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Ref 2A901F Pg 312366-
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Why i think this is a bullshit question. Asymptomatic, so it rules out Endometriosis because there will be pain every menstrual cycle because endometrium in ovaries also bleeds. Also rules out PID because no Sx such as fever and vaginal discharge. Also rules out ectopic pregnancy No unilateral pain, and other sign and Sx of pregnancy Now stuck with 2 Malignancy and Anovulation cyst. so They say patient is asymptomatic and in case of anovulation cyst there will be prolong abscence of menses and then massive bleeding so that is a symptom and it must be present if anovulation because there will be prolong follicular phase and unopposed estrogen release. so i picked ovarian neoplasm which is usually asymptomatic over long period of time but it does not fit with the age. So you have to chose between age demography and ignoring irregular menses as a symptom.