Gynecological Emergencies

Question 1

Pelvic Inflammatory Disease

Answer 1

C/C - abdominal pain, Fever

O - Gradual
P - intercourse, ambulation
Q - steady ache
R - Diffuse lower abdominal -> RUQ
S - ANY
T - ANY

H - recent Fever, pelvic exam, Chlamydia, Gonorrhea, recent Child birth, pelvic surgery, pregnancy termination

A - ANY

M - Mefoxin, Doxycylin

Pertinent Positive/Negative
\+ Guarding
\+ low grade Fever
\+ Vaginal Discharge ( yellow with odor)
\+ Dyspareunia 
\+ pain on ambulation
\+ PID shuffle
\+ bent forward when ambulating 
\+ Ascending Fever
\+ Nausea/Vomiting

Question 2

Bartholin’s Abscess

Answer 2

C/C - Pain

O - gradual (days to years), chronic, acute
P - walking, sitting, sexual intercourse (any activity that puts pressure on Vulva
Q - discomfort
R - localized to site
S - ANY
T - ANY

H - ANY
A - ANY
M - ANY

Pertinent Positive/Negative
+ Fever
+ inflammation
+ visual lump (hard and hot)

Question 3

Vaginitis

Answer 3

C/C - Fever, pain

O - gradual
P - NON (pressure on vulva, possibly)
Q - Burn, discomfort 
R - NON
S - NON
T - NON

H - Trichomoniasis, poor hygiene, recent childbirth,
A - ANY
M - ANY

Pertinent positive/negative
\+ vaginal discharge
\+ odor (fish)
\+ burn during urination 
\+ itching
\+ postmenopausal 
\+ postpartum 
\+ poor hygiene 
\+ inflammation (labia minora, labia majora, perineal area)
\+ redness
\+ swelling

Question 4

Ovarian Torsion

Answer 4

C/C - Fever, abdominal pain

O - sudden 
P - Exercise
Q - sharp, stabbing 
R - lower abdominal pain -> back, pelvis, thigh
S - Severe
T - ANY

H - pregnancy, pelvic surgeries, trauma, ovarian cyst or tumor, congenital abnormalities, Fallopian tube or ovarian disease
A - ANY
M - ANY

Pertinent negative/positive
\+ Nausea/Vomiting
\+ Fever (late)
- pain on urination
- hematuria

Tx
Pain management
Fluid replacement

Question 5

Ruptured Ovarian Cyst

Answer 5

C/C - Abdominal pain, hypotension, weak and dizzy, syncope, near syncope hypovolemic

O - acute

P - sex, exercise

Q - tearing

R - localized lower abdominal pain, radiates to back or shoulder

S - UNK

T - may or may not have happened before

H - of recent trauma
A - ANY
M - ANY

Pertinent positives
\+ rebound tenderness
\+ dyspareunia
\+ irregular vaginal bleeding 
\+ guarding (possible)
\+ S/S of hypovolemia 
\+ S/S of peritonitis

Question 6

Cystitis

Answer 6

C/C - abdominal pain, Fever

O - gradual 
P - urinating
Q - burning 
R - lower abdominal pain (generalized)
S - ANY
T - ANY

H - Fever, UTI, noncompliance with antibiotic medication
A - ANY
M - Antibiotics, Pyridium

Pertinent negative/positive
\+ Fever
\+ chills
\+ foul smelling Urine
\+ hematuria
\+ burning when urinating 
\+ frequency in urinating 
\+ urinating small amounts

Question 7

Mittelschmerz

Answer 7

C/C - abdominal pain

O - during midcycle after ovulation
P- non
Q - ANY
R - lower abdominal pain (right or left)
S - Mild
T - lasts 24-36 hours

H - ANY
A - ANY
M - ANY

Pertinent negative/positive
\+ low grade Fever
\+ spotting
\+ LMP 2-3 weeks ago 
\+ peritoneal irritation

Question 8

Dysmenorrhea

Answer 8

C/C - abdominal pain, headache, nausea/vomiting, syncope, back pain,

O - during menstruation 
P - non
Q - ANY
R - headache, back pain, leg pain, abdominal pain 
S - ANY
T - ANY

H - No sexual activity, not borne children
A - ANY
M - ANY

Pertinent negative/positive
\+headache
\+faintness
\+dizziness
\+syncope
\+diarrhea 
\+back pain
\+leg pain
\+chills
\+on her period
\+para 0, grava 0

Question 9

Endometritis

Answer 9

C/C - lower abdominal pain

O - gradual
P - non
Q - ANY
R - lower abdominal pain
S - ANY
T - ANY

H - Recent childbirth or abortion
A - ANY
M - ANY

Pertinent positive/negative
+Fever (101-104)
+purulent vaginal discharge
+48-72 hours post procedure/miscarriage

Question 10

Endometriosis

Answer 10

C/C - abdominal pain, body aches

O - Gradual
P - NON
Q - Dull or cramping
R - abdomen 
S - ANY
T - ANY

H - Grava 0, Para 0 (postpone pregnancy)
A - ANY
M - ANY

Pertinent negative/positive
\+dyspareunia
\+painful defecation
\+suprapubic soreness
\+infertility 
\+spotting (before start of period)
\+average age 37

Question 11

Ectopic pregnancy

Answer 11

C/C - abdominal pain

O - sudden
P - Worse on inspiration, palpation
Q - cramp like 
R - lower abdominal region -> to shoulder or neck
S - severe
T - 

H - ectopic pregnancy, Intrauterine Contraceptive device (IUCD), Tubal ligation
A - ANY
M - ANY

Pertinent positive/negative
\+spotting
\+late menstrual period 
\+early signs of pregnancy
\+N/V
\+Syncope
\+Guarding
\+rigidity 
\+distention

Question 12

Uterine prolapse

Answer 12

C/C -

O - gradual, acute
P - heavy lifting, straining 
Q - "sitting in a small ball", heaviness in vaginal area
R - low back pain
S - ANY
T - ANY

H - trauma during childbirth, large babies and difficult vaginal delivery, loss of muscle tone associated with aging, menopause and reduced amounts of circulating, pelvic cavity tumors, obesity, COPD, chronic constipation
A - ANY
M - ANY

Pertinent negative/positive
+vaginal bleeding
+dyspareunia