American Board of Internal Medicine (ABIM) Certification Practice Exam

Which clinical finding makes pelvic inflammatory disease unlikely?

1. Presence of fever

2. Absence of cervical motion tenderness

3. Presence of nausea

4. Positive pregnancy test

The correct answer is: Absence of cervical motion tenderness

The absence of cervical motion tenderness is a clinical finding that makes pelvic inflammatory disease (PID) unlikely. Cervical motion tenderness is a classic physical exam finding in women with PID, indicating inflammation of the reproductive organs. If this tenderness is absent, it suggests that there is less likelihood of an infectious process affecting the pelvis, as PID typically presents with a combination of symptoms, including tenderness upon examination. In contrast, the presence of fever, nausea, or a positive pregnancy test does not rule out PID. Fever can be a sign of infection, nausea may accompany various conditions including PID, and a positive pregnancy test can occur regardless of pelvic inflammatory issues. Thus, the presence of cervical motion tenderness is more definitive in supporting a diagnosis of PID, while its absence appropriately suggests that PID is unlikely.