Block 5

Question 1

Hyperthermia and Hypothermia can be sen with many disease conditions. Shivering associated with hypothermia increases energy needs and therefore, increases the body’s oxygen consumption. Hypothermia causes the metabolic rate to ______ and the body’s oxygen requirements to _____.

Answer 1

A. Increase, Increase

Question 2

Noise may be defined subjectively as a sound that is unpleasant, distracting, unwarranted, or some other way undesirable. The human hearing mechanism has a wide range and is fairly tolerant but in many aircraft this tolerance is exceeded. Unprotected exposure to noise can product undesirable effects. Which of the following is an undesired response to the noise.

Answer 2

B. Tinnitus

Question 3

In normal situations, patients may not be airlifted until the chest tube has been removed for _____ hours and have an _____ completed post removal.

Answer 3

B. 24/Chest x-ray

Question 4

Given what you know about the effect of Dalton’s Law a patient’s baseline O2 saturation of 92% on room air at sea level would result in what potential complication at altitude?

Answer 4

A. hypoxia

Question 5

At cruise altitude, you notice your patient is confused. Vital signs are: 125/89, HR 112, RR 20 and SPO2 87% room air. based on the Aeromedical Evacuation Clinical Protocol: Emergency Oxygen, what is the priority for this patient?

Answer 5

D. Titrate oxygen to maintain saturation >92%

Question 6

Ensuring every patient has ample medication supply to meet their individual requirements throughout the patient movement system is the responsibility of every care provider at every hand off location. IAW AFI 48-307V1, which of the following variables is NOT considered when determining the required amount of medication?

Answer 6

B. Number of planned sorties

Question 7

Medications in the Aeromedical Evacuation Clinical Protocol: Over the Counter Medication Administration may be administered one time, unless otherise stated, by a trained registered nurse. Which medication below requires notification of a physician before a flight nurse can administer it?

Answer 7

B. Ceftriaxone (Rocephin)

Question 8

A 24 y/o male is being transported to Germany to Andrews due to a left ankle fracture. He is currently a SAM taking Percocet 5/325mg for his pain. At cruise altitude, you ntoice he is slumped over and is not responding to verbal or painful stimuli. IAW Aeromedical Evacuation Clinical Protocol: Narcotic or Benzodiazepine Overdose, what medication will be administered?

Answer 8

D. Nalozone 0.4 mg - 2 mg IV/IO/IM/SC

Question 9

Maintaining body alignment, elevating the extremity, changing positions and consideration of application of heat or cold are examples of drug interventions.

Answer 9

B. False

Question 10

Pain is a complex experience with multiple dimensions and is always subjective. There are indicators of pain by hierarchy. The singly MOST reliable measure of pain intensity is _______.

Answer 10

A. Patient Self Report

Question 11

Initial management of status epilepticus, IAW Aeromedical Evacuation Clinical Protocol: Status Epilepticus, is divided into three phases. Which statement best describes the first phase of management?

Answer 11

C. Assess patient’s airway and support oxygenation.

Question 12

A patient with a history of status epilepticus is manifested on you rflight from Andrews Air Force Base, Maryland to Kelly Air Field, Texas. You are the AECM assigned to care for this patient. Which of the following describes signs and symptoms of a seizure?

Answer 12

D. All of the following

Question 13

You are treating a patient with a newly placed colostomy collection bag. IAW AFI 48-307V1 what, if anything, should have been done pre-flight to avoid this complication?

Answer 13

A. Poke two holes above wafer ring

Question 14

You have enplaned a patient who is status post exploratory laparotomy. During flight, your patient develops intractable nausea and gastric distension. You have administered anti-emetics as ordered and the patient has had no relief. What would be the next intervention?

Answer 14

B. Insert nasogastric tube

Question 15

When transporting a pregnant patient and fetal gestation is greater than 20 weeks, FHT’s should be obtained ________.

Answer 15

D. Before departure, at cruise altitude, every 12 hours thereafter, and immediately after the rupture of membranes.

Question 16

Pregnant patients will be transported with the airborne life support system (ALSS) if greater than ______ weeks or as otherwise indicated.

Answer 16

C. 43

Question 17

Infant and children need to be monitored closely during actual descent due to the limited ability to self-clear their ears. What are the possible methods that can be used to help infants of children clear their ears during descent?

Answer 17

D. All of the above

Question 18

Thermal changes have the greatest impact on infants and young children who have a very sensitive thermoregulating system

Answer 18

A. True

Question 19

Tommy, a 9 y/o passenger, ate a peanut butter and jelly sandwich on the plane ride from California to Hawaii. His mother alerts you that he is currently unable to breathe his face is flushed, his heart is racing. She states that he does not have any allergies. What medication are you able to give him?

Answer 19

C. Epinephrine 0.01 mg/kg (1:1000) IM or SC

Question 20

A female Security Forces troop guarding the gate was shot several time in both thighs. She was immediately taken to the ROLE 3 where she is being evaluated. She is exhibiting signs of hypovolemic shock. Her signs and symptoms most likely include ______.

Answer 20

B. Increased pulse rate, increased respiratory rate, decreased urine output

Question 21

A 61 y/o male ANG O-5 in Bagram, Afghanistan report to the ED with complaints of chest pain. Cardiac enzymes are abnormal. A 12-lead EKG reveals an SVT, and the patient remains on continuous monitoring. the ED provider on duty orders follow-up cardiac enzymes, repeat 12-lead EKG, and transport to Landstuhl for further treatment. his 12-lead EKG should be obtained within how may hours of the scheduled flight.

Answer 21

B. 24

Question 22

Transcutaneous pacing is used for short intervals until transvenous pacing can be initiated.

Answer 22

A. True.

Question 23

a 32 y/o male solider was seen in the outpatient clinic. labs have shown him to be hypoglycemic. You would expect all the following signs and symptoms.

Answer 23

A. Polydispsia and polyuria.

Question 24

What blood glucose levels should alert the clinician to look for further signs and symptoms associated with hypoglycemia in diabetic patients?

Answer 24

A. <70 mg/dl

Question 25

A 64 y/o diabetic female is complaining of anxiety, sweating, and tremors in her hands. With her history as a diabetic, you check her blood glucose and it is at 55 mg/dl. Knowing that 15-20 grams of carbohydrates intake is usually sufficient to raise the blood glucose into safe range, you suggest to your patient that she consumes __________.

Answer 25

D. 2-3 pieces of hard candy

Question 26

A hemoglobin below ______ may be transported if the condition is chronic and stable and not related to bleeding.

Answer 26

B. 8.0 mg/dl

Question 27

All of the following dietary considerations will be avoided in leukocyte disorders, EXCEPT _______.

Answer 27

D. Canned, bottled and powered beverages

Question 28

The compromise of muscle viability due to swelling of, or bleeding into tissues encased within the fascial sheath of an extremity, and is considered an emergency is known as compartment syndrome.

Answer 28

A. True

Question 29

Ensure as cast is bivalved prior to leaving the MTF, if the cast is less than ______ hours old.

Answer 29

C. 48

Question 30

A 23 y/o Airman has sustained a right femur fracture after falling off of his bicycle. He has had an external fixator placed to the right thigh. a neurovascular assessment is critical. Which statement describes a complete neurovascular assessment?

Answer 30

D. Sensation, peripheral pulse quality, capillary refill, presence of edema, pain, color and temperature of affected extremity.

Question 31

All of the following potential patient diagnoses are at risk of an ear block EXCEPT ________

Answer 31

C. Type 2 diabetes

Question 32

Recalling the principles of Boyle’s Law what stress of flight involves gas becoming trapped or partially trapped in sinuses and teeth, therefore increasing pain?

Answer 32

D. Barometric pressure changes.

Question 33

According to AFI 48-307V1, the safest and least restrictive alternative method for controlling violent and uncontrollable behavior in the AE environment includes all of the following EXCEPT __________.

Answer 33

D. Threats from the flight crew

Question 34

The goal of applying restraints is _________.

Answer 34

Safety of the patient and aircrew

Question 35

Mental health patients are typically physically health and therefore capable of independent actions that could directly threaten aircrew, patient staging personnel and other patients, if the patient is exhibiting aggressive and uncontrollable behavior, is extremely agitated or violent and/or is determined to be a danger to flight safety, self or others, give as needed (PRN) medication as ordered. If no PRN medication is ordered and Haldol is contraindicated for this patient, which medication is appropriate to administer?

Answer 35

B. Valium 10 mg IM/IV

Question 36

A solider has received 25% TBSA burns. In addition to a secured airway, what other support measure(s) should you expect this patient to have?

Answer 36

D. All of the above

Question 37

Monitoring urinary output is a key component to the recovery of a burn patient. The target resuscitation in electrical burns when pigmenturia is present is to maintain urine output of _____ ml/hr.

Answer 37

D. 75-100

Question 38

A 35 y/o female solider being evacuated for a TBI suddently starts complaining of itchhing, tingling skin, pain in her elbow and knees bilaterally, and feeling a suffocation. Based on these symptoms you can suspect the cause is ________.

Answer 38

C. Decompression Sickness

Question 39

A 28 y/o solider status post IED blast with multiple shrapnel wounds to the face and extremities. He is being transported from Bagram Air Base, Afghanistan to Andrews Air Base, Maryland. Which statement describes the appropriate wound management during flight?

Answer 39

D. All of the above

Question 40

Which statement is TRUE regarding Boyle’s law?

Answer 40

C. Ascending altitude will cause the volume of trapped gas to expand.

Question 41

_______ is the end product of all physiological and psychological stresses associated with exposure to altitude.

Answer 41

A. Fatigue

Question 42

Given what you know about the effect of Dalton’s Law, a patient’s baseline O2 saturation of 92% on room air at sea level would result in what potential complication at altitude?

Answer 42

A. Hypoxia

Question 43

a 29 y/o female has fractured her right ankle due to a vehicle roll over and has been transported to Germany on seven hour AE mission for further evaluation and care. Upon arrival to Germany, it is discovered that she has developed a Venous Thromboembolism (VTE). Which intervention is considered a pharmacological intervention?

Answer 43

D. Administer low molecular weight heparin.

Question 44

Who is responsible for verifying patient’s understanding and knowledge, providing additional education, as appropriate, on proper Self Administering Medication (SAM) patients?

Answer 44

A. Registered Nurse

Question 45

Complications during infusion of local anesthetics are rare. However, in unusual cases, systemic toxicity such as central nervous system and cardiovascular symptoms may occur. If local anesthetic toxicity (LAST) is suspected, immediately discontinue any ongoing anesthetic infusion and administer what medication for rapid progression of toxicity symptoms?

Answer 45

C. 20% intralipid 1.5ml/kg over 1 minute

Question 46

In accordance with AFI 48-307V1, pain and vital signs will be reassessed after pharmacological interventions. When will pain be reassessed?

Answer 46

B. 15-30 minutes

Question 47

Non-drug interventions are available to assist in alleviating pain. All of the following methods to assist in alleviating pain EXCEPT ______.

Answer 47

A, Remove Splint

Question 48

The Military Acute Concussion Evaluation (MACE) is mandatory for all involved in an explosion, blast, fall, blow to the head, MVC, aircraft crash, dazed, confused, saw stars, or momentary loss of consciousness. Completion of the MACE is an in-flight requirement.

Answer 48

B.False

Question 49

A 21 year old marine is being transported from Kandahar roll 3 to Rammstein Germany status post IED blast with humvee rollover. The patient experienced a loss of consciousness immediately following the accident. The Mace is currently 25. Which of the following statements is true regarding hypoxemia and the stresses of flight in the neurologically impaired patient?

Answer 49

D. hypoxic episode in the presence of a TBI may lead to catastrophic secondary brain injury

Question 50

During preflight assessment you notice coffee ground like material in the patient suction canister that ERPSS nurse states, “it’s no big deal that’s been there for the past two days” based on the nurses statement this patient is stable for flight.

Answer 50

B. False

Question 51

After the delivery of a newborn in flight the umbilical cord will not be cut and shall remain intact

Answer 51

B False

Question 52

what is the most common cause of cardiac arrest in pediatric patients?

Answer 52

D . Respiratory dysfunction

Question 53

Early recognition of the symptoms of progressive deterioration in respiratory function an prompt and initiation Of therapy can often prevent cardiac arrest an infant an pediatric patients sign in symptoms of respiratory distress / respiratory failure in infants include

Answer 53

C. Respiratory rate less than 34 per minute

Question 54

An army soldier patrolling in the area of Afghanistan stepped on an IED. He sustained multiple injuries which included bilateral below the knee amputations and severe abdominal trauma. The patient is now 4 days post operative repair of BLE stump repair in multiple a domino injuries and is now experiencing signs and symptoms similar to hypovolemic shock, chills, and a high fever. He is most likely experiencing which type of shock?

Answer 54

A. Septic

Question 55

A 52 year old contractor is currently being of act evaluated in the Kandahar roll 3 trauma Bay for chest pain. An EKG reveals St elevation in abnormal cardiac enzymes. The patient has minimal relief with pharmacological interventions. they are manifested on the next mission to Germany for father evaluation. Continuous cardiac monitoring will be conducted in flight and will require a medical attendant (MA). who makes the final determination if the patient shall be accompanied by an enroute critical care team or a medical attendant such as a physician or acls trained nurse

Answer 55

D. validating flight surgeon

Question 56

All of the following are signs and symptoms of congestive heart failure except

Answer 56

B. Warm and Rosy skin

Question 57

According to the air medical evacuation clinical protocol hypoglycemia, if a Glucagon kit is not available what other medication can be given?

Answer 57

B. D50

Question 58

you are transporting a 54 year old female who has a history of easy bruising Anne periodic nosebleeds. This CBC is normal except for a platelet count of 70,000 per MM3. What precautions should you adhere to

Answer 58

D. Position patient for safety and enforce all fall precautions

Question 59

the compromise of muscle viability due to swelling up or bleeding into tissue in case within the fashion school sheet of an extremity is considered an emergency an known as

Answer 59

C. Compartment syndrome

Question 60

what stress of flying may lead to dehydration predisposing individuals to VTE and may also cause skin dryness over time leading to itching under the cast?

Answer 60

B. Humidity

Question 61

a 28 year old soldier post explosive blast with multiple shrapnel wounds to the face and extremities. He is being transported from bogrim air base Afghanistan to Andrews Air Force Base Maryland. Which is not correct regarding wound management during flight?

Answer 61

C. Dressings will be changed as directed by provider order.

Question 62

Valsalva is not performed on patients with acute eye injuries post op surgery gli coma detached retina and or hyphema

Answer 62

A. true

Question 63

a 36 year old airman is being transported out of theater by your crew. She is diagnosed with depression and self medicating with 30 milligrams of Paroxetine Hydrochloride (paxil) During the flight she begins to demonstrate unusual changes in behavior. What stress of flight may have exacerbated this medication?

Answer 63

D. Decrease partial pressure of oxygen

Question 64

Mental health patients are typically physically healthy and therefore capable of independent actions that could directly threaten the aircrew, patient staging personnel and other patients. If the patient is exhibiting aggressive and uncontrollable haviar is extremely agitated or violent and or is determined to be a danger to flight safety, sell for others, give as needed medication as ordered. If no medication is ordered initially give ___________________.

Answer 64

A. hadol 5 milligrams IM or volume 10 milligrams IM or IV

Question 65

Criteria for activating the burn team include all of the following except

Answer 65

D. Partial thickness burns greater than 3% total body surface area

Question 66

Monitoring urinary output is a key component to recovery of a burn patient the target resuscitation is to maintain an adequate urine output of

Answer 66

B. 30 – 50 milliliters an hour

Question 67

while leaving Baghdad a tactical ascent is required.. Shortly after takeoff a patient starts exhibiting signs of decompression sickness this includes craps bends chokes staggers which intervention would not be suggested at this time

Answer 67

D. trendelenburg position for comfort