Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

3. E Med & Surgery > 2 - Acute Abdomen > Flashcards

2 - Acute Abdomen Flashcards

1
Q

Pt presents w/ acute onset of constant pain followed by emesis onset ≤ 72 hrs. On exam pt has rigid abdomen, signs of shock (hypotension, tachycardia) and involuntary guarding.

Is this pt concerning for an acute abdomen?

A

Yes! Sx are all red flags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GB pain will radiate where?

A

Right shoulder/subscapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Perforated duodenal ulcer pain will radiate where?

A

Shoulders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ureteral obstruction pain in men will radiate where?

A

Testicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chest pain due to an MI will radiate where?

A

Epigastric, jaw, neck, UE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

GYN or prostrate pain will radiate where?

A

Low back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference b/w visceral and parietal pain?

A

Visceral pain is DULL, aching, colicky & poorly localized.

Parietal pain is sharp, well localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What hx question is important in pts that present with acute abd pain?

A

Prior abdominal surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What will a lactic acid test tell you?

A

Tissue ischemia/necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A CT w/o contrast is imaging of choice for what?

A

Renal stones, obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CT w/ IV contrast is imaging of choice for what?

A

Ischemic bowel, diverticulitis, peritonitis, AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CT w/ oral contrast is imaging of choice for what?

A

Really skinny adults, children, need for enhanced imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

US is imaging of choice for what?

A

GB, free fluid, kidneys, ovaries, testicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the general tx for pts w/ acute abdomens?

A

IV fluids, anti-emetics, analgesia (IV if surgery consult), anti-pyretic, NPO, +/- ABX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What conditions required URGENT surgical referral?

A
  • Obstruction, perforation, peritonitis, ischemic bowel, dissection
  • Rapid sx evolution (out of proportion pain, increased tenderness and rigidity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What pt populations can presents atypically?

A

Elderly, diabetic, IMC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clinical presentation of a GI perforation depends on what?

A

Organ affect and contents released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of GI perf?

A
  • Spontaneous (cholecystitis, appendicitis)
  • Bowel obstruction
  • Trauma
  • Instrumentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When will peritonitis occur?

A

After perforation

  • Will cause high fever, +/- sepsis/death, can be localized or generalized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Perforation is more common in what age groups?

A

> 50 yrs & < 10 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The following are concerning for what?

Ill appearing
Motionless
\+ Rebound tenderness
Pain w/ light bumps
Diminished bowel sounds
Anorexia/low urine output
Inability to pass stool or gas
A

peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does a pt w/ a spontaneous bacterial peritonitis present?

A
  • Ascites, liver cirrhosis, fever, AMS, abd pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is used to dx spontaneous bacterial peritonitis?

A

Paracentesis

NO exploratory laparotomy (increases mortality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the med tx for spontaneous and secondary bacterial peritonitis?

A

ABX: Cefotaxime
Albumin (if renal failure develops)
D/C BB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does pt w/ secondary bacterial peritonitis present?

A

Possible perf (PUD, appendicitis) w/ ascites, fever, AMS, abd pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is used to dx secondary bacterial peritonitis?

A

Paracentesis

Exploratory laparotomy REQUIRED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pt presents w/ severe constant RUQ pain > 6 hrs, N/V and increased pain after fatty food intake. ON exam pt w/ guarding, RUQ TTP, + Murphy’s sign, tachycardia and no jaundice. What is your suspected dx?

A

Acute cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Labs show:

  • Leukocytosis w/ bands
  • Elevated CRP
  • Normal Alk phos
  • Normal bili

You decided to order a RUQ US to confirm your suspected. What is your suspected dx?

A

Acute cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does RUQ US show for pt w/ acute cholecystitis?

A

GB wall thickening
Sonographic Murphy’s sign
Gallstones or sludge
Pericholecystic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the management for acute cholecystitis?

A

NPO & IV fluids
Analgesia

ABX: Ceftriaxone, cefuroxime

Surgery consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

It pt elects for non-operative management of acute cholecystitis but does not improve within 1-2 days what is the next step?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In unstable pts that present w/ cholecystitis, what procedure can be done to relieve pain until they are more stable for surgery?

A

Percutaneous drainage (performed under radiologic guidance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is acute choledocholithiasis?

A

Gallstones WITHIN the common bile duct

(most common cause is secondary to passage of stones from GB to common bile duct vs. less commonly the formation of stones w/in the common bile duct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pt presents w/ colicky RUQ pain w/ radiation to epigastric and N/V. On exam you note RUQ/epigastric TTP and Courvoisier’s sign (palpable GB). Labs show elevated bili, alk phos, transaminases and GTT. What do you suspect?

A

Acute choledocholithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is first line imaging for acute choledocholithiasis?

A

Transabdominal US (for presence of stones in the GB/CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the tx for HIGH risk pts w/ acute choledocholithiasis?

A

GI, Surgery consult => ERCP for removal of stones

Then Elective cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the tx for LOW risk pts w/ acute choledocholithiasis?

A

GI, Surgery consult => cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are complications of choledocholithiasis?

A

Pancreatitis and acute cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is an obstruction of the biliary ducts that leads to an ascending bacterial infections?

A

Cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the most common cause of acute cholangitis?

A

Choledocholithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Acute cholangitis will often present w/ Charcot’s triad. What sx does this include?

A

Fever/chills
RUQ pain
Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If pt with acute cholangitis presents with Charcot’s triad + AMS and hypotension what is this called?

A

Reynold’s pentad

Charcot’s Triad:

  • Fever/chills
  • RUQ pain
  • Jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Labs for a pt w/ acute cholangitis will show

  • Elevated Alk phos, GGT, bilirubin, AST/ALT
  • Leukocytosis

What other lab value is elevated?

A

Pancreatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What imaging is performed on a pregnant pt w/ suspected cholangitis?

A

US is done first, then if ERCP needed, fetal shielding is used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Will a CT have high sensitivity for evaluating bile duct stones in a pt w/ suspected cholangitis?

A

No. Will show bile duct dilation and biliary stenosis, but low sensitivity for bile duct stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Imaging for acute cholangitis is dependent on what?

A

Severity of illness

  • Transabdominal US
  • EUS
  • ERCP (dx and therapeutic) /MRCP
  • CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the tx for pt w/ acute cholangitis?

A 
Admit
NPO
surgery/GI consult
ABX 
biliary drainage (ERCP) w/in 24 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What empiric ABX therapy is given to pts w/ acute cholangitis?

A

Ceftriaxone + metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How is mild pancreatitis defined?

A

No organ failure or systemic complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How is moderate pancreatitis defined?

A

Transient organ failure (resolved w/in 48 hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How is severe pancreatitis defined?

A

Persistent organ failure 1+ organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How will a pt w/ gallstone pancreatitis present?

A

Well localized pain w/ rapid onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Pt presents with N/V and acute epigastric/RUQ pain that radiates to the back. Pain is relieved by leaning forward. What is your suspected dx?

A

Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

On exam for pt w/ pancreatitis what sign’s can be present?

A

Cullen’s sign (umbilical bruising)

Grey-turner sign (flank bruising)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Labs for pt w/ pancreatitis will show what?

A 
Elevated lipase (w/in 4-8 hrs) and amylase (w/in 6-12 hrs) 3x normal
Increased CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What imaging for pancreatitis is not as sensitive in early disease but will show diffuse enlargement, necrosis, and stones?

A

CT w/ IV contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What imaging for pancreatitis is sensitive in early disease?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What will US for pancreatitis show?

A

Diffusely enlarged pancreas, +/- gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the dx criteria for pancreatitis?

A

Must meet 2 of the following:

  1. Acute onset of constant, severe epigastric pain radiation to the back
  2. Elevation in serum lipase or amylase ≥ 3x normal
  3. Characteristic findings of acute pancreatitis on imaging

*IF 1 & 2 are met, NOT imaging is needed for dx, imaging helpful to r/o necrosis, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the tx for pt w/ pancreatitis?

A 
Admit (ICU common)
NPO
NG tube
Foley catheter
Serial labs (amylase and lytes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the tx for gallstone pancreatitis?

A

GI consult => ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What disease is due to a defect in gastric or duodenal mucosa and frequently associated w/ GERD?

A

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the 2 biggest RF for PUD?

A

NSAID use

H. Pylori infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

PUD may presents atypically in what population?

A

Elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Pt presents w/ epigastric pain w/ radiation to thoracic region, heartburn, early satiety, SOB/cough when lying flat and hematemesis/melena. What is the suspected dx?

A

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

If pt w/ PUD presents with hematochezia what should you be concerned for?

A

Perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What labs do you want to check for PUD?

A

CBC - Hgb/HCT
BMP - lytes (excessive vomiting)
Hemoccult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What imaging is recommended for PUD?

A

KUB, CXR (check for free air)

69
Q

What is the tx for PUD?

A

IV fluids
IV PPI
GI consult => endoscopy w/ biopsy, d/c NSAIDs, tx H. pylori, if perf then surgery

70
Q

What is the most common cause of a splenic abscess?

A

Endocarditis or seeding from another site of infection

71
Q

What is the presentation for pt w/ suspected splenic abscess?

A

LUQ pain

Fever

72
Q

What imaging is needed to evaluated splenic abscess?

A

CT w/ IV contrast

73
Q

What is the tx for splenic abscess?

A

Admit
NPO & IV fluids
ABX
Surgery (splenectomy) and ID consults

74
Q

If splenic artery or sub branch becomes occluded by embolus, clot or infection what should you be concerned about?

A

Splenic infart

75
Q

Malignancy, Afib, infective endocarditis, sickle cell, trauma, and complications for mono are RF for what?

A

Splenic infarct

76
Q

How will a pt w/ splenic infarct present?

A

Acute LUQ pain
Fever
N/V
+/- splenomegaly

77
Q

What labs will be elevated in pt w/ splenic infarct?

A

LDH (tissue damage)

Leukocytosis

78
Q

What imaging is needed to evaluated splenic infarct?

A

CT w/ IV constrast

79
Q

What is the tx for uncomplicated splenic infarct (most common)?

A

Analgesia, monitor

Consult GI/Surgery

80
Q

What is the tx for complicated splenic infarct (abscess, sepsis, hemorrhage)?

A

Surgery eval for splenectomy

Consult GI/Surgery

81
Q

Splenic rupture can occur w/o trauma (infection, drugs, malignancy, pregnancy, idiopathic) or due to trauma. What is the presentation?

A

Pain, fullness in LUQ
Referred pain to left shoulder
Pleuritic pain
Early satiety

82
Q

What labs do you want to check w/ splenic rupture?

A

CBC - Hct/Hbg

83
Q

What imaging is gold standard for splenic rupture?

84
Q

What is the tx for splenic rupture?

A

Admit
NPO & IVF
Type and cross for transfusion
Emergency splenectomy

85
Q

What is the presentation for SBO?

A

N/V
Periumbilical cramping
Obstipation (inability to pass flatus or stool)

86
Q

Fever, leukocytosis, tachycardia (not responding to fluid), POOP, and metabolic acidosis are concerning for what GI finding?

A

Bowel ischemia

87
Q

Abd XR in pt w/ suspected SBO will show what?

A

Dilated loops of bowel w/ air fluid levels

Proximal bowel dilation w/ distal bowel collapse

88
Q

CT for pt w/ suspected SBO will be helpful for what?

A

Determining severity

89
Q

What is the tx for pt w/ pt w/ SBO?

A 
Admit
NPO &amp; IVF
Anti-emetics
NG tubes
Surgery consult
90
Q

When would pt w/ SBO have surgical intervetion?

A

Sx no resolved w/ NG tube and bowel rest

91
Q

When is a pt w/ SBO given ABX and taken to surgery emergently?

A

Complicated bowel obstruction

92
Q

What is acute mesenteric ischemia?

A

Decreased or no perfusion to section of colon

93
Q

What are non-occlusive causes of acute mesenteric ischemia?

A

Vasoconstrictive meds, sepsis, HF

94
Q

How might a pt w/ occlusive (due to ARTERIAL thrombosis/emboli) mesenteric ischemia present? What is the mortality risk?

A

Rapid onset
N/V
Severe periumbilical POOP
Post prandial pain

High mortality risk

95
Q

How might a pt w/ occlusive (due to VENOUS thrombosis) mesenteric ischemia present? What is the mortality risk?

A

Indolent course

Less associated mortality

96
Q

Labs for pt w/ acute mesenteric ischemia will be non-specific in early course. What normal lab finding can help r/o acute mesenteric ischemia?

97
Q

If Abd XR shows free air or signs of “dead bowel” in pts w/ acute mesenteric ischemia what is the tx?

A

Laparotomy

98
Q

If Abd XR DOES NOT shows free air or signs of “dead bowel” in pts w/ acute mesenteric ischemia what is the next step?

A

Abd CTA (IV contrast)

99
Q

What is the tx for acute mesenteric ischemia?

A

Admit
NPO and IVF
Foley
Empiric ABX (Ceftriaxone, metronidazole)
Consults dependent on cause ( GI, surgery, cardio)

100
Q

What is the most common abdominal emergency?

A

Appendicitis

101
Q

What is presentation/exam for normally located appendicitis?

A 
RLQ pain (starts periumbilical &amp; migrates)
\+ Rebound tenderness/ + Rovsing's sign
102
Q

What is presentation/exam for appendicitis in a retrocecal located appendix?

A

Back/flank/testicular pain

+ Psoas sign

103
Q

What is presentation/exam for appendicitis in a pelvic located appendix?

A

Suprapubic/rectal pain/dysuria/diarrhea more common

+ Obturator sign

104
Q

Pain can present where for pt in 3rd trimester w/ appendicitis?

105
Q

What is a the most common lab finding for appendicitis?

A

Leukocytosis

*If extreme elevated consider perf

106
Q

Is imaging needed if clinical appendicitis?

107
Q

What imaging is needed if dx of appendicitis is unclear?

A

CT w/ IV or oral contrast (inflammation, wall thickening, fluid collection, abscess, fat stranding)

108
Q

What imaging is needed in pregnant pts if dx of appendicitis is unclear?

A

MRI w/ contrast

109
Q

What peri-operative ABX are given for pts w/ appendicitis?

A

Cefoxitin or cefazolin + metronidazole

110
Q

PT presents with LLQ pain that is steady, deep, and constant. They report urinary frequency and change in bowel habits. On exam you note rebound tenderness and guarding, + stool guaiac and changes in bowel sounds. What is your suspected DX?

A

Diverticulitis

111
Q

Hyperactive or hight pitched bowels sounds indicate what in pt w/ diverticulitis?

A

Obstruction

112
Q

Hypoactive/absent bowel sounds indicated what in pt w/ diverticulitis?

A

Peritonitis

113
Q

Labs for pt w/ diverticulitis will show what?

A

Elevated C-reactive protein

UA: pyruia

114
Q

What is the preferred imaging for diverticulitis?

A

CT w/ IV and oral contrast (localized bowel thickening, colonic diverticula, abscess, fistulas, dilated loops of bowl/BO)

115
Q

What is the tx for uncomplicated diverticulitis?

A

Outpatient

  • Ciprofloxacin + metronidazole
  • Follow up w/ GI w/in 2 days
116
Q

What are the criteria for complicated diverticulitis?

A 
Perforation, abscess, fistula, obstruction
Sepsis
IMC
Fever > 102.5
> 70 y/o
Significant leukocytosis
Significant comorbidities
117
Q

What is the tx for complicated diverticulitis?

A

Inpatient
NPO & IVF
IV abx
Consult GI +/- surgery

118
Q

What is the most common complication of IBD?

A

Toxic megacolon

119
Q

Toxic megacolon can also presents secondary to what?

A

C. diff infection

CMV in HIV+ pts

120
Q

How will a pt w/ toxic megacolon present?

A

Severe, bloody diarrhea
Fever
Toxic appearing/AMS
Abdominal distention and tenderness

121
Q

What is the DX criteria for toxic megacolon?

A

Enlarged, dilated colon (> 6cm) on Abd XR

PLUS 3 of the following:

  • Fever > 100.4
  • HR > 120 bpm
  • Neutrophilic leukocytosis
  • Anemia

PLUS 1 of the following:

  • Dehydration
  • AMS
  • Lyte disturbance
  • Hypotension
122
Q

What is the tx for toxic megacolon

A 
Admit
NPO &amp; IVF
NG tube
NO anti-motility agents, opioids
CT w/ IV and oral contrast
Broad spectrum IV ABX (ampicillin/gentamycin/metronidazole)
IV steroids (prednisolone or methlyprednisolone)
Surgery consult
123
Q

What are the complications associated w/ toxic megacolon?

A

Perforation, massive hemorrhage, progression of dilation

124
Q

Pt presents with bright red rectal bleeding, anal pruritus (+/- prolapse), perianal pain (+/- lump). What are you concerned about?

A

Hemorrhoid

125
Q

PE for pt w/ suspected hemorrhoids includes what?

A

Visual inspection
DRE
Anoscopy
+/- Other endoscopic procedures

126
Q

T or F: Internal or external hemorrhoids can be excised in the ED?

A

TRUE (also done by surgery)

127
Q

What is the tx for thrombosed hemorrhoid?

A

Incise overlying skin and evacuate small clot

*will provide immediate relief

128
Q

What are the general tx recommendations for pts w/ hemorrhoids?

A

Increase fluids and fiber in diet

129
Q

Is a fever common in pts w/ perianal abscess?

A

No (unless cellulitis/extension)

130
Q

Will DRE for pt w/ perianal abscess have any acute findings?

131
Q

How will a pt w/ a perianal abscess present?

A

Sever pain in anal area w/ fluctuance/indurated skin in perianal area

132
Q

Is imaging needed for pts w/ perianal abscess?

A

Only if deep anorectal abscess is suspected. CT, MRI or endorectal US

133
Q

What is the tx for simple anorectal abscess?

A

I and D
Sitz bath at home
+/- ABX

134
Q

When are abx given for pts w/ perianal abscess? What abx are recommended?

A

Extension/cellulitis, signs of systemic infection, DM, valvular heart disease, IMC

Augmentin or Cipro + Metronidazole (must also perform wound culture)

135
Q

What is the tx for extensive, non-superficial perianal abscess?

A

Admit

Surgical I & D + imaging to determine extension

136
Q

What is common in pts presenting w/ rectal FB?

A

Long delay before seeking medical treatment

137
Q

If unable to palpate rectal FB on DRE does this exclude presence?

A

No
Order flat, upright abdominal XR
If radio-opaque, follow up w/ CT

138
Q

What is the tx for rectal FB?

A

Removal transanal approach (relax w/ IV sedation)
OR
Surgical removal (laparoscopy, colotomy)

139
Q

What is needed after removal or rectal FB?

A

Rigid protoscopy or flex sig

140
Q

What is first line imaging for evaluating female pelvic pain in non-pregnant women?

A

US transvaginal

- followed by CT if further eval needed)

141
Q

What is first line imaging for evaluating female pelvic pain in pregnant women?

142
Q

Pt presents w/ vaginal bleeding w/ pain 6-8 wks after last menses and lower pelvic pain. What are you concerned about?

A

Ectopic pregnancy

143
Q

What tests are need to evaluate ectopic pregnancy (+HCG)?

A

Pelvic exam
Blood type and screen
RhD typing (if not previously done in prior pregnancy)
Monitor H/H

144
Q

What imaging is needed to evaluate ectopic pregnancy?

A 
Fast US (R/o intraperitoneal hemorrhage)
Transvaginal US
145
Q

If pt w/ ectopic pregnancy is stable, no fetal cardiac activity and will comply w/ close follow up what is the tx?

A

Methotrexate

Do not use methotrexate if:

  • Hemodynamically unstable
  • High hCG
  • fetal heart activity
  • Large ectopic size
  • Renal/liver disease
  • Breastfeeding
146
Q

What is the tx for ectopic pregnancy if suspected tubal rupture/hemodynamically unstable?

A

Salpingectomy

147
Q

What is the tx for ectopic pregnancy & hemodynamically stable?

A

Salpingostomy or salpingectomy

GYN consult

148
Q

PID is most commonly related to what STIs?

A

N. gonorrhea

C. trachomatis

149
Q

New vaginal discharge, +chandelier sign, cervical friability, +/- RUQ pain (fitz-hugh curtis syndrome) are concerning for what?

150
Q

When do you hospitalized pt w/ PID? (5)

A 
Severe clinical illness
Unable to tolerate POs
Complicated PID w/ abscess
Pregnancy or post partum
Pain control
151
Q

What is the inpt tx for PID?

A 
IVF
Pain control
Anti-emetic
ABX: Cefoxitin + doxycycline (+ metronidazole if pelvic abscess)
Blood cultures
GYN consult
152
Q

What is the outpt tx for PID?

A

ABX: Ceftriaxone + doxycycline

GYN consult

153
Q

What is defined as partial or complete rotation of ovary that often results in ischemia?

A

Ovarian torsion

154
Q

What is the most common GYN emergency?

A

Ovarian torsion

155
Q

What pt population is at an increased risk of ovarian torsion?

156
Q

How will a pt w/ ovarian torsion present?

A

Acute onset of pain, N/V, adnexal mass on exam

157
Q

If pt w/ ovarian torsion presents with a fever, this is concerning for what?

158
Q

What imaging is needed to evaluate ovarian torsion?

A

US w/ duplex for BF (transvaginal + transabdominal)

159
Q

What is the tx for ovarian torsion in premenopausal women w/ viable ovary and no malignancy?

A

Consult GYN/surgery

Laparoscopic detorsion

160
Q

What is the tx for ovarian torsion in post-menopausal women w/ nonviable ovary or suspected malignancy?

A

Consult GYN/surgery

Salpingo-oophrectomy

161
Q

F pt presents with adnexal mass, abdominal distention, weight loss, and urinary frequency. What are you concerned about?

A

Ovarian CA

*If acute presentation also consider malignant effusion or SBO

162
Q

What is needed for dx of ovarian CA?

A

Imaging: Transvaginal and transabdominal US
Labs: tumor markers (CA 125)

163
Q

What is the tx for ovarian CA?

A

Consult surgery, Oncology/GYN

164
Q

What is infection of the endometrium after delivery?

A

Postpartum endometritis

165
Q

What will exam for pt w/ postpartum endometritis show?

A

Fever, foul smelling discharge (lochia), soft uterus w/ tenderness

166
Q

What is needed for dx of postpartum endometritis?

A

Clinical + elevated WBC w/ bands

167
Q

What is the tx for postpartum endometritis?

A

Admit
IV ABX (clindamycin + gentamycin)
GYN consult

168
Q

T or F: significant abd pain can be due to gastroenteritis?

A

FALSE.

NEVER attribute significant abd pain to gastroenteritis

3. E Med & Surgery (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions