Pelvic Pain

Question 1

dysmenorrhea

Answer 1

painful menses

Question 2

dyspareunia

Answer 2

pain with intercourse

Question 3

dyschezia

Answer 3

pain with bowel movements

Question 4

vulvodynia

Answer 4

pain of the vulva

Question 5

allodynia

Answer 5

pain with non-noxious stimuli

Question 6

hyperalgesia

Answer 6

increased response to noxious stimuli

Question 7

how long is acute pain?
chronic pain?

Answer 7

< 3 months
> 6 months

Question 8

what 3 labs should be done with patients presenting with pelvic pain?

Answer 8

pregnancy test
UA/urine culture
STI screening

Question 9

what is the first line imaging study for pelvic pain?
what imaging can be used if a non-gyn etiology is suspected?

Answer 9

abdominal US

CT abdomen/pelvis

Question 10

what can be used as a diagnostic in acute pain that would suggest PID, ovarian torsion, ruptured ectopic pregnancy, or persistent adnexal masses?

Answer 10

laparoscopy

Question 11

what is the most common type of trauma that causes acute pain?

Answer 11

penetrating injury

Question 12

infection of the upper female reproductive tract that includes the uterus

Answer 12

pelvic inflammatory disease

Question 13

a patient presents with cervical motion tenderness, uterine tenderness, adnexal tenderness, and macropurulent discharge. Dx? treatment? (3)

Answer 13

PID

antibiotics
antiemetics
pain control

Question 14

the presence of what in a culture would indicate PID? (2)

Answer 14

gonorrhea
trachomatis

Question 15

what imaging would diagnose PID?

Answer 15

pelvic ultrasound

Question 16

twisting of the adnexa on a vascular pedicle resulting in cessation of blood flow to the adnexa and cessation of venous drainage

Answer 16

adnexal torsion

Question 17

what side does an adnexal torsion typically occur? why?

Answer 17

right side
limited mobility of left ovary by the sigmoid colon

Question 18

patient presents with sharp lower pelvic pain, adnexal pain/tenderness, and adnexal mass on US. Dx? treatment?

Answer 18

adnexal torsion
emergency surgical laparoscopy

Question 19

extension of the endometrial glands and stroma into the uterine musculature

Answer 19

adenomyosis

Question 20

a patient presents with heavy and painful periods. On exam, the uterus is symmetrically enlarged, tender, and boggy. transvaginal US shows a heterogenous appearance of the myometrium. Dx?

Answer 20

adenomyosis

Question 21

how is adenomyosis definitively diagnosed?

Answer 21

with hysterectomy

Question 22

what is the most common uterine neoplasm?

Answer 22

uterine leiomyoma (benign)

Question 23

a patient presents with pelvic pain/pressure, feels pressure on the bladder, back pain, and heavy/prolonged menstrual bleeding. Dx?

Answer 23

uterine leiomyoma (benign)

Question 24

what are 5 treatment options for uterine leiomyomas?

Answer 24

hormones
GNRH agonists
myomectomy
uterine fibroid embolization
radiofrequency fibroid ablation

Question 25

what is the most definitive treatment option for a uterine leiomyoma?

Answer 25

hysterectomy

Question 26

what diameter is a functional ovarian cyst?

Answer 26

3 cm or more

Question 27

what is the treatment for functional ovarian cyst?

Answer 27

observation +/- surgery if symptomatic / persistent

Question 28

what can prevent further cyst formation?

Answer 28

oral contraceptives

Question 29

most common ovarian neoplasm that is a germ cell tumor, containing sweat and sebaceous glands, hair follicles, and teeth

Answer 29

mature cystic teratoma (dermoid cyst)

Question 30

what is the treatment for a mature cystic teratoma (dermoid cyst)?

Answer 30

surgery (cystectomy vs oophectomy)

Question 31

presence of endometrial glands and stroma outside of the endometrial cavity or uterine musculature

Answer 31

endometriosis

Question 32

patient presents with dysmenorrhea, dyspareuna, dyschezia, and pelvic pain. Dx? treatment?

Answer 32

endometriosis hormonal management +/- excision/ablation

Question 33

what is the only way to definitively diagnose endometriosis?

Answer 33

laparoscopy

Question 34

what does a black, blue, red, or clear appearance indicate?

Answer 34

superficial powder burn lesions

Question 35

what does a chocolate cyst appearance indicate?

Answer 35

endometriomas

Question 36

what is the definitive treatment for endometriosis?

Answer 36

hysterectomy

Question 37

42 yr old G2P2002 with 2 years of heavy painful periods and pelvic pressure. She has tried birth control pills with mild improvement of bleeding but still has pressure symptoms. On exam her uterus is at the level of the umbilicus with irregular shape. What is the most likely diagnosis?

Answer 37

leiomyoma

Question 38

A 23 y/o G1P1 presents to the clinic with a new crampy pain in her right lower quadrant over the last 3 days. Her last menstrual period was 3 weeks ago and was normal. She uses condoms for contraception and her urine pregnancy test is negative. On pelvic examination a 3-4 cm tender cystic mass is palpated in the right adnexa. The remainder of her examination is negative. What is the appropriate next step in her evaluation?

Answer 38

transvaginal ultrasound

Question 39

A 25 y/o G0 complains of a painful full sensation in her right lower quadrant. She has had regular periods since menarche. She has no history of STDs. On physical examination you find a mobile mass in her right adnexa about 8 cm x 8 cm. This mass is mobile. Her urine pregnancy test is negative. You order a transvaginal ultrasound. What is the diagnosis?

Answer 39

teratoma (dermaoid cyst)

Question 40

Patient is a 45 yr old G2P2002 with a history of progressively worsening painful and heavy periods. She has tried birth control pills without improvement. She is examined and has a boggy tender uterus. You repeat the exam two weeks later and find the uterus to be smaller and not as tender. What is the likely diagnosis?

Answer 40

adenomyosis