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Old 10-10-2012
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ObGyn Girl with PID; What to do next

A 21-year-old G0P0 woman with no significant past medical history presents to the emergency department with a 2-day history of bilateral lower abdominal pain and vaginal discharge. She began having unprotected sexual intercourse with her new boyfriend 4 weeks ago. Her temperature is 39.1C (102.4F), blood pressure is 131/73 mm Hg, heart rate is 98/min, and respiratory rate is 13/min. During the bimanual examination she has adnexal tenderness, purulent cervical discharge, and extreme pain. Which diagnostic test is most useful in guiding the treatment of her condition?

(A) β-Human chorionic gonadotropin test
(B) Diagnostic laparoscopy
(C) DNA probes for Chlamydia trachomatis and Neisseria gonorrhoeae
(D) Gram stain of discharge
(E) WBC count
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Old 10-10-2012
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Mmmm this is a weird question, she is having unprotected sex but she doesnt mention ameorrhea which even with all these symptoms would make me pick A

So i pick D, gram stain, because if we see only PMN WITHOUT gram negative intracellular diplococci we assume chlamydia and give only azithromycin or doxycycline

But if we see gram negative diplococci we have to cover for both chlamydia and gonorrheae
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It's a clear cut PID with chanadlier sign
You do not need much of the diagnostics to give her azythromycin + ceftriaxone to kill chlamydia and gonorrhea.

The question is...
Is she prego?

A. B-hCG
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Quote:
Originally Posted by K06100 View Post
A 21-year-old G0P0 woman with no significant past medical history presents to the emergency department with a 2-day history of bilateral lower abdominal pain and vaginal discharge. She began having unprotected sexual intercourse with her new boyfriend 4 weeks ago. Her temperature is 39.1C (102.4F), blood pressure is 131/73 mm Hg, heart rate is 98/min, and respiratory rate is 13/min. During the bimanual examination she has adnexal tenderness, purulent cervical discharge, and extreme pain. Which diagnostic test is most useful in guiding the treatment of her condition?

(A) β-Human chorionic gonadotropin test
(B) Diagnostic laparoscopy
(C) DNA probes for Chlamydia trachomatis and Neisseria gonorrhoeae
(D) Gram stain of discharge
(E) WBC count
(A) β-Human chorionic gonadotropin test
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The correct answer is A. This patient likely
has PID. When pregnant, patients with PID
are managed as inpatients. Empiric outpatient
therapy for PID is recommended only when
physical examination and risk factors are consistent
with PID and a pregnancy test is negative.
PID is rare in pregnancy, and thus a positive
pregnancy test would cause the likelihood
of PID to be much lower on the differential.
Answer B is incorrect. Diagnostic laparoscopy
is useful in establishing a defi nitive diagnosis
of PID. However, laparoscopy is specifi c but
not sensitive for the diagnosis of PID. Laparoscopy
is usually indicated in patients who remain
symptomatic after treatment for PID or
in whom another diagnosis, such as appendicitis,
is likely.
Answer C is incorrect. DNA probes for Chlamydia
trachomatis and Neisseria gonorrhoeae
are useful as a confi rmatory test for PID. However,
empiric therapy is often started before the
results of these tests are available, and therefore
they are rarely useful in guiding therapy.
Answer D is incorrect. Gram stain of cervical
discharge is useful only when positive for Neisseria
gonorrhoeae, which makes a diagnosis of
PID signifi cantly more likely. A negative test is
not useful in ruling out PID.
Answer E is incorrect. WBC counts are of limited
utility in the diagnosis of PID, and would
not be expected to change the management.
Fewer than half of patients with PID have an
increased WBC count.
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