Quiz 17 - Abdominal / GI / Gynecologic Flashcards Preview

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Flashcards in Quiz 17 - Abdominal / GI / Gynecologic Deck (52):
1

The conversion of glycogen to glucose occurs in the:

A. liver.

B. spleen.

C. blood.

D. pancreas.

A. liver.

2

You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should:

A. administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give 1 μg/kg of fentanyl for pain.

B. administer high-flow oxygen, start two large-bore IV lines, and administer 20- mL/kg normal saline boluses until his radial pulses strengthen.

C. apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution.

D. apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg.

B. administer high-flow oxygen, start two large-bore IV lines, and administer 20- mL/kg normal saline boluses until his radial pulses strengthen.

3

You receive a call to a residence for a 60-year-old man who is bleeding from his dialysis shunt. When you arrive, the patient's wife, who has been properly trained on the use of the dialysis machine, tells you that she panicked and called EMS. The dialysis cannula has loosened from the needle, which is still in the shunt.
Your initial action should be to:

A. immediately clamp off the cannula and apply direct pressure.

B. attempt to tighten the connection between the needle and cannula.

C. remove the dialysis needle from the shunt and apply direct pressure.

D. apply direct pressure over the shunt and carefully remove the needle.

B. attempt to tighten the connection between the needle and cannula.

4

Which of the following is NOT characteristic of the secondary stage of syphilis?

A. Mucous membrane lesions

B. Fever and swollen lymph glands

C. The presence of a skin rash

D. A single or multiple chancres

D. A single or multiple chancres

5

It is important for the paramedic to consult with medical control prior to administering analgesia to a patient with severe flank pain and suspected acute renal failure because:

A. patients with renal failure often require high doses of analgesia.

B. most patients who are given analgesia will experience hypotension.

C. renal failure may cause analgesics to accumulate to toxic levels.

D. analgesia will mask the patient's pain and skew further examination.

C. renal failure may cause analgesics to accumulate to toxic levels.

6

The presentation of Mallory-Weiss syndrome is linked to _________ and is caused by _________.

A. eating spicy foods, erosion of the lining of the gastrointestinal tract

B. blunt trauma, rupture of hollow organs with resultant peritoneal inflammation

C. spastic coughing, rupture of esophageal veins due to portal hypertension

D. severe vomiting, a tear at the junction between the esophagus and stomach

D. severe vomiting, a tear at the junction between the esophagus and stomach

7

The MOST common cause of amenorrhea is:

A. stress.

B. exercise.

C. pregnancy.

D. anorexia nervosa.

C. pregnancy.

8

As the filtrate passes through the rest of the nephron, tubular reabsorption and tubular secretion convert it to:

A. water.

B. urine.

C. salt.

D. glucose.

B. urine.

9

A 38-year-old man presents with an acute onset of severe right upper quadrant abdominal pain, pain to his right shoulder, and nausea. He is conscious and alert, but is restless from the pain. His blood pressure is 150/86 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 22 breaths/min and regular. In addition to administering supplemental oxygen, you should:

A. establish vascular access with a large-bore catheter, administer a 500-mL normal saline bolus, and avoid analgesics due to the potential for intra-abdominal bleeding.

B. encourage him to remain supine to relieve his pain, monitor his oxygen saturation level, and administer 10 to 20 mg of Nubain via the IM route.

C. start an IV with normal saline and set it to keep the vein open, place him in a position of comfort, and administer 4 mg of morphine and 12.5 mg of promethazine.

D. perform a comprehensive abdominal exam, start at least one large-bore IV line, infuse normal saline at 125 mL/hr, and consider giving him an antiemetic medication.

C. start an IV with normal saline and set it to keep the vein open, place him in a position of comfort, and administer 4 mg of morphine and 12.5 mg of promethazine.

10

Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in:

A. esophageal varices.

B. acute gastroenteritis.

C. diverticulitis.

D. peptic ulcer disease.

D. peptic ulcer disease.

11

A ruptured ovarian cyst typically presents with:

A. a sudden onset of abdominal pain that can be related to the menstrual cycle.

B. chronic waxing and waning abdominal cramping between menstrual periods.

C. a sudden onset of upper abdominal pain and nausea without vomiting.

D. dull or aching epigastric pain that radiates to the shoulders or lower back.

A. a sudden onset of abdominal pain that can be related to the menstrual cycle.

12

In contrast to somatic pain, visceral pain:

A. is difficult to localize.

B. indicates peritonitis.

C. increases with movement.

D. is well localized.

A. is difficult to localize.

13

A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should:

A. assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus.

B. turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.

C. suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted.

D. perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer's boluses to maintain a systolic blood pressure of at least 90 mm Hg.

B. turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.

14

There is evidence that a 21-year-old woman was given Rohypnol before being raped. She presents with alcohol on her breath, drowsiness, and memory loss. Her blood pressure is 98/68 mm Hg, pulse is 58 beats/min and weak, and respirations are decreased and shallow. You attempt to administer high-flow oxygen, but she resists. What should you do now?

A. Recognize that because the patient is of legal age, she can refuse EMS treatment.

B. Consider administering naloxone in case she was also given a narcotic drug.

C. Administer a sedative medication to facilitate her acceptance of the oxygen.

D. Start an IV line and administer 1 to 2 liters of an isotonic crystalloid solution.

B. Consider administering naloxone in case she was also given a narcotic drug.

15

Esophageal varices are a direct result of:

A. esophageal erosion.

B. portal hypertension.

C. alcohol consumption.

D. cirrhosis of the liver.

B. portal hypertension.

16

A 30-year-old woman complains of an “achy” pain to both lower abdominal quadrants, which she states is made worse by walking. She further tells you that she recently finished her menstrual period. She has a fever of 101.9°F. Her blood pressure is 122/62 mm Hg, pulse rate is 84 beats/min and strong, and respirations are 14 breaths/min and unlabored. After gathering the rest of her medical history, you should:

A. provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital.

B. establish vascular access and give her a 250-mL normal saline bolus, consider analgesia for her pain, and transport.

C. visually inspect her vagina for bleeding or discharge, start an IV line and set it to keep the vein open, and transport.

D. advise her that she can probably go to the hospital via personal vehicle since she is not showing signs of shock.

A. provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital.

17

You are dispatched to a residence for a 33-year-old woman with excruciating pain to the right lower quadrant of her abdomen. She is conscious and alert and tells you that she has been experiencing pain to the same area for the past few days. Her blood pressure is 110/66 mm Hg, pulse rate is 118 beats/min and strong, and respirations are 22 breaths/min with adequate depth. Her skin is warm and moist. The MOST appropriate treatment for this patient involves:

A. high-flow oxygen, two large-bore IV lines, a 20-mL/kg normal saline bolus, and rapid transport to an appropriate medical facility.

B. oxygen via nonrebreathing mask, an IV of isotonic crystalloid set to keep the vein open, morphine or fentanyl, and prompt transport.

C. supplemental oxygen via nasal cannula, 25 mg of Phenergan IM, an IV of normal saline set to keep the vein open, and prompt transport.

D. ventilation assistance with a bag-mask device, immediate transport, and establishment of vascular access en route to the closest hospital.

B. oxygen via nonrebreathing mask, an IV of isotonic crystalloid set to keep the vein open, morphine or fentanyl, and prompt transport.

18

If a young female with a known history of gonorrhea presents with abdominal pain, nausea and vomiting, and bleeding between periods:

A. one of her ovaries is probably grossly enlarged.

B. you should suspect disseminated gonococcemia.

C. it is likely that she has an ectopic pregnancy.

D. she most likely has pelvic inflammatory disease.

D. she most likely has pelvic inflammatory disease.

19

Azotemia is defined as:

A. an accumulation of uric acid in the blood.

B. excess potassium excretion by the kidneys.

C. increased nitrogenous wastes in the blood.

D. electrolyte disturbances in the blood.

C. increased nitrogenous wastes in the blood.

20

The Candida albicans fungus is the causative agent in:

A. bacterial vaginosis.

B. gardnerella vaginitis.

C. vaginal yeast infections.

D. gonorrhea and chlamydia.

C. vaginal yeast infections.

21

Which of the following statements regarding the renal system is correct?

A. Urinary tract infections are the most common renal disease.

B. The kidneys are located in the retroperitoneal space.

C. The urethra transports urine from the kidneys to the bladder.

D. Urinary tract infections are more prevalent in men.

B. The kidneys are located in the retroperitoneal space.

22

Initial signs or symptoms of end-stage renal disease include:

A. pruritus.

B. hallucinations.

C. bone pain.

D. uremic frost.

C. bone pain.

23

Reiter syndrome is:

A. an acute life-threatening condition that has been linked directly to the use of high-absorbency tampons.

B. a far more common and serious complication of untreated chlamydia than pelvic inflammatory disease.

C. a relatively common complication of untreated gonorrhea, and is characterized by low-grade fever and myalgia.

D. a rare complication associated with untreated chlamydia and is characterized by arthritis and skin lesions.

D. a rare complication associated with untreated chlamydia and is characterized by arthritis and skin lesions.

24

In contrast to a patient with peritonitis, a patient with hepatitis would MOST likely initially experience:

A. right upper quadrant pain.

B. diffuse abdominal pain.

C. referred pain to the left shoulder.

D. hematochezia.

A. right upper quadrant pain.

25

A sudden onset of discomfort in the throat, severe dysphagia, and vomiting bright red blood are MOST indicative of:

A. gastroesophageal reflux disease.

B. ruptured esophageal varices.

C. a malignancy in the esophagus.

D. hemorrhage from a peptic ulcer.

B. ruptured esophageal varices.

26

Postmenopausal women:

A. tend to experience fewer urinary tract infections.

B. are more susceptible to atherosclerosis and osteoporosis.

C. are usually over 35 years of age and tend to be obese.

D. often experience hot flashes and bradycardia.

B. are more susceptible to atherosclerosis and osteoporosis.

27

Pelvic inflammatory disease MOST commonly affects:

A. women over 30 years of age.

B. sexually active women.

C. postmenopausal women.

D. the external genitalia.

B. sexually active women.

28

You are caring for a 44-year-old woman who was sexually assaulted by several men. She is conscious but very quiet. Your partner, a female paramedic, quickly examines her and finds no immediate life-threatening injuries. The patient tells you that all she wants to do is go home and take a shower. After multiple attempts to convince the patient to consent to transport, you are unsuccessful. Your MOST appropriate action should be to:

A. explain the seriousness of the incident and have her sign a refusal form.

B. advise her that she cannot take a shower because her body is evidence.

C. allow her to take a shower, but insist upon EMS transport to the hospital.

D. ask the patient if there is a friend you can call with whom she can stay.

D. ask the patient if there is a friend you can call with whom she can stay.

29

Furosemide (Lasix) causes diuresis by:

A. inhibiting the production of antidiuretic hormone.

B. converting angiotensin I to angiotensin II.

C. inhibiting sodium reabsorption in the kidneys.

D. increasing circulating blood glucose.

C. inhibiting sodium reabsorption in the kidneys.

30

Most urinary tract infections:

A. involve the lower urinary tract in males because the urethra's large surface area can house more bacteria.

B. are asymptomatic and are diagnosed when a urinalysis is performed during a routine physical exam.

C. are the result of viruses or fungi entering the external urethral opening secondary to poor personal hygiene.

D. occur in women due to the relatively short urethra and its close proximity to the vagina and rectum.

D. occur in women due to the relatively short urethra and its close proximity to the vagina and rectum.

31

Diuril would MOST likely be prescribed to a patient with:

A. vasoconstriction-induced hypertension.

B. a decreased cardiac output.

C. persistent hypokalemia.

D. congestive heart failure.

D. congestive heart failure.

32

A positive Murphy sign is characterized by:

A. a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.

B. periumbilical ecchymosis and is a late, but highly suggestive sign of blood in the peritoneum.

C. ecchymosis to the flank area, indicative of free blood in the retroperitoneal compartment.

D. slow, shallow breathing in an attempt to reduce the severe pain associated with cholecystitis.

A. a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.

33

In contrast to endometritis, endometriosis:

A. may present without abdominal pain.

B. generally causes light menstrual periods.

C. is an inflammation of the uterine lining.

D. is often the result of gynecologic surgery.

A. may present without abdominal pain.

34

A 52-year-old man complains of vomiting and diarrhea for the past day. He is conscious and alert, has a blood pressure of 130/70 mm Hg, has a heart rate of 120 beats/min and strong, and has respirations of 20 breaths/min and regular. His past medical history is significant for anemia and congestive heart failure. Prior to administering isotonic crystalloid solutions to this patient, it is MOST important to:

A. obtain a 12-lead ECG.

B. apply a pulse oximeter.

C. check his blood sugar.

D. auscultate his lung sounds.

D. auscultate his lung sounds.

35

A patient with prerenal acute renal failure would MOST likely present with:

A. joint pain and bladder distention.

B. hypotension and tachycardia.

C. confusion and hypertension.

D. peripheral edema and hematuria.

B. hypotension and tachycardia.

36

Which of the following questions is the MOST important to ask when obtaining a patient's gynecologic history?

A. “Is there a chance that you are pregnant?”

B. “Do you have any abdominal pain?”

C. “When was your last menstrual period?”

D. “When was your last sexual encounter?”

C. “When was your last menstrual period?”

37

The glomerular filtration rate is defined as the:

A. volume of blood that flows through the kidneys per minute.

B. amount of filtrate produced by the kidneys per minute.

C. pressure in the glomerulus that forces filtrate from the blood.

D. percentage of filtrate that remains in the kidneys.

B. amount of filtrate produced by the kidneys per minute.

38

A 59-year-old woman with chronic renal failure presents with an acute onset of dyspnea while undergoing a hemodialysis treatment. She is conscious but in obvious respiratory distress. Further assessment reveals perioral cyanosis and a blood pressure of 96/56 mm Hg. Based on this patient's medical history and clinical presentation, which of the following interventions is likely NOT indicated?

A. Rapid transport to the hospital

B. IV crystalloid fluid boluses

C. Ventilation assistance as needed

D. Left lateral recumbent position

B. IV crystalloid fluid boluses

39

Which of the following statements regarding toxic shock syndrome (TSS) is correct?

A. Patients with TSS may show signs of liver failure.

B. Group B Streptococcus is a causative agent in TSS.

C. Most cases of TSS occur in the absence of a fever.

D. TSS is a condition that is exclusive to females.

A. Patients with TSS may show signs of liver failure.

40

The headache commonly experienced by women during their menstrual cycle is caused by:

A. hormonal release.

B. vasoconstriction.

C. transient cerebral edema.

D. acute stress.

A. hormonal release.

41

Which of the following statements regarding postrenal acute renal failure (ARF) is correct?

A. Patients with postrenal ARF typically develop severe hypokalemia.

B. Postrenal ARF typically results in decreased pressure on the nephrons.

C. Postrenal ARF is caused by obstruction of urine flow from the kidneys.

D. Postrenal ARF involves damage to the renal parenchyma or tubules.

C. Postrenal ARF is caused by obstruction of urine flow from the kidneys.

42

Risk factors for pelvic inflammatory disease include all of the following, EXCEPT:

A. an intrauterine device.

B. monogamy.

C. 20- to 24-year-old age group.

D. heterosexual sex with multiple partners.

B. monogamy.

43

Which of the following conditions, if it remains undetected until puberty, can result in acute pain, severe constipation, and low back pain at the onset of menses?

A. Imperforate hymen

B. Ovarian cyst

C. Ectopic pregnancy

D. Endometriosis

A. Imperforate hymen

44

You are dispatched to a residence for an elderly man with an altered mental status. As you are assessingmthe patient, his wife tells you that he goes to dialysis several times a week, but has missed his last three treatments because their car broke down. The patient's skin is yellow, his blood pressure is 98/60 mm Hg, and his pulse rate is 118 beats/min. The ECG reveals sinus tachycardia with peaked T waves. You should be MOST concerned with the potential for:

A. hypokalemia-induced cardiac arrest.

B. lethal ventricular dysrhythmias.

C. severe hypovolemia.

D. acute bradycardia or heart block.

B. lethal ventricular dysrhythmias.

45

Which of the following statements regarding endometritis is correct?

A. Endometritis is defined as an enlargement of the uterus.

B. Untreated endometritis may result in septic shock.

C. Endometritis results when endometrial tissue grows outside the uterus.

D. Endometritis is most commonly caused by an intrauterine device.

B. Untreated endometritis may result in septic shock.

46

Law enforcement request that you respond to a local apartment complex for a young woman who was sexually assaulted. When you arrive at the scene, you find the patient sitting on her couch, clearly upset. You see a small amount of blood on her shorts, near the groin area. What is your initial priority in the care of this patient?

A. Asking her if she recognized the perpetrator

B. Identifying and treating immediate life threats

C. Not allowing her to shower or use the restroom

D. Quickly assessing her blood pressure and pulse

B. Identifying and treating immediate life threats

47

The MOST important therapy the paramedic can administer to a patient with an isolated renal calculus is:

A. rehydration.

B. oxygen.

C. an antiemetic.

D. analgesia.

D. analgesia.

48

End-stage renal disease occurs when:

A. urine output falls to less than 500 mL/day.

B. the initial signs of azotemia are present.

C. the glomerular filtration rate is increased.

D. the kidneys have lost all ability to function.

D. the kidneys have lost all ability to function.

49

Which of the following abdominal segments is anterior and is the most inferior?

A. Iliac region

B. Hypogastric region

C. Umbilical region

D. Hypochondrial region

B. Hypogastric region

50

A 25-year-old woman presents with acute abdominal pain and vaginal bleeding. She tells you that she has soaked eight high-absorbency tampons in the past 2 hours. Approximately how much blood has she lost externally?

A. 240 mL

B. 300 mL

C. 200 mL

D. 160 mL

D. 160 mL

51

In the average female, the menstrual cycle lasts ___ days

A. 35

B. 28

C. 24

D. 21

B. 28

52

Common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT:

A. painful urination.

B. gross hematuria.

C. localized pain in the pelvis.

D. increased urinary frequency.

B. gross hematuria.