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OB/GYN Flashcards

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1
Q

The external female genitalia are collectively referred to as the:

A. vagina

B. pudendum

C. external labia

D. mons veneris

A

B.

pudendum

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2
Q

What part of the female genitalia is homologous to the glans penis of the male?

A. Hymen

B. Clitoris

C. Urethra

D. Vestibule

A

B.

Clitoris

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3
Q

Whish 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

A

D.

Imperforate hymen

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4
Q

In the average female, the menstrual cycle lasts _____ days.

A. 21

B. 24

C. 28

D. 35

A

C.

28

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5
Q

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

A.

25, 65

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6
Q

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

A

C.

hormonal release

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7
Q

The onset of menses is called ____, and typically occurs between the ages of _____ and ____ years.

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

A

B.

menarche, 11 and 14 years

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8
Q

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

A

D.

Are more susceptible to atherosclerosis and osteoporosis

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9
Q

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

A

B.

Glucose and fentanyl

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10
Q

Mittelschmerz is MOST accurately defined as:

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

B. bilateral abdominal pain and vaginal bleeding caused by excess hormone release

C. abdominal cramping, vaginal bleeding, and headache lasting more than a week

D. severe abdominal cramping and a vascular headache that is caused by ovulation

A

A.

unilateral abdominal pain and cramping that occurs during the ovulatory process

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11
Q

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

A

D.

may signal an underlying illness

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12
Q

The MOST common cause of amenorrhea is:

A. stress

B. exercise

C. pregnancy

D. anorexia nervosa

A

C.

pregnancy

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13
Q

Which of the following conditions poses the LEAST risk for shock due to vaginal bleeding?

A. Metorrhagia

B. Dysmenorrhea

C. Polymenorrhea

D. Hypermenorrhea

A

B.

Dysmenorrhea

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14
Q

Which of the following statements regarding endometritis is MOST correct?

A. Untreated endometritis may result in septic shock

B. Endometritis is defined as an enlargement of the uterus.

C. It is most commonly caused by an intrauterine device.

D. It results when endometrial tissue grows outside the uterus

A

A.

Untreated endometritis may result in septic shock

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15
Q

In contrast to endometritis, endometriosis:

A. may present without abdominal pain

B. in is inflammation of the uterine lining.

C. generally causes light menstrual periods

D. is often the result of gynecologic surgery

A

A.

May present without abdominal pain

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16
Q

Pelvic inflammatory disease (PID) commonly affects all of the following organs, EXCEPT the:

A. uterus

B. ovaries

C. urinary bladder

D. fallopian tubes

A

C.

urinary bladder

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17
Q

Pelvis inflammatory disease (PID) MOST commonly affects:

A. the external genitalia

B. sexually active women

C. postmenopausal women

D. woman over 30 years of age

A

B.

sexually active women

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18
Q

Which of the following is a potential complication of pelvic inflammatory disease (PID)?

A. Uterine rupture

B. Ectopic pregnancy

C. Respiratory failure

D. Urinary tract infection

A

B.

Ectopic pregnancy

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19
Q

Risk factors for pelvic inflammatory disease (PID) 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

A.

monogamy

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20
Q

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

A

D.

a “fishy” vaginal odor, itching, irritation, and vaginal discharge

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21
Q

A woman who is taking pentosan polysufate sodium (Elmiron) MOST likely has:

a. gonorrhea

B. gardnerella vaginitis

C. interstitial cystitis

D. premenstrual syndrome

A

C.

interstitial cystitis

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22
Q

Which of the following statements regarding an 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

A

D.

In ectopic pregnancy, fertilized egg implants somewhere other than the uterus

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23
Q

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

A

B.

can cause severe intra-abdominal hemorrhage

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24
Q

The MOST common type of ovarian cyst is the _____ cyst, which generally develops during the:

A. functional, menstrual cycle

B. corpus luteum, onset of menses

C. corpus luteum, second trimester

D. follicular, postmenopausal phase

A

A.

functional, menstrual cycle

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25
Q

Which of the following conditions is characterized by a lack of progesterone and increased androgen levels, and can lead to hypertension and cardiac problems?

A. Polycystic overies

B. Ectopic pregnancy

C. Corpus luteum cyst

D. Tubo-ovarian abscess

A

A.

Polycytic ovaries

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26
Q

The MOST common underlying cause of a tubo-ovarian abscess is:

A. vaginitis

B. gonorrhea

C. an ectopic pregnancy

D. a ruptured ovarian cyst

A

B.

gonorrhea

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27
Q

Which of the following statements regarding toxic shock syndrome (TSS) is MOST correct?

A. TSS is a condition that is exclusive to females

B. Patients with TSS may show signs of liver failure

C. Most causes of TSS occur in the absence of a fever

D. Group b Streptococcus is a causative agent in TSS.

A

B

Patients with TSS may show signs of liver failure

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28
Q

Initial signs symptoms of toxic shock syndrome (TSS) include all of the following, EXCEPT:

A. myalgia

B. scleral injection

C. headache and fever

D. cardiac dysrhythmias

A

D.

Cardiac dysrhythmias

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29
Q

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

A

C.

she may develop sever nausea and vomiting

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30
Q

Reiter syndrome:

A. is an acute life-threatening condition that has been linked directly to the use of high-absorbency tampons

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

C. is a far more common and serious complication of untreated chlamydia than pelvic inflammatory disease

D. is a relatively common complication of untreated gonorrhea, and is characterized by low-grade fever and myalgia

A

B.

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

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31
Q

Common signs and symptoms of infection with the cytomegalovirus (CMS) include:

A. prolonged high fever

B. lesions on the genitalia

C. enlargement of the liver

D. severe nausea and diarrhea

A

A.

prolonged high fever

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32
Q

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

A.

initially appear as small red bumps

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33
Q

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 is pregnant

D. she most likely has pelvic inflammatory disease

A

D.

she most likely has pelvic inflammatory disease

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34
Q

Which of the following statements regarding the human papillomavirus (HPV) is MOST 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.

A

C.

HPV has been identified as a causative agent in cervical cancer

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35
Q

Which of the following is NOT characteristic of the secondary stage of syphilis?

A. the presence of a skin rash

B. single or multiple chancres

C. mucous membrane lesions

D. fever and swollen lymph glands

A

B.

single or multiple chancres

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36
Q

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

A

B.

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

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37
Q

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 BSI precautions because many of these calls involve a lot of blood

D. quickly assess the need for additional resources and summon them early

A

A.

assess for danger because any scene should be considered volatile

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38
Q

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. as the patient why she is sure is not pregnant

A

D.

as the patient why she is sure she is not pregnant

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39
Q

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?”

A

C.

“When was your last menstrual period?”

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40
Q

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

A

D.

Treating for shock and transporting rapidly

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41
Q

Within a few days after have a therapeutic abortion, a 33-year-old woman presents with malaise, fever, constipation, and pelvic pain. Her blood pressure is 124/84 mmHg, pulse rate is 104 beats/minute and strong, and respirations are 22 breaths/minute and regular. You should be MOST suspicious for:

A. acute cystitis

B. endometritis

C. a ruptured ovarian cyst

D. pelvic inflammatory disease

A

B.

endometritis

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42
Q

A 25-year-old woman presents with acute abdominal pain and vaginal bleeding. She tells you that she has soaked 8 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

A

160 mL

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43
Q

You are dispatched to a grocery store for a woman with sever abdominal pain. When you arrive, you find the patient lying on her side in the manager’s office. She is confused, 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 lags 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.

A

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

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44
Q

A 30-year-old woman complains of an “achy” pain to both lower abdominal quadrant, 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 degree F. Her blood pressure is 122/62 mmHg, pulse rate is 84 beats/minute and strong, and respirations are 14 breaths/minute and unlabored. After gathering the rest of her medical history, you should:

A. provide emotional support, make her a 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

A.

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

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45
Q

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 mmHg, pulse rate is 120 beats/minutes and weak, and respirations are 24 breaths/minute 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

A

D.

Narcotic analgesia

46
Q

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 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

A

B.

a ruptured ovarian abscess

47
Q

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 short, 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

A

B.

Identifying and treating immediate life threats

48
Q

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

A.

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

49
Q

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 ventilator assistance

D. elevating her lower extremities to improve her blood pressure

A

C.

maintaining her airway and providing ventilator assistance

50
Q

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 mmHg, pulse is 58 beats/minute and weak, and her 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 an 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

A

B.

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

51
Q

Which of the of following is NOT appropriate in the care of a victim of a sexual assault?

A. Touch the patient’s shoulder or pat her on the leg often to reassure her.

B. Explain all procedures and ask for permission before beginning them.

C. Approach the patient calmly, in a professional manner.

D. Be especially attentive to the victim’s modesty.

A

A.

Touch the patient’s shoulder or pat her on the leg often to reassure her.

52
Q

A 26-year-old female 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 6 weeks ago, and she described a history of irregular periods but never to this extent. Evaluation of her abdomen shows rebound tenderness and rigidity in the midline of the lower abdomen. Management should include:

A. palpation of the cervix for dilation

B. oxygen

C. packing the vagina with absorbent dressings

D. examination of the vaginal canal

A

B.

oxygen

53
Q

The term used to describe how many times a women has been pregnant is:

A. menarche

B. para

C. gravida

D. parity

A

C.

gravida

54
Q

The period of time from ovulation to menstruation is approximately ______ days.

A. 7

B. 14

C. 28

D. 21

A

B.

14

55
Q

The muscular organ that contains the fetus, placenta, amniotic fluid, and associated structures during pregnancy is the:

A. pouch of Douglas

B. endometrium

C. oviduct

D. uterus

A

D.

uterus

56
Q

Your 28-year-old female patient was sexually assaulted with a foreign object and is bleeding heavily from the vagina. Which of the following is appropriate?

A. Packing dressing in the vagina to stop bleeding

B. IV access and fluid replacement

C. Speculum examination

D. Performing a manual pelvic exam

A

B.

IV access and fluid replacement

57
Q

Your patient is a 20-year-old female victim of a sexual assault. Her roommate came home to their dorm room to fine the patient curled up in bed crying, stating that she had just been raped “5 minutes ago.” Physical examination reveals no trauma or any other abnormal findings. HR=100, BP=130/78, RR=20, SaO2=99%. The patient agrees to be transported to the ED, but would like to change her clothes and use the bathroom before she leaves. Which of the following is the most appropriate course of action?

A. Advise the patient that using the toilet, changing her clothing, brushing her hair and teeth, or washing any part of her body will destroy evidence and that it is very important that she not do these things until be examined at the hospital

B. Ask that the patient place each article of clothing in a separate plastic bag before she uses the toilet, showers, and brushes her teeth.

C. Ask that the patient place her clothing in a paper bag before she uses the toilet, showers, and brushes her teeth.

D. Allow the patient to do as she wishes to avoid subjecting her to additional emotional trauma

A

A.

Advise the patient that using the toilet, changing her clothing, brushing her hair and teeth, or washing any part of her body will destroy evidence and that it is very important that she not do these things until be examined at the hospital

58
Q

A 20-year-old sexually active female presents in severe distress, hypotensive. she describes acute onset on severe lower R quadrant abdominal pain and states that she has not had her period in 3 months. The most likely clinical diagnosis would be:

A. ruptured ectopic pregnancy

B. torsion of an ovarian cyst

C. ruptured ovarian cyst

D. spontaneous abortion

A

A.

ruptured ectopic pregnancy

59
Q

Your patient is a 34-year-old female in no apparent distress, complaining of dysuria. She describes a 4-day history of dysuria, urinary frequency, and hematuria. She is sexually active with one partner, last menstrual period 10 days ago, and G3P3. Physical examination reveals warm. dry skin and pain with palpation above the pubis. HR=96, BP=124/68, RR=12, temp=99.9 degrees Fahrenheit. Which of the following is the most diagnosis for this patient?

A. Pelvic inflammatory disease

B. Pyelonephritis

C. Cystitis

D. Endometriosis

A

.C.

Cystitis

60
Q

A 45-year-old female presents complaining of abdominal pain just superior to the symphysis pubis, urinary frequency, dysuria, and a fever of 99 F. Based on her complaints, the best diagnosis would be:

A. endometriosis

B. ruptured ovarian cyst

C. cystitis

D. endometritis

A

C.

cystitis

61
Q

Ovulation occurs:

A. when the corpus luteum ruptures

B. secondary to an decrease in FSH and estrogen

C. as a result of an LH surge around day 14 of the menstrual cycle

D. when the corpus albicans ruptures

A

C.

as a result of an LH surge around day 14 of the menstrual cycle

62
Q

Which of the following BEST explains why the use of an intrauterine device (IUD) increases the risk of developing pelvic inflammatory disease?

A. Women with an IUD are more likely than other women to have multiple sexual partners

B. An IUD abrades the endometrium, allowing microorganisms to invade the uterine wall.

C. The absorbent cotton string of the IUD acts as a wick for bacteria to enter the uterus.

D. The use of a copper IUD use weakens the user’s immune system

A

B.

An IUD abrades the endometrium, allowing microorganisms to invade the uterine wall.

63
Q

Signs of an ectopic pregnancy include all of the following EXCEPT:

A. syncope

B. unilateral lower abdominal pain

C. missed, late, or unusually light menstrual period

D. fundal height at the level of the umbilicus

A

D.

fundal height at the level of the umbilicus

64
Q

Your patient is a 33-year-old female who is alert and in significant distress. She describes a 1 week history of diffuse lower left quadrant abdominal pain that became acutely worse and specific 1/2 hour ago. She has not had her menstrual period in 4 months. HR=120, BP=72/48, RR=20. Which of the following would be LEAST likely to have contributes to her current condition?

A. Tubal ligation

B. Previous ectopic pregnancy

C. Previous pelvic inflammatory disease

D. Oral contraceptive use

A

D.

Oral contraceptive use

65
Q

A 24-year-old female presents complaining of severe lower quadrant abdominal pain and bloody, purulent vaginal discharge 3 days after having a dilation and curettage. Of the following, which is the most likely clinical condition of this patient?

A. Endometritis

B. Abruptio placentae

C. Mettelshmerz

D. Endometriosis

A

A.

Endometritis

66
Q

Your patient is a 25-year-old female who is alert and complaining of fever and general malaise. She has had a fever for the past 2 days, along with bilateral lower quadrant abdominal pain and bloody vaginal discharge. Her last menstrual period was 2 months ago, G5P2, with an elective abortion 2 days prior. Physical examination reveals hot, moist skin and pain with palpation to the lower quadrants. HR=110, BP=108/64, RR=14, Sao2=97%. Which of the following is the most likely diagnosis for this patient?

A. Retained products of comception

B. Endometritis

C. Cervical dysplasia

D. Menorrhagia

A

B.

Endometritis

67
Q

A 33-year-old female presents with “a heavy menstrual flow” after not having her menstrual period for 2 months. What other signs and symptoms would you MOST expect with this patient?

A. Dull, lower L quadrant abdominal pain

B. Fever and purulent, foul-smelling discharge

C. Crampy abdominal pain and passing of clots and tissue

D. Sharp, lower R quadrant abdominal pain

A

C.

Crampy abdominal pain and passing of clots and tissue

68
Q

Your patient is an 18-year-old female who is alert and in moderate distress, complaining of abdominal pain and lightheadedness. She describes a 4-week history of worsening abdominal pain with onset of malaise, nausea, vomiting, and chills this week and fever yesterday. Today, she is experiencing faintness and near-syncope with exertion. Her last menstrual period was 2 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. HR=121, BP=90/58, RR=18. Which of the following is the most likely diagnosis and the most appropriate treatment for this patient?

A. Ectopic pregnancy. Treat with oxygen, IV of normal saline, transport

B. Sepsis secondary to pelvic inflammatory disease. Treat with oxygen, IV of normal saline, transport

C. Pelvic inflammatory disease. Treat with oxygen, IV of normal saline, transport

D. Pelvic inflammatory disease. BLS transport to ED

A

B.

Sepsis secondary to pelvic inflammatory disease. Treat with oxygen, IV of normal saline, transport

69
Q

Which of the following is TRUE of mittelschmerz?

A. It is usually accompanied by heavy vaginal bleeding

B. It is a sign of ectopic pregnancy

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

D. It is associated with ovulation

A

D.

It is associated with ovulation

70
Q

Menorrhagia is:

A. painful menstruation

B. irregular cycles of menstruation

C. excessive menstrual flow

D. insignificant menstruation

A

C.

excessive menstrual flow

71
Q

Which of the following is a potential complication of untreated pelvic inflammatory disease?

A. Sepsis

B. Cystitis

C. Renal failure

D. Primary amenorrhea

A

A.

Sepsis

72
Q

Which of the following would MOST suggest that a patient’s abdominal pain was secondary to Mittelschmerz?

A. History of sexual intercourse without contraception

B. Acute onset of pain 14 days after the onset of her last menstrual period

C. Purlulent vaginal discharge

D. Moderate vaginal bleeding of bright red blood

A

B.

Acute onset of pain 14 days after the onset of her last menstrual period

73
Q

If fertilization of an egg occurs, which phases of the menstrual cycle in progress do NOT occur?

A. secretory and menstrual

B. secretory and ischemia

C. ischemic and menstrual

D. proliferative and menstrual

A

C.

ischemic and menstrual

74
Q

Your patient is a 44-year-old female 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. She states the pain radiates to her lower back and rates it as a 5 on a scale of 1-10. Physical examination reveals tenderness with palpation to the lower right abdominal quadrant, and her skin is warm and dry. HR=100, RR=12, BP=116/78. Her last menstrual period was 3 weeks ago, she had a tubal ligation 10 years ago, and she states she has several small fibroid tumors. Which of the following is the most likely diagnosis for this patient?

A. Ectopic pregnancy

B. Pelvic inflammatory disease

C. Mittelschmerz

D. Ruptured ovarian cyst

A

D.

Ruptured ovarian cyst

75
Q

You are called to the scene of a sexual assault. You are presented with a 19-year-old female who is withdrawn and sitting in a corner in her bedroom. Which of the following questions is appropriate to ask?

A. “Are you injured anywhere?”

B. “Why did you bring him home with you from the nightclub?”

C. “Do you know if you were penetrated?”

D. “What type of clothing were you wearing?”

A

A.

“Are you injured anywhere?”

76
Q

Which of the following statements about the delivery of the placenta is TRUE?

A. Transport should be delayed until delivery of the placenta is complete

B. Gentle traction should be applied to the placenta to facilitate delivery

C. Fundal massage is contraindicated until the placenta is delivered

D. It should be placed in a biohazard bag and brought to the ED with the patient

A

D.

It should be placed in a biohazard bag and brought to the ED with the patient

77
Q

You are assisting in the delivery of an infant after an extremely prolonged labor. During delivery of the head, you note the presence of thick, green meconium in the patient’s airway. What should your next course of action be?

A. suction the nose and mouth with a bulb syringe, complete the delivery, then suction the hypopharynx and trachea using an endotracheal tube and a meconium aspirator.

B. Do not suction the nose and mouth, complete the delivery, then suction the oropharynx using an endotracheal tube and a meconium aspirator.

C. Immediately suction the hypopharynx and trachea before completing the delivery using an endotracheal tube and a meconium aspirator

D. Do not suction the nose and mouth, complete the delivery, then suction the hypopharynx and trachea using an endotracheal tube and a meconium aspirator.

A

D.

Do not suction the nose and mouth, complete the delivery, then suction the hypopharynx and trachea using an endotracheal tube and a meconium aspirator.

78
Q

The premature separation of the placenta from the uterine wall is called:

A. abruption placentae

B. spontaneous placentae

C. abortion

D. placenta previa

A

A.

abruption placentae

79
Q

Which of the following statements about changes in maternal physiology during pregnancy is TRUE?

A. Renal blood flow decreases

B. Progesterone causes a decrease in airway resistance

C. Maternal blood volume decreases

D. The mother’s respiratory rate increases significantly

A

B.

Progesterone causes a decrease in airway resistance

80
Q

Your patient is 34-weeks pregnant, complaining of a headache and nausea. Her blood pressure is 150/92, and she tells you that her doctor told her she has protein in her urine. You note that her face, hands, and feet are edematous. Which of the following is most likely?

A. Gestational diabetes

B. Hyperemesis gravidum

C. Eclampsia

D. Preeclampsia

A

D.

Preeclampsia

81
Q

Which of the following is part of the mother’s routine postpartum care?

A. Encouraging the mother to bear down to deliver the placenta

B. 500 to 1,00 mL normal saline infusion

C. Oxytocin administration

D. Fundal massage

A

D.

Fundal massage

82
Q

Which of the following is indicated first for a pregnant patient with no medical history who is experiencing seizures?

A. Magnesium sulfate

B. Naloxone

C. Calcium gluconate

D. Diazepam

A

A.

Magnesium sulfate

83
Q

Which of the following is appropriate in the care of the patient in the first stage of labor?

A. History, physical exam, transport

B. Save the placenta in a plastic bag for transport to the hospital

C. Prepare for imminent delivery

D. Allow the newborn to nurse

A

A.

History, physical exam, transport

84
Q

Which of the following statements about neonatal resuscitation is NOT true?

A. The umbilical vein is an acceptable intravenous access site.

B. Factors that increase the likelihood of the need for resuscitation include maternal health problems, prematurity, and inadequate prenatal care.

C. The endotracheal tube is an acceptable administration route for epinephrine, atropine, Lidocaine, glucose, and naloxone.

D. A HR below 80 bpm that is not responding to ventilation with 100% O2 indicates the need for chest compressions.

A

C.

The endotracheal tube is an acceptable administration route for epinephrine, atropine, Lidocaine, glucose, and naloxone.

85
Q

The umbilical cord should be clamped in two places and cut ______ cm from the newborn.

A. 10 - 15

B. 2 - 5

C. 5 - 10

D. 5 - 7

A

A.

10 - 15

86
Q

A newborn has blue extremities, a pink torso, a strong and active cry, a heart rate of 104, and some flexion of its extremities. What is this newborn’s APGAR score?

A. 8

B. 9

C. 5

D. 7

A

A.

8

87
Q

You have just assisted in the birth of an infant. After suctioning the airway and cutting the cord you determine that the APGAR score is 7. Which of the following is most appropriate in the care of the infant?

A. Dry, blow-by oxygen and tactile stimulation to encourage breathing, keep warm

B. Dry, ventilation with 100% oxygen, chest compressions, keep warm

C. Dry, tactile stimulation, wrap in warm blankets, lay on the mother’s chest, reassess APGAR in 5 minutes while en route to ED.

D. Dry, ventilation with 100% oxygen, keep warm

A

C.

Dry, tactile stimulation, wrap in warm blankets, lay on the mother’s chest, reassess APGAR in 5 minutes while en route to ED.

88
Q

Which of the following statements regarding meconium is NOT true?

A. Meconium-stained fluid indicates a fetal hypoxic event

B. The presence of meconium staining is often difficult to determine

C. Thin and light meconium does not require aggressive suctioning of the airway

D. The presence of meconium is often associated with prolonged labor.

A

B.

The presence of meconium staining is often difficult to determine

89
Q

Which of the following is the most reliable sign of impending delivery?

A. Loss of the cervical mucus plug

B. Crowning

C. Meconium stained amniotic fluid

D. Spontaneous rupture of the membranes

A

B.

Crowning

90
Q

Which of the following statements about the umbilical cord is TRUE?

A. The umbilical vein supplies oxygenated blood to the fetus

B. The umbilical cord is approximately 6 feet long

C. It has two veins and one artery

D. Arteries connected to the maternal circulation supply blood to the fetus.

A

A.

The umbilical vein supplies oxygenated blood to the fetus

91
Q

Your patient is a 41-year-old female who is alert and in obvious distress, complaining of abdominal pain. The patient states that she is 32 weeks pregnant and experienced and acute onset of tearing abdominal pain this evening. She admits to smoking cocaine this afternoon. She is G5P2 with two spontaneous abortions. Her skin is cool, moist, and pale, and you note about 50 mL of dark red vaginal bleeding. Her abdomen is rigid to palpation in all quadrants. HR=128, BP=90/52, RR=22, SaO2=96%. Which of the following is most likely?

A. Preterm labor

B. Placenta previa

C. Abruptio placentae

D. Preeclampsia

A

C.

Abruptio placentae

92
Q

The most important consideration when managing a premature infant is:

A. preventing the loss of body heat

B. administering 100% oxygen

C. determining blood glucose

D. continuously suctioning the airway

A

A.

preventing the loss of body heat

93
Q

When assisting with delivery, which of the following sequences is correct after instructing the mother to stop pushing when the baby’s head has deliverd?

A. Direct the baby’s head downward to deliver the anterior shoulder, direct the baby’s head upward to deliver the posterior shoulder, suction the mouth first then the nose.

B. Suction the mouth first then the nose, direct the baby’s head downward to deliver the anterior should, direct the baby’s head upward to deliver the posterior shoulder.

C. Direct the baby’s head downward to deliver the posterior shoulder, direct the baby’s head upward to deliver the anterior shoulder, suction the mouth first then the nose.

D. Suction the nose first then the mouth, direct the baby’s head downward to deliver the anterior shoulder, direct the baby’s head upward to deliver posterior shoulder.

A

B.

Suction the mouth first then the nose, direct the baby’s head downward to deliver the anterior should, direct the baby’s head upward to deliver the posterior shoulder.

94
Q

A newborn present with a heart rate of 80 that does not respond to 30 seconds of BVM ventilator with 100% O2. The next step would be:

A. Initiate chest compressions and reassess

B. Perform endotracheal intubation and administer epinephrine

C. Ventilate with 100% O2 for 30 seconds more and reassess

D. Continue ventilations, cannulate the umbilical vein and administer epinephrine

A

A.

Initiate chest compressions and reassess

95
Q

Meconium staining indicate:

A. eclampsia

B. gestational diabetes

C. fetal distress

D. prematurity

A

C.

fetal distress

96
Q

Which of the following is NOT part of normal management of the mother postdelivery?

A. Inspecting the perineum for tears

B. Frequently monitoring vital signs

C. High-flow oxygen by nonrebreather

D. Applying direct pressure to control hemorrhaging of perineal tears

A

C.

High-flow oxygen by nonrebreather

97
Q

Which of the following best describes the routine care of a newborn?

A. Deep suctioning of the airway with an ETT and meconium aspirator, ventilation with 100% O2, CPR

B. Tactile stimulation, drying, warming

C. Drying, warming, allowing for suckling at the mother’s breast

D. Suctioning of the airway with a bulb syringe as needed, tactile stimulation, dryng, warming, APGAR determination

A

D.

Suctioning of the airway with a bulb syringe as needed, tactile stimulation, dryng, warming, APGAR determination

98
Q

Which of the following maternal changes is expected during pregnancy?

A. Decreased stroke volume, decreased heart rate

B. Increased blood pressure, increased cardiac output

C. Increased heart rate, increased blood pressure

D. Increased cardiac output, increased blood volume

A

D.

Increased cardiac output, increased blood volume

99
Q

Place the following neonatal resuscitation procedures in the correct order.

  1. Tactile stimulation
  2. CPR
  3. Assisting ventilations
  4. Oxygen administration
  5. Suctioning
  6. Administration of cardiac medications

A. 4,5,1,3,2,6

B. 1,5,4,2,3,6

C. 5,1,4,3,2,6

D. 4,1,5,3,6,2

A

C.

5,1,4,3,2,6

100
Q

Which of the following structures allows the delivery of oxygen and nutrients to and removal of wastes from the fetus?

A. Morula

B. Amniotic Sac

C. Placenta

D. Allantois

A

C.

Placenta

101
Q

Which of the following is NOT appropriate when assisting with prehospital delivery?

A. Suction the mouth as soon as the head delivers

B. Wait for the umbilical cord to stop pulsating before clamping and cutting

C. Rotate the baby’s head to the side as soon as it delivers

D. Keep the newborn at the level of the vagina until the umbilical cord is cut.

A

B.

Wait for the umbilical cord to stop pulsating before clamping and cutting

OR

C.

Rotate the baby’s head to the side as soon as it delivers

102
Q

When measuring the distance from the symphysis pubis to the uterine fundus, each centimeter is roughly equal to _____ of gestation

A. 2 weeks

B. 1 week

C. 1 month

D. 10 days

A

B.

1 week

103
Q

The structure that connects the umbilical vein directly to the inferior vena cava is the:

A. formen ovale

B. foramen arteriosus

C. ductus venosus

D. ductus arteriosus

A

C.

ductus venosus

104
Q

Your patient is a 32-year-old female who complains of the onset of contractions 45 minutes ago. She is 39 weeks pregnant, G3P2. She states that the contractions are 2 minutes apart but that her membranes have not ruptured. She is anxious and responds affirmatively when you ask if she feels an urge to move her bowels. Which of the following is most likely?

A. Preterm labor

B. Stage one labor

C. Braxton-icks contractions

D. ductus arteriosus

A

D.

ductus arteriosus

105
Q

Management of the birth of twins is often made difficult by:

A. rapid succession of the births

B. low birth weight of both infants

C. one infant presenting vertex and the other breech

D. the infants sharing the placenta

A

C.

one infant presenting vertex and the other breech

106
Q

Which of the following paramedic actions is indicated after uncomplicated delivery of the newborn?

A. Performing fundal massage to maintain uterine contraction

B. Applying gentle traction to the umbilical cord to assist with delivery of the placenta

C. Administering oxytocin

D. Placing the mother on oxygen by nonrebreather

A

A.

Performing fundal massage to maintain uterine contraction

107
Q

When the fetal scalp is visible at the vaginal opening during a contraction, this is known as:

A. engagement

B. effacement

C. crowning

D. stage three labor

A

C.

crowning

108
Q

Which of the following is NOT a function of the placenta?

A. Supplying the developing fetus with maternal blood

B. Secreting estrogen and progesterone required to maintain pregnancy

C. Transferring heat and nutrients to the developing fetus

D. Removing fetal waste products

A

B.

Secreting estrogen and progesterone required to maintain pregnancy

109
Q

Which of the following is NOT useful to the prehospital care provider when obtaining the history of a pregnant patient?

A. Outcomes of previous pregnancies

B. History of prenatal care

C. The father’s general health

D. Estimated due date

A

C.

The father’s general health

110
Q

All of the following statements about the physiological changes during pregnancy are true EXCEPT:

A. pelvic joints loosen, causing postural changes and low back pain

B. renal tubular absorption increases

C. the urinary bladder is displaced posteriorly and inferiorly

D. gastrointestinal peristalsis is slowed

A

C.

the urinary bladder is displaced posteriorly and inferiorly

Paramedic (19 decks)

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