MLA Domain 5 · Presentation

Pelvic pain

11 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 5

Ectopic pregnancy

Haemodynamic instability/collapse, shoulder-tip pain, peritonism → rupture → resuscitate + emergency surgery

Endometriosis

Severe pain, bowel/urinary involvement, fertility concerns → specialist referral

Ovarian cysts

Features of malignancy (solid/multilocular, ascites, raised CA125, postmenopausal), or acute torsion/rupture with shock

Ovarian torsion

Acute abdomen with an adnexal mass — emergency; delay risks ovarian loss

Pelvic inflammatory disease (gynae)

Exclude ectopic pregnancy (pregnancy test); tubo-ovarian abscess/sepsis → admit

recognised feature · 3

Cervical cancer

Any abnormal bleeding with an abnormal-looking cervix → urgent colposcopy/referral, NOT wait for screening

Gonorrhoea

Disseminated infection, neonatal conjunctivitis, or PID

Ovarian cancer

Persistent bloating/abdominal symptoms in a woman >50 → check CA125 (and refer)

differential of the above · 3

Adenomyosis

Severe anaemia from heavy bleeding

Appendicitis

Generalised peritonitis (perforation) → emergency

Primary dysmenorrhoea

Pain starting years after menarche, deep dyspareunia, menorrhagia, or an abnormal examination → suspect a SECONDARY caus