gyno/geri/psych/infectious/toxicologic/neurologic/Endocrine /immunologic/GI/renal/hemo Flashcards by Ross Craft

2. A therapeutic dose of Valium simply relaxes one person, but causes severe central nervous system depression in another patient. This is an example of:
A) synergism.
B) potentiation.
C) hypersensitivity.
D) an idiosyncrasy.

Ans: D
Page: 1326
Type: General Knowledge

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Management for an ingested poison focuses mainly on:
A) the prompt induction of vomiting.
B) administering a counteracting agent.
C) neutralizing the poison in the stomach.
D) treating the systemic effects that result.

Ans: C
Page: 1327
Type: General Knowledge

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7. Clinical signs and symptoms following exposure to a toxin will manifest MOST rapidly if the patient:
A) is older than 70 years of age.
B) ingests a large quantity of toxin.
C) breathes in the toxic chemical.
D) is exposed by the injection route.

Ans: D
Page: 1328
Type: General Knowledge

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Unlike an opioid, an opiate:
A) is a natural product derived from opium.
B) produces a distinctly different toxidrome.
C) is not reversed by naloxone administration.
D) is a synthetic, non–opium-derived narcotic.

Ans: A
Page: 1328
Type: General Knowledge

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14. You would expect a person to be hypertensive and tachycardic following exposure to all of the following, EXCEPT:
A) cocaine.
B) parathion.
C) phenobarbital.
D) pseudoephedrine.

Ans: C

parathion = organophosphate insecticide

phenobarbital = barbiturate (bar-BIT-chur-ate). Phenobarbital slows the activity of your brain and nervous system. Phenobarbital is used to treat or prevent seizure

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24. Which of the following is atypical of an alcoholic?
A) Drinking early in the day
B) Green tongue syndrome
C) Memory loss or blackouts
D) Chronically pale face and palms

Ans: D
Page: 1333-1334
Type: General Knowledge

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Patients with alcoholism are prone to subdural hematomas and gastrointestinal bleeding because:
A) they fall more frequently than sober people.
B) their blood-clotting mechanisms are impaired.
C) they are at higher risk for violent assault.
D) alcohol causes significant immunocompromise.

Ans: B

Blood clotting factors are produced by the liver, but the liver is already getting its ass kicked on a daily basis

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28. Symptoms of delirium tremens usually begin within \_\_\_ to \_\_\_ hours after the last alcohol intake.
A) 12, 24
B) 24, 48
C) 48, 72
D) 72, 96

Ans: C
Page: 1335
Type: General Knowledge

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When caring for an unresponsive patient with a toxicologic emergency, you should:
A) intubate at once, obtain baseline vital signs, transport immediately, and perform all other interventions en route to the hospital.
B) administer high-flow oxygen, perform a detailed secondary assessment, obtain vital signs, and transport to the closest hospital.
C) try to neutralize any ingested toxins, secure a definitive airway, obtain baseline vital signs, start an IV line, and transport as soon as possible.
D) protect the airway, perform a rapid assessment, obtain vital signs, try to gather a medical history from the family, and transport promptly.

Ans: D
Page: 1331-1333
Type: General Knowledge

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31. Which of the following interventions is influenced strongly by the amount of time that has elapsed since a patient ingested a toxic substance?
A) Transport
B) IV therapy
C) Intubation
D) Gastric lavage

Ans: D

for ingested substances, we can always transport, we can always start an IV, we can always intubate, but we only have an hour or so for gastric lavage

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Which of the following questions often yields the LEAST reliable answer when questioning a patient who intentionally exposed himself or herself to a toxic substance?
A) Have you vomited?
B) Why did you take the substance?
C) When did you take the substance?
D) How much of the substance did you take?

Ans: B
Page: 1332
Type: General Knowledge

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Priority care for an unresponsive patient who has overdosed on phenobarbital includes:
A) administering oxygen and giving naloxone.
B) administering diazepam to prevent seizures.
C) securing the airway and preventing aspiration.
D) observing the ECG closely for lethal dysrhythmias.

Ans: C

phenobarbital = barbituate/slows the activity of your brain and nervous system. Phenobarbital is used to treat or prevent seizures

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If you are treating a patient with a suspected benzodiazepine overdose and find that the patient is hypotensive, bradycardic, and comatose:
A) avoid administering flumazenil and transport the patient immediately.
B) you should consider concomitant overdose with another CNS depressant.
C) it is likely that the patient is also under the influence of methamphetamine.
D) you should rapidly administer 2 mg of naloxone via the IV, IO, or IM route.

Ans: B
Page: 1341
Type: General Knowledge

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49. Which of the following drugs is a narcotic?
A) Meperidine
B) Flumazenil
C) Secobarbital
D) Lorazepam

Ans: A
Page: 1341
Type: General Knowledge

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Organophosphates exert their effect by:
A) destroying the body’s acetylcholine.
B) agonizing the sympathetic nervous system.
C) stimulating the cholinergic nervous system.
D) blocking the parasympathetic nervous system.

Ans: C
Page: 1344
Type: General Knowledge

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56. Signs and symptoms of organophosphate poisoning include:
A) vomiting.
B) tachycardia.
C) constipation.
D) pupillary dilation.

Ans: A
Page: 1344
Type: General Knowledge

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59. The LEAST common sign or symptom of carbon monoxide toxicity is:
A) nausea and vomiting.
B) cherry red skin color.
C) pallor or cyanosis.
D) roaring sensation in the ears.

Ans: B
Page: 1345
Type: General Knowledge

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63. When chlorine gas comes in contact with the body's mucous membranes, it forms:
A) boric acid.
B) a strong alkali.
C) sulfuric acid.
D) hydrochloric acid.

Ans: D
Page: 1345
Type: General Knowledge

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65. Cyanide blocks the utilization of oxygen at the cellular level by:
A) binding to monoamine oxidase.
B) directly destroying red blood cells.
C) binding to the hemoglobin molecule.
D) combining with cytochrome oxidase.

Ans: D

cytochrome oxidase is a hormone needed for cells to use O2

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66. Treatment for cyanide poisoning may include all of the following, EXCEPT:
A) amyl nitrite.
B) methylene blue.
C) calcium gluconate.
D) hydroxocobalamin.

Ans: C
Page: 1346-1347
Type: General Knowledge

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Unlike dermal exposure to a strong acid, dermal exposure to a strong alkali:
A) requires longer irrigation with water because alkalis are less water soluble.
B) should not be treated by irrigation with water as this will worsen the burn.
C) should be neutralized on the skin by applying lemon juice or dilute vinegar.
D) generally causes less damage to the skin because alkalis are water soluble.

Ans: A
Page: 1348
Type: General Knowledge

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69. If administered in conjunction with nitrates, sildenafil would MOST likely cause:
A) hypertensive crisis.
B) severe hypotension.
C) coronary vasospasm.
D) ventricular tachycardia.

Ans: B
Page: 1349
Type: General Knowledge

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70. Gamma-hydroxybutyrate is MOST commonly used to:
A) induce euphoria.
B) enhance the senses.
C) treat chronic coughing.
D) facilitate sexual assault.

Ans: D
Page: 1349
Type: General Knowledge

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73. What is a lethal dose of ethylene glycol in a 190-pound man?
A) 50 mL
B) 120 mL
C) 150 mL
D) 175 mL

Ans: D
Page: 1350
Type: General Knowledge

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Spray paints and lacquer thinner contain __________, and typically cause __________________ when they are inhaled recreationally.
A) toluene, hallucinations and mania
B) carbon tetrachloride, CNS depression
C) methylene chloride, pulmonary edema
D) benzene, drunken behavior and dizziness

Ans: A
Page: 1351
Type: General Knowledge

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Tricyclic antidepressant medications:
A) are the first-line therapy for the treatment of depression.
B) may produce toxic effects with even minimal dosing errors.
C) generally require high doses to achieve a therapeutic effect.
D) are very safe because they have a large therapeutic window.

Ans: B
Page: 1353
Type: General Knowledge

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77. Which of the following medications is NOT a tricyclic antidepressant?
A) Prozac
B) Aventyl
C) Sinequan
D) Tofranil

Ans: A

Prozac = Selective Serotonin Reuptake Inhibitor (SSRI)
It can treat depression, obsessive-compulsive disorder (OCD), bulimia nervosa, and panic disorder

Aventyl = Antidepressant and Nerve pain medication

Sinequan = Antidepressant and Nerve pain medication
It can treat depression, anxiety, and sleep disorders

Tofranil = Antidepressant and Nerve pain medication
It can treat depression

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Common signs and symptoms of a tricyclic antidepressant overdose include:
A) excessive salivation and diarrhea.
B) tachypnea and severe hypertension.
C) altered mental status and tachycardia.
D) constricted pupils and AV heart block.

Ans: C

work as norepinephrine and serotonin reuptake inhibitors. ODs can cause sympathomimetic and serotonergic effects

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Which of the following statements regarding SSRIs is correct?
A) SSRIs have fewer anticholinergic and cardiac effects than tricyclics.
B) Bradycardia with AV heart block is a hallmark sign of SSRI toxicity.
C) The most popular SSRIs include Pamelor, Zonalon, and Norpramin.
D) They are the least preferred antidepressant because they are cardiotoxic.

Ans: A
Page: 1354
Type: General Knowledge

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Inadvertent lithium toxicity would MOST likely occur in a patient who is taking:
A) a tricyclic antidepressant.
B) NSAIDs.
C) SSRIs.
D) any medication used to control blood pressure.

Ans: B
Page: 1355
Type: General Knowledge

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84. Lithium is MOST commonly used to treat patients with:
A) depression.
B) schizophrenia.
C) chronic anxiety.
D) bipolar disorder.

Ans: D
Page: 1355
Type: General Knowledge

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86. Severe salicylate toxicity produces:
A) bradypnea.
B) metabolic acidosis.
C) increased pH levels.
D) respiratory acidosis.

Ans: B
Page: 1355
Type: General Knowledge

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87. Prehospital treatment for a patient who overdosed on aspirin may include:
A) flumazenil.
B) an antipyretic.
C) calcium chloride.
D) sodium bicarbonate.

Ans: D

Helps bring down the pH

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A patient who ingested a significant quantity of acetaminophen less than 24 hours ago would MOST likely present with:
A) malaise, nausea, and a loss of appetite.
B) signs of renal failure and severe vomiting.
C) pain in the right upper abdominal quadrant.
D) flushed skin, high fever, and abdominal pain.

Ans: A
Page: 1356
Type: General Knowledge

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90. Once in the body, approximately 90% of inorganic lead accumulates in:
A) bone.
B) the liver.
C) the spleen.
D) white blood cells.

Ans: A
Page: 1357
Type: General Knowledge

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91. Hematologic manifestations of lead poisoning include:
A) anemia.
B) leukopenia.
C) coagulopathy.
D) polycythemia.

Ans: A
Page: 1357
Type: General Knowledge

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92. Which of the following is NOT a common sign of lead poisoning?
A) Irritability
B) Hypotension
C) Hypertension
D) Constipation

Ans: B
Page: 1357
Type: General Knowledge

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93. You should be MOST suspicious that a patient has systemic iron toxicity if he or she presents with:
A) bradypnea.
B) hypertension.
C) severe nausea.
D) hematemesis (vomiting of blood).

Ans: D
Page: 1357
Type: General Knowledge

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94. A metallic taste in the mouth, explosive diarrhea, and a skin rash are MOST indicative of:
A) lead poisoning.
B) cyanide poisoning.
C) arsenic poisoning.
D) mercury poisoning.

Ans: C
Page: 1358
Type: General Knowledge

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The dieffenbachia plant is also referred to as “dumb cane” because:
A) ingestion typically results in death in less than 5 minutes.
B) its leaves are highly toxic to the ears and cause deafness.
C) ingestion can result in the patient being unable to speak.
D) its toxic effects cause stupor, ataxia, and bizarre behavior.

Ans: C
Page: 1358
Type: General Knowledge

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96. The toxic chemical in castor beans is:
A) ricin.
B) cyanide.
C) lantadene A.
D) caladium oxalate.

Ans: A
Page: 1358
Type: General Knowledge

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The foxglove plant contains ______________ and can result in ______________ when it is ingested.
A) lantadene A, renal failure
B) cardiac glycosides, dysrhythmias
C) solanine, severe gastroenteritis
D) caladium oxalate crystals, bradycardia

Ans: B
Page: 1358, 1360
Type: General Knowledge

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98. The poisonous part of the apricot plant is/are the \_\_\_\_\_\_\_, which contain(s) \_\_\_\_\_\_\_.
A) leaves, iron
B) root, tyramine
C) bulb, oxalic acid
D) seed, cyanide

Ans: D
Page: 1359
Type: General Knowledge

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99. Poisoning with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is MOST often the result of improper food storage or canning.
A) Listeria
B) Salmonella
C) Toxoplasma
D) Clostridium botulinum

Ans: D
Page: 1361
Type: General Knowledge

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100. A young man is found unresponsive by his girlfriend. Your assessment reveals marked respiratory depression; a slow, weak pulse; and pinpoint pupils. There are numerous medication bottles found in his home. Of these, he has MOST likely ingested:
A) Valium.
B) Sudafed.
C) Benadryl.
D) Percodan.

Ans: D
Page: 1329
Type: Critical Thinking

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You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should:
A) insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport.
B) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
C) insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital.
D) insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.

Ans: B
Page: 1342
Type: Critical Thinking

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A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high-flow oxygen to the patient, you should:
A) start an IV line and give 1 mEq/mg of sodium bicarbonate.
B) assess his blood glucose level and apply a cardiac monitor.
C) start an IV line and begin administering a saline fluid bolus.
D) give him 100 mg of thiamine IM and assess his blood pressure.

Ans: B
Page: 1350-1351
Type: Critical Thinking

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Among other functions, the medulla oblongata:
A) directly regulates body temperature.
B) controls blood pressure and heart rate.
C) communicates with the pituitary gland.
D) sends messages to move skeletal muscles.

Ans: B
Page: 1041
Type: General Knowledge

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Myelin functions by:
A) allowing the neuron to send its signal consistently along the axon without losing its electricity.
B) insulating the neuron, thus decreasing the speed of electrical conduction between two neurons.
C) covering the neurons in the body that do not require rapid conduction of an electrical impulse.
D) briefly delaying the conduction of an electrical impulse between the synaptic cleft and dendrite.

Ans: A
Page: 1042-1043
Type: General Knowledge

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12. A neoplasm is MOST accurately defined as a:
A) normal cell.
B) new growth.
C) damaged cell.
D) cancerous tumor.

Ans: B
Page: 1071
Type: General Knowledge

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21. What is the cerebral perfusion pressure of a patient with a mean arterial pressure of 80 mm Hg and an intracranial pressure of 5 mm Hg?
A) 60 mm Hg
B) 75 mm Hg
C) 90 mm Hg
D) 95 mm Hg

Ans: B
Page: 1060
Type: General Knowledge

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28. All of the following cranial nerves are responsible for airway control, EXCEPT the:
A) abducens.
B) trigeminal.
C) hypoglossal.
D) glossopharyngeal.

Ans: A

abducens = eye sight nerve, This muscle is involved in outward eye movement. For example, you would use it to look to the side

trigeminal = facial nerve

hypoglossal = tongue movement

glossopharyngeal = nerves in back of throat, helps with gag reflex, swallowing

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33. An adult who opens her eyes in response to verbal stimuli, is disoriented, and pushes your hand away when you palpate a painful area has a Glasgow Coma Scale score of:
A) 9.
B) 10.
C) 11.
D) 12.

Ans: D
Page: 1051
Type: General Knowledge

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A patient who is experiencing agnosia:
A) has neuronal dysfunction between the temporal and frontal lobe.
B) may call a knife a fork when he or she is asked to name the object.
C) is probably experiencing an ischemic stroke in the cerebellar area.
D) cannot use a pencil secondary to dysfunction of the occipital lobe.

Ans: B

agnosia = Loss of the ability to identify objects or people

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38. A patient who is unable to use a common object is said to be:
A) agnosic.
B) aphasic.
C) atonic.
D) apraxic.

Ans: D

agnosic. = difficulty IDing objects
aphasic. = difficulty speaking
atonic. = loss of muscle tone/limp
apraxic. = Difficulty with skilled movements

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40. The involuntary, rhythmic movement of the eyes is called:
A) nystagmus.
B) hyperopia.
C) anisocoria.
D) dysphagia.

Ans: A
Page: 1073
Type: General Knowledge

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43. \_\_\_\_\_\_\_\_\_\_ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking.
A) Ataxia
B) Myoclonus
C) Bradykinesia
D) Decussation

Ans: A
Page: 1055
Type: General Knowledge

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47. A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called \_\_\_\_\_\_\_\_\_\_ activity.
A) tonic
B) clonic
C) hypertonic
D) myoclonic

Ans: B

tonic = A tonic seizure causes a sudden stiffness or tension in the muscles of the arms, legs or trunk

myoclonic = brief shock-like jerks of a muscle or group of muscles

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49. A patient experiences severe, shock-like or stabbing pain to one side of the face. This is consistent with:
A) an acoustic neuroma.
B) hemifacial spasm.
C) trigeminal neuralgia.
D) glossopharyngeal neuralgia.

Ans: C
Page: 1076
Type: General Knowledge

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You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient’s supervisor states that she has a history of seizures and takes Tegretol. The patient’s blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes:
A) administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
B) establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital.
C) giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity.
D) administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.

Ans: A
Page: 1067-1069
Type: Critical Thinking

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60. You arrive at the scene shortly after a 7-year-old girl experienced a seizure. According to the child's mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than 1 minute, after which the child's condition rapidly improved. This clinical presentation is consistent with a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_ seizure.
A) absence
B) tonic-clonic
C) simple partial
D) complex partial

Ans: A

absence = sudden loss of attention

Simple partial = A seizure that starts in one area of the brain and the person remains alert and able to interact

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2. A 33-year-old woman had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm Hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dL. The MOST likely cause of her syncopal episode is:
A) a seizure.
B) dehydration.
C) a vasovagal response.
D) acute hypoglycemia.

Ans: B
Page: 1069-1070
Type: Critical Thinking

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67. A patient with suspected meningitis involuntarily flexes her knees when her head is flexed toward her chest. This is called:
A) Kernig sign.
B) Grey Turner sign.
C) Cullen sign.
D) Brudzinski sign.

Ans: D

kernig sign = described a positive sign as the inability to extend the knees more than 135 degrees

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Increased intracranial pressure hydrocephalus occurs when:
A) the movement of CSF in the brain exceeds the production of CSF.
B) the movement of CSF decreases, but the production of CSF does not.
C) CSF production increases, which causes increased pressure in the skull.
D) total CSF volume decreases, which leads to excessive cerebral edema.

Ans: B
Page: 1080
Type: General Knowledge

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72. Which of the following cranial nerves are assessed when you ask a patient to follow your finger as you move it in an “H” shape?
A) Trochlear, oculomotor, abducens
B) Facial, accessory, glossopharyngeal
C) Accessory, olfactory, hypoglossal
D) Optic, trigeminal, glossopharyngeal

Ans: A
Page: 1054
Type: General Knowledge

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According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if:
A) the patient is younger than 45 years of age.
B) the blood glucose is between 60 and 400 mg/dL.
C) at baseline, the patient is normally bedridden.
D) a bilateral facial droop is present during the exam.

Ans: B
Page: 1064
Type: General Knowledge

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77. Which of the following causes of altered mental status is NOT an acute process?
A) Uremia
B) Acidosis
C) Psychosis
D) Epilepsy

Ans: A
Page: 1066
Type: General Knowledge

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78. During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the \_\_\_\_\_\_\_\_\_ phase of the seizure.
A) tonic
B) clonic
C) hypertonic
D) postictal

Ans: C
Page: 1067
Type: General Knowledge

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2. Which of the following is/are NOT an exocrine gland?
A) Liver
B) Sweat glands
C) Salivary glands
D) Adrenal glands

Ans: D
Page: 1212
Type: General Knowledge

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The posterior lobe of the pituitary gland secretes:
A) thyroxine and growth hormone.
B) antidiuretic hormone and oxytocin.
C) three gonadotropic hormones and oxytocin.
D) growth hormone and thyroid-stimulating hormone.

Ans: B
Page: 1213, 1215
Type: General Knowledge

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26. Common symptoms of type 2 diabetes include all of the following, EXCEPT:
A) thirst.
B) dysuria.
C) fatigue.
D) blurred vision.

Ans: B
Page: 1224
Type: General Knowledge

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Severe dehydration that commonly accompanies diabetic ketoacidosis is caused by:
A) prolonged compensatory hyperventilation.
B) decreased fluid intake secondary to hyperglycemia.
C) hyperglycemia-induced osmotic diuresis and vomiting.
D) the loss of key electrolytes such as sodium and potassium.

Ans: C
Page: 1228
Type: General Knowledge

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Which of the following statements regarding Addison disease is MOST correct?
A) Addison disease most often occurs when the immune system creates antibodies that attack and destroy the adrenal cortex.
B) Addison disease is also known as secondary adrenal insufficiency and is most often the result of a viral infection.
C) The signs and symptoms of Addison disease are a direct result of the overproduction of cortisol and aldosterone.
D) Hallmark signs of Addison disease are hypertension and fluid retention that result from excess sodium reabsorption.

Ans: A

Can’t be B because then it would just be an acute condition

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49. A patient with Cushing syndrome would MOST likely present with:
A) ketoacidosis.
B) hypoglycemia.
C) decreased urination.
D) acute hyperactivity.

Ans: B
Page: 1233
Type: General Knowledge

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You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being “drunk.” Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient’s ventilations, you start an IV and administer 50% dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should:
A) intubate his trachea to prevent aspiration and transport him immediately.
B) administer a second dose of dextrose and prepare for immediate transport.
C) give him 1 mg of glucagon IM and reassess his blood glucose.
D) conclude that he will require immediate definitive care and begin transport.

Ans: B
Page: 1227
Type: Critical Thinking

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You are dispatched to a residence for an elderly woman who is “sick.” When you arrive and assess her, you note that she is responsive to pain only and has hot, moist skin and rapid, shallow respirations. You find prednisone, Paxil, and multivitamins on her nightstand. Further assessment of this patient will MOST likely reveal:
A) a normal blood glucose level and a “moon face” appearance.
B) severe hypertension, flattened T waves, and asymmetric pupils.
C) hypoglycemia, hypotension, and ECG evidence of hyperkalemia.
D) a blood glucose reading above 400 mg/dL and a fruity breath odor.

Ans: C

Prednisone = Steroid
It can treat many diseases and conditions, especially those associated with inflammation

Paxil = Paxil (paroxetine) is an antidepressant that belongs to group of drugs called selective serotonin reuptake inhibitors (SSRIs)

possible OD on Paxil? she might have been having lots of diarrheaand vomiting beforehand that would cause that

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59. A 68-year-old obese woman presents with a markedly decreased level of consciousness. She was found in bed by her husband. Your primary assessment reveals that her respirations are slow and shallow, her pulse is slow and weak, and her skin is cold and dry. According to the patient's husband, she has had a recent infection, but he cannot remember what the doctor called it. You should be MOST suspicious that this patient is experiencing:
A) myxedema coma.
B) Addisonian crisis.
C) diabetic ketoacidosis.
D) acute hypothyroidism.

Ans: A

myxedema coma = severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs

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Which of the following clinical presentations is MOST consistent with thyrotoxicosis?
A) Severe tachycardia, fever, nausea and vomiting, and confusion
B) Profound bradycardia, hypothermia, and respiratory depression
C) Apathy, hypoglycemia, abdominal pain, and an irregular pulse
D) Obesity, cool skin, severe hypotension, and respiratory distress

Ans: A
Page: 1235
Type: Critical Thinking

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An antigen is MOST accurately defined as a:
A) chemical the immune system produces to destroy an allergen.
B) substance that causes the immune system to produce antibodies.
C) chemical mediator that deactivates foreign substances in the body.
D) harmless substance that the body does not recognize as being foreign.

Ans: B
Page: 1265
Type: General Knowledge

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____ antibodies respond in allergic reactions and are located _______.
A) IgD, in the lymph and blood
B) IgE, on the mast and basophil cells
C) IgG, in the blood, lymph, and intestines
D) IgA, in tears, saliva, blood, and lymph

Ans: B
Page: 1265
Type: General Knowledge

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4. Which of the following immunoglobulins is thought to stimulate antibody-producing cells to make antibodies?
A) IgD
B) IgE
C) IgG
D) IgM

Ans: A

IgD = Defense

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7. Patients with \_\_\_\_\_\_\_\_\_\_\_\_\_\_ are at an increased risk for anaphylaxis.
A) strep infection
B) acute pharyngitis
C) immunosuppression
D) atopic dermatitis

Ans: D
Page: 1267
Type: General Knowledge

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In contrast to cellular immunity, humeral immunity:
A) involves the use of antibodies dissolved in the blood plasma to fight off invading organisms.
B) is the result of the body’s production of leukocytes called T cells that attack and destroy invaders.
C) is an acquired form of immunity that involves desensitization through the use of immunizations.
D) protects the body against foreign substances by antibodies that are located exclusively in the lymph nodes.

Ans: A
Page: 1268
Type: General Knowledge

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13. Physiologic effects of histamine include all of the following, EXCEPT:
A) systemic vasodilation.
B) increased cardiac contractility.
C) severe bronchoconstriction.
D) increased vascular permeability.

Ans: B
Page: 1269
Type: General Knowledge

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In contrast to acquired immunity, natural immunity occurs when:
A) the body is vaccinated, allowing it to produce antibodies without having to experience the disease itself.
B) groups of people are immunized against a substance, which protects vulnerable people in the group.
C) the mother passes antibodies to the fetus via the placenta, thus protecting the fetus against a variety of diseases.
D) the body encounters the antigen and experiences a full immune response with all the pathology of the disease.

Ans: D
Page: 1270
Type: General Knowledge

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Histamine release causes all of the following effects, EXCEPT:
A) vasodilation, which results in flushed skin and hypotension.
B) contraction of the smooth muscles of the respiratory system.
C) increased cardiac contractility, which results in hypertension.
D) increased vascular permeability, which results in tissue edema.

Ans: C
Page: 1269, 1273-1274
Type: General Knowledge

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Which of the following statements regarding leukotrienes is correct?
A) In contrast to histamine, leukotrienes are less potent chemicals and do not cause vasodilation.
B) Leukotrienes compound the physiologic effects of histamine and cause additional bronchoconstriction.
C) Leukotriene release stimulates the release of histamine, which increases the severity of the allergic response.
D) Leukotrienes attempt to mitigate the negative effects of histamine by causing coronary vasodilation.

Ans: B
Page: 1274
Type: General Knowledge

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19. Early clinical manifestations of an allergic reaction include all of the following, EXCEPT:
A) pruritus.
B) stridor.
C) urticaria.
D) edema.

Ans: B
Page: 1274
Type: General Knowledge

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20. Which of the following clinical signs or symptoms are MOST indicative of upper airway swelling in a patient experiencing a severe allergic reaction?
A) Hoarseness and stridor
B) Crackles and wheezing
C) Facial edema and coughing
D) Chest tightness and dyspnea

Ans: A
Page: 1274
Type: General Knowledge

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The three MOST significant indicators of anaphylactic shock are:
A) hives, chest tightness, and restlessness.
B) dyspnea, hypotension, and tachycardia.
C) pruritus, peripheral swelling, and urticaria.
D) dizziness, flushed skin, and abdominal pain.

Ans: B
Page: 1275
Type: General Knowledge

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32. The correct dose, concentration, and route of epinephrine for a 40-pound child with an allergic reaction and no signs of cardiovascular collapse are:
A) 0.12 mg 1:1,000 IM.
B) 0.18 mg 1:1,000 SQ.
C) 0.21 mg 1:10,000 IV.
D) 0.25 mg 1:1,000 IV.

Ans: B
Page: 1277
Type: General Knowledge

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33. Adults in anaphylactic shock should receive the \_\_\_\_\_\_\_\_ concentration of epinephrine via the \_\_\_\_ route in a dose of \_\_\_\_ mg.
A) 1:1,000, IM, 1
B) 1:1,000, IV, 0.5
C) 1:10,000, IV, 0.1
D) 1:10,000, IM, 0.5

Ans: C
Page: 1277
Type: General Knowledge

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When administering an EpiPen to a 30-year-old man with a severe allergic reaction, you should recall that:
A) a 1:2,000 solution is used because the patient is an adult.
B) the SQ route is used in order to achieve a rapid effect.
C) 0.15 mg is the usual dose delivered by the adult EpiPen.
D) the drug cartridge contains 0.3 mg of a 1:1,000 solution.

Ans: D
Page: 1277
Type: General Knowledge

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Which of the following statements regarding the EpiPen Jr is correct?
A) It is used for children who weigh less than 44 lb (20 kg).
B) It is contraindicated for children with a history of asthma.
C) It contains 0.15 mg of a 1:2,000 solution and is given IM.
D) Benadryl should be given before the EpiPen in children.

Ans: C
Page: 1276-1277
Type: General Knowledge

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36. Systemic lupus erythematosus is a disease caused by:
A) a multisystem autoimmune disorder.
B) a marked deficiency of neutrophils.
C) primary immune system failure.
D) excessive IgE antibody production.

Ans: A
Page: 1267, 1277
Type: General Knowledge

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15. When forming your general impression of a patient with gastrointestinal distress, which of the following observations would provide the MOST information regarding what happened?
A) Resting blood pressure
B) Skin condition and temperature
C) The patient's facial expression
D) Body posture or position

Ans: D
Page: 1130
Type: General Knowledge

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When diarrhea contains more water than it does fecal material:
A) the body loses an equal amount of electrolytes and water.
B) the concentration of electrolytes that are lost increases significantly.
C) the body’s key electrolytes are spared and are not passed in the diarrhea.
D) smaller amounts of electrolytes are lost compared to the amount of lost water.

Ans: D
Page: 1138
Type: General Knowledge

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19. Common signs and symptoms of acute gastroenteritis include all of the following, EXCEPT:
A) fever.
B) chest pain.
C) severe diarrhea.
D) abdominal pain.

Ans: A

fevers are never acute silly

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20. Which of the following conditions would be the LEAST likely to result in peritonitis?
A) Stomach rupture
B) Splenic laceration
C) Acute appendicitis
D) Bowel perforation

Ans: B

The spleen is the most separated organ from the GI

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Dunphy sign is observed when:
A) right upper quadrant pain is referred to the right shoulder.
B) coughing causes severe right lower quadrant pain.
C) the patient’s abdominal pain radiates to the shoulder.
D) pressure on the abdominal wall is suddenly released.

Ans: B
Page: 1143
Type: General Knowledge

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24. Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in:
A) diverticulitis.
B) esophageal varices.
C) acute gastroenteritis.
D) peptic ulcer disease.

Ans: D
Page: 1140
Type: General Knowledge

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25. Common signs of bleeding in the upper gastrointestinal tract include all of the following, EXCEPT:
A) melena.
B) hematochezia.
C) hematemesis.
D) dark, tarry stools.

Ans: B

hematochezia = pooping of bright red blood
hematemesis =  vomiting of blood

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26. An obese 52-year-old woman who presents with severe pain in the right upper quadrant of her abdomen and pain in her right shoulder is MOST likely experiencing:
A) cholecystitis.
B) acute hepatitis.
C) Crohn disease.
D) Mallory-Weiss syndrome.

Ans: A

Mallory-Weiss syndrome = gastro-esophageal laceration syndrome refers to bleeding from a laceration in the mucosa at the junction of the stomach and esophagus

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Which of the following statements regarding Grey Turner sign is correct?
A) Grey Turner sign is characterized by bruising around the umbilicus.
B) The presence of Grey Turner sign should make you suspicious for hepatitis.
C) Grey Turner sign is the cessation of inspiration during abdominal palpation.
D) Grey Turner sign is characterized by flank bruising and indicates retroperitoneal hemorrhage.

Ans: D
Page: 1145
Type: General Knowledge

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29. Pyloric stenosis is the most common cause of:
A) Mallory-Weiss syndrome.
B) infantile intestinal obstruction.
C) gastrointestinal bleeding in adults.
D) mesenteric ischemia.

Ans: B

Pyloric stenosis = problem that affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration

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30. Intestinal adhesions would MOST likely result in:
A) diarrhea.
B) gastroenteritis.
C) bowel obstruction.
D) ulcerative colitis.

Ans: C

Intestinal adhesions usually occur from surgery and when they heal, they are swollen and bigger than before, increasing chance for obstruction

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An incarcerated hernia is one that:
A) causes immediate bowel necrosis.
B) cannot be reduced and becomes trapped.
C) spontaneously returns to its normal location.
D) protrudes through an incision from a recent surgery.

Ans: B
Page: 1150
Type: General Knowledge

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When auscultating bowel sounds, borborygmi is characterized by:
A) absent sounds after 2 minutes of auscultation.
B) quiet sounds, occurring at less than 1/sec.
C) soft gurgles or clicks occurring at 5-30/min.
D) loud gurgles occurring greater than 30/min.

Ans: D

rumbling or gurgling noise made by the movement of fluid and gas in the intestines

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Hepatic encephalopathy is a condition in which:
A) liver disease causes reduced brain function.
B) the liver is acutely inflamed from a virus.
C) acute hypoglycemia results from liver failure.
D) alcohol progressively destroys the liver tissue.

Ans: A
Page: 1149
Type: General Knowledge

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41. Irritation or injury to abdominal tissue, causing activation of peripheral nerve tracts, would MOST likely result in \_\_\_\_\_\_\_\_\_\_\_ pain.
A) visceral
B) somatic
C) rebound
D) parietal

Ans: B
Page: 1134
Type: General Knowledge

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A positive Murphy sign is characterized by:
A) slow, shallow breathing in an attempt to reduce the severe pain associated with cholecystitis.
B) a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.
C) ecchymosis to the flank area, indicative of free blood in the retroperitoneal compartment.
D) periumbilical ecchymosis and is a late, but highly suggestive sign of blood in the peritoneum.

Ans: B
Page: 1135
Type: General Knowledge

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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) spastic coughing, rupture of esophageal veins due to portal hypertension
C) severe vomiting, a tear at the junction between the esophagus and stomach
D) blunt trauma, rupture of hollow organs with resultant peritoneal inflammation

Ans: C
Page: 1140
Type: General Knowledge

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47. Icteric sclera and acholic stools are clinical manifestations of:
A) colitis.
B) cirrhosis.
C) pancreatitis.
D) diverticulitis.

Ans: B

cirrhosis = Chronic liver damage from a variety of causes leading to scarring and liver failure

Icteric sclera = yellow eyes

acholic stools = pale stools

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

Ans: B
Page: 1130, 1137
Type: Critical Thinking

50. 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) check his blood sugar.
B) apply a pulse oximeter.
C) obtain a 12-lead ECG.
D) auscultate his lung sounds.

Ans: D
Page: 1135, 1137
Type: Critical Thinking

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) 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.
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) 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.
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.

Ans: A

Not B because IM is not necessary

Dunphy sign here tells you it might be appendicitis. This is painful af and should be given pain meds

promethazine for the nausea

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) ventilation assistance with a bag-mask device, immediate transport, and establishment of vascular access en route to the closest hospital.
D) supplemental oxygen via nasal cannula, 25 mg of Phenergan IM, an IV of normal saline set to keep the vein open, and prompt transport.

Ans: B

possible appendicitis which is painful af

9. Angiotensin II:
A) relaxes smooth muscle.
B) decreases sodium reabsorption.
C) decreases blood pressure.
D) is a potent vasoconstrictor.

Ans: D
Page: 1163
Type: General Knowledge

Aldosterone produces all of the following physiologic effects, EXCEPT:
A) increased water reabsorption by the kidneys.
B) retention of potassium ions in the body.
C) increased sodium and chloride reabsorption.
D) decreased reabsorption of potassium ions.

Ans: B

potassium helps lower blood pressure which is against the agenda of aldosterone

Furosemide (Lasix) causes diuresis by:
A) increasing circulating blood glucose.
B) converting angiotensin I to angiotensin II.
C) inhibiting sodium reabsorption in the kidneys.
D) inhibiting the production of antidiuretic hormone.

Ans: C
Page: 1164
Type: General Knowledge

The micturition reflex:
A) produces the urge to void.
B) collapses the walls of the bladder.
C) is regulated by one of the cranial nerves.
D) causes relaxation of the urinary sphincter.

Ans: A
Page: 1164
Type: General Knowledge

18. Common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT:
A) gross hematuria.
B) painful urination.
C) increased urinary frequency.
D) localized pain in the pelvis.

Ans: A
Page: 1169
Type: General Knowledge

22. A marked decrease in urine output is called:
A) anuria.
B) oliguria.
C) dysuria.
D) polyuria.

Ans: B

anuria = failure of the kidneys to produce urine
oliguria = marked decrease in urine output
dysuria = Discomfort, pain, or burning when urinating
polyuria = frequent urination

23. A patient with prerenal acute renal failure would MOST likely present with:
A) confusion and hypertension.
B) joint pain and bladder distention.
C) hypotension and tachycardia.
D) peripheral edema and hematuria.

Ans: C
Page: 1170-1171
Type: General Knowledge

24. A common cause of intrarenal acute renal failure is:
A) hypovolemia.
B) type 1 diabetes.
C) a renal calculus.
D) myocardial infarction.

Ans: B
Page: 1171
Type: General Knowledge

Azotemia is defined as:
A) electrolyte disturbances in the blood.
B) an accumulation of uric acid in the blood.
C) increased nitrogenous wastes in the blood.
D) excess potassium excretion by the kidneys.

Ans: C
Page: 1172
Type: General Knowledge

31. Clinical manifestations of chronic renal failure include all of the following, EXCEPT:
A) dehydration.
B) hyperkalemia.
C) hypotension.
D) QT prolongation.

Ans: A
Page: 1172
Type: General Knowledge

33. Initial signs or symptoms of end-stage renal disease include:
A) bone pain.
B) uremic frost.
C) pruritus.
D) hallucinations.

Ans: A
Page: 1173
Type: General Knowledge

34. The skin of a patient with end-stage renal disease:
A) is hot and dry.
B) is thickened.
C) may appear bruised.
D) is usually flushed.

Ans: C
Page: 1173
Type: General Knowledge

41. Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of:
A) hypovolemia.
B) hypokalemia.
C) hyperkalemia.
D) air embolism.

Ans: B
Page: 1175
Type: General Knowledge

44. Which of the following abdominal segments is anterior and is the most inferior?
A) Umbilical region
B) Iliac region
C) Hypochondrial region
D) Hypogastric region

Ans: D
Page: 1167
Type: General Knowledge

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) renal failure may cause analgesics to accumulate to toxic levels.
C) most patients who are given analgesia will experience hypotension.
D) analgesia will mask the patient’s pain and skew further examination.

Ans: B
Page: 1172
Type: General Knowledge

51. 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) IV crystalloid fluid boluses
B) Left lateral recumbent position
C) Rapid transport to the hospital
D) Ventilation assistance as needed

Ans: A

you could possibly desaturate her blood turning it into water

Immediately following a dialysis treatment, a middle-aged woman complains of generalized weakness and nausea. Her blood pressure is 80/50 mm Hg, pulse rate is 40 beats/min and weak, and respirations are 22 breaths/min and regular. She is receiving supplemental oxygen, and an IV line has been established in the extremity opposite the shunt. The ECG reveals sinus bradycardia in lead II. Your next action should be to:
A) obtain a 12-lead ECG tracing.
B) administer 0.5 mg of atropine sulfate.
C) administer a 20-mL/kg fluid bolus.
D) administer calcium and bicarbonate.

Ans: B

shes having symptomatic bradycardia

A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, has a pulse rate of 90 beats/min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should:
A) recognize that she probably received an overaggressive dialysis treatment.
B) start an IV line with normal saline and infuse 200 mL of normal saline per hour.
C) transport at once, start an IV line en route, and give nitroglycerin to lower her blood pressure.
D) monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.

Ans: D
Page: 1175-1176
Type: Critical Thinking

2. The volume of plasma in an adult with a total blood volume of 6.5 liters is approximately:
A) 3.6 liters.
B) 4.1 liters.
C) 4.5 liters.
D) 5.1 liters.

Ans: A
Page: 1245
Type: General Knowledge

4. Most of the blood's formed elements are:
A) platelets.
B) leukocytes 
C) electrolytes.
D) erythrocytes

Ans: D

A) platelets.
B) leukocytes = (WBC).
C) electrolytes.
D) erythrocytes = (red blood cell).

5. Red blood cell production is stimulated by erythropoietin, which is secreted by the:
A) liver.
B) spleen.
C) kidneys.
D) bone marrow.

Ans: C
Page: 1245
Type: General Knowledge

8. Approximately one third of the body's platelets:
A) are stored in the spleen.
B) are produced by the liver.
C) circulate in the bloodstream.
D) have a life span of 72 hours.

Ans: A
Page: 1246
Type: General Knowledge

9. A patient with thrombocytopenia:
A) is severely anemic.
B) has blood that clots rapidly.
C) has a decreased platelet count.
D) is at high risk for a pulmonary embolism.

Ans: C

thrombocytopenia = decreased platelet count

10. Which of the following is NOT a major component of the hematologic system?
A) Liver
B) Spleen
C) Pancreas
D) Bone marrow

Ans: C

Pancreas deals with sugar and shit

12. Production of clotting factors is a function of the:
A) kidney.
B) liver.
C) spleen.
D) bone marrow.

Ans: B
Page: 1246
Type: General Knowledge

Which of the following statements regarding leukemia is correct?
A) Leukemia may cause leukocytosis, a low white blood cell count.
B) A hallmark of leukemia is an excess production of platelets.
C) Leukemia is the result of abnormal white blood cell development.
D) Most patients with leukemia have a normal white blood cell count.

Ans: C
Page: 1254-1255
Type: General Knowledge

Cancer is technically abnormal cell development

19. Which of the following is NOT typically associated with leukemia?
A) Absence of fever
B) Frequent bleeding
C) Chronic infections
D) Bruising from minor trauma

Ans: A
Page: 1254-1255
Type: General Knowledge

In contrast to chronic leukemia, acute leukemia occurs when:
A) bone marrow is replaced with abnormal lymphoblasts.
B) abnormal lymphoid cells accumulate in the bone marrow.
C) the patient experiences easy bruising and frequent bleeding.
D) mutated fibroblasts rapidly accumulate in the circulatory system.

Ans: A
Page: 1254
Type: General Knowledge

21. A patient who presents with petechiae is MOST likely:
A) anemic.
B) leukopenic.
C) polycythemic.
D) thrombocytopenic.

Ans: D

petechiae = round brown-purple spots due to bleeding under the skin, may be in a small area due to minor trauma or widespread due to blood-clotting disorder

Indolent non-Hodgkin lymphoma:
A) is the most aggressive form of the disease.
B) may never spread from the lymphoid system.
C) affects multiple organs over a long period of time.
D) most frequently occurs in men over 50 years of age.

Ans: B
Page: 1255
Type: General Knowledge

23. A painless, progressive enlargement of the lymphoid glands that most commonly affects the spleen and lymph nodes is called:
A) sarcoma.
B) adenocarcinoma.
C) Hodgkin lymphoma.
D) non-Hodgkin lymphoma.

Ans: C
Page: 1255
Type: General Knowledge

24. Common signs and symptoms of lymphoma include:
A) an increased appetite.
B) night sweats and chills.
C) weight gain and nausea.
D) irritability and a skin rash.

Ans: B
Page: 1255
Type: General Knowledge

During the second stage of disseminated intravascular coagulopathy:
A) decreased clotting factors cause uncontrolled hemorrhage.
B) free thrombin and fibrin deposits increase in the bloodstream.
C) the coagulation and fibrinolytic systems become overwhelmed.
D) large quantities of platelets aggregate and cause the blood to clot.

Ans: A

Compensated or subclinical stage: May see alterations in coagulation profiles or end-organ dysfunction
Fulminant or uncompensated stage: Fulminant coagulopathy and signs of hemorrhage

27. Patients with type A hemophilia:
A) have a low platelet count.
B) require infusions of factor IX.
C) bleed due to thrombocytopenia.
D) have a deficiency of factor VIII.

Ans: D

factor VIII = fancy name for clotting protein

29. As multiple myeloma progresses, the patient would MOST likely experience:
A) frequent nosebleeds.
B) spontaneous fractures.
C) acute intracranial bleeding.
D) atrophy of large muscle groups.

Ans: B

Myeloma = A cancer of plasma cells.
The plasma cells are a type of white blood cell in the bone marrow

You are transporting a 55-year-old woman to the hospital. The patient has lymphoma and complains of generalized, severe pain. She is receiving supplemental oxygen and has an IV line of normal saline established. Her blood pressure is 110/64 mm Hg, pulse rate is 104 beats/min and regular, and respirations are 22 breaths/min and adequate. You should:
A) ensure that she is in a comfortable position and administer a 250-mL saline bolus.
B) provide emotional support, but refrain from analgesia as this may cause hypotension.
C) give her 2 to 5 mg of a benzodiazepine sedative and provide constant reassurance.
D) administer narcotic analgesia as needed while closely monitoring her blood pressure.

Ans: D
Page: 1255-1256
Type: Critical Thinking

lymphoma is painful af

A 23-year-old woman with sickle cell disease presents with severe joint pain and a fever of 102.5°F. She is conscious and alert, and tells you that her symptoms began yesterday and suddenly worsened today. Her blood pressure is 118/76 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 24 breaths/min with adequate depth. After applying high-flow oxygen and initiating transport, you should:
A) obtain a 12-lead ECG tracing, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and reassess her blood pressure.
B) monitor her oxygen saturation and cardiac rhythm, start an IV line with normal saline, administer 1 µg/kg of fentanyl, and reassess her vital signs.
C) establish vascular access, administer 2 to 5 mg of midazolam, monitor her cardiac rhythm, and notify the receiving facility as soon as possible.
D) ensure that she is in a comfortable position, cover her with a blanket, start an IV line at a keep-vein-open rate, and monitor her throughout transport.

Ans: B

sickle cell is painful af

When washing your hands after a call, you should:
A) wash your hands for at least 10 seconds.
B) use an antimicrobial, alcohol-based foam or gel.
C) wash with cold water and let your hands air dry.
D) scrub your hands vigorously with an antibacterial gel.

Ans: B

18. Postexposure prophylaxis is available for all of the following diseases, EXCEPT:
A) HIV.
B) hepatitis C.
C) syphilis.
D) gonorrhea.

Ans: B

Postexposure prophylaxis= taking antiretroviral medicines (ART) after being potentially exposed to HIV

23. A common sign of the measles is:
A) petechiae.
B) a blotchy red rash.
C) severe diarrhea.
D) a purpuric rash.

Ans: B

purpuric rash = bruise

24. The onset of fever commonly occurs as early as \_\_\_ days following exposure to the measles.
A) 2
B) 3
C) 5
D) 7

Ans: D

25. Rubella is characterized by:
A) a low-grade fever.
B) visual disturbances.
C) abdominal discomfort.
D) an isolated facial rash.

Ans: A

rubella = contagious viral infection best known by its distinctive red rash. It’s also called German measles or three-day measles

26. According to the Centers for Disease Control and Prevention, all children should be immunized against all of the following diseases, EXCEPT:
A) smallpox.
B) hepatitis B.
C) seasonal influenza.
D) Haemophilus influenzae type b.

Ans: A

Which of the following statements regarding the mumps is correct?
A) Mumps can cause sterility in males past the age of puberty.
B) Postexposure vaccination against the mumps is recommended.
C) Mumps presents with fever and swelling of the parotid glands.
D) A variety of bacteria have been identified as causing the mumps.

Ans: C
Page: 1315
Type: General Knowledge

31. Which of the following diseases is bacterial in nature, has an insidious onset, and is characterized by an irritating cough that may become paroxysmal in about 1 to 2 weeks?
A) Tetanus
B) Bronchitis
C) Diphtheria
D) Pertussis

Ans: D
Page: 1316
Type: General Knowledge

34. Antibiotic therapy following exposure to meningitis is NOT appropriate for individuals who are:
A) taking birth control pills.
B) older than 45 years of age.
C) asymptomatic after 24 hours.
D) severely immunocompromised.

Ans: A

36. Common signs and symptoms of TB include all of the following, EXCEPT:
A) hemoptysis.
B) photophobia.
C) weight loss.
D) a persistent cough.

Ans: B

hemoptysis = coughing up of blood
photophobia = light sensitivity

The clinical presentation of mononucleosis includes:
A) fever, swollen lymph glands, and an enlarged spleen.
B) vomiting, a fever greater than 102°F, and shaking chills.
C) hemoptysis, low-grade fever, and up to 10% weight loss.
D) nasal drainage, a dry cough, and right upper quadrant pain.

Ans: A

mononucleosis = spleen is enlarged from backup of having to clean more than its used to

48. In males, infection with Chlamydia trachomatis would MOST likely lead to:
A) hepatitis.
B) prostatitis.
C) bladder cancer.
D) testicular torsion.

Ans: B

52. Hepatitis B is also referred to as:
A) CSF hepatitis.
B) fecal hepatitis.
C) enteral hepatitis.
D) serum hepatitis.

Ans: D

53. Following exposure to the hepatitis B virus, a person may remain asymptomatic for up to:
A) 150 days.
B) 250 days.
C) 300 days.
D) an entire year.

Ans: A

62. Signs and symptoms of HIV infection may include all of the following, EXCEPT:
A) acute febrile illness.
B) swollen lymph glands.
C) malaise and a headache.
D) right upper quadrant pain.

Ans: D

Acquired immunodeficiency syndrome:
A) occurs in as many as 85% of HIV-infected individuals.
B) exists when T-helper lymphocytes are dangerously high.
C) most often occurs within 5 to 10 years of HIV infection.
D) is characterized by the presence of opportunistic infections.

Ans: D

A 49-year-old woman presents with a severe headache, a temperature of 103.2°F, and photosensitivity. Her blood pressure is 140/76 mm Hg, pulse rate is 120 beats/min and strong, and respiratory rate is 22 breaths/min and regular. While caring for this patient, it is MOST important to:
A) apply a cardiac monitor and assess her tachycardia.
B) protect yourself from any nasopharyngeal secretions.
C) treat her as though she is experiencing viral meningitis.
D) attempt to assist her ventilations with a bag-mask device.

Ans: B

BSI

74. You are dispatched to an apartment complex for a 20-year-old woman who is sick. When you arrive at the scene and begin assessing the patient, she tells you that she has been experiencing a purulent vaginal discharge, but denies vaginal bleeding or a fever. Her blood pressure is 104/64 mm Hg, pulse rate is 88 beats/min and strong, and respirations are 14 breaths/min and regular. This patient MOST likely has:
A) syphilis.
B) chlamydia.
C) gonorrhea.
D) pelvic inflammatory disease.

Ans: C
Page: 1301
Type: Critical Thinking

Which of the following statements regarding a person’s intelligence is MOST correct?
A) All individuals possess the same basic level of intelligence.
B) A person with mental retardation has a disorder of intelligence.
C) Patients with Down syndrome typically lack basic intelligence.
D) Intelligence is generally a reflection of a person’s past education.

Ans: B

Not everyone can be as smart as me

Most psychotropic medications exert their therapeutic effects by:
A) inhibiting endocrine function.
B) suppressing cerebellar function.
C) targeting the autonomic nervous system.
D) enhancing the effects of the thyroid gland.

Ans: C

40. Klonopin and BuSpar:
A) are both benzodiazepines.
B) are anxiolytic medications.
C) are used to control seizures.
D) block the reuptake of serotonin.

Ans: A

46. Psychomotor abnormalities associated with depression include:
A) a flat affect.
B) distractibility.
C) fatigue and insomnia.
D) agitation and pacing.

Ans: D

48. Which of the following drugs is an MAOI?
A) Elavil
B) Parnate
C) Sinequan
D) Pamelor

Ans: B

Elavil/Amitriptyline = tricyclic antidepressant: Antidepressant and Nerve pain medication
It can treat depression.

Parnate/Tranylcypromine = MAOI antidepressant
Sinequan/Doxepin = dibenzoxepin tricyclic: antidepressant
Pamelor/Nortriptyline = tricyclic antidepressant

A patient who is taking Aventyl:
A) may have nonspecific T-wave changes on the ECG.
B) is usually hospitalized for debilitating, chronic depression.
C) can safely take an MAOI drug at the same time.
D) responds better than he or she will respond to treatment with a tricyclic antidepressant.

Ans: A

58. People who are overly concerned with their physical health and appearance MOST likely have a(n):
A) somatoform disorder.
B) dissociative disorder.
C) personality disorder.
D) compulsive disorder.

Ans: A
somatoform disorder = group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition

60. An alteration in one's perception of reality is MOST characteristic of:
A) depersonalization.
B) posttraumatic stress.
C) a histrionic personality.
D) a dissociative disorder.

Ans: D
Page: 1391
Type: General Knowledge

Unlike a person with bulimia nervosa, a person with anorexia nervosa:
A) is less likely to experience problems related to electrolyte imbalance.
B) commonly describes his or her eating disorder as “out of control.”
C) experiences weight loss that may cause poor health or even death.
D) compensates for binge eating by using various purging methods.

Ans: C

76. During your assessment of an unresponsive 70-year-old man, the patient's wife tells you that he takes Luvox and BuSpar, among other medications. From this limited information, you should conclude that the patient suffers from:
A) bipolar disorder.
B) paranoid schizophrenia.
C) chronic manic behavior.
D) depression and anxiety.

Ans: D
Page: 1392
Type: Critical Thinking

A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient’s vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should:
A) respect her wishes because she is coherent, but leave her with a trusted family member.
B) use reasonable force to physically restrain the patient, administer a sedative, and transport.
C) remain with the patient, contact medical control, and request law enforcement intervention.
D) contact medical control and advise him or her that you will be transporting the patient against her will.

Ans: C

7. A decreased number of pacemaker cells in the sinoatrial node would MOST likely contribute to a decline in cardiac output secondary to:
A) heart block.
B) bradycardia.
C) tachycardia.
D) atrial fibrillation.

Ans: B

No reason it would start pacing from somewhere else

21. Typical signs and symptoms of Meniere disease include all of the following, EXCEPT:
A) vertigo.
B) tinnitus.
C) otorrhea.
D) hearing loss.

Ans: C
Meniere disease = disorder of the inner ear that can lead to dizzy spells (vertigo)

otorrhea = ear drainage

24. Due to the process of aging, an elderly person commonly experiences:
A) increased thirst.
B) moderate hyperglycemia.
C) increased insulin secretion.
D) high fever with a minor illness.

Ans: B

34. The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to:
A) constipation.
B) cholelithiasis.
C) mesenteric ischemia.
D) peptic ulcer disease.

Ans: D

Which of the following statements regarding Alzheimer disease is NOT correct?
A) Alzheimer disease is likely not a part of the normal process of aging.
B) Age alone is thought to be the underlying cause of Alzheimer disease.
C) The symptoms of Alzheimer disease are generally obvious at its onset.
D) Common signs of Alzheimer disease include paranoia and delusions.

Ans: B

Age itself does not cause Alzheimer’s

Signs and symptoms of anticholinergic medication toxicity include:
A) Hypotension, palpitations, and respiratory distress.
B) urinary difficulty, constipation, and hypertension.
C) epistaxis, abdominal pain, and blood in the urine.
D) hypoglycemia, depression, and poor muscle movement.

Ans: B

anticholinergic = think anti-parasympathetic system

Which of the following risk factors is associated with the HIGHEST rate of mortality following a burn injury in an elderly person?
A) Age over 55 years
B) Musculoskeletal injury
C) Preexisting medical condition
D) Proportional increase in adipose tissue

Ans: C

58. Considering the physiologic changes that occur with age, which of the following interventions would pose the GREATEST potential for further harm when caring for an elderly patient with a severe burn that is complicated by a spinal injury?
A) Intubation
B) Fluid replacement
C) Thermal management
D) Spinal immobilization

Ans: B

Intubation might be necessary if they go into shock
Fluids could drive out the fluids that are helping them live and turn their blood into water
Thermal management is a good idea
immobilizing the spine of a burn/spinal injury patient is not a problem.

A key element of the “G” in the GEMS diamond includes:
A) checking the physical condition of the patient’s home.
B) recalling that elderly patients often present atypically.
C) assessing the elderly patient’s activities of daily living.
D) obtaining a complete medical history.

Ans: B

G = Geriatric patients = keep in mind all of the atypical ways the present and the differences in their bodies
E = Environment = make sure their surrounds are livable and adequate
M = Medical = Good medical assessment
S = Social = make sure they are being taken care for if they cant do certain things

68. A 90-year-old nursing home resident presents with confusion and a cough after several days of complaining of being weak. She is bedridden, has numerous medical conditions, and takes a variety of medications. Your assessment reveals that her temperature is 99.0°F, her skin is cool and dry, her blood pressure is 118/66 mm Hg, and her heart rate is 68 beats/min and regular. She is not experiencing obvious respiratory distress, and her oxygen saturation is 93% on room air. This patient is MOST likely experiencing:
A) pneumonia.
B) heart failure.
C) hypoglycemia.
D) a pulmonary embolism.

Ans: A

think cough + fever
93% O2 is causing AMS

You are dispatched to an assisted living center for an 80-year-old woman who is vomiting bright red blood. Upon your arrival, you find the patient sitting in a chair. She is conscious and alert, but is markedly pale and diaphoretic. Her medical history is significant for hypertension, congestive heart failure, type 2 diabetes, hypothyroidism, and osteoarthritis. Her medications include Toprol, lisinopril, Glucophage, Synthroid, and ibuprofen. Her blood pressure is 76/56 mm Hg, pulse is 76 beats/min and weak, and respirations are 24 breaths/min and shallow. Which of the following statements regarding this scenario is MOST correct?
A) You should suspect shock due to lower gastrointestinal bleeding, start two large-bore IV lines, and rapidly infuse normal saline until her systolic blood pressure is greater than 90 mm Hg.
B) Gross hematemesis suggests gastrointestinal bleeding; however, although she is in shock, you should avoid infusing isotonic crystalloid solutions due to her congestive heart failure.
C) This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.
D) This patient’s vital signs are clearly the result of the medications she is taking, and you should focus on the likelihood that her pallor and diaphoresis are most likely the result of hypoglycemia.

Ans: C

72. The son of a 76-year-old woman called 9-1-1 because his mother is “ill.” The patient presents with mild confusion, poor skin turgor, and tachycardia. She is incontinent of urine and asks you for a glass of water. Her son tells you that she had not been feeling well for the past several weeks, but would not allow him to take her to the doctor. Which of the following assessment parameters will MOST likely reinforce your suspicion regarding the underlying cause of this patient's condition?
A) Blood glucose
B) Cardiac rhythm
C) Orthostatic vital signs
D) Cincinnati stroke scale

Ans: A

She could be empiercing severe hyperglycemia

73. You respond to a residence for an unknown emergency involving an 83-year-old man. When you arrive, you find the patient, who is conscious and alert, sitting on his couch with his head held over a bowl. He tells you that his nose started bleeding about 20 minutes ago and he cannot get it to stop. As your partner assists the patient in controlling the bleeding, you inquire about his medical history. He tells you that he has chronic atrial fibrillation, has high blood pressure, and is occasionally depressed. When you ask him about compliance with his medications, he tells you, “I take my medicine every day, but the writing on the bottles is so small.” The patient's blood pressure is 112/58 mm Hg, pulse rate is 88 beats/min and irregular, and respirations are 18 and unlabored. This patient has MOST likely inadvertently:
A) overdosed on his Xanax.
B) underdosed on his Toprol.
C) underdosed on his digoxin.
D) overdosed on his warfarin.

Ans: D

Warfarin = blood thinner

Toprol = Beta blocker = treats HTX

Digoxin = Antiarrhythmic and Blood pressure support
It can treat heart failure and heart rhythm problems.

During your assessment of a 79-year-old woman who was involved in a motor vehicle crash, you find that she is responsive to pain only and is breathing with a marked reduction in tidal volume. Your rapid assessment reveals that she has ecchymosis and crepitus over several of her ribs. You should:
A) avoid any form of positive-pressure ventilation, as this may cause barotrauma and a pneumothorax.
B) stabilize her fractured ribs with bulky dressings and administer high-flow oxygen via nonrebreathing mask.
C) immediately secure her airway with an endotracheal tube because she is at increased risk for aspiration.
D) assist her ventilations with a bag-mask device, delivering just enough volume to produce visible chest rise.

Ans: D

9. Which of the following medications would MOST likely be used in the prehospital setting to treat some women with severe premenstrual syndrome?
A) Haldol and Tylenol
B) Glucose and fentanyl
C) Valium and ibuprofen
D) Insulin and acetaminophen

Ans: B

its PAF and they will drain their glucose stores dealing with the pain

Mittelschmerz is defined as:
A) unilateral abdominal pain and cramping that occur during the ovulatory process.
B) bilateral abdominal pain and vaginal bleeding caused by excess hormone release.
C) abdominal cramping, vaginal bleeding, and a headache lasting more than a week.
D) severe abdominal cramping and a vascular headache that are caused by ovulation.

Ans: A

In contrast to endometritis, endometriosis:
A) may present without abdominal pain.
B) is an inflammation of the uterine lining.
C) generally causes light menstrual periods.
D) is often the result of gynecologic surgery.

Ans: A

21. The Candida albicans fungus is the causative agent in:
A) bacterial vaginosis.
B) gardnerella vaginitis.
C) vaginal yeast infections.
D) gonorrhea and chlamydia.

Ans: C

25. Which of the following conditions is characterized by a lack of progesterone and increased androgen levels, and can lead to gestational diabetes and cardiac problems?
A) Polycystic ovaries
B) Ectopic pregnancy
C) Corpus luteum cyst
D) Tubo-ovarian abscess

Ans: A

Ovaries play a huge roll in endocrine system will mess up progesterone and androgen levels if they have cysts

26. The MOST common underlying cause of a tubo-ovarian abscess is:
A) vaginitis.
B) gonorrhea.
C) an ectopic pregnancy.
D) a ruptured ovarian cyst.

Ans: B

Which of the following statements regarding toxic shock syndrome (TSS) is correct?
A) TSS is a condition that is exclusive to females.
B) Patients with TSS may show signs of liver failure.
C) Most cases of TSS occur in the absence of a fever.
D) Group B Streptococcus is a causative agent in TSS.

Ans: B

toxic shock syndrome = infection in blood stream from something like staph

28. Initial signs and symptoms of toxic shock syndrome include all of the following, EXCEPT:
A) myalgia.
B) scleral injection.
C) headache and fever.
D) cardiac dysrhythmias.

Ans: D

toxic shock syndrome = infection in blood stream from something like staph

If a woman who is being treated with the antibiotic metronidazole for bacterial vaginosis consumes alcohol during treatment:
A) she is at high risk for sudden cardiac death.
B) severe exacerbation of the vaginosis occurs.
C) she may develop severe nausea and vomiting.
D) the antibiotic may become a toxic substance.

Ans: C

Reiter syndrome is:
A) an acute life-threatening condition that has been linked directly to the use of high-absorbency tampons.
B) a rare complication associated with untreated chlamydia and is characterized by arthritis and skin lesions.
C) a far more common and serious complication of untreated chlamydia than pelvic inflammatory disease.
D) a relatively common complication of untreated gonorrhea, and is characterized by low-grade fever and myalgia.

Which of the following statements regarding the human papillomavirus (HPV) is correct?
A) HPV infection is characterized by fever and a genital chancroid.
B) Genital warts caused by HPV are far more common in females.
C) HPV has been identified as a causative agent in cervical cancer.
D) Only one type of HPV is spread via unprotected sexual contact.

35. Which of the following is NOT characteristic of the secondary stage of syphilis?
A) The presence of a skin rash
B) A single or multiple chancres
C) Mucous membrane lesions
D) Fever and swollen lymph glands

B = single or multiple chancres are first stage shit

Primary Stage
During the first (primary) stage of syphilis, you may notice a single sore or multiple sores. The sore is the location where syphilis entered your body. Sores are usually (but not always) firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore usually lasts 3 to 6 weeks and heals regardless of whether or not you receive treatment. Even after the sore goes away, you must still receive treatment. This will stop your infection from moving to the secondary stage.

Secondary Stage
During the secondary stage, you may have skin rashes and/or mucous membrane lesions. Mucous membrane lesions are sores in your mouth, vagina, or anus. This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can look like rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it. Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis.

syphilis rash on back
Secondary rash from syphilis on torso.

Latent Stage
The latent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms.

Tertiary Stage
Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system. Tertiary syphilis is very serious and would occur 10–30 years after your infection began. In tertiary syphilis, the disease damages your internal organs and can result in death.

You are dispatched to a grocery store for a woman with severe abdominal pain. When you arrive, you find the patient lying on her side in the manager’s office. She is confused, is diaphoretic, and appears to be bleeding from her vagina. Her blood pressure is low, and her pulse and respiratory rates are elevated. You should:
A) administer 100% oxygen, elevate her legs 12 to 18 inches, keep her warm, establish vascular access and give a 500-mL fluid bolus, reassess her blood pressure, and transport at once with continuous monitoring en route to the hospital.
B) immediately place her in a supine position, firmly massage her uterine fundus to control the bleeding, establish two large-bore IV lines and run them wide open, transport at once, and apply high-flow oxygen en route to the hospital.
C) apply high-flow oxygen, visually inspect her vagina and cover it with sterile dressings, keep her warm, begin transport, establish at least one large-bore IV en route, and administer enough crystalloid fluid to maintain radial pulses.
D) assist her ventilations with a bag-mask device, carefully place a trauma dressing inside her vagina to control the bleeding, begin rapid transport, establish two large-bore IV lines en route, and administer 20-mL/kg fluid boluses as needed.

A woman brings her 18-year-old son to your EMS station. The patient is actively seizing and, according to the mother, has been seizing for the past 10 minutes. She states that her son has a history of seizures and takes Depakote. The patient is cyanotic, is breathing erratically, and has generalized muscle twitching to all extremities. You should:
A) place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM.
B) protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium.
C) hyperventilate him with a bag-mask to eliminate excess carbon dioxide, establish vascular access, and give lorazepam.
D) open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam.

19. The MOST immediate and significant complication associated with a hemorrhagic stroke is:
A) acute hypovolemic shock.
B) hypertension and bradycardia.
C) mean arterial pressure increase.
D) increased intracranial pressure.

You respond to the residence of a known heroin abuser. The patient, a 30-year-old man, is unconscious and unresponsive. He is hypoventilating, bradycardic, and hypotensive. Administration of 10 mg of naloxone has had no effect, and your transport time to the hospital is approximately 30 minutes. You should:
A) check his blood glucose level as your partner prepares to intubate.
B) transport at once and administer additional naloxone while en route.
C) administer 25 g of 50% dextrose and reassess his level of consciousness.
D) hyperventilate him with high-flow oxygen to minimize tissue hypoxia.

12. The exocrine function of the pancreas produces:
A) insulin.
B) glucagon.
C) enzymes.
D) somatostatin.

somatostatin = growth hormone-inhibiting hormone (GHIH)

In contrast to patients in shock, patients with increased intracranial pressure MOST often experience:
A) systolic hypotension.
B) an increased diastolic blood pressure.
C) a widened pulse pressure.
D) tachycardia and tachypnea.

47. Side effects of MAOI antidepressants include:
A) hypersomnia.
B) acute bradycardia.
C) suicidal behavior.
D) orthostatic hypotension.

Following the primary response to a foreign substance, the body:
A) recognizes the substance as foreign, but does not produce antibodies until subsequent exposure.
B) utilizes macrophages to immediately destroy the substance and eliminate it from the body.
C) develops sensitivity and is able to recognize the substance following subsequent exposure.
D) releases massive amounts of antigen-specific antibodies, which produce a severe allergic reaction.

During the secondary assessment of a patient experiencing a severe allergic reaction, you should:
A) focus exclusively on the patient’s blood pressure.
B) expect the patient to vomit, often without nausea.
C) apply the cardiac monitor to detect dysrhythmias.
D) recall that capnography will be a less reliable tool.

Patients with hyperosmolar hyperglycemic nonketotic coma:
A) present with severe dehydration and neurologic deficits.
B) experience more severe acidosis than patients with diabetic ketoacidosis.
C) typically require prehospital sodium bicarbonate therapy.
D) most commonly have a history of type 1 diabetes mellitus.

A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man’s wife, he has had a fever and flu-like symptoms for the past few days. She further tells you that he has “stuck to his diet” as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads “high.” This patient is MOST likely:
A) producing ketones due to fat metabolism.
B) experiencing hyperosmolar nonketotic coma.
C) significantly acidotic and requires bicarbonate.
D) hyperglycemic secondary to being dehydrated.

12. The chemical mediators that initiate and maintain the immune response are:
A) heparin and T cells.
B) basophils and mast cells.
C) macrophages and cytokines.
D) eosinophils and neutrophils.

40. Which of the following medications has the SLOWEST onset of action when given to a patient with a severe allergic reaction?
A) Albuterol
B) Glucagon
C) Diphenhydramine
D) Methylprednisolone

64. A state of delusion in which a person is out of touch with reality is MOST appropriately termed:
A) psychosis.
B) derealization.
C) schizophrenia.
D) tangential thinking.

In contrast to primary adrenal insufficiency, secondary adrenal insufficiency is caused by:
A) idiopathic atrophy of both of the adrenal glands that results in a deficiency of all the steroid hormones they secrete.
B) adrenal gland destruction caused by tuberculosis; viral, bacterial, or fungal infections; or cancer of the adrenal gland.
C) acute hypertension and overhydration due to excess sodium reabsorption.
D) decreased cortisol secretion secondary to a lack of adrenocorticotropic hormone secretion from the pituitary gland.

The glands themselves are getting messed up, not the blood flow to them or the veins/tubes away from them

13. The adrenal medulla secretes norepinephrine following stimulation from the:
A) brainstem.
B) diencephalon.
C) hypothalamus.
D) pituitary gland.

You are transferring a 60-year-old man with COPD from a community hospital to a metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied. When reading his chart, you note that he has polycythemia, a history of a prior stroke, and hypertension. The patient tells you that he feels a fluttering sensation in his chest. You glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 160 beats/min. The patient’s blood pressure is 116/70 mm Hg and he remains conscious and alert. You should:
A) carefully auscultate his lung sounds and then administer a 500-mL bolus of normal saline solution.
B) administer 5 mg of midazolam, perform synchronized cardioversion with 50 joules, and reassess his cardiac rhythm.
C) ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.
D) place the patient supine, elevate his legs 6 to 12 inches, and administer 150 mg of amiodarone over 10 minutes.

16. Anemia would result from all of the following conditions, EXCEPT:
A) acute blood loss.
B) an increase in iron.
C) chronic hemorrhage.
D) erythrocyte hemolysis.

erythrocyte hemosysis = rupturing (lysis) of red blood cells (erythrocytes) and the release of their contents (cytoplasm)

A pregnant woman with cephalopelvic disproportion:
A) requires a cesarean section to prevent fetal distress.
B) should be given a muscle relaxant prior to delivery.
C) delivers her baby vaginally in about 75% of cases.
D) generally does not experience problems during delivery.

Gestational diabetes is caused by:
A) a decreased production of insulin secondary to excess estrogen levels.
B) increased insulin production and decreased cellular sensitivity to insulin.
C) decreased cellular utilization of insulin secondary to increased estrogen.
D) ketones that are excreted in the urine during the course of the pregnancy.

48. Uterine rupture MOST commonly occurs:
A) during active labor.
B) in primiparous women.
C) during the third trimester.
D) after the placenta delivers.

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) advise her that she can probably go to the hospital via personal vehicle since she is not showing signs of shock.
C) visually inspect her vagina for bleeding or discharge, start an IV line and set it to keep the vein open, and transport.
D) establish vascular access and give her a 250-mL normal saline bolus, consider analgesia for her pain, and transport.

45. You are caring for a young woman with constant, diffuse abdominal pain, referred pain to both shoulders, and vaginal bleeding. She states that her last menstrual period was 2 months ago, but she adamantly denies being pregnant. Her blood pressure is 86/50 mm Hg, pulse rate is 120 beats/min and weak, and respirations are 24 breaths/min and regular. Which of the following interventions is NOT appropriate for this patient?
A) IV fluid boluses
B) Thermal management
C) Cardiac monitoring
D) Narcotic analgesia

A woman is in the second stage of labor when:
A) she feels a strong urge to move her bowels.
B) the cervix is fully effaced and partially dilated.
C) a gush of amniotic fluid pours from the vagina.
D) contractions occur in 5- to 10-minute intervals.

A 25-year-old woman was involved in a motor vehicle accident in which she struck the rear end of another car at a low speed. When you arrive at the scene and exit the ambulance, you immediately hear the patient screaming, “My baby, my baby!” After calming the patient down, she tells you that she is 10 weeks pregnant and that she is afraid that the car accident injured her child. She confirms that she was properly restrained at the time of impact. She is conscious and alert, denies abdominal pain, and has stable vital signs. She refuses spinal motion restriction precautions but does consent to EMS transport. You should:
A) administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.
B) be concerned that the traumatic injury may have caused an abruptio placenta, administer high-flow oxygen, establish a large-bore IV, and transport her to a trauma center.
C) reassure her that her baby was not injured, offer her oxygen via nasal cannula, defer IV therapy, and transport her to the closest hospital with continuous emotional support en route.
D) provide emotional support, administer diazepam to prevent her from becoming frantic, administer oxygen via nasal cannula at 6 L/min, and transport her to a minor emergency clinic.

A 29-year-old woman complains of abdominal cramping and vaginal bleeding. The patient is 22 weeks pregnant and tells you that she passed several large clots of blood while using the toilet. Your partner confirms that she can clearly recognize a small fetus in the toilet. The patient is conscious and alert, but her skin is diaphoretic. Her blood pressure is 98/58 mm Hg, pulse rate is 108 beats/min and regular, and respirations are 22 breaths/min with adequate depth. In addition to bringing the fetus to the hospital for inspection, the MOST appropriate treatment for this patient involves:
A) oxygen via nasal cannula at 2 L/min, two large-bore IV lines, a 20-mL/kg normal saline bolus, emotional support, and rapid transport to the hospital.
B) supplemental oxygen, careful packing of the vagina to control the bleeding, an IV line set to keep the vein open, emotional support as needed, and transport.
C) oxygen by face mask at 8 L/min, placing her in a left lateral recumbent position, a sanitary pad over her vagina, emotional support, and transport to the hospital.
D) high-flow oxygen, a sanitary pad over her vagina, a large-bore IV, crystalloid boluses as needed to maintain adequate perfusion, emotional support, and prompt transport.

If a pregnant woman is injured and is bleeding severely:
A) signs of shock will appear earlier than expected.
B) her body will automatically shunt blood to the fetus.
C) her blood pressure will fall after a 70% loss of blood.
D) blood flow will be diverted away from the uterus.

You are assessing an 80-year-old man who complains of generalized weakness. He denies chest pain or shortness of breath and tells you that he has become progressively weaker over the past 3 days. His medical history is significant for two prior heart attacks, hypertension, chronic renal insufficiency, and atrial fibrillation. His blood pressure is 108/60 mm Hg, pulse rate is 94 beats/min and irregular, and respirations are 20 breaths/min and unlabored. Auscultation of his lungs reveals scattered crackles, and the ECG reveals atrial fibrillation. In addition to administering supplemental oxygen, you should:
A) start an IV with D5W, assess his blood glucose level, and administer half the usual dose of diltiazem to lower the rate of his atrial fibrillation.
B) obtain a 12-lead ECG tracing, start an IV line with normal saline and give a 250-mL fluid bolus, reassess his blood pressure, and transport him.
C) establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport.
D) obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport to the hospital.

Appropriate care for postpartum bleeding in the prehospital setting includes all of the following, EXCEPT:
A) infusing oxytocin at a rate of 0.2–0.3 units/min.
B) massaging the uterus in a clockwise fashion.
C) administering IV fluids to maintain perfusion.
D) carefully placing sanitary pads in the vagina.

45. Hypotension and orthostatic vital sign changes would MOST likely occur in elderly people who take:
A) diuretics.
B) beta blockers.
C) antidepressants.
D) ACE inhibitors.

If a woman who is 35 weeks pregnant is placed in a supine position:
A) a paradoxical bradycardia will occur.
B) atrial preload may be reduced markedly.
C) aortic compression will cause hypotension.
D) uterine circulation will increase exponentially.

163. A 4-year-old girl presents with a fever of 103.2°F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child includes all of the following, EXCEPT:
A) 81 mg of aspirin.
B) free-flow oxygen.
C) 250 mg of acetaminophen.
D) simple cooling measures.

A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to 3 puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should:
A) give 0.35 mg of epinephrine 1:1,000 SQ.
B) give 0.5 mg of nebulized ipratropium.
C) administer another 2.5-mg dose of albuterol.
D) assist her ventilations with a bag-mask device

A 10-year-old child fell approximately 15 feet from a balcony, landing on a sidewalk. He is conscious and alert, and complains of pain to the right side of his body. After completing your primary assessment, you should:
A) apply spinal precautions, begin transport, and perform a rapid assessment while en route to the hospital.
B) provide any immediately needed care, perform a rapid assessment, apply spinal precautions, and transport.
C) perform a focused physical exam, obtain baseline vital signs, apply spinal precautions, and transport.
D) correct immediate life threats, perform a detailed head-to-toe exam, apply spinal precautions, and transport.

Several cycles of chest compressions have failed to remove a foreign body airway obstruction in an unresponsive infant. Your next action should be to:
A) perform laryngoscopy and try to visualize the foreign body.
B) continue chest compressions and perform a cricothyrotomy.
C) open the infant’s airway and sweep the infant’s mouth with your finger.
D) perform back slaps and chest thrusts and then look in the mouth.

A 10-month-old infant presents with an acute onset of increased work of breathing. According to the infant’s mother, the child was crawling around in the living room prior to the event and was fine 10 minutes earlier. Your assessment reveals that the infant appears alert to his surroundings, has loud inspiratory stridor, and pink skin. You should:
A) look inside the infant’s mouth using a tongue blade and penlight.
B) avoid agitating the infant, offer supplemental oxygen, and transport.
C) deliver five sharp back slaps between the infant’s shoulder blades.
D) apply a pediatric nonrebreathing mask and transport expeditiously.

A 9-year-old who fell off his bike has an isolated deformity to his forearm and is in significant pain. The child is conscious and alert, his vital signs are stable, and his mother is present. Your initial effort to relieve this child’s pain should involve:
A) encouraging the child to breathe high-flow oxygen.
B) not allowing the child to visualize his deformed arm.
C) providing calm reassurance to both mother and child.
D) administering morphine or fentanyl via slow IV push.

62. During your assessment of a 30-year-old woman in active labor, she admits to being a chronic heroin abuser and states that she last “shot up” about 6 hours ago. After the baby delivers, you will MOST likely need to:
A) give positive-pressure ventilations.
B) administer 0.1 mg/kg of naloxone.
C) suction meconium from its airway.
D) administer free-flow oxygen by mask.

Caput succedaneum is defined as:
A) bilateral temporal bone fractures caused by a delivery that includes the use of forceps.
B) temporary swelling of the soft tissue of the baby’s scalp secondary to pressure from the dilating cervix.
C) an area of bleeding between the parietal bone and its covering periosteum that resolves in 1 to 2 months.
D) permanent cranial disfigurement caused by vaginal delivery in a woman with cephalopelvic disproportion.

56. What dose and concentration of glucose would be MOST appropriate for a 6-pound hypoglycemic newborn?
A) 5.5 mL of 10% dextrose (D10)
B) 6 mL of 25% dextrose (D25)
C) 6.5 mL of 10% dextrose (D10)
D) 7.5 mL of 25% dextrose (D25)

55. Which of the following disorders or conditions is related to decreased glycogen stores in the newborn?
A) Large for gestational age
B) Hypoxia or hypothermia
C) Small for gestational age
D) Maternal diabetes mellitus

Which of the following statements regarding fever in the newborn is correct?
A) Fever in newborns is defined as a rectal temperature greater than 99.0°F.
B) The ability of the newborn to dissipate heat through sweating is prominent.
C) Fever may not always be a presenting feature in newborns with an infection.
D) Because of their active immune systems, newborns commonly experience fever.

A 9-year-old, 55-pound girl presents with generalized hives, marked facial swelling, and loud inspiratory stridor. She is conscious but appears sleepy. You can MOST rapidly improve this child’s condition by:
A) starting an infusion of epinephrine at 5 µg/min.
B) administering up to 50 mg of diphendydramine.
C) administering 0.25 mg of epinephrine IM.
D) intubating her and administering albuterol via the ET tube.

55lbs = 25kg

epi for poor perfusion: .01mg/kg from 1:10,000

Following significant blunt trauma to the abdomen, a 9-year-old boy presents with diaphoresis and pallor. He is conscious and alert, with a blood pressure of 90/58 mm Hg, a heart rate of 130 beats/min, and a respiratory rate of 28 breaths/min with adequate depth. With an estimated ground transport time of 30 minutes, you should:
A) assist his ventilations to increase tidal volume, cover him with a blanket, establish at least one large-bore IV line, administer a 20-mL/kg normal saline bolus, and transport to a trauma center.
B) administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion.
C) apply supplemental oxygen, start two large-bore IV lines with normal saline, administer several crystalloid boluses of 20 mL/kg, apply spinal precautions if indicated, and transport to an appropriate medical facility.
D) apply warm blankets, elevate his lower extremities 12 inches, administer high-flow oxygen, insert an IO catheter, administer a 250-mL normal saline bolus, and transport expeditiously to an appropriate trauma center.

A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child’s mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child’s ventilations with high-flow oxygen, your partner informs you that the child’s heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should:
A) ask your partner to insert an IO catheter and administer epinephrine 1:10,000.
B) attempt immediate transcutaneous pacing while continuing ventilation assistance.
C) establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate.
D) initiate one-rescuer CPR while your partner attempts to establish vascular access.

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should:
A) manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min.
B) suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask.
C) open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.
D) insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea.

44. A subtle seizure in the newborn is characterized by:
A) eye deviation.
B) repetitive jerking.
C) flexion of the arms.
D) tonic limb extension.

A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves:
A) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.
B) conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls.
C) recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation.
D) assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin.

You have just delivered a little girl who was born 4 weeks premature. There is no evidence of meconium in the amniotic fluid. After drying, warming, suctioning, positioning, and stimulating the infant, she remains acrocyanotic and is not crying. You should:
A) determine the newborn’s Apgar score.
B) begin assisting her ventilations at once.
C) resuction her mouth for up to 10 seconds.
D) open her airway and assess respirations.

107. Common medications used to treat pediatric seizures in the prehospital setting include all of the following, EXCEPT:
A) Ativan.
B) Dilantin.
C) Diazepam.
D) Midazolam.

You and your partner are caring for a child with stable supraventricular tachycardia that was refractory to initial treatment. As your partner is preparing to establish vascular access, the child’s level of consciousness decreases markedly. You reassess the child and note that his femoral pulse is rapid and weak. You should:
A) perform immediate synchronized cardioversion and reassess.
B) begin chest compressions as your partner establishes the IV line.
C) preoxygenate the child and then perform endotracheal intubation.
D) establish vascular access and administer 0.1 mg/kg of adenosine.

You are assessing a 10-year-old child with apparent ventricular tachycardia, but cannot decide whether electrical or pharmacologic therapy is the most appropriate initial treatment approach. Which of the following interventions would pose the GREATEST potential for harm?
A) Administering high-flow oxygen and obtaining a 12-lead ECG tracing
B) Establishing IO access, administering a sedative, and cardioverting at 15 joules
C) Starting an IV line and administering amiodarone followed by procainamide
D) Establishing vascular access and rapidly administering 3 mg of adenosine

mixing medications unnecessarily is dangerous

Your primary assessment of an unresponsive 5-year-old, 40-pound child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should:
A) continue high-quality CPR and reassess in 2 minutes.
B) defibrillate with 40 joules and immediately resume CPR.
C) start an IV and administer 0.2 mg of epinephrine 1:10,000.
D) charge the defibrillator to 80 joules while CPR is ongoing.

163. A 4-year-old girl presents with a fever of 103.2°F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child includes all of the following, EXCEPT:
A) 81 mg of aspirin.
B) free-flow oxygen.
C) 250 mg of acetaminophen.
D) simple cooling measures.

You and your partner arrive at the scene shortly after a 2-year-old child experienced an apparent seizure. The child’s father tells you that his son’s entire body began shaking and that the episode lasted less than 5 minutes. Your assessment of the child reveals that he is conscious, is crying, and has hot, moist skin. His heart rate is 160 beats/min, and his respirations are 40 breaths/min. You should:
A) advise the father to take his son to see a pediatrician the following day.
B) cool the child with tepid water, administer high-flow oxygen, and transport.
C) establish vascular access, give a 20-mL/kg saline bolus, and transport him.
D) keep the child cool and transport him to the hospital for physician evaluation.

You are dispatched to a residence at 6:15 AM for an unconscious 3-month-old infant who is not breathing. Upon arrival at the scene, you find the father performing CPR on the infant. The infant’s mother is sitting on the couch, crying. Your assessment reveals that the child is apneic and pulseless. His skin is pale and cold, and there is gross lividity to his chest. You should:
A) continue CPR and assess the infant’s cardiac rhythm to confirm asystole.
B) recognize that the infant has been deceased for an extended period of time.
C) pronounce the infant dead if he does not respond to 5 minutes of full ACLS.
D) tell the parents that the child likely suffocated because he slept on his stomach.

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should:
A) manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min.
B) suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask.
C) open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.
D) insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea.

Following significant blunt trauma to the abdomen, a 9-year-old boy presents with diaphoresis and pallor. He is conscious and alert, with a blood pressure of 90/58 mm Hg, a heart rate of 130 beats/min, and a respiratory rate of 28 breaths/min with adequate depth. With an estimated ground transport time of 30 minutes, you should:
A) assist his ventilations to increase tidal volume, cover him with a blanket, establish at least one large-bore IV line, administer a 20-mL/kg normal saline bolus, and transport to a trauma center.
B) administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion.
C) apply supplemental oxygen, start two large-bore IV lines with normal saline, administer several crystalloid boluses of 20 mL/kg, apply spinal precautions if indicated, and transport to an appropriate medical facility.
D) apply warm blankets, elevate his lower extremities 12 inches, administer high-flow oxygen, insert an IO catheter, administer a 250-mL normal saline bolus, and transport expeditiously to an appropriate trauma center.

You are called to a residence for a ventilator-dependent child with respiratory distress. Upon your arrival, the child’s mother tells you that the child was doing fine, but then suddenly began experiencing labored breathing. She further tells you that the child’s home ventilator was recently replaced with a newer one. Assessment of the child reveals that she is in marked respiratory distress and has intercostal retractions. Your FIRST action should be to:
A) suction the child’s tracheostomy tube to rule out secretions as the problem.
B) assess the patency of the tracheostomy tube to determine if it is dislodged.
C) remove the tracheostomy tube and replace it with a similar-sized ET tube.
D) disconnect the child from the ventilator and begin bag-mask ventilations.

You receive a call to a residence for a 6-year-old girl with a decreased level of consciousness. The child has hydrocephalus following surgery to remove a brain tumor and has a ventricular shunt in place. The child’s level of consciousness is markedly decreased from its baseline, and the child’s caregiver tells you that she thinks the shunt is obstructed. Which of the following sets of vital signs is MOST indicative of shunt obstruction and increased intracranial pressure?
A) Blood pressure 140/92 mm Hg; pulse 58 beats/min; respirations 8 breaths/min
B) Blood pressure 106/66 mm Hg; pulse 80 beats/min; respirations 14 breaths/min
C) Blood pressure 90/50 mm Hg; pulse 110 beats/min; respirations 10 breaths/min
D) Blood pressure 130/68 mm Hg; pulse 70 beats/min; respirations 28 breaths/min

A because really sigh SBP and low RR

Not B because BP is way too low
Not C because BP is hypotensive and HR is now what it would be for this kind of call
Not D because the BP isn’t high enough

A 6-year-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned?
A) 21%
B) 27%
C) 30%
D) 36%

A childs head is proportionally smaller than an infants

You have just delivered a little girl who was born 4 weeks premature. There is no evidence of meconium in the amniotic fluid. After drying, warming, suctioning, positioning, and stimulating the infant, she remains acrocyanotic and is not crying. You should:
A) determine the newborn’s Apgar score.
B) begin assisting her ventilations at once.
C) resuction her mouth for up to 10 seconds.
D) open her airway and assess respirations.

During your rapid assessment of a newborn’s cardiopulmonary status, you note that its respirations are adequate, you feel 8 pulsations in a 6-second time frame, and the newborn is centrally pink but peripherally cyanotic. The MOST appropriate next action should be to:
A) provide 30 seconds of tactile stimulation.
B) administer positive-pressure ventilations.
C) assess the newborn’s blood glucose level.
D) give free-flow oxygen by mask at 5 L/min.

After performing the initial steps of resuscitation, you assess a newborn and note that its respirations are poor and its pulse rate is 50 beats/min. You should:
A) immediately begin positive-pressure ventilations and chest compressions and then reassess the newborn’s pulse rate in 30 seconds.
B) begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation.
C) begin chest compressions, insert an endotracheal tube, and administer 0.1 to 0.3 mL/kg of epinephrine 1:10,000 down the endotracheal tube.
D) perform tactile stimulation for 30 seconds, reassess the infant’s respirations and pulse rate, and begin positive-pressure ventilations if there is no improvement.

You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia. Your estimated time of arrival at the hospital is 45 minutes. Air medical transport was unavailable due to severe weather in the vicinity. A peripheral IV line has been established in the antecubital vein and you are in the process of attempting intubation. Approximately 10 seconds into your intubation attempt, the newborn’s heart rate suddenly drops more. You should:
A) abort the intubation attempt and continue ventilations.
B) continue the intubation attempt and administer atropine.
C) administer 0.1 to 0.3 mL/kg of epinephrine rapid IV push.
D) ensure that chest compressions are of adequate rate and depth.

You have been providing bag-mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes. The infant's abdomen is markedly distended. Although you are properly trained, your protocols do not allow you to intubate newborns. The MOST appropriate intervention involves:
A) intubating immediately.
B) suctioning the oropharynx.
C) inserting an orogastric tube.
D) manual gastric decompression.

You and your partner are caring for a 5-pound distressed newborn. After providing 30 seconds of effective bag-mask ventilations, the newborn’s heart rate remains below 60 beats/min. You should:
A) cannulate the umbilical vein and give 0.5 mL of epinephrine.
B) try tactile stimulation as you continue bag-mask ventilations.
C) start a peripheral IV line and give 4 mEq of sodium bicarbonate.
D) continue bag-mask ventilations and initiate chest compressions.

During the delivery of a post-term baby, you note the presence of particulate meconium in the amniotic fluid. Your post-delivery assessment of the newborn reveals that it is active, has a strong cry, and has a heart rate of 110 beats/min. You should:
A) deliver free-flow oxygen at 5 L/min while performing deep oropharyngeal suctioning with a bulb syringe aspirator.
B) avoid any form of tactile stimulation, perform laryngoscopy, and suction meconium from the trachea with an ET tube.
C) preoxygenate the newborn with bag-mask ventilations for 30 seconds and then perform endotracheal intubation.
D) ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring.

Your assessment of a depressed 7-pound newborn reveals tachypnea, pallor, weak peripheral pulses, a heart rate of 120 beats/min, and a blood glucose level of 58 mg/dL. Which of the following interventions will MOST likely cause improvement in this newborn's condition?
A) 0.3 mg of naloxone
B) 32 mL of normal saline
C) 6.5 mL of 10% dextrose
D) 0.06 mg of epinephrine

An untreated patent ductus arteriosus may cause subsequent development of:
A) congestive heart failure.
B) ventricular septal defect.
C) pulmonary stenosis.
D) a patent foramen ovale.

When an atrial septal defect is present:
A) blood flow to the lungs is significantly decreased, which leads to severe hypoxemia.
B) the heart must push harder to force blood flow past a narrowed aorta, resulting in increased afterload.
C) deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood.
D) blood is allowed to bypass the right ventricle and lungs due to the fetus’s lungs being filled with fluid.

Tetralogy of Fallot is a combination of four heart defects, including:
A) atrial septal defect.
B) coarctation of the aorta.
C) tricuspid atresia.
D) right ventricular hypertrophy.

Which of the following congenital defects results in an undersized or absent right ventricle?
A) Tricuspid atresia
B) Pulmonary stenosis
C) Tetralogy of Fallot
D) Atrial septal defect

Total anomalous pulmonary venous return is a rare congenital defect in which:
A) pressure in the lungs causes pulmonary hypertension.
B) the four pulmonary veins connect to the right atrium.
C) venous blood mixes with arterial blood in the heart.
D) blood returns to the lungs after being reoxygenated.

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