SAEM M4 Curriculum 2: Questions
With Complete Solutions
PID cause ✔️Ans - 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 ✔️Ans - -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx ✔️Ans - 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 ✔️Ans - more likely to appear toxic (fever, N/V)
dont forget one risk factor pid ✔️Ans - -recent instrumentation of uterus
common exam findings pid ✔️Ans - -b/l adenexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more ✔️Ans - TOA
if RUQ tender think ✔️Ans - Fitz-Hugh Curtis (perihepatitis, inflamation of
liver capsule)
best test for gonorrohea and chlaymida ✔️Ans - NAAT with PCR or DNA
probes (either urine or cervical secretions)
if suspect TOA get ✔️Ans - US
ruptured ovarian cyst shows ✔️Ans - free fluid in pouch of douglas
,ovarian torsion shows ✔️Ans - absence of blood flow to one ovary on pelvic
ultrasound with doppler
why US>CT ✔️Ans - CT cannot eval for torsion bc there is no doppler
who gets abx for PID ✔️Ans - -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 ✔️Ans - -chronic pelvic pain
-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process ✔️Ans - walled-off abscess that originates in the infected
fallopian tube and extends to involve the ovary
how confirm dx of Fitz hugh curtis ✔️Ans - elevated liver fxn tests
inpatient abx pid ✔️Ans - -cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
outpatient abx pid? add _____ if 2 ✔️Ans - -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted ✔️Ans - -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing ✔️Ans - test for other STD
,describe whats going on in ovarian torsion ✔️Ans - ovary, and often the
fallopian tube as well (adnexal torsion) become twisted around their vascular
pedicle.
progression of torsion ✔️Ans - 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 ✔️Ans - ovary with a mass or cyst is more prone to
twisting by virtue of its asymmetry
classic present torsion ✔️Ans - 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 ✔️Ans - several episodes of pain over the course of
hours, days, or even weeks,
why does current pregnancy inc risk of torsion ✔️Ans - corpus lutem cyst on
ovary
tests for torsion ✔️Ans - There are no laboratory tests which are helpful in
establishing the diagnosis of adnexal torsion
best way to dx torsion ✔️Ans - US
careful with US: ✔️Ans - important to note that the presence of Doppler
blood flow does not exclude the diagnosis of torsion
signs of torsion on US ✔️Ans - -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show ✔️Ans - finding an enlarged ovary or ovarian
mass
-assocaited free fluid
-thick fallopian tube
, -deviation of uterus to the affected side
definitively dx torsion ✔️Ans - OR
tx torsion ✔️Ans - or (try and salvage ovary but testicle just gets removed)
torsion sotry often sounds like ✔️Ans - kidney story
testicular torsion is ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - 1st year of life and in puberty
hx of testicular torsion ✔️Ans - 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 ✔️Ans - left
weird cause of torsion ✔️Ans - trauma
exam ✔️Ans - -testicle is tender and swollen
-sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
With Complete Solutions
PID cause ✔️Ans - 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 ✔️Ans - -lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx ✔️Ans - 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 ✔️Ans - more likely to appear toxic (fever, N/V)
dont forget one risk factor pid ✔️Ans - -recent instrumentation of uterus
common exam findings pid ✔️Ans - -b/l adenexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more ✔️Ans - TOA
if RUQ tender think ✔️Ans - Fitz-Hugh Curtis (perihepatitis, inflamation of
liver capsule)
best test for gonorrohea and chlaymida ✔️Ans - NAAT with PCR or DNA
probes (either urine or cervical secretions)
if suspect TOA get ✔️Ans - US
ruptured ovarian cyst shows ✔️Ans - free fluid in pouch of douglas
,ovarian torsion shows ✔️Ans - absence of blood flow to one ovary on pelvic
ultrasound with doppler
why US>CT ✔️Ans - CT cannot eval for torsion bc there is no doppler
who gets abx for PID ✔️Ans - -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 ✔️Ans - -chronic pelvic pain
-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process ✔️Ans - walled-off abscess that originates in the infected
fallopian tube and extends to involve the ovary
how confirm dx of Fitz hugh curtis ✔️Ans - elevated liver fxn tests
inpatient abx pid ✔️Ans - -cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
outpatient abx pid? add _____ if 2 ✔️Ans - -ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted ✔️Ans - -toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing ✔️Ans - test for other STD
,describe whats going on in ovarian torsion ✔️Ans - ovary, and often the
fallopian tube as well (adnexal torsion) become twisted around their vascular
pedicle.
progression of torsion ✔️Ans - 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 ✔️Ans - ovary with a mass or cyst is more prone to
twisting by virtue of its asymmetry
classic present torsion ✔️Ans - 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 ✔️Ans - several episodes of pain over the course of
hours, days, or even weeks,
why does current pregnancy inc risk of torsion ✔️Ans - corpus lutem cyst on
ovary
tests for torsion ✔️Ans - There are no laboratory tests which are helpful in
establishing the diagnosis of adnexal torsion
best way to dx torsion ✔️Ans - US
careful with US: ✔️Ans - important to note that the presence of Doppler
blood flow does not exclude the diagnosis of torsion
signs of torsion on US ✔️Ans - -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show ✔️Ans - finding an enlarged ovary or ovarian
mass
-assocaited free fluid
-thick fallopian tube
, -deviation of uterus to the affected side
definitively dx torsion ✔️Ans - OR
tx torsion ✔️Ans - or (try and salvage ovary but testicle just gets removed)
torsion sotry often sounds like ✔️Ans - kidney story
testicular torsion is ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - 1st year of life and in puberty
hx of testicular torsion ✔️Ans - 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 ✔️Ans - left
weird cause of torsion ✔️Ans - trauma
exam ✔️Ans - -testicle is tender and swollen
-sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
