症例-based learning · decision training

症例 practice

Practice on 348 reviewed care pathways: get a random case, work the pathway step by step, and get instant scoring — swap in a fresh case anytime. Great for trainees and decision self-testing. Decisions and basis come from the pathways themselves; for licensed clinicians, not a substitute for clinical judgment.

Surgical approach decision · 123

症例 challenge

Acute Appendicitis · Conservative vs Surgery + Approach

Uncomplicated may have antibiotics-first or laparoscopic appendectomy; d

Start case →症例 challenge

Gallstones/Cholecystitis · Observe vs Surgery + Approach

Observe asymptomatic; symptomatic/acute → LC (early); Grade III/high-ris

Start case →症例 challenge

Inguinal Hernia · Observe vs Repair + Approach

Minimally symptomatic men may watch; repair if symptomatic; unilateral L

Start case →症例 challenge

Uterine Fibroids · Observe/Medical vs Surgery + Approach

Observe asymptomatic; medical/interventional to preserve the uterus; sur

Start case →症例 challenge

Adnexal Mass · Surveillance vs Surgery + Approach

IOTA/O-RADS/RMI stratification: surveillance or laparoscopic cystectomy

Start case →症例 challenge

Thyroid Nodule · Surveillance vs Surgery + Approach

US risk sets the FNA threshold + Bethesda: benign surveillance/RFA; inde

Start case →症例 challenge

Urinary Stones · Stone Passage vs Lithotripsy/Removal + Approach

Ureteric ≤10 mm medical expulsion (MET); surgery chooses URS/SWL/PCNL by

Start case →症例 challenge

Benign Prostatic Hyperplasia · Medical vs Surgery + Approach

Observe → medical → surgery (refractory/complications); approach by pros

Start case →症例 challenge

Lumbar Disc Herniation · Conservative vs Minimally Invasive vs Fusion

Cauda equina/progressive deficit → emergency decompression; radicular pa

Start case →症例 challenge

Hip/Knee Osteoarthritis · Conservative vs Joint Replacement + Approach

Conservative (weight loss/physio/NSAIDs/injection) 12-24 weeks failed →

Start case →症例 challenge

Pulmonary Nodule · Surveillance vs Wedge/Lobectomy + Approach

Surveillance per Fleischner/Lung-RADS; >8 mm/growing/high-risk → after w

Start case →症例 challenge

Carotid Stenosis · Medical vs CEA vs Stenting

Symptomatic ≥50% → early revascularization (CEA usually over CAS); asymp

Start case →症例 challenge

Abdominal Aortic Aneurysm · Surveillance vs Open vs EVAR

Men ≥5.5/women ≥5.0 cm, or growth >1 cm/year, or symptoms → repair (EVAR

Start case →症例 challenge

Early Breast Cancer · Breast Conservation vs Mastectomy + Axilla

Conservable → BCS + whole-breast radiotherapy (survival equal to mastect

Start case →症例 challenge

Early Gastric Cancer/Tumor · ESD vs Gastrectomy

Meeting (expanded) criteria → en-bloc ESD; beyond criteria (SM2/poorly d

Start case →症例 challenge

Colorectal Polyp/Early Cancer · Endoscopic Resection vs Surgery

<10 mm cold snare; LST → EMR; large/suspected superficial invasion → ESD

Start case →症例 challenge

Hemorrhoids · Conservative vs Banding vs Surgery

Goligher I conservative, II rubber-band ligation, III banding/surgery, I

Start case →症例 challenge

Lower-Limb Varicose Veins · Conservative vs Thermal Ablation vs Stripping

Symptomatic saphenous reflux → endovenous thermal ablation (EVLA/RFA) fi

Start case →症例 challenge

Primary Hyperparathyroidism · Observe vs Parathyroidectomy

Symptomatic or meeting criteria (calcium >ULN+1.0/age <50/eGFR <60/T-sco

Start case →症例 challenge

Pelvic Organ Prolapse · Conservative vs Surgery + Approach

POP-Q mild → PFMT; symptomatic → pessary vs surgery (sacrocolpopexy mesh

Start case →症例 challenge

Stress Urinary Incontinence · Conservative vs Sling

Conservative PFMT ≥3 months → if failed, mid-urethral sling (MUS) is the

Start case →症例 challenge

Acute Diverticulitis · Conservative vs Surgery

Uncomplicated supportive/selective antibiotics; abscess <4 cm antibiotic

Start case →症例 challenge

Common Bile Duct Stones · ERCP vs Laparoscopic Bile Duct Exploration

ASGE risk stratification: high-risk direct clearance (two-stage ERCP or

Start case →症例 challenge

Hepatocellular Carcinoma · Resection/Ablation/Transplant (BCLC)

BCLC 0/A resection/ablation/transplant; B TACE; C systemic therapy; D su

Start case →症例 challenge

Rotator Cuff Tear · Conservative vs Repair

Partial/degenerative/elderly → conservative (physio ± injection); acute

Start case →症例 challenge

ACL Injury · Conservative vs Reconstruction

Young active/instability/repairable meniscus → arthroscopic reconstructi

Start case →症例 challenge

Carpal Tunnel Syndrome · Conservative vs Release

Mild-moderate → splint/injection; severe (thenar atrophy/EMG denervation

Start case →症例 challenge

Lumbar Spinal Stenosis · Conservative vs Decompression ± Fusion

Cauda equina emergency decompression; neurogenic claudication conservati

Start case →症例 challenge

Cataract · Observe vs Surgery

No fixed visual-acuity threshold; functional impairment affecting life/w

Start case →症例 challenge

Cryptorchidism · Observe vs Orchidopexy

<6 months observe; ≥6 months undescended and palpable → inguinal orchido

Start case →症例 challenge

Congenital Hypertrophic Pyloric Stenosis · Correct First, then Pyloromyotomy

US (muscle ≥3-4 mm, canal ≥15-17 mm); correct hypochloremic hypokalemic

Start case →症例 challenge

Pituitary Tumor · Medical vs Transsphenoidal vs Craniotomy

Prolactinoma dopamine agonist first-line; other functioning/non-function

Start case →症例 challenge

Meningioma · Observe vs Resection vs SRS

Asymptomatic small → observe (serial MRI); symptomatic/growth/edema → su

Start case →症例 challenge

Intracranial Aneurysm · Observe vs Clipping vs Coiling

Ruptured treated early (coiling often preferred, ISAT); unruptured low-r

Start case →症例 challenge

Aortic Stenosis · SAVR vs TAVR

Meets indication → AVR; <65/life expectancy >20 y SAVR, 65-80 shared dec

Start case →症例 challenge

Coronary Revascularization · CABG vs PCI

Left main/multivessel + diabetes/high SYNTAX → CABG; low SYNTAX single-d

Start case →症例 challenge

Mitral Regurgitation · Repair vs Replacement

Primary severe meeting indication → surgery (repair over replacement); h

Start case →症例 challenge

Ventral/Incisional Hernia · Repair Approach

Incarceration emergency; small defect observe/mesh; medium mesh (retromu

Start case →症例 challenge

Keloid/Hypertrophic Scar · Conservative vs Excision + Adjuvant

First-line silicone/pressure; active lesions intralesional steroid injec

Start case →症例 challenge

Tonsils · Observe vs Tonsillectomy

Recurrent pharyngitis meeting Paradise (≥7/yr or ≥5/yr×2 or ≥3/yr×3) → t

Start case →症例 challenge

Chronic Rhinosinusitis · Medical vs FESS

CRS — guideline medical therapy first (nasal steroid + irrigation ± cour

Start case →症例 challenge

Thyroglossal Duct Cyst · Sistrunk Procedure

After confirming a normal thyroid, perform Sistrunk (excise cyst + mid-h

Start case →症例 challenge

Impacted Wisdom Tooth · Retain vs Extraction

Extract if pathology (recurrent pericoronitis/unrestorable caries/cyst/a

Start case →症例 challenge

Ectopic Pregnancy · Expectant vs MTX vs Surgery

Rupture/unstable → emergency surgery; low and falling hCG → expectant; s

Start case →症例 challenge

Ovarian Torsion · Preserve vs Remove

Surgical emergency: emergency laparoscopic detorsion + preserve the ovar

Start case →症例 challenge

Endometriosis · Medical vs Laparoscopy

Pain empirical medical first-line; failure/need to confirm/large endomet

Start case →症例 challenge

Trial of Labor After Cesarean (TOLAC/VBAC)

One low transverse incision, no contraindication, emergency cesarean cap

Start case →症例 challenge

Cervical Insufficiency · Cerclage Indications

History-indicated (12-14 weeks)/ultrasound-indicated (singleton + prior

Start case →症例 challenge

Renal Tumor (Localized) · Surveillance/Ablation/Partial vs Radical

cT1a (≤4 cm) prefer partial nephrectomy; ≤3 cm high-risk may ablate, <2

Start case →症例 challenge

Localized Prostate Cancer · Surveillance vs Prostatectomy vs Radiotherapy

NCCN risk stratification: low-risk active surveillance; intermediate pro

Start case →症例 challenge

Bladder Cancer · TURBT vs Radical Cystectomy

NMIBC → TURBT + instillation (high-risk BCG); MIBC (≥T2) → neoadjuvant c

Start case →症例 challenge

Pancreatic Cancer · Resectability + Approach

Resectable → surgery (Whipple/distal) + adjuvant; borderline → reassess

Start case →症例 challenge

Gallbladder Polyp · Surveillance vs Cholecystectomy

≥10 mm or 6-9 mm + risk factors or symptomatic → cholecystectomy; <10 mm

Start case →症例 challenge

Spontaneous Pneumothorax · Observe/Drain vs Surgery

Tension/unstable → drain; stable small → observe ± oxygen; large/symptom

Start case →症例 challenge

Lower-Limb Atherosclerotic Occlusion · Medical vs Endovascular vs Bypass

Claudication: exercise + medical first; lifestyle-limiting/failure → end

Start case →症例 challenge

Adrenal Tumor/Pheochromocytoma · Observe vs Resection

Functioning (pheo/aldosterone/cortisol) or ≥4 cm/imaging-suspicious → ad

Start case →症例 challenge

Anal Fistula · Fistulotomy vs Sphincter-Sparing Procedure

Drain an abscess first; simple low fistula fistulotomy; complex high use

Start case →症例 challenge

Trigeminal Neuralgia · Medical vs MVD vs Ablation

Carbamazepine first-line; refractory + MRI vascular compression operable

Start case →症例 challenge

Glaucoma · Medical vs Laser vs Surgery

Open-angle drops (prostaglandin) ± SLT; acute angle-closure urgent IOP l

Start case →症例 challenge

Hip Fracture · Internal Fixation vs Arthroplasty

Femoral neck non-displaced fixation, displaced elderly arthroplasty (hem

Start case →症例 challenge

Splenectomy Indications · Observe/Embolize vs Splenectomy

Unstable trauma emergency splenectomy, stable spleen-preserving ± emboli

Start case →症例 challenge

Rectal Cancer · Local Excision vs TME

cT1 low-risk transanal local excision (TEM/TAMIS); high-risk T1/T2 → TME

Start case →症例 challenge

Esophageal Cancer · Endoscopic vs Esophagectomy

Tis/T1a endoscopic resection; T1b esophagectomy; T2-4a/N+ neoadjuvant ch

Start case →症例 challenge

Retinal Detachment · Laser vs Scleral Buckle vs Vitrectomy

Break without detachment laser barricade; macula-on emergency reattachme

Start case →症例 challenge

Obstructive Sleep Apnea · CPAP vs Surgery

Moderate-severe first-line CPAP; mild-moderate/intolerant oral appliance

Start case →症例 challenge

Pediatric Hydrocele · Observe vs Surgery

Infant simple/communicating usually self-resolve, observe to 1-2 years;

Start case →症例 challenge

Pediatric Intussusception · Enema Reduction vs Surgery

Stable without peritonitis → air/hydrostatic enema reduction (80-90% suc

Start case →症例 challenge

Burns · Excision and Grafting + Escharotomy

Circumferential eschar with compression emergency escharotomy; major bur

Start case →症例 challenge

Cervical Spondylosis · Anterior vs Posterior

Radiculopathy conservative first; progressive myelopathy (CSM) → decompr

Start case →症例 challenge

Varicocele · Observe vs Repair

Subclinical/asymptomatic observe; palpable + abnormal semen + infertilit

Start case →症例 challenge

Ureteropelvic Junction Obstruction · Observe vs Pyeloplasty

Asymptomatic with good function observe; symptomatic/split function <40%

Start case →症例 challenge

Hydrosalpinx / Tubal Infertility

Hydrosalpinx planning IVF → salpingectomy/ligation first (improves impla

Start case →症例 challenge

Adenomyosis · Medical vs Uterus-Sparing vs Hysterectomy

Medical (LNG-IUS/GnRH/progestin) first; uterus-sparing = lesion excision

Start case →症例 challenge

Cutaneous Melanoma · Margins + Sentinel Node

Margins by Breslow: in situ 0.5-1 cm, ≤1 mm 1 cm, 1-2 mm 1-2 cm, >2 mm 2

Start case →症例 challenge

Pressure Ulcer · Stage-Based Conservative vs Flap Reconstruction

Stage I-II offloading and dressings conservative; stage III-IV debride a

Start case →症例 challenge

Atrial Fibrillation · Medical vs Catheter Ablation vs Surgical Maze

Asymptomatic/preference rate control; symptomatic AAD-refractory → cathe

Start case →症例 challenge

Congenital ASD/VSD · Device Closure vs Surgery

Intervene only for significant shunt (Qp:Qs >1.5) without Eisenmenger; s

Start case →症例 challenge

Hepatic Cystic Echinococcosis · Observe vs PAIR vs Surgery

WHO classification: CE1/CE3a simple → PAIR; CE2/CE3b/large/complicated/s

Start case →症例 challenge

Hepatic Hemangioma · Observe vs Resection

Asymptomatic with typical imaging observe (no malignant potential, rare

Start case →症例 challenge

Ovarian Cancer · Staging/Cytoreduction · Primary vs Neoadjuvant + Fertility-Sparing

Early full staging (selective fertility-sparing); advanced able to achie

Start case →症例 challenge

Endometrial Cancer · Surgical Staging + Fertility-Sparing

Surgical staging = hysterectomy + BSO + cytology ± sentinel node (better

Start case →症例 challenge

Cervical Cancer · By FIGO Stage + Approach

IA1 conization/hysterectomy; IA2 modified radical + nodes; IB1-2/IIA1 ra

Start case →症例 challenge

Vulvar Cancer · Local Excision/Vulvectomy + Inguinal Nodes

Early T1 unifocal <4 cm wide local excision (margin ≥1 cm) + lateral sen

Start case →症例 challenge

Gestational Trophoblastic Disease · Evacuation vs Chemotherapy vs Hysterectomy

Molar pregnancy suction evacuation + hCG monitoring; GTN by FIGO/WHO sco

Start case →症例 challenge

Borderline Ovarian Tumor · Fertility-Sparing vs Staging

Young fertility-sparing (ipsilateral adnexa/cystectomy + staging); compl

Start case →症例 challenge

Ovarian Germ Cell Tumor · Fertility-Sparing Surgery + Chemotherapy

Mature teratoma laparoscopic cystectomy; malignant (dysgerminoma/yolk sa

Start case →症例 challenge

Ovarian Sex Cord-Stromal Tumor · Surgery

Granulosa cell tumor etc. early young fertility-sparing (ipsilateral adn

Start case →症例 challenge

Recurrent Ovarian Cancer · Secondary Cytoreduction vs Systemic Therapy

Platinum-sensitive + AGO-positive (ECOG 0/no residual/ascites ≤500 ml) +

Start case →症例 challenge

Cervical Intraepithelial Neoplasia (CIN) · Surveillance vs Excision

CIN1 surveillance; CIN2 young may observe; CIN2-3/HSIL excision (LEEP/co

Start case →症例 challenge

Uterine Sarcoma · Surgery (Distinct from Fibroid)

Suspected sarcoma → total hysterectomy, en bloc removal, no unprotected

Start case →症例 challenge

Glioma · Maximal Safe Resection vs Biopsy

Accessible non-eloquent maximal safe resection (extent affects prognosis

Start case →症例 challenge

Brain Metastases · Surgery vs SRS vs Whole-Brain Radiotherapy

Single/oligometastatic large or mass effect → surgery + postoperative SR

Start case →症例 challenge

Chronic Subdural Hematoma · Observe vs Burr-Hole Drainage

Asymptomatic thin without mass effect observe; symptomatic/thick/midline

Start case →症例 challenge

Spontaneous Intracerebral Hemorrhage · Medical vs Surgical Evacuation

Cerebellar >3 cm/brainstem compression/hydrocephalus → emergency surgery

Start case →症例 challenge

Hydrocephalus · Shunt vs ETV

Obstructive (aqueductal stenosis) → ETV endoscopic third ventriculostomy

Start case →症例 challenge

Vestibular Schwannoma (Acoustic Neuroma) · Observe vs SRS vs Surgery

Small asymptomatic non-growing observe; small-medium growing/symptomatic

Start case →症例 challenge

Brain Arteriovenous Malformation · Surgery/Embolization/Radiosurgery

Ruptured → active cure (by SM grade); unruptured SM I-II microsurgical r

Start case →症例 challenge

Overactive Bladder/Urge Incontinence · Stepped Therapy

First-line behavioral therapy → second-line anticholinergic/beta-3 agoni

Start case →症例 challenge

Fecal Incontinence · Conservative vs Sphincteroplasty vs Sacral Neuromodulation

First-line conservative (fiber/antidiarrheal/biofeedback); sphincter def

Start case →症例 challenge

Rectocele/Obstructed Defecation · Conservative vs Repair

Conservative (fiber/biofeedback); symptomatic rectocele confirmed on def

Start case →症例 challenge

Vesicovaginal Fistula · Conservative vs Transvaginal vs Transabdominal Repair

Small new catheter trial of healing; vaginally accessible transvaginal r

Start case →症例 challenge

Rectovaginal Fistula · Repair + Approach

Infection drain with seton first; low simple advancement flap; with sphi

Start case →症例 challenge

Vaginal Vault Prolapse (Post-Hysterectomy Apical) · Reconstructive Approach

Post-hysterectomy apical prolapse; none/mild observe; conservative pessa

Start case →症例 challenge

Pelvic Mesh Complications · Management

Asymptomatic monofilament small exposure observe + topical estrogen; sym

Start case →症例 challenge

Obstetric Third/Fourth-Degree Perineal Tear (OASIS) · Graded Repair

3a end-to-end; 3b end-to-end or overlap (equivalent); 3c involving IAS r

Start case →症例 challenge

Acute Epidural Hematoma · Surgical Evacuation vs Observation

>30 cm3 or coma + anisocoria → emergency craniotomy evacuation (cranioto

Start case →症例 challenge

Acute Subdural Hematoma · Surgical Evacuation vs Observation

Thickness >10 mm or midline shift >5 mm → evacuate regardless of GCS (la

Start case →症例 challenge

Refractory Intracranial Hypertension · Decompressive Craniectomy Indications

Last-tier surgery: ICP persistently >25 mmHg (1-12 h) despite tier-1/2 t

Start case →症例 challenge

Hydrocephalus · ETV vs Ventriculoperitoneal Shunt

Obstructive (aqueductal stenosis/posterior fossa mass) → endoscopic thir

Start case →症例 challenge

Chiari I Malformation · Posterior Fossa Decompression Indications

Symptomatic (cough/strain-induced occipitocervical pain, brainstem/cereb

Start case →症例 challenge

Brain Arteriovenous Malformation (AVM) · Spetzler-Martin Grade and Treatment

Ruptured AVM → active cure to prevent rebleeding; unruptured (ARUBA) → i

Start case →症例 challenge

Deep Brain Stimulation (DBS) · Indications and Targets

Parkinson (levodopa-responsive, motor fluctuations/dyskinesia) → STN (ca

Start case →症例 challenge

Craniopharyngioma · Approach and Extent of Resection

Midline/intrasellar/suprasellar accessible → endoscopic transsphenoidal;

Start case →症例 challenge

Brain Abscess · Medical vs Aspiration vs Excision

>2.5 cm or mass effect/unknown pathogen → stereotactic aspiration (prefe

Start case →症例 challenge

Endometrial Hyperplasia · Progestin vs Hysterectomy

Without atypia → progestin (LNG-IUS preferred, 85-92% resolution, can st

Start case →症例 challenge

Early Pregnancy Loss · Expectant vs Medical vs Surgical

Stable without infection → expectant or medical (mifepristone 200 mg ora

Start case →症例 challenge

Benign Hysterectomy · Route Selection

Benign indications: vaginal preferred when feasible (fewer complications

Start case →症例 challenge

Menopausal Hormone Therapy (MHT) · Indications and Regimen

<60 years or <10 years since menopause, VMS/prevent bone loss, no contra

Start case →症例 challenge

Ovarian Endometrioma (Chocolate Cyst) · Cystectomy vs Ablation

Symptomatic/large → cystectomy (stripping, better recurrence and pain co

Start case →症例 challenge

Abnormal Uterine Bleeding (AUB · PALM-COEIN) · Triage

Acute AUB assess hemodynamics first (unstable → resuscitation + IV estro

Start case →症例 challenge

Cesarean Scar Pregnancy (CSP) · Management

Early diagnosis and treatment, first-trimester termination to prevent ru

Start case →症例 challenge

Bartholin Cyst/Abscess · Management

Asymptomatic small cyst → observe; symptomatic cyst/abscess (especially

Start case →症例 challenge

Intrauterine Adhesions (Asherman) · Hysteroscopic Adhesiolysis

Symptomatic (hypomenorrhea/amenorrhea, infertility, recurrent loss, cycl

Imaging · 69

症例 challenge

O-RADS Ultrasound · Adnexal Mass Risk Stratification

ACR O-RADS US v2022: classify 0–5 by physiologic/typical benign and morp

Start case →症例 challenge

O-RADS MRI · Adnexal Mass Assessment

For ultrasound-indeterminate adnexal lesions; classify 1–5 by compositio

Start case →症例 challenge

Postmenopausal Bleeding · Endometrial Imaging Assessment

Most PMB should have TVUS + endometrial biopsy together (2026 ACOG); onl

Start case →症例 challenge

Cervical Cancer MRI Staging (FIGO 2018)

MRI is preferred for local staging; intact stromal ring = no parametrial

Start case →症例 challenge

Endometrial Cancer MRI Staging (FIGO 2023)

MRI measures depth of myometrial invasion + cervical stroma; intact JZ/s

Start case →症例 challenge

Adenomyosis Imaging Diagnosis

TVUS (MUSA) ≥1 direct feature is diagnostic; MRI junctional zone (JZ) ≥1

Start case →症例 challenge

Uterine Fibroid FIGO Classification + Sarcoma Differentiation

Typical fibroid T2-low + ADC-low; FIGO 0–8 location guides treatment; sa

Start case →症例 challenge

Deep Endometriosis Imaging (#Enzian)

DIE invades >5 mm; MRI/TVUS localizes, map by #Enzian compartments to gu

Start case →症例 challenge

Uterine Anomaly Classification (ASRM 2021)

Use the external fundal contour to distinguish septate (external indenta

Start case →症例 challenge

Placenta Accreta Spectrum (PAS) Imaging

Previa + prior cesarean is high-risk; ultrasound ≥3 signs or positive MR

Start case →症例 challenge

Molar Pregnancy / Gestational Trophoblastic Disease Imaging

Complete mole snowstorm + very high hCG + theca lutein cysts; evacuation

Start case →症例 challenge

Polycystic Ovarian Morphology (PCOM) Ultrasound

High-frequency TVUS ≥20 follicles per ovary or volume ≥10 mL (2018/2023

Start case →症例 challenge

Tubo-Ovarian Abscess (TOA) Imaging

TVUS preferred (complex multiloculated thick-walled mass); indeterminate

Start case →症例 challenge

Endometrial Polyp / Intracavitary Lesion Imaging

TVUS feeding-vessel sign suggests a polyp; SIS is the imaging gold stand

Start case →症例 challenge

Ovarian Cancer Imaging Staging and Resectability

Abdominopelvic CT is preferred for staging; assess peritoneal implants/u

Start case →症例 challenge

Cesarean Scar Pregnancy (CSP) Ultrasound Diagnosis

TVUS five criteria for diagnosis; type 2 exophytic is high-risk for earl

Start case →症例 challenge

Cesarean Scar Niche (Isthmocele) Imaging

TVUS/SIS measure the residual myometrial thickness (RMT); symptomatic wi

Start case →症例 challenge

Hydrosalpinx Imaging Diagnosis

Tubular shape + waist sign/cogwheel/beads + a separate normal ipsilatera

Start case →症例 challenge

Adnexal Torsion Imaging Diagnosis

Whirlpool sign/follicular ring sign/stromal edema are specific; normal f

Start case →症例 challenge

Retained Products of Conception (RPOC) Imaging

An intracavitary echogenic mass is the most sensitive and specific sign;

Start case →症例 challenge

Uterine Arteriovenous Malformation / Enhanced Myometrial Vascularity (EMV)

Honeycomb high-velocity low-resistance myometrial flow; no blind curetta

Start case →症例 challenge

Ovarian Hyperstimulation Syndrome (OHSS) Imaging Grading

Bilateral enlarged ovaries + spoke-wheel follicles + ascites; modified G

Start case →症例 challenge

Vulvar/Vaginal Cancer MRI Staging

ESUR: invasion >1 mm or >4 cm or suspected adjacent organ involvement →

Start case →症例 challenge

Pelvic Congestion Syndrome (PCS) Imaging

Ovarian/pelvic vein reflux causing varices; TVUS preferred, criteria met

Start case →症例 challenge

Early Pregnancy Viability Assessment (SRU 2013)

Transvaginal ultrasound: CRL ≥7 mm without heartbeat / MSD ≥25 mm withou

Start case →症例 challenge

Ectopic Pregnancy Ultrasound Diagnosis

TVUS gold standard: a mass separate from the ovary (blob/tubal ring sign

Start case →症例 challenge

Intrauterine Adhesions (Asherman) Imaging Diagnosis

SIS/HSG for initial screening (HSG also assesses the tubes), hysteroscop

Start case →症例 challenge

Hysterosalpingography (HSG) Tubal Patency Assessment

Follicular-phase HSG: free fimbrial contrast spill = patent; proximal no

Start case →症例 challenge

Gestational Trophoblastic Neoplasia (GTN) Staging and Risk

FIGO anatomic stage I–IV + WHO risk score: ≤6 low-risk single-agent chem

Start case →症例 challenge

Cervical Length · Cervical Insufficiency Transvaginal Ultrasound

TVU cervical length ≤25 mm (<24 weeks) = short cervix; no preterm histor

Start case →症例 challenge

Ovarian Vein Thrombosis (Postpartum) Imaging

Postpartum fever + right lower quadrant pain; contrast CT shows an enlar

Start case →症例 challenge

Fetal Ventriculomegaly MRI

Atrium ≥10 mm; mild 10–12 / moderate 13–15 / severe >15 mm; fetal MRI fo

Start case →症例 challenge

Fetal Agenesis of the Corpus Callosum MRI

Midsagittal view directly shows the CC; complete vs partial agenesis; fo

Start case →症例 challenge

Fetal Posterior Fossa Malformation MRI (Dandy-Walker Continuum)

Tegmento-vermian angle assesses vermian rotation; DWM (elevated tentoriu

Start case →症例 challenge

Congenital Diaphragmatic Hernia (CDH) Fetal MRI

o/e LHR and o/e TFLV grade lung development, liver position sets prognos

Start case →症例 challenge

Congenital Pulmonary Airway Malformation (CPAM) Fetal · CVR

CVR = lesion volume/head circumference; <1.6 follow up, ≥1.6 high-risk →

Start case →症例 challenge

Open Spina Bifida · Fetal Surgery Candidacy (MOMS)

MMC with Chiari II; MOMS candidate (upper level T1–S1, hindbrain herniat

Start case →症例 challenge

Dynamic Pelvic Floor MRI · Pelvic Organ Prolapse (HMO)

Dynamic MR defecography three-compartment assessment; PCL/H line/M line,

Start case →症例 challenge

Congenital Cytomegalovirus (CMV) Brain MRI

Most common congenital infection; ventriculomegaly/calcification/tempora

Start case →症例 challenge

Sacrococcygeal Teratoma (Altman) Fetal MRI

Altman type I–IV; MRI defines pelvic-abdominal extension + excludes meni

Start case →症例 challenge

Fetal Neck Mass · EXIT Assessment

MRI characterizes + assesses the airway; large/anterior/tracheal deviati

Start case →症例 challenge

Holoprosencephaly (HPE) Fetal MRI

DeMyer classification: alobar/semilobar/lobar/middle interhemispheric va

Start case →症例 challenge

Pulmonary Sequestration (BPS) Fetal MRI

Systemic arterial supply (from the aorta) is characteristic; usually goo

Start case →症例 challenge

Fetal Lower Urinary Tract Obstruction (LUTO)

Keyhole sign + megacystis + bilateral hydronephrosis + oligohydramnios (

Start case →症例 challenge

Fetal Hydrops (Immune/Non-immune) Diagnostic Workflow

≥2 fluid collections; first distinguish immune vs NIHF; MCA-PSV for anem

Start case →症例 challenge

Twin-Twin Transfusion Syndrome (TTTS · Quintero)

MCDA + TOPS (donor <2 cm/recipient >8 cm); Quintero I–V; stages II–IV <2

Start case →症例 challenge

Fetal Abdominal Wall Defect (Gastroschisis vs Omphalocele)

Look at the cord insertion relationship and presence of a membrane; gast

Start case →症例 challenge

Congenital High Airway Obstruction (CHAOS)

Bilateral large echogenic lungs + dilated airways + inverted diaphragm +

Start case →症例 challenge

Fetal Pleural Effusion / Chylothorax

Primary (chylous) or secondary; small and stable → observe, large/medias

Start case →症例 challenge

Vein of Galen Aneurysmal Malformation (VGAM) Fetal MRI

Midline venous sac behind the third ventricle + high flow; MRI assesses

Start case →症例 challenge

Fetal Malformation of Cortical Development (MCD) MRI

Fetal MRI assesses sulcation timing: smooth + thick cortex = lissencepha

Start case →症例 challenge

Fetal Microcephaly Diagnostic Workflow

HC <2–3 SD; first distinguish from FGR; check sulcation/calcification +

Start case →症例 challenge

Fetal Aqueductal Stenosis (Obstructive Hydrocephalus)

Lateral + third ventricle dilation, normal fourth ventricle = aqueductal

Start case →症例 challenge

Fetal Intracranial Hemorrhage (IVH Grading)

SWI/T2* most sensitive for blood; IVH Papile grades I–IV; check FNAIT/co

Start case →症例 challenge

Fetal Encephalocele / Cranium Bifidum

Meningocele vs containing brain tissue; occipital most common; MRI asses

Start case →症例 challenge

Fetal Tuberous Sclerosis (Rhabdomyomas + Brain Nodules)

Multiple cardiac rhabdomyomas + brain SEN/tuber strongly suggest TSC; fe

Start case →症例 challenge

Fetal Abdominal Cyst Differential Diagnosis

Ovarian/choledochal/enteric duplication/mesenteric/meconium pseudocyst;

Start case →症例 challenge

Fetal Gastrointestinal Obstruction Imaging Differentiation

Double-bubble = duodenal atresia (check Down), multiple dilated loops =

Start case →症例 challenge

Fetal Esophageal Atresia ± TEF

Absent/small stomach bubble + polyhydramnios ± upper cervical pouch; MRI

Start case →症例 challenge

Fetal Renal Anomaly (Cystic/Dysplastic)

Amniotic fluid = renal function marker; unilateral MCDK good prognosis,

Start case →症例 challenge

Fetal Skeletal Dysplasia (Lethality Prediction)

FL/AC <0.16 or thoracic circumference/AC <0.6 suggests lethal (small che

Start case →症例 challenge

Fetal Arachnoid Cyst / Midline Cyst

Extra-axial CSF cyst, not communicating with the ventricles, mass effect

Start case →症例 challenge

Fetal Hydronephrosis (UTD Classification)

APRPD + risk parameters UTD A1/A2-3; mostly transient, increased-risk ca

Start case →症例 challenge

Fetal Adrenal/Retroperitoneal Mass Differentiation

Neuroblastoma (no single feeder/flow variable) vs sequestration (single

Start case →症例 challenge

Fetal Growth Restriction (FGR · Doppler)

Delphi early-onset (<32 weeks) vs late-onset (≥32 weeks); UA/MCA/CPR/DV

Start case →症例 challenge

Fetal Anemia (MCA-PSV)

MCA-PSV ≥1.5 MoM (Mari) predicts moderate-severe anemia; check alloimmun

Start case →症例 challenge

Twin Anemia-Polycythemia Sequence (TAPS)

MCDA via tiny AV anastomoses; donor >1.5/recipient <1.0 MoM (or delta >0

Start case →症例 challenge

Twin Reversed Arterial Perfusion (TRAP · Acardiac Twin)

Monochorionic; the acardiac twin is reverse-perfused by the pump twin; w

Start case →症例 challenge

Fetal Goiter (Hypothyroid/Hyperthyroid)

Symmetric anterior neck mass; Doppler peripheral → hypothyroid/central →

Emergency · 38

症例 challenge

Sepsis — 1-Hour Bundle (SSC)

After recognizing sepsis / septic shock, start the SSC Hour-1 bundle: la

Start case →症例 challenge

Anaphylaxis (Immediate-Type) — Management Pathway

Recognize anaphylaxis by diagnostic criteria and give intramuscular epin

Start case →症例 challenge

Cardiac Arrest (ACLS) — Management Pathway

Shockable rhythm → defibrillate immediately, epinephrine after the 2nd s

Start case →症例 challenge

Acetaminophen (Paracetamol) Poisoning — Management Pathway

Use the ingested dose and timing, the 4-hour level and the Rumack-Matthe

Start case →症例 challenge

Syncope Risk Stratification — Management Pathway

All patients get an ECG, orthostatic vitals and a search for serious cau

Start case →症例 challenge

Carbon Monoxide Poisoning — Management Pathway

All suspected cases get immediate 100% normobaric oxygen; decide hyperba

Start case →症例 challenge

Opioid Overdose — Management Pathway

Recognize the respiratory-depression triad, ventilate and oxygenate, tit

Start case →症例 challenge

Organophosphate Pesticide Poisoning — Management Pathway

Recognize the cholinergic crisis, decontaminate, titrate atropine to dry

Start case →症例 challenge

Salicylate (Aspirin) Poisoning — Management Pathway

Bicarbonate for blood/urine alkalinization, correct hypokalemia, avoid i

Start case →症例 challenge

Tricyclic Antidepressant Poisoning — Management Pathway

Sodium-channel blockade widens QRS; bicarbonate is the key antidote, ben

Start case →症例 challenge

Calcium-Channel / Beta-Blocker Poisoning — Pathway

Bradycardia + hypotension + conduction block; calcium, atropine, high-do

Start case →症例 challenge

Serotonin Syndrome — Management Pathway

Diagnose by Hunter criteria (clonus/hyperreflexia are key), stop the dru

Start case →症例 challenge

Neuroleptic Malignant Syndrome (NMS) — Pathway

Dopamine-antagonist-induced lead-pipe rigidity + hyperthermia + altered

Start case →症例 challenge

Alcohol Withdrawal / Delirium Tremens — Management Pathway

CIWA-Ar symptom-triggered benzodiazepines, thiamine before glucose; DTs/

Start case →症例 challenge

Benzodiazepine (Sedative-Hypnotic) Overdose — Pathway

Mainly supportive care; flumazenil is a risk-benefit decision, only for

Start case →症例 challenge

Acute Alcohol & Toxic-Alcohol Poisoning — Pathway

Distinguish plain ethanol from toxic alcohols (methanol/ethylene glycol)

Start case →症例 challenge

Lithium Toxicity — Management Pathway

Mainly neurotoxic; charcoal is ineffective, isotonic saline fluids; seve

Start case →症例 challenge

Iron Poisoning — Management Pathway

Five clinical stages; charcoal is ineffective, whole-bowel irrigation cl

Start case →症例 challenge

Methemoglobinemia — Management Pathway

Cyanosis not relieved by oxygen + saturation gap + chocolate-brown blood

Start case →症例 challenge

Methanol / Ethylene Glycol Poisoning — Management Pathway

High-anion-gap acidosis + raised osmolar gap; fomepizole (first-line) in

Start case →症例 challenge

Sympathomimetic Toxicity (Cocaine/Amphetamines) — Pathway

Agitation + hyperthermia + hypertension + tachycardia; benzodiazepines f

Start case →症例 challenge

Anticholinergic (Antimuscarinic) Toxicity — Pathway

Dry, hot, red, blind, mad, full toxidrome; mainly support + benzodiazepi

Start case →症例 challenge

Cyanide Poisoning — Management Pathway

Fire smoke/industrial; high lactate + anion-gap acidosis, empiric hydrox

Start case →症例 challenge

Isoniazid (INH) Poisoning — Management Pathway

Triad of refractory seizures + high-anion-gap acidosis + coma; the speci

Start case →症例 challenge

Paraquat Poisoning — Management Pathway

Highly lethal with no specific antidote; the key paradox is to avoid oxy

Start case →症例 challenge

Venomous Snakebite — Management Pathway

Immobilize and transport, avoid harmful old methods; decide antivenom by

Start case →症例 challenge

Caustic (Strong Acid/Alkali) Ingestion — Management Pathway

The four nos (no emesis/lavage/neutralization/charcoal); airway first, e

Start case →症例 challenge

Heat Stroke (Severe Heat Illness) — Management Pathway

Core temp >40°C with CNS dysfunction = heat stroke; rapid cooling is the

Start case →症例 challenge

Acute Altitude Illness — Management Pathway

Classify AMS/HACE/HAPE; descent is most important, dexamethasone for HAC

Start case →症例 challenge

Major Burns (Parkland) — Management Pathway

Assess the airway first (intubate early for inhalation injury); estimate

Start case →症例 challenge

Drowning — Management Pathway

The core injury is hypoxia, ventilation first; the Heimlich maneuver is

Start case →症例 challenge

Accidental Hypothermia — Management Pathway

Rewarm by core temperature grade; mild passive, moderate active external

Start case →症例 challenge

Cervical Spine Clearance (NEXUS/Canadian) — Pathway

If all 5 NEXUS low-risk criteria are met, no imaging; any positive or a

Start case →症例 challenge

Head Injury CT Decision (Canadian CT Head Rule)

For minor head injury, use the high-risk/medium-risk factors of the Cana

Start case →症例 challenge

Tetanus Post-Exposure Prophylaxis — Pathway

Decide on a tetanus-toxoid-containing vaccine and whether to add TIG bas

Start case →症例 challenge

Electrical Injury — Management Pathway

High-voltage/abnormal ECG/myoglobinuria → monitoring + aggressive fluids

Start case →症例 challenge

Rabies Post-Exposure Prophylaxis (PEP) Pathway

After thorough wound washing, decide vaccine and immunoglobulin by WHO e

Start case →症例 challenge

Mushroom (Amatoxin) Poisoning Pathway

GI symptoms starting >6 h after eating wild mushrooms suggests amatoxin;

Cardiology · 13

症例 challenge

Atrial Fibrillation — Anticoagulation Decision Pathway

Decide whether and what to anticoagulate by valvular status and CHA2DS2-

Start case →症例 challenge

STEMI — Reperfusion Strategy Pathway

After STEMI is confirmed, choose primary PCI or thrombolysis + pharmaco-

Start case →症例 challenge

Acute Heart Failure — Management Pathway

Bedside perfusion (warm/cold) × congestion (wet/dry) phenotyping guides

Start case →症例 challenge

Hypertensive Emergency — Management Pathway

Distinguish emergency (with acute target-organ damage) from urgency, and

Start case →症例 challenge

NSTE-ACS — Risk Stratification & Timing of Invasive Strategy

Stratify non-ST-elevation ACS into very-high / high / low risk to decide

Start case →症例 challenge

Supraventricular Tachycardia — Emergency Management

Narrow-QRS regular tachycardia managed by stability: unstable → cardiove

Start case →症例 challenge

Symptomatic Bradycardia — Management Pathway

Judge whether there is cardiorespiratory compromise; if unstable, atropi

Start case →症例 challenge

Wide-QRS Tachycardia (VT) — Management Pathway

Treat wide-QRS as VT by default; unstable → immediate synchronized cardi

Start case →症例 challenge

Cardiac Tamponade — Management Pathway

Beck's triad + pulsus paradoxus, echo showing effusion + RV collapse; if

Start case →症例 challenge

Acute Pericarditis — Management Pathway

Diagnose by ≥2 of 4 criteria, exclude ACS/dissection/PE; first-line NSAI

Start case →症例 challenge

Acute Aortic Dissection — Management Pathway

Confirm and classify by CTA; all types get anti-impulse HR/BP control fi

Start case →症例 challenge

Cardiogenic Shock — Management Pathway

SCAI A–E staging; emergency revascularization is the cornerstone of AMI-

Start case →症例 challenge

Digoxin Toxicity — Management Pathway

Acute hyperkalemia marks severity; life-threatening features or hyperkal

Neurology · 11

症例 challenge

Acute Ischemic Stroke — Reperfusion Pathway

Within the stroke code, use non-contrast CT to exclude hemorrhage and th

Start case →症例 challenge

Status Epilepticus — Management Pathway

Treat convulsive status epilepticus in time-based phases: stabilize → fi

Start case →症例 challenge

Adult Bacterial Meningitis — Empiric Management Pathway

Decide the workflow by whether CT is needed before LP; start dexamethaso

Start case →症例 challenge

TIA · ABCD2 Risk Stratification Pathway

Use ABCD2 to estimate short-term stroke risk after TIA and guide the urg

Start case →症例 challenge

Subarachnoid Hemorrhage (SAH) — Diagnostic & Management Pathway

Sudden thunderclap headache → non-contrast CT first, LP if needed to con

Start case →症例 challenge

Spontaneous Intracerebral Hemorrhage — Management Pathway

After non-contrast CT confirms it, immediately reverse anticoagulation,

Start case →症例 challenge

Cerebral Venous Sinus Thrombosis (CVST) — Management Pathway

Headache-predominant, can mimic stroke/SAH; diagnose with CTV or MRV (NC

Start case →症例 challenge

Acute Vertigo (HINTS) — Management Pathway

Use the three-step HINTS for persistent AVS; any central sign → work up

Start case →症例 challenge

Guillain-Barré Syndrome (GBS) — Pathway

Ascending flaccid paralysis + areflexia + CSF albuminocytologic dissocia

Start case →症例 challenge

Myasthenic Crisis — Management Pathway

Falling FVC/bulbar weakness → ICU respiratory support, hold pyridostigmi

Start case →症例 challenge

Wernicke Encephalopathy — Management Pathway

Thiamine deficiency, the triad complete in only 16%; IV high-dose thiami

Gastroenterology · 10

症例 challenge

Acute Upper Gastrointestinal Bleeding — Management Pathway

From hemodynamic resuscitation to GBS risk stratification, restrictive t

Start case →症例 challenge

Acute Pancreatitis — Management Pathway

Diagnose by 2-of-3, stratify by revised Atlanta, and manage with moderat

Start case →症例 challenge

Acute Cholangitis — Management Pathway

Diagnose and grade by TG18; all patients get broad-spectrum antibiotics,

Start case →症例 challenge

Spontaneous Bacterial Peritonitis (SBP) — Pathway

Diagnostic paracentesis in cirrhotic ascites; PMN ≥250 → empiric 3rd-gen

Start case →症例 challenge

Hepatic Encephalopathy — Management Pathway

West Haven grading; first find and treat the precipitant, lactulose firs

Start case →症例 challenge

Acute Mesenteric Ischemia — Management Pathway

Pain out of proportion → treat as AMI; confirm with CTA, resuscitate/ant

Start case →症例 challenge

Esophageal Variceal Bleeding — Management Pathway

Restrictive transfusion + vasoactive drug on arrival + prophylactic anti

Start case →症例 challenge

Acute Liver Failure — Management Pathway

Encephalopathy + coagulopathy without chronic liver disease; give NAC ea

Start case →症例 challenge

Toxic Megacolon — Management Pathway

Colon >6 cm + systemic toxicity (Jalan); medical-surgical co-management,

Start case →症例 challenge

Acute Colonic Pseudo-Obstruction (Ogilvie) Pathway

Colonic dilation without mechanical obstruction; conservative + neostigm

Endocrinology · 9

症例 challenge

Diabetic Ketoacidosis (DKA) — Management Pathway

Confirm DKA, grade by the 2024 ADA consensus, and manage with fluids → c

Start case →症例 challenge

Hyperosmolar Hyperglycemic State (HHS) — Management Pathway

Recognize HHS by four criteria and manage with aggressive fluids, low-do

Start case →症例 challenge

Hypoglycemia — Management Pathway

Treat at glucose <3.9 mmol/L: conscious patients use the 'rule of 15' or

Start case →症例 challenge

Thyroid Storm — Management Pathway

Use Burch-Wartofsky to recognize thyroid storm and treat with the quarte

Start case →症例 challenge

Adrenal Crisis — Management Pathway

Treat on suspicion, do not delay for confirmation: immediate hydrocortis

Start case →症例 challenge

Hypercalcemia (Hypercalcemic Crisis) — Management Pathway

Stratify by calcium and symptoms; treat severe disease with fluids, calc

Start case →症例 challenge

Myxedema Coma — Management Pathway

Decompensated severe hypothyroidism (altered consciousness + hypothermia

Start case →症例 challenge

Pheochromocytoma Crisis — Management Pathway

Catecholamine hypertensive crisis; alpha-blockade first (phentolamine),

Start case →症例 challenge

Pituitary Apoplexy Pathway

Sudden severe headache + visual/ocular motor signs; give empiric hydroco

Respiratory · 8

症例 challenge

Suspected Pulmonary Embolism (PE) — Diagnostic Pathway

From hemodynamic assessment to the two-level Wells score, (age-adjusted)

Start case →症例 challenge

Community-Acquired Pneumonia (CAP) — Disposition Pathway

Use CURB-65 to grade CAP severity and decide outpatient / ward / ICU dis

Start case →症例 challenge

Acute Asthma Exacerbation — Management Pathway

Grade severity by GINA (speech / breathing / SpO2 / PEF / consciousness)

Start case →症例 challenge

COPD Exacerbation (AECOPD) — Management Pathway

Assess outpatient vs admission; use antibiotics by Anthonisen criteria,

Start case →症例 challenge

Pneumothorax — Management Pathway

Exclude tension pneumothorax first (immediate needle decompression); man

Start case →症例 challenge

Acute Pulmonary Embolism — Risk Stratification & Treatment Pathway

After confirming PE, stratify by hemodynamics, PESI, RV function and bio

Start case →症例 challenge

Massive Hemoptysis — Management Pathway

Death is usually from asphyxiation; airway first + affected-side-down po

Start case →症例 challenge

Pleural Effusion (Light's Criteria) — Pathway

Thoracentesis for protein/LDH, Light's criteria classify exudate/transud

Pediatrics · 8

症例 challenge

Croup (Acute Laryngotracheitis) — Management Pathway

Grade by stridor at rest; all children get a single dose of dexamethason

Start case →症例 challenge

Bronchiolitis — Management Pathway

Clinical diagnosis at 1–23 months, purely supportive care; no routine br

Start case →症例 challenge

Kawasaki Disease — Diagnosis & Treatment Pathway

Fever ≥5 days + principal criteria (including incomplete), IVIG 2 g/kg +

Start case →症例 challenge

Pediatric Diabetic Ketoacidosis (DKA) — Pathway

Cerebral edema is the most feared complication; start insulin only after

Start case →症例 challenge

Pediatric Febrile Seizure — Management Pathway

Distinguish simple from complex febrile seizures to guide seizure manage

Start case →症例 challenge

Intussusception (Pediatric) — Management Pathway

Ultrasound target sign first-line; air enema reduction if stable, surger

Start case →症例 challenge

Pediatric Dehydration Graded Fluid Pathway

Choose oral rehydration or IV isotonic resuscitation by dehydration seve

Start case →症例 challenge

Button Battery Ingestion (Pediatric) Pathway

A battery in the esophagus is an absolute emergency, remove endoscopical

Infectious disease · 7

症例 challenge

Infective Endocarditis — Diagnostic Pathway

Use the 2023 Duke-ISCVID major/minor criteria for definite/possible IE;

Start case →症例 challenge

Malaria — Management Pathway

Confirm with blood film/RDT; triage by WHO severe criteria — IV artesuna

Start case →症例 challenge

Septic Arthritis — Management Pathway

Acute hot swollen painful single joint; arthrocentesis is key; after asp

Start case →症例 challenge

Clostridioides difficile Colitis (CDI) — Pathway

Grade as non-severe–severe / fulminant; stop the inciting antibiotic, or

Start case →症例 challenge

Acute Pyelonephritis — Management Pathway

Distinguish complicated/uncomplicated; outpatient oral fluoroquinolone f

Start case →症例 challenge

Herpes Simplex Encephalitis — Management Pathway

Fever + altered consciousness + focal signs/seizures; once suspected, st

Start case →症例 challenge

Toxic Shock Syndrome — Management Pathway

Superantigen-mediated; source control + fluid resuscitation + MRSA cover

Nephrology · 6

症例 challenge

Adult Hyperkalemia — Management Pathway

Decide whether emergency treatment is needed based on potassium level, E

Start case →症例 challenge

Acute Kidney Injury (AKI) — KDIGO Staging & Management

Diagnose and stage by KDIGO creatinine and urine-output criteria; find t

Start case →症例 challenge

Hyponatremia — Management Pathway

Whether severe (cerebral edema) symptoms are present decides emergency h

Start case →症例 challenge

Hypokalemia — Management Pathway

Decide oral vs IV potassium by severity and urgent features, and always

Start case →症例 challenge

Hypernatremia — Management Pathway

Correct volume first, then replace free water by acute/chronic status an

Start case →症例 challenge

Rhabdomyolysis — Management Pathway

Diagnose at CK >5× ULN; early aggressive fluids to prevent AKI, correct

Obstetrics · 6

症例 challenge

Eclampsia / Severe Pre-eclampsia — Management Pathway

Recognize severe features and seizures; magnesium sulfate to prevent/sto

Start case →症例 challenge

Postpartum Hemorrhage (PPH) — Management Pathway

Find the cause by the 4 T's and resuscitate; for uterine atony, massage

Start case →症例 challenge

HELLP Syndrome — Management Pathway

Hemolysis + raised liver enzymes + low platelets; stabilize the mother,

Start case →症例 challenge

Placental Abruption — Management Pathway

Vaginal bleeding + abdominal pain + abnormal fetal heart rate, a clinica

Start case →症例 challenge

Amniotic Fluid Embolism (AFE) — Recognition & Management

Sudden hypoxia + hypotension + DIC triad during labor/immediately postpa

Start case →症例 challenge

Preterm Labor / Premature Rupture of Membranes (PPROM) Pathway

If no contraindication, expectant: antenatal steroids + magnesium sulfat

Urology · 5

症例 challenge

Testicular Torsion — Management Pathway

'Time is testicle' — use TWIST/clinical suspicion to decide straight-to-

Start case →症例 challenge

Renal Colic / Ureteric Stone — Management Pathway

CT first-line; NSAID first-line analgesia + medical expulsive therapy; i

Start case →症例 challenge

Priapism — Management Pathway

Ischemic (painful, rigid, acidotic blood gas) is an emergency, corporal

Start case →症例 challenge

Acute Urinary Retention — Management Pathway

Immediate catheter decompression + find the cause; for BPH add an alpha-

Start case →症例 challenge

Fournier Gangrene Pathway

Necrotizing fasciitis of the perineum/genital region; early thorough deb

Surgery · 4

症例 challenge

Acute Appendicitis · Alvarado Score Pathway

Stratify with the Alvarado score: observe low-risk, image intermediate,

Start case →症例 challenge

Acute Cholecystitis — Management Pathway

Diagnose and grade with TG18; with antibiotic support, early laparoscopi

Start case →症例 challenge

Bowel Obstruction — Management Pathway

First judge for strangulation/perforation; if absent, manage conservativ

Start case →症例 challenge

Necrotizing Fasciitis — Management Pathway

Clinical diagnosis, do not wait for imaging; immediate thorough debridem

Ophthalmology · 4

症例 challenge

Acute Angle-Closure Glaucoma — Management Pathway

An ophthalmic emergency; urgent medical lowering of intraocular pressure

Start case →症例 challenge

Central Retinal Artery Occlusion (CRAO) — Pathway

Sudden painless monocular vision loss — an 'eye stroke', manage as an ac

Start case →症例 challenge

Orbital Cellulitis (Postseptal) — Pathway

Pain on eye movement + proptosis + ophthalmoplegia indicate postseptal;

Start case →症例 challenge

Chemical Eye Burn Pathway

Immediate copious irrigation to a neutral pH is the priority first aid;

Hematology · 3

症例 challenge

Thrombotic Thrombocytopenic Purpura (TTP) — Pathway

MAHA + thrombocytopenia, normal PT/APTT; with a high PLASMIC score, star

Start case →症例 challenge

Disseminated Intravascular Coagulation (DIC) — Pathway

ISTH score ≥5 = overt DIC; treating the underlying cause is paramount, g

Start case →症例 challenge

Heparin-Induced Thrombocytopenia (HIT) Pathway

Stratify with the 4T score; ≥4 immediately stop all heparin, switch to n

ENT · 3

症例 challenge

Epistaxis — Management Pathway

First-aid compression 10–15 min; cautery/packing for anterior, posterior

Start case →症例 challenge

Peritonsillar Abscess (Quinsy) — Pathway

Severe unilateral sore throat + trismus + uvular deviation; drainage + a

Start case →症例 challenge

Acute Epiglottitis (Airway) — Management Pathway

An airway emergency, do not examine the throat/do not agitate; secure th

Vascular · 2

症例 challenge

Lower-Limb Deep Vein Thrombosis (DVT) — Diagnostic Pathway

Use the two-level Wells-DVT score with D-dimer and compression ultrasoun

Start case →症例 challenge

Acute Limb Ischemia — Management Pathway

Recognize the 6 P's, give immediate heparin + CTA for all, and use Ruthe

Hematology-oncology · 2

症例 challenge

Tumor Lysis Syndrome (TLS) — Management Pathway

Cairo-Bishop laboratory/clinical classification; aggressive hydration, r

Start case →症例 challenge

Febrile Neutropenia — Management Pathway

Confirm febrile neutropenia, stratify by MASCC; high-risk get empiric an

Obstetrics & gynecology · 2

症例 challenge

Ectopic Pregnancy — Diagnosis & Management Pathway

Transvaginal ultrasound + β-hCG discriminatory zone; emergency surgery i

Start case →症例 challenge

Ovarian / Adnexal Torsion — Management Pathway

Sudden unilateral pelvic pain + nausea; normal Doppler flow does not exc

Critical care · 1

症例 challenge

Acute Respiratory Distress Syndrome (ARDS) — Pathway

Grade by the Berlin definition P/F; lung-protective ventilation 6 mL/kg,

Transfusion medicine · 1

症例 challenge

Acute Transfusion Reaction — Management Pathway

Always stop the transfusion and re-verify first; then triage by febrile-

Spine surgery · 1

症例 challenge

Cauda Equina Syndrome — Management Pathway

Recognize red flags such as saddle anesthesia and bladder/bowel dysfunct

Oncology · 1

症例 challenge

Metastatic Spinal Cord Compression (MSCC) — Pathway

In a cancer patient with back pain + neurological symptoms, do not wait

General surgery · 1

症例 challenge

Acute Diverticulitis — Management Pathway

Contrast CT + modified Hinchey grade; uncomplicated can be outpatient (s

Vascular surgery · 1

症例 challenge

Ruptured Abdominal Aortic Aneurysm — Management Pathway

Triad (hypotension + back pain + pulsatile mass), permissive hypotension

Neurosurgery · 1

症例 challenge

Spinal Epidural Abscess — Management Pathway

Back pain + fever + neuro deficit (the full triad in only ~10–15%); whol

Rheumatology · 1

症例 challenge

Giant Cell Arteritis (Temporal Arteritis) — Pathway

Age >50 with headache + jaw claudication ± visual symptoms; start high-d

Esophageal surgery · 1

症例 challenge

Spontaneous Esophageal Rupture (Boerhaave) — Pathway

Chest pain + subcutaneous emphysema after vomiting, CT first-line; emerg

Nutrition · 1

症例 challenge

Refeeding Syndrome — Management Pathway

Hypophosphatemia is the hallmark (+ low potassium/magnesium); thiamine b

Colorectal surgery · 1

症例 challenge

Sigmoid Volvulus — Management Pathway

Coffee-bean sign; for uncomplicated cases, endoscopic detorsion/decompre

Orthopedics · 1

症例 challenge

Acute Compartment Syndrome Pathway

Clinical diagnosis (pain out of proportion + pain on passive stretch); d

Neonatology · 1

症例 challenge

Neonatal Jaundice Management Pathway

Set phototherapy/exchange thresholds by the AAP 2022 hour-specific nomog

Gynecology · 1

症例 challenge

Pelvic Inflammatory Disease (PID) Pathway

CDC minimum criteria (any of cervical motion/uterine/adnexal tenderness

Anesthesia · 1

症例 challenge

Local Anesthetic Systemic Toxicity (LAST) Pathway

After local anesthetic, CNS → cardiovascular toxicity; give 20% lipid em

Each case is generated deterministically by walking one start→endpoint path of the pathway; the case data and correct management are taken verbatim from the reviewed pathway nodes — no new medical content. Teaching prototype: it mainly trains working a case correctly through the pathway. For licensed clinicians/trainees; not a substitute for clinical judgment or local protocols.