Paramedic Exam 1 Flashcards
During the initial phase of an acute stress reaction, which of the following physiological responses will occur?
A. normal vital signs that remain unchanged
B. increased vital signs that quickly return to normal
C. increased pulse rate and pupillary dilation
D. lowered pulse rate and pupillary constriction
C
Both good stress (eustress) and bad stress (distress) will initially cause sympathetic stimulation such as increased heart and respiratory rate, bronchodilation, dilated pupils, and increased blood flow to the skeletal muscles.
Which root word means blue?
A. cyan-
B. melan-
C. buce-
D. hyster-
A.
The root word cyan- means, blue, as in cyanosis
The ABC’s of initial patient assessment should be performed before anything else in which of the following situations?
A. during cardiac arrest at a swimming pool
B. when the patient is in a toxic environment
C. when the scene is not yet secured by law enforcement
D. during a recue from a fully involved structure fire
A.
Before assessing airway, breathing, and circulation, it is necessary to remove the patient (and yourself) to a place of relative safety.
The focused history and physical examination of a patient begins after you have:
A. controlled immediate threats to the patient’s life.
B. transported the patient to the hospital
C. secured the scene and gained access tot he patient
D. contacted medical control for direction
A.
The purpose of the focused history and physical is to detect additional problems after you have controlled immediate threats to the patient’s life. The on-going assessment is typically performed during transport. Medical control may be consulted anytime during the call when you feel it is appropriate or whenever your protocols and standing orders require it.
You arrive on the scene and find an elderly male complaining of severe abdominal and back pain. Upon further questioning, he states that the pain is “all over the left side.” On palpation you feel a pulsating mass in the abdomen.
This patient is most likely suffering from: A. pulsating diaphragm lesions B. acute arterial occlusion C. acute pulmonary embolism D. abdominal aortic aneurysm
D.
This patient is exhibiting the classic signs and symptoms of an abdominal aortic aneurysm. Further palpation may cause the aneurysm to rupture so be every careful in assessing this patient. The other choices will not cause abdominal pulsations to occur.
You arrive on the scene and find an elderly male complaining of severe abdominal and back pain. Upon further questioning, he states that the pain is “all over the left side.” On palpation you feel a pulsating mass in the abdomen.
This patient’s vital signs have been worsening steadily throughout the time he has been under your care. Treatment for this patient should include:
A. cardiac monitoring
B. two liters of crystalloid solution
C. dopamine administration
D. PASG/MAST application
A.
Cardiac monitoring should always be performed when you suspect an aneurysm is present. Rapid infusion of crystalloid solution is often indicated in the treatment of shock, but the fluid must be titrated to patient response. Dopamine is indicated for cardiogenic shock. Shock in this patient would be due to hypovolemia. Dopamine is contraindicated in the presence of uncorrected hypovolemia. PASG/MAST may be indicated for treatment of AAA in some jurisdiction; however, it is not a standardized treatment
Rales are best described as:
A. coarse, wet sounds
B. high-pitched whistles
C. fine crackling sounds
D. gasping sounds
c.
Rales, or crakles, indicate fluid in the lower lung tissues (bronchioles and alveoli) that is causing minor obstruction. The sound generated is often described as fine and crackling
The posterior tibial pulse is assessed on your patient with palpation of you fingertips near the:
A. arch of the foot
B. medial ankle bone
C. posterior knee
D. top of the foot
B.
The posterior tibial pulse is assessed just below and posterior to where the ankle bone protrudes medially. The pulse located on the top of the foot is the dorsalis pedis. The popliteal pulse is located behind the knee.
Which question would you ask to assess the P part of the SAMPLE acronym?
A. “Are you taking any prescription medicines?”
B. “What have you had to eat in the past 24 hours?”
C. “Have you recently been sick or had any surgery?”
D. “What were you doing when your felt sick?”
C.
The P in SAMPLE acronym stand for past and pertinent medical problems. The other letters are: S= signs and symptoms A= allergies M= medications L= last oral intake E= events leading up to the 911 call
Which patient should be transported immediately, with minimal on-scene care and any attempts at stabilization performed en route to the hospital?
A. female, age 45, pulse 132, systolic BP 78
B. male, age 60, pulse 115, respiratory rate 12
C. female, age 28, systolic BP 96, respiratory rate 18
D. male, age 18, pulse 98, diastolic BP 80
A. Indications for immediate transport include any signs or symptoms of shock; sustained pulse rate greater than 120 or less than 50, systolic BP less than 90, and respiratory rate less than 10 or greater than 29. Based only on these vital signs, the first patient appears to already by in shock.
The collective change in vital signs associated with the late stages of increasing intracranial pressure consists of:
A. increasing pulse rate, shallow respirations, increasing blood pressure
B. slowing pulse rate, deep or erratic respirations, increasing blood pressure
C. rapid and shallow pulse, deep respirations, decreasing blood pressure
D. quickening pulse rate, shallow respirations, decreasing blood pressure
B. This change in vital signs comprises Cushing’s Reflex , a sign of incereasing intracranial pressure. Cushing’s Reflex is also sometimes called Cushing’s Triad or Cushing’s Response
If your patient has an open abdominal wound with a loop of bowel obtruding, you should treat this with
A, a trauma dressing secured with triangular bandages
B. an occlusive dressing secured on only three sides
C. a wet sterile dressing and an occlusive dressing
D. a clean gauze dressing secured with sterile tape
C
The most appropriate dressing for an evisceration is the application of a wet sterile dressing (which keeps the organs moist) and an occlusive dressing (which provides a barrier against further contamination and heat loss).
Which of the following patients is likely to be a candidate for rapid transport based solely upon their age and injuries?
A. a 86-year-od female with a fractured clavicle
B. a 28-year-old male with a fractured femur
C. a 43-year-old female with a fractured rib
D. a 56-year-old male with a pelvic fracture
D.
Each fracture has a potential blood loss of one or more units per fracture site. Because of its rind shape th pelvis frequently has two or more fractures present. In addition, nerve and blood vessel damage and injury to genitourinary organ injuries can complicate the severity of this injury. Patients with pelvis fractures are always considered high priority patients and should be rapidly stabilized and transported. If a patient has bilateral femur fractures they are also a high priority patient.
An unconscious patient who has one dilated pupil that is reactive to light is showing early signs of
A. transient ischemic attacks
B. cerebral artery aneurysm
C. status epilepticus
D. increased intracranial pressure
D.
A unilaterally dilated pupil may be an early sign of increased intracranial pressure. As swelling increases in the brain it puts pressure on the optic nerve that is located near the area of swelling.
Your patient converses with you and answers most questions appropriately but is unsure of where she is or who you are even though you keep telling her your name. Her mental status is best described as
A. unresponsive or unconscious
B. responsive to painful stimuli
C. responsive to verbal stimuli
D. awake and alert
C.
The patient is responsive to verbal stimuli but is not alert because she is not oriented to her surroundings. This patient would be reported as V, when using the AVPU acronym:
A= Alert
V= Verbal
P= Painful
U= unresponsive
You could use the additional scale of AAO or CAO to further characterize her mental level. AAO stands Awake, Alert, and Oriented. CAO stands for Conscious, Alert, and Oriented. Both are medically acceptable terms. You then judge if the patient is oriented to person, place, time, and sometimes a 4th factor, event. You would report your finding as one of the following AAOx3, AAOx4, CAOx3 or CAOx4, depending on whether three or four factors were considered.
You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.
Based on the mechanism described which of the following injuries would you expect to find?
A. calcaneus fracture
B. sternum fracture
C. clavicle fracture
D. humerus fracture
A.
Based on the mechanism of injury, you would expect the force of the energy from a feet first landing to travel up both legs, through the hips, and into the lower back. Any of the bones along this pathway may be fractured by the forces applied in this fall, including the calcaneus (heel).
You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.
Because the victim first landed on his feet, the force of the fall might result in compression fractures of the
A. lumbar vertebrae
B. cervical vertebrae
C. thoracic vertebrae
D. coccyx vertebrae
A.
The lumbar spine is especially prone to compression fractures because it supports the entire weight of the upper body.
You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.
After landing on his feet the patient then fell forward. Which of the following injuries would you expect from this part of the fall?
A. pelvis fracture
B. scapula fracture
C. rib fracture
D. wrist fracture
D.
As patients fall forward, they often brace against the landing by extending their arms, resulting in fractures or dislocation of the bones and joints of the upper extremities.
You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.
Because this was a 25-foot fall, another possible life-threating injury you should suspect is:
A. hollow organ rupture
B. hemopneumothorax
C. aortic tear
D. splenic rupture
C. Although any of these injuries are technically possible with a fall more than three times greater than a patient’s height, the mechanism of injury described here suggests you should be particularly suspicious of an aortic tear. The impact from rapid vertical deceleration causes the heart to pull downward with such force that the aorta can shear off from the heart.
You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.
Treatment for this patient should include:
A. micro-drip IV titrated to effect
B. morphine sulfate for pain
C. on-scene fracture management
D. ECG monitoring for dysrhythmia
D.
Because you cannot easily determine myocardial insult in the prehospital setting, ECG monitoring should occur for any trauma patient with significant mechanism of injury. The IV should be macrodrip in case you need to run it at a fast rate. Morphine use for pain control is indicated for single, isolated fractures and injuries but for this patient its use may mask (hide) pain and the resultant respiratory depression caused by the use of morphine may be very detrimental to this patient. This patient is also a candidate for rapid transport, so the long board should be used to splint long bone fractures until the patient is loaded for transport. Once transport is begun then splinting of fractures may be done, provided the crew is not managing a threat to the ABC’s.
What does a positive tilt test suggest for a patient with acute abdominal pain?
A. The patient has appendicitis
B. The patient is hypovolemic
C. The patient has peritonitis
D. The patient is a diabetic
B
A positive tilt test in a patient with acute abdominal pain suggests that the patient is hypovolemic and may have impending shock.
A patient with an acute abdomen who shows no signs of hemorrhage and has stable vital signs should be positioned
A. in whatever position is most comfortable for the patient
B. in supine position on a padded long backboard
C. in shock position with both lower legs elevated
D. sitting upright in a High Fowler’s position
A.
Medical patients who are stable should be in a position of comfort
Forced examination of the abdomen of a patient who is complaining of abdominal pain should consist of :
A. percussion on the entire abdomen
B. auscultation of the area of discomfort
C. gentle palpation of the entire abdomen
D. repeated tests for rebound tenderness
C.
Use only gentle palpation in the field. Properly performed auscultation for bowel sounds takes several minutes and is of little value to your overall treatment regimen. Correctly performed percussion requires a relatively quiet environment and experienced hand to be of any diagnostic value. Continued assessment for rebound tenderness will aggravate the patient’s discomfort and is unnecessary once you have determined the patient has abdominal distress.
Your patient is a 28-year-old diver who has been using scuba equipment. His diving partner states he was unconscious when he surfaced after a dive. You should suspect:
A. Type I decompression sickness
B. Type II decompression sickness
C. air embolism
D. pneumomediastinum
C.
Air embolism presents as neurological deficit (including unconsciousness) during or after ascent from a dive, or a sharp pain in the chest.
Drug dosages are lower in elderly patients than in young adults primarily because elderly patients:
A. weigh less on average than younger patients
B. have a slower rate of elimination of drugs
C. forget they took their medication and overdose
D. do not respond to drugs as well as the young
B.
The dosage of many common medications is up to 50 percent lower in elderly adults primarily because of the decreased rate of elimination of the drug by the liver and kidneys.
Which statement about the pain that accompanies a myocardial infarction is incorrect?
A. Patients often describe the pain as “crushing”
B. The pain is present only during exertion of stress
C. The pain is relieved by sublingual nitroglycerin
D. Pain due to AMI radiates like angina pain
C.
The pain of MI is not generally relieved by sublingual nitroglycerin and intravenous morphine or nitroglycerin is usually necessary. It may have all of the same characteristics of angina, making a diagnosis by EMS providers relatively difficult.
Which set of vital signs is consistent with left heart failure?
A. BP 100/60, P 48 and regular, R 8 and shallow
B. BP 130/80, P 68 and irregular, R 14 and normal
C. BP 160/100, P 108 and irregular, R 26 and labored
D. BP 170/110, P 76 and irregular, R 22 and shallow
C.
A patient with left heart failure will present with elevated blood pressure, elevated and sometimes irregular pulse, and labored respirations
Which of the following is an example of an open-ended question?
A. What kinds of things make you feel sad?
B. Do you feel sad or angry right now?
C. Do you want to go to the hospital today?
D. Would you like your wife to ride with us?
A.
Open-ended questions cannot be answered by a simple “yes” or “no”; such questions help keep lines of communication open.
Which of the following signs or symptoms requires immediate corrective action in the prehospital setting?
A. decreased level of consciousness
B. night sweating in an AIDS patient
C. a pulse of 106 in a child
D. resting heart rate of 56 in an athlete
A. Decreased level of consciousness can cause airway compromise and is an early sign of many medical and trauma conditions, including decreased tissue perfusion.
You are called to the home of an elderly female who is having difficulty breathing. She has a history of chronic congestive heart failure.
Which vital-sign pattern is most likely for this patient?
A. shallow rapid respirations, decreased pulse rate, cool clammy skin
B. deep labored respirations, decreased pulse rate, hot dry skin
C. shallow rapid respirations, increased pulse rate, cool clammy skin
D. increased respiratory rate, decreased pulse rate, flushed dry skin
C.
The vital signs given in this choice are most likely for a patient with CHF who is complaining of difficulty breathing.
