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EM Exam 2 > GU/GYN emergencies > Flashcards

GU/GYN emergencies Flashcards

1
Q

Lack of blood flow of an ovary under u/s in a patient who presents with pelvic pain should have you concerned for what?

A

ovarian torsion

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2
Q

What is the most important test to order if a patient presents with ovarian cysts?

A

HCG to assess for ectopic pregnancy

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3
Q

Syncope and abdominal pain in a pregnant patient is __________ until proven otherwise

A

ruptured ectopic pregnancy

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4
Q

Sudden onset of unilateral pelvic pain (R>L) with associated nausea and vomiting following exercise or intercourse is consistent with what GYN emergency?

A

ovarian cysts

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5
Q

What antibiotic do you give to treat pyelonephritis as an inpatient?

A
  • ceftriaxone 1g IV q24hr
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6
Q

What is the primary risk factor for PID?

A

being sexually active

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7
Q

What HCG do you want to order for ectopic pregnancy?

A

serum HCG

  • need to repeat in 2 days*
  • in ectopic shouldn’t rise as fast*
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8
Q

What is the gold standard and treatment for ovarian torsion?

A

laparoscopy with detorsion or oophorectomy (if indicated)

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9
Q

PID is most commonly associated with what 2 pathogens?

A
  • gonorrhea

- chlamydia

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10
Q

Common etiologies of first trimester vaginal bleeding include these 4 things.

A
  • implantation bleeding
  • ectopic pregnancy
  • bleeding from other source
  • threatened or inevitable abortion
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11
Q

How is a ruptured ovarian cyst managed? (3 points)

A
  • assess hemodynamic status
  • pain control with NSAIDs
  • consider GYN consult if unstable or anemic
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12
Q

What is the most common location of an ectopic pregnancy?

A

in the fallopian tubes

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13
Q

Dysfunctional uterine bleeding in post-menopausal women should be concerning for what malignancy?

A

endometrial cancer

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14
Q

If someone is stable and has an ectopic pregnancy what medical treatment do gynecologists give to abort the pregnancy?

A

methotrexate

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15
Q

What sonographic finding is consistent with a ruptured ectopic pregnancy?

A

free fluid

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16
Q

If a patient presents for sexual assault, you can offer evidence collection kit if assault occurred within the past ____ hours.

A

72 hours

17
Q

Why do you want to get a type and screen in a patient with first trimester bleeding?

A

to check for Rh factor and possibly administer RhoGAM if mom is Rh negative

18
Q

An ovarian mass of ___ cm or larger is a risk factor for ovarian torsion

A

5 cm or larger

19
Q

In ovarian torsion pain may be __________ as ovary can detorse/retorse

A

intermittent

20
Q

What is the sign on pelvic untrasound that demonstrates a viable intrauterine pregnancy (IUP)?

A

cardiac activity

21
Q

RUQ pain in the setting of PID should have you concerned for what diagnosis?

A

Perihepatitis (Fitz-Hugh Curtis Syndrome)

22
Q

What medication can give you a false positive nitrite test?

A

pyridium

23
Q

What antibiotic do you give to treat an uncomplicated UTI?

A

Macrobid 100mg BID for 5 days

24
Q

What distinguishes between a threatened or inevitable abortion?

A
  • if the Os is closed = threatened

- if the Os is open = inevitable

25
Q

What imaging test do you want for ovarian torsion?

A

pelvic ultrasound with color doppler

but it is a clinical diagnosis and should consult gynecology ASAP

26
Q

What is the treatment for PID? (3 antibiotics)

A
  • Doxycycline 100 mg BID 14 days
  • Ceftriaxone 500 mg IM dose 1 time
  • Flagyl 500 mg TID
27
Q

Any abdominal pain with unexplained vaginal bleeding in a known pregnancy is consistent with what diagnoses?

A

ectopic pregnancy

28
Q

What antibiotic do you give to treat urosepsis secondary to pyelonephritis?

A

broad spectrum IV antibiotics

vancomycin (wt based) + cefepime 2g

29
Q

What antibiotic do you give to treat pyelonephritis as an outpatient?

A
  • ciprofloxacin 500 mg BID for 7 days

* if you can’t tolerate FQNL then take bactrim DS*

30
Q

Why do you need a 48 hour follow up if HCG is below discrimatory zone?

A
  • to see if it is a real pregnancy (HCG doubled in 48 hours)

- OR ectopic (HCG not increasing as high)

31
Q

What is the acute management for a ruptured ectopic pregnancy?

A
  • place two large bore IVs

- STAT gynecology consult for laparoscopy

32
Q

What is the time window to treat ovarian torsion?

A

no time window - patient’s can be torsed for days and still have viable tissue

33
Q

CVAT with associated fever, nausea and vomiting is consistent with what diagnosis?

A

pyelonephritis

34
Q

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?

A

pelvic inflammatory disease

35
Q

What is the first sonographic sign of pregnancy?

A

gestational sac

EM Exam 2 (5 decks)

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