MEDICAL

Question 1

Following ingestion of a toxic dose of acetaminophen, right upper quadrant abdominal pain typically begins within:

Answer 1

24-72 hrs

Question 2

Characteristics of DKA?

Answer 2

Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Other findings include warm, dry skin; dehydration; and deep, rapid respirations (Kussmaul respirations). The progression to DKA is typically slow, often over several hours to a few days.

Question 3

Treatment for a patient with a severe migraine headache, nausea, and vomiting includes:

Answer 3

5 mg of prochlorperazine IV.

Prochlorperazine (Compazine), a phenothiazine, is an antiemetic medication that will not only relieve nausea and vomiting from a migraine headache but has been found to be effective in terminating the headache itself.

Question 4

When the body’s blood glucose level falls, such as following strenuous exercise:

Answer 4

The pancreas secretes glucagon, which stimulates the liver to convert glycogen to glucose.

Question 5

A 39-year-old man is unresponsive, pulseless, and apneic after being lost in the woods during the middle of winter. He has a core body temperature of 85° F (29.4° C). When treating this patient, you should avoid:

Answer 5

Cardiac medications

Cardiac medications should be withheld for two reasons: 1) the patient’s metabolic rate is too slow to distribute the drugs, and 2) medications can accumulate to toxic levels in the severely hypothermic patient, which can be detrimental as the patient is rewarmed.

Question 6

You are called to an assisted living facility for a sick resident. The patient, a 70-year-old woman, reports tinnitus and difficulty concentrating. The patient’s neighbor, who is present at the scene, tells you that the patient has consumed five or six cups of ice over the past hour. You should suspect:

Answer 6

Chronic anemia

Tinnitus (ringing in the ears), a craving for ice, and difficulty concentrating are hallmark findings of chronic anemia.

Question 7

You are assessing a young female and are trying to determine if she experienced a seizure or a syncopal episode. Which of the following findings is MOST consistent with a seizure?

Answer 7

HR of 120

Tachycardia is a common finding following a seizure, when the patient is postictal; it is caused by a sympathetic nervous system discharge that occurred during the seizure.

Question 8

Polycythemia is a condition that results in:

Answer 8

Increased oxygen-carrying capacity of the blood.

Question 9

Correct statement regarding lightning injuries

Answer 9

Lightning injuries tend to resemble blast injuries more than they do high-voltage injuries.

Question 10

When released into the bloodstream, glucagon:

Answer 10

Stimulates the liver to convert glycogen to glucose

Question 11

A 60-year-old woman, who has been taking high doses of prednisone for several months to treat her rheumatoid arthritis, presents with weakness and fatigue that has progressively worsened. On appearance, her face appears swollen. You should be MOST suspicious that this patient has:

Answer 11

Cushing’s syndrome

Question 12

Which of the following describes the typical sequence of events that precedes cardiac arrest in a drowning episode?

Answer 12

Laryngospasm, hypoxia, dysrhythmias

Question 13

A person’s level of consciousness is regulated by the:

Answer 13

Reticular activating system

Question 14

You are dispatched to a residence for a patient having a seizure. Upon arriving at the scene, you find that the patient, a 39-year-old male, is experiencing a generalized tonic-clonic seizure and is cyanotic. His wife tells you that he has been like this for the past 25 minutes. You should:

Answer 14

Ventilate him with a bag-valve-mask device, establish IV access, and administer 5 mg of diazepam.

Question 15

Which of the following ECG abnormalities is associated with hypothermia?

Answer 15

Osborn wave

An Osborn wave (J wave) may be observed on the ECG. An Osborn wave is a positive deflection that causes elevation of the J point (intersection of the QRS complex and ST segment) above the isoelectric line.

Question 16

Medication that’s classified as a tricyclic antidepressant?

Answer 16

Nortriptyline hydrochloride

Question 17

Which of the following drug overdoses could be reversed with the administration of naloxone?

Answer 17

Meperidine

Question 18

Which of the following would MOST likely cause laryngeal spasm?

Answer 18

Extubation of a semiconscious patient

Question 19

A 71-year-old female presents with an altered mental status. According to her husband, she has type II diabetes and hypertension, and was recently diagnosed with a urinary tract infection. Her medications include Glucophage, Zestril, and Bactrim. The patient is confused, and has slurred speech and poor skin turgor. Her blood pressure is 112/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 30 breaths/min and shallow. Her blood glucose level reads “high,” but you do not notice any unusual odors on her breath. The primary cause of this patient’s problem is MOST likely:

Answer 19

Hyperosmolar hyperglycemic nonketotic state.

Hyperosmolar hyperglycemic nonketotic state (HHNS), most often seen in patients with type II diabetes, is marked by hyperglycemia, hyperosmolarity, and an absence of significant ketosis. Most patients present with severe dehydration and focal or global neurologic deficits. HHNS often develops in patients who have a secondary illness, usually an infection, that leads to reduced fluid intake.

Question 20

Which of the following complications would MOST likely occur if a patient with renal failure missed his or her dialysis treatment?

Answer 20

Pulmonary edema

Question 21

A 26-year-old woman was bitten on the leg by a rattlesnake. She is conscious and alert, but is anxious. Her BP is 114/66 mm Hg, her heart rate is 112 beats/min, her respirations are 20 breaths/min, and her oxygen saturation is 97%. The paramedic should:

Answer 21

Splint the affected extremity and establish an IV line with normal saline.

Question 22

A 43-year-old woman was stung by a scorpion. Within 5 minutes, she developed swelling to her face and diffuse urticaria. She is confused and has a BP of 80/60 mm Hg. After administering supplemental oxygen, you should give:

Answer 22

0.1 mg of epinephrine 1:10,000 IV.

Question 23

A 34-year-old woman overdosed on amitriptyline. She is unresponsive and has slow, shallow breathing. Her BP is 70/40 mm Hg and her heart rate is 140 beats/min. The cardiac monitor reveals sinus tachycardia. Initial treatment for her should include:

Answer 23

Assisted ventilation with a bag-valve-mask device and 20 mL/kg normal saline boluses.

Question 24

You are dispatched to a residence for a 65-year-old female whose husband reports a change in her behavior over the past several days. He states that initially she seemed forgetful, but today she is confused. Your assessment reveals an obese patient who has slow respirations; cold, dry skin; a heart rate of 50 beats/min; and a blood pressure of 90/50 mm Hg. The patient’s husband tells you that his wife does not have any medical problems that he is aware of, but remarks about her weight gain over the past few months. This patient’s history and clinical presentation are MOST likely the result of:

Answer 24

Decreased thyroid hormone production.

Question 25

Multiple sclerosis is a disease caused by:

Answer 25

An autoimmune disorder in which the body attacks the myelin sheath of the neurons in the brain and spinal cord.

Question 26

Disequilibrium syndrome manifests with signs and symptoms of:

Answer 26

Increased intracranial pressure

Question 27

A 49-year-old man with type I diabetes has not taken his insulin in the past 2 days. Which of the following signs and symptoms would the paramedic MOST likely encounter?

Answer 27

Dehydration; deep, rapid breathing; warm, dry skin

Question 28

Which of the following hormones stimulates the kidneys to reabsorb sodium and excrete potassium?

Answer 28

Aldosterone

Question 29

A 59-year-old female complains of a headache. She is conscious and alert, has a patent airway, and is breathing adequately. You should:

Answer 29

Determine when her headache began

Question 30

In contrast to an anaphylactic reaction, an anaphylactoid reaction:

Answer 30

Can occur without prior exposure to an offending agent.

Question 31

What is the MOST appropriate dose and route of diphenhydramine (benadryl) for a patient who is experiencing a severe allergic reaction?

Answer 31

25 to 50 mg IV

Question 32

A 64-year-old man presents with an acute onset of left-sided weakness, right-sided facial droop, and slurred speech. He is conscious, but confused. You should be MOST suspicious for:

Answer 32

Right-sided ischemic stroke

Question 33

Which of the following findings is MOST suggestive of myxedema?

Answer 33

Hypothermia

Advanced hypothyroidism is sometimes called myxedema. Frequently, patients have localized accumulations of mucinous material in the skin, which gives the disease its name (the prefix myx- refers to “mucin,” and edema means “swelling”). Myxedema manifests as a general slowing of the body’s metabolic processes due to a significant reduction or absence of the thyroid hormones T3 (triiodothyronine) and T4 (thyroxine). Since the thyroid gland regulates the metabolic rate and metabolism produces heat energy, patients with myxedema are prone to hypothermia.

Question 34

A 70-year-old male presents with an altered mental status and severe weakness. According to his wife, he has had lower back pain and a fever for the past few days. His BP is 82/44 mm Hg, pulse is 160 beats/min, and respirations are 22 breaths/min. Treatment for this patient should include:

Answer 34

Normal saline boluses and norepinephrine.

The patient’s vital signs clearly indicate shock, and given his recent illness and current presentation, the paramedic should suspect that he is septic. Septic patients need volume; in many cases, several liters of fluid are needed. A vasopressor (ie, norepinephrine [Levophed]) is often used in conjunction with fluid boluses, especially if hypotension persists despite fluid boluses.

Question 35

Which of the following can MOST easily be assessed without talking to a patient who is experiencing a behavioral crisis?

Answer 35

Affect

Question 36

A 52-year-old man has a headache and visual disturbances that have progressively worsened over the past 3 months. These symptoms are MOST consistent with:

Answer 36

A cerebral neoplasm

Question 37

You are assessing a patient who presents with a melena and abdominal pain. Which of the following medical history findings is the MOST clinically significant?

Answer 37

von Williebrand disease

The presence of von Willebrand disease in a patient with internal or external bleeding should concern you the most. Von Willebrand disease, a bleeding disorder similar to hemophilia, is caused by a deficiency of von Willebrand factor (vWF), a blood clotting protein. vWF circulates attached to factor VIII, another blood clotting protein. As a consequence of von Willebrand disease, the normal process of hemostasis is interrupted and the patient will continue to bleed.

Question 38

Prehospital treatment for cutaneous exposure to hydrofluoric acid includes:

Answer 38

Antacid preparations, such as Mylanta or Maalox.

Question 39

The paramedic established an IV of normal saline on a 30-year-old female with abdominal pain. During transport, she begins complaining of severe chills, a backache, and nausea. Her skin becomes flushed and is abnormally warm to the touch. The paramedic should:

Answer 39

Discontinue the IV fluid.

The patient’s signs and symptoms indicate a pyrogenic reaction. A pyrogenic reaction occurs when fever-causing agents (pyrogens) in the IV fluid produce fever; chills, nausea, and back pain are common. The paramedic should discontinue the IV fluid immediately; disconnect the IV tubing and attach a saline lock.

Question 40

During your assessment of a patient with a suspected neurologic disorder, you ask him to shrug his shoulders and turn his head from side to side. Which of the following cranial nerves are you assessing?

Answer 40

Spinal accessory

Question 41

The clinical presentation of thyroid storm MOST closely resembles that of:

Answer 41

Amphetamine use

Thyroid storm is a life-threatening condition that may occur in patients with hyperthyroidism. When produced in excess, these thyroid hormones produce signs and symptoms of adrenergic hyperactivity (ie, tachycardia, sweating, palpitations, anxiety). In thyroid storm, these clinical signs would be more severe, including profound tachycardia, dysrhythmias, agitation and paranoia, and cardiovascular collapse. Amphetamines also cause adrenergic hyperactivity; of the choices listed, amphetamine use and thyroid storm would produce the most similar clinical signs.

Question 42

A man was trapped in his burning house for approximately 15 minutes before firefighters rescued him. He reports burning in his throat and a severe headache. He has a blood pressure of 180/90 mm Hg, a pulse rate of 120 beats/min, and labored respirations of 28 breaths/min. In addition to providing supplemental oxygen, treatment should include:

Answer 42

Amyl nitrite inhaled in 20-second increments

Question 43

A 59-year-old woman with a history of Grave’s disease presents with an altered mental status. Her skin is hot to the touch and her pulse rate is 160 beats/min. These findings are MOST consistent with:

Answer 43

Thyrotoxic crisis

Question 44

Which of the following statements regarding Cheyne-Stokes respirations is correct?

Answer 44

They are not considered ominous unless grossly exaggerated or in the context of a traumatic brain injury.

Question 45

You would expect to encounter trismus in a patient with:

Answer 45

Tetanus

Trismus is the spasm of the jaw muscles that causes difficulty opening the mouth (lockjaw).

Question 46

You are called to a residence for a 39-year-old woman, who, according to her husband, is “not acting right.” She is confused, is experiencing hallucinations, and is repetitively smacking her lips. Which of the following should you suspect?

Answer 46

Complex partial seizures

Simple partial seizures involve movement (frontal lobe) or sensations (parietal lobe) to one part of the body. A focal motor seizure is a simple partial seizure with localized motor activity. There may be spasm or clonus (jerking) of one muscle or muscle group, which may remain localized or may spread to adjacent muscles (Jacksonian march). Complex partial seizures involve changes in level of consciousness. The patient can become confused, lose alertness, experience hallucinations, or may be unable to speak. Automatisms, such as lip smacking, chewing, swallowing, may occur with complex partial seizures. Generalized seizures affect the entire brain. Tonic/clonic seizures (full body jerking movements), absence seizures (freezing or staring), and pseudoseizures (tonic/clonic, but caused by a psychiatric mechanism) are examples of generalized seizures.

Question 47

Which of the following statements regarding sickle cell disease is correct?

Answer 47

In sickle cell disease, misshapen red blood cells can lodge in the spleen, causing it to swell and rupture.

Question 48

Which of the following assessment findings is MOST indicative of peritoneal irritation?

Answer 48

A decrease in pain when drawing the knees into the abdomen.

The classic position for the patient with peritoneal inflammation or irritation is recumbent with the knees drawn up into the chest (fetal position). This position takes much of the stress off of the abdominal muscles, thereby affording some pain relief. Even small bumps in the road can cause intense pain in patients with peritonitis.

Question 49

A 60-year-old male with chronic alcoholism presents with an acute onset of hematemesis. His blood pressure is 80/40 mm Hg, pulse is 130 beats/min and weak, and respirations are 28 breaths/min and shallow. What pathophysiologic process is MOST likely responsible for his condition?

Answer 49

Abnormally enlarged esophageal veins secondary to impaired blood flow to the liver

This patient likely has ruptured esophageal varices. Esophageal varices are a complication of portal hypertension (increased pressure in the portal vein [the vein that carries blood from the intestines to the liver]) due to liver disease. Liver disease (ie, hepatitis, cirrhosis) is common in patients with chronic alcoholism. As blood flow to the diseased liver is blocked, blood backs up into the smaller, more fragile blood vessels in the lower part of the esophagus. As a result, these esophageal vessels become abnormally enlarged (varices). Esophageal varices are generally asymptomatic unless they rupture, in which case life-threatening hemorrhage can occur.

Question 50

A middle-aged female with a history of hypertension presents with an acute onset of tearing abdominal pain. She is conscious and alert, but restless. Her BP is 86/56 mm Hg, pulse rate is 120 beats/min, and respirations are 28 breaths/min. The paramedic should:

Answer 50

Determine if her femoral pulses are of equal strength.

Your patient may be experiencing acute dissection of the abdominal aorta. A unilateral femoral pulse deficit (one femoral pulse is weaker than the other) may be observed in patients with dissection of the abdominal aorta - especially if the dissection occurs where the common iliac arteries branch.

Question 51

In addition to CPR, treatment for a patient in cardiac arrest with a core body temperature of 90° F includes:

Answer 51

Spacing epinephrine doses at longer than standard intervals.

Question 52

A 23-year-old man was working near a wood pile when he experienced a sudden, sharp pain in his leg. Your assessment reveals that his level of consciousness is decreased and he is experiencing intense abdominal spasms. This clinical presentation is MOST consistent with the bite of a:

Answer 52

Black widow spider

Question 53

Diarrhea, marked bradycardia, miosis, and hypersalivation are MOST consistent with a ____ toxidrome

Answer 53

Cholinergic

Cholinergic agents (ie, Diazinon, orthene, sarin, tabun) stimulate the parasympathetic nervous system by deactivating acetylcholinesterase - an enzyme that regulates the degradation of acetylcholine. The signs and symptoms of cholinergic toxicity - that is, the toxidrome - can be remembered with the mnemonic DUMBELS, which stands for defecation, urination, miosis (pupillary constriction), bradycardia and bronchorrhea, emesis, lacrimation, and salivation.

Question 54

A 30-year-old man complains of difficulty breathing and a fever for the past 10 days. He is emaciated, is coughing, and has purple blotches on his trunk. This patient’s clinical presentation is MOST consistent with:

Answer 54

HIV/AIDS

Question 55

Which of the following is a defining factor in the transition from human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS)?

Answer 55

Development of opportunistic infections

Question 56

Increased parasympathetic tone, bradycardia, shunting of blood to the brain, and hypotension describes:

Answer 56

The diving reflex

The diving reflex, also known as the mammalian diving reflex, is a protective mechanism of the body that is most prominent in cold temperatures (ie, falling in cold water).

Question 57

You are dispatched to a residence for a patient with respiratory distress. The patient, a 59-year-old female, has a tracheostomy tube in place and is ventilator dependent. She has marked respiratory distress, perioral cyanosis, and an oxygen saturation of 80%. You should:

Answer 57

Disconnect her from the mechanical ventilator and provide manual positive-pressure ventilation.

Question 58

After being stung by a hornet, a 34-year-old man is unresponsive, has stridorous respirations, a generalized rash, and swelling to the face and neck. His BP is 70/44 mm Hg, his pulse is 140 beats/min and thready, and his respirations are 36 breaths/min and labored. Which of the following represents the MOST appropriate treatment for him?

Answer 58

Orotracheal intubation and 0.1 mg of epinephrine 1:10,000 IV or IO

Question 59

You receive a call for a 55-year-old female who is ill. The patient’s husband tells you that she is an alcoholic, and has been “on the wagon” for about a week. The patient is conscious, but confused and restless. Her skin is hot to the touch, she is profusely diaphoretic, and her hands are shaking. Her blood pressure is 180/90 mm Hg, pulse is 120 beats/min, respirations are 24 breaths/min, and oxygen saturation is 98% on room air. You should:

Answer 59

Provide emotional support, establish vascular access, monitor her cardiac rhythm, assess her blood glucose level, and transport.

Question 60

A 46-year-old woman was found unresponsive on her couch by a concerned neighbor. According to the neighbor, the patient uses heroin, but recently boasted that she has “been clean.” The patient is unresponsive; has rapid, shallow breathing; and slow, weak radial pulses. You should:

Answer 60

Insert an oral airway, assist her ventilations with a bag-valve-mask device, apply the cardiac monitor, consider transcutaneous pacing, and establish vascular access.

Question 61

Which of the following combinations of drugs are indicated for a patient with copious bronchial secretions, marked bradycardia, and profuse diaphoresis following exposure to an industrial pesticide?

Answer 61

Atropine and pralidoxime chloride

Question 62

Paramedics are assessing a man who reportedly overdosed. The patient is agitated, his BP is 180/100 mm Hg, his pulse rate is 150 beats/min, and his skin is hot to the touch. Which of the following drugs would MOST likely cause these signs and symptoms?

Answer 62

Cocaine

The patient’s clinical presentation of agitation, hypertension, tachycardia, and hyperthermia are consistent with overdose of a sympathomimetic drug.

Question 63

What is the pathophysiologic difference between cyanide and carbon monoxide?

Answer 63

Carbon monoxide binds to the hemoglobin molecule.

Carbon monoxide (CO) binds to the hemoglobin molecule and inhibits the oxygen carrying ability of the blood. CO has an affinity for hemoglobin that is 200 to 250 times greater than that of oxygen. Cyanide blocks the uptake of oxygen at the cellular level.

Question 64

After administering epinephrine to a woman in anaphylactic shock, her condition improves. The paramedic should recognize that her clinical improvement is because epinephrine:

Answer 64

Constricts the blood vessels and dilates the bronchioles

Question 65

Following prolonged dehydration, a 67-year-old man presents with hypotension, tachycardia, and oliguria. He has no past medical history. Which of the following is the MOST likely cause of his condition?

Answer 65

Prerenal acute renal failure

Prerenal ARF is caused by hypoperfusion of the kidneys; not enough blood passes into the glomeruli for them to produce filtrate. The most common causes of prerenal ARF are hypovolemia (blood loss or severe dehydration), trauma, sepsis, shock, and heart failure.

Question 66

Easy bruising, lymph node enlargement, and splenomegaly are clinical manifestations of:

Answer 66

Leukemia

Question 67

An older woman presents with severe weakness, hypotension, lower back pain, and vomiting. Her husband tells you that she has not taken her prednisone in several days because she has not been feeling well. Which of the following should you suspect?

Answer 67

Addisonian crisis

Question 68

A patient with a blood glucose level of 650 mg/dL would be expected to present with:

Answer 68

Hyperpnea, dehydration, warm skin, and tachycardia

Question 69

Your assessment of a patient reveals a diffuse petechial rash. Which of the following hematologic disorders does this indicate?

Answer 69

Thrombocytopenia

Question 70

A hypotensive patient with fluid-refractory septic shock requires a norepinephrine infusion at 5 mcg/min. You add 8 mg of norepinephrine to 500 mL of normal saline and will run the infusion through a pump. How many milliliters per hour should the patient receive?

Answer 70

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