Chapter 21: Gynecologic Emergencies

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

A

EMTs treating a patient of a sexual assault may not only be dealing with medical issues, but with _____ issues as well. A. psychological B. physiological C. educational D. sociological

A

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

A

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

In rare cases, _____ causes arthritis that may be accompanied with skin lesions and inflammation of the eyes and urethra. A. chlamydia B. gonorrhea C. PID D. vaginal bleeding

A

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

A

Often the most important intervention for sexual assault patient is _____ and transport to a facility with staff specially trained to deal with this scenario. A. comforting reassurance B. excellent assessment skills C. bandaging skills D. emotional sympathy

A

The "PID Shuffle" refers to: A. a distinctive gait when the patient walks. B. rotation of the microorganisms that cause PID. C. symptoms that come and go. D. a structural that come and go.

A

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

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

A

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. Your first course of action should be to: A. determine whether the patient is physically injured. B. establish the exact events of what took place. C. allow the patient to use the restroom. D. let the police question the patient before conducting a primary assessment.

A

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, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. C. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. D. assist her ventilations with a bag-mask device, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

B

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

B

If a patient with vaginal bleeding present with a rapid pulse and pale or cool skin, you should: A. attempt to locate the source of bleeding and correct it. B. place the patient in a supine position with her legs elevated. C. consider this to be a normal sign in a menstruating woman. D. inquire about recent problems with urination.

B

Painful urination associated with burning and a yellowish discharge is assocated with: A. chlamydia. B. gonorrhea. C. endometriosis. D. syphilis.

B

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

B

The onset of menstruation usually occurs between the ages of: A. 8 and 10 years. B. 11 and 16 years. C. 16 and 18 years. D. 17 and 20 years.

B

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 obtained a complete set of vital signs. B. has gathered patient history information. C. ascertains if the patient was ever pregnant. D. has formed a general impression of the patient.

B

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

B

Which of the following statements is FALSE regarding assessment and treatment of a woman who was the victim of sexual assault? A. You may be called to testify in court regarding the incident B. You should question the victim thoroughly about the assaulter in case the police missed any details C. The patient should be given the option of being treated by a female responder D. The patient should be discouraged from urinating or changing her clothes prior to examination at the hospital

B

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 history of ectopic pregnancy B. a shuffling gait when walking C. bright red blood in the urine D. vaginal passage of blood clots

B

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

C

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

C

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

C

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. advise her that she cannot clean herself up because this will destroy evidence. B. perform a limited hands-on assessment to detect life-threatening injuries. C. provide emotional support and visually assess her for obvious trauma. D. ask her if there is anyone you can contact, such as a friend or relative.

C

Left untreated, _____ can lead to premature birth or low birth weight in pregnant women. A. chlamydia B. gonorrhea C. bacterial vaginosis D. vaginal bleeding

C

When taking a history on a patient experiencing a gynecologic emergency, you should consider asking all of the following EXCEPT: A. Are you taking birth control? B. When was your last menstrual period? C. How many sexual partners have you has in the past? D. Do you have any history of sexually transmitted diseases?

C

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

C

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. upper abdominal cramping, severe headache, and heavy vaginal bleeding C. lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge D. pain around the umbilicus, low-grade fever, and generalized weakness

C

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

C

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The second course of action involves the psychological care of the patient. You should avoid: A. making attempts to get a female EMT to examine the patient. B. examination of the vaginal canal, even if active bleeding is taking place. C. attempting to gather information to assist the police. D. granting the patient's wishes for refusing care and transport.

C

Your _____ is the best tool to gain the patient's confidence to seek medical help. A. professionalism B. content knowledge C. compassion D. empathy

C

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. perform a visual assessment of her vaginal area. C. assess her blood pressure and elevate her legs. D. assist her ventilations with a bag-mask device.

D

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

D

Possible causes of vaginal bleeding include all of the following EXCEPT: A. ectopic pregnancy. B. cervical polyps. C. vaginal trauma. D. peptic ulcer.

D

Rape is considered to be a _____ diagnosis, not a medical diagnosis. A. psychological B surgical C. sociological D. legal

D

The most common presenting sign of PID is: A. vaginal discharge. B. fever. C. nausea and vomiting. D. lower abdominal pain.

D

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

D

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

D

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. keep assessment and treatment to a minimum. D. maintain her ABCs and transport without delay.

D

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 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

When performing a physical exam on a victim of sexual assault, you should: A. expose and evaluate the patient's vaginal area regardless of whether there is bleeding. B. allow multiple people to observe the examination in case you have to testify. C. limit your examination to a brief survey for life-threatening injuries. D. place the patient's clothes into a paper bag.

D

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

D

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

D

You are called to the scene of a possible assault. Upon arrival, you are directed by police to a dark room where you find a 22 year old woman who says she was sexually assaulted by a coworker this afternoon. The patient tells you that she would really like to be transported to the hospital but refuses a physical examination. You should: A. explain to her that she cannot be transported without a physical exam. B. have the police take the patient into custody in order to legally force a physical exam. C. explain to her that this is a criminal case and that she must be examined. D. follow your system's refusal of treatment policy and respect the patient's wishes without judgement.

D