Pelvic Pain and benign gynaecology

Question 1

Marsupialisation is used to treat which condition?

Answer 1

bartholin’s cyst
acute infection

Question 2

Define fibroids

Answer 2

benign tumours of myometrium= oestrogen dependent tumour

Question 3

List two sites of fibroids

Answer 3

sub-mucosal
intramural
sub-serosal

Question 4

What happens to fibroids during pregnancy and menopause?

Answer 4

grows during pregnancy
shrinks after menopause

Question 5

What is red degeneration?

Answer 5

miscarriage due to fibroids

Question 6

What are the symptoms of fibroids?

Answer 6

heavy menstrual bleeding
abdo swelling
pressure symptoms
pain- torsion

Question 7

How to diagnose fibroids?

Answer 7

confirm by USS
MRI to plan management

Question 8

What is the management of fibroids?

Answer 8

medical
- HMB
- GnRH prior to surgery

surgical- hysterectomy, myomectomy

uterine artery embolisation

Question 9

Name two benign conditions of the uterus

Answer 9

polyps
fibroids

Question 10

Name two benign conditions of the vulva

Answer 10

bartholin cyst
lichen sclerosis
genital herpes

Question 11

Name two benign fallopian tube conditions

Answer 11

hydrosalpinx
pelvic inflammatory disease

Question 12

What are the causes of pelvic inflammatory disease?

Answer 12

chlamydia
e.coli
anaerobes

Question 13

What are the risks of blockage in fallopian tubes?

Answer 13

infertility
ectopic pregnancy
chronic pelvic pain

Question 14

Symptoms of pelvic inflammatory disease?

Answer 14

malaise
pain during sex
lower abdo pain (bilateral)
variable discharge

Question 15

List three signs of PID?

Answer 15

pyrexia
tachy
distension and tenderness
RUQ
rebound and guarding

Question 16

What is Fits-Hugh-curtis syndrome?

Answer 16

peri hepatic inflammation from PID

Question 17

What are the investigations for PID?

Answer 17

pregnancy test
FBC +CRP
MSU- exclude UTI
STI swabs
Laparoscopy

Question 18

What is the management of PID?

Answer 18

empircal antibiotics broad spectrum (don’t wait for swab)

pain relief

Question 19

Which abx used for pelvic inflammatory disease?

Answer 19

ceftriazone 500 mg IM stat then doxy + metronidazole

Question 20

Define hydrosalpinx

Answer 20

Hydrosalpinx is the condition in which the end portion of a woman’s fallopian tube becomes fluid-filled and swollen, which can cause infertility.

Question 21

How are cysts diagnosed?

Answer 21

USS or CT or MRI
Ca125 and other markers- CEA, aFP, hCG

Question 22

What is the management of ovarian cyst?

Answer 22

conservative
remove if >6cm and/or symptomatic
ovarian cystectomy or oopherectomy
laparoscopic if possible

Question 23

List three types of ovarian cysts

Answer 23

functional cyst
dermoid cyst
epithelial cyst
endometriotic cyst

Question 24

What is dermoid cyst also known as?

Answer 24

benign cystic teratoma

Question 25

What are the tumour markers to assess for in ovarian cyst?

Answer 25

Ca125, AFP, HE4

Question 26

Which accidents are associated with cysts?

Answer 26

torsion rupture

Question 27

Investigations for cysts

Answer 27

pregnancy test MSU vaginal swabs FBC +CRP Ca125 TV USS laparoscopy

Question 28

What are the three types of endometriosis?

Answer 28

superficial peritoneal lesions deep infiltrating lesions ovarian cysts (endometriomas)

Question 29

What is the treament of lichen sclerosis?

Answer 29

dermovate= potent steroid

Question 30

Which virus causes genital herpes?

Answer 30

HSV-2

Question 31

What is the management of genital herpes?

Answer 31

aciclovir 5-10 days increase fluid intake vaseiline or lidocaine for painful micturation salt water to prevent infection and promote healing

Question 32

What are the symptoms of endometriosis?

Answer 32

dysmenorrhoea dyspareunia pelvic pain subfertility

Question 33

How is endometriosis diagnosed?

Answer 33

transvaginal USS

Question 34

How to manage endometriosis?

Answer 34

conservative NSAIDs Progesterone OCP Surgical IVF

Question 35

Define nulliparous

Answer 35

“Nulliparous” is a fancy medical word used to describe a woman who hasn't given birth to a child.

Question 36

What is a complication of herpes that affects the vulva?

Answer 36

post-herpetic neuralgia= hypersensitivity of vulval nerve fibres Treatment= tricyclic antidepressants

Question 37

What is the management of chronic pelvic pain syndrome?

Answer 37

antispasmodics IBS NSAIDs MSK specialist referral MDT- chronic pain services, pschology, physio, pscyhosexual therapy, self help groups

Question 38

30 year old female patient presents with acute lower abdominal pain. What are the gynaecological differentials?

Answer 38

cyst accident pelvic inflammatory disease ectopic pregnancy

Question 39

35 year old female patient with chronic lower abdo pain. What are your differentials?

Answer 39

endometriosis chronic pelvic pain syndrome CPP

Question 40

What are the ligaments of the uterus?

Answer 40

broad (peritoneum) ovarian uterine ligaments