Ovarian Cysts, Torsion, and Other Causes of Pelvic Pain Practice Questions

25 multiple-choice questions on Ovarian cysts, torsion, and other causes of pelvic pain for paramedic and EMT students, from Chapter 23 (Gynecologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A 9-year-old girl has sudden severe lower abdominal pain and repeated vomiting. Regarding ovarian torsion, you should know that it:

   1. A. Occurs only during pregnancy
   2. B. Can occur before puberty
   3. C. Cannot happen without a period
   4. D. Is painless in children
   Show answer

   Answer: B. Can occur before puberty

   Ovarian torsion occurs in children, including premenarchal girls, often with a normal ovary. Sudden pain with vomiting in a girl needs urgent evaluation to save the ovary.

2. A 22-year-old has sudden right pelvic pain after exercise, with nausea. Her pregnancy test is negative and vitals are normal. The most likely cause is:

   1. A. Ectopic pregnancy
   2. B. Acute pancreatitis flare
   3. C. Ruptured ovarian cyst
   4. D. Kidney failure
   Show answer

   Answer: C. Ruptured ovarian cyst

   With a negative pregnancy test and stable vitals, a ruptured cyst is likely. Monitor for signs of internal bleeding.

3. Ovarian torsion is:

   1. A. Twisting of the ovary on its blood supply
   2. B. Rupture of a fluid-filled ovarian cyst
   3. C. Bacterial infection spreading to the ovary
   4. D. Tissue from the uterus growing on the ovary
   Show answer

   Answer: A. Twisting of the ovary on its blood supply

   Twisting cuts off blood flow. It is a surgical emergency to save the ovary.

4. Ovarian torsion often presents with:

   1. A. Gradual pain building over several weeks
   2. B. Painless spotting between periods
   3. C. Fever and a spreading rash only
   4. D. Sudden pain with nausea and vomiting
   Show answer

   Answer: D. Sudden pain with nausea and vomiting

   Severe, sudden one-sided pain with vomiting is typical. Large cysts increase the risk.

5. Which finding helps distinguish torsion from appendicitis?

   1. A. Fever and anorexia
   2. B. Right lower quadrant pain
   3. C. Sudden onset, known cyst
   4. D. Nausea and vomiting
   Show answer

   Answer: C. Sudden onset, known cyst

   Torsion usually starts abruptly, often with a known ovarian mass. Appendicitis usually progresses over hours.

6. Endometriosis is:

   1. A. Uterine lining tissue outside the uterus
   2. B. A bacterial infection of the uterus
   3. C. A benign tumor of the ovary itself
   4. D. A twisted fallopian tube cutting off blood
   Show answer

   Answer: A. Uterine lining tissue outside the uterus

   Endometrial tissue grows on pelvic organs and bleeds with each cycle, causing pain.

7. The main symptom of endometriosis is:

   1. A. High fever
   2. B. Painful periods
   3. C. Foul vaginal discharge
   4. D. Painless bleeding after sex
   Show answer

   Answer: B. Painful periods

   Pelvic pain that worsens with menstruation is common. It can cause infertility. Fever and foul discharge suggest infection, and painless bleeding after sex suggests a cervical lesion.

8. Mittelschmerz is:

   1. A. Pain during menstruation
   2. B. Pain after menopause
   3. C. Pain from fibroids
   4. D. Mid-cycle ovulation pain
   Show answer

   Answer: D. Mid-cycle ovulation pain

   Mild, one-sided pain around ovulation is common and usually resolves within a day.

9. A ruptured corpus luteum cyst can cause shock because it:

   1. A. Twists and cuts off the ovary's blood flow
   2. B. Spills fluid that drops the BP
   3. C. Releases a toxin into the blood
   4. D. Can bleed heavily into the abdomen
   Show answer

   Answer: D. Can bleed heavily into the abdomen

   The corpus luteum is very vascular, and its rupture can cause significant hemoperitoneum, sometimes with shock that mimics a ruptured ectopic. Anticoagulants increase the risk. Torsion causes ischemic pain rather than shock, the cyst fluid is too small in volume to drop the blood pressure, and no toxin is released.

10. Pelvic organ prolapse is:

    1. A. Infection of the uterine lining
    2. B. A tear in the vaginal wall
    3. C. Organs bulging into the vagina
    4. D. A tumor of the cervix
    Show answer

    Answer: C. Organs bulging into the vagina

    Weakened pelvic support allows the uterus, bladder, or rectum to bulge into the vagina.

11. Ovarian cancer often presents with:

    1. A. Vague bloating and fullness
    2. B. Sudden, tearing pelvic pain
    3. C. High fever with chills
    4. D. Referred left shoulder pain
    Show answer

    Answer: A. Vague bloating and fullness

    Symptoms are vague, so it is often diagnosed late.

12. A woman with an IUD cannot feel the strings and now has pelvic pain. You should be concerned that the IUD:

    1. A. Is working exactly as designed
    2. B. Has moved or perforated the uterus
    3. C. Has dissolved into the body
    4. D. Has caused a urinary tract infection
    Show answer

    Answer: B. Has moved or perforated the uterus

    Missing strings can mean expulsion, migration, or perforation through the uterine wall, which may injure nearby organs. She needs imaging, and pregnancy must be ruled out.

13. A 32-year-old with endometriosis has had several right-sided pneumothoraces, each starting around her period. This is called:

    1. A. Tension pneumothorax
    2. B. Pneumonia
    3. C. Pulmonary embolism from a clot
    4. D. Catamenial pneumothorax
    Show answer

    Answer: D. Catamenial pneumothorax

    Endometrial tissue on the diaphragm or pleura can cause recurrent pneumothorax timed with menses, most often on the right. Treat dyspnea as for any pneumothorax.

14. At the hospital, a pelvic ultrasound shows blood flow to the ovary in a patient with suspected torsion. This finding:

    1. A. Does not rule out torsion
    2. B. Proves the ovary is healthy
    3. C. Means she has an ectopic
    4. D. Rules out surgery entirely
    Show answer

    Answer: A. Does not rule out torsion

    Ovaries have a dual blood supply, and partial or intermittent twisting can preserve flow, so normal Doppler does not exclude torsion. Diagnosis often requires surgery when suspicion is high.

15. Prehospital care for pelvic pain without shock includes:

    1. A. Vaginal packing with gauze
    2. B. Firm abdominal massage
    3. C. Analgesia and transport
    4. D. Oral fluids for hydration
    Show answer

    Answer: C. Analgesia and transport

    Provide pain relief per protocol and monitor for changes.

16. The first-line imaging test for most acute pelvic pain in women at the hospital is:

    1. A. Pelvic MRI
    2. B. Pelvic ultrasound
    3. C. A plain abdominal X-ray
    4. D. A nuclear bone scan
    Show answer

    Answer: B. Pelvic ultrasound

    Pelvic ultrasound identifies ectopic pregnancy, cysts, torsion, and abscesses without radiation and is the first test for most gynecologic pain. Knowing this helps choose a destination with ultrasound available. MRI is a second-line test, and plain films and bone scans do not show the ovaries or tubes well.

17. Ovarian hyperstimulation syndrome can occur after:

    1. A. Natural menopause
    2. B. Fertility treatment
    3. C. Total hysterectomy
    4. D. Routine childhood vaccines
    Show answer

    Answer: B. Fertility treatment

    Fertility drugs can enlarge ovaries and cause fluid shifts, abdominal swelling, and breathing problems.

18. A woman who had a hysterectomy cannot have:

    1. A. A uterine pregnancy
    2. B. Ovarian cysts
    3. C. Recurrent bladder infections
    4. D. Abdominal pain
    Show answer

    Answer: A. A uterine pregnancy

    Without a uterus, a normal pregnancy cannot occur, but ovaries may still form cysts.

19. Which feature of pelvic pain most suggests endometriosis rather than infection?

    1. A. High fever with shaking chills
    2. B. Sudden pain right after heavy lifting
    3. C. Pain that recurs with each period
    4. D. Pus-like vaginal discharge
    Show answer

    Answer: C. Pain that recurs with each period

    Endometriosis causes cyclic pain that worsens around menses, often for years, along with painful intercourse and infertility. Fever and discharge point to infection.

20. Which ovarian condition commonly causes irregular periods and acne?

    1. A. Ovarian torsion
    2. B. Ectopic pregnancy
    3. C. Uterine fibroids
    4. D. PCOS
    Show answer

    Answer: D. PCOS

    PCOS causes hormonal imbalance, irregular cycles, and weight gain.

21. Which pain pattern suggests a urinary rather than gynecologic cause?

    1. A. Pain during intercourse
    2. B. Pain with menstruation
    3. C. Pain at ovulation
    4. D. Burning with urination
    Show answer

    Answer: D. Burning with urination

    Dysuria suggests a urinary tract infection.

22. Pain from ovarian torsion is sometimes intermittent because:

    1. A. Pain fibers in the ovary tire quickly
    2. B. The ovary can twist and then untwist
    3. C. A cyst on the ovary ruptures and reseals
    4. D. Pelvic blood shifts as the patient moves
    Show answer

    Answer: B. The ovary can twist and then untwist

    In partial or intermittent torsion the ovary twists, cutting off its blood flow and causing pain, then untwists and restores flow, so the pain comes and goes and the diagnosis may be delayed. Ovarian pain fibers do not tire in a way that switches the pain off. A ruptured cyst causes pain that may ease but does not repeatedly reseal and recur. Pelvic blood shifting as the patient moves does not explain the twisting pattern; ongoing torsion pain is from ischemia.

23. Dyspareunia means:

    1. A. Painful intercourse
    2. B. Painful urination
    3. C. Absent periods
    4. D. Painful bowel movements
    Show answer

    Answer: A. Painful intercourse

    It may be due to infection, endometriosis, or dryness.

24. A woman on rivaroxaban has sudden pelvic pain from a suspected ruptured ovarian cyst. Your main added concern is:

    1. A. A clot forming inside the ruptured cyst
    2. B. Slower onset of pain
    3. C. Heavier bleeding into the abdomen
    4. D. Lower risk of shock
    Show answer

    Answer: C. Heavier bleeding into the abdomen

    Anticoagulants increase the chance that a ruptured cyst will cause significant hemoperitoneum and shock. Monitor vitals closely and tell the hospital which anticoagulant she takes and when. The anticoagulant makes clotting less likely, not more, and it does not slow the onset of pain.

25. A stable 24-year-old has sudden severe right pelvic pain and vomiting, and torsion is suspected. The closest ED has no gynecologist; a hospital 15 minutes farther has gynecologic surgery. The best destination is:

    1. A. The closest ED, regardless of services
    2. B. The hospital with gynecologic surgery
    3. C. An urgent care clinic nearby
    4. D. Her own doctor's office tomorrow
    Show answer

    Answer: B. The hospital with gynecologic surgery

    Suspected ovarian torsion and ectopic pregnancy may need emergency surgery, and delay risks loss of the ovary or hemorrhage. When the patient is stable and the added time is short, transport to the facility that can provide definitive care.