What Is the Best Therapy

To answer this question, the clinician must reach the correct diagnosis, assess the severity of the condition, and then weigh the situation to reach the appropriate intervention. For the student, knowing exact dosages is not as important as understanding the best medication, the route of delivery, mechanism of action, and possible complications. It is important for the student to be able to verbalize the diagnosis and the rationale for the therapy. A common error is for the student to "jump to a treatment," like a random guess; therefore, he or she is given "right or wrong" feedback. In fact, the student's guess may be correct, but for the wrong reason; conversely, the answer may be a very reasonable one, with only one small error in thinking. Instead, the student should verbalize the steps so that feedback can be given at every reasoning point.

For example, if the question is "What is the best therapy for a 19-year-old woman with a nontender ulcer of the vulva and painless adenopathy who is pregnant at 12 weeks' gestation?" The incorrect manner of response is for the student to blurt out "azithromycin." Rather, the student should reason it in a way such as the following: "The most common cause of a nontender infectious ulcer of the vulva is syphilis. Painless adenopathy usually is associated. In pregnancy, penicillin is the only effective therapy to prevent congenital syphilis. Therefore, the best treatment for this woman with probable syphilis is intramuscular penicillin (after confirming the diagnosis)."

A related question is "What would have best prevented this condition?" For instance, if the scenario presented is a 23-year-old woman with tubal factor infertility, then the most likely etiology is C. trachomatis cervicitis that ascended to the tubes, causing damage. The best preventive measure would be a barrier contraception such as condom use.

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