SAEM M4 Exam GRADED A {LATEST}
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...
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.
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
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
signs of torsion on US - CORRECT ANSWER -enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
what does CT torsion show - CORRECT ANSWER finding an enlarged ovary or
ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
definitively dx torsion - CORRECT ANSWER OR
, tx torsion - CORRECT ANSWER or (try and salvage ovary but testicle just gets
removed)
torsion sotry often sounds like - CORRECT ANSWER kidney story
testicular torsion is - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER 1st year of life and in
puberty
hx of testicular torsion - CORRECT 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 - CORRECT ANSWER left
weird cause of torsion - CORRECT ANSWER trauma
exam - CORRECT ANSWER -testicle is tender and swollen
-sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
labs in torsion - CORRECT ANSWER usually not helpful
best way to dx testicle torsion? what show2 - CORRECT ANSWER US: painful
testicle is enlarged and hypeochoic as ocmpread to good side. can show absence
of flow but this is alte finding
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