Medical

Question 1

A conscious but confused patient presents with left-side hemiparesis; facial droop; dysarthria; and a dilated, nonreactive right pupil. Which of the following conditions do you suspect?

A) Left-sided ischemic stroke
B) Left-sided hemorrhagic stroke
C) Right-sided ischemic stroke
D) Right-sided hemorrhagic stroke

Answer 1

Answer: C

The right side of the brain controls the left side of the body and vice versa; therefore, this patient has experienced an ischemic stroke to the right side of the brain. Ischemic strokes typically present with confusion; unilateral weakness (hemiparesis); a facial droop; and dysarthria (slurred or poorly articulated speech). The pupil is affected on the same side as the stroke because of the crossover of optic nerves at the level of the midbrain. A hemorrhagic stroke typically presents with a sudden, severe headache; a rapid loss of consciousness; and signs of increased intracranial pressure (hypertension, bradycardia, and respiratory abnormalities).

Question 2

When forming the general impression of a medical patient, which of the following would MOST likely indicate an altered mental status?

A) The patient’s speech pattern is altered
B) The patient rudely tells you to leave
C) You note the patient is quietly crying
D) The patient is hypervigilant of your presence

Answer 2

Answer: A

The general impression is a quick formulation of the patient’s condition immediately on setting your eyes on the patient. One part of the general impression is to assess the patient’s mental status. Patients with garbled or altered speech patterns should be assumed to have an altered mental status, which clearly requires more investigation. Of course, before you can establish whether or not a patient’s mental status is truly altered, you must ascertain his or her baseline mental status.

Question 3

A 50-year-old man was found unresponsive in his garden. Your assessment reveals miosis, hypersalivation, and fine muscle tremors to the face. Which of the following should you be MOST suspicious for?

A) seizure
B) Pesticide exposure
C) An opiate overdose
D) A hemorrhagic stroke

Answer 3

Answer: B

Pesticides contain organophosphates and carbamates and can significantly increase parasympathetic tone, resulting in severe bradycardia and hypotension. The mnemonics SLUDGEM and DUMBELS can be used to help remember the clinical manifestations of organophosphate/carbamate poisoning. SLUDGEM stands for salivation, lacrimation, urination, defecation, gastrointestinal distress, emesis, and miosis (pupillary constriction). DUMBELS stands for defecation, urination, miosis, bradycardia/bronchorrhea, emesis, lacrimation, and salivation. Other findings may include fine muscle tremors (fasciculations) and coma.

Question 4

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?

A) Focal motor seizure
B) Simple partial seizure
C) Complex partial seizure
D) Generalized motor seizure

Answer 4

Answer: C

Seizures are classified as being generalized or partial. Your patient’s presentation is consistent with a complex partial seizure. Partial seizures affect a limited part of the brain and are further divided into simple partial and complex partial. 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 5

Which of the following hematologic abnormalities would MOST likely be present in a patient with atraumatic gastrointestinal bleeding and signs of shock?

A) Decreased hematocrit
B) Increased hematocrit
C) Decreased plasma level
D) Increased hemoglobin level

Answer 5

Answer: A

The hematocrit, which is the ratio of red blood cells to plasma, decreases in cases of severe internal or external bleeding because there is a greater ratio of plasma to red blood cells. In cases where plasma is lost, such as with burns, the hematocrit value increases because there is a greater ratio of red blood cells to plasma. The hemoglobin level falls in patients with internal or external bleeding, resulting in decreased oxygen-carrying capacity of the blood.

Question 6

Which of the following is an important aspect in the management of a patient with a suspected acute ischemic stroke?

A) Fibrinolytic therapy must be administered within 3 hours
B) Prophylactic hyperventilation significantly decreases mortality
C) Most patients with ischemic stroke require advanced airway management
D) Infusions of a solution containing dextrose enhance neurologic recovery

Answer 6

Answer: A

Fibrinolytic (clot-buster) medications have clearly been shown to reduce the neurologic injury caused by acute ischemic stroke. However, they must be administered within 3 hours after the onset of the patient’s symptoms to be of maximal benefit. Prophylactic hyperventilation is not recommended for any patient with a stroke unless there are signs of brain herniation (unresponsive, decerebrate posturing, asymmetric or fully dilated [blown] pupils). Solutions that contain dextrose should be avoided in patients with any type of neurologic injury; they may exacerbate intracerebral bleeding, if present, and have been associated with poor neurologic outcomes. If you start an intravenous line, use normal saline and set the flow rate to keep the vein open.

Question 7

You are called to treat a 49-year-old man with a headache and visual disturbances that have progressively worsened over the past 3 months. Which of the following conditions is this MOST consistent with?

A) Cerebral neoplasm
B) Epidural hematoma
C) Bacterial meningitis
D) Subdural hemorrhage

Answer 7

Answer: A

The patient’s history is consistent with a space-occupying intracranial lesion, such as a neoplasm (tumor or growth), which typically presents with a headache, visual disturbances, and other symptoms that progressively worsen over a period of several months. In some cases, a new onset of seizures is the only indicator of a brain tumor. Subdural hemorrhages commonly present with symptoms within 12 to 24 hours after head trauma. An epidural hematoma presents with symptoms immediately after a head injury, and the patient’s condition rapidly deteriorates. Patients with bacterial meningitis also experience a rapid progression of symptoms.

Question 8

You are called to the local high school for a 16-year-old girl who has ingested an unknown quantity of pills. When you arrive, you find that she is conscious and alert, but crying. Which of the following questions is the MOST important to ask her initially?

A) How much do you weigh?
B) What kind of pills did you take?
C) How long ago did you take the pills?
D) Do you have any psychiatric problems?

Answer 8

Answer: B

When treating a patient who has ingested anything, you should immediately attempt to identify what was ingested. After you have identified the substance ingested, you should then determine when the ingestion occurred. The answers to these two questions will enable you to formulate a treatment plan, which may include a specific antidote. It is important to inquire about the patient’s weight for the purposes of giving activated charcoal, if indicated, and any antidotes that may be given at the hospital. Inquiring about a history of psychiatric problems is of least pertinence during the primary assessment and treatment phase.

Question 9

The life-threatening effects of anaphylactic shock include:

A) vasodilation and damage to the vasculature.
B) vasoconstriction and decreased peripheral resistance.
C) bronchodilation and increased pulmonary perfusion.
D) bronchoconstriction and decreased systemic resistance.

Answer 9

Answer: D

The life-threatening effects of anaphylactic shock are bronchoconstriction, which impairs ventilation, and decreased systemic vascular resistance (vasodilation), which results in hypotension. These negative effects are caused by the massive release of histamines and leukotrienes from the immune system.

Question 10

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

A) Somatostatin
B) Antidiuretic hormone
C) Aldosterone
D) Adrenocorticotropic hormone

Answer 10

Answer: C

If the body experiences a drop in blood pressure or volume, a decrease in sodium levels, or an increase in potassium levels, the adrenal cortex is stimulated to secrete aldosterone (a mineralocorticoid). Aldosterone stimulates the kidneys to reabsorb sodium from the urine and excrete potassium by altering the osmotic gradient in the blood. When sodium is reabsorbed into the blood, water follows; this action increases both blood volume and pressure. Somotostatin is a hormone secreted by the delta cells of the pancreas; it inhibits insulin and glucagon secretion. Antidiuretic hormone (ADH), which is released by the pituitary gland, regulates water balance in the body. If a person is dehydrated, ADH secretion increases, which stimulates the renal tubules to reabsorb sodium and water and inhibits diuresis. If a person is overhydrated, ADH secretion decreases, thereby facilitating diuresis. Adrenocorticotropic hormone (ACTH) is secreted by the pituitary gland; it stimulates the adrenal cortex to manufacture and secrete cortisol.

Question 11

Which of the following patients is at highest risk for suicide?

A) woman who has not slept for 72 hours
B) A man who owns multiple guns and knives
C) A woman whose aunt committed suicide
D) A man whose depression suddenly resolves

Answer 11

Answer: D

People who have recently experienced a major negative life change, such as financial hardship, loss of a loved one or a job, and those who are having marital problems, are at an increased risk for suicide. Such events are often accompanied by severe depression, the single most significant risk factor for suicide. By nature, depression does not “suddenly resolve,” although it may seem to in patients who may actually feel relieved that they have developed a plan to end their own life.

Question 12

A 43-year-old woman was stung by a scorpion. Within 10 minutes, she developed a diffuse rash and facial swelling. She is now semiconscious, has labored breathing, and has a blood pressure of 80/56 mm Hg. After ensuring a patent airway and adequate ventilation and oxygenation, the AEMT should administer:

A) a 250 mL fluid bolus.
B) an inhaled bronchodilator.
C) epinephrine 1:1,000 intramuscularly.
D) epinephrine 1:10,000 subcutaneously.

Answer 12

Answer: C

The patient is showing clear signs of anaphylactic shock. After ensuring a patent airway and adequate ventilation and oxygenation, the AEMT should administer epinephrine. Epinephrine constricts the vasculature, which will improve her blood pressure, and dilates the bronchioles, which will improve her breathing. Via the auto-injector, the dose is 0.3 mg of a 1:1,000 solution intramuscularly. If you carry epinephrine on your ambulance, the dose, concentration, and route are the same. Epinephrine via the subcutaneous route would be rather ineffective for patients in shock because peripheral perfusion is poor. Furthermore, epinephrine 1:10,000 is administered intravenously, not subcutaneously. If the patient remains hypotensive despite epinephrine, IV fluid boluses (20 mL/kg) should be given. Inhaled bronchodilators (albuterol [Proventil, Ventolin] and metaproterenol [Alupent]) may be used as an adjunct to epinephrine to treat residual wheezing, but only after adequate perfusion is restored.

Question 13

Which of the following patients is LEAST prone to hypothermia?

A) 21-year-old man in hypovolemic shock
B) 49-year-old man with hyperglycemia
C) 50-year-old man with alcohol intoxication
D) 68-year-old man with a recent infection

Answer 13

Answer: B

Patients with hyperglycemia have excessive amounts of glucose in their bloodstream; of the choices listed, these patients are the least prone to hypothermia. Elderly patients have decreased thermoregulatory function, patients with infections have suppressed immune systems, alcohol is a CNS depressant and impairs thermogenesis (heat production), and patients in shock are less able to maintain body temperature because of a lack of ATP (energy).

Question 14

As you are managing a violent patient, you determine that physical restraint is necessary. When restraining a violent patient, you should be MOST concerned with:

A) the prevention of positional asphyxi
B) restraining the patient in a supine position.
C) ensuring that at least two AEMTs participate.
D) not speaking to the patient during the process.

Answer 14

Answer: A

The use of reasonable force definitely applies when physically restraining a violent patient. If physical restraint is necessary, use at least four personnel (one per extremity) and restrain the patient in a supine position. Continue to talk to the patient throughout the restraint process, even if he or she is not listening to you, and monitor his or her airway. If the patient is inappropriately restrained (a prone position), airway compromise and death may occur (positional asphyxia).

Question 15

Which of the following medications is classified as a tricyclic antidepressant?

A) Codeine
B) Enafranil
C) Fluoxetine
D) Propoxyphene

Answer 15

Answer: B

Clomipramine (Enafranil) is classified as a tricyclic antidepressant. Other examples of tricyclics include amitriptyline (Elavil) and nortriptyline (Pamelor). Codeine is a narcotic analgesic, as is propoxyphene (Darvon). Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor, which is also used for depression and obsessive-compulsive disorder.

Question 16

You arrive at a local community center, where you find a 55-year-old woman lying on the ground experiencing a generalized motor seizure. Your MOST immediate action should be to:

A) prevent her head from striking the ground.
B) insert a bite block in between her molars.
C) administer oxygen or assist her ventilations.
D) check her blood sugar to rule out hypoglycemia.

Answer 16

Answer: A

Immediate treatment for a patient who is actively seizing involves protecting him or her from injury. If the patient is lying on the ground, place a soft object under his or her head to prevent it from striking the ground. You should also move any furniture away from the patient. After preventing further injury, assess the patient’s airway and ensure adequate ventilation and oxygenation. The patient may be hypoglycemic and you should rule this out by assessing her blood sugar level. Never place anything inside the mouth of a seizing patient.

Question 17

Prehospital care for a patient with a core body temperature of 88° F who is breathing and has a slow pulse includes:

A) passive rewarming.
B) active internal rewarming.
C) sedation to suppress shivering.
D) applying the AED pads.

Answer 17

Answer: A

Patients with moderate to severe hypothermia should be passively rewarmed in the prehospital setting. Passive rewarming involves removing wet clothing, applying warm blankets, and allowing the patient’s body temperature to rise gradually and naturally. Active internal rewarming (administering warm intravenous fluids) in the field is dangerous and should generally be avoided unless otherwise directed by medical control. Active internal rewarming may cause rewarming shock, a condition in which hypotension occurs because of massive vasodilation. Do not suppress the patient’s shivering response; this is one of the body’s mechanisms for producing heat (thermogenesis). Apply the AED pads if the patient is in cardiac arrest.

Question 18

A 40-year-old woman with a history of migraine headaches presents with a severe headache that has persisted for the last 12 hours. You should recall that this type of headache is the result of:

A) vasculitis.
B) muscle spasm.
C) intracranial bleeding.
D) hypertensive crisis.

Answer 18

Answer: A

Migraine headaches are vascular in nature and are caused by vasculitis (dilation of the blood vessels), which results in large amounts of blood accumulation in the brain. Cluster headaches are less understood, but are also believed to be the result of cerebral vasodilation; they are less common than migraine headaches.

Question 19

A 38-year-old female overdosed on an unknown type of drug. Her skin is hot and flushed, her breathing is rapid and deep, and she has an acetone odor on her breath. Her BP is 98/64 mm Hg and her heart rate is 120 beats/min. Which of the following drugs would MOST likely explain her clinical presentation?

A) Heroin
B) Aspirin
C) Alcohol
D) Cocaine

Answer 19

Answer: B

Of the drugs listed, aspirin (acetylsalicylic acid [ASA]) overdose would be the most likely cause of the patient’s clinical presentation. Aspirin toxicity causes significant metabolic acidosis; the respiratory buffer system responds by increasing the rate and depth of breathing, resulting in a compensatory respiratory alkalosis. Hyperthermia (as evidenced by hot, flushed skin) is often associated with aspirin toxicity. Although an acetone breath odor is classically associated with hyperglycemic ketoacidosis, methyl alcohol, isopropyl alcohol, and aspirin toxicity can also cause an acetone breath odor. Heroin overdose is clearly unlikely. Heroin is a narcotic CNS depressant; overdose would result in slow, shallow breathing; hypotension, and bradycardia. Alcohol is also a CNS depressant; although the intoxicated patient can present with a breath odor that could be mistaken for ketoacidosis, severe toxicity causes respiratory depression. An overdose of cocaine, a sympathomimetic drug, can also cause hyperthermia; however, you would expect the patient to be significantly hypertensive and tachycardic.

Question 20

Prehospital treatment for a patient with a suspected brown recluse spider bite includes:

A) administering an antivenin.
B) applying ice to the wound.
C) applying an arterial constricting band.
D) providing supportive care and transport.

Answer 20

Answer: D

Unless the patient is in anaphylactic shock, treatment for a brown recluse spider bite is essentially supportive; monitor the patient’s ABCs, make him or her comfortable, and transport to the hospital. There is no antivenin for this type of bite. Placing ice on the site may increase the toxicity of the venom and should be avoided. Furthermore, an arterial constricting band is not indicated.

Question 21

You are dispatched to a residence for a patient with difficulty breathing. The patient is a 30-year-old man who appears emaciated. He is diaphoretic and states that he has been running a fever for the past 10 days. You note the appearance of purple blotches on his trunk. You should be MOST suspicious that this patient has:

A) hepatitis.
B) HIV/AIDS.
C) pneumonia.
D) tuberculosis.

Answer 21

Answer: B

Signs and symptoms of AIDS include weight loss, which gives the patient an emaciated appearance; persistent fever; night sweats; fatigue; and purple blotches on the skin, which are malignant lesions called Kaposi sarcoma. AIDS causes severe immune system compromise, which predisposes the patient to opportunistic infections, including hepatitis, pneumonia, and tuberculosis.

Question 22

Which of the following clinical presentations is consistent with significant insecticide exposure?

A) Pupillary dilation
B) Excessive salivation
C) Extreme hyperactivity
D) Acute urinary retention

Answer 22

Answer: B

Organophosphates, such as what is found in pesticides/insecticides and chemical nerve agents (VX, sarin, tabun, soman), deactivate acetylcholinesterase (AChE), an enzyme that regulates the degradation of acetylcholine (ACh). ACh is the chemical neurotransmitter of the parasympathetic nervous system. Without AChE, there is nothing to regulate ACh degradation; this would cause cardiovascular collapse secondary to massive parasympathetic stimulation. The clinical presentation of severe organophosphate toxicity can be recalled using the mnemonic DUMBELS, which stands for defecation, urination, miosis (pupillary constriction), bronchorrhea and bradycardia, emesis, lacrimation, and salivation. Treatment includes atropine sulfate, which blocks the effects of ACh, and pralidoxime chloride (2-PAM, Protopam), which reactivates AChE. A commercial auto-injector (DuoDote) is available; it contains both pralidoxime and atropine.

Question 23

Which of the following findings is more indicative of encephalitis than meningitis?

A) Vomiting
B) Headache
C) Pupil changes
D) Nuchal rigidity

Answer 23

Answer: C

Encephalitis is an infection localized to the brain. Because the cranial nerves are commonly affected, pupillary changes are sometimes seen. Meningitis is an infection that affects both the meninges of the brain and the spinal cord. Vomiting and a headache are common to both meningitis and encephalitis, whereas nuchal rigidity (stiff, painful neck) is more common with meningitis.

Question 24

Which of the following clinical signs indicates central nervous system depression secondary to an opiate (narcotic) overdose?

A) Ptosis
B) Miosis
C) Diplopia
D) Mydriasis

Answer 24

Answer: B

Miosis (pupillary constriction) is a classic finding in patients who have overdosed on an opiate (narcotic) drug. Ptosis, drooping of the eyelids, can be caused by such conditions as damage to the oculomotor nerve (third cranial nerve) or brain tumors. Possible causes of diplopia (double vision) include brain trauma, stroke, migraine headaches, and increased intracranial pressure. Mydriasis (pupillary dilation) is also associated with central nervous system depressant drug overdose, but is usually caused by barbiturates, not opiates. Other possible causes of mydriasis include cerebral hypoxia, atropine eye drops administered by an optometrist, and fright.

Question 25

Which of the following findings are you LEAST likely to observe in a patient with hyperglycemic hyperosmolar nonketotic coma?

A) An altered mental status
B) A history of a recent infection
C) Poor skin turgor and a furrowed tongue
D) Rapid breathing and a fruity breath odor

Answer 25

Answer: D

Hyperglycemic hyperosmolar nonketotic coma (HHNC) is a condition in which the blood sugar is markedly increased; however, some glucose is able to enter the cells, so no acidosis is present as with diabetic ketoacidosis (DKA). With DKA, the respiratory system attempts to rid the body of excess ketoacids by increasing the rate and depth of respirations (Kussmaul breathing). Additionally, the patient has the characteristic acetone odor on his or her breath. Increased rate and depth of breathing and an acetone odor on the breath do not occur with HHNC, which most commonly occurs in patients with type 2 diabetes.

Question 26

Which of the following clinical presentations is MOST consistent with anaphylactic shock?

A) Fine red rash, intense itching, BP of 112/80 mm Hg
B) Diffuse urticaria, inspiratory stridor, BP of 88/68 mm Hg
C) Localized redness and tenderness, BP of 116/56 mm Hg
D) Anxiety, BP of 140/90 mm Hg, heart rate of 104 beats/min

Answer 26

Answer: B

All of the clinical presentations listed are indicative of an allergic reaction. However, the presence of stridor and hypotension indicates respiratory and circulatory impairment. Mild or moderate reactions often present with urticaria (hives), intense itching, and anxiety; however, systemic perfusion is usually adequate. When the histamine and leukotriene release is massive, however, the cardiovascular and respiratory systems are negatively impacted, resulting in airway swelling, wheezing, and hypotension.

Question 27

A 39-year-old man reports frequently recurring headaches, nausea, and lack of coordination, which have progressively worsened over the past 2 months. He denies any past medical history. You should be MOST suspicious for a/an:

A) space-occupying intracranial lesion.
B) ruptured cerebral arterial aneurysm.
C) acute subarachnoid hemorrhage.
D) chronic epidural hematoma.

Answer 27

Answer: A

The symptoms that the patient describes, and the fact that they have persisted for 2 months and are progressively worsening, suggests a space-occupying intracranial lesion (ie, brain tumor). Ruptured cerebral aneurysms, subarachnoid hemorrhages, and epidural hematomas present acutely and lead to rapid clinical deterioration.

Question 28

Care for a patient with a severe headache and vomiting includes:

A) avoiding dim lights.
B) transporting in a supine position.
C) continual monitoring of the airway.
D) placing heat packs over the area of pain.

Answer 28

Answer: C

You should continually monitor the airway of any patient who is actively vomiting to prevent aspiration. Patients with severe headaches typically prefer to lie flat; however, if they are actively vomiting, they must be placed in a position that prevents aspiration. These patients also request that the lights be dimmed; photophobia often accompanies a headache. Placing cold packs over the area of pain causes vasoconstriction and may provide pain relief.

Question 29

You are transferring a patient from one hospital to another. While looking through his medical records, you note that he has idiopathic seizures. This means that his seizures:

A) are of an unknown cause.
B) originate in the temporal lobe.
C) last more than 10 to 15 minutes.
D) are not followed by a postictal phase.

Answer 29

Answer: A

The term “idiopathic” means of unknown cause. Some patients experience seizures that cannot be attributed to a structural or metabolic abnormality. Idiopathic does not mean that there is no cause for a patient’s problem; it simply means that the cause is not known. Seizures that originate in the temporal lobe are referred to as complex partial seizures. A patient who experiences a prolonged (greater than 10 minutes [some sources cite greater than 20 minutes]) seizure is said to be in status epilepticus.

Question 30

Which of the following conditions would produce the MOST rapid loss of consciousness?

A) Ketoacidosis
B) Insulin shock
C) Hyperglycemia
D) Ischemic stroke

Answer 30

Answer: B

Insulin shock, also referred to as hypoglycemic crisis, is most noted for its rapid onset of symptoms, which includes loss of consciousness. The brain requires glucose as much as it requires oxygen, and in the absence of glucose, the brain ceases to function properly in a very short period of time. Hyperglycemic ketoacidosis typically presents over an extended period of time; its progression to a loss of consciousness is not as rapid as a patient with insulin shock. Unlike a hemorrhagic stroke, an ischemic stroke generally does not result in a rapid loss of consciousness.

Question 31

You are assessing a young male who passed out. He is now conscious and alert, but complains of generalized weakness. His skin is pale and cool and his heart rate is slow. You should suspect:

A) a tonic-clonic seizure.
B) a syncopal episode.
C) acute ischemic stroke.
D) hyperglycemic crisis.

Answer 31

Answer: B

This patient’s presentation is consistent with syncope, a sudden but temporary loss of consciousness with accompanying loss of postural tone. There are numerous causes of syncope, including sudden cardiac dysrhythmias, dehydration, hypoglycemia, and vasovagal episodes. In this case, the patient’s slow heart rate should make you suspicious that his syncope was vasovagal in origin, although his blood sugar should be assessed to rule out hypoglycemia. Syncope during a hyperglycemic crisis (diabetic ketoacidosis [DKA]) is not common. Furthermore, patients with DKA are typically tachycardic; have deep, rapid respirations (Kussmaul breathing); and have warm, dry skin with poor turgor secondary to dehydration. A tonic-clonic seizure is unlikely; most patients are tachycardic after a generalized tonic-clonic seizure and are postictal (confused, sleepy, and not alert). There is no gross evidence to suggest an ischemic stroke, such as unilateral weakness, slurred speech, or confusion.

Question 32

Which of the following BEST describes the sequence of events that occur when a person drowns?

A) Dysrhythmias, laryngospasm, hypoxia, cardiac arrest
B) Laryngospasm, hypoxia, dysrhythmias, cardiac arrest
C) Hypoxia, laryngospasm, dysrhythmias, cardiac arrest
D) Laryngospasm, dysrhythmias, hypoxia, cardiac arrest

Answer 32

Answer: B

Typically, a swimmer who becomes panicked starts swallowing large amounts of water. Even a small volume of aspirated water (fresh or salt) can cause laryngospasm, which results in hypoxia and unconsciousness. As hypoxia worsens, the victim develops a cardiac dysrhythmia, which results in cardiac arrest.

Question 33

You should expect a patient with diabetic ketoacidosis to present with:

A) hypoglycemia and polyuri
B) hypoglycemia and dehydration.
C) hyperglycemia and oliguria.
D) hyperglycemia and dehydration.

Answer 33

Answer: D

Diabetic ketoacidosis, also referred to as diabetic coma or hyperglycemic crisis, is characterized by hyperglycemia; polyuria (excessive urination); polydipsia (excessive thirst); and polyphagia (excessive hunger). As glucose accumulates in the blood, the kidneys begin to excrete large amounts of water, resulting in dehydration. Other findings include warm, dry skin; and deep, rapid respirations with an acetone or fruity breath odor (Kussmaul breathing).

Question 34

Naloxone is useful in reversing the effects of which of the following medications?

A) Doxepin
B) Fentanyl
C) Diazepam
D) Amitriptyline

Answer 34

Answer: B

Naloxone hydrochloride (Narcan) is an opiate (narcotic) antagonist that binds to receptor sites in the body through which narcotic drugs exert their effects. Of the medications listed, fentanyl (Sublimaze) is the only one that is a narcotic; therefore, naloxone would reverse its effects. Examples of other narcotics include morphine; heroin; meperidine hydrochloride (Demerol); and hydrocodone (Vicodin, Lortab). Doxepin (Sinequan) and amitriptyline (Elavil) are tricyclic antidepressant drugs and do not respond to naloxone. Diazepam (Valium) is a benzodiazepine drug that also does not respond to naloxone.

Question 35

When you arrive at the residence of an elderly man who is reportedly ill, you find him sitting on the couch with his eyes closed. His respirations seem to be deep and rapid. You should:

A) take spinal precautions.
B) assess his mental status.
C) apply high-flow oxygen.
D) quickly move him to the floor.

Answer 35

Answer: B

Even though a patient’s eyes are closed, he or she may be conscious. The primary assessment of a patient begins by assessing the mental status. In this particular case, if you found the patient to be unresponsive, the most appropriate next step would be to move him to the floor and continue with the primary assessment. Depending on the findings of your primary assessment, the patient may require high-flow oxygen or assisted ventilation. Because this patient was found on the couch, the chances of trauma are unlikely; therefore, spinal precautions are likely not indicated unless you are informed that he fell, or was otherwise injured, and was moved to the couch from another location.

Question 36

A common finding in a severe allergic reaction is angioedema. This can pose an immediate threat to life because of:

A) airway compromise.
B) intracranial pressure.
C) congestive heart failure.
D) compartment syndrome.

Answer 36

Answer: A

Angioedema is caused by the release of histamines and is the result of vascular fluid leakage into the subcutaneous layers of the skin. This edema is prominent in the face and neck area in patients with severe allergic reactions and can pose an immediate threat to the airway. Increased intracranial pressure is the result of closed head trauma and swelling of the brain. Compartment syndrome, a condition in which pressure increases within the osteofascial compartment, is a consequence of a crush injury or a fracture and leads to metabolic waste accumulation to the part of the body that is crushed.

Question 37

Field impression is MOST accurately defined as:

A) the expected prognosis of the patient.
B) a treatment plan formulated by the AEMT.
C) findings of the detailed secondary assessment.
D) what the AEMT thinks is wrong with the patient.

Answer 37

Answer: D

The field impression, sometimes referred to as the working diagnosis, is what the AEMT thinks is wrong with the patient. It is based on clinical findings during a detailed assessment of the patient, and is used to formulate the most appropriate treatment plan. The prognosis is the expected outcome of the patient; only a physician can make this determination after performing further assessment, diagnostic testing, and additional treatment.

Question 38

What is the major physiologic difference between cyanide and carbon monoxide?

A) Cyanide attaches to the hemoglobin molecule
B) Cyanide destroys the cells of the immune system
C) Carbon monoxide destroys the red blood cells
D) Carbon monoxide binds to the hemoglobin molecule

Answer 38

Answer: D

Carbon monoxide binds to the hemoglobin molecule and inhibits the oxygen-carrying ability of the blood. Carbon monoxide has an affinity for hemoglobin that is 250 times greater than that of oxygen. Cyanide blocks the uptake of oxygen at the cellular level through a more complex mechanism. Both result in inadequate oxygenation, and if untreated, cellular death.

Question 39

The term “thermolysis” refers to the body’s ability to:

A) use heat.
B) remove heat.
C) produce heat.
D) adapt to heat.

Answer 39

Answer: B

The suffix -lysis refers to the removal or destruction of; therefore, thermolysis refers to the body’s ability to remove heat, which can occur through conduction, convection, radiation, evaporation, or respiration. The ability to generate heat is called thermogenesis.

Question 40

Which of the following is characteristic of hyperglycemic ketoacidosis?

A) Bradypnea
B) Hyperpnea
C) Diaphoresis
D) Acute onset

Answer 40

Answer: B

When glucose does not reach the cells where it can be used for energy, the cells metabolize fat instead; this produces ketoacids. As the body attempts to rid itself of these acids, respirations become deep (hyperpnea) and rapid (tachypnea); this is known as Kussmaul respirations. Hyperglycemic ketoacidosis typically manifests over several hours up to a few days. Excess glucose in the bloodstream causes a massive diuresis, in which large amounts of water are excreted from the body by the kidneys. This leads to dehydration, which typically causes the skin to be warm and dry with poor turgor.

Question 41

A 60-year-old man has a small ecchymotic blister on his left thigh. He cannot recall being bitten or stung by anything. He is conscious and alert and his vital signs are stable. This patient’s signs and symptoms are MOST likely the result of a bite from a:

A) coral snake.
B) black widow spider.
C) brown recluse spider.
D) rattlesnake or other pit viper.

Answer 41

Answer: C

The classic signs of a brown recluse spider bite appear in this patient. Patients who are bitten by the brown recluse spider typically do not recall the actual bite because it is usually painless. The bite itself appears as a small vesicle, which progresses to an ecchymotic (bruised) area in and around the blister that signifies tissue necrosis caused by the spider’s venom. By contrast, the bite from a black widow spider is usually intensely painful and the patient commonly presents with painful contractions of the major muscle groups, most notably the abdomen. Clearly, if the patient was bitten by a snake of any kind, he would have experienced immediate pain.

Question 42

The MOST appropriate field management of an unresponsive patient with diabetes in whom the blood glucose level cannot be obtained includes:

A) fluid rehydration.
B) one tube of oral glucose.
C) 10 units of insulin intravenously.
D) 25 g of glucose intravenously.

Answer 42

Answer: D

When in doubt, give the patient sugar. If your glucometer malfunctions or you are otherwise unable to obtain a blood glucose reading in an unresponsive patient with diabetes, you should administer 12.5 to 25 g (25 to 50 mL) of 50% dextrose intravenous push and then reassess the patient. Insulin is rarely, if ever, administered in the prehospital setting. Oral medication should never be given to patients who are unable to swallow; doing so increases the risk of aspiration significantly. If the patient’s blood glucose is high, fluid rehydration may be indicated because excessive blood glucose levels cause the kidneys to excrete large amounts of water from the body, resulting in dehydration.

Question 43

Which of the following statements MOST accurately defines an ischemic stroke?

A) Global disruption of cerebral blood flow
B) Regional disruption of cerebral blood flow
C) Cerebral necrosis caused by a ruptured vessel
D) Temporary neurologic deficit caused by vessel obstruction

Answer 43

Answer: B

An ischemic stroke can be caused by either a thrombus or embolus and results in damage to the region of the brain that the occluded artery supplied. A global stroke can result from generalized cerebral hypoxia (shock). A hemorrhagic stroke occurs when a cerebral artery ruptures (an aneurysm). A transient ischemic attack occurs when the body’s own hematologic system spontaneously destroys a clot in a cerebral artery, usually within 24 hours.

Question 44

A 32-year-old woman who recently had dental work was found unresponsive by her husband. Her respirations are 6 breaths/min and shallow and her heart rate is 40 beats/min and weak. Her husband tells you that she was prescribed pain medication, but he cannot remember the name of the medication. You should:

A) take her blood pressure and assess her pupils.
B) start an IV line and give her 0.4 to 2 mg of Narcan.
C) start an IV line and give a 20 mL/kg fluid bolus.
D) assist her ventilations with a bag-mask device.

Answer 44

Answer: D

This patient’s clinical presentation (unresponsiveness, hypoventilation, and bradycardia) is consistent with central nervous system depression. You should suspect that she inadvertently or intentionally overdosed on her pain medication, which is likely an opiate (narcotic). Your most immediately priority should be to assist her ventilations to restore minute volume and minimize hypoxemia. After managing her airway and breathing status, you should continue your assessment, which includes taking her blood pressure and assessing her pupils. After establishing vascular access, naloxone hydrochloride (Narcan), an opiate antagonist, should be given in a dose of 0.4 to 2 mg. If the patient is hypotensive initially, and remains hypotensive despite the administration of Narcan, a fluid bolus should be considered.

Question 45

A 39-year-old man who had been lost in the woods for 3 days during the middle of winter was found to be pulseless and apneic. His core body temperature is estimated to be below 86° F. Which of the following interventions should be avoided?

A) Intubation
B) Defibrillation
C) Cardiac medications
D) Chest compressions

Answer 45

Answer: C

Treatment for patients with severe hypothermia (core body temperature less than 86° F) and cardiac arrest includes CPR, advanced airway management, and limiting defibrillation to one attempt with the automated external defibrillator. Cardiac medications are withheld at this point because the patient’s metabolic rate is too slow for the body to absorb and circulate the drugs. Standard advanced cardiac life support is not performed by paramedics until the patient has been adequately rewarmed.

Question 46

Initial management of a patient experiencing a heat-related emergency includes:

A) starting an intravenous line.
B) administering high-flow oxygen.
C) initiating rapid cooling measures.
D) removal to a cooler environment.

Answer 46

Answer: D

The priority in any situation that is causing a patient harm or has the potential to cause harm (ie, extremes in temperature) is to move the patient to a place of safety. In the case of a heat-related emergency, this involves moving the patient to a cooler area where the appropriate care can be rendered.

Question 47

Functions of the hypothalamus include:

A) controlling a person’s appetite.
B) controlling one’s level of awareness.
C) influencing a person’s respirations.
D) maintaining equilibrium and balance.

Answer 47

Answer: A

The “hunger” center of the hypothalamus promotes eating. Among many other functions, the hypothalamus regulates body temperature, assists in the regulatory control of the pituitary gland, and promotes urine release from the bladder. Influencing the patient’s respirations is a function of the pons and medulla, which are portions of the brain stem. Maintenance of equilibrium and balance are functions of the cerebellum, and the control of emotions and level of awareness are functions of the cerebrum, which is the largest portion of the brain.

Question 48

A finding that is common in BOTH fresh and salt water drownings is:

A) pulmonary edema.
B) loss of surfactant.
C) inadequate oxygenation.
D) severe metabolic alkalosis.

Answer 48

Answer: C

Although the mechanisms of pulmonary injury differ in salt water drownings versus fresh water drownings, inadequate oxygenation and hypoxia are common to both. Uncorrected hypoxia leads to metabolic acidosis and death.

Question 49

A patient who overdosed on heroin would be expected to present with:

A) hyperpnea.
B) dilated pupils.
C) tachycardia.
D) hypotension.

Answer 49

Answer: D

Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all narcotics, legal or illegal, overdose causes depression of the central nervous system (CNS), resulting in a decreased level of consciousness; bradycardia; hypotension; and slow, shallow (reduced tidal volume) breathing. Hyperpnea (deep breathing) would not be present in a patient who overdosed on a narcotic. In a narcotic overdose, the pupils are typically constricted (miosis). Barbiturates, such as phenobarbital, are also CNS depressants and cause the same symptoms seen with narcotic overdose. The patient’s pupils, however, are typically dilated (mydriasis), not constricted.

Question 50

When assessing a patient with abdominal pain, which of the following findings is MOST indicative of peritoneal irritation?

A) Pain relief with frequent movement
B) Referred pain to the shoulder or neck area
C) Increased pain when the patient is placed on the side
D) Decreased pain when the knees are drawn to the chest

Answer 50

Answer: D

The classic position for the patient with peritoneal inflammation or irritation is with the knees drawn up to the chest (fetal position). This position removes much of the stress from the abdominal muscles, thereby affording the patient some relief. Any type of movement by the patient with peritoneal irritation causes intense pain.

Question 51

All of the following conditions would likely result in a jaundiced appearance of the skin, EXCEPT:

A) inflammation of the liver.
B) acetaminophen overdose.
C) chronic renal insufficiency.
D) subacute bacterial meningitis.

Answer 51

Answer: D

Any condition that results in increased production or inadequate removal of bilirubin (produced by the breakdown of the hemoglobin molecule) can cause jaundice, a yellowish skin color. Such conditions include inflammation of the liver (hepatitis); acetaminophen (Tylenol) overdose; and patients with chronic renal insufficiency, whose kidneys do not adequately filter metabolic waste from the blood. By itself, meningitis would not cause jaundice.

Question 52

After ingestion of an unknown quantity of household bleach, a patient complains of burning inside the mouth, abdominal pain, and nausea. Appropriate management of this patient should include:

A) administering activated charcoal.
B) notifying the poison control center.
C) inducing vomiting with syrup of ipeca
D) instructing the patient to drink a lot of water.

Answer 52

Answer: B

The poison control center can provide you with information specific to the poison that was ingested, including a possible antidote or specific treatment. After the airway has been managed, you should notify the poison control center as soon as possible. Bleach is a strong alkali. The administration of activated charcoal is contraindicated in patients who have ingested corrosive substances, and inducing vomiting with syrup of ipecac is no longer recommended for ANY patient. The poison control center can be contacted at 1-800-222-1222.

Question 53

You are assessing a 29-year-old male with an apparent emotional crisis. He is agitated and refuses to give you any information because his roommate told him not to trust anyone. His small apartment clearly indicates that he is the sole occupant. Your partner finds a prescription for Zyprexa, which is prescribed to the patient. This patient MOST likely has:

A) bipolar disorder.
B) trichotillomania.
C) schizophrenia.
D) obsessive-compulsive disorder.

Answer 53

Answer: C

Schizophrenia is a psychiatric illness marked by impairments in the perception or expression of reality. Signs include auditory hallucinations (eg, the “roommate”), paranoid or bizarre delusions (eg, you are not to be trusted), and disorganized speech and thinking. Antipsychotics such as Olanzapine (Zyprexa), risperidone (Risperdal) and clozapine (Clozaril) are commonly prescribed to treat schizophrenia. The patient’s presentation is not consistent with bipolar disorder. Bipolar disorder is a biphasic psychiatric condition characterized by alternations of depression and mania. Manic patients are excessively elated, overly talkative, and have accelerated speech. Medications used to treat bipolar disorder include lithium, quetiapine fumarate (Seroquel) and aripiprazole (Abilify). Trichotillomania, the recurrent pulling out of one’s own hair, is an impulse control disorder. Nothing in the scenario suggests this condition. Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by intrusive and unwanted thoughts or worries (obsessions), which the patient attempts to alleviate or eliminate by performing ritualistic acts (compulsions). Selective serotonin reuptake inhibitor (SSRI) drugs, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), are commonly prescribed to patients with OCD. This patient’s behavior is not consistent with OCD.

Question 54

A 60-year-old man reports a sudden onset of severe, tearing abdominal pain that radiates to his back. He is conscious and alert, his BP is 106/60 mm Hg, and his heart rate is 110 beats/min and strong. Which of the following interventions is NOT indicated for this patient at this time?

A) At least one large-bore IV line
B) 20 mL/kg bolus of normal saline
C) Keeping him warm with a blanket
D) Placing him in a recumbent position

Answer 54

Answer: B

The patient’s clinical presentation suggests acute aortic dissection, which may have already evolved into an aneurysm. He is adequately perfused, as evidenced by his level of consciousness and BP. Infusing large amounts of IV fluid may cause a sudden increase in his BP, potentially resulting in rupture of the aneurysm. You should, however, start at least one large-bore IV, but set the rate to keep the vein open unless he begins to show signs of shock. Keeping him warm may make him more comfortable, thus decreasing his level of anxiety, and is clearly appropriate. Placing him in a recumbent position is also appropriate because many patients with abdominal pain prefer this position. Furthermore, if he vomits, a recumbent position is ideal to reduce the risk of aspiration.

Question 55

Which of the following disease processes is classified as an autoimmune disease?

A) Multiple sclerosis
B) Parkinson disease
C) Alzheimer disease
D) Systemic lupus erythematosus

Answer 55

Answer: D

Systemic lupus erythematosus is an autoimmune disease that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys, and brain. In an autoimmune disease, such as lupus, the immune system cannot distinguish foreign substances from its own cells and tissues. The immune system then makes antibodies directed against itself. These antibodies, called autoantibodies, cause inflammation, pain, and damage in various parts of the body. Rheumatoid arthritis is another example of an autoimmune disorder. Parkinson disease, Alzheimer disease, and multiple sclerosis are examples of degenerative processes.

Question 56

Which of the following is NOT typical of an absence seizure?

A) Lip smacking
B) Altered mentation
C) Rapid eye movement
D) A postictal phase

Answer 56

Answer: D

Within the category of generalized seizures are tonic-clonic (formerly grand mal) and absence (formerly petit mal) types. Tonic-clonic seizures are characterized by an aura (a warning sign of an impending seizure that may include an odd taste or a high-pitched sound); loss of consciousness; a tonic phase (body-wide rigidity); a hypertonic phase (arched back and rigidity); and a clonic phase (rhythmic contraction of major muscle groups, lip smacking, trismus, rapid eye movement). Most tonic-clonic seizures are followed by a postictal phase, during which time the patient seems dazed, confused, or can even be combative. The postictal phase can last from several minutes to an hour, after which time the patient’s level of consciousness returns to normal. In contrast to a tonic-clonic seizure, an absence seizure presents with little or no movement. The patient, classically a child, presents with staring episodes (absence spells), during which physical activity ceases. Loss of motor control is uncommon, although rapid eye blinking and lip smacking are common. Absence seizures are not followed by a postictal period; the patient’s level of consciousness immediately returns to normal.

Question 57

A simple partial seizure is characterized by:

A) mood changes or bouts of rage.
B) a rapid loss of consciousness.
C) localized tonic-clonic activity.
D) an aura that lasts for minutes.

Answer 57

Answer: C

Partial (focal) seizures may be classified as simple partial or complex partial. Such seizures involve only a limited part of the brain. They may be localized or they may begin in one area and move in a wavelike manner to another area. Simple partial seizures, also called focal motor seizures, involve tonic-clonic activity to one part of the body. In some cases, simple partial seizures may spread and progress to a generalized tonic-clonic seizure. There is no aura or loss of consciousness associated with a simple partial seizure. A complex partial seizure, also called a temporal lobe or psychomotor seizure, manifests as changes in behavior (mood changes, abrupt bouts of rage) and is often preceded by an aura. The episode usually lasts only a few minutes, after which the patient quickly regains normal mental status (no postictal phase).

Question 58

Which of the following findings is MOST suggestive of myxedema?

A) Tachycardia
B) Weight loss
C) Hypothermia
D) Hyperactivity

Answer 58

Answer: C

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. This also explains why patients with hypothyroidism are poorly tolerant of cold temperatures. Other signs and symptoms of myxedema include lethargy, depression, bradycardia, and weight gain. In severe cases, coma and death can occur.

Question 59

A 60-year-old woman presents with confusion, slurred speech, and decreased use of her left arm. During transport, her symptoms seem to be improving. You should treat her as if she is experiencing a/an:

A) hemorrhagic stroke.
B) acute ischemic stroke.
C) ruptured cerebral artery.
D) transient ischemic attack.

Answer 59

Answer: B

In some patients, normal processes in the body destroy a blood clot in a cerebral artery. When this happens, blood flow is restored to the affected area and the patient regains use of the affected region of the body. When stroke symptoms resolve within 24 hours, the event is called a transient ischemic attack, also referred to as a “small stroke.” Although most patients with transient ischemic attacks do well, it is still a neurologic emergency and may be a warning sign that a larger, full stroke is imminent. For this reason, you should treat the patient as though he or she is experiencing a stroke and transport to an appropriate facility. Ischemic strokes classically present with acute confusion, slurred speech, facial droop, and unilateral weakness or paralysis. By contrast, hemorrhagic strokes, caused by a ruptured cerebral artery, classically present with a sudden, severe headache after which time the patient’s condition rapidly deteriorates.

Question 60

An abnormality of the parathyroid glands is expected to cause which of the following conditions?

A) Hypothermia
B) Hyponatremia
C) Hypocalcemia
D) Hyperkalemia

Answer 60

Answer: C

The parathyroid glands, which are embedded in the posterior aspect of the thyroid, produce hormones that maintain normal levels of calcium in the blood. Dysfunction of the parathyroid glands can result in either hypo- or hypercalcemia.

Question 61

Which of the following statements regarding glucagon is correct?

A) It helps convert glycogen to glucose
B) It inhibits insulin release from the pancreas
C) It is released from the beta cells of the pancreas
D) It promotes uptake of sugar into the cells for use

Answer 61

Answer: A

Glucagon, a hormone that is secreted by the alpha cells of the islets of Langerhans (a part of the pancreas), stimulates the liver to convert glycogen to glucose (glycogenolysis). Glycogen is a complex sugar that the body cannot readily use; glucose is a simpler sugar that the body uses to produce energy. The beta cells within the islets of Langerhans secrete the hormone insulin, which promotes the uptake of sugar from the bloodstream into the cell.

Question 62

A woman was bitten on her leg by a rattlesnake while hiking. She is conscious and alert. Her blood pressure is 100/56 mm Hg and her heart rate is 120 beats/min. Which of the following signs is MOST suggestive of envenomation?

A) Generalized weakness
B) Anxiety and tachycardia
C) Visible puncture wounds
D) An absence of lymphangitis

Answer 62

Answer: A

Signs of envenomation from a pit viper include edema that occurs immediately after the bite; local bruising that spreads around the bitten area; lymphangitis (red streaks emanating away from the bitten extremity); generalized weakness; and signs of shock (hypotension, altered mental status, and so forth). Anxiety and tachycardia could indicate envenomation, but could also be the result of fear. The presence of visible puncture marks does not, in and of itself, indicate envenomation.