Gynecologic Trauma, Toxic Shock, and Other Emergencies Practice Questions

25 multiple-choice questions on Gynecologic trauma, toxic shock, and other emergencies for paramedic and EMT students, from Chapter 23 (Gynecologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Bleeding from an external genital laceration is best controlled with:

   1. A. Direct pressure with a pad
   2. B. Gauze packed into the vagina
   3. C. A tourniquet on the upper thigh
   4. D. A hemostatic dressing inserted inside
   Show answer

   Answer: A. Direct pressure with a pad

   The genital area is very vascular, but firm external pressure controls most bleeding. Never pack the vagina in the field.

2. A 9-year-old fell onto a bicycle crossbar and has vulvar swelling and bleeding. This is a:

   1. A. Pelvic fracture
   2. B. Straddle injury
   3. C. Ovarian torsion
   4. D. Urethral stone
   Show answer

   Answer: B. Straddle injury

   Straddle injuries crush soft tissue against the pubic bone, causing hematomas and lacerations. Consider urethral injury if she cannot urinate.

3. A large, painful vulvar hematoma after a fall is best managed in the field with:

   1. A. Cold packs and transport
   2. B. Warm packs to the area
   3. C. Needle drainage on scene
   4. D. Tight vaginal packing
   Show answer

   Answer: A. Cold packs and transport

   Cold reduces swelling and pain. Expanding hematomas can hide significant blood loss and may need surgical drainage.

4. A woman was struck in the abdomen by a vehicle handlebar at 30 weeks pregnant. Your main concern is:

   1. A. Ovarian cyst rupture
   2. B. Placental abruption
   3. C. Toxic shock syndrome
   4. D. Bartholin abscess
   Show answer

   Answer: B. Placental abruption

   Blunt abdominal trauma in pregnancy can separate the placenta, causing pain, bleeding, and fetal distress. Transport to a facility with obstetric care.

5. A 5-year-old has foul-smelling vaginal discharge and spotting for a week. The most likely cause is:

   1. A. Ovarian torsion
   2. B. Ectopic pregnancy
   3. C. Early onset of menstruation
   4. D. A retained foreign body
   Show answer

   Answer: D. A retained foreign body

   Small children often insert objects, commonly toilet paper. Abuse must also be considered and handled per local law.

6. Toxic shock syndrome is caused by:

   1. A. Viral infection
   2. B. An allergic reaction
   3. C. Bacterial toxins
   4. D. Hormonal imbalance
   Show answer

   Answer: C. Bacterial toxins

   Toxins from Staphylococcus aureus or Streptococcus act as superantigens, triggering fever, rash, and shock. It is linked to tampons, packing, and wounds.

7. A 19-year-old using a tampon has fever, a sunburn-like rash, vomiting, and BP 82/48. You should:

   1. A. Treat shock; remove tampon
   2. B. Give oral fluids and release
   3. C. Leave the tampon for the ED
   4. D. Give an antihistamine only
   Show answer

   Answer: A. Treat shock; remove tampon

   Remove the toxin source if she can or will allow it, give IV fluids per protocol, and transport. TSS can progress to multiple organ failure.

8. The rash of toxic shock syndrome is typically:

   1. A. Clustered painful blisters
   2. B. Raised hives that itch
   3. C. Purple spots on the legs
   4. D. Diffuse and sunburn-like
   Show answer

   Answer: D. Diffuse and sunburn-like

   A flat, red, widespread rash appears early and later peels, especially on the palms and soles.

9. A woman has a tender, swollen, warm lump at the lower edge of the vaginal opening. This is most likely a:

   1. A. Strangulated inguinal hernia
   2. B. Uterine prolapse
   3. C. Bartholin gland abscess
   4. D. Vulvar hematoma
   Show answer

   Answer: C. Bartholin gland abscess

   Blocked Bartholin ducts become infected, forming a painful abscess. It needs drainage but is rarely life-threatening.

10. Five days after a hysterectomy, a woman has sudden dyspnea and pleuritic chest pain. You suspect:

    1. A. Postoperative pneumonia
    2. B. Pulmonary embolism
    3. C. Anxiety attack
    4. D. Wound infection
    Show answer

    Answer: B. Pulmonary embolism

    Pelvic surgery and immobility raise clot risk. Sudden dyspnea and tachycardia after surgery are a PE until proven otherwise.

11. A day after gynecologic surgery, a patient has a pulse of 122, abdominal pain, and dizziness. You should suspect:

    1. A. Normal postop pain
    2. B. Internal bleeding
    3. C. Mild dehydration
    4. D. Constipation
    Show answer

    Answer: B. Internal bleeding

    Tachycardia and dizziness after surgery suggest hemorrhage. Treat for shock and transport, ideally to the operating hospital.

12. Bleeding after intercourse in a 45-year-old woman should prompt evaluation for:

    1. A. Normal ovulation
    2. B. Kidney stones
    3. C. Appendicitis
    4. D. Cervical lesions
    Show answer

    Answer: D. Cervical lesions

    Postcoital bleeding can come from infection, polyps, or cervical cancer. It always needs follow-up.

13. In pregnancy, an abusive partner most often injures the:

    1. A. Hands and wrists
    2. B. Feet and lower legs
    3. C. Abdomen and breasts
    4. D. Upper back and neck
    Show answer

    Answer: C. Abdomen and breasts

    Abuse often begins or increases during pregnancy and targets the pregnancy. Ask about safety privately.

14. Which question screens for intimate partner violence most effectively?

    1. A. Has anyone hurt you?
    2. B. Are you a clumsy person?
    3. C. Does your partner drink?
    4. D. Why do you stay with him?
    Show answer

    Answer: A. Has anyone hurt you?

    Ask directly, privately, and without judgment. Questions that blame or assume make disclosure less likely.

15. In intimate partner violence, which history most increases the risk that the victim will be killed?

    1. A. Prior strangulation by the partner
    2. B. The couple argues about money
    3. C. The partner works long hours
    4. D. The victim has moved homes once in the past
    Show answer

    Answer: A. Prior strangulation by the partner

    Nonfatal strangulation by a partner is one of the strongest predictors of later homicide, raising the risk about sevenfold. Ask about it directly and make sure the patient is connected with advocates.

16. You suspect intimate partner violence in an adult patient. The best action is to:

    1. A. Confront the partner on scene
    2. B. Tell her she must leave him today
    3. C. Say nothing to avoid conflict
    4. D. Give resources; follow local law
    Show answer

    Answer: D. Give resources; follow local law

    Ensure scene safety, document objectively, give hotline information, and report per local law. Confrontation can increase danger.

17. A woman 2 days after an abortion procedure has heavy bleeding and a pulse of 130. The main threat is:

    1. A. Pulmonary embolism
    2. B. Hemorrhagic shock
    3. C. Anaphylaxis to the drugs
    4. D. Hypoglycemia
    Show answer

    Answer: B. Hemorrhagic shock

    Retained tissue or uterine injury can cause heavy bleeding. Treat for shock and transport promptly. With heavy bleeding and a rising pulse, blood loss is the threat; nothing here points to a clot, an allergic reaction, or low glucose.

18. Weeks after a hysterectomy, a woman feels a sudden pop during intercourse and now sees bowel at the vaginal opening. You should:

    1. A. Push the bowel back into place
    2. B. Have her walk to the ambulance
    3. C. Cover it with moist sterile dressings
    4. D. Give her water to drink before transport
    Show answer

    Answer: C. Cover it with moist sterile dressings

    Vaginal cuff dehiscence with evisceration is a surgical emergency. Manage like any evisceration: do not reduce the bowel, cover with moist sterile dressings, keep her supine, and transport.

19. Heavy vaginal bleeding after intercourse that does not slow with external pad pressure suggests:

    1. A. A normal first period
    2. B. A laceration that needs repair
    3. C. A urinary tract infection
    4. D. An ovarian cyst that has ruptured
    Show answer

    Answer: B. A laceration that needs repair

    Vaginal lacerations from intercourse can bleed briskly and need surgical repair. Control what you can with external pads, treat for shock, and transport. Consider assault and ask privately.

20. A woman 10 weeks pregnant fell down three stairs and has mild cramping. She feels fine. Best care is to:

    1. A. Transport for evaluation
    2. B. Release with advice to rest
    3. C. Treat cramps with ice only
    4. D. Advise a doctor visit next week
    Show answer

    Answer: A. Transport for evaluation

    Even minor trauma can cause bleeding or pregnancy loss. Early evaluation is recommended, and Rh status may matter.

21. A postmenopausal woman has vaginal bleeding after a fall onto a chair. You should consider:

    1. A. A normal menstrual period returning
    2. B. An early pregnancy
    3. C. Ovulation bleeding
    4. D. Tears in thin, fragile tissue
    Show answer

    Answer: D. Tears in thin, fragile tissue

    Low estrogen thins the vaginal tissue, which tears easily. Postmenopausal bleeding also needs evaluation for cancer.

22. When you give an intimate partner violence survivor information about resources, it is safest to:

    1. A. Hand her a printed pamphlet
    2. B. Leave it with her partner
    3. C. Ask how she can keep it safely
    4. D. Post it on her refrigerator door
    Show answer

    Answer: C. Ask how she can keep it safely

    If an abuser finds written materials, the danger can escalate. Ask how she would like to receive the information, for example a hotline number she can memorize or store discreetly.

23. Uterine prolapse becomes an emergency mainly when it:

    1. A. Is noticed for the first time
    2. B. Cannot be reduced, turns dark
    3. C. Causes mild pressure
    4. D. Leaks urine with coughing
    Show answer

    Answer: B. Cannot be reduced, turns dark

    An irreducible, discolored prolapse may be losing blood supply. Cover it with moist dressings and transport.

24. A woman who had pelvic radiation for cancer now notices stool passing from her vagina. You should suspect:

    1. A. A yeast infection
    2. B. A normal effect of age
    3. C. A urinary tract infection
    4. D. A rectovaginal fistula
    Show answer

    Answer: D. A rectovaginal fistula

    Radiation, obstetric injury, Crohn disease, and surgery can create a fistula between the rectum and vagina, causing passage of gas or stool and infections. It needs surgical evaluation.

25. A woman taking tamoxifen after breast cancer has new postmenopausal bleeding. Tamoxifen is relevant because it raises the risk of:

    1. A. Uterine cancer and blood clots
    2. B. Osteoporosis and hip fractures
    3. C. Gout and high uric acid
    4. D. Low blood sugar
    Show answer

    Answer: A. Uterine cancer and blood clots

    Tamoxifen acts like estrogen on the uterus, increasing the risk of endometrial cancer, and it also raises venous thromboembolism risk. Postmenopausal bleeding on tamoxifen needs prompt evaluation. In postmenopausal women tamoxifen tends to protect bone, and it does not cause gout or low blood sugar.