Pelvic Inflammatory Disease

PELVIC INFLAMMATORY DISEASE

Q. 1

In a patient with pelvic inflammatory disease due to tuberculosis, which of the following statements is true :

 A

Mycobacterium can be grown from menstrual blood

 B

Associated with infertility

 C

Ectopic pregnancy is common

 D

All of These

Q. 1

In a patient with pelvic inflammatory disease due to tuberculosis, which of the following statements is true :

 A

Mycobacterium can be grown from menstrual blood

 B

Associated with infertility

 C

Ectopic pregnancy is common

 D

All of These

Ans. D

Explanation:

All of These

Mycobacterium can be grown from menstrual blood; Associated with infertility; and Ectopic pregnancy is common Most common symptom of TB is infertility. It is seen in 35 – 60% of cases.

Cause of infertility : Blockage of the fallopian tube or Altered tubal and Endometrial function in presence of patent tubes.

  • Ectopic pregnancy : Every woman who had or has, a tubal pregnancy should be suspected of having tubal tuberculosis active or healed.
  • Dysmenorrhea : Shaw does not specify whether dysmenorrhea is common or uncommon in TB. “Dysmenorrhea rarely, if occurs.”
  • For diagnosis : Dilatation and curettage is done in the premenstrual phase and specimen sent for histo pathological examination and culture.

First day menstrual blood can also be used but the results are not as satisfactory as premenstrual tissue. °

It For more details about Genital Tuberculosis, see previous answer


Q. 2

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Q. 2

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Ans. A

Explanation:

Hysteroscopy + Laparoscopy


Q. 3

Most comon cause of pelvic inflammatory disease in virgin girls is :

 A

Gonorrhoea

 B

Chlamydia

 C

Treponema pallidum

 D

Tubercular

Q. 3

Most comon cause of pelvic inflammatory disease in virgin girls is :

 A

Gonorrhoea

 B

Chlamydia

 C

Treponema pallidum

 D

Tubercular

Ans. D

Explanation:

Tubercular


Q. 4

Surest sign of salpingitis is :

 A

Edema of tubes

 B

Enlargement of tubes

 C

Seropurulent discharge from the fimbria/ part of the tube

 D

Hyperaemic tubes

Q. 4

Surest sign of salpingitis is :

 A

Edema of tubes

 B

Enlargement of tubes

 C

Seropurulent discharge from the fimbria/ part of the tube

 D

Hyperaemic tubes

Ans. C

Explanation:

Seropurulent discharge from the fimbria/ part of the tube


Q. 5

Incidence of sterility is maximum in pelvic inflammatory disease caused by :

 A

Staphylococci

 B

Streptococci

 C

Proteus vulgaris

 D

Gonococci

Q. 5

Incidence of sterility is maximum in pelvic inflammatory disease caused by :

 A

Staphylococci

 B

Streptococci

 C

Proteus vulgaris

 D

Gonococci

Ans. D

Explanation:

Gonococci


Q. 6

The following is a characteristic symptom of chronic pelvic inflammatory disease :

 A

Dysuria

 B

Constipation

 C

Backache

 D

Fever

Q. 6

The following is a characteristic symptom of chronic pelvic inflammatory disease :

 A

Dysuria

 B

Constipation

 C

Backache

 D

Fever

Ans. C

Explanation:

Backache


Q. 7

Pelvic inflammatory disease is caused by all ex­cept :

 A

Schistosomiasis

 B

Crohn’s disease

 C

Syphilis

 D

Leprosy

Q. 7

Pelvic inflammatory disease is caused by all ex­cept :

 A

Schistosomiasis

 B

Crohn’s disease

 C

Syphilis

 D

Leprosy

Ans. D

Explanation:

Leprosy


Q. 8

Pelvic Inflammatory Disease occurs least com­mon with :

 A

OCPs

 B

Condom

 C

IUCD

 D

Diaphragm

Q. 8

Pelvic Inflammatory Disease occurs least com­mon with :

 A

OCPs

 B

Condom

 C

IUCD

 D

Diaphragm

Ans. B

Explanation:

Ans. is b i.e. Condom

Barrier methods (especially condom) and OCP’s both protect against PID, but the protection offered by OCP’s is less than that by Barrier method.

“The incidence of pelvic inflammatory disease (P1D) is reduced. though it does not reach the same low level as seen with the barrier methods.”

As far as diaphragm is concerned, it does not protect against HIV, whereas condom does.



Q. 9

During laparoscopy the preferred site for obtain­ing cultures in a patient with acute pelvic inflammatory disease is :

 A

Endocervix

 B

Pouch of Douglas

 C

Endometrium

 D

Fallopian tubes

Q. 9

During laparoscopy the preferred site for obtain­ing cultures in a patient with acute pelvic inflammatory disease is :

 A

Endocervix

 B

Pouch of Douglas

 C

Endometrium

 D

Fallopian tubes

Ans. D

Explanation:

Ans. is d i.e. Fallopian tube

  • Laparoscopic visualization of the pelvis is the most accurate method of confirming diagnosis of an acute P1D.
  • However, it is not practical to advise diagnostic laparoscopy to all patients of PID,
  • Indications of Laparoscopy in Acute PID :

–   Patients not responding to therapy, in order to confirm the diagnosis.

–   To obtain cultures from cul-de-sac or fallopian tube.

–   To drain pus. if necessary.

Thus, cultures can be obtained from both cul-de-sac and fallopian tube.

Telinde’s Operative Gynae. 9/e, p 679 further says

“Laparoscopy is an excellent means of obtaining cultures directly from the tubes.” My answer to this question is Fallopian tube. You can have your opinion.


Q. 10 A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy? 
 A Previous tubal surgery
 B Pelvic inflammatory disease (PID)
 C Use of a contraceptive uterine device (IUD)
 D Induction of ovulation
Q. 10 A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy? 
 A Previous tubal surgery
 B Pelvic inflammatory disease (PID)
 C Use of a contraceptive uterine device (IUD)
 D Induction of ovulation
Ans. B

Explanation:

Mishell, 3/e, pp 452–457.) Any factor delaying transit of the ovum through the fallopian tube may predispose a patient to ectopic pregnancy. The major predisposing factor in the development of ectopic pregnancy is pelvic inflammatory  disease.   However,  any  operative procedure on the fallopian tubes may increase a patient’s  risk.  It  appears  that  tubal  sterilizations with laparoscopic fulguration have a higher rate of ectopic pregnancy than tubal ligations performed with clips or rings. Women who have had one ectopic pregnancy are at increased risk of having a second. DES exposure, induction of ovulation, and IUD use increase the possibility of ectopic pregnancy.The best choice is B PID.


Q. 11

Commonest cause of ectopic pregnancy is :

 A

Endometriosis

 B

Previous salpingitis

 C

Anemia

 D

Cervicitis

Q. 11

Commonest cause of ectopic pregnancy is :

 A

Endometriosis

 B

Previous salpingitis

 C

Anemia

 D

Cervicitis

Ans. B

Explanation:

Previous salpingitis


Q. 12

A female with previous history of pelvic inflammatory disease (PID) brought to the casuality with high fever and abdominal pain. She had abnormal vaginal discharge since few days. On examination, there was tenderness on both quadrants of lower abdomen and the liver was enlarged and tender. 

Assertion: This can be Fitz-Hugh-Curtis syndrome which is a complication of PID

Reason: Pain and discomfort in the right hypochondrium is due to concomittent perihepatitis which is known as Fitz-Hugh-Curtis syndrome

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 12

A female with previous history of pelvic inflammatory disease (PID) brought to the casuality with high fever and abdominal pain. She had abnormal vaginal discharge since few days. On examination, there was tenderness on both quadrants of lower abdomen and the liver was enlarged and tender. 

Assertion: This can be Fitz-Hugh-Curtis syndrome which is a complication of PID

Reason: Pain and discomfort in the right hypochondrium is due to concomittent perihepatitis which is known as Fitz-Hugh-Curtis syndrome

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

Fitz-Hugh-Curtis syndrome may occur in 5-10% of cases of acute salpingitis. The liver is involved due to transperitoneal or vascular dissemination of either gonococcal or chlamydial infection.

 
Ref: Text book of Gynaecology by D C Dutta, 4th Edition, Page 120

Q. 13

21-year-old woman presents to the emergency department complaining of pelvic pain, a yellow-green vaginal discharge, and fever, all of which have been worsening over the last 24 hours. She has no frequency or dysuria. She has no medical problems. Her past surgical history is significant for a cesarean delivery 2 years ago performed for a nonreassuring fetal heart rate tracing. She takes no medications and is allergic to sulfa drugs. She is sexually active with multiple male partners who sometimes use condoms. She works as a medical assistant. Her temperature is 38.2 Deg C (100.7 F), blood pressure is 100/60 mm Hg, pulse is 110/minute, and respirations are 12/minute. Her abdominal examination is significant for diffuse tenderness, rebound, and guarding. Speculum examination demonstrates a copious greenish vaginal discharge that appears to be coming from the cervix. Pelvic examination is significant for cervical motion tenderness and adnexal tenderness. Laboratory evaluation shows:
 
Urine hCG: negative
Urinalysis: negative
Leukocytes: 15,000/mm3
Hematocrit: 39%
Platelets: 200,000/mm3
 
Which of the following is the most likely diagnosis?
 A

Ectopic pregnancy

 B

Gonococcal cervicitis

 C

Pelvic inflammatory disease (PID)

 D

Spontaneous abortion

Q. 13

21-year-old woman presents to the emergency department complaining of pelvic pain, a yellow-green vaginal discharge, and fever, all of which have been worsening over the last 24 hours. She has no frequency or dysuria. She has no medical problems. Her past surgical history is significant for a cesarean delivery 2 years ago performed for a nonreassuring fetal heart rate tracing. She takes no medications and is allergic to sulfa drugs. She is sexually active with multiple male partners who sometimes use condoms. She works as a medical assistant. Her temperature is 38.2 Deg C (100.7 F), blood pressure is 100/60 mm Hg, pulse is 110/minute, and respirations are 12/minute. Her abdominal examination is significant for diffuse tenderness, rebound, and guarding. Speculum examination demonstrates a copious greenish vaginal discharge that appears to be coming from the cervix. Pelvic examination is significant for cervical motion tenderness and adnexal tenderness. Laboratory evaluation shows:
 
Urine hCG: negative
Urinalysis: negative
Leukocytes: 15,000/mm3
Hematocrit: 39%
Platelets: 200,000/mm3
 
Which of the following is the most likely diagnosis?
 A

Ectopic pregnancy

 B

Gonococcal cervicitis

 C

Pelvic inflammatory disease (PID)

 D

Spontaneous abortion

Ans. C

Explanation:

Pelvic inflammatory disease (PID) is a significant cause of morbidity among sexually active menstruating women. PID refers to an upper genital tract infection, especially of the endosalpingeal cells that line the fallopian tubes. When the infection involves the fallopian tubes only, it is referred to as a salpingitis. When it involves the ovaries as well, it is then referred to as a salpingo-oophoritis. The endometrium is also often involved (endometritis).

The peak incidence of the disease is in the 15- to 24-year-old-group. This patient presents with the typical symptoms of PID, particularly abdominal/pelvic pain. Fever and vaginal discharge are often present in gonococcal PID, but may be absent in other forms of PID. The diagnosis of PID is made when the patient has abdominal tenderness, cervical motion tenderness, and adnexal tenderness plus a temperature > 38 C (100.4 F), or leukocytosis (>10,000/mm3), or laboratory documentation of chlamydial or gonorrheal infection. Treatment is with antibiotics.

Ectopic pregnancy is ruled out with the negative urine pregnancy test. An ectopic pregnancy is a pregnancy that is implanted abnormally, most often in the fallopian tubes. As a pregnancy, it secretes human chorionic gonadotropin (hCG), which can be found in the blood or urine. When this is not present, ectopic pregnancy is ruled out.
 
Gonococcal cervicitis presents with findings localized to the cervix. This patient has findings that go beyond a cervicitis. Given her abdominal tenderness with rebound, cervical motion tenderness, and adnexal tenderness, she is manifesting involvement of the fallopian tubes and peritoneum. While the gonococcus may be the offending organism in this case, this patient has more than a gonococcal cervicitis.
 
A patient with a spontaneous abortion can present in a variety of ways, but most commonly she will present with complaints of vaginal bleeding or the passage of tissue from the vagina. A spontaneous abortion represents a failed pregnancy and this patient has no evidence of a failed pregnancy, and an abundance of evidence for PID.

Q. 14

A 25 year old woman complains of abdominal pain of rapid onset in the right lower quadrant. She subsequently undergoes surgery for suspected acute appendicitis. At surgery, however, a tubal pregnancy is discovered. The most frequent predisposing factor for this condition is?

 A

Endometriosis

 B

A an intrauterine device

 C

Leiomyomas of the uterus

 D

Pelvic inflammatory disease

Q. 14

A 25 year old woman complains of abdominal pain of rapid onset in the right lower quadrant. She subsequently undergoes surgery for suspected acute appendicitis. At surgery, however, a tubal pregnancy is discovered. The most frequent predisposing factor for this condition is?

 A

Endometriosis

 B

A an intrauterine device

 C

Leiomyomas of the uterus

 D

Pelvic inflammatory disease

Ans. D

Explanation:

The great majority of ectopic pregnancies (90%) occur in the fallopian tubes. The
other sites are the ovaries, abdominal cavity, and the intrauterine segment of the fallopian tubes. Any condition that leads to anatomical abnormalities of the uterus and fallopian tubes may predispose to ectopic pregnancy. The most frequent of such conditions is pelvic inflammatory disease (PID), which is usually associated with salpingitis. PID is a common infectious condition most frequently caused by Neisseria gonorrhoeae and Chlamydia trachomatis, both sexually transmitted. Other cases are due to a polymicrobial population, including staphylococci, streptococci, coliform bacteria, and Clostridium perfringens, acquired during abortion or delivery. PID leads to acute purulent salpingitis. If this is untreated or inadequately treated, it progresses to salpingo-oophoritis, tubal abscesses, pyosalpinx, or hydrosalpinx. Even milder cases may cause adhesions within the tube or between the tube and the ovary that interfere with implantation of the ovum and result in tubal pregnancy. All the remaining conditions listed above may also predispose to ectopic pregnancy.
 
Endometriosis refers to the presence of endometrium in abnormal locations, such as the ovary, uterine ligaments, rectovaginal pouch, and pelvic peritoneum. It is an important clinical condition manifesting with pain, dysmenorrhea, and infertility. Scarring at endometriotic sites may cause peritubal adhesions and ectopic pregnancy.
 
An intrauterine device may also increase the risk of ectopic pregnancy, but the mechanism of action is not clear.
 
Leiomyomas of the uterus are the most frequent benign tumor in women. They develop from the smooth muscle as well-circumscribed nodules within the uterine wall (intramural), in a subserosal or submucosal location. Leiomyomas may cause significant distortion of the uterine wall and interfere with implantation, increasing the risk of ectopic pregnancy.
 
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 10. Ectopic Pregnancy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Q. 15

Sequence of events, after salpingitis, in gonorrhoeal pelvic infection is:          

March 2013

 A

Hydrosalpinx, pyosalpinx, pelvic abscess

 B

Pyosalpinx, hydrosalpinx, pelvic abscess

 C

Pelvic abscess, hydrosalpinx, pyosalpinx

 D

Pelvic abscess, pyosalpinx, hydrosalpinx

Q. 15

Sequence of events, after salpingitis, in gonorrhoeal pelvic infection is:          

March 2013

 A

Hydrosalpinx, pyosalpinx, pelvic abscess

 B

Pyosalpinx, hydrosalpinx, pelvic abscess

 C

Pelvic abscess, hydrosalpinx, pyosalpinx

 D

Pelvic abscess, pyosalpinx, hydrosalpinx

Ans. B

Explanation:

Ans. B i.e. Pyosalpinx, hydrosalpinx, pelvic abscess



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