Emergency Medicine - Vagina Problems Flashcards
What are the four steps to working up gynecologic complaints?
- Is she pregnant - Serum/Urine HcG?
- UA - Nitrites/Leuko/Blood?
- Pelvic Exam - Discharge/Blood?
- Ultrasound (not always necessary, but great for issues with uterus/ovaries)
Most common pelvic infection?
Chlamydia trachomatis
Easiest test for Pelvic Infection?
Wet Mount
Source of PID?
Ascending infection from cervical infection
CDC Guidelines for PID diagnosis?
Low abdominal pain without any other cause plus…
Uterine tenderness… OR
Adnexal tenderness (95.5% sensitivity)… OR
Cervical motion tenderness!
Outpatient treatment for PID?
Ceftriaxone 250mg IM once PLUS!
Doxycycline 100mg BID x14days!
With/Without Metronidazole 500mg BID x14days!
Concerning PID finding that would lead to hospital admission (5)?
Tubo-ovarian abscess.
Inability to tolerate PO.
Severe illness. Pregnancy.
Failed outpatient therapy.
A 25 year old female patient presents with sharp, intermittent, localized in the lower abdomen, along with vomiting and fever? Is an adnexal mass always noted on exam?
Ovarian Torsion. No.
Most common mass found in ovarian torsion?
Teratoma (60% of the time).
What side does ovarian torsion more often occur on?
Right side.
Does pregnancy increase or decrease the likelihood of developing enlarged ovaries that can produce torsion?
Increase.
Best diagnostic test for ovarian torsion? Importance of doppler signal?
Ultrasound. ~ 50% of surgically confirmed torsion cases will have had normal Doppler flow.
Most common diagnostic finding on ultrasound for ovarian torsion? Second most common finding?
Ovarian enlargement. Obstructed venous drainage.
Although more conservative methods can be used, such as untwisting the ovary or oophorexy, what is the definitive treatment of Ovarian Torsion?
Salpingo-oophorectomy.
What is the most common risk factor for ectopic pregnancy? What is the strongest predictor of having an ectopic pregnancy.
PID. Prior ectopic pregnancy.
How to diagnose ectopic pregnancy? Any additional actions if patient is bleeding?
Serum B-HCG + Pelvic Sonogram.
send Type and Screen
Most common symptoms (>70%) of Ectopic Pregnancy (5)?
Abdominal Pain/Tenderness, CMT, Adnexal Tenderness, Amenorrhea, Vaginal Bleeding.
Two discriminatory zones for ectopic pregnancy on ultrasound?
Transvaginal visualization of IUP: B-HCG > 1500 mIU/mL.
Transabdominal visualization of IUP: B-HCG > 4000 mIU/mL.
When is surgical management of ectopic pregnancy warranted?
Laparoscopic surgical management is warranted if patient is unstable or ectopic sac has ruptured.
What is the medical management of ectopic pregnancies? When is it warranted (4)?
Methotrexate. Unruptured adnexal mass < 3.5 cm, Hemodynamically stable, Desire for future fertility, Stable or rising β-hCG < 15,000 mIU/mL.
What aged women need to get pregnancy tests to rule out a gynecologic emergency? What if they say they are not sexually active?
10-55. Test them anyway.
A 22 year old, 36-week pregnant patient appears quite somnolent. She has a BP of 150/100, but she usually tests 130/90.She is minimally responsive, and has a decreased respiratory rate and marked decreased deep tendon reflexes? What would be found on UA? Definitive treatment? Cause of respiratory depression and loss of deep tendon reflexes? How to treat this complication?
Pre-ecclampsia. Protein (>5g in 24 hour collection). Delivery (do it after 34 weeks). Magnesium toxicity (used for seizure prophylaxis). Calcium gluconate.
What is HELPP Syndrome (4)?
A severe variant of pre-eclampsia! • Hemolysis (LDH>600, often seen as schistocytes on smear). • Elevated Liver enzymes (AST>70) • Low Platelets (<100,000) • Epigastric or RUQ abdominal pain
Difference between eclampsia and pre-eclampsia?
Eclampsia has seizures (up to 4 weeks postpartum)
How to treat the dehydration and hypertension from pre-eclampsia?
IV fluids and labetalol (or Hydralazine).
Agent for seizure prophylaxis in pre-eclampsia?
Magnesium sulfate
Important test to preform in abdominal trauma to a pregnant mother?
Kleihauer-Betke testing (assess if fetal hemoglobin has transferred to mother’s bloodstream).
What side should pregnant trauma patient be kept on?
Left side?
How long should fetal monitoring go on after mother (who suffered trauma) is stable?
4 hours.
If the mom has been dead on the trauma table for less than 10 minutes, what can you do to save the baby? What factors lead to higher chances for survival (2)?
Peri-mortem C section.
Fetus >28wks and maternal death <15mins prior to delivery.
Bacterial vaginosis
Overgrowth of natural flora: vaginal flora gardnerella vaginalis; anaerobes bacteroides spp, peptococcus
