This page is dedicated to organizing various examples of standardized exam questions whose answer is ovarian torsion. While this may seem a odd practice, it is useful to see multiple examples of how ovarian torsion will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
21 year old woman comes to the clinic due to 5 hours of severe pain in her right lower abdomen. She explains that the pain came on suddenly and has been very “intense” and constant. She is unable to eat or drink anything today due to nausea and frequent vomiting. This patient has a past history of a 5 cm right ovarian cyst that was first detected last year on an ultrasound test. She explains that she has had 2 sexual partners in the last 4 years, and does have a history of chlamydial cervicitis. Her last menstrual period was 3 weeks ago. The patient explains that during menses she often takes ibuprofen to relieve cramps on the first day of flow. Her temperature is 99.2 F, blood pressure is 110/75 mm Hg, and pulse is 101/min. Her BMI is 29 kg/m². Physical exam reveals tenderness to deep palpation in the right lower quadrant. her urine pregnancy test is negative, and a CBC shows a leukocyte count of 8,2000/mm³. What is the most likely explanation for this patient’s symptoms?
A 20 year old woman comes to the emergency department after experiencing lower abdominal pain. The pain is intermittent, and began this morning when she was attending her regular spin class. Over the next 8 hours the pain has intensified, and ibuprofen has not addressed her severe pain. She has vomited 3 times. Her last menstrual period was a week ago. She has never been sexually active. She explains that she has no medical conditions or surgical history. She does not take any medications, and does not use tobacco or alcohol. Her physical exam shows diffuse tenderness across the lower abdomen (left greater then right). There is no guarding or rebound tenderness. A pelvic ultrasound shows a complex left adnexal mass without Doppler flow. There is a small amount of free fluid visualized. What is the most likely diagnosis in the patient?
Explanation: loss of Doppler flow = ovarian torsion
Page Updated: 10.04.2016