Emergency Medicine Examination & Board Review

Susan Promes

Chapter 10 Gynecologic and Obstetric Emergencies - all with Video Answers

Educators

Chapter Questions

Problem 1

Which of the following gynecologic malignancies generally does not present with vaginal bleeding?
(A) Cervical cancer.
(B) Vaginal cancer.
(C) Ovarian cancer.
(D) Uterine cancer.

Joanna Quigley

Numerade Educator

03:49

Which of the following statements regarding the diagnosis and management of vaginal bleeding is TRUE?
(A) All patients presenting to the ED with vaginal bleeding who are not pregnant can be referred to clinic without further ED evaluation.
(B) Blood clots are abnormal in vaginal bleeding.
(C) Patients with vaginal bleeding who are hemodynamically unstable are resuscitated according to standard practice.
(D) Ultrasonography has no role in the evaluation of nonpregnant patients with vaginal bleeding.

April Townson

Numerade Educator

01:19

Problem 3

Which of the following statements regarding leiomyomas is TRUE?
(A) Leiomyomas or fibroids are uncommon pelvic tumors.
(B) Most patients with leiomyomas are symptomatic.
(C) Leiomyomas decrease in size during menopause.
(D) These tumors decrease in size during pregnancy.

Christina Sorrentino

Numerade Educator

Problem 4

A 49-year-old female presents to the ED with a complaint of right flank pain and mild nausea. She had an abdominal hysterectomy 5 days prior to presentation. She has no dysuria or hematuria. Which of the following tests would be LEAST helpful?
(A) Abdominal and pelvic CT scan without contrast.
(B) Intravenous pyelogram.
(C) Renal function tests.
(D) Urinalysis.

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Problem 5

Which of the following is NOT consistent with hyperemesis gravidarum?
(A) Abdominal pain.
(B) Hypokalemia.
(C) Ketonuria.
(D) Weight loss.

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Problem 6

A 25-year-old female presents to the ED with a complaint of dysuria and nausea. She is 6 weeks pregnant by dates. Her evaluation indicates that she has a simple urinary tract infection (UTI). Which of the following medications is not safe in pregnancy?
(A) Cephalexin.
(B) Ciprofloxacin.
(C) Nitrofurantoin.
(D) Metoclopramide.

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06:20

Problem 7

A 30-year-old female with type 2 diabetes presents to the ED with a complaint of nausea, vomiting, polydipsia, and polyuria for a week. Despite being compliant with her oral hypoglycemic agents, her glucose checks at home have been in the 280-350 mg/dL range. Her screening urine test for $\beta$-hCG is positive. What is the MOST appropriate next step in management?
(A) Give an oral fluid challenge, double the oral hypoglycemic agent, and have the patient follow up with OB at the next available appointment.
(B) Give an oral fluid challenge, check electrolytes and serum glucose, and have the patient follow up with OB at the next available appointment.
(C) Give intravenous fluids, check electrolytes and serum glucose, double the oral hypoglycemic agent, and have the patient follow up with OB at the next available appointment.
(D) Give intravenous fluids, check electrolytes and serum glucose, stop the oral hypoglycemic agent, and call for an appointment with OB within the week.

Bryan Valdivia

Numerade Educator

01:24

Problem 8

Which of the following statements regarding vulvovaginitis is TRUE?
(A) Symptoms can occur in sexually active, virgin, and postmenopausal women.
(B) Microscopic evaluation of vaginal secretions is not necessary to establish a diagnosis.
(C) Polymicrobial infections are uncommon.
(D) The most common cause of vulvovaginitis is trichomoniasis.

Joanna Quigley

Numerade Educator

Problem 9

A previously healthy 27-year-old female $G_1 P_0$ at 16 weeks gestation presents to the ED with a complaint of continued nausea and vomiting and new vaginal bleeding. She has no abdominal pain. Her blood pressure is $160 / 90 \mathrm{mmHg}$ with a heart rate of 110 beats per minute. What is the MOST likely diagnosis?
(A) Implantation bleeding.
(B) Ectopic pregnancy.
(C) Molar pregnancy.
(D) Preeclampsia.

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Problem 10

A 28-year-old female presents to the ED with a complaint of left lower abdominal pain and vaginal bleeding. She has a history of irregular menses. She has 2 healthy children at home. Which of the following tests would narrow the differential and help determine disposition?
(A) Complete blood count.
(B) $\beta$-HCG .
(C) Urinalysis.
(D) $\mathrm{Rh}$ factor.

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Problem 11

A 44-year-old female presents to the ED with a complaint of a white nipple discharge that has been present for a week. She thought the symptoms would resolve. She has no pain and has felt no masses. Her neurological exam is normal. The urine pregnancy test is negative. Which of the following statements is TRUE?
(A) Decreased cortisol levels can cause galactorrhea.
(B) Decreased prolactin levels can cause galactorrhea.
(C) This patient can be worked up by her primary care provider.
(D) This patient requires neurosurgery evaluation.

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01:15

Problem 12

A 54-year-old female presents to the ED with a complaint of a breast mass. Which of the following statements is TRUE?
(A) The most common cause for breast disease in postmenopausal women is fibrocystic disease.
(B) All women with a palpable mass should be referred to a breast specialist.
(C) Fibrocystic changes of the breast include skin thickening, discoloration, and discharge.
(D) Patients over the age of 40 with a normal exam do not need a mammogram.

Joanna Quigley

Numerade Educator

Problem 13

A 64-year-old female with a history of diabetes presents to the ED with a complaint of progressive urinary incontinence over the past 3 weeks with the sensation of never completely emptying her bladder. Which of the following studies would be MOST appropriate to order to determine which type of incontinence is present?
(A) Postvoid residual.
(B) Glucose.
(C) Urinalysis.
(D) Intravenous pyelogram.

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01:59

Problem 14

Which of the following statements regarding gynecologic malignancies is TRUE?
(A) The diagnosis of cervical cancer in an HIV-positive patient is an AIDS-defining illness.
(B) Lymphedema is treated surgically for patient comfort.
(C) Human papillomavirus is not a risk factor for cervical and vulvar cancers.
(D) Gastrointestinal obstruction is the most common oncologic complication.

Ashok Prajapati

Numerade Educator

Problem 15

A 25-year-old female presents to the ED with a complaint of lower abdominal pain, vaginal bleeding, and fever. She underwent an induced abortion 2 weeks prior to presentation. Which of the following tests is MosT helpful in the management of this patient?
(A) Pelvic ultrasound.
(B) Complete blood count.
(C) Urinalysis.
(D) Urine $\beta$-hCG.

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00:19

Problem 16

Which of the following is NOT a risk factor for pelvic inflammatory disease (PID)?
(A) Multiple sex partners.
(B) Frequent vaginal douching.
(C) Lack of barrier contraceptive.
(D) Pregnancy.

Morgan Thompson

Numerade Educator

01:18

Problem 17

Which of the following is LEAST helpful in the diagnosis of PID?
(A) Leukorrhea on wet preparations of vaginal secretions.
(B) Thickened fluid-filled fallopian tubes with free pelvic fluid seen with transvaginal pelvic ultrasound.
(C) Leukocytes and bacteria from culdocentesis.
(D) Elevated C-reactive protein levels.

Joanna Quigley

Numerade Educator

01:17

Problem 18

Treatment of bacterial vaginosis in pregnancy does NOT include which of the following regimens?
(A) Metronidazole $250 \mathrm{mg}$ po bid for 7 days.
(B) Clindamycin cream $2 \%$ intravaginally qhs for 7 days.
(C) Clindamycin $300 \mathrm{mg}$ po bid for 7 days.
(D) Metronidazole gel 0.75 \% intravaginally bid for 5 days.

Eric Goldman

Numerade Educator

01:59

Problem 19

Which of the following statements regarding labor in the pregnant patient is TRUE?
(A) False labor or Braxton Hicks contractions are characterized by irregular, brief contractions that lead to changes in the cervix.
(B) True labor is characterized by painful, repetitive uterine contractions that increase steadily and lead to changes in the cervix.
(C) Cervical dilatation of the cervix refers to the process of thinning that occurs during labor.
(D) Effacement describes the diameter of the internal cervical os and is used as an indicator of the progression of labor.

Rikhil Makwana

Numerade Educator

Problem 20

A 25-year-old $\mathrm{G}_1 \mathrm{P}_0$ female presents to the ED frantic because her "water broke." she states that she is from out of town and does not know a physician in the area. She is 37 weeks gestation by dates and has a blood pressure of $118 / 65 \mathrm{mmHg}$ and a heart rate of 110 beats per minute. Which of the following statements regarding spontaneous rupture of membranes (SROM) is TRUE?
(A) Rupture of membranes can be confirmed by nitrazine paper changing to red.
(B) Ferning is diagnostic of vaginal fluid.
(C) A speculum and digital exam should not be performed if SROM is suspected.
(D) SROM signals the end of active labor.

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01:08

Problem 21

Which of the following physiologic changes does NOT take place during normal pregnancy?
(A) Delayed gastric emptying.
(B) Increased respiratory rate.
(C) Delayed gallbladder emptying.
(D) Increased renal blood flow.

Jessica Wooten

Numerade Educator

03:49

Problem 22

Which of the following statements regarding ovarian cysts is TRUE?
(A) Typical presentation is unilateral pelvic pain.
(B) Ultrasonography should be done immediately for all patients with suspected ovarian cysts.
(C) Cysts that are $>8 \mathrm{~cm}$, unilocular, and unilateral are observed.
(D) Complications include rupture, hemorrhage, torsion, and infection.

April Townson

Numerade Educator

Problem 23

Which of the following statements regarding diagnostic evaluation of the female patient of childbearing age with abdominal and pelvic pain is TRUE?
(A) Ultrasonography is the test of choice for evaluating suspected pelvic and gynecologic pathology.
(B) An elevated white blood cell count is sensitive for an acute surgical condition.
(C) Positive urinalysis findings are specific for urine pathology.
(D) Laparotomy is the gold standard for diagnosing PID.

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Problem 24

A 36-year-old female presents to the ED with a complaint of abdominal pain and vaginal spotting. Figure 10-1a and $10-1 \mathrm{~b}$ shows the ultrasound images that were obtained. Which of the following statements does NOT apply to this patient's diagnosis?
(A) Abdominal pain or discomfort is the most common symptom.
(B) Vital signs are usually normal.
(C) A low progesterone level aids in the diagnosis.
(D) A negative urine pregnancy test rules out the diagnosis.

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Problem 25

Which of the following is NOT appropriate management for a patient with an ectopic pregnancy?
(A) Methotrexate.
(B) Laparoscopy in the hemodynamically unstable patient.
(C) Anti-Rho immunoglobulin in an Rh-negative patient.
(D) Expectant management with serial $\beta$-hCG levels and ultrasound.

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Problem 26

Which of the following statements regarding the diagnosis and management of thromboembolism in pregnancy is TRUE?
(A) Perfusion lung scan with technetium $99 \mathrm{~m}$ is harmful to the fetus.
(B) Iodine-125 fibrinogen scanning should not be used in pregnancy.
(C) Warfarin can be used safely in pregnancy.
(D) Heparin cannot be used safely in pregnancy.

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Problem 27

A 28-year-old female presents to the ED in active labor. On visual inspection the fetal head is seen at the introitus. Which of the following should NOT be done?
(A) Support the inferior portion of the perineum with a sterile towel.
(B) Immediately suction the infant's nose and mouth after delivery of the infant's head.
(C) Maintain control of the slippery newborn so that inadvertent dropping does not occur.
(D) Transfer the patient to the labor and delivery ward.

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01:35

Problem 28

Which of the following statements regarding complications of delivery is TRUE?
(A) Decelerations in fetal heart rate must be treated with immediate delivery of the infant.
(B) In the event of a prolapsed cord the examiner's hand should be used to elevate the presented fetal part until the patient is prepared for cesarean section.
(C) Breech presentations occur most frequently in term pregnancies.
(D) During suspected shoulder dystocia fundal pressure should be applied to assist in delivery.

Amy Adkisson

Numerade Educator

Problem 29

A 21-year-old female presents with a complaint of severe pain on urination, subjective fever, and headache. She states that she has "bumps" on her vulva. She has no history of similar episodes. Which of the following is NOT a treatment option?
(A) Confirm the diagnosis by culture and treat with acyclovir $400 \mathrm{mg}$ tid for 7-10 days.
(B) Confirm the diagnosis by culture and treat with acyclovir $400 \mathrm{mg}$ bid daily.
(C) Confirm the diagnosis by polymerase chain reaction (PCR) and treat with famciclovir $250 \mathrm{mg}$ tid for 7-10 days.
(D) Confirm the diagnosis by PCR and treat with valacyclovir $1 \mathrm{~g}$ bid for 7-10 days.

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Problem 30

While a 35-week pregnant patient is in the ED for headache, she has a generalized seizure. She does not have a history of seizure disorder. She is now postictal and unable to give further information. Which of the following is LEAST helpful in management?
(A) Neurology consultation.
(B) Obstetrics consultation.
(C) Administration of magnesium sulfate.
(D) Repeat vital signs.

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Problem 31

Which of the following statements regarding HELLP syndrome is TRUE?
(A) Platelet count is $>100,000$.
(B) Patients are hypertensive.
(C) Most patients are multigravid.
(D) The coagulation profile is normal.

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