Adnexal Masses
The imaging modality of choice for evaluation of a pelvic mass
What is ultrasound?
The two classic bacterial etiologies for PID
What are Neisseria Gonorrhea and Chlamydia Trachomatis?
The classic triad of clinical presentation of ectopic pregnancy
What is vaginal bleeding, missed menses, unilateral lower abdominal pain?
This tumor marker is more reliable with respect to specificity and positive predictive valuate when used in the evaluation of the postmenopausal female with an adnexal mass
What is CA 125?
Endometrial biopsy with histopathologic evidence of endometritis, TVUS or MRI imaging showing thickened fluid filled tubes (with or without free pelvic fluid or TOA), Laparoscopic findings consistent with PID
What are the most specific criteria for diagnosing PID?
The most common location within the fallopian tube for an ectopic pregnancy
What is the ampulla?
This tumor marker is elevated in the setting of Choriocarcinoma
What is Beta-HCG?
The non-classical source of descending infection that causes PID
What is GI Tract Flora (i.e. from ruptured appendicitis or rupture diverticulum)?
Three risk factors for ectopic pregnancy
(Must list 3 of the following in the form of a question)
Question: What are: History of Ectopic Pregnancy, Smoking, IVF, Infertility, Prior pelvic surgery, History of Tubal sterilization, IUD usage, History of PID, History of Endometriosis, History of STI?
“Simple”, Thin, smooth walls, absence of solid components, absence of septations
What are features of a benign pelvic mass?
Three suggested criteria for inpatient management of PID.
What are Surgical Emergencies cannot be ruled out (i.e. Appendicitis), Tubo-ovarian Abscess, Pregnancy, Severe illness, N/V or high fever, Inability to tolerate an outpatient oral regimen, no clinical response to oral antimicrobial therapy
Barring no contraindications to its use, this medication is used in medical management of ectopic pregnancy
What is methotrexate?
Postmenopausal elevated CA 125, Ultrasound findings suggestive of malignancy, ascites, a nodular or fixed pelvic mass, or evidence of abdominal or distant metastasis
What are indications for referral to GYN ONC?
A parenteral treatment regimen for PID
(any of the following regimens – dose/route bonus)
What are Cefotetan 2g IV q 12 Plus Doxycycline 100mg PO q 12?
OR What are Cefoxitin 2g IV q6 PLUS Doxycycline 100mg PO q 12?
OR What are Clindamycin 900mg IV q8 PLUS Gentamicin 2mg/kg IV Load followed by 1.5mg/kg q 8?
Three absolute contraindications to medical management of ectopic pregnancy.
(Must list 3 of the following in form of a question)
Question: What are: Intrauterine pregnancy, Sensitivity to MTX, Active Pulmonary Disease, Active Peptic Ulcer Disease, Clinically important hepatic dysfunction, Clinically important renal dysfunction, Ruptured ectopic pregnancy, Hemodynamically unstable patient, Inability to participate in follow up?