PELVIC INFLAMMATORY DISEASE (PID)
This presentation is prepared as a case based discussion.
References include American Academy of Family Physicians AAFP
I WOULD LIKE TO DEDICATE SPECIAL THANKS TO
DR ALI AL KHALAF FOR REVISING THIS MATERIAL
This document discusses cervical cancer screening. It begins with the epidemiology of cervical cancer, noting it is the 3rd most common gynecologic cancer in the US but 2nd most common in countries without screening. Risk factors include early sexual activity, multiple partners, HPV infection, and low socioeconomic status. Screening with Pap tests has reduced cervical cancer rates by 70% in the US. The document then discusses screening guidelines, techniques for Pap tests, interpreting results, HPV vaccination, and screening special populations like immunocompromised women.
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
Evidence Based Guide of Screening for Prevention of Cervical Cancer Lifecare Centre
This document discusses cervical cancer prevention in India. It notes that India accounts for about 23-25% of new cervical cancer cases and deaths worldwide despite having only about 16% of the world's female population. Human papillomavirus (HPV) infection, especially types 16 and 18, is responsible for nearly all cervical cancer cases. The document recommends primary prevention through HPV vaccination and secondary prevention via cervical cancer screening to detect and treat precancerous lesions. However, it notes that current cervical cancer screening coverage in India is very low at only about 2.6% of the female population, highlighting the need to scale up screening efforts.
Screening for premalignant cervical lesions in Egypt is important given the high incidence of cervical cancer. Visual inspection with acetic acid (VIA) is recommended for screening in developing countries due to its low cost, simplicity, and ability to provide immediate results and treatment. Mansoura University experience found VIA to be a sensitive screening method, detecting cervical lesions. While a positive VIA does not always indicate cancer, it allows for low-cost screening and identification of suspicious lesions requiring further evaluation or treatment.
This document discusses pre-cancerous lesions of the cervix. It begins by defining premalignant lesions and explaining the multi-step process of carcinogenesis. It then discusses specific pre-cancerous lesions including hyperplasia, metaplasia, dysplasia, and cervical intraepithelial neoplasia (CIN). High-risk HPV infection plays a key role in the development of these lesions. Screening methods like the Pap test and HPV testing can detect pre-cancerous lesions early. Colposcopy is used to examine the cervix in more detail when abnormalities are found. Biopsies of suspicious lesions allow diagnosis and treatment if needed to prevent progression to invasive cancer.
Cervical cancer begins in the cells of the cervix and is caused by human papillomavirus (HPV) infection in most cases. Regular cervical screening can detect pre-cancerous changes that may develop into cancer if left untreated. Early stage cervical cancer is often treated with surgery to remove the tumor while more advanced stages may require a combination of surgery, radiation therapy, and chemotherapy. The document discusses risk factors, symptoms, screening, diagnosis, staging, and treatment options for cervical cancer in detail.
(I) The document discusses various types of ovarian tumours including functional cysts, inflammatory cysts, and benign and malignant neoplastic tumours.
(II) Functional cysts include follicular cysts, corpus luteal cysts, and theca lutein cysts which are usually asymptomatic and resolve on their own. Inflammatory cysts include tubo-ovarian abscesses.
(III) Benign neoplastic tumours discussed are serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, thecoma, and Brenner's tumour. Malignant transformations are possible in some tumour types.
Vulvar cancer accounts for about 5% of cancers of the female genital system in the US. Possible signs include bleeding, itching, lumps or growths on the vulva, skin color changes, or ulcers. Risk factors include HPV infection, smoking, and precancerous skin conditions. Treatment depends on stage but may involve surgery to remove the tumor and nearby lymph nodes, radiation therapy, or chemoradiation. Side effects can include skin irritation in the vulvar area, as well as urinary and bowel issues. Overall survival rates vary from over 80% for local stage to under 20% for distant stage disease.
This document discusses cervical cancer screening. It begins with the epidemiology of cervical cancer, noting it is the 3rd most common gynecologic cancer in the US but 2nd most common in countries without screening. Risk factors include early sexual activity, multiple partners, HPV infection, and low socioeconomic status. Screening with Pap tests has reduced cervical cancer rates by 70% in the US. The document then discusses screening guidelines, techniques for Pap tests, interpreting results, HPV vaccination, and screening special populations like immunocompromised women.
The document discusses cervical histology and screening for cervical cancer. It describes the squamocolumnar junction (SCJ) and transformation zone of the cervix. The location of the SCJ changes with age due to regenerative changes. Screening guidelines from ACOG and WHO are provided regarding what ages to screen and what tests to use. Screening methods like Pap smear, HPV testing, visual inspection with acetic acid are outlined. Management of abnormal screening results including follow up testing and treatment options like cryotherapy, LEEP, and hysterectomy are summarized.
Evidence Based Guide of Screening for Prevention of Cervical Cancer Lifecare Centre
This document discusses cervical cancer prevention in India. It notes that India accounts for about 23-25% of new cervical cancer cases and deaths worldwide despite having only about 16% of the world's female population. Human papillomavirus (HPV) infection, especially types 16 and 18, is responsible for nearly all cervical cancer cases. The document recommends primary prevention through HPV vaccination and secondary prevention via cervical cancer screening to detect and treat precancerous lesions. However, it notes that current cervical cancer screening coverage in India is very low at only about 2.6% of the female population, highlighting the need to scale up screening efforts.
Screening for premalignant cervical lesions in Egypt is important given the high incidence of cervical cancer. Visual inspection with acetic acid (VIA) is recommended for screening in developing countries due to its low cost, simplicity, and ability to provide immediate results and treatment. Mansoura University experience found VIA to be a sensitive screening method, detecting cervical lesions. While a positive VIA does not always indicate cancer, it allows for low-cost screening and identification of suspicious lesions requiring further evaluation or treatment.
This document discusses pre-cancerous lesions of the cervix. It begins by defining premalignant lesions and explaining the multi-step process of carcinogenesis. It then discusses specific pre-cancerous lesions including hyperplasia, metaplasia, dysplasia, and cervical intraepithelial neoplasia (CIN). High-risk HPV infection plays a key role in the development of these lesions. Screening methods like the Pap test and HPV testing can detect pre-cancerous lesions early. Colposcopy is used to examine the cervix in more detail when abnormalities are found. Biopsies of suspicious lesions allow diagnosis and treatment if needed to prevent progression to invasive cancer.
Cervical cancer begins in the cells of the cervix and is caused by human papillomavirus (HPV) infection in most cases. Regular cervical screening can detect pre-cancerous changes that may develop into cancer if left untreated. Early stage cervical cancer is often treated with surgery to remove the tumor while more advanced stages may require a combination of surgery, radiation therapy, and chemotherapy. The document discusses risk factors, symptoms, screening, diagnosis, staging, and treatment options for cervical cancer in detail.
(I) The document discusses various types of ovarian tumours including functional cysts, inflammatory cysts, and benign and malignant neoplastic tumours.
(II) Functional cysts include follicular cysts, corpus luteal cysts, and theca lutein cysts which are usually asymptomatic and resolve on their own. Inflammatory cysts include tubo-ovarian abscesses.
(III) Benign neoplastic tumours discussed are serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, thecoma, and Brenner's tumour. Malignant transformations are possible in some tumour types.
Vulvar cancer accounts for about 5% of cancers of the female genital system in the US. Possible signs include bleeding, itching, lumps or growths on the vulva, skin color changes, or ulcers. Risk factors include HPV infection, smoking, and precancerous skin conditions. Treatment depends on stage but may involve surgery to remove the tumor and nearby lymph nodes, radiation therapy, or chemoradiation. Side effects can include skin irritation in the vulvar area, as well as urinary and bowel issues. Overall survival rates vary from over 80% for local stage to under 20% for distant stage disease.
This document provides information on Pelvic Inflammatory Disease (PID), including its definition, epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, and staging. PID is defined as an inflammatory process involving the upper female genital tract, including the endometrium, fallopian tubes, ovaries, and pelvic peritoneum. Sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes. Clinical presentation can vary from asymptomatic to severe symptoms like pelvic pain and fever. Diagnosis is based on patient history, physical exam findings, and ruling out other potential causes through tests and imaging. Untreated PID can lead
This 3-page document presents information about preterm labor from several students in the 4th course, 8th semester at Ivane Javakhishvili Tbilisi State University. It defines preterm labor as regular contractions before 37 weeks of pregnancy that result in cervical changes. The main risks of preterm birth are serious health problems in babies that are not fully developed. Treatments discussed include cerclage sutures to stitch the cervix closed, corticosteroids to speed lung maturity, magnesium sulfate to reduce brain damage risk, and tocolytics to temporarily stop contractions.
The document discusses the Pap smear screening test for cervical cancer. It describes how Pap smears have reduced cervical cancer incidence by 80% and mortality by 70% by allowing for treatment of pre-cancerous lesions. Screening should begin within 3 years of becoming sexually active and can typically decrease in frequency to every 2-3 years after 3 normal annual tests. Screening may stop at age 70 after recent negative tests or hysterectomy. The document outlines the anatomy of the cervix and squamo-columnar junction, techniques for Pap smear collection, abnormal findings, screening guidelines, and accuracy of Pap smears.
Cervical intraepithelial neoplasia (CIN) refers to pre-cancerous changes that occur in the cells of the cervix. CIN is classified into three grades (CIN 1-3) based on how deep the abnormal cells are in the cervix. Human papillomavirus infection is the main cause of CIN. Screening through Pap tests and HPV testing can detect CIN early. Diagnosis involves colposcopy and biopsy of abnormal areas. Treatment options depend on the grade of CIN and include cryotherapy, loop electrosurgical excision, and conization. Leaving low-grade CIN untreated may allow spontaneous regression.
Cervical cancer develops slowly over time from pre-cancerous changes caused by HPV infection. Screening allows these changes to be detected early before cancer develops. The document outlines the history and timeline of cervical cancer, how it spreads, prevention strategies including vaccination and screening guidelines. Screening involves Pap and HPV testing to find abnormal cells, with testing frequency depending on age. Screening can typically stop after age 65 if a woman has a low risk history.
The document discusses the cervix and cervical intraepithelial neoplasia (CIN). Some key points:
1) The cervix contains two types of epithelium that meet at the squamocolumnar junction (SCJ), which shifts locations throughout life. The transformation zone (TZ) is the area at risk for developing pre-cancerous and cancerous lesions.
2) CIN is characterized by abnormal cell growth in the cervix and is graded from I to III based on severity. Left untreated, some CIN lesions can progress to cervical cancer over many years.
3) Human papillomavirus (HPV) infection is required for cervical cancer but most infections clear on
The document discusses cervical cancer screening and treatment methods. It covers:
1. Premalignant stages of cervical cancer including cervical intraepithelial neoplasia grades 1-3 (CIN 1-3).
2. Screening methods for developing countries including visual inspection with acetic acid (VIA) and HPV testing, which are effective and affordable options.
3. Treatment of precancerous lesions generally involves cryotherapy, cold coagulation, or loop electrosurgical excision procedure (LEEP) depending on the severity, with a "see and treat" single visit approach recommended.
This document provides guidance on prenatal screening tests and what they can detect. It discusses the principles of screening and outlines various first and second trimester screening options for detecting chromosomal abnormalities, structural defects, and conditions like preeclampsia. Diagnostic tests mentioned include karyotyping, FISH, QF-PCR, microarrays, and their abilities to identify abnormalities like trisomies, deletions, and duplications. Low-dose aspirin is noted as an intervention for preeclampsia in high-risk patients.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
The document describes the anatomy of the pelvic floor, urogenital diaphragm, and perineum. It discusses the levator ani muscles that form the pelvic floor and their functions in supporting pelvic organs and assisting in childbirth. It describes the urogenital diaphragm deep to the pelvic floor and the perineal spaces and triangles below. The document then discusses perineal tears that can occur during childbirth, their degrees of severity, symptoms, repair techniques, and complications if left untreated.
The new pap guidelines recommend the following key changes:
1. The first pap smear should be at age 21 instead of younger teenagers, as pap smears before this age often led to unnecessary treatment.
2. For women in their 20s with normal immune systems and no previous abnormal pap results, pap smears can now be done every 2 years instead of annually.
3. For women in their 30s meeting the same criteria, pap smears can now be done every 3 years instead of annually.
The guidelines were updated based on new technologies for examining cervical cells and a better understanding of HPV and its latency period. The aim is to reduce overtreatment while still effectively screening for cervical cancer.
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
This document discusses abnormal uterine bleeding (AUB) or menorrhagia in puberty. It lists various potential causes of AUB including anovulation, polyps, adenomyosis, leiomyoma, and bleeding disorders. Anovulation due to an immature hypothalamic-pituitary-ovarian axis is the most common cause. The document provides guidelines on evaluating AUB, including taking a detailed history, physical exam, lab tests, and ultrasound. Differential diagnoses are discussed. Bleeding disorders are more commonly platelet dysfunction disorders in Southeast Asia, unlike the West where Von Willebrand disease is more common.
This document provides information on managing abnormal Pap smear results according to the Bethesda system. It discusses the categories of Pap smear results including within normal limits, benign cellular changes, and epithelial cell abnormalities. It describes what constitutes an adequate versus inadequate sample. Abnormal results can be due to issues with the sample, inflammation, infection, or dysplastic changes. Management depends on the specific result and may include treating any infections, repeating the Pap smear, or proceeding to colposcopy and/or biopsy. The document outlines recommendations for various abnormal results including low grade and high grade squamous intraepithelial lesions, atypical squamous cells, glandular abnormalities and more.
Cervical cancer is a major health problem worldwide, especially in developing countries like Egypt where it is the second most common cancer in women. Screening is important for early detection and treatment of pre-cancerous lesions to prevent the development of invasive cancer. The document discusses various screening methods for cervical cancer including cytology-based tests like Pap smears and HPV testing as well as visual inspection methods. It also reviews the prevalence of pre-cancerous lesions in Egypt and limitations of screening in low resource settings.
This document provides information on ectopic pregnancy, including its definition, types, risk factors, diagnosis, and management. Some key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It can seriously endanger a woman's health if not promptly recognized and treated.
- Risk factors include previous pelvic inflammatory disease, previous ectopic pregnancy, infertility, and certain contraceptive methods. Diagnosis involves clinical history, examination, ultrasound, and beta-hCG levels.
- Management options depend on the clinical situation and include expectant management for stable patients, medical management using methotrexate, and surgical management including laparoscopy
A 28-year-old woman presents with a missed abortion. The document discusses medical management as an option for miscarriage. It outlines protocols for using misoprostol alone or with mifepristone for first and second trimester miscarriages. Vaginal administration of misoprostol is most effective. Outpatient medical management is possible but women should have access to support. Contraindications include suspected ectopic pregnancy or medical conditions. The document concludes that medical management is a safe and effective alternative to surgery for miscarriage.
This document provides information about placental pathology. It describes the structure, development, functions and examination of the placenta. It discusses various anomalies and non-neoplastic lesions seen in placenta such as twin pregnancy, succenturiate lobes, membranacea and infarcts. It also covers tumors and tumor-like conditions including chorioangioma and gestational trophoblastic disease. Complete hydatidiform mole is described as a condition caused by abnormal gametogenesis resulting in trophoblastic hyperplasia and cistern formation.
This was a joint lecture for the Chong Hua Hospital Postgraduate Course by OB-infectious disease specialist Dr Helen Madamba and IM-infectious disease specialist Dr Mitzi Chua.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and surrounding pelvic structures. It is usually caused by sexually transmitted pathogens ascending from the cervix, such as Chlamydia trachomatis or Neisseria gonorrhoeae. Symptoms can include pelvic pain and abnormal vaginal discharge. Treatment involves antibiotics to eliminate the infection.
This document provides information on Pelvic Inflammatory Disease (PID), including its definition, epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, and staging. PID is defined as an inflammatory process involving the upper female genital tract, including the endometrium, fallopian tubes, ovaries, and pelvic peritoneum. Sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes. Clinical presentation can vary from asymptomatic to severe symptoms like pelvic pain and fever. Diagnosis is based on patient history, physical exam findings, and ruling out other potential causes through tests and imaging. Untreated PID can lead
This 3-page document presents information about preterm labor from several students in the 4th course, 8th semester at Ivane Javakhishvili Tbilisi State University. It defines preterm labor as regular contractions before 37 weeks of pregnancy that result in cervical changes. The main risks of preterm birth are serious health problems in babies that are not fully developed. Treatments discussed include cerclage sutures to stitch the cervix closed, corticosteroids to speed lung maturity, magnesium sulfate to reduce brain damage risk, and tocolytics to temporarily stop contractions.
The document discusses the Pap smear screening test for cervical cancer. It describes how Pap smears have reduced cervical cancer incidence by 80% and mortality by 70% by allowing for treatment of pre-cancerous lesions. Screening should begin within 3 years of becoming sexually active and can typically decrease in frequency to every 2-3 years after 3 normal annual tests. Screening may stop at age 70 after recent negative tests or hysterectomy. The document outlines the anatomy of the cervix and squamo-columnar junction, techniques for Pap smear collection, abnormal findings, screening guidelines, and accuracy of Pap smears.
Cervical intraepithelial neoplasia (CIN) refers to pre-cancerous changes that occur in the cells of the cervix. CIN is classified into three grades (CIN 1-3) based on how deep the abnormal cells are in the cervix. Human papillomavirus infection is the main cause of CIN. Screening through Pap tests and HPV testing can detect CIN early. Diagnosis involves colposcopy and biopsy of abnormal areas. Treatment options depend on the grade of CIN and include cryotherapy, loop electrosurgical excision, and conization. Leaving low-grade CIN untreated may allow spontaneous regression.
Cervical cancer develops slowly over time from pre-cancerous changes caused by HPV infection. Screening allows these changes to be detected early before cancer develops. The document outlines the history and timeline of cervical cancer, how it spreads, prevention strategies including vaccination and screening guidelines. Screening involves Pap and HPV testing to find abnormal cells, with testing frequency depending on age. Screening can typically stop after age 65 if a woman has a low risk history.
The document discusses the cervix and cervical intraepithelial neoplasia (CIN). Some key points:
1) The cervix contains two types of epithelium that meet at the squamocolumnar junction (SCJ), which shifts locations throughout life. The transformation zone (TZ) is the area at risk for developing pre-cancerous and cancerous lesions.
2) CIN is characterized by abnormal cell growth in the cervix and is graded from I to III based on severity. Left untreated, some CIN lesions can progress to cervical cancer over many years.
3) Human papillomavirus (HPV) infection is required for cervical cancer but most infections clear on
The document discusses cervical cancer screening and treatment methods. It covers:
1. Premalignant stages of cervical cancer including cervical intraepithelial neoplasia grades 1-3 (CIN 1-3).
2. Screening methods for developing countries including visual inspection with acetic acid (VIA) and HPV testing, which are effective and affordable options.
3. Treatment of precancerous lesions generally involves cryotherapy, cold coagulation, or loop electrosurgical excision procedure (LEEP) depending on the severity, with a "see and treat" single visit approach recommended.
This document provides guidance on prenatal screening tests and what they can detect. It discusses the principles of screening and outlines various first and second trimester screening options for detecting chromosomal abnormalities, structural defects, and conditions like preeclampsia. Diagnostic tests mentioned include karyotyping, FISH, QF-PCR, microarrays, and their abilities to identify abnormalities like trisomies, deletions, and duplications. Low-dose aspirin is noted as an intervention for preeclampsia in high-risk patients.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
The document describes the anatomy of the pelvic floor, urogenital diaphragm, and perineum. It discusses the levator ani muscles that form the pelvic floor and their functions in supporting pelvic organs and assisting in childbirth. It describes the urogenital diaphragm deep to the pelvic floor and the perineal spaces and triangles below. The document then discusses perineal tears that can occur during childbirth, their degrees of severity, symptoms, repair techniques, and complications if left untreated.
The new pap guidelines recommend the following key changes:
1. The first pap smear should be at age 21 instead of younger teenagers, as pap smears before this age often led to unnecessary treatment.
2. For women in their 20s with normal immune systems and no previous abnormal pap results, pap smears can now be done every 2 years instead of annually.
3. For women in their 30s meeting the same criteria, pap smears can now be done every 3 years instead of annually.
The guidelines were updated based on new technologies for examining cervical cells and a better understanding of HPV and its latency period. The aim is to reduce overtreatment while still effectively screening for cervical cancer.
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
This document discusses abnormal uterine bleeding (AUB) or menorrhagia in puberty. It lists various potential causes of AUB including anovulation, polyps, adenomyosis, leiomyoma, and bleeding disorders. Anovulation due to an immature hypothalamic-pituitary-ovarian axis is the most common cause. The document provides guidelines on evaluating AUB, including taking a detailed history, physical exam, lab tests, and ultrasound. Differential diagnoses are discussed. Bleeding disorders are more commonly platelet dysfunction disorders in Southeast Asia, unlike the West where Von Willebrand disease is more common.
This document provides information on managing abnormal Pap smear results according to the Bethesda system. It discusses the categories of Pap smear results including within normal limits, benign cellular changes, and epithelial cell abnormalities. It describes what constitutes an adequate versus inadequate sample. Abnormal results can be due to issues with the sample, inflammation, infection, or dysplastic changes. Management depends on the specific result and may include treating any infections, repeating the Pap smear, or proceeding to colposcopy and/or biopsy. The document outlines recommendations for various abnormal results including low grade and high grade squamous intraepithelial lesions, atypical squamous cells, glandular abnormalities and more.
Cervical cancer is a major health problem worldwide, especially in developing countries like Egypt where it is the second most common cancer in women. Screening is important for early detection and treatment of pre-cancerous lesions to prevent the development of invasive cancer. The document discusses various screening methods for cervical cancer including cytology-based tests like Pap smears and HPV testing as well as visual inspection methods. It also reviews the prevalence of pre-cancerous lesions in Egypt and limitations of screening in low resource settings.
This document provides information on ectopic pregnancy, including its definition, types, risk factors, diagnosis, and management. Some key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It can seriously endanger a woman's health if not promptly recognized and treated.
- Risk factors include previous pelvic inflammatory disease, previous ectopic pregnancy, infertility, and certain contraceptive methods. Diagnosis involves clinical history, examination, ultrasound, and beta-hCG levels.
- Management options depend on the clinical situation and include expectant management for stable patients, medical management using methotrexate, and surgical management including laparoscopy
A 28-year-old woman presents with a missed abortion. The document discusses medical management as an option for miscarriage. It outlines protocols for using misoprostol alone or with mifepristone for first and second trimester miscarriages. Vaginal administration of misoprostol is most effective. Outpatient medical management is possible but women should have access to support. Contraindications include suspected ectopic pregnancy or medical conditions. The document concludes that medical management is a safe and effective alternative to surgery for miscarriage.
This document provides information about placental pathology. It describes the structure, development, functions and examination of the placenta. It discusses various anomalies and non-neoplastic lesions seen in placenta such as twin pregnancy, succenturiate lobes, membranacea and infarcts. It also covers tumors and tumor-like conditions including chorioangioma and gestational trophoblastic disease. Complete hydatidiform mole is described as a condition caused by abnormal gametogenesis resulting in trophoblastic hyperplasia and cistern formation.
This was a joint lecture for the Chong Hua Hospital Postgraduate Course by OB-infectious disease specialist Dr Helen Madamba and IM-infectious disease specialist Dr Mitzi Chua.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and surrounding pelvic structures. It is usually caused by sexually transmitted pathogens ascending from the cervix, such as Chlamydia trachomatis or Neisseria gonorrhoeae. Symptoms can include pelvic pain and abnormal vaginal discharge. Treatment involves antibiotics to eliminate the infection.
R2 management of menstrual disordersllAmir Mahmoud
This patient is a 26-year-old woman who presents with secondary amenorrhea, having not had her period for 9 months. She has a history of normal menstrual cycles after giving birth and breastfeeding her two children. On examination, she appears tired but otherwise normal. Her prolactin level was initially elevated but normalized with fasting. The differential diagnoses for her secondary amenorrhea include pregnancy, hypothalamic-pituitary dysfunction, and ovarian dysfunction. Additional testing is needed to determine the cause.
Notes on clinical predictions to distinguish pelvic inflammatory diseaseTana Kiak
Diagnosis of lower abdominal pain in women can be difficult to distinguish between appendicitis and pelvic inflammatory disease (PID) as they often present similarly. This document outlines clinical predictors that may help differentiate the two conditions. It notes that up to 33% of appendicitis cases in women of childbearing age are misdiagnosed, with PID and STIs being the most common misdiagnoses. Delayed treatment of either condition can result in severe consequences. The document then describes symptoms of each condition and lists clinical features more commonly associated with appendicitis or PID to aid in diagnosis.
Pelvic Inflammatory Disease (PID) is an inflammation of the female genital tract that is usually caused by bacterial infections such as Chlamydia trachomatis and Neisseria gonorrhoeae spreading from the vagina or cervix. Left untreated, PID can cause serious complications like infertility, ectopic pregnancy, and chronic pelvic pain. Treatment involves antibiotics to eradicate the infection as well as managing symptoms. Prevention focuses on screening and treatment of sexually transmitted infections, particularly among young sexually active women.
This patient presented with retained placenta after a vaginal delivery. Her ultrasound and MRI showed placenta increta, where placental villi had invaded into the myometrium. She was initially managed conservatively with methotrexate injection, which led to a partial reduction in her beta-hCG levels. However, she later developed heavy bleeding and required an emergency hysterectomy. Placenta accreta spectrum (PAS) describes abnormal placental invasion that can cause life-threatening bleeding. Risk factors include prior uterine surgery. Management challenges include delayed referrals, lack of blood product availability, and counseling patients on prolonged hospitalization sometimes required.
This document provides information on antenatal care. It discusses the aims of antenatal care including promoting health, detecting complications, providing education and support. It describes the components of antenatal care visits including medical history, examinations, investigations, and advice provided at each visit. The document outlines the schedule of typical antenatal visits and care provided, including monitoring of vital signs, testing, and growth assessments. Complications are also addressed through specialized antenatal clinics.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that can cause long-term complications like infertility and ectopic pregnancy. Common causes are sexually transmitted bacteria like Chlamydia and gonorrhea. Diagnosis involves examining for cervical tenderness and confirming with tests like endometrial biopsy or laparoscopy. Treatment aims to eliminate the infections with antibiotics and prevent complications through follow up testing and partner treatment. Long term risks counseling is important due to potential issues like chronic pelvic pain.
This document summarizes spontaneous and recurrent abortion, including etiology, diagnosis, and treatment. It discusses risk factors like maternal age and chromosomal abnormalities. Diagnosis involves history, exam, ultrasound, and hCG levels. Treatment depends on severity but may include manual vacuum aspiration, medications, or expectant management. It also covers ectopic pregnancy, noting risk factors and clinical signs like abdominal pain and bleeding. Diagnosis involves ultrasound and hCG levels. Treatment is typically surgical or medical with methotrexate depending on stability and hCG levels.
An Obstetrics and gynecology presentation: A 20 years old single female undergraduate presents to the emergency unit with fever, lower abdominal pain and abnormal vaginal discharge of 5 days duration. Discuss her management
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This patient is a 30-year-old female who presented with vaginal spotting during her first trimester of pregnancy. An ultrasound was ordered which did not show an intrauterine or ectopic pregnancy. The patient's beta-hCG level was measured at 1056. At follow-up two days later, the patient's symptoms had resolved but her beta-hCG had risen to 1465. A repeat ultrasound now showed a right tubal ectopic pregnancy, so the patient underwent a laparoscopic right salpingectomy to remove the ectopic pregnancy from her fallopian tube.
Patient Information Please see attachment for Rubrics and Soap T.docxssuser562afc1
Patient Information
Please see attachment for Rubrics and Soap Template
Family Medicine 27: 17-year-old male with groin pain
User:
Beatriz Duque
Email:
[email protected]
Date:
September 5, 2020 11:01PM
Learning Objectives
The student should be able to:
Elicit focused history of patients presenting with scrotal pain.
Demonstrate the ability to perform proficient testicular examination and to elicit signs specific to identify or exclude testicular torsion.
Develop a differential diagnosis for adolescent male presenting with scrotal pain.
Identify appropriate laboratory and radiological studies as it relates to the differential diagnosis of scrotal pain. Outline the algorithmic approach to testicular pain.
Discuss management of testicular torsion.
Recognize sexually transmitted infections as a cause of testicular pain among adolescent males.
Discuss the importance of counseling to prevent sexually transmitted infections.
Discuss epidemiology and USPSTF recommendations for screening for common testicular cancers.
Knowledge
Important Features of the History for a Patient in Pain
The following acronym can be helpful:
LAQ CODIERS:
L
ocation
A
ssociated symptoms
Q
uality
C
haracter
O
nset
D
uration
I
ntensity
E
xacerbating factors
R
elieving factors other
S
ymptoms
HEEADSSS Adolescent Interview
Home
Education / Employment
Eating
Activities
Drugs
Sexuality
Suicide / Depression Safety / Violence
Scrotal Exam Findings
Cremasteric reflex
Cremasteric reflex can be assessed by lightly stroking or pinching the superior medial aspect of the thigh. An intact cremasteric reflex causes brisk ipsilateral testicular retraction. Absence of the cremasteric reflex is a sensitive but nonspecific finding for testicular torsion. It can be absent on physical exam in normal testes. It should be assessed after inspection and before palpation of the testicles.
Blue dot sign
Tenderness limited to the upper pole of the testis suggests torsion of a testicular appendage, especially when a hard, tender nodule is palpable in this region. A small bluish discoloration known as the "blue dot sign", may be visible through the skin in the upper pole. This sign is virtually pathognomonic for appendiceal torsion when tenderness is also present.
Prehn sign
Prehn reported that physical lifting of the testicles relieves the pain caused by epididymitis but not pain caused by testicular torsion. A positive Prehn sign is pain that is relieved by lifting of the testicle; if present this can help distinguish epididymitis from testicular torsion.
Causes of Testicular Torsion
Congenital anomaly
A congenital anomaly that results in failure of normal posterior anchoring of the gubernaculum, epididymis, and testis is called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell, causing an intravaginal torsion. A large mesentery betwee.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and ovaries. It is usually caused by ascending infection with bacteria such as Neisseria gonorrhoeae and Chlamydia trachomatis that spread from the vagina or cervix. Risk factors include multiple sex partners and prior STDs. Symptoms can include lower abdominal pain and abnormal vaginal discharge. Diagnosis is based on clinical criteria and treatment involves antibiotics targeting the common causative agents. Complications may include infertility, ectopic pregnancy, and chronic pelvic pain if left untreated. Prevention focuses on screening and treatment of STDs, partner management, and education.
This document presents the case of a 21-year-old female admitted for abdominal pain. She has a history of smoking and is diagnosed with pelvic inflammatory disease (PID) based on symptoms of abdominal pain and vaginal discharge. She is treated with antibiotics and blood transfusions and shows improvement. The document also discusses PID, its causes, symptoms, diagnosis and treatment guidelines. It profiles the patient's family and their economic situation.
Antenatal care screening involves regular checkups during pregnancy to monitor the health of the mother and baby. The goals are to ensure the mother and baby's health, have a good birth outcome, identify high-risk pregnancies, and decrease mortality rates. Checkups include checking weight gain, screening for conditions like anemia, providing dietary advice, and assessing fetal well-being through ultrasounds and monitoring. Women see their provider monthly until 32 weeks, every two weeks until 36 weeks, and weekly after that until delivery.
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This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
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GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
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A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
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Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
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Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
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Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
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In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
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Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
3. Pelvic inflammatory disease (PID) is a polymicrobial infection
of the upper genital tract that primarily affects young, sexually
active women.
4.
5. 20 years old newly married female, presents with moderate lower
abdominal pain for 1 day. There is history of unusual vaginal discharge
O/E: The patient is febrile (38.4°C).
Remaining physical examination was unremarkable except for adnexal
tenderness.
1- What are the diagnostic criteria if PID is suspected?
2- What is the single clinical finding that can lead to a diagnosis of PID?
3- Is this patient at increased risk of any complications?
6. 1- What are the diagnostic criteria
if PID is suspected?
One or more of the following minimum
criteria must be present on pelvic
examination to diagnose PID:
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
7. 2- What is the single clinical finding that can lead to a diagnosis
of PID?
No single clinical finding or laboratory test is sensitive or specific
enough to definitively diagnose PID.
8. 3- Is this patient at increased risk of any complications?
20 % chance of developing infertility from tubal scarring.
9 % percent chance of having an ectopic pregnancy.
18 % chance of developing chronic pelvic pain.
9. 20 years old newly married female ,presents with moderate lower abdominal pain for 1 day.
There is history of unsual vaginal discharge and the patient is febrile (38.4°C).
Remaining physical examination was unremarkable except for adnexal tenderness
… After reviewing the previous patient history you are still suspecting
PID as a primary diagnosis and planning to initiate management with
antibiotics.
1- How would we choose between outpatient or inpatient management?
2- What are the preferred outpatient treatment options?
10. 1-How would we choose between outpatient or inpatient management?
(Suggested Criteria for Hospitalization of Patients with Pelvic Inflammatory Disease):
Inability to follow or tolerate an outpatient oral medication regimen
No clinical response to oral antimicrobial therapy
Pregnancy
Severe illness, nausea and vomiting, or high fever
Surgical emergencies (e.g., appendicitis) cannot be excluded
Tubo-ovarian abscess
11. 2- What are the preferred
outpatient treatment options ?
12. Dr.Fatemah is a 27 years old GP who presents with a 2 days history of
cramping lower abdominal pain and nausea and vomiting.
The patient had inserted an IUD last week and have been using vaginal
douching daily.
On examination she has cervical motion tenderness and a mucopurulent
discharge.
1- Would you advice her to remove or keep the IUD?
2- Would you recommend antibiotics at time of insertion to prevent a similar
condition?
3- If she is 10 weeks pregnant, how would that affect the management?
13. 1- Would you advice her to remove or keep the IUD?
Women with IUDs have an increased risk of PID only within the first
three weeks after insertion of the IUD.
There is no evidence that suggests removal of the IUD is necessary in
patients with acute PID; however, close follow-up is recommended.
Data indicate no difference in outcomes of PID in women with copper
IUDs versus the levonorgestrel-releasing intrauterine system (Mirena).
14. 2- Would you recommend antibiotics at time of insertion to
prevent a similar condition?
There are insufficient data to suggest that antibiotics should be given
to patients at the time of IUD insertion to decrease the risk of
developing infection
15. 3- If she is 10 weeks pregnant, how would that affect the
management plan?
PID is uncommon during pregnancy, although if it occurs, it is usually
within the first 12 weeks before the mucous plug can act as an
adequate barrier.
Pregnant women with suspected PID should be hospitalized and given
parenteral antibiotics.
PID during pregnancy increases the risk of preterm delivery and
increases maternal morbidity.
16. Dr Fatemah is a 27 years old GP who presents with a 2 days history of cramping lower abdominal pain and
nausea and vomiting.
The patient had inserted and IUD last week and have been using vaginal douching daily.
On examination she has Cervical motion tenderness and a mucopurulent discharge.
You decide to send C/S sample which confirms positive sensitivity to
ciprofloxacin (as an effective choice).
However Dr Fatemah argues that fluoroquinolones are not the 1st line for PID !
1- How would you counsel Dr Fatemah regarding treatment options?
2- When do you expect the clinical improvement (how many hours?)
3- Should we treat her husband?
4- Should they be advised to abstain from intercourse?
17. 1- How would you counsel Dr Fatemah regarding treatment
options?
Unless there is proven sensitivity, fluoroquinolones should not be
used in women with PID because of widespread resistance in
Neisseria gonorrhoeae;
A parenteral cephalosporin is recommended instead.
18. 2- When do you expect the clinical improvement (how many hours?)
Follow-up is important to ensure that the patient is responding to
outpatient treatment.
Clinical symptoms should improve within 72 hours of treatment, and if
not, further evaluation is advised.
Some patients may require additional testing to rule out other diagnoses,
such as a tubo-ovarian abscess, and assessment is needed for additional
antimicrobial therapy, parenteral antimicrobials, and hospitalization.
19. 3- Should we treat her husband?
Male partners of women with PID should be evaluated and treated
if they have had sexual contact within 60 days of a diagnosis of PID.
Men are often asymptomatic even when their partners are
positive for chlamydia or gonorrhea.
20. 4- Should they be advised to abstain from intercourse?
To decrease the chance of recurrence, women and their partners
should abstain from sexual intercourse until they have completed
the course of treatment.
22. Physicians must consider PID in the differential diagnosis in
women 15 to 44 years of age who present with lower
abdominal or pelvic pain and cervical motion or pelvic
tenderness, even if these symptoms are mild.
23. However, there is no single symptom, physical finding, or
laboratory test that is sensitive or specific enough to
definitively diagnose PID; clinical diagnosis alone is 87 %
sensitive and 50 % specific.
24. One or more of the following minimum criteria must be
present on pelvic examination to diagnose PID:
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
25. The following criteria can improve the specificity of the diagnosis:
Oral temperature > 101°F (> 38.3°C)
Abnormal cervical or vaginal mucopurulent discharge
Presence of abundant numbers WBCs on saline microscopy of
vaginal fluid
Elevated ESR
Elevated C-reactive protein level
Laboratory documentation of cervical infection with gonorrhea or
chlamydia
26. The following test results are the MOST SPECIFIC criteria for
diagnosing PID:
Endometrial biopsy with histopathologic evidence of
endometritis.
Transvaginal sonography or MRI showing thickened, fluid-
filled tubes with or without free pelvic fluid or tubo-ovarian
complex, or Doppler studies suggesting pelvic infection (e.g.,
tubal hyperemia).
Laparoscopic abnormalities consistent with PID.
27. Age <25 years.
Young age at first sexual encounter (younger than 15 years).
Use of non-barrier contraception, especially IUD or OCP.
New, multiple, or symptomatic sex partners.
History of PID or STD.
Recent IUD insertion.
Black women may be at higher risk of PID.
Vaginal douching also may be a risk factor.
28. Lower abdominal or pelvic pain, although it may be mild.
New or abnormal vaginal discharge,
Fever or chills,
Cramping, dyspareunia, dysuria,
and abnormal or postcoital bleeding.
Some women also may have low back pain, nausea, and
vomiting.
29. It is less common for women to have no symptoms or atypical
symptoms, such as right upper quadrant pain from perihepatitis
(i.e., Fitz-Hugh–Curtis syndrome)
30.
31. Female patient with a 2-day history of severe abdominal pain. She is a 24-year-old G1 P1
whose LMP was 1 week ago.
She is on OCP for birth control. Her pain is across her lower abdomen and a little more on
the right side than the left. She has felt feverish. She has had some nausea but no
vomiting. She denies bowel or bladder problems. Her pain is improves with
acetaminophen and worsens with activity.
On examination, she appears uncomfortable but not toxic. Her temperature is 38°C, but
the rest of her vitals are normal.
Her abdominal examination reveals decreased bowel sounds, with tenderness to palpation
primarily across the lower quadrants. She has initial guarding and no rebound tenderness.
Her pelvic examination is remarkable for cervical motion tenderness. The uterus is of
normal size and consistency with no masses.
32. Which of the following diagnoses can be absolutely excluded from your
differential at this point?
A) Ectopic pregnancy
B) Appendicitis
C) Pelvic inflammatory disease (PID)
D) Pyelonephritis
E) None of the above diagnoses should be excluded based on the
information available.
33. You obtain cultures/PCR for chlamydia and gonorrhea. The urine pregnancy test
is negative. The urinalysis is negative for nitrites and leukocytes, and the WBC is
15,600/mm3 with an increase in bands.
She reports that she’s had an appendectomy.
What is the most appropriate next step?
A) Consult surgery and gynecology to confirm your findings.
B) Admit for IV antibiotics and IV hydration.
C) Treat as an outpatient with antibiotics and schedule follow-up for 36 to 48 hours.
D) Treat with IV antibiotics on an outpatient basis utilizing visiting nurse care.
E) Obtain cultures, discharge the patient, and treat based on culture results.
34. For empiric antibiotic therapy for PID in this patient, you prescribe:
A) Amoxicillin 500 mg PO ID or 14 days.
B) Ceftriaxone 250 mg IM once PLUS azithromycin 1 g.
C) Ceftriaxone 250 mg IM once PLUS doxycycline 100 mg PO BID or 14 days.
D) A and B.
E) B and C.
35. Which of the following is NOT a potential consequence of PID?
A) Infertility
B) Chronic pelvic pain
C) Increased risk for ectopic pregnancy
D) Recurrent PID
E) None of the above
36. A 24-year-old woman is noted to have lower abdominal tenderness,
cervical motion tenderness, and a vaginal discharge. She has a low
grade fever of 100.5oC (38.0oC).
Which of the following is the best therapy for her condition?
A) Ceftriaxone intramuscularly and doxycycline orally
B) Ampicillin orally and azithromycin orally
C) Metronidazole orally as a single dose
D) Ciprofloxacin orally as a single dose
37. A 28-year-old woman with a recent new sexual partner presents
with pelvic pain, fever, vaginal discharge, and nausea with
vomiting. Examination shows a significant cervical motion
tenderness.
The most likely diagnosis is:
A) Ectopic pregnancy
B) Pyelonephritis
C) PID
D) BV
E) Yeast vaginitis
38. Which of the following physical findings would most strongly
support diagnosis of PID?
A) Courvoisier’s sign
B) Chandelier sign
C) Cullen’s sign
D) Grey-Turner’s sign
E) Positive Murphy’s sign
Cervical motion tenderness (positive Chandelier sign).
39. An 18-year-old woman presents to your office complaining of pelvic pain,
dysuria, and a purulent yellowish-green vaginal discharge. A Gram’s stain of
cervical secretions shows gram-negative diplococci.
The most appropriate medication is:
A) Ceftriaxone + azithromycin
B) Penicillin G + azithromycin
C) Cefuroxime + tetracycline
D) Cefoxitin + doxycycline
E) Metronidazole + doxycycline
For patients with a severe allergy to cephalosporins, CDC recommends a single 2-g dose of
azithromycin orally.
40. A 32-year-old woman presents to the emergency room complaining of
severe lower abdominal pain. She says she was diagnosed with pelvic
inflammatory disease by her gynecologist last month, but did not take
the medicine that she was prescribed because it made her throw up.
She has had fevers on and off for the past 2 weeks.
In the emergency room, the patient has a temperature of 38.3°C
(101°F). Her abdomen is diffusely tender, but more so in the lower
quadrants. She has diminished bowel sounds. On bimanual pelvic
examination, bilateral adnexal masses are palpated. The patient is sent
to the ultrasound department, and a transvaginal pelvic ultrasound
demonstrates bilateral tuboovarian abscesses.
41. Which of the following is the most appropriate next step in the
management of this patient?
A) Admit the patient for emergent laparoscopic drainage of the abscesses.
B) Consult interventional radiology to perform CT-guided percutaneous
drainage of the abscesses.
C) Send the patient home and arrange for intravenous antibiotics to be
administered by a home health agency.
D) Admit the patient for intravenous antibiotic therapy.
E) Admit the patient for exploratory laparotomy, TAH/BSO.