4: DD of Pelvic Pain Flashcards

1
Q

What is the differential diagnosis?

Unilateral crampy pain that is often continuous

A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the differential diagnosis?

  • Tender abdomen with PE and localized rebound tenderness in lower abdominal quadrants
  • Most important sign: large pelvic mass on PE
  • Mild temperature elevation
  • Mild elevated WBC
A

Adnexal torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the differential diagnosis?

  • Often asymptomatic, can have increased uterine bleeding, pelvic pressure or pain, and dyspareunia (pain with intercourse)
  • Acute pain with torsion or rupture
  • Note: may be confused with subacute salpingo-oophoritis
A

Uterine fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the differential diagnosis?

  • Pain is mild to moderate and self-limiting unless it is due to a hemorrhagic corpus luteum cyst, which can result in significant blood loss and hemoperitoneum
  • Onset of pain is usually sudden and midcycle.
A

Ovarian cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the differential diagnosis?

  • Lower abdominal, uterine adnexal, and cervical motion tenderness
  • Pain is often described as dull or achy and may radiate to back or upper thighs
  • May have nausea and vomiting due to pain
A

PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the differential diagnosis?

  • Pain intensity is related to position
  • Abdominal tenderness increases when abdominal wall is tensed
A

Abdominal wall hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the differential diagnosis?

  • Results in ischemia and rapid onset of acute pelvic pain
  • Pain is usually severe and constant unless torsion is intermittent, in which case the pain will come and go
  • Pain may worsen with lifting, exercise, and intercourse
A

Adnexal torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the differential diagnosis?

Sharp pain sometimes radiates to lower back

A

Abdominal wall hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the differential diagnosis?

  • Low-grade fever
  • Purulent discharge
  • Elevated WBC
  • Elevated ESR
A

PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the differential diagnosis?

  • Significant abdominal distention
  • Bowel sounds are abnormal: at onset they are high pitched during pain and later will decrease and may be absent due to ischemia
  • Elevated WBC and fever are noted as the condition progresses
A

Intestinal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the differential diagnosis?

  • May have low-grade fever
  • High fever if ruptured
  • Chills
  • Rebound tenderness
  • Positive psoas sign
  • Positive obturator sign
  • Rovsing’s sign elicited
  • May observe leukocyte shift to left
A

Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the differential diagnosis?

  • Usually vaginal bleeding is present
  • May have very slight elevation of temperature
  • ESR and WBC may be slightly elevated
  • Serum β-hCG is positive
  • US may help with diagnosis
  • PE may reveal an adnexal mass
A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the differential diagnosis?

  • PE findings may be absent or limited
  • Laparoscopy with biopsy is the gold standard for diagnosis
A

Endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the differential diagnosis?

  • Severe, colicky pain in suprapubic area and in pelvis
  • Urinary frequency
  • Dysuria
  • Nausea, vomiting
A

Ureteral lithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the differential diagnosis?

  • Abdominal pain with palpation
  • May note blood with stool and/or rectal bleeding
A

IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the differential diagnosis?

  • Acute abdominal pain (may also cause chronic pelvic pain)
  • Bloating
  • Urgency of defecation
  • Diarrhea
  • Constipation
A

IBS

17
Q

What is the differential diagnosis?

  • Colicky abdominal pain
  • Abdominal distention
  • Vomiting
  • Constipation and obstipation
A

Intestinal obstruction

18
Q

What is the differential diagnosis?

Crampy, intermittent pain that is in the midline or bilateral lower abdomen

A

Abortion: threatened, inevitable, or incomplete

19
Q

What is the differential diagnosis?

  • Vomiting
  • Diarrhea
  • Abdominal cramping and pain
A

Gastroenteritis

20
Q

What is the differential diagnosis?

  • Often asymptomatic
  • May experience abdominal bloating, constipation, and diarrhea
  • Severe LLQ pain
A

Diverticulitis

21
Q

What is the differential diagnosis?

  • Palpation of abdomen reveals mass(es) arising from uterus
  • May note tenderness with palpation
  • May have elevated temperature and WBC
A

Uterine fibroids

22
Q

What is the differential diagnosis?

  • Diffuse abdominal pain, generally periumbilical
  • Anorexia, nausea, vomiting
  • Pain usually in RLQ (McBurney’s point)
  • Chills
A

Appendicitis

23
Q

What is the differential diagnosis?

  • Often asymptomatic
  • Most common symptoms are dysmenorrhea, deep dyspareunia, and sacral backache during menses
A

Endometriosis

24
Q

What is the differential diagnosis?

  • May have systemic toxicity such as fever and tachycardia
  • Marked abdominal tenderness with palpation
A

Gastroenteritis

25
Q

What is the differential diagnosis?

  • Pregnancy test usually positive
  • Vaginal bleeding usually present
  • If infection: elevated WBC and ESR
A

Abortion: threatened, inevitable, or incomplete

26
Q

What is the differential diagnosis?

  • Lower abdominal or pelvic pain usually midline
  • Dysuria, urinary urgency and frequency
A

Cystitis

27
Q

What is the differential diagnosis?

Urine dipstick positive for leukocyte esterase or nitrite

A

Cystitis

28
Q

What is the differential diagnosis?

  • Hypovolemia only if there is hemoperitoneum
  • Most critical sign is significant abdominal tenderness, often associated with rebound tenderness due to peritoneal irritation
  • May be able to palpate a mass during the pelvic examination if not entirely ruptured
A

Ovarian cysts

29
Q

What is the differential diagnosis?

  • Hematuria
  • Flank and costovertebral angle pain
A

Ureteral lithiasis

30
Q

What is the differential diagnosis?

  • Distended abdomen with LLQ tenderness with palpation
  • Localized rebound tenderness
  • May palpate a doughy, mobile mass in the LLQ
  • Hypoactive bowel sounds
  • May see elevated WBC
A

Diverticulitis