Midterm medicine

Question 1

You are dispatched to a residence for a 20-year-old male with respiratory distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began experiencing breathing difficulty. You should:

A: remove him from the mechanical ventilator and ventilate him manually.
B: remove the ventilator tubing and place an oxygen mask over the tracheostomy tube.
C: check the settings on the ventilator to ensure that it is functioning properly.
D: detach the ventilator, suction the tracheostomy tube, and reassess the patient.

Answer 1

A: remove him from the mechanical ventilator and ventilate him manually.

Question 2

After moving a hypothermic patient to a warmer area, your primary focus should be to:

A: prevent further body heat loss.
B: give warm, humidified oxygen.
C: assess his or her body temperature.
D: provide rapid rewarming.

Answer 2

A: prevent further body heat loss.

Question 3

Which of the following would MOST likely cause a rapid drop in a patient’s blood glucose level?

A: Forgetting to take prescribed insulin
B: Mild exertion after eating a meal
C: Taking too much prescribed insulin
D: Eating a meal after taking insulin

Answer 3

C: Taking too much prescribed insulin

Question 4

A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is confused, combative, and has slurred speech. With the assistance of law enforcement personnel, you and your partner physically restrain him in order to provide care and transport. In this situation, a court of law would MOST likely:

A: determine that the patient had decision-making capacity.
B: consider your actions in providing care to be appropriate.
C: agree that you and your partner are guilty of assault and battery.
D: conclude that you should have had a court order to restrain.

Answer 4

B: consider your actions in providing care to be appropriate.

Question 5

When insulin levels in the blood remain high:

A: glucose is rapidly taken out of the blood to fuel the cells.
B: a fruity odor can be detected on the patient’s breath.
C: the cells starve for glucose and begin to metabolize fat.
D: the patient urinates excessively and becomes dehydrated.

Answer 5

A: glucose is rapidly taken out of the blood to fuel the cells.

Reason:

Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream. If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock. By contrast, if insulin levels are too low, such as when a diabetic forgets to take his or her insulin, glucose cannot enter the cells and pools in the bloodstream (hyperglycemia). In the absence of glucose, the cells begin to metabolize fat, which produces ketoacids (diabetic ketoacidosis [DKA]). The respiratory system attempts to eliminate ketoacids from the blood with an increased rate and depth of breathing that is accompanied by a fruity or acetone breath odor (Kussmaul respirations). Hyperglycemia causes the patient to eliminate excess water from the body through urination (diuresis), resulting in dehydration.

Question 6

A 46-year-old man presents with generalized weakness and shortness of breath after he was bitten on the leg by a rattlesnake. His blood pressure is 106/58 mm Hg and his pulse rate is 112 beats/min. In addition to supplemental oxygen, further treatment for this patient should include:

A: ice packs to the wound and splinting.
B: splinting and lowering of the affected part.
C: proximal arterial constricting band and splinting.
D: elevation of the affected part and ice packs.

Answer 6

B: splinting and lowering of the affected part.

Reason:
Care for a patient with a bite from a pit viper (rattlesnake, copperhead, water moccasin) includes keeping the patient calm, administering supplemental oxygen, splinting the affected part, and keeping it below the level of the heart. Do NOT apply ice to a snakebite; this will cause local vasoconstriction and may force the venom deeper into the patient’s circulation. If a constricting band is applied, it should be proximal to the bite and should be tight enough to slow venous return only, not cut off arterial supply.

Question 7

A 28-year-old woman has severe lower quadrant abdominal pain. When assessing her abdomen, you should:

A: ask her where the pain is located and palpate that area first.
B: ask her where the pain is located and palpate that area last.
C: encourage the patient to lie supine with her legs fully extended.
D: auscultate for bowel sounds for approximately 2 to 5 minutes.

Answer 7

B: ask her where the pain is located and palpate that area last.

Reason:
Assessment of a patient’s abdomen includes asking where the pain is located and then palpating that area last. Palpating the painful area first may interfere with the rest of your assessment because of the significant pain the patient will be in. Bowel sounds are of little value in the field and generally are not included in the abdominal assessment. Patients with severe abdominal pain typically prefer to lie on their side with their knees drawn up into their chest (fetal position). Moving them from this position will aggravate their pain.

Question 8

Which of the following structures is responsible for regulating body temperature?

A: Hypothalamus
B: Medulla oblongata
C: Cerebrum
D: Cerebellum

Answer 8

A: Hypothalamus

Question 9

You respond to a baseball field for a person who was struck by lightning. When you arrive, you see one patient who appears confused and is ambulatory; a second patient who is conscious, sitting on the ground, and holding his arm; and a third patient who is supine and motionless. After requesting additional responders, you should:

A: treat the conscious patients because the motionless patient is likely deceased.
B: assess and begin treating the sitting patient first because he is obviously injured.
C: assess the motionless victim and perform CPR and defibrillation if necessary.
D: proceed to the ambulatory patient, sit him down, and assess his mental status.

Answer 9

C: assess the motionless victim and perform CPR and defibrillation if necessary.

Question 10

An 80-year-old woman has pain in the right upper quadrant of her abdomen and a yellow tinge to her skin. You should suspect dysfunction of the:

A: spleen.
B: gallbladder.
C: liver.
D: pancreas.

Answer 10

C: liver

Question 11

Which of the following actions should be carried out during the primary assessment of an unresponsive patient?

A: Assessing the skin
B: Palpating the cranium
C: Obtaining a blood pressure
D: Auscultating the lungs

Answer 11

A: Assessing the skin

Question 12

You are called to the residence of a 39-year-old male with flu-like symptoms. The patient tells you that he has been feeling ill for the last 2 days. He has a fever, headache, and diarrhea, and asks that you take him to the hospital. His blood pressure is 120/60 mm Hg, his pulse is 110 beats/min, and his respirations are 16 breaths/min. You should:

A: advise him that he can drive himself to his family physician.
B: ask him if he has a history of HIV infection or hepatitis.
C: offer oxygen and transport him in a position of comfort.
D: request an ALS ambulance to the scene to start an IV line.

Answer 12

C: offer oxygen and transport him in a position of comfort.

Question 13

You are assessing a 40-year-old male with an apparent psychiatric crisis. According to the mans’s wife, he has a history of depression and schizophrenia and takes Zoloft and Zyprexa. A police officer is present at the scene. The patient, who is obviously scared, tells you that he sees snakes everywhere. You should:

A: let him know that it is important for him to be transported as soon as possible.
B: tell him that you do not see any snakes, but they are obviously scaring him.
C: let him know that going to the hospital will keep him safe from the snakes.
D: advise him that you suspect he has not been compliant with his medications.

Answer 13

B: tell him that you do not see any snakes, but they are obviously scaring him.

Question 14

The MOST obvious way to reduce heat loss from radiation and convection is to:

A: increase metabolism by shivering.
B: wear a thick wind-proof jacket.
C: move to a warmer environment.
D: move away from a cold object.

Answer 14

C: move to a warmer environment.

Question 15

A 60-year-old male complains of a tearing sensation in his abdomen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering high-flow oxygen, you should:

A: vigorously palpate his abdomen to assess for a pulsating mass.
B: perform a rapid head to toe assessment and prepare for transport.
C: auscultate over his epigastrium to assess for bowel sounds.
D: transport at once and be prepared to treat him for severe shock.

Answer 15

D: transport at once and be prepared to treat him for severe shock.

Question 16

Which of the following is a physiologic effect of epinephrine when used to treat anaphylactic shock?

A: As a bronchodilator, it improves the patient’s breathing.
B: As a vasodilator, it increases the blood pressure.
C: As an antihistamine, it blocks chemicals that cause the reaction.
D: As a vasoconstrictor, it lowers the blood pressure.

Answer 16

A: As a bronchodilator, it improves the patient’s breathing.

Question 17

Which of the following is the MOST significant finding in a patient with a severe headache?

A: Chest discomfort
B: Pain in both legs
C: Unilateral weakness
D: Abdominal tenderness

Answer 17

C: Unilateral weakness (weakness on one side of the body)

Question 18

Which of the following signs or symptoms is MOST suggestive of a systemic reaction following ingestion of a poison?

A: Nausea and vomiting
B: Painful or difficult swallowing
C: Tachycardia and hypotension
D: Burns around the mouth

Answer 18

C: Tachycardia and hypotension

Question 19

Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water?

A: Hyperglycemia
B: Laryngospasm
C: Gastric distention
D: Spinal injury

Answer 19

A: Hyperglycemia

Question 20

A 50-year-old woman who is conscious and alert complains of a severe migraine headache. When caring for her, you should generally avoid:

A: shining a light into her pupils.
B: transporting her in a supine position.
C: dimming the lights in the ambulance.
D: applying ice packs to her forehead.

Answer 20

A: shining a light into her pupils.

Question 21

You are called to a local park for an ill person. It is a hot day and the humidity is high. When you arrive, a bystander directs you to the patient, a young male who is semiconscious. His skin is flushed, hot, and moist. Your FIRST action in the management of this patient should be to:

A: ensure an open airway.
B: move him to a cool area.
C: begin rapid cooling measures.
D: administer high-flow oxygen.

Answer 21

B: move him to a cool area.

Question 22

When dealing with an emotionally disturbed patient, you should be MOST concerned with:

A: gathering all of the patient’s medications.
B: whether the patient could harm you.
C: safely transporting to the hospital.
D: obtaining a complete medical history.

Answer 22

B: whether the patient could harm you.

Question 23

Which of the following statements regarding the function of insulin is correct?

A: It promotes the entry of glucose from the cell into the bloodstream.
B: It stimulates the liver to release glucose into the bloodstream.
C: It causes the pancreas to produce glucose based on the body’s demand.
D: It facilitates the uptake of glucose from the bloodstream into the cell.

Answer 23

D: It facilitates the uptake of glucose from the bloodstream into the cell.

Question 24

A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any medical problems and does not take any medications. You should be MOST suspicious for:

A: influenza.
B: meningitis.
C: acute stroke.
D: tuberculosis.

Answer 24

B: meningitis

Reason:
Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient’s signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever.

Question 25

You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because: A: active rewarming has been shown to cause severe hypertension. B: the risk of inadvertently inducing hyperthermia is too high. C: rewarming too quickly can cause a fatal cardiac dysrhythmia. D: it is painful for the patient and you cannot give analgesic drugs.

Answer 25

C: rewarming too quickly can cause a fatal cardiac dysrhythmia.

Question 26

A middle-aged man was found floating facedown in a small pond. When you arrive at the scene, bystanders are present, but nobody has removed him from the water because they thought he was dead. After reaching the victim, you should: A: stabilize his head as you remove it from the water and open his airway by tilting his head back. B: grab him by his clothing, remove him from the pond, and assess for breathing and a pulse. C: float a buoyant backboard under him, remove him from the pond, and begin rescue breathing. D: move him to a supine position by rotating the entire upper half of his body as a single unit.

Answer 26

D: move him to a supine position by rotating the entire upper half of his body as a single unit.

Question 27

Hypoglycemia and acute ischemic stroke can present similarly because: A: both oxygen and glucose are needed for brain function. B: they are both caused by low levels of glucose in the blood. C: the most common cause of a stroke is hypoglycemia. D: the majority of stroke patients have a history of diabetes.

Answer 27

A: both oxygen and glucose are needed for brain function.

Question 28

Law enforcement requests your assistance to evaluate a young female who they believe has overdosed. The patient is conscious, is displaying bizarre behavior, and is very restless. Her BP is 170/90 mm Hg and her heart rate is 130 beats/min. You see needle tracks on both of her arms. She is MOST likely under the influence of a: A: sedative-hypnotic. B: powerful narcotic. C: methamphetamine. D: benzodiazepine.

Answer 28

C: methamphetamine.

Question 29

You are called to an assisted living center where an attendant found a 72-year-old man unresponsive. The patient had recent hip surgery and has been taking Vicodin for pain. His respirations are slow and shallow and his pulse is slow and weak. You should: A: request an ALS ambulance to respond to the scene. B: apply the AED in case he develops cardiac arrest. C: apply high-flow oxygen via a nonrebreathing mask. D: begin ventilation assistance with a bag-mask device.

Answer 29

D: begin ventilation assistance with a bag-mask device.

Question 30

When insulin levels in the blood remain high: A: the cells starve for glucose and begin to metabolize fat. B: a fruity odor can be detected on the patient’s breath. C: glucose is rapidly taken out of the blood to fuel the cells. D: the patient urinates excessively and becomes dehydrated.

Answer 30

C: glucose is rapidly taken out of the blood to fuel the cells.

Question 31

A 50-year-old female complains of severe pain to the right lower quadrant of her abdomen. You should: A: suspect that she has an acute problem with her liver. B: quickly palpate that area first to assess for rigidity. C: keep her supine with her legs fully extended. D: palpate the left upper quadrant of her abdomen first.

Answer 31

NA

Question 32

When you arrive at a residence for a man who is “not acting right,” you enter the house and find him sitting on his couch. Which of the following findings would be MOST indicative of an altered mental status? A: Tired appearance. B: Odor of alcohol. C: Slurred speech. D: Eyes are closed.

Answer 32

C: Slurred speech.

Question 33

After removing a patient from the water, your assessment reveals that he is not breathing and is continuously regurgitating large amounts of water. You should: A: place him on his side and press on his abdomen. B: begin rescue breathing after he stops regurgitating. C: alternate suctioning with artificial ventilations. D: perform abdominal thrusts to remove the water.

Answer 33

C: alternate suctioning with artificial ventilations.

Question 34

How should you classify a patient's nature of illness if he or she has a low blood glucose level, bizarre behavior, and shallow breathing? A: Behavioral emergency B: Cardiac compromise C: Altered mental status D: Respiratory emergency

Answer 34

C: Altered mental status

Question 35

Your FIRST action in managing a patient with an altered mental status should be to: A: determine if the patient is breathing adequately. B: ask a family member how the patient normally acts. C: administer high-flow supplemental oxygen. D: administer one tube of oral glucose.

Answer 35

A: determine if the patient is breathing adequately.

Question 36

Immediately following a generalized motor seizure, most patients are: A: awake and alert. B: apneic. C: confused. D: hyperactive.

Answer 36

C: confused

Question 37

Which of the following is the MOST significant finding in a patient experiencing an allergic reaction? A: Widespread rash. B: Abdominal cramps. C: Headache D: Hoarseness

Answer 37

D: Hoarseness

Question 38

A 34-year-old female complains of persistent fever, fatigue, and night sweats. During your assessment, you note that she has purple blotches on her arms and legs. She MOST likely has: A: chickenpox. B: viral hepatitis. C: HIV/AIDS. D: tuberculosis.

Answer 38

C: HIV/AIDS

Question 39

Which of the following mechanisms cause respiratory and circulatory collapse during anaphylactic shock? A: Bronchoconstriction and vasodilation B: Bronchodilation and vasoconstriction C: Bronchoconstriction and vasoconstriction D: Bronchodilation and vasodilation

Answer 39

A: Bronchoconstriction and vasodilation

Question 40

You are transporting a 30-year-old man who is experiencing an emotional crisis. The patient does not speak when you ask him questions. How should you respond to his unwillingness to speak? A: Remain silent until the patient speaks to you. B: Do not speak to the patient, even if he begins to speak to you. C: Tell the patient that you cannot help if he won’t talk. D: Continually encourage the patient to talk to you.

Answer 40

A: Remain silent until the patient speaks to you.

Question 41

Which of the following signs is LEAST suggestive of a diabetic emergency? A: Tachycardia B: Bradycardia C: Fruity breath odor D: Combativeness

Answer 41

B: Bradycardia

Question 42

A behavioral crisis is MOST accurately defined as: A: any reaction to an event that interferes with the activities of daily living or has become unacceptable to the patient, family, or community. B: a chronic mental health problem in which the patient experiences frequent thoughts of suicide or other self-destructive behavior. C: an acute psychiatric emergency characterized by violent behavior, mood swings, and a loss of connection to reality. D: a persistent feeling of sadness, despair, or hopelessness that incapacitates the patient and prevents him or her from interacting socially.

Answer 42

A: any reaction to an event that interferes with the activities of daily living or has become unacceptable to the patient, family, or community.

Question 43

Which of the following signs and symptoms are MOST characteristic of hyperglycemic ketoacidosis? A: Warm, dry skin and a rapid onset B: Cool, clammy skin and a slow onset C: Warm, dry skin and a slow onset D: Cool, clammy skin and a rapid onset

Answer 43

C: Warm, dry skin and a slow onset

Question 44

You are caring for a conscious patient who you believe is having an acute ischemic stroke. After administering oxygen, your next priority should include: A: providing prompt transport for possible fibrinolytic therapy. B: administering 1 tube of oral glucose to rule out hypoglycemia. C: closely monitoring the blood pressure every 15 to 20 minutes. D: determining whether the patient has prescribed nitroglycerin.

Answer 44

A: providing prompt transport for possible fibrinolytic therapy.

Question 45

A 56-year-old diabetic man is found unresponsive by his wife. She tells you that he ate breakfast this morning, but is unsure if he took his insulin. His respirations are rapid and shallow, his skin is cool and profusely diaphoretic, and his pulse is rapid and weak. Which of the following statements regarding this patient is correct? A: You should request an ALS unit so they can give the patient his insulin. B: He needs glucose as soon as possible because he is likely hypoglycemic. C: The fact that he ate breakfast makes hypoglycemia highly unlikely. D: He probably did not take his insulin and has a high blood glucose level.

Answer 45

B: He needs glucose as soon as possible because he is likely hypoglycemicp

Question 46

You and your partner arrive at the home of a 60-year-old man with shortness of breath. As you enter the residence, you find the patient sitting in his recliner; he is in obvious respiratory distress. As you approach him, he becomes verbally abusive, stating that it took you too long to get to his home. A small handgun is sitting on a table next to his recliner. You should: A: verbally distract the patient as your partner attempts to retrieve the gun. B: turn around, rapidly exit the residence, and notify law enforcement. C: explain the reason for your delay as your partner administers oxygen. D: slowly back your way out of the residence and call law enforcement.

Answer 46

D: slowly back your way out of the residence and call law enforcement.

Question 47

The bite of a brown recluse spider is characterized by: A: two small puncture marks, swelling, and delayed onset of pain. B: rapid swelling within 30 minutes and a decline in mental status. C: immediate pain, swelling at the site, and painful muscle spasms. D: delayed onset of pain, swelling, and blister formation at the site.

Answer 47

D: delayed onset of pain, swelling, and blister formation at the site.

Question 48

You are transporting a 35-year-old male who has a history of alcoholism. He stopped drinking 4 days ago and is now disoriented, diaphoretic, and tachycardic. You should be MOST concerned that he: A: will develop a high fever. B: may have a seizure. C: will begin hallucinating. D: is severely dehydrated.

Answer 48

B: may have a seizure.

Question 49

Which of the following organs are contained within the right upper quadrant of the abdomen? A: Liver and spleen B: Stomach and gallbladder C: Liver and stomach D: Liver and gallbladder

Answer 49

D: Liver and gallbladder

Question 50

Which of the following statements regarding lightning-related injuries is correct? A: Multiple fractures, including those of the cervical spine, are the most common cause of lightning-related deaths. B: The majority of patients who are struck by lightning die, even if CPR is provided immediately. C: The cardiovascular and nervous systems are most commonly injured during a lightning strike. D: Because of the high electrical energy associated with lightning, full-thickness burns are a common finding.

Answer 50

C: The cardiovascular and nervous systems are most commonly injured during a lightning strike.

Question 51

A 73-year-old male presents with confusion; cool, pale, clammy skin; absent radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells you that he has had abdominal pain for a week and began vomiting a coffee-ground substance yesterday. His past medical history includes hypertension and gastric ulcer disease. Your MOST immediate concern should be that: A: his condition requires surgery within 2 hours. B: his blood glucose level is probably too high. C: he is in shock and requires prompt transport. D: he is bleeding from his gastrointestinal tract.

Answer 51

C: he is in shock and requires prompt transport. Reason: The patient is likely bleeding from his gastrointestinal (GI) tract.

Question 52

When caring for any patient with a decreased level of consciousness, your primary concern should be the: A: potential for airway compromise. B: possibility of a spinal injury. C: patient’s blood glucose level. D: possibility of a drug overdose.

Answer 52

A: potential for airway compromise.

Question 53

Which of the following structures is NOT part of the endocrine system? A: Pituitary B: Thyroid C: Gallbladder D: Pancreas

Answer 53

C: Gallbladder

Question 54

All of the following are signs of gastrointestinal bleeding, EXCEPT: A: melena. B: hematemesis. C: hemoptysis. D: tachycardia.

Answer 54

C: hemoptysis

Question 55

A known diabetic female is found unresponsive. Her respirations are rapid and shallow; her skin is cool, clammy, and pale; and her pulse is rapid and weak. Which of the following would BEST explain the likely cause of her condition? A: Insulin overdose B: Excessive eating C: Failure to take insulin D: High blood sugar

Answer 55

A: Insulin overdose

Question 56

Which of the following statements regarding the function of insulin is correct? A: It facilitates the uptake of glucose from the bloodstream into the cell. B: It stimulates the liver to release glucose into the bloodstream. C: It causes the pancreas to produce glucose based on the body’s demand. D: It promotes the entry of glucose from the cell into the bloodstream.

Answer 56

A: It facilitates the uptake of glucose from the bloodstream into the cell.

Question 57

A man is experiencing a severe allergic reaction after being stung by a scorpion. He does not have his own epinephrine; however, his wife is allergic to bees and has a prescribed epinephrine auto-injector. You should: A: request an ALS unit to respond to the scene to administer epinephrine. B: assist the patient with one half the usual dose of the wife’s epinephrine. C: assist the patient with the wife’s prescribed epinephrine. D: provide rapid transport and consider an ALS rendezvous.

Answer 57

D: provide rapid transport and consider an ALS rendezvous.

Question 58

You receive a call to a restaurant where a 34-year-old man is experiencing shortness of breath. When you arrive, you immediately note that the man has urticaria on his face and arms. He is conscious, but restless, and is in obvious respiratory distress. You should: A: obtain a set of baseline vital signs and a SAMPLE history. B: place a nonrebreathing mask set at 15 L/min on the patient. C: ask the patient if he has an epinephrine auto-injector. D: remove the patient’s shirt to inspect his chest for urticaria.

Answer 58

B: place a nonrebreathing mask set at 15 L/min on the patient.

Question 59

Which of the following is a later sign of hepatitis? A: Loss of appetite B: Fever and vomiting C: Fatigue D: Jaundice

Answer 59

D: Jaundice

Question 60

A young woman reports significant weight loss over the last month, persistent fever, and night sweats. When you assess her, you note the presence of dark purple lesions covering her trunk and upper extremities. You should suspect: A: tuberculosis. B: end-stage cancer. C: HIV/AIDS. D: rheumatic fever.

Answer 60

C: HIV/AIDS

Question 61

A 60-year-old man presents with a severe right-sided headache. He is conscious and alert. As you are assessing him, he tells you that the left side of his body feels weak. His blood pressure is 190/100 mm Hg, pulse is 88 beats/min, and respirations are 14 breaths/min. His past medical history includes diabetes, arthritis, and hypertension. You should be MOST concerned with: A: his current blood pressure. B: the presence of hemiparesis. C: his blood glucose level. D: the location of his headache.

Answer 61

B: the presence of hemiparesis. Reason: In some patients, however, a headache can signal a serious problem. In this patient, you should be most concerned with his unilateral weakness (hemiparesis); this is not a common finding in patients with otherwise benign headaches and suggests a serious underlying problem (eg, intracranial bleeding, brain tumor).

Question 62

Your patient is a 75-year-old female who, according to her son, tripped on a throw rug and fell. The patient is conscious and alert, is sitting on the couch, and has a hematoma to her forehead. When you ask her what happened, her son interjects by saying, “I already told you, she tripped and fell.” As you further question her, you find that she is hesitant to answer your questions and keeps looking at her son. You should: A: notify law enforcement and have the son removed. B: ask the patient if someone hurt her intentionally. C: tell the son that you suspect his mother has been abused. D: interview the patient and her son separately if possible.

Answer 62

D: interview the patient and her son separately if possible.

Question 63

When caring for a patient with severe hypothermia who is in cardiac arrest, you should: A: perform rescue breathing only. B: perform BLS and transport. C: hyperventilate the patient. D: avoid using the AED.

Answer 63

B: perform BLS and transport.

Question 64

You receive a call to a restaurant where a 34-year-old man is experiencing shortness of breath. When you arrive, you immediately note that the man has urticaria on his face and arms. He is conscious, but restless, and is in obvious respiratory distress. You should: A: remove the patient’s shirt to inspect his chest for urticaria. B: place a nonrebreathing mask set at 15 L/min on the patient. C: ask the patient if he has an epinephrine auto-injector. D: obtain a set of baseline vital signs and a SAMPLE history.

Answer 64

B: place a nonrebreathing mask set at 15 L/min on the patient.

Question 65

You respond to a grocery store where a 39-year-old man reportedly experienced a seizure. When you arrive at the scene, a clerk begins to escort you to the patient. She tells you that the man stopped seizing about 5 minutes ago. If the patient truly experienced a seizure, you will MOST likely find that he: A: is confused and disoriented. B: is not breathing and is cyanotic. C: is fully conscious and alert. D: has a slow heart rate.

Answer 65

A: is confused and disoriented.

Question 66

A young male experienced a syncopal episode after working in the heat for several hours. He is conscious and alert; has cool, clammy skin; and complains of nausea and lightheadedness. You should: A: advise him to go home and rest. B: provide rapid cooling. C: transport him on his side. D: give him cold water to drink.

Answer 66

C: transport him on his side.

Question 67

When assessing a conscious patient who overdosed on a drug, you should FIRST determine: A: when the medication was ingested. B: the type of medication ingested. C: the patient’s weight in kilograms. D: if there is a history of prior overdose.

Answer 67

B: the type of medication ingested.

Question 68

Activated charcoal is contraindicated for a patient who is: A: emotionally upset and has ingested two bottles of aspirin. B: awake and alert and has swallowed a commercial drain cleaner. C: conscious and alert and has ingested a large amount of Motrin. D: agitated and claims to have ingested a bottle of Tylenol.

Answer 68

B: awake and alert and has swallowed a commercial drain cleaner.

Question 69

A young female is unresponsive after overdosing on an unknown type of drug. Her respirations are slow and shallow and her pulse is slow and weak. Which of the following drugs is the LEAST likely cause of her condition? A: Seconal B: Cocaine C: Heroin D: Valium

Answer 69

B: Cocaine

Question 70

You receive a call to a restaurant where a 34-year-old man is experiencing shortness of breath. When you arrive, you immediately note that the man has urticaria on his face and arms. He is conscious, but restless, and is in obvious respiratory distress. You should: A: place a nonrebreathing mask set at 15 L/min on the patient. B: ask the patient if he has an epinephrine auto-injector. C: remove the patient’s shirt to inspect his chest for urticaria. D: obtain a set of baseline vital signs and a SAMPLE history.

Answer 70

A: place a nonrebreathing mask set at 15 L/min on the patient.

Question 71

The two MOST important steps in treating a patient with a contact poisoning are: A: donning a pair of gloves and performing a physical examination to determine if a significant exposure occurred. B: immediately washing any dry chemicals off of the patient’s skin and removing his or her clothing as soon as possible. C: determining when the exposure occurred and irrigating the patient’s entire body with copious amounts of water. D: avoiding self-contamination and removing the irritating or corrosive substance from the patient as rapidly as possible.

Answer 71

D: avoiding self-contamination and removing the irritating or corrosive substance from the patient as rapidly as possible.

Question 72

In the patient with diabetes, insulin shock typically presents with: A: clammy skin and a slow onset. B: dry skin and a slow onset. C: dry skin and a rapid onset. D: clammy skin and a rapid onset.

Answer 72

D: clammy skin and a rapid onset.

Question 73

Prior to administering nitroglycerin to a patient with chest pain, you should: A: inquire about an allergy to salicylates. B: elevate the patient's lower extremities. C: auscultate the patient's breath sounds. D: obtain vital signs to detect hypotension.

Answer 73

D: obtain vital signs to detect hypotension.

Question 74

Approximately 5 minutes after being stung by a bee, a 21-year-old male develops hives and begins experiencing difficulty breathing. When you arrive at the scene, you note that his level of consciousness is decreased, his breathing is labored, and wheezing can be heard without a stethoscope. The patient has a bee sting kit, but has not used it. You should: A: give him high-flow oxygen via a nonrebreathing mask, cover him with a blanket and elevate his legs, and assist him in swallowing the antihistamine tablets that are in his bee sting kit. B: assist his ventilations with a bag-mask device, administer epinephrine from his bee sting kit after receiving approval from medical control, and prepare for immediate transport. C: provide positive-pressure ventilations, initiate rapid transport, and coordinate a rendezvous with a paramedic unit so they can administer the epinephrine from his bee sting kit. D: administer high-flow oxygen via a nonrebreathing mask, apply a chemical cold pack to the sting, transport at once, and be prepared to administer the epinephrine from his bee sting kit.

Answer 74

B: assist his ventilations with a bag-mask device, administer epinephrine from his bee sting kit after receiving approval from medical control, and prepare for immediate transport.

Question 75

A 44-year-old woman was bitten on the ankle by an unidentified snake while working in her garden. She is conscious and alert, has stable vital signs, and denies shortness of breath. Her only complaint is a burning sensation at the wound site. Your assessment reveals two small puncture wounds, redness, and swelling. You should: A: administer high-flow oxygen, apply a constricting band proximal to the bite, and use ice to prevent venom spread. B: give supplemental oxygen, splint her leg to decrease movement, and keep her leg below the level of her heart. C: elevate her leg, cover the wound with a dry sterile dressing, and apply an ice pack to reduce pain and swelling. D: conclude that envenomation likely did not occur, provide reassurance, and allow a friend to take her to the hospital.

Answer 75

B: give supplemental oxygen, splint her leg to decrease movement, and keep her leg below the level of her heart.

Question 76

A 36-year-old male, who is a known diabetic, presents with severe weakness, diaphoresis, and tachycardia. He is conscious, but confused. His blood pressure is 110/58 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min. The glucometer reads error after several attempts to assess his blood glucose level. In addition to high-flow oxygen, medical control will MOST likely order you to: A: give him a salt-containing solution to drink. B: give at least one tube of oral glucose. C: transport only and closely monitor him. D: assist the patient in taking his insulin.

Answer 76

B: give at least one tube of oral glucose.

Question 77

You receive a call for a 54-year-old female who is having a seizure. When you arrive at the scene, the patient is actively seizing. Her husband tells you that she has a history of seizures, and that she has been seizing continuously for 20 minutes. It is MOST important for you to recognize that: A: her husband’s description is consistent with status epilepticus. B: her seizure could be the result of a low blood glucose level. C: the patient is hypoxic and needs oxygen as soon as possible. D: the patient may have stopped taking her seizure medication.

Answer 77

C: the patient is hypoxic and needs oxygen as soon as possible.

Question 78

You are at the scene where a man panicked while swimming in a small lake. Your initial attempt to rescue him should include: A: rowing a small raft to the victim. B: throwing a rope to the victim. C: reaching for the victim with a long stick. D: swimming to the victim to rescue him.

Answer 78

C: reaching for the victim with a long stick.

Question 79

A 45-year-old woman calls EMS because of severe chest pain. When you arrive, she advises you that she has taken two of her husband’s nitroglycerin (NTG) tablets without relief. What is your MOST appropriate course of action? A: Apply supplemental oxygen and transport the patient to the hospital without delay. B: Apply oxygen, assess the patient's blood pressure, and give a third and final NTG tablet. C: Call medical control and request permission to assist the patient with one more NTG tablet. D: Attach the AED, administer 100% oxygen, and contact medical control for advice.

Answer 79

A: Apply supplemental oxygen and transport the patient to the hospital without delay.

Question 80

An elderly man is found unresponsive in his kitchen. The patient’s wife tells you that her husband has diabetes and that he took his insulin, but did not eat anything. You should suspect: A: hyperglycemia. B: hypoglycemia. C: diabetic coma. D: ketoacidosis.

Answer 80

B: hypoglycemia

Question 81

You are caring for a conscious patient who you believe is having an acute ischemic stroke. After administering oxygen, your next priority should include: A: administering 1 tube of oral glucose to rule out hypoglycemia. B: determining whether the patient has prescribed nitroglycerin. C: closely monitoring the blood pressure every 15 to 20 minutes. D: providing prompt transport for possible fibrinolytic therapy.

Answer 81

D: providing prompt transport for possible fibrinolytic therapy.

Question 82

A patient who overdosed on methamphetamine would be expected to have all of the following clinical signs, EXCEPT: A: bradycardia. B: agitation. C: dilated pupils. D: hypertension.

Answer 82

A: bradycardia

Question 83

In general, you should avoid rewarming a frostbitten body part in the field if: A: arrival at the emergency department will be delayed. B: the affected part could refreeze after rewarming. C: a paramedic is not present to administer analgesia. D: you are unable to obtain water that is at least 120°F.

Answer 83

B: the affected part could refreeze after rewarming.

Question 84

Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment, she tells you that she is lightheaded and feels like she is going to faint. Her symptoms are MOST likely due to: A: an irregular heartbeat. B: a drop in her blood sugar. C: low blood pressure. D: nervousness and anxiety.

Answer 84

C: low blood pressure.

Question 85

When restraining a violent patient, you should make sure that: A: consent for restraint has been obtained from a family member. B: the patient is restrained using maximal force. C: someone talks to the patient during the process. D: at least two EMTs restrain the patient.

Answer 85

C: someone talks to the patient during the process.

Question 86

Hypoxia-induced unresponsiveness during a submersion injury is usually the result of: A: associated hypothermia. B: laryngospasm. C: water in the lungs. D: a cardiac dysrhythmia.

Answer 86

B: laryngospasm

Question 87

Which of the following devices is contraindicated in patients with blunt chest trauma? A: Oral airway B: Nasal airway C: Bag-mask device D: Oxygen-powered ventilator

Answer 87

D: Oxygen-powered ventilator

Question 88

A young male experienced a syncopal episode after working in the heat for several hours. He is conscious and alert; has cool, clammy skin; and complains of nausea and lightheadedness. You should: A: advise him to go home and rest. B: provide rapid cooling. C: transport him on his side. D: give him cold water to drink.

Answer 88

C: transport him on his side.

Question 89

Unresponsiveness, shallow breathing, and constricted pupils are indicative of what type of drug overdose? A: Barbiturate B: Amphetamine C: Narcotic D: Marijuana

Answer 89

C: Narcotic

Question 90

Propoxyphene (Darvon) is categorized as what type of drug? A: Barbiturate B: Benzodiazepine C: Narcotic D: Amphetamine

Answer 90

C: Narcotic

Question 91

A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She tells you that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are MOST likely the result of: A: tetanus. B: a localized allergic reaction. C: Lyme disease. D: Rocky Mountain spotted fever.

Answer 91

C: Lyme disease Reason: The patient’s symptoms and her history of a recent hiking trip are consistent with Lyme disease, which was the result of a tick bite. Ticks can carry two infectious diseases: Lyme disease and Rocky Mountain spotted fever. Both are spread through the tick’s saliva, which is injected into the skin when the tick attaches itself. The first symptom of Lyme disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The rash may eventually resemble a target bull’s-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. If recognized and treated promptly with antibiotics, many patients recover completely. Rocky Mountain spotted fever, which is not limited to the Rocky Mountains, occurs within 7 to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary failure.

Question 92

Rapid transport of a patient who ingested a large dose of Tylenol is important because: A: activated charcoal cannot be given to patients who ingested Tylenol. B: it only takes a small dose of Tylenol to cause cardiopulmonary arrest. C: an antidote may prevent liver failure if administered early enough. D: liver failure usually occurs within 6 hours following a Tylenol overdose.

Answer 92

C: an antidote may prevent liver failure if administered early enough.

Question 93

Law enforcement requests your assistance to evaluate a young female who they believe has overdosed. The patient is conscious, is displaying bizarre behavior, and is very restless. Her BP is 170/90 mm Hg and her heart rate is 130 beats/min. You see needle tracks on both of her arms. She is MOST likely under the influence of a: A: sedative-hypnotic. B: powerful narcotic. C: benzodiazepine. D: methamphetamine.

Answer 93

D: methamphetamine