virgola82
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A 19 yo woman comes to emergency department and reports taht she fainted at work in the day. She has mild vaginal bleeding. Her abdomen is diffusely tender and distended. in addition, she complains of shoulder and abdominal pain. Her temperature is 97.6 °F, HR 120/min, BP 96/50. to confirm the diagnosis suggested by the available clinical data the best diagnostic procedure is
A Pregnancy test
B Posterior colpotomy
C Dilation & curettage
D Culdocentesis
E Laparoscopy
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| faraym
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A.
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| Justice
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D Culdocentesis
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| tanmaynator
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a
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| Justice
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faraym wrote:
A.
So, some guys are persistent about (A)... Are you thinking about ectopic pregnancy? Then I choose (A)...
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| faraym
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With such history , I wonder why u need to CONFIRM!
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| virgola82
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The right ans is D, culdocentesis.
It is because the history allows the diagnosis of ruptured ectopic pregnancy. Because she is tachycardic and BP is going down she must be bleeding in the peritoneum. Waiting for a hCG measurement could result in the patient to die. Moreover rapid pregnancy tests are negative in almost 50% of true pregnancies. Anyway the explanation points also out that culdocentesis is also not 100% sensitive so a negative result should not justify deciding not to operate the patient and further evaluation should be pursued
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| yasmeen
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d is best diagnostic
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| ram3
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culdocentesis is rarely done the first step is pregnancy which will show you if she is pregnant
big time culdocentesis in invasive start with a test that not invasive always
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| ashfaque
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BUT THE QUETION ASKS BEST TEST TO CONFIRM DIAGNOSIS NOT INITIAL TEST FIRST TEST IS PREGNANCY TEST but confirmatory is culdo
Edited by Aashi on 06/16/07 - 10:22 PM. Reason: AVOID writing in ALL CAPS.this is a forum rule
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| yasmeen
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culdocentesis
Edited by Aashi on 06/16/07 - 10:22 PM. Reason: AVOID writing in ALL CAPS.this a forum rule
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| ram3
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culdocentesis
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| Lim
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thanks for the good q.
why not just to run to Laparoscopy?
is it more definitive?
in kaplan, hCG(+), vaginao sono: no iup and no ectopy confirmed and..
Qualitive hCG over 1800 : it's Ectopy -> Laparoscopy...
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| claudia_i
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Culdocentesis will show blood in the posterior cul-de-sac (versus peritoneal fluid, for example) but it's considered an obsolete method do confirm ectopic pregnancy. At present, endovaginal U/S is the method of choice to look for fluid in cul-de-sac, although it can show only that fluid is present but cannnot identify the nature of this fluid. Laparoscopy is for treatment. Tricky Q.
Edited by claudia_i on 08/30/07 - 09:31 AM
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| gr8doc
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Culdocentesis. Good Question. However, can any one convincingly explai as to why not a diagnostic laparoscopy with sos treatment of the cause ?
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| claudia_i
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In an unstable patient like this one I would think that laparoscopy will be the procedure to cofirm the diagnosis and to treat but all the sources list laparoscopy only for management not for diagnosis ...
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| Lim
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sensitivity of culdocentesis is 93%.
we don't have hCG result, so culdocentesis is better i think(i shoud think)
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