Randy Final Review Flashcards by Ricky Clarke

Pick the hypertensive crisis patient

52-year-old female with a facial droop and a blood pressure 180/120

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Patients have generalized weakness and malaise. She’s alert and oriented, no difficulty breathing, um some tenderness in the right upper quadrant, all lung sounds clear. O2 IV monitor

O2 IV monitor

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Your patient is complaining of weakness and dizziness. Her family members say that she’s been in and out of consciousness. She has a history of an MI, hypertension, and pancreatitis. Heart rate of 132, respirations are 32 with rails, pulse ox of 88, blood pressure 70/36, sinus tach on the monitor, non-diagnostic 12 lead. She’s cool, diaphoretic, mildly cyanotic. What do you think is going on with her?

Cardiogenic shock

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84-year-old acute CHF goals and the management of this patient are aimed at

Improving myocardial contractility, decreasing preload, and decreasing afterload

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You initiate transcutaneous pacing on a 75-year-old male with a heart rate of 38 and poor perfusion. How do you verify mechanical capture?

Pulse and blood pressure

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A young woman with a history of Graves’ disease is currently experiencing agitation, confusion, abdominal pain. Her skin is hot to the touch and dry, and her heart rate is 140. You suspect

Thyroid storm

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When blood glucose levels rise, the secretion of insulin from the beta cells of the pancreas increases. This is an example of

Negative feedback

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DKA occurs when certain acids accumulate because of what?

Not enough insulin

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Pre-hospital management of DKA includes what?

Administration of insulin and glucose

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Unlike exocrine glands, endocrine glands do what?

Have ducts that carry their secretions into a body cavity

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Two signs or symptoms associated with hypothyroidism

Sluggish reflexes and irritability

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Know the differences between myxedema coma, Addisonian crisis, and acute hyperthyroidism

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The most immediate and significant complication of sodium associated with a hemorrhagic stroke is

Increased intracranial pressure

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3 lead

Sinus bradycardia

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You go on scene for an 18-year-old patient actively seizing according to the mother, who has been seizing for the past 10 minutes. The patient’s cyanotic, breathing erratically, and has generalized muscle twitching to all extremities. What do you want to do?

Open his airway and begin assisting his ventilations

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Which of the following cranial nerves are assessed when you ask a patient to follow your finger with their eyes as you move it in an H shape?

Ocular, trochlear, and abducens

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A 7-year-old patient experienced a strange event. She was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than one minute, after which the child’s condition returned to normal. This clinical presentation is most consistent with

Absence seizures

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You go on scene for a 53-year-old patient with tonic-clonic seizure activity. The family states the patient complained of the worst headache ever and went to lie down. Approximately 10 minutes later, they heard a noise in the room and found the patient seizing. The patient has no significant past medical history and takes only over-the-counter vitamins. You suspect

Hemorrhagic stroke

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A reflex differs from an intentional action because

A reflex bypasses conscious control and the signal doesn’t go to the brain

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What type of skull fractures are most common following high-energy direct trauma to a small surface area of the head with a blunt object?

Depressed

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50-year-old man working on his car, the jacks collapsed, and the car landed on his chest. The assessment reveals profound cyanosis and swelling to the chest and face, agonal respirations, and a weak carotid pulse. The patient will benefit most from

Aggressive airway management and rapid transport

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A young man was assaulted and has extensive maxillofacial injuries. The primary assessment reveals that he’s semi-conscious, has shallow breathing, and has blood draining from the corner of his mouth. The initial management involves

Manually stabilizing his head in a neutral position, suctioning his oral pharynx, and assisting ventilations with a BVM and 100% O2

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A patient with suspected spinal trauma who is in her last trimester of pregnancy has become hypotensive. What should you do?

Tilt the backboard to the left side

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Select three early signs and symptoms of increased intracranial pressure. Early signs

Headache, vomiting, irregular heart rate

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(GCS) An adult patient presents to you by opening his eyes

Four questions: APGAR scale or GCS

An unresponsive adult patient with signs of anaphylactic shock requires immediate what?

0.5 mg of EPI IM

A 31-year-old man presents with diffuse hives, intense itching, watery eyes that began acutely about an hour ago. He is conscious, alert, breathing normally, and denies any allergies or significant medical problems. Vital signs are stable, but he's a little tachycardic. The most appropriate drug dose for this patient is

Benadryl 25-50mg

A 20-year-old woman complains of difficulty breathing and feels a growing lump in her throat approximately 10 minutes after being stung by a wasp. What should you do?

Administer EPI IM, IV, monitor vitals, give O2, consider Benadryl and dexamethasone

What is an antigen most accurately defined as?

A substance that causes the immune system to produce antibodies

Hypotension secondary to histamine release is due to what?

Profound bradycardia and vascular dilation

A kid was stung by a bee at a playground. The patient states his arm hurts near the site of the sting, and he's afraid of bees, but the patient's mother is concerned because she is allergic to bees and carries a prescribed EpiPen. The child shows redness and swelling at the site. Your treatment should include scraping the stinger away and

Apply a cold compress, and transport to the closest hospital

Leukotrienes are released secondary to histamine and worsen an anaphylactic reaction by

Increased permeability and causing edema

You're treating a child who weighs 44 lbs for anaphylaxis. You should administer

EPI 0.15mL, Benadryl 0.4mL, and Albuterol 3mL (2.5mg)

Exposure to organophosphates would result in

Excessive lacrimation

The most important prehospital treatment intervention for a patient with CO poisoning is

Removing the patient from the exposure environment

The hyperpnea and tachypnea associated with methyl alcohol intoxication is secondary to

Metabolic acidosis

A breath that smells like acetone is usually following the ingestion of

Isopropyl alcohol

A kid in the backyard, a 3-year-old, is actually eating mud pies. You mention this to your friend, and she says that he does that all the time. She later tells you that she's noticed her son behaving oddly at times, as though he is confused and unable to walk normally. Knowing she lives in an inner-city rural home, you become concerned that her child may be suffering from

Lead poisoning

Lyrica is commonly prescribed for

Nerve pain

Heat lost from air currents passing over the body is called

Convection

One mechanism for increasing heat loss is

Vasodilation

You are treating a patient with a heat emergency. What should you do?

Move the patient to a cooler area

The diagnosis of heat stroke is usually made when a patient has a high core body temperature and an absence of sweating. True or False?

TRUE

A 12-year-old male patient rode his bicycle into traffic and was struck on his left side. He has fractures of the 9th or 11th ribs on the left side. He's pale and confused and sweating heavily. Breath sounds are present bilaterally. The left upper quadrant of the abdomen is tender. He also complains of pain in his left shoulder, which appears to be uninjured. You suspect an injury of the

Spleen

Tarry stool results from a significant bleed in the upper GI tract. What is it called?

Melena

Inflammation of the membranes that may result from chemical irritation or bacterial invasion of the sterile abdominal cavity is called

Peritonitis

Telescoping or folding of a bowel into an adjacent section is called

Intussusception

A 35-year-old single patient complains of right upper and lower quadrant pain that radiates down his right leg. He's awake and oriented to person, place, time, and event. He states that his right leg also feels numb. His history includes hypertension. You should suspect

AAA (Abdominal Aortic Aneurysm)

Yellowish color of the skin, what's that called?

Jaundice

Patients with peptic ulcer disease are often infected by

H. pylori

A condition that can cause pain commonly mistaken as cardiac in origin and esophageal erosion is the flow of gastric contents up into the esophagus (Sophus). What is it called?

GERD (Gastroesophageal Reflux Disease)

Firefighters overcome by toxic fumes and later experience severe dyspnea, rails crackles, and cough up pink frothy sputum. What condition do you suspect?

ARDS (Acute Respiratory Distress Syndrome)

A young woman approaches you complaining of sudden severe unexplained dyspnea and chest pain. She is healthy, doesn't drink but smokes, and her only medication is birth control pills. What do you suspect?

Pulmonary thromboembolism

A 16-year-old male is complaining of mild constant dyspnea and has been coughing up thick phlegm for months. He has smoked since he was 20 years old and weighs 120 kilos. What condition do you suspect?

Chronic bronchitis

What are carpopedal spasms indicative of?

Hypercapnia

Failure of the clotting system may result from

Patient medications

Hypoperfusion may result from

Increased cardiac output

The characteristics of irreversible shock include

Shunting blood away from the liver and kidneys

Septic shock is what form of shock?

Distributive

In shock, the redirection of blood flow away from other organs to the heart, brain, lungs, and kidneys is accomplished by

The autonomic nervous system

What are the differences between Class 1, 2, 3, and 4 hemorrhages, and what are the characteristics of each one?

Diaphoresis, tachycardia, and narrowing of pulse pressure

A rough estimate of perfusion is measured by obtaining the patient's

Blood pressure

In trauma, if the blood pressure is within normal limits, what type of shock is it?

Compensated shock

Hyperkalemia is defined as

Elevated serum potassium level

What is a hematocrit?

The overall proportion of red blood cells in the blood

If an RH-negative person receives RH-positive blood, what happens?

Hemolysis and anemia will result

Question

Answer

Wheezing is resolved with medications that

Relax bronchial smooth muscles

In a person who normally has good mobility, most pulmonary infections occur

At the bases of the lungs

A patient with orthopnea

Seeks a sitting position when short of breath

A sudden increase of end-tidal CO2 may be the earliest indicator of

ROSC (Return of Spontaneous Circulation)

The most immediate danger to a deeply unconscious patient with acute alcohol intoxication is

Aspiration of vomitus

Patient is found unresponsive by her husband. He notes that the patient's respirations are slow and shallow or pulse is slow and weak and her pupils are markedly dilated. Partner begins assisting the patient's ventilations and her blood pressure is 70/48. Husband hands you an empty bottle of phenobarbital and tells you this wife takes a medication for seizures. After establishing vascular access you should

Administer crystalloid fluid boluses to improve the blood pressure

Death from acetaminophen overdose (Tylenol) is most commonly caused by

Liver failure

Caring for an alcoholic patient who's been abstinent for about 3 days from alcohol. The patient is confused, restless, and tells you that he sees snakes crawling on the walls. His blood pressure is 76/52, heart rate of 140 and weak, referring to 24 with an adequate depth. In addition to administering oxygen, you should

Provide fluid boluses

What is LSD classified as?

Hallucinogen

Cardiac arrest following a narcotic overdose is usually the result of

Respiratory arrest

Your teenage patient has overdosed on amitriptyline. Amitriptyline falls under which group of medications? What symptoms do you expect to see?

Tricyclics. Altered mental status and tachycardia

Pre-hospital management of kidney stones includes

Fluids and analgesia (pain management)

Of the following injuries, which would be considered a true emergency?

Testicular torsion

Classic symptoms of meningitis include

Headache, stiff neck, and fever

Which sexually transmitted disease can pass from a mother to her baby during delivery through the birth canal as well as through breastfeeding?

HIV

The most common EKG changes in your patients experiencing renal failure are

Peaked T waves, with a prolonged QRS and heart blocks

You are dispatched to the residence for an elderly man with an altered mental status. Assessing the patient's wife tells you that he goes to dialysis several times a week but has missed his last three treatments because their car broke down. The patient's skin is yellow, blood pressure is 98/60, and heart rate is 118. EKG shows sinus tach with peak symmetrical T waves. Your most immediate concern should be

LVH (Left Ventricular Hypertrophy) - ventricular dysrhythmias

The structural and functional unit of the kidney is

The nephron

The pediatric assessment triangle includes

Appearance

Your patient is a 16-month-old suspected of having bronchiolitis (RSV). What would you expect to see in this patient?

Thick nasal secretions

You're treating a child with suspected epiglottitis. What would you expect?

High fever

What size cuffed ET tube would you use to intubate a normal-sized 6-year-old?

Your 6-month-old patient was involved in a motor vehicle crash with the rollover. He opens his eyes, has speech

Glasgow Coma Scale is 12

Which of the following is true regarding autism?

Physical exam of an autism patient should be completed slowly to decrease anxiety

Which type of meningitis is potentially more life-threatening in the pediatric patient?

Bacterial

Your five-year-old patient fell from a second-floor balcony. Your initial assessment reveals a large hematoma on the right part of his forehead. He opens his eyes when you call his name, tries to push your hand away when you start the IV, and is mumbling words you cannot understand. His vital signs are blood pressure 104/60, heart rate of 110, respirations are 12, pulse ox of nine. What should you do?

Provide BVM (Bag-Valve-Mask) ventilations titrated to an end-tidal CO2 of 30 to 35

A 12-year-old boy presents with marked respiratory distress, hot moist skin, anxiety, and drooling. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child's grandmother, his symptoms began suddenly about 30 minutes ago. What should you be most suspicious of?

Bacterial epiglottitis

You go to the house for a vent-dependent child with respiratory distress. Upon your arrival, the child's mother tells you that the child was doing fine but then suddenly began experiencing labored breathing. She further tells you that the child's home ventilator was recently replaced with a newer one. Assessment of the child reveals that she is in marked respiratory distress and has intercostal retractions. What should be your first action?

Disconnect the child from the ventilator and begin BVM (Bag-Valve-Mask) ventilation

A 4-year-old child pulled a pot of boiling water off the stove. He has circumferential burns to both legs. What percentage of his body surface area has been burned?

33%

Child vocal cords can be difficult to visualize during intubation because

The epiglottis is floppy and U-shaped

Length-based resuscitation tape is used to

Estimate the child's weight based on his or her height

Cardiac arrest in children is usually caused by

Respiratory failure

You're examining a 24-year-old patient. You palpate the fundus of the uterus at the level of the umbilicus. You estimate this patient is approximately how many weeks pregnant?

20-22 weeks

You've just delivered a baby boy at one minute of life following the neonatal resuscitation protocol. Evaluation reveals central cyanosis, a heart rate greater than 100, a grimace, some flexion of extremities, and a slow and irregular respiratory effort. What is the Apgar score?

The only two situations in which a prehospital provider should place his or her gloved hand into the woman's vagina are

Prolapsed cord and breech presentation

You have cleared the airway of your newly born patient and tried to stimulate her. She is still apneic and cyanotic. What should you do?

Begin positive pressure ventilation at a rate of 40 to 60 breaths per minute and reassess in 30 seconds

(12 lead, no blocks) A 56-year-old patient with seizures, blood pressure 188/108, pulse rate 48, and no reason to suspect illicit drug use. What should you do?

Obtain vascular access, check blood

Your 30-year-old female patient presents with bright red vaginal bleeding and severe abdominal pain. She tells you she's 35 weeks pregnant. What is the likely diagnosis?

Abruptio placenta

The leading cause of first-trimester maternal death is

Ectopic pregnancy

HPV is a very common STD. HPV transmission usually results in

Can cause cervical cancer

Pelvic inflammatory disease most commonly affects

Sexually active women

A 23-year-old patient with sharp pain in the right lower quadrant of her abdomen that began suddenly 10 minutes ago. She says her last menstrual period was about 8 weeks ago and that she has had a small amount of vaginal bleeding for two days. She's weak, pale, and diaphoretic. What is the likely diagnosis?

Ruptured ectopic pregnancy

Which of the following statements regarding the umbilical cord is correct?

The umbilical vein carries oxygenated blood from the placenta to the fetus

A woman has been pregnant three times, has had two spontaneous abortions, and has carried one baby to full term. How do you document this?

G: 3 A: 2 P: 1

During the second stage of labor, what happens?

Effacement of the cervix begins

A 75-year-old patient complains of difficulty hearing, which came on suddenly after he began taking a new medication. This form of hearing impairment would be described as

Sensorineural deafness

A 30-year-old complains of left arm and wrist pain after a ground-level fall. The patient says she fell when she was getting out of bed because her right leg would not hold her up. She also complains of feeling weak for two days. During your assessment, it is revealed that the patient is too weak to stand on her own. She says this has happened a couple of times in the last year, but, in fact, it was her left leg that was weak. In addition to any musculoskeletal injuries sustained in the fall, what is the likely diagnosis?

Multiple sclerosis

What must be ruled out in the case of an acute change in mental status?

Medical causes

The leading cause of death in Americans older than 65 is

Pneumonia

Therapeutic doses of certain drugs may reach toxic levels in older people due to the deterioration of the

Liver

Which of the following central nervous system functions does not change as a person ages?

Intelligence level

Most age-related visual disturbances are the result of

Cataracts or glaucoma

During the process of wound healing, what does hemostasis do?

Temporarily stops bleeding via vasoconstriction and platelet aggregation

A patient with hemorrhagic shock would be expected to have

Widened pulse pressure

Your patient was stabbed in the abdomen 20 minutes ago. Vital signs are 80/50, heart rate is 136, he is anxious and pale. What is the most likely stage of shock he is in?

Decompensated

One of the ways the human body attempts to compensate for decreased perfusion is

The adrenal gland secretes EPI and norepinephrine to increase myocardial contractility

Obstructive shock may be caused by

Pericardial tamponade

Distributive shock may be caused by

Anaphylactic reaction

A hypotensive bradycardic patient whose skin is warm, flushed, and dry is a classic presentation of

Neurogenic shock

The physiological response to hemorrhage includes

Vasoconstriction

(ECG) Unstable third-degree block. What is your treatment?

Initiate pacing and transport

(ECG) Atrial fibrillation with rapid ventricular response (RVR) rate at 72, complaining of palpitations and weakness. A 44-year-old with blood pressure of 142/90, heart rate at 172, respiration 20, and pulse ox of 96%. What medication would you administer?

0.25 milligrams per kilogram of diltiazem

Side effects of albuterol may include

Tremors, lightheadedness, and irritability

Prior to administering dopamine to a patient, the paramedic must ensure that the patient is

Not hypovolemic

Skin turgor in an infant or child is most indicative of

Dehydration

Ipratropium bromide (Atrovent) causes bronchodilation by

Antagonizing beta-2 receptors

Which patient is likely to be easiest to intubate?

A 12-year-old patient who experienced sudden cardiac arrest for an unknown reason

(Drug calculation) Dopamine label states it is 1600 mcg per mL. You've been ordered to initiate a dopamine infusion for the patient at 8 mcg/kg/min. Your patient weighs 132 pounds (60 kg). You're using a microdrip (60 gtts). What is your drip rate?

18 gtts/min