Question 1

Mittelschmerz refers to which of the following?

Accepted Answer

A)   Purulent vaginal discharge
B)   False labor pains
C)   Midcycle abdominal pain
D)   Painful urination C

Question 2

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

Accepted Answer

A)   Placing sterile gauze over the opening of the vagina
B)   Using a tampon
C)   Using a sanitary napkin
D)   Placing an absorbent pad under the patient B

Question 3

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?

Accepted Answer

A)   Ectopic pregnancy
B)   Pelvic inflammatory disease
C)   Mittelschmerz
D)   Ruptured ovarian cyst D

Question 4

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:

Accepted Answer

A)   ask her if she has ever had a miscarriage.
B)   perform a vaginal exam to determine if she is still bleeding.
C)   transport the patient in a position of comfort and provide emotional support.
D)   inform the patient's husband that she may be having a miscarriage.

Question 5

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?

Accepted Answer

A)   Ectopic pregnancy
B)   Pelvic inflammatory disease
C)   Menopause-related dysfunctional uterine bleeding
D)   Spontaneous abortion

Question 6

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?

Accepted Answer

A)   Endometriosis
B)   Pelvis inflammatory disease
C)   Miscarriage
D)   Ectopic pregnancy

Question 7

All of the following are associated with spontaneous abortion EXCEPT:

Accepted Answer

A)   nontraumatic vaginal bleeding.
B)   the passage of clots and tissue.
C)   hypotension and fever.
D)   cramping abdominal pain.

Question 8

Which of the following occurs during the proliferative phase of the menstrual cycle?

Accepted Answer

A)   Ovulation
B)   An increase in uterine vascularity
C)   Endometrial thickening
D)   A drop in estrogen levels

Question 9

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?

Accepted Answer

A)   IV fluids, oxygen, and transport
B)   Position of comfort, pain medication, and delayed transport
C)   Detailed secondary exam and 12-lead ECG
D)   Knee-chest position and rapid transport

Question 10

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

Accepted Answer

A)   life-threatening hemorrhagic shock and the need for fluid resuscitation.
B)   potentially dangerous obstructive shock that requires rapid transport.
C)   a common medical condition that affects many women each year.
D)   a very rare disease process that requires immediate surgery to save the pregnancy.

Question 11

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?

Accepted Answer

A)   "My boyfriend was just diagnosed with chlamydia."
B)   "I just had an IUD inserted."
C)   "My last menstrual cycle was normal."
D)   "I have chronic urinary tract infections."

Question 12

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

Accepted Answer

A)   ovarian cysts.
B)   pelvic inflammatory disease.
C)   a urinary tract infection.
D)   an ectopic pregnancy.

Question 13

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?

Accepted Answer

A)   Explain to the patient that she must allow you to examine her for injuries.
B)   Ask the patient to describe how she was assaulted so you know where she is injured.
C)   Tell the patient that you cannot help her if she won't allow you to touch her.
D)   Explain to the patient that you will not touch her if she does not want you too.

Question 14

Which of the following is TRUE of mittelschmerz?

Accepted Answer

A)   It is typically located unilaterally in one of the upper abdominal quadrants.
B)   It is usually accompanied by heavy vaginal bleeding.
C)   It is associated with ovulation.
D)   It is a sign of ectopic pregnancy.

Question 15

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:

Accepted Answer

A)   make it clear that she must be honest about her sexual history.
B)   start a large-bore IV and transport emergently.
C)   ask the mother if the patient might be pregnant.
D)   transport in a position of comfort.

Question 16

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

Accepted Answer

A)   Allow a friend to accompany the victim in the back of the ambulance.
B)   Ask simple, closed-ended questions about the nature of the assault.
C)   Keep the back of the ambulance well lit and warm.
D)   Do not touch the patient unless it is necessary to obtain vital signs or examine injuries.

Question 17

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:

Accepted Answer

A)   allow her to change and carefully bag each item of clothing.
B)   refuse to let her change her clothing, as it will destroy evidence.
C)   allow her to change only her shirt, not her pants or undergarments.
D)   promise to let her change as soon as you get to the hospital.

Question 18

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?

Accepted Answer

A)   "Are you planning to have gender reassignment surgery?"
B)   "When was your last menstrual cycle?"
C)   "How often do you use illegal drugs?"
D)   "Are you usually sexually active with men, or with women?"

Question 19

The innermost lining of the uterus is called the:

Accepted Answer

A)   myometrium.
B)   perimetrium.
C)   endometrium
D)   vasometrium.

Question 20

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:

Accepted Answer

A)   palpate the abdomen.
B)   administer oxygen.
C)   withhold pain medication.
D)   look for vaginal bleeding.

Exam 1: Gynecology