What concise checklist should I use to take a focused history for a patient with suspected ovarian torsion or polycystic ovary syndrome presenting with right iliac fossa pain?

History Checklist for Right Iliac Fossa Pain: Suspected Ovarian Torsion or PCOS

Pain Characteristics

Document the exact nature and timing of pain onset, as ovarian torsion typically presents with severe, constant pain that may fluctuate in intensity but rarely completely resolves, distinguishing it from other causes of right iliac fossa pain. 1

• Onset: Sudden vs. gradual (sudden onset more characteristic of torsion) 1
• Quality: Severe, constant pain with fluctuating intensity suggests torsion 1
• Duration: Hours to days (torsion is typically <24 hours at presentation) 1
• Location: Unilateral lower abdominal/pelvic pain (right-sided in this case) 1
• Radiation: To back, flank, or groin 2
• Associated nausea/vomiting: Common in torsion 2

Gynecologic History

• Last menstrual period (LMP): Date and regularity 3, 4
• Menstrual pattern: Oligomenorrhea (cycles >35 days apart) or amenorrhea suggests PCOS 4, 5
• Pregnancy test status: Negative urine pregnancy test essentially rules out ectopic pregnancy 1
• Known PCOS diagnosis: Enlarged polycystic ovaries are a risk factor for torsion 6, 7
• Recent hormonal treatment changes: Cessation of hormonal therapy in PCOS patients may precipitate torsion 6
• Fertility treatment or ovulation induction: Increases ovarian size and torsion risk 7

Signs of Hyperandrogenism (for PCOS)

• Hirsutism: Excess facial/body hair 4, 5
• Acne: Persistent or severe 5
• Male-pattern hair loss: Androgenic alopecia 5

Metabolic and Systemic Features

• Weight changes: Obesity is common in PCOS (though 20-30% are lean) 3, 5
• Acanthosis nigricans: Dark, velvety skin patches suggesting insulin resistance 5
• Family history: PCOS is highly heritable; diabetes and metabolic syndrome in family 5

Exclusion of Mimicking Conditions

• Fever: Presence suggests tubo-ovarian abscess rather than torsion 1
• Urinary symptoms: Dysuria can occur with torsion due to anatomical proximity, but pyuria has low positive predictive value for UTI 1
• Gastrointestinal symptoms: Periumbilical pain migrating to RLQ suggests appendicitis rather than torsion 1
• Previous abdominal/pelvic surgery: May predispose to adhesions 2

Red Flags for Torsion

• Prior episodes of similar pain: May indicate intermittent torsion 1, 8
• Known ovarian cyst or mass: Increases torsion risk 7, 2
• Bilaterally enlarged ovaries on prior imaging: PCOS patients with significantly enlarged ovaries are at higher risk 6, 7