Pelvic Pain

Question 1

Pelvic Pain
Differential Diagnosis
Gynecological Ovaries

Answer 1

Ruptured cyst
Abscess
Torsion

Other: Bartholin abscess
Urinary Tract U

Question 2

Pelvic Pain
Differential Diagnosis
Gynecological Fallopian tubes

Answer 2

Salpingitis
Tubal abscess
Hydrosalpinx

Question 3

Pelvic Pain
Differential Diagnosis
Gynecological Uterus:

Answer 3

PID
Endometriosis
Fibroids

Question 4

Pelvic Pain
Differential Diagnosis
Gynecological Pregnancy related

Answer 4

(1st trimester):
Ectopic pregnancy
Threatened Abortion
Ovarian hyperstimulation

(2nd-3rd trimester)
Placental abruption
Round ligament pain
Braxton-Hicks contractions

Question 5

Pelvic Pain
Differential Diagnosis
Gynecological Other

Answer 5

Bartholin abscess

Question 6

Pelvic Pain
Differential Diagnosis
Urinary Tract

Answer 6

Urolithiasis
Pyelonephritis
Cystitis

Question 7

Pelvic Pain
Differential Diagnosis
Urological

Answer 7

Testicular torsion
Prostatitis

Question 8

Pelvic Pain
Assessment History

Answer 8

OPQRST
O: nset: When did the symptom start?
P: rovocation/Palliation: What makes
the symptom worse or better?
Q: uality: Describe the symptom (e.g.,
sharp, dull, burning)
R: adiation: Does the symptom spread
to other areas?
S: everity: How intense is the symptom
(e.g., on a scale of 1-10)
T: ime: How long has the symptom
been present?
Associated symptoms
Vaginal bleeding
Discharge
Dyspareunia
Bowel or bladder symptom
Pregnancy and sexual history

Question 9

Pelvic Pain
Assessment
Physical Exam

Answer 9

Vitals
Abdominal exam

Question 10

Pelvic Pain
Assessment
Pelvic exam

Answer 10

Cervical motion tenderness
Adnexal tenderness

Question 11

Pelvic Pain
Investigations
Labs

Answer 11

CBC
CMP
BUN/Cr
β-hCG
+/- vaginal and cervical swabs

Question 12

Pelvic Pain
Investigations
Tests

Answer 12

PoCUS – rule out ectopic, free fluid assessment
Formal abdo/pelvic ultrasound

Question 13

Pelvic Pain
Management
General

Answer 13

ABCs
IV access
Analgesia
Antiemetics
+/- admit and consult
For STIs/PID: safe sex practices, partner testing

Question 14

Pelvic Pain
Management
Ovarian Cyst

Answer 14

Uncomplicated: analgesia with followup
Hemoperitoneum or hemodynamically unstable: surgery

Question 15

Pelvic Pain
Management
Ovarian Torsion/Testicular Torsion

Answer 15

Surgical detorsion or removal

Question 16

Pelvic Pain
Management
Pelvic Inflammatory Disease

Answer 16

Severe infection: admit with IV antibiotics (Cefoxitin 2g IV q6h IV +
Doxycycline 100mg IV q12h x 24 hrs then switch to PO)
Mild-moderate infection: Ceftriaxone 500mg IM x 1 + Doxycycline
100 PO BID x 14 days