THE WRITTEN EMERGENCY MEDICINE FELLOWSHIP COURSE
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EXtended match questions.

EMQ PAPER 1.

Select the most appropriate diagnosis for each clinical scenario.

Mittelschmerz
Endometriosis
Adenomyosis
Cervical stenosis
Pelvic Inflammatory Disease
Ovarian Torsion
Uterine prolapse
Diverticulitis
Irritable bowel syndrome






Post‐partum haemorrhage
Interstitial cystitis
Depression
Chronic urethritis
Placenta praevia
Ectopic Pregnancy
Threatened miscarriage
Ruptured ovarian cyst
Pre‐eclampsia
Hyperemesis gravidarum
Multiple pregnancy
1.  A 17 year old female presents with left sifed pelvic pain which occurs midway through her cycle each month. She is distressed on initial arrival, with nornal observations. The physical examination reveals only mild discomfort on palpation. Investigations show a Hb of 130mg/dL and a serum bHCG <5 IU/L. An ultrasound shows no pathology. What is the most likely diagnosis?

2. A 52 year old femal presents with cyclical left pelvic pain, menorrhagia and dysmenorrhoea. Examination reveals a symmetrically enlarged, slightly tender uterus with a diffusely boggy consistency. Ultrasound is performed and shows generalized uterine elnargement with indistinct myo-endometrial margins. The most likely diagnosis is?

3. A 17 year old female presents with sudden onset severe RIF pain. Her last period was 10 days ago and she describes a regular 28 day cycle. Her observations are: T 37.7 degrees C degrees  deg, HR 94/min, BP 140/70 mmHg. Her urine is clear and negative for bHCG. What is the most likely diagnosis?

4. A 17 year old female with vague lower abdominal pain presents with a fever and purulent vaginal discharge. On internal examination she has significant cervical motion tenderness. What is the likely diagnosis?
take me to the answers!

EMQ PAPER 2.

Select the most appropriate diagnosis for each clinical scenario.

Acute appendicitis
Incomplete miscarriage
Ovarian hyperstimulation syndrome
Indeterminate ultrasound/pregnancy of unknown location
Ovarian teratoma
​Threatened miscarriage
Molar pregnancy




Ruptured Ovarian Cyst
Ectopic Pregnancy
Septic miscarriage
Heterotropic Pregnancy
Missed miscarriage
Complete miscarriage
1. A 42 year old primigravid female on clomiphene presents with severe left sided lower abdominal pain and bleeding per vaginum. Her bHCG is measured at 13000 IU/L.

Her vital signs are:

BP        80/60 mmHg
HR        116    /min
RR        22       /min
Sats     99%    RA
T            37.1    oC

A transvaginal ultrasound shows a live intrauterine pregnancy, as well as a large volume of free pelvic fluid.

2. A 28 year old woman presents to the emergency department with cramping lower abdominal pain and PV spotting. Her serum bHCG is measured at 2800 IU/L. A transabdominal ultrasound does not show a gestational sac in the uterus, and the findings are otherwise unremarkable.

Her vital signs are:

BP        115/80 mmHg
HR        91   /min
RR        18       /min
Sats     99%    RA
T            37.0    oC

3. A 26 year old woman presents with significant lower abdominal pain and mild PV spotting at 7/40. She denies a significant vaginal bleed. Her bHCG is 1900 IU/L.

BP        105/71 mmHg
HR        101   /min
RR        18       /min
Sats     99%    RA
T            37.0    oC

A transvaginal ultrasound shows an empty uterus and a small amount of free pelvic fluid.

4. A 22 year old woman presents with lower abdominal cramping and PV spotting at 9/40. Her bHCG is  2800 IU/L.  A transvaginal ultrasound shows an intrauterine pregnancy with a heart rate seen at 140 bpm. There is no pelvic free fluid.

Her vital signs are:

BP        119/81 mmHg
HR        81   /min
RR        16       /min
Sats     99%    RA
T            37.0    oC

5. A 29 year old woman presents after a large PV bleed at home. She is 10 weeks pregnant with her first child. A serum bHCG is 2100 IU/L. The bleeding has now ceased.

Her vital signs are:

BP        124/86 mmHg
HR        88    /min
RR        16       /min
Sats     99%    RA
T            37.0    oC

A transvaginal ultrasound is performed, which shows an empty uterus with no other abnormal findings in the pelvis.
TAKE ME TO THE ANSWERS!


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