09-14-2014, 12:22 PM
22. A 28-year-old African-American woman comes to the office because of low back pain and decreased urine output. She is a semiprofessional basketball player and she is married. She had one pregnancy 12 years ago that was uncomplicated and resulted in vaginal delivery of a term female neonate. Medications include oral contraceptive pills and a corticosteroid inhaler for asthma. She is 182 cm (6 ft) tall and weighs 88 kg (195 lb). Physical examination is normal except for a palpable lower abdominal mass that extends to the umbilicus. Speculum examination discloses a 3-cm ulcerative lesion circumferentially around the external cervical os. Bimanual examination shows a firm, nodular, central pelvic mass filling the pelvis and extending cephalad to the umbilicus. Rectovaginal examination confirms these findings. Stool is negative for occult blood. Which of the following is the most appropriate recommendation?
A) Arrange for laparoscopy
B) Do a cervical biopsy
C) Do an endometrial biopsy
D) Increase Pap smear screening to every 3 months
[E) Obtain pelvic ultrasonography]
A) Arrange for laparoscopy
B) Do a cervical biopsy
C) Do an endometrial biopsy
D) Increase Pap smear screening to every 3 months
[E) Obtain pelvic ultrasonography]