Gynecologic Emergencies

Which of the following statements regarding the fallopian tubes is correct? A. They extend from the uterus and terminate at the ovary. B. Their purpose is to carry an unfertilized egg to the uterus. C. They are too large to accommodate a male spermatozoa. D. Growth of the fetus typically occurs in the fallopian tubes.

A. They extend from the uterus and terminate at the ovary

A 22-year-old female presents with lower abdominal pain; a frothy, yellow, odorous vaginal discharge; and dysuria. She tells you that she experiences severe pain during sexual intercourse. Her clinical presentation is MOST consistent with: A. Trichomoniasis. B. secondary syphilis. C. Chlamydia. D. bacterial vaginosis.

A. Trichomoniasis

A 21-year-old female was sexually assaulted with a glass bottle. Your assessment reveals that she is semiconscious with shallow breathing. The bottle is still inside her vagina. You should: A. assist ventilations, perform a head-to-toe assessment, and stabilize the bottle in place. B. apply oxygen via nonrebreathing mask, remove the object and place it in a plastic bag. C. intubate the patient, perform a detailed physical exam, and stabilize the bottle in place. D. assist ventilations, obtain baseline vital signs, and carefully remove the impaled bottle.

A. assist ventilations, perform a head-to-toe assessment, and stabilize the bottle in place

When palpating the abdomen of a female in pain, you should: A. examine the area farthest away from the pain first. B. palpate vigorously to determine the problem organ. C. auscultate bowel sounds for at least 3 to 5 minutes. D. locate the area of pain and palpate that area first.

A. examine the area farthest away from the pain first

When assessing a woman who has been sexually assaulted, it is important to: A. have a female AEMT present if possible. B. place potential evidence in plastic bags. C. thoroughly examine the genitalia for injuries. D. document minimally to protect the patient's privacy.

A. have a female AEMT present if possible

An ectopic pregnancy occurs when an ovum develops: A. outside of the uterus. B. inside a fallopian tube. C. within the abdominal cavity D. inside of one of the ovaries.

A. outside of the uterus

A 32-year-old female complains of acute lower abdominal pain that began approximately 1 week after her menstrual period ended. Her blood pressure is 116/66 mm Hg, heart rate is 96 beats/min, and respirations are 14 breaths/min with adequate depth. Further assessment reveals that she is running a fever of 101.6°F. Treatment for this patient should include: A. placing her in a position of comfort, starting an IV line at a KVO rate, and transporting to an appropriate hospital. B. placing her supine and elevating her legs, administering a 20 mL/kg normal saline bolus, and prompt transport. C. placing her on her side with her knees drawn into her abdomen, a 250 mL normal saline bolus, and transport. D. placing her in a semisitting position, starting an IV at a KVO rate, and transporting her to an appropriate hospital.

A. placing her in a position of comfort, starting an IV line at a KVO rate, and transporting to an appropriate hospital

When collecting potential evidence at the scene of a sexual assault, you should place any items in paper bags, because: A. plastic bags may develop condensation and could destroy the evidence. B. plastic bags would reveal the potential evidence to curious onlookers. C. the condensation developed in the paper bag will preserve the evidence. D. paper bags are easier to seal and mark for later evaluation by the police.

A. plastic bags may develop condensation and could destroy the evidence

Functions of the ovaries include: A. production of oocytes, estrogen, and progesterone. B. fertilizing a spermatozoa and producing estrogen. C. production of a mature egg and estrogen excretion. D. receiving a spermatozoa and excreting progesterone.

A. production of oocytes, estrogen, and progesterone

During your assessment of a 30-year-old pregnant patient, you determine that she has given birth to two children and has had one miscarriage. You should document her obstetric history as: A. G2, P2, A1. B. G3, P2, A1. C. G3, P1, A0. D. G2, P2, A0.

B. G3, P2, A1

The corpus luteum is a/an: A. small endocrine structure that develops within a ruptured ovarian follicle. B. small almond-shaped structure that produces an ova every 28 to 30 days. C. fold of mucous membrane that partially covers the entrance to the vagina. D. exocrine gland that secretes human chorionic gonadotropin throughout pregnancy.

A. small endocrine structure that develops within a ruptured ovarian follicle

When assessing and treating a female patient with a sexually transmitted disease, it is important to: A. treat the patient without moral judgment. B. report the disease to the appropriate authorities. C. wear full facial protection in addition to gloves. D. determine how the patient contracted the disease.

A. treat the patient without moral judgment

What is the pathophysiology of bacterial vaginosis? A. A painless chancre that is caused by the Treponema pallidum bacterium B. Normal vaginal bacteria are replaced by an overgrowth of other bacterial forms. C. Caused by the bacterium Haemophilus ducreyi and causes ulcers on the genitalia D. Caused by the bacterium Neisseria gonorrhoeae, which grows in warm, moist areas

B. Normal vaginal bacteria are replaced by an overgrowth of other bacterial forms

A 35-year-old female complains of an acute onset of pain to her left lower abdominal quadrant. During your assessment, she tells you that the pain moves around to her back and that she is experiencing a small amount of vaginal bleeding. This patient is MOST likely experiencing: A. intrauterine cancer. B. a ruptured ovarian cyst. C. an ectopic pregnancy. D. gonorrhea or syphilis.

B. a ruptured ovarian cyst

A 25-year-old female, who is in the third trimester of pregnancy, was involved in a motor-vehicle crash and was not wearing a seatbelt. She complains of severe, tearing abdominal pain. She is experiencing dark red vaginal bleeding, and is exhibiting signs of shock. On the basis of the mechanism of injury and her clinical presentation, you should be MOST suspicious for: A. placenta previa. B. abruptio placenta. C. uterine inversion. D. traumatic abortion.

B. abruptio placenta

A 52-year-old female was brutally assaulted by several perpetrators. Your assessment reveals that she is semiconscious, is breathing shallowly, and has a rapid heart rate. You note that there is blood in the region of her vagina. Appropriate management for this patient includes: A. oxygen via nonrebreathing mask, placing gauze pads in the vagina, and IV therapy. B. assisted ventilations, an absorbent pad over her vagina, and a head-to-toe assessment. C. assisted ventilations, avoiding examination of the vagina, and placing a blanket on her. D. insertion of a Combitube, an absorbent pad over the vagina, and 2 liters of crystalloid.

B. assisted ventilations, an absorbent pad over her vagina, and a head-to-toe assessment

A 22-year-old female complains of pain during sexual intercourse. This is referred to as: A. menarche. B. dyspareunia. C. dysmenorrhea. D. amenorrhea.

B. dyspareunia

Pregnancy hormones cause the _____________ of the uterus to thicken in preparation for implantation of a fertilized egg. A. myometrium B. endometrium C. perimetrium D. cervical os

B. endometrium

The secondary stage of syphilis is characterized by: A. swollen lymph nodes and high fever. B. mucous membrane lesions and a rash. C. poor muscle coordination and dementia. D. the appearance of a single, painless lesion.

B. mucous membrane lesions and a rash

When treating a woman with vaginal bleeding and signs of shock, you must: A. assist her ventilations. B. observe standard precautions. C. establish two large-bore IV lines. D. perform a comprehensive assessment.

B. observe standard precautions

A 26-year-old female, who is at the end of her first trimester of pregnancy, complains of vaginal bleeding. She denies abdominal pain, and states that her last menstrual cycle was approximately 2 months ago. She is conscious and alert and her vital signs are stable. You should be MOST suspicious for: A. placenta previa. B. spontaneous abortion. C. uterine rupture. D. premature labor.

B. spontaneous abortion

The _____________ is the outermost cavity of a woman's reproductive system and forms the lower portion of the birth canal. A. cervix B. vagina C. uterus D. fundus

B. vagina

Prehospital documentation of a sexual assault case should: A. be turned over to law enforcement. B. remain on file for at least 6 months. C. be objective, factual, and detailed. D. include your opinion of the situation.

C. be objective, factual, and detailed

Acute abdominal pain and vaginal bleeding during the 23rd week of pregnancy could be caused by any of the following, EXCEPT: A. placenta previa. B. abruptio placenta. C. ectopic pregnancy. D. spontaneous abortion.

C. ectopic pregnancy

The uppermost portion of the uterus is called the: A. os. B. neck. C. fundus. D. cervix.

C. fundus

The myometrium is the: A. neck of the uterus. B. inner layer of the uterus. C. muscular wall of the uterus. D. uppermost part of the uterus.

C. muscular wall of the uterus

Approximately 1 week following her menstrual period, a 33-year-old female complains of bilateral lower abdominal quadrant pain, vaginal discharge, and fever. This clinical presentation is MOST consistent with: A. an ovarian cyst. B. an ectopic pregnancy. C. pelvic inflammatory disease. D. a spontaneous abortion.

C. pelvic inflammatory disease

Vaginal yeast infections develop when: A. an intrauterine device is left in place too long. B. a woman is exposed to cytomegalovirus. C. the vaginal environment becomes less acidic. D. a woman has repeated outbreaks of genital herpes.

C. the vaginal environment becomes less acidic

A 30-year-old female with abdominal pain would be LEAST likely to answer your questions if she: A. is currently menstruating. B. has had a miscarriage. C. was sexually abused. D. is having unprotected sex.

C. was sexually abused

Common signs and symptoms associated with menstruation include all of the following, EXCEPT: A. breast tenderness. B. mood or behavioral changes. C. abdominal cramping or bloating. D. 60 mL to 100 mL of blood loss.

D. 60 mL to 100 mL of blood loss

Which of the following clinical or historical findings would be the LEAST likely to increase a woman's risk of an ectopic pregnancy? A. An intrauterine device (IUD) B. Previous ectopic pregnancy C. Pelvic inflammatory disease D. Two spontaneous abortions

D. Two spontaneous abortions

Acute abdominal pain in a female of childbearing age should be assumed to be: A. an ovarian cyst. B. a sexually transmitted disease. C. pelvic inflammatory disease. D. a ruptured ectopic pregnancy.

D. a ruptured ectopic pregnancy

Estrogen and progesterone are secreted by the: A. corpus callosum. B. mammary glands. C. ovarian follicle. D. corpus luteum.

D. corpus luteum

A 49-year-old female was the victim of a sexual assault. Your assessment reveals that she is conscious and alert and is breathing adequately. There is no gross external bleeding and her vital signs are stable. You should: A. visually examine her genitalia for trauma. B. start an IV at a keep-vein-open (KVO) rate. C. question her as to the events of the assault. D. discourage her from showering or douching.

D. discourage her from showering or douching

You are dispatched to a residence for a young female who was sexually assaulted when a perpetrator broke into her home. She is conscious and alert and has multiple abrasions and bruises to her face and arms. As you begin to assess her, she tells you that she does not want to go to the hospital. You should: A. tell her that she can take a shower if she will allow you to transport her. B. advise her that since she was the victim of a crime she must be transported. C. transport her since the assault has interfered with her ability to think clearly. D. explain the seriousness of the situation but allow her to refuse if she wishes.

D. explain the seriousness of the situation but allow her to refuse if she wishes

Signs and symptoms of infection with cytomegalovirus include: A. low back pain and pain during intercourse. B. a rash on the palms of the hands and fatigue. C. dysuria, foul-smelling discharge, and fever. D. fever, chills, fatigue, and an enlarged spleen.

D. fever, chills, fatigue, and an enlarged spleen

Genital warts are caused by infection with: A. Neisseria gonorrhoeae. B. Treponema pallidum. C. Candida albicans. D. human papillomavirus.

D. human papillomavirus

A 31-year-old female complains of heavy vaginal bleeding and generalized weakness. She is conscious and alert; however, her blood pressure is 88/56 mm Hg and her pulse is 120 beats/min and weak. You should apply 100% oxygen and then: A. place her on her left side and administer up to 3 liters of normal saline or lactated ringers solution. B. elevate her legs and administer isotonic crystalloid fluids until her blood pressure exceeds 110 mm Hg. C. insert a trauma dressing inside the vagina and start two large-bore IV lines of normal saline or lactated ringers. D. place absorbent dressings over the vagina and administer 20 mL/kg boluses of an isotonic crystalloid to maintain perfusion.

D. place absorbent dressings over the vagina and administer 20 mL/kg boluses of an isotonic crystalloid to maintain perfusion

Postpartum eclampsia is characterized by: A. hypertension that develops immediately before delivery. B. a history of seizures before pregnancy occurred. C. a sudden drop in blood pressure following delivery. D. seizures within 24 hours following delivery of a baby.

D. seizures within 24 hours following delivery of a baby

Which of the following statements regarding pelvic inflammatory disease (PID) is correct?

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

Which of the following statements regarding gonorrhea is correct?

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

Which of the following statements regarding rape is correct?

Rape is a legal diagnosis, not a medical diagnosis.

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 shuffling gait when walking

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:

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

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:

assist her ventilations with a bag-mask device.

In anticipation of receiving a fertilized ovum, the lining of the uterine wall:

becomes engorged with blood.

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT:

carefully removing any foreign bodies from the vagina

Which of the following conditions would MOST likely lead to PID if left untreated?

chlamydia

It is not uncommon for young females who experience their first menstrual period to:

experience abdominal cramping, which may be misinterpreted.

Each ovary produces an ovum in alternating months and releases it into the:

fallopian tube.

Which of the following conditions does NOT typically present with vaginal discharge?

genital herpes

Whenever possible, a female sexual assault victim should be

given the option of being treated by a female EMT

Whenever possible, a female sexual assault victim should be:

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:

has gathered patient history information.

When documenting a call in which a female was sexually assaulted, you should

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

When documenting a call in which a female was sexually assaulted, you should:

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

The physical examination of a sexual assault victim should be:

limited to a brief survey for life-threatening injuries.

Which of the following clinical presentations is MOST consistent with PID?

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

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to:

maintain her ABCs and transport without delay.

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer:

may be relatively painless.

Bacterial vaginosis is a condition that occurs when

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

Bacterial vaginosis is a condition that occurs when:

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

When caring for a female patient who has been sexually assaulted, you should:

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

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:

provide emotional support and visually assess her for obvious trauma.

When a female has reached menarche

she is capable of becoming pregnant.

PID typically does NOT affect the:

urinary bladder.