12-year-old girl is brought to the office for evaluation of increasing lower abdominal pain


12-year-old girl is brought to the office for evaluation of increasing lower abdominal pain. The pain began last week, was initially col icky, and was rel ieved with ibuprofen. Now the pain is constant and the patient has pain with defecation and a sense of incomplete bowel evacuation. She has had decreased appetite for the last 3 days due to the pain but has had no fever, vomiting, diarrhea, or bloody stool. The patient has had intermittent lower abdominal pain for the last 6 months, but the pain usually resolves after a few days without intervention. She has no medical conditions or prior surgeries. She has not reached menarche. BMI is 19 kg/m2 There is a tender, symmetric suprapubic mass to the level of the umbilicus. External genitalia are normal and breast and pubic hair development is Tanner stage 2. T here is a blue-tinged bulge between the labia. Rectal examination reveals an anterior tender, central mass. Which of the following is the best next step in management of this patient?

  • QA CA-125 and CEA levels
  • 0 B. Diagnostic laparoscopy
  • 0 C. Hymenal incision and drainage
  • 0 D. Hysterosalpingogram
  • 0 E. Karyotype analysis
  • 0 F Uterine myomectomy

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58-year-old right-handed man is brought to the emergency department with sudden onset of severe difficulty speaking and weakness that developed over a few seconds while he was at work. His other medical problems include hypertension, hyperlipidemia, severe left atrial enlargement (seen on previous echocardiogram), mild bilateral carotid disease with recent carotid ultrasound showing <30% stenosis, type 2 diabetes mellitus, and autosomal dominant polycystic kidney disease . He is not compliant with his medication regimen. The patient smokes a pack of cigarettes a day and drinks alcohol occasionally. His blood pressure is 156/96 mm Hg and pulse is 124/min and irregularly irregular. His body mass index is 35 kg/m2. There are no carotid bruits. The patient speaks in very short sentences and has difficulty finding words while trying to speak. He is awake and alert but has difficulty following simple commands. There is a forced conjugate gaze preference to the left, neglect of the right visual field, and severe right lower facial droop. He has marked weakness and sensory loss in the right arm and mild weakness and sensory loss in the right leg. His fingerstick glucose value is 345 mg/dl. Which of the following is the most likely cause of this patient’s current condition?

  • QA Cardiogenic emboli
  • 0 B. Carotid artery atherosclerosis
  • 0 C. Hyperglycemic nonketotic state
  • 0 D. Subarachnoid hemorrhage
  • 0 E. Subcortical lacunar stroke

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