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Mildly Tender Left Adnexa and Negative Pregnancy Test

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A healthy 24-year-old woman comes for a routine health maintenance examination. Menses occur at regular 28-day intervals and last 5 to 6 days. Her last menstrual period was 3 weeks ago. She takes no medications. Bimanual examination shows a 5-cm, mildly tender left adnexa. A pregnancy test is negative. Which of the following is the most appropriate next step in management?

A) Repeat examination in 2 weeks

B) Measurement of serum CA 125 level

C) Measurement of serum α-fetoprotein level

D) CT scan of the pelvis

E) Diagnostic laparoscopy

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A.

I would just leave it for now. I suppose she is asymptomatic.
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