Pelvic Inflammatory Disease

Question 1

What is a Polymicrobial infection of the upper genital tract

Answer 1

Pelvic Inflammatory Disease

Question 2

PID is commonly associated with what?

Answer 2

(a) The sexually transmitted organisms Neisseria Gonorrhoeae and Chlamydia Trachomatis
(b) Endogenous organisms, including anaerobes
(c) Haemophilus Influenzae
(d) Enteric gram-negative rods
(e) Streptococci

Question 3

PID It is most common in what demographic?
It is a leading cause of what?

Answer 3

-young, nulliparous, sexually active women with multiple
partners
-leading cause of infertility and ectopic pregnancy

Question 4

PID is more likely to occur when…..

Answer 4

(a) There is a history of PID
(b) Recent sexual contact
(c) Recent onset of menses
(d) Recent insertion of an IUD
(e) If the partner has a sexually transmitted disease

Question 5

Acute PID is highly ______ when recent (within 60 days) intercourse has not taken place. So history is important.

Answer 5

Unlikely

Question 6

Women with cervical motion, uterine, or adnexal tenderness should be considered to have PID and be treated with antibiotics unless what?

Answer 6

there is a competing diagnosis such as ectopic pregnancy or appendicitis.

Question 7

Signs and symptoms of what issue?
1) Lower abdominal pain
(2) Chills and fever
(3) Menstrual disturbances
(4) Purulent cervical discharge
(5) Cervical and adnexal tenderness
(6) Many women may have subtle or mild symptoms such as
—(a) Postcoital bleeding
—(b) Urinary frequency
—(c) Low back pain

Answer 7

PID

Question 8

Differential diagnosis PID

Answer 8

(1) Appendicitis
(2) Ectopic pregnancy
(3) Septic abortion
(4) Hemorrhagic or ruptured ovarian cysts or tumors
(5) Torsion of an ovarian cyst
(6) Degeneration of a myoma
(7) Acute enteritis

Question 9

Ancillary study considerations

Answer 9

Lab
1) Endocervical culture for
—-(a) Chlamydia
—-(b) Gonorrhea
—-(c) Other pathogens
(2) Pregnancy test
Imaging
(1) Vaginal ultrasound
(2) Laparoscopy can be used to diagnose PID

Question 10

When is Laparoscopy indicated to diagnose PID

Answer 10

(a) If diagnosis is not certain
(b) If the patient has not responded to antibiotic therapy after 48 hours

Question 11

Treatment PID with severe disease

Answer 11

Cefoxitin (Mefoxin) 2g IV Q6H and doxycycline 100mg PO or IV Q12H
——-1) Continued for a minimum of 24 hours after the patient shows significant clinical improvement.
——-2) Then, an oral regimen should be given for a total course of antibiotics of 14 days.

Question 12

Risk for infertility from PID increases with repeated episodes of salpingitis:
a) __% after the first episode,
b) __% after a second episode, and
c) __% after a third episode.

Answer 12

a) 10%
b) 25%
c) 50%

Question 13

PID
Patient should be MEDEVACED if any of the what are present?

Answer 13

(a) The patient has or is suspected to have a tubo-ovarian abscess.
(b) The patient is pregnant.
(c) The patient is unable to follow or tolerate an outpatient regimen.
(d) The patient has not responded clinically to outpatient therapy within 72 hours.
(e) The patient has severe illness, nausea and vomiting, or high fever not controlled.
(f) Another surgical emergency, such as appendicitis, cannot be ruled out.