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63 Cards in this Set
- Front
- Back
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What must you r/o in reproductive age women with an "acute pelvis"?
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Ectopic pregnancy
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What is the trend of incidence of ectopic pregnancies?
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The incidence of ectopic pregnancies is increasing.
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What is the trend of fatalies from ectopic pregnancies?
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The fatality rate is decreasing.
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What was the fatality rate of ectopic pregnancies in 1970?
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35.5 Per 10,000 ectopic pregnancies.
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What was the fatality rate of ectopic pregnancies in 1980?
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8.8 per 10,000 ectopic pregnancies.
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What was the fatality rate of ectopic pregnancies in 1989?
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3.8 per 10,000 ectopic pregnancies.
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Who has a greater risk?
& how much greater is that risk? |
Non white have 3.4 times greater risk.
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When should be ectopic pregnancy be considered?
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-ectopic pregnancy must be considered in any reproductive age woman with abdominal/pelvic pain or unexplained hypovolemia.
-History of abnormal bleeding, fever, pain, or amenorrhea. -History of prior ectopic, or acute salpingitis. |
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What body fluids do you test?
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Urine HCG is positive early, if in doubt get serum HCG.
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What imaging modality do you use to r/o ectopic pregnancy?
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Use sono to r/o ectopic pregnancy. Will also give status of IUP.
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What can you do if you suspect an ectopic pregnancy with a non-diagnostic sonogram?
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Laparoscopy.
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What does this image show?
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Ectopic pregnancy
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What does this image show?
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Fluid in cul-de-sac
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What is the disease?
1/2 to 2/3 of PTS complain of abdominal pain, nausea, and vomiting. Pain then localizes to RLQ. Fever is late finding except when _____. |
Acute appendicitis; ruptured.
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What helps with the diagnosis of acute appendicitis?
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- Labs, CBC, & UA
- Flat & Upright of abdomen; may show free air under diaphragm -SONO |
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_______ Pathology such as _______ cyst or torsion of adnexa. Sono is main Dx help.
-CBC may show incr. WBC -HCG Negative |
Ovarian
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Causes of acute pelvis
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-Pelvic Inflamatory Disease
-Acute Salpingitis -Acute Endometritis -Peritonitis |
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What does this cartoon represent?
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-Endometriosis
-Acute pain from ruptured endometrioma. |
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For your viewing pleasure...
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Read & learn
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These endometrial implants are the definitive diagnosis for what disease?
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endometriosis
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What are causes of endometrial implants?
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-Sexual assault and pelvic trauma
-ureteral colic -pain secondary to obstruction from a stone or blood clot |
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What is the nature of the pain due to endometrial implants?
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Pain is usually spastic & can elicit peritoneal signs since kidneys are covered with peritoneum.
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What can acute pelvic pain be secondary to ?
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-Threatened or inevitable abortion
-Incomplete abortion or septic abortion. -Heterotopic pregnancy combined IUP and ectopic -sono dx -acute urinary tract infection esp. cystitis. -ruptured corpus luteum cyst in early pregnancy. |
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Acute Pelvic main in post menopausal patients is due to what?
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-Urinary tract more common cause of acute symptoms.
-Must R/O adnexal pathology -Degenerating myoma |
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Why is the incidence of ectopic is increasing
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Increased STD infections, esp chlamydia.
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Why is the incidence of ecotopic pregnancies increasing?
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More & more STD/UTI infections.
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What is the number one cause of amenorrhea in any woman of reproductive age?
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Pregnancy
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What is the Differential Diagnosis of Pelvic Pain?
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-Salpingitis
-Salpingitis plus tubo-ovarian abscess -Incomplete abortion -Septic abortion -ectopic pregnancy -Ruptured ovarian cyst -mittelschmerz -Torsion of ovarian tumor -Endometoritis with or with out IUD -Dysmenorrhea -Appendicitis |
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What are the History and Symptoms of Salpingitis?
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-It acompanies or is just after period.
-The pain is constant & severe. -The patient may have a history of prior salpingits -The vaginal discharge is scant to purulent (early on won't see a vaginal discharge). |
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What are the signs of salpingitis?
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-Fever
-Cervix is tender with motion -Uterus is tender -There is no adnexal mass -Adenexal tenderness is bilateral. |
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What laboratory findings are associated with Salpingitis?
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-Urine Immunologic Pregnancy Test is indicated.
-Leukocytosis is elevated. |
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What is the line on the female pelvic u/s called?
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endometrial stripe
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What is the history & symptoms of salpingitis plus tubo-ovarian abscess?
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-Pain that accompanies or is just after then period.
-A Constant & Severe Pain -Usually associated with a history of prior salpingitis. -A scant to purulent discharge that you won't see early in the discharge period. |
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What are the signs associated with salpingitis plus tubo-ovarian abscess?
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-Fever
-Cervix is tender with motion -Uterus is tender -Adnexal mass -usually Bilateral adnexal tenderness |
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What laboratory findings do you have in patient with salpingitis plus tubo-ovarian abcess
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Indictated urine immulonogic pregnancy test & elevated erthrocyte sedimentation rate.
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What are the History & Symptoms of Incomplete Abortion?
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-period of amenorrhea with recent spotting or frank blood
-cramping and suprapubic pain -may or may not have history of prior salphingitis. -vaginal discharge is heavy with clots. |
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What are the signs of incomplete abortion?
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-no fever
-dilated cervix -enlarged & tender uterus -no adnexal mass -no adnexal tenderness |
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What are the laboratory findings of incomplete abortions?
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-Urine immunologic pregnancy test is positive or negative
-Leukocytosis is + or - |
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What is the history & symptoms of a septic abortion?
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-a period of amenorrhea with recent spotting or frank blood
-cramping and suprapubic pain -may or may not have history of prior salpingitis -a thick & bloody discharge that is foul smelling. |
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What are the signs of a septic abortion?
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-fever
-dilated & tender cervix -enlarged & tender uterus -may or may not have adnexal masses -bilateral adnexal tenderness. |
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What are the laboratory findings of a septic abortion?
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- + or - urine immunologic pregnancy test
-increased leukocytosis |
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What are the history and symptoms of ectopic pregnancy?
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-amenorrhea with recent spotting
-intermittent pain with variable severtity -pts may or may not have a history of salpingitis. -pts have a scant discharge but rarely none. |
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What are the signs of an ectopic pregnancy?
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+ or - fever
-slightly tender cervix -normal to slightly enlarged uterus -most of the time there is an adnexal mass. -unilateral tenderness. |
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What are the laboratory findings of ecotopic pregnancy?
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-Urine immunologic Pregnancy Test + or -
-won't see leukocytosis unless it ruptures. |
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What are the history and symptoms of ruptured ovarian cyst?
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-It proceeds the menstrual period
-Sudden & severe pain -no history of salpingitis -No vaginal discharge |
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What are the signs of a ruptured ovarian cyst?
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-may or may not have a fever.
-cervix feels normal -uterus feels normal -may or may not have adnexal mass -unilateral adnexal tenderness |
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What are the laboratory findings of ruptured ovarian cysts?
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-A pregnancy test is indicated
-may or may not have leukocytosis |
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What is the history & symptoms of mittelschmerz?
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-midcycle menstrual pain
-sudden pain -no history of prior salpingitis -spotting vaginal discharge |
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What are the signs of mittelschmerz?
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-no fever
-normal cervix -normal uterus -no adnexal mass -unilateral adnexal tenderness. |
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What are the laboratory findings of mittelschmerz?
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No laboratory findings
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What are the history & symptoms of torsion of ovarian tumor
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-pain has no relationship to menstrual period.
-intermittent pain that radiates to the thigh -no history of prior salpingitis. -no vaginal discharge |
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What are the signs of torsion of ovarian tumor?
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-May or may not have fever
-slightly tender cervix -slightly tender uterus -no adnexal mass -unilateral adnexal tenderness |
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What are the laboratory findings associated with torsion of ovarian tumor?
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-May or may not be a positve pregancy test
-No leukocytosis |
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What are the history & symptoms of endometritis w/ or w/o IUD?
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-Variable relationship to menstrual period.
-cramping pain -may or may not have history of salpingitis -scant or no vaginal discharge. |
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What are the signs of endometritis with or without IUD?
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-Have fever
-Variable cervix -variable tenderness of uterus -negative adnexal mass -variable adnexal tenderness |
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What are the laboratory findings associated with endometritis with or without IUD
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+ or - pregnancy test
may or may not have |
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How do you treat endometritis with or without IUD?
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Treat oral antibiotics.
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What are the history and symptoms of dysmenorrhea?
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-Pain that accompanies the period
-cramping pain -may or may not have history of prior salpingitis. -normal menses |
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What are the signs of dysmenorrhea?
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-no fever
-normal cervix -uterus has midplane pain and/or variable tenderness -no adnexal mass -patients seldom have adnexal tenderness |
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What are the laboratory findings of dysmenorrhea?
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Negative pregnancy test & leukocytosis
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What are the history and symptoms of appendicitis?
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-pain has no relationship to menstrual cycle.
-preumbilical; cramping; progressing -no history of prior salpingintis -no associated vaginal discharge |
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What are the signs of appendicitis?
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-may or may not have fever
-normal cervix -normal uterus -no adnexal mass -unilateral adnexal tenderness. |
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What are the laboratory findings of appendicitis?
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+ or - pregnancy test
+ or - leukocytosis |
