SAEM M4 CURRICULUM 2 || ANSWERED PERFECTLY 100%.
PID cause correct answers originates as a cervical infection with Neisseria gonorrheaand/or
Chlamydia trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes
and ovaries.
3 sx PID correct answers -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx correct answers Symptoms begin shortly after the start of the menstrual cycle,
when there are fewer defenses by the cervical mucosal barrier to ascending infections.
PID with gonnoccal correct answers more likely to appear toxic (fever, N/V)
dont forget one risk factor pid correct answers -recent instrumentation of uterus
common exam findings pid correct answers -b/l adenexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more correct answers TOA
if RUQ tender think correct answers Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule)
best test for gonorrohea and chlaymida correct answers NAAT with PCR or DNA probes (either
urine or cervical secretions)
,if suspect TOA get correct answers US
ruptured ovarian cyst shows correct answers free fluid in pouch of douglas
ovarian torsion shows correct answers absence of blood flow to one ovary on pelvic ultrasound
with doppler
why US>CT correct answers CT cannot eval for torsion bc there is no doppler
who gets abx for PID correct answers -lower abdominal or pelvic pain coupled with adnexal,
uterine or cervical motion tenderness on exam, in a patient at risk for STDs with no other
discernible cause for the illness identified
complications of pid correct answers -chronic pelvic pain
-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process correct answers walled-off abscess that originates in the infected fallopian tube and
extends to involve the ovary
how confirm dx of Fitz hugh curtis correct answers elevated liver fxn tests
inpatient abx pid correct answers -cefoxitin + doxy
or
-cefotentan + doxy
,or
clinda+gentamycin
outpatient abx pid? add _____ if 2 correct answers -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted correct answers -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing correct answers test for other STD
describe whats going on in ovarian torsion correct answers ovary, and often the fallopian tube as
well (adnexal torsion) become twisted around their vascular pedicle.
progression of torsion correct answers twisting initially obstructs venous flow, which causes
engorgement and edema. The engorgement can progress until arterial flow is compromised,
leading to ischemia and infarction
risk factors for torsion correct answers ovary with a mass or cyst is more prone to twisting by
virtue of its asymmetry
, classic present torsion correct answers sudden onset of unilateral lower abdominal pain which is
initially visceral in character (ie, vague and poorly localized) and may be accompanied by nausea
and vomiting. It may radiate to the groin or flank.
intermittent torsion correct answers several episodes of pain over the course of hours, days, or
even weeks,
why does current pregnancy inc risk of torsion correct answers corpus lutem cyst on ovary
tests for torsion correct answers There are no laboratory tests which are helpful in establishing
the diagnosis of adnexal torsion
best way to dx torsion correct answers US
careful with US: correct answers important to note that the presence of Doppler blood flow does
not exclude the diagnosis of torsion
signs of torsion on US correct answers -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show correct answers finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion correct answers OR
tx torsion correct answers or (try and salvage ovary but testicle just gets removed)
PID cause correct answers originates as a cervical infection with Neisseria gonorrheaand/or
Chlamydia trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes
and ovaries.
3 sx PID correct answers -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx correct answers Symptoms begin shortly after the start of the menstrual cycle,
when there are fewer defenses by the cervical mucosal barrier to ascending infections.
PID with gonnoccal correct answers more likely to appear toxic (fever, N/V)
dont forget one risk factor pid correct answers -recent instrumentation of uterus
common exam findings pid correct answers -b/l adenexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more correct answers TOA
if RUQ tender think correct answers Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule)
best test for gonorrohea and chlaymida correct answers NAAT with PCR or DNA probes (either
urine or cervical secretions)
,if suspect TOA get correct answers US
ruptured ovarian cyst shows correct answers free fluid in pouch of douglas
ovarian torsion shows correct answers absence of blood flow to one ovary on pelvic ultrasound
with doppler
why US>CT correct answers CT cannot eval for torsion bc there is no doppler
who gets abx for PID correct answers -lower abdominal or pelvic pain coupled with adnexal,
uterine or cervical motion tenderness on exam, in a patient at risk for STDs with no other
discernible cause for the illness identified
complications of pid correct answers -chronic pelvic pain
-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process correct answers walled-off abscess that originates in the infected fallopian tube and
extends to involve the ovary
how confirm dx of Fitz hugh curtis correct answers elevated liver fxn tests
inpatient abx pid correct answers -cefoxitin + doxy
or
-cefotentan + doxy
,or
clinda+gentamycin
outpatient abx pid? add _____ if 2 correct answers -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted correct answers -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing correct answers test for other STD
describe whats going on in ovarian torsion correct answers ovary, and often the fallopian tube as
well (adnexal torsion) become twisted around their vascular pedicle.
progression of torsion correct answers twisting initially obstructs venous flow, which causes
engorgement and edema. The engorgement can progress until arterial flow is compromised,
leading to ischemia and infarction
risk factors for torsion correct answers ovary with a mass or cyst is more prone to twisting by
virtue of its asymmetry
, classic present torsion correct answers sudden onset of unilateral lower abdominal pain which is
initially visceral in character (ie, vague and poorly localized) and may be accompanied by nausea
and vomiting. It may radiate to the groin or flank.
intermittent torsion correct answers several episodes of pain over the course of hours, days, or
even weeks,
why does current pregnancy inc risk of torsion correct answers corpus lutem cyst on ovary
tests for torsion correct answers There are no laboratory tests which are helpful in establishing
the diagnosis of adnexal torsion
best way to dx torsion correct answers US
careful with US: correct answers important to note that the presence of Doppler blood flow does
not exclude the diagnosis of torsion
signs of torsion on US correct answers -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show correct answers finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion correct answers OR
tx torsion correct answers or (try and salvage ovary but testicle just gets removed)
