Obstetrics and Gynaecology

Fifth Edition

Lawrence Impey, Tim Child

Extended Matching Questions (EMQs)

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Chapter 9


1. Choose the most likely diagnosis from the descriptions below. Each option may be used once, more than once or not at all.

Possible Answers

A AdenomyosisF Interstitial cystitis
B CholecystitisG Irritable bowel syndrome
C Chronic pelvic inflammatory diseaseH Musculoskeletal cause of pain
D Chronic pelvic painI Ovarian cyst
E EndometriosisJ Pelvic congestion syndrome

For each of the questions below, select the answer which is most appropriate. Each option can be used once, more than once or not at all.

a.) A 25-year-old girl presents with a 5-year history of daily pelvic pain; she is not currently in a relationship. She finds intercourse very painful with both superficial and deep dyspareunia and believes her pain to be the reason for the break-up of her relationship 2/12 ago. She has previously been investigated for this pain and has had three negative laparoscopies. She has also been seen by the gastroenterologist and has been given a diagnosis of irritable bowel syndrome.

b.) A patient presents to her gynaecologist with a 2-year history of infertility. She has not had any children with any of her 10 previous partners although she was using the COCP until her current relationship. She reports recurrent episodes of pelvic pain which have required treatment with cefradrine, doxycycline and metronidazole. Over the last 6 months her episodes of pain have become increasingly frequent and she suffers from deep dyspareunia.

c.) A woman presents with a 6-month history of dysmenorrhoea, deep dypareunia and 18/12 history trying to conceive without success. On laparoscopy to check tubal patency, she is discovered to have an ovarian cyst filled with dark brown fluid; on the surrounding pelvic side wall there are red dots.

d.) A 50-year-old woman presents with a 6/12 history of cyclical pain following an endometrial ablation for menorrhagia and dysmenorrhoea. She no longer menstruates, but has kept a diary of her pain episodes and has noticed they occur when her periods were previously due.

e.) A 40-year-old P4 woman presents with a 1-year history of pelvic pain. The pain is typically dull and is usually worse before periods. It progresses throughout the day and is improved on sitting after prolonged standing. She doesn't experience dyspareunia regularly, but when it does occur it is prolonged and continues after intercourse.

f.) A 20-year-old girl presents with a 12-month history of pelvic pain and associated nausea. She has symptoms 2–3 times/week. She takes laxatives in order to maintain a regular bowel habit. The pain is exacerbated by periods of constipation and she gets relief after passing stools.