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Ovarian torsion — MCCQE Part 1 MCQ

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HardPelvic PainOvarian torsionMCCQE Part 1

19-year-old woman presents with sudden severe unilateral pelvic pain and vomiting. Ultrasound shows an enlarged ovary; Doppler flow is present. Which of the following is the most appropriate next step?

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Correct answer: C — Arrange urgent gynaecologic laparoscopy despite Doppler flow

Arrange urgent gynaecologic laparoscopy despite Doppler flow is best because torsion remains possible with Doppler flow and is time-sensitive. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Normal flow does not exclude torsion.

Reference: SOGC adnexal torsion guidance