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.
- 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 1 / 4
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 2 / 4
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 3 / 4
-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
- most common ages get torsion ✔️Ans - 1st year of life and in puberty
- / 4
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)