saem m4 curriculum 2 exam 2023 with 100% correct 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