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MC > Pelvic Pain > Flashcards

Pelvic Pain Flashcards

1
Q

Sudden sharp pain in the pelvis that becomes

more generalised indicates_______

A

rupture of an ectopic

pregnancy or an ovarian cyst.

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2
Q

The principal afferent pathways of the pelvic

viscera arise from _______ to _______

A

T10–12, L1 and S2–4

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3
Q

Genital Causes of acute lower abdominal and

pelvic pain in women

A 
Acute salpingitis
Pelvic peritonitis
Bleeding
Rupture or torsion of ovarian cyst
Threatened or incomplete abortion
Rupture or aborting tubal ectopic pregnancy
Rupture or bleeding endometrioma
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4
Q

non- Genital Causes of acute lower abdominal and

pelvic pain in women

A

Acute appendicitis
Bowel obstruction
Urinary tract infection (cystitis)
Ureteric colic (calculus)

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5
Q

Functional Causes of acute lower abdominal and

pelvic pain in women

A

Primary dysmenorrhoea

Retrograde menstruation

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6
Q

Chronic pelvic pain is constant or recurrent pain of at

least_______

A

6 months’ duration

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7
Q

It is the reason for up to 40% of gynaecological

laparoscopies

A

Chronic pelvic pain

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8
Q

it is difficult to distinguish clinically between
endometriosis of the uterus (adenomyosis) and _______________Both conditions are associated
with dysmenorrhoea and a tender normal-sized
uterus

A

pelvic

congestion syndrome.

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9
Q

It is the commonest cause
of intraperitoneal haemorrhage. There is usually a
history of a missed period but a normal menstrual
history may be obtained in some instances.

A

Ectopic pregnancy

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10
Q

RF for ectopic pregnancy

A 
— previous ectopic pregnancy
— previous PID
— previous abdominal or pelvic surgery,
especially sterilisation reversal
— IUCD use
— in-vitro fertilisation/GIFT
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11
Q

amenorrhoea (65–80%) + lower
abdominal pain (95 + %) + abnormal vaginal
bleeding (65–85%)

A

ectopic pregnancy

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12
Q

Pain patterns of ectopic pregnancy

A

Pain may radiate to rectum (lavatory sign),

vagina or leg

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13
Q

Vaginal examination of patients with ectopic pregnancy

A

• Vaginal examination:
— tenderness on bimanual pelvic examination
(pain on cervical provocation i.e. cervical
motion tenderness)
— palpable adenxal mass
— soft cervix

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14
Q

In EP, Serum β -hCG assay________ (invariably
positive if a significant amount of viable
trophoblastic tissue present

A

> 1500 IU/L

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15
Q

Transvaginal ultrasound can diagnose at
______ weeks (empty uterus, tubal sac, fluid in
cul-de-sac)

A

5–6

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16
Q

Ectopic pregnancy diagnosis

A
  • Pregnancy test
  • β-hCG assay
  • Transvaginal ultrasound
  • Laparoscopy
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17
Q

tx of EP

Treatment may be conservative (based on
ultrasound and β -hCG assays); medical, by injecting
_______ into the ectopic sac;
_________ for severe cases

A

methotrexate

laparoscopic
removal; or laparotomy

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18
Q

Post management

  • Successful pregnancy _______
  • Subsequent risk of ectopic pregnancy ______
A

60–65%

10–15%

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19
Q

When the Graafian follicle ruptures a small amount
of blood mixed with follicular fluid is usually
released into the pouch of Douglas. What is this phenomenon called?

A 
Ruptured ovarian (Graafian)
follicle (mittelschmerz)
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20
Q

Pain character of Ruptured ovarian (Graafian)

follicle (mittelschmerz)

A
  • Deep pain in one or other iliac fossa (RIF > LIF)
  • Often described as a ‘horse kick pain’
  • Pain tends to move centrally
  • Relieved by sitting or supporting lower abdomen
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21
Q

Benign ovarian tumours, particularly ________may be asymptomatic but will cause pain if
complicated

A

ovarian

cysts,

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22
Q

_______ tend to rupture just prior to ovulation or

following coitus.

A

ovarian cyst

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23
Q

What is the dx

  • Patient usually 15–25 years
  • Sudden onset of pain in one or other iliac fossa
  • May be nausea and vomiting
  • No systemic signs
  • Pain usually settles within a few hours
A

Ruptured ovarian cyst

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24
Q

When to do conservative MX for Ruptured ovarian cyst

A

— simple cyst <4 cm
— internal haemorrhage
— minimal pain

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25
Q

When to do lap sx for ovarian cyst?

A

— complex cysts
— large cysts
— external bleeding

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26
Q

Torsions are mainly from ______ and, when
right-sided, may be difficult to distinguish from acute
pelvic appendicitis

A

dermoid cysts

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27
Q

SSx of torsion of ovarian cyst

A
  • Severe cramping lower abdominal pain
  • Diffuse pain
  • Pain may radiate to the flank, back or thigh
  • Repeated vomiting
  • Exquisite pelvic tenderness
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28
Q

_______ has an incidence of 10 cases per 10 000
women per year and accounts for 5% of all cancers
in women and 20% of all gynaecological cancers

A

Ovarian cancer

29
Q

Ovarian cancer tends to remain asymptomatic for
a long period. No age group is spared but it becomes
progressively more common after _______

A 
45 years (peak
incidence 60–65 years)
30
Q

RF for ovarian CA

A
  • Age
  • Family history (first-degree relatives)
  • Nulliparity
31
Q

Protective factors for ovarian CA

A
  • COC pill

* Pregnancy

32
Q

T or F

Any ovary that is easily palpable is usually
abnormal (normal ovary rarely >4 cm).

A

T

33
Q

Dx of ovarian CA

A 
• Ultrasound ± colour Doppler
• Tumour markers such as CA-125, β -hCG
(choriocarcinoma) and alpha-fetoprotein are
becoming more important in diagnosis and
managemen
34
Q

Dysmenorrhoea (painful periods) may commence
with the onset of the menses (menarche) when it is
called ______ or later in life when
the term ________ is applied

A

primary dysmenorrhoea,

secondary dysmenorrhoea

35
Q

This is menstrual pain associated with ovular cycles
without any pathologic findings. The pain usually
commences within 1–2 years

A

Primary (functional) dysmenorrhoea

36
Q

Conservative Mx of Primary dysmen

A
  • Vitamin B1 (thiamine) 100 mg daily
  • COC (low-oestrogen triphasic pills preferable) 5
  • progestogen-medicated IUCD
37
Q

A Cochrane review found that the most beneficial

medication was the NSAIDs, and____ and ______

A

vitamin B1 and

magnesium also proved effective

38
Q

_________ is menstrual pain for
which an organic cause can be found. It usually
begins after the menarche after years of pain-free
menses; the patient is usually over 30 years of
age

A

Secondary dysmenorrhoea

39
Q

Commonest causes of Secondary dysmenorrhoea

A
  • endometriosis (a major cause)
  • PID (a major cause)
  • IUCD
  • submucous myoma
  • intra-uterine polyp
  • pelvic adhesions
40
Q

Pelvic adhesions may be the cause of pelvic pain,
infertility, dysmenorrhoea and intestinal pain. They
can be diagnosed and removed ________

A

laparoscopically

41
Q

______ is the condition where ectopically
located endometrial tissue (usually in dependent parts
of the pelvis and in the ovaries

A

Endometriosis

42
Q

What are the factors affecting EM

A

responds to female sex
hormone stimulation by proliferation, haemorrhage,
adhesions and ultimately dense scar tissue changes

43
Q

dysmenorrhoea + menorrhagia +

dyspareunia = abdominal/pelvic pain

A

endometriosis

44
Q

Signs of EM

A

• Fixed uterine retroversion
• Tenderness and nodularity in the pouch of
Douglas/retrovaginal septum
• Uterine enlargement and tenderness

45
Q

________ this is endometriosis of the
myometrium affecting the endometrial glands and
stroma

A

Adenomyosis:

46
Q

The symptoms of adenomyosis are similar to endometriosis plus an enlarging _____

A

tender uterus

47
Q

Gold standard for dx of EM

A

• Usually by direct visual inspection at laparoscopy

(the gold standard) or laparotom

48
Q

What is the use of curettage in EM Dx

A

• Curettage, which shows small sensory C nerve

fibres in the endometrium

49
Q

OCPs are used for the Tx of EM to:

A

To induce amenorrhoea (only twothirds

respond to drugs

50
Q

OCPs used in the Tx of EM

A

— levonorgestrel-releasing IUCD (Mirena) 5
yearly and indefinite
— danazol (Danocrine)—for 3–6 months
— COC: once daily continuously—long term
— progestogens (e.g. medroxyprogesterone
acetate—Depo-Provera) or orally 10 mg bd
for up to 6 months
— GnRH analogues (e.g. goserelin, 3.6 mg SC
implant every 28 days for up to 6 months,
nafarelin

51
Q

____________PID
is a major public health problem and is the most
important complication of STIs among young wome

A

Acute

52
Q

CX of PID

A

tubal obstruction,

infertility and ectopic pregnancy

53
Q

What is the dx

  • Fever ≥ 38 ° C
  • Moderate to severe lower abdominal pain
A

Acute PID

54
Q

What is the dx

  • Ache in the lower back
  • Mild lower abdominal pain
A

Chronic PID

55
Q

Diagnostic criteria for acute PID

All three of the following should be present

1
2
3

A

1 Lower abdominal tenderness (with or without rebound)
2 Cervical motion tenderness
3 Adnexal tenderness (may be unilateral) plus

56
Q

Diagnostic criteria for acute PID

One of the following should be present
1 Temperature _____
2 White blood cell count_______
3 Purulent fluid obtained via culdocentesis
4 Inflammatory mass present on bimanual pelvic
examination and/or sonography
5 ESR ≥ 15 mm/h or CRP >1.0 mg/dL
6 Isolation of ________
7 Histological evidence of infection (e.g. plasma cells)

A

≥ 38°C

≥ 10 500/mm2

N. gonorrhoeae and/or C. trachomatis

57
Q

Exogenous organisms: those which are community
acquired and initiated by sexual activity. They
include the classic STIs including

A 
Chlamydia trachomatis (most common causative organism) and Neisseria
gonorrhoeae
58
Q

Endogenous infections: these are normal

commensals of the lower genital tract, especially

A

Escherichia coli and Bacteroides fragilis

59
Q

Portal of entry of endogenous infection

A

The commonest portals of entry are

cervical lacerations and the placental site

60
Q

These
organisms cause an ascending infection and
can spread direct or via lymphatics to the broad
ligament, causing __________

A

pelvic cellulitis

61
Q

organism associated with prolonged IUD use

A

Actinomycosis: due to prolonged IUCD use. Look

for Actinomyces israelii on culture

62
Q

Sex partners of women with PID should be treated

with agents effective against ________

A

C. trachomatis and N.

gonorrhoeae.

63
Q

Mild to moderate infection Tx for PID (treated as an

outpatient

A

ceftriaxone 500 mg (in 2 ml 1% lignocaine) IM or
500 mg IV, as a single dose (for gonorrhoea)
plus
azithromycin 1 g (o), as 1 dose
plus
metronidazole 400 mg (o) 12 hourly for 14 days

64
Q

moderate to severe infection Tx for PID (treated as an

outpatient

A

ceftriaxone 1 g IV daily
plus
azithromycin 500 mg IV daily
plus
metronidazole 500 mg IV 12 hourly until there is substantial clinical improvement,
when the oral regimen above can be used for the
remainder of the 14 days

65
Q

Tx of actinomyces

A

amoxycillin 500 mg tds + metronidazole 400 mg

bd for 14 days. Ensure IUCD is removed

66
Q

In any woman whose normal activities are
disturbed by dysmenorrhoea unrelieved by
NSAIDs,_______ should be suspected

A

endometriosis

67
Q

If an ectopic pregnancy is suspected and there
are no facilities for resuscitation, digital vaginal
examination should be deferred for it may provoke
_____

A

rupture.

68
Q

Acute abdominal and pelvic pain in the presence of a

negative β-hCG is most often due to an ______

A

ovarian cyst

69
Q

A positive β-hCG plus an empty uterus and an
adnexal mass are the classic diagnostic features of
_________

A

ectopic pregnancy

MC (90 decks)

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