SAEM M4 UPDATED EXAM SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔who getsa dmitted - ✔✔-toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
✔✔d/c with PID need what testing - ✔✔test for other STD
✔✔describe whats going on in ovarian torsion - ✔✔ovary, and often the fallopian tube
as well (adnexal torsion) become twisted around their vascular pedicle.
✔✔progression of torsion - ✔✔twisting initially obstructs venous flow, which causes
engorgement and edema. The engorgement can progress until arterial flow is
compromised, leading to ischemia and infarction
✔✔risk factors for torsion - ✔✔ovary with a mass or cyst is more prone to twisting by
virtue of its asymmetry
✔✔classic present torsion - ✔✔sudden onset of unilateral lower abdominal pain which is
initially visceral in character (ie, vague and poorly localized) and may be accompanied
by nausea and vomiting. It may radiate to the groin or flank.
✔✔intermittent torsion - ✔✔several episodes of pain over the course of hours, days, or
even weeks,
✔✔why does current pregnancy inc risk of torsion - ✔✔corpus lutem cyst on ovary
✔✔tests for torsion - ✔✔There are no laboratory tests which are helpful in establishing
the diagnosis of adnexal torsion
✔✔best way to dx torsion - ✔✔US
✔✔careful with US: - ✔✔important to note that the presence of Doppler blood flow does
not exclude the diagnosis of torsion
✔✔signs of torsion on US - ✔✔-enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
,✔✔what does CT torsion show - ✔✔finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
✔✔definitively dx torsion - ✔✔OR
✔✔tx torsion - ✔✔or (try and salvage ovary but testicle just gets removed)
✔✔torsion sotry often sounds like - ✔✔kidney story
✔✔testicular torsion is - ✔✔twisting of the testis and spermatic cord within the scrotum,
with resulting in occlusion of venous return and and edema which can progress to
arterial occlusion and ischemia
✔✔normal testicle anatomy and issue with torsion - ✔✔anchored within the scrotum by
the tunica vaginalis, which surrounds the testicle and attaches posteriorly to the scrotal
wall and epididymis. The tunica vaginalis consists of a visceral and parietal layer with an
interposed potential space. This potential space allows the testicle to rotate about the
spermatic cord within the tunica vaginalis if a firm posterior scrotal attachment is
lacking.
✔✔bell clapper deformity - ✔✔When the tunica vaginalis attaches higher up on the
spermatic cord, the testicle can move and twist within the scrotum. inc risk of torsion
✔✔2 most common ages get torsion - ✔✔1st year of life and in puberty
✔✔hx of testicular torsion - ✔✔airly sudden, severe unilateral testicular pain, sometimes
radiating into the abdomen, associated with nausea and vomiting
-may have urgency, freuqency, dysuria
✔✔which testicle most common - ✔✔left
✔✔weird cause of torsion - ✔✔trauma
✔✔exam - ✔✔-testicle is tender and swollen
-sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
✔✔labs in torsion - ✔✔usually not helpful
✔✔best way to dx testicle torsion? what show2 - ✔✔US: painful testicle is enlarged and
hypeochoic as ocmpread to good side. can show absence of flow but this is alte finding
, ✔✔torsion v. epididymitis - ✔✔usually associated with increased blood flow to the
testicle and the epididymis, as part of the body's inflammatory response.
✔✔torsion of testicular appendage
-age of pop
-where is pain
-timeline of paiin
-creamsteric reflex
-us shows
-tx
-outcome - ✔✔-7-14yrs
-upper pole of testicle
-hrs-day
-reflex is present
-Body of testis similar to asymptomatic side with focal hypoechoic area
-supportive
-Infarction and resorption of appendage, no effect on fertility
✔✔epididymis
-timeline
-2 sx
-cremasteric reflex
-exam shows
-2 labs
-US shows
-tx
-outcome - ✔✔-over days
-fever, dysuria
-present
-Epididymal tenderness with or without testicular tenderness
-wbc and nitrites
-Body of testis similar to asymptomatic side with hypoechoic epididymis
-abx
-Possible scarring, possible impaired fertility
✔✔definitive dx testicle torsion - ✔✔OR
✔✔if delay in getting to OR what do - ✔✔manual detorsion (rotat eit way from midline at
least 360)
-know it owrked if dec pain within minutes
✔✔how know twist right way - ✔✔-if hard to untwist, try twisting the other way
ANSWERS GRADED A+
✔✔who getsa dmitted - ✔✔-toa
-fitz hugh curtis
-septic
-peritontiis
-pre-pubertal kid
-iud (which needs to be removed)
-pregnant
✔✔d/c with PID need what testing - ✔✔test for other STD
✔✔describe whats going on in ovarian torsion - ✔✔ovary, and often the fallopian tube
as well (adnexal torsion) become twisted around their vascular pedicle.
✔✔progression of torsion - ✔✔twisting initially obstructs venous flow, which causes
engorgement and edema. The engorgement can progress until arterial flow is
compromised, leading to ischemia and infarction
✔✔risk factors for torsion - ✔✔ovary with a mass or cyst is more prone to twisting by
virtue of its asymmetry
✔✔classic present torsion - ✔✔sudden onset of unilateral lower abdominal pain which is
initially visceral in character (ie, vague and poorly localized) and may be accompanied
by nausea and vomiting. It may radiate to the groin or flank.
✔✔intermittent torsion - ✔✔several episodes of pain over the course of hours, days, or
even weeks,
✔✔why does current pregnancy inc risk of torsion - ✔✔corpus lutem cyst on ovary
✔✔tests for torsion - ✔✔There are no laboratory tests which are helpful in establishing
the diagnosis of adnexal torsion
✔✔best way to dx torsion - ✔✔US
✔✔careful with US: - ✔✔important to note that the presence of Doppler blood flow does
not exclude the diagnosis of torsion
✔✔signs of torsion on US - ✔✔-enlargement/edema of ovary
-ovrian mass or cyst
-free pelvic fluid
,✔✔what does CT torsion show - ✔✔finding an enlarged ovary or ovarian mass
-assocaited free fluid
-thick fallopian tube
-deviation of uterus to the affected side
✔✔definitively dx torsion - ✔✔OR
✔✔tx torsion - ✔✔or (try and salvage ovary but testicle just gets removed)
✔✔torsion sotry often sounds like - ✔✔kidney story
✔✔testicular torsion is - ✔✔twisting of the testis and spermatic cord within the scrotum,
with resulting in occlusion of venous return and and edema which can progress to
arterial occlusion and ischemia
✔✔normal testicle anatomy and issue with torsion - ✔✔anchored within the scrotum by
the tunica vaginalis, which surrounds the testicle and attaches posteriorly to the scrotal
wall and epididymis. The tunica vaginalis consists of a visceral and parietal layer with an
interposed potential space. This potential space allows the testicle to rotate about the
spermatic cord within the tunica vaginalis if a firm posterior scrotal attachment is
lacking.
✔✔bell clapper deformity - ✔✔When the tunica vaginalis attaches higher up on the
spermatic cord, the testicle can move and twist within the scrotum. inc risk of torsion
✔✔2 most common ages get torsion - ✔✔1st year of life and in puberty
✔✔hx of testicular torsion - ✔✔airly sudden, severe unilateral testicular pain, sometimes
radiating into the abdomen, associated with nausea and vomiting
-may have urgency, freuqency, dysuria
✔✔which testicle most common - ✔✔left
✔✔weird cause of torsion - ✔✔trauma
✔✔exam - ✔✔-testicle is tender and swollen
-sits higher in sac
-sits in transverse lie
-loss of cremasteric reflex (rise hihgerthan .5cm)
✔✔labs in torsion - ✔✔usually not helpful
✔✔best way to dx testicle torsion? what show2 - ✔✔US: painful testicle is enlarged and
hypeochoic as ocmpread to good side. can show absence of flow but this is alte finding
, ✔✔torsion v. epididymitis - ✔✔usually associated with increased blood flow to the
testicle and the epididymis, as part of the body's inflammatory response.
✔✔torsion of testicular appendage
-age of pop
-where is pain
-timeline of paiin
-creamsteric reflex
-us shows
-tx
-outcome - ✔✔-7-14yrs
-upper pole of testicle
-hrs-day
-reflex is present
-Body of testis similar to asymptomatic side with focal hypoechoic area
-supportive
-Infarction and resorption of appendage, no effect on fertility
✔✔epididymis
-timeline
-2 sx
-cremasteric reflex
-exam shows
-2 labs
-US shows
-tx
-outcome - ✔✔-over days
-fever, dysuria
-present
-Epididymal tenderness with or without testicular tenderness
-wbc and nitrites
-Body of testis similar to asymptomatic side with hypoechoic epididymis
-abx
-Possible scarring, possible impaired fertility
✔✔definitive dx testicle torsion - ✔✔OR
✔✔if delay in getting to OR what do - ✔✔manual detorsion (rotat eit way from midline at
least 360)
-know it owrked if dec pain within minutes
✔✔how know twist right way - ✔✔-if hard to untwist, try twisting the other way
