saem m4 curriculum 2 PID cause correct answeroriginates as a cervical infection with Neisseria gonorrheaand/or Chlamydia trachomatis, and becomes polymicrobial as it ascends into the uterus, fallopian tubes and ovaries.
- sx PID correct answer-lower abd pain
-purulent vag d/c -vag bleed when getPID sx correct answerSymptoms 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 answermore likely to appear toxic (fever, N/V) dont forget one risk factor pid correct answer-recent instrumentation of uterus common exam findings pid correct answer-b/l adenexal tenderness -cervical d/c cervical motion tenderness -uterine tender -lower abd tenderness if pain is u/l think more correct answerTOA if RUQ tender think correct answerFitz-Hugh Curtis (perihepatitis, inflamation of liver capsule) best test for gonorrohea and chlaymida correct answerNAAT with PCR or DNA probes (either urine or cervical secretions) 1 / 4
if suspect TOA get correct answerUS ruptured ovarian cyst shows correct answerfree fluid in pouch of douglas ovarian torsion shows correct answerabsence of blood flow to one ovary on pelvic ultrasound with doppler why US>CT correct answerCT cannot eval for torsion bc there is no doppler who gets abx for PID correct answer-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 answer-chronic pelvic pain -infertility -ectopic -toa -fitz-hiugh curtis toa process correct answerwalled-off abscess that originates in the infected fallopian tube and extends to involve the ovary how confirm dx of Fitz hugh curtis correct answerelevated liver fxn tests inpatient abx pid correct answer-cefoxitin + doxy or -cefotentan + doxy or clinda+gentamycin 2 / 4
outpatient abx pid? add _____ if 2 correct answer-ceftriaxone -doxy -add metro if severe infection or hx of uterine instrumentation who getsa dmitted correct answer-toa -fitz hugh curtis -septic -peritontiis -pre-pubertal kid -iud (which needs to be removed) -pregnant d/c with PID need what testing correct answertest for other STD describe whats going on in ovarian torsion correct answerovary, and often the fallopian tube as well (adnexal torsion) become twisted around their vascular pedicle.progression of torsion correct answertwisting 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 answerovary with a mass or cyst is more prone to twisting by virtue of its asymmetry classic present torsion correct answersudden 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 answerseveral episodes of pain over the course of hours, days, or even weeks, 3 / 4
why does current pregnancy inc risk of torsion correct answercorpus lutem cyst on ovary tests for torsion correct answerThere are no laboratory tests which are helpful in establishing the diagnosis of adnexal torsion best way to dx torsion correct answerUS careful with US: correct answerimportant to note that the presence of Doppler blood flow does not exclude the diagnosis of torsion signs of torsion on US correct answer-enlargement/edema of ovary -ovrian mass or cyst -free pelvic fluid what does CT torsion show correct answerfinding an enlarged ovary or ovarian mass -assocaited free fluid -thick fallopian tube -deviation of uterus to the affected side definitively dx torsion correct answerOR tx torsion correct answeror (try and salvage ovary but testicle just gets removed) torsion sotry often sounds like correct answerkidney story testicular torsion is correct answertwisting of the testis and spermatic cord within the scrotum, with resulting in occlusion of venous return and and edema which can progress to arterial occlusion and ischemia
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