36-year-old African American woman, gravida 2 para 0, comes to the office with a worsening "heavy feeling" in her lower abdomen over the last year


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36-year-old African American woman, gravida 2 para 0, comes to the office with a worsening “heavy feeling” in her lower abdomen over the last year. Menses occur at regular 28-day intervals and last 9-10 days with no bleeding or spotting between cycles. She has cramping with her menses that causes her to miss a day of work each month. The patient’s last menstrual period ended a few days ago. She has had 2 first-trimester miscarriages in the last year and would like to conceive again Examination shows a mobile, globular mass with several protuberances located below the umbilicus. Urine pregnancy test is negative Which of the following is the most likely cause of this patient’s symptoms?

  • QA Adenomyosis
  • 0 B. Bicornuate uterus
  • 0 C. Endometrial carcinoma
  • 0 D. Endometrial polyps
  • 0 E. Endometriosis
  • 0 F Leiomyomata uteri
  • 0 G. Ovarian carcinoma
  • 0 H. Uterine leiomyosarcoma

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14-year-old girl is brought to the office due to 8 days of fever, sore throat, and malaise. Her appetite has decreased but she is able to tolerate fluids. The patient has no cough, abdominal pain, nausea, or vomiting. Her mother gave her leftover amoxicillin for her symptoms, and the girl later developed a rash over her entire body. The patient has no medical issues and has taken amoxicillin previously without reaction. Temperature is 38.3 C (100.9 F), blood pressure is 110/70 mm Hg, pulse is 84/min, and respirations are 12/min. Examination shows enlarged, erythematous tonsils bilaterally with white exudates and diffuse bilateral cervical lymphadenopathy. Heart sounds reveal a 1/6 systolic murmur along the left sternal border. The lungs are clear to auscultation bilaterally. The abdomen is soft and nontender with mild hepatosplenomegaly. An erythematous, polymorphous, maculopapular rash is present over her entire body. Which of the following is the most likely explanation for this patient’s rash?

  • QA Acute rheumatic fever
  • 0 B. Antibiotic allergy
  • 0 C . Epstein-Barr virus infection
  • 0 D. Erythema infectiosum
  • 0 E. Kawasaki disease
  • 0 F Stevens-Johnson syndrome
  • 0 G. Streptococcal scarlet fever

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