Which condition is characterized by vaginal bleeding, shoulder and lower back pain, pelvic tenderness, and a palpable adnexal mass?

The condition characterized by vaginal bleeding, shoulder and lower back pain, pelvic tenderness, and a palpable adnexal mass is an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. This leads to symptoms such as pelvic pain, abnormal bleeding, and sometimes shoulder pain, which occurs due to referred pain from diaphragmatic irritation caused by internal bleeding.

The palpable adnexal mass is significant as it indicates the presence of the ectopic tissue within the adnexa (the structures adjacent to the uterus, including the ovaries and fallopian tubes). Shoulder pain, particularly, serves as a critical clinical sign and can point towards internal bleeding, which could lead to serious complications if not addressed promptly. Various imaging techniques, like ultrasound, can further confirm the diagnosis by visualizing the ectopic tissue.

In contrast, the other conditions listed present with different symptoms and complications. For example, pyelonephritis, an infection of the kidneys, generally manifests with fever, flank pain, and urinary symptoms rather than the specific combination seen in ectopic pregnancy. Placenta previa usually involves painless vaginal bleeding in the third trimester, while abruptio placentae is characterized by painful bleeding due to premature