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saem m4 curriculum 2| 365 Questions| Answers With Complete Solutions
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saem m4 curriculum 2| 365 Questions| Answers With Complete Solutions
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saem m4 curriculum 2| 365 Questions|Answers With Complete Solutions
PID cause correct 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 correct answer: -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx correct 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 correct answer: more 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 answer: TOA
if RUQ tender think correct answer: Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule)
best test for gonorrohea and chlaymida correct answer: NAAT with PCR or DNA probes (either urine or cervical secretions)
if suspect TOA get correct answer: US
ruptured ovarian cyst shows correct answer: free fluid in pouch of douglas
ovarian torsion shows correct answer: absence of blood flow to one ovary on pelvic ultrasound with doppler
why US>CT correct answer: CT 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 answer: walled-off abscess that originates in the infected fallopian tube and extends to involve the ovary
how confirm dx of Fitz hugh curtis correct answer: elevated liver fxn tests
inpatient abx pid correct answer: -cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
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 answer: test for other STD
describe whats going on in ovarian torsion correct answer: ovary, and often the fallopian tube as well (adnexal torsion) become twisted around their vascular pedicle. progression of torsion correct 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 correct answer: ovary with a mass or cyst
is more prone to twisting by virtue of its asymmetry
classic present torsion correct 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 correct answer: several episodes of pain over the course of hours, days, or even weeks,
why does current pregnancy inc risk of torsion correct answer: corpus lutem cyst on ovary
tests for torsion correct answer: There are no laboratory tests which are helpful in establishing the diagnosis of adnexal torsion
best way to dx torsion correct answer: US
careful with US: correct answer: important to note that the presence of Doppler blood flow does not exclude the diagnosis of torsion
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