MRCOG part 2 Mini Combo – Chronic Pelvic Pain GTG 41 – EMQ

Options List :

A. Amitriptyline
B. Codeine
C. Co-dydramol
D. Combined oral contraceptive pill (COCP)
E. Danazol
F. Fluoxetine
G. Gabapentin
H. Glycerin suppositories
I. GnRH analogue
J. Ibuprofen
K. Lactulose
L. Mebeverine
M. Notreatmentrequired
N. Paracetamol
O. Paroxetine
P. Peppermint water
Q. Senna
R. Sertraline
For each of the following clinical scenarios, what would be the most appropriate first- line
pharmacological treatment from the options above? Each option may be used once, more than once
or not at all.
1. A 22-year-old woman presents with an 8-month history of significant intermittent abdominal pain. Her menstrual cycle is irregular. She has noted an increase in frequency in passing
stools. The pain seems to improve after defecation.

Option List

A. Amitriptyline
B. Codeine
C. Co-dydramol
D. Combined oral contraceptive pill (COCP)
E. Danazol
F. Fluoxetine
G. Gabapentin
H. Glycerin suppositories
I. GnRH analogue
J. Ibuprofen
K. Lactulose
L. Mebeverine
M. Notreatmentrequired
N. Paracetamol
O. Paroxetine
P. Peppermint water
Q. Senna
R. Sertraline

2. A 20-year-old woman presents with a 2-year history of chronic pelvic pain. The pain is present on most days but is worse around the time of menstruation. She has noted that her stools are more firm than previously. She does not have urinary frequency.

Option List

A. Amitriptyline
B. Codeine
C. Co-dydramol
D. Combined oral contraceptive pill (COCP)
E. Danazol
F. Fluoxetine
G. Gabapentin
H. Glycerin suppositories
I. GnRH analogue
J. Ibuprofen
K. Lactulose
L. Mebeverine
M. Notreatmentrequired
N. Paracetamol
O. Paroxetine
P. Peppermint water
Q. Senna
R. Sertraline

3. A 30-year-old woman with a BMI of 25 kg/m2 presents to the clinic with cyclical chronic pelvic pain. An ultrasound scan is normal. At her insistence, a diagnostic laparoscopy is performed, which shows no obvious pathology. She has completed symptoms charts, which show a distinct cyclical pattern to her symptoms.

Option List
A Non-steroidal anti-inflammatory
B Danazol
C Oral contraceptive pills
D LUNA
E Mebeverine hydrochloride
F Diagnostic laparoscopy
G Referral to urologist
H Screen for sexually transmitted infection I Referral for counselling
J Gastroenterology referral K Referral to pain team
L Gabapentin

Match the most appropriate management to each scenario:

4. A 34-year-old woman with irregular vaginal bleeding and postcoital bleeding complains of chronic pelvic pain.

Option List

A Non-steroidal anti-inflammatory
B Danazol
C Oral contraceptive pills
D LUNA
E Mebeverine hydrochloride
F Diagnostic laparoscopy
G Referral to urologist
H Screen for sexually transmitted infection I Referral for counselling
J Gastroenterology referral K Referral to pain team
L Gabapentin

Match the most appropriate management to each scenario

5. A 26-year-old woman referred by her GP complains of lower abdominal pain for over 12 months. She has also been complaining of recent onset bleeding per rectum and feels that the pain occasionally gets better with the passage of stools