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saem m4 curriculum 2
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saem m4 curriculum 2
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saem m4 curriculum 2PID cause - ANSWER 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 - ANSWER -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx - ANSWER 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 - ANSWER more likely to appear toxic (fever, N/V)
dont forget one risk factor pid - ANSWER -recent instrumentation of uterus
common exam findings pid - ANSWER -b/l adenexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more - ANSWER TOA
if RUQ tender think - ANSWER Fitz-Hugh Curtis (perihepatitis, inflamation of liver
capsule)
best test for gonorrohea and chlaymida - ANSWER NAAT with PCR or DNA probes
(either urine or cervical secretions)
if suspect TOA get - ANSWER US
ruptured ovarian cyst shows - ANSWER free fluid in pouch of douglas
ovarian torsion shows - ANSWER absence of blood flow to one ovary on pelvic
ultrasound with doppler
why US>CT - ANSWER CT cannot eval for torsion bc there is no doppler
who gets abx for PID - 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 - ANSWER -chronic pelvic pain
-infertility
,-ectopic
-toa
-fitz-hiugh curtis
toa process - ANSWER walled-off abscess that originates in the infected fallopian
tube and extends to involve the ovary
how confirm dx of Fitz hugh curtis - ANSWER elevated liver fxn tests
inpatient abx pid - ANSWER -cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
outpatient abx pid? add _____ if 2 - ANSWER -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted - ANSWER -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing - ANSWER test for other STD
describe whats going on in ovarian torsion - ANSWER ovary, and often the fallopian
tube as well (adnexal torsion) become twisted around their vascular pedicle.
progression of torsion - ANSWER 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 - ANSWER ovary with a mass or cyst is more prone to twisting
by virtue of its asymmetry
classic present torsion - ANSWER 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 - ANSWER several episodes of pain over the course of hours,
days, or even weeks,
why does current pregnancy inc risk of torsion - ANSWER corpus lutem cyst on
ovary
, tests for torsion - ANSWER There are no laboratory tests which are helpful in
establishing the diagnosis of adnexal torsion
best way to dx torsion - ANSWER US
careful with US: - ANSWER important to note that the presence of Doppler blood
flow does not exclude the diagnosis of torsion
signs of torsion on US - ANSWER -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show - ANSWER finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion - ANSWER OR
tx torsion - ANSWER or (try and salvage ovary but testicle just gets removed)
torsion sotry often sounds like - ANSWER kidney story
testicular torsion is - ANSWER twisting 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
normal testicle anatomy and issue with torsion - ANSWER anchored within the
scrotum by the tunica vaginalis, which surrounds the testicle and attaches posteriorly
to the scrotal wall and epididymis. The tunica vaginalis consists of a visceral and
parietal layer with an interposed potential space. This potential space allows the
testicle to rotate about the spermatic cord within the tunica vaginalis if a firm
posterior scrotal attachment is lacking.
bell clapper deformity - ANSWER When the tunica vaginalis attaches higher up on
the spermatic cord, the testicle can move and twist within the scrotum. inc risk of
torsion
2 most common ages get torsion - ANSWER 1st year of life and in puberty
hx of testicular torsion - ANSWER airly sudden, severe unilateral testicular pain,
sometimes radiating into the abdomen, associated with nausea and vomiting
-may have urgency, freuqency, dysuria
which testicle most common - ANSWER left
weird cause of torsion - ANSWER trauma
exam - ANSWER -testicle is tender and swollen
-sits higher in sac
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