WBR0857

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Infectious Disease
Prompt	A 29 year- old female comes to ED complaining of sever lower abdominal pain. The pain started 2 days ago with a progressive course, with vaginal secretion. The patient is sexually active, doesn’t have any medical problems. On examination, the patient is feverish with temperature 39 C (102 F), heart rate 100/min, blood pressure 135/80 mmHg, and respiratory rate of 19/min. There is lower abdominal tenderness, cervical discharge with cervical motion tenderness. What is the best next step in the management of this patient?
Answer A	Pelvic ultrasonography
Answer A Explanation	Incorrect In pelvic inflammatory disease, you should exclude pregnancy first, and then culture the discharge for proper therapy
Answer B	Start antibiotic treatment
Answer B Explanation	Incorrect In pelvic inflammatory disease, you should exclude pregnancy first, and then culture the discharge for proper therapy
Answer C	Cervical discharge culture
Answer C Explanation	Incorrect It is done after excluding pregnancy using pregnancy test
Answer D	Urine culture
Answer D Explanation	Incorrect Although the co-existence of urinary infection in some cases, pregnancy should be excluded, and culture the cervical discharge for prober therapy
Answer E	Urine pregnancy test
Answer E Explanation	Correct The best way to manage these cases is to exclude the pregnancy, and then proceed with culturing the discharge, and proceed with antibiotics
Right Answer	E
Explanation	Pelvic inflammatory disease (PID) patients present with leukocytosis, lower abdominal pain and tenderness, fever, vaginal discharge, and cervical motion tenderness. The best way to manage these cases is to exclude the pregnancy, and then proceed with culturing the discharge and DNA prop for Chlamydia and gonorrhea, and prescribe the proper antibiotics. Laparoscopy is the most accurate test, but it is rarely needed. It is used with recurrent or persistent infection despite using the proper antibiotics, or when the diagnosis is not clear. Educational Objective: References:
Approved	No
Keyword	[[WBRKeyword::Pelvic inflammatory disease]]
Linked Question
Order in Linked Questions