Gynecology

Question 1

The paramedic accurately describes the difference between endometritis and endometriosis when she states:
Question 1 options:

A)

“Endometriosis is an infection of the uterine lining, while endometritis occurs when endometrial tissue is found outside the uterus.”

B)

“Endometritis patients can be transported code 2, while those with endometriosis should always go code 3.”

C)

“Endometriosis occurs in women under age 40, while endometriosis is more common in women who are older.”

D)

“Endometritis is an infection of the uterine lining, while endometriosis occurs when endometrial tissue is found outside the uterus.”

Answer 1

“Endometritis is an infection of the uterine lining, while endometriosis occurs when endometrial tissue is found outside the uterus.”

Question 2

Your patient tells you that she is being treated for cystitis. You recognize that she is being treated for:
Question 2 options:

A)

pelvic inflammatory disease.

B)

an ectopic pregnancy.

C)

ovarian cysts.

D)

a urinary tract infection.

Answer 2

a urinary tract infection

Question 3

Which of the following is TRUE of mittelschmerz?
Question 3 options:

A)

It is usually accompanied by heavy vaginal bleeding.

B)

It is associated with ovulation.

C)

It is typically located unilaterally in one of the upper abdominal quadrants.

D)

It is a sign of ectopic pregnancy.

Answer 3

it is associated with ovulation

Question 4

Menorrhagia is:
Question 4 options:

A)

excessive menstrual flow.

B)

painful menstruation.

C)

irregular cycles of menstruation.

D)

absence of menstruation.

Answer 4

excessive menstrual flow

Question 5

Mittelschmerz refers to which of the following?
Question 5 options:

A)

False labor pains

B)

Midcycle abdominal pain

C)

Purulent vaginal discharge

D)

Painful urination

Answer 5

midcycle abdominal pain

Question 6

Which of the following occurs during the proliferative phase of the menstrual cycle?
Question 6 options:

A)

A drop in estrogen levels

B)

Ovulation

C)

Endometrial thickening

D)

An increase in uterine vascularity

Answer 6

endometrial thickening

Question 7

The innermost lining of the uterus is called the:
Question 7 options:

A)

vasometrium.

B)

endometrium

C)

perimetrium.

D)

myometrium.

Answer 7

endometrium

Question 8

A 22-year-old woman presents in moderate distress, complaining of diffuse lower abdominal pain. She states that the pain has become progressively worse for the past two weeks and she is now unable to walk without an increase in pain. Your physical exam reveals severe pain with palpation of the lower abdomen and the following vital signs: heart rate 102, blood pressure 118/74 mmHg, and respirations 20. Which of the following statements made by the patient would most indicate the presence of pelvic inflammatory disease?
Question 8 options:

A)

“I just had an IUD inserted.”

B)

“I have chronic urinary tract infections.”

C)

“My last menstrual cycle was normal.”

D)

“My boyfriend was just diagnosed with chlamydia.”

Answer 8

my boyfriend was just diagnosed with chlamydia

Question 9

A 20-year-old sexually active woman presents with severe right-side abdominal pain that radiates to her back. She states that the pain came on sharply during intercourse about 15 minutes earlier, and she reports a small amount of vaginal bleeding. She states that her menstrual cycles have been irregular for the past 3 months. The most likely clinical diagnosis would be:
Question 9 options:

A)

ruptured ectopic pregnancy.

B)

pelvic inflammatory disease.

C)

spontaneous abortion.

D)

ruptured ovarian cyst.

Answer 9

ruptured ovarian cyst

Question 10

A 33-year-old woman presents with a low-grade fever and abdominal pain. She reports that she noticed blood in her urine this morning. Which of the following questions would be most helpful when trying to identify the underlying cause of this patient’s symptoms?
Question 10 options:

A)

“Have you vomited today?”

B)

“Do you have any pain or burning with urination?”

C)

“Do you take birth control?”

D)

“Have you noticed any foul-smelling discharge?”

Answer 10

do you have any pain or burning with urination

Question 11

A 19-year-old woman presents with severe lower abdominal pain, an oral temperature of 102.4°F, and skin that is pale and sweaty. She reports that she had an elective abortion 72 hours earlier and has had bloody vaginal discharge ever since. Appropriate treatment for this patient would include which of the following?
Question 11 options:

A)

IV fluids, oxygen, and transport

B)

Knee-chest position and rapid transport

C)

Position of comfort, pain medication, and delayed transport

D)

Detailed secondary exam and 12-lead ECG

Answer 11

Iv fluids, oxygen and transport

Question 12

A 22-year-old woman presents with severe abdominal pain and signs of shock. When asked whether she is pregnant, she states, “There’s no way I’m pregnant, I have an IUD.” Which of the following is the most likely cause of her signs and symptoms?
Question 12 options:

A)

Miscarriage

B)

Endometriosis

C)

Ectopic pregnancy

D)

Pelvis inflammatory disease

Answer 12

ectopic pregnancy

Question 13

All of the following are associated with spontaneous abortion EXCEPT:
Question 13 options:

A)

hypotension and fever.

B)

nontraumatic vaginal bleeding.

C)

cramping abdominal pain.

D)

the passage of clots and tissue.

Answer 13

hypotension and fever

Question 14

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?
Question 14 options:

A)

Menopause-related dysfunctional uterine bleeding

B)

Pelvic inflammatory disease

C)

Ectopic pregnancy

D)

Spontaneous abortion

Answer 14

spontaneous abortion

Question 15

A 34-year-old woman presents with complaints of vaginal bleeding and pain during intercourse. Her last menstrual period was two weeks ago and was reportedly heavier than normal. She reports that she had saturated two menstrual pads in the past two hours. You should:
Question 15 options:

A)

ask her if she has a family history of uterine cancer.

B)

advise her to insert a tampon to control the bleeding.

C)

assess vital signs and transport.

D)

apply oxygen and start a large-bore IV.

Answer 15

assess vital signs and transport

Question 16

A 16-year-old female patient presents with complaints of abdominal pain and dizziness. She is pale and clammy, and reluctant to answer your questions regarding her sexual activity. Vital signs are: blood pressure 92/62 mmHg, heart rate 102, and respirations 20. You should:
Question 16 options:

A)

transport in a position of comfort.

B)

start a large-bore IV and transport emergently.

C)

ask the mother if the patient might be pregnant.

D)

make it clear that she must be honest about her sexual history.

Answer 16

start a large bore Iv and transfer emergently

Question 17

Your patient is a 35-year-old woman who is complaining of severe abdominal pain in both lower quadrants. She states that she had a tubal ligation two years ago. Which of the following questions is appropriate to ask during your care of this patient?
Question 17 options:

A)

“Do you have more than one sexual partner?”

B)

“Have you ever had pelvic inflammatory disease (PID)?”

C)

“Have you ever had a sexually transmitted disease?”

D)

“When was your last menstrual period?”

Answer 17

when was your last menstrual period

Question 18

Risk factors for ectopic pregnancy include all of the following EXCEPT:
Question 18 options:

A)

previous ectopic pregnancies.

B)

pelvic inflammatory disease.

C)

use of an intrauterine device for birth control.

D)

IV drug usage.

Answer 18

IV drug usage

Question 19

You are called to the scene of a sexual assault. The patient is a 17-year-old female who is crying inconsolably and withdraws when you attempt to touch her. Which of the following is the most appropriate response?
Question 19 options:

A)

Ask the patient to describe how she was assaulted so you know where she is injured.

B)

Tell the patient that you cannot help her if she won’t allow you to touch her.

C)

Explain to the patient that she must allow you to examine her for injuries.

D)

Explain to the patient that you will not touch her if she does not want you too.

Answer 19

explain to the patient that you will not touch her if she does not want you too

Question 20

A 35-year-old woman has been raped. She states repeatedly that she wants to change her clothes before going to the hospital, and becomes hysterical when you advise her that she should remain dressed to preserve evidence. You should:
Question 20 options:

A)

allow her to change and carefully bag each item of clothing.

B)

allow her to change only her shirt, not her pants or undergarments.

C)

promise to let her change as soon as you get to the hospital.

D)

refuse to let her change her clothing, as it will destroy evidence.

Answer 20

allow her to change and carefully bag each item of clothing

Question 21

Which of the following is NOT an appropriate adaptation to make in the assessment and care of a sexual assault victim?
Question 21 options:

A)

Ask simple, closed-ended questions about the nature of the assault.

B)

Do not touch the patient unless it is necessary to obtain vital signs or examine injuries.

C)

Allow a friend to accompany the victim in the back of the ambulance.

D)

Keep the back of the ambulance well lit and warm.

Answer 21

ask simple close ended questions about the nature of the assault

Question 22

A 35-year-old woman presents with abdominal pain that she describes as “cramping and dull.” She reports having multiple sexual partners in the past six months, and states that she has an IUD. Vital signs are: blood pressure 118/76 mmHg, heart rate 88, and respirations 18. Appropriate care of this patient includes:
Question 22 options:

A)

examining the genitalia for hemorrhage.

B)

cardiac monitoring and transport.

C)

elevating the legs during transport.

D)

position of comfort and routine ALS care.

Answer 22

position of comfort and routine ALS care

Question 23

A 22-year-old woman presents with left-sided lower abdominal pain. She reports that her last menstrual cycle ended approximately 10 days ago. Her blood pressure is normal and she rates the pain as 6 on a scale of 10. You should:
Question 23 options:

A)

palpate the abdomen.

B)

look for vaginal bleeding.

C)

withhold pain medication.

D)

administer oxygen.

Answer 23

palpate the abdomen

Question 24

Your patient is an 18-year-old woman who is alert and in moderate distress, complaining of abdominal pain and light-headedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea, and vomiting this week. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. Her vital signs are: heart rate 121, blood pressure 90/58 mmHg, respirations 18. The patient’s presentation is most consistent with:
Question 24 options:

A)

spontaneous abortion.

B)

pyelonephritis.

C)

pelvic inflammatory disease.

D)

ectopic pregnancy.

Answer 24

ectopic pregnancy

Question 25

A 30-year-old woman presents with a fever of 103.5°F, pale skin, and an altered mental status. She cries out and withdraws when you palpate her abdomen. Her husband reports that she had a cervical biopsy three days earlier, and has be “feeling sick” ever since. Vital signs are: blood pressure 88/60 mmHg, heart rate 110, and respirations 22. You suspect:
Question 25 options:

A)

shock due to pelvic inflammatory disease.

B)

hypovolemia secondary to miscarriage.

C)

infection of fibroid tumors.

D)

sepsis secondary to endometritis.

Answer 25

sepis secondary to endometritis

Question 26

A 26-year-old woman is complaining of severe abdominal pain and heavy vaginal bleeding. She has used five sanitary napkins in the past hour. Her last menstrual period was six weeks ago, and she describes a history of irregular periods, but never to this extent. Management of this patient should include:
Question 26 options:

A)

IV dextrose.

B)

oral antiemetic.

C)

IM epinephrine.

D)

IV fluids.

Answer 26

IV fluids

Question 27

Your patient is a 44-year-old woman who is alert and in mild distress. She states that she had an acute onset of sharp, right lower quadrant abdominal pain last evening while having intercourse and that the pain has not subsided. Physical examination reveals tenderness with palpation to the lower right abdominal quadrant. Vital signs are: heart rate 98, respirations 16, blood pressure 116/78 mmHg. She reports she had a tubal ligation ten years ago and that she has several small fibroid tumors. Which of the following is the most likely diagnosis for this patient?
Question 27 options:

A)

Ruptured ovarian cyst

B)

Mittelschmerz

C)

Pelvic inflammatory disease

D)

Ectopic pregnancy

Answer 27

ruptured ovarian cyst

Question 28

Your patient is a transgender man complaining of severe lower abdominal pain. He states that he is in the process of transitioning from female to male, and that he takes hormone supplements. When evaluating this patient, which of the following questions is most appropriate?
Question 28 options:

A)

“How often do you use illegal drugs?”

B)

“When was your last menstrual cycle?”

C)

“Are you planning to have gender reassignment surgery?”

D)

“Are you usually sexually active with men, or with women?”

Answer 28

when was your last menstrual cycle

Question 29

A 27-year-old woman reports significant vaginal bleeding. She states that she is 11 weeks pregnant and awoke this morning to heavy bleeding including the passage of clots. She is crying and very upset, stating, “I can’t lose this baby—I can’t live with that.” When caring for this patient, you should:
Question 29 options:

A)

perform a vaginal exam to determine if she is still bleeding.

B)

inform the patient’s husband that she may be having a miscarriage.

C)

ask her if she has ever had a miscarriage.

D)

transport the patient in a position of comfort and provide emotional support.

Answer 29

transport the patient in a position of comfort and provide emotional support

Question 30

A 30-year-old woman has right-sided abdominal pain and is hypotensive. You suspect she may have a ruptured ectopic pregnancy. You recognize:
Question 30 options:

A)

life-threatening hemorrhagic shock and the need for fluid resuscitation.

B)

a common medical condition that affects many women each year.

C)

potentially dangerous obstructive shock that requires rapid transport.

D)

a very rare disease process that requires immediate surgery to save the pregnancy.

Answer 30

life threatening hemorrhagic shock and the need for fluid resuscitation

Question 31

Which of the following is NOT an appropriate way to control vaginal bleeding in the prehospital setting?
Question 31 options:

A)

Using a sanitary napkin

B)

Placing sterile gauze over the opening of the vagina

C)

Using a tampon

D)

Placing an absorbent pad under the patient

Answer 31

using a tampon

Question 32

Your patient is a 36-year-old woman who is alert and complaining of abdominal pain. She states that she is having her period and that this pain is “much different than the cramps I usually get.” She describes the pain as achy throughout her pelvis and lower abdomen. She says that this has occurred the past three menstrual cycles and that she has experienced dyspareunia and spotting over the same period. She is G2P2 and has no other significant gynecologic history. Physical examination reveals pain with palpation over her entire abdomen; her skin is warm and dry. Vital signs are: heart rate 84, blood pressure 124/76 mmHg, respiration 12, SpO2 = 99%. Which of the following is the most likely diagnosis for this patient?
Question 32 options:

A)

Primary dysmenorrhea

B)

Polycystic ovary disease

C)

Endometriosis

D)

Uterine fibroids

Answer 32

endometriosis