PID

Question 1

A nonspecific term for a spectrum of upper genital tract conditions ranging
from acute bacterial infection to massive adhesions from old inflammatory scarring.

Answer 1

PID

Question 2

MC initial organisms for PID

Answer 2

The most common initial organisms are chlamydia and gonorrhea

Question 3

What is the usual initial infection in pts with PID

Answer 3

The initial infection starts with invasion of endocervical glands with chlamydia
and gonorrhea.

Question 4

How does Acute salpingo-oophoritis occur in pts with PID

Answer 4

Usually after a menstrual period with breakdown of the cervical mucus barrier, the pathogenic organisms ascend through the uterus, causing an endometritis, and then the bacteria enter the oviduct where acute salpingo-oophoritis
develops.

Question 5

RF for PID

Answer 5

The most common risk factor is female sexual activity in adolescence, with multiple
partners.

PID is increased in the month after insertion of an IUD, but this is probably exacerbation of preexisting subclinical infection

Question 6

Mx of Cervicitis

Answer 6

Single dose orally of cefixime and azithromycin

Question 7

What is the dx?

Bilateral lower abdominal-pelvic pain may be variable ranging from minimal to
severe.

Onset may be gradual to sudden, often after menses. Nausea and vomiting may be found if abdominal involvement is present

Answer 7

Acute salpingo-oophoritis

Question 8

PE of Acute salpingo-oophoritis

Answer 8

Mucopurulent cervical discharge, cervical-motion tenderness, and bilateral
adnexal tenderness are present

Question 9

Minimal criteria for Acute salpingo-oophoritis

Answer 9

– Sexually active young woman
– Pelvic or lower abdominal pain
– Tenderness: cervical motion or uterine or adnexal

Question 10

Supportive criteria for Acute salpingo-oophoritis

Answer 10

– Oral temperature >101°F (>38.3°C)
– Abnormal cervical or vaginal mucopurulent discharge
– Presence of abundant WBC on vaginal fluid saline microscopy
– Elevated erythrocyte sedimentation rate
– Positive lab findings of cervical N. gonorrhoeae or C. trachomatis
– Most specific criteria for diagnosis:
– Endometrial biopsy showing endometritis
– Vaginal sono or MRI imaging showing abnormal adnexae
– Laparoscopic abnormalities consistent with PID

Question 11

Abx for Acute salpingo-oophoritis

Answer 11

Ceftriaxone IM x 1 plus doxycycline po bid for 14 days with/without metronidazole
po bid for 14 days

Question 12

______ is the accumulation of pus in the adnexae forming an inflammatory mass involving the oviducts, ovaries, uterus, or omentum

Answer 12

TOA

Question 13

PE of TOA

Answer 13

Abdominal examination shows peritoneal signs, guarding, and rigidity.

Pelvic examination may show such severe pain that a rectal examination
must be performed. Bilateral adnexal masses may be palpated

Question 14

Cervical cultures for TOA

Answer 14

Cervical cultures are positive for chlamydia or gonorrhea

Question 15

Blood cultures for TOA

Answer 15

Blood cultures may be positive for gram-negative bacteria and anaerobic organisms such as Bacteroides
fragilis.

Question 16

DDx for TOA

Answer 16

Septic abortion, diverticular or appendiceal abscess, and adnexal torsion

Question 17

Mx of TOA

Answer 17

Inpatient IV clindamycin and gentamicin should result in fever defervescence
within 72 hours.

Question 18

Sx MX of TOA

Answer 18

Exploratory laparotomy with possible

TAH and BSO or percutaneous drainage through a colpotomy incision may be required

Question 19

SSx of chronic PID

Answer 19

Chronic bilateral lower abdominal-pelvic pain is present, varying from minimal to severe.

Other symptoms may include history of infertility, dyspareunia, ectopic pregnancy,
and abnormal vaginal bleeding. Nausea and vomiting are absent.

Question 20

UTZ for chronic PID

Answer 20

Sonography may show bilateral cystic pelvic masses consistent with hydrosalpinges.

Question 21

Dx of PID

Answer 21

This is based on laparoscopic visualization of pelvic adhesions

Question 22

_____refers to recurrent, crampy lower abdominal pain, along with nausea, vomiting, and diarrhea, that occurs during menstruation in the absence of pelvic pathology

Answer 22

Primary dysmenorrhea

Question 23

Primary dysmenorrhea severity categorized into a grading system based on?

Answer 23

menstrual pain, presence of systemic symptoms, and impact on daily activities.

Question 24

Sx of primary dysmenorrhea from?

Answer 24

Symptoms appear to be caused by excess production of endometrial prostaglandin
F2α resulting from the spiral arteriolar constriction and necrosis that follow progesteronewithdrawal as the corpus luteum involutes

Question 25

effect of PG to the uterus

Answer 25

The prostaglandins cause dysrhythmic uterine contractions, hypercontractility, and increased uterine muscle tone, leading to uterine ischemia.

Question 26

The effect of the prostaglandins on the ______also can account for nausea, vomiting, and diarrhea via stimulation of the gastrointestinal tract

Answer 26

gastrointestinal smooth muscle

Question 27

_______ is a benign condition in which endometrial glands and stroma are seen outside the uterus. This is not a premalignant condition.

Answer 27

Endometriosis

Question 28

Although the etiology of endometriosis is not known, the most accepted theory of explanation is that of Sampson, which is ________

Answer 28

retrograde menstruation.

Question 29

The most common site of endometriosis is the ______

Answer 29

ovary,

Question 30

because this is functioning endometrium, it bleeds on a monthly basis and can create adnexal enlargements known as endometriomas, also known as a ____

Answer 30

chocolate cyst.

Question 31

The second most common site of endometriosis is the______, and in this area the endometriotic nodules grow on the uterosacral ligaments, giving the characteristic _____ and tenderness appreciated by rectovaginal examination

Answer 31

cul-de-sac uterosacral ligament nodularity

Question 32

Endometriosis _______of endometriotic nodules or endometriomas is the definitive way of making the diagnosis

Answer 32

laparoscopic identification

Question 33

Mx of EM ___can be helpful to endometriosis because there is no menstruation and also the dominant hormone is progesterone, which causes atrophic changes in the endometrium

Answer 33

Pregnancy

Question 34

Mx of EM ______achieves this goal through preventing progesterone withdrawal bleeding

Answer 34

Pseudopregnancy

Question 35

How to achieve pseudopregnancy

Answer 35

``` Continuous oral medroxyprogesterone acetate (MPA [Provera]), subcutaneous medroxyprogesterone acetate (SQ-DMPA [Depo Provera]), or combination oral contraceptive pills (OCPs) can mimic the atrophic changes of pregnancy. ```

Question 36

Mx of EM _____achieves this goal by making the ectopic endometrium atrophic. The treatment is based on inhibition of the hypothalamic–pituitary–ovarian axis to decrease the estrogen stimulation of the ectopic endometrium

Answer 36

Pseudomenopause

Question 37

Meds for Pseudomenopause

Answer 37

– Testosterone derivative (danazol or Danocrine) | – Gonadotropin-releasing hormone (GnRH) analog (leuprolide or Lupron)

Question 38

The best inhibition of the hypothalamic–pituitary–ovarian axis is achieved by____

Answer 38

GnRH analogs

Question 39

GnRH stimulates the pituitary in a____, and GnRH analogs stimulate by ______ which produces a condition known as down-regulation of the pituitary

Answer 39

pulsatile fashion continuous stimulation,

Question 40

EM Tx Patients on Lupron therapy for >3–6 months can complain of

Answer 40

menopausal symptoms, such as hot flashes, sweats, vaginal dryness, and personality changes

Question 41

Lupron medication is continued for 3–6 months’ duration, and then a more acceptable medication for the inhibition of the axis can be used, such as _____

Answer 41

birth control pill | medication.

Question 42

An alternative to Lupron is _____, which also suppresses FSH and LH but does not result in vasomotor symptoms

Answer 42

DMPA (Depo Provera)

Question 43

Conservative Mx of EM __________ may allow adherent fimbria to function and achieve pregnancy

Answer 43

Lysis of paratubal adhesions

Question 44

Conservative Mx of EM Ovarian cystectomies as well as ______ can be treatment for endometriomas.

Answer 44

oophorectomies

Question 45

Aggressive MX of EM If fertility is not desired, particularly if severe pain is present because of diffuse adhesions, definitive surgical therapy may be carried out through a

Answer 45

total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO).

Question 46

Endometriosis is not a malignant condition but is associated with higher risk of ________ mechanism unclear

Answer 46

ovarian carcinoma;