Pelvic Mass/Pain

Question 1

** A 35 y/o presents with 6 months of RLQ pain. She had a tubal sterilization. Her LMP was one week ago. She describes her pain as sharp, stabbing, intermittent. She thinks she has a cyst on her ovary because she had similar pain before and was told it was “a cyst.” Your exam reveals tenderness in the RLQ in the superficial structures of the abdomen. You have her mimic a sit up and she winces in pain. Her pelvic exam is unremarkable without palpable masses but tender with abdominal fingers. The sign that produces her pain on sitting up is called? (TEST QUESTION)

Answer 1

Carnetts sign

Question 2

** In the same case above, you are able to reproduce her pain on abdominal exam. Your most likely Dx is? (TEST QUESTION)

Answer 2

myofascial pain.

Question 3

** 28 y/o nulligravid presents to your office wanting to get pregnant. Her cycles are “every month” but she complains of severe cramping with them. This has been going on for “years” and takes a bottle of Midol every cycle and will occasionally miss work. With further questioning, she admits to having painful sex. She is married and in a monogamous relationship and prior STI testing has been negative. Your presumptive Dx is? (TEST QUESTION)

Answer 3

endometriosis

Question 4

** A 32 y/o woman, never pregnant, presents with what she describes as her “chronic bladder infections.” You obtain records from her PCP and none of her last 4 cultures grew any bacteria. You question her further and she describes her symptoms as urgency, frequency, and bladder pain and occasionally spasm. They are there daily but some days worse than others. Your nurse dips her urine and it shows trace blood but the remainder of the strip is negative. She states her symptoms have been there for almost 2 years but getting worse. Most likely in your differential is? (TEST QUESTION)

Answer 4

interstitial cystitis

Question 5

• *** Pelvic floor pain and dysfunction as well as abdominal wall trigger points can be treated with all of the following except? (TEST QUESTION)
• OMT
• Tricyclic antidepressants
• functional electrical stimulation
• Ciprofloxacin
• Lidocaine and/or cortisone injections

Answer 5

Ciprofloxacin

Question 6

** A 19 y/o para 1 presents with LLQ abdominal pain since delivery 9 months ago and getting worse. After a thorough H&P you note she has a moderate diasthesis rectus hernia, but her pain is more lateral on the left side of her c-section incision. Both straight leg raise and Carnetts are positive. You correctly diagnose myofascial pain or trapped nerve in scar tissue. You do soft tissue massage and prescribe a course of Anaprox DS and abdominal wall stretches. She presents in 4 weeks but the pain still persists. Your next course of action is? (TEST QUESTION)

Answer 6

inject a mixture of Lidocaine/Marcaine with cortisone into the lesion (trigger point injection).

Question 7

What is interstitial cystitis?

Answer 7

• chronic inflammatory condition of the bladder causing urgency, frequency, and/or pain in the absence of a defined etiology.

Question 8

How do we treat interstitial cystitis?

Answer 8

• palliative care.