SAEM M4 CURRICULUM 2 EXAM
2025/2026 QUESTIONS AND ANSWERS
100% PASS
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.
3 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
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,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
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
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,-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
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, d/c with PID need what testing - ANS test for other STD
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
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
2025/2026 QUESTIONS AND ANSWERS
100% PASS
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.
3 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
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,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
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
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,-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
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, d/c with PID need what testing - ANS test for other STD
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
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
