10 free EMT practice questions: Obstetric, Neonatal & Gynecologic Emergencies

The newborn is in severe distress and needs immediate resuscitation: Immediate resuscitation is for a newborn who is limp and not breathing or only gasping, with a heart rate under 100. Heart rate and effective breathing are the two numbers that guide newborn resuscitation. A newborn who is crying hard with good tone does not need positive pressure ventilation. Starting resuscitation here interrupts a normal transition. Resuscitation also delays the drying and warming this baby needs.

The newborn requires back blows for airway obstruction: Back blows are for a choking infant who cannot cry, cannot cough well, and is not moving air. This newborn is crying vigorously, and the crying tells you the airway is open. Back blows on a healthy newborn are force with no reason behind them, and they can injure the baby.

The newborn should be placed in a cool environment to reduce metabolic demand: Cooling a newborn has no place in field care. Therapeutic cooling for brain injury from lack of oxygen is decided in the hospital by a neonatal team. Newborns lose heat very fast. They have a large surface area, thin insulation, and wet skin. Cold stress raises the newborn's oxygen use and makes acidosis worse, so cooling raises metabolic demand instead of lowering it. In the field, dry the infant, throw out the wet linens, cover the head, and keep the baby warm.

Apply firm fundal pressure while continuing gentle downward traction on the head: Fundal massage is what you do for a boggy uterus, after the placenta has delivered. Fundal pressure is never used in a shoulder dystocia. The push from above drives the stuck shoulder harder into the pubic bone. Fundal pressure can also rupture the uterus. The pressure that helps goes low, just above the pubic bone, right onto the shoulder.

Assist the patient into a standing squat to open the pelvic outlet for delivery: Changing the mother's position can help a shoulder dystocia that will not come free. The position change used in the field is hands and knees, and it comes after hip flexion and suprapubic pressure have failed. Standing the patient up in the middle of the delivery costs time while the cord is squeezed. The patient could fall, or the baby could deliver uncontrolled onto the floor.

Apply firm, continuous traction to the fetal head to free the impacted shoulder: Firm traction sounds like the next step after gentle traction failed. The shoulder is jammed against bone, so pulling harder does not free it. The extra force goes into the nerves of the baby's neck and shoulder, the brachial plexus. Hard traction on the head is how brachial plexus injuries happen.

Position the patient supine with legs elevated to maximize cerebral perfusion: Lying flat with the legs raised is for a hypotensive patient, where better blood return to the heart helps in some types of shock. This patient is hypertensive at 172/110, so there is no perfusion problem to fix. Laying a patient who is 36 weeks pregnant flat on her back lets the uterus press on the aorta and vena cava. That pressure lowers the cardiac output the position was supposed to raise. Left side positioning improves blood return without that problem.

Insert a padded bite block between the patient's teeth in case another seizure occurs: Getting ready for another seizure is right, because an eclamptic patient can seize again at any moment. Placing something between the teeth is not part of those precautions. A bite block in the mouth of a postictal patient can break teeth, block the airway, or cause vomiting and aspiration. Tongue biting happens at the start of a seizure, before a device could be placed anyway. Protect the airway with positioning, suction within reach, and oxygen.

Delay transport until a full neurologic exam confirms baseline mental status: A full neurologic exam is valuable, and it can happen during transport. A postictal patient can take many minutes to return to baseline. Nothing that exam finds changes what you can do on scene, because the treatment for eclampsia is not carried on the ambulance. Those minutes are better spent getting the patient to magnesium and delivery.

Suspect uterine atony; perform vigorous fundal massage until bleeding stops: Uterine atony is a soft, boggy uterus that is not contracting. Atony is the most common cause of bleeding after delivery, and fundal massage is the treatment for it. This fundus is firm and well-contracted, so the uterus is not atonic. Massaging a uterus that is already firm does nothing for a tear and causes the patient real pain.

Recognize the bleeding as normal lochia; monitor the amount during transport: Some bleeding after delivery is normal, and that normal discharge is called lochia. Lochia is darker. Bright red blood still coming two minutes after delivery is active bleeding. A pulse of 108 shows the body is compensating for blood loss. Only watching the amount treats a real bleed like a normal one.

Suspect a birth canal laceration; pack the vagina with dressings to control bleeding: A laceration is the right call, and packing is the wrong treatment for it. Packing a wound works to control bleeding in a lot of other places. You do not pack the vagina in the field. Packing hides how much blood is being lost, adds a risk of infection, and does not reliably press on a tear. Pressure on the outside keeps the bleeding where you and the hospital can see it.

Delay treatment until a second blood pressure reading confirms the first result: Repeating a blood pressure makes sense when one odd reading shows up in a patient who otherwise looks fine. This low pressure is not alone. The pulse of 128, the pale cool skin, and the soft uterus all back up that reading. A second reading tells you nothing new, and the patient keeps bleeding while you take it.

Place the patient in a seated position before treating the vaginal bleeding: Sitting up is the position for a patient who is working hard to breathe, like with pulmonary edema or heart failure. This patient's problem is blood loss, not breathing. Sitting a patient with a low blood pressure upright sends even less blood to the brain. Lying flat keeps the blood that is left where the patient needs it.

Administer oxygen only, since the respiratory rate is the most abnormal finding: Oxygen alone would fit if low oxygen were the only problem. The respiratory rate of 24 is the body reacting to the blood loss. Giving oxygen and leaving the soft uterus alone treats the fast breathing and lets the bleeding continue.

Placenta previa: painful bleeding with uterine rigidity, unlike painless abruption: Previa and abruption are the right two conditions, but the features are swapped. Placenta previa causes painless, bright red bleeding with a soft uterus. Nothing is tearing away from the uterine wall, so nothing irritates the uterus into rigidity. Severe constant pain with a rigid, tender abdomen is an abruption.

The two conditions are clinically identical and cannot be distinguished in the field: Neither condition can be confirmed without an ultrasound. You can still tell them apart in the field by the pain, how firm the uterus is, and the color of the blood. What the two conditions share is the treatment. Do no vaginal exam, place the patient on her left side, give oxygen, treat for shock, and transport rapidly.

Ectopic pregnancy, since any painful third-trimester bleeding is diagnostic of it: Ectopic pregnancy causes pain and low blood pressure in the first trimester, usually around 6 to 8 weeks. The pregnancy grows outside the uterus and ruptures. At 35 weeks, the pregnancy is inside the uterus, so the gestational age rules out an ectopic pregnancy.

Treat as normal labor progression and transport without urgency: Contractions can space out at times during normal labor. Contractions that stop completely after a tearing feeling, with pale, diaphoretic skin, mean the uterus has torn. Transporting without urgency ignores bleeding that is happening right now.

Treat as a placental abruption; expect heavy vaginal bleeding first: Placental abruption also causes sudden, severe abdominal pain late in pregnancy. An abruption gives you a rigid, tender uterus, and the vaginal bleeding can stay hidden behind the placenta. The tearing feeling and the old cesarean scar fit the uterine wall giving way rather than the placenta separating. In both conditions the bleeding can stay hidden, so you cannot wait for heavy vaginal bleeding to show up first.

Treat as a precipitous delivery and prepare for imminent birth en route: A prior cesarean does not rule out a vaginal birth, and fast labor can look like a delivery is about to happen. A precipitous delivery shows crowning and a strong urge to push. This patient has a tearing feeling, contractions that stopped, and signs of shock. Those findings point to hemorrhage.

Tell the patient not to push, place her on her left side, and prepare for immediate transport: Telling a patient not to push and moving right away fits preterm labor that you are trying not to speed up. It also fits an abnormal presentation, like a prolapsed cord, a breech, or a limb. This patient is at 37 weeks, and the vaginal opening bulges with each contraction. Her urge to push is her body finishing the delivery, and telling her not to push will not stop it. She ends up fighting her own body while the head comes down in a moving ambulance. Left side positioning is right for transporting a pregnant patient. Option A still leaves out getting ready for a delivery that is already happening.

Have the patient bear down and push with contractions to speed delivery: Coached pushing has a place in a hospital, where a provider manages the perineum and monitors the baby. Pushing her harder to speed things up can make the delivery come too fast. A fast delivery can tear the perineum, and the newborn can arrive before your hands are in position. Let her follow her own urge to push.

Place the patient upright on the edge of the bed to facilitate delivery: Some patients do deliver sitting upright. The mistake is choosing the position for her. On the edge of a bed, a fast delivery can drop a slippery newborn toward the floor. You also have no control of the head as it comes out. Let her pick a comfortable position and set up around her.

The infant is improving; the decreased work of breathing and fading retractions show the distress is resolving: Fewer retractions and a slower rate really do mean improvement when the baby's color, tone, and alertness are getting better too. Here the alertness is getting worse. Less effort with a falling mental status is decompensation. A newborn has very little reserve, so the time between tiring out and apnea is short.

The infant is fatigued but holding steady; close observation is appropriate, and transport urgency can be reduced: Fatigued but holding steady fits a patient who is working hard to breathe while the oxygen level and mental status stay steady. For that patient, you watch closely and stay ready. In a newborn, tiring out does not level off. A tired newborn heads toward apnea and then bradycardia, a slow heart rate. Cutting transport urgency does the real harm, because now is when you need to be moving and ventilating.

The infant has settled into periodic breathing, since 30 breaths per minute is within the expected newborn range: A rate of 30 does sit inside the textbook newborn range. Periodic breathing is something you see in a comfortable baby with normal tone and alertness. This baby was working hard to breathe minutes ago and is now lethargic. A rate that falls after obvious distress is exhaustion.

Continue observation and stimulation; a heart rate of 110 is adequate and spontaneous breathing should improve: Stimulating and watching is the routine first step after birth, while a newborn starts breathing on its own. This newborn is already gasping, with irregular, labored respirations. Gasping is a failing pattern, and more watching will not fix it.

Apply supplemental oxygen at high flow and observe for spontaneous breathing: Free-flow oxygen is for a newborn with a heart rate above 100 and good breathing effort who stays blue in the trunk and face. That blue center is central cyanosis. Blue hands and feet with a pink trunk is acrocyanosis, and acrocyanosis is normal right after birth. This newborn's problem is the breathing. Oxygen alone does not move air into the lungs of a newborn who is gasping.

Begin chest compressions immediately; the heart rate is too low despite gasping efforts: Chest compressions are for a newborn whose heart rate stays below 60 after 30 seconds of good positive pressure ventilation. This heart rate is 110, well above 60. Ventilation comes first.