Cervical Abnormalities

Question 1

What is Cervicitis?

Answer 1

Inflammation of the uterine cervix

Question 2

What are common causes of Cervicitis?

Answer 2

Infection: gonorrhea and chlamydia are common

Question 3

How can Cervicitis present?

Answer 3

mucopurulent vaginal discharge, dyspareunia or postcoital bleeding

However; most cases of Gonorrhea and Chlamydia are asymptomatic

Question 4

How do you treat Cervicitis caused by Chlamydia?

Answer 4

Doxycycline

Question 5

How do you treat Cervicitis caused by Gonorrhea?

Answer 5

Single dose of Ceftriaxone

Question 6

What is Lymphogranuloma Venereum (LGV)?

Answer 6

genital ulcer disease caused by L1-L3 serovars of Chlamydia trachomatis

Question 7

How is primary Lympogranuloma Venereum (LGV) characterized?

Answer 7

Small genital ulcers or mucosal inflammatory reaction

Question 8

What are Buboes in LGV?

Answer 8

Unilateral painful inguinal nodes that develop with initial infection

Question 9

What is a late disease feature of LGV?

Answer 9

Genital Elephantiasis

Question 10

How do you treat LGV?

Answer 10

Doxycycline

Question 11

What is Pelvic Inflammatory Disease?

Answer 11

Acute infection of the upper genital tract including: Uterus, Fallopian tubes and/or ovaries

Question 12

What are common clinical findings in PID?

Answer 12

Pelvic or lower abdominal pain, cervical motion tenderness with chandelier sign, signs of infection

Question 13

What are potential long-term complications of PID?

Answer 13

Infertility, ectopic pregnancy and chronic pelvic pain

Question 14

What is the Chandelier Sign in PID?

Answer 14

Pelvic exam elicits pain: causes the patient to reach up toward the ceiling for relief

Question 15

How do you treat PID in an outpatient setting?

Answer 15

Ceftriaxone + Doxycycline + Metronidazole

Question 16

How do you treat PID in an inpatient setting?

Answer 16

Cefoxitin or Cefotetan + Doxycycline

Question 17

What are indications to Treat PID in an Inpatient setting?

Answer 17

pregnancy, failure of outpatient therapy or nonadherence, inability to tolerate oral mediation, severe complications or presence of TOA

Question 18

How do you treat PID in an inpatient setting if the patient has a penicillin allergy?

Answer 18

Gentamicin and Clindamycin

Question 19

What is a Tubo-Ovarian Abscess (TOA)?

Answer 19

Complication of PID

Question 20

How does TOA present?

Answer 20

Cervical motion tenderness, acute lower abdominal pain, fever and chills

Question 21

When should you suspect a ruptured TOA?

Answer 21

Patient has hypotension, tachycardia, tachypnea and acute peritoneal signs

Question 22

What are acute peritoneal signs?

Answer 22

Abdominal tenderness, rebound, rigidity, guarding

Question 23

What is the best initial imaging to diagnose TOA?

Answer 23

Transvaginal US showing a complex, multilocular mass

Question 24

What is the preferred imaging to diagnose TOA if bowel pathology must be excluded?

Answer 24

CT scan: showing a thick-walled rim-enhancing adnexal mass

Question 25

How do you treat TOA?

Answer 25

Inpatient IV abx: Cefoxitin and Doxycline (clindamycin/Gentamicin if penicillin allergy)

Question 26

If TOA does not improve with Abx alone in 48-72 hours or the abscess is large >9cm what do you do?

Answer 26

Image-guided percutaneous drainage

Question 27

What is Fitz-Hugh Curtis Syndrome?

Answer 27

Perihepatitis from inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ in a patient with acute PID

Question 28

Wha patients should you suspect Fitz-Hugh Curtis Syndrome in?

Answer 28

RUQ pain referred to the right should and worse with inspiration with normal or slightly elevated LFT

Question 29

What is seen on Laparoscopy in Fitz-Hugh Curtis Syndrome?

Answer 29

Fibrinous Exudates ("Violin-string' adhesions) which spare the liver parenchyma