Pelvic Inflammatory Disease

Question 1

PID is an infection of the upper female reproductive tract. Which of the following is NOT one of the internal sex organs that can be affected by PID?

1 - ovaries
2 - uterus
3 - vulva
4 - fallopian tubes
5 - cervix

Answer 1

3 - vulva

Question 2

PID is an infection of the upper female reproductive tract. Which of the following is NOT one of the external sex organs?

1 - labia minora
2 - labia majora
3 - clitoris
4 - mons pubis
5 - cervix

Answer 2

5 - cervix

• name for all the external sex organs together is the vulva

Question 3

PID is caused by an infection of the mucosal membrane of the vagina or cervix. Which causes inflammation of this mucosal layer that can affect the uterus, fallopian tubes, ovaries and the surrounding peritoneum. PID is also referred to as an ascending infection as it moves up the reproductive tract. What is this called if the vagina is affected?

1 - vaginitis
2 - bacterial vaginosis
3 - vagina viralosis
4 - all of the above

Answer 3

2 - bacterial vaginosis

• essentially there is an imbalance in vaginal flora

Question 4

Although the exact incidence of PID is unknown, which age group has the highest incidence?

1 - 16-20
2 - 20-24
3 - 30-40
4 - >40

Answer 4

2 - 20-24

• rates are declining though due to National Chlamydia Screening Programme

Question 5

A patients presents to the GUM clinic and based on clinical examination you suspect the patient has PID. Which of the following are you NOT worried about testing and treating for as a cause of the PID?

1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
3 - Mycoplasma Genitalium
4 - Escherichia coli
5 - Anaerobic organisms

Answer 5

4 - Escherichia coli

• most common cause of UTI but not PID

Question 6

There are number of risk factors that can increase the risk of PID. Which of the following is NOT a risk factor for PID?

1 - unprotected sex and multiple sexual partners
2 - combined oral contraception pill
3 - intrauterine contraceptive device (IUCD) in previous 20 days
4 - termination of pregnancy
5 - retrograde menstruation

Answer 6

2 - combined oral contraception pill

Question 7

Which part of the internal sex organs is most problematic if the infection reaches this?

1 - ovaries
2 - uterus
3 - vulva
4 - fallopian tubes
5 - cervix

Answer 7

4 - fallopian tubes

• this is call salpingitis
• inflammatory cells invade fallopian tubes, filling it with pus
• scar tissue forms and creates similar tubes and pouches as diverticula
• causes infertility

Question 8

A 21 year old female patient presents to the GUM clinic after having unprotected sex with several men with the following symptoms:

• abdominal / pelvic pain, vaginal discharge, dyspareunia (pain during sex) with post coital bleeding and purulent vaginal/cervical discharge.

All of the following are differentials, but which of the following is the most likely diagnosis?

1 - chlamydia alone
2 - endometriosis
3 - PID
4 - ectopic pregnancy
5 - appendicitis

Answer 8

3 - PID

Typical PID symptoms:
- dyspareunia
- pain BUT no dysmenorrhea
- post coital bleeding

Question 9

Can PID affect the menstrual cycle?

Answer 9

• yes
• can cause abnormal menstrual cycles

Question 10

PID can cause inflammation of peritoneum and glissons capsule forming violin string adhesions that causes upper right quadrant pain. What is the name for this group of symptoms?

1 - Fitz-Hugh Curtis syndrome
2 - Courvoisier syndrome
3 - Mirizzi syndrome
4 - Gilberts syndrome

Answer 10

1 - Fitz-Hugh Curtis syndrome

• typically causes by chlamydia or gonorrhoea

Question 11

A 21 year old female patient presents to the GUM clinic after having unprotected sex with several men with the following symptoms:

• abdominal / pelvic pain, vaginal discharge, dyspareunia (pain during sex) with post coital bleeding and purulent vaginal/cervical discharge.

Which of the following would you want to test for immediately to rule out?

1 - urine for pregnancy test
2 - urine for protein and creatinine
3 - blood for pregnancy test
4 - blood for liver enzymes

Answer 11

1 - urine for pregnancy test

• ectopic pregnancies can present in a similar manner

Question 12

Which imaging modality is most useful in trying to diagnose patients with PID?

1 - ultrasound
2 - MRI
3 - CT with contrast
4 - X-ray

Answer 12

1 - ultrasound

• easy and accessible
• can identify ectopics, abscess, fibroids, hydrosalpinx, etc..

Question 13

We need to do swabs of the cervix to try and identify the cause of PID, if PID is suspected. Which 2 of the following are the most common causes of PID?

1 - Chlamydia trachomatis
2 - Ardnerella vaginalis
3 - Mycoplasma hominis
4 - Neisseria gonorrhoeae

Answer 13

1 - Chlamydia trachomatis
4 - Neisseria gonorrhoeae

• needs to be a high vaginal swab

Question 14

What is the best most single test that can be used to confirm a diagnosis of PID?

1 - positive chlamydia trachomatis and Neisseria gonorrhoeae tests
2 - Elevated CRP and ESR
3 - laparoscopy
4 - urinalysis

Answer 14

3 - laparoscopy

• provides visualisation of fallopian tubes, but invasive and expensive
• typically diagnosed through swabs and clinical diagnosis

Question 15

Does a negative swab rule out PID?

Answer 15

• no
• can still have PID

Question 16

If a patient is diagnosed with PID, broad spectrum antibiotics should be given, without waiting for the microbiology results. Which of the following should be given as an intramuscular injection?

1 - Doxycycline
2 - Prednisolone
3 - Gentamicin
4 - Ceftriaxone

Answer 16

4 - Ceftriaxone
- broad spectrum antibiotic
- inhibits bacterial cell wall synthesis
- 1g dose prescribed

Question 17

If a patient is diagnosed with PID, broad spectrum antibiotics should be given, without waiting for the microbiology results. Ceftriaxone is given as a 1g does intramuscularly followed by which 2 antibiotics together?

1 - Doxycycline
2 - Prednisolone
3 - Gentamicin
4 - Metronidazole

Answer 17

1 - Doxycycline
- 100 mg twice daily for 14 days

4 - Metronidazole
- 400 mg twice daily for 14 days

Question 18

A 24 year old female patient has presented to the GUM clinic with a diagnosis of PID, for which she is being treated for. You need to discuss all of the following, EXCEPT which one with her as a complication of PID?

1 - Fitz-Hugh Curtis syndrome
2 - tubo-ovarian abscess
3 - infertility
4 - ectopic pregnancy

Answer 18

2 - tubo-ovarian abscess
- not common in PID