SAEM M4 Curriculum 2 Test Review with Answers Graded A
PID cause - -originates as a cervical
infection with Neisseria gonorrheaand/or
Chlamydia trachomatis, and becomes
polymicrobial as it ascends into the uterus, best test for gonorrohea and chlaymida - -
fallopian tubes and ovaries. NAAT with PCR or DNA probes (either urine or
cervical secretions)
3 sx PID - --lower abd pain
-purulent vag d/c if suspect TOA get - -US
-vag bleed
ruptured ovarian cyst shows - -free fluid in
when getPID sx - -Symptoms begin shortly pouch of douglas
after the start of the menstrual cycle, when there
are fewer defenses by the cervical mucosal
barrier to ascending infections.
ovarian torsion shows - -absence of blood
flow to one ovary on pelvic ultrasound with
doppler
PID with gonnoccal - -more likely to appear
toxic (fever, N/V)
why US>CT - -CT cannot eval for torsion
bc there is no doppler
dont forget one risk factor pid - --recent
instrumentation of uterus
who gets abx for PID - --lower abdominal
or pelvic pain coupled with adnexal, uterine or
common exam findings pid - --b/l adenexal cervical motion tenderness on exam, in a patient
tenderness at risk for STDs with no other discernible cause
-cervical d/c for the illness identified
cervical motion tenderness
-uterine tender
-lower abd tenderness
complications of pid - --chronic pelvic pain
-infertility
-ectopic
if pain is u/l think more - -TOA -toa
-fitz-hiugh curtis
if RUQ tender think - -Fitz-Hugh Curtis
(perihepatitis, inflamation of liver capsule) toa process - -walled-off abscess that
, SAEM M4 Curriculum 2 Test Review with Answers Graded A
originates in the infected fallopian tube and
extends to involve the ovary
progression of torsion - -twisting initially
obstructs venous flow, which causes
engorgement and edema. The engorgement can
how confirm dx of Fitz hugh curtis - - progress until arterial flow is compromised,
elevated liver fxn tests leading to ischemia and infarction
inpatient abx pid - --cefoxitin + doxy risk factors for torsion - -ovary with a mass
or or cyst is more prone to twisting by virtue of its
-cefotentan + doxy asymmetry
or
clinda+gentamycin
classic present torsion - -sudden onset of
unilateral lower abdominal pain which is initially
outpatient abx pid? add _____ if 2 - -- visceral in character (ie, vague and poorly
ceftriaxone localized) and may be accompanied by nausea
-doxy and vomiting. It may radiate to the groin or flank.
-add metro if severe infection or hx of uterine
instrumentation
intermittent torsion - -several episodes of
pain over the course of hours, days, or even
who getsa dmitted - --toa weeks,
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid why does current pregnancy inc risk of torsion -
-iud (which needs to be removed) -corpus lutem cyst on ovary
-pregnant
tests for torsion - -There are no laboratory
d/c with PID need what testing - -test for tests which are helpful in establishing the
other STD diagnosis of adnexal torsion
describe whats going on in ovarian torsion - best way to dx torsion - -US
-ovary, and often the fallopian tube as well
(adnexal torsion) become twisted around their
vascular pedicle.
careful with US: - -important to note that
, SAEM M4 Curriculum 2 Test Review with Answers Graded A
the presence of Doppler blood flow does not epididymis. The tunica vaginalis consists of a
exclude the diagnosis of torsion 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
signs of torsion on US - -- attachment is lacking.
enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
bell clapper deformity - -When the tunica
vaginalis attaches higher up on the spermatic
cord, the testicle can move and twist within the
what does CT torsion show - -finding an scrotum. inc risk of torsion
enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side 2 most common ages get torsion - -1st
year of life and in puberty
definitively dx torsion - -OR
hx of testicular torsion - -airly sudden,
severe unilateral testicular pain, sometimes
radiating into the abdomen, associated with
tx torsion - -or (try and salvage ovary but nausea and vomiting
testicle just gets removed) -may have urgency, freuqency, dysuria
torsion sotry often sounds like - -kidney which testicle most common - -left
story
weird cause of torsion - -trauma
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 exam - --testicle is tender and swollen
and ischemia -sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
normal testicle anatomy and issue with torsion -
-anchored within the scrotum by the tunica
vaginalis, which surrounds the testicle and labs in torsion - -usually not helpful
attaches posteriorly to the scrotal wall and
PID cause - -originates as a cervical
infection with Neisseria gonorrheaand/or
Chlamydia trachomatis, and becomes
polymicrobial as it ascends into the uterus, best test for gonorrohea and chlaymida - -
fallopian tubes and ovaries. NAAT with PCR or DNA probes (either urine or
cervical secretions)
3 sx PID - --lower abd pain
-purulent vag d/c if suspect TOA get - -US
-vag bleed
ruptured ovarian cyst shows - -free fluid in
when getPID sx - -Symptoms begin shortly pouch of douglas
after the start of the menstrual cycle, when there
are fewer defenses by the cervical mucosal
barrier to ascending infections.
ovarian torsion shows - -absence of blood
flow to one ovary on pelvic ultrasound with
doppler
PID with gonnoccal - -more likely to appear
toxic (fever, N/V)
why US>CT - -CT cannot eval for torsion
bc there is no doppler
dont forget one risk factor pid - --recent
instrumentation of uterus
who gets abx for PID - --lower abdominal
or pelvic pain coupled with adnexal, uterine or
common exam findings pid - --b/l adenexal cervical motion tenderness on exam, in a patient
tenderness at risk for STDs with no other discernible cause
-cervical d/c for the illness identified
cervical motion tenderness
-uterine tender
-lower abd tenderness
complications of pid - --chronic pelvic pain
-infertility
-ectopic
if pain is u/l think more - -TOA -toa
-fitz-hiugh curtis
if RUQ tender think - -Fitz-Hugh Curtis
(perihepatitis, inflamation of liver capsule) toa process - -walled-off abscess that
, SAEM M4 Curriculum 2 Test Review with Answers Graded A
originates in the infected fallopian tube and
extends to involve the ovary
progression of torsion - -twisting initially
obstructs venous flow, which causes
engorgement and edema. The engorgement can
how confirm dx of Fitz hugh curtis - - progress until arterial flow is compromised,
elevated liver fxn tests leading to ischemia and infarction
inpatient abx pid - --cefoxitin + doxy risk factors for torsion - -ovary with a mass
or or cyst is more prone to twisting by virtue of its
-cefotentan + doxy asymmetry
or
clinda+gentamycin
classic present torsion - -sudden onset of
unilateral lower abdominal pain which is initially
outpatient abx pid? add _____ if 2 - -- visceral in character (ie, vague and poorly
ceftriaxone localized) and may be accompanied by nausea
-doxy and vomiting. It may radiate to the groin or flank.
-add metro if severe infection or hx of uterine
instrumentation
intermittent torsion - -several episodes of
pain over the course of hours, days, or even
who getsa dmitted - --toa weeks,
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid why does current pregnancy inc risk of torsion -
-iud (which needs to be removed) -corpus lutem cyst on ovary
-pregnant
tests for torsion - -There are no laboratory
d/c with PID need what testing - -test for tests which are helpful in establishing the
other STD diagnosis of adnexal torsion
describe whats going on in ovarian torsion - best way to dx torsion - -US
-ovary, and often the fallopian tube as well
(adnexal torsion) become twisted around their
vascular pedicle.
careful with US: - -important to note that
, SAEM M4 Curriculum 2 Test Review with Answers Graded A
the presence of Doppler blood flow does not epididymis. The tunica vaginalis consists of a
exclude the diagnosis of torsion 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
signs of torsion on US - -- attachment is lacking.
enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
bell clapper deformity - -When the tunica
vaginalis attaches higher up on the spermatic
cord, the testicle can move and twist within the
what does CT torsion show - -finding an scrotum. inc risk of torsion
enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side 2 most common ages get torsion - -1st
year of life and in puberty
definitively dx torsion - -OR
hx of testicular torsion - -airly sudden,
severe unilateral testicular pain, sometimes
radiating into the abdomen, associated with
tx torsion - -or (try and salvage ovary but nausea and vomiting
testicle just gets removed) -may have urgency, freuqency, dysuria
torsion sotry often sounds like - -kidney which testicle most common - -left
story
weird cause of torsion - -trauma
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 exam - --testicle is tender and swollen
and ischemia -sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
normal testicle anatomy and issue with torsion -
-anchored within the scrotum by the tunica
vaginalis, which surrounds the testicle and labs in torsion - -usually not helpful
attaches posteriorly to the scrotal wall and
