Ovarian torsion and cyst accidents — structured oral station (12 minutes)

FRANZCOG oral-format station on ovarian torsion and cyst accidents: candidate describes the clinical presentation and the whirlpool sign, defends time-critical laparoscopy on suspicion, argues the detorsion-and-observation versus oophorectomy decision, distinguishes torsion from rupture and haemorrhagic cyst, and applies the IOTA Simple Rules and ADNEX model. Scored against the eight published RANZCOG oral domains.

Prompt

You are the gynaecology registrar on call. A 22-year-old woman presents with sudden-onset right-sided pelvic pain and vomiting; her pregnancy test is negative and her ultrasound shows an enlarged ovary with a coiled vascular pedicle. The examiner will ask you to define torsion, justify your operative decision, defend the detorsion-and-observation approach, distinguish the cyst accidents, and apply the IOTA assessment. You may be shown a transvaginal ultrasound image.

Station format

4 minutes reading, 12 minutes examination, 20 marks, global scoring. The eight published RANZCOG oral domains apply to every station: history and examination; investigations and interpreting results; treatment and management; clinical knowledge; complex, urgent or unusual clinical presentations; rapport with patient, support person or colleague; respect; communication skills. You are marked on how you behave, not only what you know. ^[1]

References5Show

[1]American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care Adnexal Torsion in Adolescents: ACOG Committee Opinion No. 783. Obstet Gynecol, 2019.PMID 31348225
[2]Vijayaraghavan SB Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med, 2004.PMID 15557307
[3]Dawood MT, Naik M, Bharwani N, Sudderuddin SA, Rockall AG, et al. Adnexal Torsion: Review of Radiologic Appearances. Radiographics, 2021.PMID 33577417
[4]Sriram R, Zameer MM, Vinay C, et al. Black Ovary: Our Experience with Oophoropexy in All Cases of Pediatric Ovarian Torsion and Review of Relevant Literature. J Indian Assoc Pediatr Surg, 2022.PMID 36530821
[5]Timmerman D, Testa AC, Bourne T, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol, 2008.PMID 18504770

Ovarian torsion and cyst accidents — structured oral station (12 minutes)

Station format

References5Show

[1]American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care Adnexal Torsion in Adolescents: ACOG Committee Opinion No. 783. Obstet Gynecol, 2019.PMID 31348225
[2]Vijayaraghavan SB Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med, 2004.PMID 15557307
[3]Dawood MT, Naik M, Bharwani N, Sudderuddin SA, Rockall AG, et al. Adnexal Torsion: Review of Radiologic Appearances. Radiographics, 2021.PMID 33577417
[4]Sriram R, Zameer MM, Vinay C, et al. Black Ovary: Our Experience with Oophoropexy in All Cases of Pediatric Ovarian Torsion and Review of Relevant Literature. J Indian Assoc Pediatr Surg, 2022.PMID 36530821
[5]Timmerman D, Testa AC, Bourne T, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol, 2008.PMID 18504770