CC March 2016 Pelvic Inflammatory Disease (PID)

echoecho's version from 2016-07-06 18:07


Question Answer
Define PID?a syndrome including BOTH lower and upper genital tract inflammation / infection
How many US women are diagnosed annually?800,000
PID is a polymicrobial disease often associated with traditional sexually transmitted infections, including what 2 bacteria, in addition to normal bacterial vaginal flora?1) N. gonorrhea 2) C. trachomatis
True or false? Pathogens causing bacterial vaginosis also play a role?true
What 2 infections are associated with a 10-20% chance of developing PID?1) Chlamydial 2) gonorrheal
What % of women with PID will develop infertility due to fallopian tube scarring?20
What % of women with PID will develop subsequent ectopic pregnancy?9
What % of women with PID will develop chronic pelvic pain?18
True or false? Early treatment of PID helps decrease risk for long-term sequelae?true
How does PID beginwhen vaginal or cervical bacterial travel into the endometrium (passing into the fallopian tubes or peritoneum)
Most long-term PID sequelae result from tubal inflammation causing what?1) hydrosalpinx 2) tubo-ovarian abscess 3) peritonitis
PID causes tubal swelling with possible long-term _____?scarring
Dx of PID is ______?clinical
Delayed treatment may worsen long-term _____?outcomes
List the symptoms that most women with PID have (often mild)?1) abdominal pain 2) vaginal symptoms (discharge, abnormal bleeding, pain or bleeding with intercourse)
True or false? Many women are afebrile with NO systemic symptoms, making a fever a SUPPORTIVE feature but NOT a requirement for diagnosis?true
List the characteristic physical examination findings?1) pelvic organ tenderness 2) vaginal discharge 3) cervical motion tenderness
When is ultrasound indicated?if tubo-ovarian abscess is suspected OR dx is in question
Differentiating between what 2 acute problems from PID is a challenge?1) acute appendicitis 2) right-sided ovarian pain
*** The CDC recommends what MINIMAL criteria for PID dx and empiric treatment?1) abdominal pain PLUS EITHER cervical motion tenderness OR uterine OR adnexal tenderness
All women should have what 2 tests?1) pregnancy test 2) cervical cultures
List the 3 minimum clinical criteria for PID?1) presence of lower abdominal / pelvic pain PLUS 2) cervical motional tenderness OR uterine tenderness OR adnexal tenderness AND 3) no other cause of pain apparent
List 6 additional criteria that increase specificity and support the dx of PID?1) oral temp > 101 F 2) abnormal mucopurulent cervical d/c or cervical friability 3) abundant WBCs on saline microscopy of vaginal fluid 4) elevated ESR 5) elevated CRP 6) lab-documented infection with N. gonorrhea or C trachomatis
The vast majority of women may be appropriately treated as an outpatient using a combination of what?parenteral and oral antibiotics
*** Data suggest a similar response to inpatient and _____ antibiotic regimens?outpatient
If outpatient therapy is chosen, it should be initiated immediately, without waiting for what resujlts?culture
List the 7 criteria for hospitalization for PID?1) pregnancy 2) need for surgical intervention (can't r/o appendicitis or other cause of surgical abdomen) 3) inability to tolerate oral antibiotics 4) nausea and vomiting 5) failed outpatient treatment 6) severe illness (high fever, vomiting) 7) tubo-ovarian abscess
PID can lead to _____ delivery, so aggressive inpatient treatmnet of pregnant women is important?pre-term