PID

[doc0610]

So a patient ( 15 year old ) comes with all the signs of PID. How do you manage the patient next?

1) do you treat the patient ) i.e., hospital and IV antibiotics
2) Pelvic CT to rule out pelvic abscess?

can someone help me out here, thank you

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[wonderbread12]

If you're thinking abscess I would assume she may have a fever or clinical picture is pointing to that. Someone can correct me but I feel like a tuboovarian abscess might have peritoneal like signs. Otherwise PID would be h/o infertility. You'd treat with antibiotics and to r/o abscess I'd do a pelvic ultrasound before messing with a CT

 

[Soilworkgmbh]

Always r/o ectopic pregnancy when female patient presents with peritoneal signs, even in light of new sexual partners without condom use etc.

If PID is suspected with negative pregnancy test, speculum + pelvic exam with cultures probably a good start if their vitals are stable. If they are septic, establishing IV access and starting broad spectrum abx would probably bump up to the top of the list if it was me.

 

[doc0610]

So a patient with fever 39.5 and abdominal tenderness, cervical motion tenderness, tachycardia nausea vomiting, her abdominal examination shows peritoneal signs and tenderness, pelvic examination shows discharge and uterine tenderness

what is it? what will you do next?

 

[doc0610]

Always r/o ectopic pregnancy when female patient presents with peritoneal signs, even in light of new sexual partners without condom use etc.

If PID is suspected with negative pregnancy test, speculum + pelvic exam with cultures probably a good start if their vitals are stable. If they are septic, establishing IV access and starting broad spectrum abx would probably bump up to the top of the list if it was me.

question in the above post, would appreciate your help.

 

[Soilworkgmbh]

question in the above post, would appreciate your help.

Edit: What is it? PID v. Ectopic pregnancy

I would establish IV access and bolus with NS, start broad spectrum abx and obtain urine pregnancy test.

If pregnancy test is positive - probably get a quantitative hCG, transvaginal ultrasound to get baseline hCG and also r/o ectopic. Probably also cervical cultures as well for chlamydia and gonococcus

If negative - cervical cultures. CT maybe. Feel like in 'real life' she would probably get a CT after negative pregnancy test to rule out abscess or api

If I'm on the wrong track anyone please feel free to chip in

 

[doc0610]

Edit: What is it? PID v. Ectopic pregnancy

I would establish IV access and bolus with NS, start broad spectrum abx and obtain urine pregnancy test.

If pregnancy test is positive - probably get a quantitative hCG, transvaginal ultrasound to get baseline hCG and also r/o ectopic. Probably also cervical cultures as well for chlamydia and gonococcus

If negative - cervical cultures. CT maybe. Feel like in 'real life' she would probably get a CT after negative pregnancy test to rule out abscess or api

If I'm on the wrong track anyone please feel free to chip in

So, it's one of the nbme clinical mastery series question for OBGYN, i was confused between IV administration of antibiotics and CT scan. Hence, asking it here, her peritoneal signs are positive, so I am assuming it is an abscess and would require a ct?

 

[Soilworkgmbh]

So, it's one of the nbme clinical mastery series question for OBGYN, i was confused between IV administration of antibiotics and CT scan. Hence, asking it here, her peritoneal signs are positive, so I am assuming it is an abscess and would require a ct?

Well, peritoneal signs are caused by anything that could possibly irritate the peritoneum. Including abscess, infection, ruptured viscous.. The list goes on. So just because someone has peritoneal signs doesn't mean it's absolutely an abscess

 

[doc0610]

Well, peritoneal signs are caused by anything that could possibly irritate the peritoneum. Including abscess, infection, ruptured viscous.. The list goes on. So just because someone has peritoneal signs doesn't mean it's absolutely an abscess

So, how would I differentiate a pt with slapping-oophritis vs TOA? clinically?
I appreciate all the input, thank you

 

[Soilworkgmbh]

I'm sure it was a typo, but I laughed at 'slapping-oophoritis'....but just off the top of my head, I would go with transvaginal or transabdominal ultrasonography as a good start, then more advanced imaging if results are inconclusive - ie contrast CT. Again, n=1 here, this is just the way I would approach the clinical problem

For step 2 purposes, I think it's just important to recognize: 1) stabilize the patient no matter what their problem is (IV access, saline bolus, airway etc.) 2) rule out ectopic pregnancy in a female with peritoneal signs. I think that's pretty high yield stuff. That answer your question?

 

[doc0610]

I'm sure it was a typo, but I laughed at 'slapping-oophoritis'....but just off the top of my head, I would go with transvaginal or transabdominal ultrasonography as a good start, then more advanced imaging if results are inconclusive - ie contrast CT. Again, n=1 here, this is just the way I would approach the clinical problem

For step 2 purposes, I think it's just important to recognize: 1) stabilize the patient no matter what their problem is (IV access, saline bolus, airway etc.) 2) rule out ectopic pregnancy in a female with peritoneal signs. I think that's pretty high yield stuff. That answer your question?

I honestly am tripping on the NEXT best step. So, if the options were between,

1) IV antibiotics
2) USG
3) CT

what will be the next best step

1) Iv antibiotics
2) CT

what will be the next best step in management?

P.S- hahahah, yes, that was a typo. But, right now it feels like it is slapping me!

 

[Soilworkgmbh]

Gah, well I guess you gotta go with acute abdomen work-up. Get a CT...does your review book tell you the answer?

 

[doc0610]

Gah, well I guess you gotta go with acute abdomen work-up. Get a CT...does your review book tell you the answer?

No

thank you for your time and patience though! Appreciate it

Also, how bad was the real deal. my D day is approaching and it's nerve wrecking. I am just going over my weak areas. I don't want to push it and I am honestly not aiming that high!

 

[doc0610]

@Phloston any inputs here please?

Since you have done the nbme, maybe you can help?

 

[Phloston]

So a patient ( 15 year old ) comes with all the signs of PID. How do you manage the patient next?

1) do you treat the patient ) i.e., hospital and IV antibiotics
2) Pelvic CT to rule out pelvic abscess?

can someone help me out here, thank you

I'd have to see the actual question as supporting details and symptoms/signs affect management, but less invasive first in this case. I'd give ceftriaxone and azithromycin and if she were refractory or febrile would consider the CT only at that point to rule out abscess.

 

[Soilworkgmbh]

Also, how bad was the real deal. my D day is approaching and it's nerve wrecking. I am just going over my weak areas. I don't want to push it and I am honestly not aiming that high!

Real deal was difficult, just need to trust your preparation and your practice scores! Get enough sleep the night before, stay relaxed. That counts for a lot more than you think!

 

[doc0610]

I'd have to see the actual question as supporting details and symptoms/signs affect management, but less invasive first in this case. I'd give ceftriaxone and azithromycin and if she were refractory or febrile would consider the CT only at that point to rule out abscess.

Thank you!