Medical

Question 1

You arrive on scene to find a patient with an altered mental status. You quickly scan the scene. Which of the following items will help to point you in the right direction in finding a cause of the altered mental status?

a) unkept house with animal fur & dirt on the floor
b) high blood pressure, anxiety & depression meds
c) smell of dirty clothes and cat feces
d) OTC pain relievers

Answer 1

High blood pressure, anxiety & depression meds

The scene survey can lead to some very important clues as to what might be going on with your patient. Medications for specific medical conditions can lead you in the correct direction. Not only does it give you the patient’s past medical history, but it tells where to start your assessment and investigation of the patient’s signs and symptoms. An unkept house and smells can provide an indication of a patient’s lifestyle and ability to care for themselves.

Question 2

Your patient is not responding to your loud verbal stimuli. You find the following medications: Glucophage and Lipitor. What is the likely cause of the patient’s problem?

Answer 2

Diabetic reaction

Glucophage is a diabetic medication. You may not be able to identify what type of reaction your patient is having without more diagnostic testing but it puts you looking in the correct direction. The Lipitor may come into play later on in long term care but high cholesterol generally has no effect on mental status the way hypo or hyperglycemia will.

Question 3

Your neuro assessment of an unresponsive patient reveals pin point pupils. What is your primary field diagnosis?

Answer 3

Narcotic overdose

Narcotics will cause pupils to constrict making them the classic pin point. All of the other medications mentioned here do not affect the pupils, even though they may cause an altered mental status.

Question 4

Your patient is a known diabetic who takes up to four insulin injections a day. Today he is found unresponsive, diaphoretic, and tachycardic. He is breathing 18 times a minute. What is likely the patient’s chief medical issue?

Answer 4

Hypoglycemia

A known insulin dependent diabetic with the above symptoms is most likely suffering from hypoglycemia. The tachycardia and diaphoresis is from a catecholamine release trying to mobilize more glucose. The patient may also be hypertensive but that is not the reason for the unresponsiveness.

Question 5

You find that your diabetic patient is hypoglycemic. You have oral glucose to give to the patient. You will give 15 grams of instant glucose to the patient except if they are ___________?

a) conscious
b) semi-conscious with a gag reflex & ability to swallow
c) semi-conscious without the ability to swallow
d) conscious but altered and blood sugar of 80mg/dl

Answer 5

Semi-conscious without the ability to swallow

You should never give any patient who cannot swallow anything by mouth because aspiration is a real risk.

Question 6

What is an often fatal complication of diabetes and is also the first indication of diabetes in many young patients?

Answer 6

DKA - diabetic ketoacidosis

Often the first signs and symptoms of diabetes is diabetic ketoacidosis. When there is no fuel (i.e., glucose) for the cells to burn, the cells will burn fat and protein which does not burn clean. The incomplete combustion produces acids which are not cleared. These acids will build up and can be fatal if not treated aggressively. Hypertension and cardiovascular disease are long term complications of diabetes.

Question 7

Diabetic Ketoacidosis (DKA) has the following signs and symptoms ___________.

Answer 7

appearance of intoxication

Due to the hyperglycemic state, the kidneys try to diereses the glucose out of the blood stream causing the patient to become more dehydrated. As the blood becomes thicker and thicker, the cardiac output lowers and the heart has to work harder. With the excess glucose and incomplete combustion from other fuel sources, the brain is impaired as if the patient is intoxicated.

Question 8

There are two types of cerebral vascular accidents (i.e., strokes). The most common is an ischemic stroke. What is the other type?

Answer 8

Hemorrhagic

The second type of cerebral vascular accident is a hemorrhagic stroke, also known as a bleed. Thrombotic and embolic strokes are types of ischemic strokes where the blood flow is stopped by a clot. A transient ischemic attack is most often referred as a mini stroke, a prelude to a full on CVA.

Question 9

For a condition to be diagnosed as a transient ischemic attack (TIA), the symptoms must be resolved in 24 hours ______________?

Answer 9

without any permanent effects

Most TIAs will resolve within 15 minutes, however for it to be diagnosed as a TIA all signs and effects must be resolved within 24 hours after onset. TIA’s are often the precursor to a major stroke.

Question 10

To assess a patient with a stroke, there are two major assessment tools: the Cincinnati Stroke Scale and the Los Angeles Prehospital Stroke Screen. Which one of these two tools uses arm drift as a diagnostic tool?

Answer 10

Cincinnati Stroke Scale

The Cincinnati stroke scale uses arm drift as a diagnostic tool. Ask the patient to lift both arms up in front of them, close their eyes and watch for an arm to drift downward. If there is a drift downward on one arm then assess for a CVA on that side.

Question 11

Stroke symptoms often present the same as other medical problems. To prevent improper treatment for the signs and symptoms, working through the differentials is a must. Hypoglycemia is often mistaken for a CVA. How can a clinician rule in or out this differential?

Answer 11

Check a blood sugar

One of the easiest and most often over looked diagnosis tools is the use of glucometer to check the blood sugar.

Question 12

The clinician’s best role in the assessment and treatment of a stroke patient is rapid recognition and transport to a stroke center. What is the window of opportunity from the onset of symptoms until treatment?

Answer 12

3 hours

Anytime there is a restriction of blood flow, the quicker blood flow is returned, the better the results. It is well established that if TPA is infused within three hours of the onset of symptoms, there is a greater chance that all deficits will resolve without lasting effects.

Question 13

Statements from patients are used as assessment tools. What statement about stroke symptoms should cause the clinician to use a higher index of suspicion?

Answer 13

“This is the worst headache I have ever had”

This statement should not be ignored or considered to the dramatic, it should cause the clinician to modify their assessment to include a hemorrhagic stroke in their differential.

Question 14

A medical condition where the patient sometimes suffers convulsions or seizure activity is known as?

Answer 14

Epilepsy

Epilepsy is medical condition where the patient often suffers seizures. Tonic-clonic and focal motor are types of seizure activity and a postictal state is the period of time after a seizure where the patient is slow to respond and is possibly unresponsive where the brain is resetting and resting.

Question 15

When assessing a patient complaining of depression, what would be most suggestive that the patient is at risk for suicide?

Answer 15

A previous attempt that was unsuccessful

A previous attempt at suicide is highly suggestive of a patient’s risk for suicide. This is compounded by the depression, which can exacerbate suicidal feelings and willingness to carry out the act.

Question 16

You are assessing a 32-year-old male complaining of abdominal pain and weakness. The patient informs you that he has Addison’s disease as a result of steroid use as a teenager. No life-threatening conditions are noted to the airway, breathing, or circulation. Vital signs are pulse 110 beats per minute, respirations 16 per minute, blood pressure 110/72 mmHg, and SpO2 98% on room air. Given the patient’s past medical history, you would:

a) Administer Activated Charcoal.
b) Administer Oral Glucose.
c) Contact ALS.
d) Check the blood glucose level.

Answer 16

D - Check the blood glucose level

Always check the blood glucose level of any patient with adrenal insufficiency.

Question 17

What is the most common cause of anaphylaxis?

Answer 17

Penicillin

Penicillin and other antibiotics are the most common causal agents for anaphylaxis. Authorities estimate penicillin produces an allergic or anaphylactic reaction 1 out of every 10,000 times it is used and causes an estimated 500 deaths per year.

Question 18

You are planning a continuing education seminar with your service’s medical director. After you both decide that behavioral emergencies need to be addressed, he asks you to define normal behavior. You would reply:

Answer 18

Behavior that society views as acceptable

Although a universal definition is difficult to establish, normal behavior is generally defined as behavior that is readily accepted within a society.

Question 19

You are assessing a 53-year-old female who neighbors discovered acting funny. The patient appears to be fatigued and confused and exhibiting slurred speech. She is breathing and has a pulse and skin that is cool and mottled. Vital signs are pulse 68 beats per minute, respirations 14 per minute, blood pressure 108/60 mmHg, and temperature 92.7 degrees Fahrenheit. There are no signs of trauma to the patient. Patient prescriptions of Verapamil, Digoxin, Synthroid, and nitroglycerin are found in the bedroom. Allergies are unknown. The temperature in her apartment is 55 degrees Fahrenheit. Based on the assessment findings, what condition is most likely a contributing factor to the patient’s condition?

Answer 19

Hypothyroidism

The EMT must recognize that the patient is hypothermic, based on the body temperature as well as the temperature in the apartment. Furthermore, the paramedic must recognize that the patient suffers from hypothyroidism, as evidenced by her use of Synthroid. Hypothyroidism describes a thyroid that is slow and can only generate minimal cellular metabolism. Since heat generation is a product of cellular metabolism, the patient s body temperature drops accordingly.

Question 20

What medication would you expect to find a patient who is being treated for peptic ulcer disease to be taking?

Answer 20

Antibiotic

It is estimated that about 80 percent of all cases of peptic ulcer disease are caused by the presence of Helicobacter pylori (H pylori) bacteria. The bacteria damage the protective mucosal lining of the stomach and/or duodenum, allowing it to be damaged by the strong gastric acids used for digestion. Consequently, ulcerations in the mucosal lining and tissue occur. Antibiotic therapy can control the population of H pylori and definitively treat the ulcerative disease.

Question 21

You have responded for a 17 year-old male who has had a sudden onset of shortness of breath. During your evaluation of the patient, he tells you that he has a history of Marfan’s syndrome. The patient is dyspneic and has decreased lung sounds on the left side of his chest. What do you think is the most likely cause of this patient’s shortness of breath?

Answer 21

Spontaneous pneumothorax

A common complication seen in the patient with Marfan’s syndrome is a spontaneous pneumothorax. Marfan’s syndrome is a connective tissue disorder that results in weak organ and tissue structure. Along with spontaneous pneumothoracies, they are also more likely to develop aortic aneurysms.

Question 22

The physiological function of insulin is to promote utilization of glucose by the cells. What would happen to a patient with a low level of insulin?

Answer 22

Glucose would remain on the outside of the cell and would not be broken down.

Insulin is a hormone that is responsible for transporting glucose into the cell where it can be metabolized and made into energy. With a low level of insulin, very little sugar can be metabolized; the result is that the cells’ ability to function is drastically reduced.

Question 23

You have responded to a juvenile detention center for a teenager who has reportedly injected himself with some form of opiates. Name a drug that would be classified as an opiate?

Answer 23

Heroin
Fentanyl
Oxycodone
Hydrocodone
Codeine
Morphine

Question 24

You have been called to the top of a mountain resort for a patient that is complaining of a sudden onset of shortness of breath and coughing. Your assessment of the patient reveals an anxious patient with basilar crackles in his lungs. The patient’s vital signs include a heart rate of 136, respirations of 28, and a blood pressure of 176/94 mmHg. What is your field diagnosis of this patient?

Answer 24

High altitude pulmonary edema

High-altitude pulmonary edema (HAPE) usually occurs in an un-acclimatized individual who rapidly ascends to an altitude that exceeds 8,000 feet. HAPE develops as a result of increased pulmonary pressure and hypertension caused by changes in blood flow at high altitudes.

Question 25

Status epilepticus is a seizure that:

Answer 25

Begins again after one seizure stops without the patient regaining consciousness.

Status epilepticus is defined as a seizure that lasts longer than 10 minutes or a seizure that begins again after one seizure stops without that patient regaining consciousness. It is a dire medical emergency, as the patient may sustain bone fractures, airway occlusion, and possible death.

Question 26

You are transporting a patient that is having night sweats, mild fever, and a productive cough. He states that the health department has been treating him at home for a respiratory condition. How should the patient be transported to the hospital?

Answer 26

With a mask on both the patient and the EMT

The patient that has possible TB and should wear either a surgical mask or a nonrebreather mask. This is used to prevent the spread of the disease and to protect the safety of the health care provider.

Question 27

Which of the following vital signs would be most indicative of a patient who has entered the decompensated stage of shock?

Answer 27

Heart rate of 128, respirations of 26, and a blood pressure of 82/62 mmHg

Decompensated shock physiologically occurs as the precapillary sphincters that guard the peripheral capillary beds relax secondary to local blood chemistry changes due to shock. The opening of these sphincters allows blood to flow back into the stagnant capillary beds which decreases the available blood volume for core perfusion, and, results in a significant drop in systemic vascular resistance. Thus the clinical finding consistent with decompensated drop is a sudden decrease in blood pressure, tachypnea, and continued elevation of the heart rate.

Question 28

Your patient has indicated fear about his illness, stating that he is afraid that he may die. This has made the interview difficult, as you have been unable to get the patient to give you many details regarding his symptoms or the events preceding them. What technique is an acceptable method to focus the interview and get the needed information?

Answer 28

Repeat back to the patient whatever relevant information you have obtained, and then ask him for further information.

Repeating your understanding of the situation back to the patient is useful in helping them realize what relevant information they have not yet revealed.

Question 29

A 65-year-old male with terminal brain cancer calls 911 for shortness of breath. The patient has a Do Not Resuscitate order. What should you do for this patient?

Answer 29

Administer oxygen and transport the patient to the most appropriate emergency room.

The patient has the right to comfort care even if he is a DNR. This means that the patient has the right to receive oxygen and medications for pain. The patient has the right to make his own medical decisions unless his family has the medical power of attorney to decide if the patent is transported. Patients have the right to die with dignity.

Question 30

You have a patient that has suffered frostbite to his fingers. How should you prepare the patient’s fingers for transport?

Answer 30

Wrap the fingers individually

When a patient has suffered frostbite to his fingers, the digits should be wrapped individually to prevent the digits from freezing together and producing more damage. The digits may be submerged in room temperature water if there is no risk of them refreezing. The fingers should never be massaged. This causes the very sharp ice crystals to pierce the cells and cause cellular death.