TEALE FENNING

drhatta · Joined: 20 Feb 2007 Posts: 31 Location: Malaysia

Chronic Pelvic Pain

Options

A Endometriosis
B Acute PID
C Chronic PID
D Irritable bowel syndrome
E Residual ovary syndrome
F Ovarian remnant syndrome
G Diverticular disease
H Interstitial cystitis
I Primary dysmenorrhoea
J Adenomyosis
K Uterine fibroids
L Polycystic ovary syndrome
M Inflammatory bowel disease
N Chronic constipation
O Musculoskeletal pain
P Psychological
Q Nerve entrapment
R Pelvic congestion syndrome

Dear All,

Sample EMQ reads:

A 35-year old woman complains of a 10 months history of pelvic pain, dysmenorrhoea and deep dyspareunia since discontinuing the combined oral contraceptive pill. She also complains of rectal bleeding during menstruation but has a regular bowel habit and there is no recent weight loss. Clinical examination showed a bulky tender uterus with decreased mobility and palpable nodules within the pouch of Douglas. Rectal examination was normal.

What would be your answer?
Endometriosis?
Adenomyosis?

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 886

pelvic pain, dysmenorrhoea and deep dyspareunia = classical endometriosis

rectal bleeding during menstruation = vicarious menses = endometriosis

decreased mobility and palpable nodules within the pouch of Douglas = endometriosis.

bulky tender uterus = though bulky may confuse one into considering adenomyosis, it is still endometriosis, as peri menses the ut will feel bulky and may well be tender due to surface endometriotic spots being active.

the answer is ENDOMERTIOSIS.

p.s-- i think you could have camoflouged the question a bit more, the nodules and vicarious menses totally rule out adenomyosis. Laughing

_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

wolverine · Century Club Joined: 16 Jan 2007 Posts: 393

100% agreed with Raj

Abik · Posted: Tue Feb 20, 2007 10:13 am Post subject:

Great classic sentence.
A history of pelvic pain and dyspareunia with a finding of palpable nodules in the POD!!
What else?

Hope you're practising these Wolverine!

Abik · Posted: Tue Feb 20, 2007 10:21 am Post subject:

What about the rest?

B A 21 yr old with offensive PV discharge, pelvic pain with pyrexia and cervical excitation?
C A history of chronic pelvic pain with a tender uterus?
D A history of bloating and constipation with a normal examination?
E eh?
F I say again... eh?
G A 52 yr old with LIF pain and constipation?
H A long history of dysuria and SP pain with negative MSUs?
I An 18 yr old with history of menstrual pain since menarche responds well to NSAIDS?
J A para 4 with IMB and cyclical pelvic pain?
K An African woman with heavy periods, frequency and a pelvic mass?
L A 21 yr old nullip with a beard and oligomenorrhoea!!!
M A 28 year old with bloody, mucous in her stools and a BMI of 19?
N A 72 yr old with LIF pain and confusion?

Any takers?

vani s · Joined: 20 Jan 2007 Posts: 141

E Post hysterectomy( ovaries preserved), chronic pelvic pain n dyspareunia Laughing

vani s · Joined: 20 Jan 2007 Posts: 141

J is doubtful

Abik · Posted: Tue Feb 20, 2007 1:25 pm Post subject:

Why? Write a better one then.

Abik · Posted: Tue Feb 20, 2007 2:43 pm Post subject:

I've got a better one for D - chronic pain, relieved by defecation!

Nick Raine-Fenning · Posted: Tue Feb 20, 2007 5:08 pm Post subject:

Nick Raine-Fenning · Posted: Tue Feb 20, 2007 5:12 pm Post subject:

I think Abi's idea of taking each one and defining the key clinical features is a great idea. This alos helps your essay writing.

Let's try and make a few questions / clinical scenarios as well.

Irritable bowel disease

Intermittent constipation and diarrhoea associated with abdominal bloating relieved at night. May be associated with stress and partially relieved by a high fibre diet and antispasmodics.
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Abik · Posted: Tue Feb 20, 2007 5:15 pm Post subject:

The guigeline on CPP has got some definition for IBS;

[b]APPENDIX 2: Rome II criteria for the diagnosis of irritable bowel syndrome
At least 12 weeks of continuous or recurrent abdominal pain or discomfort associated with at least two of
the following:
? pain relieved with defecation
? associated with a change in frequency of stool
? associated with appearance or form of stool.
Symptoms such as abdominal bloating and the passage of mucus are commonly present and are suggestive
of irritable bowel syndrome.Extra-intestinal symptoms such as lethargy,backache,urinary frequency and
dyspareunia may also occur in association with irritable bowel syndrome.

Nick Raine-Fenning · Posted: Tue Feb 20, 2007 5:36 pm Post subject:

Excellent ... some nice facts there and a few phrases that should stand out in any EMQ.
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Xerxes I · Posted: Fri Apr 04, 2008 10:33 pm Post subject:

I would say a better scenario for interestitial cystitis is chronic pelvic pain which gets better by emptig the bladder, urgency and frequency. Dysuria is suggestive of UTI and is not a characteristic of IC.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 788

34 year old with 3 living children, compalins of heavy and prolonged menstrual bleeding associated with excrucaiting pelvic pain during menstruation. She feels her tummy seems bigger. She had a cesarean section in her last pregnancy. She has had an abdominal myomectomy 4 years ago. She has had 3 miscarriages for which she underwent surgical evacaution.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 886

asha,

this is a nicely formed question.

i have taken the answer out from your above post. lets get people to answer this and have a bit of a discussion.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

Nick Raine-Fenning · Posted: Mon Apr 21, 2008 6:05 am Post subject:

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 788

[quote="Nick Raine-Fenning"]

Nick Raine-Fenning · Posted: Mon Apr 21, 2008 6:50 pm Post subject:

Yeah good point - I'll put it down to jet lag - I was in Cairo airport!!

Adenomyosis?? Still not excruciating though?

Excrutiating, for me, would be watching man Utd throw away the Championship and Champions League this week Very Happy