MMC Practice Exam 2017.2 Question 5 (12 marks)

Pass rate 75% (needed 8/12 to pass)

List 4 investigations you would order for this patient in the ED with one rationale for each choice. (8 marks)  urine or serum bHCG- high risk for ectopic with hx of PID (REQUIRED ANSWER) eFAST – confirm free fluid in ruptured ectopic fbc (>20 000 WCC suggestive of bacterial infection) urine dipstick and m/c/s- exclude UTI/ blood for renal colic First pass urine for STI PCR high vaginal swab- STI formal pelvic ultrasound (tuboovarian abscess, appendicitis, torsion etc.) other tests may be accepted. Eg VBG A 29 y.o female with past history of pelvic inflammatory disease presents with severe abdominal pain.

NOTES: Did not accept bHCG for “pregnancy”, must mention high possibility of ectopic. Did not accept U/S- needed to specify pelvic Did not accept CT abdo or other random, non-specific to this scenario tests.

Systemic toxicity Severe pain Unable to tolerate oral meds Pregnancy Pre-pubertal- sexual abuse Tubo-ovarian absess Regarding pelvic inflammatory disease, list four (4) admission criteria.

NOTES: Did not accept vague reference to social issues as reason for admission.