Chapter 17 Upper Female Reproductive Tract and Systemic Infections

Question 1

endometritis

Answer 1

infection of uterine endometrium.

Question 2

endomyometritis

Answer 2

if infection invades into myometrium.

Question 3

risk factors for pelvic inflammatory disorder include

Answer 3

retained products of conception, sexually transmitted infections, intrauterine foreign bodies / growths, instrumentation of intrauterine cavity.

Question 4

diagnosis of endomyometritis

Answer 4

clinical settings with a bimanual exam revealing uterine tenderness, as well as fever and elevated WBC count.

Question 5

diagnosis of chronic endometritis suspected in pts with chronic irregular bleeding, discharge, and pelvic pain. dx made in a puerperal pt with

Answer 5

endometrial biopsy showing plasma cells.

Question 6

treatment of severe endomyometritis unrelared to pregnancy same as treatment for PID.

Answer 6

parenteral antibiotics.

Question 7

pelvic inflammatory disease (PID) is infection of upper female genital tract including any combination of endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis. it is the most common serious complication of STIs. PID strongly associated with

Answer 7

infertility.

Question 8

risk of ectopic pregnancy with hx of PID is increased as much as

Answer 8

7-10 fold and approximately 20% of woemn develop chronic pelvic pain during their lifetime.

Question 9

clinical manifestations of acute salpingitis is abdominal / pelvic/adnexal pain. other symptoms include

Answer 9

increased vaginal discharge, abnormal odor, abnormal bleeding, gastrointestinal disturbances, and urinary tract symptoms.

Question 10

PID can lead to serious sequelae (infertility) therefore

Answer 10

a low threshold for diagnosis and treatment should be maintained.

Question 11

Minimum criteria for empiric treatment include pelvic/ lower abdominal pain in sexually active young women, or women at risk for STIs, and one or more of the following:

Answer 11

cervical motion tenderness, uterine tenderness, or adnexal tenderness.

Question 12

additional diagnostic criteria that supports dx of PID include fever, abnormal cervical or vaginal mucopurulent discharge, abundant WBC on saline microscopy of vaginal secretions, elevated ESR, elevated c-reactive protein and cervical Neisseria gonorrhoeae or Chlamydia trachomatis infections.

Answer 12

true

Question 13

cervical cultures are performed to find a causative organism but, because of the disease’s polymicrobial nature, should not dictate the treatment regimen.

Answer 13

true.

Question 14

principal organisms suspected of causing PID are

Answer 14

N. gonorrhoeae and C. trachomatis. these 2 organisms together account for approximately 40% of all PID cases. HOWEVER, cultures from upper reproductive tract have shown that PID is likely to be polymicrobial.

Question 15

treatment of PID. high rate of ambulatory treatment failures and seriousness of sequelae. pts are often

Answer 15

hospitalized for treatment. PID treated with broad spectrum cephalosporin such as cefoxitin 2g IV. then doxycycline 100mg orally bid x 14 days.

Question 16

persistent PID can lead to development of

Answer 16

tubo-ovarian abscess. TOA.

Question 17

diagnosis of TOA

Answer 17

adnexal or posterior cul de sac mass / fullness. most pts will have abdomial / pelvic pain and demonstrate fever and leukocytosis. WBC elevated, ESR elevated.

Question 18

treatment of TOAs can be medical or surgical. medical management

Answer 18

broad spectrum antibiotics in an inpatient setting. Unless abscess is ruptured and causing peritoneal signs or is impenetrable by antibiotics, surgical treatment can be AVOIDED.

Question 19

If responsive to IV meds, pts can be converted to oral antibiotics to complete a 10-14 day course with doxycycline plus clindamycin or metronidazole.

Answer 19

true

Question 20

toxic shock syndrome

Answer 20

caused by infection with specific strains of staphylococcus aureus that produce an epidermal toxin

Question 21

symptoms of TSS

Answer 21

high fever (102F), hypotension, diffuse erythematous macular rash, desquamation of palms and soles 1-2 weeks after acute illness, multisystem involvement of 3 or more organ systems.

Question 22

treatment of TSS

Answer 22

highest priority is supportive treatment of hypotension with IV fluids and pressors if needed. this disease is caused by the EXOTOXIN. treatment with IV antibiotics does not often shorten the length of acute illness.

Question 23

outpatient treatment of PID

Answer 23

ceftriaxone 250mg IM plus doxycyline 100mg orally bid x 14 days.