Pelvic Pain and Adnexal Masses

Question 1

What are the gynae causes of acute onset pelvic pain?

Answer 1

1. PID
2. Mittelschmerz
3. Ovarian cyst
4. Ovarian torsion

Question 2

What are the non-gynae causes of acute onset pelvic pain?

Answer 2

1. Renal stones
2. Constipation

Question 3

What are the gynae causes of chronic pelvic pain?

Answer 3

1. Teratoma
2. Endometriosis
3. Fibroids

Question 4

What are the non-gynae causes of chronic pelvic pain?

Answer 4

1. Interstitial cystitis
2. IBD

Question 5

26yo G0, LMP 1 week ago, presents to the ED complaining of 2 day history of lower abdo pain following vaginal discharge. What is the likely diagnosis?

Answer 5

PID

Question 6

What is cervical motion tenderness pathognomonic of?

Answer 6

PID

Question 7

What is adnexal fullness pathognomonic of?

Answer 7

Tubo-ovarian abscess (PID)

Question 8

What are the risk factors for PID?

Answer 8

Multiple sexual partners
Previous STI
Immunocompromised

Question 9

How is PID investigated and managed?

Answer 9

Ix - NAAT (STIs)
Mx - 14 days Abx PO

Question 10

26yo, G0, 2 day history of acute onset pelvic pain associated with nausea and vomiting. Intermittent pain and patient is lying flat, afraid to move. What is the most likely diagnosis?

Answer 10

Ovarian torsion

Question 11

What is the management of ovarian torsion?

Answer 11

Laparoscopy +/- oophorectomy

Question 12

26yo, G0, LMP was 12-14 days ago. Presents with abdominal pain that is relieved with NSAIDs. Exam in benign. What is the most likely diagnosis?

Answer 12

Mittelschmerz

Question 13

How is Mittelschmerz managed?

Answer 13

NSAIDs, COCP

Question 14

43yo G2P2 with one day of lower abdo pain associated with gross haematuria and back pain. WBC are 14, urinalysis + blood, leukocytes. What is the most likely diagnosis?

Answer 14

Renal colic

Question 15

24yo complains of two days of diffuse abdo pain. O/E tympanic abdo, mildly tender, normal gynae, firm stool in rectum. Most likely diagnosis?

Answer 15

Constipation

Question 16

36yo G3P3, LMP 2 weeks ago, presents with pelvic pain lasting 6 months. Pain is intermittent and not related to menses with no associated symptoms. O/E no tenderness, adnexal fullness on RHS. Diagnosis?

Answer 16

Teratoma (dermoid cyst)

Question 17

How is a teratoma managed?

Answer 17

Surgical removal if >3cm
Monitor if <3cm
Check tumour markers (CA-125, CEA)

Question 18

38yo G0, reports lifelong history of dysmenorrhoea and now, constant pain. No relief with NSAIDs - experienced some relief with COCP in 20’s. O/E frozen pelvis. Diagnosis?

Answer 18

Endometriosis

Question 19

Where is the most common site of endometriosis?

Answer 19

Ovary

Question 20

How is endometriosis managed?

Answer 20

NSAIDs
Hormonal contraception
GnRH agonist (Depo Lupron)
Surgical removal if endometrioma >3cm
Hysterectomy + oophorectomy

Question 21

What is Depo Lupron (GnRH agonist) used in the management of?

Answer 21

Endometriosis and fibroids (suppresses menstruation)

Question 22

42yo P2, 3 year history of worsening pelvic pain. Began as dysmenorrhoea but is now almost constant. Feels constant pressure in the vagina. O/E tender and irregular uterus, bloods and urine normal. Diagnosis?

Answer 22

Fibroids

Question 23

What is the management of fibroids?

Answer 23

NSAIDs
Hormonal contraception
Depo Lupron (GnRH agonist)
Myomectomy