CLIPP 22

Question 1

pattern of insidious onset of abd pain

Answer 1

inflammation of the visceral peritoneum alone or a well-contained process (like an abscess).

Question 2

crampy or colicky abd pain

Answer 2

obstruction in a peristaltic organ (like bowel or ureter).

Question 3

is diarrhea common in appys

Answer 3

no - typically no BM in last several hr

Question 4

pain –> shoulder

Answer 4

cholecystits

Question 5

RUQ pain in PID

Answer 5

perihepatitis–Fitz-Hugh-Curtis syndrome–an occasional complication (5% of cases) of PID caused by N. gonorrhoeae or C. trachomatis (this pain is of sudden onset and may refer to the right shoulder).
-infalmm of pericolic gutter, hepatic capsule and diaphragm

Question 6

group most at risk for PID (age wise)

Answer 6

the highest rates of PID are in sexually active girls 15-19 years of age), PID must be considered in a young woman with acute abdominal pain, even if there is no history of sexual activity.

Question 7

mesenteric adentisi

Answer 7

nflammation of the mesenteric lymph nodes, has many causes and often presents like appendicitis. The typical presentation is of RLQ pain with fever, vomiting, and diarrhea.

Question 8

what respi infection can -> abd pain

Answer 8

pneumonia if in lower lobes

Question 9

important cause of male abd pain

Answer 9

testicular torsion

Question 10

male urologic emergency

Answer 10

testicular torsion!

Question 11

cremasteric reflex

Answer 11

stroke thigh, causes that side of the testicle and scotum to rise

Question 12

testicular torsion sx

Answer 12

sually occurs in early adolescence and presents with acute onset of severe hemi-scrotal pain, nausea, and vomiting.
Physical examination reveals an enlarged tender testis, scrotal edema, and absence of the cremasteric muscle reflex.

Question 13

dx of testc torsion

Answer 13

made mainly on clinical suspicion - can use US for help but clinical sups is key and don’t delay tx if you have high suspiecion

Question 14

common lab tests in appy

Answer 14

cbc, crp

Question 15

cosider rectal exam if

Answer 15

abd complaint or if neuro sx

Question 16

key PEx findings in PID

Answer 16

purulent cervix, adnexal/cerv motion tendernss

Question 17

absence of CVA tenderness argues against

Answer 17

uTI, tho this is not specific

Question 18

PEx in early ectopics

Answer 18

can be totally normal

Question 19

US is critical test in

Answer 19

PID complicated cases - i.e. tubo ovarian abscess

Question 20

barium studies used in eval of

Answer 20

chronic abd pain, intussceuption

Question 21

4 complications of PID

Answer 21

infertiltiy, sepsis, tubo ovarian abscess, intra abd abscess

Question 22

things that can make you be tx inpatient for PID

Answer 22

Pregnancy (A)
Previous noncompliance/homeless (B)
High fever (C)
Intractable vomiting (C), and/or
Inability to exclude a surgical emergency (D).
Patients with HIV (E) who have mild or moderate PID may be managed as an outpatient.

Question 23

do states require reporting of STI

Answer 23

yes

Question 24

what is expedited partner therapy

Answer 24

when pt given enough meds to tx their partner for the STI too - recommended by CDC

Question 25

what gyn thing causes hemodyn instability

Answer 25

ruptured ectopic (bc of hemorrhage, which can spill into peritoneum and causes peritoneal signs and radiation to R shoulder)

Question 26

pt w/ pain;ess bleeding 6-8 weeks post LMP

Answer 26

ectopic