Term
| Pelvic pain starting at END of period: |
|
Definition
|
|
Term
| Pelvic pain starting with period: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| sudden onset of pain during coitus/exercise: |
|
Definition
|
|
Term
| Unilateral pelvic pain ddx: |
|
Definition
- Ectopic Pregnancy
- Appendicitis
- Tubo-ovarian abscess
- Ovarian torsion
- Ovarian cyst rupture
- Ureteral colic |
|
|
Term
| Bilateral pelvic pain ddx: |
|
Definition
- Endometrisosis (chocolate cysts)
- PID (tubo-ovarian abscess) |
|
|
Term
|
Definition
|
|
Term
| An in pulse of 20-30 beats per minute or a decrease in systolic pressure of 20-30 mm/Hg with position change is suggestive of a 30% or more loss of intravascular volume. |
|
Definition
|
|
Term
| Beta hcg should increase by __/week. |
|
Definition
|
|
Term
| Treatment options for ectopic pregnancy: |
|
Definition
- beta hcg <15,000, no heart rate, mass less than 3.5 cm> Methotrexate, beta hcg should drop 15% with each dose
- if methotrexate does not work> laparoscopic removal of fallopian tube |
|
|
Term
| Before treating an ectopic pregnancy with methotrexate, what should be done? |
|
Definition
- Renal function studies, BUN & Cr
- Liver function studies
- CBC and WBC |
|
|
Term
| Describe methotrexate treatment for ectopic pregnancy: |
|
Definition
- Day 1: 50mg/m2 Methotrexate IM
- Day 4: Measure b-hcg
- Day 7: Measure b-hcg
If hcg fails to fall by more than 15%, second dose of methotrexate given and follow up restarted
- Once, beta-hcg begins to fall, weekly testing should be done until it is less than 5
(mean time to resolution- 35 days) |
|
|
Term
| How do you treat at ruptured ectopic pregnancy? |
|
Definition
| - Laparoscopic surgery immediately |
|
|
Term
| CDC says IF THERE IS__ __ __, OR __ __ __ OR __ __, TREAT WITH ANTIBIOTICS FOR PID. GONHORRHEA AND CHLAMYDIA ARE MAIN CAUSES OF PID. SO IF DON’T TREAT THIS> INCREASED RISK OF ___ BY 15-20%, AND INCREASES RISK OF __ __ 15-25% AND INCREASES RISK OF ___ __ __ 15-25%. |
|
Definition
- bilateral abdominal pain
- cervical motion tenderness
- adnexal tenderness
- infertility
- ectopic pregnancy
- chronic pelvic pain |
|
|
Term
| Who should be screened for gonorrhea and chlamydia? |
|
Definition
| All sexually active women under the age of 25 y/o and all women over 25 with multiple sex partners |
|
|
Term
| Pt may have PID but negative cervical culture for G &C. This is bc can have infected tubes but not on cervix. |
|
Definition
|
|
Term
| When are PID symptoms most likely to occur: |
|
Definition
| - end of menses and first 10 days after cycle |
|
|
Term
PID is a clinical dx. So treat if lower abdominal tenderness, adexal tenderness, or CMT and no other explainable reason. But here are some tests to aid in dx:
Pregnancy test
Differential diagnosis of ectopic pregnancy
Urinalysis
Exclude cystitis or pyelonephritis
WBC count
Fewer than 50% of women with PID have an WBC >10,000
An elevated WBC is NOT a CDC criteria for diagnosing PID
Erythrocyte sedimentation rate (ESR)
Other diagnoses may elevate ESR
C-Reactive protein
Gonorrhea and chlamydia cultures |
|
Definition
|
|
Term
| Transvaginal u/s findings in acute PID (not routinely done, but helpful to differentiate b/w tubo-ovarian abscess): |
|
Definition
- tubal wall thickening
- incomplete septa in tube
- fluid in cul de sac |
|
|
Term
| Oral tmt for mild-moderate PID: |
|
Definition
- Ofloxacin 400 mg po bid x 14 days, with or without Metrondizazole (Flagyl) 500 mg po bid x 14 days
OR
Levofloxacin (Levaquin) 500 mg po qd x 14 days |
|
|
Term
| IM and oral dosing for PID: |
|
Definition
- Ceftriaxone 250 mg IM single dose + Doxycycline 100 mg bid x 14 days, with or without Metronidazole 500 mg bid x 14 days
OR
Cefoxitin 2 gm IM single dose+ Probonecid 1 gm po single dose + Doxycycline 100 mg po bid x 14 days, with or without Metronidazole 500 mg bid x 14 days
if not better in 72 hrs> admit to hospital
all women with PID should be offered HIV testing |
|
|
Term
| Criteria for hospital admission with PID: |
|
Definition
- pregnancy
- surgical emergencies (appendicitis) cannot be excluded
- no response to oral abx
- cannot follow outpt directions
- severe illness
- tubo-ovarian abscess present |
|
|
Term
| Parenteral abx for tmt of PID: |
|
Definition
- Cefoxitin or Cefotetan 2 gm IV q6hr + Doxycycline 100 mg po/IV q12hrs
OR
- Clindamycin 900 mg IV q8hr + Gentamycin
OR
- Ampicillin and sulbactam (Unasyn) 3 gm IV q6hr + Doxycyclin 100 mg po/IV q12h |
|
|
Term
| Parenteral therapy for PID can be d/c 24hrs after clinical improvement, then continue the following meds: |
|
Definition
- Doxycycline 100 mg bid x 14 days
- Clindamycin 450 mg 4 times a day x 14 days |
|
|
Term
| You have a pt with PID. What should you do about her sexual contacts? |
|
Definition
| Document and make an attempt to contact her sexual partners from the past 60 days, if do not attempt or document this> lawsuite materal |
|
|
Term
Barrier contraceptives (e.g. diaphragms with spermicidal agents) and oral contraceptives are thought to reduce the risk of developing PID.
Intrauterine devices predispose patients to PID |
|
Definition
|
|
Term
| Before you dx PID make sure you have ruled out everything else (i.e. pregnancy). Also make sure you test for syphilis and offer HIV testing. |
|
Definition
|
|
Term
| Indurated nodules in the cul de sac on the uterosacral ligament: |
|
Definition
| Classic sign of Endometriosis |
|
|
Term
|
Definition
Limited to reproductive years
More frequent in white population
More frequent in nulliparous patients
Pain more prominent during menses
All sites of endometriosis symptomatic during menses |
|
|
Term
| With endometriosis there is NO relationship b/w severity of symptoms and severity of disease. |
|
Definition
|
|
Term
| Endometriosis medical treatment: |
|
Definition
GnRh – agonist
Temporary medical castration producing a marked but temporary regression of endometriosis
Danazol
Androgenic derivative used as a “pseudomenopause” regimen to suppress pain
40% recurrence rate
Oral contraceptives
Oral progesterone
Levonorgestrol –releasing IUD reduces dysmenorrhea
Get rid of endometriosis the same way you get rid of fibroids: get rid of estrogen make them menopausal, create an anti-estrogenic atmosphere by giving GnRH agonist: stop bleeding and pain but increase risk of osteoporosis. For every injection you give, reduce bone density by 1%, so no more than 3-6 months. So jusst use this for severe symptoms for short period of time> then birth control pills or progesterone |
|
|
Term
| Surgical tmt endometriosis: |
|
Definition
Desire for future fertility
Laparoscopic or open surgery designed to destroy endometriotic implants and remove all adhesive disease
Most comprehensive surgery includes abdominal hysterectomy, bilateral salpingo-oophorectomy with destruction of peritoneal implants and dissection of all adhesions.
Large endometriomas (>3cm) are amenable only to surgical resection |
|
|
Term
Sudden acute pain in RLQ: probably not rupture b/c rupture pain would be in all 4 quadrants.
Acute sudden pain: cut off blood supply to any organ
Pelvic mass and intermittent pain> think torsion |
|
Definition
|
|
Term
| Ureteral calculus lab data: |
|
Definition
Urinalysis
RBC’s
Occasion WBC
Albumin
Crystals
Abdominal Plain Films
Radio opaque stones seen often (80%)
CT Scan
Shows filling defect (80%)
IVP
Shows filling defect (80%) |
|
|
Term
| criteria for dx appendicitis: |
|
Definition
- dull periumbilical pain> RLQ
- N/V
- WBC 12-15,000
- Temp 99-100F |
|
|
