Your 34-year-old female patient complains of a feeling of "heaviness" in the right lower quadrant, achiness, and bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative
The diagnostic tool that would be most helpful is:
A. Digital rectal exam
B. Transvaginal ultrasound
C. Pap smear
D. Urinalysis
ANS: B
Ovarian masses are often asymptomatic, but symptoms may include pressure-type pain, heaviness, aching, and bloating. Masses are typically detected on pelvic examination. In advanced malignancies, ascites is often present. An elevated cancer antigen 125 (CA-125) result indicates the likelihood that the mass is malignant. A transvaginal pelvic ultrasound has a higher diagnostic sensitivity than transabdominal ultrasound. If diagnosis is unclear, CT, MRI, or PET scan can be performed. A laparoscopy or exploratory laparotomy is necessary for staging, tumor debulking, and resection.
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