Which of the following risk factors is most often associated with the diagnosis of PID?
A. Cryotherapy of the cervixB. Endometrial biopsyC. HysterosalpingographyD. Multiple sexual partnersE. Recent dilation and curettage
A 25 year old woman presents to the emergency department with abdominal pain. Shehas not had a menstrual period for seven weeks. A culdocentesis is performed and 4ml of nonclotting blood are withdrawn. A serum B-hCG pregnancy test comes backnegative. What is the most likely diagnosis?
A. AppendicitisB. Ectopic pregnancyC. Laceration of the vaginal artery during performance of culdocentesisD. Pelvic inflammatory diseaseE. Rupture of a hemorrhagic ovarian cyst
An 18 year old sexually active female presents complaining of itching around her vulvaand a vaginal discharge. On physical examination you find a scant white clumpyvaginal discharge. Wet mount shows few white blood cells and hyphae. The mostappropriate treatment wuld be:
A. Doxycycline 100 mg po BID for 7 daysB. Metronidazole 2 gm po onceC. Clotrimazole 1% cream intravaginally for 7 daysD. Ciprofloxacillin 500 mg po once
Information useful in helping to establish the diagnosis of testicular torsion include all ofthe following except:
A. Absence of a cremasteric reflex on the side of the affected testicleB. Relief of pain with elevation of the affected testicle (Prehns Sign)C. Abnormal axis of the affected testicleD. Pain of sudden onset and durationE. A normal urinalysis
A 15 year old sexually active male presents with one hour onset of right sided testicularpain after physical education class. He denies fever, swelling or penile discharge. Onphysical examination, the testicle is tender to palpation anteriorly near the upper poleand a "blue dot" is noted on the skin of the scrotum. This suggests:
A. Incarcerated inguinal herniaB. Testicular tortionC. Testicular tumorD. EpididymitisE. Torsion of testicular appendage
All of the following may predispose towards UTI except:
A. Low urine pHB. Neurogenic bladderC. Sexual intercourseD. Women who do not secrete blood group antigens
This male homosexual patient presented with complaints of these lesions on his anus.
A. Lymphogranuloma venereumB. Condylomata latumC. Condylomata acuminataD. SyphilisE. Common warts
A young sexually active women presents with a new greenish, malodorous, somewhatfrothy vaginal discharge with mild vaginal irritation. She denies abdominal pain orsystemic symptoms. Her vital signs are stable, she is afebrile. On speculum exam, yousee this:
A wet mount of this cervical material reveals these things swimming around:
Treatment options include all of the following except:
A. Intravaginal clotrimazoleB. Singe dose metronidazole, 2 gC. Metronidazole, 500 mg bid for 7 daysD. Intravaginal boric acidE. Diflucan, single dose of 150 mg
This 28 year old male patient, in previous good health with no medical problems,presents with about 15 hours of painful sustained erection. He was recently prescribedZoloft (sertraline) for depression. He denies recent sexual activity or using any sexualaid devices. His vital signs are stable and he is afebrile.
A. Terbutaline, 0.25-0.5 mg SQB. Oral pseudoephedrine (60 to 120 mg)C. Corporal aspiration D. Corporal irrigation with an alpha-agonist (epinephrine or phenylephrineE. All of the above
A 58 year old man with a history of diabetes mellitus presents to the ED complaining oflow back pain, dysuria, and frequency of two days duration. His vital signs are BP140/80; P 90; R 16, and T 38 C. Rectal exam reveals a tender, swollen prostate glandthat is warm to touch. Massaging the prostate gland should be avoided because itcould cause which of the following?
A. BacteremiaB. CystitisC. EpididymitisD. UrethritisE. Urinary retention
A 45 year old patient presents complaining of irritation of the glans of his penis. Onphysical examination you note an uncircumcized male with erythema and swelling ofthe glans. All of the following should be done EXCEPT:
A. Consider evaluating for diabetes mellitusB. Suggest improved hygiene by cleaning this area with soap and waterC. Apply a topical cream containing nystatin and steroidsD. Treat the patient's sexual partner for exposure to sexually transmitted disease
Medical therapies that should be considered in victims of sexual assault may include which of the following?
A. Ceftriaxone 125mg IMB. Azithromycin 1gm POC. Metronidazole 2gms POD. Tetanus prophylaxisE. All of the above
All of the following are true concerning Bartholin's gland infections EXCEPT:
A. Gland duct obstruction is often due to parturition, episiotomy or traumaB. Gonoccocal disease is more common cause than mixed bacterial pathogensC. Treatment of bartholin's abscess includes incision and drainageD. Ward catheters should remain in place for 4-6 weeksE. Systemic antibiotics are not routinely indicated
A 25 year old sexually active male presents complaining of burning with urination. Heis afebrile and no urethral discharge is visible. His urinalysis show ph 8, sp gravity1.015, one WBC/HPF and the remainder of the urinalysis is unremarkable. You wouldtreat with which of the following:
A. Ciprofloxacillin 500 mg PO single doseB. Amoxicillin 500 mg PO TID for 7 daysC. Ceftriaxone 125 mg IMD. Doxycycline 100 mg PO BID for 7 daysE. Flagyl 250 mg PO for 7 days
Which of the following must be present to clinically diagnose acute PID?
A. Direct abdominal tenderness with or without reboundB. Fever greater than 39 CC. Inflammatory mass palpable on bimanual exam
D. White blood cell count greater than 12,000/mm3
When a patient with sickle cell disease presents to the ED with priapism, which of thefollowing might improve the patient's condition?
A. TransfusionB. Morphine IVC. TerbutalineD. None of the above, only a urological drainage procedure will help the patient
A patient presents to the emergency department complaining of penile pain andinability to retract the prepuce from the glans penis.
A. PhimosisB. ParaphimosisC. BalantitisD. Corpus cavernosa rupture
All of the following are true of orchitis EXCEPT:
A. The epididymis is almost never involvedB. Blood-borne dissemination is a major route of infectionC. In mumps, orchitis begins prior to swelling of the parotidsD. High fever and system illness can be profound
An eighteen year old nulliparous, previously healthy woman presents to the ED with 12hours of bilateral severe lower abdominal pain. There is no past history of PID. Hervital signs are: BP 120/70; P 100; R 20; and T101.1 F. Abdominal exam reveals bothright and left adnexal tenderness, but no adnexal masses. Her WBC is 14,500. Herserum beta-hCG is negative. She has no allergies. Which one of the followingmedicine regimens is most indiciated?
A. Ampicillin, gentamicin, clindamycinB. Ceftriaxone, doxycyclineC. Azithromycin, tetracyclineD. Metroniadazole, clindamycinE. Trimethoprim-sulfamethoxazole, erythromycin
A 25 year old sexually active female prsents complaining of malodorous (fishy) vaginaldischarge. On physical examination you note a white-gray frothy vaginal discharge. Presence of amine order is noted and white blood cels and clue cells are found on wetmount. Best treatment would be:
A. Doxycycline 100mg po BID for 7 daysB. Metronidazole 500 mg BID po for 7 daysC. Clotrimaziole 1% cream intravaginally for 7 daysD. Ciprofloxacillin 500 mg po once
The lifetime prevalence of sexual assault among women is estimated at:
A 25 year old woman returns to the ED with continued dysuria three days after beingstarted on a 10-day course of oral trimethoprimsulfamethoxazole for presumed urinarytract infection. During her previous visit, a urinalysis had shown a positive leukocyteesterase dip stick and 30-40 white blood cells per high power field. A culture of cleancatch urine sent at that time is reported as "no growth". She is afebrile and her physicalexamination is normal. Which of the following regimens is most likely to resolve hersymptoms?
A. Admission for IV antibioticsB. A one year course of isoniazid and rifampinC. Changing to a course of nitrofurantoin for 10 daysD. Doubling the dose of trimethoprim-sulfamethoxazoleE. Oral doxycycline for seven days
The most important role of the physician in regard to the care of victims of sexual assault is:
A. Evidence collectionB. Identification of high risk behaviorsC. Cooperation with law enforcementD. Physical screening and psychological supportE. Never allowing victims to return to an abusive relationship
Which of the following is considered criteria for inpatient parenteral (intravenous)antibiotic treatment of a patient with PID?
A. AdolescenceB. Gonococcal salpingitisC. Intrauterine pregnancyD. Multiple sex partnersE. Use of birth control pills
A 65 year old sexually active male complains of left sided testicular pain which started18 hours ago. He has temp 100.9 F; BP 170/90; HR 80; and RR 18. He is tenderposteriorly above his left testicle with some swelling of that testicle. Urinalysis shows5-10 WBC/HPF. Most appropriate therapy would be:
A. Treatment with trimethoprim/sulfamethoxazole or ciprofloxacin BID for 14 daysB. Emergent urological evaluationC. Testicular scanD. Treatment with doxycycline 100 mg BID for 10 daysE. Treatment with ceftriaxone 125 mg IM
Anaesthesia for Cerebral Aneurysm Repair Epidemiology Exact incidence is unclear but probably about 4%. An annual incidence rupture is about 15-20 per Sex : Male to Female 2 : 3 but more males below 40 and more females after. Rupture : 90% < 12mm, 5% 12-15mm, 5% > 15mm. First aneurysm clipped in 1931, Operating microscope first used for clipping in 1960. Aetiology It had been
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