07-27-2016, 04:01 AM
An otherwise healthy 16-year-old girl is brought to the physician by her mother because of a 6-month history of ¡increasingly severe pain with menses. Her mother reports that during this time, her daughter has missed 2 days of school during each menstrual period because of severe pelvic cramps associated with vomiting. Menses occur at regular 28-day intervals and last 4 to 5 days. Her last menstrual period was 7 days ago. She currently takes
acetaminophen, which provides minimal relief of her symptoms. She has had three lifetime sexual partners, and they use condoms inconsistently. The patient is an honor roll student despite frequent absences from school. Physical examination shows no abnormalities. Pelvic examination shows a tender, normal-sized uterus and no masses. Which of the following is the most appropriate next step in management?
A) Pregnancy test
B) Pelvic ultrasonography
C) Narcotic therapy
D) Nonsteroidal anti-inflammatory drug therapy
E) Selective serotonin-reuptake inhibitor therapy
acetaminophen, which provides minimal relief of her symptoms. She has had three lifetime sexual partners, and they use condoms inconsistently. The patient is an honor roll student despite frequent absences from school. Physical examination shows no abnormalities. Pelvic examination shows a tender, normal-sized uterus and no masses. Which of the following is the most appropriate next step in management?
A) Pregnancy test
B) Pelvic ultrasonography
C) Narcotic therapy
D) Nonsteroidal anti-inflammatory drug therapy
E) Selective serotonin-reuptake inhibitor therapy