Case Files - Approach To Clinical Problem Solving Flashcards
Woman complains of lower abdominal pain and has a history of a prior STI
Maybe she has salpingitis!
Patient who has abdominal pain, amenorrhea and a history of prior tubal surgery
Maybe she has an ectopic pregnancy!
Patient who has a one-day history of periumbilical pain that localized to the RLQ
Maybe she has appendicitis!
Clinical Pearl - What is the first step in clinical problem-solving?
Making the diagnosis
Clinical Pearl - What is the second step in clinical problem-solving?
Assessing the severity of the disease. This often provides prognostic or treatment significance.
Clinical Pearl - What is the third step in clinical problem-solving?
Tailoring the treatment to the extent or stage of disease
Treatment for severe preeclampsia at 32 weeks
Magnesium Sulfate (to prevent seizures) Delivery (most important part)
Main cure for preeclampsia
Delivery
Bacterial Vaginosis (BV) is associated with
Preterm delivery
Endometritis
Vaginal cuff cellulitis (following hysterectomy)
Clinical Pearl - What is the fourth step in clinical problem-solving?
Monitor treatment response or efficacy
The most common cause of postpartum hemorrhage
Uterine atony
Postpartum hemorrhage
Blood loss > 500mL with a vaginal delivery
Most commonly caused by uterine atony
First step upon discovering this finding should be uterine massage to determine if it is boggy.
Most common cause of postpartum hemorrhage with a firm uterus
Genital tract laceration
What findings on ultrasound would shift a non-severe diagnosis of PID into the severe category?
Tubo-ovarian abscess
The gold standard for the diagnosis of acute salpingitis
Laparoscopy:
Visualize the tubes, see if purulent material drains from them
Classic presentation of pyelonephritis
Fever
Flank tenderness
Pyuria
Risk factors of endometrial cancer
Long history of anovulation
Diabetes
Nulliparity
Hypertension
Life-threatening complication of a tubo-ovarian abscess
Rupture
This presents as hypotension (shock), confusion, apprehension, tachycardia
Therapy = Surgery
Failing to recognize it is commonly associated with patient mortality
Primary syphillis - RPR and VDRL tests are negative because the patient has not yet developed an antibody response. How do we confirm the diagnosis?
Dark field microscopy
Another word for PID that patients might be more familiar with
Tubal infection
