GU/GYN emergencies Flashcards
Lack of blood flow of an ovary under u/s in a patient who presents with pelvic pain should have you concerned for what?
ovarian torsion
What is the most important test to order if a patient presents with ovarian cysts?
HCG to assess for ectopic pregnancy
Syncope and abdominal pain in a pregnant patient is __________ until proven otherwise
ruptured ectopic pregnancy
Sudden onset of unilateral pelvic pain (R>L) with associated nausea and vomiting following exercise or intercourse is consistent with what GYN emergency?
ovarian cysts
What antibiotic do you give to treat pyelonephritis as an inpatient?
- ceftriaxone 1g IV q24hr
What is the primary risk factor for PID?
being sexually active
What HCG do you want to order for ectopic pregnancy?
serum HCG
- need to repeat in 2 days*
- in ectopic shouldn’t rise as fast*
What is the gold standard and treatment for ovarian torsion?
laparoscopy with detorsion or oophorectomy (if indicated)
PID is most commonly associated with what 2 pathogens?
- gonorrhea
- chlamydia
Common etiologies of first trimester vaginal bleeding include these 4 things.
- implantation bleeding
- ectopic pregnancy
- bleeding from other source
- threatened or inevitable abortion
How is a ruptured ovarian cyst managed? (3 points)
- assess hemodynamic status
- pain control with NSAIDs
- consider GYN consult if unstable or anemic
What is the most common location of an ectopic pregnancy?
in the fallopian tubes
Dysfunctional uterine bleeding in post-menopausal women should be concerning for what malignancy?
endometrial cancer
If someone is stable and has an ectopic pregnancy what medical treatment do gynecologists give to abort the pregnancy?
methotrexate
What sonographic finding is consistent with a ruptured ectopic pregnancy?
free fluid
If a patient presents for sexual assault, you can offer evidence collection kit if assault occurred within the past ____ hours.
72 hours
Why do you want to get a type and screen in a patient with first trimester bleeding?
to check for Rh factor and possibly administer RhoGAM if mom is Rh negative
An ovarian mass of ___ cm or larger is a risk factor for ovarian torsion
5 cm or larger
In ovarian torsion pain may be __________ as ovary can detorse/retorse
intermittent
What is the sign on pelvic untrasound that demonstrates a viable intrauterine pregnancy (IUP)?
cardiac activity
RUQ pain in the setting of PID should have you concerned for what diagnosis?
Perihepatitis (Fitz-Hugh Curtis Syndrome)
What medication can give you a false positive nitrite test?
pyridium
What antibiotic do you give to treat an uncomplicated UTI?
Macrobid 100mg BID for 5 days
What distinguishes between a threatened or inevitable abortion?
- if the Os is closed = threatened
- if the Os is open = inevitable
What imaging test do you want for ovarian torsion?
pelvic ultrasound with color doppler
but it is a clinical diagnosis and should consult gynecology ASAP
What is the treatment for PID? (3 antibiotics)
- Doxycycline 100 mg BID 14 days
- Ceftriaxone 500 mg IM dose 1 time
- Flagyl 500 mg TID
Any abdominal pain with unexplained vaginal bleeding in a known pregnancy is consistent with what diagnoses?
ectopic pregnancy
What antibiotic do you give to treat urosepsis secondary to pyelonephritis?
broad spectrum IV antibiotics
vancomycin (wt based) + cefepime 2g
What antibiotic do you give to treat pyelonephritis as an outpatient?
- ciprofloxacin 500 mg BID for 7 days
* if you can’t tolerate FQNL then take bactrim DS*
Why do you need a 48 hour follow up if HCG is below discrimatory zone?
- to see if it is a real pregnancy (HCG doubled in 48 hours)
- OR ectopic (HCG not increasing as high)
What is the acute management for a ruptured ectopic pregnancy?
- place two large bore IVs
- STAT gynecology consult for laparoscopy
What is the time window to treat ovarian torsion?
no time window - patient’s can be torsed for days and still have viable tissue
CVAT with associated fever, nausea and vomiting is consistent with what diagnosis?
pyelonephritis
A patient presents with insidious onset, bilateral, lower abdominal pain with dyspareunia and dysuria. On pelvic exam you see mucopurulent discharge and cervical motion tenderness (CMT). What is the likely diagnosis?
pelvic inflammatory disease
What is the first sonographic sign of pregnancy?
gestational sac
