Forward for your information:

----- Forwarded message from Anne Sorvari <[log in to unmask]> -----
    Date: Thu, 31 Aug 2006 16:13:19 -0400
    Subject: September Review - Gynecologic Emergencies

Dear Colleague;

We are pleased to announce the September 2006 Surgery-in Africa  review by
Dr. Laurie Elit, entitled " Gynecologic Emergencies", is now posted where
all can read it at HYPERLINK
"http://www.utoronto.ca/ois/SIA.htm"http://www.utoronto.ca/ois/SIA.htm
(without the clinical questions or full-text references).



To access the full-text references (which are copyright material) you will
still have to log-in to the password protected Surgery in Africa website at:
HYPERLINK "http://www.ptolemy.ca/members"www.ptolemy.ca/members.  If you do
not have a username and password, please contact us.



To comment on the current review or past reviews, please visit the SIA
Discussion group at: HYPERLINK
"http://groups.yahoo.com/group/Surgery-in-Africa/"http://groups.yahoo.com/gr
oup/Surgery-in-Africa/.  You will need to sign in either by using your
existing Yahoo user name and password or creating a username and password
for yourself.  Should you have any difficulty creating an account or
navigating the site, please contact us.



In response to our readers’ requests, we have made available .pdfs of all
the monthly Reviews for ease of downloading.  These are located at the end
of each Review in a link that says “save review as .PDF”.



Secondly, we have added an information page concerning content and format
for use by prospective reviewers on the main SIA page at:
www.ptolemy.ca/members.



Best regards,



The Surgery in Africa Reading Course Team



   _____

Questions for September 2006 – Gynecologic Emergencies



1.  25 year old presents with 7 weeks amenorrhea, new onset right lower
quadrant pain for the last 3 hours, nausea and vomiting. BP=90/60. HR=
100/min. RR=24/min. The abdomen is distended and there is guarding
especially in the right lower quadrant. On pelvic exam, there is a 4 cm mass
in the right adnexa and there is significant tenderness when the right
adnexa is put on stretch. Your differential diagnosis is:

a.	Chlamydia cervicitis
b.	Endometritis
c.	PID
d.	Corpus luteum cyst in pregnancy
e.	Ectopic pregnancy



2.  Your management is:

a.       Watch patient and re-examine in 4-6 hours

b.       Start an IV, send lab work, do a urine pregnancy test, pelvic
ultrasound

c.       Start antibiotics

d.       Culdocentesis

e.       Laparoscopy/laparotomy to make a diagnosis



3.  year old woman comes to emergency 48 hours after a laparoscopy to remove
an ovarian mass. She is known to have diabetes, hypertension and heart
disease. She has excruciating pain at the left lower quadrant trochar site.
There is brown dish water like material coming from the site. There is a
purple hughe to the tissues around the site. BP=90/60. HR= 100/min.
RR=30/min. Differential diagnosis is:

a.       trauma to small bowel

b.       trauma to large bowel

c.       trauma to bladder

d.       wound cellulits

e.       necrotizing fasciitis



4. Your management would be

a.       check for crepitus in the tissue by palpation or plain XRay

b.        Consult General Surgery, Plastic Surgery, Infectious Disease,
Intensive Care

a.	Start an IV, place a foley cateter
b.	Broad spectrum high dose antibiotics
c.	Plan surgery to widely debride the wound
d.

5.  40 year old woman is rushed into emergency. She is unconscious and
cannot give a history. She is bleeding profusely on a towel between her
legs. BP = 60/40, HR=130/min, RR=24/min, Afebrile. What do you do first:

a.	Try to find someone who can give a history
b.	b.Complete physical exam
c.	Send off lab work including: CBC, Cross Match
d.	Start 2 large bore IVs
e.	Go to the operating room



6.  Once you have begun the resuscitation and gotten appropriate personnel
to help, you begin the pelvic exam. There is extensive bruising of the
suprapubic region, upper thighs bilaterally, and the left vulva is huge
looking like it is going to rupture blood clot everywhere. This injury is
compatible with:

a.	trauma from falling on the cross bar of a bicycle
b.	trauma from a sexual assault
c.	vulvar cancer
d.	motor vehicle accident
e.	recent vulvar surgery ie., episiotomy, I+D Bartholins abscess







Answers to these questions will be provided next month!





Answers for August Review – Snakebites in children in Africa:  A practical
approach to management



1.	A four-year old male presents to your clinic with a history of
snakebite at the left ankle.  A developing compartment syndrome should be
suspected if;

a)      A tourniquet had been applied as “first aid” T

b)      The dorsal pedis pulse is impalpable F

c)      Stretching the muscles in the affected compartment causes pain T

d)      The bite is promixal to the knee or elbow F

e)      Haematuria is present F



2.	Clinical signs of envenomation following snakebite include:

a)      The presence of paired fang marks F

b)      Nystagmus T

c)      Rapid local swelling F

d)      Bleeding from the bite wound F

e)      Bronchospasm F



3.	A six year old 20 kg male is brought to your clinic four hours after
having apparently been bitten by a snake.  Fang marks are visible and a
tourniquet has been applied at mid-thigh.  The limb below the tournique is
swollen.  The posterior tibial pulse is palpable but the dorsalis pedis
pulse is absent.  You would

a)      Remove the tourniquet and give 400 mls intravenous crystalloid
rapidly T

b)      Remove the tourniquet and give 40 mls polyvalent antivenom
intravenously F

c)      Perform an urgent fasciotomy F

d)      Remove the tourniquet and elevate the limb on pillows F



4.	Children are thought to be at risk following snake bite because

a)      They have a small mass T

b)      They have had no previous exposure to snake venom antigens F

c)      They lack the wisdom to leave snakes alone T

d)      Snakes regard them as prey F

e)      Few children wear protective footwear T



5.	Following snakebite

a)      Analgesia is rarely necessary F

b)      Anti-tetanus serum should be used with caution T

c)      Antibiotics against anaerobes are indicated T

d)      Both haematuria and myoglobinuria may occur T

e)      Recovery is unusual if envenomation has occurred F



----- End forwarded message -----


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Fax: 416-736-5188 < [log in to unmask] >   Cell: 416-816-2852
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