Clinical care pathways

From hemodynamic assessment to the two-level Wells score, (age-adjusted) D-dimer and CTPA for suspected acute PE.

Decide whether emergency treatment is needed based on potassium level, ECG changes and symptoms, and manage acute hyperkalemia with the 'stabilize–shift–remove' three-step approach.

Use CURB-65 to grade CAP severity and decide outpatient / ward / ICU disposition, integrating severe-CAP criteria and sepsis recognition.

Confirm DKA, grade by the 2024 ADA consensus, and manage with fluids → check potassium before insulin → monitor → find the trigger.

After recognizing sepsis / septic shock, start the SSC Hour-1 bundle: lactate, blood cultures, broad-spectrum antibiotics, crystalloid and vasopressors.

Recognize anaphylaxis by diagnostic criteria and give intramuscular epinephrine first, with airway, volume and adjunctive treatment.

Diagnose and stage by KDIGO creatinine and urine-output criteria; find the cause, stop nephrotoxins, optimize volume and manage complications.

Decide whether and what to anticoagulate by valvular status and CHA2DS2-VASc annual stroke risk (DOAC preferred); HAS-BLED is to improve, not withhold, anticoagulation.

Within the stroke code, use non-contrast CT to exclude hemorrhage and the last-known-well (LKW) time to decide IV thrombolysis (4.5 h) and mechanical thrombectomy (up to 24 h).

From hemodynamic resuscitation to GBS risk stratification, restrictive transfusion and endoscopy timing, distinguishing variceal from non-variceal bleeding.

Grade severity by GINA (speech / breathing / SpO2 / PEF / consciousness) to guide SABA, steroids, magnesium and ventilatory escalation.

After STEMI is confirmed, choose primary PCI or thrombolysis + pharmaco-invasive strategy based on whether primary PCI can be done within 120 min.

Shockable rhythm → defibrillate immediately, epinephrine after the 2nd shock, amiodarone after the 3rd; non-shockable → no defibrillation, early epinephrine; treat the H's & T's.

Treat convulsive status epilepticus in time-based phases: stabilize → first-line benzodiazepine → second-line antiseizure drug → refractory anesthesia.

Decide the workflow by whether CT is needed before LP; start dexamethasone + empiric antibiotics within 1 hour and do not delay for tests.

Bedside perfusion (warm/cold) × congestion (wet/dry) phenotyping guides diuresis, vasodilators, inotropes and vasopressors, plus finding the trigger.

Assess outpatient vs admission; use antibiotics by Anthonisen criteria, systemic steroids and controlled oxygen, with NIV for those who meet criteria.

Diagnose by 2-of-3, stratify by revised Atlanta, and manage with moderate fluids, analgesia, early enteral nutrition and finding the cause.

Distinguish emergency (with acute target-organ damage) from urgency, and set the rate and target of BP lowering for general or special situations.

Stratify non-ST-elevation ACS into very-high / high / low risk to decide an immediate, early or selective invasive strategy.

Whether severe (cerebral edema) symptoms are present decides emergency hypertonic saline, with a strict rate limit to prevent osmotic demyelination.

Recognize HHS by four criteria and manage with aggressive fluids, low-dose insulin and potassium, lowering osmolality slowly and finding the trigger.

Use the ingested dose and timing, the 4-hour level and the Rumack-Matthew nomogram to decide N-acetylcysteine (NAC).

Use the two-level Wells-DVT score with D-dimer and compression ultrasound to safely confirm or exclude DVT.

Narrow-QRS regular tachycardia managed by stability: unstable → cardiovert; stable → vagal maneuvers → adenosine → other drugs.

Judge whether there is cardiorespiratory compromise; if unstable, atropine 1 mg first, then transcutaneous pacing or dopamine/epinephrine.

Treat wide-QRS as VT by default; unstable → immediate synchronized cardioversion; stable → single antiarrhythmic, treat as VT when in doubt.

Beck's triad + pulsus paradoxus, echo showing effusion + RV collapse; if unstable, emergency pericardiocentesis/drainage.

Diagnose by ≥2 of 4 criteria, exclude ACS/dissection/PE; first-line NSAIDs + colchicine, steroids are not first-line, admit high-risk.

Confirm and classify by CTA; all types get anti-impulse HR/BP control first; type A is emergency surgery, type B is mainly medical.

Grade by the Berlin definition P/F; lung-protective ventilation 6 mL/kg, plateau <30; prone position for moderate-severe, ECMO for refractory.

SCAI A–E staging; emergency revascularization is the cornerstone of AMI-CS, norepinephrine + inotrope, mechanical circulatory support for refractory cases.

Use ABCD2 to estimate short-term stroke risk after TIA and guide the urgency of evaluation, antiplatelet therapy and secondary prevention.

Sudden thunderclap headache → non-contrast CT first, LP if needed to confirm; once confirmed, nimodipine + early aneurysm treatment.

After non-contrast CT confirms it, immediately reverse anticoagulation, control BP smoothly by SBP, and obtain neurosurgical assessment.

Headache-predominant, can mimic stroke/SAH; diagnose with CTV or MRV (NCCT often normal); anticoagulation is the cornerstone (even with hemorrhagic infarction).

Use the three-step HINTS for persistent AVS; any central sign → work up as posterior-circulation stroke, all three peripheral = vestibular neuritis.

All patients get an ECG, orthostatic vitals and a search for serious causes; the Canadian Syncope Risk Score triages admission vs discharge.

Treat at glucose <3.9 mmol/L: conscious patients use the 'rule of 15' oral carbs; unable to swallow/comatose use IV glucose or glucagon.

Decide oral vs IV potassium by severity and urgent features, and always measure and replace magnesium.

Use Burch-Wartofsky to recognize thyroid storm and treat with the quartet — beta-blocker, thionamide, iodine, steroid — plus supportive care.

Treat on suspicion, do not delay for confirmation: immediate hydrocortisone + rapid fluids, and find the precipitant.

Stratify by calcium and symptoms; treat severe disease with fluids, calcitonin and a bisphosphonate together, and treat the underlying cause.

Correct volume first, then replace free water by acute/chronic status and control the correction rate to avoid cerebral edema.

Diagnose at CK >5× ULN; early aggressive fluids to prevent AKI, correct hyperkalemia and other electrolytes, RRT for refractory cases.

Diagnose and grade by TG18; all patients get broad-spectrum antibiotics, with biliary drainage timing set by grade.

Diagnostic paracentesis in cirrhotic ascites; PMN ≥250 → empiric 3rd-generation cephalosporin + albumin, with quinolone prophylaxis after recovery.

West Haven grading; first find and treat the precipitant, lactulose first-line ± rifaximin, protect the airway in grade 3–4 to prevent aspiration.

All suspected cases get immediate 100% normobaric oxygen; decide hyperbaric oxygen by loss of consciousness, neuro/cardiac involvement, COHb, etc.

Recognize the respiratory-depression triad, ventilate and oxygenate, titrate naloxone, and watch for re-sedation from long-acting opioids.

Recognize the cholinergic crisis, decontaminate, titrate atropine to dry secretions, and give pralidoxime early to reactivate cholinesterase.

Bicarbonate for blood/urine alkalinization, correct hypokalemia, avoid intubation where possible, hemodialysis for severe cases per EXTRIP.

Sodium-channel blockade widens QRS; bicarbonate is the key antidote, benzodiazepines for seizures, avoid certain antiarrhythmics.

Bradycardia + hypotension + conduction block; calcium, atropine, high-dose insulin euglycemia, vasopressors and glucagon in a stepwise approach.

Acute hyperkalemia marks severity; life-threatening features or hyperkalemia → digoxin-specific antibody (DigiFab); do not give calcium or pace.

Diagnose by Hunter criteria (clonus/hyperreflexia are key), stop the drug + support + benzodiazepines + cyproheptadine, intubate and cool for severe cases.

Dopamine-antagonist-induced lead-pipe rigidity + hyperthermia + altered mentation + raised CK; stop the drug + cool/hydrate + benzodiazepines/dantrolene.

CIWA-Ar symptom-triggered benzodiazepines, thiamine before glucose; DTs/seizures need ICU, IV benzodiazepines ± phenobarbital.

Mainly supportive care; flumazenil is a risk-benefit decision, only for iatrogenic isolated overdose without dependence, contraindicated in mixed/dependent cases.

Distinguish plain ethanol from toxic alcohols (methanol/ethylene glycol); the former gets supportive care, the latter fomepizole and dialysis when indicated.

Mainly neurotoxic; charcoal is ineffective, isotonic saline fluids; severe / Li >4 with renal injury / seizures → hemodialysis, watch for rebound.

Five clinical stages; charcoal is ineffective, whole-bowel irrigation clears tablets; serum iron >500 / shock / acidosis → deferoxamine.

Cyanosis not relieved by oxygen + saturation gap + chocolate-brown blood; methylene blue antidote, contraindicated in G6PD deficiency.

High-anion-gap acidosis + raised osmolar gap; fomepizole (first-line) inhibits ADH, dialysis for severe disease/end-organ damage.

Agitation + hyperthermia + hypertension + tachycardia; benzodiazepines first-line, physical cooling, avoid beta-blockers.

Dry, hot, red, blind, mad, full toxidrome; mainly support + benzodiazepines, bicarbonate for wide QRS, physostigmine only for the pure type.

Fire smoke/industrial; high lactate + anion-gap acidosis, empiric hydroxocobalamin, avoid nitrites in smoke-inhalation victims.

Triad of refractory seizures + high-anion-gap acidosis + coma; the specific antidote is gram-for-gram IV pyridoxine.

Highly lethal with no specific antidote; the key paradox is to avoid oxygen, give early adsorbents and hemoperfusion, and prognosticate by ingested dose.

Immobilize and transport, avoid harmful old methods; decide antivenom by local progression or systemic envenomation, ready to manage anaphylaxis.

The four nos (no emesis/lavage/neutralization/charcoal); airway first, early endoscopy grading at 12–24 h.

Always stop the transfusion and re-verify first; then triage by febrile-hemolytic / respiratory distress / fever-or-rash-only.

Exclude tension pneumothorax first (immediate needle decompression); manage spontaneous pneumothorax symptom-directed per BTS 2023.

Core temp >40°C with CNS dysfunction = heat stroke; rapid cooling is the key determinant of outcome.

Pain out of proportion → treat as AMI; confirm with CTA, resuscitate/anticoagulate/give antibiotics and decide surgery by peritonitis.

Recognize the 6 P's, give immediate heparin + CTA for all, and use Rutherford grade to decide urgency of revascularization vs amputation.

After confirming PE, stratify by hemodynamics, PESI, RV function and biomarkers: thrombolyse high-risk, anticoagulate-only for low-risk.

Cairo-Bishop laboratory/clinical classification; aggressive hydration, rasburicase for hyperuricemia, manage electrolytes and dialyze as needed.

Use the 2023 Duke-ISCVID major/minor criteria for definite/possible IE; blood cultures and echo are central, with multidisciplinary management.

Recognize red flags such as saddle anesthesia and bladder/bowel dysfunction; emergency MRI and early surgical decompression (aim within 48 h).

Confirm with blood film/RDT; triage by WHO severe criteria — IV artesunate for severe, oral ACT for uncomplicated.

Classify AMS/HACE/HAPE; descent is most important, dexamethasone for HACE, nifedipine + oxygen for HAPE.

Restrictive transfusion + vasoactive drug on arrival + prophylactic antibiotics + endoscopy within 12 h; balloon tamponade as a bridge → TIPS for refractory.

Acute hot swollen painful single joint; arthrocentesis is key; after aspiration give empiric antibiotics + joint drainage.

In a cancer patient with back pain + neurological symptoms, do not wait for paralysis; dexamethasone 16 mg + whole-spine MRI <24 h + radiotherapy ± surgery within 24 h.

Death is usually from asphyxiation; airway first + affected-side-down positioning to protect the healthy lung; definitive hemostasis is bronchial artery embolization.

Recognize severe features and seizures; magnesium sulfate to prevent/stop seizures, first-line antihypertensives for severe hypertension, plan delivery.

Find the cause by the 4 T's and resuscitate; for uterine atony, massage plus a uterotonic ladder, tranexamic acid for all, interventional or surgical for refractory.

Hemolysis + raised liver enzymes + low platelets; stabilize the mother, control BP + magnesium; delivery is definitive — deliver at ≥34 weeks or for maternal/fetal deterioration.

Vaginal bleeding + abdominal pain + abnormal fetal heart rate, a clinical diagnosis; deliver promptly if mother/fetus unstable or at term, plus correct blood loss and DIC.

Sudden hypoxia + hypotension + DIC triad during labor/immediately postpartum → treat as AFE with high-quality resuscitation and DIC correction.

Transvaginal ultrasound + β-hCG discriminatory zone; emergency surgery if unstable/ruptured, methotrexate for eligible stable patients.

Stratify with the Alvarado score: observe low-risk, image intermediate, surgical consult for high-risk; the score alone does not decide surgery.

Diagnose and grade with TG18; with antibiotic support, early laparoscopic cholecystectomy is preferred for grade I–II, organ support ± drainage for grade III.

First judge for strangulation/perforation; if absent, manage conservatively (decompression + fluids + water-soluble contrast, ≤72 h); if present, emergency surgery.

Contrast CT + modified Hinchey grade; uncomplicated can be outpatient (selective no-antibiotics), drain abscesses, emergency surgery for diffuse peritonitis.

'Time is testicle' — use TWIST/clinical suspicion to decide straight-to-surgery vs ultrasound; do not delay exploration when suspicion is high.

Sudden unilateral pelvic pain + nausea; normal Doppler flow does not exclude it; if suspected, laparoscopic detorsion with ovary preservation.

CT first-line; NSAID first-line analgesia + medical expulsive therapy; infection + obstruction/AKI/uncontrolled pain → emergency decompression.

Triad (hypotension + back pain + pulsatile mass), permissive hypotension; unstable → straight to OR, stable → CTA to assess EVAR.

Grade by stridor at rest; all children get a single dose of dexamethasone, moderate–severe add nebulized epinephrine with observation for rebound.

Clinical diagnosis at 1–23 months, purely supportive care; no routine bronchodilators/steroids/antibiotics; admit by risk factors and distress.

Fever ≥5 days + principal criteria (including incomplete), IVIG 2 g/kg + aspirin within 10 days, echo for coronary arteries.

Cerebral edema is the most feared complication; start insulin only after 1 h of fluids, no bolus, avoid bicarbonate, watch for cerebral edema.

Distinguish simple from complex febrile seizures to guide seizure management, whether to do an LP/work-up, and parent education.

Ultrasound target sign first-line; air enema reduction if stable, surgery for perforation/peritonitis/failure.

Grade as non-severe–severe / fulminant; stop the inciting antibiotic, oral fidaxomicin or vancomycin, add surgery for fulminant disease.

Distinguish complicated/uncomplicated; outpatient oral fluoroquinolone for uncomplicated, admit for IV antibiotics in complicated/septic cases, emergency drainage for infected obstruction.

Fever + altered consciousness + focal signs/seizures; once suspected, start empiric IV acyclovir immediately, do not wait for PCR.

Clinical diagnosis, do not wait for imaging; immediate thorough debridement + broad-spectrum antibiotics (including clindamycin) + aggressive resuscitation.

MAHA + thrombocytopenia, normal PT/APTT; with a high PLASMIC score, start plasma exchange + steroids without waiting for ADAMTS13; do not transfuse platelets.

ISTH score ≥5 = overt DIC; treating the underlying cause is paramount, give blood products for bleeding/procedures rather than numbers alone.

Ascending flaccid paralysis + areflexia + CSF albuminocytologic dissociation; IVIG/plasma exchange, serial FVC monitoring to prevent respiratory failure.

Falling FVC/bulbar weakness → ICU respiratory support, hold pyridostigmine, plasma exchange or IVIG, avoid aggravating drugs.

Confirm febrile neutropenia, stratify by MASCC; high-risk get empiric anti-pseudomonal monotherapy within 1 h, low-risk may have oral outpatient therapy.

Superantigen-mediated; source control + fluid resuscitation + MRSA cover plus clindamycin to suppress toxin, add IVIG for severe/streptococcal disease.

Back pain + fever + neuro deficit (the full triad in only ~10–15%); whole-spine contrast MRI, emergency decompression + antibiotics if there is a deficit.

Age >50 with headache + jaw claudication ± visual symptoms; start high-dose steroids on suspicion, do not wait for biopsy, to prevent permanent blindness.

Thiamine deficiency, the triad complete in only 16%; IV high-dose thiamine, before any glucose.

Decompensated severe hypothyroidism (altered consciousness + hypothermia + trigger); hydrocortisone before thyroid hormone, passive rewarming, support.

Catecholamine hypertensive crisis; alpha-blockade first (phentolamine), never a beta-blocker before adequate alpha-blockade.

Assess the airway first (intubate early for inhalation injury); estimate TBSA by the rule of nines, Parkland fluids titrated to urine output, transfer to a burn center.

The core injury is hypoxia, ventilation first; the Heimlich maneuver is not recommended; symptomatic/hypoxic → oxygen ± intubation, observe asymptomatic for 4–8 h.

Rewarm by core temperature grade; mild passive, moderate active external, severe core/ECMO; handle gently to prevent VF, do not declare death before rewarming.

An ophthalmic emergency; urgent medical lowering of intraocular pressure, then urgent ophthalmology for laser peripheral iridotomy.

Sudden painless monocular vision loss — an 'eye stroke', manage as an acute stroke; suspect giant cell arteritis if >50.

Encephalopathy + coagulopathy without chronic liver disease; give NAC early, transfer early to a transplant center once King's College criteria are met.

Chest pain + subcutaneous emphysema after vomiting, CT first-line; emergency surgery if unstable/large leak, conservative/endoscopic + drainage for a contained leak.

Colon >6 cm + systemic toxicity (Jalan); medical-surgical co-management, emergency colectomy for perforation/progressive dilation/no improvement.

If all 5 NEXUS low-risk criteria are met, no imaging; any positive or a Canadian C-spine high-risk feature → cervical spine CT.

For minor head injury, use the high-risk/medium-risk factors of the Canadian CT Head Rule to decide whether a head CT is needed.

Decide on a tetanus-toxoid-containing vaccine and whether to add TIG based on wound type and prior immunization history.

Hypophosphatemia is the hallmark (+ low potassium/magnesium); thiamine before feeding, start low and advance slowly, replace electrolytes aggressively.

Thoracentesis for protein/LDH, Light's criteria classify exudate/transudate; suspected hemothorax/empyema → emergency drainage.

First-aid compression 10–15 min; cautery/packing for anterior, posterior balloon packing + admission + ENT for posterior.

Severe unilateral sore throat + trismus + uvular deviation; drainage + antibiotics ± steroid, admit for airway involvement/deep neck spread.

Pain on eye movement + proptosis + ophthalmoplegia indicate postseptal; admit + contrast CT + IV antibiotics, surgery for abscess/visual deterioration.

An airway emergency, do not examine the throat/do not agitate; secure the airway first if there are obstruction signs (controlled intubation/surgical airway standby), then IV cephalosporin.

Ischemic (painful, rigid, acidotic blood gas) is an emergency, corporal aspiration + phenylephrine; non-ischemic is not an emergency.

Immediate catheter decompression + find the cause; for BPH add an alpha-blocker then a trial of voiding; suprapubic catheter if urethral catheterization is contraindicated.

Coffee-bean sign; for uncomplicated cases, endoscopic detorsion/decompression + elective resection to prevent recurrence, emergency surgery for ischemia/perforation.

High-voltage/abnormal ECG/myoglobinuria → monitoring + aggressive fluids; asymptomatic low-voltage with a normal ECG may be discharged.

Uncomplicated may have antibiotics-first or laparoscopic appendectomy; drain an abscess first; emergency for perforation; laparoscopic approach preferred.

Observe asymptomatic; symptomatic/acute → LC (early); Grade III/high-risk drain percutaneously first; laparoscopic approach preferred.

Minimally symptomatic men may watch; repair if symptomatic; unilateral Lichtenstein or laparoscopic, bilateral/recurrent favor laparoscopic; emergency for incarceration.

Observe asymptomatic; medical/interventional to preserve the uterus; surgery = myomectomy (approach by location) to preserve fertility vs hysterectomy as definitive.

IOTA/O-RADS/RMI stratification: surveillance or laparoscopic cystectomy for low-risk, refer for gyne-onc staging if intermediate-high, emergency for torsion/rupture.

US risk sets the FNA threshold + Bethesda: benign surveillance/RFA; indeterminate repeat or molecular; cancer lobectomy vs total by size.

Ureteric ≤10 mm medical expulsion (MET); surgery chooses URS/SWL/PCNL by site and size; obstruction + infection → emergency drainage.

Observe → medical → surgery (refractory/complications); approach by prostate volume: <30 TUIP/UroLift, 30-80 TURP/laser, >80 HoLEP/simple prostatectomy.

Cauda equina/progressive deficit → emergency decompression; radicular pain conservative 6-12 weeks → discectomy (minimally invasive) if failed; fusion only for instability/spondylolisthesis.

Conservative (weight loss/physio/NSAIDs/injection) 12-24 weeks failed → replacement; knee unicompartmental UKA/osteotomy, multicompartmental TKA, hip THA.

Surveillance per Fleischner/Lung-RADS; >8 mm/growing/high-risk → after work-up, wedge-segmentectomy (≤2 cm peripheral) vs lobectomy.

Symptomatic ≥50% → early revascularization (CEA usually over CAS); asymptomatic ≥60-70% high-risk → CEA; otherwise best medical therapy.

Men ≥5.5/women ≥5.0 cm, or growth >1 cm/year, or symptoms → repair (EVAR vs open); surveillance below threshold; emergency for rupture.

Conservable → BCS + whole-breast radiotherapy (survival equal to mastectomy) + SLNB (Z0011); contraindicated → mastectomy; large/triple-negative/HER2+ → neoadjuvant downstaging.

Meeting (expanded) criteria → en-bloc ESD; beyond criteria (SM2/poorly differentiated deep/lymphovascular+) → surgical gastrectomy + lymphadenectomy.

<10 mm cold snare; LST → EMR; large/suspected superficial invasion → ESD; deep invasion (≥1000 µm)/poorly differentiated/lymphovascular+ → colectomy.

Goligher I conservative, II rubber-band ligation, III banding/surgery, IV/large/recurrent hemorrhoidectomy or PPH; thrombosed external <72 h may be excised.

Symptomatic saphenous reflux → endovenous thermal ablation (EVLA/RFA) first-line; anatomy unsuitable → high ligation and stripping; mild/unsuitable → compression stockings.

Symptomatic or meeting criteria (calcium >ULN+1.0/age <50/eGFR <60/T-score ≤−2.5 or fracture/stones) → parathyroidectomy; otherwise monitor.

POP-Q mild → PFMT; symptomatic → pessary vs surgery (sacrocolpopexy mesh/transvaginal native tissue/colpocleisis).

Conservative PFMT ≥3 months → if failed, mid-urethral sling (MUS) is the gold standard; for mixed, treat the predominant component first.

Uncomplicated supportive/selective antibiotics; abscess <4 cm antibiotics, ≥4 cm percutaneous drainage; Hinchey III/IV peritonitis → emergency surgery.

ASGE risk stratification: high-risk direct clearance (two-stage ERCP or single-stage LCBDE); intermediate EUS/MRCP first; low-risk cholecystectomy ± IOC; cholangitis emergency ERCP.

BCLC 0/A resection/ablation/transplant; B TACE; C systemic therapy; D supportive; transplant within Milan, ablation ≤3 cm.

Partial/degenerative/elderly → conservative (physio ± injection); acute traumatic full-thickness, young active → early arthroscopic repair; massive irreparable + arthropathy → reverse arthroplasty.

Young active/instability/repairable meniscus → arthroscopic reconstruction; low-demand willing to modify activity → rehab (reconstruction can be delayed); locking/multiligament/vascular → early surgery.

Mild-moderate → splint/injection; severe (thenar atrophy/EMG denervation) or conservative failure → carpal tunnel release (open/endoscopic); acute compression emergency decompression.

Cauda equina emergency decompression; neurogenic claudication conservative 3-6 months → decompression (laminectomy) if failed; add fusion for instability/spondylolisthesis.

No fixed visual-acuity threshold; functional impairment affecting life/work or patient preference → phacoemulsification + IOL (phaco); lens-induced glaucoma/need to view the fundus → clear indication.

<6 months observe; ≥6 months undescended and palpable → inguinal orchidopexy (ideally 6-18 months); non-palpable → laparoscopic localization; hormones not routine.

US (muscle ≥3-4 mm, canal ≥15-17 mm); correct hypochloremic hypokalemic metabolic alkalosis first (not a surgical emergency), then Ramstedt pyloromyotomy.

Prolactinoma dopamine agonist first-line; other functioning/non-functioning with mass effect → transsphenoidal; giant or suprasellar/lateral invasion → craniotomy; apoplexy emergency decompression.

Asymptomatic small → observe (serial MRI); symptomatic/growth/edema → surgical resection (Simpson); small/hard-to-reach/residual → SRS; WHO II/III resection + radiotherapy.

Ruptured treated early (coiling often preferred, ISAT); unruptured low-risk (<7 mm anterior) observe, high-risk treat; approach coiling vs clipping by anatomy.

Meets indication → AVR; <65/life expectancy >20 y SAVR, 65-80 shared decision, >80/high-risk TF-TAVR; unsuitable access/concomitant surgery → SAVR.

Left main/multivessel + diabetes/high SYNTAX → CABG; low SYNTAX single-double vessel → PCI; stable low-risk → medical; ACS/STEMI emergency reperfusion.

Primary severe meeting indication → surgery (repair over replacement); high-risk with suitable anatomy → TEER; secondary after GDMT → TEER (COAPT).

Incarceration emergency; small defect observe/mesh; medium mesh (retromuscular); large/complex → component separation + mesh.

First-line silicone/pressure; active lesions intralesional steroid injection; refractory/large excision + adjuvant (radiotherapy/steroid) to prevent recurrence.

Recurrent pharyngitis meeting Paradise (≥7/yr or ≥5/yr×2 or ≥3/yr×3) → tonsillectomy; OSA + hypertrophy → adenotonsillectomy; not met → observe.

CRS — guideline medical therapy first (nasal steroid + irrigation ± course); maximal medical failure → FESS; complications (orbital/intracranial/invasive fungal/tumor) emergency.

After confirming a normal thyroid, perform Sistrunk (excise cyst + mid-hyoid + tract); control acute infection first; exclude ectopic thyroid/malignancy.

Extract if pathology (recurrent pericoronitis/unrestorable caries/cyst/adjacent root resorption/periodontal damage); do not extract prophylactically if asymptomatic; control acute infection first.

Rupture/unstable → emergency surgery; low and falling hCG → expectant; stable <5000/mass ≤3.5-4 cm/no cardiac activity → MTX; surgery is salpingostomy vs salpingectomy.

Surgical emergency: emergency laparoscopic detorsion + preserve the ovary where possible (even if dusky/ischemic-appearing); remove only for clear necrosis/postmenopausal/suspected malignancy.

Pain empirical medical first-line; failure/need to confirm/large endometrioma → laparoscopy; infertility individualized (laparoscopy/ART); refractory after completed childbearing → definitive surgery.

One low transverse incision, no contraindication, emergency cesarean capability → TOLAC possible (success ~60-80%, rupture ~0.5-0.9%); classical incision/rupture history/placenta previa → repeat cesarean.

History-indicated (12-14 weeks)/ultrasound-indicated (singleton + prior preterm <34 weeks + CL <25 mm)/exam-indicated rescue cerclage; short cervix without preterm history → vaginal progesterone.

cT1a (≤4 cm) prefer partial nephrectomy; ≤3 cm high-risk may ablate, <2 cm elderly may surveil; cT1b selective partial; cT3+ radical.

NCCN risk stratification: low-risk active surveillance; intermediate prostatectomy/radiotherapy ± short ADT; high-risk prostatectomy ± adjuvant or radiotherapy + long ADT; elderly watchful waiting.

NMIBC → TURBT + instillation (high-risk BCG); MIBC (≥T2) → neoadjuvant chemo + radical cystectomy or trimodality bladder preservation; metastatic systemic therapy.

Resectable → surgery (Whipple/distal) + adjuvant; borderline → reassess after neoadjuvant; locally advanced/metastatic → systemic ± palliative.

≥10 mm or 6-9 mm + risk factors or symptomatic → cholecystectomy; <10 mm no risk factors surveil; >15-18 mm/suspected malignancy → extended resection.

Tension/unstable → drain; stable small → observe ± oxygen; large/symptomatic → aspirate or drain; recurrence/persistent leak/high-risk occupation/blebs → VATS + pleurodesis.

Claudication: exercise + medical first; lifestyle-limiting/failure → endovascular (focal) or bypass (long segment); CLTI → early limb-salvage revascularization; acute ischemia emergency.

Functioning (pheo/aldosterone/cortisol) or ≥4 cm/imaging-suspicious → adrenalectomy; pheo needs preoperative alpha-blockade; non-functioning <4 cm benign → surveillance.

Drain an abscess first; simple low fistula fistulotomy; complex high use sphincter-sparing (seton/LIFT/advancement flap); Crohn's seton + biologics.

Carbamazepine first-line; refractory + MRI vascular compression operable → microvascular decompression (most durable); elderly/no compression/recurrence → gamma knife or percutaneous lesioning.

Open-angle drops (prostaglandin) ± SLT; acute angle-closure urgent IOP lowering + laser iridotomy; progression on maximal medical → trabeculectomy/drainage device/MIGS.

Femoral neck non-displaced fixation, displaced elderly arthroplasty (hemi/total), young displaced emergency ORIF to preserve the head; intertrochanteric nail/SHS; operate early.

Unstable trauma emergency splenectomy, stable spleen-preserving ± embolization; refractory ITP/severe hereditary spherocytosis → elective laparoscopic splenectomy (preoperative vaccines); splenic mass/hypersplenism resection.

cT1 low-risk transanal local excision (TEM/TAMIS); high-risk T1/T2 → TME (LAR/APR); locally advanced neoadjuvant chemoradiation then TME; cCR may watch-and-wait.

Tis/T1a endoscopic resection; T1b esophagectomy; T2-4a/N+ neoadjuvant chemoradiation (CROSS) then resection; cervical SCC/inoperable definitive chemoradiation; metastatic systemic + palliative.

Break without detachment laser barricade; macula-on emergency reattachment; single superior break gas; complex/PVR/pseudophakic vitrectomy; tractional vitrectomy.

Moderate-severe first-line CPAP; mild-moderate/intolerant oral appliance; intolerant + anatomic obstruction → UPPP/hypoglossal nerve stimulation/MMA; children adenotonsillectomy.

Infant simple/communicating usually self-resolve, observe to 1-2 years; persistent/large/communicating → high ligation of the processus vaginalis; repair if hernia present; adults find the cause.

Stable without peritonitis → air/hydrostatic enema reduction (80-90% success); peritonitis/perforation/shock or failed reduction → surgery; resect a pathological lead point.

Circumferential eschar with compression emergency escharotomy; major burns Parkland resuscitation then transfer; superficial second-degree conservative healing; deep second-/third-degree early excision + grafting.

Radiculopathy conservative first; progressive myelopathy (CSM) → decompression; 1-2 levels anterior/kyphosis/K-line(-)/canal occupancy ≥60% → anterior ACDF/ACCF; multilevel + lordosis + K-line(+) → posterior laminoplasty; multilevel kyphosis/K-line(-) → posterior decompression-fusion-correction or anterior.

Subclinical/asymptomatic observe; palpable + abnormal semen + infertility or significant pain → microsurgical varicocelectomy; adolescent testicular hypotrophy → surgery.

Asymptomatic with good function observe; symptomatic/split function <40% or declining/progressive hydronephrosis → dismembered pyeloplasty; infection/pyonephrosis emergency drainage.

Hydrosalpinx planning IVF → salpingectomy/ligation first (improves implantation); mild distal, young, good ovarian reserve → neostomy; bilateral severe/dense adhesions → IVF.

Medical (LNG-IUS/GnRH/progestin) first; uterus-sparing = lesion excision/UAE/HIFU; completed childbearing/definitive → hysterectomy.

Margins by Breslow: in situ 0.5-1 cm, ≤1 mm 1 cm, 1-2 mm 1-2 cm, >2 mm 2 cm, down to fascia; sentinel node for ≥pT1b/pT2a.

Stage I-II offloading and dressings conservative; stage III-IV debride and control infection first, clean granulation and fit → flap reconstruction; poor general condition → palliative conservative.

Asymptomatic/preference rate control; symptomatic AAD-refractory → catheter ablation (PVI); concomitant cardiac surgery → simultaneous Cox-Maze; ablation failure → standalone surgical ablation.

Intervene only for significant shunt (Qp:Qs >1.5) without Eisenmenger; secondum ASD device closure, primum/sinus venosus surgery; VSD mostly surgical, some perimembranous device; Eisenmenger contraindicated.

WHO classification: CE1/CE3a simple → PAIR; CE2/CE3b/large/complicated/superficial → surgery (pericystectomy); CE4/CE5 inactive observe; perioperative albendazole for all.

Asymptomatic with typical imaging observe (no malignant potential, rare rupture); symptomatic/giant progressive/uncertain diagnosis → resection or enucleation; Kasabach-Merritt/rupture emergency.

Early full staging (selective fertility-sparing); advanced able to achieve R0/good performance → primary debulking PDS; not optimally resectable/poor performance → neoadjuvant chemotherapy + interval debulking IDS.

Surgical staging = hysterectomy + BSO + cytology ± sentinel node (better than systematic dissection), early minimally invasive; G1/IA without myometrial invasion young may have progestin fertility-sparing; high-risk add adjuvant.

IA1 conization/hysterectomy; IA2 modified radical + nodes; IB1-2/IIA1 radical hysterectomy (open superior to minimally invasive LACC); early small-volume fertility-sparing trachelectomy; locally advanced concurrent chemoradiation.

Early T1 unifocal <4 cm wide local excision (margin ≥1 cm) + lateral sentinel/ipsilateral groin; midline/≥4 cm bilateral groin; locally advanced radical excision ± chemoradiation.

Molar pregnancy suction evacuation + hCG monitoring; GTN by FIGO/WHO score: low-risk (≤6) single-agent, high-risk (≥7) EMA-CO; completed childbearing/localized resistance/PSTT → hysterectomy.

Young fertility-sparing (ipsilateral adnexa/cystectomy + staging); completed childbearing full staging; invasive implants debulking + staging, usually good prognosis without chemotherapy.

Mature teratoma laparoscopic cystectomy; malignant (dysgerminoma/yolk sac/immature) fertility-sparing surgery + BEP chemotherapy (highly chemosensitive, curable with preserved fertility).

Granulosa cell tumor etc. early young fertility-sparing (ipsilateral adnexa + staging); completed childbearing TAH-BSO + staging; estrogenic type needs endometrial assessment.

Platinum-sensitive + AGO-positive (ECOG 0/no residual/ascites ≤500 ml) + completely resectable → secondary cytoreduction (DESKTOP III); platinum-resistant non-platinum single agent, no surgery.

CIN1 surveillance; CIN2 young may observe; CIN2-3/HSIL excision (LEEP/conization); AIS cold-knife conization (negative margins).

Suspected sarcoma → total hysterectomy, en bloc removal, no unprotected morcellation; sarcoma found incidentally after fibroid surgery, multidisciplinary supplementary staging; advanced debulking + systemic (low-grade ESS hormone-sensitive).

Accessible non-eloquent maximal safe resection (extent affects prognosis); deep/eloquent/diffuse stereotactic biopsy; GBM resection + Stupp (radiotherapy + temozolomide).

Single/oligometastatic large or mass effect → surgery + postoperative SRS; small few → SRS (better than WBRT, protects cognition); multiple diffuse → WBRT; posterior fossa mass emergency decompression.

Asymptomatic thin without mass effect observe; symptomatic/thick/midline shift → burr-hole drainage (± middle meningeal artery embolization to lower recurrence); acute deterioration/herniation emergency evacuation.

Cerebellar >3 cm/brainstem compression/hydrocephalus → emergency surgery; supratentorial superficial lobar mass effect/deterioration selective evacuation; deep mainly medical; intraventricular hemorrhage + obstructive hydrocephalus EVD.

Obstructive (aqueductal stenosis) → ETV endoscopic third ventriculostomy; communicating → VP shunt; NPH positive tap test shunt; acute obstruction EVD.

Small asymptomatic non-growing observe; small-medium growing/symptomatic → SRS (gamma knife); large (>2.5-3 cm)/brainstem compression → microsurgical resection.

Ruptured → active cure (by SM grade); unruptured SM I-II microsurgical resection, III multimodal, IV-V mostly conservative (ARUBA: unruptured may be managed medically).

First-line behavioral therapy → second-line anticholinergic/beta-3 agonist → third-line refractory: sacral neuromodulation/tibial nerve stimulation/intravesical botulinum toxin A (check residual urine).

First-line conservative (fiber/antidiarrheal/biofeedback); sphincter defect → sphincteroplasty; no defect/failed repair → sacral neuromodulation; refractory → stoma etc.

Conservative (fiber/biofeedback); symptomatic rectocele confirmed on defecography → transvaginal/transanal repair; intussusception-predominant STARR; combined with prolapse joint pelvic floor reconstruction.

Small new catheter trial of healing; vaginally accessible transvaginal repair (Latzko); high/near ureters/complex transabdominal (O'Conor); radiation/recurrence tissue flap interposition.

Infection drain with seton first; low simple advancement flap; with sphincter defect sphincteroplasty; complex (Crohn's/radiation/high) tissue interposition/staged/stoma.

Post-hysterectomy apical prolapse; none/mild observe; conservative pessary/PFMT; reconstructive abdominal sacrocolpopexy (mesh, most durable) vs transvaginal native tissue (SSLF/USLS); elderly frail colpocleisis.

Asymptomatic monofilament small exposure observe + topical estrogen; symptomatic vaginal exposure transvaginal partial excision; erosion into bladder/bowel/fistula excise involved mesh + organ repair; chronic pelvic pain multidisciplinary.

3a end-to-end; 3b end-to-end or overlap (equivalent); 3c involving IAS repair separately end-to-end without overlap; 4th degree layered inside-out; PDS 3-0; postoperative antibiotics + laxative + pelvic floor rehabilitation.

>30 cm3 or coma + anisocoria → emergency craniotomy evacuation (craniotomy over burr hole); <30 cm3 and <15 mm and midline <5 mm and GCS >8 without focal deficit → close observation + serial CT.

Thickness >10 mm or midline shift >5 mm → evacuate regardless of GCS (large craniotomy, craniectomy if marked swelling); comatose even if thin, operate if GCS dropped ≥2 from injury, fixed dilated pupil, or ICP >20; all comatose get ICP monitoring.

Last-tier surgery: ICP persistently >25 mmHg (1-12 h) despite tier-1/2 therapy → decompressive craniectomy (RESCUEicp lowers mortality but increases vegetative/severe disability); early craniectomy for moderate ICP >20 not recommended (DECRA worse outcome). Large flap 12-15 cm.

Obstructive (aqueductal stenosis/posterior fossa mass) → endoscopic third ventriculostomy (ETV, no implant, success estimated by ETVSS); communicating/infant <1 year/post-hemorrhage or post-infection → ventriculoperitoneal shunt (VPS) more reliable; NPH positive tap test → shunt.

Symptomatic (cough/strain-induced occipitocervical pain, brainstem/cerebellar/cord signs) or with syringomyelia → posterior fossa decompression (suboccipital craniectomy + C1 laminectomy, ± expansile duraplasty); asymptomatic without syrinx (incidental) → observe.

Ruptured AVM → active cure to prevent rebleeding; unruptured (ARUBA) → intervention vs medical follow-up needs careful weighing. Spetzler-Martin I-II suit microsurgery; III multimodal; IV-V high surgical risk → mostly conservative; small/deep may have SRS; embolization mostly adjunctive.

Parkinson (levodopa-responsive, motor fluctuations/dyskinesia) → STN (can reduce medication) or GPi (controls dyskinesia, fewer neuropsychiatric effects); essential/parkinsonian tremor → VIM thalamus; dystonia → GPi; drug-refractory focal epilepsy → ANT thalamus (SANTE) or RNS, CM.

Midline/intrasellar/suprasellar accessible → endoscopic transsphenoidal; large/lateral/retrochiasmatic/into third ventricle → transcranial; marked hypothalamic involvement → subtotal + radiotherapy (preserve function) over forced gross total; predominantly cystic → Ommaya/intracystic therapy adjunct. Perioperatively manage pituitary function and diabetes insipidus.

>2.5 cm or mass effect/unknown pathogen → stereotactic aspiration (preferred) + IV antibiotics ≥6 weeks; superficial encapsulated/multiloculated/traumatic foreign body/fungal/aspiration failure → craniotomy excision; <2.5 cm and known pathogen → antibiotics + weekly imaging; rupture into ventricle → external ventricular drain.

Without atypia → progestin (LNG-IUS preferred, 85-92% resolution, can stay 5 years) + 6-monthly biopsy to two negatives, not first-line hysterectomy; atypical/EIN → ~35-40% concurrent cancer, total hysterectomy is definitive (minimally invasive, not subtotal, remove both tubes ± ovaries); fertility-sparing → high-dose progestin + 3-monthly biopsy, hysterectomy after childbearing.

Stable without infection → expectant or medical (mifepristone 200 mg oral → 24 h later misoprostol 800 mcg vaginal, complete expulsion 83.8% vs 67.1% misoprostol alone); hemodynamically unstable/heavy bleeding/infection/failure → surgery (suction/MVA); give anti-D if Rh-negative; do not decide intervention by endometrial thickness alone.

Benign indications: vaginal preferred when feasible (fewer complications, faster recovery); not feasible vaginally → laparoscopic (better than open); open only for huge uterus/severe adhesions/malignancy/need for extensive exploration; avoid power morcellation if malignancy suspected (occult sarcoma).

<60 years or <10 years since menopause, VMS/prevent bone loss, no contraindication → benefit > risk; with uterus add progestogen (protects endometrium), post-hysterectomy estrogen alone; transdermal + low dose lowers VTE/stroke; GSM only → vaginal low-dose estrogen; contraindicated or outside the window → non-hormonal alternatives.

Symptomatic/large → cystectomy (stripping, better recurrence and pain control) but lowers ovarian reserve (AMH); low reserve/bilateral/fertility-focused → ablation (CO2 laser/plasma) to preserve reserve or combined; asymptomatic small → surveillance (O-RADS to exclude malignancy); no routine surgery before IVF (no outcome benefit and harms reserve) unless pain/large/unclear diagnosis.

Acute AUB assess hemodynamics first (unstable → resuscitation + IV estrogen/high-dose progestin/TXA/intrauterine tamponade/emergency evacuation); chronic by PALM-COEIN classification; endometrial sampling indications: ≥45 years, or <45 with risk factors (obesity/PCOS/unopposed estrogen/Lynch/tamoxifen), or persistent/medical failure.

Early diagnosis and treatment, first-trimester termination to prevent rupture/hemorrhage/placenta accreta; expectant (lowest success 41.5%/complications 53.7%) and blind curettage (48%/21%) not recommended; stable → MTX (systemic/local), UAE + ultrasound/hysteroscopic-guided evacuation, hysteroscopic or laparoscopic scar excision (the latter also repairs the niche to prevent recurrence), multimodal; unstable/rupture → emergency surgery/hysterectomy.

Asymptomatic small cyst → observe; symptomatic cyst/abscess (especially first) → incision and drainage + Word catheter (preferred, promotes epithelialization, less recurrence); recurrent cyst → marsupialization (not for abscess); cellulitis/systemic symptoms/high-risk → add antibiotics (cover MRSA); recurrent/>5 cm → gland excision; ≥40 years or irregular solid mass → biopsy to exclude adenocarcinoma.

Symptomatic (hypomenorrhea/amenorrhea, infertility, recurrent loss, cyclic pain) → hysteroscopic adhesiolysis (protecting normal endometrium under direct vision); prevent re-adhesion: intrauterine barrier (balloon/IUD/hyaluronic acid gel) + estrogen (± progestogen) for endometrial regeneration + second-look hysteroscopy; severe disease has poorer prognosis; asymptomatic incidental can be left alone.

Choose oral rehydration or IV isotonic resuscitation by dehydration severity and presence of shock, and calculate the cumulative deficit plus maintenance.

After thorough wound washing, decide vaccine and immunoglobulin by WHO exposure category I/II/III.

Clinical diagnosis (pain out of proportion + pain on passive stretch); delta pressure ≤30 mmHg means emergency fasciotomy, do not wait for late signs.

Stratify with the 4T score; ≥4 immediately stop all heparin, switch to non-heparin anticoagulation, no platelet transfusion, no warfarin until platelets recover.

Set phototherapy/exchange thresholds by the AAP 2022 hour-specific nomogram (gestational age + risk factors); watch for G6PD/hemolysis.

GI symptoms starting >6 h after eating wild mushrooms suggests amatoxin; fluids + silibinin/NAC, transfer early to transplant if progressing to liver failure.

CDC minimum criteria (any of cervical motion/uterine/adnexal tenderness triggers treatment); outpatient triple therapy or inpatient IV, drain a TOA.

If no contraindication, expectant: antenatal steroids + magnesium sulfate neuroprotection <32 weeks + short-course tocolysis + GBS prophylaxis; deliver immediately for infection/fetal distress.

After local anesthetic, CNS → cardiovascular toxicity; give 20% lipid emulsion at the first sign, manage arrest with modified ACLS reducing epinephrine.

Sudden severe headache + visual/ocular motor signs; give empiric hydrocortisone immediately, urgent MRI, transsphenoidal decompression if vision deteriorates.

Necrotizing fasciitis of the perineum/genital region; early thorough debridement is central + broad-spectrum antibiotics + sepsis resuscitation.

A battery in the esophagus is an absolute emergency, remove endoscopically immediately; honey/sucralfate to mitigate before removal; past the stomach and asymptomatic may be observed.

Immediate copious irrigation to a neutral pH is the priority first aid; grade by corneal opacity/limbal ischemia, alkali burns are worse.

Colonic dilation without mechanical obstruction; conservative + neostigmine, cecum >12 cm is high-risk, ischemia/perforation/failure → surgery.

ACR O-RADS US v2022: classify 0–5 by physiologic/typical benign and morphology score, with corresponding malignancy risk and management.

For ultrasound-indeterminate adnexal lesions; classify 1–5 by composition and enhancing solid tissue TIC, enhancing solid = potentially malignant.

Most PMB should have TVUS + endometrial biopsy together (2026 ACOG); only highly selected ≤4 mm may use ultrasound alone; persistent bleeding always needs pathology.

MRI is preferred for local staging; intact stromal ring = no parametrial invasion; parametrium/pelvic wall/nodes decide surgery vs chemoradiation.

MRI measures depth of myometrial invasion + cervical stroma; intact JZ/subendometrial enhancement band = no invasion, <50% = IA, ≥50% = IB.

TVUS (MUSA) ≥1 direct feature is diagnostic; MRI junctional zone (JZ) ≥12 mm is the most established criterion; differentiate adenomyoma from fibroid.

Typical fibroid T2-low + ADC-low; FIGO 0–8 location guides treatment; sarcoma red flags → gynecologic oncology, avoid morcellation.

DIE invades >5 mm; MRI/TVUS localizes, map by #Enzian compartments to guide multidisciplinary surgery.

Use the external fundal contour to distinguish septate (external indentation <1 cm) from bicornuate (external indentation >1 cm); MRI/3D ultrasound, always check the kidneys.

Previa + prior cesarean is high-risk; ultrasound ≥3 signs or positive MRI → PAS center MDT, planned cesarean hysterectomy.

Complete mole snowstorm + very high hCG + theca lutein cysts; evacuation + serial beta-hCG; hCG plateau/rise → GTN chemotherapy.

High-frequency TVUS ≥20 follicles per ovary or volume ≥10 mL (2018/2023 guidelines); not used in adolescents; AMH may be used in adults.

TVUS preferred (complex multiloculated thick-walled mass); indeterminate/suspected GI → contrast CT; an afebrile complex mass should raise suspicion of malignancy.

TVUS feeding-vessel sign suggests a polyp; SIS is the imaging gold standard, hysteroscopy the diagnostic gold standard; differentiate from a submucosal fibroid.

Abdominopelvic CT is preferred for staging; assess peritoneal implants/unresectable sites to decide primary debulking vs neoadjuvant chemotherapy.

TVUS five criteria for diagnosis; type 2 exophytic is high-risk for early rupture/hemorrhage; blind curettage is absolutely contraindicated.

TVUS/SIS measure the residual myometrial thickness (RMT); symptomatic with thin RMT consider surgical repair; it is the CSP implantation site.

Tubular shape + waist sign/cogwheel/beads + a separate normal ipsilateral ovary is diagnostic; thick wall with debris suggests pyosalpinx/TOA.

Whirlpool sign/follicular ring sign/stromal edema are specific; normal flow does not exclude torsion, high suspicion warrants laparoscopic exploration.

An intracavitary echogenic mass is the most sensitive and specific sign; differentiate EMV/AVM (high-velocity myometrial flow, no curettage) from clot.

Honeycomb high-velocity low-resistance myometrial flow; no blind curettage; stratify by PSV, high PSV/bleeding → UAE.

Bilateral enlarged ovaries + spoke-wheel follicles + ascites; modified Golan grade; severe/critical admission, VTE prophylaxis.

ESUR: invasion >1 mm or >4 cm or suspected adjacent organ involvement → pelvic MRI including the groin; nodal status is the most important prognostic factor.

Ovarian/pelvic vein reflux causing varices; TVUS preferred, criteria met + symptoms → pelvic vein embolization, exclude secondary obstruction first.

Transvaginal ultrasound: CRL ≥7 mm without heartbeat / MSD ≥25 mm without embryo = diagnostic of early pregnancy loss; do not intervene on equivocal findings, follow up.

TVUS gold standard: a mass separate from the ovary (blob/tubal ring sign) = ectopic; cul-de-sac blood = rupture; PUL must exclude ectopic.

SIS/HSG for initial screening (HSG also assesses the tubes), hysteroscopy is the gold standard and can lyse adhesions at the same time.

Follicular-phase HSG: free fimbrial contrast spill = patent; proximal non-filling needs spasm excluded; distal non-spill + dilation = hydrosalpinx.

FIGO anatomic stage I–IV + WHO risk score: ≤6 low-risk single-agent chemotherapy, ≥7 high-risk combination chemotherapy, ≥13 ultra-high-risk.

TVU cervical length ≤25 mm (<24 weeks) = short cervix; no preterm history → vaginal progesterone, with preterm history → cerclage + progesterone.

Postpartum fever + right lower quadrant pain; contrast CT shows an enlarged ovarian vein + intraluminal thrombus + peripheral enhancement; anticoagulation + antibiotics.

Atrium ≥10 mm; mild 10–12 / moderate 13–15 / severe >15 mm; fetal MRI for parenchyma and associated anomalies + chromosomes + TORCH.

Midsagittal view directly shows the CC; complete vs partial agenesis; focus on associated anomalies + chromosomes, MRI superior to ultrasound.

Tegmento-vermian angle assesses vermian rotation; DWM (elevated tentorium + enlarged posterior fossa) vs vermian hypoplasia vs Blake pouch vs mega cisterna magna.

o/e LHR and o/e TFLV grade lung development, liver position sets prognosis; severe (liver up, LHR <25%) assess FETO.

CVR = lesion volume/head circumference; <1.6 follow up, ≥1.6 high-risk → maternal steroids, with hydrops → thoraco-amniotic shunt for a large cyst.

MMC with Chiari II; MOMS candidate (upper level T1–S1, hindbrain herniation, 19–25.9 weeks) refer for in-utero repair assessment.

Dynamic MR defecography three-compartment assessment; PCL/H line/M line, an organ descending below the PCL = prolapse, graded by HMO.

Most common congenital infection; ventriculomegaly/calcification/temporal pole cysts/white matter/migration; MRI is the gold standard, combined with amniotic fluid PCR and viral load.

Altman type I–IV; MRI defines pelvic-abdominal extension + excludes meningocele; solid hypervascular/TFR >0.12 → high-output cardiac failure.

MRI characterizes + assesses the airway; large/anterior/tracheal deviation/polyhydramnios → plan EXIT to secure the airway intrapartum.

DeMyer classification: alobar/semilobar/lobar/middle interhemispheric variant; common feature absent cavum septi pellucidi, the face predicts the brain, trisomy 13.

Systemic arterial supply (from the aorta) is characteristic; usually good prognosis and may regress, large/effusion/hydrops → fetal intervention.

Keyhole sign + megacystis + bilateral hydronephrosis + oligohydramnios (mostly PUV); urine biochemistry assesses renal function, favorable → vesicoamniotic shunt.

≥2 fluid collections; first distinguish immune vs NIHF; MCA-PSV for anemia, echocardiography, infection, chromosomal microarray; manage by cause.

MCDA + TOPS (donor <2 cm/recipient >8 cm); Quintero I–V; stages II–IV <26 weeks fetoscopic laser is first choice.

Look at the cord insertion relationship and presence of a membrane; gastroschisis usually isolated, omphalocele often with chromosomal/anomalies; MRI for associated anomalies and lung volume.

Bilateral large echogenic lungs + dilated airways + inverted diaphragm + small central heart + ascites/hydrops; MRI localizes the obstruction level; EXIT/intrauterine decompression.

Primary (chylous) or secondary; small and stable → observe, large/mediastinal shift/hydrops → thoracocentesis or thoracoamniotic shunt.

Midline venous sac behind the third ventricle + high flow; MRI assesses heart failure/melting brain/hydrocephalus prognostic markers, postnatal staged embolization.

Fetal MRI assesses sulcation timing: smooth + thick cortex = lissencephaly spectrum, abnormal sulci = PMG, gray-matter cleft = schizencephaly, nodules = heterotopia.

HC <2–3 SD; first distinguish from FGR; check sulcation/calcification + CMV/Zika + chromosomal microarray + exome; often only apparent in the third trimester.

Lateral + third ventricle dilation, normal fourth ventricle = aqueductal stenosis; funnel-shaped aqueduct; check X-linked L1CAM/hemorrhage/infection.

SWI/T2* most sensitive for blood; IVH Papile grades I–IV; check FNAIT/coagulation/infection, FNAIT → maternal IVIG.

Meningocele vs containing brain tissue; occipital most common; MRI assesses herniated contents + associated; check Meckel-Gruber.

Multiple cardiac rhabdomyomas + brain SEN/tuber strongly suggest TSC; fetal MRI for brain nodules + TSC1/2 genetics.

Ovarian/choledochal/enteric duplication/mesenteric/meconium pseudocyst; characterize by location and features; MRI helps differentiate, mostly good prognosis.

Double-bubble = duodenal atresia (check Down), multiple dilated loops = jejunoileal, calcification = meconium peritonitis, bilobed = anal atresia.

Absent/small stomach bubble + polyhydramnios ± upper cervical pouch; MRI better than ultrasound; check VACTERL/trisomy 18/cardiac.

Amniotic fluid = renal function marker; unilateral MCDK good prognosis, bilateral/anhydramnios → lethal pulmonary hypoplasia; check the contralateral kidney.

FL/AC <0.16 or thoracic circumference/AC <0.6 suggests lethal (small chest → pulmonary hypoplasia); skeletal survey + CT + genetic typing.

Extra-axial CSF cyst, not communicating with the ventricles, mass effect displacing structures; middle cranial fossa most common; differentiate from Blake pouch/DWM/cavum velum interpositum.

APRPD + risk parameters UTD A1/A2-3; mostly transient, increased-risk cases monitor the cause, bilateral severe → LUTO.

Neuroblastoma (no single feeder/flow variable) vs sequestration (single aortic feeder) vs hemorrhage (shrinks over time, no flow).

Delphi early-onset (<32 weeks) vs late-onset (≥32 weeks); UA/MCA/CPR/DV Doppler grading; critical Doppler → close monitoring + steroids.

MCA-PSV ≥1.5 MoM (Mari) predicts moderate-severe anemia; check alloimmunization/parvovirus/thalassemia; ≥1.5 or hydrops → intrauterine transfusion.

MCDA via tiny AV anastomoses; donor >1.5/recipient <1.0 MoM (or delta >0.5), no fluid discordance; manage by stage.

Monochorionic; the acardiac twin is reverse-perfused by the pump twin; weight ratio >70% or pump-twin heart failure → radiofrequency ablation/cord occlusion.

Symmetric anterior neck mass; Doppler peripheral → hypothyroid/central → hyperthyroid; cordocentesis confirms; hypothyroid intra-amniotic levothyroxine, hyperthyroid adjust maternal ATD.