Emergency

Question 1

Where is the most common site of an ectopic pregnancy?

Answer 1

Ampulla-fallopian tube

Question 2

What are the signs & symptoms of an ectopic pregnancy?

Answer 2

Blood in vaginal vault
Adnexal tenderness/mass
Abdo pain

Question 3

How is an ectopic pregnancy investigated?

Answer 3

TVUS- donut sign or no visible pregnancy

Question 4

What sign is an indication of possible rupture of an ectopic pregnancy?

Answer 4

Urge to defecate

Question 5

How is an ectopic pregnancy managed?

Answer 5

Low risk: Expectant management
Moderate: Medical- Methotrexate 50mg IM (takes 4-6weeks to completely resolve) CI trying for another baby for 3months afterwards
Ruptured: Laparoscopy w/salpingostomy/salpingectomy, post-surgical methotrexate

Question 6

What are the chances or ectopic recurrence?

Answer 6

5-20% or >30% after 2 consecutive ectopics

Question 7

What are the causes of testicular torsion?

Answer 7

Bell clapper deformity

Trauma

Question 8

In testicular torsion what is the time frame to treat in order to save the testis?

Answer 8

4-6hours: Testicle viable
10-12hours: Ischaemia & irreversible damage
>12hours: Testicular necrosis

Question 9

What are the Sx of testicular torsion?

Answer 9

Intermittent testicular pain
NOT relieved on elevation
Scrotal swelling/oedema
Erythema
Reactive hydrocele
High riding testicle
Horizontal lying testicle
ABSENT cremasteric reflex

Question 10

How is testicular torsion investigated?

Answer 10

USS: Whirlpool sign

Power Doppler

Question 11

How is testicular torsion treated?

Answer 11

URGENT referral to urology
Morphine: 10mg IM/IV 4hourly
Ondansetron: 4mg IV/IM
Manual de-torsion WITHIN 6hours

Question 12

What are the complications of testicular torsion?

Answer 12

Ischaemia & infarction
Infertility
Psychological implications