genitourinary Flashcards
What should be treated as a ruptured ectopic pregnancy until proven otherwise.
The combination of a FAST positive for free fluid and positive pregnancy test
Methotrexate may be considered in hemodynamically stable patients: 4 things?
Without evidence of rupture
With β-hCG < 5000 mIU/mL
With gestations < 4 cm
Without fetal cardiac activity
What is considered the discriminate zone?
5-6k transabdominal, 1-2k transvaginal
2 most common presenting symptoms of PID
bilateral lower pelvic pain and purulent discharge
If we are thinking PID and there is unilateral adnexal tenderness what are we thinking?
What about PID and right right upper quadrant pain?
tubo ovarian abscess
fitz hugh curtis syndrome and the infection has reached the liver
What is the diagnositc image choice for TOA?
US
Where do we most commonly see ovarian torsion?
What is the most common cause?
right
enlargement of the ovary because of cyst or mass
The best initial imaging for ovarian torsion is?
a transvaginal ultrasound with Doppler.
The most common ultrasound finding in torsion is?
enlargement or edema of the ovary. Commonly an ovarian mass or cyst can be visualized and in, later stages, free pelvic fluid
Which testicle is more commonly affected in torsion?
What is prehns sign?
What reflex is commonly lost?
left
elevation of the testicle providing pain relief
cremasteric
image of choice for testicular torsion?
US
In pregnancy, What is the most common non-obstetric surgical emergency.
appendicitis
image choice for appendicitis for kids, pregnancy and others?
US for kids and pregnancy
CT others
Typically the first place that jaundice is manifest is in the?
scleara of the eyes
What is the difference between partial and complete bowel obstruction?
gas and liquid stool can get through
nothing
What is my thinking with the cause of obstruction on the bowel?
because adhesions is most common, consider recent surgery or history of surgery. Then move on to history of bowel problems or dsisease like crohns. Then if the patient has no history of any of it, I need to start thinking of hernias and masses or tumors.
Findings on plain film that suggest SBO include?
air-fluid levels in the small bowel or dilated loops of small bowel.
most dangerous complication of obsturction?
strngulation
What is classic presentaiton of mesenteric ischemia?
over 60, more females, out of proportion pain to exam. acute pain coming on.
what is the most common cause of mesenteric ischmia?
mesenteric artery embolus
3 risk factors for mesenteric artery embolus?
afib, post MI mural thrombus and valve disease
What is the constellation of these symptoms termed chronic mesenteric ischemia? 4
abdominal angina, diarrhea, fear of food, and weight loss.
MVT occurs in younger patient populations and is most likely due to?
hypercoagulable states
What is gold standard imaging for mesenteric ischmeia?
multidetector CT angiography of the abdomen and pelvis
