Question 1

The innermost lining of the uterus is called the:

Accepted Answer

The innermost lining of the uterus is called the endometrium. The myometrium is the middle layer of the uterus composed of muscle tissue, while the perimetrium is the outer layer of the uterus. Vasometrium is not a recognized term.

Question 2

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

The patient's symptoms and vital signs suggest the possibility of a serious medical condition such as ectopic pregnancy, ruptured ovarian cyst, or pelvic inflammatory disease. Therefore, the patient should be transported emergently to a hospital with appropriate resources. Starting an IV is also an appropriate intervention to support the patient's blood pressure during transport. Asking about the patient's sexual history is important for diagnostic purposes, but should be done in a sensitive and non-judgmental manner. Transporting in a position of comfort may not be appropriate if the patient's medical condition requires a specific position or if there is concern for internal bleeding.

Question 3

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

In this situation, it is important to respect the patient's autonomy and need for control. It is inappropriate to force an examination on a patient who is not consenting to touch. Option A and B do not prioritize the patient's emotional and mental well-being. Option C is not helpful in building trust with the patient and may further traumatize her. Therefore, the best option is to explain to the patient that you will not touch her if she does not want you to, but also offer reassurance that you are there to support her in any way possible.

Question 4

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

It is important to preserve evidence in cases of sexual assault, but it is also important to provide compassionate care to the survivor. Allowing the survivor to change her clothes while carefully bagging each item will preserve evidence and also allow the survivor to feel more comfortable and in control of her body.

Question 5

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

Accepted Answer

IV drug usage is not directly associated with an increased risk of ectopic pregnancy. Risk factors for ectopic pregnancy primarily involve conditions that affect the fallopian tubes or reproductive system, such as pelvic inflammatory disease, use of an intrauterine device, and a history of previous ectopic pregnancies.

Question 6

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

The patient's recent sexual history and her boyfriend's diagnosis of chlamydia suggest that she may have contracted an STD, which can lead to pelvic inflammatory disease. Option B is a possible risk factor for the development of PID, but it does not specifically suggest that the patient currently has PID. Option C and D are not indicative of pelvic inflammatory disease.

Question 7

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:

Accepted Answer

The symptoms described, including severe pain that started during intercourse, a small amount of vaginal bleeding, and a history of irregular menstrual cycles, are most consistent with a ruptured ovarian cyst. Ruptured ovarian cysts can cause sudden, severe pain and bleeding. The location of the pain and its acute onset further support this diagnosis over the others listed.

Question 8

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

Accepted Answer

Cystitis is an inflammation of the bladder and is commonly caused by a urinary tract infection. Therefore, the patient is being treated for a urinary tract infection.

Question 9

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

The most likely cause of severe abdominal pain and signs of shock in a woman with an IUD is an ectopic pregnancy. This occurs when a fertilized egg implants outside the uterus, typically in the fallopian tube, and can cause life-threatening bleeding. It is important to consider the possibility of ectopic pregnancy in any sexually active woman of reproductive age with abdominal pain and especially if she has an IUD in place. Endometriosis and pelvic inflammatory disease may also cause abdominal pain but are less likely to cause signs of shock. Miscarriage is unlikely in someone with an IUD in place as the device is highly effective in preventing pregnancy.

Question 10

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?

Accepted Answer

Asking about the last menstrual period is important to assess for possible pregnancy-related issues, even after tubal ligation, as it is not 100% effective.

Question 11

All of the following are associated with spontaneous abortion EXCEPT:

Accepted Answer

Hypotension and fever are not typically associated with spontaneous abortion, but may indicate a complication such as sepsis or hemorrhage. A, B, and D are commonly associated symptoms of spontaneous abortion.

Question 12

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

Accepted Answer

The paramedic accurately describes the difference between endometritis and endometriosis when she states that "Endometritis is an infection of the uterine lining, while endometriosis occurs when endometrial tissue is found outside the uterus." Option A is incorrect as endometriosis does not involve an infection of the uterine lining. Option B is incorrect as both conditions can occur in women of any age. Option D is incorrect as the mode of transportation should be determined by the severity of the patient's condition and not by the diagnosis.

Question 13

Which of the following is TRUE of mittelschmerz?

Accepted Answer

Mittelschmerz is a German word that translates to "middle pain." It is a type of ovulation pain that typically occurs in one side of the lower abdomen, corresponding to the ovary that is releasing an egg. It is not usually accompanied by heavy vaginal bleeding and is not a sign of ectopic pregnancy.

Question 14

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

Accepted Answer

The proliferative phase is characterized by the thickening of the endometrium, as a result of increased estrogen levels.

Question 15

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?

Accepted Answer

The presence of blood in the urine along with abdominal pain and fever suggests a possible urinary tract infection. Asking about pain or burning with urination can help confirm this suspicion. The other questions may be helpful in gathering additional information, but they are not as directly related to the patient's presenting symptoms.

Question 16

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

This patient is exhibiting symptoms of a spontaneous abortion, also known as a miscarriage. The heavy vaginal bleeding and lack of significant gynecologic history suggest that the bleeding is not related to pelvic inflammatory disease or menopause-related dysfunctional uterine bleeding. While ectopic pregnancy can also cause vaginal bleeding, the fact that the patient has had three previous pregnancies suggests that this is less likely.

Question 17

Menorrhagia is:

Accepted Answer

Menorrhagia is characterized by excessive menstrual flow, which may lead to bleeding through clothing or menstrual products in a short period of time.

Question 18

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:

Accepted Answer

The patient's symptoms suggest a potential gynecological emergency, and vital signs should be assessed to determine the severity of the situation. Transport to the hospital should also be initiated as soon as possible for further evaluation and treatment. Applying oxygen and starting an IV may not be necessary at this time, and advising the patient to insert a tampon may worsen the situation. Asking about family history of uterine cancer may be relevant to the evaluation, but assessing the patient's vital signs and initiating transport should be prioritized.

Question 19

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

This patient is likely experiencing complications from her recent abortion, such as infection or hemorrhage, indicated by her symptoms of severe abdominal pain, fever, and ongoing bloody discharge. Immediate supportive care with IV fluids and oxygen is crucial to manage potential shock or sepsis, and rapid transport to a medical facility is necessary for further evaluation and treatment.

Question 20

Mittelschmerz refers to which of the following?

Accepted Answer

Mittelschmerz is midcycle abdominal pain associated with ovulation in women. It is not related to the other options.

Quiz 1: Gynecology