Gynecologic Emergencies Ch. 22

A 32-year-old female complains of acute lower abdominal pain that began approximately 1 week after her menstrual period ended. Her blood pressure is 116/66 mm Hg, heart rate is 96 beats/min, and respirations are 14 breaths/min with adequate depth. Further assessment reveals that she is running a fever of 101.6°F. Treatment for this patient should include:

A. placing her in a position of comfort, starting an IV line at a KVO rate, and transporting to an appropriate hospital.

B. placing her supine and elevating her legs, administering a 20 mL/kg normal saline bolus, and prompt transport.

C. placing her on her side with her knees drawn into her abdomen, a 250 mL normal saline bolus, and transport.

D. placing her in a semisitting position, starting an IV at a KVO rate, and transporting her to an appropriate hospital.
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A 32-year-old female complains of acute lower abdominal pain that began approximately 1 week after her menstrual period ended. Her blood pressure is 116/66 mm Hg, heart rate is 96 beats/min, and respirations are 14 breaths/min with adequate depth. Further assessment reveals that she is running a fever of 101.6°F. Treatment for this patient should include:

A. placing her in a position of comfort, starting an IV line at a KVO rate, and transporting to an appropriate hospital.

B. placing her supine and elevating her legs, administering a 20 mL/kg normal saline bolus, and prompt transport.

C. placing her on her side with her knees drawn into her abdomen, a 250 mL normal saline bolus, and transport.

D. placing her in a semisitting position, starting an IV at a KVO rate, and transporting her to an appropriate hospital.
A. placing her in a position of comfort, starting an IV line at a KVO rate, and transporting to an appropriate hospital
In most cases, care for a patient who presents with a complaint that is related to a sexually transmitted disease (STD) involves:

A. crystalloid fluid boluses because many STDs cause severe hypovolemia.

B. a detailed examination of the genitalia and control of vaginal bleeding.

C. placing the patient in a position of comfort and providing supportive care.

D. elevating the patient's lower extremities and administering high-flow oxygen.
...
Acute abdominal pain in a female of childbearing age should be assumed to be:

A. an ovarian cyst.

B. a sexually transmitted disease.

C. pelvic inflammatory disease.

D. a ruptured ectopic pregnancy.
D. a ruptured ectopic pregnancy
Prehospital documentation of a sexual assault case should:

A. be turned over to law enforcement.

B. remain on file for at least 6 months.

C. be objective, factual, and detailed.

D. include your opinion of the situation.
C. be objective, factual, and detailed
The _____________ is the outermost cavity of a woman's reproductive system and forms the lower portion of the birth canal.

A. cervix

B. vagina

C. uterus

D. fundus
B. vagina
Which of the following clinical or historical findings would be the LEAST likely to increase a woman's risk of an ectopic pregnancy?

A. An intrauterine device (IUD)

B. Previous ectopic pregnancy

C. Pelvic inflammatory disease

D. Two spontaneous abortions
D. Two spontaneous abortions
A 22-year-old female presents with lower abdominal pain; a frothy, yellow, odorous vaginal discharge; and dysuria. She tells you that she experiences severe pain during sexual intercourse. Her clinical presentation is MOST consistent with:

A. Trichomoniasis.

B. secondary syphilis.

C. Chlamydia.

D. bacterial vaginosis.
A. Trichomoniasis
The secondary stage of syphilis is characterized by:

A. swollen lymph nodes and high fever.

B. mucous membrane lesions and a rash.

C. poor muscle coordination and dementia.

D. the appearance of a single, painless lesion.
B. mucous membrane lesions and a rash
During your assessment of a 30-year-old pregnant patient, you determine that she has given birth to two children and has had one miscarriage. You should document her obstetric history as:

A. G2, P2, A1.

B. G3, P2, A1.

C. G3, P1, A0.

D. G2, P2, A0.
B. G3, P2, A1
When assessing and treating a female patient with a sexually transmitted disease, it is important to:

A. treat the patient without moral judgment.

B. report the disease to the appropriate authorities.

C. wear full facial protection in addition to gloves.

D. determine how the patient contracted the disease.
A. treat the patient without moral judgment
Approximately 1 week following her menstrual period, a 33-year-old female complains of bilateral lower abdominal quadrant pain, vaginal discharge, and fever. This clinical presentation is MOST consistent with: A. an ovarian cyst. B. an ectopic pregnancy. C. pelvic inflammatory disease. D. a spontaneous abortion.C. pelvic inflammatory diseaseCommon signs and symptoms associated with menstruation include all of the following, EXCEPT: A. breast tenderness. B. mood or behavioral changes. C. abdominal cramping or bloating. D. 60 mL to 100 mL of blood loss.D. 60 mL to 100 mL of blood lossPostpartum eclampsia is characterized by: A. hypertension that develops immediately before delivery. B. a history of seizures before pregnancy occurred. C. a sudden drop in blood pressure following delivery. D. seizures within 24 hours following delivery of a baby.D. seizures within 24 hours following delivery of a babyThe uppermost portion of the uterus is called the: A. os. B. neck. C. fundus. D. cervix.C. fundusWhich of the following statements regarding the fallopian tubes is correct? A. They extend from the uterus and terminate at the ovary. B. Their purpose is to carry an unfertilized egg to the uterus. C. They are too large to accommodate a male spermatozoa. D. Growth of the fetus typically occurs in the fallopian tubes.A. They extend from the uterus and terminate at the ovaryEstrogen and progesterone are secreted by the: A. corpus callosum. B. mammary glands. C. ovarian follicle. D. corpus luteum.D. corpus luteumA 35-year-old female complains of an acute onset of pain to her left lower abdominal quadrant. During your assessment, she tells you that the pain moves around to her back and that she is experiencing a small amount of vaginal bleeding. This patient is MOST likely experiencing: A. intrauterine cancer. B. a ruptured ovarian cyst. C. an ectopic pregnancy. D. gonorrhea or syphilis.B. a ruptured ovarian cystAn ectopic pregnancy occurs when an ovum develops: A. outside of the uterus. B. inside a fallopian tube. C. within the abdominal cavity D. inside of one of the ovaries.A. outside of the uterusSigns and symptoms of infection with cytomegalovirus include: A. low back pain and pain during intercourse. B. a rash on the palms of the hands and fatigue. C. dysuria, foul-smelling discharge, and fever. D. fever, chills, fatigue, and an enlarged spleen.D. fever, chills, fatigue, and an enlarged spleenGenital warts are caused by infection with: A. Neisseria gonorrhoeae. B. Treponema pallidum. C. Candida albicans. D. human papillomavirus.D. human papillomavirusThe myometrium is the: A. neck of the uterus. B. inner layer of the uterus. C. muscular wall of the uterus. D. uppermost part of the uterus.C. muscular wall of the uterusFunctions of the ovaries include: A. production of oocytes, estrogen, and progesterone. B. fertilizing a spermatozoa and producing estrogen. C. production of a mature egg and estrogen excretion. D. receiving a spermatozoa and excreting progesterone.A. production of oocytes, estrogen, and progesteroneA 22-year-old female complains of pain during sexual intercourse. This is referred to as: A. menarche. B. dyspareunia. C. dysmenorrhea. D. amenorrhea.B. dyspareuniaPregnancy hormones cause the _____________ of the uterus to thicken in preparation for implantation of a fertilized egg. A. myometrium B. endometrium C. perimetrium D. cervical osB. endometriumWhen treating a woman with vaginal bleeding and signs of shock, you must: A. assist her ventilations. B. observe standard precautions. C. establish two large-bore IV lines. D. perform a comprehensive assessment.B. observe standard precautionsA 49-year-old female was the victim of a sexual assault. Your assessment reveals that she is conscious and alert and is breathing adequately. There is no gross external bleeding and her vital signs are stable. You should: A. visually examine her genitalia for trauma. B. start an IV at a keep-vein-open (KVO) rate. C. question her as to the events of the assault. D. discourage her from showering or douching.D. discourage her from showering or douchingA 31-year-old female complains of heavy vaginal bleeding and generalized weakness. She is conscious and alert; however, her blood pressure is 88/56 mm Hg and her pulse is 120 beats/min and weak. You should apply 100% oxygen and then: A. place her on her left side and administer up to 3 liters of normal saline or lactated ringers solution. B. elevate her legs and administer isotonic crystalloid fluids until her blood pressure exceeds 110 mm Hg. C. insert a trauma dressing inside the vagina and start two large-bore IV lines of normal saline or lactated ringers. D. place absorbent dressings over the vagina and administer 20 mL/kg boluses of an isotonic crystalloid to maintain perfusion.D. place absorbent dressings over the vagina and administer 20 mL/kg boluses of an isotonic crystalloid to maintain perfusionA 25-year-old female, who is in the third trimester of pregnancy, was involved in a motor-vehicle crash and was not wearing a seatbelt. She complains of severe, tearing abdominal pain. She is experiencing dark red vaginal bleeding, and is exhibiting signs of shock. On the basis of the mechanism of injury and her clinical presentation, you should be MOST suspicious for: A. placenta previa. B. abruptio placenta. C. uterine inversion. D. traumatic abortion.B. abruptio placentaA 52-year-old female was brutally assaulted by several perpetrators. Your assessment reveals that she is semiconscious, is breathing shallowly, and has a rapid heart rate. You note that there is blood in the region of her vagina. Appropriate management for this patient includes: A. oxygen via nonrebreathing mask, placing gauze pads in the vagina, and IV therapy. B. assisted ventilations, an absorbent pad over her vagina, and a head-to-toe assessment. C. assisted ventilations, avoiding examination of the vagina, and placing a blanket on her. D. insertion of a Combitube, an absorbent pad over the vagina, and 2 liters of crystalloid.B. assisted ventilations, an absorbent pad over her vagina, and a head-to-toe assessmentWhen assessing a woman who has been sexually assaulted, it is important to: A. have a female AEMT present if possible. B. place potential evidence in plastic bags. C. thoroughly examine the genitalia for injuries. D. document minimally to protect the patient's privacy.A. have a female AEMT present if possibleYou are dispatched to a residence for a young female who was sexually assaulted when a perpetrator broke into her home. She is conscious and alert and has multiple abrasions and bruises to her face and arms. As you begin to assess her, she tells you that she does not want to go to the hospital. You should: A. tell her that she can take a shower if she will allow you to transport her. B. advise her that since she was the victim of a crime she must be transported. C. transport her since the assault has interfered with her ability to think clearly. D. explain the seriousness of the situation but allow her to refuse if she wishes.D. explain the seriousness of the situation but allow her to refuse if she wishesWhen collecting potential evidence at the scene of a sexual assault, you should place any items in paper bags, because: A. plastic bags may develop condensation and could destroy the evidence. B. plastic bags would reveal the potential evidence to curious onlookers. C. the condensation developed in the paper bag will preserve the evidence. D. paper bags are easier to seal and mark for later evaluation by the police.A. plastic bags may develop condensation and could destroy the evidenceA 21-year-old female was sexually assaulted with a glass bottle. Your assessment reveals that she is semiconscious with shallow breathing. The bottle is still inside her vagina. You should: A. assist ventilations, perform a head-to-toe assessment, and stabilize the bottle in place. B. apply oxygen via nonrebreathing mask, remove the object and place it in a plastic bag. C. intubate the patient, perform a detailed physical exam, and stabilize the bottle in place. D. assist ventilations, obtain baseline vital signs, and carefully remove the impaled bottle.A. assist ventilations, perform a head-to-toe assessment, and stabilize the bottle in placeAcute abdominal pain and vaginal bleeding during the 23rd week of pregnancy could be caused by any of the following, EXCEPT: A. placenta previa. B. abruptio placenta. C. ectopic pregnancy. D. spontaneous abortion.C. ectopic pregnancyWhat is the pathophysiology of bacterial vaginosis? A. A painless chancre that is caused by the Treponema pallidum bacterium B. Normal vaginal bacteria are replaced by an overgrowth of other bacterial forms. C. Caused by the bacterium Haemophilus ducreyi and causes ulcers on the genitalia D. Caused by the bacterium Neisseria gonorrhoeae, which grows in warm, moist areasB. Normal vaginal bacteria are replaced by an overgrowth of other bacterial formsThe corpus luteum is a/an: A. small endocrine structure that develops within a ruptured ovarian follicle. B. small almond-shaped structure that produces an ova every 28 to 30 days. C. fold of mucous membrane that partially covers the entrance to the vagina. D. exocrine gland that secretes human chorionic gonadotropin throughout pregnancy.A. small endocrine structure that develops within a ruptured ovarian follicleVaginal yeast infections develop when: A. an intrauterine device is left in place too long. B. a woman is exposed to cytomegalovirus. C. the vaginal environment becomes less acidic. D. a woman has repeated outbreaks of genital herpes.C. the vaginal environment becomes less acidicWhen palpating the abdomen of a female in pain, you should: A. examine the area farthest away from the pain first. B. palpate vigorously to determine the problem organ. C. auscultate bowel sounds for at least 3 to 5 minutes. D. locate the area of pain and palpate that area first.A. examine the area farthest away from the pain firstA 26-year-old female, who is at the end of her first trimester of pregnancy, complains of vaginal bleeding. She denies abdominal pain, and states that her last menstrual cycle was approximately 2 months ago. She is conscious and alert and her vital signs are stable. You should be MOST suspicious for: A. placenta previa. B. spontaneous abortion. C. uterine rupture. D. premature labor.B. spontaneous abortionA 30-year-old female with abdominal pain would be LEAST likely to answer your questions if she: A. is currently menstruating. B. has had a miscarriage. C. was sexually abused. D. is having unprotected sex.C. was sexually abused