Finding	Suggested diagnoses	Further diagnostic considerations
Carnett sign (increased pain to palpation when the abdominal wall musculature is voluntarily contracted)	Musculoskeletal (abdominal wall) pain	No further testing needed in the absence of other historical or physical examination findings that might suggest intrapelvic or intra-abdominal conditions
Cervical motion tenderness	Pelvic inflammatory disease	Consider testing for sexually transmitted infections
Fever	Appendicitis	Ultrasonography or contrast CT of the abdomen and pelvis
		Complete blood count demonstrating leukocytosis
	Pelvic inflammatory disease	Consider testing for sexually transmitted infections
	Pyelonephritis	Urinalysis demonstrating evidence of urinary tract infection (white blood cells, bacteria, leukocyte esterase, or nitrites)
		Complete blood count demonstrating leukocytosis, left shift
	Tubo-ovarian abscess	Pelvic ultrasonography
		Complete blood count demonstrating leukocytosis, left shift
Pelvic mass	Ectopic pregnancy	See Table 2
	Fibroid uterus	Pelvic ultrasonography
	Ovarian cancer	Pelvic ultrasonography
		Consider CT of the chest, abdomen, and pelvis if metastatic disease is suspected
	Ovarian cyst	Pelvic ultrasonography
	Tubo-ovarian abscess	Pelvic ultrasonography
Rovsing sign (palpation in the left lower quadrant causes pain in the right lower quadrant)	Appendicitis	Contrast CT of the abdomen and pelvis
		Complete blood count demonstrating leukocytosis
Tachycardia, hypotension	Ruptured ectopic pregnancy	Consider urgent referral to facility with immediate surgical
	Ruptured hemorrhagic cyst capability