VOLUME 5 CHAPTER 1 (GYNECOLOGY) PARAMEDIC

D. Cystitis.

A UTI and an occasional cause of abdominal​ pain, but it would typically cause problems with urination and not these other symptoms. A. Endometritis. B. Ectopic pregnancy. C. Pelvic inflammatory disease. D. Cystitis.

D. mittelschmerz. ​Occasionally, ovulation is accompanied by midcycle abdominal pain known as mittelschmerz. The unilateral​ pain, midcycle​ spotting, and​ low-grade fever are all consistent with mittelschmerz.

A female patient is experiencing lower quadrant pain on one side and her temperature is running slightly high. She tells you that she is in the midst of her menstrual cycle and experiencing some spotting. You​ suspect: A. endometritis. B. cystitis. C. menorrhagia. D. mittelschmerz.

B. absorb the flow. Your field management of patients suffering nontraumatic vaginal bleeding will depend on the severity of the situation and your assessment of the​ patient's status. Absorb the blood flow. Do not pack the vagina.

A patient presents with nontraumatic vaginal bleeding of an unknown cause. The​ paramedic's goal in managing this​ patient's bleeding should be​ to: A. discover the cause. B. absorb the flow. C. prevent the passage of clots and tissue. D. stop the flow.

B. kidneys Bacteria usually enter the urinary tract via the​ urethra, ascending into the bladder. The bladder lies anterior to the reproductive organs​ and, when​ inflamed, causes​ pain, generally immediately above the pubic symphysis. If​ untreated, the infection can progress to the kidneys.

A patient with cystitis asks if it will just go away if left alone. The paramedic responds that if left untreated cystitis can progress to involve​ the: A. uterus. B. kidneys. C. balance of the ovary. D. fallopian tubes.

A. endometritis.

An infection of the uterine lining is called _________________ and is an occasional complication of​ miscarriage, childbirth, or a​ D&C procedure. A. endometritis. B. cystitis. C. menorrhagia. D. mittelschmerz.

D. Endometritis.

An infection of the uterine lining with occasional complication of miscarriage. It may case mild to severe lower abdominal​ pain, but also typically causes a​ bloody, foul-smelling discharge and fever A. Cystitis. B. Pelvic inflammatory disease. C. Ectopic pregnancy. D. Endometritis.

D. corpus.

Another name for the body of the uterus. A. cervix. B. birth canal. C. fundus. D. corpus.

C. make the patient as comfortable as possible The primary treatment for PID is​ antibiotics, often administered intravenously over an extended period. In the​ field, the primary goal is to make the patient as comfortable as possible.

A​ 22-year-old female​ patient's presentation is consistent with pelvic inflammatory disease. The patient is not hypoxic by pulse ox and shows no signs of sepsis or shock. The primary goal of the prehospital management of this patient is​ to: A. administer supplemental oxygen. B. administer supplemental fluids to combat dehydration and adhesions. C. make the patient as comfortable as possible. D. place the victim in shock position and keep warm.

B. Dysfunctional uterine bleeding Dysfunctional uterine bleeding is nontraumatic vaginal bleeding and would not be the result of blunt force trauma.

A​ 25-year-old female patient has received severe blunt force trauma to the abdomen and genitalia. What is not a concern for the paramedic regarding this​ patient? A. Peritonitis B. Dysfunctional uterine bleeding C. Sepsis D. Hematoma

B. shock Occasionally a woman will experience​ menorrhagia, or excessive menstrual​ flow, but rarely is it the cause for a 911 call.​ Hemorrhage, regardless of​ cause, is always potentially life​ threatening, so be alert for signs of impending shock.

A​ 33-year-old female patient presents with nontraumatic vaginal bleeding that is apparently the result of menorrhagia. The paramedic should be on the alert​ for: A. leiomyomas. B. shock. C. passage of clots and tissue. D. straddle injury.

C. menorrhagia.

Excessive menstrual flow? A. endometritis. B. cystitis. C. menorrhagia. D. mittelschmerz.

A. Respect her wishes and transport her to the ED for a more thorough assessment. Assess your​ patient's emotional state. If she is reluctant to discuss her complaint in​ detail, respect her wishes and transport her to the emergency department where a more thorough assessment can be done.

How should you respond if your female patient is reluctant to discuss the specifics of her gynecologic complaint with you in​ detail? A. Respect her wishes and transport her to the ED for a more thorough assessment. B. Insist that she provide you with the information. C. Have her sign a refusal of treatment form. D. Tell her that you are unable to perform your duties without the requested information.

B. It may be impossible for you to rule out appendicitis instead of PID. In severe cases of​ PID, the abdomen will be tense with obvious rebound tenderness. Such cases may be impossible to distinguish from appendicitis in the prehospital setting.

If a patient presents with what you suspect is a severe case of pelvic inflammatory disease with lower abdominal pain and rebound​ tenderness, which of the following statements is​ true? A. The patient also likely has appendicitis. B. It may be impossible for you to rule out appendicitis instead of PID. C. Routine treatment includes oxygen therapy and an IV of D5W. D. If the patient is​ menstruating, the discharge should be clear and thin.

B. ​"What is the amount and frequency of the​ bleeding?" If a patient reports vaginal discharge or​ bleeding, obtain information about the​ color, amount,​ frequency, or odors associated with either vaginal bleeding or discharge. If she reports vaginal​ bleeding, how does the amount compare with the volume of her usual menstrual​ period? Does she report dizziness with changes in position​ (orthostatic hypotension),​ syncope, or​ diaphoresis?

If a patient reports vaginal discharge and​ bleeding, what is an appropriate​ follow-up question? A. ​"Why do you think you are​ bleeding?" B. ​"What is the amount and frequency of the​ bleeding?" C. ​"Does walking or defecation aggravate your​ pain?" D. ​"Does positioning yourself on your back or side reduce your​ discomfort?"

A. A female paramedic It is​ important, if at all​ possible, to have a paramedic of the same gender assess and take care of the patient. This is for psychological as well as physiological​ well-being and care.

If it becomes necessary to perform a physical exam of the genitalia of a female who was sexually​ assaulted, who would best perform such an​ examination? A. A female paramedic B. A male law enforcement officer C. A female law enforcement officer D. A male paramedic

C. treat the patient and the situation as a crime scene. Since this is an act of​ crime, the entire situation should be treated as a crime scene and the paramedic should attempt to keep the scene as intact as possible and preserve anything that may be used as evidence at a later time during prosecution. The patient should be discouraged from showering or bathing before transport.

If you are caring for a patient who you suspect was sexually​ abused, you​ should: A. ask the patient to shower quickly before transport. B. examine the perineal area for injuries even if the patient has no relative complaint in that location. C. treat the patient and the situation as a crime scene. D. remove all the​ patient's clothing and place it in a paper bag for transport.

A. secrete the hormones estrogen and progesterone. The​ ovaries, not the​ vagina, secrete the hormones estrogen and progesterone.

It is not a function of the vagina​ to: A. secrete the hormones estrogen and progesterone. B. form the final passageway for the infant during childbirth. C. provide an outlet for menstrual blood and tissue to leave the body. D. receive the penis during sexual intercourse.

C. when the patient is being evaluated for infertility. It is not uncommon for endometriosis to be diagnosed when the patient is being evaluated for infertility.

It is not unusual for endometriosis to be​ diagnosed: A. during elective surgery. B. during the performance of a Caesarean section. C. when the patient is being evaluated for infertility. D. during delivery of the placenta.

D. excessive menstrual flow.

Menorrhagia is: A. irregular cycles of menstruation. B. painful menstruation. C. absence of menstruation. D. excessive menstrual flow.

D. mittelschmerz.

Midcycle abdominal pain and will not present with painful urination. A. cystitis. B. ectopic pregnancy. C. pelvic inflammatory disease. D. mittelschmerz.

D. mittelschmerz. Occasionally, ovulation is accompanied by midcycle abdominal pain known as mittelschmerz. It is thought that the pain is related to peritoneal irritation due to follicle rupture or bleeding at the time of ovulation.

Midcycle abdominal pain in a female that occurs in conjunction with follicle rupture or bleeding at the time of ovulation is also known​ as: A. endometriosis. B. endometrialgia. C. paralytic ileus. D. mittelschmerz.

C. Midcycle abdominal pain

Mittelschmerz refers to which of the following? A. Purulent vaginal discharge B. False labor pains C. Midcycle abdominal pain D. Painful urination

D. Mons pubis

The fatty layer of tissue over the pubic​ symphysis, the junction of pubic bones. A. Perineum B. Prepuce C. Labia D. Mons pubis

C. clitoris. The clitoris is part of the external female genitalia.

The female external genitalia include​ the: A. vagina. B. uterus. C. clitoris. D. fallopian tubes.

C. proliferative phase. The first two weeks of the menstrual​ cycle, known as the proliferative​ phase, are dominated by​ estrogen, which causes the uterine lining​ (endometrium) to thicken and become engorged with blood.

The first two weeks of the menstrual cycle are known as​ the: A. secretory phase. B. menstrual phase. C. proliferative phase. D. ischemic phase.

B. Prepuce

The fold of the labia minora that covers the clitoris. A. Perineum B. Prepuce C. Labia D. Mons pubis

B. Ectopic pregnancy.

The implantation of a fetus outside of the uterus and occasionally occurs. The pain from ectopic pregnancy often radiates to the shoulder on the affected side. A. Endometritis. B. Ectopic pregnancy. C. Pelvic inflammatory disease. D. Cystitis.

C. fundus.

The rounded uppermost portion of the body of the uterus. A. cervix. B. birth canal. C. fundus. D. corpus.

A. secretory phase.

The stage of the menstrual cycle immediately surrounding ovulation is referred to as: A. secretory phase. B. menstrual phase. C. proliferative phase. D. ischemic phase.

D. ischemic phase.

The stage of the menstrual cycle where if fertilization does not​ occur, estrogen and progesterone levels fall. Vascular changes cause the endometrium to become pale and small blood vessels to rupture. A. secretory phase. B. menstrual phase. C. proliferative phase. D. ischemic phase.

B. menstrual phase.

The stage of the menstrual cycle where the ischemic endometrium is​ shed, along with a discharge of​ blood, mucus, and cellular​ debris, a process known as menstruation. A. secretory phase. B. menstrual phase. C. proliferative phase. D. ischemic phase.

C. Labia

The structures that protect the vagina and the urethra. A. Perineum B. Prepuce C. Labia D. Mons pubis

A. cervix. The uterus has two major parts called the body or corpus and the cervix or neck.

The uterus has two major parts called the body and​ the A. cervix. B. birth canal. C. fundus. D. corpus.

A. leiomyomas.

These are uterine​ fibroids, noncancerous tumors that develop in the uterus? A. leiomyomas. B. shock. C. passage of clots and tissue. D. straddle injury.

D. pregnancy. Until proven​ otherwise, you should assume that any missed or late period is due to​ pregnancy, even though your patient may deny it. Direct questions such as​ "Could you be​ pregnant?" are generally unlikely to get an accurate response. Inquire about other​ signs, including a late or missed​ period, breast​ tenderness, bloating, urinary​ frequency, or nausea and vomiting.

Until proven​ otherwise, you should assume that a missed or late menstrual period is due​ to: A. stress. B. menopause. C. IUD. D. pregnancy.

A. Gynecology The term gynecology is derived from the Greek gynaik​, meaning​ "woman." Gynecology is the branch of medicine that deals with the health maintenance and the diseases of women and their reproductive organs.

What branch of medicine deals with the reproductive health needs of​ females? A. Gynecology B. Reproductive specialists C. Obstetrics D. Perineology

C. Straddle injuries to females Vaginal injury occurs far more commonly than male genital injury. Blunt trauma occurs more frequently than penetrating trauma. Straddle injury is the most common form of blunt trauma.

What is the most common form of genital​ trauma? A. Blunt trauma to males B. Penetrating trauma to females C. Straddle injuries to females D. Seat belt injuries

A. Perineum The perineum is a roughly​ diamond-shaped, skin-covered area of muscular tissues separating the vagina and the anus. These tissues form a slinglike structure that supports the internal pelvic organs and that is able to stretch during childbirth.

What tissues form a slinglike structure that supports the internal pelvic organs and that is able to stretch during​ childbirth? A. Perineum B. Prepuce C. Labia D. Mons pubis

D. ectopic pregnancy. An ectopic pregnancy is the implantation of a fetus outside the uterus. The most common site is within the fallopian tubes. This is a surgical​ emergency, because the tube can​ rupture, triggering a massive hemorrhage

When a​ female's egg becomes fertilized but implants in a location outside of the​ uterus, it is known as​ a(n): A. exotopic pregnancy. B. exometriosis. C. malfertilized pregnancy. D. ectopic pregnancy.

C. Between the ages of 10 and 14 The onset of the first menstrual cycle in females at puberty establishes female sexual maturity. This​ onset, known as​ menarche, usually begins between the ages of 10 and 14.

When does menarche usually occur for​ females? A. During the menstrual phase of the cycle B. On the 14th day of the cycle C. Between the ages of 10 and 14 D. Following ovulation every month

D. Hypertension Generally on physical​ examination, the blood pressure of the patient with PID is​ normal, although the pulse may be slightly increased.

Which of the following findings from a physical examination or patient history is least likely to be present with a patient who is suspected to have​ PID? A. Patient has an IUD B. Abdominal pain C. Patient has had multiple sexual partners D. Hypertension

B. Using a tampon

Which of the following is NOT an appropriate way to control vaginal bleeding in the prehospital setting? A. Placing sterile gauze over the opening of the vagina B. Using a tampon C. Using a sanitary napkin D. Placing an absorbent pad under the patient

C. It is associated with ovulation.

Which of the following is TRUE of mittelschmerz? A. It is typically located unilaterally in one of the upper abdominal quadrants. B. It is usually accompanied by heavy vaginal bleeding. C. It is associated with ovulation. D. It is a sign of ectopic pregnancy.

A. To obtain vital signs Avoid touching the patient other than to take vital signs or examine other physical injuries. Do not examine the genitalia unless there is​ life-threatening hemorrhage.

Which of the following is a legitimate reason to touch a sexual assault​ victim? A. To obtain vital signs B. To clean and dress abrasions C. To perform a vaginal examination D. To collect evidence

A. Implantation of a fetus outside of the uterus An ectopic pregnancy is the implantation of a fertilized egg outside the uterus. The most common site is within the fallopian tubes.

Which of the following most accurately defines ectopic​ pregnancy? A. Implantation of a fetus outside of the uterus B. Fertilization of the egg within the uterus C. Failure of the ovum to become fertilized D. Rupture of the fallopian tube

A. Most sexual assaults are never reported. More than​ 700,000 women are sexually assaulted annually. It is estimated that more than 60 percent of all sexual assaults are never reported to authorities. In most​ states, penetration must occur for an act to be classified as rape.

Which of the following statements concerning sexual assault is​ accurate? A. Most sexual assaults are never reported. B. Most sexual assaults are committed by persons unknown to the victim. C. Most reported sexual assaults are never solved. D. Penetration is not usually required for the assault to be considered rape.

C. Regardless of its​ location, the tissue bleeds in a cyclic manner. Regardless of its​ location, endometrial tissue responds to the hormonal changes associated with the menstrual cycle and thus bleeds in a cyclic manner.

Which of the following statements is true regarding​ endometriosis? A. Commonly reported signs and symptoms include lower abdominal​ pain; bloody,​ foul-smelling discharge; and fever. B. It is commonly seen in postmenopausal women. C. Regardless of its​ location, the tissue bleeds in a cyclic manner. D. It can be quite serious if not treated with the appropriate antibiotics.

B. Is the pain related to the​ pregnancy? If a pregnant​ patient's chief complaint is of​ pain, then use the mnemonic OPQRST to gather more information. Asking where the pain is relates to​ "R" in​ OPQRST, or radiation.

Which of these questions is not appropriate to ask when a pregnant​ patient's chief complaint is of​ pain? A. How does the​ patient's pain compare to how she usually​ feels? B. Is the pain related to the​ pregnancy? C. Is the​ patient's pain abdominal or in the pelvic​ region? D. ​What, if​ anything, alleviates the​ pain?

A. A complaint of​ one-sided moderate to severe abdominal pain that may radiate to the back In the field​ setting, a patient with ovarian cysts is likely to complain of moderate to severe unilateral abdominal​ pain, which may radiate to her back.

While ovarian cysts may be found during routine pelvic​ exams, in the field setting which of the following would likely assist the paramedic in differential​ diagnosis? A. A complaint of​ one-sided moderate to severe abdominal pain that may radiate to the back B. A complaint of sudden vaginal bleeding C. A complaint of a sudden onset of clear vaginal discharge D. A complaint of sudden onset rebound tenderness affecting the lower abdomen bilaterally

D. A male paramedic It is​ important, if at all​ possible, to have a paramedic of the same gender assess and take care of the patient. This is for psychological as well as physiological​ well-being and care.

Who would be the best person to perform a physical exam of the genitalia of a male adolescent who was sexually assaulted if such an examination is​ necessary? A. A female paramedic B. A female law enforcement officer C. A male law enforcement officer D. A male paramedic

A. cystitis. In addition to abdominal​ pain, your patient with cystitis may report urinary​ frequency, pain or burning with urination​ (dysuria), and a​ low-grade fever. She may also complain of trouble starting and stopping her urinary stream​ (hesitancy). Occasionally the urine may be​ blood-tinged.

You are called to the residence of a​ 20-year-old female patient complaining of abdominal​ pain, burning with​ urination, and trouble starting and stopping her urinary stream. Her urine is also​ blood-tinged. She is likely suffering​ from: A. cystitis. B. ectopic pregnancy. C. pelvic inflammatory disease. D. mittelschmerz.

A. Ectopic pregnancy Patients with ectopic pregnancy often have severe unilateral abdominal pain that may radiate to the shoulder on the affected​ side, a late or missed menstrual​ period, and,​ occasionally, vaginal bleeding. This is a surgical emergency because the tube can​ rupture, triggering a massive hemorrhage

You are dispatched to the residence of a​ 17-year-old female complaining of severe​ left-sided abdominal pain radiating to her left shoulder. On your arrival you note that she is alert and well​ oriented, respirations are​ unlabored, and she has a palpable radial pulse of 118. As you begin to gather your focused​ history, she tells you that the pain has been present for several​ days, but this morning it suddenly became severe as she was getting out of bed. She also tells you that her period was about two weeks​ late, but she thinks it began this morning. Her vitals are respirations​ 22, blood pressure​ 92/70, and pulse ox 99 percent. The patient refuses to allow you to examine her to determine the amount of vaginal discharge. What is your field​ diagnosis? A. Ectopic pregnancy B. Ruptured ovarian cyst C. Severe pelvic inflammatory disease D. Appendicitis

A. ​"I know who did this to me."​ Most victims of sexual assault know their assailants.​ Friends, acquaintances,​ intimates, and family members commit the vast majority​ (80 percent) of sexual assaults against women.

You are treating a patient who was just sexually assaulted. Which of the following statements made by this patient is most likely to be​ true? A. ​"I know who did this to​ me." B. ​"It's not a problem and​ I'm fine." C. ​"I deserved this for how I was​ acting." D. ​"I wasn't​ injured."

B. Symptomatic treatment only Nothing more than symptomatic care and reassurance are typically necessary for mittelschmerz.

You respond to a call for a patient complaining of midcycle abdominal pain you field diagnose as mittelschmerz. Treatment of this patient should include which of the​ following? A. Monitor vaginal discharge for excessive bleeding B. Symptomatic treatment only C. Oxygen therapy and an IV of D5W D. Abdominal massage

C. the severity of the situation and the​ patient's status. Your field management of patients suffering nontraumatic vaginal bleeding will depend on the severity of the situation and your assessment of the​ patient's status.

You respond to a call for a patient complaining of vaginal bleeding with no known cause. Management of nontraumatic vaginal bleeding is dependent​ on: A. the severity of the flow and degree of associated pain. B. the severity and length of time of the flow. C. the severity of the situation and the​ patient's status. D. the severity of the flow and the suspected cause.

B. providing supportive care and analgesia to manage the​ patient's pain. You will primarily provide supportive​ care, administering analgesia as necessary to help manage the​ patient's pain.

You respond to a call for a patient presenting with severe abdominal pain that you field diagnose as ovarian cysts. The​ patient's pulse ox is 98 percent. Your management should consist​ of: A. intravenous access and fluid management. B. providing supportive care and analgesia to manage the​ patient's pain. C. performing an internal vaginal exam. D. administering oxygen.

A. list any evidence turned over to hospital staff on the patient care report. Document on the patient care report any evidence​ (e.g., clothing,​ sheets) turned over to the hospital staff and the name of the individual you gave it to.

You respond to a call for a​ 13-year-old female sexual assault victim and transport the patient to a trauma center. You​ should: A. list any evidence turned over to hospital staff on the patient care report. B. indicate remarks by the patient you believe are incorrect. C. interpret the​ patient's emotional state. D. explain why you believe a rape occurred.

A. ​"Can you tell me where you are​ injured?"

You respond to a call for a​ 19-year-old female patient who was sexually assaulted at a college party where she was drinking. She appears to be slightly intoxicated. She is wearing high​ heels, a short​ skirt, and a​ low-cut halter top. What is an appropriate question to ask this​ patient? A. ​"Can you tell me where you are​ injured?" B. ​"What did you think was going to happen dressed like​ this?" C. ​"Did you clearly say no or try to​ resist?" D. ​"Was there penetration or do you​ know?"

B. ​"Can you tell me where you are​ injured?"

You respond to a call for a​ 19-year-old female patient who was sexually assaulted at a college party where she was drinking. She appears to be slightly intoxicated. She is wearing high​ heels, a short​ skirt, and a​ low-cut halter top. What is an appropriate question to ask this​ patient? A. ​"Was there penetration or do you​ know?" B. ​"Can you tell me where you are​ injured?" C. ​"Did you clearly say no or try to​ resist?" D. ​"What did you think was going to happen dressed like​ this?"

D. Consider the patient a crime scene and protect that scene. Consider the patient a crime scene and protect that scene. Preservation of physical evidence is important. When the patient arrives at the​ hospital, a physician or sexual assault nurse examiner will complete a sexual assault examination to gather physical evidence.

You respond to a call for a​ 27-year-old female sexual assault victim. Which of the following guidelines is true regarding management of the sexual assault​ victim? A. Dispose of bloody sheets and blankets in biohazard bags. B. Clean all significant wounds. C. Place bloody articles in plastic bags. D. Consider the patient a crime scene and protect that scene.

D. Spontaneous abortion

Your patient is a 42-year-old woman who is alert and upset, complaining of vaginal bleeding. She states that the bleeding began ten hours ago and is heavier than her normal menstrual flow. Her last menstrual period was three months ago, G3P3, and there is no other significant gynecologic history. Which of the following is the most likely cause of her signs and symptoms? A. Ectopic pregnancy B. Pelvic inflammatory disease C. Menopause-related dysfunctional uterine bleeding D. Spontaneous abortion

C. a urinary tract infection.

Your patient tells you that she is being treated for cystitis. You recognize that she is being treated for: A. ovarian cysts. B. pelvic inflammatory disease. C. a urinary tract infection. D. an ectopic pregnancy.

C. Pelvic inflammatory disease. Probably the most common cause of nontraumatic abdominal pain in women of childbearing age is pelvic inflammatory disease​ (PID), an infection of the female reproductive tract that can be caused by a​ bacterium, virus, or fungus. Patients with PID appear acutely ill or toxic. Palpation of the lower abdomen generally elicits moderate to severe pain. Patients with PID tend to walk with a shuffling​ gait, walking intensifies their​ pain, and these patients may wish to draw their knees up toward their chest to make themselves more comfortable during transport.

Your​ 26-year-old patient appears to be acutely ill and palpation of her lower abdomen produces severe pain. She has drawn her knees up to her chest because she says that this enables her to feel the most comfort. She says walking intensifies her pain. You suspect which of the​ following? A. Endometritis. B. Ectopic pregnancy. C. Pelvic inflammatory disease. D. Cystitis.