Master the board step 3

Master the Boards: USMLE Step 3
Treatment
1. Admit to the hospital and give cefoxitin and doxycycline.
2. If no response within 72 hours or if there is abscess rupture, perform an
exploratory laparotomy ± TAH and BSO or percutaneous drainage.
When are outpatient antibiotics the answer?
··
All cases of cervicitis
··
Acute salpingo-oophoritis when there is no systemic infection or pelvic
abscess
When are inpatient antibiotics the answer?
··
Previous outpatient treatment failure, intrauterine device (IUD) in place,
presence of fever, or pelvic abscess
··
All cases of tubo-ovarian abscess
Dysmenorrhea
Primary Dysmenorrhea
··
Primary dysmenorrhea is the diagnosis when the case describes recurrent,
crampy lower abdominal pain along with nausea, vomiting, and diarrhea
during menstruation. Symptoms begin 2–5 years after onset of menstruation
(ovulatory cycles). There is no pelvic abnormality.
··
Symptoms are related to excessive endometrial prostaglandin F2, which
causes uterine contractions and acts on gastrointestinal smooth muscle.
Treatment
··
NSAIDs are the first line of therapy.
··
Combination oral contraceptives are the second line.
Secondary Dysmenorrhea
Secondary dysmenorrhea presents similar symptoms as primary dysmenorrhea
but is due to another disorder. Most commonly, secondary dysmenorrhea
occurs due to endometriosis. However, other pathology (such as adenomyosis
or leiomyomas) can also be the underlying pathology.
472