SAEM Practice 2024 questions and
answers
Regarding the diagnosis of acute appendicitis, all the following are true EXCEPT:
A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
B. Rebound is usually elicited only after the appendix has ruptured or infarcted....
saem m4 curriculum 2 questions and
answers
PID cause✔✔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✔✔-lower abd pain
-purulent vag d/c
-vag bleed
when getPID sx✔✔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✔✔more likely to appear toxic (fever, N/V)
dont forget one risk factor pid✔✔-recent instrumentation of uterus
common exam findings pid✔✔-b/l adenexal tenderness
-cervical d/c
cervical motion tenderness
-uterine tender
-lower abd tenderness
if pain is u/l think more✔✔TOA
if RUQ tender think✔✔Fitz-Hugh Curtis (perihepatitis, inflamation of liver capsule)
best test for gonorrohea and chlaymida✔✔NAAT with PCR or DNA probes (either
urine or cervical secretions)
if suspect TOA get✔✔US
ruptured ovarian cyst shows✔✔free fluid in pouch of douglas
ovarian torsion shows✔✔absence of blood flow to one ovary on pelvic ultrasound
with doppler
why US>CT✔✔CT cannot eval for torsion bc there is no doppler
who gets abx for PID✔✔-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✔✔-chronic pelvic pain
,-infertility
-ectopic
-toa
-fitz-hiugh curtis
toa process✔✔walled-off abscess that originates in the infected fallopian tube and
extends to involve the ovary
how confirm dx of Fitz hugh curtis✔✔elevated liver fxn tests
inpatient abx pid✔✔-cefoxitin + doxy
or
-cefotentan + doxy
or
clinda+gentamycin
outpatient abx pid? add _____ if 2✔✔-ceftriaxone
-doxy
-add metro if severe infection or hx of uterine instrumentation
who getsa dmitted✔✔-toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
d/c with PID need what testing✔✔test for other STD
describe whats going on in ovarian torsion✔✔ovary, and often the fallopian tube as
well (adnexal torsion) become twisted around their vascular pedicle.
progression of torsion✔✔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✔✔ovary with a mass or cyst is more prone to twisting by virtue
of its asymmetry
classic present torsion✔✔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✔✔several episodes of pain over the course of hours, days, or
even weeks,
why does current pregnancy inc risk of torsion✔✔corpus lutem cyst on ovary
, tests for torsion✔✔There are no laboratory tests which are helpful in establishing the
diagnosis of adnexal torsion
best way to dx torsion✔✔US
careful with US:✔✔important to note that the presence of Doppler blood flow does
not exclude the diagnosis of torsion
signs of torsion on US✔✔-enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show✔✔finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion✔✔OR
tx torsion✔✔or (try and salvage ovary but testicle just gets removed)
torsion sotry often sounds like✔✔kidney story
testicular torsion is✔✔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✔✔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✔✔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✔✔1st year of life and in puberty
hx of testicular torsion✔✔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✔✔left
weird cause of torsion✔✔trauma
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