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  #1  
Old 01-05-2013
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ObGyn Postpartum Fever

A 33-year-old gravida II, para II female is seen on postpartum day 7 following an emergency cesarean section as a result of arrest of descent. On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia. She was appropriately treated, but she continues to have a spiking fever between 38.5C (101. ?3F) and 40.5C (104.9F). Physical examination of the abdomen and pelvis is unremarkable. A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section.
What is the most appropriate management.

A. Clindamycin and gentamicin
B. Computed tomography (CT) guided drainage
C. Dicloxacillin
D. Endometrial culture
E. Heparin
F. Incentive spirometry
G. Laparotomy
H. Nitrofurantoin
I. Surgical debridement
J. Trimethoprim-sulfamethoxazole
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endometritis caused by polymicrobial bacteria.

Clindamycin and gentamicin
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Quote:
Originally Posted by aknz View Post
endometritis caused by polymicrobial bacteria.

Clindamycin and gentamicin
Try again What else can cause spiking fever in the immediate postpartum period despite being on appropriate antibiotics (for endometritis) and a CT scan ruling out an abscess.
Quote:
A 33-year-old gravida II, para II female is seen on postpartum day 7 following an emergency cesarean section as a result of arrest of descent. On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia. She was appropriately treated, but she continues to have a spiking fever between 38.5C (101. ?3F) and 40.5C (104.9F). Physical examination of the abdomen and pelvis is unremarkable. A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section.
What is the most appropriate management.
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she continues to have a spiking fever between 38.5C (101. ?3F) and 40.5C (104.9F). Physical examination of the abdomen and pelvis is unremarkable. A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section.

I/V thrombophelbitis .......heparin
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Day 3 post op fever is most likely UTI

4W:wind(air ways)day 1,
water (UTI)day3,
walking(thrombophlebitis)day 5,
Wound on day7
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Default E. Heparin

E. Heparin


Ovarian Vein thrombosis
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Old 01-06-2013
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I would go with E. Heparin
On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia.Most probably Endometritis, which was appropriately treated, but she continues to have a spiking fever, this may clue that she is not complain of infection so no meaning for doing culture or adding another antibiotics (answers A,C,D,H, and J are not correct). A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section, this exclude Abscess (ans-B). The clinical scenario and Physical examination of the abdomen and pelvis is unremarkable not suggestive for ischemia, necrosis, perforation, so why doing G. Laparotomy or I. Surgical debridement.
So i think that when there is postoperative spiking fever resistant to treatment should put DVT as first differential diagnosis.
This is my explanation, but may be i am wrong
Though Q
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Quote:
Originally Posted by Novobiocin View Post
A 33-year-old gravida II, para II female is seen on postpartum day 7 following an emergency cesarean section as a result of arrest of descent. On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia. She was appropriately treated, but she continues to have a spiking fever between 38.5C (101. ?3F) and 40.5C (104.9F). Physical examination of the abdomen and pelvis is unremarkable. A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section.
What is the most appropriate management.

A. Clindamycin and gentamicin
B. Computed tomography (CT) guided drainage
C. Dicloxacillin
D. Endometrial culture
E. Heparin
F. Incentive spirometry
G. Laparotomy
H. Nitrofurantoin
I. Surgical debridement
J. Trimethoprim-sulfamethoxazole
H Nitrofurantoin. most probable cause UTI.
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Quote:
Originally Posted by heartbeat View Post
I would go with E. Heparin
On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia.Most probably Endometritis, which was appropriately treated, but she continues to have a spiking fever, this may clue that she is not complain of infection so no meaning for doing culture or adding another antibiotics (answers A,C,D,H, and J are not correct). A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section, this exclude Abscess (ans-B). The clinical scenario and Physical examination of the abdomen and pelvis is unremarkable not suggestive for ischemia, necrosis, perforation, so why doing G. Laparotomy or I. Surgical debridement.
So i think that when there is postoperative spiking fever resistant to treatment should put DVT as first differential diagnosis.
This is my explanation, but may be i am wrong
Though Q
Excellent thinking process and the right answer.
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Quote:
Originally Posted by Novobiocin View Post
A 33-year-old gravida II, para II female is seen on postpartum day 7 following an emergency cesarean section as a result of arrest of descent. On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia. She was appropriately treated, but she continues to have a spiking fever between 38.5C (101. ?3F) and 40.5C (104.9F). Physical examination of the abdomen and pelvis is unremarkable. A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section.
What is the most appropriate management.


A. Clindamycin and gentamicin
B. Computed tomography (CT) guided drainage
C. Dicloxacillin
D. Endometrial culture
E. Heparin
F. Incentive spirometry
G. Laparotomy
H. Nitrofurantoin
I. Surgical debridement
J. Trimethoprim-sulfamethoxazole
@Novobiosin
from MTB,fever 3rd day post op is almost always from UTI.
how can we rule out UTI in this case?thanx
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my question is same as blade.. mtb says uti.
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Quote:
Originally Posted by blade View Post
@Novobiosin
from MTB,fever 3rd day post op is almost always from UTI.
how can we rule out UTI in this case?thanx
There is nothing in the question stem to suggest UTI. Remember, if a specific information you are looking for is not there in the question stem then it is presumed to be normal.
Also, she is having spiking fever, characteristic of an abscess or thrombophlebitis and her CT scan is normal essentially ruling out an abscess or pyelonephritis secondary to an UTI.
Also, it is not day 3 since she developed endometritis on day 3 and she was started on antibiotics. You usually wait for 48 hours after starting a patient on antibiotics before getting worried about a second pathology. So, it is post day 5.

Step 2 CK is all about understanding as compared to memorization. They are testing whether you understand a particular topic or not. What MTB says is also true but you have to understand that anything can happen anytime which is also true in post-op period. That's why it is essential to arrive at the answer based on the information provided in the question stem by using your knowledge and thinking skills as demonstrated by heartbeat so beautifully in his post.
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Last edited by Novobiocin; 01-06-2013 at 11:11 AM.
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[QUOTE=Novobiocin;169238]There is nothing in the question stem to suggest UTI.?????
nothing suggests uti in this question???a pxt that was cathertarized with spiking fever 3daz post op?hmm
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[QUOTE=Donb;169240]
Quote:
Originally Posted by Novobiocin View Post
There is nothing in the question stem to suggest UTI.?????
nothing suggests uti in this question???a pxt that was cathertarized with spiking fever 3daz post op?hmm
What are you on ?
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[QUOTE=Novobiocin;169242]
Quote:
Originally Posted by Donb View Post
What are you on ?
???
are you ok Mr Know all??
how can you claim nothing supports uti in this case and act as if you the prof
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[QUOTE=Donb;169243]
Quote:
Originally Posted by Novobiocin View Post

???
are you ok?
I must be blind as not to read that the patient was catheterized.

You can argue or learn here----your choice.

From now on I am just going to ignore your posts as I am going to follow the famous saying

Quote:
"Never argue with an idiot. They will only bring you down to their level and beat you with experience."
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[QUOTE=Novobiocin;169244]
Quote:
Originally Posted by Donb View Post

I must be blind as not to read that the patient was catheterized.

You can argue or learn here----your choice.

From now on I am just going to ignore your posts as I am going to follow the famous saying
the IDIOT in this case is obvious...
you have to be told a pxt needs catheterized in a CS??
your stupid ignorance is presenting itself and you claim you know everything without memorization.........f..k off
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Old 01-07-2013
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Answer is heparin. This is septic pelvic
thrombophlebitis. After treatment with antibiotics for endometritis the
patient continued to spike, CT would be done to look for any abscesses which u would drain and give antibiotics for-in this case it was negative. SPT is a diagnosis of exclusion-only after you have ruled out other causes should u think about SPT. GL guys and gals!
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