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Ch. 22 - Gynecologic Emergencies

Terms in this set (27)

Mittelschmerz is defined as:
A) a sudden premature cessation of menses
B) two consecutively missed menstrual periods
C) pain in the middle of the menstrual cycle
D) pain that occurs outside the menstrual cycle
C) pain in the middle of the menstrual cycle
In contrast to endometritis, endometriosis:
A) may present without abdominal pain
B) is an inflammation of the uterine lining
C) generally causes light menstrual periods
D) is often the result of gynecologic surgery
A) may present without abdominal pain
Which of the following is a potential complication of PID?
A) uterine rupture
B) ectopic pregnancy
C) respiratory failure
D) UTI
B) ectopic pregnancy
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
B) can cause severe intra-abdominal hemorrhage
In an ectopic pregnancy, bleeding usually occurs:
A) before the onset of pain
B) after the onset of pain
C) only if a fallopian tube is involved
D) after signs of shock have developed
B) after the onset of pain
A patient was secretly given large doses of Xanax and Rohypnol before being sexually assaulted. The patient is unresponsive and has slow, shallow breathing. What additional assessment finding would you expect to encounter?
A) bradycardia
B) hypertension
C) tachypnea
D) tachycardia
A) bradycardia
In contrast to endometriosis, a patient with endometritis would be expected to present with:
A) painful intercourse
B) escalating menstrual cramping
C) a feeling of rectal pressure
D) fever, chills, and vomiting
D) fever, chills, and vomiting
Bleeding followed by pelvic pain in a patient who is less than 20 weeks' pregnant may be caused by:
A) ovarian torsion
B) Braxton-Hicks contractions
C) an ectopic pregnancy
D) PID
C) an ectopic pregnancy
Which of the following is a predisposing factor in the development of an ectopic pregnancy?
A) ovarian cyst
B) uterine prolapse
C) PID
D) Mittelschmerz
C) PID
Which of the following reflects typical findings associated with an ectopic pregnancy?
A) sudden high fever, diarrhea, and abdominal tenderness
B) syncope, dizziness, and no abdominal pain
C) headache, lower abdominal pain, and vaginal bleeding
D) abdominal pain, delayed menses, and abnormal vaginal bleeding
D) abdominal pain, delayed menses, and abnormal vaginal bleeding
You are called for a 48 y/o woman reporting abdominal cramping and vaginal bleeding. She states that her periods have become irregular over the past 6 months with her LMP occurring 2 weeks ago. Her symptoms recurred today with blood flow that is much heavier than usual. What should you suspect?
A) DUB
B) ovarian torsion
C) PID
D) vaginitis
A) DUB
You are responding to a 24 y/o woman who is reporting lower abdominal pain and vaginal bleeding. She is laying on the sofa and is conscious, alert, and cooperative. She tells you she has been having lower back pain and pelvic pain for at least 3 months. She has had a very heavy menstrual flow with spotting between periods. She adamantly denies a possibility she could be pregnant. What should you suspect?
A) endometriosis
B) vaginal yeast infection
C) endometritis
D) ruptured ovarian cyst
A) endometriosis
As a paramedic, which of the following is NOT part of your responsibilities in the case of sexual assault?
A) preserving evidence
B) collecting evidence
C) providing emotional support
D) treating the patient for physical injuries
B) collecting evidence
A 41 y/o woman has called you for what she describes as "something falling out of my vagina". Her symptoms began after a lengthy shopping excursion. She proudly reports that she exercises regularly, adheres to a healthy diet, and is the mother of 6 children. What should you suspect?
A) ectopic pregnancy
B) ruptured ovarian cyst
C) uterine prolapse
D) endometriosis
C) uterine prolapse
Which of the following is most likely to cause ovarian torsion?
A) ectopic pregnancy
B) Bartholin abscess
C) ovarian cyst
D) cystitis
C) ovarian cyst
You are dispatched to a residence for a 34 y/o woman who is "sick". Upon your arrival, the patient greets you at the door. She tells you that she has been experiencing a dull aching pain in the LLQ of her abdomen. She further states that she recently had her menstrual period, which was accompanied by more bleeding than usual. Her vitals are stable, she is conscious and alert, and she denies vaginal bleeding or fever. This patient MOST likely has:
A) PID
B) a tubo-ovarian abscess
C) a ruptured ovarian cyst
D) an ectopic pregnancy
C) a ruptured ovarian cyst
An obese 30 y/o female had two children within an 18-month time span. She presents with a feeling of "heaviness" in her pelvis and lower back pain. She states that the symptoms resolve slightly when she lies down. What should you suspect?
A) ectopic pregnancy
B) uterine prolapse
C) endometriosis
D) endometritis
B) uterine prolapse
A woman is diagnosed with a prolapsed uterus. Her cervix has dropped, but remains within the vagina. This is a _____ degree prolapse.
A) second
B) fourth
C) first
D) third
C) first
While caring for an unresponsive young woman who was apparently sexually assaulted, you note that her respirations are shallow and slow, 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) visualizing her vaginal area to assess for external bleeding
B) establishing an IV line and administering 0.5 mg of atropine
C) maintaining her airway and providing ventilatory assistance
D) elevating her lower extremities to improve her blood pressure
C) maintaining her airway and providing ventilatory assistance
A 30 y/o woman complains of an "achy" pain to both lower quadrants, 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. Her BP is 122/62, pulse rate is 84 bpm and strong, and respirations are 14/min and unlabored. After gathering the rest of her medical history, you should:
A) visually inspect her vagina for bleeding or discharge, start an IV line and set it to KVO, and transport
B) provide emotional support, make her as comfortable as possible, and safely transport
C) establish vascular access and give her a 250 mL bolus of NS, consider analgesia for her pain, and transport
D) advise her that she can probably go to the hospital via personal vehicle since she is not showing signs of shock
B) provide emotional support, make her as comfortable as possible, and safely transport
You are dispatched to a grocery store for a woman with severe abdominal pain. When you arrive, you find the patient laying on her side in the manager's office. She is confused, diaphoretic, and appears to be bleeding from her vagina. Her BP is low, and her pulse and RR are elevated. You should:
A) 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 O2
B) apply high-flow O2, 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
C) assist her ventilations with a BVM, 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 boluses as needed
D) administer 100% oxygen, elevate her legs 12-18 inches, keep her warm, establish vascular access and give a 500 mL bolus, reassess her BP, and transport at once with continuous monitoring en route to the hospital
B) apply high-flow O2, 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
If a young female with a known history of gonorrhea presents with abdominal pain, nausea, vomiting, and bleeding between periods:
A) she most likely has PID
B) it is likely that she has an ectopic pregnancy
C) one of her ovaries is probably grossly enlarged
D) you should suspect disseminated gonococcemia
A) she most likely has PID
Which 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) endometriosis
B) ectopic pregnancy
C) ovarian cyst
D) imperforate hymen
D) imperforate hymen
You are caring for a young woman with constant, diffuse abdominal pain, referred pain to both shoulders, and vaginal bleeding. She states that her LMP was 2 months ago, and she adamantly denies being pregnant. Her BP is 86/50, pulse is 120 bpm and weak, respirations are 24/min and regular. Which of the following interventions is NOT appropriate for this patient?
A) cardiac monitoring
B) narcotic analgesia
C) IV fluid boluses
D) thermal management
B) narcotic analgesia
A young female experienced trauma to her genitalia and has profuse vaginal bleeding. She is hypotensive, tachycardic, and tachypneic. You should:
A) perform a quick internal exam to locate the bleeding
B) place a trauma dressing into her vagina
C) administer an analgesic
D) transport immediately
D) transport immediately
You are caring for a 44 y/o 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 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 transport
A) ask the patient if there is a friend you can call with whom she can stay
Risks for PID include:
A) monogamy
B) heterosexual sex with multiple partners
C) an IUD
D) 20-24 year-old age group
A) monogamy
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