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EMT230 Flashcards

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1
Q

acute coronary syndrome (ACS) is a term used to describe:

a. acute chest pressure or discomfort that subsides with rest or nitroglycerin
b. a clinical condition in which patients experience chest pain during exertion
c. any group of clinical symptoms consistent with acute myocardial ischemia
d. a sudden cardiac rhythm disturbance that causes a decrease in cardiac output

A

c. any group of clinical symptoms consistent with acute myocardial ischemia

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2
Q

the left main coronary artery subdivides into the:

a. left anterior descending and ascending arteries
b. left posterior descending and circumflex arteries
c. left anterior descending and circumflex arteries
d. right coronary and left posterior descending arteries

A

c. left anterior descending and circumflex arteries

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3
Q

the P-R interval (PRI) should be no shorter than ___ seconds and no longer than ___ seconds in duration.

a. 0.14, 0.30
b. 0.16, 0.40
c. 0.12, 0.20
d. 0.18, 0.20

A

c. 0.12, 0.20

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4
Q

unstable angina:

a. indicated that myocardial necrosis has occurred
b. often awakens the patient from his or her sleep
c. occurs following periods of strenuous exertion
d. is less frequent but is associated with more pain

A

b. often awakens the patient from his or her sleep

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5
Q

atrial kick is defined as:

a. the volume of blood that the atria contracts into the ventricles
b. an attempt of the atria to contract against closed valves
c. the blood that flows passively into the ventricles
d. pressure on the atrioventricular valves during ventricular contraction

A

a. the volume of blood that the atria contracts into the ventricles

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6
Q

TRUE or FALSE: to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump moves two potassium (K+) ions into the cell for every three sodium (Na+) ions it moves out of the cell.

A

TRUE

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7
Q

the area of conduction tissue in which electrical activity arises at any given time is called the:

a. sinus node
b. myocyte
c. pacemaker
d. bundle of His

A

c. pacemaker

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8
Q

sympathetic nerves are regulated primarily by:

a. epinephrine
b. acetylcholine
c. adrenaline
d. norepinephrine

A

d. norepinephrine

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9
Q

the further removed the conduction tissue is from the sinoatrial node:

a. the slower its intrinsic rate of firing
b. the longer the PRI will be
c. the narrower the QRS will be
d. the faster the intrinsic rate of firing

A

a. the slower its intrinsic rate of firing

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10
Q

in the context of cardiac compromise, syncope occurs due to:

a. a drop in cerebral perfusion
b. an acute increase in heart rate
c. a sudden cardiac dysrhythmia
d. an increase in vagal tone

A

a. a drop in cerebral perfusion

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11
Q

a patient asks you about his risk of cardiovascular disease (CVD). he is 50 y/o and has diabetes, is overweight and smokes. what should the paramedic advise him?

a. his risk cannot be modified because of his hereditary risk factors
b. he can modify his risk by losing weight and not smoking
c. his risk will remain high and modifying his lifestyle will not reduce risk
d. his age and gender raise risk more than lifestyle

A

b. he can modify his risk by losing weight and not smoking

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12
Q

which statement is true of the coronary arteries?

a. the right coronary artery supplies most of the blood to the heart
b. the coronary arteries run inside the myocardium
c. the coronary arteries begin just above the aortic valve
d. there are three primary coronary arteries

A

c. the coronary arteries begin just above the aortic valve

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13
Q

of what branch is the circumflex artery?

a. LCA
b. LAD
c. RCA
d. RMA

A

a. LCA

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14
Q

in the event of a coronary artery blockage, how could the muscle of the hear still received blood?

a. anastomoses
b. arota
c. vasoconstriction
d. coronary veins

A

a. anastomoses

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15
Q

the right atrium receives blood from the systemic circulation and the ____.

a. left ventricle
b. coronary vein
c. pulmonary arteries
d. pulmonary veins

A

b. coronary vein

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16
Q

what is the valve between the right atrium and the right ventricle?

a. tricuspid valve
b. mitral valve
c. semilunar valve
d. pulmonic valve

A

a. tricuspid valve

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17
Q

what term describes relaxation of the heart?

a. systole
b. diastole
c. refractory period
d. propagation

A

b. diastole

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18
Q

stroke volume depends on preload, afterload, and ____.

a. blood pressure
b. vascular resistance
c. heart rate
d. myocardial contractility

A

d. myocardial contractility

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19
Q

what is Starling’s law?

a. HR increases as O2 demands increase
b. myocardial fibers contract more forcefully when they are stretched
c. afterload increase with increased BP
d. stroke volume decreases when the preload decreases

A

b. myocardial fibers contract more forcefully when they are stretched

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20
Q

what is the most important factor in determining stroke volume (SV) in a health heart?

a. preload
b. afterload
c. heart rate
d. myocardial contractility

A

a. preload

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21
Q

what does an increase in peripheral vascular resistance cause?

a. increased SV
b. decreased SV
c. only minimally affects SV
d. doubles the SV

A

b. decreased SV

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22
Q

complete the equation:

Cardiac Output = __ x __

a. stroke volume, heart rate
b. preload, heart rate
c. stroke volume, afterload
d. preload, afterload

A

a. stroke volume, heart rate (CO = SV x HR)

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23
Q

the RCA and the LAD supply most of the blood to what part of the cardiac muscle?

a. septum
b. left atrium
c. lateral left ventricle
d. right atrium and ventricle

A

d. right atrium and ventricle

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24
Q

the circumflex branch of the LCA mainly supplies blood to what part of the cardiac muscle?

a. septum
b. left atrium
c. lateral left ventricle
d. intrinsic pacemakers

A

b. left atrium

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25
Q

the LAD mainly supplies blood to what part of the cardiac muscle?

a. septum
b. left atrium
c. lateral right ventricle
d. intrinsic pacemakers

A

a. septum

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26
Q

how is preload defined?

a. ventricular end-diastolic volume
b. ventricular pre-diastolic volume
c. atrial end-diastolic volume
d. atrial pre-diastolic volume

A

a. ventricular end-diastolic volume

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27
Q

what is the group of nerves that innervates the atria and ventricle known as?

a. branchial plexus
b. aortic plexus
c. cardiac plexus
d. carotid plexus

A

c. cardiac plexus

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28
Q

what is the major neurotransmitter for the parasympathetic system?

a. norepinephrine
b. epinephrine
c. dopamine
d. acetylcholine

A

d. acetylcholine

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29
Q

what of these nerve fibers mainly innervate the ventricles of the heart?

a. parasympathetic
b. sympathetic
c. somatic
d. efferent

A

b. sympathetic

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30
Q

what is the parasympathetic control of the heart provided by?

a. subclavian nerve
b. fourth cranial nerve
c. phrenic nerve
d. vagus nerve

A

d. vagus nerve

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31
Q

the resting membrane potential is determined primarily by the difference between the intracellular potassium ion level and what ion level?

a. extracellular potassium
b. intracellular sodium
c. extracellular magnesium
d. intracellular calcium

A

a. extracellular potassium

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32
Q

when depolarization takes places, what action occurs?

a. magnesium ions rush into the cell
b. sodium ions rush into the cell
c. potassium ions rush out of the cell
d. calcium ions rush out of the cell

A

b. sodium ions rush into the cell

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33
Q

what is the movement function of the sodium-potassium pump?

a. sodium ions into the cell and potassium ions out of the cell
b. potassium ions into the cell and sodium ions out of the cell
c. sodium and potassium ions into the cell
d. sodium and potassium ions out of the cell

A

b. potassium ions into the cell and sodium ions out of the cell

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34
Q

Phase I of the action potential represents what period?

a. rapid depolarization
b. early rapid repolarization
c. plateau
d. rest between action potentials

A

b. early rapid repolarization

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35
Q

what occurs during the period between action potentials?

a. the inside of the cell is positive in relation to the outside of the cell
b. there is excessive sodium in the cell
c. there is excessive potassium in the cell
d. pacemaker cells are rapidly repolarizing

A

b. there is excessive sodium in the cell

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36
Q

the AV junction is formed by the AV node and what other part of the cardiovascular electrical system?

a. SA node
b. right ventricle
c. Bundle of His
d. left bundle branch

A

c. Bundle of His

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37
Q

TRUE or FALSE:

the dominant pacemaker of the heart is the AV node

A

FALSE.

the sinoatrial (SA) node is the dominant pacemaker (60-100 bpm).

the atrioventricular AV node/junction is a backup pacemaker (40-60 bpm).

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38
Q

how does acetylcholine affect the heart?

a. increasing heart rate
b. decreasing heart rate
c. increasing contractility
d. decreasing contractility

A

b. decreasing heart rate

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39
Q

what is the activation of myocardial tissue more than one time by the same impulse called?

a. automaticity
b. excitability
c. doubling
d. reentry

A

d. reentry

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40
Q

which is a bipolar lead?

a. V1
b. aVF
c. aVR
d. Lead II

A

d. Lead II

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41
Q

in lead II ECG placement, where is the positive lead located?

a. left arm
b. left leg
c. right shoulder
d. right leg

A

b. left leg

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42
Q

a paramedic places 10 leads: 4 on the limbs and 6 on the chest. what type of ECG is this?

a. standard 3 lead
b. 10-lead
c. 12-lead
d. modified

A

c. 12-lead

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43
Q

which lead is placed at the 4th intercostal space just to the right of the sternum?

a. V1
b. V2
c. V3
d. V4

A

a. V1

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44
Q

what kind of leads are Lead II and Lead III?

a. inferior
b. superior
c. lateral
d. precordial

A

a. inferior

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45
Q

what does each small block represent on standard ECG paper?

a. 0.01 second
b. 0.04 second
c. 0.10 second
d. 0.20 second

A

b. 0.04 second

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46
Q

each small square of ECG graph paper represents __ mV

a. 0.001
b. 0.01
c. 0.1
d. 1

A

c. 0.1

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47
Q

each square on ECG paper is ____ in height and width

a. 1 mm
b. 1 cm
c. 2 mm
d. 2 cm

A

a. 1 mm

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48
Q

in a 12-lead ECG, what cardiac position are the leads V1 and V2?

a. anterior
b. inferior
c. septal
d. lateral

A

c. septal

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49
Q

__ second is measured in each large box of ECG graph paper

a. 0.01
b. 0.04
c. 0.10
d. 0.20

A

d. 0.20

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50
Q

what statement best describes the triplicate method of determining heart rate?

a. most accurate for children
b. accurate when the heart rhythm is regular and > 50 bpm
c. used when the HR is irregular
d. preferred for patients with rapid ventricular rhythms

A

b. accurate when the hear rhythm is regular and > 50 bpm

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51
Q

when analyzing an ECG tracing, you notice the rhythm is highly irregular. what is the best method to calculate rate?

a. triplicate method
b. R-R method
c. six-second count method
d. caliper method

A

c. six-second couth method

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52
Q

what can an ECG help determine?

a. whether there is ischemic cardiac muscle
b. the force of contractions
c. the quality of the patient’s pulse
d. a range of expected blood pressures

A

a. whether there is ischemic cardiac muscle

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53
Q

Lead I looks at the heart from what view?

a. inferior
b. superior
c. lateral
d. anterior

A

c. lateral

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54
Q

what is the first upward deflection on an ECG tracing?

a. A wave
b. P wave
c. Q wave
d. T wave

A

b. P wave

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55
Q

the PRI represents the time that it takes an electrical impulse to do which action

a. generate ventricular response
b. be formed in the SA node
c. travel through the Purkinje fibers
d. be conducted through the atria and AV node

A

d. be conducted through the atria and the AV node

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56
Q

the duration of the QRS complex be should be __ second

a. 0.01 to 0.04
b. 0.04 to 0.20
c. 0.08 to 0.10
d. 0.08 to 0.20

A

c. 0.08 to 0.10

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57
Q

while analyzing an ECG, you cannot identify a Q wave. what does this most likely indicate?

a. the patient’s heart is ischemic
b. the Q wave may not be visible in the lead you are viewing
c. the patient has previously had an MI
d. the electrodes are placed incorrectly

A

b. the Q wave may not be visible in the lead you are viewing

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58
Q

what does the ST segment reflect?

a. early repolarization of the ventricles
b. time delay for the depolarization of the ventricles
c. absolute refractory period for the ventricles
d. time of ventricular contraction

A

a. early repolarization of the ventricles

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59
Q

what lead is routinely used for monitoring dysrhythmias?

a. Lead I
b. Lead II
c. aVL
d. V2

A

b. Lead II

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60
Q

what is a characteristic of NSR?

a. electrical impulse originates from the SA node
b. Purkinje fibers delay electrical transmission
c. PRI is > 0.24 second
d. QRS is > 0.18 second

A

a. electrical impulse originates from the SA node

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61
Q

ECG analysis reveals that each P wave in the tracing has different shape. the heart rate is 80. what rhythm should the paramedic suspect?

a. P-P morphology
b. wandering pacemaker
c. sinus arrhythmia
d. Type II AV block

A

b. wandering pacemaker

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62
Q

you see an irregular rhythm on the monitor with a rate of 66 to 80, a normal PRI, and P wave for every QRS. the rate speeds up and slows down with the patient’s RR.

a. afib with controlled response
b. atrial flutter with controlled response
c. sinus rhythm with frequent PVCs
d. sinus dysrhythmia

A

d. sinus dysrhythmia

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63
Q

what is the most likely cause of atrial flutter?

a. hyperexcitability syndrome
b. rapid reentry
c. enhanced conduction channels
d. ectopic atrial pacemakers

A

b. rapid reentry

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64
Q

what is a characteristic of junctional escape rhythm?

a. pathologic response to bradycardia
b. occurs when the SA node fails to fire
c. typically occurs at rate of 60-80
d. should be aggressively treated to prevent VF

A

b. occurs when the SA node fails to fire

65
Q

an ECG strip shows a rhythm with a rate of 45, a QRS of 0.08, and a P wave that appears after the QRS. what dysrhythmia should the paramedic suspect?

a. idioventricular
b. sinus bradycardia
c. afib
d. junctional

A

d. junctional

66
Q

TRUE or FALSE:

the intrinsic rate for a ventricular pacemaker is 10 to 20 bpm.

A

FALSE.

the intrinsic rate for a ventricular pacemaker is 20 to 40 bpm.

67
Q

a patient has a regular bradycardic rhythm with a rate of 40, no P waves, and a QRS > 0.12. the paramedic should diagnose what rhythm?

a. sinus bradycardia with aberrancy
b. junctional escape with aberrancy
c. afib with slow response
d. ventricular escape rhythm

A

d. ventricular escape rhythm

68
Q

sinus bradycardia is a sinus rhythm with a heart rate less than _ bpm

a. 80
b. 70
c. 60
d. 50

A

c. 60

69
Q

what does an elevated ST segment suggest?

a. ischemia
b. injury
c. infarction
d. necrosis

A

b. injury

70
Q

what does a depressed ST segment suggest?

a. ischemia
b. injury
c. infarction
d. necrosis

A

a. ischemia

71
Q

what part of the ECG tracing is the most important for detecting life-threatening arrhythmias?

a. P wave
b. PR interval
c. QRS complex
d. ST segment

A

c. QRS complex

72
Q

22 y/o. female. athlete/runner. skin condition, BP, and mental status are normal. HR 46. P waves and QRS complexes look normal. PRI is 0.16. there is a QRS following each P wave.

a. NSR
b. First-degree AV block
c. sinus arrhythmia
d. sinus bradycardia

A

d. sinus bradycardia

73
Q

22 y/o. female. athlete/runner. skin condition, BP, and mental status are normal. HR 46. P waves and QRS complexes look normal. PRI is 0.16. there is a QRS following each P wave. what treatment does this patient need?

a. no treatment at this time
b. 0.5 mg atropine IVP
c. dopamine drip
d. epinephrine drip

A

a. no treatment at this time

74
Q

an ECG strip shows a regular rhythm with a WRS complex of 0.08, a rate of 145, a PRI of 0.12, and one upright P wave before each QRS complex. what rhythm should the paramedic suspect?

a. sinus tachycardia
b. SVT
c. atrial trachycardia
d. afib

A

a. sinus tachycardia

75
Q

you are called to evalute a 64 y/o woman c/o palpitation, weakness, and dizziness. HR 160, BP 118/80, RR 28. the ECG tracing shows narrow QRS complexes and no identifiable P waves.

a. SVT
b. afib
c. atrial flutter
d. multifocal atrial tachycardia

A

a. SVT

76
Q

what may be lethal treatment for patient with a ventricular escape rhythm?

a. atropine
b. dopamine
c. transcutaneous pacing
d. lidocaine

A

d. lidocaine

77
Q

Paramedics are treating a patient who is c/o palpitations. ECG shows frequent PVCs that are occurring in groups. Systolic BP is 100. what should the treatment for this patient include?

a. withhold treatment until serious signs and symptoms develop
b. immediate transcutaneous pacing
c. high flow oxygen and lidocaine
d. atropine and dopamine

A

this question is flawed and PSESI has two correct answers:

a. withhold treatment until serious signs and symptoms develop (we do not want to withhold treatment [oxygen])
- -AND–
c. high flow oxygen and lidocaine (prior to administration of lidocaine, it needs to be determined if the PVCs are perfusing or not!)

78
Q

what is the treatment of choice for a severe symptomatic ventricular escape rhythm?

a. atropine
b. pacing
c. lidocaine
d. epinephrine

A

b. pacing

79
Q

which statement is true regarding ventricular tachycardia?

a. the rate must be higher than 150 bpm
b. it may be triggered by a PVC
c. caused when the ventricles beat before the atria
d. cannot be associated with stable vital signs

A

b. it may be triggered by a PVC

80
Q

patients with pulseless ventricular tachycardia should be treated in the same way as what other dysrhythmia?

a. asystole
b. PEA
c. ventricular fibrillation
d. SVT

A

c. ventricular febrillation

81
Q

what is the class I intervention for all symptomatic bradycardia?

a. atropine
b. dopamine
c. transcutaneous pacing
d. there are no class I interventions

A

d. there are no class I interventions [for symptomatic bradycardia. the patient needs transcutaneous pacing which is a class IIa intervention]

82
Q

a patient with SVT begins to develop chest pain and the blood pressure drops to 100/60. what treatment should be implemented next?

a. adenosine rapid IVP
b. diltiazem IV bolus
c. carotid sinus massage
d. synchronous cardioversion

A

d. synchronous cardioversion

83
Q

what is the joule setting for the initial synchronous cardioversion of SVT?

a. 25 J
b. 50 J
c. 120 J
d. 300 J

A

b. 50 J

84
Q

when attempting to perform a vagal maneuver on a child, what action is most appropriate?

a. deep carotid massage
b. placement in the Trendelenburg’s position
c. jugular vein massage
d. placing ice packs to the neck

A

d. placing ice packs to the neck

85
Q

what is a hallmark trait of afib?

a. an irregularly irregular rhythm
b. multifocal PVCs
c. P waves following the QRS complex
d. 1:3 conduction through the AV node

A

a. an irregularly irregular rhythm

86
Q

Paramedics have determined that a patient is in afib, unstable and requires electrical therapy. Paramedics should perform ____ countershock with ____ joules.

a. unsynchronized, 50
b. synchronized, 50
c. unsynchronized, 100
d. synchronized, 120

A

d. synchronized, 120

87
Q

Trace the electrical impulse from the sinoatrial node to the Purkinje fibers in the heart (6 steps):

(1) sinoatrial node –> (2) intranodal and intra-atrial pathways –> (3) atrioventricular node –> (4) bundle of His –> (5) right and left bundle branches –> (6) Purkinje fibers

A

[this card intentionally left blank]

:-)

88
Q

trace a drop of blood through the circulatory system starting at the inferior/superior vena cava (13 steps):

(1) inferior/superior vena cava –> (2) right atrium –> (3) tricuspid valve –> (4) right ventricle –> (5) pulmonic valve –> (6) pulmonic arteries –> (7) lungs –> (8) pulmonary veins –> (9) left atrium –> (10) bicuspid or mitral valve –> (11) left ventricle –> (12) aortic valve –> (13) aorta

A

[this card intentionally left blank]

:-)

89
Q

how will PEA present on ECG?

a. VF
b. VT
c. any electrical activity other than VF or VT
d. asystole

A

c. any electrical activity other than VF or VT

90
Q

second degree type II heart block occurs when the impulse is not conducted through what portion of the cardiac electrical system?

a. SA node
b. AV node
c. Purkinje fibers
d. bundle branches

A

d. bundle branches

91
Q

ECG shows wide QRS complexes that are produced by supraventricular activity. on MCL1, paramedics see a QS pattern. what should you suspect?

a. the patient had has an MI
b. RBBB
c. LBBB
d. myocardial ischemia

A

c. LBBB

92
Q

a right axis shift of the ECG is noted when the QRS deflection has what characteristic?

a. positive in leads I, II, and III
b. positive in leads I and II but negative in lead III
c. positive in lead I and negative in leads II and III
d. negative in lead I, negative or positive in lead II and positive in lead III

A

d. negative in lead I, negative or positive in lead II and positive in lead III

93
Q

what is emergency care for a bundle-branch block?

a. aimed at the cause of the block if it is identifiable
b. atropine
c. high-doses of dopamine
d. TCP

A

a. aimed at the cause of the block if it is identifiable

94
Q

65 y/o man c/o CP and SOB. ventricular HR is 56. there are more P waves than QRS complexes. the PRI is constant when a QRS follows a P wave. QRS complexes are widened.

a. first degree
b. second degree type I
c. second degree type II
d. third degree

A

c. second degree type II

95
Q

what statement is true in regards to the identification of bundle-branch blocks?

a. not important in the prehospital setting
b. helpful in identifying patient who have had an MI
c. can only be determined with a 12-lead ECG
d. impossible without specialized equipment such as a Doppler

A

c. can only be determined with a 12-lead ECG

96
Q

what is typically found on an ECG with a bundle-branch block?

a. a narrow QRS complex
b. QRS complexes of ventricular origin
c. a widened QRS complex
d. a normal PR interval

A

c. a widened QRS complex

97
Q

what is a characteristic of a LBB?

a. less serious than a RBBB
b. a Q wave is seen instead of an R wave in MCL1
c. the conduction is delayed through the right ventricle
d. the QRS complex is less than 0.12 second

A

b. a Q wave is seen instead of an R wave in MCL1

98
Q

what does T wave inversion suggest?

a. ischemia
b. injury
c. infarction
d. necrosis

A

a. ischemia

99
Q

TRUE or FALSE:

ventricular fibrillation is the most common arrhythmia in sudden cardiac arrest?

A

TRUE

100
Q

a paramedic notes deep and symmetrically inverted T waves. of what may this be indicative?

a. current MI
b. hyperkalemia
c. cardiac ischemia
d. sodium depletion

A

c. cardiac ischemia

101
Q

how should a second degree type II heart block be considered?

a. benign arrhythmia
b. serious arrhythmia only if there are serious signs and symptoms
c. serious arrhythmia regardless of signs and symptoms
d. lethal arrhythmia if not immediately treated

A

c. serious arrhythmia regardless of signs and symptoms

102
Q

what is the most likely cause of a second degree type II heart block?

a. lateral MI
b. septal MI
c. drug toxicity
d. hypoxia

A

b. septal MI

103
Q

what is a typical characteristic of a third degree heart block?

a. regular atrial rhythm with irregular ventricular rhythm
b. irregular atrial rhythm with regular ventricular rhythm
c. regular but dependent atrial and ventricular rhythms
d. no regularity in the atrial or ventricular rhythms

A

c. regular but dependent atrial and ventricular rhythms

104
Q

what sound is heart when the AV valves close during ventricular systole?

a. S1
b. S2
c. S3
d. S4

A

a. S1

105
Q

after paramedics administer NTG 0.4 mg SL to a patient with chest pain who has ST-segment elevation in leads II, III, and AVF, the patient’s BP drops to 78/50 mm Hg. Where is the most likely location of the cardiac muscle damage?

a. anterior wall, which impairs left ventricular function
b. inferior wall and right ventricle, which increases dependence on preload
c. lateral wall, which impairs conduction
d. septal wall, which increases the sensitivity to nitrates

A

b. inferior wall and right ventricle, which increases dependence on preload

106
Q

ST elevation in leads II, III, and AVF may be indicative of _____ MI

a. inferior wall
b. lateral wall
c. anterior
d. septal wall

A

a. inferior wall

107
Q

in what position should JVD in cardiac patients be evaluated?

a. sitting straight up
b. leaning forward
c. lying flat
d. with head elevated 45 degrees

A

d. with the head elevated 45 degrees

108
Q

what is the first recommended treatment for SVT?

a. Valsalva maneuver
b. carotid sinus massage
c. synchronous cardioversion
d. no treatment required

A

a. Valsalva maneuver

109
Q

what is the prehospital care for a patient in second degree type II heart block?

a. lidocaine administration
b. amioadarone administration
c. synchronous cardioverson
d. transcutaneous pacing

A

d. transcutaneous pacing

110
Q

which home medication would indicate that your patient has a strong risk factor for heart disease?

a. carbamazepine
b. levodopa
c. metformin
d. levothyroxine

A

c. metformin

111
Q

an inferior wall MI is usually caused by occlusion of the ____ artery.

a. right coronary
b. left anterior descending
c. circumflex
d. left coronary

A

a. right coronary

112
Q

if afib has been present for more than 48 hours, conversion of the rhythm may lead to what complication?

a. release of emboli
b. sudden VF
c. refractory hypotension
d. rebound tachycardia

A

a. release of emboli

113
Q

paramedics discover a patient in asystole. in regards to electrical therapy, how should the paramedic proceed?

a. attempt to pace immediately
b. synchronize cardioversion at 100 J
c. deliver an initial unsynchronized shock of 200 J
d. electrical therapy is not recommended

A

d. electrical therapy is not recommended

114
Q

which rhythm is an absolute indication for unsynchronized cardioversion?

a. VT
b. PEA
c. VF
d. asystole

A

c. VF

115
Q

which is a cause of PEA correctable in the field?

a. tension pneumothorax
b. pulmonary embolism
c. myocardial infarction
d. ischemia during resuscitation

A

a. tension pneumothorax

116
Q

what is a characteristic of Wolff-Parkinson-White syndrome?

a. preexcitation syndrome
b. type of AV block
c. bradycardic rhythm caused by sick sinus syndrome
d. tachycardia rhythm as a result of increased automaticity in the cardiac cells

A

a. preexcitation syndrome

117
Q

Wolff-Parkinson-White syndrome is of little clinical important unless the patient is experiencing what condition?

a. hypoxia
b. tachycardia
c. bradycardia
d. heart murmur

A

b. tachycardia

118
Q

the three characteristics of Wolff-Parkinson-White syndrome are short PR interval, QRS widening, and a(n) ____.

a. J notch
b. Q complex
c. delta wave
d. alpha spike

A

c. delta wave

119
Q

what is the definitive treatment for second degree type II?

a. atropine administration
b. dopamine administration
c. transcutaneous pacemaker placement
d. transvenous pacemaker insertion

A

d. transvenous pacemaker insertion

120
Q

paramedics are treating a patient who is in PEA following home dialysis. which drug may be indicated?

a. lidocaine
b. sodium bicarbonate
c. calcium chloride
d. potassium chloride

A

b. sodium bicarbonate

121
Q

pacemakers are usually set to a rate of ____ bpm beginning with ____ milliamps.

a. 80 to 120; 80
b. 40 to 70; 75
c. 60 to 100; 100
d. 70 to 80; 50

A

d. 70 to 80; 50

122
Q

what is a major effect of norepinephrine?

a. bronchoconstriction
b. uterine relaxation
c. renal artery dilation
d. vasoconstriction

A

d. vasoconstriction

123
Q

how will parasympathetic stimulation affect the heart?

a. a decreased heart rate
b. an increased force of contraction
c. dilation of the coronary arteries
d. no effect at all

A

a. a decreased heart rate

124
Q

which statement best describes the firing characteristics of demand pacemakers?

a. continuously at a rate of 80 bpm
b. when the patient’s rate drops below a preset number
c. in the atria first and then in the ventricles
d. at an adjusted rate based on the patient’s activities

A

b. when the patient’s rate drops below a preset number

125
Q

when is synchronized cardioversion most acceptable for patient with ventricular tachycardia?

a. when the patient is pulseless
b. if they have decreased cardiovascular function
c. following two trials of drug therapy
d. when the patient is symptomatic

A

b. if they have decreased cardiovascular function

126
Q

you are treating a 75 y/o woman c/o persistent heartburn with a history of diabetes and atherosclerosis. what should the paramedic suspect?

a. this event is not related to her heart because she feels no chest pain
b. this may be a cardiovascular problem
c. if this is a cardiovascular problem, she will develop chest pain or shortness of breath
d. treatment for diabetes is more appropriate than treatment for cardiovascular problems

A

b. this may be a cardiovascular problem

127
Q

what is a compensatory mechanism of the heart in the presence of chronic hypertension?

a. enlarge the muscle mass of the heart
b. reduce the stroke volume
c. lower the heart rate
d. produce lower cardiac output

A

e. enlarge the muscle mass of the heart

128
Q

what organ(s) is at most risk in a hypertensive crisis?

a. kidneys
b. lungs
c. liver
d. eyes

A

a. kidneys

129
Q

during assessment, the paramedic discovers a carotid bruit. what underlying condition should the paramedic suspect?

a. a previous mI
b. an irregular heart rhythm
c. atherosclerosis
d. pulmonary hypertension

A

c. atherosclerosis

130
Q

what is a characteristic of atherosclerosis?

a. progressive narrowing of the lumen of medium and large arteries
b. blood clots forming because of high blood cholesterol
c. occluded coronary arteries
d. plaques forming the smallest arteries where this is smooth blood flow

A

a. progressive narrowing of the lumen of medium and large arteries

131
Q

what is a characteristic of Prinzmetal angina?

a. coronary arteries are totally blocked
b. patient have angina on exertion only
c. angina is progressively worsening
d. coronary arteries spasm

A

d. coronary arteries spasm

132
Q

what are most myocardial infarctions caused by?

a. acute thrombotic occlusion
b. coronary spasm
c. coronary embolism
d. severe hypoxia

A

a. acute thrombotic occlusion

133
Q

the majority of AMIs involve what section of the heart?

a. left ventricle
b. right ventricle
c. anterior portion of both ventricles
d. inferior portion of both ventricles

A

a. left ventricle

134
Q

what is a sign of cardiac tamponade?

a. bradycardia
b. flattened neck veins
c. decreased venous pressure
d. muffled heart tones

A

d. muffled heart tones

135
Q

what is a patient in left ventricular failure expected to have?

a. bradycardia
b. vasodilation
c. activation of the renin-angiotensin-aldosterone system
d. increased stroke volume

A

c. activation of the renin-angiotensin-aldosterone system

136
Q

if the left ventricle loses 25% of its muscle mass because of myocardial infarction, what affect will it have?

a. the patient is likely to die
b. the heart can still pump effectively
c. the patient will always have angina
d. the right ventricle must take over some of the pumping activities of the left ventricle

A

b. the hear can still pump effetively

137
Q

when performing CPR on an adult, how many inches should the paramedic compress the chest?

a. 0.5 to 1 inch
b. 1 to 1.5 inches
c. 1.5 to 2 inches
d. at least 2 inches

A

d. at least 2 inches

138
Q

what is the first medication a paramedic should administer to a patient with angina?

a. oxygen
b. aspirin
c. nitroglycerin
d. morphine

A

a. oxygen

139
Q

what is the position of comfort for patient with left ventricular failure?

a. sitting with legs dependent
b. Trendelenburg’s
c. left lateral recumbent
d. supine with head raised

A

a. sitting with legs dependent

140
Q

what is the desired action of prehospital medications when treating a patient with left ventricular failure?

a. increase preload
b. reduce afterload
c. reduce contractile function of the heart
d. increase venous return

A

b. reduce afterload

141
Q

what sign is most indicative of a right ventricular infarct?

a. foam, blood-tinged sputum
b. adventitious lung sounds
c. peripheral edema
d. orthopnea

A

c. peripheral edema

142
Q

if a patient is in cardiogenic shock, when should signs of cardiogenic shock develop?

a. when chest pain has relieved
b. after hypovolemia and dysrhythmias have been corrected
c. after fibrinolytic therapy has been administered
d. when the patient has received surgical interventions

A

b. after hypovolemia and dysrhythmias have been corrected

143
Q

what drug may improve the symptoms of cardiogenic chock patients in the field?

a. epinephrine
b. furosemide
c. dopamine
d. atropine

A

c. dopamine

144
Q

what will occur if the paddle positions are switched (if the apex paddle is applied to the sternum and the sternum paddle to the apex) during defibrillation?

a. only half the energy will be delivered
b. the monitor will not fire
c. QRS complexes will be upright on a quick look
d. defibrillation will occur as usual

A

d. defibrillation will occur as usual

145
Q

what is the initial pediatric defibrillation joule setting?

a. 1 J/kg
b. 1 J/kg
c. 3 J/kg
d. 4 J/kg

A

b. 2 J/kg

146
Q

if a patient with cardiac tamponade becomes hypotensive in the field, what should the paramedic do?

a. administer nitroglycerin
b. begin CPR
c. administer a fluid bolus
d. intubate

A

c. administer a fluid bolus

147
Q

[DISCREPANCY]

what are aneurysms most commonly the result of?

a. atherosclerotic disease
b. infectious disease
c. traumatic injury
d. genetic disorders

A

[DISCREPANCY]

a. atherosclerotic disease

[BUT PER D2L, C. TRAUMATIC INJURY]

148
Q

what is true of abdominal aortic aneurysm (AAA)?

a. more commonly seen in women
b. occurs most commonly in patients between the ages of 35 and 50
c. may be asymptomatic as long as it is stable
d. commonly found above the renal arteries

A

c. may be asymptomatic as long as it is stable

149
Q

how do patients usually describe the pain of an aortic dissection?

a. mild and tolerable
b. ripping or tearing
c. crushing pressure
d. dull and throbbing

A

b. ripping or tearing

150
Q

paramedics are called to the local airport to evaluate a 40 y/o woman who is c/o pain to her left lower leg. she has just completed a 12-hour flight and the pain developed as she got off the plane. her leg is warm, swollen, and painful.

a. arterial occlusion of the popliteal artery
b. dissection of the femoral artery
c. deep-vein thrombosis
d. a venous aneurysm

A

c. deep-vein thrombosis

151
Q

which illness/complication may cause sinus bradycardia?

a. hyperthermia
b. intrinsic sinus node disease
c. hypercapnia
d. increased sympathetic tone

A

b. intrinsic sinus node disease

152
Q

[DISCREPANCY]

what is the most common cause of death following myocardial infarction?

a. acidosis
b. electrolyte imbalance
c. ruptured myocardium
d. fatal dysrhythmia

A

[DISCREPANCY]

d. fatal dysrhythmia

[BUT PER D2L, B. ELECTROLYTE DISTURBANCE]

153
Q

what is right ventricular failure most often the result of?

a. hypoxia
b. hypertension
c. myocardial infarction
d. left ventricular failure

A

d. left ventricular failure

154
Q

when does synchronous cardioversion deliver the energy?

a. 10 ms after the peak of the R wave
b. during the relative refractory period
c. on top of the QRS complex
d. at the beginning of the P wave

A

a. 10 ms after the peak of the R wave

155
Q

[DISCREPANCY]

what is an undesirable side effect of atropine?

a. ventricular conduction delays
b. decreased conduction through the SA node
c. increased heart tone
d. increased myocardial oxygen demand (MVO2)

A

[DISCREPANCY]

d. increased myocardial oxygen demand (MVO2)

[BUT PER D2L, A. VENTRICULAR CONDUCTION DELAYS]

156
Q

what property of dopamine causes an increased heart rate?

a. alpha agonist
b. alpha antagonist
c. beta agonist
d. beta antagonist

A

c. beta agonist

157
Q

[DISCREPANCY]

what does the medication atropine inhibit?

a. alpha receptors
b. beta receptors
c. sympathetic response
d. parasympathetic response

A

[DISCREPANCY]

d. parasympathetic response

[BUT PER D2L, C. SYMPATHETIC RESPONSE]

158
Q

[DISCREPANCY]

when is fibrinolytic therapy for an MI patient most effective?

a. inferior-wall MI
b. if the patient is less than 45 y/o
c. when administered within 12 hours after the onset of symptoms
d. when chest pain cannot be resolved with nitroglycerin or morphine

A

[DISCREPANCY]

c. when administered within 12 hours after the onset of symptoms

[BUT PER D2L, D. WHEN CHEST PAIN CANNOT BE RESOLVED WITH NITROGLYCERIN OR MORPHINE]

Paramedic Review (kp) (9 decks)

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