Young Girl with Grapes
A 13-year-old female presents to her primary care physician
because of abdominal pain and an enlarging mass in the right lower quadrant.
With a slightly deep but, somber voice, the patient describes herself as being in
“good health until the recent onset of abdominal pain several months ago”.
She has noticed some hair growth on her face, which she is embarrassed about but does not
understand. Says that her mom told her it was part of growing up and it would go away.
Upon physical exam, she is noted to be within normal height and weight for her age,
strong but petite, has not yet had onset of menses, and otherwise appears healthy.
She has a moderate amount of acne on her forehead and face, which started appearing
about six months ago. Lung and bowel sounds are normal,
and the heart has a regular rate and rhythm with no murmurs.
Abdominal exam reveals right lower quadrant, rebound tenderness to palpation
(a slight but definite wince by the patient), and fluid wave.
Percussion demonstrated shifting dullness.
If you hadn't palpated the mass or found the fluid wave, which would you
consider as the cause of her acne? Choose all that apply.
Normal teenage development
Polycystic ovary syndrome