#6 -- 2014-09-12 SAEM Tests Practice Questions 2013 Flashcards
Which of the following analgesics operates by a non-opioid mechanism? A. fentanyl B. meperidine C. codeine D. hydromorphone E. ketorolac
E. ketorolac
With regard to U.S. Emergency Medical Services (EMS), all the following are true EXCEPT:
A. The Department of Transportation is the federal government agency tasked with promulgation of EMT training requirements.
B. The levels of EMT training and EMT-level nomenclature are the same throughout the United States.
C. “First responders” are not always Emergency Medical Technicians (EMTs).
D. A community is said to have “E-911” when the telephone number of a 911 caller is displayed at the operator’s console.
E. Most EMTs in the field operate under off-line medical control.
B. The levels of EMT training and EMT-level nomenclature are the same throughout the United States.
A “BLS” ambulance differs from an “ALS” ambulance in that the BLS ambulance:
A. is stocked with different supplies and equipment
B. operates under off-line, as opposed to on-line, medical control
C. arrives at the patient first
D. is staffed by one EMT crew member (and one driver) rather than two EMTs
E. is a smaller “van”-type ambulance
A. is stocked with different supplies and equipment
With regard to U.S. Emergency Medical Services (EMS) systems, all of the following are true EXCEPT:
A. EMS medical directors do not have to be trained, or board-certified, in emergency medicine.
B. EMS fellowships are available for both ground and air transport, however no EMS subspecialty certification exists.
C. EMS is an integral component of disaster management.
D. EMS systems operated by a government agency (e.g. a city department of public health) have no malpractice liability.
E. There is evidence that helicopter EMS transport for injured patients results in improved mortality.
D. EMS systems operated by a government agency (e.g. a city department of public health) have no malpractice liability.
The pharmacologic interventions most likely to improve outcome when given in the field, as compared to those given upon arrival in the emergency department, include all of the following EXCEPT: A. albuterol B. adenosine C. diazepam D. dextrose E. epinephrine
B. adenosine
The answer is B. This question addresses whether the agents listed are “time-critical” rather than whether or not they “work.” While useful in effecting rate control for tachycardia, adenosine is the least likely of those listed (assuming an indication for their administration) to impact patient outcome when given in the field as compared to being given in the emergency department. Glucose can be life-saving in patients with hypoglycemia. In addition to its use in cardiac arrest, epinephrine can be life-saving when administered, for example, to patients with anaphylaxis. Bronchodilators can help reverse bronchospasm in severe asthmatics. Diazepam (or other benzodiazepines) can be a critical intervention when there is seizure activity.
If the parents are present and refuse treatment for their child in a life-threatening emergency, prehospital care providers should:
A. Provide treatment for the child
B. Call the police to have the parents arrested
C. Confirm the identities of the parents and follow parental wishes
D. Contact their ambulance service’s legal counsel to discuss whether to treat
E. Contact on-line medical control for physician permission to treat
A. Provide treatment for the child
Which of the following is FALSE concerning emergency intervention for traumatic emergencies encountered by EMS paramedics?
A. Severely injured patients require endotracheal intubation.
B. Intubating head injured patients may result in dental or soft tissue damage.
C. Increasing MAP to near normal levels may cause hemodilution and decreased oxygen saturation.
D. When short transport time is expected, use of pneumatic antishock garment appears to be associated with increased mortality in penetrating torso injuries.
E. Aggressive fluid resuscitation prior to surgical hemostasis is an absolute standard of care to minimize post-traumatic morbidity.
E. Aggressive fluid resuscitation prior to surgical hemostasis is an absolute standard of care to minimize post-traumatic morbidity.
Regarding the EMS role in prehospital care, all the following are true EXCEPT:
A. Automatic external defibrillators (AEDs) can be used by firefighters, policemen and other trained first responders.
B. Thrombolytic therapy in the field is the standard of care for patients suspected of having an acute coronary syndrome.
C. Survival after cardiac arrest is less than 10% when resuscitation efforts are initiated after 10 minutes from the arrest.
D. EMS personnel evaluate and release many patients they deem well enough not to need hospital treatment.
E. Pharmacotherapy that can be initiated in the field by paramedics in most jurisdictions includes naloxone for opiate overdose, diazepam for seizure control, and beta agonists for acute asthma exacerbations.
B. Thrombolytic therapy in the field is the standard of care for patients suspected of having an acute coronary syndrome.
Which of the following statements regarding use of Helicopter Emergency Medical Services (HEMS) for trauma scene transports is true?
A. Nonphysician crews staff most HEMS vehicles in the United States
B. The potential benefit of HEMS in improving trauma outcome remains unstudied.
C. Transport of a patient from a motor vehicle collision to a trauma center is termed “secondary” transport if a helicopter is used.
D. If the patient is in cardiopulmonary arrest, HEMS transport should be expedited to maximize chances of patient survival.
E. The flight physician should take command of the trauma scene upon HEMS arrival.
A. Nonphysician crews staff most HEMS vehicles in the United States
The Figure below depicts laryngoscopy and endotracheal intubation (ETI) occurring in an in-flight EMS helicopter. Regarding the patient depicted, and prehospital airway management in general, which of the following is true?
[image]
A. Flight crew ETI success rates tend to be high in part because of their enhanced drug formulary (e.g. neuromuscular blockade) as compared to most ground EMS units.
B. If the patient in the Figure has an easy ETI with minimal requirement for manual (bag-valve-mask) ventilation, gastric decompression (e.g. with an orogastric tube) is unnecessary.
C. ETI in the helicopter cabin is technically no more difficult than it would be in the hospital emergency department.
D. For the patient in the Figure, post-intubation breath sounds will be a critical component of tube placement confirmation.
E. Postponing ETI until the aircraft is en route to the receiving center should save time when a flight crew decides a community hospital patient will require the procedure.
A. Flight crew ETI success rates tend to be high in part because of their enhanced drug formulary (e.g. neuromuscular blockade) as compared to most ground EMS units.
With growing regionalization of care for many patient types and conditions, the traditional province of “prehospital” care is growing to include “out-of-hospital” care. The increasing need for critical care transport to regional centers has translated into regularly-occurring out-of-hospital, intratransport utilization of all the following EXCEPT:
A. mechanical ventilation
B. extracorporeal membrane oxygenation (ECMO)
C. continuous propofol infusion
D. ventilation with nitric oxide-containing gas
E. intra-aortic balloon counterpulsation
B. extracorporeal membrane oxygenation (ECMO
You are caring for a 24-year-old man with appendicitis in the Emergency Department. You dosed him with Morphine upon arrival. The morphine provided relief for a few hours, but he is now experiencing severe pain again. He denies allergies to medications. You call the surgical intern to evaluate and admit the patient. She directs you not to administer any additional narcotic pain medications until after her evaluation because it will interfere with her physical examination. What is the most appropriate course of action to address your patient’s pain at this time?
A. Administer narcotic pain medications
B. Administer acetaminophen
C. Administer non-steroidal anti-inflammatory agents
D. Administer no pain medications until after the intern’s examination
A. Administer narcotic pain medications
An elderly female presents to the emergency department with vomiting and abdominal pain. She has a history of a cholecystectomy about 5 years ago. On exam, she is significantly uncomfortable and nauseated. Lung and cardiovascular exam is normal. Abdominal exam shows diffuse tenderness, some distention with tympany, and an empty rectal vault. Vital signs are: HR 102 BP 145/86 RR 24 SpO2 96% RA Temp 99.9F. You order an acute abdominal series, which is read by the radiologist as “nonspecific bowel gas pattern, no perforation.”
What is your management plan?
A. IV fluids, pain medication, CT abdomen
B. IV fluids, pain medication, consult vascular surgery
C. IV fluids, pain medication, discharge if improved
D. IV fluids, pain medication, consult vascular surgery for serial exams
A. IV fluids, pain medication, CT abdomen
A 27 year old male presents to the emergency department with 12 hours of worsening abdominal pain, associated with 1 episode of nausea and non-bloody non-bilious vomiting as well as a slight fever. Initially the pain was centered around the umbilicus and the patient attributed it to the take-out food he ate last night. Now the pain has migrated to his lower right abdomen and become more severe. Which of the following is the most effective management?
A. Administration of an enema to ensure the patient has a bowel movement while in the emergency department, followed by a reassessment to ensure resolution of pain
B. IV access, analgesia, NPO, pre-op labs, surgical consult, and possibly a CT scan of the abdomen, and administration of antibiotics
C. Dietary counseling and arrangement of GI followup for this patient’s acute irritable bowel syndrome
D. Administration of famotidine, maalox and viscous lidocaine, followed by a reassessment to ensure resolution of pain
B. IV access, analgesia, NPO, pre-op labs, surgical consult, and possibly a CT scan of the abdomen, and administration of antibiotics
A 26 year old male presents with 24 hours of epigastric pain and chills. The patient states it was his birthday 36 hours ago and he drank more alcohol than he should have. He had multiple episodes of violent, severe retching and non-bilious vomiting that have resolved. The patient feels that he is progressively getting sicker and has lately had chills and rigors. On physical examination, the patient looks unwell with a heart rate of 125 beats per minute and blood pressure of 89/53 mm Hg. He has pain in his epigastrium, a crunching sound on auscultation of his lungs, and subcutanesous emphysema. Which of the following is correct with regards to this patient’s condition?
A. Majority of cases are managed non-operatively
B. Nasogastric tube insertion is contraindicated
C. Most injuries occur in the distal esophagus
D. Pleural effusions commonly develop on the right side
C. Most injuries occur in the distal esophagus
A 59-year-old woman was recently diagnosed with a large annular sigmoid colon cancer. Her severe pain for the last 4 days in her left lower quadrant and back prompted her primary care physician to order a CT of the abdomen which revealed air surrounding the colon and in the retroperitoneum. One antibiotic that should be considered as part of her management should be: A. Ampicillin/Sulbactam B. Cephalexin C. Metronidazole D. Gentamicin
C. Metronidazole
A CT of the abdomen reveals air surrounding the duodenum and under the diaphragm in a 45 year old man in the ED. Your surgeon has taken him to the OR after rapid IV fluid resuscitation and antibiotics were started in the ED. His family arrives after he already went to the theater and wants to know his risk of dying. You can tell them even with advances in surgery, antibiotics and ICU care his risk of mortality is: A. 1-5% B. 5-20% C. 30-50% D. 50-70%
C. 30-50%
A 45 year old female presents to the ED brought in by her husband. He is concerned that the patient is not acting appropriately and has been confused and repeating herself. She even tried to drive in the wrong direction just prior to presentation He does note that yesterday she complained of a headache. She is otherwise healthy, except for occasional NSAIDS, thyroid medication, and prn valcyclovir for oral herpes. He denies alcohol or other substances. On exam, the patient’s temperature is 99.8 F, Pulse 108, RR 22, BP 118/77, O2sat 99% RA. Her airway is patent, GCS is 14, and her neck is supple. The rest of the physical exam is non focal.
For which of the following conditions is the patient at greatest risk?
A. Narcotic abuse
B. Influenza
C. Encephalitis
D. Epilepsy
C. Encephalitis
A 45 year old female patient presents to the emergency department in the care of her husband with a complaint of agitation and anxiety. Her husband states that she has been acting "strangely" for the past several days. She's been hyperactive, "agitated", and sometimes delusional. She is previously healthy but has allergies to penicillins, iodine, and morphine. On exam, the patient is clearly anxious and frustrated with the visit. She's diaphoretic and on cardiovascular exam a harsh systolic murmur is heard as well as an irregularly irregular rhythm. Vital signs show a temperature of 101.5, HR 123, BP 175/98, RR 27, and SpO2 98% on RA. An EKG shows rapid atrial fibrillation. What is the definitive treatment for her condition? A. Aspirin, benzodiazepines, fluids B. Acetaminophen, haloperidol, atenolol C. Diltiazem, benzodiazepines, IV fluids D. Lithium, propranolol, acetaminophen
D. Lithium, propranolol, acetaminophen
A 26 year old female is brought into the Emergency Department for suicidal ideations. She has been depressed with the thoughts of wanting to hurt herself for the past 2 days. Her past medical history is significant for hypertension, seasonal allergies, and panic disorder. Currently she is married and living with her husband. She is employed and has been working at a bank for 7 years. The patient denies any alcohol or drug use. Which factor in this patient’s history increases the patient’s suicide risk? A. Female gender B. Panic disorder C. Married status D. Job employment
B. Panic disorder
A 20 year-old man presents to the Emergency Department with right-sided chest pain and dyspnea. His symptoms started while walking his dog five hours ago. He describes the pain as sharp, pleuritic, and diffuse throughout his right chest. He has a history of asthma for which he takes albuterol as needed. He took four puffs of his inhaler today without relief. He has no surgical history, and reports occasional cigarette and alcohol use. He denies trauma. On exam, he appears uncomfortable. He has a heart rate of 105 beats/minute, a blood pressure of 145/85, a respiratory rate of 22 breaths/minute, a temperature of 98.9 degrees Fahrenheit and a pulse oximeter reading of 93% on room air. He has decreased breath sounds heard over his right chest. A triage chest x-ray is shown. What is the most appropriate next step in managing this patient?
A. Insert a tube thoracostomy
B. Administer empiric antibiotics
C. Administer prednisone
D. Perform a chest computed tomography (CT) angiogram
A. Insert a tube thoracostomy
You are taking care of a 65 year old male with sudden onset of sharp central chest pain and shortness of breath about 1 hour ago. He also says his left arm feels “funny.” His vital signs are HR 113 bpm, BP 175/101, RR 28 breaths per minute, SpO2 94% on room air, and temp 98.7F. On exam, the patient is diaphoretic, uncomfortable, but his exam is otherwise unremarkable. Which bedside diagnostic maneuver will help you confirm your suspicions about his diagnosis?
A. Ankle/brachial indices bilaterally
B. Bilateral upper extremity blood pressures
C. Valsava maneuver to reproduce murmurs
D. Auscultation of carotid arteries for bruits
B. Bilateral upper extremity blood pressures
A 75 year old male with a history of hypercholesterolemia, hypertension, and diabetes presents to a tertiary care center with left leg pain which started yesterday. He has also noted chest pain and shortness of breath. Vital signs are HR 75 bpm, BP 186/97, RR 23, temp 97.8, SpO2 96% on NRB. On exam the patient is pale, diaphoretic, with labored breathing. He has a loud holodiastolic murmur at the right upper sternal border. His left leg is pale and there is no palpable pulse. His EKG is shown below [EKG missing on Test]. What is the most appropriate management at this time?
A. Heart catheterization and stent placement
B. Beta blocker infusion for blood pressure control
C. Intravenous heparin infusion
D. Intravenous thrombolytic therapy
B. Beta blocker infusion for blood pressure control
Paramedics arrive with a nursing home patient in respiratory distress. The patient is breathing at 30 breaths per minute, has a blood pressure of 180/100, a heart rate of 95, and an oxygen saturation of 88%. On physical exam, she is diaphoretic. speaking in few word sentences, has jugular venous distention, diffuse rales in both lungs, and bilateral lower extremity edema. She states that she does not want to end up on a ventilator in the ICU like her late husband. Paramedics provide you with a phone number for her son. She is given nitroglycerin, aspirin, and furosemide. The most appropriate next step in management is:
A. Administer morphine based on the ethical principal of double effect
B. Initiate treatment with bilevel positive airway pressure (BiPAP)
C. Proceed with rapid sequence endotracheal intubation
D. Contact her son to clarify her code status
B. Initiate treatment with bilevel positive airway pressure (BiPAP)
A 57 year-old male is brought in by emergency medical services in cardiac arrest. The paramedics have initiated ventilations via a bag-valve-mask and chest compressions. He has no spontaneous respirations, pulse or blood pressure. He was defibrillated at 360 joules after which an intravenous line was placed. Which of the following is the most appropriate intervention? A. amiodarone 300 mg B. atropine 1 mg C. epinephrine 1 mg D. lidocaine 100 mg
C. epinephrine 1 mg
A 73 year old woman is brought in by BLS after witnessed collapse. They found the patient unresponsive and provided CPR until arrival in the Emergency Department. In the Emergency Department the EKG demonstrates a wide-complex, regular rhythm and there is no palpable carotid pulse, consistent with PEA arrest. The patient is intubated and CPR is continued. According to ACLS guidelines, what is the next step in this patient’s management? A. Defibrillation B. Heparin C. Epinephrine D. Nitroglycerine
C. Epinephrine
A 68 year old male presents to the emergency department with worsening shortness of breath for 3 days. This morning he woke up from sleep with shortness of breath. He has a past medical history of hypertension and coronary artery disease. He takes losarten, clonidine, metoprolol and aspirin daily. He has no medication allergies. Temperature is 37.5°C, blood pressure is 188/92, heart rate is 94 and respiratory rate is 22. Pulse oximetry on room air shows an oxygen saturation of 93%. The patient appears to be in moderate respiratory distress and is using accessory muscles to breath. His cardiac examination reveals an S3, pulmonary examination reveals bibasilar rales. Jugular venous distention is noted at 6cm. He has 1+lower extremity edema. The remainder of the examination is unremarkable. Which of the following is the most appropriate next step in management? A. Nitroglycerin B. Intubation C. Chest radiograph D. Non-invasive ventilation E. Furosemide F. Supplemental oxygen
F. Supplemental oxygen
You are taking care of diabetic 32 year old male in the emergency department. He presents with several days of illness including vomiting, diffuse abdominal pain, and weakness. On exam, the patient appears uncomfortable and dehydrated. He is taking frequent deep breaths and his breath has a fruity odor. His abdominal exam shows a soft abdomen with mild diffuse tenderness but no rebound or guarding. Lung sounds are clear and cardiovascular exam is normal. Vital signs are: HR 123 BP 105/65 RR 19 SpO2 98% RA Temp 100.3.
Initial laboratory studies show: Sodium 128 meq/L Potassium 2.3 meq/L Glucose 434 mg/dL Chloride 94 meq/L
What is the most appropriate initial therapy? A. IV lactated ringer’s solution B. IV normal saline with potassium C. IV 3% sodium chloride D. IV insulin
B. IV normal saline with potassium
