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16. A 25-year-old nulligravid woman comes to the emergency department because of severe pain in the right lower quadrant of the abdomen for 4 hours. She has had no nausea, vomiting, fever, or chills. Three weeks ago, a right adnexal mass was found on routine examination. Her last menstrual period was 3 days ago. Her temperature is 37.2°C (99°F), blood pressure is 110/70 mm Hg, and pulse is 92/min. Pelvic examination shows right adnexal tenderness. Hemoglobin level is 13 g/dL, and leukocyte count is 9000/mm3. Pelvic ultrasonography shows a small amount of free fluid in the cul-de-sac. Which of the following is the most likely cause of the pain?

A ) Appendicitis

B ) Endometriosis

C ) Ovarian hemorrhage

D ) Ruptured ovarian cyst

E ) Torsion of the adnexa

F ) Tubal obstruction


D ) Ruptured ovarian cyst

and i think its an nbme question


yes this is nbme , y not endomtriosis ?


this can not be endometriosis, because we dont see free fluid in cul de sac in case of endometriosis.

this is most probably rupture of ovarian cyst only
but how can we differentiate clinically torsion and rupture of ovarian cyst.


D- ruptured ovarian cyst


there s no vomiting .. i guess this is the only way to diff between the two pratap

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