Pelvic Inflammatory Disease and STIs Practice Questions

25 multiple-choice questions on Pelvic inflammatory disease and STIs 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. Pelvic inflammatory disease (PID) is an infection of the:

   1. A. Bladder and urethra only
   2. B. Kidneys and ureters
   3. C. Uterus, tubes, ovaries
   4. D. Lower bowel and rectum
   Show answer

   Answer: C. Uterus, tubes, ovaries

   PID is an ascending infection of the upper genital tract. It can scar the fallopian tubes and cause infertility and ectopic pregnancy.

2. The most common causes of PID are:

   1. A. E. coli and Klebsiella
   2. B. Influenza and RSV viruses
   3. C. Candida and tinea
   4. D. Gonorrhea and chlamydia
   Show answer

   Answer: D. Gonorrhea and chlamydia

   Sexually transmitted organisms ascend from the cervix. Other bacteria may join the infection later.

3. A 20-year-old has lower abdominal pain, fever, and foul vaginal discharge. She walks with a shuffling gait. You suspect:

   1. A. An obstructing kidney stone
   2. B. Ovarian torsion
   3. C. Pelvic inflammatory disease
   4. D. Urinary tract infection
   Show answer

   Answer: C. Pelvic inflammatory disease

   Pain with walking (the 'PID shuffle'), fever, and discharge are typical. Pain usually involves both sides of the pelvis.

4. PID pain is classically:

   1. A. Right upper quadrant only
   2. B. Bilateral lower abdominal
   3. C. Left shoulder tip only
   4. D. Epigastric and burning pain
   Show answer

   Answer: B. Bilateral lower abdominal

   PID usually affects both tubes, so pain is felt on both sides. Unilateral pain should raise suspicion of ectopic or torsion.

5. A long-term complication of PID is:

   1. A. Infertility
   2. B. Uterine fibroids
   3. C. Early menopause
   4. D. Cervical cancer
   Show answer

   Answer: A. Infertility

   Tubal scarring blocks the egg's passage, raising the risk of infertility and ectopic pregnancy. PID does not cause fibroids or early menopause, and cervical cancer is linked to HPV rather than PID.

6. Fitz-Hugh-Curtis syndrome, a PID complication, causes:

   1. A. Left lower quadrant pain
   2. B. Left upper quadrant pain
   3. C. Pain in the left shoulder tip
   4. D. Right upper quadrant pain
   Show answer

   Answer: D. Right upper quadrant pain

   Infection spreads to the liver capsule and causes RUQ pain that can mimic gallbladder disease. The liver sits on the right, so left-sided abdominal or shoulder pain does not fit.

7. A tubo-ovarian abscess is dangerous because it can:

   1. A. Rupture and cause sepsis
   2. B. Resolve without treatment
   3. C. Form kidney stones
   4. D. Stop menstruation
   Show answer

   Answer: A. Rupture and cause sepsis

   A ruptured abscess spills pus into the abdomen, causing peritonitis and septic shock.

8. Which patient with PID needs the most urgent care?

   1. A. One with mild, thin discharge
   2. B. One with hypotension, fever
   3. C. One with pain for a week
   4. D. One with normal vitals
   Show answer

   Answer: B. One with hypotension, fever

   Signs of sepsis require fluids per protocol and rapid transport.

9. Chlamydia infection in women is often:

   1. A. Always severely painful
   2. B. Accompanied by rash
   3. C. Without symptoms
   4. D. Limited to the skin
   Show answer

   Answer: C. Without symptoms

   Many women have no symptoms, so the infection goes untreated and can lead to PID.

10. Genital herpes typically causes:

    1. A. Painless warts
    2. B. Painful blisters, ulcers
    3. C. A single painless sore
    4. D. No visible skin changes
    Show answer

    Answer: B. Painful blisters, ulcers

    Herpes causes painful clusters of blisters. A painless chancre suggests syphilis.

11. A sexually active adult has a rash on the palms and soles, fever, and swollen lymph nodes. You should consider:

    1. A. Genital herpes
    2. B. Bacterial vaginosis
    3. C. A yeast infection
    4. D. Secondary syphilis
    Show answer

    Answer: D. Secondary syphilis

    Secondary syphilis typically appears weeks after the chancre with a rash that involves the palms and soles, fever, and lymphadenopathy. Syphilis cases have risen sharply; use standard precautions.

12. Gonorrhea is now treated with injected ceftriaxone mainly because it:

    1. A. Resists many oral antibiotics
    2. B. Is caused by a virus
    3. C. Is not treatable with any drug
    4. D. Is a type of fungal infection
    Show answer

    Answer: A. Resists many oral antibiotics

    Neisseria gonorrhoeae has developed resistance to penicillins, tetracyclines, and fluoroquinolones, so current CDC guidance recommends a single IM dose of ceftriaxone.

13. Expedited partner therapy for an STI means:

    1. A. Treating only the patient
    2. B. Testing the patient twice
    3. C. Giving treatment for the partner
    4. D. Reporting the partner to the police
    Show answer

    Answer: C. Giving treatment for the partner

    With expedited partner therapy, the clinician gives the patient medication or a prescription to deliver to sex partners without examining them, reducing reinfection. It is legal in most states.

14. Which contraceptive method also lowers the risk of STIs?

    1. A. Birth control pills
    2. B. A copper IUD
    3. C. Contraceptive implant
    4. D. Condoms
    Show answer

    Answer: D. Condoms

    Condoms are the only common contraceptive method that reduces transmission of many STIs. Hormonal methods and IUDs prevent pregnancy but offer no STI protection.

15. Trichomoniasis typically causes:

    1. A. Thick, white discharge
    2. B. Frothy, foul discharge
    3. C. Painful genital blisters
    4. D. Painless genital warts
    Show answer

    Answer: B. Frothy, foul discharge

    Trichomonas causes a yellow-green, frothy, foul-smelling discharge with itching. Thick white discharge suggests yeast, painful blisters suggest herpes, and warts are caused by HPV.

16. A vaginal yeast infection usually causes:

    1. A. Fever and severe pelvic pain
    2. B. Referred shoulder pain
    3. C. White discharge, itching
    4. D. Low blood pressure
    Show answer

    Answer: C. White discharge, itching

    Candida causes cottage cheese-like discharge and itching without fever.

17. Bacterial vaginosis is known for:

    1. A. A fishy odor
    2. B. Severe pelvic pain
    3. C. High fever
    4. D. Bloody urine
    Show answer

    Answer: A. A fishy odor

    BV causes a thin, gray discharge with a fishy odor.

18. Gonorrhea can spread through the bloodstream, causing:

    1. A. A painless genital ulcer
    2. B. Genital warts
    3. C. Joint pain and rash
    4. D. Liver failure and jaundice
    Show answer

    Answer: C. Joint pain and rash

    Disseminated gonococcal infection causes fever, joint pain, and skin lesions. A painless ulcer is the chancre of syphilis, warts come from HPV, and gonorrhea does not cause liver failure.

19. Taking doxycycline within 72 hours after sex (doxy-PEP) is used in some patients to prevent:

    1. A. Bacterial STIs such as syphilis
    2. B. HIV infection
    3. C. Unplanned pregnancy
    4. D. Recurrent genital herpes outbreaks
    Show answer

    Answer: A. Bacterial STIs such as syphilis

    CDC guidance (2024) supports doxycycline post-exposure prophylaxis for certain high-risk groups to reduce syphilis, chlamydia, and gonorrhea. It does not prevent HIV, viral STIs, or pregnancy.

20. HPV infection is important because it can cause:

    1. A. Ovarian cancer
    2. B. Pelvic inflammatory disease
    3. C. Endometrial cancer
    4. D. Cervical cancer
    Show answer

    Answer: D. Cervical cancer

    Some HPV types cause cervical cancer. Vaccination reduces risk. HPV is not a cause of ovarian or endometrial cancer, and PID is caused mainly by gonorrhea and chlamydia.

21. A woman with pelvic pain is being assessed for PID. Which part of her history most raises the likelihood of PID?

    1. A. Regular, vigorous exercise
    2. B. Multiple partners or a prior STI
    3. C. Use of condoms with every partner
    4. D. Having her appendix removed as a child
    Show answer

    Answer: B. Multiple partners or a prior STI

    PID is usually caused by sexually transmitted organisms ascending from the cervix, so new or multiple partners and prior STIs raise risk. Consistent condom use lowers it.

22. On a hospital pelvic exam, pain when the cervix is moved (cervical motion tenderness) suggests:

    1. A. A urinary tract infection
    2. B. A normal pregnancy
    3. C. Pelvic inflammatory disease
    4. D. Constipation with hard stool
    Show answer

    Answer: C. Pelvic inflammatory disease

    Cervical motion, uterine, or adnexal tenderness is a minimum diagnostic criterion for PID in sexually active women with pelvic pain. It can also occur with ectopic pregnancy, so pregnancy must be excluded.

23. Untreated PID can lead to chronic:

    1. A. Hot flashes
    2. B. Urinary incontinence
    3. C. Vaginal yeast infections
    4. D. Pelvic pain
    Show answer

    Answer: D. Pelvic pain

    Scarring and adhesions can cause long-term pelvic pain. PID does not cause hot flashes, lasting incontinence, or yeast infections.

24. Which age group has the highest rate of PID?

    1. A. 40 to 50 years
    2. B. 15 to 25 years
    3. C. Over 60 years
    4. D. Under 10 years
    Show answer

    Answer: B. 15 to 25 years

    Young, sexually active women are at highest risk.

25. Two to four weeks after a possible exposure, a patient has fever, sore throat, rash, and swollen lymph nodes. You should consider:

    1. A. Acute HIV infection
    2. B. Seasonal influenza
    3. C. Hepatitis A infection
    4. D. Iron-deficiency anemia
    Show answer

    Answer: A. Acute HIV infection

    Acute HIV often causes a flu- or mono-like illness weeks after exposure, when viral levels are very high and transmission risk is greatest. It is frequently missed unless the exposure history is taken. Influenza rarely causes a rash with swollen nodes, hepatitis A presents with jaundice and GI symptoms, and anemia does not cause fever.