42yo G3P2A1 Caucasian female presents for annual well woman examination, required prior to deployment to Afghanistan. Patient reports “twisting” left lower quadrant pain since 2003. Adenxal tenderness noted on left side during bimanual. PMH: No hx of STDs; Breast cancer (right)-estrogen/progesterone related in 2006; endometriosis diagnosed while having bilateral tubal ligation performed in 2003. Had pelvic US performed in 2009, ovarian cysts, less than 3cm in size identified; LGSIL in 1990 (no other abnormal paps reported) lumpectomy performed 2006. Family history: Mom with history of uterine cancer. Patient currently followed by breast care center. Patient is due to deploy in August. Patient’s previous US report did not indicate repeat recommendations. Differentials: PCOS, endometriosis, uterine cancer. A pelvic US was ordered and a referral to Oncology was ordered. An oncologist has not followed the patient since 2006 and for further evaluation/recommendations as it relates to her symptoms. The challenge for this case is how to manage the patient’s current problem as it relates to the time constraints involved with the deployment.