PID

Question 1

Pain assessment

Answer 1

P - position
Q - quality
R - radiation
S - severity
T - timing
A - alleviating
A - aggravating
A - associated symptoms

Question 2

Adolescent interview

Answer 2

H - home
E - employment/education
E - eating
A - activity/aspiration
D - drugs
S - sexuality
S - safety
S - suicide

Question 3

DDx for ab pain and vomiting

Answer 3

Appendicitis
Cholecystitis
Hepatitis
Pancreatitis
Ectopic Pregs - low abdominal pain and abnormal period
PID - FHC from N. gonorrhea or chlamydia
Ovarian Torsion - stabbing pain, N/V
UTI

Question 4

Testicular Torsion

Answer 4

urologic emergency with goal to save testis

• early adolescence with sudden onset of severe testicular pain (hemiscrotal), N/V
• enlarged, tender testis, scrotal edema, absent cremaster reflex
• doppler study to confirm and orchipexy

Question 5

Acute Appendicitis

Answer 5

most common reason for emergency surgery in kids (older)

• up to a 1/3 of population have atypical signs
• accurate history and physical (McBurney point)
• pain starting periumbilical and moving to RLQ (can be RUQ)
• US or CT to confirm

Question 6

Pelvic exam

Answer 6

should do in any sexually active female with abdominal pain

Question 7

Rectal exam

Answer 7

should do with abdominal pain or if there is serious concern for neurologic damage anywhere (check for tone)

Question 8

Cholecystitis

Answer 8

RUQ pain and (+) Murphy’s sign

Question 9

Ectopic pregnancy

Answer 9

diffuse abdominal tenderness, cervical motion tenderness and (+) adnexal mass tenderness

Question 10

Hepatitis

Answer 10

fever, RUQ pain, jaundice, hepatomegaly

Question 11

Pancreatitis

Answer 11

epigastric abdominal pain radiating to back

Question 12

PID PE

Answer 12

fever, diffuse abdominal pain, cervical motion tenderness, purulent discharge
- RUQ pain = FHC

Question 13

UTI

Answer 13

CVA tenderness, suprapubic tenderness

Question 14

Abdominal imagin

Answer 14

KUB (kidney, ureter, bladder)
CT
MRI
US

Question 15

Pelvic Inflammatory Disease

Answer 15

sexually active females 15-19 most commonly (fewer protective antibodies, not fully mature SCJ, lack of protection)
- caused by N. gonorrhea, Chlamydia
DIAGNOSIS = cervical motion tenderness, purulent discharge, abdominal pain, culture, gram stain
COMPLICATIONS = sepsis, FHC, abscess, infertility

Question 16

Hep B Vaccine

Answer 16

recommended for all infants and 11-12 year olds

Question 17

HPV vaccine

Answer 17

quad - 6, 11, 16, 18
bi - 16, 18
*both for males and females 11-12 years old

Question 18

Hospitalization in PID

Answer 18

Reasons:

• Pregnancy
• High risk of noncompliance
• Fever and intractable vomiting
• Can’t exclude surgical emergency

Question 19

Treating STIs

Answer 19

all states require reporting of STIs

- encourage partner to seek treatment (expedited partner treatment)

Question 20

Abx for STIs

Answer 20

1. Ceftriaxone –> Neisseria
2. Doxycycline –> Chlamydia
   * can also use metronidazole