Gynecology Flashcards
(170 cards)
1
Q
What is primary amenorrhea?
A
the absense of menses by age 13 without pubertal development
OR
the absence of menses by age 15 regardless of pubertal development
2
Q
What is secondary amenorrhea?
A
the absense of menses for 3 months with previously regular cycles
OR
the absense of menses for 6 months with previously irregular cycles
3
Q
What is the MCC of secondary amenorrhea?
A
Pregnancy
4
Q
What is the suspected etiology of amenorrhea in a patient with an elevated prolactin?
A
Prolactinoma
get a brain MRI
5
Q
What is the suspected etiology of amenorrhea in a patient with low FSH?
A
HPA failure
OR
pubertal delay (athletes, anorexia)
6
Q
What is the suspected etiology in a patient with high FSH?
A
Ovarian causes
(premature ovarian failure, turners syndrome)
7
Q
How do you treat amenorrhea?
A
Treat the underlying cause
* No desire to be pregnant: OCPs
* Desires pregnancy: cyclic progesterone
8
Q
What is abnormal/dysfunctional uterine bleeding?
A
Unexplained, abnormal bleeding in a non-pregnant women
MC > 40 years old
9
Q
What are common causes of AUB?
A
PALM-COEIN
* Polyp
* Adenomyosis
* Leiomyoma
* Malignancy & hyperplasia
* Coagulopathy
* Ovarian dysfunction
* Endometrial
* Iatrogenis (IUDs)
* Not otherwise classified
MCC: anovulatory
10
Q
What labs should be ordered for AUB?
A
CBC, TSH, iron studies, PT/PTT, progesterone, prolactin, FSH
11
Q
What testing should be done for AUB?
A
- Initial: TVUS
- Gold standard: D&C
- R/o CA: endometrial bx
12
Q
How do you treat AUB?
A
- Levonorgestrel-releasing IUD: most effective longterm tx
- NSAIDs/tranexamic acid: unable/unwilling to use hormonal therapy
- Definitive: hysterectomy
- Acute hemorrhage: high-dose IV estrogen, COCs or oral progestins
13
Q
What is dysmenorrhea?
A
Painful menstruation that affects normal activities
13
Q
What is primary dysmenorrhea?
A
painful menses that begins within 12 months of menarche due to increased prostaglandins
14
Q
What is secondary dysmenorrhea?
A
- Painful menses due to another disorder
- MCC: PID & endometriosis
- MC in 20-30 year olds
14
Q
What are symptoms of dysmenorrhea?
A
Recurrent, crampy midline lower abdominal pain or pelvic pain 1-2 days before or at the onset of menses & gradually decreases over 12-72 hours
HA, N/V/D, fatigue, malaise
14
Q
How is dysmenorrhea diagnosed?
A
Clinically
TVUS helpful
15
Q
How is dysmenorrhea treated?
A
- NSAIDs: started prior to pain onset and taken for 2-3 days
- Combined OCPs
- Laproscopy: indicated if unresponsive to 3 cycles of inital treatment to rule out secondary causes
16
Q
What is first line treatment for vasomotor symptoms of menopause?
A
HRT
* No uterus: estrogen only
* Uterus present: estrogen + progestin
17
Q
What is second line for vasomotor symptoms of menopause?
A
SSRIs
* Paroxetine
* Escitalopram
* Venlafaxine
18
Q
How do you treat osteoperosis in menopause?
A
- Calcium & vitamin D supplements
- Bisphosphonates (alendronate)
- DEXA scan at 65 and every 2 years
- SERMs (Raloxifene): alterntative to estrogen replacement in menopausal women at risk of osteoporosis
19
Q
How do you treat vaginal dryness?
A
- Topical vaginal estrogens
- Vaginal mositurizers
- Lubricant
20
Q
How do you treat stress incontience?
A
- Kegal exercises
- Estrogen replacement (if due to menopause)
- Sling procedure
21
Q
How do you treat urge incontinence?
A
- Bladder training, kegals
- Mirabegron (Beta-3 agonist, least sx)
- Oxybutyin (antimuscurinic)
22
What is premensutral syndrome?
recurrent physical and emotional symptoms that develop during the 5 days before the onset of menses and subside within 4 days after menstruation begins
23
What is premenstural dysphoric disorder?
Severe PMS with functional impairment when anger, irritablity and internal tension are prominent
24
What are symptoms of PMS and PMDD?
Bloating, weight gain, constipation, anxiety, breast tenderness, depression, cravings, **irritablity**, mood swings, anger
25
How is PMDD diagnosed?
DSM-5 criteria
* Sx occur during the last week of the luteal phase of most menstrual cycles during the previous 12 months and remit within a few days after the onset of menstruation
* Total of 5 symptoms needed
26
How are PMS and PMDD treated?
* Conservative: diet & **exercise**
* 1st line: SSRIs -- Fluoxetine, sertralin
* Pain/cramping: NSAIDs
* Bloating: Spironolactone
* w/ contraception: OCPs with drospierenone
27
What are gonorrhea and chlamydia?
Neisseria gonorrhea
* gram negative diplococci
Chlamydia trachomatis
* gram negative
* **MCC of cervicitis**
28
What are the symptoms of gonorrhea and chlamydia?
Mostly ASX
* Female: **mucopurulent discharge**, post-coital bleeding, friable cervix, urinary sx
* Male: dysuria, urethral discharge
29
How are gonorrhea and chlamydia diagnosed?
NAAT
* Annually screening recommended by the CDC in sexually active women
30
How are gonorrhea and chlamydia treated?
Pregnant
* Gonorrhea only or coinfxn: azithroymycin 1g PO & ceftriaxone 500 mg IM
* Chlamydia: azithromycin 1 g PO
* Test of cure 4 weeks after tx
Not-Pregnant
* Gonorrhea: ceftriaxone 500 mg IM
* Chlamydia: doxycycline 100 mg BID x 7 days
* Retesting 3 months after tx
31
What are symptoms of herpes simplex cervicitis?
**Vulvar burning & pruritus preceded by multiple vesicles on an erythematous base**
* flu-like sx, malaise, myalgias, N/D, fever
32
How is HSV cervicitis diagnosed?
* Gold standard: viral culture
* Tzanck smear: multinucleated giant cells
33
How is HSV cervicitis treated?
* Primary: valacyclovir 1g BID x 10 days
-----Alt. acyclovir 400 mg TID x 7-10 days
* Recurrent: topical lido + valcyclovir
* Supressive: 500 mg once daily
34
What is condylomata acuminata?
Anogenital warts
* MCC HPV types 6 & 11
* MC STI worldwide
35
What are symptoms of condylomata acuminata?
* Flat, dome-shaped, verrucous, and cauliflower-shaped warts soft to palpation
* Single or multiple, MC fleshy-colored but can vary
* Pap smear: **Koilocytic squamous epithelial cells in clumps**
36
How is condylomata acuminata treated?
Self: **imiquimod**, podophyllotoxin
Office: trichloroacetic acid, cryotherapy, surgery
37
What is HPV cervicitis?
Human papilloma virus
* Types **16** & 18
* **MCC of cervical cancer**
* RF: IC + sexually active
38
What are symptoms of HPV cervicitis?
postcoital bleeding, dyspareunia, large amounts of unusal dyscharge
39
How is HPV cervicitis diagnosed?
**White, sharply demarcated lesion of the cervix after acetic acid is applied**
* HPV viral typing
40
How is HPV cervicitis treated?
Surgical excision
* LEEP
41
How can HPV be prevented?
**Gardasil-9**
* Ages 9-14: 2 doses at 0, 6-12 months
* > 15: 3 doses at 0, 2 and 6 months
42
What is trichomoniasis?
Trichomonas vaginalis
* flagellated protozoan
* sexually transmitted
* can affect fertility!
43
What are symptoms of trichomoniasis?
**Frothy yellow-green discharge worse with menses**
* itching, dysuria, post-coital bleeding
* men usually asx
44
What are physical exam findings of trichomoniasis?
**Friable Cervix**
* Strawberry cervix
45
How is trichomoniasis diagnosed?
**Saline wet mount**: flagellated motile trichomonads
* pH > 5
46
How is trichomoniasis treated?
**Metronidazole**
* Screen/treat partners
* Retest in 2 weeks
* Prevention: spermicidal agents
47
What is bacterial vaginosis?
**Gardnerella vaginalis**
* **MCC of vaginitis**
* Due to lack of lactobacilli
* Not sexually active, but MC in sexually active women with new/multiple partners
48
What are symptoms of bacterial vaginosis?
Thin, milky discharge with a fishy odor
* Worse after sex and during menses
* Vaginal pH > 4.5
49
How is bacterial vaginosis diagnosed?
* Amine whiff test (KOH prep)
* **Clue cells** on wet mount (most reliable)
50
How is bacterial vaginosis treated?
Metronidazole 500 mg BID x 7 days
* Alt: clindamycin
51
What is candidiasis?
**Candida albicans**
* RF: DM, steriods, pregnancy, recent abx use
52
What are symptoms of candidasis?
**Thick, white, "cottage-cheese" discharge + itching**
* Dyspareunia, beefy red vaginal mucosa
53
How is candidiasis diagnosed?
KOH: budding hyphae, yeast & spores
54
How is candidiasis treated?
Fluconazole 150mg PO x1
55
What is PID?
Ascending infection of the uterus, ovaries and fallopian tubes
* Mixed etiolgoy: chlamydia (MC), gonorrhoeae, BV
56
What are symptoms of PID?
**Pelvic or lower abdominal pain, often bilateral and worse during sex**
* abnormal vaginal discharge, fever, bleeding, N/V
57
What are physical exam findings of PID?
**Cervical motion tenderness with chandelier sign**
58
How is PID diagnosed?
Mostly clinical
* NAAT for chlamydia or gonorrhea
59
How is PID treated?
* Outpatient: ceftriaxone + doxycycline + metronidazole
* Inpatient (pregnant, severe): IV ceftoxin + doxycycline
60
What are complications of PID?
* Chronic pelvic pain due to adhesions
* infertility
* tubo-ovarian abscess
* ectopic pregnancy
* Fitz Hugh-Curtis syndrome
61
What is chancroid?
Haemophilus ducreyi
* Painful anogenital ulcers
* gram negative coccobacillus
* sexually transmitted
* MC in undeveloped countaries
62
What are symptoms of chancroid?
**Tender erythematous papules** with a ragged border and purulent base that become **pustules** then **painful ulcers** with soft irregular margins
* Marked unilateral inguinal lymphadenopathy
* In women: dysuria, dyspareunia, abnormal discharge, rectal bleeding, painful defecation
63
How is chancroid diagnosed?
* Rule out other causes: RPR/VDRL, PCR
* Gram stain
* Chocolate agar culture
64
How is Chancroid treated?
Ceftriaxone 250mg IM x 1
OR
Azithromycin 1g PO x1
65
What is lymphogranuloma venereum?
Painless genital ulcer
* Due to chlamydia trachomatis, esp. serotypes L1, L2, and L3
* **MC in undeveloped countries (tropical areas)**
66
What are symptoms of lymphogranuloma venereum?
3 stages
1. painless genital ulcers or papules
2. unilateral or bilateral tender inguinal and/or femoral lymphadenopathy (buboes)
3. strictures, fibrosis, and fistulae of the anogenital area
67
How is lymphogranuloma venereum diagnosed?
NAAT
* Rule out other causes
68
How is Lymphogranuloma venereum treated?
Doxycycline 100 mg PO BID x 21 days
* Alt. erythromycin 500 mg PO QID x 21 days
* +/- I&D
69
What is syphilis?
Treponema pallidum
70
What are symptoms of syphilis?
3 stages following a 3 week incubation period
1. **painless genital ulcer (chancre)** for 3 to 6 weeks
2. **nonpruritic maculopapular rash on palms and soles** or condyloma latum (painless, flat, gray, wart-like lesions), lymphadenopathy, fatigue/malaise for 2 to 6 weeks
3. major vessel changes, neurosyphilis, gummas (painless, soft, tumor-like masses that can form in the skin, bones, liver, or any other organ)
71
How is syphilis diagnosed?
RPR/VDRL confirmed by the treponemal antibody-absorption test (FTA-ABS)
72
How is syphilis treated?
Pen G IM
73
What is the most common type of breast cancer?
Infiltrating ductal carcinoma
74
What are symptoms of breast cancer?
Hard, nontender, immobile breast mass with irregular boarders
* Pagets (ductal CA): eczematous nipple lesion
* Inflammatory: peau d'orange
75
How is breast cancer diagnosed?
Inital test:
* > 40: mammogram: group microcalcification & spiculated high-density masses
* < 40: ultrasound
Initial procedure: large needle core bx
76
How is breat cancer treated?
* Early stages I, IIA, IIB: lumpectomy + receptor tx if needed
* Stages IIB-IIIA & triple negative: chemo then surgery, then radiation
* Stage IV (metastatic): pallative care
77
Medications for estrogen receptor + breast cancer
* Premenopause: Tamoxifen
* Postmenopausal: Letrozole, anastrozole
78
Medications for HER2+ breast cancer
Trastuzumab after surgical excision + chemo
79
What are the screening recommendations for breast cancer?
Mammogram every 2 years for women 50-74 years old
80
What is the MC type of cervical cancer?
Squamous Cell Carcinoma
81
What is the most important risk factor for cervical cancer?
HPV, primarily types 16 & 18 but also 31 & 33
82
What are symptoms of cervical cancer?
* Early: post-coital bleeding
* Late: back pain, anorexia, weight loss
83
How is cervical cancer diagnosed?
* Friable, bleeding cervical lesion on exam
* Biopsy and colposcopy definitive
84
How is cervical cancer treated?
Resect and/or chemotherapy and radiation
* Stage 1: conservative, simple, or radical hysterectomy
* Stage 2 +: chemo +/– radiation
85
What are the cervical cancer screening guidelines?
* 21-29: pap q3yrs
* 30-65: pap + HPV q5yrs
* >65 or hystrectomy: no screening
86
What follow-up testing is required for a cervical pap histology of ASC-US or LSIL?
HPV testing
* positive & > 25: colposcopy
* negative or < 25: retest in 1 year
87
What follow-up testing is required for a cervical pap histology of HSIL?
Colposcopy
* Outside cervix – LEEP or cryotherapy
* Inside cervix – cone biopsy
88
How can cervical cancer be prevented?
HPV vaccine
89
What is endometrial cancer?
* MC gyn cancer in the US
* **MC type: adenocarcinoma**
* MC in postmenopausal women
90
What are risk factors for endometrial cancer?
* Age
* Lynch syndrome
* PCOS
* Tamoxifen
91
What is a protective factor against endometrial and ovarian cancer?
Combined estrogen + progestin
92
What are symptoms of endometrial cancer?
heavy, prolonged, frequent menses or postmenopausal bleeding
93
How is endometrial cancer diagnosed?
Initial: **TVUS** - thickened enometrial stripe > 4 mm
Definitive: endometrial bx
94
How is endometrial cancer treated?
* Stage 1: TAH-BSO
* Stage 2: TAH-BSO + lymph node excision + radiation
* All others: TAH-BSO + lymph node excision + radiation + chemo
95
What are the types of ovarian cancer?
Most deadly gyn cancer
* **Epithelial (MC): > 50 years old**
* Stromal: any age
* Germ cell: ages 15-19
96
What are symptoms of ovarian cancer?
ASX until late disease
* pain, bloating, earily satiety, anorexia, weight loss
97
What are physical exam findings of ovarian cancer?
Palpable abdominal/ovarian mass
* solid, fixed, irregular
* ascities
98
How is ovarian cancer diagnosed?
Initial: TVUS
Labs: CA-125, AFP, LHD, hCG, testosterone
99
How is ovarian cancer treated?
* Stage I: TAH-BSO + selective lymphadenectomy & omentectomy
* Stages II-TV: surgical removal followed by chemo
* Monitoring: serum CA-125
100
What is the MC type of vaginal and vulvar cancers?
Squamous cell carcinoma
101
What are risk factors for vaginal and vulvar cancer?
* HPV subtypes 16, 18 & 31
* Smoking
102
What are symptoms of vaginal cancer?
* MC 60-65 years old
* Usually secondary to another cancer
* Changes in menstration, abnormal vaginal bleeding
103
How is vaginal cancer diagnosed?
Direct visualization of lesion/mass/plaque/ulcer on the upper 1/3 of the posterior vaginal wall (MC site)
104
How is vaginal cancer treated?
Radiation
105
What are symptoms of vulvar cancer?
* Peak incidence at 50 years old
* Single pruritic lesion on labia majora (MC site)
* Pagets: red and white ulcerative lesions
106
How is vulvar cancer diagnosed?
Bx & histology
* Acetic acid or staining with toluidine blue may help direct optimal biopsy location
107
How is vulvar cancer treated?
Vulvectomy and lymph node dissection
* Pagets: Local resection
108
What is a breast abscess?
local pus collection in breast tissue
* **MCC: staph aureus**
* **MC in primigravida breastfeeding**
109
What are symptoms of a breast abscess?
Unilateral painful inflammation of breast
* +/- fever, malaise
110
What are physical exam findings of a breast abscess?
Unilateral tender indurated fluctuant mass
111
How do you diagnosis a breast abscess?
Mostly clinical
* US to clarify cellulitis vs abscess if needed
* Severe: blood culture for ABX selection
112
How do you treat a breast abscess?
**US guided needle aspiration + ABX + contuine breastfeeding**
* Nonsevere: dicloxacillin, cephalexin
* MRSA: bactrim, clindamycin
* Severe: vanco
113
What is a fibroadenoma?
Benign solid tumor
* hormone dependent
* MC in young adults & adolescence
* MC in AA
114
What are symptoms of fibroadenoma?
painless, slow growing mass that does NOT significantly change size with menses
115
What are physical exam findings of a breast fibroadenoma?
Solid, firm, rubbery, mobile lesion ~2.5 cm
116
How is fibroadenoma diagnosed?
Clinical
* US: solid, well-circumscribed, avascular mass
* Definitive: FNA -- fibrous tissue & collagen in a "swirl"
117
How is fibroadenoma treated?
Observation, repeat US in 3-6 months
* Excision
118
What is fibrocystic breast disease?
* MC benign breast disorder
* Exaggeration of normal changes in breast tissue due to cyclic levels of estrogen
119
What are symptoms of fibrocystic breast disease?
Cyclic bilateral breast pain + fluctuation in size
* Sx peak before menses
120
What are physical exam findings of fibrocystic breast disease?
multiple, nodular, mobile, smooth round/ovid lumps bilaterally of varying sizes
121
How is fibrocystic breast disease diagnosed?
* **Initial: US w/ biopsy**
* Mammogram, aspiration
122
How is fibrocystic breast disease treated?
Supportive
* NSAIDs, OCPs
123
What is mastitis?
Infection of the breast
* MC in lactating women in the 1st 12 weeks postpartum
* **MCC: staph aureus**
124
What are symptoms of mastitis?
**Unilateral firm, red, tender, swollen area of the breast**
* sore, cracked nipples or visable fissure
* fever, myalgia, chills, malaise, flu-like sx
125
How is mastitis treated?
**NSAIDs, hot compress, emptying of breast, contuine breastfeeding**
```
```
> 24 hrs: ABX
* **Dicloxacillin, cephalexin**
* MRSA: bactrim, clnidamycin
* Severe: canvo
126
What are symptoms of uterine prolapse?
vaginal bulge/fullness
* pelvic pressure, constipation
* urinary & sexual dysfunction
* worse with prolonged standing, better with lying down
127
What are the stages of uterine prolapse?
1. Uterus is in the upper 2/3 of the vagina
2. Uterus is at the opening of the vagina
3. Uterus has protruded out of the vagina
4. Uterus is completely out of the vagina
128
How is uterine prolapse treated?
* Conservative: kegels, pessaries, PT
* Surgery
129
What is ovarian torsion?
Complete/partial rotation of ovarian ligamental supports resulting in ischemia
* RF: ovarian mass
130
What are symptoms and physical exam findings of ovarian torsion?
* Sx: acute onset of unilateral pelvic pain + N/V
* PE: palpable adnexal mass
131
How is ovarian torsion diagnosed?
* **US w/ doppler**: decreased blood flow
* Definitive: direct visualization at the time of surgical exploration
132
How is ovarian torsion treated?
Laproscopy w/ detorsion
133
What are ovarian cysts?
Fluid-filled sac within the ovaries, MC related to ovulation
* Can be functional or neoplastic
* Functional: follicular (MC), corpus luteum
134
What are symptoms of ovarian cysts?
ASX (functional) or pelvic pain
* amenorrhea, delayed menses
135
What are symptoms of a ruptures ovarian cyst?
abrupt, unilateral, sharp, focal pain that occurs during sex or with strenous physical activity
136
How are ovarian cysts diagnosed?
Ultrasound
* Follicular: smooth, thin-walled, unilocular
* Corpus luteal: complex, thick, peripheral vascularity
* Rupture: adnexal mass + pelvic fluid
137
How are ovarian cysts treated?
**OCPs**, cystectomy
* Most spontaneously resolve within a few weeks
138
What is endometriosis?
The presense of endometrial tissue outside of cavity, **MC in the ovary**
* estrogen-stimulated inflammatory respone
* MC in ages 25-35
139
What are symptoms of endometrosis?
**Dysmenorrhea, dyspareunia, dyschezia**
* cyclic pelvic pain peaking 1-2 days before menses
* Sx improve with pregnancy and after menopause
140
What are physical exam findings of endometriosis?
**fixed retroverted uterus**
* tenderness in the posterior vaginal fornix
141
How is endometriosis diagnosed?
Inital: Ultrasound
Definitive: Laparoscopy with biopsy
* "powder burn"
* "**chocolate cyst**" if ovaries
Endometrioma on US: ground glass
142
How is endometriosis treated?
* Definitve: TAH-SBO
* Medical: NSAIDs, OCPs, Danazol
* **Complications: infertility**
143
What is infertility?
Failure to concieve after 1 year of regular unprotected sex
* **MCC: Anovulatory cycles**
* In males: abnormal spermatogenesis
144
How is infertility diagnosed?
**Hysterosalpingography**
* to evaluate tubual patency & abnormalities
* progesterone levels
145
How is infertility treated?
**Letrozole**
* PCOS: clomiphene citrate
* Fallopian tube defect: IVF
146
What is leiomyoma?
Uterine fibroids
* Benign smooth muscle tumors that grow in reponse to estrogen
* MC benign gyno tumor
* **MC location: intramural**
* MCC of AUB
147
What are risk factors for leiomyoma?
AA, > 35 years, HTN, nulliparity, FHx, early menarche < 10 years
148
What are symptoms of leiomyoma?
ASX or DUB
* **MC: heavy/prolonged menses**
* Infertility, pelvic pain, anemia
149
What are physical exam findings of leiomyoma?
**Nontender irregular enlarged mobile uterus**
150
How is leiomyoma diagnosed?
US: heterogenic hypoechoic mass or masses
151
How is leiomyoma treated?
Observation, TX if SX
* NSAIDs, traneximic acid
* OCPs, GNRH agonist (**leuprolide**, natarein)
* Myomectomy: preserve fertility
* Hysterectomy: definitve
152
What is PCOS?
Gonadotropic dysregulation with increased LH
* a/w endometrial cancer due to excess estrogen
* **MCC of infertility**
153
What are symptoms of PCOS?
* bilateral enlarged cystic ovaries
* insulin resistance
* hyperandrogenism
* amenorrhea or oligomenorrhea
154
How is PCOS diagnosed?
Rotterdam criteria (2/3)
* hyperandrogenism
* ovulatroy dysfunction
* cystic ovaries on US
US: string of pearls
Increased LH:FSH & testosterone
155
What is STAT?
Have you been
* Slapped
* Threatened
* or Thrown
155
What is adenomyosis?
Extension of endometrial tissue into myometrium
* increased estrogen stimulates hyperplasia of basalis layer
155
How do you treat PCOS?
OCPs & lifestyle changes for weight loss
* Metformin, spironolactone, clomiphene citrate
155
What is HITS?
Does your partner
* Hit
* Insult
* Threaten
* or Scream at you
155
What is RADAR?
Remember to
* Ask
* Document
* Assess
* and Refer
156
What are symptoms and physical exam findings of adenomyosis?
Sx: ASX, dysmenorrhea, menorrhagia, chronic pelvic pain
PE: diffusedly enlarged symmetrically soft or "boggy" uterus
157
How is adenomyosis diagnosed?
US then **MRI**
158
How is adenomyosis treated?
NSAIDs, **levonorgestrel releasing IUD**
* Definitive: hysterectomy
159
How do you treat cystitis?
Nitrofurantoin
* avoid in 1st trimester and at term
* alt. fosfomycin
Bactim, ciprofloxacin
160
What is a tubo-ovarian abscess?
inflammatory mass involving the fallopian tubes, ovaries or occasionally other pelvic organs
* most occur as a complication of PID
161
What are symptoms of a tubo-ovarian abscess?
acute lower abdominal pain, vaginal discharge, fever, chills
* ruptured: leaking contents into abdominal cavity, acute abdomen, sepsis
162
How is tubo-ovarian abscess diagnosed?
Mostly clinically with the presence of an inflammatory adrenxal mass on TVUS or CT
163
How is tubo-ovarian abscess treated?
IV cefoxitin + doxycycline +/- drainage
* Ruptured: immediate surgical exploration
