Adolescent Medicine Flashcards
What are the three treatment regimens for PID?
- Ceftriaxone + metronidazole + doxycycline
- Cefotetan + doxycline
- Cefoxitin + doxycline
Regardless of initial therapy, transition to metronidazole + doxycline for 14 days total therapy once clinically improving for 24 - 48 hours.
What are the four indications for hospitalization for patients with suspected PID?
- Pregnant
- Tubo-ovarian abscess
- Cannot tolerate PO treatment
- Do not improve with 72 hours of oral therapy
Women with HIV are at higher risk for what complication of PID?
Tubo-ovarian abscess. (However, this should not alter management including antibiotic selection or route of antibiotics.)
What should be the empiric treatment regimen for a patient with suspected urethritis secondary to an STI?
Ceftriaxone 500mg x 1 + doxycyline x 7 days.
When should azithromycin be used in place of doxycline for treatment of a woman with STI?
If the patient is pregnant or allergic to doxycycline.
(NOTE: It is often argued that single dose azithromycin is also an acceptable therapy where compliance is a concern–but this is not consistent with the guidelines and is rather paternalistic. At a minimum, this treatment should only be offered with informed consent and shared decision making.)
What is the treatment of STI known to be caused by N. gonorrhoeae?
Ceftriaxone 500mg x 1
What is the treatment of STI known to be caused by C. trachomatis?
Doxycycline x 7 days
What is the treatment of STI known to be caused by Trichomonas?
Metronidazole x 7 days
What patient population should have a test of cure following treatment for STI?
Pregnant patients.
(High risk patients should be rescreened in 6 months.)
You are treating a patient with abdominal pain and adnexal tenderness. Serum hCG is negative and abdominal ultrasound shows only mildly thickened fallopian tubes. You note the patient has an IUD for contraception. In addition to starting antibiotics, should the IUD be removed?
No, the IUD can be left in place. Removal can be considered if the patient does not improve clinically in 48-72 hours.
How is functional neurological symptom disorder distinguished from somatic symptom disorder?
In functional neurological symptom disorder, there is loss of function without explanatory findings on exam or other evaluations, often coupled with relative indifference to the symptoms.
In contrast, in somatic symptom disorder the actual symptoms are mild and largely consistent with exam findings, but the patient is very distressed by their perceived symptoms.
How is functional neurological symptom disorder distinguished from factitious disorder?
In factitious disorder, the patient (or patient’s guardian) is intentionally deceiving care givers with respect to their symptoms.
In contrast, in functional neurological symptom disorder the patient is truthfully reporting symptoms even though their cause cannot be demonstrated by exam or other evaluations.
What are the three components of initial treatment for functional neurological symptom disorder?
- Clearly communicating the diagnosis, including the facts that the symptoms, that the cause is poorly understood, but nevertheless the condition is time limited and will resolve either spontaneously or with treatment.
- Physical rehabilitation
- Cognitive behavioral therapy
Describe the characteristics of normal menstrual cycles.
They occur every 21-45 (some sources say 24-38) days, vaginal bleeding lasts 2-7 days, and inter-cycle variability is less than 10 days. There is no vaginal bleeding between menstrual episodes.
What are the three characteristics of patients presenting with complaints of abnormal menstrual bleeding that suggest an underlying bleeding disorder?
- Prolonged vaginal bleeding with every menstrual cycle
- Hemoglobin less than 8g/dL
- Excessive bleeding at menarche
What two criteria–alone or together–indicate a patient requires hospitalization for abnormal menstrual bleeding?
- Symptomatic anemia
- Cannot take oral medication
What are the elements of the initial workup for an acute episode of abnormal (heavy) menstrual bleeding?
(Note: a single episode in a patient of reproductive age that does not produce hemodynamic instability can be simply monitored for resolution and recurrence.)
- Thorough gynecologic, obstetric, and reproductive history
- Physical exam including complete pelvic exam to assess for non-uterine sources of bleeding, infectious processes, uterine or adnexal abnormalities
- CBC
- Urine (and possibly serum) hCG
- Transvaginal US
- Possibly endometrial sampling
- Possible coags and VWD testing
What is the initial treatment for a hemodynamically unstable patient with acute abnormal uterine bleeding?
- Consideration of uterine tamponade.
- Uterine curettage as soon as possible.
- Can consider high dose IV estrogen in select patients.(Not so unstable patients in whom curetage can be safely delayed. Note: estrogen is contraindicated if high risk of thrombosis.)
What is the initial treatment for a hemodynamically stable patient with acute abnormal uterine bleeding?
High dose combination oral contraceptive treatment.
(Note: estrogen is contraindicated if high risk of thrombosis)
Bonus round: what is a possible regimen for oral contraceptive treatment of acute uterine bleeding in a hemodynamically stable patient?
A combination pill containing 35 mcg ethinyl estradiol:
5 on day 1, tapering to 1 on day 5.
(Re-evaluate if no improvement in 48 hours.)
(Different regimen if suspect anovulatory cycles.)
(So just call Ob-Gyn.)
What is Fitz-Hugh-Curtis syndrome?
Inflammation of the liver capsule and subsequent adhesion formation that is a complication of about 10% of PID cases.
