A 62-Year-Old Nulligravid Woman Comes to the Office for Follow-Up

question 18

Multiple Choice

A 62-year-old nulligravid woman comes to the office for follow-up of a right adnexal mass.  The patient was undergoing a pelvic examination and Pap testing 2 weeks ago when a right adnexal mass was palpated on bimanual examination.  The Pap test was normal, and she has had no symptoms.  Menopause occurred at age 52, and there has been no postmenopausal spotting.  The patient's medical history is otherwise unremarkable.  She does not use tobacco, alcohol, or illicit drugs.  There is no family history of ovarian or breast cancer.  Temperature is 36.7 C (98.1 F) , blood pressure is 120/70 mm Hg, and pulse is 72/min.  The abdomen is soft, nondistended, and has no palpable masses.  A pelvic ultrasound reveals a 5-cm right ovarian cyst.  Which of the following is the best next step in management of this patient?

• A)Endometrial biopsy
• B)Laparoscopy
• C)Needle aspiration for cytology
• D)Reassurance and observation only
• E)Serum CA-125 level

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