Chapter 23: OBGYN Emergencies (Gynecologic Emergencies EMT)

A patient with pelvic inflammatory disease will typically complain of _________. - aches and fever associated with urination - abdominal pain associated with menstruation - bleeding associated with stress - nausea and vomiting associated with intercourse

A patient with pelvic inflammatory disease will typically complain of _________. - aches and fever associated with urination *- abdominal pain associated with menstruation* - bleeding associated with stress - nausea and vomiting associated with intercourse

You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings would increase your index of suspicion for PID? A. a shuffling gait when walking B. bright red blood in the urine C. a history of ectopic pregnancy D. vaginal passage of blood clots

A. a shuffling gait when walking

Which of the following conditions would MOST likely lead to PID if left untreated? A. chlamydia B. ovarian cysts C. genital herpes D. ectopic pregnancy

A. chlamydia

Whenever possible, a female sexual assault victim should be: A. given the option of being treated by a female EMT. B. encouraged to take a shower and change her clothes. C. thoroughly assessed, even if no signs of injury exist. D. asked to provide a brief description of the perpetrator.

A. given the option of being treated by a female EMT.

When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she: A. has gathered patient history information. B. has obtained a complete set of vital signs. C. ascertains if the patient was ever pregnant. D. has formed a general impression of the patient.

A. has gathered patient history information.

As a woman approaches menopause: A. her menstrual periods may become irregular and vary in severity. B. she cannot become pregnant because of fluctuating hormone levels. C. she usually experiences abdominal cramping without vaginal bleeding. D. her risk of developing PID lowers significantly.

A. her menstrual periods may become irregular and vary in severity.

The physical examination of a sexual assault victim should be: A. limited to a brief survey for life-threatening injuries. B. performed in the presence of at least two police officers. C. as detailed as possible so all injuries can be documented. D. deferred until the patient can be evaluated by a physician.

A. limited to a brief survey for life-threatening injuries.

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer: A. may be relatively painless. B. is typically not as severe. C. can be controlled in the field. D. often presents with acute pain.

A. may be relatively painless.

Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should: A. provide emotional support and visually assess her for obvious trauma. B. advise her that she cannot clean herself up because this will destroy evidence. C. ask her if there is anyone you can contact, such as a friend or relative. D. perform a limited hands-on assessment to detect life-threatening injuries.

A. provide emotional support and visually assess her for obvious trauma.

When a female has reached menarche: A. she is capable of becoming pregnant. B. she can no longer produce an ovum. C. she usually requires hormone therapy. D. menstrual periods become less frequent.

A. she is capable of becoming pregnant.

Which of the following statements regarding pelvic inflammatory disease (PID) is correct? A. The most severe cases of PID occur in women who are not sexually active. B. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy. C. PID most commonly affects women who have had an ectopic pregnancy in the past. D. The most common presenting symptom of PID is generalized upper abdominal pain.

B. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.

Which of the following statements regarding gonorrhea is correct? A. Most men who are infected with gonorrhea do not experience symptoms. B. Painful urination is a common symptom of gonorrhea in men and women. C. Symptoms of gonorrhea usually appear within 3 months after being infected. D. Mild infections with gonorrhea cause abdominal pain, vomiting, and fever.

B. Painful urination is a common symptom of gonorrhea in men and women.

Which of the following statements regarding rape is correct? A. The EMT should try to determine if rape occurred. B. Rape is a legal diagnosis, not a medical diagnosis. C. Rape causes more physical harm than emotional harm. D. Only a licensed physician can make a diagnosis of rape.

B. Rape is a legal diagnosis, not a medical diagnosis.

During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse is rapid and weak. You should: A. perform a rapid secondary assessment. B. assist her ventilations with a bag-mask device. C. assess her blood pressure and elevate her legs. D. perform a visual assessment of her vaginal area.

B. assist her ventilations with a bag-mask device.

In anticipation of receiving a fertilized ovum, the lining of the uterine wall: A. thins and begins to separate. B. becomes engorged with blood. C. diverts blood flow to the vagina. D. sheds and is expelled externally.

B. becomes engorged with blood.

The onset of menstruation is called menarche and usually occurs in women who are: A. between 12 and 14 years of age. B. between 11 and 16 years of age. C. between 25 and 35 years of age. D. between 45 and 50 years of age.

B. between 11 and 16 years of age.

If a woman with vaginal bleeding reports syncope, the EMT must assume that she: A. is pregnant. B. is in shock. C. has an infection. D. has an ectopic pregnancy.

B. is in shock.

Bacterial vaginosis is a condition that occurs when: A. harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes. B. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. C. numerous bacteria enter the uterus through the cervix and cause severe tissue damage. D. abnormal bacteria enter the vagina and cause damage without causing any symptoms.

B. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: A. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. B. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. C. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. D. assist her ventilations with a bag-mask device, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

C. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: A. supplemental oxygen and lower extremity elevation. B. refraining from placing any dressings into the vagina. C. carefully removing any foreign bodies from the vagina. D. treating external lacerations with moist, sterile compresses.

C. carefully removing any foreign bodies from the vagina.

It is not uncommon for young females who experience their first menstrual period to: A. have a falsely positive home pregnancy test result. B. lose up to 500 mL of blood within the first 24 hours. C. experience abdominal cramping, which may be misinterpreted. D. become so emotionally distraught that they contemplate suicide.

C. experience abdominal cramping, which may be misinterpreted.

Which of the following conditions does NOT typically present with vaginal discharge? A. chlamydia B. gonorrhea C. genital herpes D. PID

C. genital herpes

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to: A. determine the underlying cause of her problem. B. ask questions related to her gynecologic history. C. maintain her ABCs and transport without delay. D. keep assessment and treatment to a minimum.

C. maintain her ABCs and transport without delay.

PID typically does NOT affect the: A. uterus. B. ovaries. C. urinary bladder. D. fallopian tubes.

C. urinary bladder.

Causes of vaginal bleeding include which of the following? - Ectopic pregnancy - Vaginal trauma - Spontaneous abortion - All of these answers are correct.

Causes of vaginal bleeding include which of the following? - Ectopic pregnancy - Vaginal trauma - Spontaneous abortion *- All of these answers are correct.*

Each ovary produces an ovum in alternating months and releases it into the: A. vagina. B. uterus. C. cervix. D. fallopian tube.

D. fallopian tube.

When documenting a call in which a female was sexually assaulted, you should: A. only use quotation marks when recording any statements made by witnesses. B. translate the patient's words or statements using proper medical terminology. C. record your opinion only if you have reasonable proof to justify the statement. D. keep the report concise and record only what the patient stated in her own words.

D. keep the report concise and record only what the patient stated in her own words.

Which of the following clinical presentations is MOST consistent with PID? A. left lower quadrant pain, referred pain to the left shoulder, and fever B. pain around the umbilicus, low-grade fever, and generalized weakness C. upper abdominal cramping, severe headache, and heavy vaginal bleeding D. lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

D. lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

Potentially life-threatening consequences of PID include: A. ovarian cysts and gonorrhea. B. bacterial vaginosis and chlamydia. C. uterine rupture with severe bleeding. D. ovarian abscess and ectopic pregnancy.

D. ovarian abscess and ectopic pregnancy.

When caring for a female patient who has been sexually assaulted, you should: A. ask the patient for a concise, detailed report of what happened to her. B. allow law enforcement to take her statement before you begin treatment. C. advise her that she will not be allowed to shower or change her clothes. D. place any bloodstained clothing or other articles in separate paper bags.

D. place any bloodstained clothing or other articles in separate paper bags.

During gynecologic emergencies, in addition to the standard SAMPLE questions, the EMT should attempt to determine which of the following? - The amount of time since of the patent's last menstrual cycle - The possibility that the patient may be pregnant - If the patient is sexually active - All of these answers are correct.

During gynecologic emergencies, in addition to the standard SAMPLE questions, the EMT should attempt to determine which of the following? - The amount of time since of the patent's last menstrual cycle - The possibility that the patient may be pregnant - If the patient is sexually active *- All of these answers are correct.*

(T/F) PID is the most common vaginal infection in women age 15 to 44.

False. *Bacterial vaginosis* is the most common vaginal infection in women age 15 to 44.

(T/F) Symptoms of gonorrhea are generally more severe in women than in men.

False. Symptoms of gonorrhea are generally more severe in *men* than in women.

If PID is not treated, what can occur? - Ectopic pregnancy - Arthritis - Low-birth-weight babies - Uterine collapse

If PID is not treated, what can occur? *- Ectopic pregnancy* - Arthritis - Low-birth-weight babies - Uterine collapse

In ________, the placenta separates prematurely from the wall of the uterus. - Abruptio placenta - Placenta previa - Preeclampsia - Vertex presentation

In ________, the placenta separates prematurely from the wall of the uterus. *- Abruptio placenta* - Placenta previa - Preeclampsia - Vertex presentation

In addition to providing medical care to a rape victim, which of the following is the most critical thing you should do? - Ask very specific questions to help identify the assailant. - Do a full assessment of the victim's mental status to determine whether an assault has actually occurred. - Move the patient to a private location. - Refer the patient to a rape crisis center.

In addition to providing medical care to a rape victim, which of the following is the most critical thing you should do? - Ask very specific questions to help identify the assailant. - Do a full assessment of the victim's mental status to determine whether an assault has actually occurred. *- Move the patient to a private location.* - Refer the patient to a rape crisis center.

In cases of sexual assault, it is important to ensure that you do which of the following? - Immediately write down your observations of the scene before assessing the patient. - Call for a female EMT or ALS care provider. - Discuss with law enforcement any suspicions that you may have about the perpetrator. - All of these answers are correct.

In cases of sexual assault, it is important to ensure that you do which of the following? - Immediately write down your observations of the scene before assessing the patient. - Call for a female EMT or ALS care provider. - Discuss with law enforcement any suspicions that you may have about the perpetrator. *- All of these answers are correct.*

In the case of a sexual assault, what is your most important treatment option? - Low-flow oxygen - Psychologic support - Transport to the hospital - Supine positioning

In the case of a sexual assault, what is your most important treatment option? - Low-flow oxygen *- Psychologic support* - Transport to the hospital - Supine positioning

It is common for young females who experience their first menstrual period to: - lose up to 500 mL of blood within the first 24 hours. - become so emotionally distraught that they contemplate suicide. - experience abdominal cramping, which may be misinterpreted. - have a false positive home pregnancy test result.

It is common for young females who experience their first menstrual period to: - lose up to 500 mL of blood within the first 24 hours. - become so emotionally distraught that they contemplate suicide. *- experience abdominal cramping, which may be misinterpreted.* - have a false positive home pregnancy test result.

Patient complaints of pain during intercourse, lower abdominal discomfort, and nausea may be indicative of which of the following? - Pelvic inflammatory disease - Bacterial vaginosis - Chlamydia - Gonorrhea

Patient complaints of pain during intercourse, lower abdominal discomfort, and nausea may be indicative of which of the following? *- Pelvic inflammatory disease* - Bacterial vaginosis - Chlamydia - Gonorrhea

Some women experience ___________ during ovulation. - severe abdominal pain - severe bleeding - slight cramping - hypotension

Some women experience ___________ during ovulation. - severe abdominal pain - severe bleeding *- slight cramping* - hypotension

The EMT should ensure that vaginal bleeding is _________. - controlled directly by the patient - taken seriously and the patient is transported for gynecologic evaluation - not caused by traumatic injury - severe enough to warrant transport

The EMT should ensure that vaginal bleeding is _________. - controlled directly by the patient *- taken seriously and the patient is transported for gynecologic evaluation* - not caused by traumatic injury - severe enough to warrant transport

The __________ and _________ are folds of tissue that surround the urethral and vaginal openings. - perineum; anus - fallopian tubes; uterus - labia majora; labia minora - vagina; cervix

The __________ and _________ are folds of tissue that surround the urethral and vaginal openings. - perineum; anus - fallopian tubes; uterus *- labia majora; labia minora* - vagina; cervix

The _____________ connect(s) each ovary with the uterus. - egg - cervix - abdomen - fallopian tubes

The _____________ connect(s) each ovary with the uterus. - egg - cervix - abdomen *- fallopian tubes*

(T/F) In a gynecologic emergency, you should leave any foreign bodies in place after stabilizing them with bandages.

True.

(T/F) The most common presenting sign of PID is generalized lower abdominal pain.

True.

What is an EMT's responsibility regarding evidence in the case of a sexual assault? - Analyze - Collect - Catalogue - Preserve

What is an EMT's responsibility regarding evidence in the case of a sexual assault? - Analyze - Collect - Catalogue *- Preserve*

What is menarche? - The cycle in which the ovum is released - The end of menstrual activity, which usually occurs in a woman's 50s - The onset of menstruation, which usually occurs between ages 11 and 16 years - The area of tissue between the vagina and the anus

What is menarche? - The cycle in which the ovum is released - The end of menstrual activity, which usually occurs in a woman's 50s *- The onset of menstruation, which usually occurs between ages 11 and 16 years* - The area of tissue between the vagina and the anus

What should you do when a female patient has vaginal bleeding of unknown cause? - Pack the vagina with sterile gauze to stop blood loss. - Treat for shock. - Determine the cause of the bleeding. - Tell the patient to see her gynecologist as soon as possible.

What should you do when a female patient has vaginal bleeding of unknown cause? - Pack the vagina with sterile gauze to stop blood loss. *- Treat for shock.* - Determine the cause of the bleeding. - Tell the patient to see her gynecologist as soon as possible.

Which of the following drugs is commonly referred to as "roofies"? - MDMA - Ketamine - GHB - Rohypnol

Which of the following drugs is commonly referred to as "roofies"? - MDMA - Ketamine - GHB *- Rohypnol*

Which of the following infections, when left untreated, may lead to infection of the blood and brain? - Bacterial vaginosis - Gonorrhea - Chlamydia - Pelvic inflammatory disease

Which of the following infections, when left untreated, may lead to infection of the blood and brain? - Bacterial vaginosis *- Gonorrhea* - Chlamydia - Pelvic inflammatory disease

Which of the following organs or structures controls the process of ovulation and menstruation? - Fallopian tubes - Ovaries - Vagina - Cervix

Which of the following organs or structures controls the process of ovulation and menstruation? - Fallopian tubes *- Ovaries* - Vagina - Cervix

While the ages can vary, women typically experience menstruation from approximately _________ to ____________ years of age. - 10; 70 - 11; 50 - 20; 60 - 10; 40

While the ages can vary, women typically experience menstruation from approximately _________ to ____________ years of age. - 10; 70 *- 11; 50* - 20; 60 - 10; 40

Why is it important to transport a sexual assault victim to the hospital even if she does not have any obvious injuries? - The police need confirmation that a sexual assault actually occurred. - There may be injuries that were not detected in the field, such as internal bleeding, that have a delayed onset of symptoms. - It is not safe to allow the victim to return home until the police have had a chance to collect evidence. - Full documentation needs to be completed before the case can go to court.

Why is it important to transport a sexual assault victim to the hospital even if she does not have any obvious injuries? - The police need confirmation that a sexual assault actually occurred. *- There may be injuries that were not detected in the field, such as internal bleeding, that have a delayed onset of symptoms.* - It is not safe to allow the victim to return home until the police have had a chance to collect evidence. - Full documentation needs to be completed before the case can go to court.

You are assessing a 38-year-old woman who is reporting achy abdominal pain, burning on urination, and a slight fever. As you assist her to the ambulance, you notice that she has a shuffling gait. What condition does this indicate? - Bacterial vaginosis - Chlamydia - Ectopic pregnancy - PID

You are assessing a 38-year-old woman who is reporting achy abdominal pain, burning on urination, and a slight fever. As you assist her to the ambulance, you notice that she has a shuffling gait. What condition does this indicate? - Bacterial vaginosis - Chlamydia - Ectopic pregnancy *- PID*

You are assessing a female patient who tells you she feels blood coming from her vaginal area. She gives you permission to look and you observe moderate bleeding from the vagina. What should you do to manage the bleeding? - Apply direct pressure using trauma dressings. - Pack the vagina with trauma dressings. - Ask the patient to insert a tampon. - Place a sanitary pad over the vaginal opening.

You are assessing a female patient who tells you she feels blood coming from her vaginal area. She gives you permission to look and you observe moderate bleeding from the vagina. What should you do to manage the bleeding? - Apply direct pressure using trauma dressings. - Pack the vagina with trauma dressings. - Ask the patient to insert a tampon. *- Place a sanitary pad over the vaginal opening.*