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pelvic pain

Practice targeted AMC-style multiple-choice questions on pelvic pain.

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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 45-year-old woman presents with a 3-month history of increasing abdominal bloating and occasional pelvic discomfort. She reports normal menstrual cycles and no weight loss or changes in bowel habits. Physical examination is unremarkable except for mild abdominal distension. Routine blood tests, including CA-125, are within normal limits. A CT scan of the pelvis is performed, with a relevant axial image shown. Considering the clinical presentation, the normal CA-125 level, and the findings demonstrated in the image, what is the MOST appropriate next step in the management of this patient?

A. Reassurance and discharge with advice to return if symptoms worsen.
B. Referral to a gynaecological oncologist for further assessment.
C. Repeat CT scan in 3 months to monitor size and characteristics.
D. Laparoscopic cystectomy for definitive diagnosis and treatment.
E. Initiate a trial of oral contraceptive pills to reduce cyst size.
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are regular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?

A. Ruptured ovarian cyst
B. Ovarian torsion
C. Appendicitis
D. Pelvic inflammatory disease
E. Ectopic pregnancy
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. What is the MOST appropriate next step in the management of this patient?

A. Emergency hysterectomy
B. Laparoscopic cystectomy
C. Administration of broad-spectrum antibiotics
D. Initiate anticoagulation therapy
E. Expectant management with analgesia
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 32-year-old woman presents to her general practitioner with a 6-month history of worsening dysmenorrhea and pelvic pain, particularly on the left side. She reports no fever, weight loss, or abnormal vaginal bleeding. Her last menstrual period was 2 weeks ago and was normal. Physical examination reveals mild left adnexal tenderness. A CT scan of the pelvis was performed, the relevant image is shown. Given the clinical context and the imaging findings, what is the MOST appropriate next step in management?

A. Refer for diagnostic laparoscopy
B. Prescribe NSAIDs and schedule a follow-up appointment in 3 months
C. Initiate combined oral contraceptive pill
D. Repeat pelvic ultrasound in 6-12 weeks
E. Order serum CA-125 levels
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old female presents with sudden onset severe right lower quadrant pain, associated with nausea and one episode of vomiting. Her last menstrual period was 6 weeks ago. On examination, she is afebrile, heart rate 88, blood pressure 120/70. Abdominal examination reveals tenderness in the right iliac fossa. A CT scan of the abdomen and pelvis is performed, with a relevant axial image shown. Considering the clinical presentation and the findings demonstrated in the image, what is the MOST appropriate immediate next step in the management of this patient?

A. Perform a diagnostic laparoscopy to confirm appendicitis
B. Order a pelvic ultrasound for further characterisation
C. Arrange for outpatient follow-up with gynaecology
D. Laparoscopic surgical exploration
E. Administer broad-spectrum antibiotics
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 35-year-old female presents with chronic pelvic pain. The provided CT was performed. What is the MOST appropriate initial management?

A. Laparoscopic cystectomy
B. CA-125 level
C. Trial of oral contraceptives
D. Observation with repeat imaging in 6 weeks
E. Immediate laparotomy
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are irregular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?

A. Tubo-ovarian abscess
B. Ovarian torsion
C. Ectopic pregnancy
D. Hemorrhagic ovarian cyst
E. Appendicitis
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 31-year-old woman presents with pelvic pain and bloating for 3 months. Her periods are regular. Pelvic exam reveals mild adnexal tenderness. A CT scan is performed, with a relevant image shown. What is the MOST appropriate next step?

A. CA-125 level
B. Reassurance and follow-up in 6-12 months
C. Immediate laparotomy
D. Oral contraceptive pills
E. Laparoscopic cystectomy
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