Inflammatory & Infective Disorders

Question 1

Pelvic pain is described as being chronic when it has been present for how long?

Answer 1

More than 6 months

Question 2

What are the two most common causes of chronic pelvic pain?

Answer 2

Endometriosis and PID

Question 3

What is endometriosis?

Answer 3

The presence of endometrial glands and stroma outside the uterine cavity

Question 4

What is the most widely accepted theory behind the occurrence of endometriosis?

Answer 4

Retrograde menstruation

Question 5

Describe the relationship between endometriosis and genetics?

Answer 5

Women are 5 times more likely to have endometriosis if their mother also had the condition

Question 6

The prevalence of endometriosis is lower in women using what medication?

Answer 6

Hormonal contraceptives

Question 7

What are the three main clinical features of endometriosis?

Answer 7

Cyclical pelvic pain, deep dyspareunia and subfertility

Question 8

When does the pelvic pain of endometriosis usually begin in relation to the menstrual cycle?

Answer 8

A few days before the onset of bleeding

Question 9

What is the typical examination finding of severe endometriosis?

Answer 9

A fixed, retroverted uterus

Question 10

What is the relationship between the severity of symptoms of endometriosis and the extent of disease?

Answer 10

These do not correlate well

Question 11

What are some non-gynaecological symptoms of endometriosis?

Answer 11

Fatigue, depression, bowel and urinary symptoms

Question 12

What are some bowel symptoms that may occur in endometriosis?

Answer 12

Pain on defaecation, diarrhoea

Question 13

What are some urinary symptoms that may occur in endometriosis?

Answer 13

Dysuria, haematuria, urgency

Question 14

The presence of blood filled ‘chocolate’ ovarian cysts on ultrasound is suggestive of what diagnosis?

Answer 14

Endometriosis

Question 15

Endometriosis increases the risk of developing which malignancy?

Answer 15

Epithelial ovarian cancer (particularly endometrioid, clear cell and low grade serous)

Question 16

What is the gold standard diagnostic investigation for endometriosis?

Answer 16

Laparoscopy

Question 17

What effect does pregnancy have on endometriosis?

Answer 17

It usually makes the condition better

Question 18

What symptomatic management is offered first line to women with endometriosis?

Answer 18

NSAIDs and/or paracetamol

Question 19

What is the aim of medical management for endometriosis?

Answer 19

To suppress ovulation and induce amenorrhoea

Question 20

What are some options of medical management that can be used in endometriosis to suppress ovulation and induce amenorrhoea?

Answer 20

COCP, POP, contraceptive implants, injections or IUS

Question 21

If hormonal contraceptives are not successful in the management of endometriosis, what is the next line medical management and what is the effect of this?

Answer 21

GnRH analogues and HRT - stimulate the menopausal state but without the symptoms

Question 22

What is done if medical management fails in the treatment of endometriosis, or the woman is wishing to become pregnant in the near future?

Answer 22

Surgical management (ablate/excise endometrial deposits, remove cysts, divide adhesions)

Question 23

Intractable symptoms of endometriosis may warrant what surgical procedure?

Answer 23

Hysterectomy

Question 24

When do symptoms of endometriosis usually resolve and why?

Answer 24

After the menopause as there are lower levels of circulating oestrogens

Question 25

What organism is the most common cause of PID?

Answer 25

Chlamydia trachomatis

Question 26

The risk of PID can be reduced how?

Answer 26

Barrier contraceptives

Question 27

What are some risk factors for the development of PID?

Answer 27

Aged < 25, multiple sexual partners, unprotected sex, recent insertion of Cu-IUD

Question 28

What types of abnormal menstrual bleeding may be seen in those with PID?

Answer 28

Inter-menstral and post-coital bleeding

Question 29

What are some features that may be seen on examination of someone with PID?

Answer 29

Cervical excitation, adnexal tenderness and swelling

Question 30

What blood tests are useful in the investigation of suspected PID?

Answer 30

WCC and CRP

Question 31

How should chlamydia and gonorrhoea be screened for in women with suspected PID?

Answer 31

NAATs from high vaginal and endocervical swabs

Question 32

What imaging investigations can be used in individuals with suspected PID?

Answer 32

Trans-vaginal US, MRI

Question 33

In those with PID, there may be free fluid where?

Answer 33

The rectouterine pouch

Question 34

What is Fitz-Hugh-Curtis syndrome, and what infection is most likely to cause it?

Answer 34

Peri-hepatic adhesions, caused by chlamydia

Question 35

How does Fitz-Hugh-Curtis syndrome present?

Answer 35

RUQ pain

Question 36

How long are antibiotics given for in the treatment of PID?

Answer 36

14 days

Question 37

What is the standard outpatient antibiotic treatment for PID?

Answer 37

Ofloxacin and metronidazole PO (bd)

Question 38

What is the outpatient antibiotic treatment for PID in those aged < 18 years or who are at high risk of gonorrhoea?

Answer 38

PO metronidazole and PO doxycycline (bd) and a single dose of IM ceftriaxone

Question 39

What antibiotics are used in the inpatient treatment of PID?

Answer 39

IV ceftriaxone and metronidazole and PO doxycycline

Question 40

Do patients with mild PID need to have their Cu-IUD removed (if present)?

Answer 40

No

Question 41

When may surgery be necessary in the treatment of PID?

Answer 41

To drain pelvic abscesses that do not respond to antibiotics

Question 42

What are some long-term consequences of PID?

Answer 42

Chronic pelvic pain, adhesions, ectopic pregnancy, infertility

Question 43

Who are vulval skin disorders typically seen in?

Answer 43

Post-menopausal women

Question 44

What type of condition is lichen sclerosus?

Answer 44

Autoimmune

Question 45

What is the risk associated with the majority of vulval skin conditions?

Answer 45

Risk of progression to vulval cancer

Question 46

What vulval skin disorder is this describing: whitened skin in a figure of eight distribution, and loss of vulval architecture?

Answer 46

Lichen sclerosus

Question 47

What are some risk factors for vulval intra-epithelial neoplasia?

Answer 47

High risk HPV infection, immunosuppression and smoking

Question 48

What vulval skin disorder is this describing: white, red or pigmented nodules that may co-exist with an invasive vulval carcinoma?

Answer 48

Vulval intra-epithelial neoplasia

Question 49

What vulval skin disorder is this describing: red plaques with white 'cake icing' effect?

Answer 49

Extra-mammary Paget's disease

Question 50

Extra-mammary Paget's disease may be associated with which malignancies?

Answer 50

Breast, colon or GU tract

Question 51

What vulval skin disorder is this describing: reddened vulval skin in a 'nappy distribution'?

Answer 51

Chronic vulval dermatitis

Question 52

What are the most common symptoms of vulval skin disorders?

Answer 52

Itching and irritation

Question 53

An extremely painful, hot, swollen, red labium is suggestive of what diagnosis?

Answer 53

Bartholin's cyst abscess

Question 54

If cases of vulval skin disorders do not respond to treatment or are ambiguous, what investigation is necessary?

Answer 54

Vulval biopsy

Question 55

What can be used to relieve symptoms in cases of lichen planus, lichen sclerosus and vulval intra-epithelial neoplasia?

Answer 55

Topical corticosteroids

Question 56

When is surgical excision considered in women with vulval skin disorders?

Answer 56

If symptoms are unbearable or if there is suspicion of cancer

Question 57

How are patients with lichen sclerosus, lichen planus and vulval intra-epithelial neoplasia followed up?

Answer 57

Annual review to exclude malignancy

Question 58

Where does Mittelschmerz cause pain?

Answer 58

RIF

Question 59

What is the imaging investigation of choice for adenomyosis?

Answer 59

Pelvic MRI