Q. A 14-year-old girl is brought to the physician’s office by her mother for severe lower abdominal pain associated with menstrual periods for the past 1 day. The pain is cramping in nature and she has severe nausea and had vomited twice. She attained menarche at the age of 12 years. Her menstrual cycles are regular and with normal blood flow. She had similar symptoms in the last 2 menstrual cycles and they were mild and relieved by NSAIDs. But this time, the tablets are not giving her relief. She is not sexually active. Her temperature is 98.6°F (37°C), pulse is 88/min, blood pressure is 110/70 mmHg, and respirations are 14/min. On physical examination, the abdomen is soft and non-tender. A pelvic examination is normal with regular menstrual blood flow. This patient’s condition is most likely associated with which of the following findings?