Vaginal Bleeding and Ectopic Pregnancy Practice Questions

25 multiple-choice questions on Vaginal bleeding and ectopic pregnancy 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. Most ectopic pregnancies implant in the:

   1. A. Cervix
   2. B. Fallopian tube
   3. C. Ovary
   4. D. Abdominal wall
   Show answer

   Answer: B. Fallopian tube

   More than 90% of ectopic pregnancies are tubal, usually in the ampulla. Cervical, ovarian, and abdominal ectopics are rare but can also bleed heavily.

2. The leading cause of maternal death in the first trimester is:

   1. A. Ruptured ectopic pregnancy
   2. B. Preeclampsia
   3. C. Placenta previa with hemorrhage
   4. D. Gestational diabetes
   Show answer

   Answer: A. Ruptured ectopic pregnancy

   Ruptured ectopic pregnancy causes massive internal bleeding. Early recognition and transport save lives.

3. A woman being treated with methotrexate for an ectopic pregnancy now has severe pelvic pain and dizziness. You should:

   1. A. Treat it as a possible rupture
   2. B. Assume it is a drug side effect
   3. C. Tell her to rest and wait
   4. D. Give her water and reassess later
   Show answer

   Answer: A. Treat it as a possible rupture

   Medical treatment does not eliminate the risk of tubal rupture. Increasing pain with dizziness or signs of shock after methotrexate should be treated as rupture with hemorrhage until proven otherwise.

4. Risk factors for ectopic pregnancy include:

   1. A. Regular exercise
   2. B. Prior PID or tubal surgery
   3. C. High-fiber diet
   4. D. Previous normal vaginal births
   Show answer

   Answer: B. Prior PID or tubal surgery

   Scarring of the fallopian tubes from infection, surgery, or a previous ectopic increases risk.

5. A woman who is miscarrying has severe cramping, HR 48, and BP 80/50. Tissue may be stuck in the cervix, causing:

   1. A. Spinal shock from the cramping
   2. B. Amniotic fluid embolism
   3. C. A vagal reaction (cervical shock)
   4. D. A normal response to the severe cramping
   Show answer

   Answer: C. A vagal reaction (cervical shock)

   Products of conception lodged in the cervical opening can trigger an intense vagal response with bradycardia and hypotension. Removal of the tissue in the hospital reverses it. Bleeding must also be considered. Spinal shock follows cord injury, not cramping, and amniotic fluid embolism occurs around delivery, not in an early miscarriage.

6. Spontaneous abortion (miscarriage) is pregnancy loss before:

   1. A. 12 weeks
   2. B. 28 weeks
   3. C. 36 weeks
   4. D. 20 weeks
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   Answer: D. 20 weeks

   Most miscarriages occur in the first trimester. After 20 weeks, it is a fetal death.

7. Which finding suggests a miscarriage is in progress?

   1. A. Fever and dysuria
   2. B. Back pain after lifting
   3. C. Shoulder pain after a fall
   4. D. Cramping, passing tissue
   Show answer

   Answer: D. Cramping, passing tissue

   Cramping, bleeding, and tissue passage are common signs. Bring any tissue to the hospital.

8. Bleeding with a missed period and no pain is still concerning because it may be:

   1. A. A normal menstrual period
   2. B. Kidney stones
   3. C. A threatened miscarriage
   4. D. A urinary tract infection
   Show answer

   Answer: C. A threatened miscarriage

   Painless bleeding in early pregnancy needs evaluation. It may or may not progress to miscarriage.

9. Dysfunctional uterine bleeding is:

   1. A. Bleeding without structural cause
   2. B. Bleeding from a cervical cancer
   3. C. Bleeding from genital trauma
   4. D. Bleeding during active labor
   Show answer

   Answer: A. Bleeding without structural cause

   Hormonal imbalance is the most common cause. It can still be heavy enough to cause anemia.

10. Uterine fibroids can cause:

    1. A. Fever and foul discharge
    2. B. Heavy periods, pressure
    3. C. Frothy vaginal discharge
    4. D. Painless breast lumps
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    Answer: B. Heavy periods, pressure

    Fibroids are benign uterine growths that can cause heavy periods, pain, and anemia. Fever with foul discharge suggests infection, frothy discharge suggests trichomoniasis, and fibroids grow in the uterus, not the breast.

11. How should you manage heavy vaginal bleeding in the field?

    1. A. Pack the vagina with gauze
    2. B. External pads; treat shock
    3. C. Apply a tourniquet to the thigh
    4. D. Give oral fluids
    Show answer

    Answer: B. External pads; treat shock

    Do not pack the vagina. Place pads externally, monitor vitals, and treat shock.

12. A woman with heavy bleeding is pale and has a pulse of 124. Your fluid strategy should be:

    1. A. IV fluids to keep perfusion
    2. B. No fluids to prevent edema
    3. C. Oral rehydration solution
    4. D. Large fluids to reach a normal BP
    Show answer

    Answer: A. IV fluids to keep perfusion

    Give fluids per protocol to support perfusion and mental status. Avoid unnecessary delays.

13. Irregular, sometimes heavy periods in the first year or two after menarche are most often caused by:

    1. A. Ovarian cancer
    2. B. Pelvic inflammatory disease
    3. C. A ruptured ectopic pregnancy
    4. D. Cycles without ovulation
    Show answer

    Answer: D. Cycles without ovulation

    The hormonal axis takes time to mature after menarche, so anovulatory cycles are common and can cause irregular or heavy bleeding. Severe bleeding still warrants evaluation for a bleeding disorder.

14. A hemodynamically unstable patient with a suspected ruptured ectopic pregnancy will most likely need:

    1. A. Oral pain medicine
    2. B. A repeat home pregnancy test
    3. C. Emergency surgery
    4. D. Observation at home
    Show answer

    Answer: C. Emergency surgery

    A ruptured ectopic with shock needs rapid transport and surgery to stop the bleeding; methotrexate is used only for stable, unruptured cases. Pre-notify a hospital with gynecologic surgery.

15. A molar pregnancy may cause:

    1. A. A uterus smaller than dates
    2. B. Bleeding and a large uterus
    3. C. A very low hCG level
    4. D. No symptoms at all
    Show answer

    Answer: B. Bleeding and a large uterus

    Gestational trophoblastic disease causes abnormal tissue growth, bleeding, and severe nausea. The uterus is often larger than expected for dates, and hCG levels are typically very high.

16. After taking medication for an early abortion, which finding goes beyond expected bleeding and needs care?

    1. A. Cramping that is like a heavy period
    2. B. Passing some small clots
    3. C. Soaking 2 pads an hour for 2 hours
    4. D. Spotting for a week afterward
    Show answer

    Answer: C. Soaking 2 pads an hour for 2 hours

    Cramping, clots, and bleeding heavier than a period are expected. Soaking two or more thick pads per hour for 2 hours in a row, fever after the first day, or fainting suggests hemorrhage or infection.

17. What is the best position for a patient with suspected ruptured ectopic and hypotension?

    1. A. Sitting fully upright on the cot
    2. B. Prone on the stretcher
    3. C. Standing to walk to the stretcher
    4. D. Supine, legs raised per protocol
    Show answer

    Answer: D. Supine, legs raised per protocol

    Supine positioning may help perfusion. Raise legs per local protocol.

18. Which finding helps distinguish ectopic pregnancy from appendicitis?

    1. A. Positive hCG and shock
    2. B. Fever and nausea
    3. C. Right lower quadrant pain
    4. D. Loss of appetite
    Show answer

    Answer: A. Positive hCG and shock

    Both ectopic pregnancy and appendicitis cause pain, nausea, and loss of appetite, but a positive pregnancy (hCG) test with shock points to a ruptured ectopic. Fever and nausea fit appendicitis or infection. Right lower quadrant pain occurs in both. Loss of appetite is common to both and does not separate them.

19. Patients with bleeding disorders such as von Willebrand disease may present with:

    1. A. Clots in the deep leg veins
    2. B. A high platelet count
    3. C. Heavy menstrual bleeding
    4. D. No bleeding problems at all
    Show answer

    Answer: C. Heavy menstrual bleeding

    Bleeding disorders often cause heavy periods and should be reported. Von Willebrand disease makes clotting weaker, not stronger, and it does not raise the platelet count.

20. Rh-negative women with vaginal bleeding in pregnancy may need:

    1. A. Antibiotics in the field
    2. B. Rh immune globulin
    3. C. Insulin with glucose
    4. D. Aspirin 324 mg
    Show answer

    Answer: B. Rh immune globulin

    This prevents antibody formation against future Rh-positive babies. Report bleeding to the hospital.

21. Which finding in a bleeding patient most strongly suggests shock?

    1. A. Altered mental status
    2. B. Normal capillary refill
    3. C. Warm, dry skin
    4. D. Calm speech
    Show answer

    Answer: A. Altered mental status

    Altered mental status shows inadequate brain perfusion and needs rapid intervention.

22. A woman with bleeding and a positive pregnancy test is stable. She should still be transported because:

    1. A. Bleeding always stops
    2. B. She needs a pregnancy test
    3. C. Bleeding is normal in pregnancy
    4. D. Ectopic pregnancy can rupture
    Show answer

    Answer: D. Ectopic pregnancy can rupture

    Even stable patients can deteriorate quickly if an ectopic ruptures.

23. A woman who had a cesarean birth 2 years ago is 7 weeks pregnant with bleeding and pain. Her history raises concern for:

    1. A. A pregnancy implanted in the scar
    2. B. A normal pregnancy
    3. C. Pelvic inflammatory disease
    4. D. A urinary tract infection from the catheter
    Show answer

    Answer: A. A pregnancy implanted in the scar

    Cesarean scar pregnancy is a form of ectopic pregnancy that can cause severe hemorrhage and uterine rupture. Prior uterine surgery is a risk factor for abnormal implantation.

24. After a miscarriage, a woman may have strong emotions. Your best approach is:

    1. A. Tell her it was meant to be
    2. B. Offer support, avoid blame
    3. C. Ignore her feelings
    4. D. Tell her to try again
    Show answer

    Answer: B. Offer support, avoid blame

    Be supportive and respectful. Avoid comments that minimize the loss.

25. Which finding with vaginal bleeding suggests infection after miscarriage?

    1. A. Painless spotting only
    2. B. Normal vital signs
    3. C. Mild cramps without fever
    4. D. Fever, foul discharge
    Show answer

    Answer: D. Fever, foul discharge

    Septic abortion is a serious infection that can lead to shock.