test 4 fb

Question 1

What would be the best position for a neonate with myelomeningocele?

Answer 1

prone

Question 2

What protective clothing does CAMTS require that is pertinent to safe operations?

Answer 2

Boots

Question 3

During flight operations, at what altitude interval does the most significant change in atmospheric pressure occur?

Sea level - 5,000ft
5,000ft - 10,000ft
10,000 - 15,000ft
15,000ft - 20,000ft

Answer 3

15,000ft - 20,000ft

Question 4

What would most likely cause dyspnea with a normal pulmonary capillary wedge pressure (PCWP), an increase in pulmonary artery diastolic pressure (PADP), an increase in pulmonary vascular resistance (PVR), and an increase in central venous pressure (CVP)?

Myocardial infarction
Pulmonary embolism
Cardiac tamponade
Right ventricular failure

Answer 4

Pulmonary embolism

A pulmonary embolus leads to pulmonary hypertension, causing the PADP to increase more than the PCWP, as well as an increase in PVR. Cardiac tamponade would cause elevation and equalization of the CVP, PADP, and PCWP. Left ventricular failure would cause an increase in PADP and PCWP. An MI would not cause any of the above changes, but if there was left ventricular failure or cardiogenic shock that went along with it, there could be increases in the PADP and PCWP.

Question 5

A patient with an extensive anterior wall myocardial infarction has a blood pressure of 88/60, a pulmonary capillary wedge pressure (PCWP) of 15 mmHg, and a cardiac index (CI) of 2.0 L/min. Which of the following diagnoses best describes this condition?

Ventilation-perfusion disorder secondary to progressing pulmonary hypertension

Activity intolerance secondary to an imbalance between supply and demand

Fluid volume excess secondary to decreased cardiac output

Decreased cardiac output secondary to impaired myocardial contractility

Answer 5

Decreased cardiac output secondary to impaired myocardial contractility

Question 6

The team is called to transfer a 5-month-old infant with Tetralogy of Fallot with DiGeorge syndrome. Enroute, the patient begins to have seizures which are most likely secondary to what?

Hyponatremia
Hypoglycemia
Hypomagnesemia
Hypocalcemia

Answer 6

Hypocalcemia

DiGeorge syndrome is the key to this answer. DiGeorge is a primary immunodeficiency disease caused by T-cell deficiency, congenital heart defects, and hypocalcemia. Seizure activity can occur secondary to the hypocalcemia.

Question 7

The most common congenital heart defect in neonates is which of the following?

Answer 7

Ventricular septal defect (VSD)

Question 8

Minimum urine output for the pediatric burn patient with non-suspected rhabdomyolysis would be?

Answer 8

0.5-1 mL/kg/hr

Question 9

How much circulating blood volume does your pediatric patient have?

Answer 9

75-80 mL/kg

Question 10

For an infant with a respiratory syncytial virus (RSV), the best treatment combination is which of the following?

Answer 10

Nebulized normal saline and suctioning

Question 11

A neonate has sudden decompensation two days after going home with parents. The infant was full-term and seemingly healthy. On assessment, the pre-ductal SpO2 on the right hand is 90%, and lower extremity SpO2 is 70%. No femoral pulses are noted, and there is a distended abdomen. What is the suspected clinical diagnosis?

Answer 11

Left outflow obstruction defect

If the assessment reveals no femoral pulses and a lower SpO2 on the lower extremities in comparison to the upper pre-ductal SpO2, this indicates a left side outflow obstruction defect such as coarctation of the aorta, hypoplastic left heart, Tetralogy of Fallot, or transposition of the great vessels.

Question 12

A pediatric patient is presenting with clinical signs of a spinal cord injury after a diving accident. They have no lower extremity movement; however, they can flex their arms but not extend them. Where is the fracture?

C4
C5
C6
C7

Answer 12

C7

Within the realm of any spinal cord injury is the determination of dermatome activation of the different parts of the body. Determining the dermatome will allow the clinician the ability to gain insight into the level of injury and make clinical decisions based on that information. First, C3-C5 controls the phrenic nerve and diaphragm. There is no information in the question for this type of presentation. C5-C6 controls elbow flexion, with C7 controlling wrist and elbow extension. Because the patient can flex but not extend her arms, the injury would be at the level of C7.

Question 13

A 15-year-old with a past medical history of diabetes mellitus presents very lethargic and only responsive to painful stimuli. They have been sick with a virus for the past couple of days. When reviewing their lab results, what would you expect to find?

Hyperglycemia, hypokalemia, acidosis, elevated serum osmolality

Hyperglycemia, hyperkalemia, acidosis, elevated serum osmolality

Hyperglycemia, hypokalemia, alkalosis, elevated serum osmolality

Hyperglycemia, hyperkalemia, alkalosis, elevated serum osmolality

Answer 13

Hyperglycemia, hyperkalemia, acidosis, elevated serum osmolality

Question 14

A patient who ingested an entire bottle of acetaminophen (Tylenol) is now complaining of right upper quadrant pain. Based on the presentation, when did this patient most likely ingest this drug?

less than 1 hour ago
Within the last 1-4 hours
Within the last 6-12 hours
Within the last 24-72 hours

Answer 14

Within the last 24-72 hours

Question 15

Non-cardio selective beta blockers could cause an increased risk of complications in which patient situation?

Answer 15

Reactive airway disease

Question 16

Myoglobinuria, if left untreated, will result in what critical condition?

Hyperkalemic crisis
Acute tubular necrosis
Cardiomyopathy
Polycystic kidney disease

Answer 16

Acute tubular necrosis

Myoglobinuria is the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction. If left untreated it can result in acute tubular necrosis and profound renal failure.

Question 17

Morphine has what other effect on the body besides analgesia?

Answer 17

Decreases preload

One systemic effect of morphine is peripheral vasodilation, thereby decreasing venous return and decreasing preload. It also leads to a decrease in afterload, thereby potentially decreasing myocardial oxygen demand.

Question 18

Non-cardio selective beta blockers could cause an increased risk of complications in which patient situation?

Answer 18

Reactive airway disease

Question 19

Morphine has what other effect on the body besides analgesia?

Answer 19

Decreases preload

Question 20

Which of the following is associated with a poor prognosis in a patient with severe acute respiratory distress syndrome (ARDS)?

Answer 20

Significantly elevated lactate

Question 21

A patient is receiving heparin after being diagnosed with a pulmonary embolus. After five days, they have developed heparin-induced thrombocytopenia. What clinical sign is expected initially?

Increased platelet count and chest pain
Increased platelet count and dyspnea
Decreased platelet count and skin lesions
Decreased platelet count and bleeding from the gums

Answer 21

Decreased platelet count and skin lesions

There are two different types of heparin-induced thrombocytopenia (HIT). Type 1 HIT develops within two days of initiation of heparin therapy and is considered non-immune. Type 2 HIT develops 4-10 days after heparin exposure and is immune-mediated. HIT is generally not manifested by bleeding but rather by thromboembolic material formation and complications secondary to that. It is sometimes referred to as heparin-induced thrombocytopenia and thrombosis for this reason. There will be a dramatic decrease in the patient’s platelet count and usually skin lesions at injection sites or on the body is the first clinical manifestation seen. They also can have chills, fever, dyspnea, and chest pain that develops.

Question 22

A patient presents in a thyroid storm from an exacerbation of hyperthyroidism. What are their expected labs?

Answer 22

TSH depressed, T4 and T3 elevated

In a hyperthyroidism state, there is an excess of thyroid hormone circulating in the body which causes a marked increase in cellular function. The patient’s TSH level would be decreased, and their T4 and T3 would be increased.

Question 23

Dead space is calculated by using which formula?

Answer 23

33% of Vt or approximately 1mL/pound of ideal body weight

Question 24

Your patient was involved in a motor vehicle collision and sustained moderate head injuries. They are currently awake and talking and have no neurologic deficits noted. Current vitals: BP 112/76, HR 82, RR 18 and regular. Labs have been normal. Over the past couple of days, they have had a urine output of approximately 50 mL/hr; however, they have recently had an increase to 350-375 mL/hr for the last few hours. Their current urine specific gravity is 1.001. Which IV solution would you find most appropriate for this patient?

Normal Saline (NS)
Lactated Ringers (LR)
5% Dextrose in water (D5W)
10% Dextrose in water (D10W)

Answer 24

5% Dextrose in water (D5W)

Remember that D5W is considered an isotonic solution in the bottle, however, when it is administered, the body uses the dextrose quickly, and you are left with free water. Patients in diabetes insipidus (DI) lose more water than compared with sodium; therefore they need to be administered more water than sodium. NS and LR would contribute to the already hypernatremic state. D10W has the potential to cause a hypertonic diuresis to occur which further worsens the current state.

Question 25

What is the goal for the SvO2 in the septic shock patient?

Answer 25

65 - 70%

According to the Society of Critical Care Medicine Consensus Panel, the endpoint for mixed venous oxygen saturation should be 65-70%. The SvO2 is going to be the quickest way to identify trends in treatment positively or negatively, and is a marker of true tissue oxygenation consumption, as it is a venous measurement.