disease but will answer affirmatively to being hospitalized for a tubal infection. Reaching a diagnosis may be achieved by systematically reading about each possible cause and disease. The patient s presentation is then matched up against each of these possibilities and each is cither placed high up on the list as a potential etiology or moved lower down because of disease prevalence the patient s presentation or other clues. A patient s risk factors may influence the probability of a diagnosis. 16 C ASK FILES OBSTETRICS AND GYNECOLOGY Usually a long list of possible diagnoses can be pared down to two to three most likely ones based on selective laboratory or imaging .
