GU/GYN emergencies

Question 1

Lack of blood flow of an ovary under u/s in a patient who presents with pelvic pain should have you concerned for what?

Answer 1

ovarian torsion

Question 2

What is the most important test to order if a patient presents with ovarian cysts?

Answer 2

HCG to assess for ectopic pregnancy

Question 3

Syncope and abdominal pain in a pregnant patient is __________ until proven otherwise

Answer 3

ruptured ectopic pregnancy

Question 4

Sudden onset of unilateral pelvic pain (R>L) with associated nausea and vomiting following exercise or intercourse is consistent with what GYN emergency?

Answer 4

ovarian cysts

Question 5

What antibiotic do you give to treat pyelonephritis as an inpatient?

Answer 5

• ceftriaxone 1g IV q24hr

Question 6

What is the primary risk factor for PID?

Answer 6

being sexually active

Question 7

What HCG do you want to order for ectopic pregnancy?

Answer 7

serum HCG

• need to repeat in 2 days*
• in ectopic shouldn’t rise as fast*

Question 8

What is the gold standard and treatment for ovarian torsion?

Answer 8

laparoscopy with detorsion or oophorectomy (if indicated)

Question 9

PID is most commonly associated with what 2 pathogens?

Answer 9

• gonorrhea

- chlamydia

Question 10

Common etiologies of first trimester vaginal bleeding include these 4 things.

Answer 10

• implantation bleeding
• ectopic pregnancy
• bleeding from other source
• threatened or inevitable abortion

Question 11

How is a ruptured ovarian cyst managed? (3 points)

Answer 11

• assess hemodynamic status
• pain control with NSAIDs
• consider GYN consult if unstable or anemic

Question 12

What is the most common location of an ectopic pregnancy?

Answer 12

in the fallopian tubes

Question 13

Dysfunctional uterine bleeding in post-menopausal women should be concerning for what malignancy?

Answer 13

endometrial cancer

Question 14

If someone is stable and has an ectopic pregnancy what medical treatment do gynecologists give to abort the pregnancy?

Answer 14

methotrexate

Question 15

What sonographic finding is consistent with a ruptured ectopic pregnancy?

Answer 15

free fluid

Question 16

If a patient presents for sexual assault, you can offer evidence collection kit if assault occurred within the past ____ hours.

Answer 16

72 hours

Question 17

Why do you want to get a type and screen in a patient with first trimester bleeding?

Answer 17

to check for Rh factor and possibly administer RhoGAM if mom is Rh negative

Question 18

An ovarian mass of ___ cm or larger is a risk factor for ovarian torsion

Answer 18

5 cm or larger

Question 19

In ovarian torsion pain may be __________ as ovary can detorse/retorse

Answer 19

intermittent

Question 20

What is the sign on pelvic untrasound that demonstrates a viable intrauterine pregnancy (IUP)?

Answer 20

cardiac activity

Question 21

RUQ pain in the setting of PID should have you concerned for what diagnosis?

Answer 21

Perihepatitis (Fitz-Hugh Curtis Syndrome)

Question 22

What medication can give you a false positive nitrite test?

Answer 22

pyridium

Question 23

What antibiotic do you give to treat an uncomplicated UTI?

Answer 23

Macrobid 100mg BID for 5 days

Question 24

What distinguishes between a threatened or inevitable abortion?

Answer 24

• if the Os is closed = threatened

- if the Os is open = inevitable

Question 25

What imaging test do you want for ovarian torsion?

Answer 25

pelvic ultrasound with color doppler *but it is a clinical diagnosis and should consult gynecology ASAP*

Question 26

What is the treatment for PID? (3 antibiotics)

Answer 26

- Doxycycline 100 mg BID 14 days - Ceftriaxone 500 mg IM dose 1 time - Flagyl 500 mg TID

Question 27

Any abdominal pain with unexplained vaginal bleeding in a known pregnancy is consistent with what diagnoses?

Answer 27

ectopic pregnancy

Question 28

What antibiotic do you give to treat urosepsis secondary to pyelonephritis?

Answer 28

broad spectrum IV antibiotics vancomycin (wt based) + cefepime 2g

Question 29

What antibiotic do you give to treat pyelonephritis as an outpatient?

Answer 29

- ciprofloxacin 500 mg BID for 7 days | * if you can't tolerate FQNL then take bactrim DS*

Question 30

Why do you need a 48 hour follow up if HCG is below discrimatory zone?

Answer 30

- to see if it is a real pregnancy (HCG doubled in 48 hours) | - OR ectopic (HCG not increasing as high)

Question 31

What is the acute management for a ruptured ectopic pregnancy?

Answer 31

- place two large bore IVs | - STAT gynecology consult for laparoscopy

Question 32

What is the time window to treat ovarian torsion?

Answer 32

no time window - patient's can be torsed for days and still have viable tissue

Question 33

CVAT with associated fever, nausea and vomiting is consistent with what diagnosis?

Answer 33

pyelonephritis

Question 34

A patient presents with insidious onset, bilateral, lower abdominal pain with dyspareunia and dysuria. On pelvic exam you see mucopurulent discharge and cervical motion tenderness (CMT). What is the likely diagnosis?

Answer 34

pelvic inflammatory disease

Question 35

What is the first sonographic sign of pregnancy?

Answer 35

gestational sac