What disorder of the adnexa is most likely the diagnosis?

Question

A 23-year-old waitress comes to your clinic complaining of severe pelvic pain radiating to her right side. The pain began yesterday and is getting much worse. She has had no burning with urination and denies any recent sexual activity. She has no nausea, vomiting, constipation, diarrhea, fever, or vaginal discharge. Her last period was 3 to 4 weeks ago. Her past medical history consists of severe acne, depression, and mild obesity. She has had no surgeries. She broke up with her boyfriend 6 months ago and denies dating anyone else. She smokes one pack of cigarettes a day, drinks three to four beers two to three times a week, and denies any illegal drug use. Her mother is diabetic and her father has coronary artery disease. On examination you see a mildly obese female in moderate distress. Her blood pressure is 130/80 and her pulse is 90. She is afebrile. On auscultation she has active bowel sounds. She has no rebound or guarding in any abdominal quadrant. Speculum examination shows no lesions on the cervix and no discharge or bleeding from the os. During the bimanual examination she has no cervical motion tenderness, but her right adnexal area is swollen and tender. A urine analysis is normal and the urine pregnancy test is pending.

A) Ovarian cyst
B) Tubal pregnancy
C) Pelvic inflammatory disease

Answer 1

A) Ovarian cyst

Ovarian cysts often occur just before the onset of menses. They are also common in a disease known as polycystic ovarian syndrome. Other symptoms of this disorder are acne, hirsutism (increased hair growth), irregular periods, obesity. This disorder runs in families and later manifestations include diabetes, high blood pressure, and coronary artery disease. Single cysts on the right side can mimic the symptoms of appendicitis.