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initial physical examination, you detect a firm, non-tender, multinodular uterus whose size corresponds to that at approximately 8 to 10 weeks of pregnancy, which is consistent with leiomyomata uteri. The remainder of the medical history and physical examination is within normal limits, as is her husband's semen analysis. Normal ovulatory status has been documented by basal body temperature monitoring and luteal-phase progesterone measurement. Your next best step is to recommend a: normal pelvic ultrasonography b: hysterosalpingogram (HSG) c: in vitro fertilization - embryo transfer (IVF-ET) d: myomectomy e: arterial embolization of the fibroids 12: A 36-year-old woman with regular, monthly, 5-day menstrual cycles presents with a 2-year history of severe right-sided pelvic pain. Pelvic examination reveals no abnormalities. She reports insomnia, loss of appetite, and decreased libido. The patient once considered evaluation for infertility but now does not desire childbearing. She has had three laparoscopic procedures in the last 18 months that showed minmal peritoneal adhesions, with no change in the pain. Appropriate management of this includes a: repeat diagnostic laparoscopy b: barium enema, intravenous pyelography, and plevic ultrasonography c: presacral neurectomy d: transabdominal hysterectomy and bilateral salpingo-oophorectomy e: psychological counseling with antidepressant therapy 13: A 63-year-old woman with 6 months of early satiety and increased abdominal girth has an abdominal fluid wave and a palpable 12 cm nodular right adnexal mass. The next BEST step would be for her to obtain a: a diagnostic laparoscopy b: a staging laparotomy and debulking for her presumed ovarian cancer c: a CT scan to get the exact dimensions of the mass d:
