Questions

Just like the actual exam

Aligned with the American Association of Nurse Practitioner and American Nurses Credentialing Center format. Authored & peer-reviewed by Emergency NPs.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
  • Must be well structured

Question

A 24-year-old woman presents with abdominal pain. She states her pain is located in the right lower abdomen and pelvic area. Her pain started 3 hours prior to arrival, and she rates it 10/10. She reports there is no associated nausea or vomiting. Vital signs are remarkable for tachycardia at 120 bpm but are otherwise unremarkable. Physical examination is significant for pain on palpation in the right pelvis and is negative for Rovsing or psoas signs. Pelvic exam reveals scant discharge with fullness and pain in the right pelvis. Pelvic ultrasound demonstrates a right ovary that is 5 cm in size with peripherally placed small follicles and a positive whirlpool sign. What is the most likely diagnosis?

A Appendicitis
B Hemorrhagic ovarian cyst
C Ovarian torsion
D Tubo-ovarian abscess

Ovarian torsion is a surgical emergency that requires prompt diagnosis and treatment to preserve ovarian function. It results in an ischemic condition that is almost always associated with ovarian enlargement, usually due to ovarian cysts or masses. This enlargement causes the ovary to twist, resulting in blockage of venous return and arterial occlusion. However, in some cases, only venous return will be blocked, or only one of the two arterial supplies will be occluded. Also, in some cases, the ovary has been known to twist and untwist. Thus, Doppler ultrasound may appear normal in some cases, and thus a high index of suspicion is required when approaching these patients to avoid delayed diagnosis. Classically, the clinical features include unilateral lower abdominal pain and guarding, unilateral adnexal tenderness on bimanual exam, and the presence of a latero-uterine mass. The diagnosis is often made with Doppler of the ovary, but definitive diagnosis is enabled via direct visualization with laparoscopy. An ovary measuring > 4 cm due to cyst, tumor, or edema is the most common ultrasonographic finding associated with torsion, and its presence, even with a normal Doppler study, should be worrisome for torsion. Other findings on ultrasound that are concerning for ovarian torsion include peripherally displaced follicles due to edema of the ovary and a positive whirlpool sign, representing twisting of the vascular pedicle. Treatment is surgical correction, so close consultation with OB/GYN is critical, even in suspected cases with normal Doppler results.

Appendicitis (A) occurs when luminal obstruction of the vermiform appendix occurs, typically secondary to a fecalith. Patients classically present with pain in the RLQ over McBurney point. Guarding, abdominal rigidity, and rebound tenderness are usually present. Although appendicitis should be within the differential for the patient above, her pain is mostly located in the pelvis and she has ultrasound findings consistent with ovarian torsion. A hemorrhagic ovarian cyst (B) is a common cause of pelvic pain and occurs when a blood vessel inside the cyst wall ruptures. Patients present with pelvic pain, often acute in onset, and will have findings on ultrasound of an ovarian cyst and free fluid in the pelvis. Tubo-ovarian abscesses (D) are most commonly a late complication of pelvic inflammatory disease, and the majority have associated peritonitis, fever, vaginal discharge, and cervical motion tenderness.


Explanations

Written with a purpose

Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

  • Created for optimal learning and recall
  • Help reinforce your knowledge
  • Focus on the essential information

Illustrations

Created to enhance learning

Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.

ovarian torsion

Powerful Analytics

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Compare with your peers (chart)

Compare with your peers

Discover how your answer choices align with those selected by learners across the country.

Find out your probability of passing

Using data generated by previous users, your Qbank gives a prediction of how likely you are to pass your exam.


One Step Further

Taking your learning to the next level

After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Q: True or false: the majority of ovarian torsions occur on the right side.

REVEAL ANSWER

A: True. It is estimated that 70% of cases occur on the right, which is thought to be due to the increased length of the utero-ovarian ligament on the right and the sigmoid colon on the left limiting movement.

Ovarian Torsion

  • Patient will be a woman age 15–30 years old or postmenopausal
  • Complaining of sudden onset of unilateral (right > left) abdominal and pelvic pain
  • Labs will show leukocytosis
  • Diagnosis is made by transvaginal ultrasound. Gold standard: laparoscopy
  • Most commonly caused by cyst or tumor
  • Treatment is emergent surgery

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information
I only used Rosh Review to prepare for the ENP exam, and I passed first go around. Your question style was similar to the exam format. Thank you very much!

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Every question in your Qbank is based on topics found in the most recent version of your specialty’s practice model. As you review each question, the category that correlates with the material being tested will appear on the screen. If it’s not in the model, it won’t be on the exam.

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