Which condition is associated with palpable adnexal mass and tenderness during a vaginal exam in the first trimester?

An ectopic pregnancy is characterized by the implantation of a fertilized egg outside the uterus, often in a fallopian tube. During a vaginal examination, a palpable adnexal mass may be felt, and tenderness is commonly present due to the abnormal location of the pregnancy. This tenderness and the mass can lead to suspicion of ectopic pregnancy, especially when coupled with symptoms such as abdominal pain or vaginal bleeding.

In contrast, while an ovarian cyst can also present as an adnexal mass, it typically does not cause the same level of tenderness or associated symptoms that indicate an ectopic pregnancy. A normal pregnancy generally does not present with these findings; the absence of an adnexal mass or tenderness is expected during a healthy first trimester. Pelvic inflammatory disease, although it can cause adnexal tenderness, usually presents with different signs and symptoms, including fever and discharge, which distinguishes it from the specific situation of an ectopic pregnancy. Thus, the signs of palpable adnexal mass and tenderness during examination in the first trimester point clearly toward an ectopic pregnancy as the cause.