Disorders of the Pelvis and Ovaries

Question 1

Etiologies of Chronic Pelvic Pain: Episodic

Answer 1

dyspareunia
midcycle pelvic pain (Mittelschmerz)
dysmenorrhea

Question 2

Etiologies of Chronic Pelvic Pain: Continuous

Answer 2

Endometriosis (mostly cyclic pain)
adenomyosis
chronic salpingitis (PID)
adhesions
loss of pelvic support

Question 3

PID diagnostic features

Answer 3

Minimal Requirement:
Uterine/adnexal tenderness or
Cervical motion tenderness
Additional:
Temperature >38.3°C (101°F)
Abnormal cervical or vaginal mucopurulent discharge
Presence of WBCs on saline wet prep 
Elevated erythrocyte sedimentation rate (ESR)
Elevated C-reactive protein (CRP)
Gonorrhea or chlamydia test positive

Question 4

PID Outpatient first line therapy

Answer 4

Ceftriaxone 250 mg IM in a single dose, AND azithromycin 1 g PO once weekly x 2 weeks

Ceftriaxone 250 mg IM in a single dose AND doxycycline (covers chlamydia)

Cefoxitin 2 g IM in a single dose AND Probenecid AND Doxycycline

WITH OR WITHOUT
Metronidazole (Flagyl)

Question 5

Polycystic Ovarian Syndrome Typical Symptoms

Answer 5

oligomenorrhea or amenorrhea, anovulation, obesity, acne, hirsutism, and infertility

Question 6

PCOS Diagnosis

Answer 6

no single definitive test
Rotterdam Criteria: a diagnosis of PCOS can be made with 2 out of the following 3 features:
Oligomenorrhea or anovulation
Clinical and/or biochemical signs of hyperandrogenism (acne and hirsutism)
Polycystic ovaries

Question 7

Ovarian Cysts

Answer 7

NOT a neoplasm, but arises as a result of normal ovarian physiology.
fluid-filled sacs that develop in or on the ovary.
occur commonly in women of all ages. Some women with ovarian cysts have pain or pelvic pressure, while others have no symptoms

Question 8

Follicular cyst physical exam

Answer 8

mobile, cystic, adnexal mass