Review Question - QID 108617

A 45-year-old G5P4105 presents to her gynecologist’s office with 6 months of increasingly heavy periods. She now soaks a super absorbent tampon every 2 hours for 5 days each cycle. Her cycles have also become irregular, with intermenstrual bleeding for the last 2 months. She now experiences significant dysmenorrhea, requiring 400 mg ibuprofen every 4 hours for the majority of each menses. In addition, she reports new onset mild dyspareunia with intercourse and a “heavy feeling” in her pelvis. She has also noticed increased urinary frequency but denies bowel changes. The patient has a past medical history of obesity and type 2 diabetes on metformin. Her last child was born 4 years ago, and she has had 5 spontaneous vaginal deliveries. At this office visit, temperature is 98.5°F (36.9°C), blood pressure is 137/84 mmHg, pulse is 87/min, and respirations are 14/min. Her lower abdomen is tender to palpation. Which of the following physical exam findings is most likely to be present in this patient?