Chapter 23: Gynecologic Emergencies

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

Which of the following signs/symptoms is considered particularly significant in gynecological emergencies? A. Syncope B. Abdominal cramping C. Painful Urination D. Vaginal bleeding

A. Syncope

EMTs receive a call for a possible sexual assault. The patient is a young female who is conscious and alert and has no apparent injuries. She states, "I cannot remember anything, but I know I was raped." The EMTs should suspect that: A. The patient was given a drug prior to the incident B. The patient knew her attacker, but is afraid to say C. An underlying head injury is causing her amnesia D. The traumatic experience has created a mental block

A. The patient was given a drug prior to the incident

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. a distinctive gait when the patient walks.

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 pelvic inflammatory disease? 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

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

A. chlamydia

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. comforting reassurance

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. determine whether the patient is physically injured.

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

A. fallopian tube.

As a woman approaches menopause: Select one: 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 pelvic inflammatory disease lowers significantly.

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

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

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

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. psychological

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 threrapy D. menstrual periods become less frequent

A. she is capable of becoming pregnant

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.

The EMT should perform a "rapid scan" to determine if the patient is __________ during the __________. Select one: A. stable or unstable; primary assessment B. breathing or not breathing; primary assessment C. complaining of vaginal bleeding; history taking D. pregnant; secondary assessment

A. stable or unstable; primary assessment

The sperm typically fertilises the egg in the _________. Select one: A.fallopian tube B. vagina C. uterus D. ovary

A.fallopian tube

Signs and symptoms of bacterial vaginosis typically include _________. A. blood associated with vaginal intercourse B. "fishy," foul-smelling discharge C. low back pain D. rectal pain and discharge

B. "fishy," foul-smelling discharge

Which of the following statements regarding pelvic inflammatory disease (PID) is correct? Select one: 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 generalised upper abdominal pain.

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

Patient complaints of pain during intercourse, lower abdominal discomfort, and nausea may be indicative of which of the following? Select one: A. Chlamydia B. Pelvic inflammatory disease C. Gonorrhea D. Bacterial vaginosis

B. Pelvic inflammatory disease

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 should question the victim thoroughly about the assaulter in case the police missed any details

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: Select one: A. perform a rapid secondary assessment. B. assist her ventilations with a BVM. C. assess her blood pressure and elevate her legs. D. perform a visual assessment of her vaginal area.

B. assist her ventilations with a BVM.

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

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

B. experience abdominal cramping, which may be misinterpreted.

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

B. genital herpes

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

B. gonorrhoea.

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. has gathered patient history information.

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

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

A patient with vaginal bleeding _________. A. will have profound and obvious signs of shock B. may not have obvious signs of shock even if she has experienced significant blood loss C. may want to stand, rather than sit or lie on the stretcher D. will have a weak and rapid pulse but not pale or diaphoretic skin

B. may not have obvious signs of shock even if she has experienced significant blood loss

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

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

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. place the patient in a supine position with her legs elevated.

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: Select one: A. advise her that she cannot clean herself up because this will destroy evidence. B. provide emotional support and visually assess her for obvious trauma. 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.

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

Menstrual flow will typically last approximately _________. A. 1 day B. 3 days C. 1 week D. 1 month

C. 1 week

While the ages can vary, women typically experience menstruation from approximately _________ to ____________ years of age. Select one: A. 10; 40 B. 20; 60 C. 11; 50 D. 10; 70

C. 11; 50

Which of the following conditions would MOST likely lead to pelvic inflammatory disease if left untreated? Select one: A. Genital herpes B. Ectopic pregnancy C. Chlamydia D. Ovarian cysts

C. Chlamydia

What is typically the most important intervention that an EMT can provide to the victim of sexual assault? Select one: A. Control of vaginal bleeding B. Calling for ALS personnel C. Comfort and reassurance D. High-flow oxygen therapy

C. Comfort and reassurance

______________ may be a cause of vaginal bleeding in a patient who states that she is NOT pregnant. Select one: A. Bacterial vaginosis B. Hypotension C. Ectopic pregnancy D. Menopause

C. Ectopic pregnancy

Which of the following infections, when left untreated, may lead to infection of the blood and brain? Select one: A. Pelvic inflammatory disease B. Bacterial vaginosis C. Gonorrhea D. Chlamydia

C. Gonorrhoea

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 had in the past? D. Do you have any history of sexually transmitted diseases?

C. How many sexual partners have you had in the past?

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

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

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. attempting to gather information to assist the police.

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. bacterial vaginosis

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

C. carefully removing any foreign bodies from the vagina.

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. compassion

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. compassion

At the scene of a sexual assault, the EMT should attempt to preserve evidence by _________. A. avoiding direct, physical contact with the patient B. discouraging the patient from speaking with anyone other than EMS or law enforcement C. discouraging the patient from removing clothes, using the bathroom, or showering D. All of these answers are correct.

C. discouraging the patient from removing clothes, using the bathroom, or showering

The _____________ connect(s) each ovary with the uterus. Select one: A. abdomen B. egg C. fallopian tubes D. cervix

C. fallopian tubes

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

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. is in shock.

The __________ and _________ are folds of tissue that surround the urethral and vaginal openings. Select one: A. fallopian tubes; uterus B. perineum; anus C. labia majora; labia minora D. vagina; cervix

C. labia majora; labia minora

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 generalised weakness

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

If fertilization has not occurred in approximately 14 days postovulation: Select one: A. the ovum will begin to travel to the uterus. B. another egg will be released. C. menstruation will begin. D. All of these answers are correct.

C. menstruation will begin.

Chlamydia, bacterial vaginosis, and gonorrhea are all examples of _________. Select one: A. "women's conditions" B. diseases that can cause scarring of the fallopian tubes C. sexually transmitted diseases D. causes of vaginal bleeding

C. sexually transmitted diseases

The EMT should ensure that vaginal bleeding is _________. Select one: A. controlled directly by the patient B. not caused by traumatic injury C. taken seriously and the patient is transported for gynecologic evaluation D. severe enough to warrant transport

C. taken seriously and the patient is transported for gynecologic evaluation

Causes of vaginal bleeding include which of the following? Select one: A. Ectopic pregnancy B. Vaginal trauma C. Spontaneous abortion D. All of these answers are correct.

D. 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? Select one: A. The amount of time since of the patent's last menstrual cycle B. The possibility that the patient may be pregnant C. If the patient is sexually active D. All of these answers are correct.

D. All of these answers are correct.

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

D. All of these answers are correct.

When prioritising care for the victim of a sexual assault, the EMT should focus on _________ first. A. preserving evidence B. relaying the patient's account of the events C. soft-tissue injuries D. Life-threatening injuries

D. Life-threatening injuries

What is (are) the primary female reproductive organ(s) called? A. Uterine tubes B. Uterus C. Vagina D. Ovaries

D. Ovaries

Which of the following drugs is commonly referred to as "roofies"? Select one: A. Ketamine B. GHB C. MDMA D. Rohypnol

D. Rohypnol

A patient with pelvic inflammatory disease will typically complain of _________. Select one: A. aches and fever associated with urination B. bleeding associated with stress C. nausea and vomiting associated with intercourse D. abdominal pain associated with menstruation

D. abdominal pain associated with menstruation

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: Select one: A. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. B. assist her ventilations with a bag-valve mask, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport. 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. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

D. 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: 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. assist her ventilations with a bag-mask device.

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. chlamydia

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. follow your system's refusal of treatment policy and respect the patient's wishes without judgement.

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

D. legal

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

D. lower abdominal pain.

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. maintain her ABCs and transport without delay.

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

D. ovarian abscess and ectopic pregnancy

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

D. peptic ulcer.

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. place the patient's clothes into a paper bag.

Some women experience ___________ during ovulation. Select one: A. hypotension B. severe bleeding C. severe abdominal pain D. slight cramping

D. slight cramping

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

D. urinary bladder.

True or False Gynecologic emergencies are typically not embarrassing for women.

False

True or False Because menstrual bleeding is monthly occurence, it is not necessary to assess for other causes of vaginal bleeding.

False

True or False Chlamydia infection of the cervix can spread to the rectum, leading to rectal pain, discharge, or bleeding

True

True or False If gonorrhoea is not treated, the bacteria may enter the bloodstream and spread to other parts of the body, including the brain.

True

True or False Most cases of gynecologic emergencies are not life threatening.

True

True or False Obtaining an accurate and detailed patient assessment is critical when dealing with gynecologic issues.

True

True or False When taking a history of a woman with a gynecologic complaint, you should inquire about the possibility of pregnancy and exposure to sexually transmitted diseases.

True