Ch 22 Gynecologic Emergencies

25. Which of the following conditions is characterized by a lack of progesterone and increased androgen levels, and can lead to gestational diabetes and cardiac problems? A) Polycystic ovaries B) Ectopic pregnancy C) Corpus luteum cyst D) Tubo-ovarian abscess

A) Polycystic ovaries

14. Which of the following statements regarding endometritis is correct? A) Untreated endometritis may result in septic shock. B) Endometritis is defined as an enlargement of the uterus. C) Endometritis is most commonly caused by an intrauterine device. D) Endometritis results when endometrial tissue grows outside the uterus.

A) Untreated endometritis may result in septic shock.

24. A ruptured ovarian cyst typically presents with: A) a sudden onset of abdominal pain that can be related to the menstrual cycle. B) chronic waxing and waning abdominal cramping between menstrual periods. C) dull or aching epigastric pain that radiates to the shoulders or lower back. D) a sudden onset of upper abdominal pain and nausea without vomiting.

A) a sudden onset of abdominal pain that can be related to the menstrual cycle.

48. You are caring for a 44-year-old woman who was sexually assaulted by several men. She is conscious but very quiet. Your partner, a female paramedic, quickly examines her and finds no immediate life-threatening injuries. The patient tells you that all she wants to do is go home and take a shower. After multiple attempts to convince the patient to consent to transport, you are unsuccessful. Your MOST appropriate action should be to: A) ask the patient if there is a friend you can call with whom she can stay. B) advise her that she cannot take a shower because her body is evidence. C) explain the seriousness of the incident and have her sign a refusal form. D) allow her to take a shower, but insist upon EMS transport to the hospital.

A) ask the patient if there is a friend you can call with whom she can stay.

35. Which of the following is NOT characteristic of the secondary stage of syphilis? A) The presence of a skin rash B) A single or multiple chancres C) Mucous membrane lesions D) Fever and swollen lymph glands

B) A single or multiple chancres

2. What part of the female genitalia is homologous to the glans penis of the male? A) Hymen B) Clitoris C) Urethra D) Vestibule

B) Clitoris

22. Which of the following statements regarding ectopic pregnancy is MOST correct? A) Ectopic pregnancy occurs when a fertilized egg implants in a fallopian tube. B) Most ectopic pregnancies present with symptoms during the second trimester. C) Use of an intrauterine device is the most common cause of an ectopic pregnancy. D) In ectopic pregnancy, a fertilized egg implants somewhere other than the uterus.

D) In ectopic pregnancy, a fertilized egg implants somewhere other than the uterus.

45. You are caring for a young woman with constant, diffuse abdominal pain, referred pain to both shoulders, and vaginal bleeding. She states that her last menstrual period was 2 months ago, but she adamantly denies being pregnant. Her blood pressure is 86/50 mm Hg, pulse rate is 120 beats/min and weak, and respirations are 24 breaths/min and regular. Which of the following interventions is NOT appropriate for this patient? A) IV fluid boluses B) Thermal management C) Cardiac monitoring D) Narcotic analgesia

D) Narcotic analgesia

20. Common signs and symptoms of gardnerella vaginitis include: A) high fever, polymenorrhea, dysuria, and pain during sex. B) a thick vaginal discharge, abdominal pain, and vaginal irritation. C) low-grade fever, itching, vaginal bleeding, and abdominal pain. D) a "fishy" vaginal odor, itching, irritation, and vaginal discharge.

D) a "fishy" vaginal odor, itching, irritation, and vaginal discharge.

8. Postmenopausal women: A) often experience hot flashes and bradycardia. B) tend to experience fewer urinary tract infections. C) are usually over 35 years of age and tend to be obese. D) are more susceptible to atherosclerosis and osteoporosis.

D) are more susceptible to atherosclerosis and osteoporosis.

38. If a 17-year-old woman with a gynecologic problem answers your question, "Is there any possibility that you are pregnant?" with a firm "No way!" you should: A) document the response and continue your assessment. B) assume that she is pregnant and document this thoroughly. C) ask her mother or father about the possibility of pregnancy. D) ask the patient why she is sure that she is not pregnant.

D) ask the patient why she is sure that she is not pregnant.

28. Initial signs and symptoms of toxic shock syndrome include all of the following, EXCEPT: A) myalgia. B) scleral injection. C) headache and fever. D) cardiac dysrhythmias.

D) cardiac dysrhythmias.

11. Dysmenorrhea that occurs before, during, and after menstrual flow: A) affects about 80% of women. B) is called primary dysmenorrhea. C) is generally hormonal in nature. D) may signal an underlying illness.

D) may signal an underlying illness.

33. If a young female with a known history of gonorrhea presents with abdominal pain, nausea and vomiting, and bleeding between periods: A) you should suspect disseminated gonococcemia. B) one of her ovaries is probably grossly enlarged. C) it is likely that she has an ectopic pregnancy. D) she most likely has pelvic inflammatory disease.

D) she most likely has pelvic inflammatory disease.

40. The MOST important aspect in the care of a woman with severe vaginal bleeding is: A) controlling the vaginal bleeding. B) administering crystalloid fluid boluses. C) giving oxygen via nonrebreathing mask. D) treating for shock and transporting rapidly.

D) treating for shock and transporting rapidly.

42. A 25-year-old woman presents with acute abdominal pain and vaginal bleeding. She tells you that she has soaked eight high-absorbency tampons in the past 2 hours. Approximately how much blood has she lost externally? A) 160 mL B) 200 mL C) 240 mL D) 300 mL

A) 160 mL

5. During normal menstruation, approximately ____ to ____ mL of blood is discharged from the vagina. A) 25, 65 B) 50, 75 C) 65, 80 D) 75, 100

A) 25, 65

37. When conducting the scene size-up of a call involving a gynecologic emergency, it is MOST important to: A) assess for danger because any scene should be considered volatile. B) quickly ascertain if the patient's problem is medical or trauma in nature. C) take standard precautions because many of these calls involve a lot of blood. D) quickly assess the need for additional resources and summon them early.

A) assess for danger because any scene should be considered volatile.

32. The lesions associated with genital herpes: A) initially appear as small red bumps. B) present as moderately sized blisters. C) are isolated to the external genitalia. D) typically cause scarring after they heal.

A) initially appear as small red bumps.

15. In contrast to endometritis, endometriosis: A) may present without abdominal pain. B) is an inflammation of the uterine lining. C) generally causes light menstrual periods. D) is often the result of gynecologic surgery.

A) may present without abdominal pain.

19. Risk factors for pelvic inflammatory disease include all of the following, EXCEPT: A) monogamy. B) an intrauterine device. C) heterosexual sex with multiple partners. D) 20- to 24-year-old age group.

A) monogamy.

31. Common signs and symptoms of infection with the cytomegalovirus include: A) prolonged high fever. B) lesions on the genitalia. C) enlargement of the liver. D) severe nausea and diarrhea.

A) prolonged high fever.

44. A 30-year-old woman complains of an "achy" pain to both lower abdominal quadrants, which she states is made worse by walking. She further tells you that she recently finished her menstrual period. She has a fever of 101.9°F. Her blood pressure is 122/62 mm Hg, pulse rate is 84 beats/min and strong, and respirations are 14 breaths/min and unlabored. After gathering the rest of her medical history, you should: A) provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital. B) advise her that she can probably go to the hospital via personal vehicle since she is not showing signs of shock. C) visually inspect her vagina for bleeding or discharge, start an IV line and set it to keep the vein open, and transport. D) establish vascular access and give her a 250-mL normal saline bolus, consider analgesia for her pain, and transport.

A) provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital.

10. Mittelschmerz is defined as: A) unilateral abdominal pain and cramping that occur during the ovulatory process. B) bilateral abdominal pain and vaginal bleeding caused by excess hormone release. C) abdominal cramping, vaginal bleeding, and a headache lasting more than a week. D) severe abdominal cramping and a vascular headache that are caused by ovulation.

A) unilateral abdominal pain and cramping that occur during the ovulatory process.

50. There is evidence that a 21-year-old woman was given Rohypnol before being raped. She presents with alcohol on her breath, drowsiness, and memory loss. Her blood pressure is 98/68 mm Hg, pulse is 58 beats/min and weak, and respirations are decreased and shallow. You attempt to administer high-flow oxygen, but she resists. What should you do now? A) Administer a sedative medication to facilitate her acceptance of the oxygen. B) Consider administering naloxone in case she was also given a narcotic drug. C) Start an IV line and administer 1 to 2 liters of an isotonic crystalloid solution. D) Recognize that because the patient is of legal age, she can refuse EMS treatment.

B) Consider administering naloxone in case she was also given a narcotic drug.

13. Which of the following conditions poses the LEAST risk for shock due to vaginal bleeding? A) Metrorrhagia B) Dysmenorrhea C) Polymenorrhea D) Hypermenorrhea

B) Dysmenorrhea

18. Which of the following is a potential complication of pelvic inflammatory disease? A) Uterine rupture B) Ectopic pregnancy C) Respiratory failure D) Urinary tract infection

B) Ectopic pregnancy

9. Which of the following medications would MOST likely be used in the prehospital setting to treat some women with severe premenstrual syndrome? A) Haldol and Tylenol B) Glucose and fentanyl C) Valium and ibuprofen D) Insulin and acetaminophen

B) Glucose and fentanyl

47. Law enforcement request that you respond to a local apartment complex for a young woman who was sexually assaulted. When you arrive at the scene, you find the patient sitting on her couch, clearly upset. You see a small amount of blood on her shorts, near the groin area. What is your initial priority in the care of this patient? A) Asking her if she recognized the perpetrator B) Identifying and treating immediate life threats C) Not allowing her to shower or use the restroom D) Quickly assessing her blood pressure and pulse

B) Identifying and treating immediate life threats

27. Which of the following statements regarding toxic shock syndrome (TSS) is correct? A) TSS is a condition that is exclusive to females. B) Patients with TSS may show signs of liver failure. C) Most cases of TSS occur in the absence of a fever. D) Group B Streptococcus is a causative agent in TSS.

B) Patients with TSS may show signs of liver failure.

30. Reiter syndrome is: A) an acute life-threatening condition that has been linked directly to the use of high-absorbency tampons. B) a rare complication associated with untreated chlamydia and is characterized by arthritis and skin lesions. C) a far more common and serious complication of untreated chlamydia than pelvic inflammatory disease. D) a relatively common complication of untreated gonorrhea, and is characterized by low-grade fever and myalgia.

B) a rare complication associated with untreated chlamydia and is characterized by arthritis and skin lesions.

46. You are dispatched to a residence for a 34-year-old woman who is "sick." Upon your arrival, the patient greets you at the door. She tells you that she began experiencing a dull aching pain in the left lower quadrant of her abdomen. She further states that she recently had her menstrual period, which was accompanied by more pain than usual. Her vital signs are stable, she is conscious and alert, and she denies vaginal bleeding or fever. This patient MOST likely has: A) an ectopic pregnancy. B) a ruptured ovarian cyst. C) a tubo-ovarian abscess. D) pelvic inflammatory disease.

B) a ruptured ovarian cyst.

23. Implantation of a fertilized egg within a fallopian tube: A) produces atypical signs of pregnancy. B) can cause severe intra-abdominal hemorrhage. C) represents only 3% of all ectopic pregnancies. D) is usually detected after the 20th week of pregnancy.

B) can cause severe intra-abdominal hemorrhage.

41. Within a few days after having a therapeutic abortion, a 33-year-old woman presents with malaise, fever, constipation, and pelvic pain. Her blood pressure is 124/84 mm Hg, pulse rate is 104 beats/min and strong, and respirations are 22 breaths/min and regular. You should be MOST suspicious for: A) acute cystitis. B) endometritis. C) a ruptured ovarian cyst. D) pelvic inflammatory disease.

B) endometritis.

26. The MOST common underlying cause of a tubo-ovarian abscess is: A) vaginitis. B) gonorrhea. C) an ectopic pregnancy. D) a ruptured ovarian cyst.

B) gonorrhea.

7. The onset of menses is called ___________, and typically occurs between the ages of ___________. A) menorrhea, 10 and 12 years B) menarche, 11 and 14 years C) menopause, 12 and 15 years D) the climacteric, 14 and 16 years

B) menarche, 11 and 14 years

1. The external female genitalia are collectively referred to as the: A) vagina. B) pudendum. C) external labia. D) mons veneris.

B) pudendum.

17. Pelvic inflammatory disease MOST commonly affects: A) the external genitalia. B) sexually active women. C) postmenopausal women. D) women over 30 years of age.

B) sexually active women.

36. In the late stage of syphilis: A) most patients become acutely ill and complain of symptoms such as blurred vision, a headache, and nausea. B) the patient is usually asymptomatic, but damage to the brain, heart, blood vessels, and liver is occurring. C) the patient experiences weight loss, muscle aches, and headaches that will not resolve without treatment. D) the disease has damaged the central nervous system permanently and is considered untreatable at this point.

B) the patient is usually asymptomatic, but damage to the brain, heart, blood vessels, and liver is occurring.

3. Which of the following conditions, if it remains undetected until puberty, can result in acute pain, severe constipation, and low back pain at the onset of menses? A) Ovarian cyst B) Endometriosis C) Ectopic pregnancy D) Imperforate hymen

D) Imperforate hymen

39. Which of the following questions is the MOST important to ask when obtaining a patient's gynecologic history? A) "Do you have any abdominal pain?" B) "When was your last sexual encounter?" C) "When was your last menstrual period?" D) "Is there a chance that you are pregnant?"

C) "When was your last menstrual period?"

4. In the average female, the menstrual cycle lasts ___ days. A) 21 B) 24 C) 28 D) 35

C) 28

34. Which of the following statements regarding the human papillomavirus (HPV) is correct? A) HPV infection is characterized by fever and a genital chancroid. B) Genital warts caused by HPV are far more common in females. C) HPV has been identified as a causative agent in cervical cancer. D) Only one type of HPV is spread via unprotected sexual contact.

C) HPV has been identified as a causative agent in cervical cancer.

43. You are dispatched to a grocery store for a woman with severe abdominal pain. When you arrive, you find the patient lying on her side in the manager's office. She is confused, is diaphoretic, and appears to be bleeding from her vagina. Her blood pressure is low, and her pulse and respiratory rates are elevated. You should: A) administer 100% oxygen, elevate her legs 12 to 18 inches, keep her warm, establish vascular access and give a 500-mL fluid bolus, reassess her blood pressure, and transport at once with continuous monitoring en route to the hospital. B) immediately place her in a supine position, firmly massage her uterine fundus to control the bleeding, establish two large-bore IV lines and run them wide open, transport at once, and apply high-flow oxygen en route to the hospital. C) apply high-flow oxygen, visually inspect her vagina and cover it with sterile dressings, keep her warm, begin transport, establish at least one large-bore IV en route, and administer enough crystalloid fluid to maintain radial pulses. D) assist her ventilations with a bag-mask device, carefully place a trauma dressing inside her vagina to control the bleeding, begin rapid transport, establish two large-bore IV lines en route, and administer 20-mL/kg fluid boluses as needed.

C) apply high-flow oxygen, visually inspect her vagina and cover it with sterile dressings, keep her warm, begin transport, establish at least one large-bore IV en route, and administer enough crystalloid fluid to maintain radial pulses.

6. The headache commonly experienced by women during their menstrual cycle is caused by: A) acute stress. B) vasoconstriction. C) hormonal release. D) transient cerebral edema.

C) hormonal release.

49. While caring for an unresponsive young woman who was apparently sexually assaulted, you note that her respirations are slow and shallow, her pulse is slow and weak, and her blood pressure is low. There is a small amount of dried blood on her thigh, but no grossly active bleeding. Immediate care for this patient involves: A) establishing an IV line and administering 0.5 mg of atropine. B) visualizing her vaginal area to assess for external bleeding. C) maintaining her airway and providing ventilatory assistance. D) elevating her lower extremities to improve her blood pressure.

C) maintaining her airway and providing ventilatory assistance.

12. The MOST common cause of amenorrhea is: A) stress. B) exercise. C) pregnancy. D) anorexia nervosa.

C) pregnancy.

29. If a woman who is being treated with the antibiotic metronidazole for bacterial vaginosis consumes alcohol during treatment: A) she is at high risk for sudden cardiac death. B) severe exacerbation of the vaginosis occurs. C) she may develop severe nausea and vomiting. D) the antibiotic may become a toxic substance.

C) she may develop severe nausea and vomiting.

16. Pelvic inflammatory disease commonly affects all of the following organs, EXCEPT the: A) uterus. B) ovaries. C) urinary bladder. D) fallopian tubes.

C) urinary bladder.

21. The Candida albicans fungus is the causative agent in: A) bacterial vaginosis. B) gardnerella vaginitis. C) vaginal yeast infections. D) gonorrhea and chlamydia.

C) vaginal yeast infections.