Differential for Cervical Motion Tenderness

[Tedebear]

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I keep getting a presentation of Cevical Motion Tenderness and Adnexal Tenderness on practice questions for Step 1. What is the significance of these two findings on physical examination. Also, how can you distinguish a ruptured fallopian tube versus a ruptured ovarian cyst from a classic presentation. I never in my wildest dreams thought I would have to be versed in gynecology for Step 1!

Also, if someone can give a good rule of thumb on how to handle pain in the RLQ, and how to come up with the diagnosis. I would be very appreciative.

Thanks in advance

 

[Hawkeye Kid]

Didn't QBank explain this in the explanations? You are using QBank, right? Anyway...

I don't claim to be an expert on the pelvis (just ask any of my ex gf's) but for the purposes of exams, "cervical motion tenderness" = PID unless there's a good reason to think otherwise. Adnexal tenderness is referring to pain elicited when the tubes/ovaries are palpated. This could also indicate PID, but in the absence of cervical motion tenderness, I'd probably look for something else (on an exam, at least).
As far as isolated RLQ pain, think about the anatomy and what could go wrong with the stuff that lives there:
-appy--sudden onset, initially dull periumb pain that becomes sharp and RLQ. If they say "tender at McBurney's point" stop reading, click on appendicitis and move on. Also, elev WBC, fever, hurts to move. Oh, and if they have a PMH of appy or a little scar in the RLQ, look for something else 😉. Also, in a preg pt, this could present as RUQ pain since the kid screws up the normal anatomy (this is likely more of an OB/GYN shelf ? and not step 1, though).
-kidney stones--hematuria, colicky pain, can't sit still, similar hx. 80% can be seen on plain film XR.
-female stuff--appy can look like PID, but appy wouldn't have BILATERAL adnexal tenderness (but PID doesn't HAVE to either). Also think about ectopic preg (+hCG), ovarian stuff (cyst, torsion), etc.

This is a decent list for boards. There are other things that will cause more general abd pain, obviously, but the exam won't try to trick you like that (real pts will). Thanks for making me think about that stuff--it's always good to review. Good luck.