Obgyn Exam 3

Front 1

what are the MC complaints in GYN?

Back 1

pelvic pain and abdominal pain

Front 2

True of False:
pelvic pain is poorly localized and slowly conducted and persists after a stimulis is removed

Back 2

true

Front 3

Pelvic pain is visceral, does that mean it does or does not respond to thermal, chemical, or tactile sensations?

Back 3

It does NOT respond.

visceral pain is referred

Front 4

what kind of pain suggests and inflammatory response?

Back 4

dull pain

Front 5

Diagnosit Laparscopy is contraindicated in patients with?

Back 5

hypovolemic shock or GI obstruction

Front 6

What percent of patients wih pelvic pain will have a normal pelvis via laparoscopy?

Back 6

30%

Front 7

What labs do we get for suspected ectopic pregnancy?

Back 7

1. hCG subunits
2. US
3. culdocentesis
4. laparoscopy

Front 8

pain in the lower abdomen around ovulation and believed to be secondary to chemical irritation of peritoneium from ovarian folicular cyst fluid.

Back 8

Mittelschmerz

Front 9

inflammatory cysts, endometriomas, benign or malignant cysts, or solid tumors, are referred to as what in the DDs of pelvic pain?

Back 9

ovarian accidents

Front 10

What are 3 types of ovarian accidents seen in Ddx of pelvic pain

Back 10

1. bleeding
2. rupture
3. torsion

Front 11

May occur in pts who have hx of infertility being tx with fertility hormones

Back 11

ovarian hyperstimulation syndrome

Front 12

ovaries are enlarged withmultiple follicular cysts, a large cystic corpus luteum and stromal edema

Back 12

ovarian hyperstiulation sydnrome

Front 13

what are associated sx w/ ovarian hyperstimulation syndrome?

Back 13

1. weight gain
2. abdominal distention
3. abdominal pain
if severe: ascities, plueral effusion, hypoveolemia, oliguria, lyte disturbances dyspnea

Front 14

What is the therapy for pts with ovarian hyperstimulation sydnromes?

Back 14

1. hospitalization
2. obv
3. bed res
4. fluid and lyte replacement

Front 15

what are the associated sx of appendicities?

Back 15

Anorexia, N and V

Front 16

results from residual ovarian tissue after bilateral oophorectomy. present with sx of pelvic mass, pelvic pain or flank pain from associated ureteral obstruction

Back 16

Ovarian Remnant Syndrome

Front 17

spectrum of inflammatory disorders of the upper female genital tract or reproductive tract

Back 17

pelvic inflammatory disease

Front 18

True or false
1. PID is a dz of older women
2. MC serious infection in 16-25 yo
3. MC in AA and Hispanics
4. 1/2 develop sequellae

Back 18

1. False, PID is a dz of younger women
2. T
3. T
4. False, 1/4 develope sequelae - ectopics, chronic pain, absecess, infertility, mortality,

Front 19

what meds appear to protect users against PID?

Back 19

OCPs

Front 20

IUD have been linked to an increase or decrease of PID?

Back 20

an increase!

Front 21

Barrier methods of contraceptions protect against PID. T or F?

Back 21

true

Front 22

this microbe is found in 15% of IUD cases of PID. Rare in non-IUD users

Back 22

Actinomyces Israelii

Front 23

What are the common causative agents of PID?

Back 23

1. Neisseria gonorrhoeae*
2. Chlamydia trachomatis *
3. enteric gram - rods
4. Actinomyces Israelii - in IUD pts
5. Gardnerella -

Front 24

what two organisms cause 2/3 of cases of acute PID?

Back 24

Neisseria gonorrhoeae
chlamydia trachomatis

Front 25

this PID infection usually is seen bilaterally esp if using IUD.May progress from endosalpingitis to oophoritis to possible peritonitis

Back 25

salpingo-oophoritis

Front 26

Development of perihepatitis with adhesion and RUQ abdominal pain is called?

Back 26

Fitz-Hugh-Curtis syndrome

Front 27

acute PID is hard to dx because signs and sx are relatively non specific however _____ is essential in making diagnosis

Back 27

high index of suspicion

Front 28

consensus, disease oriented evidence, usualy practice, expert option or case series

Back 28

C evidence based

Front 29

Consistent good quality patient oriented evidence

Back 29

A evidence based rating

Front 30

what evidence based medicine rating do we have for PID?

Back 30

A evidence. sscreening for and tx symptomatic lower genital tract chlamydial infection is recommended to reduce the incidence of pID

Front 31

What is the CDC dx criteria for PID?

Back 31

PID should be suspected and tx initiated if:
Patient is at risk of PID and
Patient has uterine, adnexal, or CMT with no other apparent cause

Front 32

what is in our DDx of PID that we must rule out?

Back 32

ectopic pregnancy

Front 33

what is the best test for dx PID?

Back 33

there is no single lab test that has good sensitivity and specificity. dx usually based on clinical findings

Laparoscopy is the gold standard because provides direct visulaization but its expensive, not readily available and intrusive

Front 34

when and how might we see a cogwheel sign

Back 34

Through Transvaginal ultrasound - may help to define adnexal masses, ectopic pregnancies -- shows thickened fluid filled types = hydrosalpinx

Front 35

what test does the CDC consider the findings to be the most specific dx criteria for acute PID?

Back 35

findings of histologic endometritis on endometrial bx

Front 36

what is the tx for PID?

Back 36

empiric broad spectrum abx:
"the faculty doesn't like (-), noelle, cristina, shae"
1. Facultative bacteria
2. gram negatives
3. neisseria gonorrhea
4. chlamydia
5. sterptococcus species

Front 37

Levofloxacin or ofloxacind should not be used unless infection with what has been excluded?

Back 37

QRNG

Front 38

what is PID criteria for hospitalization?

Back 38

PID - Who's Fu#%d & Needs Special Treatment Today
1. Pregnancy
2. IUD use
3. Dx uncertain
4. WBC low or high
5. HIV +
6. Outpatient oral regimen no good
7. Surgical emergencies
8. Failure to improve after 3d of output therapy
9. Nulliparity
10. Severe illness
11. TOA / Pelvic abscess
12. Temperature

Front 39

what abx does the CDC tell us to avoid in treating PID?

Back 39

quinolones

Front 40

what is the oral treatment for PID?

Back 40

Ceftriaxone 250 mg IM once PLUS
Doxycycline 100mg po bid x 14 days w/ or w/o
Metronidazole 500mg po bid x 14 days

Front 41

patients should demonstrate substantial clinical improvement within how many days after initiation of therapy?

Back 41

3 days

pts who do not improve within this time usually require hospitalization, additional dx tests and surical intervention

Front 42

treating sex partners without direct examination or counseling either by rx or giving med for the parter to the index pt is called?

Back 42

expedited partner treatment (EPT)

Front 43

what do we do with a patient with TOA?

Back 43

admit. they are sick. have septic. toxic picture.
Fever, N/V, diarreha, ilieu? tachycardia, hypotensive, abd. pain, decreased urine ouput

Front 44

If a patient with TOA is not better in 72 hours what is the next step?

Back 44

go to the OR and do exploratory lap

Front 45

with this condition you may see swollen tubes filled with fluid, closed off. Adhesions, frozen pelvis - all organs fixed and fibrosis

Back 45

chronic PID

Front 46

what does chronic PID very closely resemble?

Back 46

endometriosis

Front 47

non-cyclic pelvic pain over 6 months duration, not relived with meds

Back 47

chronic pelvic pain syndrome