This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Endometriosis & H, Subject name: Gynaecology & Obstetrics
A 25 year old infeile lady is having menorrhagia. On examination an abdominal mass is palpable which is immobile. On PV examination- uterus and appendages are fixed. The most appropriate first line treatment in this case is 
Select and explain. 
A. Diagnostic laparoscopy, B. Tubal microsurgery, C. Anti tubercular drugs, D. Hysterectomy
A: Diagnostic laparoscopy
Answer: A: Diagnostic laparoscopy 
Explanation: There can be 2 main diagnosis, Endometriosis and Tuberculosis. Menorrhagia is common with early tubercular endometritis but in this question there is history of an abdominal mass and hence it s likely a chronic presentation Endometriosis is a condition of estrogen access and is frequently associated with menorrhagia A laparoscopy is the best tool to diagnose endometriosis and also to take biopsies to confirm/rule out Tuberculosis