Study Guide #1 Flashcards
____ sign is a crunching sound auscultated on the anterior chest wall and is synchronized to the patients heartbeat.
Hamman’s
Parkland Formula
4ml x kg x bsa= fluid over 24 hours (half given in first 8 hours)
Which of the following coronary arteries supplies the majority of the circulation to the inferior portion of the heart?
A. Left coronary
B. Left ascending
C. Right coronary
D. Circumflex
C. Right coronary
Hyperkalemia >7.0 can exhibit which of the following changes on the ECG tracing?
A. Inverted T waves
B. U waves
C. Tented or peak T waves
D. Flattened T waves
C. Tented or peak T waves
Which of the following is characteristics of the 12 lead ECG for a patient with a history of WPW?
A. J point
B. Delta wave
C. Osborne wave
D. Q wave
B. Delta wave
Your patient is exhibiting ST elevation in leads II, III, and AVF, ST depression is noted in V1-V3. Which of the following may prove hazardous?
A. Isotonic fluid bolus
B. Heparin
C. GII/BIIIa inhibitors
D. Nitroglycerin
D. Nitroglycerin
Inferior wall MI is caused by an occlusion of which coronary artery?
A. LAD
B. RCA
C. Circumflex
D. Inferior vena cave
B. RCA
On 12-lead ECG, posterior wall MIs manifest as
A. ST elevation in II, III, AVF
B. ST depression in II, III, AVF
C. ST depression in V1-V4 with abnormal tall R waves
D. ST elevation in V1-V4 with abnormal tall R waves
C. ST depression in V1-V4 with abnormal tall R waves
ST elevation in leads I, AVL, V5, and V6 are indicative of injury to which area of the heart?
A. Inferior
B. Lateral
C. Anterior
D. Posterior
B. Lateral
A patient with a history of tricyclic antidepressant overdose can exhibit which of the following on the ECG tracing?
A. Short PR interval
B. Peaked or tented T waves
C. Prolonged QT interval
D. Prolonged PR interval
C. Prolonged QT interval
Which changes in the ECG would a patient presenting with an inferior wall MI most likely have?
A. ST depression in II, III, and AVF
B. ST elevation in leads I, AVL, V5 and V6
C. ST elevation in leads II, III, and AVF
D. ST depression in leads V1 and V2
C. ST elevation in leads II, III, and AVF
Normal K+ lab value is
A. 3.0-4.0
B. 3.5-4.5
C. 4.0-5.0
D. >5.5
B. 3.5-4.5
The balloon has dislodged when treating your IABP patient. Which is the most common site that will be affected?
A. Right radial
B. Left radial
C. Right femoral
D. Left femoral
B. Left radial
During transport you note rust-colored “flakes” in the IABP tubing. This indicates
A. Helium tank degradation
B. IABP pump failure/lubricant leak
C. Helium oxidation
D. Balloon rupture
D. Balloon rupture
The primary trigger used for most IABP operations is the
A. A-line
B. PA catheter
C. EKG
D. CVP catheter
C. EKG
When timing the IABP, inflation should initiate in synchronization with
A. ECG P wave
B. Anacrotic notch of the A-line
C. Beginning systole
D. Dictrotic notch indicated in the A-line pressure wave
D. Dictrotic notch indicated in the A-line pressure wave
A common cause of elevated PA pressures is
A. Mitral valve stenosis
B. Mitral valve regurgitation
C. Left ventricular failure
D. All of the above
D. All of the above
A patient’s peripheral A-line is showing a very sharp waveform with readings that appear exaggerated. This may be due to
A. Catheter embolus formation
B. Catheter whip due to hypertension
C. Over-dampening of the pressure system
D. Kinking of the pressure tubing
B. Catheter whip due to hypertension
Central venous pressure is a reflection of
A. Right atrial pressure
B. Cardiac index
C. Left atrial pressure
D. After load for the right side of the heart
A. Right atrial pressure
Pulmonary artery pressure reflects
A. The filling pressure in the left ventricle
B. The amount of blood ejected with each heart beat from the ventricles during systole
C. Right atrial pressures
D. Right and left sided heart pressures
D. Right and left sided heart pressures
The pulmonary artery wedge pressure evaluates
A. The right side of the heart
B. Stroke volume
C. Preload of the left side of the heart
D. After load of the left side of the heart
C. Preload of the left side of the heart
Normal range for cardiac output is
A. 2-4 L/min
B. 4-8 L/min
C. 8-12 L/min
D. 15-20 L/min
B. 4-8 L/min
Normal range for pulmonary artery wedge pressure(PAWP) is
A. 2-6 mmHg
B. 8-12 mmHg
C. 4-8 mmHg
D. 0-5 mmHg
B. 8-12 mmHg
Normal range for right atrial pressure is
A. 2-6 mmHg
B. 8-12 mmHg
C. 4-8 mmHg
D. 0-5 mmHg
A. 2-6 mmHg
Cardiac output is determined by
Heart rate and stroke volume
Systemic vascular resistance measure the
A. Preload for the right side of the heart
B. Preload for the left side of the heart
C. Afterload for the right side of the heart
D. Afterload for the left side of the heart
D. Afterload of the left side of the heart
Stroke Volume is
A. Measure afterload for the right side of the heart
B. Measures afterload for the left side of the heart
C. The amount of blood ejected with each heartbeat from the ventricles during systole
D. The amount of blood ejected with each heartbeat from the ventricles during diastole
C. The amount of blood ejected with each heartbeat from the ventricles during systole
The dicrotic notch signifies
A. Closure of the tricuspid valve
B. Closure of the pulmonic valve
C. Closure of the aortic valve
D. Closure of the mitral valve
C. Closure of the aortic valve
Medications that can decrease preload include all of the following EXCEPT
A. Morphine sulfate
B. Nitroglycerin
C. Vasopressin
D. Furosemide
C. Vasopressin
Positive pressure ventilation will cause cardiac pressure to
A. Rise upon inspiration
B. Rise upon expiration
C. Fall upon inspiration
D. Fall upon expiration
A. Rise upon inspiration
Hemodynamic pressures should be assessed and recorded at the
A. End of exhalation
B. Beginning of exhalation
C. End of inspiration
D. Beginning of inspiration
A. End of exhalation
You are in flight with a seventy-year-old male cardiac patient on 6 L O2 by NC. You are at 5,000 feet and the patient is becoming hypoxic. What is your initial intervention for this patient?
A. Decrease cabin pressure
B. Increase O2 delivery to the patient
C. Administer fluid bolus to increase perfusion to the heart
D. RSI and intubate the patient
B. Increase O2 delivery to the patient
Your patient is experiencing left ventricular diastolic failure. Therapy should be focused on
A. Augmentation of left ventricular clearing
B. Decreasing afterload
C. Decreasing preload
D. Diuretic and relief of anxiety
D. Diuretic and relief of anxiety
Electrical alternans may be caused by
A. PE
B. Pericardial Tamponade/effusion
C. Tension Pneumothorax
D. Diaphragmatic rupture
B. Pericardial tamponade/effusion
Antidote for Coumadin overdose is
A. Prtaomine sulfate
B. Glucagon
C. Vitamin K, FFP
D. Physostigmine
C. Vitamin K, FFP
Your patient has a chief complaint of dyspnea and weakness with the following vitals: BP 72/64, HR 112, RR 28, SpO2 88%, temp 99.1 F. He is on 6 L/min O2 via NC. EKG shows ST with frequent PVCs. Physical exam reveals profound vesicular rales and bronchial wheezing. Your most likely diagnosis is
A. CHF
B. ARDS
C. Asthma
D. Cardiogenic shock
D. Cardiogenic shock
Treatment of cardiac tamponade includes all of the following EXCEPT
A. Force fluids
B. Pericardiocentesis
C. Rapid transport
D. Needle thoracostomy
D. Needle thoracostomy
A patient presenting with Beck’s triad is most likely experiencing
A. Tension pneumothorax
B. Increased ICP
C. Cardiac tamponade
D. Intra-abdominal bleeding
C. Cardiac tamponade
You are transporting a 45 YOM with acute respiratory distress syndrome(ARDS) and MODS secondary to probable organ rejection after a heart transplant. During transport, the patient becomes Bradycardiac with heart rate in the 30s with hypotension. Which of the following therapies will likely prove fruitless?
A. 250-500mL
B. Dopamine 5-20 mcg/kg/min
C. Transcutaneous pacing
D. Atropine 0.5-1mg IV push
D. Atropine 0.5-1 mg IV push
You are transporting a 50 YOM from ICU to another facility for further evaluation. The patient has been diagnosed with AMI. He has been complaining of increasing CP, SOB, and dramatic weight loss. He appears very nervous, and you note tremors. His ECG shows A-Fib at 148. The patient may be experiencing
A. Addison’s disease
B. Thyrotoxicosis (grave’s disease)
C. Myexdema coma
D. Cushing’s syndrome
B. Thyrotoxicosis (grave’s disease)
The formula to calculate MAP is
A. 2/3 DBP x SBP
B. 2 (DBP + SBP/3)
C. 2 (DBP + SBP)
D. 2 + (DBP x SBP/3)
B. 2 (DBP + SBP/3)
You have a 60 YOM that complains of chest pain for three days with a low-grade fever. Patient complains of increased pain when lying in supine position and states that the chest pain decreases when sitting forward. What is the most likely diagnosis?
A. PE
B. Pleurisy
C. Pericarditis
D. Pericardial tamponade
C. Pericarditis
Inferior wall MI is caused by an occlusion of which coronary artery
A. LAD
B. RCA
C. Circumflex
D. Inferior vena cava
B. RCA
What medications would you expect to administer to a patient presenting with severe chest/abdominal pain, diaphoresis, and is restless? SBP is 170/palp and heart rate is 116. You note a difference BP when taken on each arm.
A. NTG and atenolol
B. Nipride and b-blockers
C. Lasix and NTG
D. Bumex and dobutrex
B. Nipride and b-blockers
A sign of hyperventilation and hypocalcemia is
A. Kehr’s
B. Grey Turner’s
C. Trousseau’s
D. Brudzinski’s
C. Trousseau’s
The MD has ordered a brain natriuretic peptide(BNP), which would evaluate the patient for
A. Sepsis
B. Hypovolemia
C. Right ventricular failure
D. CHF
D. CHF
Levine’s sign relates to
A. Meningitis; neck pain
B. Pancreatitis; periumbilical bruising
C. Cardiac; clenched fist over chest
D. Splenic injury; left shoulder
C. Cardiac; clenched fist over chest
Drug choice for GI bleed
A. Normal saline
B. Nipride
C. Whole blood
D. Sandostatin
D. Sandostatin
You are transporting a 50 YOM from a rural facility. Your patients ECG is demonstrating ST at 112 with peaked T waves. The ABG indicates pH 7.2, pCO2 18, HCO3 12, and pO2 108. CMP reveals Na 130, K 2.3, C1 95, HCO3 10, BUN 48, creat 2.2, and BGL 685. The most appropriate diagnosis would be
A. Cardiogenic shock
B. DKA
C. HHNKS
D. Dehydration
B. DKA
Recommended urinary output when caring for an adult patient should be
A. 100mL/hr
B. 30-50 mL/hr
C. 1-2cc/kg/hr
D. >200 mL/hr
B. 30-50 mL/hr
A patient presents with meningitis may exhibit which sign on assessment?
A. Cullen’s
B. Grey Turner’s
C. Kernig’s
D. Levine’s
C. Kernig’s
Murphy’s sign would indicate which of the following?
A. Splenic injury
B. Cardiac problem
C. Pancreatitis
D. Gallbladder
D. Gallbladder
A common problem seen with hepatic encephalopathy is
A. Hyperkalemia
B. Increased ammonia levels
C. Low protein levels
D. Low BUN
B. Increased ammonia levels
Treatment of pancreatitis would include all of the following, except
A. Fluid resuscitation
B. NPO and place OG/NG tube
C. Morphine for pain
D. Antibiotics for sepsis
C. Morphine for pain
The treatment of diabetes insipidus is
A. Aggressive fluid replacement and vasopressin
B. Restrict fluids and mannitol
C. Aggressive fluid replacement and Dilantin
D. Aggressive fluid replacement and octreotide
A. Aggressive fluid resuscitation and vasopressin
Drug of choice for profound hypotension in septic shock is
A. Isotonic crystalloid solution
B. Levophed
C. Nipride
D. Dobutamine
B. Levophed
Grey Turner’s sign may indicate
A. Meningitis
B. Splenic injury
C. Pancreatitis
D. Gallbladder
C. Pancreatitis
Repeated dose of etomidate can cause
A. Increased ICP
B. Acute adrenal insufficiency
C. AMI
D. Pulmonary edema
B. Acute adrenal insufficiency
A clinical sign that indicates hypocalcemia may present is
A. Kehr’s
B. Grey Turner’s
C. Chvostek’s
D. Brudzinski’s
C. Chvostek’s
Your patient presents with upper body obesity with thin arms and legs. He has a rounded face, “buffalo jump” and is complaining of fatigue. He is hypertensive and hyperglycemic. What condition is he most likely presenting?
A. Myxedema coma
B. Thyroid storm
C. Addisons disease
D. Cushing’s syndrome
D. Cushing’s syndrome
Cullen’s sign may indicate
A. Meningitis
B. Pancreatitis
C. Gallbladder disease
D. Cardiac problem
B. Pancreatitis
You are transporting a 30 YOM involved in a MCA from a rural area facility. The 70-kg patient is on a ventilator with the following settings: FiO2 1.0, Vt 500, rate 16, PIP 22, and PEEP 5. The ABG results are pH 7.01, pCO2 68, HCO3 12, pO2 280. Interpretation of the blood has reveals
A. Metabolic and respiratory acidosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Compensated respiratory acidosis
A. Metabolic and respiratory acidosis
You are transporting a 10 year old boy weighing 60-kg with diagnosis of status asthmaticus on a ventilator. EtCO2 56 and pulse ox 95%. Ventilator settings are Vt 450, FiO2 1.0, rate 16, I:E 1:2, PEEP 5, PIP 48. How will you manage this patient?
A. Increased tidal volume
B. Reduced I:E ratio
C. Increase PEEP
D. Increase respiratory rate
B. Reduced I:E ratio
When inserting a chest tube, correct insertion site recommended is
A. 2nd ICS midclavicular line
B. 4th-5th ICS anterior axillary line
C. 4th ICS midaxillary line
D. 5th ICS midaxillary line
B. 4th-5th ICS anterior axillary line
ABGs reveal pH 7.31, pCO2 58, HCO3 26, pO2 106. What is your interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Respiratory acidosis
You are transporting a 24 YO trauma patient from a rural facility who had just been given Anectine in preparation for endotracheal intubation. The patients heart rate increases, muscles rigidity, and you observe his end tidal CO2 has increased to 60 mmHg. Your next intervention would be to administer
A. Midazolam
B. Sodium Bicarb
C. Dantrolene
D. Glucagon
C. Dantrolene
When performing a needle thoracostomy, which of the following is generally the preferred site?
A. 2nd ICS, anterior-axillary line
B. 5th ICS, anterior-midaxillary line
C. 4th ICS, midclavicular line
D. 2nd ICS, midclavicular line
D. 2nd ICS, midclavicular line
ABG reveals pH 7.41, pCO2 38, HCO3 22, pO2 56 of a 70kg patient on a ventilator with the following settings: Vt 700, F 14, FiO2 0.5, I:E 1:2, PIP 46, Pplat 40, and PEEP 5. How will you manage this patient?
A. Increase FiO2
B. Increase PEEP
C. Decrease Vt
D. All of the above
A. Increase FiO2
When managing pO2 of <60 you would
A. Increase FiO2 and apply/or increase PEEP
B. Increase Vt and apply/or increase PEEP
C. Increase FiO2
D. Increase VT
A. Increase FiO2 and apply/or increase PEEP
Minute volume is
A. RR x kg
B. RR x SpO2
C. Vt x kg
D. Vt x RR
D. Vt x RR
High pressure alarms can be caused by all of the following EXCEPT
A. Hypovolemia
B. Connections
C. Pneumothorax
D. Obstructions
A. Hypovolemia
Low pressure alarms can be caused by all of the following, EXCEPT
A. Hypovolemia
B. Leaks in ventilator tubing
C. Pneumothorax
D. Connections
C. Pneumothorax
Vt is calculated at
A. 3-5 mL/kg
B. 5-8 mL/kg
C. 6-10 mL/kg
D. 10-15 mL/kg
B. 5-8 mL/kg
60 kg male patient- ABG: pH 7.51, pCO2 28, HCO3 24, pO2 110. Vt 650, F14, FiO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation and how will you correct it?
A. Respiratory acidosis; increase respiratory rate (F)
B. Respiratory alkalosis; decrease Vt
C. Metabolic alkalosis; increase FiO2
D. Respiratory alkalosis; increase PEEP
B. Respiratory alkalosis; decrease Vt
Situations that involve a left shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT
A. Alkalosis
B. Hypocapnoa
C. Hypothermia
D. Increased levels of 2,3-DPG
D. Increased levels of 2,3-DPG
Situations that involve a right shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT
A. Alkalosis
B. Hypercapnoa
C. Hyperthermia
D. Increased levels of 2,3-DPG
A. Alkalosis
Interpret the following blood gas: pH 7.39, HCO3 18, pCO2 31
A. Respiratory alkalosis, completely compensated
B. Respiratory acidosis, partially compensated
C. Metabolic acidosis, partially compensated
D. Metabolic acidosis, completely compensated
D. Metabolic acidosis, completely compensated
You are transporting a 40 YOM from a rural ICU. The CXR reveals a ground glass appearance. The patient is on a ventilator with settings at: Vt 900mL, rate of 16, FiO2 0.8, PEEP 5. ABGs reveal pH 7.34, pO2 76, pCO2 38, and HCO3 24. What pulmonary condition do you expect?
A. Pneumothorax
B. Pulmonary edema
C. ARDS
D. Cor pulmonale
C. ARDS
You are transporting a 40 YOM from a rural ICU. The CXR reveals a ground glass appearance due to ARDS. The patient is on a ventilator with settings at: Vt 900mL, rate of 16, FiO2 0.8, PEEP 5. ABGs reveal pH 7.34, pO2 76, pCO2 38, and HCO3 24. How would you manage this patient?
A. Increasing the rate
B. Increasing PEEP
C. Performing a rapid needle decompression
D. Administering lasix
B. Increasing PEEP
Which of the following paralytics stimulates motor end plate acetylcholine receptors causing persistent depolarization?
A. Succinylcholine
B. Rocuronium
C. Vecuronium
D. Pancuronium
A. Succinylcholine
An elevated anion gap can indicate the presence of which of the following?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
C. Metabolic acidosis
The average ET tube size that should be utilized for an adult male patient is
A. 6.0
B. 7.0
C. 8.0
D. 9.0
C. 8.0
The administration of succinylcholine is contraindicated in which of the following?
A. Hypoglycemia
B. Hyperkalemia
C. Hypercalcemia
D. Hypernatremia
B. Hyperkalemia
A COPD patient would most likely present with which of the following x-ray findings?
A. Hyperinflation of the lungs, narrow and elongated heart shadow, and increased anterior-posterior diameter of the heart
B. Widespread pulmonary infiltrates, ground-glassy appearance
C. Lobar infiltrates and consolidation
D. Cardiomegaly and pulmonary vascular congestion
A. Hyperinflation of the lungs, narrow and elongated heart shadow, and increased anterior-posterior diameter of the heart
The diagnosis of ARDS would most likely present with which of the following x-ray findings?
A. Hyperinflation of the lungs, narrow and elongated heart shadow, and increased anterior-posterior diameter of the heart
B. Widespread pulmonary infiltrates, ground-glassy appearance
C. Lobar infiltrates and consolidation
D. Cardiomegaly and pulmonary vascular congestion
B. Widespread pulmonary infiltrates, ground-glassy appearance
The most likely cause of metabolic alkalosis can include all of the following, EXCEPT
A. Vomiting
B. NG suctioning
C. Diarrhea
D. Diuretics
C. Diarrhea
What is the initial clinical presentation that may indicate that ICP may be increasing?
A. Hypotension
B. Deteriorating LOC
C. Tachypnea
D. Tachycardia
B. Deteriorating LOC
You are transporting a 40 YOM diagnosed with a subarachnoid hemorrhage. Which of the following assessment findings can be associated with his diagnosis?
A. Presence of doll’s eyes reflex
B. Positive Battle’s sign
C. Positive Brudzinski’s sign
D. Absence of ipailateral pupillary dilation
C. Positive Brudzinski’s sign
Pupillary dilation in response to the oculomotor nerve insult that occurs in uncal herniation is a result of
A. Loss of parasympathetic stimulation
B. Loss of sympathetic stimulation
C. Parasympathetic overstimulation
D. Sympathetic overstimulation
A. Loss of parasympathetic stimulation
Which formula can be used when calculating a cerebral perfusion pressure(CPP)?
A. [(DBP x 2) + SBP] divided by 3
B. MAP - ICP
C. ICP - DBP
D. [(DBP + 2) x SBP] divided by 3
B. MAP - ICP
You are preparing to transport a 20 YOM weighing 200 pounds with a hx of a self-inflicted GSW to the head. He is intubated with A/C ventilator setting of FiO2 0.5, Vt 600, I/E 1:2, flow 5 L, RR 10, PIP 30. V/S: BP 100/60, HR 66, SaO2 94%. ICP 28. His CPP is approximately
A. 100 mmHg
B. 70-90 mmHg
C. 60 mmHg
D. <50 mmHg
D. <50 mmHg
An early sign of tentorial herniation would be
A. Doll’s eye reflex
B. Ataxic breathing
C. Paralysis below the diaphragm
D. Ipsilateral pupillary dilation
D. Ipsilateral pupillary dilation
You have been requested to transport a 32 YOM involved in a 2 car MVC in which the right side of his struck the “A-post”. Right middle meningeal artery damage has been noted by CT with right sided “mass effect” resulting. You would expect which of the following?
A. Epidural hematoma
B. Ventricular collapse
C. Cranial midline shift to the left
D. All of the above
D. All of the above
A head-injured patient would most likely experience an increased ICP as a result of which action?
A. Hip flexion
B. Gagging in the ETT
C. Adduction of the head
D. Rotation of the head
E. All of the above
E. All of the above
The expected average normal CPP range is
A. 80-100 mmHg
B. 50-60 mmHg
C. 70-90 mmHg
D. >100 mmHg
C. 70-90 mmHg
The average normal ICP range is
A. 0-10 mmHg
B. 10-20 mmHg
C. 20-30 mmHg
D. >30 mmHg
A. 0-10 mmHg
You are transporting an awake multisystem trauma patient from a small rural facility with the following V/S: BP 200/66, HR 56, RR 20-36, SaO2 97% and temp 99.9% F. Further assessment reveals a large laceration to the occipital area of the head with bleeding controlled and is moving all extremities. Pupils are reactive to light and equal at 4 mm with extraocular movement intact. Presentation is suggestive of which of the following?
A. Demonstrating s/s of Cushing’s triad
B. Already herniated & will like deteriorate further
C. Demonstrating s/s of Brown-Sequard syndrome
D. Demonstrating s/s of Hypovolemic shock
A. Demonstrating s/s of Cushing’s triad
Classic picture if neurogenic shock presents with
A. Hypertension
B. Absence of Tachycardia
C. Cool skin
D. Pallor
B. Absence of tachycardia
You are transporting a patient with a spinal cord injury above T6 level. His baseline v/s prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing headache with nasal stiffness. Your assessment reveals that the patient is becoming increasingly agitated. Skin color is flushed and profusely diaphoretic. Repeat v/s are BP 206/100, HR 52, RR 26. Your initial management of the patient would be
A. Insert a Foley catheter
B. Administer NTG to help reduce BP
C. Hang a Nipride drip if diastolic is >130 mmHg
D. Do nothing because increased HTN is expected with altitude and spinal cord injuries
A. Insert a Foley catheter
You have been requested to transport a 40 YOM fall victim of approximately 25-30 feet, 3 hours prior to your arrival. Your assessment reveals a greater motor weakness in upper extremities than in lower extremities, with varying degrees of sensory loss. The clinical presentation may suggest which of the following spinal cord syndrome?
A. Brown-Sequard
B. Central cord
C. Anterior cord syndrome
D. Neurogenic shock
B. Central cord
Hypothermia, low levels of 2,3-DPG, and hypocarbia can cause the oxyhemoglobin dissociation curve shift to go
A. Up
B. Down
C. Right
D. Left
D. Left
In addition to glucose, which electrolyte must be maintained within normal limits when managing a head-injured patient?
A. Calcium
B. Magnesium
C. Potassium
D. Sodium
D. Sodium
Calculate the following patients CPP: BP 150/75, HR 140, RR 28, SpO2 100%, CVP 2, ICP 25.
A. 98
B. 125
C. 65
D. 75
D. 75
You are transporting a normotensive patient, who is presenting with a history of head injury and complaining of extreme thirst. Your assessment reveals he is excreting large amounts of diluted urine, sunken appearance to the eyes, dry mouth, and tachycardia is noted. The initial treatment of the patient would be?
A. Restrict fluid
B. Administer Sandostatin
C. Aggressive fluid replacement and vasopressin
D. Administer anti-thyroid medication
C. Aggressive fluid replacement and vasopressin
Cushing triad involves all of the following, EXCEPT
A. Varying respiratory patterns
B. Narrowing pulse pressure
C. Widening pulse pressure
D. Bradycardia
B. Narrowing pulse pressure
A patient presenting with an initial loss of consciousness with a period of a lucid interval, with return of normal neurologic status, suddenly complains of a headache, with a deteriorating LOC. The patient is most likely experiencing a
A. Subdural bleed
B. Subarachnoid bleed
C. Intrcerebral bleed
D. Epidural bleed
D. Epidural bleed
Brudzinski’s clinical sign may indicate
A. Subarachnoid bleed or meningitis
B. Subdural bleed or meningitis
C. Epidural bleed or meningitis
D. Basilar skull fracture
A. Subarachnoid bleed or meningitis
The presence of a Babinski’s sign in an adult patient would be exhibited by
A. Flaccid movement of the toes
B. Plantar flexor reflex
C. Plantar extensor reflex
D. Toes fanning upward
B. Plantar flexor reflex
Which cranial nerve is affected with a patient presenting with Bell’s Palsy?
A. I
B. V
C. VII
D. X
C. VII
A patient diagnosed with Gullian-Barre would most likely present with all of the following, EXCEPT
A. Descending paralysis
B. Ascending paralysis
C. Dysphasia
D. Dysesthesia
A. Descending paralysis
You are transporting a 25 YOM with a history of acute alcohol intoxication who was involved in a single vehicle roll-over two hours prior to your arrival. The patient is presenting with variable loss of motor function and sensory function from the nipple line down. What dermatome would most likely be affected and what clinical condition do you expect?
A. C3; central cord syndrome
B. C6; Brown-Sequard syndrome
C. T4; anterior cord syndrome
D. T10; anterior cord syndrome
C. T4; anterior cord syndrome
The oculovestibular reflex exam is used to assess
A. The presence of ICP
B. Brainstem function
C. Spinal cord injury
D. Pupil response
B. Brainstem function
Mydriasis is defined as
A. Increased salivation
B. Pinpoint pupils
C. Dilated pupils
D. Fixed, mid position pupils
C. Dilated pupils
The patient presenting with Battle’s and Raccoon’s clinical signs is most likely experiencing which of the following?
A. Epidural bleed
B. Basilar Skull Fracture
C. Subdural bleed
D. Increased ICP
B. Basilar Skull Fracture
Which of the following is most likely affected with a patient presenting with an epidural bleed?
A. Middle meningeal artery
B. Carotid artery
C. Communicating artery
D. Subclavian artery
A. Middle meningeal artery
Another term used to describe pinpoint pupils is
A. Mydriasis
B. Miosis
C. Mitosis
D. Doll’s eyes
D. Miosis
You would expect the normal range when measuring a mean arterial pressure(MAP) to be
A. 50-60 mmHg
B. 70-90 mmHg
C. 80-100 mmHg
D. 100-120 mmHg
C. 80-100 mmHg
Which clinical s/s initially would indicate that a ventricular-peritoneal shunt is malfunctioning?
A. Deteriorating LOC
B. Vomiting
C. Hypotension
D. Bradycardia
B. Vomiting
You have been requested to transport a 33 YOM with a history of being stabbed multiple times in the back. The patient presents with ipsilateral loss of motor function and contralateral loss of pain and temperature. The most likely diagnosis is
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. Compartment syndrome
B. Brown-Sequard syndrome
What PPE should have been worn when transporting a patient with bacterial meningitis?
A. Mask, gloves, gown, and eye protection
B. Gloves only
C. Mask and gloves
D. Gloves and eye protection
A. Mask, gloves, gown, and eye protection
The patient you are transporting is exhibiting decerebrate posturing. What does this term mean?
A. Increased tone in the exterior muscles with active tonic reflexes, resulting in all four limbs being rigidly extended and rotated internally, opisthotonos, and clenched teeth
B. A stooped, hyper-flexed posture, with positive Kernig’s sign
C. Externally rotated and extended lower extremities, with upper extremities flexed at the elbows
D. Sustained muscular contractions, which lead to fixed contractures
A. Increased tone in the exterior muscles with active tonic reflexes, resulting in all four limbs being rigidly extended and rotated internally, opisthotonos, and clenched teeth
You are managing a burn patient who weighs 90kg with a 65% burn surface area (BSA). How much fluid should this patient receive in the first eight hours when using the Parkland formula?
A. 23,400 mL
B. 11,700 mL
C. 8,450 mL
D. 5,850 mL
B. 11,700 mL
What does the clinical presentation of abnormal posturing generally indicate?
A. Frontal lobe dysfunction
B. Upper motor neuron dysfunction
C. Severe injury/damage to the brain and Brainstem
D. Lower motor neuron dysfunction
C. Severe injury/damage to the brain and Brainstem
The most commonly abused organ or system is?
A. Head
B. Orthopedic
C. Integumentary
D. Genitourinary
C. Integumentary
You are transporting a 27 YOM involved in a high-speed MVA with history of being ejected from the vehicle two hours prior to your arrival. The patient has been intubated and remains unconscious, with abnormal posturing noted. Mechanisms of injury associated with acceleration and deceleration that occurs with high speed motor vehicle accidents or ejection from a vehicle can cause what type of brain injury?
A. Cerebral contusion
B. Concussion
C. Diffuse axonal injury
D. Depressed skull fracture
C. Diffuse axonal injury
When inserting a chest tube, correct insertion site recommended is
A. 2nd ICS midclavicular
B. 5th ICS anterior midaxillary
C. 5th ICS midaxillary
D. 4th ICS midaxillary
B. 5th ICS anterior midaxillary
You are transporting a 23 YOM with a diagnosis of a left-sided hemothorax. Guidelines for tube clamping suggest that the chest tube be clamped after how many milliliters of blood have been removed in the adult patient?
A. 100 mL
B. 1000 mL
C. 1,500 mL
D. 500 mL
B. 1,000 mL
You arrive on the scene to manage a fall victim. She presents with a BP 80/50, HR 128, RR 36, SaO2 90%. Ground EMS reports that upon their physical examination, the patient revealed decreased bowel-like breath sounds on the left side of the chest. The patient is complaining of difficulty breathing and severe left shoulder pain. The most likely diagnosis is
A. Diaphragmatic rupture and spleen injury
B. Neurogenic shock and tension pneumothorax
C. Hypovolemic shock and cardiac tamponade
D. Hemothorax and liver injury
A. Diaphragmatic rupture and spleen injury
You are preparing to transport a 72 kg patient presenting with second and third degree burns to his entire face, anterior torso, and complete left arm. How much fluid should the patient receive in the first 8 hours using the Parkland formula?
A. 4,600 mL
B. 9,200 mL
C. 3,066 mL
D. 2,300 mL
A. 4,600 mL
A 60 YOM patient has been trapped under a tractor for almost 6 hours. Once extricated, he is most likely going to experience
A. Tension pneumothorax
B. Massive hemothorax
C. Rhabdomyolysis
D. Compartment syndrome
C. Rhabdomyolysis
A patient in early shock most probably would present with which of the following acid-base imbalance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
D. Respiratory alkalosis
You are managing a 25 YOM with burns to the entire face, left forearm, right hand, and anterior portion of the entire left leg. His BSA would be
A. 12%
B. 19%
C. 24%
D. 30%
B. 19%
Immediate release of intrpleural pressure should be performed where
A. 4th ICS, anterior axillary line
B. 5th ICS, anterior midaxillary line
C. 4th ICS, midclavicular line
D. 2nd ICS, midclavicular line
D. 2nd ICS, midclavicular line
You patient was involved in a single car roll-over and is complaining of neck and left shoulder pain. You note bruising to the left chest wall. V/S: BP 80/48, HR 130, RR 28, SpO2 96%. The most likely cause is
A. Cardiac Tamponade
B. Tension pneumothorax
C. Splenic injury
D. Intra-abdominal bleeding
C. Splenic injury
What is a common problem associated with electrical injuries?
A. Myoglobinuria
B. Ventricular fibrillation
C. Diabetes insipidus
D. Hypokalemia
A. Myoglobinuria
Dry chemicals such as lime should be
A. Brushed off before irrigation
B. Neutralized with a special agent before irrigation
C. Irrigated immediately with water or physiologic saline
D. Wrapped in a dressing and not irrigated
A. Brushed off before irrigation
Hamman’s sign may indicate the presence of
A. Tension pneumothorax
B. Tracheobronchial injury
C. Aortic rupture
D. Cardiac tamponade
B. Tracheobronchial injury
Recommended urinary output when managing a burn patient without an electrical injury is
A. 100mL/hr
B. 10-20 mL/hr
C. 30-50 mL/hr
D. >100 mL/hr
C. 30-50 mL/hr
Hydrofluoric burns can be managed with copious amounts of water and
A. Calcium gluconate
B. Osmotic diuretics
C. Glucagon
D. Pyroxidine
A. Calcium gluconate
The management approach for a patient experiencing brain herniation can include all of the following, EXCEPT
A. Serum sodium goal 155
B. Serum osmolality less than 320
C. Hypertonic saline, mannitol
D. Hyperventilation to maintain EtCO2 at 20-30 mmHg
D. Hyperventilation to maintain EtCO2 at 20-30 mmHg
When should escharotomies ideally be performed?
A. Circumferential burns are present in chest or extremities and transport time exceeds >30 minutes
B. Circumferential burns to the extremities or digits have adequate circulatory stability
C. Circumferential burns to the chest decrease chest wall compliance
D. Circumferential burns are present on any pediatric patients
C. Circumferential burns to the chest decrease chest wall compliance
A patient presents with a further drop in MAP of 20% with an increase in fluid loss of over 1,800 mL. Vasoconstriction continues and leads to O2 deficiency. Physiologically, the body switches to anaerobic metabolism, forming lactic acid as a waste product. The patient would most likely be in which stage of shock?
A. Early reversible and compensated shock
B. Late shock
C. Intermediate or progressive and decompensated shock
D. Refractory or irreversible shock
C. Intermediate or progressive and decompensated shock
All of the following conditions are considered a form of obstructive shock, EXCEPT
A. Cardiac tamponade
B. ICP
C. Tension pneumothorax
D. Massive pulmonary embolism
B. ICP
Late signs and symptoms of a tension pneumothorax can include all of the following, EXCEPT
A. Narrowing pulse pressure
B. Hypotension
C. Bradycardia
D. Tracheal shift away from affected side
A. Narrowing pulse pressure
The most common cause of PEA in a trauma patient is
A. Hypoxia
B. Hypovolemia
C. Tension pneumothorax
D. Cardiac tamponade
B. Hypovolemia
You respond to a fire in a building with 5 victims. You notice that a large portion of the synthetic carpet has been burned in a room where you are treating the patients. The patients are exhibiting increasing signs of respiratory distress and coughing after high oxygen has been applied. What may be causing the patients’ signs and symptoms?
A. Cyanide
B. Ammonia
C. Carbon dioxide
D. Hydrocarbon
A. Cyanide
You are transporting a 38 YOM who has present to the ER with a history of cocaine-induced tachycardia and is complaining of midsternal chest pain. V/S: temp 101.2 F, BP 200/100, HR 140, RR 28, SpO2 97% on 2LPM O2 via nasal cannula. Which of the following medications is contraindicated for management of this patient?
A. NTG
B. Morphine Sulfate
C. Metoprolol
D. Midazolam
C. Metoprolol
You have been requested to transport a 24 YOF with a history of acetylsalicyclic acid poisoning 2 hours prior to your arrival at the sending facility. The patient is complaining of nausea, headache, and tinnitus. When evaluating her ABGs, you would expect which of the following acid-base disturbances to manifest in the early stage of poisoning?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
A. Respiratory alkalosis
Defibrillation is usually not effective until the body core temp is greater than
A. 25 C
B. 28 C
C. 30 C
D. 32 C
C. 30 C
Which of the following blood transfusion reactions occur within minutes of administration?
A. Hemolytic
B. Anaphylactic
C. Febrile
D. Circulatory overload
A. Hemolytic
The treatment for acetaminophen poisoning is
A. Normal saline
B. N-acetycsteine (NAC)
C. Sodium bicarbonate IV drip
D. Pyridoxine
B. N-acetycsteine (NAC)
Treatment of Digitalis toxicity would include all of the following, EXCEPT
A. Digibind
B. TCP
C. Magnesium
D. Beta-blockers
D. Beta-blockers
The drug of choice for a patient exhibiting signs and symptoms of malignant hyperthermia is
A. Anectine
B. Sodium bicarbonate
C. Dantrolene
D. Glucagon
C. Dantrolene
The most critical goal and life-saving measure in heat illness is
A. Cooling the patient to rapidly decrease body temperature
B. Administrating large amounts of fluids and inotropic agents to correct dehydration
C. Immediate endotracheal intubation to prevent aspiration
D. Administering H2 blockers, mannitol, and sodium bicarbonate to prevent acute renal failure and GI bleeding
A. Cooling the patient to rapidly decrease body temperature
The most common type of decompression sickness typically seen in diving emergencies is
A. Musculoskeletal
B. Pulmonary
C. Arterial gas embolism
D. Cutaneous
B. Pulmonary
Gases in the lungs of a scuba diver expand as ambient pressure decreases during ascent best describes which has law?
A. Henry’s
B. Dalton’s
C. Graham’s
D. Boyle’s
D. Boyle’s
You are transporting a patient who you note have tea-colored urine in small amounts in the Foley catheter bag. The nurse reports that his output is only 50mL in the last 24 hours. What treatment would you expect to initiate during the two-hour flight?
A. Rapid fluid resuscitation, sodium bicarbonate drip, and consider lasix and mannitol
B. Rapid fluid resuscitation, potassium replacement therapy, and aggressive pain management
C. Fluid restriction, sodium bicarbonate drip, and consider lasix and mannitol
D. Rapid fluid restriction, potassium replacement therapy, and aggressive pain management
A. Rapid fluid resuscitation, sodium bicarbonate drip, and consider lasix and mannitol
You have been requested to a farming area to transport a 40 YOM involved in a plane crash. On arrival, the patient is complaining of shortness of breath with increased salivation and blurred vision. V/S: BP 100/58, HR 50, RR 36, SaO2 92%. Management of the patient would include all of the following, EXCEPT
A. Diazepam
B. Atropine
C. Sodium thiosulfate
D. Pralidoxime
C. Sodium thiosulfate
The antidote for ethanol toxicity is
A. Dextrose
B. Sodium bicarbonate
C. Fomepizole
D. Naloxone
C. Fomepizole
Digitalis toxicity can easily be exacerbated by
A. Acute MI
B. Electrolyte abnormalities
C. Undiagnosed diabetes
D. Beta-blockers
D. Beta blockers
All of the following medications are classified as calcium channel blockers, EXCEPT
A. Diltiazem
B. Calan, Isoptin
C. Nicardipine
D. Metoprolol
D. Metoprolol
A patient presenting with a complaint of tinnitus and flu-like symptoms will most likely have which of the following diagnosis?
A. Acetaminophen overdose
B. Beta-blocker overdose
C. Salicylate overdose
D. Magnesium toxicity
C. Salicylate overdose
Which of the following lab test is typically ordered four hours post-ingestion of acetaminophen overdose?
A. BUN
B. Liver function
C. Electrolytes
D. Coagulation
B. Liver function
Iron poisoning can be managed by
A. Naloxone
B. Romazicon
C. Deferoxamine
D. Fomepizole
C. Deferoxamine
A patient presenting with ethylene glycol ingestion would present with the following signs and symptoms, EXCEPT
A. Nystagmus
B. Elevated anion gap
C. Seizures
D. Metabolic alkalosis
D. Metabolic alkalosis
Pralidoxime chloride is administered in the management of
A. Heparin overdose
B. Organophosphate poisoning
C. Iron ingestion
D. Cyanide toxicity
B. Organophosphate poisoning
Antidote for heparin overdose is
A. Vitamin K
B. Fresh frozen platelets
C. Protamine sulfate
D. Protopam chloride
C. Protamine sulfate
Elevated BUN can indicate all of the following, EXCEPT
A. Dehydration
B. Intra-abdominal hemorrhage
C. Renal failure
D. Cerebral vascular accident
D. Cerebral vascular accident
Management of cyanide toxicity includes all of the following, EXCEPT
A. Amyl nitrate
B. Sodium nitrate
C. Protopam chloride
D. Sodium thiosulfate
C. Protopam chloride
Normal magnesium levels
A. 0.6-1.4
B. 3.5-4.5
C. 1.5-2.5
D. 6-23
C. 1.5-2.5
Preeclampsia is characterized by all of the following, EXCEPT
A. Hypertension
B. Edema
C. Proteinuria
D. Seizures
D. Seizures
After administering fluid resuscitation, performing vigorous fundal massage, and giving oxytocin, your patient continues with postpartum hemorrhage. Which drug would be indicated to decrease blood loss?
A. Apresoline
B. Methergine
C. Terbutaline
D. Magnesium sulfate
B. Methergine
When administering magnesium sulfate, the following adverse reactions can occur, EXCEPT
A. Transient drop in blood pressure
B. Flushing
C. Increase in FHR variability
D. Nausea and vomiting
C. Increase in FHR variability
Hemolytic disease of the newborn can be prevented by the administration of which of the following to a R-negative mother who had a pregnancy with a R-positive infant?
A. Albumin
B. Rho(D) immune globulin
C. Steroids
D. Indomethacin
B. Rho(D) immune globulin
Frequency of a contraction is defined as
A. End of a contraction to the beginning of the next contraction
B. End of a contraction to the end of the next contraction
C. Beginning of a contraction to the end of the next contraction
D. Beginning of the contraction to the beginning of the next contraction
D. Beginning of the contraction to the beginning of the next contraction
Duration of a contraction is defined as
A. End of a contraction to the beginning of the next contraction
B. End of a contraction to the end of the next contraction
C. Beginning of a contraction to the end of the next contraction
D. Beginning of the contraction to the beginning of the next contraction
C. Beginning of a contraction to the end of the next contraction
Gravies means
A. Total number of live births
B. Total number of pregnancies
C. Term gestation thirty-seven weeks or greater
D. Total number of miscarriages
B. Total number of pregnancies
You are transporting a 23 YOF from a small rural hospital with a diagnosis of preterm labor. Her fundal height is measured just slightly about the umbilicus. Your patient is approximately in how many weeks’ gestation?
A. 16-20 weeks
B. 20-24 weeks
C. 24-28 weeks
D. 28-32 weeks
B. 20-24 weeks
A patient exhibiting signs and symptoms of magnesium toxicity can present with all of the following, EXCEPT
A. Deteriorating loss of consciousness
B. Respiratory depression
C. Depressed deep tendon reflexes
D. Increased deep tendon reflexes
D. Increased deep tendon reflexes
A patient presenting with shoulder pain and lower abdominal pain with a history of having her last menses approximately 6-8 weeks ago is most likely experiencing which of the following?
A. Missed abortion
B. Ectopic pregnancy
C. Pelvis inflammatory disease
D. Spleen injury
B. Ectopic pregnancy
Placental abruption can be defined as
A. An overt cord prolapse that slips down into the vagina or appears externally after the amniotic membranes have ruptured
B. A spontaneous or traumatic disruption of the uterine wall
C. A blood loss in excess of 500 mL after delivery
D. The premature detachment of a normally implanted placenta from the uterine wall
D. The premature detachment of a normally implanted placenta from the uterine wall
The diastolic blood pressure goal when managing pregnancy-induced hypertension is
A. <80 mmHg
B. 80-90 mmHg
C. 90-100 mmHg
D. 110-120 mmHg
C. 90-100 mmHg
Pediatric dose for epinephrine is
A. 0.1 mg/kg IV
B. 0.01 mg/kg ETT
C. 1 mg IV
D. 0.01 mg/kg IV
D. 0.01 mg/kg IV
Which of the following would calculate an appropriate ETT size for a pediatric patient?
A. (Age + 12)/4
B. Age + (16/4)
C. (Age + 16)/4
D. Age/4 + 4
C. (Age + 16)/4
A pediatric patient presents to the ED in acute respiratory distress, with increased work of breathing and reduced O2 saturation. The patient is treated with multiple rounds of nebulizer albuterol, ipratropium, O2 supplementation, and parental steroids, with none to minimal improvement in clinical and objective evidence of respiratory distress. Which of the following medications is recommended for sedation prior to intubation because of the bronchodilatory effect it possesses?
A. Etomidate
B. Ketamine
C. Versed
D. Fentanyl
B. Ketamine
You are transporting a 9 YOM weighing 40-kg with diagnosis of status asthmaticus on a ventilator. EtCO2 is 60. Ventilator settings are at Vt 250, FiO2 1.0, Rate 16, I:E 1:3, PEEP 5, PIP 48. How will you many this patient?
A. Increase tidal volume
B. Increase I:E ratio
C. Increase PEEP
D. Increase respiratory rate
B. Increase I:E ratio
Recommended urinary output when caring for a pediatric patient should be
A. 100 mL/hr
B. 30-50 mL/hr
C. 1-2 cc/kg/hr
D. >200 mL/hr
C. 1-2 cc/kg/hr
The fetus was delivered with obvious meconium staining. His one minute APGAR is 8. Endotracheal suctioning
A. Should be performed via nose, then mouth
B. Should be performed via mouth, then nose
C. Should be performed endotracheally, then mouth, then nose
D. Should not be performed
D. Should not be performed
Pediatric airway anatomy differs from adults anatomy in the following ways, EXCEPT
A. Airway diameter in children is smaller than adults
B. The larynx is located more anterior in infants and children
C. The epiglottitis is long and narrow and angled away from the trachea
D. In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process
D. In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process
Primary cause of bradycardia in the neonate and pediatric patient is
A. Hypoglycemia
B. Hypoxia
C. Hypovolemia
D. Hemorrhage
B. Hypoxia
You are managing a 4 year old boy who is requiring intubation. The appropriate size ET tube for this patient would be
A. 3.5
B. 4.0
C. 4.5
D. 5.0
D. 5.0
What findings would you expect to see on a chest x-ray for a patient presenting with laryngotracheobronchitis?
A. MacDonald’s sign
B. Angel wing sign
C. Steeple sign
D. Thumb print sign
C. Steeple sign
What finding would you expect to see on the lateral neck x-ray to confirm suspicion of epiglottitis?
A. McDonald’s sign
B. Steeple sign
C. Angel wing sign
D. Thumb print sign
D. Thumb print sign
Fluid resuscitation in a neonate patient would be administered at
A. 5 mL/kg
B. 10 mL/kg
C. 15 mL/kg
D. 20 mL/kg
B. 10 mL/kg
A surgical airway can be placed through the cricothyroid membrane on children over the age of
A. 8 years
B. 10 years
C. 11 years
D. 12 years
C. 11 years
Which of the following scenarios would be most suspicious for possible child abuse?
A. Three year old who presents with tibial fracture after reportedly falling down a few steps
B. Two year old who presents with a forehead hematoma after reportedly falling out of stroller
C. Four month old who presents with a nondisplaced femur fracture after reportedly rolling off the changing table
D. Four year old who presents with a spiral fracture of the tibia after reportedly getting his leg twisted while falling off a tricycle
C. Four month old who presents with a nondisplaced femur fracture after reportedly rolling off the changing table
You are beginning to prepare for landing and you have a news reporter riding along for the day. You see a high-rise tower at 1,100 high. Sterile cockpit applies how?
A. The news reporter can speak anytime during flight
B. Flight crew members are the only one allowed to speak
C. Say nothing about the high-rise tower
D. Pilot is the only crew member to speak during all phases of flight
B. Flight crew members are the only one allowed to speak
You are transporting a non-intubated 70 YOM with a history of bilateral pneumonia on 2L O2 by nasal cannula. You are at 10,000 feet and the patients V/S are BP 190/100, HR 102, RR 24, and SaO2 86%. What is the immediate intervention for this patient?
A. Decrease cabin pressure
B. Increase oxygen delivery to patient
C. Administer fluid bolus to increase perfusion to the heart
D. RSI and intubate the patient
B. Increase oxygen delivery to patient
Gas that diffuses from an area of higher concentration to an area of lower concentration, best describes which gas law?
A. Graham’s law
B. Charles’ law
C. Gay-Lusaac’s law
D. Henry’s law
A. Graham’s law
Malpractice is based on a professional standard of care. The elements that must be proved for a malpractice case include all of the following, EXCEPT
A. Causation
B. Injury
C. Abandonment
D. Damages
C. Abandonment
Administration of the wrong medication to a patient best describes which element of malpractice?
A. Breach of duty as a result of malfeasance
B. Breach of duty as a result of nonfeasance
C. Breach of duty as a result of foreseeability
D. Negligence
A. Breach of duty as a result of malfeasance
All of the following are considered stressors of flight, EXCEPT
A. G-forces
B. Increased partial pressure of oxygen
C. Barometric pressure
D. Decreased humidity
B. Increased partial pressure of oxygen
Which Cormack-Lebanese grade choice is the arytenoid cartilages or the posterior portion of the glottis opening is visible?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
B. Grade 2
Which choice is the correct location for the ET tube placement?
3-7 cm above the carina
What would you expect with a leftward shift?
A. Hypothermia
B. Fever
C. Acidosis
D. Increased CO2
A. Hypothermia
When fremitus is palpated over the carina/main bronchus, what is indicated?
A. CHF
B. Pneumonia
C. COPD
D. Pneumothorax
B. Pneumonia
Signs and symptoms of pneumonia
Fever, shortness of breath, and yellow odorish sputum
Your patient has a chest tube and you notice excessive bubbles and that would indicate what?
A pleural or system leak
What is the purpose of giving corticosteroids in an asthma patient?
A. Bronchodilator
B. Dry up secretions
C. Reduce inflammation
C. Reduce inflammation
You have an ARDS patient being mechanically ventilated. What is the purpose of not increasing the FiO2 above 50%?
V/Q mismatch: inadequate ventilation, perfusion, or both
Which vent setting can the patient breath over set limits but each breath is at present tidal volume?
A. SIMV
B. Assist/Control
C. Continuous
D. Room air
B. Assist/Control
You have a patient with a high BNP (B-type natriuretic peptide). What would that indicate?
A. ARDS
B. Increased ICP
C. CHF
D. Respiratory distress
C. CHF
Which drug prolongs the QT interval?
A. Metoprolol
B. Ancef
C. Promethazine
D. Procainamide
D. Procainamide
You have a patient with decreased cardiac output and heart failure. What drug would be the best choice to give this patient to improve cardiac output?
A. Dopamine
B. Dobutamine
C. Epinephrine
D. Levophed
B. Dobutamine
What would you see on a 12 lead ECG that shows an Inferior MI?
ST elevation in leads II, III, and aVF with ST inversion/depression in reciprocal leads
What is Aggrastat?
A. Ace inhibitor
B. Calcium channel blocker
C. Glycoprotein IIb/IIIa inhibitor
D. Anticholinergic
C. Glycoprotein IIb/IIIa inhibitor
What is the best choice describing the goal of therapy for IAMP?
A. Increase oxygen demand
B. Decrease cardiac output
C. Increase blood flow to the coronary arteries
D. All of the above
C. Increase blood flow to the coronary arteries
What drug would you give a patient in Wolfe-Parkinson White (WPW)?
A. Lidocaine
B. Atropine
C. Procainamide
D. Adenosine
C. Procainamide
What drug is contraindicated in a patient with Stokes Adam Syndrome?
A. Procainamide
B. Lidocaine
C. Dobutamine
D. Atropine
B. Lidocaine
What is the goal of malignant hypertension?
A. Lower no more than 20-25% of BP
B. Maintain diastole pressure between 100-110 mmHg
C. Maintain systolic pressure between 120-150 mmHg
D. A and B
D. A and B
What location is the phlebostatic axis?
A. 2nd ICS, axillary line
B. 4th ICS, midaxillary line
C. 2nd ICS, midaxillary line
D. 4th ICS, axillary line
B. 4th ICS, midaxillary line
You pick up a patient to transfer that has a subclavian central line placed and the patient is complaining of SOB and has absent breath sounds on the right. What would you suspect is wrong with the patient?
A. Hemothorax
B. Tension pneumothorax
C. Pneumothorax
D. Coiled central line
B. Tensions pneumothorax
Normal range for Troponin?
A. 0-0.04
B. 0-0.4
C. 0-4
D. 0-400
A. 0-0.04
What would an elevated Troponin indicate?
A. Myocardial necrosis
B. Myocardial bruising
C. Infection
D. CHF
A. Myocardial necrosis
What is afterload?
Resistance against which the ventricles must pump against. Afterload=Pressure
Damage to what area of the brain causes expressive aphasia?
A. Cerebellum
B. Medulla
C. Broca’s Area
D. Cerebrum
C. Broca’s Area
Trauma to what area of the brain would cause loss of the ability to coordinate fine movements?
A. Cerebellum
B. Cerebrum
C. Broca’s Area
D. Medulla
A. Cerebellum
Your patient is on the ventilator, has no gag reflex, and fixed pupils. What area of the brain is damaged?
A. Cerebellum
B. Medulla
C. Broca’s Area
D. Cerebrum
B. Medulla
You have a patient with a spinal cord injury that has a Foley catheter and is presenting with goosebumps, fever, and diaphoresis. Would would you consider the problem to be?
A. Urinary Tract Infection
B. Autonomic Dysreflexia
C. Blockage in bladder
D. Foley catheter kinked
A. Autonomic Dysreflexia
If a patient is having a subclinical seizure, how would you expect the patient to present?
A. Clinic-Tonic
B. Grand-mail
C. Smacking lips/repetitive eye movement
D. Paralyzed state
C. Smacking lips/repetitive eye movement
Sign or symptom of a Subarachnoid hemorrhage?
Worst headache ever
Your patient fell and has greater loss of function in the upper extremities than in the lower. What do you expect?
A. Anterior Cord Syndrome
B. Brown-Sequard Syndrome
C. Basilar Skull Fracture
D. Central Cord Syndrome
D. Central Cord Syndrome
Signs and Symptoms of Cushing’s Triad
Hypertension, Bradycardia, Irregular Respirations
Your patient has a brain injury that has eyes open but not aware of surroundings. What would you indictate is wrong?
A. Clinically brain dead
B. Persistent vegetative state
C. Lock-in syndrome
D. Cervical fracture
B. Persistent vegetative state
Your patient has motor loss on the same side of damage, but below the injury. What would that indicate?
A. Central Cord Syndrome
B. Anterior Cord Syndrome
C. Brown-Sequard Syndrome
D. Basilar skull fracture
C. Brown-Sequard Syndrome
What indicates proper placement of the bolt for monitoring ICP?
A. ECG
B. Waveform
C. 10-20 mmHg
D. Pupils
B. Waveform
How must Mannitol be administered?
A filter line
What drug would you use to blunt increased ICP in RSI?
A. Ketamine
B. Versed
C. Rocuronium
D. Lidocaine
D. Lidocaine
How much Solu-Medrol would you administer to patient with a spinal cord injury?
Bolus: 30 mg/kg
Infusion: 5.4 mg/kg/hr
What complication would be expected if a patient with a VP shunt started seizing?
A. Brain bleed
B. Obstruction of the shunt
C. Hypoglycemia
D. Dislodgement of shunt
B. Obstruction of the shunt
What should you maintain ETCO2 at for a patient with increased ICP?
A. 25
B. 30
C. 35
D. 40
B. 30
What is the proper level of an EVD transducer?
Foramen of monro measured at the outer canthus of the eye, tragus of the ear
Your patient has been struck by lightening. What should you be concerned about?
A. Necrosis
B. Death
C. Heart failure
D. Rhabdomyolsis
D. Rhabdomyolsis
Why would your burn patient have an increased HCT?
A. Plasma loss
B. Fluid loss
C. Hypovolemic shock
D. Urinary retention
A. Plasma loss
