Gyrus Daily Questions; Obstetrics & Gynecology #9 - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 11-05-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Arrow Gyrus Daily Questions; Obstetrics & Gynecology #9

A 16-year-old girl comes to the emergency department because of severe right-sided abdominal pain Her last menstrual period was 2 weeks ago and lasted 4 days She appears to be in moderate distress Her temperature is 101 3F (38.5 C). blood pressure 128/75 mm Hg. pulse 80/min. and respiration 22/min Examination of the throat shows mild pharyngitis The abdomen is diffusely tender, especially the lower abdomen Rectal examination shows guaiac-negative brown stool and exquisite tenderness of the lateral wall of the rectum Pelvic examination shows cervical tenderness and fullness of the right adnexa A urine pregnancy test is negative. Which of the following is the most likely diagnosis?

A. Constipation
B. Endometriosis
C. Ovarian cyst
D. Pelvic inflammatory disease
E. Pyelonephritis
Reply With Quote Quick reply to this message
The above post was thanked by:
water (12-31-2012)



  #2  
Old 11-05-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 170
Threads: 6
Thanked 137 Times in 90 Posts
Reputation: 147
Default

D. Pelvic inflammatory disease
Reply With Quote Quick reply to this message
  #3  
Old 11-05-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by cingulate.gyrus View Post
A 16-year-old girl comes to the emergency department because of severe right-sided abdominal pain Her last menstrual period was 2 weeks ago and lasted 4 days She appears to be in moderate distress Her temperature is 101 3F (38.5 C). blood pressure 128/75 mm Hg. pulse 80/min. and respiration 22/min Examination of the throat shows mild pharyngitis The abdomen is diffusely tender, especially the lower abdomen Rectal examination shows guaiac-negative brown stool and exquisite tenderness of the lateral wall of the rectum Pelvic examination shows cervical tenderness and fullness of the right adnexa A urine pregnancy test is negative. Which of the following is the most likely diagnosis?

A. Constipation
B. Endometriosis
C. Ovarian cyst
D. Pelvic inflammatory disease
E. Pyelonephritis
B, endometriosis

Eventho she has a fever, the physical examination points to either a ruptured chocolate cyst or an ovarian torsion which could be responsible for the fever and distress
Also the rectal pain means metastases to the cul-de-sac which is the second most common place after the ovary, which is mentioned here.

I dont think D is the answer has they would mention cervical leakage and pain with bimanual examination, but i could be wrong
Reply With Quote Quick reply to this message
  #4  
Old 11-05-2012
doxorubicin's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 391
Threads: 98
Thanked 160 Times in 98 Posts
Reputation: 170
Default

Option D.PID
__________________
if ur ready to learn......world is ready to teach...take d leap!!
Reply With Quote Quick reply to this message
  #5  
Old 11-05-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,087 Times in 1,047 Posts
Reputation: 2107
Default

Quote:
Originally Posted by cingulate.gyrus View Post
A 16-year-old girl comes to the emergency department because of severe right-sided abdominal pain Her last menstrual period was 2 weeks ago and lasted 4 days She appears to be in moderate distress Her temperature is 101 3F (38.5 C). blood pressure 128/75 mm Hg. pulse 80/min. and respiration 22/min Examination of the throat shows mild pharyngitis The abdomen is diffusely tender, especially the lower abdomen Rectal examination shows guaiac-negative brown stool and exquisite tenderness of the lateral wall of the rectum Pelvic examination shows cervical tenderness and fullness of the right adnexa A urine pregnancy test is negative. Which of the following is the most likely diagnosis?

A. Constipation
B. Endometriosis
C. Ovarian cyst
D. Pelvic inflammatory disease
E. Pyelonephritis
D. Pelvic inflammatory disease
__________________
A man doesn't know what he knows until he knows what he doesn't know.
What is man? He's just a collection of chemicals with delusions of grandeur.
Reply With Quote Quick reply to this message
  #6  
Old 11-05-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

The correct answer is D. Pelvic inflammatory disease

PID can be difficult to diagnose in a teenage girl There may be a history of abnormal uterine bleeding and dysmenorrhea
However, young patients may not be forthcoming about their sexual history.

Most patients with PID have signs of abdominal pain, lower abdominal tenderness, and cervical motion tenderness during the pelvic exam In addition, the pelvic exam may reveal purulent cervical discharge and possibly an adnexal mass or tenderness Fever >38 0 C is frequently present Lab tests may reveal an elevated white blood cell count and sedimentation rate >15 mm/hr The most common pathogens in PID are the gonococcus and Chlamycka Less frequently. PID is caused by a mixed infection with anaerobic and aerobic bacteria In this case. the emergency physician was initially concerned that the patient might have an ectopic pregnancy. but a urine hCG was performed and the result was negative An ectopic pregnancy may have been more likely if there had been adnexal fullness and tenderness on one side without pain on cervical motion

Constipation (choice A) would be unlikely to result in right lower quadrant pain In older children and adolescents, constipation may be a cause of left upper quadrant pain or referred pain to the left lower chest area In cases involving children and adolescents.
Reply With Quote Quick reply to this message
The above post was thanked by:
fadi551 (11-10-2012), heartbeat (11-20-2012), ts1234 (11-06-2012), water (12-31-2012)
  #7  
Old 11-20-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 612 Times in 234 Posts
Reputation: 622
Default

Quote:
Originally Posted by XpaezX View Post
B, endometriosis

Eventho she has a fever, the physical examination points to either a ruptured chocolate cyst or an ovarian torsion which could be responsible for the fever and distress
Also the rectal pain means metastases to the cul-de-sac which is the second most common place after the ovary, which is mentioned here.

I dont think D is the answer has they would mention cervical leakage and pain with bimanual examination, but i could be wrong
I like you explanation.
You are right if they mention that the patient had low grade fever + pain is occurring during cycle + dyspareunia, and one of the options is Rupture endometrioma

I would like to ask, what is the relation b/w pharyngitis and PID?
Reply With Quote Quick reply to this message
  #8  
Old 11-20-2012
USMLE Forums Scout
 
Steps History: ---
Posts: 84
Threads: 2
Thanked 38 Times in 36 Posts
Default

D Pelvic inflmmatory disease. She has cervical motion tenderness. plus peritonitis. so points more towards PID. she recently had menses which were normal. so i think its definitely PID and not endometriosis,
Reply With Quote Quick reply to this message



Reply

Tags
ObGyn-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Gyrus Daily Questions; Obstetrics & Gynecology #2 cingulate.gyrus USMLE Step 2 CK Forum 7 11-20-2012 07:17 PM
Gyrus Daily Questions; Obstetrics & Gynecology #4 cingulate.gyrus USMLE Step 2 CK Forum 7 11-20-2012 07:01 AM
Gyrus Daily Questions; Obstetrics & Gynecology #1 cingulate.gyrus USMLE Step 2 CK Forum 4 11-04-2012 08:27 PM
Gyrus Daily Questions; Obstetrics & Gynecology #3 cingulate.gyrus USMLE Step 2 CK Forum 3 11-04-2012 08:14 PM
Gyrus Daily Questions; Obstetrics & Gynecology #1 cingulate.gyrus USMLE Step 2 CK Forum 4 10-27-2012 11:12 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)