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43 Cards in this Set
- Front
- Back
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__ is an ascending infection of the female genital tract involving the uterus, fallopian tubes, ovaries, and adjacent pelvic structures.
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Acute pelvic inflammatory disease
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up to __ million american women are diagnosed and treated with pid each year.
-.5 million -1.5 million -5 million |
1.5 million
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PID arises from the ascent of microorganisms from the vagina and __ into the upper female genital tract.
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cervix
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PID commonly stems from a __.
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cervicitis
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What bugs usually cause cervicitis, in turn causing PID?
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N. gonorrhea
C. Trachomatis bacterial vaginosis may put a woman at increased risk for developing PID. |
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what micro-organisms are commonly found in the upper genital tract of women wtih PID?
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C. Trachomatis
N. Gonorrhea aerobic/anaerobic bacteria such as Strep, Gardnerella vaginalis, H. Flu, and enteric gram neg. rods |
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What are some risk factors for developing PID?
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sexarche before age 16, PID before age 25, multiple sex partners, history of STD's, postinsertion period IUD users, vaginal douching more than 3-4 x's qmth, bacterial vaginosis
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All of the following are risk factors for PID, except ?
-bacterial vaginosis -multiple sex partners -sex before age 15 -hx of previous STD's |
sex before age 15---before age 16.
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All of the following are criteria for the provisional dx of PID except which?
-cervical motion tenderness -uterine tenderness -yellow cervical drainage -adenexal tenderness |
yellow cervical drainage
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If a pt fails to respond to therapy for a suspected dx of PID, how should it be corroborated?
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diagnostic labs
imaging surgical procedures |
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t/f
PID presents with a very distinct clinical presentation. |
false; can present with a wide spectrum of nonspecific clinical symptoms and signs, ranging in degree from mild to severe.
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how does a pt generally describe there abdominal pain when they have PID?
-constant/dull -sharp/wavering -constant/stabbing |
constant/dull
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what are other common c/o women presenting with PID?
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abnormal vaginal discharge
abn. vaginal bleeding GI upset dysuria |
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if a pt with pid is c/o ruq pain...what must you think about?
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fitzhugh-curtis syndrome
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how often is fitzhugh-curtis syndrome seen in women with pid?
5-10% 10-15% 15-20% |
10-15%
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what is another name for perihepatitis?
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fithugh-curtiss syndrome
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what abdominal physical findings are most commonly seen?
-cervical motion tenderness -uterine tenderness -adenexal tenderness -a & c -all of the above |
a & c is seen in up to 16-49% of patients
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t/f
all pt's with pid present with a fever above 100.5 |
false; fever only presents in 24-60% of patients.
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what might you see in 1/2 of all pt's CBC's, with pid?
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leukocytosis
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A pid pt's esr is elevated in what percentage of pt's?
-25% -50% -75% |
75% will have an elevated esr above 15.
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a crp is elevated in what % of pid patients?
-40% -55% -70% |
70%
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what might you find in the male partner of a pid pt?
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urethritis
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what lab should ALWAYS be done in a pt. you suspect has pid?
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very sensitive pregnancy test-to rule out ectopic pregnancy
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which is the most sensitive pregnancy test?
-urine -serum qualitative -serum quantitative |
serum quantitative is sensitive to hcg at 5mIU/ML
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at what level of hcg will a qualitative hcg identify pregnancy?
-5 mIU -15 mIU -25 mIU |
25 mIU, that is why a quantitative is more sensitive.
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what are the 3 physical findings on pelvic exam that are strongly indicative of PID?
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cervical motion tenderness
adnexal tenderness uterine tenderness |
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what lab test is considered gold standard for the dx of pid?
-culture/sensitivity -koh/wet prep -nuclear amplification |
culture/sensitivity
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what is cornerstone of treatment of PID?
-diagnostic lap -ivf and pain control -antibiotics |
antibiotics
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do transvaginal pelvic ultrasound and/or MRI confirm a diagnosis of PID?
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yes
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what could you/will you see on endometrial biopsy of a pt with pid?
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histopathologic finding of plasma cell infiltration in the endometrial stroma confirms pid
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what is considered the surgical gold standard for the diagnosis of pid?
-endometrial biopsy -diagnostic laparoscopy |
diagnostic lap
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when selecting an abx for the tx of pid, what bugs should you focus on killing?
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n. gonorrhea
c. trachomatis e. coli (gram -) some anaerobics |
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what is the preferred tx of inpatient pid?
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IV doxycycline 100mg q12h plus cefoxitin 2gm IV q12h....or cefotetan.
IV clindamycin 900mg q8h plus IV gent 2.0mg/kg/ IV to be followed up with doxy or p.o. clindamycin so that the pt has a complete 14 day course of antibiotics. |
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what is the current outpatient tx of pid?
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cefoxitin 2gm IM x1 + probenecid 1gm po concurrently or rocephin 1 gm IM x1 plus doxy with or without flagyl for a full 14 day course.
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what are other flouroquinolones used in the tx of pid-outpatient?
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ofloxacin 400mg po bid or levoflaxacin 500mg po qd x 14 days. either with or without flagyl
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what are indications for surgery in a pid pt?
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confirm diagnosis in a pt failing to respond
excision of chronically infected pelvic organs, and ... draining of pelvic abscesses |
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t/f
iud's in a women with pid should be removed as soon as possible. |
false; iud removal is not supported by evidence but they should be very closely watched.
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how soon should a pid pt be followed up on?
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within 3 days of therapy initiation
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male sex partners of a woman with pid should be treated for what bugs?
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c. trachomatis
n. gonorrhea |
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when is screening for c. trachomatis recommended?
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sexually active women for infection; including unmarried women 25 years of age or younger.
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if a woman has had 2 cases of pid her risk for infertility is...
-8-12% -20-25% -49-50% |
20-25% for 2 occurances
8-12% for 1 40-50% for 3 or more episodes |
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how often is chronic pelvic pain reported after tx of pid?
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15-20%
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what is the risk of ectopic pregnancy after pid?
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increases 3-10 fold
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