A 28-year-old woman presents with sudden-onset severe lower abdominal pain on the right side. She also complains of nausea but denies fever or vaginal bleeding. Her last menstrual period was two weeks ago. Examination reveals tenderness in the right adnexa, but no guarding or rebound tenderness. What is the most likely diagnosis? A) Ectopic pregnancy B) Ovarian torsion C) Pelvic inflammatory disease (PID) D) Ruptured ovarian cyst E) Endometriosis Correct Answer: B) Ovarian torsion Explanation: Ovarian torsion presents with sudden-onset severe pelvic pain, often associated with nausea and vomiting. The absence of fever, vaginal bleeding, or signs of infection makes PID less likely. The fact that she is in the mid-cycle (2 weeks after her period) suggests an ovulatory event, increasing the risk of torsion. A) Ectopic pregnancy → Incorrect. No missed period or vaginal bleeding. Urine pregnancy test should be done to rule it out. C) PID → Incorrect. PID is associated with fever, cervical motion tenderness, and vaginal discharge. D) Ruptured ovarian cyst → Incorrect. A ruptured cyst causes sudden pain but usually resolves spontaneously unless there is significant bleeding. E) Endometriosis → Incorrect. Endometriosis causes chronic cyclic pain, not sudden severe pain. Key Tips for PLAB 1: ✅ Ovarian torsion → Sudden severe pain + nausea/vomiting. ✅ First-line investigation = Pelvic ultrasound with Doppler. ✅ Management = Emergency laparoscopy to detorse the ovary.
