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Gynaecology > Pelvic pain > Flashcards

Pelvic pain Flashcards

1
Q

Where is the most common site for an ectopic pregnancy to implant?

A

Ampulla

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2
Q

What are the risk factors for ectopic pregnancy?

A 
PID
Endometriosis
Previous ectopic
IUD/IUS
Tubal surgery
Previous pelvic surgery
IVF
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3
Q

What is the classical sign of an ectopic pregnancy?

A

Prune juice discharge

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4
Q

What are typical findings on bimanual in ectopic pregnancy?

A

CMT

Adnexal tenderness

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5
Q

How is an ectopic pregnancy diagnosed?

A
  1. Positive urinary hCG
  2. Transabdominal and transvaginal USS show no IU pregnancy
  3. Serum hCG >1500 = ectopic until proven otherwise
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6
Q

How should serum hCG be interpreted in ectopic pregnancy?

A 
1500+ = ectopic until otherwise proven
Less than 1500: serial hCGs performed
Viable pregancy: hCG doubles every 48hrs
Miscarriage: hCG halves every 28hrs
Outside of these limits (rise or fall): treat as ectopic
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7
Q

What are the main treatment and conditions for these in ectopic pregnancy?

A

Expectant: stable patient with low hCG. Serial hCGs to check falling by 50% every 48hrs.

Medical: IM methotrexate. Stable patient with hCG under 1500. Serial hCGs to show decline. Repeat dose if not declining.

Surgical: if 1500+ or unwell
Salpingectomy: preferred
Salpinotomy: if contralateral tube damaged and wish to preseve fertility

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8
Q

Following the management of an ectopic pregnancy, when should a urinary pregnancy test show a negative result?

A

After 4wks

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9
Q

What is the most common benign ovarian cyst?

A

Follicular cyst

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10
Q

What type of ovarian cyst occurs most commonly in woman with endometriosis?

A

Endometrioid cysts (chocolate cysts)

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11
Q

What type of ovarian cyst occurs most frequently in young and pregnancy women?

A

Dermoid cyst (germ cell tumour, teratoma)

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12
Q

Which blood markers should be measured in women under 40 with a new ovarian cyst and why?

A

LDH, AFP and hCG: possibility of dermoid cyst (germ cell tumour, teratoma)

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13
Q

What pathology would a whirlpool sign on USS show?

A

Ovarian torsion

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14
Q

What are the classical symptoms of PID?

A

Lower abdominal pain
Deep dyspareunia
IMB or PCB
Abnormal discharge

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15
Q

How is PID treated?

A

Doxycline PO 100mg BD 14/7
Metronidazole PO 400mg BD 14/7
Ceftriaxone IM 1000mg single dose

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16
Q

For what condition is Fitz-Hugh-Curtis (perihepatitis) syndrome a complication of?

A

PID

17
Q

What is Mittelschmerz?

A

Cyclical lower abdominal pain occuring with ovulation

18
Q

What are the cardinal symptoms of endometriosis?

A

Painful and heavy periods
Subfertility
Deep dyspareunia

19
Q

What findings on bimanual would suggest a diagnosis of endometriosis?

A

Fixed and tender uterus
Retroverted position of uterus
Adnexal tenderness

20
Q

What findings on bimanual would suggest a diagnosis of PI?

A

Adnexal tenderness

CMT

21
Q

Describe the first, second and third and fourth line management for endometriosis

A

First line: analgesia
Second line: hormonal contraceptives (Mirena, COCP)
Third line: GnRH analogues
Fourth line: surgical interventions

22
Q

What are the three layers of vaginal support?

A

Cervix and proximal vagina: cardinal and uterosacral ligament
Mid-vagina: fascia attaches to pelvid side wall
Lower vagina: levator ani and perineal body

23
Q

What classification system is used to grade the severity of a vaginal prolapse?

A

Baden-Walker system

24
Q

Describe the grading of a prolapse

A 
0 = normal anatomy
1 = descent halfway to the hymen 
2 = descent to the hymen 
3 = descent halfway past the hymen
4 = maximum possible descent
25
Q

How would a prolapse present?

A 
Visible bulge
Dragging sensation in the pelvis
Pressure sensation in the vagina
Urinary incontinence
Sexual discomfort
26
Q

How is a prolapse managed?

A

Conservative: if limited impact on life
Medical: pessary
Surgical: hysterectomy, repair, uterosacral ligament suspension

27
Q

What is cervical stenosis

A

Pathological narrowing of the uterine cervix - inability to pass 2.5mm dilator through cervical os.

28
Q

What are the causes of cervical stenosis?

A 
Congenital
Menopause
Chronic cervicitis
Trauma (e.g. due to LLETZ)
Polyp
Carcinoma
29
Q

How might cervical stenosis present?

A

Largely asymptomatic

May present with haematometra, subfertility and endometriosis

30
Q

How is cervical stenosis managed?

A

Gradual dilation of the cervix under USS

31
Q

What is vulvodynia?

A

Chronic discomfort in the vulva without pathology or neurological disorder.

32
Q

How is vulvodynia managed?

A

First line: topical anaesthetics, emollients, CBT.

Second line: tricyclic antidepressants, gabapentin

33
Q

What is Asherman’s syndrome?

A

Syndrome caused by adhesions resulting in uterine adhesions and cervical stenosis

34
Q

How might Asherman’s syndrome present?

A

Secondary amenorrhoea
Miscarriage
Infertility
Decrease in menstrual bleeding

35
Q

How is Asherman’s syndrome managed?

A

Hysteroscopic removal or adhesions

Gynaecology (7 decks)

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