An NP is performing a bimanual vaginal exam. During the exam, the NP palpates a smooth, compressible, non-tender mass over the right ovary. Which of the following diagnostic tests is recommended to confirm the presumptive diagnosis?

A smooth, compressible, non-tender mass over the ovary on bimanual examination is characteristic of a functional ovarian cyst. Pelvic ultrasonography is the first-line and recommended imaging modality for evaluating adnexal masses because it is readily available, non-invasive, uses no ionizing radiation, and provides excellent detail about cyst morphology, including size, wall characteristics, internal echogenicity, and septations. These features help differentiate simple functional cysts from complex or potentially malignant masses. Ultrasonography can be performed transvaginally for better resolution of pelvic structures or transabdominally. CT scan exposes the patient to ionizing radiation and provides less soft-tissue resolution for ovarian pathology than ultrasound; it is generally reserved for staging known malignancy or evaluating acute abdominal emergencies. MRI offers excellent soft-tissue contrast and may be used as a problem-solving tool when ultrasound findings are inconclusive, but it is not the initial recommended test. Pelvic radiography has essentially no utility in evaluating ovarian masses because soft-tissue structures are not well visualized on plain X-ray. Therefore ultrasonography is the appropriate next diagnostic step.